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   Table of Contents - Current issue
Coverpage
January-April 2021
Volume 8 | Issue 1
Page Nos. 1-71

Online since Wednesday, April 7, 2021

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EDITORIAL  

Global scenario of COVID-19 Highly accessed article p. 1
Uwe Wollina, Roxanna Sadoughifar, Torello Lotti
DOI:10.4103/Pigmentinternational.Pigmentinternational_59_20  
COVID-19, caused by SARS-CoV-2 virus, has developed into a pandemic that is still going on. The disease is transmitted mainly by aerosols. Here we discuss diagnostics and disease control measures. The social distortion by the pandemic has a negative impact on many facettes of society that potentially increase social tensions. Disease control warrants science and transparency. Vaccination provides hope to overcome the pandemic eventually.
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REVIEW ARTICLE Top

The unhealthy obsession with fairness and the menace of fairness creams in India p. 4
Arijit Coondoo, Rashmi Sarkar
DOI:10.4103/Pigmentinternational.Pigmentinternational_19_21  
Humanity has been obsessed with the partiality towards fair skin since time immemorial leading to unhealthy practices. The recent manifestation of this obsession is the huge number of fairness creams which has flooded the Indian cosmetic market. Some corticosteroid creams are also used as fairness creams because of the side-effect of hypopigmentation which is mistaken for fairness. Such misuse of topical corticosteroids leads to unwanted physical and psychological side-effects which have been collectively described as “Topical steroid dependent/damaged face” (TSDF). Concerted efforts by professional and social organizations [such as IADVL and Pigmentary Disorders Society (PDS)], politicians and media representatives, to fight this social menace of fairness craze and fairness creams have started yielding some positive results recently.
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Use of immunosuppressants in vitiligo during COVID-19 pandemic: a quick review Highly accessed article p. 8
Hitaishi Mehta, KT Soufila, Sheetanshu Kumar, Rashmi Sarkar, Muthu Sendhil Kumaran
DOI:10.4103/pigmentinternational.pigmentinternational_11_21  
Owing to the recent coronavirus (COVID-19) pandemic, there is a concern regarding the use of systemic immunosuppressive agents. There are no guidelines at present regarding the use of immunosuppressants. The main aim at this time should be to keep the dermatoses under control without exposing the patient to increased risk of infection and the consequent morbidity. In vitiligo, immunosuppressive agents are utilized in stabilization of progressive disease. An informed decision regarding the use of immunosuppressive agents can be made only after understanding the immune response to coronavirus, reviewing the mechanism of action of drug and evidence from previous studies on risk of infection. This review briefly discusses the mechanism of action and the safety data of various immunosuppressants used in vitiligo.
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Dermoscopy of disorders of hyperpigmentation p. 14
Sunmeet Sandhu, Shekhar Neema, S. Radhakrishnan
DOI:10.4103/Pigmentinternational.Pigmentinternational_40_20  
Disorders of hyperpigmentation are common in clinical practice and accounts for a large number of dermatology consultation in our country. These disorders, especially with facial involvement can result in tremendous psycho-social impact and are associated with poor quality of life. Disorders of hyperpigmentation are clinical diagnosis; the role of histopathology is limited by its invasive nature and reluctance on part of patient to undergo facial biopsy as well. Dermoscopy is a relatively new tool to diagnose these groups of disorders, but it has become popular due to its noninvasive nature and ability to perform the dermoscopic examination repeatedly over a period of time. Dermoscopy cannot replace thorough clinical history and histopathological examination, but it has distinct advantage in diagnosis of many disorders of hyperpigmentation. In this review, we will cover dermoscopy of disorders of hyperpigmentation and our approach to dermoscopy of these disorders.
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ORIGINAL ARTICLES Top

Dermoscopic analysis of idiopathic guttate hypomelanosis: a cross-sectional study p. 25
Harish M. R., Shashikumar B. M., Priyanka R Magod, Deepadarshan K.
DOI:10.4103/Pigmentinternational.Pigmentinternational_7_20  
Background: Idiopathic guttate hypomelanosis (IGH) is a common pigmentary disorder encountered in older age group, causing cosmetic disfigurement with considerable psychological impact. Diagnosis is generally based on history and clinical features. In the situation of diagnostic dilemma, dermoscopic examination is the quick and easiest method to solve the clinical uncertainty and thereby avoid unnecessary biopsies. Objectives: The aims of the study were to describe the varied clinical presentations and to enumerate the dermoscopic features of IGH. Methods: Study was conducted after obtaining approval from Institutional Ethics Committee. All the patients presenting with IGH attending the Department of Dermatology were examined and enrolled for the study after taking written informed consent. Each subject was evaluated by detailed personal history, clinical examination and dermoscopic examination. Results: A total of 100 patients of IGH were included in the study. The most affected age group was 46–65 years (52%). Females were most commonly affected with M: F ratio 1:1.17. Different dermoscopic patterns of IGH documented were amoeboid (58.2%), feathery (19.1%), petaloid (14.5%) and nebuloid (8.2%). Ten percent of the patients showed more than one patterns. Conclusion: Dermoscope aids in evaluation of different patterns of IGH lesions, which helps to differentiate it from other hypopigmented conditions with considerable overlap in the site, morphology and clinical features. Dermoscopic analysis makes it easier to diagnose the disorder and subsequently plan for the appropriate treatment.
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ORIGINAL ARTICLE Top

Does copper has a role in vitiligo? Analysis of tissue and serum copper in vitiligo p. 30
S.A. Archana, Vinutha Rangappa, T.G. Savitha, B. Jayadev, P.A. Kushalappa, P.K. Ashwini
DOI:10.4103/Pigmentinternational.Pigmentinternational_5_20  
Background: Vitiligo is an acquired, primary, idiopathic disorder characterized by depigmented macules and patches. Melanin, a natural pigment of skin, requires amino acid tyrosine for its synthesis. Tyrosinase, a key regulatory enzyme, is a copper (Cu) dependent enzyme. Thus, Cu plays a role in melanogenesis however, we need to look at the role of Cu in the pathogenesis of vitiligo. Aim: To estimate serum and tissue copper levels in vitiligo patients, and to compare with first degree relatives of patients and control group. Materials and Methods: All cases of vitiligo attending tertiary care hospital were included in the study. Venous blood samples were collected from subjects, first degree relatives and controls, punch biopsy specimens were collected from lesional and non-lesional skin of cases, controls and were analysed using inductively coupled plasma emission spectrometry. Results: Of 60 patients, serum Cu levels in cases were found to be low in 35, normal in 22 and high in 3. Mean serum Cu of first degree relatives was also low. Mean lesional Cu was 1.3 μg/g and non-lesional Cu was 1.4μg/g in vitiligo patients, which was lower than tissue Cu levels of controls(1.9 μg/g) (p value > 0.05). Conclusions: In our study the lesional and non-lesional Cu levels were lower in vitiligo patients. This low Cu levels may lead to reduced activity of enzyme tyrosinase, which is essential in the process of melanogenesis. Though role of Cu in melanogenesis is proven, its role in pathogenesis of vitiligo needs to be studied further.
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Simplification of noncultured epidermal cell suspension: A need of the hour p. 35
Sidharth Tandon, Kezhaleto Zutso, Konchok Dorjay, Ajeet Singh, Surabhi Sinha
DOI:10.4103/Pigmentinternational.Pigmentinternational_23_18  
Context: Vitiligo is the most common acquired disorder of pigmentation. The treatment options for vitiligo are either medical or surgical modalities. Noncultured epidermal cellular grafting is an innovative surgical technique that can be used for the treatment of stable vitiligo. Aim: To evaluate the effect of noncultured epidermal cellular grafting in stable vitiligo utilizing normal saline as a trypsin inhibitor. Materials and Methods: Thirty-three patients with stable vitiligo for the past 2 years were recruited in the study. Noncultured epidermal cell suspension grafting was done with normal saline as trypsin inhibitor. Result: Out of 33 patients, maximum patients had focal vitiligo (21), followed by segmental (7) and generalized (5). Response was excellent in 7 patients (21%), good in 16 (48%), regular in 7 (21%), and poor in 3 patients. Thus, 23 (69%) patients had a satisfactory (excellent to good) response. Satisfactory pigmentation over trunk was seen in 83%, face and neck in 90%, and limbs in 57%. Three patients had lesions involving the fingertips and toes and only one of them had a good response with the other two patients showing a poor response. Conclusion: The noncultured epidermal cell suspension grafting is an effective surgical procedure for stable vitiligo patients. In this study, we have tried to simplify the procedure by utilizing only normal saline as a trypsin inhibitor.
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Evaluation of serum levels of zinc and copper in vitiligo p. 42
Isha Narang, Krishna Deb Barman, Bijaylakshmi Sahoo, Pramod Lali
DOI:10.4103/Pigmentinternational.Pigmentinternational_57_19  
Background: Vitiligo has high prevalence in India and higher socio-psychological impact due to pigmented skin. Its etiopathogenesis remains unclear and role of zinc (Zn) and copper (Cu) has been speculated in previous studies with conflicting results. Materials and Methods: This is a case-control study of 100 patients of vitiligo and 60 controls. Serum Zn and Cu were estimated by photometric analysis. Results: The mean serum levels of Zn and Cu were significantly different between the cases and controls (P < 0.001). The mean serum Zn was low whereas Cu was higher when compared to controls but the actual levels of Zn and Cu both in patients and controls were much higher than the reference range. Conclusion: Our study shows that though significant difference in levels between cases and controls does point out possibility of important role of Zn and Cu in pathogenesis of vitiligo. Various environmental and nutritional factors affect their levels and so empirical treatment with zinc-copper supplements increases cost of treatment and isn’t supported by evidence. Also, for further studies to evaluate these levels in serum, a normal reference range for that specific population has to be defined and taken into consideration.
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CASE REPORT Top

Erythematous linear patch on lower limb complicated by lymphatic filariasis: a diagnostic dilemma p. 48
Sunil K Gupta, Sushantika S
DOI:10.4103/Pigmentinternational.Pigmentinternational_47_20  
Asymptomatic erythematous patches are mostly congenital vascular malformations that may be a part of syndromes like Sturge-Weber or Klippel Trenaunay syndrome. Acquired erythematous lesions are difficult to diagnose with differentials ranging from acquired port-wine stain to early morphea. We are reporting a case of a middle aged woman suffering from early morphea hardly distinguishable from Port-wine stain that was further complicated by her acquiring lymphatic filariasis in the same leg.
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CASE REPORTS Top

An unusual case of acral lentiginous melanoma with leukoderma p. 52
Shreya Deoghare, Ajay Kumar, M.S. Deora
DOI:10.4103/Pigmentinternational.Pigmentinternational_32_20  
Melanoma is an aggressive skin cancer with high mortality. The sole of the foot is an uncommon site where it may remain unnoticed or be misdiagnosed. Melanoma-associated leukoderma (MAL) may be an early sign and a high index of suspicion in late-onset vitiligo may result in early diagnosis. We present a case of MAL with acral lentiginous melanoma (ALM) in an elderly female.
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CASE REPORT Top

The convergence of extragenital lichen sclerosus with generalized vitiligo – an unusual presentation p. 55
Khushboo Arora, Aditi Dhanta, Neirita Hazarika, Prashant Joshi
DOI:10.4103/Pigmentinternational.Pigmentinternational_6_20  
Lichen sclerosus (LS), also known as Csillag’s disease, is an autoimmune, chronic inflammatory dermatosis with predilection for localized involvement of anogenital skin. However, extragenital LS is not uncommon. There is strong association of autoimmune disorders with LS. Vitiligo is an autoimmune disorder characterized by progressive loss of melanocytes causing appearance of localized and/or generalized depigmentation of the skin and/or mucous membranes. There have been a few reported cases in the literature of the coexistence of acrofacial vitiligo and LS. Here, we report a case of 70 year old female with coexistence of extragenital lichen sclerosus and generalised vitiligo. Interestingly in our patient LS lesions developed over generalised vitiligo patches. Histopathology confirmed the coexistence of vitiligo and LS.
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LETTERS TO THE EDITOR Top

Vitiligo after knee replacement: Koebnerization? p. 59
Jaspriya Sandhu, Sunil Kumar Gupta
DOI:10.4103/Pigmentinternational.Pigmentinternational_32_19  
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Lichen planus pigmentosus mimicking an amateur tattoo: an atypical presentation p. 62
Sunmeet Sandhu, Prince Yuvraj Singh, Preema Sinha, Shekhar Neema
DOI:10.4103/Pigmentinternational.Pigmentinternational_21_20  
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Tattooing Gone Whimsical p. 64
Vinod Hanumanthu, Raihan Ashraf, Divya Aggarwal, Bishan Dass Radotra, Muthu Sendhil Kumaran
DOI:10.4103/Pigmentinternational.Pigmentinternational_46_20  
In India, prevalence of cutaneous reactions secondary to tattoo pigment are increasing now a days. Among these granulomatous tattoo reactions warrants thorough investigation to rule out systemic sarcoidosis. Clinicians should consider LASER or oral and topical steroids in the management of granulomatous hypersensitivity reactions after ruling out mycobacterial (typical/atypical) and fungal infections and also create awareness to decrease its incidence.
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SPOT THE DIAGNOSIS Top

Brownish black nodule over foot − a subtle presentation of a grave disorder p. 68
Seema Manjunath, Anuradha Bishnoi, Muthu Sendhil Kumaran
DOI:10.4103/Pigmentinternational.Pigmentinternational_43_19  
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THE CLINICAL PICTURE Top

Linear streaky hypopigmentation p. 70
Pooja Arora, Sinu Rose Mathachan
DOI:10.4103/Pigmentinternational.Pigmentinternational_55_19  
Intralesional steroids are associated with several local cutaneous adverse effects. Linear streaky hypopigmentation is a rarely reported side effect that mimics vitiligo. We report a case of linear streaky hypopigmentation following intralesional triamcinolone acetonide and highlight the importance of preventing such side effects by avoiding excess and deeper injections of steroids.
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