Background: Vitiligo is the most prevalent pigmentary disorder occurring worldwide. In most cases, the diagnosis is made by clinical examination alone. The disease status (active/stable) needs to be assessed to make appropriate therapeutic decisions. Objective: The aim of the present study was to evaluate the histopathological and immunohistochemical features in active and stable lesions. Materials and Methods: Biopsies from vitiliginous areas from 50 patients (25 each of clinically active and stable vitiligo); with hematoxylin and eosin, Masson Fontana (MF), S-100, and human melanoma black-45 (HMB-45) stained sections were studied. Results: Age of the patients ranged from 7 to 69 years (mean age: 33.6 ± 15.73 years). Of 50 patients, 27 (54%) were male and 23 (46%) were female. All the cases showed variable degree of basal hypopigmentation. Histopathological findings, epidermal spongiosis, basal vacuolar degeneration, dermal melanophages, and dermal lymphomononuclear cells were commonly observed in active lesions as compared to the stable ones. On MF staining, 23/25 cases (92%) of active vitiligo showed complete loss of basal melanin. Quantitative analysis of HMB-45 immunostaining in stable and active vitiligo revealed mean number of positive melanocytes as 2.52 ± 1.0/high power field (hpf) and 0.08 ± 0.28/hpf, respectively, while on S-100 immunostaining the mean values of positive Langerhans cells were 1.70 ± 0.38/hpf and 7.78 ± 4.11/hpf, respectively. Conclusion: The demonstration of overall reduction in the number of HMB-45-positive melanocytes and increase in S-100-positive Langerhans dendritic cells in the active vitiligo lesions is facilitated by immunohistochemistry. The technique is of immense help in differentiating active and stable stages of vitiligo, thus guiding therapy.

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Porokeratosis (PK) is an uncommon disorder of keratinization that presents with keratotic papules or annular plaques that expand centrifugally with a thread-like elevated border. Genital involvement in PK is a rare occurrence even in disseminated forms. We encountered two patients who had PK primarily affecting the genital area. Both cases were males out of which one case had involvement of the scrotum and thigh and other case had only scrotal involvement. The cases were difficult to diagnose clinically, but dermoscopy was helpful and was further confirmed on histopathology.

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Background: Wnt genes code for a family of secreted, lipid-modified glycoproteins. Wnt5a has important functions in cell proliferation, fate determination, and differentiation. Dysregulation of Wnt5a signaling implicated in multiple disease. Aim of Work: The aim is to elucidate the possible role of Wnt5a in pathogenesis of papulosquamous skin disorders through the evaluation of its expression immunohistochemically. Patients and Methods: This study included 80 patients with various papulosquamous diseases (psoriasis, lichen planus, ptyriasis rosea, and ptyriasis rubra pilaris), in addition to 20 healthy controls served as control. Punch skin biopsies were taken from all individuals for immunohistochemical staining with Wnt5a. Results: There was a highly statistically significant upregulation in Wnt5a expression in all stained skin specimens of the studied papulosquamous diseases in both epidermis and dermal lymphocytes compared to normal control. Conclusion: The upregulated expression of Wnt5a indicated its involvement in pathogenesis of papulosquamous diseases. Wnt5a and/or its receptor can be a challenging target for therapeutic intervention. Regular follow-up for these patients is recommended as Wnt5a also may be involved in their malignant transformation.

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Verruciform xanthoma (VX) is an uncommon benign lesion that can affect oral, genital mucosa, and rarely skin. The characteristic foam cells seen in papillary dermis are a hallmark for diagnosing this entity. A 42-year-old male, tobacco-chewer presented with asymptomatic white-circular plaques on the bilateral buccal mucosa and yellow papules on retromolar area which on histopathological evaluation showed parakeratotic epithelium with surface and deep invagination of columns of parakeratosis throughout the hyperplastic epidermis, few neutrophils in upper spinous layers, and uniform elongation of rete ridges. The rete ridges showed numerous lipid-laden CD 68-positive foam cells. Punch excision coupled with cryotherapy was done, which resulted in the complete resolution of lesions. We publish this uncommon benign entity for increased awareness among physicians to consider it as a differential of verrucous lesion in the mucosa. Our patient had two different morphology of lesions, both suggestive of VX with characteristic foam cells on histopathology.

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Benign fibrous histiocytomas of soft tissue are composed of spindled fibroblasts admixed with secondary elements including histiocytes, foam cells, and inflammatory cells. These tumors occur equally in males and females and most often arise in the dermis and subcutaneous tissues. We report a rare case of benign fibrous histiocytic tumor of the palate with histologic features and immunohistochemical characteristics.

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Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vascular tumor which presents as a dermal papule or a nodule over the head-and-neck region. Histopathologically, there is vascular proliferation in the upper dermis and diffuse lymphocytic infiltrate with eosinophilia. Kimura's disease is the closest differential of ALHE, which presents as subcutaneous nodules. We report a case of ALHE presenting with a violaceous papule overlying a subcutaneous nodule, histopathologically; both lesions were diagnosed as ALHE.

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Acrokeratoelastoidosis (AKE), first described by Costa in 1953, is characterized by small, firm, keratotic papules with central umbilication along the borders of the hands and feet. It is a type of palmoplantar marginal papular keratoderma and needs to be differentiated from other marginal papular keratodermas. AKE can be inherited or sporadic, with predisposing factors being excessive sun exposure, hyperhidrosis, and repetitive trauma. We here describe a case of AKE in a leprosy patient with probably secondary to repetitive chronic trauma due to loss of sensory function.

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