Bhushan Madke

Papulonecrotic tuberculid is an uncommon hypersensitivity manifestation associated with Mycobacterium tuberculosis infection and typically presents as recurrent necrotising papules on the extensor surfaces of the extremities. Isolated genital involvement is rare and may mimic sexually transmitted infections, inflammatory balanitis, papular scabies or neoplasia. A man in his early 30s from a tuberculosis-endemic tribal region presented with a 2-month history of asymptomatic hypopigmented papules and a 3 × 3 mm shallow punched-out ulcer on the glans penis, accompanied by intermittent evening pyrexia and generalised weakness. Serological testing for HIV, hepatitis B, hepatitis C, and syphilis was non-reactive. Chest radiography and abdominal ultrasonography were unremarkable, and two early-morning sputum smears were negative for acid-fast bacilli. The tuberculin skin test showed 19 mm induration. A lesional biopsy was recommended but declined by the patient, precluding histopathological and tissue-based microbiological confirmation. Given the compatible morphology, strong tuberculin reactivity, epidemiological setting, absence of a more convincing alternative diagnosis, and inability to obtain tissue, a presumptive diagnosis of penile papulonecrotic tuberculid was made. We administered weight-based first-line antitubercular therapy for 6 months. The lesions progressively resolved, with varioliform atrophic scarring at 4 months and complete clinical healing at the end of treatment. This case illustrates both the diagnostic challenge of genital papulonecrotic tuberculid and the importance of explicitly acknowledging diagnostic uncertainty when histopathological confirmation cannot be obtained.

Histoid Hansen disease is a distinct variant of lepromatous leprosy characterized by nodular lesions, spindle-shaped histiocytes and a very high bacillary load, often associated with relapse and drug resistance. While standard multibacillary multidrug therapy (MB-MDT) remains the mainstay of treatment, very short-course bactericidal regimens appear inadequate in bacillary-rich disease. We report a case of histoid leprosy treated with adjunctive rifampicin and ofloxacin for 3 months alongside MB-MDT, resulting in marked clinical regression. Although causality cannot be inferred from a single case, this observation suggests a potential role for short-term intensified bactericidal therapy as an adjunct in selected high-risk morphological variants.

Nevus lipomatosus cutaneous superficialis (NLCS) is a rare benign cutaneous hamartoma characterised by the presence of mature adipose tissue within the dermis. We report the case of a woman in her mid-20s who presented with an uncomfortable progressively enlarging lesion over the gluteal region. Histopathological examination of a skin biopsy demonstrated mature adipocytes interspersed among dermal collagen bundles, confirming the diagnosis. The patient underwent surgical excision for symptomatic relief, with no recurrence at one-year follow-up. This case underscores the importance of clinicopathological correlation in differentiating NLCS from other dermal and subcutaneous nodular lesions.

Introduction Lichen planus (LP) is an inflammatory dermatosis that is often diagnosed clinically but may require histopathological confirmation in equivocal cases. Dermoscopy enhances the visualisation of subsurface morphologic features and may improve non-invasive diagnosis. Ultraviolet-induced fluorescence dermoscopy (UVFD) is an emerging modality that may reveal additional diagnostic clues through the interaction of ultraviolet light with cutaneous structures. This study aims to investigate the dermoscopic and UVFD features of cutaneous LP, correlate them with histopathological findings, and evaluate the diagnostic accuracy of dermoscopy using histopathology as the reference standard. Methods This is a two-year prospective observational study to be conducted in the Dermatology outpatient department of Acharya Vinoba Bhave Rural Hospital, Wardha, India. Adults with clinically suspected cutaneous LP who are willing to undergo biopsy will be enrolled after written informed consent. Dermoscopic and UVFD findings from selected lesions will be documented before punch biopsy. Histopathological examination will serve as the reference standard. Dermoscopic, UVFD, and histopathological findings will be correlated using imaging alignment methods and image analysis software, including ImageJ and QuPath. Diagnostic accuracy measures, including sensitivity, specificity, positive predictive value, negative predictive value, agreement statistics, and receiver operating characteristic analysis, will be calculated. Ethics and dissemination The study has received approval from the Institutional Ethics Committee of Datta Meghe Institute of Higher Education and Research, Wardha, India ( study approval number: DMIHER (DU)/IEC/2024/141 ; IEC registration/re-registration number: ECR/440/Inst/MH/2013/RR-2019 ). Written informed consent will be obtained from all participants prior to enrolment. The findings will be disseminated through peer-reviewed publication and academic presentation. Trial registration: Clinical Trials Registry–India (CTRI): CTRI/2025/05/086296; Reference No. REF/2024/03/080873.

Dermoscopic monitoring has emerged as a valuable noninvasive adjunct for evaluating inflammatory dermatoses by providing objective assessment of disease activity and therapeutic response. Its role in actinic lichen planus (ALP), however, remains incompletely characterized. We report a biopsy‐confirmed case of ALP in a middle‐aged man presenting with asymptomatic hyperpigmented plaques over photoexposed areas of the face. Baseline polarized dermoscopy demonstrated annular Wickham’s striae, a central gray structureless area, gray–brown dots, fine white scales, and diffuse brown pigmentation. Histopathological examination revealed compact orthokeratosis, wedge‐shaped hypergranulosis, basal cell vacuolar degeneration, pigment incontinence, and a dense band–like lichenoid lymphocytic infiltrate, confirming the diagnosis. The patient received combined therapy comprising oral hydroxychloroquine, topical corticosteroid therapy, broad‐spectrum photoprotection, and two sessions of fractional CO ₂ laser performed at 4‐week intervals. At the 8‐week follow‐up, clinical improvement was accompanied by attenuation of inflammatory dermoscopic structures with persistence of residual pigmentary features, reflecting regression of active interface dermatitis despite ongoing postinflammatory pigmentation. This case highlights the clinicodermoscopic and histopathological correlation in ALP and illustrates the practical utility of dermoscopic monitoring (inflammoscopy) as a noninvasive adjunct for assessing therapeutic response in routine clinical practice.

Syphilis, known for its varied presentations, often mimics other conditions, posing diagnostic challenges. Secondary syphilis can rarely manifest as generalised lymphadenopathy, resembling lymphoproliferative disorders. A male in his late 20s presented with appetite loss, bilateral painless lymphadenopathy and hepatosplenomegaly. Initial investigations suggested a lymphoproliferative disorder. Biopsy revealed dermatopathic lymphadenopathy. Detailed sexual history confirmed syphilis, treated with benzathine penicillin, resolving symptoms and lymphadenopathy. Diagnostic delay occurred due to an incomplete sexual history. Syphilis should be considered, even without typical cutaneous manifestations. Similar cases highlight syphilis’s resemblance to malignant lymphoma. Comprehensive patient education and a multidisciplinary approach are vital. Early diagnosis and treatment are essential for optimal outcomes.

Steatocystoma multiplex (SM) and eruptive vellus hair cysts (EVHC) are relatively rare, benign tumours of the pilosebaceous unit. SM and EVHC are distinct entities with comparable clinical characteristics but significant histological distinctions. We report a case of a young male patient in his 20s who presented with multiple, asymptomatic raised skin lesions over the front and back of the trunk. A provisional diagnosis of SM was made clinically, but histopathology revealed features of both SM and EVHC, confirming the dual nature of the lesions.