Do oxidative stress and melanin accumulation contribute to the pathogenesis of idiopathic guttate hypomelanosis: A prospective case-control study.

BACKGROUND: Oxidative stress parameters have been reported to be significantly higher than controls in diverse disorders of pigmentation but no such data seem to be extant for IGH. OBJECTIVES: To verify whether heightened oxidative stress levels are seen in patients with IGH (compared with matched controls) and quantify the same in blood using appropriate biochemical markers. Further, an attempt to determine if there might be any correlation between the amount of oxidative stress and the severity of the disease. METHODOLOGY: This prospective case-control study was conducted in Northern India. Thirty Indian patients (Fitzpatrick skin phototype (SPT) IV-V) were included. The diagnosis of IGH lesions was confirmed based on characteristic clinical, and dermoscopic characteristics and confirmed on histopathological examination (H & E) of one of the lesions. RESULTS: The oxidative stress enzyme level was significantly higher among the cases compared to controls which were statistically significant (p < 0.05). A positive correlation was also observed between the levels of these markers and number of lesions, but this finding was statistically not significant [p > 0.05]. Assessment of melanin level by Dopa staining method in the IGH lesions revealed irregularly distributed melanin with areas of high and low melanin content and greater accumulation in the basement layer. CONCLUSION: The results of this probably the first study evaluating oxidative stress in IGH show that the oxidative stress is increased in patients with IGH. Level of oxidative stress seems to be correlated with both age of the patient (more in the elderly) and number of lesions.

Entodermoscopy Update: A Contemporary Review on Dermoscopy of Cutaneous Infections and Infestations.

Infectious cutaneous diseases are very common, especially in certain geographic and tropical regions. Sometimes they may simulate other dermatoses, ordering verification of diagnosis with particular investigations. Dermoscopy is among one of the most important tools readily available in the outpatient setting for the dermatologist to confirm the diagnosis. In this up-to date review, literature concerning the various dermoscopic features of parasitic, viral, dermatophytic and bacterial cutaneous infections is composed. In addition artefacts as well as practical issues in dermoscopy usage are discussed; with the aim to empower dermatologists to promptly and non-invasively diagnose and manage cutaneous infections and infestations.

"Azole menace"-An underappreciated trigger perpetuating the epidemic of antifungal therapeutic failure in cutaneous mycoses.

The South-Asian epidemic of anti-fungal therapeutic failures (AFTF) is on the rise. Although many demographic, environmental, and socioeconomic factors have been implicated in the genesis of this problem, two pharmacological issues warrant attention. While detailed discussions on the role of topical corticosteroid (TCS) in the changing landscape of the superficial mycotic infections in this region have been making headlines, another equally, rather more important pharmacological factor seems to have been undermined by the hype around TCS. The fastidious pharmacokinetic properties and related practical aspects of the triazole group of oral and topical antifungals, especially oral itraconazole seem to contribute significantly to the persistence of AFTF epidemic. In this paper, we shall discuss the broad aspects of the spectral precariousness of oral triazole antifungals with special emphasis to itraconazole, a concept known as the "azole menace" in the overall pathogenesis and tenacity of the AFTF epidemic.

Teledermatology and its Current Perspective.

Teledermatology is one of the most important and commonly employed subsets of telemedicine, a special alternative to face-to-face (FTF) doctor--patient consultation that refers to the use of electronic telecommunication tools to facilitate the provision of healthcare between the "seeker" and "provider." It is used for consultation, education, second opinion, and monitoring medical conditions. This article will review basic concepts, the integration of noninvasive imaging technique images, artificial intelligence, and the current ethical and legal issues.

Linear Patch of Alopecia in a Child: Trichoscopy Reveals the Actual Diagnosis.

Linear scleroderma en coup de sabre (LSCS) is a clinical variant of morphea that presents with a linear alopecic patch over the frontal scalp. Linear alopecia areata may present as a close differential in the incipient stages of LSCS in the pediatric population, especially when the binding down and pigmentary changes characteristic of LSCS have not developed. Histopathology may also be noncontributory in such scenarios. We hereby report a case of linear alopecia in a 5-year-old Indian girl and highlight the role of trichoscopic evaluation in clinching the diagnosis. This emphasizes the importance of clinicodermoscopic-pathological correlation over clinicopathological correlation for cutaneous diagnosis.

Dermoscopy Update: Review of Its Extradiagnostic and Expanding Indications and Future Prospects.

The technique of dermoscopy has come a long way since its inception for characterization of suspicious nevi for early detection of dysplastic changes in predisposed individuals. Not only has its scope expanded to aid in quick diagnosis of a majority of nonmelanocytic disorders of the skin, hair, and nails, but it is being rightfully exploited for a plethora of nondiagnostic uses. Its use in the diagnosis of various pigmentary, papulosquamous, and infectious disorders and disorders of the scalp and hair, nails, and mucosa bears testimony to the ongoing expansion of its protean indications across skin types. Dermoscopy has transformed the conventional approach to dermatological diagnosis from clinicopathological correlation to clinico-dermoscopic-pathological correlation. It aids in convincing an otherwise reluctant patient to agree to biopsy and guides the selection of optimum site for the same. Dermoscopic clues suggestive of stability or activity of the lesion and/or disease in various dermatoses are being accrued. Early assessment of therapeutic response to treatment is helpful for physicians, patients, and researchers conducting clinical studies. Aesthetic uses of dermoscopy are opulent and being explored. Dermoscopy has also provided the much-needed balancing act of interaction between practitioners and the new generation of patients. Last but not the least, dermoscopy has resulted in patients' better understanding of their disorders and improved compliance with treatment protocols.

Intralesional vitamin D immunotherapy for recalcitrant molluscum contagiosum.

Molluscum contagiosum (MC) is a benign viral infection, which may have florid manifestations in immunosuppressed patients. Moreover, the treatment is often unsatisfactory in these patients and it maybe recalcitrant. We hereby report the use of intralesional vitamin D immunotherapy in two immunosuppressed patients with persistent widespread MC lesions.

Low-Dose Naltrexone-Induced Remission in Hailey-Hailey Disease Maintained in Remission with Topical Combination of Ketamine and Diphenhydramine.

Recent anecdotal evidence suggests that oral low-dose naltrexone (LDN) is effective for Hailey-Hailey disease (HHD) but suffers the limitation of immediate relapse following cessation of the medication. With lack of safety data on long-term administration of LDN, we explored the utility of a topical diphenhydramine/ketamine (DK) cream in maintaining the remission achieved with LDN. A 42-year-old male with treatment-refractory HHD remitted with 5 mg naltrexone/day but relapsed on stopping the drug. Symptoms abated after restarting LDN. The impact of regular twice-a-day application of a specially formulated DK cream containing diphenhydramine (2% w/w) and ketamine (1% w/w) over the affected areas on maintenance of remission was explored till the next relapse. Our approach enabled dose reduction of naltrexone to 3 mg/day without loss of treatment benefit. After 3-month overlap of naltrexone and DK cream, withdrawal of naltrexone maintained remission with only the topical regime with no adverse effects till 4 months of follow-up. The use of topical agents with anti-inflammatory, antipruritic, antinociceptive, and naltrexone-mimicking properties merits exploration as an option to provide short but significant period of naltrexone-free maintenance of remission to patients with HHD.

Topical Ciclopirox Olamine 1%: Revisiting a Unique Antifungal.

The injudicious use of antifungals, indiscriminate use of corticosteroids for instant relief, persistence of predisposing factors like sweat retention and uncontrolled diabetes, and emerging resistance to antifungals across the globe have rendered the management of an erstwhile simple infection, the superficial cutaneous mycoses highly complicated and tricky. Ciclopirox is an old yet efficacious, versatile, and safe topical antifungal of the hydroxypyridone family. Despite its numerous beneficial properties over the majority of other topical antifungals, it remains underutilized.