Melanocyte senescence predominantly occurs in sun-exposed skin of elderly individuals and contributes to skin aging and hypopigmentary disorders. To identify early molecular events preceding melanocyte senescence and to evaluate a therapeutic strategy for preventing melanocyte aging. Single-cell RNA sequencing and time-course bulk transcriptome analyses were performed on UVB-induced senescent melanocytes to identify senescence-associated pathways. Autophagy impairment was validated using gene and protein assays, immunohistochemistry, and ATG7 knockdown or overexpression. The protective effects of metformin on ATG7-dependent autophagy and redox balance were assessed in senescent melanocytes. Autophagy dysregulation was identified as an early event preceding glycolytic reprogramming during UV-induced melanocyte senescence. ATG7 downregulation emerged as the earliest molecular alteration and was consistently observed in both senescent melanocytes and idiopathic guttate hypomelanosis skin. Metformin treatment restored autophagic activity, including ATG7 upregulation, and mitigated oxidative stress, thereby delaying melanocyte senescence. Early autophagy dysfunction represents a key initiating event in melanocyte senescence. Autophagy preservation particularly through ATG7 maintenance offers a promising early intervention strategy to prevent melanocyte aging and related hypopigmentary disorders.

Background: Hypopigmented patches encompass a variety of disorders that can closely be mistaken for each other to the untrained eye in certain clinical scenarios. Aims: This study aims to identify and describe the characteristic dermoscopic features of common disorders of hypopigmentation along with recording the frequency of each finding while corelating them with previous studies. Methods: A total of 100 cases presenting to the Dermatology Department with hypopigmented patches, of all age groups, were enrolled, and detailed history and clinical examination were done followed by dermoscopic examination using a hand-held dermoscope (Dermlite DL4, USA) application (10× magnification). Results: A total of 100 cases were taken including the following diseases: Pityriasis alba (26 cases), Achromic Pityriasis versicolor (25 cases), Vitiligo (17 cases), Idiopathic guttate hypomelanosis (13 cases), Lichen sclerosus et atrophicus (10 cases), and Nevus depigmentosus (9 cases) in decreasing order of frequency. Among Pityriasis alba cases, fine scales focally distributed with no specific accentuation along skin furrows in 80.7% cases were a distinctive feature. In Achromic Pityriasis versicolor, majority (92%) showed fine scales accentuated along skin cleavage lines as a characteristic sign. Among vitiligo patients, trichrome pattern (33.3%), satellite lesions (26.6%), and comet tail appearance (20%) were among specific patterns observed. In Idiopathic guttate hypomelanosis, Amoeboid pattern (63.6%) was the most common pattern observed. Lichen sclerosus et atrophicus demonstrated the most consistent finding as Chrysalis strands visible as white shiny refractile structures under polarized light in 90% cases. In Nevus depigmentosus, the presence of serrated borders with feathery margins in all cases was the most typical feature with subtle uniform reticular pigment network scattered within the lesion in 88.8% cases. Conclusion: This study consolidated the eminence of these characteristic and typical dermoscopic features for a myriad of hypopigmentary disorders affecting the Indian skin, thus avoiding unnecessary stigma and distress for any patient presenting with a white patch.

Idiopathic guttate hypomelanosis (IGH) is a common benign leucoderma, the incidence of which increases with age. Treatment is often sought for cosmetic reasons. However, there is a paucity of information regarding effective treatments for this condition. To evaluate and compile the effects of interventions for IGH. MEDLINE (through PubMed), Web of Science and Scopus databases were searched for articles reporting interventions for IGH, from inception up to November 2023. Reference lists of identified articles were searched for additional articles. Eligibility criteria included human randomized controlled trials (RCTs), clinical studies (non-RCTs) and case series studies (n > 5 patients) of topical treatments, light-based or energy-based devices and procedural interventions for IGH. Repigmentation was the primary outcome of interest. At least two reviewers were involved in article screening, selection, data extraction and quality assessment. Our search returned 522 articles, of which 20 met the eligibility criteria: 9 randomized studies and 11 quasi-experimental studies. The number of patients per study ranged from 6 to 240, and the maximum number of macules included was 2129. Thirteen studies used a quartile grading score to report outcomes. Half of the randomized studies had a high risk of bias, and the outcome measures were heterogeneous across studies. The treatment modalities were well-tolerated. A wide range of interventions are effective in treating IGH. Most treatment modalities involve some form of therapeutic wounding. However, study design and methodology limitations must be considered for each intervention that has been evaluated. There is a paucity of large RCTs with standardized outcome measures and follow-up data regarding the longevity of repigmentation in patients with IGH.

Deciphering the role of skin aging in pigmentary disorders.

Non-vitiligo hypopigmented skin lesions may be close clinical mimickers of vitiligo, resulting in a diagnostic dilemma. Dermoscopic features of vitiligo have been studied, but those of other hypopigmentation disorders are not well-characterized. We aimed to describe and compare the dermoscopic features of vitiligo and other hypopigmented skin lesions. This was a cross-sectional study including 105 vitiligo and 137 other hypopigmented skin lesions, including ash-leaf macules (N=17), nevus depigmentosus (N=16), post-inflammatory hypopigmentation (N=16), pityriasis alba (N=15), pityriasis versicolor (N=14), idiopathic guttate hypomelanosis (IGH) (N=14), lichen sclerosus (N=12), leprosy (N=9), and others. Dermoscopic findings were recorded by concordance of at least two qualified dermatologists. Common dermoscopic findings in vitiligo were intermediate or ill-defined margins (96/105, 91.4%) and a complete absence of pigment network (70/105, 66.7%). Nevus depigmentosus lesions were mostly hypopigmented, with a faint pigment network throughout the lesion. In 15/17 (88.2%) ash-leaf macules, a characteristic pattern of sharply demarcated areas of normal pigment network was seen within a depigmented lesion. Almost all lesions of IGH had a sharply defined margin with completely absent pigment network; discernible eccrine openings within the lesion were seen in 9/14 (64.3%). Dermoscopic findings of a complete absence of pigment network, perifollicular retention of pigment, presence of vascular pattern, loss of discernibility of eccrine openings within the lesion, and lack of scaling were statistically significantly more common in vitiligo than other hypopigmented skin lesions (P <0.001). Vitiligo, nevus depigmentosus, ash-leaf macule, and IGH have distinctive dermoscopic features. Dermoscopy can aid in the differential diagnosis of vitiligo and other hypopigmented skin lesions.

Background:Patchy pigmentation of lower legs presents with patches of hyperpigmentation, hypo, or depigmentation of legs. Dermoscopy is an efficient diagnostic tool dermatologists use to bridge the clinical and histological evaluation gap. This study on lower leg pigmentation is probably the first report from India.Aim and Objectives:To study the clinical, dermoscopic, and histopathological features of patchy pigmentation of lower legs in patients presenting to our Out-Patient Department (OPD).Materials and Methods:This was a cross-sectional descriptive study done on 150 patients with patchy pigmentation of lower legs in patients above the age of 18 years attending the dermatology OPD, JIPMER, during the study period of March 2022 to December 2023 by convenient sampling. A detailed history was taken and a detailed dermatological examination was performed. Dermoscopy and skin biopsy for histopathological examination was performed and recorded in a proforma.Results:The mean age of the cases was found to be 52.3 (±14.06) years (ranged from 18 to 97 years) with female:male ratio of 1.7:1. Among 150 cases, 127 (84.66%) cases had patchy hypopigmentation and 23 cases (15.33%) had patchy hyperpigmentation of lower legs. Among 127 cases of patchy hypopigmentation of lower legs, idiopathic guttate hypomelanosis (IGH) was the most common cause found in 61 (48.81% cases), followed by vitiligo (32, 25.19% cases), and post-inflammatory depigmentation (29, 22.65% cases). Among 23 cases of patchy hyperpigmentation of lower legs, pigmented purpuric dermatosis (PPD) was the most common cause seen in 12 (52.17% cases), followed by post-inflammatory hyperpigmentation (10, 43.47% cases). The most common dermoscopic pattern was amoeboid (21, 33.87%) in IGH, white structureless areas (31, 96.9% cases), followed by perifollicular pigmentation (18, 56.3% cases) in vitiligo and red dots (10, 83.3%) in PPD.Conclusion:Nearly 85% of lower leg pigmentation cases were hypopigmentary. Amongst hypopigmentary disorders, nearly 50% of cases were of idiopathic guttate hypomelanosis, followed by others like vitiligo, post-inflammatory depigmentation, contact leukoderma, nevus depigmentosus, and hypopigmented macular amyloidosis. Dermoscopic features of vitiligo and post-inflammatory depigmentation were similar. Pigmented purpuric dermatosis was the most common cause of hyperpigmentary disorders of the lower legs, followed by post-inflammatory hyperpigmentation and macular amyloidosis.

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.

Depigmented skin lesions are of great concern in society, especially in the Indian subcontinent. These comprise many infective and inflammatory conditions that cause apprehension and anxiety among patients due to the social stigma attached to these conditions. Idiopathic guttate hypomelanosis (IGH) appears similar to many depigmented lesions and differentiation of IGH from these conditions is difficult clinically as well as histopathologically. IGH is one of the common causes of acquired leukoderma. It is also called disseminated lenticular leukoderma. The etiology is yet not clearly delineated, probably multifactorial. Various etiological factors have been proposed including ultraviolet (UV) exposure, post-phototherapy (psoralen and UVA monotherapy, narrowband-UVB), aging, genetic factors, trauma, and autoimmunity. Clinically, it is characterized by multiple, discrete porcelain-white round to oval macules of 2–5 mm average size. It most commonly occurs in the elderly. The most common sites observed are chronically sun-exposed areas such as the arm, pretibial regions, and forearm extensors. It is not easy to differentiate IGH from other hypo and depigmented conditions such as vitiligo, pityriasis versicolor, extragenital lichen sclerosus et atrophicus, guttate morphea, and post-inflammatory hypopigmentation. It poses a diagnostic challenge to dermatologists. One has to differentiate depigmented lesions from vitiligo as it carries tremendous social implications as social stigma, especially in India. Research on dermoscopic evaluation is uncommon in the literature, despite the abundance of clinic-epidemiological and histological studies of IGH. Four dermoscopic patterns, namely, petaloid, amoeboid, feathery, and nebuloid have been described. These patterns are specific to IGH and help clinicians to differentiate many depigmented skin lesions from IGH in clinical practice. Patients often seek cosmetic treatment. There has been no standard therapy for this condition. Newer treatment modalities range from topical agents to procedure-based therapies and have enhanced the therapeutic armamentarium.

Diagnosis of cutaneous hypopigmentation can sometimes be challenging. Dermoscopy may play a role in identifying hypo or-depigmented dermatoses. The aim was to investigate which dermoscopic criteria represent potent indicators for the diagnosis of vitiligo, nevus depigmentosus, pityriasis alba, hypopigmented pityriasis versicolor, idiopathic guttate hypomelanosis, hypopigmented mycosis fungoides (MF), lichen sclerosus et atrophicus and ash leaf hypopigmented macules of tuberous sclerosis, and evaluate their diagnostic accuracy. 168 individuals diagnosed with one of these hypopigmented disorders were evaluated for the presence or absence of predetermined dermoscopic criteria. Evaluation of dermatoscopic characteristics in each condition and analysis for sensitivity and specificity of dermatoscopic diagnosis in these hypopigmented lesions was performed. The starburst pattern, micro-koebnerization, and trichrome pattern were unique to vitiligo diagnosis. Vitiligo had higher comet-tail appearance, perifollicular pigmentation, and perilesional hyperpigmentation than other hypopigmented illnesses. Other hypopigmented lesions had greater incidence of amoeboid pattern, faint or diminished pigment network, islands of pigmentation, ill-defined boundaries, pseudopods, and widespread scaling than vitiligo. Finally, perifollicular scaling, comedo-like openings, blue-gray specks, and fibrotic regions excluded vitiligo. Dermoscopy can help identify common hypopigmented skin lesions and reduce the need for skin biopsy. Nevus depigmentosus, pityriasis alba and idiopathic guttate hypomelanosis were the top three hypopigmented dermatoses that could be diagnosed by dermoscopy with 100% sensitivity. Vitiligo was in the second rank (94.7%), followed by lichen sclerosis et atrophicus (93.3%) then hypopigmented MF at 81.2% sensitivity. Dermoscopy sensitivity was lowest in pityriasis versicolor and ash leaf macules of tuberous sclerosis (52.6% and 46.7%, respectively).

The correlation between dermoscopic patterns and histopathological features in idiopathic guttate hypomelanosis at a tertiary care center

Background A wide continuum of cutaneous manifestations might accompany blood diseases and hemoglobinopathies, especially β-thalassemia. In this situation, cutaneous manifestations occur due to both hemoglobin disorder and treatment complications. These manifestations are usually neglected and frequently underdiagnosed among those patients. Aim To study the cutaneous manifestations in Egyptian children with β-thalassemia to minimize its subsequent complications. Furthermore, we aimed to analyze their relations to duration of disease and frequency of blood transfusions and other disease parameters. Patients and methods This was a cross-sectional study that included 158 patients with β-thalassemia major. All patients were subjected to detailed history, clinical examination, and laboratory investigations, namely, serum ferritin and hemoglobin level. All patients were subjected to meticulous dermatological examination by an experienced dermatologist to evaluate cutaneous manifestations. The data were analyzed using Student t test, Mann–Whitney U test, χ 2 test, and Fisher exact test. Results Xerosis was the commonest encountered cutaneous change (present in 61% of patients), followed by hyperhidrosis (30%), hyperpigmentation (28%), pruritus and pityriasis alba (25%), urticaria (22%), and idiopathic guttate hypomelanosis, scars, ephelides, contact dermatitis, discoid eczema, nail disorders, melasma, tinea, alopecia areata, and warts in descending order. Statistically significant relations were present between the presence of some cutaneous manifestations and disease duration. Conclusion Cutaneous manifestations are common among Egyptian children with β-thalassemia major. Both xerosis and hyperhidrosis are the commonest cutaneous signs in those patients. Some of those cutaneous manifestations are correlated with disease duration and frequency of blood transfusions.

Hypomelanosis is an idiopathic guttate process with the appearance of small struts of hypopigmented, rounded patches on the skin. Despite the high caution of diseases among the population, this dermatosis, as a rule, remains unrecognized throughout life, and it is also difficult to consider this moment of therapy, remaining a cosmetic defect throughout life. This article provides information on the epidemiology, pathogenesis, manifestations, differential diagnosis and therapy of idiopathic guttate hypomelanosis.

Idiopathic guttate hypomelanosis (IGH) is a common skin disorder with no standard treatment. Assess the efficacy and safety of 5-fluorouracil (5FU) compared with saline, delivered using a tattoo machine, to repigment IGH lesions. This split-body randomized single-blinded trial recruited adults with symmetrical IGH lesions. A tattoo machine was used to deliver 5FU in IGH lesions of 1 limb and saline in the contralateral limb. Outcomes were the number of achromic lesions 30 days after treatment compared with baseline, patient satisfaction, and local or systemic adverse events. Twenty-nine patients (28 women) were included. The median number of achromic lesions decreased significantly in 5FU-treated limbs (baseline: 32, interquartile range (IQR) 23-37 × post-treatment: 12, IQR 6-18, p = .000003) and saline-treated limbs (baseline: 31, IQR 24-43 × post-treatment: 21, IQR 16-31, p = .000006), but reduction was significantly more pronounced in 5FU-treated limbs (p = .00003). All participants were satisfied or very satisfied with results on 5FU-treated limbs. There were no adverse events. 5-fluorouracil delivery using a tattoo machine was more effective than saline to repigment IGH lesions, with high patient satisfaction and no adverse events.Clinicaltrials.gov: NCT02904564.

Introduction: Depigmented skin lesions are commonly encountered in day-to-day practice and can cause significant social stigma. They are challenging to diagnose clinically and histopathologically. Idiopathic Guttate Hypomelanosis (IGH), a pigmentary condition commonly affecting older individuals, can lead to cosmetic deformity and have a significant psychological impact. Dermoscopic evaluation offers a quick and easy way to resolve diagnostic confusion and prevent unnecessary biopsies. Aim: To study the clinical and dermoscopic features of IGH. Materials and Methods: This cross-sectional observational study was conducted in the Department of Dermatology, Venereology, and Leprosy at Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh (MP), India from July 2021 to June 2022. A total of 180 patients with IGH lesions underwent a detailed clinical history, dermatological and systemic examinations, followed by dermoscopic examination. The collected data were statistically analysed using Statistical Package for Social Sciences (SPSS) version 20.0, and the results were tabulated in terms of distribution, frequency, and mean±Standard Deviation (±SD). Results: Among the 180 patients, the most affected age group was 51-60 years. A total of 108 (60%) were females and 72 (40%) were males. The most common site of involvement was the distal part of the lower extremity in 152 (84.4%) cases, followed by the distal part of the upper extremity in 115 (63.8%) cases. A total of 46 (25.5%) patients had a history of excessive sun exposure. Additionally, 21 (11.6%) patients had other associated features of photoaging, such as xerosis, solar lentigo, seborrhoeic keratosis, freckles, and actinic keratosis. The most common dermoscopic pattern observed was amoeboid in 103 (57.2%) patients, followed by feathery in 41 (22.7%), petaloid in 23 (12.7%), nebuloid in 13 (7.2%), and a combination of patterns in six percent of patients. Conclusion: The IGH was more common in females and older age groups, with the distal parts of the lower extremity being the most frequently involved site. Excessive sun exposure was a common risk factor for IGH, and several patients may have associated signs of photoaging. The most common dermoscopic pattern observed was amoeboid. Therefore, clinical dermoscopic examination can be helpful in identifying IGH and differentiating it from other depigmented lesions.

A 55-year-old stone quarry worker presented with a 5-month history of severe dyspnea and persistent nonproductive cough. He also complained of tightening of the skin for 1 year and a history consistent with Raynaud’s phenomenon. On auscultation, coarse crepitus was heard in bilateral upper lobes. Cutaneous examination revealed generalized hyperpigmentation, skin sclerosis, sclerodactyly, calcinosis cutis, and salt-and-pepper dyspigmentation. There was also a peculiar septate pattern of skin indentation running through the salt-and-pepper dyspigmentation on the forehead, parallel to course of supraorbital vein, and its branches identified as the groove sign [Figure 1a-c]. Dermoscopy of the lesion on the forehead revealed three concentric zones of perifollicular pigmentary changes, namely, outermost hexagonal rims of white areas, middle circular zone of pigment retention, and an innermost zone of whitish perifollicular halo [Figure 2a and b]. Interestingly, there were no white areas (depigmentation) in the skin indentation over superficial veins. Onychoscopic findings were also characteristic with dilated nail-fold capillaries, avascular areas, and capillary dropouts in proximal nail fold as well as nail plate onychomadesis [Figure 2c]. Computed tomography was suggestive of silicosis [Figure 2d]. Scl-70 titer was 114.58 units. Histopathological analysis revealed epidermal thinning, reduced, and pulled appendages. In addition, dermal lymphocytic infiltration and homogenous edematous collagen bundles were seen [Figure 2e]. The patient was diagnosed with Erasmus syndrome, and advised strict smoking cessation, avoidance of silica exposure, and to put off calcium channel blockers.Figure 1: (a) Shiny tight skin with generalized hyperpigmentation, calcinosis cutis over wrist and elbow, salt-and-pepper dyspigmentation over the right side of the scalp near the temple. (b) Septate or branching pattern of salt-and-pepper dyspigmentation on the right side of the forehead near the hairline. (c) Ulcerated calcinosis cutis over the elbowFigure 2: (a): Polarized Dermoscopy at 10× (DermLite DL3) from the center of salt-and-pepper dyspigmentation revealing three concentric zones around a follicle, namely, outermost hexagonal rims of white areas (green arrow), middle circular zone of pigment retention (red arrow), and an innermost zone of whitish perifollicular halo (blue arrow). There is also the presence of pseudo reticular brown areas along the course of superficial veins corresponding to the site of the groove sign (yellow arrow). (b): Polarized Dermoscopy at 10× (DermLite DL3) from the periphery of salt-and-pepper dyspigmentation at the trunk revealing multiple brown dots (black arrow) arranged regularly within white areas (red stars). (c): Onychoscopy at 10× (DermLite DL3) showing dilated nail-fold capillaries (white arrow), avascular areas with capillary dropouts in proximal nail fold (red arrow), and cuticle (black arrow). There is also presence of onychomadesis (blue arrow). (d): Enlarged calcified lymph nodes (egg-shell calcification) and nodules in upper lobes in mediastinum suggestive of silicosis, as seen on high-resolution computed tomography scan of the chest. (e): Histopathological analysis revealing epidermal thinning, reduced and pulled appendages, dermal lymphocytic infiltration, and homogenous edematous collagen bundles (hematoxylin and eosin stain, 400×)The term “Erasmus syndrome” was coined by Devulder et al.[1] in 1977 for concurrent presence of silicosis with systemic sclerosis (SS). Short-term or prolonged intense inhalation of silica causes accumulation of silica in alveolar macrophages, which upregulates IL-1, IL-2, and TNF-alpha that stimulate anti-topoisomerase 1 (Scl-70) antibody. This leads to stimulation of collagen synthesis, sclerosis, vasculopathy, and pulmonary fibrosis.[2] The pathogenesis of salt-and-pepper dyspigmentation in systemic sclerosis is melanocyte destruction with retention of perifollicular melanogenesis due to a rich capillary network. The groove sign arises due to a relative split between the epidermis and dermis along the superficial veins secondary to dermal fibrosis. Although primarily seen in eosinophilic fasciitis, the sign has also been demonstrated in other diseases of the scleroderma spectrum. We hypothesize that the close proximity of melanocytes with the vessels and local expression of endothelin 1 in the area of groove sign plays a role in pigment retention in the overlying skin. Dermoscopy can be a useful tool to differential salt-and-pepper dyspigmentation in systemic sclerosis with clinically similar presentations. The dermoscopic differentials considered were vitiligo, idiopathic guttate hypomelanosis (IGH), and lichen sclerosus et atrophicus (LSA). However, these diseases have additional dermoscopic findings such as absence of pigment network, perilesional brown areas, and reversed network of pigmentation along with typical appearances like starburst, comet-tail, etc., are seen in vitiligo. IGH has nebuloid, petal-like, or amoeba-like dyspigmentation, whereas LSA has the presence of follicular plugging with pale structureless zones and perilesional erythema on dermoscopy.[3] Apart from medical management with penicillamine, calcium channel blockers, endothelin receptor blockers, PDE-5 inhibitors, and immunosuppressives, the further progression of Erasmus syndrome can be halted by strict avoidance of silica exposure. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Objective: Assess the knowledge of common geriatric skin conditions in Thai physicians.Materials and Methods: This retrospective study was conducted among Thai physicians attending annual dermatology courses by the Dermatological Society of Thailand from 2016 to 2019. Data was assessed based on knowledge of diagnosis and management of common geriatric skin conditions.Results: A total of 197 participants, mainly general practitioners, were included. The highest percentage of correct diagnoses were benign erythematous, eczematous lesions (35.5%, senile purpura; 36.0%, xerotic eczema), and malignant diseases (35.5%, basal cell carcinoma; 27.4%, squamous cell carcinoma; 11.7%, subungual melanoma; 24.4%, acral lentiginous melanoma). In contrasts, the lowest percentage of correct diagnosis were premalignant diseases (0.5%, arsenical keratosis; 4.6%, actinic keratosis; 1.0% Bowen’s disease) and benign hypopigmented lesion (0.5%, stellate pseudoscar; 7.6%, idiopathic guttate hypomelanosis). Harmful treatment with systemic antifungal therapy was used in subungual melanoma (58.0%). Harmful management of senile comedone, subungual melanoma and acral lentiginous melanoma was significantly found in physicians given the incorrect diagnosis. (p = 0.027, p &lt;0.001, p = 0.014, respectively).Conclusion: Most physicians recognized malignant lesions, benign erythematous or eczematous diseases in elderly skin. Surprisingly, almost all physicians couldn’t diagnose premalignant lesions and benign hypopigmented lesions.

Aims: The aim of the study is to highlight that cutaneous lesion can be markers of nutritional status in the elderly.&#x0D; Study Design: This is a cross-sectional descriptive study.&#x0D; Place and Duration of Study: This study took place within the wards of University of Port Harcourt Teaching Hospital over a 3 month period.&#x0D; Methodology: A sample of 126 elderly patients were calculated as the sample size to be assessed for cutaneous lesions, of which 122 were fit enough to have their BMI assessed using standardized protocol of measuring height and weight. The BMI was calculated using the formula -BMI = kg/m2.&#x0D; Results: Out of the total, 55 of them representing 45.1% had normal BMI, 13 representing 10.7% were underweight, 33 (27%) over weight and 21(17.2%) obese. Underweight elderly patients were more likely than those with normal weight to have xerosis, itching, wrinkles, idiopathic guttate hypomelanosis and ulcers. The elderly with overweight and obesity were more likely to have dermatosis papulosa nigra, signs of post-bleaching syndrome and surgical scars.&#x0D; Conclusion: Complaints or observance of cutaneous lesions in elderly should be a reason to investigate nutrition and the solution may lie in nutrition based treatment. More research is however needed to further evaluate the association between cutaneous lesions and body mass index.

Abstract BackgroundIdiopathic guttate hypomelanosis (IGH) is a pigment disorder of unknown etiology. Despite its high prevalence and the unaesthetic appearance of the lesions, there are relatively few histological studies on this disorder. This is an important gap to understanding its pathogenesis.ObjectivesTo assess the microscopic structure of IGH lesions compared to normal adjacent skin areas and the possible interaction between melanocytes and the subjacent dermis.MethodsIn this cross‐sectional study, we took biopsy specimens of hypochromic lesions and adjacent normal skin from 20 patients with IGH. We analyzed the fragments using routine stains, immunohistochemistry, and electron microscopy.ResultsWe found superficial dermal fibrosis in 90% (18/20) of our IGH cases and unreported keratinocyte cytoplasmic changes on electron microscopy.ConclusionOur results suggest an interaction between melanocytes and the subjacent dermis in IGH. These findings can help to understand melanocyte biology and the pathogenesis of other achromic lesions.

Abstract Background: Idiopathic guttate hypomelanosis (IGH) is a common benign acquired leukodermic dermatosis characterized by multiple, discrete, hypopigmented-to-depigmented macules. Various treatment modalities were tried for this condition with varied results. Purpose: This study was conducted to compare the efficacy and safety of fractional carbon dioxide laser and 88% phenol in the treatment of IGH. Methods: A total of 40 patients with five IGH macules on each side were treated with one session of fractional carbon dioxide laser on the right side and a single application of 88% phenol on the left side and were assessed monthly for 3 months. The improvement in pigmentation was graded as ≤25% - poor, 26%–50% - minimal, 51%–75% - good, and &gt;75% - excellent response. Results: A total of 32 patients completed the study. Out of the 160 macules treated with laser, 16 (10%) macules showed an excellent response and 40 (25%) showed a good response, and 40 (25%) and 48 (30%) macules in the phenol group showed excellent and good improvement, respectively. Side effects such as persistent scabbing and ulceration were seen only on the phenol side. Conclusion: Single application of 88% phenol was more efficacious than one session of fractional carbon dioxide laser in inducing pigmentation in IGH macules in this study. However, fractional carbon dioxide laser can be considered a safer alternative modality.

Diabetes mellitus (DM) is a frequent metabolic disease whose prevalence is estimated to be around 9.3 % in the world population in the age group 20—79, corresponding to 463 million affected subjects. Moreover, this prevalence will probably increase in the course of the next years. It accounts for more than 90% of the diabetic patients. Besides systemic complications, those ay also be observed in dermatology. According to the region, the prevalence of skin disorders in patients suffering DM is ranging from 35.4 to 98.8 %. This makes these symptoms a frequent cause of consultation in dermatological practice. The most occurring disorders are skin infections, but yellow nails, candidiasis, acrochordons, limited joint mobility and idiopathic guttate hypomelanosis may also be frequently observed. Diabetic dermopathy and diabetic foot syndrome are also common, such as pigmentation disorders such as acanthosis nigricans and vitiligo. Differences between patterns of lesions remain unclear among types of DM (type 1 or type 2). Overall, cutaneous infection and xerosis showed to be highly prevalent and important skin disorders in several studies, regardless DM type. Among cutaneous infections, fungal aetiology appears to be the most common and those with bacterial origin are the less frequent.DM affects the skin through several mechanisms — High levels of glycaemia strongly affect skin homeostasis by impairing the normal functioning of keratinocytes in vitro, decreasing their proliferation and differentiation. They also lead to advanced glycation end products (AGEs) formation. The latter are formed from glycation of proteins, lipids and nucleic acids. They have various deleterious effects at skin levels: inducing reactive oxygen species (ROS) formation, impairing ROS clearance, as well as intra and extracellular proteins function, and inducing pro inflammatory cytokine through nuclear factor κβ (NF-κβ) pathway. AGE alters collagen properties, decreasing flexibility and solubility and increasing its rigidity, thickening dermal collagen, with increased cross linking from non-enzymatic glycosylation, participating in the development of fibrosis. In diabetic patients, the vascular changes found in the skin are similar to those caused by UV-exposure, i. e. thickening of the vessels walls, increasing from thigh to foot and most marked in the capillaries and leading to failure of vascular responsivenessThis paper is aimed to summarize all these pathologies, reporting their prevalence, giving a brief description of the symptoms, of their pathogenesis and guidelines for their management. Dermatologists have a key role in their treatment, but also in detecting new cases of DM when taking in charge these pathologies. They must also promote glycaemic control by these patients.