Exogenous ochronosis is difficult to treat. Dermatologists should be able to differentiate it from melasma and immediately discontinue hydroquinone. Exogenous ochronosis has characteristic features on dermatoscopy which may obviate the need for an invasive procedure of biopsy for its diagnosis.

Loose anagen syndrome (LAS) is a benign, self-limiting condition where anagen hairs are easily and painlessly extracted. It is mainly reported in childhood; however, it may variably present in adulthood as well. The presence of anagen hair devoid of its sheath and with ‘floppy sock appearance’ is a characteristic feature of loose anagen hair (LAH) on trichogram. LAH can be seen in normal population and in alopecia areata. The percentage of LAH in LAS is more than 50%. The histopathological findings show clefting between the layers of hair and are very useful in differentiating LAS from alopecia areata. Here, a review on the diagnostic criteria and practical guidelines are discussed so as to enable the trichologist in managing this benign, self-limiting condition and differentiating it from the other causes of non-scarring alopecias.

Trigeminal trophic syndrome is a rare condition resulting from self-manipulation of the skin after a peripheral or central injury to the trigeminal system. The syndrome consists of a classic triad of anaesthesia, paraesthesia, and a secondary persistent or recurrent facial ulceration. We describe a 60 year-old woman who developed this syndrome as a sequel to the gasserian ganglion block for trigeminal neuralgia. She had also developed melasma within 1 year. A remarkable benefit was achieved by proper patient education and topical antibiotics which led to the healing of all ulcerations within 4 weeks. In the case reported here, the diagnosis of the trigeminal trophic syndrome was made primarily as a result of the physician's experience with the syndrome previously.

Background:Extensive alopecia areata includes alopecia universalis, alopecia totalis, ophiasis and patients having more than 50% scalp involvement. Alopecia universalis (AU) and totalis (AT) are considered to be resistant to single modalities of treatment. Our study highlights the efficacy and safety of combination therapy in extensive alopecia areata.Aim:To evaluate the efficacy and safety of a combination treatment with oral bethametasone mini-pulse, topical minoxidil and short contact anthralin in long-standing, treatment-resistant, extensive alopecia areata.Materials and Methods:Fifteen patients aged 7 to 45 years with extensive, treatment-resistant alopecia areata (AU: 7; AT: 1; ophiasis: 4; patients with more than 50% scalp involvement: 3) were treated with betamethasone oral mini-pulse (0.1 mg per kg body weight per dose on two consecutive days per week) along with short contact anthralin (1.15%) and 2-5% minoxidil lotion daily, till response. The response was assessed by the severity of alopecia tool (SALT) score. Cosmetic response was defined as regrowth obviating the need of a wig. Failure of treatment was defined as no growth or vellus hair on the scalp.Results:Out of eight patients with AU/AT, two attained cosmetic response as early as three months, two at six months and one had partial response. Cosmetic response was attained in all four patients with ophiasis and all three patients with more than 50% scalp involvement at six months. All responders maintained their response without systemic steroids beyond 12 months. Among a total of twelve responders (80%), two with AU showed a mild relapse and were effectively treated with intralesional steroids. Side effects to therapy were mild and reversible.Conclusion:A combination therapy of oral steroid minipulse with topical anthralin and minoxidil acts synergistically, being effective as well as safe in treatment-resistant, extensive, long-standing alopecia areata.

Angiosarcoma is a soft tissue tumour with a dismal prognosis. We present a 74 year old male presenting with a non healing ulcer on the scalp. On histopathology a diagnosis of angiosarcoma was made. An early diagnosis and tumour size play a pivotal role in the survival of the patient.