Ameet Dandale

A Randomized Evaluator Blinded Study of Effect of Microneedling in Androgenetic Alopecia: A Pilot Study

Introduction: Dermal papilla (DP) is the site of expression of various hair growth related genes. Various researches have demonstrated the underlying importance of Wnt proteins and wound growth factors in stimulating DP associated stem cells. Microneedling works by stimulation of stem cells and inducing activation of growth factors. Materials and Methods: Hundred cases of mild to moderate (III vertex or IV) androgenetic alopecia (AGA) were recruited into 2 groups. After randomization one group was offered weekly microneedling treatment with twice daily 5% minoxidil lotion (Microneedling group); other group was given only 5% minoxidil lotion. After baseline global photographs, the scalp were shaved off to ensure equal length of hair shaft in all. Hair count was done in 1 cm2 targeted fixed area (marked with tattoo) at baseline and at end of therapy (week 12). The 3 primary efficacy parameters assessed were: Change from baseline hair count at 12 weeks, patient assessment of hair growth at 12 weeks, and investigator assessment of hair growth at 12 weeks. A blinded investigators evaluated global photographic response. The response was assessed by 7- point scale. Results: (1) Hair counts – The mean change in hair count at week 12 was significantly greater for the Microneedling group compared to the Minoxidil group (91.4 vs 22.2 respectively). (2) Investigator evaluation – Forty patients in Microneedling group had +2 to +3 response on 7-point visual analogue scale, while none showed the same response in the Minoxidil group. (3) Patient evaluation – In the Microneedling group, 41 (82%) patients reported more than 50% improvement versus only 2 (4.5%) patients in the Minoxidil group. Unsatisfied patients to conventional therapy for AGA got good response with Microneedling treatment. Conclusion: Dermaroller along with Minoxidil treated group was statistically superior to Minoxidil treated group in promoting hair growth in men with AGA for all 3 primary efficacy measures of hair growth. Microneedling is a safe and a promising tool in hair stimulation and also is useful to treat hair loss refractory to Minoxidil therapy.

Multiple capillary hemangiomas: a distinctive lesion of multicentric Castleman's disease and POEMS syndrome.

A diagnosed case of Castlemans disease, proven by biopsy from enlarged inguinal lymph nodes, presented with multiple, asymptomatic, erythematous papules and nodules prevalent since nine years over the trunk and extremities. The lesions had been gradually increasing in number and size. The patient had had plasmacytoma of the lower thoracic vertebra 12 years ago, for which he was adequately treated with chemotherapy and local radiotherapy. Dermatological examination revealed erythematous papules and nodules on the face, trunk, and extremities that were diagnostic of capillary hemangiomas. Histopathology of the erythematous, soft papule was suggestive of capillary hemangioma. Contrast-enhanced computerized tomography of the abdomen and pelvis showed multiple retroperitoneal nodes suggestive of Castlemans disease along with multiple osteolytic lesions in the pelvic girdle and vertebrae. The patient was treated with injection rituximab and is currently under follow-up. We report this case to highlight a rare association between Castlemans disease and POEMS syndrome.

Perianal pseudoverrucous papules and nodules.

Perianal pseudoverrucous papules and nodules (PPPN) is a rare entity attributed to chronic irritation. We came across this entity in a case of spina bifida. A 14 year old girl having spina bifida at L3 presented with complaints of multiple asymptomatic whitish lesions on the inner aspect of thighs and labia majora since early childhood. She had incontinence of stool and urine since birth. Cutaneous examination revealed multiple 3-12 mm flat topped moist papules, few verrucous nodules, some of these lesions coalesced to form plaques at the perianal area extending upto the labia majora. On histology marked epidermal hyperplasia and pale keratinocytes in the epidermis was seen. This confirmed the diagnosis of PPPN. This rare condition can be mistaken with sexually transmitted diseases leading to unnecessary investigations and treatment.

Case Report: Solitary mastocytoma treated successfully with topical tacrolimus

Solitary mastocytoma, a rare dermatological entity accounts for 10-15% of cutaneous mastocytosis. We report a rare case of solitary mastocytoma presenting at birth, treated successfully with topical tacrolimus. Along with reassurance and strict avoidance of triggering factors, no recurrence was reported within the one year follow-up period.

Papulonecrotic tuberculid of glans penis: A common disease at an uncommon site.

A 65-year-old man presented with multiple asymptomatic papulo-pustules and ulcers over glans penis since last 1 year. The lesions used to resolve spontaneously in a few days with scarring. The clinical features and histopathology were suggestive of papulonecrotic tuberculids of the glans penis.

Unusual presentation of lichen scrofulosorum

Indian Journal of Dermatology, Venereology, and Leprology | May-June 2013 | Vol 79 | Issue 3 436 the location that had not been reported before. An excisional biopsy was performed without imaging studies, such as X‐rays, computed tomography, and ultrasonography as the patient refused to take further studies. During surgery, we confirmed that the nodule was not attached to the underlying skull, and the mass located in the subcutaneous layer was easily excised. Histopathologic examination revealed an encapsulated nodule that was entirely composed of mature cartilage [Figure 1b]. Chondrocytes in lacunae had oblong nuclei of various size [Figure 1c]. There were no cytologic atypia, mitosis or necrosis. Based on the characteristic histopathologic features, the patient was diagnosed with extraskeletal chondroma of the scalp, and there were no signs of recurrence at 6 months from the excision.

Standardization of SMP procedure and its impact on outcome

Background: Cosmetic deformities can result from various types of alopecia or even post hair transplantation procedures. Patients with such deformities seek aesthetically appealing longer-lasting options. Scalp concealers are commonly used by men and women to camouflage these deformities. Scalp micropigmentation (SMP) is one of the concealers recently gaining popularity. Objectives: SMP is a novel technique wherein microdot tattoos are placed in a stippling pattern to mimic hair follicles that are cut close to the scalp and various variables affecting its outcome were evaluated. Methods: Forty-five subjects were recruited for the study. The various factors affecting outcome of SMP—angle of needle against the scalp, depth of needle into the scalp, time of the needle contact in scalp, speed of the rotor, resistance of scalp, color of pigment, viscosity of dye, needle number, needle thickness, and pattern of dot placement—were systematically studied in 15 patients through clinical photographs and trichoscopy. Ideal depth of pigment deposition was assessed through histopathological examination. After using these optimum variables, standardized SMP was performed in 30 patients with hair loss (3 patients with cicatricial and 27 patients with diffuse non-cicatricial alopecia). SMP was also used to create an aesthetically denser hairline. The outcome of the procedure was evaluated using standardized global photographs. Results: The ideal parameters were established to achieve standard reproducible results. There were great patient satisfaction and acceptance of the procedure. All the patients showed moderate to great improvement after the procedure with satisfactory scalp coverage. Adverse events were transient which were seen in the form of edema and redness. Conclusion: SMP offers a non-medical, tattoo-based cosmetically appealing and effective “cover-up” that hides the unsightly conditions. The cosmetic tattoo placement creates an illusion of thicker hair.

Case of unilateral temporal triangular alopecia

© 2017 Indian Dermatology Online Journal | Published by Wolters Kluwer Medknow An 8‐year‐old boy born out of a non‐consanguineous marriage presented with localized area of hair loss since the age of 2 years; the patch being persistent since its appearance. There was no history of any trauma or absent skin at birth at the site of alopecia. He had been treated with topical and intralesional steroids by several dermatologists. Examination showed a 3 cm × 2 cm lancet‐shaped area of hair loss on the right temporal scalp [Figure 1a]. There was no scaling or erythema. Dermatoscopy showed non‐cicatricial patch with predominantly vellus hair [Figure 1b]. Histopathological examination showed normal number of hair follicles, which were predominantly vellus or indeterminate. Inflammation and scarring was not observed [Figure 1c]. In children with patchy hair loss, a common diagnosis to be considered is alopecia areata, which is characterized by peribulbar lymphocytic infiltrate on histopathology and presence of black dots, broken hair, and exclamation hair on dermatoscopy. Trichotillomania can also be considered, where there would be a history indicative of the same.

Pedunculated poroma on forearm: A rare clinical presentation

Eccrine poroma (EP) is an adnexal tumor that commonly occurs on soles as a soft sessile flesh colored nodule. We report here a case of 54-year-old man who presented with a pedunculated red colored nodule on the right forearm. Histopathological examination was consistent with EP. This presentation of EP on the forearm as a pedunculated nodule is rare.

Bowen's disease: An unusual clinical presentation.

526 Indian Dermatology Online Journal October-December 2014 Volume 5 Issue 4 protein defi ciency, and vitamin A and zinc defi ciency.[5] Low urinary levels of N-methylnicotinamide and pyridone of less than 1.5 mg in 24 h indicate severe Niacin defi ciency and can be used whenever in doubt.[1] Treatment of pellagra includes exogenous Niacin, multivitamin and zinc supplementation and a diet rich in calories along with topical emollients and sunscreen for skin lesions.[1] The prevention of pellagra is based on nutritional advice that includes avoidance foods such as jowar, ragi, maize and alcohol and inclusion of diet rich in niacin such as eggs, bran, meat, poultry, fi sh, legumes and seeds.[1,4]