Background: Hair and scalp disorders cause significant morbidity, warranting an early diagnosis and treatment. Trichoscopy has shown great promise in the diagnosis and assessment of these disorders. Aims: The aim of this study was to determine the trichoscopic findings in cases of alopecia and scalp disorders and to determine their statistical significance. Materials and Methods: This was a case–control study in which trichoscopy using a hand-held dermoscope was done in 605 patients and 200 controls. Results: The trichoscopic findings that showed statistical significance in 405 alopecia cases when compared with controls were broken hair, exclamation hair, black dots, yellow dots, vellus hair and pigtail hair in alopecia areata, hair diameter variability, single hair predominance, brown and white peripilar sign in androgenetic alopecia, corkscrew hair, comma hair, morse-code hair and interfollicular scale in tinea capitis, and white dots and peripilar erythema in primary cicatricial alopecia. The findings which had a statistical relevance among scalp disorders included light red background, dots and globules and dermoscopic Auspitz’s sign for psoriasis, dark red background and arborizing vessels for eczemas and yellowish background for verrucae, comedo-like openings, milia-like cysts and moth-eaten borders for seborrheic keratosis, and viable nits for pediculosis capitis. Conclusion: Our study documented many trichoscopic features which were statistically significant among cases of alopecia and scalp disorders when compared with controls. Limitations: Histopathological confirmation of diagnosis was not done in most of the cases. The patients were not subjected to follow-up trichoscopy after treatment.

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The diagnosis of skin cancers in the past was based on a visual inspection of the lesion, with the confirmation of doubtful lesions by a histopathological examination of the skin biopsy. Clinical examination alone, as the basis for undergoing skin biopsy of the lesion, may result in misdiagnosis in some cases, resulting in the mismanagement of lesions with malignant potential or unnecessary evaluation when a doubtful lesion is suspected. The development of dermoscopy as a noninvasive in vivo tool in the diagnosis of skin lesions has the potential to improve diagnosis as well as aid in early and more accurate identification of skin cancers as compared with the unaided eye. Dermoscopy has also gained increased interest in the management of skin cancers by regular dermoscopic examination on follow-ups to decide further course of management. When detected early, skin cancers can be cured by simple procedures or techniques; however, as the disease advances, it becomes more difficult to treat. This article reviews the role of dermoscopy in the diagnosis of commonly encountered primary skin cancers in skin of color.

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Background: Dystrophic nails represent an alteration in nail morphology that can occur due to various disorders. Although KOH is used commonly in the diagnosis, the sensitivity and specificity of KOH are less. Chicago sky blue (CSB) stain when used with KOH provides color contrast, to aid the detection of fungal elements, and is a simple and inexpensive method. Materials and Methods: Nail scrapings from the surface and subungual areas and nail clippings were examined with 40% KOH, CSB stain, and also subjected to fungal culture. Results: The detection rate of fungal elements in dystrophic nails in our hospital-based study was 46.5%. The sensitivity of KOH was 36.36% and CSB staining was 66.6% using fungal culture as a gold standard. Conclusion: CSB stain serves as a useful, simple, and rapid method for detecting the presence of fungal elements.

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Background: Dermatophyte infections (DI) mimic a wide range of inflammatory diseases clinically and hyphae often play hide and seek on microscopy. Pathologists encounter biopsies with no clinical suspicion. In such instances, we need to recognize clues that point to the diagnosis. Aim: This study aims to describe the histopathologic patterns in DI. Materials and Methods: A total of 20 cases of DI were reviewed for various epidermal and dermal patterns. Results: Altered pattern of cornification was seen in all 20 cases (100%), the commonest being parakeratosis (75%), often in small mounds (55%), followed by compact orthokeratosis (50%). Neutrophils (65%) and crusting (55%) were seen, with sandwich sign noted in 65% cases. The reaction pattern most commonly seen was spongiosis (50%). Pustules were rare (20%). Mild superficial perivascular lymphocytic infiltrate (45%) was the commonest dermal pattern. Neutrophils (45%) and eosinophils (25%) were less frequent. Fungal hyphae were identified either within the zone of compact orthokeratosis (55%) or at the junction between two different patterns of cornification (45%). The limitations of this study are relatively small number of cases studied and lack of correlation with fungal culture, as they were not done in 90% of patients due to lack of clinical suspicion. Conclusion: Histopathologic patterns in DI are most often subtle, in the form of small mounds of parakeratosis and mild superficial perivascular dermal infiltrate, which overlap with several other skin diseases. Neutrophils and sandwich sign are not seen in almost half the cases. A careful search for fungi together with periodic acid–Schiff stain is mandatory whenever altered cornification is seen. Investigations such as potassium hydroxide preparation and cultures are not done unless there is clinical suspicion, which is absent in majority of the cases. Histopathology offers the only opportunity to establish a diagnosis in this easily curable condition.

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Immunoglobulin A (IgA) pemphigus is a group of autoimmune intraepidermal blistering diseases presenting with vesiculopustular eruptions, neutrophilic infiltration of the skin, and in vivo bound and circulating IgA autoantibodies against the cell surface of keratinocytes. It usually occurs in middle-aged or elderly persons. We report a case of childhood IgA pemphigus in a 5-year-old male child, with direct immunofluorescence confirmation, which is an uncommon occurrence.

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Nuchal fibroma is a benign tumor-like proliferation which presents as asymptomatic, slow-growing solitary swelling located in the lower back and the neck with microscopic findings of collagen fibers and entrapped adnexae. It occurs more frequently in males between 25 and 60 years. It is associated with diabetes mellitus, Gardner’s syndrome, and trauma. Histopathological examination and differentiation of nuchal fibroma from other soft tissue tumors over the posterior neck are essential for the accurate diagnosis. Complete excision and follow-up are necessary for proper management. We report a rare case of nuchal fibroma presenting as posterior neck swelling in a 58-year-old diabetic patient.

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