Erosive Pustular Dermatosis of the Scalp: Report of Three Cases.

Erosive pustular dermatosis of the scalp is a chronic cutaneous condition presenting with areas of erosions and pustules, healing with scarring and alopecia. We report three such cases presenting with pus-filled lesions of the scalp with nonspecific pathological changes. This condition is often misdiagnosed and shows a poor response to antibiotics. Clinical suspicion is of primary importance for early diagnosis and proper treatment.

A Clinico-Trichoscopic Analysis of Hair Density and Diameter Variability in Relation to Severity Grading of Female Pattern Hair Loss.

Context: Hair loss is a common complaint among Indian women. For female pattern hair loss (FPHL), diagnosis is primarily clinical. In the early stages, it can be confused with other conditions. Histopathology is the diagnostic method of choice but requires multiple biopsies and can be disfiguring. Trichoscopy is an alternative noninvasive, rapid tool. Aim: The aim of this study is to study the hair density and hair diameter variance in relation with severity grading of FPHL. Settings and Design: Cross-sectional study. Materials and Methods: Ninety women aged 18 years and above were included in this cross-sectional study conducted at the dermatology department of Bangalore Medical College and Research Institute. Trichoscopic examination was done with a videodermoscope (Firefly DE300) at 20 and 70-fold magnification. Only those patients who met the trichoscopic diagnostic criteria for FPHL were included. Statistical Analysis Used: Descriptive statistics, ANOVA, and Spearman's correlation test for fitness of good, using Microsoft Excel data analysis tools. Results: Increase in disease severity from grade one to grade three positively correlated with a decrease in hair density over the frontal scalp (P < 0.001) and the occipital scalp (P < 0.001), decrease in average hair shaft diameter over both frontal and occipital scalp (P < 0.001). Conclusion: Trichoscopic tools, particularly hair density and hair diameter variance over both frontal and occipital scalp can be useful to help determine FPHL disease severity and its progression.

The Use of Botulinum Toxin-A as an Adjunctive Treatment for Facial Atrophic and Hypertrophic Scars After Surgical Correction.

Background: Facial wounds, especially the ones lying perpendicular to the Lines of Langer, heal poorly. Several methods have been attempted to rectify this, but most of them do not target the underlying pathological process of scarring. Botulinum Toxin-A (BTA) has been successfully used for atrophic and hypertrophic scars. Materials and Methods: This is a prospective study, where 30 patients who were operated for facial scar revision were divided into two equal groups: The first group was injected with BTA, but the second group was not. They were followed up for three months, and the results were analyzed. Results: Manchester scar scale (MSS) was used to assess the scars. In all the cases, the MSS score reduced after surgical correction, which further reduced after the injection of BTA in the first group of patients. The results are statistically significant (P < 0.01). Conclusion: The BTA plays an important role in the treatment of scars after scar revision surgeries.

Efficacy of 532-nm Q-switched Nd:YAG Laser in the Treatment of Lip Melanosis.

INTRODUCTION: Lip pigmentation is frequently encountered in the Dermatology outpatient department. No effective treatment is available so far. Topical treatment requires longer time and is often unsatisfactory. AIM: The aim of this work was to study the efficacy of 532-nm Q-switched Nd:YAG laser in the treatment of lip melanosis. SETTINGS AND DESIGN: This was a prospective interventional study. MATERIALS AND METHODS: Twenty patients in the age group 27-53 years were included in the study. Eight patients had diffuse pigmentation and twelve patients had focal pigmentation. Test spot was done. After topical anesthesia, Q-switched Nd:YAG laser was used. Treatment interval was 4 weeks. Follow-up was done at 1 week and then monthly. STATISTICAL ANALYSIS USED: Wilcoxon signed ranks test and P value. RESULTS: Seven patients (35%) showed an excellent response with more than 75% of pigment clearance. Seven patients (35%) showed a good response, two patients (10%) moderate response, and two patients (10%) had a mild response. Two patients had recurrence after 3 months follow-up. The average number of sessions required for clearance of pigmentation was 2.5. No scarring was seen. CONCLUSION: 532-nm Q-switched Nd:YAG laser is safe and effective in the management of lip pigmentation and gives rapid results.

To Study the Outcome of Three-Flap Technique in the Management of Pincer Nail.

CONTEXT: Pincer nail deformity is a transverse overcurvature of the nail. Though various conservative and surgical techniques have been described in the literature, very few studies are based on objective measurements. This study was undertaken to evaluate the outcome of three-flap technique in the management of pincer nail. AIM: To study the outcome of three-flap technique in the management of pincer nail. SETTINGS AND DESIGN: Prospective interventional study. SUBJECTS AND METHODS: Fifteen patients with pincer nail deformity, fulfilling inclusion and exclusion criteria were enrolled for the study. Routine X-ray was carried out for all patients to detect underlying bony abnormalities such as exostoses. Width and height indices were calculated before the procedure. A three-flap technique was performed on all affected toe nails and outcome was assessed at the end of 6 months and 1 year. STATISTICAL ANALYSIS USED: Paired t-test and P value. RESULTS: Satisfactory cosmetic outcome and statistically significant improvement (P < 0.0001) were achieved in all patients. CONCLUSIONS: Three flap technique is an useful technique in the management of pincer nail.

Scalp Defect Reconstruction with Triple Rotation Flap: A Case Report.

Scalp surgeries are some of the surgeries frequently performed in dermatosurgery department. These surgical procedures may leave large defects, especially when performed for malignant condition in which wide margin has to be excised. Such large defects are difficult to close primarily when reconstruction with local flap is essential. Here we report a case of epithelioid angiosarcoma of the scalp in a 24-year-old man where excision and reconstruction were performed using triple rotation flap.

Nose: Applied Aspects in Dermatology.

Nose is the most prominent part of the mid-face and has important physiological, aesthetic and psychological functions. Skin diseases on the nose are commonly seen by dermatologists, otorhinolaryngologists, and plastic surgeons. Because of its exposed, highly visible localization, lesions on the skin of the nose are often noticed by patients themselves, typically very early in the course of the disease. Similarly, the dermatological lexicon is well known with descriptive terminologies, synonyms, acronyms, eponyms, toponyms, misnomers. We have tried to compile the anatomical applications of nose in cosmetology and dermatosurgery subspecialities with nasal eponyms and signs encountered in clinical dermatology that would be helpful for residents.

A Study of the Outcome of Primary Excision and Closure Technique in the Management of Lip Leukoderma in 30 Patients.

CONTEXT: Lips being one of the graceful cosmetic units of the face, any disfigurement, including depigmentation, can be embarrassing, psychologically distressing, and socially stigmatizing. Even with the evolution of various surgical modalities, none of the techniques ensure 100% pigmentation with a good cosmetic appearance. With this background, this study was undertaken to study the efficacy of the technique-primary excision and closure in treatment of lip leukoderma (LL). AIMS: To study the efficacy, cosmetic outcome, and recurrence following primary excision and closure technique in the management of LL. SETTINGS AND DESIGN: A prospective single-center open-label uncontrolled study. MATERIALS AND METHODS: Thirty patients with LL involving inner margin of the lower lip and those who fulfilled inclusion and exclusion criteria were included in the study. After obtaining consent and physician fitness, patients were posted for primary excision and closure of the vitiliginous area of the lip. Patients were followed up at the immediate postoperative period and 6 months later. Patient satisfaction scale was done by asking the patient to grade the response between one and ten. STATISTICAL ANALYSIS USED: Mean and percentiles. RESULTS: Out of 30 patients, 29 patients achieved complete clearance that was cosmetically acceptable. Only one patient showed recurrence at the end of 6 months. Average patient satisfaction scale showed an average of 9.66. CONCLUSIONS: Primary excision and closure technique is one of the safe, inexpensive modality in the management of LL involving the inner margin of the lip with immediate result.

Outcome of Flap Surgeries in Dermatosurgical Unit at a Tertiary Care Centre in India with a Review of Literature.

INTRODUCTION: Flap surgeries are an excellent choice for closing large defects following trauma, excision of carcinomas or removal of large lesions. This article is a prospective interventional study of various flap surgeries performed at a tertiary care centre with their outcome in dermatosurgical unit. MATERIALS AND METHODS: A total of 35 flap surgeries performed from January 2012 to December 2014 formed part of the study. Data were recorded for each case including age, sex, indications and type of flap surgery and any occurrence of complications. RESULTS: Out of the 35 patients, basal cell carcinoma was the most common indication for surgery in 22 patients, followed by Bowen's disease in five, dermatofibroma in three and porocarcinoma in two. Other indications were squamous cell carcinoma, tuberous xanthoma, myxoid cyst and nevus sebaceous. Rhomboid flap and rotaion flap were done in 12 patients each, V-Y plasty in three patients, advancement flap, crescentic advancement flap and O-Z plasty were done in two patients each, O-Z plasty was done in two patients, A-T plasty and H plasty were done in one patient each. Common complications observed were flap necrosis seen in three patients and one patient developed hematoma on the second post-operative day, hypertrophic scar in one case and recurrence of BCC. CONCLUSION: Malignant and pre-malignant lesions were common indications in our study. Excellent outcome of flap surgeries promises to be a birdie stroke in the armamentarium of dermatosurgeons.

Outcome of Dermal Grafting in the Management of Atrophic Facial Scars.

BACKGROUND: Scars over the face are cosmetically and psychologically disturbing. Various techniques have been described and are being practiced in the management of these scars. AIMS AND OBJECTIVES: This study was undertaken to study the safety, effectiveness of using dermal grafts as fillers in the management of facial scars due to acne, chickenpox, trauma or any others. MATERIALS AND METHODS: Fifteen patients with atrophic facial scars of varied aetiology and willing for surgery were considered for dermal graft technique. After pre-operative workup, subcision was done 2 weeks before planned surgery. Depending on the type of scar, grafts were inserted using pocket or road railing techniques. Scar improvement was assessed based on patient satisfaction. RESULTS: Linear scars showed excellent improvement. Acne, varicella and traumatic scars also showed good improvement. However, two patients did not appreciate improvement due to marked surface irregularities as the scars were elevated. They were further subjected to LASER and chemical peel resurfacing. CONCLUSION: Dermal grafting can be used in the management of any round to oval facial scar which is soft, prominent and at least 4-5 mm across; linear scars at least 2-3 mm across and 3-4 cm in length. However, scars with prominent surface irregularities need further resurfacing techniques along with dermal grafting. LIMITATIONS: Limitations of the study include small sample size, and only subjective assessment of the scar has been taken into consideration to assess the outcome.