Ashy dermatosis (AD), lichen planus pigmentosus (LPP), erythema dyschromicum perstans (EDP), and idiopathic eruptive macular pigmentation are several acquired macular hyperpigmentation disorders of uncertain etiology described in literature. Most of the published studies on these disorders are not exactly comparable, as there are no clear definitions and different regions in the world describe similar conditions under different names. A consensus on the terminology of various morphologies of acquired macular pigmentation of uncertain etiology was a long-felt need. Several meetings of pigmentary disorders experts were held to address this problem. A consensus was reached after several meetings and collation of e-mailed questionnaire responses and e-mail communications among the authors of publications on the above conditions. This was achieved by a global consensus forum on AD, LPP, and EDP, established after the 22nd International Pigment Cell Conference held in Singapore in 2014. Thirty-nine experts representing 18 countries participated in the deliberations. The main focus of the deliberations was terminology of the conditions; as such, we present here the consensus statement of the forum and briefly review the available literature on the subject. We have not attempted to discuss treatment modalities in detail.

Ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus and idiopathic eruptive macular pigmentation are various types of acquired macular hyperpigmentation disorders of the skin described in literature. However, a global consensus on the definitions of these entities is lacking. We report two cases of acquired macular (hyper)pigmentation of uncertain aetiology diagnosed as ashy dermatosis and attempt to clarify the various confusing nosologies based on existing literature. We infer that acquired small and large macular pigmentation of uncertain aetiology should be considered separate from that associated with lichen planus. We also propose a diagnostic algorithm for patients with acquired macular hyperpigmentation.

Hyperkeratotic eruptions in the flexures, especially in the inguinal region, often pose a diagnostic and therapeutic dilemma. Inguinal keratotic eruptions may be caused by various infections, inflammatory dermatoses, vesico-bullous dermatoses, nutrient deficiencies, medication allergies and other miscellaneous causes such as granular parakeratosis. We hereby report four patients who presented with idiopathic hyperkeratotic erythematous eruptions with a migratory nature involving the inguinal region and occasionally showing the histopathologic features of granular parakeratosis. All four patients showed a dramatic therapeutic response to amoxicillin-clavulanic acid combination. We suggest that 'granular parakeratosis' should be considered as a histopathologic feature rather than the diagnosis. We would prefer to label our cases as 'Hyperkeratotic Flexural Erythema'. We recommend that detailed study of skin microbiome may help identify a possible alteration in skin microbiome contributing to the pathogenesis. We briefly review strategies on characterising the skin microbiome and the latest knowledge surrounding how alterations to the skin microbial populations can contribute to some diseases.

Chromoblastomycosis is very common in Central Kerala. The disease mainly affects male agriculturists especially those employed in rubber plantations. The most common organism is F. pedrosoi.

3. The COVID-19 pandemic is likely to continue for many months before being downgraded to seasonal epidemic status. This means a patient may have their immunomodulator withheld for many months. SYSTEMIC CORTICOSTEROIDSDoses of predniso(lo)ne >20 mg/day are considered immunosuppressive, but sudden stopping, or significant reduction of dose, in patients on long-term systemic corticosteroids, is unwise, particularly if they have suddenly become physiologically stressed. Note that systemic corticosteroids are part of many adult respiratory distress syndrome (ARDS) protocols, but are not currently recommended for SARS-CoV-2, as there is weak evidence of harm when used in influenza-associated adult respiratory distress syndrome. REDUCING IMMUNOMODULATOR DOSEThe immunomodulating actions of conventional systemic agents are dose-related. Whilst there is no hard data to make firm recommendations, consider the following lower dosages.•Azathioprine: reduce to ≤0.5 mg/kg/day •'Biologics: no specific data available, but as their half-lives are considerable, they may better be modify on a case-bycase basis •Ciclosporin: reduce to ≤1 mg/kg/day. Some in vitro evidence of potential benefit in COVID-19 disease •Methotrexate: reduce to ≤10 mg/week •Mycophenolate mofetil: reduce to ≤1 gm/day (mycophenolic acid to ≤720 mg/day) •Retinoids: no need for dose adjustment •Systemic corticosteroids: reduce to ≤10 mg/day predniso (lo)ne equivalent.