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   2022| September-December  | Volume 9 | Issue 3  
    Online since November 30, 2022

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Perioral pigmentation
Siddharth Bhatt, Shekhar Neema, Biju Vasudevan
September-December 2022, 9(3):151-165
ABSTRACT Perioral pigmentation is a commonly encountered condition in the skin Out Patient Department (OPD), occurring due to a variety of primary as well as secondary causes. The affection of the perioral skin being readily visible negatively impacts the patient’s quality of life. As the etiology of perioral pigmentation is multifactorial, treatment modalities vary according to the cause. The perioral skin, because of its location close to the mouth, is exposed to various allergens associated with food, saliva, toothpaste, cosmetics, etc., which can all lead to allergic manifestations resolving with pigmentation. Certain other dermatoses like melasma can first present with pigmentation over the perioral region. Infections like chikungunya and dengue and infestation with Demodex mite can also lead to pigmentation at this site. Perioral pigmentation can also be a marker of underlying systemic disease. Localized lentigines-like pigmentation can be associated with various cancer predisposition syndromes like Peutz-Jeghers syndrome. Diffuse pigmentation can occur due to Addison disease, vitamin deficiencies, or can be drug-induced. All these causes of pigmentation are seen more commonly in type IV and V skin. Currently, very little literature is available elucidating the cause of perioral pigmentation and the diagnostic approach. This article reviews the causes of perioral pigmentation and highlights their important features.
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Frictional melanosis and macular amyloidosis – exploring the link
Ashwini Padubidri Kombettu, Chethana Gurumurthy, Vinutha Rangappa, Veeranna Shastry
September-December 2022, 9(3):166-175
Frictional melanosis is a condition that is often encountered in dermatology practice. The acquired pigmentary disorder has clinical similarity to the condition termed macular amyloidosis. These two entities have etiological-epidemiological and clinical overlap. Dermoscopy and histopathology can demonstrate subtle differences. The review is an attempt to understand the different etiological aspects proposed for these conditions. We discuss the clinical features of the two conditions, dermoscopic features and histopathological changes. It is imperative for dermatologists to be aware of the similarities and the differences between the two entities for their better management.
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Nutraceuticals in vitiligo: not just “designer” foods
Pooja Arora
September-December 2022, 9(3):147-150
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A study of dermoscopy in patients of melasma in a tertiary care centre in North India
Neerja Puri, Sukhpreet Kaur Gill, Sumir Kumar, B.K. Brar, Anahita Chahal
September-December 2022, 9(3):176-181
Aims and Objectives: The aim of the study is to determine dermoscopic findings of melasma after evaluating them based upon clinical examination and to correlate each clinical picture with dermoscopic findings. Materials and methods: Various patients of melasma from December 2019 to December 2020 were enrolled from outpatient department. Detailed history was taken. The dermoscopic examination and photographic documentation of clinical as well as dermoscopic picture was done and findings were noted. Results: We enrolled 50 patients in study including 80% females and 20% males. Mean age of melasma in our study was 31.28 years. Mostly the patients were farmers and housewives with the most common precipitating factor being sun exposure.Twenty patients on clinical examination along with Wood’s lamp showed epidermal pattern, 18 patients showed mixed pattern, and 12 patients had dermal pattern. On dermoscopy, melasma showed perifollicular sparing in all patients (100%), but in 36 patients, along with perifollicular sparing, it also showed perifollicular pigmentation in some areas, granular pattern in 38 patients, globular pattern in 42 patients, blotches in 36 patients, telangiectasias in 30 patients, arcuate pattern in 32 patients, and annular in 12 patients.The frequency of findings was nearly similar in all three three types except for the arcuate pattern. In the dermal pattern, nearly 83% patients (P = 0.1) showed arcuate pattern as compared to 40% (P = 0.004) in epidermal pattern. Limitations: A larger sample size is required. Also, since a few of the patients were already on topical corticosteroids, it may have affected the dermoscopic findings. Conclusion: Dermoscopy is a noninvasive tool that can be used to diagnose and differentiate it from other disorders of hyperpigmentation, but it cannot be used to classify melasma into epidermal, dermal, or mixed pattern.
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A comparative study of efficacy and safety of topical 10% phenylalanine gel versus 0.1% mometasone furoate cream in limited nonsegmental vitiligo
Abhishek Kumar, Ramachandran Ramakrishnan, Murali Narasimhan, N. Jegadish
September-December 2022, 9(3):210-219
Background: Among various therapeutic options for treating vitiligo, the search for an effective agent to minimize disease progression and achieve repigmentation continues. Topical phenylalanine 10% gel has shown promising results, and hence this study was carried out in patients with limited vitiligo. Aim: To compare the efficacy and safety of topical 10% phenylalanine gel versus topical 0.1% mometasone furoate cream in patients with limited nonsegmental vitiligo. Materials and methods: This study included 74 participants diagnosed as limited nonsegmental vitiligo (≤5 skin lesions). Group A received topical 10% phenylalanine gel (twice daily application), whereas Group B received topical 0.1% mometasone furoate cream (once daily application) for a period of 16 weeks. Clinical improvement based on vitiligo area severity index (VASI) scoring was assessed at intervals of 4 weeks until the end of the study duration. Physician’s global improvement assessment was calculated at the end of the study based on VASI scores. Results: Group A participants showed improvement of 24% when compared with 30.7% in group B at end of 16 weeks. Reduction in VASI scores and clinically visible improvement were noted in both groups after 8 weeks. Adverse events were not noted in any of the groups. Lesions over hands and feet were 11.3 times less likely to show response to treatment when compared with other sites. Conclusion: Both phenylalanine and mometasone were able to achieve significant repigmentation in the participants without any adverse effects. Mometasone achieved marked to excellent response in a higher percentage of participants. The overall efficacy of topical mometasone cream was better than topical phenylalanine gel.
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Comparison of therapeutic efficacy of intralesional platelet-rich plasma and topical alpha-glucoside derivative of trihydroxy benzoic acid in melasma: a randomized controlled study
Milan Jhavar, Hita Mehta, Shreya Somani, Neha Agrawal
September-December 2022, 9(3):188-196
Background: Melasma is the most common cause of facial melanosis and presents with a complex therapeutic problem. Intralesional platelet-rich plasma (PRP) has shown promising results in hyperpigmentation, whereas alpha-glucoside derivative of trihydroxy benzoic acid (THBG) is a newer molecule for the management of pigmentation. Aims and objective: To compare therapeutic effects of PRP and THBG in facial melasma, note any untoward side effects of therapy and evaluate dermoscope as a tool for therapeutic prognosis. Methods: A total of 60 patients were enrolled based on inclusion and exclusion criteria after due written informed consent. After clinical, dermoscopic, and Wood lamp examination with relevant blood investigations, group P was treated by three sittings of intralesional injection of PRP at monthly interval, whereas group B was subjected to local application of THBG twice a day. Intergroup as well as intragroup comparative analyses were performed by subjective scores and dermoscope. Results: The mean of difference between modified melasma area and severity index (mMASI) score at the end of the study (i.e., difference mMASI at 12 and 0 weeks) was 2.21 for group P and 0.18 for group B and on comparison, the P-value was <0.0001 which is considered statistically significant. The average %mMASI improvement in group P was 35.05%, whereas in group B, it was 3.18%. On analysis of other parameters, physician global assessment, patient global assessment, and melasma quality of life scale patients of group P showed higher and significant improvements in comparison with group B. Changes in dermoscopic parameters could be appreciated in patients with significant improvement only. Conclusion: There is mild–moderate improvement in melasma (average 35.05%) with PRP with no untoward side effects, whereas THBG did not show any promising result in the treatment of melasma in FT grade IV/V.
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Ectopic Cushing syndrome presenting as hyperpigmentation
Pooja Arora, Sinu Rose Mathachan
September-December 2022, 9(3):234-235
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Knowledge and use of sunscreens among traders at an urban market in Lagos, Nigeria
Erere Otrofanowei, Ehiaghe Lonia Anaba, Ayesha Omolara Akinkugbe, Olufolakemi Adeife-Cole, Olusola Ayanlowo, Viola Ikebudu, Rashmi Sarkar
September-December 2022, 9(3):204-209
Introduction: Public health awareness on sun-protection practices especially sunscreen use is established in developed countries compared with some other tropical African countries. Open-market traders in Nigeria, who typically have black skin, spend up to 8 hours in daylight with unprotected sun exposure. Aim: To determine prevalence of the knowledge of sunscreen use and to discover if adequate and appropriate sunscreen use is practiced by market traders. Methods: Cross-sectional study on 307 consenting traders at Sandgrouse Market in Lagos, Nigeria. Demographic data and responses to questions on sun exposure and its effects, knowledge and use of sunscreen, source of knowledge, and frequency of application were documented with a predesigned study questionnaire. Data were analyzed with SPSS 22. Results: More females (207; 67.4%) were observed and the mean age was 42.7 ± 12.8 years, though most were within the 35- to 39-year age range. One-third (102; 33.2%) were unaware that sun exposure could damage the skin and only 30 (9.8%) were aware of or knew what sunscreen meant. Commercials or advertisements were the most common source of knowledge and females were significantly more aware of sunscreens (P = 0.018). Conclusion: There is poor knowledge and awareness of the use of sunscreen among urban market traders in Nigeria who have prolonged unprotected exposure during their daily activities. Females were significantly more aware of sunscreens than males but there was no significant difference in the use pattern.
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Pityriasis alba: current clinicoepidemiologic scenario in a rural tertiary care hospital in central India
Komal A Ramteke, Sumit Kar, Safa Patrick, Ajinkya Sawant, Vivek Ambhore
September-December 2022, 9(3):182-187
Background: Pityriasis alba (PA) is a common, benign skin disorder occurring predominantly in children and adolescents. It is characterized by the presence of multiple, ill-defined, hypopigmented patches with fine scaling particularly over the face. Aims and objectives: To study the clinical characteristics and epidemiologic parameters in the context of current scenario in a rural tertiary care hospital in central India. Materials and methods: We conducted a descriptive observational study over a period of 1 year. We studied 100 clinically diagnosed patients with PA of the age group 2 to 15 years during this study. Results: Most common age group of patients observed was 6 to 10 years. About 87% patients had Fitzpatrick skin type IV followed by type III (7%) and type V (6%). Male to female ratio was 1.17:1. Maximum patients belonged to class III (50%) followed by class IV (37%) and class V (10%) according to the modified Kuppuswamy socioeconomic status scale (2018). Maximum patients had age of onset ranging from 6 to 10 years. Clinical characteristics revealed that maximum patients had 0 to 5 patches, with a duration of 1 to 2 months most commonly over cheeks. Associated features such as itching, scaling, and erythema were present in 18%, 98%, and 1% of the patients, respectively. Pallor was observed in 28% patients. However, significant history of atopy was elucidated in only 21% of patients. Around 6% patients showed positive family history of having PA and 14% having a positive history of atopy in first-degree family members. Conclusion: Due to the easily visible hypopigmented patches most commonly over face, PA is a common cause of concern in pediatric age group. In recent times, possibility of multiple factors other than atopy should be kept in mind while thinking of the associating or implicating factors which will lead to proper management of this pigmentary disorder.
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Dermatopathia pigmentosa reticularis: a rare case
Nidhin Varghese, J. P Prathibha
September-December 2022, 9(3):220-224
Dermatopathia pigmentosa reticularis (DPR) is a rare ectodermal dysplasia with a triad of generalized reticulate hyperpigmentation, noncicatricial alopecia, and onychodystrophy. We report a case of a 21-year-old man who had generalized reticulate pigmentation, diffuse noncicatricial alopecia, and onychodystrophy of finger and toe nails. Along with this triad, he also had mild atrophy of skin over hands and feet, palms and soles, and loss of dermatoglyphics. There was no evidence of involvement of other organs with ectodermal origin.
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“Chik sign” in chikungunya: three cases with dermoscopic findings
Sambasiviah Chidambara Murthy, Megha Shankar
September-December 2022, 9(3):231-233
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A case control study on the role of interleukin 17 in the pathogenesis of vitiligo
Priyanka Karagaiah, Leelavathy Budamakuntla
September-December 2022, 9(3):197-203
Background: Interleukin 17 (IL-17) has recently been implicated in the pathogenesis of vitiligo by many studies but it is unclear whether it has any definitive role in causing depigmentation. IL-17 inhibitors have already been used in other inflammatory disorders with good results and may prove to be a valuable therapeutic modality in vitiligo. Thus, this study aims at adding to the existing data on the role of IL-17 in the pathogenesis of vitiligo. Objectives: (1) To determine the correlation between IL-17 and the extent of body surface area involvement. (2) To determine the correlation between IL-17 and the severity of disease activity. (3) To determine the correlation between IL-17 and serum vitamin D levels. Methodology: Thirty-two clinically diagnosed patients with vitiligo and 26 age- and sex-matched controls who fulfill the inclusion criteria were enrolled in the study. After obtaining a detailed history, a complete dermatologic examination was performed and vitiligo area severity index (VASI) and vitiligo disease activity score (VIDA) were assigned. The baseline serum IL-17 level was measured using Raybiotech serum IL-17 enzyme-linked immunosorbent assay kit. Serum vitamin D was measured for all cases and controls. Results: In our study, the mean VASI score of all the patients was 6.32 ± 10.14 and the mean VIDA score was 1.97 ± 0.999. The mean serum IL-17 levels were 155.72 ± 79.412 pg/mL in patients with vitiligo compared to 102.73 ± 56.478 pg/mL of the controls, with a mean difference of 52.99 pg/mL and the difference was statistically significant (P = 0.008). Although, there is no significant correlation between the serum IL-17 levels with the VASI score, our study noticed slightly higher levels of IL-17 in generalized vitiligo and lowest levels were noticed in localized vitiligo. Limitations: Our study was limited by the small sample size of 32. Conclusion: Although, serum IL-17 levels were significantly higher in the patient group than the controls, there was no correlation with the disease extent or activity. Thus, it is difficult to establish a causal role of serum IL-17 in vitiligo.
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Lichen planus pigmentosus in linear and zosteriform pattern along the lines of Blaschko: a rare presentation
Subhra Dhar, Abhishek De, Aarti Sarda, Sandipan Dhar
September-December 2022, 9(3):225-226
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Dyschromatosis universalis hereditaria with keratoacanthoma: a rare presentation
Veena Thimmappa, Rajatha Anand, Sachin Shivayogappa Shabadi, Narendra Gangaiah
September-December 2022, 9(3):227-230
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