No abstract

Trichoscopy is a non invasive tool useful for diagnosis of dermatoses on hair bearing skin. Alopecia Areata (AA) is a common non scarring alopecia with varying aetiologies including autoimmune and genetic factors. Trichotillomania (TTM) is a psychocutaneous dermatosis characterised by compulsive hair plucking leading to hair loss at accessible sites. Trichoscopy can be used for diagnosing both these dermatoses at an early stage due to presence of distinct trichoscopic signs. Authors hereby intend to report two cases presenting with a trichoscopic overlap of trichotillomania superseding alopecia areata. First case was of a 27-year-old male presented with patchy hair loss for three months over scalp. On clinical examination, the case appeared to be of AA with involvement of three well-defined patches on the scalp, though trichoscopy suggested an overlap of AA with TTM. On probing patient gave a history of stressors predominantly of unemployment due to Coronavirus Disease-2019 (COVID-19) pandemic but denied the history of compulsive hair pulling, indicating that TTM must have superseded patches AA. The second case was a 20-year-old female presenting with a single patch of hair loss over mid scalp. There was atrophy in the centre and easy pluckability at borders. Trichoscopy yet again suggested an overlap of AA with TTM. The patch of AA was persistent in the patient giving rise to depression and anxiety which had probably provoked hair plucking. TTM and AA are two distinct clinical entities but can be simultaneously present in patients. Trichoscopy can be indeed helpful for diagnosis in such cases. Treatment modalities should therefore address both these conditions in such cases for better outcomes.

The follicular variant of lichen planus is also known as lichen planopilaris. it is an inflammatory, primary cicatricial alopecia which accounts for 30-40% of scarring alopecia. It usually occurs between 30 to 70 years of age group with a female predominance of varying ratio ranging between 1.8:1 and 9:1. LPP is usually an insidious process evolving over several years. It usually presents as irregular patchy hair loss with loss of follicular ostia and perifollicular erythema and perifollicular scales are typically present at the periphery of active lesions. So, hereby reporting this case for its rarity in occurrence in male patient.

Cutaneous Tuberculosis (TB) is a chronic bacterial infection. It is difficult to diagnose these lesions since they mimic various other dermatological conditions. Cutaneous tuberculosis has a wide range of variations in morphology, histopathology, immunology and treatment response and a diagnosis of cutaneous tuberculosis is very much common in developing countries like India. Cutaneous tuberculosis can be exogenous; endogenous: caused by contiguity or autoinoculation and by haematogenous spread; induced by the Calmette-Guérin bacillus and manifest as a tuberculoid. The diagnosis of the infection is supported through the direct test, culture, histopathology, tuberculin skin test, polymerase chain reaction, interferon-gamma release assay, and genotyping. Drugs used for treatment comprises of isoniazid, rifampicin, pyrazinamide and ethambutol. The authors hereby present a case series of various types of lupus vulgaris and scrofuloderma that came to Dermatology Outpatient Department with similar findings

Basal cell carcinoma (BCC), also known as basal cell epithelioma is the most common cutaneous malignancy affecting fair skinned individuals arising from sun exposed skin especially head and neck area. It is a slow growing tumor which rarely metastasizes. UV radiation is the most important predisposing factor. It includes mainly four variants: (a) nodular, (b) pigmented, (c) superficial BCC, (d) sclerosing or morphea form of which most common is nodular variant. Dermoscopy of pigmented BCC shows well focussed arborizing vessels which is the hallmark. The best modality of treatment is surgical excison of tumour, electrodesiccation and curettage, cryosurgery, and Mohs micrographic surgery.