A Cross-Sectional Study of Epidemiological and Clinical Aspects of Pityriasis Rosea along with Dermoscopic Analysis and Histopathology Correlation.

Background: Pityriasis Rosea (PR) is a common, yet enigmatic, dermatological condition characterized by a distinctive clinical presentation. Despite its prevalence, the aetiology and pathogenesis of PR remain elusive. Aims: To study the epidemiological and clinical aspects of patients with PR. To study dermoscopic findings and carry out histopathological correlation. Methods: A cross-sectional study of 50 patients was conducted. A detailed clinical history was taken and an examination was done followed by a dermoscopy. Quantitative data like age and duration of disease are presented with the help of standard deviation. Qualitative risk factors, like gender, age groups, symptomatology, site of lesion, findings or cutaneous examination, dermoscopy findings, and histopathology findings, are presented with the help of frequency and percentages. Results: PR shows male preponderance and mean age of occurrence being 30.8 ± 15.7 years. Forty per cent of patients had an atypical clinical presentation. The most frequently seen dermoscopy findings were diffuse red background (58%), peripheral collarette scale (62%), and peripheral dotted vessels (50%). On histopathology, the most common findings were spongiosis (44%), parakeratosis (38%), irregular acanthosis (34%), perivascular lymphocytic infiltrate (56%), and red blood cell extravasation (36%). Limitations: Sample size was less due to COVID. As this was a corss-sectional study follow up of patients could not be done. Conclusion: While the diagnosis of PR is clinical, it is difficult in atypical cases where dermoscopy comes to the aid. It also helps identify the age of lesions, thus helping decide the treatment strategy for patients. Biopsy remains the gold standard in ruling out other differentials of PR.

Dermoscopic Perspective of Pityriasis Versicolor in a Cross-Sectional Study.

Background: Pityriasis versicolor is a common superficial fungal infection which is usually easily diagnosed with Wood's lamp examination and 10% potassium hydroxide mount. However, these modalities have varying sensitivity and specificity. Aims and Objectives: This study aimed to ascertain the dermoscopic features of pityriasis versicolor lesionally as well as perilesionally using dermoscopy, a non-invasive diagnostic tool. Materials and Methods: In this cross-sectional study, consecutive patients with pityriasis versicolor underwent dermoscopic examination of lesions and 2 cm around lesions, noting lesional and perilesional features. Semi-objective grading of pigmentation, scaling, and vascularity was done. The association between parameters was determined using heat maps and violin plots with Kolmogorov-Smirnov test. Lesional analysis was performed since lesions at different sides showed disparate features. Results: A total of 353 lesions from 233 patients (males = 150/233; 64.38% and females = 84/234; 36.05%) were studied. On lesional dermoscopy, pigmentary and scaling abnormalities were universal. 258/353 (73.1%) of lesions showed vascular abnormalities. Perilesionally, scaling (223/353; 63.17%) followed by pigmentation (205/353; 58.07%) and vascular changes (111/353; 31.44%) constituted the most common dermoscopic abnormalities and were noted in 294/353 (83.29%) of lesions overall. Increased disease duration corresponded with increased intensity of perilesional pigmentation alterations, perifollicular (P = 0.04), and follicular scales (P = 0.02). Conclusion: Awareness of dermoscopic features could improve the diagnostic accuracy in doubtful cases of pityriasis versicolor. Vascular findings are common and may point to an underlying inflammatory pathogenesis. Perilesional findings constitute early dermoscopic features of pityriasis versicolor and hint at the need for treatment beyond the confines of lesions. Larger follow-up studies and research into immunopathogenesis may be of further benefit.

Dermatitis artefacta: A diagnostic dilemma.

Dermatitis artefacta (DA) is a rare psychological disorder in which patients self-inflict cutaneous lesions to satisfy an emotional need. Here, we describe a case of DA initially misdiagnosed as pemphigus. This case represents the importance of the timely recognition and treatment of DA to prevent its progression like in our case scarring alopecia.

A Six-Year Retrospective Analysis of Skin Biopsies in the Pediatric and Adolescent Population Performed at a Tertiary Health Care Center in India.

Background: Hesitancy to perform skin biopsies in children or adolescents may lead to delayed diagnosis or misdiagnosis and relatively, few studies analyzing pediatric skin biopsies exist. Aim and Objectives: This study aims to analyze the spectrum of skin diseases biopsied and demographic data of pediatric patients underwent skin biopsies at a tertiary health care center in India. Materials and Methods: Biopsy records over six years were analyzed, noting demographic data, disease duration, clinical differential diagnoses (CDD), final diagnosis after histopathology, disease categorization, and agreement between clinical and final diagnosis. The mean, range, and statistical significance of differences between proportions were calculated. Results: A total of 1308 biopsy records were analyzed. A male preponderance was noted (males - 55.1%; n = 721, females - 44.9%; n = 587). Most biopsies were performed in adolescents (12-18 years; 55.2%) followed by school-age children (5-12 years; 31.4%). Preponderant disease groups biopsied comprised papulosquamous (17.7%; n = 231) and infectious diseases (14.1%; n = 184). Leprosy was the most common infectious disease (37.5%; n = 69) with most patients belonging to borderline tuberculoid spectrum. The overall diagnostic agreement was 74.7%. No correlation of final diagnosis was noted with the number of CDD offered. In more than a fifth of cases, biopsy averted misdiagnosis. Conclusions: This study highlights the importance of skin biopsies in pediatric patients and the relatively high clinico-histopathologic agreement. Leprosy and papulosquamous diseases were preponderant in the pediatric dermatopathology caseload.

Acral involvement in lichen scrofulosorum: A diagnostic oddity with distinctive features on dermoscopy.

A commonly underdiagnosed harbinger of visceral tuberculosis, lichen scrofulosorum classically manifests as centripetally located erythematous to violaceous cutaneous papules. Perifollicular and perieccrine tuberculoid granulomas constitute the histologic hallmark. We report a case of lichen scrofulosorum with involvement of the acral areas which is unusual. Also, dermoscopy, which has not yet been widely utilized in this condition gave a novel insights into histopathology in this case.

Halting the Progression of Cicatricial Alopecia with Injectable Platelet-Rich Fibrin.

Discoid lupus erythematosus (DLE) is a chronic variant of cutaneous lupus erythematosus characterized by well-defined erythematous plaques with adherent scales and follicular plugging. The affected scalp shows erythema, edema, atrophy, alopecia, and telangiectasia. Trichoscopy of DLE shows branching capillaries, white patches, keratin plugs, reduced follicular ostia, and white dots and blue-gray dots arranged in speckles pattern. Prompt diagnosis and aggressive, early multimodal therapy helps in preventing disfiguring hair loss and psychosocial sequelae. Hereby, we present a case of reversal of hair loss in DLE with newer modalities of treatment such as injectable platelet-rich fibrin.

Use of Topical Steroids in Dermatology: A Questionnaire Based Study.

CONTEXT: Topical steroids, the most widely prescribed drugs in dermatology are being increasingly misused. AIMS: This study was conducted to assess knowledge and practices regarding the use of topical steroids and to analyze prescriptions containing topical steroids. SUBJECTS AND METHODS: Following approval from the institutional ethics committee, participants were recruited as per the selection criteria and divided into those treated in the institution and those having outside prescription. They were administered a pre-validated questionnaire to assess knowledge and practices regarding the use of topical steroids. STATISTICAL ANALYSIS USED: Comparison of awareness between two patient categories was done using Chi-square test. Prescription variables were analyzed using descriptive statistics. Significance of P value was set at 0.05. RESULTS: Out of 400 patients, 167 had external prescriptions whereas 233 were institutional patients. Only 5.5% of all patients knew about the type of drug prescribed whereas 31.25% were aware of the indication. A total of 33.75% of the patients knew topical steroids required a prescription and 5.6% said they were aware that topical steroid use was associated with side effects. Side effects were reported by 96 patients. Awareness regarding knowledge, indication, and need for prescription were significantly better in institutional patients whereas knowledge about side effects was lacking in both groups. Psoriasis was the most common indication overall whereas tinea was the most common indication (51.5%) among externally prescribed. CONCLUSIONS: Although this study showed that institutional patients had comparatively better knowledge than community-treated patients, there is a need to create more awareness among patients overall and implement measures to stop irrational prescribing practices in the community.

Comparison of Dermoscopic Patterns at the Center and Periphery of Alopecia Areata Patch - A Cross-sectional Study in 100 Patients.

BACKGROUND: Dermoscopy is a noninvasive tool for the diagnosis of various dermatological disorders. Dermoscopy of alopecia areata (AA) aids in confirming the diagnosis and severity of the disease. MATERIALS AND METHODS: A total of 100 patients of AA were evaluated with a dermoscope (×20 and × 200) to determine the dermoscopic features at the center and periphery of patches of AA. RESULTS: Black dots were the most common dermoscopic finding at the periphery of AA patch among the study population, followed by yellow dots, vellus hair, broken hair, tapering/exclamation mark hair, kinking at the point of emergence of a hair shaft, piggy tail hair, and depressed follicular opening. At the center of the patch, yellow dots were the most common dermoscopic findings among the study population, followed by black dots, vellus hair, broken hair, and piggy tail hair. CONCLUSION: Black dots were the most common dermoscopic findings at the periphery of the patch. Yellow dots were the most common dermoscopic findings at the center of patch among the study population. Kinking at the point of emergence of the hair shaft was a new sign in this study seen at the periphery of the patches in 19 patients. It is the latest finding which requires further elaboration with larger sample size studies.

A descriptive observational study on clinical and dermoscopic features of benign melanocytic neoplasms.

BACKGROUND: Benign melanocytic neoplasms have nests of melanocytic cells and show characteristic dermoscopic features. Clinical and dermoscopic features have not been studied previously in the Indian population. AIMS: To study the clinical, epidemiological and dermoscopic patterns of benign melanocytic neoplasms. METHODS: This was a descriptive, observational, single centre study. In 107 patients with melanocytic neoplasms, 167 lesions were clinically examined and studied under the dermoscope and histopathological examination was done when indicated. The lesions were broadly divided as acquired and congenital. Five main dermoscopic patterns were seen-globular, homogenous, reticular, parallel and streaks. If there were two of these patterns in a particular lesion, it was termed 'mixed pattern'. The presence of three or more patterns was called 'multicomponent pattern'. Various other features were also observed. RESULTS: The majority of patients belonged to the third decade with a female preponderance. History of increased UV exposure and family history was significant in acquired nevi. The dermoscopic pattern progressed from predominantly reticular in junctional nevi to predominantly globular in compound nevi and lesser pigment in intradermal nevi, with more vascular structures. The congenital melanocytic nevi showed additional features of comedo- like lesions, milia- like cysts, perifollicular pigmentary changes and increased colour variation. Even though colour variation was observed in both acquired and congenital lesions, no signs of dysplasia were seen on histopathology. LIMITATIONS: A larger sample size is required, with follow up of lesions. No parallel studies in brown skinned population were found for exact comparison. CONCLUSION: Benign melanocytic proliferations are often neglected in our country. This study will help in understanding the course, clinical features and dermoscopic patterns of various benign melanocytic neoplasms, and will be a step forward towards research in our population. To the best of our knowledge, this is the first study of its kind in India.

"Pink glow": A new sign for the diagnosis of glomus tumor on ultraviolet light dermoscopy.

Glomus tumors are usually benign hamartomas, which are painful, small, and uncommon. They are usually subungal in location but may occur at other sites. A female patient presented to the outpatient department with painful swelling over the nail matrix of her right index finger. Here, we describe the use of a videodermosope having white light, polarized light, and ultraviolet (UV) light in the localization of glomus tumors that revealed a pinkish glow on UV light examination suggesting the vascular nature of the tumor. Thus, videodermoscopy can be used as an outpatient department procedure to confirm the diagnosis of glomus tumors.

Zosteriform spiradenoma with spiradenocarcinoma: A rare entity.

Eccrine spiradenoma (ES) is an uncommon well-differentiated benign tumor originating from the sweat glands. It usually occurs as a single lesion in adults. Multiple ES in a linear or zosteriform distribution are rare. Spiradenomacarcinoma is an extremely rare tumor, which develops in an existing benign spiradenoma of several years of duration. We report a case of a 23-year-old- female patient with multiple spiradenomas arranged in zosteriform pattern and malignant transformation occurred in one of the lesions over a period of 10 years.