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   Table of Contents - Current issue
Coverpage
July-December 2020
Volume 7 | Issue 2
Page Nos. 63-109

Online since Thursday, December 3, 2020

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REVIEW ARTICLES  

Psychological management of vitiligo during the COVID-19 pandemic Highly accessed article p. 63
Farhat Fatima, Anupam Das, Mohammad Jafferany
DOI:10.4103/Pigmentinternational.Pigmentinternational_74_20  
COVID-19 pandemic has changed our outlook toward the diagnosis and treatment of dermatological conditions. Accessibility to health care facilities has been jeopardized due to lockdowns, fear of contracting COVID infection, maintaining social distance, and financial concerns. Vitiligo, one of the notorious chronic dermatoses, had a negative impact on the quality of life of patients, even during pre-COVID era. Now, with the arrival of the pandemic, patients are unable to seek consultation for the disease. Stress being one of the key players in the pathogenesis of the disease, is leading to exacerbation of the condition. In this review, we have attempted to highlight the role of psychological management of vitiligo, amidst the ongoing pandemic
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Staff and clinic protection during COVID pandemic p. 66
Vinod Hanumanthu, Raihan Ashraf, Rashmi Sarkar, Muthu Sendhil Kumaran
DOI:10.4103/Pigmentinternational.Pigmentinternational_75_20  
The impact of novel coronavirus pandemic (COVID-19) on the healthcare system has been devastating and the medical fraternity is facing challenges to tackle this catastrophic outbreak. With regard to dermatology practice, we review various outbreak response measures to be followed by the dermatology staff at clinic in constrained environment. Preventive measures like social distancing, hand hygiene practices and protective measures such as introduction of personal protective equipment (PPE) for staff, standardization of clinical guidelines and continuing medical services via teleconsultation are recommended. Physical consultation has been limited to emergency-based services. Although teledermatology would never replace physical consultation, it might serve as an adjunctive role in providing adequate services to the non-emergent conditions and minimizes the risk of exposure of both doctors and patients. Non-urgent visits of the patients are being discouraged and elective dermatology procedures are being postponed. Dermatologists should also recognize and educate health care workers about primary cutaneous features of COVID-19 as well possible dermatological side effects arising from prolonged usage of PPE and hand hygiene practices. Limited office-based and in-patient services with a parallel increase in teledermatology consultations will allow effective dermatologic care and services to the public while ensuring minimum transmission of the virus.
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ORIGINAL ARTICLES Top

Clinico-dermatoscopic study of seborrheic keratosis from a rural tertiary care centre of western India p. 69
Pragya A Nair, Namrata Bhavsar, Dhruv Patel
DOI:10.4103/Pigmentinternational.Pigmentinternational_30_19  
Background: Seborrheic keratosis is a benign papilloma of the skin having different clinical variants. A dermatoscope is used to reach to the correct diagnosis without going for any interventional investigation like biopsy, thus the study was done to correlate clinical and dermatoscopic findings in seborrheic keratosis. Material and Methods: It was an observational study conducted after permission from ethics committee. Patients diagnosed clinically as seborrheic keratosis were enrolled over a period of 6 months. Detail history and examination were done based on pre-structured proforma. Dermatoscopy was done from randomly selected lesions and images were captured and stored in laptop. Descriptive statistics was calculated for patterns of various changes. Results: Total 51 patients were clinically diagnosed as seborrheic keratosis, with maximum in the age ranging from 51 to 70 years. Sex ratio was equal with positive family history in 68.6%. Total 298 lesions were found of which, maximum were on the face in 56.37%. Commonest variant seen was CSK in 50.67% lesions. Comedone like opening was the most common dermoscopic pattern in 66.44% lesions followed by sharp demarcation in 55.70% and fissures and ridges in 53.69% lesions. Conclusion: Seborrheic keratosis was more commonly seen in elderly, with CSK as commonest variant and comedone like opening as most common dermatoscopic pattern in our study.
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Assessment of quality of life of melasma patients as per melasma quality of life scale (MELASQoL) p. 75
Priyanka N Dodmani, Ashish R Deshmukh
DOI:10.4103/Pigmentinternational.Pigmentinternational_46_19  
Background: Melasma is the most common cause of facial melanoses in Indian population. It most commonly affects women of reproductive age group. Melasma poses a significant impact on social and psychological health. Aim: To study specific aspects of life affected in patients’ life by melasma and study the effect of melasma on their level of functioning using melasma quality of life scale (MELASQoL). Materials and Methods: In a cross-sectional descriptive study of 160 patients of melasma with any severity (assessed by MASI) were included. QoL of the patients was assessed using MELASQoL scale based on three domains of life e.g. emotional, social and recreation-leisure. Results: MELASQoL score was calculated for each patient. As per score, QoL in young, females and married patients were more affected than others. Patients having late onset of the disease and short duration are more affected. We found that half of patients were having moderate score, 46% of patients having mild score and only 4% of patients having severe score. In our study most affected domain of life was emotional well-being. Conclusion: Melasma causes a significant effect on QoL in many aspects of daily life. There is no significant correlation between MASI score and QoL affected. There is a need for patient counseling and development of educational programs and appropriate psychological intervention.
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Experience of cosmetology in rural Central India: a clinico-epidemiological profile and comparative study of 35% glycolic acid peel and 15% trichloroacetic acid peel in melasma p. 80
Pratiksha M Sonkusale, Sumit Kar, Abhay V Deshmukh
DOI:10.4103/Pigmentinternational.Pigmentinternational_14_20  
Background: Melasma, an acquired hypermelanosis, is challenging to treat rural population more exposed to ultraviolet (UV) rays in Central India. Chemical peeling is a new, safe and cost-effective treatment with very few studies comparing Glycolic acid (GA) peel and Trichloroacetic acid (TCA) peel in pigmented patients (Fitzpatrick skin type IV and V) in melasma using both subjective and objective methods; melasma area severity index (MASI) of evaluation. Aim: To study the clinico-epidemiological profile and to compare the therapeutic efficacy of chemical peeling with 35% GA and 15% TCA in melasma patients. Methods: 50 epidermal melasma patients were enrolled divided into two groups, 25 patients in each. These groups were treated with 35% of GA (Group A) and 15% TCA peel (Group B), respectively. They were primed and test peeled. Three sessions of peeling two weeks apart with follow up after 3 months were evaluated using subjective response and MASI score. Results: The mean age of onset was 35.20±7.11 with male to female ratio was 1: 5. The mean duration of melasma was 3.57±2.58. Positive family history (32%) was present with centrofacial (56%) was the most common pattern. Subjective evaluation in the GA group and TCA group showed good and very good response in 92% and 84% respectively. The MASI score at baseline and at 3 month for Group A was 11.8 and 3.66, while it was 10.5 and 3.7 for group B. Conclusion: Both GA and TCA peels proved to be an equally effective treatment in epidermal melasma in our study.
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Clinico-dermatoscopic and histopathological evaluation of cervico-facial hypermelanosis: a study from a tertiary care hospital p. 87
Simplepreet Kaur, Jasleen Kaur, Saurabh Sharma
DOI:10.4103/Pigmentinternational.Pigmentinternational_39_19  
Introduction: Hypermelanosis is a rampant cosmetic problem nowadays. Unvarying and uniform skin color is the essence of vibrant skin. Hypermelanosis involving the face and neck is quite common and often becomes a challenge to the diagnostician. Persisting cervico-facial hypermelanosis causes cosmetic disfigurement which immediately sets one apart and consequently threatens psychosocial and psychosexual identity. Combining different modalities like dermatoscope and histopathology helps in early diagnosis and in time management of these disorders. Aims and Objectives: The data regarding the characterization of face and neck hyperpigmentation are scarce. This study was performed to determine the clinical types of face and neck hypermelanoses and establishment of their diagnosis using clinical, dermatoscopic, and histopathological features. Material and Methods: A total of 100 clinically diagnosed patients with hyperpigmentation over face and neck, in the age group of 18–70 years of either sex were enrolled in the study. Thorough clinical examination followed by dermatoscopic and histopathological examination were performed. All the features were noted and tabulated along with photographic documentation. Results: Out of total 100 cases, there were 35% cases of melasma, 23% cases of lichen planus pigmentosus, 12% cases of ashy dermatosis, 7% cases of post inflammatory hyperpigmentation, 6% cases of periorbital hypermelanosis, 4% cases of drug induced hyperpigmentation, 3% cases of acanthosis nigricans, nevus of ota, and macular amyloidosis each, 2% cases of riehl’s melanosis and exogenous ochronosis each. Conclusion: Hyperpigmentary disorders are great mimickers. Clinical examination alone can misdiagnose certain conditions. Dermatoscope, a novel office tool, when used along with time tested modality like histopathology, can reduce the diagnostic burden of clinicians while treating hyperpigmentary conditions.
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CASE REPORTS Top

Lichen planus pigmentosus in systemic sclerosis: a rare association p. 96
Pallavi Goyal, Surabhi Dayal
DOI:10.4103/Pigmentinternational.Pigmentinternational_36_19  
A 30 year old female came to outpatient department with gradually progressing asymptomatic hyperpigmented lesions over face and neck since 2 years. Patient was a known case of systemic sclerosis and hypothyroidism and was on treatment for the same since 8 years. Differential diagnosis included lichen planus pigmentosus (LPP), ashy dermatoses, drug-induced hyperpigmentation, Riehl’s melanosis. Histopathology confirmed the diagnosis of lichen planus pigmentosus. Patient was put on topical depigmenting agents and topical calcineurin inhibitors along with photoprotection and the response was good. Patient had been regular in follow up.
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Adult onset progressive cribriform and zosteriform hyperpigmentation: a rare presentation p. 99
Aastha Gupta, Prekshi Bansal, Pooja Arora
DOI:10.4103/Pigmentinternational.Pigmentinternational_51_19  
Progressive cribriform and zosteriform hyperpigmentation (PCZH) is an uncommon pigmentary disorder characterized by the presence of asymptomatic cribriform brown macules involving a dermatome. Most cases of PCZH present in the second decade of life with gradual extension and absence of systemic involvement. Though the lesions of PCZH are usually localized, multiple lesions may be seen in some cases. We report a rare case of a 50 year old female with adult onset of this disease in fifth decade with extensive involvement of skin along multiple dermatomes.
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Pigmented Bowen’s disease over photo protected site in an Indian male: a rare case report p. 102
Ishan Agrawal, Debasmita Behera, Ipsita Debata, Maitreyee Panda
DOI:10.4103/Pigmentinternational.Pigmentinternational_1_20  
Bowen’s disease is a relatively common, yet under-recognized form of squamous cell carcinoma in situ. Pigmented BD (Pigmented BD) is a rare subtype of BD characterized by a hyperpigmented appearance, accounting for only 2% of all reported cases of BD. A 56 year old male presented with a scaly violaceous plaque over the scrotal skin with a dermoscopic picture of structure-less areas and bluish-brown dots, black globules with diffuse light violaceous pigmentation. Biopsy showed full thickness keratinocyte atypia with mitosis at all levels and pigment incontinence. We report this case because of the atypical presentation of BD, supported by dermoscopy and histopathology findings. The rarity of such a clinical presentation signifies the need of a high index of clinical suspicion in such cases.
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LETTERS TO THE EDITOR Top

Bleomycin-induced flagellate dermatitis p. 106
Abheek Sil, Dibyendu B Bhanja, Sayantani Chakraborty
DOI:10.4103/Pigmentinternational.Pigmentinternational_12_20  
Flagellate pigmentation represents a unique adverse effect of bleomycin therapy that is encountered in 8–22% of patients. But this occurrence is independent of dose, route of administration, and underlying disorder (including type of malignancy). We highlight a case of a middle-aged man who developed flagellate hyperpigmentation following bleomycin-containing combined chemotherapy for Hodgkin’s lymphoma. Early recognition of bleomycin as the culprit drug is of paramount importance as these patients are usually on multiple medications.
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THE CLINICAL PICTURE Top

Giant pigmented basal cell carcinoma p. 108
Anupam Das, Abheek Sil
DOI:10.4103/Pigmentinternational.Pigmentinternational_53_19  
Basal cell carcinoma is a nonmelanocytic skin malignancy, which develops from the basal cells of the skin. More than 80% of BCCs occur on the face, head and neck. The clinicopathological types of BCC are nodular, infiltrative, micronodular, morpheaform and superficial. When the largest dimension of the lesion is more than 5 cms, it is referred to as giant basal cell carcinoma. Presentation of giant BCC indicates neglect and/or follow up. We hereby present a case of giant pigmented BCC in an elderly lady.
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