Reddish Background Research Articles

A clinicoepidemiological study on topical steroid misuse in a tertiary-care hospital in North India and the role of dermoscopy as a non-invasive diagnostic modality

Background: Topical corticosteroids (TCs) are one of the most frequently prescribed medications by dermatologists, yet may lead to an array of side effects due to prolonged and improper use. Because of the easy availability of topical corticosteroids as over-the-counter medications in India, these drugs are misused and abused. Objective: The objective was to determine the extent and the side effect profile of topical corticosteroid misuse/abuse in patients attending the OPD, to determine the demographic data and the reason and source of procuring TCs, and to characterize the dermoscopic findings of TSDF. Materials and Methods: This was a prospective, cross-sectional, clinical study conducted over a period of two years in which a predesigned, questionnaire-based proforma was employed. Patients above the age of fifteen reporting to the OPD giving a history of the application of a steroid cream continuously or intermittently for the minimum duration of four weeks were included in the study. A total of two hundred patients who met the clinical criteria were subjected to dermoscopic examination with a handheld dermoscope (DermLite DL4; 3Gen, U.S.; 10×). Results: A total of 2400 patients (fifteen-year-old or older) were enrolled in the study, in which 65% of the patients were females while 35% were males. Mostly, the patients procured these medicines from the pharmacist or paramedic, followed by general practitioners. The most common indications for which topical preparations were used included acne, followed by photodermatoses and ephelides. Most of the patients used combination creams, followed by potent steroids such as clobetasol propionate and betamethasone valerate. The most common side effects were erythema (74%), followed by photosensitivity (49%), hypertrichosis (47%), telangiectasia (42%), acneiform eruption (33%), contact dermatitis (21%), wrinkles (23.50%), etc. The main findings noticed on dermoscopy were irregularly dilated, branching, tortuous vessels almost interconnecting with each other in 79.78%, followed by hypertrichosis in 56.34%, white structureless areas representing atrophy in 42.33%, red dots in 7.22%, and a reddish background in 92.20%. Conclusion: The rampant use of TCs by patients for a prolonged period of time leads to a variety of side effects. Due to the topographical location, the climate of the valley, and the lighter skin type of the local population, the indications for which TCs were employed in our study group and the side effect profile were unique from the rest of the country. Dermoscopy may play a vital role in improving the diagnostic accuracy of TSDF and help us to differentiate it from close mimics.

A case of eccrine spiradenoma presenting as a painless, reddish nodule on the forearm

Sir, Eccrine spiradenoma (ES) is a rare and benign adnexal tumor originating from the eccrine glands. It is usually located in the truncal region and is most common in young adults twenty to forty years old. Herein, we report a clinical, dermoscopic, and histological description of the case of an elderly male with an atypical tumor localization. A 74-year-old male presented with a painless, nodular mass on the anterior aspect of the left forearm, growing progressively over the previous year. He had no medical history. A dermatological examination revealed a solid, skin-colored nodule with a central ulceration and a peripheral collar, measuring approx. 1 to 1.5 cm in diameter, not bleeding on contact (Fig. 1a). There were no similar nodules or palpable lymph nodes. Dermoscopy was performed with DermLite 4. It demonstrated a vascular pattern of branched vessels and a central ulceration with a reddish background and scattered blue clods. It also showed a yellowish-brown, serohematic crust surrounding the ulceration and the reddish background (Figs. 1b and 1c). Upon histopathologic examination, the excised nodule revealed a tumoral proliferation, which was well demarcated from the surrounding tissue. It consisted of sharply defined lobules and cords intertwined into a puzzle-like structure (Fig. 2a). Two cell populations were identified: small basaloid cells and larger cuboidal ones. The cells displayed high mitotic activity yet no abnormal mitotic figures and no necrotic background. The section also showed numerous amorphous eosinophilic deposits within the cell cords and a richly vascularized stroma (Fig. 2b). The excision was complete and there were no recurrences on subsequent checks.

A new diagnostic paradigm for Erythromelanosis Follicularis Faciei et Colli: Dermoscopic and reflectance confocal microscopic features

Introduction: Erythromelanosis Follicularis Faciei et Colli is a rare variant of Kerastosis pilaris, characterized by a clinical triad of erythema, hyperpigmentation and follicular papules involving bilaterally cheeks, preauricular and maxillary areas of young male or, more rarely, female patients Case presentation: A 21-year-old Caucasian woman presented symmetrical patches of hyperpigmentation, erythema with microscopic telangiectasias and tiny follicular papules involving cheeks, preauricular and maxillary areas, forehead, pinna and neck since childhood. Lesions were asymptomatic but caused profound cosmetic disfigurement and had a negative impact on her social life. The patient underwent a non-invasive diagnostic procedure with epiluminescence and confocal microscopy. Dermoscopic examination revealed prominent yellowwhitish follicular keratotic plugging over a reddish background with short fine telangiectasia in the perifollicular and interfollicular areas. Furthermore, RCM features displayed the presence of enlarged the presence of enlarged follicular openings, absence of demodex mites within the follicles and slight infundibular hyperkeratosis. At the level of the epidermal-dermal junction hyperpigmentation of the epithelial basal cell layer and dilation of dermal capillaries inside dermal papillae were observed, correlating to typical histological features of EFFC. Our patient benefited from the topical use of tretinoin 0.05% cream, with attenuation of the instrumental pictures. Conclusion: Characteristic plugging over a reddish background and morphological features revealed by RCM may be helpful for assessment and monitoring in patients with EFFC. Starting from the observation of this case we would like to underline the importance of a noninvasive diagnostic procedure and an effective therapy for such a rare condition. Keywords: Erythromelanosis Follicularis Faciei et Colli; Erythromelanosis Follicularis Faciei diagnosis; Dermoscopy; In vivo reflectance confocal microscopy.

Marine flatworms in the Gulf of Guinea: a description of a new species of Pseudobiceros (Platyhelminthes; Polycladida) from Principe Island

A new species of polyclad flatworm belonging to the genus Pseudobiceros Faubel, 1984 is described based on external and internal morphological features from specimens collected on the coasts of Principe Island. Pseudobiceros principensis sp. nov. is a large-sized worm, with well-developed pseudotentacles, an elongated oval body shape, and deep marginal ruffles. It is characterized by a blackish to reddish background color, with scattered yellow and white spots or stripes of different sizes (forming a star-like shape) along the whole dorsal surface.

Dermoscopy of Urticaria Pigmentosa.

Dermoscopy of Urticaria Pigmentosa.

Dermoscopic profile of pityriasis rosea

Background: Pityriasis rosea (PR) is a common, self-limited cutaneous disease characterized by wide distributed erythematous scaly lesions. The diagnosis is usually based on the clinical features. Objectives: Here, we aimed to investigate the dermoscopic features of PR which may provide helpful clues to the diagnosis. Methods: Demographic, clinical, and dermoscopic features of the patients with PR were retrospectively reviewed, and the findings identified were recorded. Results: A total of 100 lesions from 25 different patients were included in the study. The most common dermoscopic finding was peripheral collarette scale (84%), followed by central yellow with peripheral reddish background (40%), peripheral dotted vessels with patchy distribution (35%), diffuse reddish background (31%), scattered dotted vessels (30%), and irregular distributed scales and red globules (20%). Conclusion: To the best of our knowledge, this is the most comprehensive study focusing on the dermoscopic features of PR. Here, we identified new dermoscopic findings which were not described previously for PR. These findings were irregular linear vessels, blood spots, brown globules, and brown structureless areas. It can be concluded that dermoscopy may provide remarkable clues to diagnosis, especially in atypical presentations of the entity.

Multiple Simultaneous Primary Squamous Cell Carcinomas in the Oral Cavity

The incidence of multiple primary tumors confined to the oral cavity is 1.4%, more often affecting women without smoking habits. A 67-year-old woman presented with a painful tongue lesion that had not healed for 4 months. She denied smoking and alcoholism. An intraoral examination showed an ulcer with raised borders measuring 2 × 2 cm on the tongue's right border, reddish gingiva with white irregular plaques between teeth 46 and 47, whitish striations with reddish background on the right buccal mucosa, and a 0.5 cm reddish area on anterior lower gingiva. The main diagnostic hypothesis was squamous cell carcinoma; incisional biopsies were performed in all lesions. The histopathological examination confirmed the diagnosis, except on the anterior gingiva with moderate epithelial dysplasia. The patient was referred to the head and neck department for surgical treatment. The possibility of multiple, simultaneous primary oral squamous cell carcinomas should be considered, even in patients without risk factors.

Rapid autographic method for detection of enzymatic browning inhibitors based on enzyme immobilization

This work describes a TLC-coupled bioautographic assay suitable for the separation and detection of apple polyphenol oxidase (PPO) inhibitors from natural extracts. PPO was immobilised in agar containing l-DOPA as substrate and 3-methyl-2-benzothiazolinone hydrazone hydrochloride (MBTH) to enhance colour development. The inhibition was detected as white spots on reddish background. Minimum amount of PPO inhibitors detected was 0.0125 µg of 4-hexylresorcinol, 0.025 µg of ascorbic acid, 0.5 µg of cysteine and 1 µg of kojic acid. The assay was compatible with normal and reverse phase TLC systems and allows detecting compounds that directly had action on the enzyme as well as agents that could convert quinones back to their reduced form. The chromatographic run evidenced the different nature of enzymatic browning inhibitory compounds from garlic and onion extracts. Using natural enzymes will provide a fast and cheap alternative for target specific exploration of natural enzymatic inhibitors.

Dermoscopy of arteriovenous tumour: A morphological study of 39 cases.

Arteriovenous tumour is a distinct, benign, acquired vascular lesion that can be misdiagnosed. A dermoscopic examination of 39 cases of arteriovenous tumours collected from four Spanish hospitals was performed to evaluate specific dermoscopic criteria and patterns. The most common structures found were vascular, 95% of cases (37/39); 90% (35/39) were non-arborising telangiectasia. All the lesions except two (95%) had a homogeneous pigmentation background that was red in 30 cases (77%), bluish-red in three (8%), brown in two (5%) and blue or multicoloured in one case each. Lacunae were seen in only three cases (8%). Non-arborising telangiectasia on a reddish background was identified in 72% of cases. Dermoscopy is helpful in improving the diagnosis of arteriovenous tumours and allows the observer to differentiate them from other cutaneous lesions such as other vascular tumours, basal cell carcinomas and melanomas.

Non-follicular milky globules-dermoscopy saves the day.

Acute generalized exanthematous pustulosis (AGEP) is a rare severe cutaneous adverse reaction caused mostly by medication. Early diagnosis is important as initiation of supportive treatment and avoidance of drug is of prime importance. A young male presented with an erythematous rash after taking diclofenac for pain. Polarized dermoscopy revealed milky globules on a uniform reddish background sparing the follicles, which confirmed the diagnosis of AGEP.

A Red Nodule on the Cheek - a Case Report

Abstract Introduction: Merkel cell carcinoma (MCC) is a rare, very aggressive neuroectodermal tumor of the skin typically located on sun-exposed areas and frequently found in Caucasian men between 70 and 80 years of age. Case Report: We present a case of a 86-year-old woman who was referred to our Skin Cancer Unit with a red and well defined nodule located on her left commissure of the mouth, that grew during a couple of months and was completely asymptomatic. Dermoscopic examination revealed a reddish background with linear and arborizing irregular vessels, some out of focus vessels and whitish areas. The lesion was excised, histological examination showed that the tumor was hypercellular and composed of round epithelial elements with large nuclei and scant cytoplasm suggestive of MCC. Immunohistochemical stains confirmed a diffuse positivity with cytokeratin (CK) 2 chromogranin, and synaptophysin; CK7 and thyroid transcription factor-1(TTF-1) were negative. Sentinel lymph node biopsy was done, resulting negative for neoplastic cells, and computed tomography (CT) of the chest, abdomen and pelvis showed no distant metastasis. Adjuvant radiotherapy on the tumor site and on homolateral neck lymph nodes was also done. Conclusion: Merkel cell carcinoma presents as an asymptomatic, rapidly growing nonpigmented nodule without specific characteristics. Dermoscopic features may help to distinguish MCC from other similar tumors: linear irregular vessels, milky pink areas, architectural disorders and structureless areas, even if not specific, when present are strongly suggestive of MCC. Wide excision with 2 cm margins with adjuvant radiotherapy is the treatment of choice in high-risk primary tumors, while sentinel lymph node biopsy and computed tomography scans are necessary for early diagnosis of metastatic disease.

Dermoscopic Follow-Up of the Skin towards Acute Graft-versus-Host-Disease in Patients after Allogeneic Hematopoietic Stem Cell Transplantation.

Background. Acute graft-versus-host disease (aGVHD) involving skin is one of the most frequent complications of allogeneic hematopoietic stem cell transplantation (alloHSCT), usually diagnosed based on clinical manifestations. So far, skin biopsy with histopathological evaluation is the only method to confirm the diagnosis. Objective. In this prospective study we monitored alloHSCT recipients by dermoscopy in order to assess its utility as an alternative noninvasive tool to early diagnose acute GVHD. Methods. Thirteen consecutive patients who received alloHSCT were examined clinically and dermoscopically towards aGVHD [days 28 (±7), 56 (±7), and 100 (±7)], as well as in each patient who developed cutaneous aGVHD diagnosed according to clinical criteria (Glucksberg scale). Results. Six patients (46%) developed symptoms of cutaneous acute GVHD (grade 1, n = 3; grade 2, n = 3). Dermoscopic evaluation revealed pinkish or reddish background and well-visible, multiple thin telangiectasias. Conclusion. To our knowledge, this is the first report on the use of dermoscopy to evaluate skin involvement in the course of acute GVHD suggesting its role as a diagnostic tool in follow-up of GVHD, which can be also used before clinical symptoms occur.

Dermatoscopy in diagnosing maculopapular cutaneous mastocytosis

The diagnosis of cutaneous mastocytosis is based on the clinical finding of the pigmented macules or papules, positive Darier's sign and a dermal infiltrate composed of mast cells that can be better visualized by the use of special stains (Giemsa or Toluidine blue). Clinical, dermatoscopic and histopathological presentations of new appearing pigmented lesions in a female patient were presented. Dermatoscopic findings of pigment network-like structure combined with parallel pigmented lines and central reddish background in a adult patient with new appearing pigmented lesions should led us to searching for cutaneous mastocytosis.

Verruciform Xanthoma of The Palate: Case Report

Verruciform xanthoma is an uncommon benign lesion of unknown etiology that mainly affects the oral mucosa. Clinically, this painless plaque has a papillary or verrucous surface. Man, 52, was referred for evaluation of an asymptomatic lesion on the palate. The lesion had appeared 6 years earlier, but had never been treated. Intraoral examination showed a 0.8-cm, well-demarcated, rounded whitish plaque with a verrucous surface and reddish background on the left side of the hard palate. The patient denied prior local trauma and reported tobacco use. Papilloma was the presumptive clinical diagnosis and an excisional biopsy was performed. Histopathological analysis revealed papillary epithelial hyperplasia and foamy macrophages in the lamina propria papillary zone. After 1 month of follow-up there is no sign of recurrence. The histopathological characterization of verruciform xanthoma is essential for the diagnosis, which clinically is often mistaken for a papilloma, condyloma, or wart.

Color shifts caused by perceived structure-from-motion

When a figure is segmented from a chromatic background using stereoscopic depth, only weak shifts in color appearance are found (Shevell & Miller, 1996). When, however, a figure is segmented from ground by percepts of transparent layers, shifts in color appearance are large (Wollschlager & Anderson, 2009). Color appearance, therefore, may depend critically on the specific perceptual attributes that segment an object from its chromatic background. This study shows that changes in color appearance due to chromatic adaptation depend on a cortical neural representation at the level of three-dimensional object perception. Shifts in the color appearance of an equilateral-triangle test (0.125 deg in area) were measured using a red/green hue cancellation technique following adaptation to a larger reddish background [L/(L+M) = 0.75, S/(L+M) = 0.2]. The test was perceptually segmented from the background using structure-from-motion so the overall percept was a separate triangular test field on a distinct background. The background was sprinkled with small dots (same chromaticity but slightly higher luminance) that were (i) stationary, (ii) randomly located on each successive frame, or (iii) presented so they were perceived to move coherently over time to create the percept of a 3D sphere. An important feature of the experimental design was that retinal adaptation within 1 deg of the test field was constant in all conditions. When the dot motion created the percept of a 3D sphere, the color shift induced by the background was reduced for three observers, compared to the stationary-dots condition. Randomly relocating dots on each frame also caused some reduction in the influence of the background, but significantly less reduction than when the dots gave the percept of a 3D sphere. In sum, central neural mechanisms of object perception significantly alter the color-appearance changes caused by a given chromatic adapting light. Meeting abstract presented at VSS 2013

Dermoscopy for the Pediatric Dermatologist Part I: Dermoscopy of Pediatric Infectious and Inflammatory Skin Lesions and Hair Disorders

The dermoscope allows physicians to examine the macroscopic and microscopic primary morphology of skin lesions, identify subtle clinical clues, confirm naked-eye clinical diagnoses, and monitor treatment progress while posing little threat to the young patient. This review summarizes important dermoscopic structures seen in infectious and inflammatory skin conditions and hair disorders in children. Scabies, pediculosis, phthiriasis, molluscum contagiosum, tinea nigra, and verrucae are well characterized dermoscopically by delta-shaped structures, ovoid-shaped nits, the crab louse, red corona, brown strands or spicules, and multiple densely packed papilla with a central black dot surrounded by a whitish halo, respectively. These dermoscopic structures will be discussed, focusing on the dermoscopic morphologies and dermoscopic sensitivity for diagnosis and its utility in monitoring treatment progress. Dermoscopy has also been shown to significantly improve the clinician's diagnostic and monitoring accuracy of inflammatory skin lesions such as psoriasis, which is characterized dermoscopically by uniformly distributed dotted blood vessels, and lichen planus, which is characterized by whitish lines on a purple to reddish background. Dermoscopy of the hair and scalp (trichoscopy) facilitates the differential diagnosis of hair diseases in children, including alopecia areata, trichotillomania, and tinea capitis. It can also assist in the diagnosis of multiple genetic hair shaft disorders, such as monilethrix, trichorrhexis invaginata, trichorrhexis nodosa, pili torti, and pili annulati.

Combining local and global contributions to perceived colour: An analysis of the variability in symmetric and asymmetric colour matching

Are surfaces’ colours judged from weighted averages of the light that they reflect to the eyes and the colour contrast at their borders? To find out we asked subjects to set the colour and luminance of test disks to match reference disks, on various backgrounds, and analysed the variability in their settings. Most of the variability between repeated settings was in luminance. The standard deviations in the set colour were smallest when the disk and background were the same colour, irrespective of the colour itself. Matches were equally precise for greenish or reddish disks on a grey background, as for grey disks on a greenish or reddish background. The precision was less dependent on the colour contrast at the disks’ borders when the backgrounds were more complex and when there was a large luminance contrast at the disks’ borders. Subjects were less precise when different colours surrounded the two disks. These findings are consistent with the perceived colour at any position being a weighted average of the local cone excitation ratio and the change in the cone excitation ratio at the borders of the surface in question. However, the involved weights must be variable and depend systematically on parameters such as the luminance contrast at the surface’s borders and other chromatic contrasts within the scene.

PHYLOGENY AND BIOGEOGRAPHY OF THE ATLANTIC AND EASTERN PACIFIC HYPSELODORIS STIMPSON, 1855 (NUDIBRANCHIA, CHROMODORIDIDAE) WITH THE DESCRIPTION OF A NEW SPECIES FROM THE CARIBBEAN SEA

A new species, based on two specimens from Guana Island, British Virgin Islands, is described. The new species agrees with the genus Hypselodoris in having a high body profile, a large vestibular gland and mantle glands. It differs from other members of the genus in the Atlantic Ocean by having a reddish background body colour. In addition, dorsal colour patterns such as a broad central white line with lateral extensions and the lack of yellow lines or spots further differentiate this species. The radular formula of 52 x 41.0.41 and a smaller seminal receptacle are also distinctive. The phylogenetic relationships of 34 species and subspecies of Hypselodoris from the eastern Pacific and Atlantic are examined using morphological characters. With the exception of the new species, these are characterized by a dark blue background body colour. The phylogenetic analysis of the data matrix resulted in eight most-parsimonious trees. The resulting consensus tree shows that eastern Pacific and Atlantic species of Hypselodoris constitute a monophyletic group that is basally split into two sister clades. One clade contains the eastern Pacific species and most of the Caribbean species, whereas the other clade contains the eastern Atlantic species. The new species is the sister to the rest of the Caribbean species, which also form a monophyletic group. This phylogenetic hypothesis suggests that two consecutive vicariant events have affected the biogeography of Hypselodoris: (1) the closure of communication between the tropical Indo-Pacific region and the Atlantic and eastern Pacific, completed with the formation of the East Pacific Barrier; and (2) the rise of the Panama isthmus.

A Rudimentary Labellar Speculum in Cymbidium lowianum (Rchb.f.) Rchb.f. and Cymbidium devonianum Paxton (Orchidaceae)

The labellar 'hairs' of some Cymbidium spp. are said to be thin-walled and to contain 'plasma', oil and sugars and it has long been speculated that they may function as food-hairs. However, the present authors' preliminary studies showed that certain atypical papillae may have a different role and, by reflecting light, function as a speculum. The purpose of the paper is to test this hypothesis. Light microscopy, scanning electron microscopy, transmission electron microscopy, histochemistry and ultraviolet photography were used to investigate the structure, food content and light-reflecting properties of these papillae. The labellum of Cymbidium lowianum (Rchb.f.) Rchb.f. is densely clothed with obconical to conical papillae with wide bases and pointed tips. However, on either side of the median axis of the lip occur silvery patches comprising papillae with truncated tips and it is thought that these reflect light and thereby attract insect pollinators. Similar patches are also found in Cymbidium devonianum Paxton, and in both species, they are set against a reddish background, which, since bees cannot perceive this colour, probably appears dark to the insect thus enhancing the visual impact of the light-reflecting patches. In Cymbidium tigrinum Parish ex Hook. and Cymbidium mastersii Griff. ex Lindl., however, the labellum is mainly white and no light-reflecting patches were observed. Instead, unlike C. lowianum and C. devonianum, these species are highly fragrant and the attraction of insects probably depends to a greater extent on olfactory cues. In C. lowianum both types of papillae contain protein, starch and lipid bodies but only protein is seemingly present at elevated concentrations. However, lipoidal material also occurs upon the surface of the labellum and it is possible that this may be gathered by insects as reported for C. iridifolium A. Cunn (syn. C. madidum Lindl.). The labellar papillae of C. lowianum, thus, have the potential to function as food-hairs, although direct evidence for this is lacking.

Environmental Control of Body-Color Polyphenism in the American Grasshopper, <I>Schistocerca americana</I>

The effects of various environmental factors on body color were investigated for nymphs of the American grasshopper, Schistocerca americana (Drury). Two types of body color variation were separately analyzed. In so-called green-brown polyphenism, a green, yellow and reddish background body colors were recognized, though the variation was continuous. The reddish morph was common at low temperatures (e.g., 30 and 34°C), while the green and yellow ones became predominant at high temperatures (e.g., 38 and 42°C). The other factors including humidity, background color and rearing density had little influence on this polyphenism. The variation in intensity of black patterns was also continuous, and greatly influenced by temperature. Nymphs with intensive black patterns occurred at low temperatures and the incidence of such individuals decreased with an increase in temperature. Rearing density had only a moderate effect on the induction of black patterns: nymphs with more black patterns occurred at a higher density, but even under isolated conditions some nymphs developed intensive black patterns.