BACKGROUND:Melasma, an acquired hyperpigmentation disorder, affects individuals of all ethnicities. Its multifactorial aetiology, high recurrence rates and psychosocial impact complicate management and necessitate comprehensive, evidence-based recommendations. OBJECTIVES:The objective was to develop an international consensus on the diagnosis and management of melasma by synthesizing expert opinions and the latest scientific evidence. METHODS:This consensus was developed using a modified Delphi approach. A core group of two senior dermatologists who were experts in pigmentary disorders guided the process, and a diverse panel of 38 dermatologists with a special interest in pigmentary disorders from 11 countries (Australia, Brazil, France, India, Italy, Mexico, Philippines, South Africa, South Korea, Taiwan and the USA) participated in three rounds of surveys and discussions, under the aegis of the Pigmentary Disorders Society (PDS). A literature search of articles published between 2014 and 2024 identified key studies that were graded using the Oxford levels of evidence (2009). Consensus statements were drafted, refined and finalized based on expert feedback. Responses were assessed using a 5-point Likert scale, with predefined thresholds for high (≥75%), moderate (55%-74%) and low (<55%) agreement. RESULTS:The consensus development process started with 34 statements, and at the end of the third round of the Delphi process, 21, 4 and 1 statement reached high, moderate and low consensus, respectively. Key recommendations highlighted photoprotection with broad-spectrum sunscreens as essential, regulated and supervised use of hydroquinone-based triple combination creams as the gold standard, and alternatives such as topical azelaic acid, kojic acid and oral tranexamic acid. Adjunctive procedural therapies, such as chemical peels and microneedling, were suggested to enhance topical efficacy, while lasers were reserved for refractory cases. CONCLUSIONS:These recommendations aim to improve the outcomes of melasma patients globally by integrating expert opinion and evidence-based strategies. Future research should focus on evaluating emerging therapies and optimizing long-term maintenance strategies.

BACKGROUND:Facial dyschromias (FD) are common among individuals with skin of color. At present, information on the pattern and dermoscopic features of various FD is scarce from South India. OBJECTIVE:To describe the clinical and dermoscopic features of FD in patients presenting to a tertiary healthcare center in South India. PATIENTS AND METHODS:Clinical and dermoscopic examination was performed in 274 patients presenting with FD in the outpatient department of a tertiary healthcare center in South India. RESULTS:Disorders of facial hyperpigmentation (90.87%) were more commonly encountered than facial hypopigmentation (7.66%); four patients presented with both hyperpigmentation and hypopigmentation (1.46%). Females (76.27%) were more commonly affected than males (23.72%), and most of the patients belonged to the young to middle-aged groups. The common causes of facial hyperpigmentation include melasma, lichen planus pigmentosus, facial acanthosis nigricans, maturational dyschromia, and post-inflammatory hyperpigmentation. The common causes of facial hypopigmentation include tinea versicolor, seborrheic dermatitis, vitiligo, salt and pepper pigmentation, and nevus depigmentosus. Each of these conditions had distinct dermoscopic features, which aided in the diagnosis. LIMITATIONS:Histopathological examination was done in a limited number of cases, being a cross-sectional study, and no follow-up was conducted to observe the evolution of facial pigmentation. CONCLUSION:Nearly 90% of FD are hyperpigmentary in nature. The common causes of facial hyperpigmentation include melasma, lichen planus pigmentosus, facial acanthosis nigricans, maturational dyschromia, and post-inflammatory hyperpigmentation. In contrast, tinea versicolor, seborrheic dermatitis, and vitiligo are three common causes of hypopigmentation of the face.

Cosmetic dermatology is being rapidly reshaped by the digital age, where filtered images, artificial intelligence (AI)-enhanced beauty standards, and social media-driven trends dominate patient expectations. While technological advances such as AI-powered skincare, virtual consultations, and augmented reality previews offer opportunities for personalized care, they also introduce ethical dilemmas related to misinformation, unrealistic goals, and psychological vulnerability. Patients increasingly seek procedures influenced by influencer esthetics and homogenized ideals, often without understanding the risks or limitations. This trend is particularly concerning for individuals with skin of color, who may be disproportionately affected by global beauty norms and algorithmic bias. Dermatologists today must act not only as clinicians but also as educators and gatekeepers. They are tasked with addressing body image concerns, screening for body dysmorphic disorder, and providing ethically sound, evidence-based guidance. Digital marketing practices, especially the use of patient images, further complicate issues around consent and representation. Meanwhile, most commercial AI-based cosmetic tools lack transparency, diverse training datasets, and clinical validation, raising concerns about bias, privacy, and the promotion of unnecessary treatments. To navigate this evolving landscape, dermatologists must uphold patient-centered care, foster informed consent, and critically evaluate emerging technologies. As the cosmetic field becomes increasingly digitized, the imperative remains clear: Innovation must be tempered by ethics, inclusivity, and a deep commitment to the patient’s well-being.

Background:Trichomycosis axillaris (TA) is the most common superficial bacterial infection of hair shaft, mainly of axillary hairs and producing pigmented concretions around hair shaft caused by various species of corynebacteria. Aims and Objectives:To study the clinical characteristics, Wood's lamp findings, dermoscopic features, microbiological and histopathological aspects of TA, and frequency of the corynebacterial triad. Patients and Methods:A descriptive cross-sectional study of 78 patients diagnosed with TA was done in a tertiary care center in South India from July 2021 to December 2022. Results:The mean age was 29 years. Among 78 patients, 94.8% (74) were males. Nineteen (47.5%) patients were asymptomatic, and others had malodor, staining of clothes, and itching. The flava variant was the most common [96.15% (75 patients)] with yellow fluorescence in 96.15% (75 patients) on Wood's lamp. The brown variant, seen in 3.85% (3 patients), had no fluorescence. On histopathological staining with hematoxylin and eosin, Gram's, Periodic Acid-Schiff, Alcian Blue-Periodic Acid-Schiff, and Hales colloidal iron, all stained bacilli except Hale's colloidal iron. Bacteriological culture was positive in only 34 (43.59%) cases; 29 (85.29%) grew a single organism, and five (14.71%) grew two organisms. The majority, 64.71% (22 samples), grew diphtheroids, and 41.17% (14 samples) grew Staphylococcus. Four (5.13%) patients had corynebacterial triad. Limitations:Cross-sectional study, small sample size, and poor culture yield. Conclusion:TA involves young males from rural areas, commonly in summer. The flava variant is the most common. No distinct species of bacteria (diphtheroids and staphylococci) could be related to its cause.

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.

International Journal of DermatologyEarly View Clinical Correspondence Facial ulceration in a patient with lepromatous leprosy Arun Somasundaram, Arun Somasundaram orcid.org/0009-0009-2798-3573 Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaSearch for more papers by this authorAravind Sivakumar, Aravind Sivakumar orcid.org/0000-0002-1477-677X Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaSearch for more papers by this authorArun P. Arulnathan, Arun P. Arulnathan Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaSearch for more papers by this authorBheemanathi H. Srinivas, Bheemanathi H. Srinivas Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaSearch for more papers by this authorDevinder M. Thappa, Corresponding Author Devinder M. Thappa [email protected] orcid.org/0000-0003-2207-8848 Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaSearch for more papers by this author Arun Somasundaram, Arun Somasundaram orcid.org/0009-0009-2798-3573 Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaSearch for more papers by this authorAravind Sivakumar, Aravind Sivakumar orcid.org/0000-0002-1477-677X Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaSearch for more papers by this authorArun P. Arulnathan, Arun P. Arulnathan Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaSearch for more papers by this authorBheemanathi H. Srinivas, Bheemanathi H. Srinivas Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaSearch for more papers by this authorDevinder M. Thappa, Corresponding Author Devinder M. Thappa [email protected] orcid.org/0000-0003-2207-8848 Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaSearch for more papers by this author First published: 15 May 2024 https://doi.org/10.1111/ijd.17233 Conflict of interest: None. Funding source: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Sakral A, Dogra N, Dogra D, Sharma K. Clinical and epidemiological trends in childhood leprosy: a 20-year retrospective analysis from a tertiary care hospital in Jammu, North India. Indian J Dermatol Venereol Leprol. 2022; 88(6): 755–760. 10.25259/IJDVL_1326_20 PubMedGoogle Scholar 2Miyashiro D, Cardona C, Valente NYS, Avancini J, Benard G, Trindade MAB. Ulcers in leprosy patients, an unrecognized clinical manifestation: a report of 8 cases. BMC Infect Dis. 2019; 19(1): 1013. 10.1186/s12879-019-4639-2 CASPubMedGoogle Scholar 3Belgaumkumar VA, Chavan RB, Salunle AS, Chirame SS. De-novo ulceration-rare lazarine leprosy-like presentation of borderline lepromatous Hansen's disease. Indian J Lepr. 2018; 90(1): 69–73. Google Scholar 4Mushtaq S. Ulcerated cutaneous lesions in type 1 lepra reaction healing with morpheaform scarring: an unusual presentation. Int J Dermatol. 2023; 62(6): e350–e351. 10.1111/ijd.16586 CASPubMedWeb of Science®Google Scholar 5Gogate S, Khurana A, Ahuja A, Sardana K. Trans-epidermal extrusion of lepra bacilli from histoid lesions: a risk of continued transmission. Int J Dermatol. 2024; 63(4): 521–523. 10.1111/ijd.17035 PubMedGoogle Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Facial dyschromias are a common complaint among individuals with skin of color. Until the advent of dermoscopy, clinical examination and histopathology were used to arrive at a definitive diagnosis. Dermoscopy is an emerging tool used to diagnose various pigmentary conditions. It may be used to diagnose various facial dyschromias, including melasma, lichen planus pigmentosus, facial acanthosis nigricans, post-inflammatory pigmentation, maturational dyschromia, vitiligo, and salt and pepper pigmentation, to name a few. Some of these conditions show characteristic dermoscopic features, thereby obviating the need for a skin biopsy for confirmation of diagnosis. Dermoscopy is, therefore, a reliable, non-invasive tool which can be used to diagnose various facial dyschromias.

Pigmented purpuric dermatosis (PPD) is an acquired chronic relapsing skin condition. It is characterized by asymptomatic or itchy symmetric petechiae, macules, and red-brown patchy pigmentation. The most common age group is between 4th and 5th decades of life. The most common site is the lower limbs. It is divided into 6 types: Progressive pigmentary dermatosis (Schamberg disease, pigmented purpuric lichenoid dermatitis of Gougerot and Blum, purpura annularis telangiectodes (Majocchi purpura), lichen aureus, eczematid-like purpura of Doucas and Kapetanakis, and itching purpura). The dermoscopic features of PPD are well established. They include red dots and globules, coppery red pigmentation, brown patches, brown dots, red patches, linear vessels, annular/comma-like vessels, and lentigines-like reticular pigmentation. Main histopathological features include superficial perivascular lymphocytic and histiocytic infiltration with marked hemosiderin deposition and no leukocytoclastic vasculitis. As there is no standardized treatment, various methods with varying efficacy are employed. This article presents a dermoscopic and management perspective of PPD and reviews the current literature related to this entity.

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.