Ashok K. Aggarwal

Localized scleroderma/morphea.

Localized scleroderma/morphea, a relatively benign wellcircumscribed scleroderma, is characterized by round and/or oval, irregular/ linear plaques. The plaques are initially dull red/violaceous, smooth, and indurated. Ultimately, the plaque(s) progress to chalky/ivory white atrophy with the same configuration. The conversion of localized scleroderma into systemic scleroderma is largely disputed. 1 The preceding sequence ultimately leads to sclerosis of the dermis (superficial) and/or subcutaneous (deep) tissue, resulting in a spectrum which encompasses several clinical variants, namely lichen sclerosus et atrophicus, morphea en plaque, atrophoderma of Pasini and Pierini, guttate and linear morphea with or without facial hemiatrophy, and morphea profunda, in that order. Raynaud’s phenomenon and systemic organ involvement are conspicuously absent in localized scleroderma. Their etiology is largely open to discussion. It is imperative to confirm the diagnosis through microscopic pathology to establish the nature of the tissue changes of the disease. 1–3

Melasma: Treatment strategy

Abstract Melasma, a hypermelanosis of the face, is a common skin problem of middle-aged women of all racial groups, especially with dark complexion. Its precise etio-pathogenesis is evasive, genetic influences, exposure to sunlight, pregnancy, oral contraceptives, estrogen-progesterone therapies, thyroid dysfunction, cosmetics, and drugs have been proposed. Centro-facial, malar, and mandibular are well-recognized. Epidermal pigmentation appears brown/black, while dermal is blue in color, and can be distinguished by Woods lamp illumination. The difference may be inapparent with mixed type of melasma in skin types V and VI. An increase in melanin in epidermis: basal and suprabasal layers and/or dermis is the prime defect. There is an increased expression of tyrosinase related protein-1 involved in eumelanin synthesis. The use of broad-spectrum sunscreen is important, lightening agents like retinoic acid (tretinoin), azelaic acid, and combination therapies containing hydroquinone, tretinoin, and corticosteroids, have been used in the treatment of melasma, and are thought to have increased efficacy as compared with monotherapy. Quasi-drugs, placental extracts, ellagic acid, chamomilla extract, butylresorcinol, tranexamic acid, methoxy potassium salicylate, adenosine monophosphate disodium salt, dipropyl-biphenyl-2,2′-diol, (4-hydroxyphenyl)-2-butanol, and tranexamic acid cetyl ester hydrochloride, in addition to kojic and ascorbic acid have been used. Chemical peeling is a good adjunct. Laser treatment is worthwhile.

Acrodermatitis continua of Hallopeau: evolution of treatment options

Ever since its inception, acrodermatitis continua of Hallopeau, has been recognized as an uncommon clinical entity which has been sparingly reported from across the globe. The attempt to have cumulative information on prevalent nomenclature, definition, reminiscences, and clinical overtures has brought differential diagnosis and diagnosis in sharp focus, the highlights of which are outlined. Hence, it was considered important to review the evolution of treatment options available thus far including use of biologics.

Hand dermatitis/eczema: Current management strategy

Ever since its inception a couple of centuries ago, hand dermatitis/eczema has been in the reckoning. Idiosyncrasies continued to loom large thereafter, till it acquired its appropriate position. Dermatitis/eczema are synonymous, often used to indicate a polymorphic pattern of the inflammation of the skin, characterized by pruritus, erythema and vesiculation. A spectrum delineated into acute sub‐acute and chronic dermatitis of the hands. Pompholyx, recurrent focal palmer peeling, ring, wear and tear and fingertip eczema, apron, discoid eczema, chronic acral dermatitis, gut and patchy papulosquamous eczema are its clinical variants. Occupational dermatitis/eczema may be contributory. Etiological definitions are clinched by detailed history of exogenous and endogenous factors. However, scientific confirmation of the entity is through patch testing by using available antigens.

Plexiform neurofibromas in neurofibromatosis type 1

Plexiform neurofibroma developing in neurofibromatosis type 1 is a fascinating overture whereby diagnosis is primarily based on clinical characteristics, the details of which are outlined. Nonetheless, it is imperative to establish a clear‐cut clinical status vis‐á‐vis the adjoining tissues. Magnetic resonance imaging (MRI) may provide an additional supplement to the diagnosis and an aid to further management of the condition.

Efficacy of isotretinoin in pityriasis rubra pilaris: Unapproved use

Efficacy of isotretinoin in pityriasis rubra pilaris: Unapproved use Dear Sir, The details of clinical and complementary histopathological features are herein described in six pityriasis rubra pilaris patients comprising four men, a woman and a child. The former (males) belonged to adult classic type I, while the female and child belonged to familial form type V (atypical juvenile type). Oral isotretinoin (13cis -retinoic acid) in 40-mg dosages was selected for administration. The therapeutic response of the drug indicated that laboratory work was monitored independently of the clinical response. The synopsis of the results is discussed.

Atopic Dermatitis: Clinical Connotations, Especially a Focus on Concomitant Atopic Undertones in Immunocompromised/Susceptible Genetic and Metabolic Disorders.

Atopic dermatitis (AD) is an intriguing clinical entity. Its clinical connotations are varied, the updates of which are required to be done periodically. An attempt to bring its various facets have been made highlighting its clinical features keeping in view the major and the minor criteria to facilitate the diagnosis, differential diagnosis, complications, and associated dermatoses. The benefit of the current dissertation may percolate to the trainees in dermatology, in addition to revelations that atopic undertones in genetic susceptibility and metabolic disorder may provide substantive insight for the future in the understanding of thus far enigmatic etiopathogenesis of AD.

Atopic dermatitis: A cross-sectional (descriptive) study of 100 cases

Background: Atopic dermatitis is a distinct age-related clinical entity. Its etiopathogenesis is largely insubstantial. Nevertheless, it seems to be an outcome of interplay of maternal and inheritance, pregnancy/intrauterine and environmental factors. Besides, immune dysregulation, and nutritional supplements also play essential roles. Its diagnosis has been perpetuated by three or more major/minor criteria. Objectives: An endeavor to study its demographic and clinical pattern in contemporary prospective. Materials and Methods: 100 fresh patients of atopic dermatitis, diagnosed on the basis of an established three or more major and minor criteria, salient presentations of which were recorded in a preset proforma, which also recorded age, duration, age of onset, and sex. Serum immunoglobulin E (IgE) levels were determined by conventional technique. The data thus obtained was analysed to study its clinical pattern and to correlate its severity to IgE levels. Results: Its overall (new and old) prevalence was 0.98%, while that of new patients was 0.24%. 83 (83%) were in the age group of 2-12 years, of which 54 (83.1%) were males and 29 (82.9%) were female, of which 70 (70%) had urban, while 30 (30%) had rural background. Its duration varied from 8 to 192 weeks, with a mean of 76 weeks, and a standard deviation of 21.42 weeks [76 ± 21.42]. Conclusion: Atopic dermatitis is a discrete, overt, age and IgE-related entity frequently displaying varying demographic and clinical connotation.

Atopic dermatitis; Etio-pathogenesis, An overview

Atopic dermatitis is a well-recognized clinical entity, several facets of which continue to be mystified. Accordingly, its etio-pathogenesis is largely elusive. It appears to be an outcome of interplay of several undertones, namely: genetics, maternal factor and inheritance, pregnancy/intrauterine, environmental factors, immune dysregulation, immuno-globulins, role of diet, and infection. Besides, recent innovative breakthroughs consisting of nutritional supplementation, the highlights of which were considered worthwhile to take stock of to define its current status. An endeavor to enlighten the audience has been made for their benefit.