Dermoscopy in the Diagnosis of Palmoplantar Eczema and Palmoplantar Psoriasis: A Cross-Sectional, Comparative Study from a Tertiary Care Centre in North India.

Introduction: Palmoplantar hyperkeratotic lesions pose a diagnostic difficulty when differentiating clinically between palmoplantar psoriasis (PPP) and palmoplantar eczema (PPE). Dermoscopy can provide valuable clues in reaching the final diagnosis. Objectives: To identify and compare dermoscopic findings seen in PPP and PPE. Methods: This was a cross-sectional, comparative study carried out prospectively between March 2019 and June 2020. All adult, consenting patients visiting the dermatology outpatient department who were clinically diagnosed and histopathologically confirmed as PPP and PPE were recruited into two groups. The dermoscopic examination was done, and images were taken from the representative area. The findings were analysed by two dermatologists who were unaware of the diagnosis. The sensitivity, specificity, positive predictive value and negative predictive value of these findings were assessed. Result: A total of 81 patients were recruited (39 patients of PPP and 42 patients of PPE). Significant findings seen in psoriatic plaques were the presence of regular vessels (84.6%, P < 0.001), with diffuse scales (87.2%) over a dull red/pink background (69.2%, P < 0.001). Dermoscopy of PPE displayed a significant presence of yellowish scales (76.2%, P < 0.001), with focal (61.9%) or absent vessels (35.7%), brown/orange-brown dots and/or globules (66.7%), yellow/yellow-orange crusts (57.1%) over a yellow/yellow-brown background (88.1%). Conclusion: Distribution of vessels, distribution of scales and the colour of scales, presence of brown/orange-brown dots and/or globules, yellow/yellow-orange crust and background colour (dull red vs. yellow/yellow-brown) of the plaques can be useful clues in the diagnosis of PPP and PPE.

Dermoscopy of Bacterial, Viral, and Fungal Skin Infections: A Systematic Review of the Literature.

Over the last three decades, the use of dermoscopy has been extended to inflammatory and infectious dermatoses. Regarding the latter, while the first applications concerned skin parasitoses, there has been a significant increase in the publication trend regarding nonparasitic dermatoses over recent years, yet data on this topic are sparse and often lack a standardized analytical approach. This systematic literature review summarizes published data on dermoscopy of bacterial, viral, and fungal dermatoses (dermoscopic findings, used setting, pathological correlation, and level of evidence of studies) and provides a homogeneous terminology of reported dermoscopic features according to a standardized methodology. A total of 152 papers addressing 43 different dermatoses and describing 184 different dermoscopic findings were included in the analysis. The majority of them displayed a level of evidence of V (107 single case reports and 40 case series), with only 5 studies showing a level of evidence of IV (case-control studies). Moreover, our analysis also underlined a high variability in the terminology used in published articles (even for the same dermatosis). Therefore, despite significant potential, future studies designed according to a systematic and standardized approach are required for a better characterization of dermoscopy of nonparasitic skin infections.

Steroid abuse, quality of life, and various risk factors in dermatophytosis: a cross-sectional observational study from a tertiary care center in northern India.

INTRODUCTION: Dermatophytosis is a superficial cutaneous mycosis and is steadily progressing to epidemic proportions in India. Various factors such as steroid overuse and misuse are currently making its treatment challenging. The study examines various sociodemographic characteristics, clinical factors, and steroid abuse in patients with dermatophytosis and also assess their quality of life (QOL). METHODS: A hospital­based cross­sectional study was carried out for a period of 1 year among adult patients with dermatophytosis after obtaining informed written consent. Sociodemographic and clinical details were recorded, and QOL was assessed with the Dermatology Life Quality Index (DLQI) questionnaire. RESULTS: Among 550 patients analyzed, the most common dermatophytosis was tinea (n = 408/550, 74.18%), dominated by tinea cruris and tinea corporis. Steroid abuse was frequent (n = 511/550, 92.90%), the most common being clobetasol propionate (n = 26/52, 50%). Hypopigmentation and atrophy were the most common side effects (53.52%). The mean DLQI was 14.44 ± 7.29 in males and 15.78 ± 6.26 in females. DLQI scores were statistically influenced (p < .05) by steroid abuse, low socioeconomic status, young adult status, widespread tinea, and poor hygiene. CONCLUSION: Dermatophytosis was found to have a significant adverse impact on QOL. As seen in this study, the widespread abuse of steroids may be a leading cause of the emergence of recalcitrant tinea in India.

Dermoscopic Characterization of Zoon Balanitis: First Case Series from Asia.

Zoon balanitis is a rare chronic inflammatory dermatosis involving genitalia. It is often misdiagnosed or diagnosed late leading to significant patient distress. Dermoscopy can act as a useful modality in prompt diagnosis of zoon balanitis. Herein, we report dermoscopic findings in twelve lesions of zoon balanitis in seven patients.

Intralesional measles, mumps, and rubella vaccine immunotherapy in molluscum contagiosum: A retrospective observational study from a tertiary care center in north India.

Molluscum contagiosum (MC) is a mucocutaneous viral infection, often self-limiting but untreated lesions can often last for 2 months to 2 years. Previously intralesional measles, mumps, and rubella (MMR) vaccine has been tried for the treatment of warts but no studies exist of its use in MC. We report our experience with intralesional MMR in 22 patients of MC. The study was carried out to assess the efficacy and safety of intralesional MMR vaccine in patients of MC. We retrospectively analyzed records of patients who received intralesional MMR for MC from September 2018 to September 2019. Demographic characteristics, number, size, and site of molluscum lesions, number of MMR injections given, and response were recorded. Records of 22 patients were analyzed. There were 10 males and 12 females. The age of the patients ranged from 6 to 50 years with a mean of 19.72 ± 10.92. At the end of 12 weeks, 18 patients (81.8%) had complete clearance of lesions, with 4 patients (18.18%) having a partial response of more than 50%. No patient showed less than 50% or no response. In only one patient who had giant molluscum, postinflammatory hyperpigmentation was noted. No other adverse effect was seen in any of the patients. MMR is a safe, effective, easy to administer, time-saving, and inexpensive therapy for lesions of MC.

Polymorphic Eruption of Extensive Cutaneous Sarcoidosis.

A 40-year-old man presented with a 1-year history of asymptomatic multiple raised reddish lesions that started on the face and gradually progressed in size and number to involve the neck, trunk, and arms. There was no history of fever, fatigue, weight loss, arthralgia, cough, dyspnea, or ocular complaints. Past and family history was insignificant, and no significant drug history could be elicited. On examination, multiple reddish brown, shiny, firm papuloplaques and nodules were present over the face, neck, and arms. There was a reddish brown plaque with central depression and overlying prominent telangiectasia over the left perioral area. The lesions over the posterolateral aspects of the arms were atrophic with peripheral reddish brown papules and central clearing, assuming an annular configuration. There were multiple large indurated subcutaneous and atrophic plaques over the arm and back. The palms, soles, hair, nail, and mucosal areas were not involved.

Generalized Hailey-Hailey disease with flexural keratotic papules: An interesting presentation and remarkable response with minocycline.

Hailey-Hailey disease is a hereditary blistering disorder characterized by episodic vesicles, pustules, erosions, and maceration mainly in intertriginous areas with generalized eruptions encountered rarely. We present a case of generalized HHD with keratotic papules over flexural areas along with its dermoscopic features; treated successfully with minocycline alone.

Aceclofenac-Induced Erythema Annulare Centrifugum.

Erythema annulare centrifugum (EAC) is characterised by slowly enlarging annular erythematous lesions and is thought to represent a clinical reaction pattern to infections, medications, and rarely, underlying malignancy. Causative drugs include chloroquine, cimetidine, gold sodium thiomalate, amitriptyline, finasteride, etizolam etc. We present a case of 40-year-old woman who presented to us with a 10 days history of nonpruritic, peripherally growing annular erythematous eruption. She had a history of recent onset of joint pain, for which she was taking aceclofenac 90 mg once a day for 5 days prior to the onset of the rash. This was confirmed on biopsy as EAC. The rash promptly subsided after stopping the drug. We report this case as there was no previous report of aceclofenac induced EAC.

H Syndrome: A Case Report and Review of Literature.

H syndrome is a rare autosomal recessive syndrome characterised by constellation of clinical features and systemic manifestations including cutaneous hyperpigmentation, hypertrichosis, hepatosplenomegaly, hearing loss, heart anomalies, hypogonadism, hyperglycaemia, low height, and hallux valgus. We report a case of this syndrome with typical clinical findings. We report this case citing the rarity of this uncommon entity.

Linear verrucous hemangioma-a rare case and dermoscopic clues to diagnosis.

Verrucous hemangioma (VH) is a rare, congenital and localized vascular malformation, which usually presents as warty, bluish, vascular papules, plaques, or nodules, mainly on the lower extremities. Linear presentation of the disease is rare. A deep biopsy is necessary to confirm the clinical diagnosis by histopathological examination, with dermoscopy acting as a useful tool for evaluating the precise vascular structure. Here, we report on a 13-year-old female child with linear VH presenting over her foot since infancy and dermoscopic findings of VH along with the clinical-pathologic features.

Measles, mumps, and rubella vaccine in genital warts: A case report of two patients.

Genital warts have a big psychological impact on the affected individuals, as the treatment requires time and multiple sessions at a time. They can also increase the chances of acquiring other sexually transmitted diseases. Various treatment options are available including the topical application of imiquimod, podophyllin, trichloroacetic acid application, cryotherapy, and radiofrequency cautery. However, all of these require multiple sessions, and chances of recurrences are high. Some of them also have multiple local side effects as burning, irritation, erythema, and swelling. Overall genital warts represent a frustrating challenge for both patients and physicians. Intralesional immunotherapy has shown promising efficacy in the treatment of warts including the following: Bacille Calmette-Guerin vaccine, candida antigen, Mw vaccine, and measles, mumps, and rubella (MMR) vaccine. We report the two cases of genital warts, who had an excellent response with intralesional MMR vaccine.

Punctate vascular papules on the tongue and scrotum.

We report a 60-year-old man who presented with a 2-year history of painless red raised lesions involving the tongue and scrotum. Histopathology was suggestive of angiokeratoma. Oral angiokeratomas are most commonly found as a component of the generalized systemic disorder in Fabry's disease or fucosidosis. Our patient had isolated mucosal angiokeratomas which is very rare.