Hypopigmented Patches Research Articles

A New Case of Mitochondrial RNA Helicase SUPV3L1-Associated Neurodegenerative Disease: Ataxia, Spasticity, Optic Atrophy, and Skin Hypopigmentation (ASOASH)

Background: The SUPV3L1 gene encodes ATP-dependent RNA helicase SUPV3L1, which is a part of the mitochondrial degradosome complex or SUV3. SUPV3L1 unwinds secondary structures of mitochondrial RNA (mtRNA) and facilitates the degradation of mtRNA molecules. A nonsense homozygous variant in the SUPV3L1 gene was recently associated with mitochondrial disease. Our study presents the second documented case of SUPV3L1 pathology in humans. Methods: Whole-genome sequencing was performed on the NovaSeq 6000 platform using pair-end reading. Data analysis was performed with an in-house developed pipeline. Results: The 17-year-old female patient exhibited a diverse array of symptoms, including ataxia, spastic paraparesis, cognitive deficit, optic atrophy, and horizontal gaze-evoked nystagmus. Early onset of symptoms, such as ataxic gait and nystagmus, was noted, with subsequent progression of neurological manifestations. At the time of the observation, the proband had extensive regions of hypopigmented skin patches on the body and extremities, which have progressed over time. Whole-genome sequencing revealed compound heterozygous variants in the SUPV3L1 gene: c.272-2A>G and c.1924A>C; p.(Ser642Arg). RNA analysis demonstrated splicing changes attributable to the c.272-2A>G variant. ELISA assay showed increased Complex I content in the patient’s fibroblasts. This case underscores the phenotypic diversity associated with SUPV3L1 mutations, emphasizing the importance of considering mitochondrial RNA helicase dysfunction in the differential diagnosis of neurodegenerative disorders. Further elucidation of the molecular mechanisms underlying SUPV3L1-associated pathology may provide valuable insights into targeted therapeutic interventions.

An Unusual Skin Finding in a Rare Case of Goltz Syndrome

Abstract Introduction/Objective Goltz Syndrome (Focal Dermal Hypoplasia) is a rare X linked dominant genetic disorder with various dermatologic, musculoskeletal and neurologic manifestations, secondary to a mutation in the PORCN gene. Skin findings include telangiectasias, raspberry-like papillomas (angiofibroma like lesions), nodular fat herniation, xerosis and photosensitivity. Lesions are bilateral, and asymmetrically distribututed along the lines of Blasco. The adipocytic lesions can be diagnosed via a skin biopsy showing adipose tissue in the superficial epidermis and dermis or via molecular techniques showing a mutation in the PORCN gene. Here we report a case of Goltz Syndrome with unique dermal findings. Methods/Case Report A male infant presented at birth with mild diffuse xerosis, large hypopigmented and depigmented atrophic patches and plaques and multiple pink yellow red exophyitic soft papules distributed asymetrically across the body along the lines of Blascho. Additionally the patient had clinodactly, widely spaced nipples, extra pads of fat in the toes and philtrum and fingernails with longitudal ridges and lateral nail plate deviation. A diagnosis of Goltz syndrome was made via molecular analysis that showed mosiacism at C.502G>A (p.Gly168Arg) in the PORCN gene. The patient had a very superficial 2-3 mm erosion at the intersection between the scrotum and perineum. At 18 months, this had grown to finger like projections and eventually grew into multiple tan red exophytic warty papillomatous telangactatic like lesions measuring 3.0 x 0.8 cm that were painful and bled easily. A biopsy of this lesion showed focal mild epidermal hyperplasia and elongation of the rete ridges with wide spread diffuse vascular proliferation with multiple ectactic vessels along with mild dermal and perivascular inflammatory infiltrates. Also noted was infiltration of mature adipose tissue in the superficial epidermis and dermis. We preformed elastin and trichrome stains to identify if this lesion was reactive in nature or de novo. Our results showed retained elastin staining with a negative trichrome eluding to a denovo process. Additionally GLUT1 was negative, ruling out an infantile hemangioma. The above findings in this lesion do not represent any previously described dermatologic entity. Results (if a Case Study enter NA) NA Conclusion This is a rare and unique dermatologic finding of a case of Goltz sydrome, which itself is a rare disorder. In our literature review, this is the only case of Goltz Syndrome thusfar to have presented with this unique skin lesion.

Hypopigmented atrophic patch on face: unusual lesion of BTHD

Hypopigmented atrophic patch on face: unusual lesion of BTHD

Case of Hypopigmented Mycosis Fungoides: Clinical and Pathological Discrimination from Mimicking Conditions

Background: Hypopigmented mycosis fungoides (HMF) is an uncommon variant of mycosis fungoides (MF), a cutaneous T-cell lymphoma. It presents a diagnostic challenge due to its clinical resemblance to various benign dermatological conditions. This case report highlights the importance of a comprehensive approach to diagnosis, incorporating clinical, histopathological, and immunohistochemical findings. Case presentation: A 48-year-old Indonesian woman presented with a one-year history of progressive, asymptomatic hypopigmented patches on her extremities. Initially misdiagnosed as progressive macular hypomelanosis, the patient's condition did not improve with topical treatments. Clinical examination revealed multiple hypopigmented patches and macules on both extremities, with some lesions exhibiting fine scales. Histopathological examination demonstrated atypical lymphocytes with epidermotropism and Pautrier's microabscesses. Immunohistochemical staining confirmed the presence of CD3+ T-cells, leading to the diagnosis of HMF. Conclusion: HMF can mimic various dermatological conditions, making diagnosis challenging. A thorough clinical assessment, coupled with histopathological and immunohistochemical evaluation, is crucial for accurate diagnosis and appropriate management. This case underscores the importance of considering HMF in the differential diagnosis of hypopigmented skin lesions, particularly in individuals with persistent or atypical presentations. Early recognition and intervention are essential for optimizing patient outcomes.

Bilateral hypomelanosis of Ito: Report of two cases

Hypomelanosis of Ito, also known as incontinentia pigmenti achromians of Ito, is a rare neuroectodermal disorder often associated with mental retardation and epilepsy. Here we report two patients with bilateral hypopigmented streaks and patches.

CLINICAL POTENCY OF UNANI REGIMEN IN MANAGEMENT OF VITILIGO: A CASE REPORT

vitiligo is a common skin disorder in which there is a focal failure of pigmentation due to destruction of melanocytes that is thought to be mediated by immunological mechanism.10-30% of patients have history in other relatives. A 5 years old male child was brought to outpatient department of National research institute of Unani medicine for skin disorder Hyderabad, with presenting complaints of hypopigmented patches covering right cheek and periorbital area for from past 3 years, he was treated with topical Unani formulation UNIM001 for the period of 1 year from 0ctober 2020 to October 2021. All the routine blood and urine investigations were done before and after treatment. After 1 year of treatment patient started showing significant clinical results with re-pigmentation of affected area. Therefore, this case study proved successful use of Unani formulation in management of vitiligo.

Spectrum of cutaneous lesions in a cohort of patients with neurofibromatosis type 2.

Neurofibromatosis type 2 (NF2) is a rare autosomal dominant syndrome with a predisposition to the development of central nervous system tumors, ophthalmic manifestations, and dermatological lesions. The latter are present in 70-95% of patients and can precede the evolution of other tumors. However, they are not included in the diagnostic criteria and are frequently undervalued during follow-up. An observational cross-sectional study characterizing cutaneous lesions in a cohort of NF2 patients was carried out. Dermatological examinations were performed, and lesions were classified into neural cutaneous tumors (superficial, SNCT, and deep, DNCT), hyperpigmented patches (HyperP), and hypopigmented patches (HypoP). The Dermatology Life Quality Index (DLQI) and EQ-5D questionnaires were applied to evaluate the impact on quality of life. Nineteen patients with a mean age of 36 years were included. Sixteen (84%) patients had cutaneous lesions, mostly developed 10 or more years before the diagnosis. SNCT, DNCT, and HyperP showed similar frequencies (58%). HypoP were observed in only one patient. HyperP developed, on average, earlier than NCT (9.6 vs. 16.5 SNCT, 17.0 DNCT; years). The excised lesions had different histological patterns, including neurofibromas, schwannomas, and a hybrid tumor. Most patients reported a low impact of cutaneous manifestations on the quality of life (DLQI 0 or 1). Cutaneous lesions are frequent in NF2 and may precede the diagnosis by several years. Their identification is important to establish the diagnosis earlier and potentially reduce morbidity and mortality.

Multiple unilateral angiofibromas with a hypopigmented patch as a possible presentation of tuberous sclerosis complex (TSC)

Tuberous sclerosis complex (TSC), known as Bourneville’s disease or epiloia, is an autosomal dominant inherited disorder that may affect numerous organ systems. TSC has many forms of clinical presentation. The cutaneous features of TSC include facial angiofibromas, shagreen patches, ash leaf hypopigmented macules, periungual fibromas, forehead fibrous plaques, confetti hypopigmentation, and poliosis. Rarely, the angiofibromas in TSC have a segmental distribution. It has been suggested that the segmental expression of tuberous sclerosis may result from a postzygotic mutation. The aim of this concise communication was to describe a patient with unilateral angiofibromas associated with a hypopigmented patch. No other features of TSC were present. We think this could have been a rare presentation of TSC. Key words: Angiofibroma, Hypopigmented patch, Loss of heterozygosity (LOH), Tuberous sclerosis complex (TSC)

Characteristics, clinical manifestations and management of leprosy in KwaZulu-Natal, South Africa: A 20-year retrospective study.

Although leprosy, a neglected tropical disease, has been eliminated (<1 case per 10 000 population) in South Africa (SA) since 1926, according to the World Health Organization, new cases continue to be reported. The management of leprosy poses several challenges, including patient adherence, education and insufficient training of healthcare practitioners. To describe the biographical profile, clinical manifestations and treatment outcomes in patients with leprosy in KwaZulu-Natal Province. This retrospective study aimed to analyse the clinical data of leprosy patients in SA from 2002 to 2022. Data collected included patient demographics, comorbidities, cutaneous and neurological manifestations of leprosy, complications, treatment and adverse reactions. Descriptive statistics were used to summarise the data. The study analysed the clinical data of 194 leprosy patients from 2002 to 2022. The majority of patients were male and middle aged, with a disproportionate representation of black South Africans. Regarding socioeconomic status, 80% were unemployed and 40% were social grant recipients. Most cases were clustered in urban centres and diagnosed at secondary care facilities, with 15% being HIV positive. The majority of patients (90%) were classified as having multibacillary leprosy. Common symptoms included upper respiratory tract involvement, hair loss and painful nerves, with the face and limbs being most frequently affected. Cutaneous morphology predominantly included plaques and hypopigmented patches, while neurological signs included ulnar nerve tenderness, muscle weakness and sensory deficits. Debilitating neurological complications were found in one-fifth of patients. Despite initiation of multidrug therapy in most patients, a significant proportion (27.3%) did not complete the full course of treatment, and treatment reactions were noted in 33.5% of patients. These findings emphasise the urgent need for enhanced patient and healthcare worker education, particularly in primary healthcare settings, to improve adherence to treatment, advocate for prophylactic measures and prevent new cases. Achieving leprosy-free status in SA requires the collaboration of many role-players to address these challenges and improve healthcare practices.

An Uncommon Tumor in Stomach in A Young Girl

Introduction: Gastrointestinal stromal tumours (GIST) are rare tumours of the Gastrointestinal tract. They are the most common mesenchymal tumour of the gastrointestinal tract. All GISTs are malignant.Among all Gastrointestinal tract malignancies GIST Comprises 0.1- 3%. The most common location is stomach. They are usually found in elderly and they are not common in pediatric age group. Case Report: A girl aged 16 years presented with the history of melena, hematemesis with dyspepsia. Physical examination revealed mild tenderness over right hypochondrium. On examination, multiple hypopigmented patches noted over both upper limbs. CECT abdomen showed a well-defined heterogeneously enhancing predominantly exophytic necrotic soft tissue SOL over the greater curvature of the proximal body of the stomach with intraluminal extension. Her complete blood count and routine biochemical tests were within normal limits. Endoscopic biopsy from the polyploid lesion along the greater curvature show fragmented bits of gastric mucosa involved by a tumour composed of sheets and fascicles of round to oval cells having eosinophilic to vacuolated cytoplasm and a few spindle cells. Histopathological examination revealed a mesenchymal neoplasm favouring GIST.. Then wide local excision of the stomach was done and sent for histopathological examination. The stomach mass was diagnosed as Epithelioid GIST which was confirmed by immunohistochemistry. Conclusion: GISTs are most common mesenchymal tumours of GI tract. They are malignant in nature. The primary treatment of choice is surgery followed by chemotherapy.

P16 Hypopigmented Mycosis Fungoides in a Caucasian child

Abstract We report a case of hypopigmented MF in an 8-year-old Caucasian boy whose skin had been managed as pityriasis alba for a number of years. On initial presentation to the emergency department, multiple non-itchy scattered hypopigmented macules were incidentally noted on the lower abdomen, groin, lateral flanks and axillae. Physical examination revealed widespread hypopigmented patches. Differential diagnoses included pityriasis alba or post inflammatory hypopigmentation secondary to atopic dermatitis. He was initially managed with mild to moderate corticosteroids and emollients, but continued to develop multiple atypical asymmetrical macules, particularly on the lower abdomen and groin. Although the skin was responsive to anti-inflammatory treatment, given the progression, a skin biopsy was requested. A lesional punch biopsy from the abdomen revealed focal lymphocyte exocytosis and interface change at the epidermis. Given the subtle findings the case was discussed at our histopathology MDT meeting. Further specialist review of the histopathology showed clinicopathological correlation in keeping with CD8+ mycosis fungoides (hypopigmented variant). He is currently managed with regular potent topical steroids, 0.1% topical tacrolimus. TL01 phototherapy has been suggested. Juvenile onset MF constitutes hypopigmented, poikilodermatosis, pityriasis lichenoides-like, folliculotropic, and pigmented purpura- like presentations1. Generally there is no disease progression beyond stage 1A or 1B disease2. Hypopigmented MF is well described in black and Asian skin types but it is also important to appreciate that multiple reoccurring atypical hypopigmented patches in Caucasian skin may also be a variant of hypopigmented MF.

P15 A Case of Juvenile Dermatomyositis in a 15-year old African-descent Girl

Abstract A 15-year-old female with skin of colour (SOC), was diagnosed with Juvenile dermatomyositis (JDM) following a presentation with muscle weakness, swallowing difficulties and rash. Investigations showed CK&amp;gt;1300, positive Mi-2 alpha, beta antibodies and bilateral myositis on MRI pelvis. Her skin features commenced 2 months prior to her rheumatological presentation. They included erythematous pruritic patches on the limbs, generalised hyperpigmentation of the face and trunk, hyperpigmentation of palmar creases and nail folds, flagellate hyperpigmentation of the hands &amp; arms, and hypopigmented macules with follicular sparing across the face. She also presented skin thickening over the interphalangeal joints and nail fold capillary dilatation and infarctions. Skin biopsy showed interface dermatitis, in keeping with dermatomyositis. She was managed with weaning prednisolone, methotrexate, topical tacrolimus and sunscreen. JDM is a small-vessel autoimmune vasculopathy leading to muscle inflammation and skin changes. Unlike adult-onset disease, JDM is not associated with malignancy. The typically described violaceous skin features of JDM including photosensitive rash periorbitally, and over the knees and knuckles (Gottron’s sign) may be hyperpigmented rather than erythematous in skin of colour. Additional skin features described in SOC are generalised hyperpigmentation and pigmentation in skin creases. A flagellate dermatitis is uncommon, but recognised in association with Mi-2 antibodies in JDM. TIF1 antibodies have been reported in association with hypopigmented patches which may mimic vitiligo postulated possibly secondary to interface inflammation perhaps leading to dyspigmnentation. Notably our patient was negative for TIF1. This presentation highlights some of the less commonly described skin features of dyspigmentation in JDM in SOC.

Diagnostic findings in Various Cutaneous Hypopigmented Disorders: A Scoping Review

Introduction: Medical conditions can cause the skin to become hypopigmented or depigmented, mainly due to decreased production of melanin. Hypomelanosis is mainly benign and rarely malignant. Depigmentation refers to a complete lack of melanin, with the most common cause being vitiligo. Differentiating between these conditions can be difficult. Diagnosis of the condition is primarily based on the patient’s detailed history, clinical signs and symptoms, accurate evaluation, and dermoscopy. Repigmentation can occur following early diagnosis and appropriate management. Aim: To highlight diagnostic findings of various cutaneous hypopigmented macular lesions and patches. Materials and Methods: PubMed and Google Scholar databases were searched using a mix of terms, including “cutaneous disorders”, “dermoscopy”, “skin biopsy”, and “hypopigmented disorders” for this scoping review, which followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines. Boolean operators “AND” and “OR” were used between the keywords. The inclusion criteria consisted of articles with full text availability, articles describing various cutaneous disorders with characteristic morphology, diagnosis, types and subtypes, conditions associated with systemic diseases, histological examination findings, and prognosis of the condition, peer-reviewed papers with a comprehensive diagnosis of cutaneous hypopigmented diseases, histological biopsies. Randomised Controlled Trials (RCTs), review articles, case reports, and articles in the English language were included in this review. Results: Based on the selection criteria, a total of 12 studies were included in the review, describing various cutaneous disorders with characteristic morphology, diagnosis, types and subtypes, conditions associated with systemic diseases, histological examination findings, and prognosis of the condition. Conclusion: Knowledge regarding various outcomes from the studies related to diagnostic findings in various cutaneous hypopigmented disorders is essential for dermatologists for awareness, appropriate examination, and adequate treatment.

A clinical evaluation of Bakuchi Hartal Lepa and Amalaki Khadir Kashayam in the management of Switra (Vitiligo) - A Pilot Study

Vitiligo is usually patchy depigmentary disorder, due to reduced or absent melanocytes. Most paediatric cases present after first decade of life with well-demarcated milky-white or hypopigmented patches. In Ayurveda vitiligo is known as Shwitra and described under Kushtha. The Tridoshas (Vata, Pitta, and Kapha) and Dhatus (such as Rasa, Rakta, Mamsa, and Meda) vitiations are what give rise to this variety of Kushta in the classical Ayurvedic texts. The disease is significant primarily because it raises cosmetic concerns, which ultimately cause the sufferer to experience several socialised psychological stigmas. Ayurveda provide effective and safe treatment protocol for vitiligo. In the present Pilot study Amalaki- Khadir Kashaya with Bakuchi (Prakshep Dravya) is used as internal medication and Bakuchi, Hartala Lepa with Gomutra as external therapy in 8 patients. The Gunas of these drugs are opposite to Doshas responsible for Switra. This study shows significant decrease in number of hypopigmented patch as well as improvement in the psychological status of the patient.

Pityriasis Versicolor-A Narrative Review on the Diagnosis and Management.

This narrative review presents a comprehensive overview of the diagnosis and management of pityriasis versicolor (PV), a common superficial fungal infection caused by the yeast Malassezia. PV is characterised by scaly hypopigmented or hyperpigmented patches, primarily affecting the upper trunk, neck, and upper arms. Regarding commensal interactions, Malassezia utilises nutrient sources without affecting the human host. In cases of pathogenicity, Malassezia can directly harm the host via virulence factors or toxins, or indirectly by triggering damaging host responses. The diagnosis typically relies on recognising characteristic clinical features. Due to the wide variability in its clinical presentation, recognising the differential diagnosis is critical. In this paper, we discuss the clinical differentials, with their dermatoscopic presentation, but also describe a range of helpful diagnostic techniques (microscopy, conventional and ultraviolet-induced fluorescence dermatoscopy, and confocal microscopy). Topical therapies are the primary treatment for PV, encompassing non-specific antifungal agents like sulphur with salicylic acid, selenium sulphide 2.5%, and zinc pyrithione. Additionally, specific topical antifungal medications with either fungicidal or fungistatic properties may also be incorporated into the topical treatment regimen, such as imidazoles, allylamines, and ciclopirox olamine. Systemic therapies might occasionally be used. Patient education and the promotion of good personal hygiene are pivotal to reduce the risk of recurrence. In recurrent cases, particularly during warmer and more humid periods, prolonged prophylaxis with topical agents should be considered.

Vitiligo: Portrait of a woman with hypopigmented patches.

Vitiligo: Portrait of a woman with hypopigmented patches.

Serum interleukin-6 and high sensitivity C-reactive protein levels and their correlation with the vitiligo disease activity and extent: A cross-sectional study of 58 patients.

Vitiligo is an acquired depigmenting disorder due to the destructive loss of melanocytes, clinically presenting as hypopigmented or depigmented macules and/or patches. Many theories have been proposed to explain its etiopathogenesis among which cell-mediated immunity is one of the crucial links. Estimation of vitiligo activity and extent in a patient is important in tailoring an optimal treatment regimen. Interleukin-6 (IL-6) and high-sensitivity C-reactive protein (HsCRP) are sensitive indicators for systemic inflammation and are found to be relevant in determining vitiligo disease activity. This study was conducted to estimate serum levels of IL-6 and HsCRP in vitiligo patients and to correlate them with the disease activity and extent in order to assess if these serum markers serve as objective indicators of vitiligo disease activity. This was a hospital-based cross-sectional study of 58 vitiligo patients diagnosed clinically irrespective of age, gender, and any ongoing or past treatment. Disease activity and extent were calculated using the vitiligo disease activity (VIDA) score and vitiligo area severity index (VASI), respectively. Serum levels of IL-6 and HsCRP were obtained and their correlation with VIDA and VASI values were statistically analyzed. A weak negative statistically insignificant correlation was found between IL-6 and VIDA (P = 0.092). No correlation was found between VIDA and HsCRP (P = 0.998). A weak positive, statistically insignificant correlation was found between VASI and IL-6 as well as between VASI and HsCRP (P = 0.175 and P = 0.238, respectively). Although statistically insignificant, the patients who were not on immunosuppressive therapy showed higher mean values of IL-6 and HsCRP compared to those who were on immunosuppressive therapy. In contrast to the findings of previous studies, our study found a weak negative correlation between VIDA and IL-6 levels possibly attributable to the difference between the mean levels of IL-6 among the subgroups of patients who were, and were not on immunosuppressive therapy. The VIDA score and HsCRP levels did not show any statistical correlation. However, patients who were not on immunosuppressive therapy showed a higher albeit statistically insignificant mean value of HsCRP. Our observations suggest that any ongoing and/or treatment in the recent past, especially immunosuppressive therapy, and any co-morbidities should be essentially considered while investigating for sensitive serum markers of inflammation as determinants of vitiligo disease activity.

External Jugular Veinous Thrombosis: A Rare Presentation of Hansen’s Disease

Veinous thrombosis is a rare manifestation of leprosy (Hansen’s disease). In this case report, we bring to notice this extremely rare presentation and challenges faced during management. A 26-year-old young healthy individual presented with painless cord-like swellings on both sides of the neck for 1 month. This was evaluated to be external jugular vein (EJV) thrombosis on ultrasonography Doppler. Trying to evaluate the cause of the thrombosis, there was no specific etiology found. On further detailed evaluation, it was found that he had hypopigmented skin patches. This led to the diagnosis of borderline tuberculoid leprosy downgrading to borderline lepromatous in type 1 lepra reaction. He responded to rifampicin, clofazimine, and dapsone with progressive resolution of skin lesions. Simultaneous treatment with apixaban caused complete resolution of EJV thrombosis. Further evaluation revealed heterozygous methylenetetrahydrofolate reductase mutation and beta-2-glycoprotein immunoglobulin M positivity. An extensive literature review suggested that intimal damage caused by lepra bacilli can lead to veinous thrombosis in Hansen’s disease. However, the interplay of genetic procoagulant predispositions in phenotypic presentation is yet to be determined.

CPC09 New-onset agminated Spitz naevi following hypopigmented pityriasis lichenoides chronica

Abstract A 9-year-old girl presented to dermatology with erythematous scaly patches affecting her legs and arms, and hypo­pigmented patches affecting the trunk. She was otherwise fit and well, with no preceding illness or new medications. Treatment with mometasone 0.1% and an emollient was unsuccessful. Two years later, she had continued to develop new hypopigmented patches, as well as dark clustered naevi on the trunk. An incisional biopsy was taken from a hypopigmented patch of the right abdomen and one of the new naevi from the right hip. Incisional biopsy of the hypo­pigmented patch showed scattered necrotic keratinocytes in the epidermis with mild hydropic degeneration of basal cells and a mild superficial and perivascular lymphohistiocytic infiltrate in the dermis, consistent with pityriasis lichenoides chronica (PLC). Incisional biopsy of an eruptive naevus showed a junctional proliferation of melanocytes with overlying epidermal hyperplasia and hyperkeratosis and transepidermal elimination of melanin. Nests of epithelioid melanocytes were present at the rete tips, with no pagetoid spread and no atypia, consistent with an eruptive Spitz naevus. PLC is a benign lymphoproliferative disorder, typically presenting with erythematous scaly papules that relapse and remit. However, cases of PLC presenting with hypopigmentation alone have also been reported, as in this case, which can be part of a postinflammatory dyspigmentation or active disease (Elbendary A, Abdel-Halim MR, Youssef R et al. Hypopigmented lesions in pityriasis lichenoides chronica patients: are they only post-inflammatory hypopigmentation? Aust J Dermatol 2021; 63:68–73). The clustered pattern of Spitz naevi in this patient is termed agminated Spitz naevus. Eruptive disseminated and agminated Spitz naevi are much rarer than the solitary presentation. Triggers of eruptive Spitz naevi include pregnancy, blistering disorders and topical tacrolimus, and in one case following pityriasis lichenoides et varioliformis acuta (Mazzurco J, Menssen K, Schapiro B et al. Eruptive disseminated Spitz nevi in a 26-year-old African-American woman. Int J Dermatol 2012; 51:1270–1), while agminated Spitz naevi are reported to occur after radiotherapy and sunburn, and to arise in naevus spilus or congenitally hypo- or hyperpigmented patches. No cases of malignancy in agminated or eruptive disseminated Spitz naevi have been reported. In this case, the new onset of agminated Spitz naevi may have been triggered by the inflammatory process of PLC. As far as we can ascertain, there have not been previous cases of this published in the literature. Our patient’s hypopigmented areas have now started to self-resolve and we have planned for ongoing monitoring of the agminated Spitz naevi.

Usage of Dermoscopy as an Effective Diagnostic Tool in Pityriasis Alba: A Prospective Observational Study Among Children in a Suburban Hospital in South India.

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. To evaluate the effectiveness of dermoscopy by correlating the clinical features of Pityriasis alba with dermoscopic images. Hypopigmented patches in 16 patients that were clinically diagnosed as Pityriasis alba were examined with a DermLiteDL200 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. 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 theseas 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. 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.