Fig. 1a). Initial tentative clinical diagnoses were TFFD, pityriasis versicolor and extrafacial melasma. Potassium hyroxide examination of skin scrapings was negative. Dermatoscopy showed a 'stone pavement' pattern, consisting of large polygonal brownish scales interrupted by furrows. Examination under Wood light (WL) in a darkened room revealed white fluorescence of the lesions, reminiscent of snow in a clear night (Fig. 1b). A biopsy was not taken, as a 'wipe test' with 70% ethyl alcohol accomplished clearance of the lesions, thus confirming the diagnosis of TFFD (Fig. 2a,b). Clinically, TFFD is characterized by brown-grey, velvety, pigmented patches or plaques, usually on the face, neck, trunk or ankles. 1,2 Occurrence of TFFD at surgical sites has been documented. 3 The mechanism of TFFD is unknown. It has been hypothesized that retention hyperkeratosis (abnormal and delayed keratinization) is the underlying endogenous pathogenetic trigger. Exposure to sunlight and urea-containing emollients have been incriminated as exogenous triggering factors. 1 A relationship between TFFD, xerosis and atopic dermatitis has also been put forward. 1,2 We previously theorized that remnants of soaps, cleansers, emollients, bath oils, ointments or adhesives over genetically susceptible, scaly, dry or eczematous skin may impart to the skin adherent or keratoplastic features that impede adequate exfoliation, thereby resulting in melanin retention and buildup of scales, sweat, dirt and sebum. 1 Skin biopsy is not required for establishing the diagnosis of TFFD. The diagnosis may be supported by dermoscopy, which shows a 'stone pavement' pattern of scales and furrows in a mosaic, cobblestone or tile-like pattern, and confirmed by forceful rubbing with a gauze pad immersed in 70% isopropyl alcohol or ethyl alcohol. 1,2 This noninvasive and rapid diagnostic test, termed SMART (Skin Modified by Alcohol Rubbing Test), prevents unnecessary laboratory investigations or skin biopsy. 4 In dermatology, WL is principally utilized for the diagnosis of fungal and bacterial infections, pigmentation disorders and porphyrias. 5 Clinically TFFD is characterized by hyperpigmented lesions; however, WL paradoxically excited chalk-white fluorescence in the present case. This technique helped us to exclude pityriasis versicolor, acanthosis nigricans, confluent and reticulated papillomatosis, ashy dermatosis and extrafacial melasma. Contrary to the positive results for WL examination in the present case, some published previous reports documented negative WL results in TFFD. 6 The main reason(s) for white fluorescence of TFFD under WL and its diagnostic and differential utility in TFFD requires elucidation. Previously, keratin reflectance was incriminatedas the source of white fluorescence under WL in some keratinization disorders. 5 Routine and meticulous use of WL in TFFD cases is required to collect cases with similar observations.

Onychocryptosis, or ingrown toenail, is a frequent, painful condition affecting young individuals. Controversies still exist regarding its etiopathogenesis and treatment options, including conservative and surgical techniques. The choice of treatment method depends on the stage of disease as conservative measures are mostly effective in early stages and surgical procedures are required in the later stages. Among surgical techniques, phenol cauterization of lateral nail matrix has been the most effective, safe, and commonly performed method. Other more destructive surgical procedures are rarely done nowadays. In this review, we briefly discuss the etiopathogenesis, clinical features, and different treatment options of ingrown toenail.

Purpose of Review:Gossypibomas remain a dreaded and unwanted complication of surgical practice. Despite significant interest and numerous guidelines, the number of reported cases remains sparse due to various factors, including potential legal implications. Herein, we review related data from India to ascertain if the problem is better or worse than that reported in world literature.Materials and Methods:A literature search was performed on PubMed and Google Scholar, to collect and analyze all case reports and case reviews regarding the condition in India.Results:On analysis of the results, there were 100 publications reporting a total of 126 events. The average patient age was 38.65 years. Average time to discovery was 1225.62 days. Forty-nine percent of reported cases were discovered within the 1st year. The most common clinical features were pain (73.8%), palpable mass (47.6%), vomiting (35%), abdominal distention (26%), and fever (12.6%). Spontaneous expulsion of the gossypiboma was noted in five cases (3.96%). Transmural migration was seen in 36 cases (28.57%).Conclusions:Despite advancements in surgical approaches and preventive measures, gossypibomas continue to be a cause of significant morbidity. A safe working culture, open communication, teamwork, and an accurate sponge count remain our best defence against this often unpredictable complication of surgery.

IMPORTANCE Surgical interventions, notably noncultured epidermal suspension (NCES), are the next line of treatment in patients with vitiligo who fail to respond to medical therapy. Noncultured epidermal suspension is usually performed in patients with vitiligo with duration of clinical stability (DS) of 12 months or longer because DS is a vital parameter in determining outcome of NCES. In this pilot study, we planned to assess the efficacy of a novel combination of noncultured epidermal cell suspension and noncultured dermal cell suspension (NCES and NDCS) in patients with vitiligo with shorter DS (3-6 months). OBJECTIVE To compare the efficacy of transplantation of NCES and NDCS vs NCES alone in patients with vitiligo with DS of 3 to 6 months. DESIGN, SETTING, AND PARTICIPANTS A single-center randomized clinical trial including 40 patients with focal, segmental, or generalized vitiligo with DS of 3 to 6 months or more than 12 months was carried out. Based on DS, 2 groups including 20 patients each were recruited (DS in group 1, 3 to 6 months; DS in group 2, more than 12 months). Each group was further randomized into 2 subgroups, A and B. INTERVENTION Patients in subgroups 1A and 2A underwent NCES alone, whereas patients in subgroups 1B and 2B underwent NCES and NDCS. MAIN OUTCOMES AND MEASURES Extent of repigmentation, color match, and pattern of repigmentation at 24 weeks. RESULTS Of the 40 study participants, mean (SD) age was 24.9 (4.0) years and 24 (60%) were women; in group 1 with DS for 3 to 6 months, more than 75% repigmentation at 24 weeks was observed in all 10 patients in subgroup 1B (NCES and NDCS) compared with 3 of 10 patients in subgroup 1A (NCES) (100% vs 30%, P = .003). In group 2 (DS > 12 months), the same was observed in 6 of 10 patients in subgroup 2A and 7 of 10 patients in subgroup 2B (NCES) (60% vs 70%, P > .99). The 2 groups and subgroups did not show any significant differences with respect to color matching and pattern of repigmentation. CONCLUSIONS AND RELEVANCE Combination of NCES and NDCS resulted in excellent response in patients with vitiligo with shorter duration of clinical stability compared with NCES alone. This combination may be used early in the course of stable vitiligo without waiting for a period of 12 months or more since last clinical activity.

Ponatinib-induced lamellar ichthyosis-like eruptionDear Editor, Tyrosine kinase inhibitors (TKI) have significantly improved the outcome and survival in patients of leukemia. However, these agents are frequently associated with mucocutaneous adverse effects including, but not limited to, cutaneous rash, xerosis, pruritus, alopecia, and stomatitis. 1,2 Herein, we report a Figure 1 A case of ponatinib-induced lamellar ichthyosis-like eruption. (a) Diffuse parchment like shiny skin stretched over the proximal extremities. (b) At 2 weeks follow-up, the parchment-like skin had desiccated to form well-defined skin-colored to mildly erythematous ichthyosiform plaques with plate-like brownish adherent scales

BackgroundDespite advances in surgical management of vitiligo, lesions on acral areas and bony prominences remain treatment refractory. There is lack of literature on the treatment efficacy of various surgical modalities over these treatment refractory sites.ObjectiveTo compare the efficacy of three common methods of grafting in vitiligo in known resistant areas.MethodsA single‐center interventional clinical trial involving 30 patients of stable vitiligo (disease stability ≥1 year) located over bony prominences and acral areas. All patients were treated with noncultured epidermal cell suspension (NCES), suction blister epidermal grafting (SBEG), and mini punch grafting (MPG) on three separate patches. Extent of repigmentation was assessed at 12 and 24 weeks, color matching and patient satisfaction were evaluated at 24 weeks.ResultsAmong 30 participants, 22 (73%) were females, mean age was 27.4 (±10.7) years, and the majority (93.3%) had nonsegmental vitiligo. At 12 weeks, repigmentation >75% was noted in 56.6, 60, and 16.6% of patches treated by NCES, SBEG, and MPG, respectively. At 24 weeks, results remained the same in both the NCES and SBEG groups, while the number of patches with >75% repigmentation increased to 23.3% in the MPG group. The difference in repigmentation rate between NCES and MPG as well as between SBEG and MPG achieved statistical significance. Color matching of treated area and patient satisfaction were better in NCES and SBEG groups compared to MPG.ConclusionNCES and SBEG are superior to MPG with reasonably good efficacy and can be offered as a therapeutic modality for stable vitiligo patches over these sites.

Intracellular lipase producer screened from the library available in the laboratory, identified through 16S rRNA asPseudomonas stutzeri, was studied for maximum enzyme production in shake flask. The work was intended to evaluate the effect of different physicochemical factors like carbon, nitrogen, metal ions, surfactant, inoculum, pH, temperature, agitation, and aeration on lipase production. Optimized media showed 1.62-fold increase in lipase production when compared to basal media. Scale-up of lipase inin situbioreactor showed reduction in fermentation time in both basal and optimized media, giving 41 and 99 U/mg of lipase activity after 48 h of fermentation.

Noncultured epidermal cell suspension (NCES) is a well‐established surgical treatment modality for stable vitiligo. The outcome of this procedure significantly depends on the method of recipient site preparation, a critical step to achieve cosmetically acceptable repigmentation. To compare the efficacy of recipient site preparation using three methods namely, dermabrasion, cryoblister, and dermaroller followed by NCES in stable vitiligo. In this single‐center, prospective, intra‐patient, randomized clinical trial; 36 participants having at least three vitiligo patches in same anatomic region with minimum lesional stability of 1 year were randomized 1:1:1 for recipient site preparation using manual dermabrasion, cryoblister, and dermaroller followed by NCES. Patients were followed up at 4, 8, and 12 weeks and assessment of extent and pattern of repigmentation, color match and patient satisfaction were done. Among 36 patients, 22 (61.1%) were females; mean (SD) age was 28.33 (9.4) years. Dermabrasion and cryoblister techniques showed equal efficacy with respect to extent of repigmentation (>75% repigmentation; 55.6% vs 47.2%; P = .63) and patient satisfaction score (20.2 ± 9.6 vs 19.9 ± 7.9, P = .194). However, dermabrasion was superior to cryoblister in terms of rapidity (65% vs 32.5% at 4 weeks, P = .04) and color match (47.2% vs 19.4%, P = .004). Dermaroller had poor repigmentation outcomes compared to both dermabrasion and cryoblister. Cryoblister as a method of recipient site preparation is equally effective as manual dermabrasion in NCES for attaining good to excellent repigmentation, but with risk of hyperpigmentation. However, dermaroller is inferior to both dermabrasion and cryoblister.