Dermoscopy of Infectious Dermatoses (Infectiouscopy) in Skin of Color—A Systematic Review by the International Dermoscopy Society “Imaging in Skin of Color” Task Force

Dermoscopy has been showed to facilitate the non-invasive recognition of several infectious disorders (infectiouscopy) thanks to the detection of peculiar clues. Although most of the knowledge on this topic comes from studies involving light-skinned patients, there is growing evidence about its use also in dark phototypes. This systematic literature review summarizes published data on dermoscopy of parasitic, bacterial, viral and fungal dermatoses (dermoscopic findings, used setting, pathological correlation, and level of evidence of studies) and provides a homogeneous terminology of reported dermoscopic features according to a standardized methodology. A total of 66 papers addressing 41 different dermatoses (14 bacterial, 5 viral, 11 fungal infections, and 11 parasitoses/bites and stings) and involving a total of 1096 instances were included in the analysis. The majority of them displayed a level of evidence of V (44 single case reports and 21 case series), with only 1 study showing a level of evidence of IV (case-control analysis). Moreover, our analysis also highlighted a high variability in the terminology used in the retrieved studies. Thus, although promising, further studies designed according to a systematic and standardized approach are needed for better characterization of dermoscopy of infectious skin infections

Dermoscopy of Hair and Scalp Disorders (Trichoscopy) in Skin of Color—A Systematic Review by the International Dermoscopy Society “Imaging in Skin of Color” Task Force

Hair and scalp disorders are of significant interest for physicians dealing with dark phototypes due to their prevalence and potential aesthetic impact resulting from a higher tendency for scarring. In order to facilitate their non-invasive diagnosis, several dermoscopic studies have been published, yet data are sparse and no systematic analysis of the literature has been performed so far. This systematic literature review summarizes published data on trichoscopy of hair and scalp diseases (trichoscopic findings, used setting, pathological correlation, and level of evidence of studies). A total of 60 papers addressing 19 different disorders (eight non-cicatricial alopecias, nine cicatricial alopecias, and two hair shaft disorders) were assessed, for a total of 2636 instances. They included one cross-sectional analysis, 20 case-control studies, 25 case-series, and 14 single case-reports, so the level of evidence was V and IV in 65% and 33% of cases, respectively, with only one study showing a level of evidence of III. Notably, although there is a considerable body of literature on trichoscopy of hair/scalp diseases, our review underlined that potentially significant variables (e.g., disease stage or hair texture) are often not taken into account in published analyses, with possible biases on trichoscopic patterns, especially when it comes to hair shaft changes. Further analyses considering all such issues are therefore needed

Dermoscopy of Cutaneous Neoplasms in Skin of Color – A Systematic Review by the International Dermoscopy Society “Imaging in Skin of Color” Task Force

Over the last few decades, dermoscopy has been showed to facilitate the non-invasive diagnosis of both benign and malignant skin tumors, yet literature data mainly comes from studies on light phototypes. However, there is growing evidence that skin neoplasms may benefit from dermoscopic assessment even for skin of color. This systematic literature review evaluated published data in dark-skinned patients (dermoscopic features, used setting, pathological correlation, and level of evidence of studies), also providing a standardized and homogeneous terminology for reported dermoscopic findings. A total of 20 articles describing 46 different tumors (four melanocytic neoplasms, eight keratinocytic tumors, 15 adnexal cutaneous neoplasms, seven vascular tumors, four connective tissue tumors, and eight cystic neoplasms/others) for a total of 1724 instances were included in the analysis. Most of them showed a level of evidence of V (12 single case reports and six case series), with only two studies featuring a level of evidence of IV (case-control analysis). Additionally, this review also underlined that some neoplasms and phototypes are underrepresented in published analyses as they included only small samples and mainly certain tones of “dark skin” spectrum (especially phototype IV). Therefore, further studies considering such limitations are required for a better characterization

Dermoscopy of Inflammatory Dermatoses (Inflammoscopy) in Skin of Color—A Systematic Review by the International Dermoscopy Society “Imaging in Skin of Color” Task Force

Dermoscopic patterns of inflammatory dermatoses (inflammoscopy) have been extensively studied in the recent years, though data on patients with darker phototypes (IV-VI) are sparse. The aims of this systematic review were to summarize the current state of knowledge on inflammoscopy applied to skin of color and provide a standardized nomenclature of reported findings. Besides dermoscopic features, type of setting and magnification, number of cases, and histopathological correlation were analyzed. Eighty-five papers addressing 76 different dermatoses (25 papulosquamous dermatoses, 19 hyperpigmented dermatoses, seven hypopigmented dermatoses, four granulomatous dermatoses, two sclerotic dermatoses, five facial inflammatory dermatoses, and 14 miscellaneous conditions) for a total of 2073 instances were retrieved. Only one study showed a level of evidence of III (cross-sectional study), whereas 10 and 74 displayed a level of evidence of IV (case-control studies) and V (case-series and case-reports), respectively. Moreover, our analysis also highlighted that most of papers focalized on a limited number of dermatoses, with several conditions having only single dermoscopic descriptions. Additionally, few studies compared findings among phototypes belonging to the “skin of color” spectrum. Further studies designed according to a systematic approach and considering the above-mentioned issues are therefore needed

Omalizumab for management of refractory urticaria: Experience of a tertiary care centre in Eastern India

Aim: To study the effects of omalizumab in chronic spontaneous urticaria in Indian patients. Setting and Design: The study was conducted in a tertiary care centre and it was retrospective and descriptive in nature. Material and Methods: We analysed the data of patients who were administered omalizumab between June 2014 and June 2015 for the management of refractory chronic spontaneous urticaria at our centre. Omalizumab was used in those patients who did not respond to updosing of antihistaminics and cyclosporine. Omalizumab was used in dose of 300 mg per month for 3 doses. Results: Twenty-four patients were administered omalizumab during the study period. Average age of the patients was 36.54 years, female:male ratio was 1.4:1, mean duration of disease was 20.66 months, and autologous serum skin test was positive in 33% of studied individuals. Ninety six percent of cases showed response to treatment in our study. Remission was seen in 25% of patients, 50% showed satisfactory response, and 20.83% showed partial response. Average UAS7 scoring before starting omalizumab in preceding week was 24.4. Average UAS7, 2 weeks after starting omalizumab was 4 in responsive patients. Conclusion: Omalizumab is safe and effective treatment for the management of chronic spontaneous urticaria. It can be used in Indian setting after failure to other third-line therapies such as addition of montelukast and cyclosporine due to high cost of treatment

A pilot study to evaluate effectiveness of botulinum toxin in treatment of androgenetic alopecia in males

Introduction: Androgenetic alopecia is a common form of alopecia with multifactorial etiology. Finasteride and minoxidil are approved by the FDA for the treatment of androgenetic alopecia. Balding scalp is believed to have relative microvascular insufficiency. Blood vessels in the scalp travel through the intramuscular plane. Intramuscular injection of botulinum toxin relaxes muscles and thereby increases blood flow in balding scalp. We conducted a pilot study to evaluate the efficacy of botulinum toxin in androgenetic alopecia management. Material and Methods: The study was conducted in a tertiary care center. A total of 10 male patients with androgenetic alopecia meeting inclusion criteria of the study were included. In the scalp, 30 sites were injected with 5 U of botulinum toxin in each site. Preprocedure photograph taken and evaluation was done, which was repeated after 24 weeks. Efficacy was assessed by photography and self-assessment scoring was done by patients. Results: Of 10 patients, 8 had good to excellent response on photographic assessment. At the end of 24 weeks, 1 patient showed poor and 1 showed fair response to treatment. As per self-assessment, 7of 10 patients showed good to excellent response. Two patients had fair response and 1 patient showed poor response to treatment. Conclusion: Botulinum toxin was found to be safe and effective therapy for the management of androgenetic alopecia in this pilot study. Studies with larger sample size and randomized controlled trials are required to establish the role of botulinum toxin in the management of androgenetic alopecia