Altered Pigmentation Research Articles

Unilateral, bilateral symmetric or asymmetric isolated hearing loss in patients with heterozygous KITLG variants.

KITLG pathogenic variants have been associated to three distinct clinical presentations with different combinations of hearing loss and/or pigmentation abnormalities. However, its involvement in isolated hearing loss has not been confirmed since its initial description in two families. Besides, KITLG is so far the only gene prevailingly involved in unilateral isolated hearing loss. We therefore conducted a retrospective study of patients with KITLG alterations in the French national Reference Network for Genetic Hearing Loss and one case was added through the Genematcher exchange platform. We describe a series of monoallelic KITLG deletions and variations in a cohort of 14 symptomatic patients from eight unrelated families. All patients presented with unilateral, bilateral symmetric or asymmetric sensorineural hearing loss. When not profound, hearing loss was predominant on low frequencies. Most KITLG alterations are likely to result in loss-of-function and aggregate in the extracellular region, disrupting the KIT-binding domain or its structure. Penetrance is not complete, and unspecific pigmentation alterations were observed in only three patients. The present study confirms KITLG involvement in isolated unilateral, bilateral symmetric or asymmetric hearing loss. This confirmation indicates that genetic testing can be relevant in early-onset, non-sudden, isolated unilateral hearing loss.

Conserved and novel roles of the bHLH transcription factor SPATULA in tomato.

Arabidopsis has served as a model plant for studying the genetic networks that guide gynoecium development. However, less is known about other species such as tomato, a model for fleshy fruit development and ripening. Here, we study in tomato the transcription factor SPATULA (SPT), a bHLH-family member that in Arabidopsis is known to be important for gynoecium development. We analysed the expression of SlSPT during flower and fruit development, and its interaction with proteins previously reported as interactors of AtSPT in the gynoecium. We also generated and characterised loss-of-function tomato lines using CRISPR-Cas9. The results show that SlSPT forms homodimers and partially conserves the interactions reported in Arabidopsis with some HECATE proteins, and has a role in floral organ development, particularly in stamen fusion, style and stigma development, and trichome formation on the carpels. Furthermore, lack of SlSPT causes altered exocarp pigmentation. A metabolomic analysis of the exocarp showed perturbations in several pathways in the slspt mutant, with the flavonoid biosynthesis being the most affected, which could potentially impact the nutritional value of the fruit. In summary, the results show conserved functions during gynoecium development and novel roles that enrich the knowledge of the SPT gene in fleshy fruits.

IL-7 secreted by keratinocytes induces melanogenesis via c-kit/MAPK signaling pathway in Melan-a melanocytes.

Abnormal melanin synthesis within melanocytes can result in pigmentary skin disorders. Although pigmentation alterations associated with inflammation are frequently observed, the precise reason for this clinical observation is still unknown. More specifically, although many cytokines are known to be critical for inflammatory skin processes, it is unclear how they affect epidermal melanocyte function. Here, we wanted to see how IL-7, a type I cytokine, affects melanocytes because cytokine is known to be associated with various skin diseases. To this end, Melan-a melanocytes were tested for expression of the IL-7 receptor α (IL-7Rα) and common gamma chain (γc) and their response to IL-7. IL-7 promotes melanogenesis in Melan-a melanocytes, resulting in increased intracellular tyrosinase activity and melanin content. It also upregulates the transcription of melanogenesis-related genes like MITF, tyrosinase, TRP1, and TRP2. IL-7 receptor α (IL-7Rα) and common gamma chain (γc) are interacted with c-kit in Melan-a melanocytes. IL-7 also activates the phosphorylated c-kit and its downstream target genes, such as ERK1/2, JNK, and p38 phosphorylation in Melan-a melanocytes. Furthermore, inhibition of c-kit by ISCK03, c-kit inhibitor, significantly reversed c-kit phosphorylation and MITF expression. We also showed that IL-7 induces melanogenesis via the c-kit/MAPK signaling pathway based on the findings of this study. In conclusion, Melan-a melanocytes express IL-7 receptors on their surface, and IL-7 treatment on Melan-a cells leads to melanogenesis via the c-kit/MAPK signaling pathway. These results could lead to new treatments for pigmentation disorders and provide insight into the immunological processes surrounding melanocytes.

Beyond the Surface: Decoding Pityriasis Versicolor Through Clinical, Dermoscopic and Microbiological Exploration.

Pityriasis versicolor (PV) is an asymptomatic, superficial fungal infection caused by the Malassezia species and causes discolouration of the skin leading to altered pigmentation. It is usually a clinical diagnosis, but in doubtful cases wherein potassium hydroxide (KOH) mount is unavailable, alternative modalities like dermoscopy aid in the management. To evaluate the clinical and dermoscopic patterns in PV and correlate with the associated risk factors and study the fungal culture. A cross-sectional observational study was conducted for 12 months. A total of 115 patients clinically diagnosed with PV showing positivity on KOH mount were recruited. Dermoscopy was done, following which the scales were scraped and cultured in the laboratory on Saborauds dextrose agar and modified Dixon media, and the results were analysed after 3 weeks. Among the 115 participants, on clinical evaluation, 79 patients had achromic and 36 patients had chromic lesions. The dermoscopic features were categorized into domains such as scaling, pigmentation and other features. Fine scaling was the most common feature observed in 88.7% of the patients. Pigmentary changes were noted in all the patients with non-uniform pigmentation being the most common. We have also observed and described newer dermoscopic findings such as barbed wire fence appearance of ridges and furrows, fluffy cotton ball appearance of hypopigmented perifollicular lesions and sprinkled pepper appearance of pigmented dispersion. Out of the 115 KOH mount positive cases, 51 (44.3%) showed growth on fungal culture with Malassezia furfur being the most common species to be isolated in 18 patients. Dermoscopy is a new, popular non-invasive diagnostic modality, which shows specific features like fine scaling, pigment alteration, ridges and furrows with perifollicular involvement, and can be used to diagnose doubtful cases of PV as an adjunct or substitute to a KOH mount.

Improving Diversity in a Novel Psoriasis Study

Diverse racial and ethnic representation in clinical trials has been limited, not representative of the US population, and the subject of pending US Food and Drug Administration guidance. Psoriasis presentation and disease burden can vary by skin pigmentation, race and ethnicity, and socioeconomic differences. Overall, there are limited primary data on clinical response, genetics, and quality of life in populations with psoriasis and skin of color (SoC). The Varying Skin Tones in Body and Scalp Psoriasis: Guselkumab Efficacy and Safety trial (VISIBLE) is underway and uses strategies aimed at addressing this persistent gap. To assess the innovative strategies used in the VISIBLE trial to recruit and retain diverse participants in a randomized clinical trial of psoriasis in participants with SoC. This was an ad hoc quality improvement assessment of participant recruitment and retention approaches used by the VISIBLE trial. VISIBLE enrolled and randomized 211 participants (mean [SD] age, 43 [13] years; 75 females [36%] and 136 males [64%]) with SoC and moderate to severe plaque psoriasis from August 2022 to March 2023 to evaluate guselkumab treatment. The self-identified race and ethnicity of the participants was: 1 American Indian/Alaska Native (0.5%), 63 Asian (29.9%), 24 Black (11.4%), 94 Hispanic/Latino (44.5%), 13 Middle Eastern (6.2%), 1 Pacific Islander/Native Hawaiian (0.5%), 12 multiracial (5.7%), and 3 of other race and/or ethnicity (1.4%). Using a combination of objective (colorimetry to determine Fitzpatrick skin type) and self-reported (race and ethnicity consistent with SoC) parameters, VISIBLE sought to broaden inclusion of participants from various backgrounds. Observed improvements were that participant enrollment occurred approximately 7 times faster than anticipated (vs historical recruitment data for psoriasis studies); 211 participants (100%) self-identified themselves as a race or ethnicity other than White; and more than 50% had skin tone in the darker half of the Fitzpatrick skin type spectrum (type IV-VI). Innovations implemented by VISIBLE were (1) assessment of the natural history of postinflammatory pigment alteration and improvements over time using combined objective colorimetry and clinician- and patient-reported outcomes; (2) evaluation of genetic and comorbidity biomarkers relevant to participants with SoC; (3) a diverse demographic-driven approach to site selection (emphasizing investigator and staff diversity and experience with populations with SoC); (4) provision of cultural competency training to enhance participant enrollment and retention; (5) collection of patient-reported outcomes data in participants' primary language; and (6) periodic, blinded central review and feedback on investigator efficacy scoring to promote consistency and accuracy in evaluating psoriasis in participants with SoC. VISIBLE is a unique study focused on addressing important knowledge and data gaps in populations of patients with psoriasis and SoC, with the goal of generating data to help improve clinical care and inform future best practices in diversity within dermatology research. The rapid study enrollment demonstrates that intentional and strategic approaches to clinical trial design and conduct can speed recruitment and bolster participation and retention of diverse populations in a dermatologic setting. ClinicalTrials.gov Identifier: NCT05272150.

FC15 Psoriasis in skin of colour patients: where are we now?

Abstract Psoriasis is a chronic immune-mediated inflammatory disease affecting individuals across all races and ethnicities with reports of varying prevalence in different populations. Apart from similarities, there are nuances in various aspects of psoriasis in populations with skin of colour (SOC) as well as disparities in access to care and research.1 Our objective was to further understand the unique characteristics of plaque psoriasis in SOC patients. A literature search from January 2018 until August 2023 in Pubmed/MEDLINE and Cochrane Library was performed. Level of evidence for each study was assessed using the Oxford Centre for Evidence-Based Medicine recommendations and only studies with a level of evidence of I–III were included. The prevalence of plaque psoriasis is higher in White populations compared with those with SOC, although the disease is more severe, with higher body surface area affected and with a greater impact on quality of life in the latter group. The clinical picture in SOC patients may vary as lesions can appear as violaceous/grey and postinflammatory pigmentary alteration is a common associated feature. High-impact site involvement might be more common and more severe in patients with SOC. In terms of management, disparities in care have been reported. Data about the use of biologics or oral small molecules have shown similar efficacy and safety profiles across self-identified racial and ethnic groups. Psoriasis has been shown to have a greater impact on quality of life (QoL) in patients with SOC and new QoL tools that are more culturally appropriate for SOC patients may be required for use in global populations. Historically, access to clinical care and research has been more limited in people with SOC due to multiple factors. Inclusion of representative patient populations in registration trials has not changed significantly over the last years; however, postmarketing studies specifically involving SOC populations in North America have recently emerged. A limitation of our study is the lack of a universal definition and use of terms, such as ethnicity, race and SOC. In conclusion, racial and ethnic variations in epidemiology, clinical presentation, access to care, and QoL impact in psoriasis have been reported. However, data involving global populations with SOC are limited. This study raises awareness about the need to better understand psoriasis in patients with SOC so as to improve patient care globally.

Use of a bioactive matrix glove in the treatment of paediatric hand burns: a case series.

Burns to the hand are a common injury in paediatrics and can be traumatic to children, both physically and psychologically. Timely conservative or operative management is critical to maximise healing and minimise long-term complications in these young patients. Here, we present the cases of patients treated with a novel skin substitute formed into a prefabricated glove. The glove (PermeaDerm, Inc., US) is a bioactive matrix composed of a silicone composite membrane embedded with collagen and aloe extract with variable porosity that allows moisture to pass to a secondary dressing. To our knowledge, our group was the first to treat a small set of paediatric patients with hand burns with the glove. A chart review was conducted to analyse hospital course, treatment length, complications and outcomes for each patient. The age range of the five patients included in this case series was seven months to three years. All five patients had scald burns to the hand. Overall, healing with the glove was successful, with little scarring or altered skin pigmentation, and a full range of motion at the affected joints. Hand burns in paediatric patients are traumatic and cumbersome to the patient and their families. This bioactive matrix glove allows for a one-time application, decreases operating room time and need, and reduces the demand for multiple dressing changes. In our set of five patients, the glove showed promising results as a safe and effective noninvasive treatment option for hand burns in paediatric patients.

Pathology Findings and In-Life Correlates in the Nonclinical Development of Adeno-Associated Virus (AAV)-Based Retinal Gene Therapies.

Adeno-associated virus (AAV)-based vectors are the most frequently used platform for retinal gene therapy. Initially explored for the treatment of loss-of-function mutations underpinning many inherited retinal diseases, AAV-based ocular gene therapies are increasingly used to transduce endogenous cells to produce therapeutic proteins, thus producing site-specific biofactories. Relatively invasive ocular routes of administration (ROA) mean prominent procedure-related in-life, and histopathological findings may be observed with some regularity. Test article-related findings may vary with the ROA and cell populations transduced, with retinal pigmented epithelium (RPE) changes prominent (ranging from pigment alteration through degeneration, with or without associated degeneration of the overlying retina) with subretinal ROA, and more anterior changes (iris, ciliary body) generally observed with the intravitreal ROA. Ocular inflammation is the most frequent finding that occurs nonclinically and in patients, and is particularly pronounced with intravitreal administration. Extraocular findings may be observed in extraocular muscles, regional ganglia, or central visual pathways with multiple ocular ROA. Work is still needed to understand the mechanisms underpinning many of these ocular and extraocular findings. Emerging patient data is helping to clarify both the potential for translating nonclinical findings to predict possible human responses and the applicability of nonclinical biomonitoring methods to the clinical setting.

MFRP GENE MUTATION: NOVEL MANIFESTATION AND INSIGHTS ON PATHOPHYSIOLOGY - A CASE REPORT.

The aim of this study is to delineate a novel manifestation linked to the mutation of the MFRP gene: a macular neovascular membrane (MNV). The authors provide detailed insights into this rare condition, shedding light on a previously unreported observation and proposing potential pathophysiological mechanisms. A single case report from a tertiary center in Brazil was conducted for evaluation. A female patient presenting with microphthalmos, retinal pigmentary alterations, and optic disc drusen, which had previously been misdiagnosed as Intracranial Idiopathic Hypertension (IIH), was diagnosed with MNV and inherited retinal dystrophy. Genetic testing confirmed the presence of an MFRP mutation, revealing novel manifestation of heterozygous gene mutations (c.498del p. Asn167Thrfs*25 and c.650G>A p. Gly217Glu). MNV in the context of retinal dystrophies is a rare occurrence and has not been previously associated with an MFRP mutation. The documentation of this novel observation is crucial for enhancing our understanding of the potential disease presentations, aiding in diagnosis, elucidating the underlying pathophysiology, and guiding appropriate management strategies in such cases.

Bipolar Radiofrequency Combined with Non-Crosslinked Hyaluronic Acid Mesotherapy: A Protocol for Skin Enhancement

Changes associated with aging, such as alterations in epidermal hydration, pigmentation, thickness, and cell renewal, impact skin appearance and may result in laxity, dryness, and uneven skin tone. This case series aimed to evaluate the combined effects of bipolar radiofrequency and non-crosslinked hyaluronic acid mesotherapy on skin appearance, with the goal of achieving synergistic benefits. This retrospective data analysis included subjects aged 33-67 years with facial skin dryness and laxity. Subjects received treatment with a bipolar radiofrequency device on the face, followed immediately by mesotherapy with 2.5 ml of non-crosslinked hyaluronic acid. Photographic documentation and skin analysis were conducted before treatment and 30 days post-treatment. Fourteen subjects with a mean age of 45 years (range 33-67) and presenting with dry, lax facial skin were included. All measured indicators showed significant improvement following the combined radiofrequency and mesotherapy protocol. The combined protocol also correlated with greater improvement in both patient and physician satisfaction, observed immediately after the procedure and at 30 days post-procedure. The treatment was well tolerated, and no adverse events were reported. The combination of bipolar radiofrequency and non-crosslinked hyaluronic acid mesotherapy resulted in significant improvements in skin appearance, firmness, tone, and overall subject satisfaction compared to the baseline condition. The treatments were well received, leading to noticeable enhancements in facial aesthetics. No adverse events were reported, confirming the safety of the protocol.

"Red flags" during pregnancy-skin symptoms and their causes during pregnancy

Pregnancy is aspecial state for the expectant mother. Not only is ahuman being growing, but the pregnant woman's body is also constantly changing during the 40-week pregnancy. One organ that is frequently affected by these changes is the skin. As diagnosis and treatment during pregnancy can present treating physicians with particular challenges, it is important to know the relevant pregnancy dermatoses, to recognize and diagnose them reliably, and to observe red flags in order to protect the pregnant women and the unborn child. In this article, the most important changes in the skin of pregnant patients are explained and potential warning signs are presented. In addition to aspects of altered pigmentation, the influence of pregnancy on pre-existing inflammatory dermatoses and their improvement or worsening is also described. The occurrence of so-called specific pregnancy dermatoses over the course of pregnancy is also explained. Finally, the extent to which autoimmune diseases of the mother can also affect the unborn child and to what extent skin changes in the newborn can indicate adisease of the mother are described. The respective "red flags" are presented as leading symptoms and their relevance is discussed.

Influence of the painting medium on the alteration process of smalt in oil paintings studied using combined K and Co K-edge XANES

This study investigates the alteration processes affecting the smalt pigment in historical artworks through a combination of analytical techniques including X-ray Absorption Near Edge Structure (XANES) spectroscopy at the potassium (K) and cobalt (Co) K-edges, coupled with scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM-EDX) and micro X-ray fluorescence elemental mapping (µ-XRF). Laboratory mock-up samples prepared with different oil binding media were artificially aged, revealing varying rates of smalt degradation. µ-XANES analyses at the K K-edge provided grain-scale insights into smalt alteration, highlighting the influence of binding media composition on degradation kinetics. Crossed clustering data analysis over K µ-XANES acquired on both model samples and historical cross-sections corroborated findings and identified distinct spectral signatures associated with different stages of smalt degradation. Furthermore, identification of potential transformation products such as potassium alum in historical samples emphasized the dynamic nature of pigment alteration processes.

Exploring Carolingian and Romanesque cycles: a study of the detached wall paintings from the Church of St. Johann in Müstair

Twenty-six fragment of wall paintings detached from the upper register of the Carolingian and Romanesque cycles of the church of St. John in Müstair (Switzerland) have been part of the Swiss National Museum collection since the beginning of the twentieth century. As some of these objects were in a critical state of conservation, a research project was launched to assess and document their conditions, and to gain knowledge about painting materials and execution techniques, in view of planning a conservation project. In a first phase, non-destructive analyses were carried out, using handheld XRF and portable FTIR spectroscopy; followed by the targeted collection of samples for detailed analysis in the laboratory. In parallel, similar investigations were carried out on the imprints left on the walls of the church’s attic. The results allowed the identification of the pigment palette and the execution technique. Besides earth pigments such as ochres, a lime-based white, probably bianco di San Giovanni, and limited amounts of lapis lazuli were used in both painting cycles. For the Carolingian cycle, Egyptian blue and mixtures of several lead-based pigments were also identified. In several instances, the deterioration of lead-based pigments resulted in shades of grey to black severely modifying the original appearance of the wall paintings. Additionally, both cycles have suffered from pigment alteration due to fire. The obtained results, together with iconographic considerations, allowed for an extended interpretation of possible original colour palette.Graphical

Dermoscopic Features of Cutaneous Hypopigmented Lesions

Abstract Background Pigmentation disorders are rather common in dark skin. In India, 11% of patients presenting to the dermatology outpatient department in Western India have pigmentary disorders. Recently, dermoscopy has been involved as an important tool in the diagnosis of various dermatological diseases. Aim of the Work The aim of this study was to describe the Dermoscopic features of some hypopigmented skin disorders that may be clinically overlapping in order to facilitate differentiation between these skin disorders. Patients and Methods This Cross section descriptive study included 104 patients who complained of patchy or macular hypopigmented lesions. Results The most common dermoscopic features of progressive vitiligo were; Perifollicular hyperpigmentation, diffuse white glowing areas, white vellus and terminal hairs. The most common dermoscopic features of repigmenting vitiligo were; perifollicular pigmentation, marginal hyperpigmentation and interfollicular pigmentation. The most common dermoscopic features of stable vitiligo were; starburst appearance and altered pigmentation, marginal hyperpigmentation and perifollicular pigmentation. The most common dermoscopic features of idiopathic guttate hypomelanosis were; multiple, shiny and porceilin like macules, most of the lesions were well- defined (amoeboid pattern), few lesions were ill-defined with irregular cloudy whitish pattern (nebuloid pattern) and hyperpigmented networks were seen on the surrounding skin of some lesions giving the appearance of the cloudy-sky pattern. The most common Dermoscopic features of nevus depigmentosus were; hypopigmented patch with irregular and serrated borders, faint reticular network in some patches, borders showed pseudopods pattern protruding into the normal skin, the surrounding skin was scaly on some lesions and hair was pigmented with no peri-follicular hyperpigmentation. The most common dermoscopic features of pityriasis alba were; fairly demarcated hypopigmented macules, fine scales and hair inside patches of normal color. Conclusion Dermoscopy can aid in the diagnosis of hypopigmented skin disorders and can help in assessing the activity of vitiligo, however in sometimes the condition may be challenging and difficult to differentiate even by dermoscopy and in such cases histopathological examination may be helpful.

Ecotoxicological effects of triclosan on Lemna minor: bioconcentration, growth inhibition and oxidative stress.

Triclosan (TCS), an emerging pollutant, is a notable contributor to adverse impacts on aquatic organisms due to its widespread use during COVID-19 and hydrophobic properties. There is extensive documented literature on TCS toxicity in commercially important fish species; however, studies on aquatic plants remain limited. In this prelude, the present study aims to evaluate the effect of TCS on Lemna minor, a commercially important aquatic plant species for 7days. The results showed dose-dependent significant alterations in growth, pigments and stress enzymes of L. minor at varied concentrations of TCS (1 to 8mg L-1). Median inhibitory concentration (IC50) was found to be 4.813mg L-1. Total chlorophyll and carotenoid levels decreased 73.11 and 81.83%, respectively after 7days of TCS exposure. A significant increase in catalase and superoxide dismutase activity was observed in TCS exposed groups as compared to the control. Bioconcentration factor was found to be in the range of 5.855 to 37.129 signifying TCS ability to accumulate and transfer through the food chain. Scanning electron microscopy (SEM) analysis showed deformation in the cell surface and alteration of stroma morphology of TCS exposed groups. Furthermore, the Fourier transform infrared spectroscopy (FTIR) study also revealed that higher concentrations of TCS could cause alteration in the functional groups in the plant. This study demonstrates that TCS negatively impacts the growth and metabolism of primary producers, offering crucial insights into its interactions with aquatic plants and establishing baseline information essential for crafting effective mitigation strategies for TCS contamination in aquatic environments.

Lipid lysination by MprF contributes to hemolytic pigment retention in group B Streptococcus

Group B Streptococcus (GBS) is the leading cause of neonatal sepsis and meningitis. A major virulence factor is a pigmented beta-haemolytic/cyto-lysin (β-h/c) toxin with an ornithine rhamnolipid structure. We initially observed that absence of MprF enzyme altered pigmentation and haemolytic activity in GBS. Next, we showed that MprF-dependent lipid lysination contributes to the retention of the ornithine rhamnolipid within GBS membrane. Furthermore, cationic lipidation by MprF altered membrane properties contributing to resistance to the cyclic lipopeptide daptomycin and to acidic pH. This study highlights the importance of cationic lipids in cell envelope homeostasis and in modulating β-h/c activity.

Cutaneous Complications after Autologous Stem Cell Transplantation

Autologous stem cell transplantation (ASCT) has become more prevalent for high-grade non-Hodgkin's lymphoma (NHL) over the past decade. ASCT serves as a salvage treatment for high-risk or relapsed patients, offering potential long-term remission. Cutaneous modifications post-ASCT can be classified as early (within 100 days) and late (after 100 days). Understanding these changes is crucial for timely diagnosis and management. Early modifications typically include transient erythema, hyperpigmentation, and acute dermatitis, often linked to the conditioning regimen. Late modifications, occurring months to years posttransplantation, can encompass chronic skin changes such as scleroderma-like features and persistent pigmentary alterations. Emerging evidence challenges the notion that ASCT is free of graft-versus-host disease (GVHD), with incidences of auto-GVHD reported. However, cutaneous GVHD post-ASCT, though uncommon, poses significant diagnostic challenges. Cutaneous GVHD manifestations range from mild eruptions to severe, systemic involvement. The role of skin biopsy in these cases is invaluable, providing histopathological confirmation and distinguishing GVHD from other dermatoses. Recognizing the early and late cutaneous modifications following ASCT is essential for clinicians. Despite the rarity of skin GVHD in ASCT, awareness and prompt biopsy can facilitate accurate diagnosis and appropriate management, improving patient outcomes.

Pigmentary Changes in Systemic Sclerosis are Associated with More Severe Cutaneous Sclerosis and Severity of Other Systems: A Cross-sectional Study from India.

Pigmentary changes of the skin in systemic sclerosis in the form of diffuse hyperpigmentation and salt-and-pepper pigmentation are well documented in the literature; however, its association with disease severity and extent of underlying internal organ involvement has not been well studied. To assess the correlation between morphology and extent of pigmentary changes with the degree of cutaneous sclerosis and frequency and degree of major organ involvement. This was a cross-sectional descriptive study conducted in a tertiary care teaching hospital from December 2014 to November 2016. Consecutive patients of systemic sclerosis attending the outpatient department were screened, and patients satisfying the diagnosis as per the American Rheumatism Association criteria were recruited. Skin sclerosis was quantified using modified Rodnan skin score (MRSS), whereas pigmentary changes were calculated in terms of percentage of body surface area involved by rule-of-nine method. Investigations were carried out depending on organ involvement and as per respective specialty consultations with focus on pulmonary, cardiac, and gastrointestinal systems. Of the 50 patients recruited, all had cutaneous involvement in the form of binding down of skin, followed by pigmentary changes. MRSS was significantly higher in patients with any pigmentary alteration (P = 0.03) compared to those without any pigmentary changes. There was a rising trend in between the MRSS severity and the proportion of patients with hyperpigmentation, and it was statistically significant (P = 0.04). Among systemic involvement, lung was involved in the form of interstitial lung disease in 94% patients (n = 47). However, skin pigmentation of any type was associated with lower high-resolution computed tomography scores (P = 0.02). This study shows that in systemic sclerosis patients presenting with pigmentary skin manifestations, cutaneous sclerosis is significantly higher.

Chikungunya fever's chromatic chronicle: a kaleidoscope of pigmentary alterations.

Chikungunya fever (CKF), a neglected tropical disease caused by the chikungunya virus, manifests with skin pigmentary changes in a significant portion of people. A myriad of pigmentary alterations in individuals with CKF have been documented in the literature. This review highlights the pathogenesis, clinical features, histopathology, diagnosis and treatment of CKF-associated pigmentation. Notable presentations include the 'Chik sign' often seen in neonates and children. Treatment involves reassurance and topical agents for persistent pigmentation. Understanding these pigmentary changes is crucial for accurate diagnosis and management, facilitating improved patient outcomes. Further research is warranted to fully elucidate the underlying mechanisms and optimize therapeutic strategies.

Efficacy of 785-nm Picosecond Titanium Sapphire Laser for Treatment of Brown Nevus of Ota Lesions in FST II-V: A Retrospective Analysis.

Nevus of Ota (NOTA) is a dermal melanocytosis acquired in early childhood or pregnancy. Given their color variability, NOTA often require a combination of wavelengths for successful treatment. Quality-switched lasers have consistently shown efficacy in targeting dermal pigment, while picosecond lasers (PSLs) are an emerging technology for pigmentary disorders. To further elucidate its efficacy, the authors conducted a retrospective review of 17 patients with NOTA treated with a 785-nm PSL for brown NOTA lesions between 2021 and 2023. The primary end point analyzed clinical improvement based on before and after photography reviewed by 3 board-certified dermatologists using a five-point visual analog scale. Seventeen patients of Fitzpatrick skin types (FSTs) II to V, ranging from ages 14 to 38 years, were included in this study. Patients were treated for an average of 3.2 sessions in 2 to 3-month intervals. Visual analog scale scores demonstrated a mean clearance of 51% to 75%. No pigmentary alterations were noted. Because NOTA is common in higher FSTs, the authors believe that the 785-nm PSL is an excellent treatment option for brown NOTA in these skin types. This study highlights the need for further investigation to determine optimal treatment parameters for the color-based laser treatment approach for NOTA.