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Sharma A, Aggarwal B, Kakkar A, Pandey NN, Taneja N. Dermoscopy of hypopigmented macules unveiling genetic diagnosis of tuberous sclerosis complex type 2 in an infant presenting with sacral chordoma. Pediatr Dermatol 2024; 41:736-738. [PMID: 38500310 DOI: 10.1111/pde.15581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/17/2024] [Indexed: 03/20/2024]
Abstract
A 2-month-old male with surgically resected sacral chordoma presented with multiple hypopigmented macules showing characteristic patchy, sharply demarcated areas of pigment network on dermoscopy. These dermoscopic findings were suggestive of the ash-leaf macules of tuberous sclerosis over other common hypopigmented macules in neonates. Chordomas presenting in early childhood in the sacral location have been reported as a rare manifestation of tuberous sclerosis complex. The combination of these findings led to a diagnosis of tuberous sclerosis, confirmed with the finding of a heterozygous TSC2 gene deletion; treatment with sirolimus resulted in regression of cardiac rhabdomyomas and hypopigmented macules.
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Affiliation(s)
- Ananya Sharma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, AIIMS, New Delhi, India
| | - Bhawana Aggarwal
- Department of Medical Genetics, All India Institute of Medical Sciences, AIIMS, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, AIIMS, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, AIIMS, New Delhi, India
| | - Neha Taneja
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, AIIMS, New Delhi, India
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Abdi P, Anthony MR, Farkouh C, Chan AR, Kooner A, Qureshi S, Maibach H. Non-invasive skin measurement methods and diagnostics for vitiligo: a systematic review. Front Med (Lausanne) 2023; 10:1200963. [PMID: 37575985 PMCID: PMC10416110 DOI: 10.3389/fmed.2023.1200963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Vitiligo is a multifaceted autoimmune depigmenting disorder affecting around 0.5 to 2.0% of individuals globally. Standardizing diagnosis and therapy tracking can be arduous, as numerous clinical evaluation methods are subject to interobserver variability and may not be validated. Therefore, there is a need for diagnostic tools that are objective, dependable, and preferably non-invasive. Aims This systematic review provides a comprehensive overview of the non-invasive objective skin measurement methods that are currently used to evaluate the diagnosis, severity, and progression of vitiligo, as well as the advantages and limitations of each technique. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used for the systematic review. Scopus, Embase, Cochrane Library, and Web of Science databases were comprehensively searched for non-invasive imaging and biophysical skin measuring methods to diagnose, evaluate the severity of, or monitor the effects of vitiligo treatment. The risk of bias in included articles was assessed using the QUADAS-2 quality assessment scale. Results An extensive literature search resulted in 64 studies for analysis, describing eight imaging techniques (reflectance confocal microscopy, computer-aided imaging analysis, optical coherence tomography, infrared photography, third-harmonic generation microscopy, multiphoton microscopy, ultraviolet light photography, and visible light/digital photograph), and three biophysical approaches (dermoscopy, colorimetry, spectrometry) used in diagnosing and assessing vitiligo. Pertinent information about functionality, mechanisms of action, sensitivity, and specificity was obtained for all studies, and insights into the strengths and limitations of each diagnostic technique were addressed. Methodological study quality was adequate; however, statistical analysis was not achievable because of the variety of methods evaluated and the non-standardized reporting of diagnostic accuracy results. Conclusions The results of this systematic review can enhance clinical practice and research by providing a comprehensive overview of the spectrum of non-invasive imaging and biophysical techniques in vitiligo assessment. Studies with larger sample sizes and sound methodology are required to develop verified methods for use in future practice and research. Systematic review registration (PROSPERO) database, (CRD42023395996).
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Affiliation(s)
- Parsa Abdi
- Memorial University of Newfoundland, Faculty of Medicine, St. Johns, NL, Canada
| | | | | | - Airiss R. Chan
- Division of Dermatology, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Amritpal Kooner
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, United States
| | - Simal Qureshi
- Memorial University of Newfoundland, Faculty of Medicine, St. Johns, NL, Canada
| | - Howard Maibach
- Division of Dermatology, Faculty of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Thomas IN, James JJ, Bala A, Mohan S, Dogiparthi S, Shanmugam NP. Usage of Dermoscopy as an Effective Diagnostic Tool in Pityriasis Alba: A Prospective Observational Study Among Children in a Suburban Hospital in South India. Cureus 2023; 15:e40271. [PMID: 37448397 PMCID: PMC10336270 DOI: 10.7759/cureus.40271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Hypopigmented patches in patients with skin of color are usually a cause of concern. Pityriasis alba is a common skin condition that causes visible patches of hypopigmentation in children and adolescents. In addition to the cosmetic impairment, parents are concerned about the diagnosis of vitiligo and leprosy which also cause hypopigmented patches and have negative social implications. Dermoscopy is a useful diagnostic aid that is acquiring prominence in diagnosing a variety of skin diseases. Few studies exist that validate the use of dermoscopy as an effective tool in the diagnosis of Pityriasis alba. OBJECTIVE To evaluate the effectiveness of dermoscopy by correlating the clinical features of Pityriasis alba with dermoscopic images. METHODS Hypopigmented patches in 16 patients that were clinically diagnosed as Pityriasis alba were examined with a DermLite DL200 Hybrid dermoscope (Dermlite, CA, USA). All the dermoscopic images were photographically recorded and the findings were noted and correlated with the clinical stages of the disease. RESULTS Out of the 40 patches examined in 16 patients, dermoscopic images of white structureless spots, scaling, indistinct borders and normally pigmented hairs were consistently present in all the patches to propose these as the four dermoscopic criteria for the diagnosis of Pityriasis alba. Areas of light brown pigmentation, 17 (42.5%), erythema, 3 (7.5%), and faint pigmented network,11 (27.5%) were the other features noted in some of the patches. CONCLUSION In an ethnic South Indian population where the skin color is predominantly brown, hypopigmented patches are visibly obvious and concerning. Pityriasis alba, Pityriasis versicolor, Vitiligo, Nevus depigmentosus, and Leprosy are the five common conditions seen among children of which Pityriasis alba is the most prevalent. Offering the right diagnosis is essential for the correct management as well as excluding more serious conditions such as leprosy and vitiligo. In this study, Dermoscopy provided a valuable diagnostic aid in achieving this objective.
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Affiliation(s)
- Irene N Thomas
- Dermatology, Shri Sathya Sai Medical College & Research Institute, Shri Balaji Vidyapeeth, Chennai, IND
| | - Joseph Jenson James
- Dermatology, Shri Sathya Sai Medical College & Research Institute, Shri Balaji Vidyapeeth, Chennai, IND
| | - Arishta Bala
- Dermatology, Shri Sathya Sai Medical College and Research Institute, Shri Balaji Vidyapeeth, Chennai, IND
| | - Saranya Mohan
- Dermatology, Shri Sathya Sai Medical College & Research Institute, Shri Balaji Vidyapeeth, Chennai, IND
| | - Sowmya Dogiparthi
- Dermatology, Shri Sathya Sai Medical College & Research Institute, Shri Balaji Vidyapeeth, Chennai, IND
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Burshtein A, Burshtein J, Rekhtman S. Extragenital lichen sclerosus: a comprehensive review of clinical features and treatment. Arch Dermatol Res 2023; 315:339-346. [PMID: 36198917 DOI: 10.1007/s00403-022-02397-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/18/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022]
Abstract
Lichen sclerosus (LS) is a chronic inflammatory skin disease commonly affecting the anogenital area with less frequent extragenital occurrence. Extragenital LS cutaneous manifestations vary and precipitating factors are not well described. Recent evidence for etiology and clinical associations of extragenital LS provide insight into disease recognition and pathogenesis. Novel diagnostic techniques as well as treatment standardization have the potential to improve management of this rare condition. This review details both past and new insights into the pathogenesis, clinical manifestations, and treatment options of extragenital LS.
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Affiliation(s)
- Aaron Burshtein
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Avenue, Suite 300, New Hyde Park, NY, 11042, USA
| | - Joshua Burshtein
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Avenue, Suite 300, New Hyde Park, NY, 11042, USA
| | - Sergey Rekhtman
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Avenue, Suite 300, New Hyde Park, NY, 11042, USA.
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Das A, Madke B, Jakhar D, Neema S, Kaur I, Kumar P, Pradhan S. Named signs and metaphoric terminologies in dermoscopy: A compilation. Indian J Dermatol Venereol Leprol 2022; 88:855-866. [PMID: 35146985 DOI: 10.25259/ijdvl_1047_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 06/01/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Bhushan Madke
- Department of Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
| | - Deepak Jakhar
- Department of Dermatology, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
| | - Shekhar Neema
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ishmeet Kaur
- Department of Dermatology, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
| | - Piyush Kumar
- Department of Dermatology, Katihar Medical College, Katihar, Bihar, India
| | - Swetalina Pradhan
- Department of Dermatology, All India Institute of Medical Sciences, Patna, Bihar, India
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Thakur V, Dev A, Vinay K. Dermatoscopy of Nevus Anemicus. Indian Dermatol Online J 2022; 13:822-823. [PMID: 36386743 PMCID: PMC9650755 DOI: 10.4103/idoj.idoj_679_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 06/16/2023] Open
Affiliation(s)
- Vishal Thakur
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anubha Dev
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Clinical Features, Immunopathogenesis, and Therapeutic Strategies in Vitiligo. Clin Rev Allergy Immunol 2021; 61:299-323. [PMID: 34283349 DOI: 10.1007/s12016-021-08868-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 12/19/2022]
Abstract
Vitiligo is an autoimmune disease of the skin characterized by epidermal melanocyte loss resulting in white patches, with an approximate prevalence of 0.5-2% worldwide. Several precipitating factors by chemical exposure and skin injury present commonly in patients with vitiligo. Although the diagnosis appears to be straightforward for the distinct clinical phenotype and specific histological features, vitiligo provides many challenges including chronicity, treatment resistance, frequent relapse, associated profound psychosocial effect, and negative impact on quality of life. Multiple mechanisms are involved in melanocyte disappearance, including genetics, environmental factors, and immune-mediated inflammation. Compelling evidence supports the melanocyte intrinsic abnormalities with poor adaptation to stressors leading to instability and release of danger signals, which will activate dendritic cells, natural killer cells, and innate lymphoid cells to initiate innate immunity, ultimately resulting in T-cell mediated adaptive immune response and melanocyte destruction. Importantly, the cross- talk between keratinocytes, melanocytes, and immune cells, such as interferon (IFN)-γ signaling pathway, builds inflammatory loops that give rise to the disease deterioration. Improved understanding of the immune pathogenesis of vitiligo has led to the development of new therapeutic options including Janus kinase (JAK) inhibitors targeting IFN-γ signaling pathways, which can effectively reverse depigmentation. Furthermore, definition of treatment goals and integration of comorbid diseases into vitiligo management have revolutionized the way vitiligo is treated. In this review, we highlight recent developments in vitiligo clinical aspects and immune pathogenesis. Our key objective is to raise awareness of the complexity of this disease, the potential of prospective therapy strategies, and the need for early and comprehensive management.
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Vinay K, Ankad BS. Dermatoscopic Features of Pigmentary Diseases in Ethnic Skin. Indian Dermatol Online J 2021; 12:24-33. [PMID: 33768020 PMCID: PMC7982038 DOI: 10.4103/idoj.idoj_561_20] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/25/2020] [Accepted: 09/26/2020] [Indexed: 11/17/2022] Open
Abstract
Dermatoscopy is a non-invasive, handy tool, which is increasingly being used in diagnosis and prognostication of pigmentary dermatoses. Dermatoscopic changes in pigmentary pattern, scaling, and vasculature help us to differentiate among the myriad of hypo and hyper pigmentary diseases. This review gives a brief overview of the dermatoscopic features of pigmentary diseases, which are commonly encountered in clinical practice. We also provide a diagnostic approach based on salient dermatoscopic features.
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Affiliation(s)
- Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, Karnataka, India
| | - Balachandra S Ankad
- Department of Dermatology, S Nijalingappa Medical College, Bagalkot, Karnataka, India
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