Vasculitis comprises a diverse group of disorders with varying clinical, histopathological, and immunofluorescence findings arising due to an array of underlying pathogenic mechanisms. These varying reactions are primarily a reflection of complex interplay of different cells, vessels, and stroma. There are several controversies and differences of opinions in the diagnostic criteria, classifications, and terminologies. This article deals with different concepts and controversies in the subject, and also attempts to provide an algorithmic approach for the histopathological diagnosis.

Objective: Women with diffuse hair loss need to be screened for possible causes or factors responsible for increased hair shedding and also to exclude factors that can increase hair shedding and aggravate the disease. Material and Methods: A prospective cross-sectional study of 40 cases (18–45years) of diffuse hair loss and 40 healthy females were included. The diagnosis was based on the detailed history, clinical examination to rule out pattern hair loss, and hair pull test. Complete hemogram, serum ferritin, vitamin D, and thyroid function tests (T3, T4, thyroid-stimulating hormone [TSH]) along with all routine investigations were determined for each participant. A diet history of vegetarians and non-vegetarians was also taken. Results: On screening, serum ferritin in cases ranged from 3.92 to 104 ng/mL with a mean of 22.36±23.10 ng/mL and that in controls ranged from 5.5 to115 ng/mL with a mean of 29.97±45.72 ng/mL. The serum ferritin level in cases was lower, at a cut-off value of 10 ng/mL, which is statistically significant (p= 0.027). For those with serum ferritin level >10 ng/mL, the mean concentration of hemoglobin was 11.65 ± 0.79 gm%, whereas for the <10 ng/mL serum ferritin level, the mean concentration of hemoglobin was 11 ± 1.1 gm% with a significant statistical difference (p= 0.027). The serum level of vitamin D in cases ranged from 8 to 57.4 IU/dL with a mean of 20.24±11.98 IU/dL while that in controls ranged from 11.1 to 42.6 IU/dL with a mean of 22.42±9.29 IU/dL, which was statistically significant difference (p= 0.003). We found no association of thyroid dysfunction with diffuse hair loss. On dietary evaluation, significant statistical association among vegetarians (67.5% cases and 40% controls) and non-vegetarians (32.5% cases and 60% controls) was observed (p= 0.024); however, we could not find any statistical significant association of diet with ferritin and vitamin D. Conclusion: Low ferritin and vitamin D may contribute to diffuse hair loss.

Rosai–Dorfman’s disease (RDD) is sinus histiocytosis with massive lymphadenopathy. Cutaneous RDD is a rare entity that presents with isolated skin involvement without any systemic involvement. We report a 35-year-old man with an asymptomatic large nodule on the preauricular region of the face with an irregular surface and multiple yellow studded nodules. On detailed physical and systemic examination, there was no lymph node or systemic involvement. Skin biopsy on histopathology showed dense dermal inflammatory infiltrate and foamy histiocytes with emperipolesis. Immunohistochemical markers were positive for S100 protein and CD68 protein but negative for CD1a. Thus, a diagnosis of cutaneous RDD was made.

Porokeratotic adnexal ostial nevus is a rare nevoid condition, with a characteristic histological feature of coronoid lamella involving the acrosyringium and the hair follicle. Here we report a case of an 11-year-old female child presented with multiple hyperpigmented and hyperkeratotic papules present over the posterior aspect of right lower extremities along Blaschko’s lines.

Plexiform schwannoma (PS) is a rare benign encapsulated peripheral nerve sheath tumor characterized by a plexiform pattern of intraneural growth often with a multinodular appearance. It usually presents as a solitary mass with a strong predilection for young adults between 20 and 50 years. Despite its common presentation in the head and neck region, involvement of the lip is extremely rare. Multiple cutaneous PSs are commonly associated with Neurofibromatosis type 2 or Schwannomatosis. To date, only a few cases of PS involving the lip have been reported. Here in we report another unusual case of PS involving the angle of mouth which was removed completely by surgical excision without any recurrence seen at 1-year post-surgery.

Graham-Little-Piccardi-Lassueur syndrome is a rare variant of lichen planopilaris. It is characterized by multifocal, patchy, cicatricial alopecia of the scalp, noncicatricial alopecia of axilla and pubic region, and keratotic follicular papules involving the trunk and extremities. Trichoscopy shows perifollicular erythema, tubular perifollicular scales, fibrotic white dots, and hair casts along the hair shafts. We are reporting this rare syndrome in a 26-year-old pregnant woman with concomitant oral lichen planus and lichen planus pigmentosus. This case is unique as no previous report of coexistence of these variants of lichen planus has been published.

Nail examination is an important aspect of a wholistic dermatological examination, which when overlooked leads to missing out on important and interesting relevant findings. We observed one such typical interesting finding in a patient who presented to the out patient department with characteristic nail changes suggestive of habit tic type of onychotillomania as an incidental finding. Further, dermoscopy of the affected nails showed characteristic features of the same.

Dermatofibroma is one of the most common dermal dermatologic tumors. In its classic variant, a dermatofibroma is easily recognized by dermatologists; however, studies have identified numerous variants of the dermatofibroma that do not present with a classic clinical picture. Aneurysmal fibrous histiocytoma, one of these variants, is not easily recognized because of its rarity and potentially malignant appearance. Microscopically, aneurysmal fibrous histiocytoma displays some similarities to a classic dermatofibroma along with distinguishing characteristics, such as blood-filled pseudovascular spaces. Aneurysmal fibrous histiocytoma is a benign lesion with a risk for recurrence if not adequately excised. In this case, we present this rare histological variant of dermatofibroma that stimulates clinically other malignant lesions.

Lichen nitidus (LN) is a relatively uncommon chronic cutaneous lichenoid group of disease characterized by tiny quintessentially discrete hypopigmented to skin coloured papules commonly seen over dorsa of hands/forearms, lower abdomen, penis, and buttocks. The cutaneous manifestation of a disease on palms/soles varies from their presentation on body, which makes it difficult to diagnose at times. A 23-year-old healthy female presented with mildly itchy lesions on bilateral wrist, fingers, elbows, peri-umbilical area, and left palm since 6 months. On dermoscopy, we could appreciate the classical described findings of LN which were confirmed on histopathology. LN has a characteristic dermoscopic features, which come to rescue for diagnosis and also avoid a biopsy. We describe a rare presentation of palmar LN with two different morphologies along with classical cutaneous distribution of LN and their dermoscopy.