Sarvesh S Thatte

The utility of dermoscopy in the diagnosis of evolving lesions of vitiligo

BACKGROUND Early lesions of vitiligo can be confused with various other causes of hypopigmentation and depigmentation. Few workers have utilized dermoscopy for the diagnosis of evolving lesions of vitiligo. AIM To analyze the dermoscopic findings of evolving lesions in diagnosed cases of vitiligo and to correlate them histopathologically. METHODS Dermoscopy of evolving lesions in 30 diagnosed cases of vitiligo was performed using both polarized light and ultraviolet light. RESULT On polarized light examination, the pigmentary network was found to be reduced in 12 (40%) of 30 patients, absent in 9 (30%), and reversed in 6 (20%) patients; 2 patients (6.7%) showed perifollicular hyperpigmentation and 1 (3.3%) had perilesional hyperpigmentation. A diffuse white glow was demonstrable in 27 (90%) of 30 patients on ultraviolet light examination. Melanocytes were either reduced in number or absent in 12 (40%) of 30 patients on histopathology. CONCLUSION Pigmentary network changes, and perifollicular and perilesional hyperpigmentation on polarized light examination, and a diffuse white glow on ultraviolet light examination were noted in evolving vitiligo lesions. Histopathological examination was comparatively less reliable. Dermoscopy appears to be better than routine histopathology in the diagnosis of evolving lesions of vitiligo and can obviate the need for a skin biopsy.

“Pink glow”: A new sign for the diagnosis of glomus tumor on ultraviolet light dermoscopy

Glomus tumors are usually benign hamartomas, which are painful, small, and uncommon. They are usually subungal in location but may occur at other sites. A female patient presented to the outpatient department with painful swelling over the nail matrix of her right index finger. Here, we describe the use of a videodermosope having white light, polarized light, and ultraviolet (UV) light in the localization of glomus tumors that revealed a pinkish glow on UV light examination suggesting the vascular nature of the tumor. Thus, videodermoscopy can be used as an outpatient department procedure to confirm the diagnosis of glomus tumors.

Diamond necklace appearance in superficial porokeratosis.

CLINICAL CHALLENGE Superficial varieties of porokeratosis may be difficult to diagnose because of imperceptible or incomplete ridges at the edge of the lesions. Moreover, biopsy sections may sometimes miss the typical cornoid lamella, making the diagnosis more difficult. Herein, we present a new finding on ultraviolet (UV) dermoscopy in superficial porokeratosis that the keratotic ridge in porokeratosis glows in UV light with a ‘‘diamond necklace’’ appearance. A 21-year-old woman presented to our outpatient department with asymptomatic lesions of 15 years’ duration on both her upper and lower extremities. The physical examination revealed the presence of multiple, well defined, barely elevated papules with a slightly atrophic center at these sites (Fig 1). The mucosae and nails were spared.

Reversed pigmentary network pattern in evolving lesions of vitiligo

Normal reticulate pattern of pigmentation seen over normal skin corresponds to the pigmentation of the keratinocytes along the rete ridges while the pale area in between corresponds to the papillary dermis.[1] In vitiligo there is gradual loss of melanocytes and melanin due to which light directly passes into the dermis without being reflected by the melanocytes and melanin. This leads to a window through which light passes into the dermis and is reflected by dermal collagen. In initial stages of evolving vitiligo this leads to area of relative hyperpigmentation produced by the pale area corresponding to papillary dermis in normal reticulate pattern of pigmentation. This leads to the appearance of “reversed pigmentary network pattern” in evolving vitiligo.

Neutrophilic dermatosis of the dorsal hands: A rare unilateral presentation.

DOI: 10.4103/2229-5178.164468 4. Sheikh SS, Amr SS. Mycotic cysts: Report of 21 cases including eight pheomycotic cysts from Saudi Arabia. Int J Dermatol 2007;46:388‐92. 5. Sharkey PK, Graybill JR, Rinaldi MG, Stevens DA, Tucker RM, Peterie JD, et al. Itraconazole treatment of phaeohyphomycosis. J Am Acad Dermatol 1990;23:577‐86. 6. Hossain MA, Ghannoum MA. New investigational antifungal agents for treating invasive fungal infections. Exp Opin Invest Drugs 2000;9:1797‐813.

Acquired smooth muscle hamartoma

Smooth muscle hamartoma is an uncommon, usually congenital, cutaneous hyperplasia of the arrectores pilorum muscles. When it is acquired, it may be confused with Beckers nevus. We report a case of this rare tumor in a 19-year-old man. The disease started several years ago as multiple small skin-colored papules that subsequently coalesced to form a large soft plaque on the back of the left shoulder. The diagnosis of acquired smooth muscle hamartoma was confirmed on histopathology. The patient was reassured about the benign nature of the lesion and was not advised any treatment.

Porokeratotic eccrine ostial and dermal duct nevus: A report of three cases.

Sir, Porokeratotic eccrine ostial and dermal duct nevus is a rare non-hereditary eccrine hamartoma. This disorder of keratinization usually occurs at birth or in early childhood but may sometimes present in adults. It generally involves acral areas, especially palms and soles and is characterized by multiple punctate pits or keratotic papules and plaques with comedo-like plugs in a linear distribution.[1] The histopathological hallmark of porokeratotic eccrine ostial and dermal duct nevus is the presence of a cornoid lamella with subjacent acrosyringium.

Angioma serpiginosum: A case series of 4 patients

Angioma serpiginosum is clinically characterized by multiple copper to red-colored grouped macules that are arranged in serpiginous or gyrate patterns. Histologically, it is characterized by dilatation and proliferation of vessels in the papillary dermis.[1] The occurrence of angioma serpiginosum on the upper limb is rare while we were unable to find previous reports of its occurrence on the face and neck.

Key messages from a rare case of annular sarcoidosis of scalp

Sarcoidosis, a multisystem disease of obscure etiology, is characterized by the formation of noncaseating epithelioid cell granulomas in several organs or tissues. The diagnosis of sarcoidosis requires a compatible clinical picture, histologic demonstration of noncaseating granulomas, and exclusion of other diseases capable of producing similar histology or clinical features. The lung is the most commonly affected organ, but the skin is frequently involved. Sarcoidosis occurs worldwide and affects all ages and races with female predominance. Scalp involvement is decidedly rare among the myriad cutaneous manifestations of sarcoidosis. Alopecia is common in sarcoidosis and is generally scarring in nature. Annular sarcoidosis is a rare morphology and annular sarcoid of scalp is seldom reported. Herein we present a case of annular scalp sarcoid with systemic involvement and without alopecia.

Giant bilateral Becker's nevus appearing as gladiator arm armor.

Indian Dermatology Online Journal July-August 2016 Volume 7 Issue 4 329 4. Luo DQ, Li Y, Huang YB, Wu LC, He DY. Aquagenic syringeal acrokeratoderma in an adult man: Case report and review of the literature. Clin Exp Dermatol 2009;34:e907‐9. 5. Uyar B. Aquagenic syringeal acrokeratoderma. Indian J Dermatol 2014;59:632. 6. Baldwin BT, Prakash A, Fenske NA, Messina JL. Aquagenic syringeal acrokeratoderma: Report of a case with histologic findings. J Am Acad Dermatol 2006;54:899‐902.