RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE – 2

PROFORMA FOR REGISTRATION OF TOPIC FOR DISSERTATION

1 / Name of the candidate
and address / Dr. KAVYA.M
Room no 326,
S.V.B.L. Combined Hospitals Dharamshala,
Victoria hospital campus,
Bangalore 560002.
2. / Name of the Institution / Bangalore Medical College and Research Institute
3. / Course of study and subject / M.D (Dermatology Venereology and Leprosy)
4. / Date of Admission to the course / 04.03.2010
5. / Title of topic / “Epidemiological and clinical study of 100 cases of Facial hypermelanosis”
6. / Brief Resume of the intended work:
6.1. Need for study:
Pigmentary disorders are an important source of human misery more so when they involve face. They immediately set one apart and consequently threaten psychosocial and psychosexual identity. Hypermelanosis involving predominantly the face and the neck is relatively common and often presents a complex diagnostic problem.
The aim of this study is to evaluate the various clinical and epidemiological factors causing facial hypermelanosis.
6.2. Review of Literature
Hyperpigmentation in the skin can result from increased production of melanin pigment, pigment incontinence, accumulation of large number of melanocytes and deposition of other (non-melanin) pigments or substances in the skin.1
Hypermelanosis may result from increased melanin in the epidermis (epidermal hypermelanosis) or the presence of melanin in the dermis (dermal hypermelanosis). Some forms of epidermal hypermelanosis may also have a dermal component (mixed hypermelanosis).2
Facial hypermelanosis is a clinical feature of a diverse group of disorders which includes2,3:
1.  Melasma (chloasma)
2.  Riehl’s melanosis
3.  Erythema dyschromicum perstans
4.  Phototoxic dermatitis
5.  Drug-induced facial hyperpigmentation4
6.  Pigmentary demarcation lines
7.  Nevus of ota.
8.  Poikiloderma of Civatte
9.  Facial hypermelanosis secondary to systemic disorders like Addison’s disease, hemochromatosis, porphyria cutanea tarda.
Melasma is a common disorder of macular hyperpigmentation which commonly involves sun exposed areas of the face and neck. Those most affected are women. Multiple factors have been postulated to involve in the etiology and pathogenesis of melasma including pregnancy, oral contraceptives, genetics, sun exposure, cosmetics and race. 5
Riehl’s melanosis is mostly seen in middle-aged women, especially in darker skin types, such as Mexican and Asian women.6
Erythema dyschromicum perstans or Ashy dermatosis is an idiopathic, acquired and chronic skin disorder characterized by hyperpigmented patches on the trunk, face and extremities.
Pigmentary demarcation lines are physiological, abrupt transitions from deeper pigmented skin to lighter pigmented skin. These are fairly common in the Indian population especially amongst the females.7
The frequency of Poikiloderma of Civatte (PC) among dermatologic patients was estimated to be 1.4%. PC can be classified into three clinical forms: the erythemato-telangiectatic clinical type predominated, followed by mixed and the pigmented type.8
6.3. Objectives of the Study:
·  To study the clinical and epidemiological characteristics of facial hypermelanosis.
·  To assess the role of various aetiological factors in the pathogenesis of facial hypermelanosis.
Materials and Methods:
7.1. Source of data:
All patients of facial hypermelanosis attending the outpatient department of Dermatology and Venereology in Victoria Hospital and Bowring and Lady Curzon Hospitals attached to Bangalore Medical College Research Institute in the period of September 2010 to October 2012.
7.2. Method of collection of data (including sampling procedure)
Inclusion criteria:
Patients of all ages who present with facial hypermelanosis.
Exclusion Criteria:
Those patients who refused to give consent were excluded from the study.
Methods of data collection:
In this prospective study patients with facial hypermelanosis attending the outpatient department of Dermatology and Venereology in Victoria Hospital and Bowring and Lady Curzon Hospitals attached to Bangalore Medical College Research Institute will be enrolled.
Informed consent of the patient will be taken. A questionnaire will be used to record the name, age, sex, detailed history of the complaints, exposure to sunlight, use of cosmetics, family history, drug history and other associated symptoms.
Then each patient will undergo detailed general physical, systemic and dermatological examination. The diagnosis of facial hypermelanosis will be made on clinical grounds and relevant investigations including biopsy will be done wherever necessary. Photographs will be taken for documentation.
Statistical analysis:
By descriptive analysis
7.3. Does the study require any investigation or interventions to be conducted in patients or animals? If so describe briefly.
YES, on the patient.
The patients will be subjected to the following investigations:
1.  Wood’s lamp examination
2.  Complete haemogram.
3.  Random blood sugar estimation.
4.  Skin biopsy wherever needed.
5.  Special investigations like thyroid profile serum electrolytes depending on the cases.
7.4. Has ethical clearance been obtained from your institution in case of 7.3.
YES
8 / LIST OF REFERENCES:
1.  Pasricha JS, Khaitan BK, Dash S. Pigmentary Disorders in India. Dermotol Clin 2007;25:343-352.
2.  Nicolaidou E, Antoniou C, Katsambas AD. Origin, Clinical Presentation, and
Diagnosis of Facial Hypermelanosis. Dermatol Clin. 2007;25:321-326.
3.  Anstey AV. Disorders of Skin Colour. Rook’s Textbook of Dermatology.
Blackwell Publication; 2010, 8th ed, vol 3, p 58.34-58.37.
4.  Dereure O. Drug-induced skin pigmentation. Epidemiology, diagnosis and treatment. Am J Clin Dermatol. 2001;2(4):253-62.
5.  Kauh YC, Zachian TF. Melasma. Adv Exp Med Biol. 1999;455:491-9.
6.  Hornyak TJ. Albinism and other Genetic Disorders of Pigmentation. Fitzpatrick’s Dermatology in General Medicine. The Mc Graw-Hill Companies;2008;7th ed, vol 1, p 639.
7.  Somani VK, Razvi F, Sita VV. Pigmentary demarcation lines over face. Indian J Dermatol Venereol Leprol 2004;70:336-41.
8.  Katoulis AC, Stavrianeas NG, Georgala S, Bozi E, Kalogeromitros D, Koumantaki E et al. Poikiloderma of Civatte: a clinical and epidemiological study. J Eur Acad Dermatol Venereol. 2005 Jul;19(4):444-8.
9. / Signature of the Candidate
10. / Remarks of the Guide / Facial hypermelanosis is a clinical feature of a diverse group of disorders with varied etiology like hormonal, sunlight and certain drugs. Because of this varied etiology and cosmetic unacceptance, early diagnosis and proper management of these conditions aid early restoration of physical and psychological well being of patients.
11. / 11.1. Name & Designation of Guide
(in block letters) / DR.NATARAJ.H.V
PROFESSOR
DEPARTMENT OF DERMATOLOGY STD AND LEPROSY
BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE
VICTORIA HOSPITAL
BANGALORE 560002.
11.2. Signature
11.3. Head of the Department / DR.MALLIKARJUN M.
PROFESSOR AND HEAD
DEPARTMENT OF DERMATOLOGY STD AND LEPROSY
BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE
VICTORIA HOSPITAL
BANGALORE 560002.
11.4. Signature
12. / 12.1. Remarks of the Director/Dean
12.2. Signature