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  Most popular articles (Since April 10, 2014)

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Lichen planus pigmentosus: A short review
Irene Mathews, Devinder Mohan Thappa, Nidhi Singh, Debasis Gochhait
January-June 2016, 3(1):5-10
Lichen planus pigmentosus (LPP) is a condition characterized by persistent and asymptomatic slaty-gray pigmentation, predominantly in the face. Classically, the pattern is “actinic” with symmetric and diffuse pigmentation in sun-exposed areas, commonly in dark-skinned individuals. It can also rarely present as macular pigmentation of the flexures in the lighter-skinned. LPP is a disease of the middle-aged, with onset in the third to fourth decades of life and few studies show as slightly greater incidence in females. The photo-distributed or actinic pattern, which is more common, is a disease of tropics and Type IV–Type V skin types. Reports are mainly from India, the Middle East, and South America. The inversus type is relatively rare, predominantly occurring in Caucasians. LPP is thought to be a type hypersensitivity IV reaction to unknown antigen with lichenoid inflammation, leading to melanin incontinence and superficial dermal pigmentation. The natural course of the disease is not clear with some cases showing spontaneous resolution, and some cases with persistence of pigmentation for years. In addition, LPP may have marked overlap clinically and histologically with conditions such as pigmented contact dermatitis, differentiation of which may not be possible in routine practice. Because of these issues, as well as the relative rarity of the condition, there is not much evidence on the efficacy of the various treatment options. Currently, none of the available treatment options show consistent responses or a clear superiority to other modalities, the evidence on efficacy being restricted to a few case series.
  26,062 1,329 3
Pigmentary demarcation lines
Nidhi Singh, Devinder Mohan Thappa
January-June 2014, 1(1):13-16
Pigmentary demarcation lines (PDLs) are areas of an abrupt transition from hyperpigmented to hypopigmented or normal skin color. They are seen on limbs, face, and sometimes trunk. They are common in the black race. There are eight groups of PDL A to H. Facial PDL should be differentiated from melasma and postinflammatory pigmentation over the face. PDL are common in black women during pregnancy and are considered to be normal variants of pigmentation. Etiology of PDL continues to be an enigma and needs further research. PDL in pregnancy may regress spontaneously after delivery and do not require treatment. Facial PDL have a persistent course posing cosmetic concern for the patient and a challenge for dermatologist.
  14,424 828 1
A brief review of nevus depigmentosus
Samujjala Deb, Rashmi Sarkar, Asit Baran Samanta
July-December 2014, 1(2):56-58
Nevus depigmentosus is a congenital disorder of pigmentation which occurs in all sexes and races. It commonly presents in childhood and is mostly nonprogressive. It is a form of cutaneous mosaicism with functionally defective melanocytes and abnormal melanosomes. Localized solitary lesions need to be differentiated from conditions like nevus anemicus, ash leaf macule, vitiligo, etc., and generalized lesions from hypomelanosis of Ito. Treatment is usually not required although cosmetic camouflage, phototherapy, grafting, and other modalities may be tried.
  11,871 604 1
Recent advances in melasma
Manas Chatterjee, Biju Vasudevan
July-December 2014, 1(2):70-80
Melasma is one of the most common pigmentary disorders worldwide with a still unresolved pathogenesis and treatment continues to be challenging. Increased sun exposure and genetic factors are considered the two most important etiological factors. Estrogens, progesterones and increased melanocyte stimulating hormone are also involved. Melasma treatment can be very frustrating as many modalities can turn out to be ineffective. Dermal and mixed variants are quite resistant to therapy. Most patients seek medical help much after the onset of the condition, making treatment even more difficult. Sunscreens and topical depigmenting agents remain mainstay of therapy. Chemical peels and light sources are beneficial as adjuncts. There have been numerous advances in the understanding and management of melasma. This review attempts to look at these newer vistas in melasma. Literature search for the review was done from PubMed, the Cochrane Library, MEDLINE and Embase using the key word "melisma," "melasma pathogenesis" and "melasma treatment."
  11,126 1,304 -
Linear lichen planus pigmentosus: A rare entity with an illusory presentation
Anupam Das, Vivek Mishra, Indrashis Podder, Piyush Kumar, Dipti Das, Nilay Kanti Das
July-December 2014, 1(2):100-102
We report a case of lichen planus pigmentosus (LPP) that developed in a linear pattern, that too over nonsun-exposed areas. The patient presented with linear dark brown macules and patches on the back in the midline. Skin biopsy showed features consistent with a diagnosis of LPP. LPP should be considered in the clinical differentials of linear hyperpigmented skin lesions.
  11,654 374 2
Stem cells in vitiligo: Current position and prospects
Keshavamurthy Vinay, Sunil Dogra
January-June 2014, 1(1):8-12
Skin is an easily accessible source of various sub population of stem cells including epidermal stem cells, hair follicle stem cells (HFSCs) and dermal mesenchymal stem cells. The outer root sheath (ORS) of the hair follicle is a rich source of a type of HFSCs called the melanocytes stem cells (MelSCs). These HFSCs have a vast, unexplored potential in the treatment of vitiligo as initial re-pigmentation often occurs around the hair follicles. Common therapeutic modalities such as tacrolimus, phototherapy and dermabrasion acts through MelSCs. Newer cellular techniques have explored the use of ORS hair follicle suspension in surgical treatment of vitiligo. Advancement in melanocyte and stem cell research has identified various cytokines, growth factors and regulators involved in proliferation and differentiation of melanoblasts, which can be used for autologous in situ melanocyte regeneration. In this review, we briefly discuss the current position and future prospects of stem cells in vitiligo.
  10,358 1,031 2
Tranexamic acid: An emerging depigmenting agent
Anju George
July-December 2016, 3(2):66-71
Tranexamic acid (TXA), an antifibrinolytic drug, is now gaining popularity as a depigmenting agent. It is a synthetic lysine amino acid derivative which mainly blocks the conversion of plasminogen to plasmin by inhibiting plasminogen activator. This results in less free arachidonic acid production, and hence a reduction in the prostaglandin (PG) levels as well. Thus, by reducing PG production, TXA reduces the melanocyte tyrosinase activity and plays an important role in the treatment of melasma, ultraviolet-induced hyperpigmentation, and other postinflammatory hyperpigmentation. It has been tried topically, orally, and intradermally in the management of melasma with minimal adverse effects. However, more randomized trials are needed to fully elucidate the exact mechanism of action, ideal route, frequency, and duration of administration of the drug, along with its potential to treat other pigmentary disorders.
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Postinflammatory hyperpigmentation: Review of pathogenesis, prevention, and treatment
Anisha B Patel
July-December 2014, 1(2):59-69
Postinflammatory hyperpigmentation (PIH) is a common pigmentary disorder that is distressing to patients, particularly those with skin of color, and can be very difficult to treat. Part of this difficulty arises from the dermal melanosis in addition to the epidermal hyperpigmentation. This article reviews the mechanisms that induce the hyperpigmentation including inflammatory mediators such as metabolites of arachidonic acid and reactive oxygen species (ROS) and how these may influence prevention and treatment strategies. Treating the inflammatory cause and sun protecting are crucial to effective therapy. Although common, few studies have been done focusing on prevention and treatment of this disease. Topical therapies are the mainstay of treatment for PIH, but have shown poor efficacy for the dermal hyperpigmentation component. Hydroquinone in combination with topical steroids, retinoids, glycolic acid, and lactic acid have been augmented with numerous emerging natural therapies such as kojic acid, arbutin, ascorbic acid, soy, and niacinamide. Although efficacious for hyperpigmentation, most of the natural therapies have not been studied specifically for PIH. Salicylic acid and glycolic acid chemical peels, as well as the quality-switched (QS) neodymium-doped yttrium aluminum garnet (Nd: YAG), QS Ruby, 1550 nm erbium fiber fractional thermolysis, and 1927 nm fractional thulium fiber lasers have shown good efficacy for the treatment of facial hyperpigmentation.
  9,279 1,170 1
Progressive macular hypomelanosis: An update
Seemal R Desai, Joshua L Owen
July-December 2014, 1(2):52-55
Progressive macular hypomelanosis (PMH) is a common and often misdiagnosed disorder characterized by numerous nummular, coalescing hypopigmented macules on the trunk of adolescents, and young adults. It was originally described in patients with Fitzpatrick skin types V-VI from tropical countries, but is now understood to have a worldwide distribution in a variety of skin types. The pathogenesis of PMH is unknown, but is thought to involve Propionibacterium acnes, which has been found in abundance in the pilosebaceous units of lesional skin. Biopsies of lesions demonstrate normal architecture of epidermis and dermis, but exhibit decreased melanin content. It is important to note that this is different from vitiligo, which has a total absence of melanin. Many patients with PMH often times go misdiagnosed for tinea (pityriasis) versicolor, postinflammatory hypopigmentation, and other dyschromias. Topical antifungal and corticosteroid therapy have proven ineffective in PMH, but successes have been reported with topical and systemic antibacterial treatment modalities and even phototherapy. Given the increasing prevalence of patients with skin of color, it is important to better understand the nature of this condition, along with its diagnosis, management, and treatment.
  7,990 507 1
The enigma of color in tinea versicolor
Divya Gupta, Devinder Mohan Thappa
January-June 2014, 1(1):32-35
  7,729 525 -
Narrowband ultraviolet B and beyond: Evolving role of phototherapy in vitiligo
Amanjot K Arora, Sunil Dogra
January-June 2015, 2(1):9-20
Vitiligo is an acquired depigmentation disorder with great impact on patient's appearance and quality of life. Till date, the etiology of vitiligo remains elusive, which makes it difficult to have curative therapies. Photochemotherapy (psoralen and ultraviolet A) long remained the mainstay of treatment of vitiligo, until the advent of narrowband ultraviolet B (NBUVB) phototherapy, which revolutionized the treatment of vitiligo with better results, tolerability and side effect profile than the former. It has been used favorably, both alone as well as in combination with other agents like topical calcineurin inhibitors, Vitamin-D analogs, oral and topical corticosteroids, antioxidants, etc. Recently, various new phototherapeutic modalities like excimer light and laser have come into use with encouraging results. In this article, we review the journey of NBUVB so far and highlight the current status of other new phototherapy modalities in the treatment of vitiligo.
  6,284 517 -
Physiologic pigmentation: Molecular mechanisms and clinical diversity
Cecilia A Larocca, Roopal V Kundu, Neelam A Vashi
July-December 2014, 1(2):44-51
Dyschromia is one of the leading diagnoses in skin of color of populations. Inclusive within this broad realm of diagnoses includes physiologic pigmentation, which refers to normal biologic variations in skin coloration. In order to properly diagnose and manage disorders of pigmentation, one must be aware of the normal variations in skin pigmentation. Our review summarizes molecular mechanisms and the diverse patterns of physiologic pigmentation that may be encountered in the clinic and that are especially common in richly pigmented individuals.
  4,550 1,223 2
Role of dermoscopy in the diagnosis of pigmentary dermatoses in skin of color
Sunil Dogra, Ankit Mittal
July-December 2014, 1(2):41-43
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Topical therapy in vitiligo: What is new?
Munisamy Malathi, Devinder Mohan Thappa
January-June 2016, 3(1):1-4
  4,903 502 1
Talon noir: A mirage of melanoma
Subramaniam Keerthi, Sankar Madhavi, Kaliaperumal Karthikeyan
January-June 2015, 2(1):54-56
A 45-year-old female patient presented with two black plaques over her toes for the past 3 months that were persistent without any changes in the color, size or surface. Histopathology showed epidermal hyperplasia with corneal collection of fibrinous proteinaceous material and hemosiderin-laden macrophages and fibrinous exudate. We report this case to highlight the importance of proper diagnosis by means of dermoscopy and paring, of any black patch over acral regions in order to exclude the more concerning acral lentiginous melanoma.
  4,968 158 -
Skin color matters in India
Devinder Mohan Thappa, Munisamy Malathi
January-June 2014, 1(1):2-4
  4,488 435 -
A clinico-epidemiological study of facial melanosis
Iffat Hassan, Samia Aleem, Yasmeen Jabeen Bhat, Parvaiz Anwar
January-June 2015, 2(1):34-40
Background: Facial melanosis is a group of heterogenous entities, sharing a common clinical feature of altered pigmentation of the face and thus easily visible cosmetic disfigurement and significant psychosocial consequences. The importance of these disorders is growing, as they form the major percentage of dermatology consultations. Aims: To assess the patients of facial pigmentary disorders for demographic, etiological and clinical profile. Methods: This prospective hospital-based clinical study, conducted in a tertiary center over 1-year, involved 208 patients with facial pigmentary disorders, assessed using detailed history taking and clinical examination for demographic, etiological and clinical data. Relevant investigations including the skin biopsy and patch testing were also done wherever required. Results: The maximum number of patients belonged to 21-40 years age group (56.73%). Females predominated the study, with a female to male ratio of 1.92: 1. Among patients of facial hypermelanosis, melasma was the most common comprising of 73 patients, followed by postinflammatory hyperpigmentation (35), periorbital hyperpigmentation (14), ephelides (10) and lichen planus pigmentosus (9). Riehl's melanosis (8), drug-induced hyperpigmentation (6), naevoid hyperpigmentation (1), acanthosis nigricans (1) and Addison's disease (1) were other hypermelanosis conditions. Pityriasis alba (22) was the most common cause of facial hypomelanosis followed by vitiligo (19), postinflammatory hypopigmentation (8) and leprosy (1). Almost all cases of facial hyperpigmentation gave history of exacerbation following sun exposure. Conclusion: A variety of pigmentary disorders, both hyper and hypopigmentation, with variable clinical presentations and etiological factors, and associated with significant distress affect the face.
  4,364 456 -
Premature graying of hair: The voids and tiffs
Sidharth Sonthalia, Rashmi Sarkar
July-December 2015, 2(2):73-75
  2,392 2,316 1
Exogenous ochronosis in melasma: A study from South India
Sivashankari Kulandaisamy, Devinder Mohan Thappa, Divya Gupta
January-June 2014, 1(1):17-22
Background: Exogenous ochronosis (EO) can be associated with the prolonged application of hydroquinone (HQ) used for the treatment of melasma. Histopathological examination is required for a definite diagnosis. Dermoscopy can be used to avoid unnecessary biopsies from the face. Aims and Objectives: The aim was to characterize the clinical profile of melasma, to elicit the dermoscopic features of melasma and EO if any, and to histopathologically confirm any suspected cases of EO. Materials and Methods: This was a descriptive study spanning October 2011 to June 2013. With informed consent, a detailed history and examination was carried out along with details of skin lightening creams used if any. This was followed by cutaneous examination and dermoscopic evaluation. In those who had lesions suspicious of EO, consent for 3 mm punch biopsy was obtained and the samples were studied using hematoxylin and eosin stain for banana-shaped ochre colored fibers. Results: In 104 (94 females, 10 males), the mean age at onset and duration of melasma was 36.6 and 4.14 years, respectively. Past history of treatment for melasma was present in 30.8% patients. The most common clinical type of melasma was malar (51.9%). EO was suspected in five patients. In suspected cases, brown-blue globules were noted in addition to melasma features dermoscopically. Telangiectasias were noted in 37.5% of patients. Histopathological confirmation of EO was obtained in only one out of four patients who gave consent for biopsy. Conclusion: The frequency of EO in our study was found to be 0.9%. The incidence of EO in Indian population appears to be quite low, which might be due to under reporting, lack of awareness, irregular and infrequent use of HQ or population based difference in prevalence.
  3,985 314 -
Asymptomatic hypopigmented macules on the trunk and limbs of a young male
Soumya Jagadeesan, Malini Eapen, Jacob Thomas
January-June 2016, 3(1):52-53
  3,992 145 -
Glutathione for skin lightning: an update
Sidharth Sonthalia, Rashmi Sarkar
January-June 2017, 4(1):3-6
  3,519 583 1
Skin pigmentation in relation to gender: truth and myth
Rashmi Sarkar, Shivani Bansal
January-June 2017, 4(1):1-2
  3,862 208 -
Etiopathogenesis of melasma
Sidharth Sonthalia, Rashmi Sarkar
January-June 2015, 2(1):21-27
Melasma is a notoriously recidivist condition with yet unclear etiopathogenesis. It seems to have a multifactorial origin with both genetics and environment playing an important role. A genetic predisposition is suggested by a high reported incidence in family members in certain racial groups. Among the environmental factors, exposure to ultraviolet and visible light constitutes the biggest risk factor. Onset or worsening of melasma during pregnancy and during or following intake of hormonal oral contraceptive pills suggest the involvement of hormonal factors. The role of cutaneous vasculature in its pathogenesis is suggested by presence of clinically appreciable telangiectatic erythema confined to the melasma lesional skin in many patients, a finding reinforced by dermatoscopic evaluation and detection of upregulated expression of vascular endothelial growth factor, in the lesional skin. Various other factors such as thyroid disorder, drugs, cosmetics, stress may exacerbate existing melasma in a subset of patients. Although the precise molecular pathogenesis of melasma remains mysterious, up regulation of inducible nitric oxide synthase and many melanogenesis-related genes and melanocyte markers such as TYR, MITF, SILV, and TYRP1, Wnt pathway modulator genes, genes of prostaglandin metabolic processes, and those regulating lipid metabolism seem to be operative. In summary, though the exact etiopathogenesis of melasma remain appalling, newer studies have provided corporeal evidence in favor of certain previously suspected and some novel factors. Further research in this area will not only provide more evidence for their involvement in the pathophysiology of melasma, but also offer attractive targets for development of newer treatment modalities. This article exhaustively reviews the validity of the previously postulated etiological factors based on hitherto-accrued evidence, and explores the newer suggested pathogenetic mechanisms, which may pave way for development of novel therapeutic strategies.
  3,429 635 -
Acral melanosis
Mala Bhalla, Shimona Garg
January-June 2018, 5(1):14-27
The term “acral” means the distal portions of the limbs (hand, foot) and the head (ears, nose). The term acral melanosis is loosely applied to an increase in melanin pigmentation, in a diffuse, reticulate, or focal pattern over the distal parts of the arms and legs. There are various causes of acral pigmentation varying from genetic to acquired, benign to malignant, autoimmune to infectious, drug-induced, nutritional deficiencies, postinflammatory, and even exogenous reasons. The pigmentation may be occurring in isolation or associated with various systemic features. An earlier age of the onset of pigmentation, a positive family history, and a reticulate or mottled pattern usually point to a genetic cause. The diffuse pattern of pigmentation is usually seen in racial, endocrine diseases, and nutritional deficiencies. Postinflammatory acral pigmentation may follow both infectious and autoimmune diseases and may even be drug induced. A correct diagnosis is important to decide on the management which varies from reassurance and counseling to active treatment. This review paper is an attempt to classify acral pigmentation based on its diverse etiological causes.
  3,701 267 -
Persistent type B pigmentary demarcation lines in pregnancy
Raghavendra Kalasapura, Akshy Kumar, Devendra Kumar Yadav, Suresh Kumar Jain
January-June 2014, 1(1):23-24
Pigmentary demarcation lines (PDLs) are abrupt demarcation lines between the areas of light and dark pigmentation and also called as Futcher's or Voigt lines. These lines are most commonly seen in upper and lower limbs but can also be seen in other body parts. They occur almost in all races, but the incidence is more in Japanese, Caucasians and Negros. Treatment is not necessary because of transitory and asymptomatic nature of PDL. If at all required, it is due to cosmetic concerns only. We are reporting a rare case of type B PDL persisting even after 1 year postpartum.
  3,429 171 1