Dirty Papules and Plaques in Skin of Color: New Observations by Dermoscopic Dissection

Context

Confluent reticulated papillomatosis (CRP), terra-firme-forme-dermatitis (TFFD), and dermatitis neglecta (DN) are the benign, acquired conditions that present with dirty-looking hyperpigmented and hyperkeratosis lesions on neck, back, and truncal areas. They pose difficulty in diagnosis because of their clinical similarities and thereby in treatment approaches. Bedside test and histopathology is helpful in the diagnosis. Dermoscopy is utilized as an evidence-based diagnostic method.

Aims

To evaluate and to compare the dermoscopic patterns among CRP, TFFD, and DN and to correlate them in terms of histopathological features.

Materials and Methods

It was a cross-sectional observational study with a total of 62 patients, among whom 30 were CRP, 20 had TFFD, and 12 were diagnosed as DN. Clinical and dermoscopic evaluation was done in all patients, and histopathology was carried out in selective cases to confirm the diagnosis.

Results

Global view of dermoscopy in CRP revealed a cerebriform pattern. The arrangement of pigment globules was characteristic in CRP, TFFD, and DN, giving a "cobblestone," "mosaic," and "cornflake-like" appearance, respectively. The color of the pigment globules was strikingly significant. Yellow globules were predominant in CRP and TFFD, having p values of 0.001 and 0.004, respectively. Scales were conspicuously present in CRP, with a statistically significant p value of 0.003. Focal white areas and hair changes were observed in CRP alone, whereas black dots were found only in TFFD.

Conclusion

Dermoscopy acts as an in vivo and a noninvasive, rapid technique in the diagnosis of clinically look-alike conditions. It demonstrates characteristic features in CRP, TFFD, and DN. Thus, it is an evidence-based diagnostic method that assists the treating physician in daily clinical practice.

Implications of dermoscopy and histopathological correlation in discoid lupus erythematosus in skin of color

Background:

Discoid lupus erythematosus (DLE) is chronic dermatosis manifests as scaly indurated plaques with erythema and peripheral hyperpigmentation. Few cases progress to systemic lupus erythematosus. Differentials include lichenoid photo dermatitis, Jessner's lymphocytic infilterate, and polymorphus light eruptions. It is difficult to assess the activity clinically. Histopathology is characteristic and evaluation of disease activity is possible. Dermoscopy is a useful diagnostic method in many dermatoses. Dermoscopy is reflection of histological changes. Hence, dermoscopic features may act as a tool for activity assessment. Here authors have pursued dermoscopic and histopathological correlation in DLE lesions to assess the activity of disease.

Aims:

To study dermoscopic features in DLE and correlate the patterns with histopathological changes in skin of color.

Method:

This study was conducted in a tertiary hospital. Clinically suspected and histopathologically proven lesions of DLE were enrolled in this study. The target lesion was marked and sent for biopsy after performing dermoscopy. Activity of the lesion was assessed on the basis of histopathological features. SPSS statistics for windows v20.0 (SPSS Inc, Chicago, USA) was used to analyze data. Chi-square and Fisher's χ² test was used to statistically signify association. Cohen's kappa coefficient was used to determine the agreement.

Results:

Study included 110 patients with Fitzpatrick skin type IV-V having 120 lesions. Follicular keratotic plug [73 (60.8%)] and peri-follicular whitish halo [65(54.1%)] were commonly found in dermoscopy. Blue-gray and brown dots, telangiectasia, follicular red dots, white rosettes and white areas include other features. Interface dermatitis, peri-appendageal infilterate, melanin incontinence, melanophages and fibrosis were noted in histopathology. Perfect agreement was observed in follicular plugs.

Conclusion:

Dermoscopy patterns were well correlated with histopathological changes. Thus dermoscopy played an important role in assessing the activity of lesion.

Spatial changes of estuary in Ernakulam district, Southern India for last seven decades, using multi-temporal satellite data

The study area, located in the western side of Kerala State, South India, is a part of Vembanad-Kol wetlands - the largest estuary in India's western coastal wetland system and one of the Ramsar Sites of Kerala. Major portion of this estuary comes under the Ernakulam district which includes the Cochin City - the business and Industrial hub of Kerala, which has seen fast urbanization since independence (1947). Recently, this region is subjected to a characteristic fast urban sprawl, whereas, the estuarine zone is subjected to tremendous land use/land cover changes (LULC). Periodic monitoring of the estuary is essential for the formulation of viable management options for the sustainable utilization of this vital environmental resource. Remote sensing coupled with GIS applications has proved to be a useful tool in monitoring wetland changes. In the present study, the changes this estuarine region have undergone from 1944 to 2009 have been monitored with the help of multi-temporal satellite data. Estuarine areas were mapped with the help of Landsat MSS (1973), Landsat ETM (1990) and IRS LISS-III (1998 and 2009) using visual interpretation and digitization techniques in ArcGIS 9.3 Environment. The study shows a progressive decrease in the estuarine area, the reasons of which are identified chronologically.