No abstract

Background: Psoriasis is a chronic auto-inflammatory condition. Treatment modalities include methotrexate (MTX) and apremilast (APL). Although the efficacy of MTX and APL is well studied, evidence of their superiority of one over the other is lacking. Dermoscopy is helpful in diagnosis and treatment evaluation. Therefore, dermoscopy is utilized to assess the treatment response. Objectives: This study aimed to evaluate dermoscopic assessment in psoriatic lesions treated by MTX and APL and compare their efficacy by calculating the respective Psoriasis Area and Severity Index (PASI) scores and study the effect of MTX and APL on different dermoscopic patterns in psoriasis at different levels of treatment. Methods: This randomized interventional comparative study was conducted in a tertiary care hospital. A total of 98 patients were randomly divided into two groups of 50 and 48 patients, given oral/intramuscular MTX 7.5 mg once weekly and APL 30 mg twice daily for 3 months, respectively. The patients were assessed clinically and dermoscopically using a videodermoscope, and comparisons were performed between the two groups. The PASI score was calculated and evaluated. Results: The PASI score was reduced by 83% and 65% from the baseline in MTX and APL groups, respectively. The patients with patchy (61.5%) and minimal (23%) patterns of vessels and red dots (92.3%) showed faster achievement of PASI-100. However, the patients with a regular distribution of vessels and globular vessels failed to obtain PASI-100, suggesting a poor response to treatment. Conclusions: Vascular structures play a significant role in the diagnosis and prediction of the treatment response. Particular patterns and type vessels under dermoscopy can give a hint about choosing appropriate drugs for psoriasis.

Background: Hypopigmentary skin disorders are the most worrisome complaints from Indian and Indian subcontinent people. Pityriasis alba (PA), polymorphic light eruption (PLE), and vitiligo are clinically look-alike conditions commonly seen in children. Objectives: We attempted to characterize the dermoscopic features of PA and PLE and differentiate them from vitiligo in the facial region in skin of color. Methods: Dermoscopic evaluation was done using a handheld dermoscope at 10X magnification on facial lesions of a total of 60 patients with PA, PLE, and vitiligo. Dermoscopic features of all three conditions were compared and correlated with histological features. Results: Out of 60 patients, 30 (50%), 20 (33.33%), and 10 (16.66%) patients were diagnosed with PA, PLE, and vitiligo clinically and histologically, respectively. Dermoscopy of PA showed white structureless areas (100%), ill-defined margins (86%), faint brownish pigmentation (70%), and fine scales (70%) (P value = 0.001). Besides, 70% of PLE cases showed white structureless areas and ill-defined margins, and 10% showed faint brownish pigmentation (P value = 0.0001). Coarse scales and clustered dots were the most common findings (75%) in PLE lesions, followed by light brown background (60%), crusts (40%), and yellow clods (30%) (P value = 0.0001). Also, 40% and 35% of the PLE cases showed white and brown course scales, respectively (P value = 0.0001). Moreover, 13.33% of PA cases showed coarse white scales, and 3.33% showed a light brown background. All vitiligo cases showed a white glow appearance (100%), followed by perifollicular pigmentation, leukotrichia, and koebnerization shown by 40% of the cases (P value = 0.0001). Finally, 20% of the cases showed perilesional pigmentation and satellite lesions. Conclusions: PA lesions are dermoscopically characterized by ill-defined white areas with fine branny scales, whereas PLE shows coarse brown scales, ring scales, crusts, and yellow clods along with the above findings. Vitiligo lesions are devoid of scales with various pigment network abnormalities, perilesional and perifollicular pigmentation, and leukotrichia.

Introduction: Griscelli syndrome (GS) is a very rare autosomal recessive disorder, belongs to group of “silvery hair syndromes” which includes Chediak-Higashi syndrome (CHS) and Elejalde syndrome. Hair light microscopy helps in the differentiation of GS and CHS, as both manifest with clinical features. Trichoscopy is useful in the diagnosis of many hair shaft disorders. Here, authors describe the trichoscopic features of GS in skin of color. Materials and Methods: This was an observational study conducted in a private dermatology clinic and in a tertiary care hospital. A total of 5 cases of suspected GS were referred by pediatrician. Consent was obtained. The demographic data in terms of age, gender, consanguinity, and clinical history was documented. Trichoscopic examination was performed with FotoFinder videodermoscope with 20× magnification, the clinical images were captured with Medicam 1000. Trichoscopy showed large and irregular pigment clumps in 4 cases. One case demonstrated hypopigmentation of hair without pigment clumps [ Figure 3a ]. Results: Trichoscopy showed large and irregular pigment clumps in 4 cases. One case demonstrated hypopigmentation of hair without pigment clumps. Conclusion: Trichoscopy shows characteristic features GS. It is a useful method when facility for light or polarized microscope is unavailable.