Cutaneous Distribution Research Articles

Anterior quadratus lumborum block for analgesia after living-donor renal transplantation: a double-blinded randomized controlled trial

IntroductionLimited non-opioid analgesic options are available for managing postoperative pain after renal transplantation. We aimed to investigate whether the unilateral anterior quadratus lumborum (QL) block would reduce postoperative opioid consumption...

Full factorial design-based development and characterization of ciclopirox olamine loaded transferosomes: An efficient approach for the management of Athlete's foot

The aim of the current research is to develop ciclopirox olamine (CO) loaded transferosomes to achieve enhanced permeation via thickened, dry, scaly, and cracked stratum corneum during athlete's foot, which conventional topical formulation fails to achieve. In addition, the potential of developed formulation was compared with marketed formulation via in vitro antifungal studies. CO-transferosomes were optimized and developed using design of experiment approach viz. 24 full-factorial design and employing four independent variables viz. ratio of edge activators viz. sodium deoxycholate (SDC) and tween 80, ratio of lipids viz. soya lecithin (SL), and cholesterol, ratio of solvent system i.e., chloroform and ethanol and volume of hydrating solvent viz. phosphate buffer saline PBS (pH 7.4). Rotary evaporation-sonication technique was used to formulate transferosomes. Particle size, polydispersity index (PDI), and zeta potential were three selected dependent variables. To comprehend the intricate interaction between the underlying variables and the outcome variables of the developed formulation, the response surface methodology suggested by Design Expert® was found to be desirable with a desirability value of 0.676. Based on desirability function, the optimized formulation was developed and characterized. The results of optimized formulation for particle size were found to be 124.2 ± 5.1 nm, PDI was 0.280 and a negative zeta potential value of −12.20 ± 6.49 mV. Furthermore, the drug entrapment efficiency was found to be 96.56 ± 0.08 % with a release of 95.67 ± 1.05 % at the end of 24h. The results of release kinetics displayed that the release followed Higuchi diffusion kinetics with highest regression coefficient, followed by zero order. Additionally, the formulation was evaluated for in vitro antifungal activity against Trichophyton mentagrophytes which revealed a wider zone of inhibition of 28.05 mm ± 0.86 as compared to the marketed formulation. The results of ex vivo skin permeation studies of CO-loaded transferosomes revealed high permeability of transferosomes with enhancement ratio of 2.2. Based on the promising results, it may be possible to treat athlete's foot with improved cutaneous distribution of ciclopirox olamine using transferosomes.

Mapping Cutaneous Tissue Distribution of Sesquiterpene Lactone Goyazensolide Using MALDI Imaging

Mapping Cutaneous Tissue Distribution of Sesquiterpene Lactone Goyazensolide Using MALDI Imaging

Changes in the Cutaneous Nerve Fiber Staining and Distribution of PGP9.5 in Clinically Uninvolved Skin in Leprosy Patients after Completion of Multidrug Therapy and Assessing PGP9.5 as a Marker of Treatment Response.

Subclinical involvement of nerves may sometimes be present much before the overt clinical manifestations become apparent. Protein gene product (PGP) 9.5, a ubiquitin-C-terminal hydrolase, has been widely used as a marker to study the involvement of peripheral nerve fibers in many diseases. To evaluate the change in cutaneous nerve fiber staining and distribution from pre-treatment and post completion of multidrug therapy through the expression of PGP9.5 and to assess PGP9.5 as a marker of treatment response. In this prospective single-center observational study, skin biopsy was taken in patients with leprosy, having areas of nerve function impairment (NFI), based on findings of nerve conduction studies (NCSs), but not having lesions or impaired tactile or thermal impairment clinically. The thin nerve fiber density in the clinically normal skin in areas supplied by nerve showing changes of sensory neuropathy was evaluated to study the density of the fibers. A second biopsy was taken at the end of treatment from a site near the previous site to assess the changes in intra-epidermal nerve fiber staining and distribution. Thirty-three patients were recruited in the present study (24 males and 9 females). Pre-treatment, 27 patients had abnormal NCSs, while six patients did not have any evidence of neuropathy on NCSs. Staining for nerve fibers using PGP9.5; in the epidermis was positive in five patients pre-treatment and 11 patients post treatment (P = 0.181). Staining in the dermis revealed positivity in 14 pre-treatment, which increased to 18 post treatment (P = 0.342). Adnexae showed positivity in five patients pre-treatment and increased to 17 post treatment (P = 0.005). A reduced PGP9.5 staining in the epidermal, dermal, and adnexal regions was seen in leprosy patients, which improved post treatment. Thus, PGP9.5 may serve as a marker of NFI and treatment response.

Investigation of the anatomical course of articular branches to the thoracic zygapophysial joints

BackgroundRecent studies have questioned the validity of targeting the thoracic medial branch via anesthetic blocks or radiofrequency neurotomy for the diagnosis or treatment of pain from the thoracic zygapophysial joints. PurposeTo define the origin and course of the articular branches to the thoracic zygapophysial joints at all levels. DesignCadaveric dissection. SettingThe Gross Anatomy Laboratory at the University of New England College of Osteopathic Medicine. SubjectsOne cadaveric thoracic spine. MethodsGross and stereoscopic dissection of the bilateral dorsal rami T1–T12 was performed on one embalmed cadaver. The medial and lateral branches were traced from their cutaneous distribution to the origin at the dorsal ramus. The articular branches were identified using stereoscopic dissection by tracing their origin from the dorsal ramus or medial branch to the capsule of the zygapophysial joint. The images were recorded using digital photography. ResultsTwenty-two of the twenty-four articular branches were identified in a single cadaveric specimen. Articular branches at T7 on the right side and T9 on the left side were not identified. 5 of the 22 (18%) articular branches were observed to arise from the proximal segment of the medial branch of the dorsal ramus. Of the remainder, 17 of the 22 (78%) articular branches were observed to arise from the dorsal primary ramus itself. At levels T1-9, the articular branch coursed inferiorly along the lamina to reach the joint capsule. At levels T10-T12, the articular branch traversed the intervertebral foramen to reach the facet joint. The T12 medial branch on the left was seen to travel inferior to innervate the L1/L2 zygapophysial joint. ConclusionThe source of the innervation for the thoracic zygapophysial is variable and can arise from the dorsal ramus itself or from the proximal segment of the medial branch. Unlike the cervical and lumbar medial branches, which innervate two joints each, in this case, the thoracic dorsal rami appear to innervate only the zygapophysial joint at the level of the nerve exit. It should be noted that the findings may be limited in their generalizability due to the reliance on a single cadaver study.

Cutaneous nerve distribution around first extensor compartment of the wrist: Clinical implications for ultrasound-guided injections

To evaluate the course of the cutaneous nerve regarding the first extensor compartment to determine whether the dorsal or volar approach is safer for local injection into the first extensor compartment guided by ultrasound. We dissected the radial side of the wrists from 28 cadavers (52 wrists). Four-points along the imaginary line were set: the styloid process and 1 cm, 2 cm, and 3 cm proximal to the styloid process. The numbers of superficial radial nerve (SRN) and lateral antebrachial cutaneous nerve (LACN) branches were counted, and distances from the imaginary line at these points and nerve diameters were recorded. Digital images were superimposed to observe overall distribution of cutaneous nerve. There were means of 3.3 SRN and 0.9 LACN branches observed in each wrist. The mean number of both SRN and LACN branches was 2.3 on the dorsal side and 1.9 on the volar side. The superimposed images indicated that both the dorsal and volar sides comprised abundant cutaneous nerves and that their paths varied markedly between patients. However, we observed that larger nerves with meaningful diameters were more abundant on the dorsal than the volar side. There were similar numbers of cutaneous nerves on both the dorsal and volar sides; however, we observed greater abundance of thicker cutaneous nerves on the dorsal side, and these were closer to the reference line than on the volar side. This anatomical study suggests that the risk imposed to cutaneous nerves would therefore be reduced when injection on the volar side.

Pediatric Psoriasis with or without Arthritis: Does It Make a Difference?

Psoriasis and psoriatic arthritis can present simultaneously or separately in children and may pose a diagnostic challenge. To compare the dermatological manifestations in pediatric psoriatic patients with and without arthritis. A retrospective case-control study of psoriatic patients ≤ 18 years old at Sheba Medical Center was conducted between 2011 and 2021. Patients with psoriatic arthritis versus psoriasis-only were compared according to body surface area (BSA) involvement, cutaneous distribution, severity of skin disease, response to treatment and related side effects. The study cohort included 29 psoriatic arthritis and 64 psoriasis-only patients matched by age and sex. The psoriasis-only group had a significantly higher mean BSA (19.7%, SD ± 18.7) than the psoriatic arthritis group (6.1%, SD ± 11.4), (p = 0.029). The skin distribution differed with the psoriasis group showing more involvement of the extremities, scalp, trunk, and genitals. Both groups primarily experienced partial responses to methotrexate, whereas the psoriasis group mainly saw complete responses to biologics. Adverse events were rare, with a higher incidence in the psoriasis group. This retrospective study highlights the differences in cutaneous disease characteristics, severity, and treatment response in pediatric patients with psoriasis and psoriatic arthritis, providing valuable insights for diagnosis and disease course in the pediatric population.

Exploration of transcutaneous vagus nerve stimulation as a treatment option for adjuvant cancer and heart failure therapy

Vagus nerve stimulation (VNS) has gained prominence in the treatment of various clinical disorders such as migraine, depression, and tinnitus. Based on increased scientific knowledge of the VNS and insights into the vagus nerve (VN) function and anatomy/conduction, robust treatment approaches have been developed. There are both noninvasive and invasive VNS (iVNS) techniques. Currently, only iVNS techniques are approved by the US Food and Drug Administration (FDA). In contrast, transcutaneous VNS (tVNS) is a new treatment option that is receiving increasing attention. The tVNS application uses the cutaneous distribution of afferent VN fibers in the auricle, the auricular branch of the VN (ABVN), or in the neck, the cervical branch of the VN (CBVN). However, the tVNS technique has not yet been sufficiently researched in its application and mode of action to be used clinically on a large scale. Moreover, the stimulation parameters of the VN vary widely in different studies. Despite the growing number of research papers on this topic, more coherence in neurostimulation research and neuroanatomical basis is needed. The aim of this review is to highlight new clinical treatment options based on existing clinically applied treatment options. In this article, current clinical applications of tVNS are analyzed and important stimulation parameters are highlighted. Based on this data, useful new tVNS therapies are recommended. The focus will be placed on the study of inflammatory processes associated with cancer and on applications to cardiovascular events such as heart failure.

Formulation of Transliposomal Nanocarrier Gel Containing Strychnine for the Effective Management of Skin Cancer.

Strychnine (STCN) has demonstrated an exceptional anticancer effect against various cancers. However, the STCN clinical utility has been hampered by its low water solubility, restricted therapeutic window, short half-life, and significant toxicity. The objective of this investigation was to design and optimize a formulation of strychnine-loaded transliposomes (STCN-TLs) for dermal administration of STCN to treat skin cancer. The formulations of STCN-TL were examined in terms of vesicle size (VS), polydispersity index (PDI), entrapment efficiency (EE), and in vitro delivery. The improved STCN-TL formulation exhibited VS, PDI, EE, and in vitro delivery of 101.5 ± 2.14 nm, 0.218 ± 0.12, 81.74 ± 1.43%, and 85.39 ± 2.33%, respectively. In an ex vivo penetration, the created STCN-TL formulation demonstrated a 2.5-fold increase in permeability compared to the STCN solution. CLSM pictures of skin (rat) revealed that the rhodamine B-loaded transliposome preparation penetrated deeper than the rhodamine B hydroalcoholic mixture. Additionally, rat skin managed with STCN-TL nanogel exhibited a significant increase in Cskin max and AUC0-8 compared to rat skin treated with traditional STCN gel. The findings demonstrated that the transliposome preparation might be a suitable nanocarrier for the cutaneous distribution of STCN in the amelioration of skin cancer.

Chronic Musculocutaneous Nerve Injury: An Important Differential in Progressive Arm Atrophy

An isolated musculocutaneous nerve (MCN) injury is a rare condition that can be easily missed if it presents late. A 28-year-old man reported painless and progressive wasting of the right arm for 6 months. On examination, there was visible wasting of the right biceps brachii muscle along with its slight weakness, depressed biceps jerk, and an impaired pinprick sensation in the lateral antebrachial cutaneous nerve distribution. He described a history of a road traffic accident 14 months beforehand. Based on the history and clinical examination, the differential diagnosis included an isolated MCN injury, upper trunk plexopathy, lateral cord plexopathy, C5/6 radiculopathy, and monomelic amyotrophy involving the C5/6 myotomes on the right side. The results of nerve conduction studies and electromyography were consistent with chronic proximal MCN neuropathy (right). In cases of arm wasting without pain or numbness, MCN injury should be included in the differential diagnosis, even in the presence of good power of the elbow flexors. The importance of detailed history-taking and clinical correlation cannot be over-emphasized in such cases.

Phosphorylated α-Synuclein Deposits in Cutaneous Nerves of Early Parkinsonism.

The role of peripheral phosphorylated-α-Synuclein (p-α-syn) deposition on nerve degeneration in synucleinopathies is still unknown. To assess the cutaneous neural distribution of p-α-Syn deposits and its correlation with clinical data and with morphology and function of cutaneous sensory and autonomic nerves in early Parkinson's disease (PD) and multiple system atrophy-parkinson type (MSA-p). We recruited 57 PD (F/M = 21/36; age 63.5±9.4 years) and 43 MSA-p (F/M = 16/27; age 62.3±9.0 years) patients within 2 years from motor symptoms. We applied questionnaires and clinical scales, sensory thresholds, and sudomotor testing to assess severity of motor and non-motor involvement and sensory and autonomic dysfunction. We quantified, in skin biopsy from thigh, leg, and fingertip, epidermal, pilomotor, and sudomotor nerve fibers, Meissner corpuscles and intrapapillary myelinated endings and the neural distribution of p-α-syn deposits. Compared to controls, we found a cutaneous denervation paralleling functional and clinical impairment. Sensory and autonomic denervation was more severe in MSA-p than in PD. Deposits of p-α-syn were found in the majority of patients, with no significant differences among sites in both groups. Higher occurrence of p-α-syn deposits in autonomic nerves differentiated (p < 0.01) PD from MSA-p. p-α-syn deposits correlated positively with sudomotor function, epidermal, pilomotor and sudomotor nerve densities, and inversely with non-motor symptoms and disease progression. Our work demonstrated an early peripheral sensory and autonomic involvement in synucleinopathies, more severe in MSA-p than in PD. Higher p-α-syn deposits in autonomic nerves differentiated PD from MSA-p. p-α-syn deposits were associated with preserved innervation and slower disease progression.

Sensory Assessment and Block Duration of Deep Parasternal Intercostal Plane Block in Patients Undergoing Cardiac Surgery: A Prospective Observational Study.

IntroductionThere has been increasing interest in using deep parasternal intercostal plane (PIP) block as a supplement to multimodal analgesia regimens in cardiac surgery. The aim of this study was to observe cutaneous sensory block distribution and its duration for deep PIP blocks in patients undergoing open cardiac surgery.MethodsThis observational, prospective clinical study consisted of 113 participants. All patients received bilateral ultrasound-guided deep PIP block with 40 ml 0.33% ropivacaine. The primary study outcome was cutaneous sensory block distribution of deep PIP blocks in patients undergoing open cardiac surgery. Secondary outcome included block duration in all participants. The area of cutaneous sensory block was tested by using a cold stimulus (ice cube) 30 min after the end of deep PIP block administration. Cutaneous sensory testing was performed once every hour after extubation until the return of normal sensation.ResultsThirty minutes after bilateral deep PIP block administration, the successful block rate of dermatomes T4 to T6 was almost 100%. However, T2 (percentage of left T2 block: 64.6%; percentage of right T2 block: 42.5%) and T3 (percentage of left T3 block: 88.5%; percentage of right T3 block: 87.6%) had a lower percentage of success. A few patients had blocked dermatomes at T1 or T7 (percentage of left T1 block: 7.08%; percentage of right T1 block: 2.65%; percentage of left T7 block: 6.19%; percentage of right T7 block: 10.6%). The mean effective duration of the deep PIP block was 17 h.ConclusionBilateral deep PIP blocks can produce a widespread cutaneous sensory blockade with variable dermatomal distribution in the mid-sternum for a considerable effective duration.Trial RegistrationThis study was registered in the Chinese Clinical Trial Registry (ChiCTR2100047755).

Immunohistological study of the density and distribution of human penile neural tissue: gradient hypothesis.

Immunohistological patterns of density and distribution of neural tissue in the human penis, including the prepuce, are not fully characterized, and effects of circumcision (partial or total removal of the penile prepuce) on penile sexual sensation are controversial. This study analyzed extra- and intracavernosal innervation patterns on the main penile axes using formalin-fixed, paraffin-embedded human adult and fetal penile tissues, single- and double-staining immunohistochemistry and a variety of neural and non-neural markers, with a special emphasis on the prepuce and potential sexual effects of circumcision. Immunohistochemical profiles of neural structures were determined and the most detailed immunohistological characterizations to date of preputial nerve supply are provided. The penile prepuce has a highly organized, dense, afferent innervation pattern that is manifest early in fetal development. Autonomically, it receives noradrenergic sympathetic and nitrergic parasympathetic innervation. Cholinergic nerves are also present. We observed cutaneous and subcutaneous neural density distribution biases across our specimens towards the ventral prepuce, including a region corresponding in the adult anatomical position (penis erect) to the distal third of the ventral penile aspect. We also describe a concept of innervation gradients across the longitudinal and transverse penile axes. Results are discussed in relation to the specialized literature. An argument is made that neuroanatomic substrates underlying unusual permanent penile sensory disturbances post-circumcision arerelated to heightened neural levels in the distal third of the ventral penile aspect, which could potentially be compromised by deep incisions during circumcision.

Hematoma Formation After Hip Corticosteroid Injection in a Patient with Chronic Myelomonocytic Leukemia: A Case Report.

We present a 70-year-old woman with history of chronic myelomonocytic leukemia with a right thigh hematoma after a corticosteroid hip injection. Aspiration of the hematoma was attempted, but she developed a significant transfusion requirement with paresthesias in a lateral femoral cutaneous nerve distribution, prompting transfer. Imaging demonstrated no active extravasation, and she was managed conservatively. At 8-month follow-up, she had a persistent consolidated hematoma on the right side, and she subsequently died of complications of her cancer. This case demonstrates an unusual complication from a common nonoperative modality, as well as important coagulopathies that must be considered in patients with leukemia.

Can skin histology be a useful tool for ancestry assessment in forensic settings? Ancestry assessment based on melanin pigment

Building the biological profile of a deceased person represents a pivotal step in order to achieve the victim’s identification. Specifically with regard to ancestry, the melanin distribution pattern in the dermal-epidermal layers has been poorly explored in the forensic field as a potential useful tool. In particular, nothing has been reported about the reliability of such method in bodies in active decay or in advanced state of decomposition. In this study fragments of skin sampled from bodies of known ancestry, both in good and in poor states of preservation, were subjected to histological analysis. We selected 15 subjects, which were divided into three groups: group A (5 white Europeans), group B (5 black Africans) and group C (5 Orientals). A double skin sample was performed on all the bodies, one from the abdomen and the other one from the right forearm. After histological processing and staining with hematoxylin and eosin (H&E) and Masson-Hamperl trichrome technique, the cutaneous melanin distribution pattern was assessed using a semi-quantitative score. The melanin distribution patterns observed both in fresh and in putrefied cadaveric skin were found to be in all cases consistent with the victims’ known ancestry. Moreover no differences were observed between abdominal and forearm skin samples and all the histological findings highlighted by H&E were confirmed by the Masson-Hamperl trichrome staining. We demonstrated that the histological analysis aimed at assessing the melanin distribution pattern may be a valuable useful tool in the assessment of ancestry.

Diagnosis and Treatment of Cervical Spondylotic Radiculopathy Using Selective Nerve Root Block (SNRB): Where are We Now?

Cervical spondylotic radiculopathy (CSR) is one of the most common degenerative diseases of the spine that is commonly treated with surgery. The primary goal of surgery is to relieve symptoms through decompression or relieving pressure on compressed cervical nerves. Nevertheless, cutaneous pain distribution is not always predictable, making accurate diagnosis challenging and increasing the likelihood of inadequate surgical outcomes. With the widespread application of minimally invasive surgical techniques, the requirement for precise preoperative localization of the affected segments has become critical, especially when treating patients with multi-segmental CSR. Recently, the preoperative use of a selective nerve root block (SNRB) to localize the specific nerve roots involved in CSR has increased. However, few reviews discuss the currently used block approaches, risk factors, and other aspects of concern voiced by surgeons carrying out SNRB. This review summarized the main cervical SNRB approaches currently used clinically and the relevant technical details. Methods that can be used to decrease risk during cervical SNRB procedures, including choice of steroids, vessel avoidance, guidance with radiographs or ultra-sound, contrast agent usage, and other concerns, also are discussed. We concluded that a comprehensive understanding of the current techniques used for cervical SNRB would allow surgeons to perform cervical SNRB more safely.

Effect of mRNA Delivery Modality and Formulation on Cutaneous mRNA Distribution and Downstream eGFP Expression.

In vitro transcribed messenger ribonucleic acid (mRNA) constitutes an emerging therapeutic class with several clinical applications. This study presents a systematic comparison of different technologies—intradermal injection, microneedle injection, jet injection, and fractional laser ablation—for the topical cutaneous delivery of mRNA. Delivery of Cy5 labeled mRNA and non-labeled enhanced green fluorescent protein (eGFP) expressing mRNA was investigated in a viable ex vivo porcine skin model and monitored for 48 h. Forty 10 µm-thick horizontal sections were prepared from each skin sample and Cy5 labeled mRNA or eGFP expression visualized as a function of depth by confocal laser scanning microscopy and immunohistochemistry. A pixel-based method was used to create a semi-quantitative biodistribution profile. Different spatial distributions of Cy5 labeled mRNA and eGFP expression were observed, depending on the delivery modality; localization of eGFP expression pointed to the cells responsible. Delivery efficiencies and knowledge of delivery sites can facilitate development of efficient, targeted mRNA-based therapeutics.

Transferosomes: Novel Delivery System for Increasing The skin Permeation of Drugs

The use of vesicular carriers has recently emerged as a feasible method for minimizing the obstructive effects of the stratum corneum. The use of transferosomes, also known as ultradeformable lipids or elastic liposomes, in cutaneous distribution has attracted a lot of attention. They are generally used to treat a range of chronic skin disorders, but they may also be utilised to guarantee patient compliance via concentrated and controlled distribution. These self-assembled nanocarriers may adjust their pore size to that of the stratum corneum. Edge activators (specific surfactants), phospholipids, buffering agents, and other substances are found in transferosomes. Due to the activity of edge activators and their concentration, constructed vesicles have the requisite flexibility. Drug solubilization, efficient drug loading, and therapeutic molecule permeability may all be improved by elastic liposomes. As nanocarriers, transferosomes have improved reflectivity and provide a diverse platform for effective transdermal applications. These one-of-a-kind nanocarriers also have exceptional elasticity and penetration. These systems are thought to be safe, with effective delivery routes for pharmaceutically and aesthetically active chemical moieties. Recent scientific results highlighting the need for ultradeformable liposomes have revealed that medication penetration is constant and effective. This book contains up-to-date research as well as in-depth updates on crucial issues and the usage of future transferosomes with enhanced bioavailability profiles.

Comparative Analysis of Cutaneous Fungi in Atopic Dermatitis Patients and Healthy Individuals.

BackgroundAtopic dermatitis (AD) is a chronic relapsing inflammatory skin disease triggered by diverse factors. Microbes are one of the crucial risk factors for AD development or exacerbation. However, the effect of a fungal burden on AD has been overlooked compared to bacteria.ObjectiveThis study aimed to comparatively analyze cutaneous fungal distribution between AD patients and healthy individuals by polymerase chain reaction (PCR)-based analysis.MethodsSkin samples of AD outpatients and healthy individuals collected at the Chung-Ang University were analyzed. Representative AD-associated fungal genera, Candida, dermatophytes, and Malassezia , were analyzed using specific primer and amplification methods. Amplicons were sequenced, and the fungal distribution of both groups were compared.ResultsTotally, 211 patients and 23 healthy individuals were studied. Of the 211 patients, 10.90% (23/211) had Candida species, whereas 0% (0/23) healthy individuals showed its presence. The most frequently detected species in patients was Candida albicans (5.21%) followed by Candida parapsilosis (3.79%). For dermatophytes, 1.42% (3/211) of patients showed positive results, whereas 0% (0/23) healthy individuals showed positive results. Malassezia species were identified in 20.85% (44/211) and 8.70% (2/23) in patients and healthy individuals, respectively. Malassezia restricta was the most frequently identified species in the AD patient group, and the only species found in the healthy control group.ConclusionThe distribution of Candida spp., dermatophytes, and Malassezia spp. are altered with AD development.

Dermoscopy of Cutaneous and Palmar Lichen Nitidus

Lichen nitidus (LN) is a relatively uncommon chronic cutaneous lichenoid group of disease characterized by tiny quintessentially discrete hypopigmented to skin coloured papules commonly seen over dorsa of hands/forearms, lower abdomen, penis, and buttocks. The cutaneous manifestation of a disease on palms/soles varies from their presentation on body, which makes it difficult to diagnose at times. A 23-year-old healthy female presented with mildly itchy lesions on bilateral wrist, fingers, elbows, peri-umbilical area, and left palm since 6 months. On dermoscopy, we could appreciate the classical described findings of LN which were confirmed on histopathology. LN has a characteristic dermoscopic features, which come to rescue for diagnosis and also avoid a biopsy. We describe a rare presentation of palmar LN with two different morphologies along with classical cutaneous distribution of LN and their dermoscopy.