Exogenous pigmentation due to arthropods or coloring agents/dyes may be mistaken for melanocytic lesions. Dermoscopy is a useful tool for the evaluation of pigmented lesions. We discuss the dermoscopic and histopathological features in a case of pigmented spots mimicking lentigines caused by burrowing bug and review the pertinent literature on exogenous pigmentation.

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“Interface dermatoses” are defined as inflammatory dermatoses primarily affecting the interface elements along the dermoepidermal junction, resulting in epidermal basal cell damage. This epidermal basal cell damage can be of two forms: vacuolar/hydropic degeneration and filamentous degeneration (resulting in Civatte bodies). This may be associated with a range of secondary epidermal (atrophy to hypertrophy) and dermal changes (varying from simple effacement of the rete ridges to the diffuse dermal fibrosis/sclerosis). With so many variables, “Interface dermatitis” per se is not a diagnosis by itself but simply a reaction pattern, similar to “psoriasiform dermatitis” or “spongiotic dermatitis.” One should never use these terms as the final sign out diagnosis in reports, though in difficult cases one may allude to the reaction pattern and discuss the possible differentials. This article analyzes and discusses in detail, the basic pathogenesis behind the primary/secondary features associated with interface dermatoses and the steps involved in their histopathological evaluation; thorough knowledge of which may help one arrive at a specific diagnosis.

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Primary cutaneous amyloidosis (PCA) is the deposition of amyloid proteins in the skin without systemic involvement. Amyloidosis cutis dyschromica (ACD) is a rare variant of PCA with onset typically in early childhood or at a prepubertal age. It is more common in the Asian and Southeast Asian people. Clinically it manifests as asymptomatic diffuse hyperpigmentation interspersed with hypopigmented spots without papulation. Histologically, small foci of amyloid closely under the epidermis are seen. There are only few case reports in the literature of this rarer variant. We report a case of a 32-year-old male presenting as dyschromatosis with a prepubertal onset and histopathological evidence of intradermal deposits in the upper dermis which was confirmed on Congo red staining and hence was diagnosed as a case of ACD.

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Granuloma annulare (GA) is a common benign inflammatory dermatosis of unknown cause. The subcutaneous form of GA also known as pseudorheumatoid nodule is a relatively uncommon entity, more so in the adult age. We came across a middle-aged female with multiple or disseminated lesions of subcutaneous GA located at an unusual location such as the volar aspect of palms beside the relatively common sites such as elbow and forearm.

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Epithelioid angiosarcoma (AS) is a rare vascular tumor affecting more commonly men in their seventh decade. We are reporting a case of epithelioid AS affecting a male patient in his third decade. He presented with a well-defined ulcerated plaque with an elevated border on the scalp. Histopathology showed sheets of epithelioid cells infiltrating the dermis, formation of slit-like vascular spaces, and cellular atypia. Immunohistochemistry showed positive CD31, D2-40, and FLI-1 and negative cytokeratin and epithelial membrane antigen. With these findings, a diagnosis of epithelioid AS was made. This case highlights the rare occurrence of this condition in younger age group.

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Glomangioma, currently termed as glomuvenous malformation, is a rare type of venous malformation (VM) with a rim of glomus cells around the dilated vessels. This glomus cell lesion is not usually as painful as solid glomus tumor. Rarely, thrombus may be seen in the vessels like other VMs. A male with adult-onset extradigital glomangioma presented with a painful nodule with thrombus seen on histopathology. The thrombus was responsible for the tenderness of the lesion, and its presence confirms it to be a malformation than a tumor.

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Background: Granulomatous dermatoses of various types, etiologies, and clinical features frequently present with similar clinicopathological features which create a dilemma and diagnostic challenge for experts. Early diagnosis of facial lesions is of prime concern due to potential social stigma and psychological stress because of cosmetic disfigurement. Objective: To study the epidemiological and clinicopathological features of various granulomatous facial skin lesions and their concordance rate. Materials and Methods: A retrospective, hospital-based study was carried out at the Department of Dermatology, College of Medical Sciences, Bharatpur, over a period of 5 years (January 2013–January 2018). All clinically suspected cases of facial granulomatous dermatoses were included, their clinical and histological findings were recorded and analyzed according to the standard protocol, and a clinicopathological correlation was ascertained. Results: Among 850 skin biopsies performed during the study, 30 cases were clinically suspected as facial granulomatous dermatoses. There was female predominance (n = 22, 73.33%), and the mean age of patients was 41.7 years. Majority of cases (n = 29, 96.66%) were of infectious origin with leprosy as predominant cause (n = 25, 83.33%), followed by cutaneous tuberculosis (n = 4, 13.33%). Histologically, epithelioid cell granulomas (n = 26, 86.67%) and histiocytic granuloma (n = 3, 10%) were observed. Fite Faraco stain was positive in 6 (20%) cases of leprosy. An overall concordance rate of 80% was observed in facial granulomatous dermatoses in our study. Conclusion: In our study, infectious etiology is the most common cause of facial granulomatous dermatoses. Among infections, leprosy is the most common.

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Background: Pemphigus vulgaris (PV) is an autoimmune bullous disease involving both the skin and mucus membranes. Infiltrating CD4+ and CD8+ T-lymphocytes may have a vital role in its pathogenesis. The autoimmune bullous skin disorder intensity score (ABSIS) was proposed for clinical evaluation and scoring of PV patients. Aims and Objectives: This work aimed to assess the role of CD4+ and CD8+ T-lymphocytes in the pathogenesis of PV and the correlation between number of T-lymphocytes infiltrate and clinical severity of the disease evaluated by ABSIS. Patients and Methods: Forty PV patients (patient group) and 10 healthy volunteers (control group) were enrolled. All patients were scored by ABSIS. Immunohistochemical staining was performed on skin biopsies for IgG, IgA, CD8, and CD4. Results: IgG was positive in 97.5% of patients, combined IgG and IgA were positive in 20% of patients, and only one case was negative for both antibodies. Thirty-three cases showed the predominance of CD4+ T cells, and seven cases showed predominance of CD8+ T cells. CD4/CD8 ratio was 2.578. Non-significant positive correlation was found between the total count of lymphocytic infiltrate and ABSIS. Conclusion: CD4+ and CD8+ T-lymphocytes share in the pathogenesis of PV and CD4+ are more expressed than CD8+ in the inflammatory infiltrate of PV lesions. The correlation between total lymphocytic count and ABSIS score may help to predict the clinical state of the patient from skin biopsy, and ABSIS score can predict the lymphocytic infiltration in PV cases. This correlation is in need to be reapplied on larger scales of patients to confirm its validity and reliability.

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Cutaneous lymphoid infiltration is common histology seen in the day-to-day practice of dermatopathology. The reasons for this infiltration can range from a spontaneously remitting pseudolymphoma such as Jessner's infiltration to a sinister and aggressive cytotoxic T-cell lymphoma. Before analyzing the slide, the clinical perspective needs to be borne in mind as a diagnosis can never be made in isolation, especially in dermatopathology. In this article, we discuss in brief the various common cutaneous lymphoid infiltrative entities encountered in routine practice, discuss the differentiating features, and suggest an algorithmic approach to arrive at the possible diagnosis.

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