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Background: Spinal dysraphism occurs due to incomplete fusion of the midline mesenchymal, bony, or neural elements of the spine. The defects in the spinal cord can be associated with skin lesion since both have same embryonic origin. Aims and Objectives: This study was conducted to determine the association of midline and paramedian cutaneous lesions with spinal dysraphism by using spinal ultrasonography. Materials and Methods: Two thousand apparently healthy neonates were screened in the postnatal ward of a tertiary care center in South India. Those neonates with cutaneous lesions in the midline and paramedian region were screened for evidence of spinal dysraphism by using spinal ultrasonography. Results: Among 2000 neonates, 120 (6%) had at least one cutaneous lesion, of which 114 (5.7%) were in the midline and 6 (0.3%) were on the paramedian region of dorsal and ventral aspect of the body. Among these neonates, two cases had more than one skin lesions. The most common cutaneous lesion observed was typical dimple (82, 68%) followed by hypertrichosis (12, 10%). Ultrasonography revealed spinal anomaly in six (5%) of them. The cutaneous lesions associated with spinal dysraphism were obvious midline swelling, dermal sinus, and multiple skin lesions. Conclusion: Congenital midline and paramedian skin lesions may be the marker of spinal dysraphism. In the presence of such cutaneous lesions, only 5% of them had associated spinal anomaly in our study. [ABSTRACT FROM AUTHOR]

The article is a book review of "Dermatitis-A contemporary approach in primary care practice." The book is aimed at general practitioners who struggle with diagnosing and managing eczemas, which make up about 30% of skin diseases. The book covers commonly encountered dermatitis in the Indian context, with each chapter introducing a case scenario and providing information on diagnosis and treatment. The reviewer recommends the book to private practitioners and inexperienced dermatologists, as it addresses the issue of misuse of topical corticosteroids. [Extracted from the article]

Background: Psoriasis is one of the most common skin disorders with a prevalence rate of 0.1%-3%. Chronic nature, frequent relapses, absence of permanent cure, and the cosmetic disfigurement of psoriasis have a negative impact on quality of life (QoL) by causing psychological stress. Patients with psoriasis often have unambiguous ideas about the causes, controllability, consequences, and expected time-course of their disease. Aim: The aim of this study is to assess the effectiveness of a video-assisted teaching program regarding psoriasis on the level of knowledge and relaxation therapy on QoL among patients with psoriasis. Materials and Methods: Experimental design was adapted. One hundred and four participants diagnosed with psoriasis were randomly allocated either to an experimental or to a control group. Fifty-two participants were included in each group by simple random sampling. A video-assisted teaching program on psoriasis and relaxation exercises was taught to the participants over a period of 3 months. The tools used were: Psoriasis Knowledge Assessment Questionnaire, modified psoriasis disability index, and modified psoriasis life stress inventory. Results: In the experimental group, the knowledge score was increased significantly from 9 ± 2.2 at baseline to 23.6 ± 1.5 after the intervention. The disability score was decreased from 15.6 to 9.9 and the stress score related to the illness was decreased from 22.8 to 16.9 after the intervention. Conclusion: Educational intervention about disease process and relaxation exercises was effective in improving the knowledge and QoL of patients with psoriasis. [ABSTRACT FROM AUTHOR]

Background: Chronic paronychia, earlier considered to be an infection due to Candida, is currently being considered as a dermatitis of the nail fold. Irritant, allergic and protein contact dermatitis are the suggested major pathogenic mechanisms. Hypersensitivity to Candida is more likely to be the etiology, rather than the infection itself. Aims: To assess the clinico-etiological profiles of patients with chronic paronychia and to determine the role of contact sensitization and hypersensitivity to Candida. Methods: All consecutive patients of chronic paronychia attending the dermatology outpatient department (OPD) were assessed for risk factors, number of nails affected, clinical presentation and presence of fungus, patch tested for contact allergy and prick tested for hypersensitivity to Candida allergen. Results: A total of 80 patients of chronic paronychia were recruited into our study. There was female preponderance (66 patients, 82.5%), with the most common group affected being housewives (47 patients, 58.8%). Frequent washing of hands (64 patients, 80%) was the most common risk factor. Fungal culture was positive in 56.1% (41 patients), the predominant species cultured was Candida albicans (15 patients, 36.5%). Patch testing with Indian standard series was positive in 27.1% patients (19 out of 70 patients tested), with nickel being the most common allergen. Prick test with Candida allergen was positive in 47.6% patients (31 out of 65 patients tested). Limitations: Prick test and patch test provide indirect evidence of hypersensitivity, with inherent limitations. Conclusion: Our study shows that chronic paronychia is probably a form of hand dermatitis associated with prolonged wet work, and that there is a higher incidence of contact sensitization and Candida hypersensitivity in these patients. [ABSTRACT FROM AUTHOR]

The article focuses on various research on psoriasis in India. Topics discussed include identifying human leukocyte antigen and genetic polymorphisms associated with psoriatic risk, metabolic syndrome and cardiovascular risk amongst psoriatics; role of Th2 cytokine, T-cell gene polymorphism - interleukin-10 and IL-23R polymorphisms in increasing the risks of psoriasis; and data related to genetics, epidemiology, disease types related to the same.

A wide prevalence of socio‑religious and cultural practices in the Asian subcontinent often leads to multitude of skin diseases which may be missed by the dermatologists because of a lack of awareness. ‘Henna’ use causes IgE‑mediated hypersensitivity reactions and contact dermatitis. ‘Kumkum' application can result in pigmented contact dermatitis and lichen planus pigmentosus. Sticker ‘bindis' and ‘alta’ induce contact leukoderma. Irritant and allergic contact dermatitis occurs after playing with ‘Holi' colors. Threading and drawstring dermatitis lead to koebnerization of pre‑existing dermatoses, infections and even squamous cell carcinoma of skin. Mild irritant reactions and contact sensitization occur secondary to balm and hair oil use. ‘Mudichood' represents the comedogenic effect of hair oils combined with occlusion and humidity. Aromatherapy oils can cause contact dermatitis and photosensitive reactions. Heavy metal and steroid toxicity along with severe cutaneous adverse effects like erythroderma can occur as a consequent to the use of alternative medicines. Squamous cell carcinoma due to chronic heat exposure from the heating device “kangri” is seen in Kashmiris. Prayer nodules in Muslims and traction alopecia in Sikhs illustrate how religious practices can negatively affect the skin. With increasing globalization and migration, the practice of indigenous customs and traditions is no longer limited to regional territories, making it imperative for the dermatologists to be acquainted with the cutaneous side effects they can cause. [ABSTRACT FROM AUTHOR]

Mongolian spots (MS) are birthmarks that are present at birth and their most common location is sacrococcygeal or lumbar area. Lesions may be single or multiple and usually involve < 5% total body surface area. They are macular and round, oval or irregular in shape. The color varies from blue to greenish, gray, black or a combination of any of the above. The size varies from few to more than 20 centimetres. Pigmentation is most intense at the age of one year and gradually fades thereafter. It is rarely seen after the age of 6 years. Aberrant MS over occiput, temple, mandibular area, shoulders and limbs may be confused with other dermal melanocytoses and bruises secondary to child abuse, thus necessitating documentation at birth. Although regarded as benign, recent data suggest that MS may be associated with inborn errors of metabolism and neurocristopathies. Mongolian spots usually resolve by early childhood and hence no treatment is generally needed if they are located in the sacral area. However, sometimes it may be required for extrasacral lesions for cosmesis. [ABSTRACT FROM AUTHOR]

Background: Intralesional corticosteroids are the treatment of choice for adults with less than 50% of scalp area involvement with alopecia areata. The sensitivity of picking up clinical response to treatment by clinical examination is very variable and has inter individual variation. Aims: To evaluate the efficacy of intralesional triamcinolone acetonide in the treatment of alopecia areata and to use dermoscopy to identify signs of early clinical response and adverse effects. Methods: Seventy patches in 60 patients were injected with steroid at 4 weeks interval and followed up for 24 weeks. Treatment response was evaluated using regrowth scale (RGS). Heine DELTA 20® dermatoscope was used to assess disease activity, response to treatment and side effects. Results: Twenty eight patients responded early and achieved RGS of 4 within 12 weeks and 29 patients responded late and achieved RGS of 4 within 24 weeks of initiating therapy. There were 3 patients who did not achieve RGS of 4 at 24 weeks. Late and incomplete responders showed statistically significant association with family history of alopecia areata (p < 0.0001), presence of recurrent disease (p = 0.0147) and presence of nail changes (p = 0.0007). Dermoscopically, 60 patches demonstrated regrowth of new vellus hair at 4 weeks. Tapering hair disappeared maximally at 4 weeks. At 12 weeks, complete disappearance was seen in tapering hairs, broken hairs and black dots whereas for yellow dots to disappear completely in all patches it took 16 weeks. The adverse effects were observed at an earlier stage using dermoscopy than clinically. Conclusion: Intralesional triamcinolone acetonide is efficacious for treatment of localized patchy alopecia areata. Dermoscopy is very useful to identify signs of early clinical response, adverse effects and markers of disease activity. [ABSTRACT FROM AUTHOR]

There is increasing evidence in support of the interplay of growth hormone (GH), insulin, and insulin-like growth factor-1 (IGF-1) signaling during puberty, which have a causal role in pathogenesis of acne by influencing adrenal and gonadal androgen metabolism. Milk consumption and hyperglycemic diets can induce insulin and IGF-1-mediated PI3K/Akt-activation inducing sebaceous lipogenesis, sebocyte, and keratinocyte proliferation, which can aggravate acne. Occurence of acne as part of various syndromes also provides evidence in favor of correlation between IGF-1 and acne. [ABSTRACT FROM AUTHOR]

The authors reflect on the concept of impact factor (IF) which has become a common parlance in the scientific community. They outline the factors relevant on the calculation of IF, including the coverage and language preferences of the Science Citation Index (SCI) database, negative citations and publication lag. The authors further claim the need to realize that IF is a misleading tool in assessing the quality of the paper and the researcher as well.

Background: Cutaneous manifestations of diabetes mellitus generally appear subsequent to the development of the disease, but they may be the first presenting signs and in some cases they may precede the primary disease manifestation by many years. Aims: The aim of our study was to study the spectrum of dermatoses in diabetics, to know the frequency of dermatoses specific to diabetes mellitus (DM), and to establish the mucocutaneous markers of DM. Material and Methods: The study was conducted at a diabetic clinic and our department between September 2008 and June 2010. Two hundred and twenty-four diabetic patients were included in the study group and those with gestational diabetes were excluded. Healthy age- and sex-matched individuals were taken as controls. Results: The male to female ratio was 1 : 1.21. Type 2 DM was seen in 89.7% and type 1 DM in 10.3% of the patients. Dermatoses were seen in 88.3% of the diabetics compared to 36% in non-diabetic controls (P<0.05). Cutaneous infections were the most common dermatoses followed by acanthosis nigricans and xerosis in diabetics. Type 2 DM was found to have an increased risk of complications than type 1 DM. Complications of diabetes were seen in 43.7% of the diabetic cases. Diabetic dermopathy, loss of hair over the legs, diabetic foot ulcer, and so on, were found to be the cutaneous markers of DM in our group of cases. Conclusion: Dermatoses were more common in diabetics than non-diabetics. Cutaneous infections formed the largest group of dermatoses in DM. [ABSTRACT FROM AUTHOR]

Congenital melanocytic nevus (CMN) may rarely regress which may also be associated with a halo or vitiligo. We describe a 10-year-old girl who presented with CMN on the left leg since birth, which recently started to regress spontaneously with associated depigmentation in the lesion and at a distant site. Dermoscopy performed at different sites of the regressing lesion demonstrated loss of epidermal pigments first followed by loss of dermal pigments. Histopathology and Masson-Fontana stain demonstrated lymphocytic infiltration and loss of pigment production in the regressing area. Immunohistochemistry staining (S100 and HMB- 45), however, showed that nevus cells were present in the regressing areas. [ABSTRACT FROM AUTHOR]

Background: Even though seborrheic keratoses (SK) have been well characterized clinically and histopathologically, data regarding clinical and dermoscopic correlation of different types of SK are inadequate. Aims: We carried out a study to establish any correlation between the clinical and dermoscopic appearance of SK and its variants. Methods: This was a descriptive study conducted in the Department of Dermatology, a tertiary care institute, from August 2008 to June 2010. Patients with SK were evaluated with respect to age, sex, age of onset, duration, site of lesions, number of lesions, and morphology. Dermoscopy was performed in all cases. Results: A total of 250 cases of SK were recruited. A male-to-female ratio was 1:1.04. The most common age group affected by SK was 60 years and above (40%). The most common clinical variant was common seborrheic keratosis (CSK) (60%). Comedo-like openings (CL) (80%), fissures and ridges (FR) (52%), and sharp demarcation (SD) (83%) were consistent finding on dermoscopy in CSK. Dermatosis papulosa nigra (DPN) and pedunculated seborrheic keratoses (PSK) had characteristic CL and FR in both of them. Fingerprint (FP) (55%) and network-like (NL) (88%) structures were commonly seen in flat SK. Stucco keratoses demonstrated SD (100%) and NL structures (100%). Conclusions: The most common clinical variant of SK was CSK, followed by DPN, PSK, Flat SK, and stucco keratoses. Dermoscopic findings were consistent with those described in the literature. [ABSTRACT FROM AUTHOR]

Venereology-the study of venereal diseases or more recently, the sexually transmitted infections (STI) includes a variety of pathogens namely viruses, bacteria, fungi and protozoa for which the common factor is the mode of transmission and acquisition: Sexual relations between human beings. Medical and other historians have often suggested that well-known diseases such as syphilis, gonorrhea, chancroid and lymphogranuloma venereum have existed since earliest times. However, it is difficult to identify modern disease entities based on written historical record. Studying the origin of STIs helps us to learn the political, economic and moral conditions that led to the disease. Effective management of STI rests on three pillars of diagnosis, prevention and treatment. For most of past 50 years in India, the diagnostic pillar has been the least well-supported. Until well into present century, diagnosis of STI in India was clinical. Treatment of STIs in India followed the methods used in England. Of course in the 19th century, in many parts of the world, only a few had access to modern methods of treatment; in India, there was extensive use of Ayurvedic treatment with traditional medicines. This article thus gives just an overview and evolution of venereology in India with regard to venereal diseases (now more often known as STIs/disease), control measures, academic, association and journal development and finally future perspective. [ABSTRACT FROM AUTHOR]

Background: Lichen simplex chronicus (LSC) of the anogenital region, is a benign, extremely uncomfortable disease. Aims: As very little is known about the cause of anogenital LSC (AGLSC), we undertook this study to determine various clinico-etiological factors involved in it and to assess the frequency of AGLSC. Methods: This was a descriptive study, including 105 patients with AGLSC, who attended the Dermatology clinic in our institute from September 2007 to June 2009. Detailed history, physical examination, and relevant investigations were done. The collected data were tabulated and analyzed. Results: The frequency of AGLSC among patients presenting with anogenital pruritus was 2.54%. Primary AGLSC was more common than secondary AGLSC (69.5% vs. 30.5%). AGLSC manifested more commonly in males than in females (56.2% vs. 43.8%). The mean duration of the disease was 30.6 months. The common triggering factors for itching were sweating (41.9%), rubbing of thighs while walking for long distances (9.5%), and mental stress (5.7%). Pruritus of AGLSC was related to the intake of various food items in 37.1% of patients. In males, scrotum was the predominant site involved (89.8%), whereas in females, labia majora was the predominant site involved (78.2%). Nearly one-third of cases (30.5%) of AGLSC had some other dermatoses in the anogenital region. Conclusions: Though psychological factors are thought to play an important role in disease causation and perpetuation among AGLSC patients, their significance could not be ascertained by us. [ABSTRACT FROM AUTHOR]

Background: Melasma is a common cause of facial hyperpigmentation with significant cosmetic deformity. Many modalities of treatment are available, but none is satisfactory. Aim: This study was designed to compare the therapeutic response of melasma in Indian women to glycolic acid (GA 20-35%) versus trichloroacetic acid (TCA 10-20%) for chemical peeling. Methods: Forty nonpregnant female patients with a minimum melasma area and severity index (MASI) of 10 were recruited in the study. After a detailed history and clinical examination under natural light, MASI was calculated and color photographs were taken of all the patients. The patients were advised to carry out a prepeel program of daily application of 12% GA cream or 0.1% tretinoin at night for 2 weeks. They were then treated with graded concentrations of 20-35% GA facial peel every 15 days in GA group and 10-20% TCA in the second group. Results: Objective response to treatment evaluated by reduction in MASI scoring after 12 weeks was by 79% reduction (from 26.6 to 5.6) in GA group and by 73% reduction in TCA group (from 29.1 to 8.2) but this difference was not significant. Patients with epidermal-type melasma showed a better response to treatment than those with mixed-type melasma (P < 0.05). Subjective response, as graded by the patient, showed good or very good response in 75% in GA group and 65% in TCA group. No relation of treatment response to age and duration of melasma could be established in this study. Conclusions: A prepeel program of daily application of 12% GA cream at night for 2 weeks, followed by graded increase in GA and TCA concentrations proved to be an equally effective treatment modality for epidermal and mixed melasma. There are hardly any major side effects, and regular use of sunscreens prevents chances of postpeel hyperpigmentation. GA peel is associated with fewer side effects than TCA and has the added advantage of facial rejuvenation. [ABSTRACT FROM AUTHOR]

Diet has an important role to play in many skin disorders, and dermatologists are frequently faced with the difficulty of separating myth from fact when it comes to dietary advice for their patients. Patients in India are often anxious about what foods to consume, and what to avoid, in the hope that, no matter how impractical or difficult this may be, following this dictum will cure their disease. There are certain disorders where one or more components in food are central to the pathogenesis, e.g. dermatitis herpetiformis, wherein dietary restrictions constitute the cornerstone of treatment. A brief list, although not comprehensive, of other disorders where diet may have a role to play includes atopic dermatitis, acne vulgaris, psoriasis vulgaris, pemphigus, urticaria, pruritus, allergic contact dermatitis, fish odor syndrome, toxic oil syndrome, fixed drug eruption, genetic and metabolic disorders (phenylketonuria, tyrosinemia, homocystinuria, galactosemia, Refsum's disease, G6PD deficiency, xanthomas, gout and porphyria), nutritional deficiency disorders (kwashiorkar, marasmus, phrynoderma, pellagra, scurvy, acrodermatitis enteropathica, carotenemia and lycopenemia) and miscellaneous disorders such as vitiligo, aphthous ulcers, cutaneous vasculitis and telogen effluvium. From a practical point of view, it will be useful for the dermatologist to keep some dietary information handy to deal with the occasional patient who does not seem to respond in spite of the best, scientific and evidence-based therapy. [ABSTRACT FROM AUTHOR]

Management of genital herpes is complex. Apart from using the standard antivirals, an ideal management protocol also needs to address various aspects of the disease, including the psychological morbidity. Oral acyclovir, valacyclovir or famciclovir are recommended for routine use. Long-term suppressive therapy is effective in reducing the number of recurrences and the risk of transmission to others. Severe or disseminated disease may require intravenous therapy. Resistant cases are managed with foscarnet or cidofovir. Genital herpes in human immunodeficiency virus-infected individuals usually needs a longer duration of antiviral therapy along with continuation of highly active anti retroviral therapy (HAART). Genital herpes in late pregnancy increases the risk of neonatal herpes. Antiviral therapy and/or cesarean delivery are indicated depending on the clinical circumstance. Acyclovir appears to be safe in pregnancy. But, there is limited data regarding the use of valacyclovir and famciclovir in pregnancy. Neonatal herpes requires a higher dose of acyclovir given intravenously for a longer duration. Management of the sex partner, counseling and prevention advice are equally important in appropriate management of genital herpes. Vaccines till date have been marginally effective. Helicase-primase inhibitors, needle-free mucosal vaccine and a new microbicide product named VivaGel may become promising treatment options in the future. [ABSTRACT FROM AUTHOR]

The article presents different literature of dermatological research with the best evidence. The author highlighted studies like the significance of autologous fat transplantation on infraorbital dark circles, the effects of folic or folinic acid on inflammatory disease and the impact of nickel allergy on hand eczema. The author also provided comments on each dermatological research.

Background: Pemphigus disorders are a group of serious and potentially life-threatening diseases affecting skin and/or mucus membranes. Dexamethasone-cyclophosphamide pulse (DCP) therapy has shown promising results in the management of these diseases. Aims: The objective of the study was to assess the outcome of DCP therapy in pemphigus. Methods: Pemphigus patients who had been treated with DCP therapy from 2001 to 2008 were prospectively and retrospectively analyzed. Results: A total of 65 pemphigus patients were enrolled. Male to female ratio was 1 : 1.82. Mean age of patients was 44.65 ± 11.85 years with a range of 14 to 73 years. Thirty two patients completed phase I, of which 28 (9 in phase II, 7 in phase III and 12 in phase III) were maintaining remission and four patients relapsed. Relapse was observed only in patients who discontinued or took irregular treatment. Six patients were declared cured of disease. Five patients died during phase I. Dexamethasone-cyclophosphamide pulse therapy is not absolutely free from adverse effects. Most of the immediate side effects were expected, tolerable and did not pose any problem in continuing treatment. There was a slight increased incidence of weight gain, hypertension, diabetes mellitus, cataract and Cushingoid habitus, since most of our patients also received additional daily oral steroids. Also, there was a high incidence of secondary pyogenic infections of skin lesions and oral candidiasis during phase I. Staphylococcus aureus was the commonest bacteria isolated from the pus of skin lesions. Most of the alterations in laboratory parameters were transitory or correctable, and did not pose a problem in continuing therapy. Conclusions: DCP therapy was found to be effective in inducing and maintaining remission in pemphigus, provided the patients receive regular and complete treatment. [ABSTRACT FROM AUTHOR]

The article presents abstracts related to dermatology which include the treatment of erosive vulvovaginal lichen planus with methotrexate, the literature concerning psychogenic purpura, and the results of a prospective observational study of the homeopathic treatment of patients with psoriasis.

Background: Acne vulgaris is believed to be the most common disease of the skin. There is no Indian study on the profile of acne vulgaris, markers of severe forms of acne vulgaris and a possible correlation between acne vulgaris and markers of androgenicity in females. Aim: To study the profile of acne vulgaris, its seasonal variation, relationship with smoking and possible correlation between acne vulgaris and markers of androgenicity in females. Methods: The study was conducted between August 2006 and June 2008. All patients with acne vulgaris who consented to participate in the study were included. The parameters evaluated included age, gender, age of onset, duration of lesions, site of lesions, grade, relation with menstrual cycle, markers of androgenicity, number of acne lesions such as comedones, papules pustules and nodules, number and site of post-acne scarring, post-acne hyperpigmentation, seasonal variation and history of smoking. Results: A total of 309 patients with acne vulgaris were included in the study. The frequency of acne vulgaris in our study was 1.068%. Mean age of the study group was 19.78 years. Male to female ratio was 1.25:1. The most common age group involved was 16 to 20 years (59.8%). Mean age of onset was 15.97 years. Face was involved in all the patients, followed by back (28.2%), chest (20.1%), neck (9.4%) and arms (10%). In the older age groups, women were more likely to report having acne vulgaris than men (P = 0.01). The closed comedones outnumbered open comedones by a factor of 4.9:1. A total of 186 patients (60.2%) had grade 1 acne vulgaris, 85 (27.5%) had grade 2 acne, 8 (2.6%) had grade 3 acne and 30 (9.7%) had grade 4 acne vulgaris. There was a higher incidence of scarring (39.5%) and post-acne hyperpigmentation (24.6%) in our study. In female patients, 57.7% had premenstrual flare and 12.4% had cutaneous markers of androgenicity. There was no association between severity of acne vulgaris and other markers of androgenicity (P = 0.108). Seborrheic dermatitis (21.35%) was the most common disease associated. Seasonal variation was observed only in 80 patients (25.9%); 71 patients (23%) exacerbated in summer and 9 patients (2.9%) in winter. Smokers had more severe grade of acne vulgaris compared to nonsmokers (P = 0.001). Conclusion: This study brings out the clinical profile of acne vulgaris in a tertiary care hospital in South India. [ABSTRACT FROM AUTHOR]

This article takes a critical look at the pros and cons of human papillomavirus (HPV) vaccines. There is enough evidence to suggest that the prophylactic vaccines are efficacious in preventing various benign and malignant conditions (including cervical cancers) caused by HPV. Even though the vaccine is costly, hypothetical analysis has shown that HPV vaccination will be cost effective in the long run. Therapeutic HPV vaccines used to treat established disease are still undergoing evaluation in clinical studies, and results seem to be encouraging. Although several countries have started mandatory vaccination programs with the prophylactic HPV vaccines, conservatives have voiced concerns regarding the moral impact of such vaccination programs. [ABSTRACT FROM AUTHOR]

The article offers information on the history of the Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) in India. The association was established on January 28, 1973. U. B. Narayan Rao began the publication "Indian Journal of Venereology" in 1935. He was the brainchild of the creation of the association of dermatologists and venereologists. The association was inaugurated by Home and Revenue Minister Shri Morarji M. Desai.

Leprosy is unique in terms of the nature of the causative organism (Mycobacterium leprae), the chronicity of the disease, its prolonged treatment and the definitions of "cure" and "relapse." The principal mode of assessing the efficacy of therapeutic regimens in leprosy is the "relapse rate." There are wide variations in estimates of relapse rates after the World Health Organization (WHO) multidrug therapy in different regions. The important predisposing factors for relapse include the presence of "persister" bacilli, monotherapy, inadequate/irregular therapy, presence of multiple skin lesions/thickened nerves and lepromin negativity. The conventional methods of confirming activity or relapse in an infectious disease (demonstration and/or culture of the etiologic agent) have limited utility in leprosy because of the difficulty in demonstrating bacilli in paucibacillary (PB) cases and absence of a method of in vitro cultivation of M. leprae. Bacteriological parameters are useful in multibacillary (MB) leprosy, whereas in PB leprosy, the criteria for relapse depend primarily on clinical features. Although there are no widely available serologic tests for leprosy other than in a research setting, various immunological tests may be useful for monitoring patients on chemotherapy as well as for confirming suspected cases of relapse. The main differential diagnoses for relapse are reversal reactions, erythema nodosum leprosum and reactivation/ resistance/reinfection. The most reliable criteria for making an accurate diagnosis of relapse include clinical, bacteriological and therapeutic criteria. Additional ones that may be used, depending on the setting, are histopathological and serologic criteria. Relapsed cases of leprosy should be identified and put back on chemotherapy as soon as possible to prevent further disability and transmission of infection. Factors that should be considered in choosing an appropriate regimen are the type of leprosy (PB or MB), previous treatment and drug resistance. Occasionally, clinicians may need to use their judgement to modify the standard WHO treatment regimens according to the scenario in each patient. [ABSTRACT FROM AUTHOR]

The article discusses the emergence of dermatology in India. Dermatology as a specialty came into prominence only in the twentieth century, although skin diseases like leprosy, viral fevers like measles and chicken pox, psoriasis, and vitiligo were recognized long back. The incidence and etiology of endemic skin diseases in the country is reviewed. The start of postrgraduate teaching in the specialty is included.

Background: The pattern of eczema is altered by geography, habits of people and environmental factors and regional variation in skin structure and function. Aims: Our study was done to estimate frequency and patterns of lower leg and foot eczemas. Methods: A total of 200 patients with various types of lower leg and foot eczemas were recruited over a period of 2 years. Demographic and clinical characteristics were noted. Suspected cases of allergic contact dermatitis were patch tested. Results: The frequency of these eczemas was 2.5 per 1000 out patients. Mean age of patients was 40.49 years. Female to male ratio was 1.6:1. Sixty (30%) patients were farmers, sixty (30%) were housewives, forty (20%) were students, nineteen (9.5%) were daily laborers, nine had sedentary jobs and three were teachers. Most eczemas were bilateral (72%). Mean duration of eczema was 36.6 months. Most common type of eczema was lichen simplex chronicus (36%) followed by discoid eczema (18.5%), allergic contact dermatitis (14.5%) and stasis eczema (7.5%). Other eczemas noted were juvenile plantar dermatosis, cumulative irritant contact dermatitis, infected eczema, hyperkeratotic eczema, asteatotic eczema, pompholyx, infective eczema and unclassified endogenous eczema. Common sites of involvement were dorsa of feet (49.5%), followed by lateral aspect of lower leg (31%), medial aspect of lower leg (17.5%) and ankle (12%). Conclusion: Our study highlights lichen simplex chronicus as the most common eczema affecting the lower legs and feet. [ABSTRACT FROM AUTHOR]

BACKGROUND Among surgical methods, punch skin grafting (PSG) and suction blister epidermal grafting (SBEG) are simple, inexpensive, and effective treatment methods for resistant lip vitiligo cases, but there is a lack of comparison between these procedures for lip vitiligo. OBJECTIVE The objective was to compare the outcome following PSG and SBEG in stable lip vitiligo. METHODS Eighteen patients with stable lip vitiligo were randomly selected. Eight patients were included in PSG group and 10 patients in SBEG. All patients were kept on PUVA-SOL (psoralen+ultraviolet A therapy of solar origin) treatment after grafting. The results were evaluated after a follow-up period of 6 months. RESULTS At the end of 6 months of grafting in PSG group, two patients had a repigmentation of 50% to 75%, one had 75% to 90%, and three had 90% to 100% in the recipient site in lip. In SBEG group, one patient had repigmentation of 50% to 75%, three had 75% to 90%, and two had 90% to 100%. The color match was statistically significant in PSG when compared to SBEG. In the recipient site, cobblestone appearance was the predominant complication in PSG whereas hyperpigmentation and thickening of grafts were common in SBEG. In the donor site, superficial scarring and hypopigmentation were the common findings in PSG group whereas hyperpigmentation was the main problem in SBEG group. CONCLUSIONS Although both the procedures are effective in lip vitiligo, PSG gives a better color match than SBEG. [ABSTRACT FROM AUTHOR]

The author reflects the medical study for onychomycosis treatment in India. He describes onychomycosis as one of the intergumental fungal infects and nail disease in the country. Dermatophytes is demonstrated as the common cause in onychomycosis disease. He cites some alternative therapies of onychomycosis disease such as palliative care, mechanical/chemical debridement and other antifungal agents. He also illustrates some of the antifungal drug agents including terbinafine and itraconazole.

Lichen sclerosus (LS) is a chronic inflammatory dermatosis that causes substantial discomfort and morbidity, most commonly in adult women. The objective of our study is to study the pattern of vulval LS and to correlate LS with various clinical parameters. The study included 26 female patients with vulval LS presenting over a period of 22 months, starting from September 2005 to June 2007. Demographic characteristics and clinical findings were recorded. The mean age of LS patients was 44 years (range 3-65 years). Lichen sclerosus was most commonly observed in postmenopausal women (18, 69.2%), followed by women in reproductive age group (5, 19.23%), and prepubertal girls (3, 11.5%). All patients presented with ivory white atrophic plaque. Surface of the plaque showed telangiectasia in one patient; both erosions and fissuring in two patients, erosions in four patients, fissuring in two patients, and wrinkling in all patients. Introitus was stenosed in five (19.2%) patients, out of which three (11.5%) patients also had perianal involvement leading to "figure of 8" appearance. Three patients had atrophy of labia minora and clitoris to an extent that labia minora appeared merged with labia majora and clitoris was buried. This study highlights the importance of diagnosing LS as it is associated with considerable morbidity. [ABSTRACT FROM AUTHOR]

Prostitution describes sexual intercourse in exchange for remuneration. The legal status of prostitution varies in different countries, from punishable by death to complete legality. The great degree of social stigma associated with prostitution, of both buyers and sellers, has lead to terminology such as 'commercial sex trade', 'commercial sex worker' (CSW), female sex worker (FSW) or sex trade worker. Organisers of prostitution are typically known as pimps (if male) and madams (if female). Brothels are establishments specifically dedicated to prostitution, often confined to special red-light districts in big cities. The devadasi (handmaiden of god) system of dedicating unmarried young girls to gods in Hindu temples, which often made them objects of sexual pleasure of temple priests and pilgrims, was an established custom in India by 300 AD. An estimated 85% of all prostitutes in Calcutta and Delhi enter the sex work at an early age. The causes of prostitution include ill treatment by parents, bad company, family prostitutes, social customs, inability to arrange marriage, lack of sex education, media, prior incest and rape, early marriage and desertion, lack of recreational facilities, ignorance, and acceptance of prostitution. Truck drivers engaging in unprotected sexual intercourse with multiple partners in rural India could be major vectors of HIV transmission. The commercial sex industry is a multibillion dollar Indian and global market which now includes strip clubs, massage brothels, phone sex, adult and child pornography, street brothel, and escort prostitution. So long as men want to buy sex, prostitution is assumed to be inevitable. [ABSTRACT FROM AUTHOR]

Sexually transmitted infections (STIs) are more dynamic than other infections prevailing in the community. It is important that such dynamic epidemiological changes in STIs are acknowledged and kept track of in a vast and populous developing country like India, particularly in this HIV era. It is with this aim that the authors have reviewed the relevant literature in STI epidemiology in India during the past 25 years. Admittedly, there has been heterogeneity of data to account for the subcontinental dimension of this country. But a basic pattern in the changing epidemiology is discernible. Like the developed countries, in India too the bacterial STIs like chancroid and gonorrhea are declining, while viral STIs like HPV and herpes genitalis are on an upswing. The overall decline in the prevalence of STIs has to be interpreted with caution, however. This may partially reflect the improved facilities of treatment in the peripheral centres that obviates the need of many patients in attending the STD clinics in the tertiary centres. Also, the improved pharmacotherapy of many of the bacterial STIs may result in partial clearance and non-reporting of many of these infections. [ABSTRACT FROM AUTHOR]

The article discusses the methods of specimen collection for the diagnosis of sexually transmitted infections (STIs). According to the authors, the correct method of specimen collection facilitates in achieving desirable goals in the laboratory diagnosis of STIs. They stress that if simple precautions are taken, it will avert spurious results. They also note that the collection of specimens and use of the appropriate swab and transport media are critical in the success of tissue culture.

The article talks about the evolution of venereology in India. It discusses venereal diseases, such as syphilis, gonorrhea, chancroid, donovanosis, lymphogranuloma venereum, and other STDs. India's STD control measures, advent of the acquired immune deficiency syndrome (AIDS), and status of human immunodeficiency virus (HIV) epidemic are offered. The emerging sexually transmitted infections (STIs) in India and the academic developments in treating STDs are also discussed.

Background: Vascular nevi are cutaneous anomalies of angiogenesis and vasculogenesis resulting in various different clinical presentations.Aim: The purpose of our descriptive study was to observe the various types of vascular nevi in children and their features.Methods: A total of 4256 pediatric cases attending the dermatology OPD during the study period from August 2002 to August 2004 were screened for vascular nevi.Results: Out of these, 19 children (0.44%) had vascular nevi-17 hemangiomas of infancy (HOIs) and 2 port-wine stains. The mean age of the affected children was 1.3 years (ranging from 2.5 months to 8 years). There were 13 girls and 6 boys. Seventeen (89.5%) patients had progressing lesions and two (10.5%) had non-involuting ones. A solitary lesion was seen in ten (52.6%) cases and two to five lesions were present in five (26.3%) cases. The nevi were distributed over multiple sites in seven (36.8%) cases, the head and neck in six (31.6%) cases, the chest and lower limb in two (10.5%) cases each, and the upper limbs and genitalia in one (5.3%) case each. Among the hemangiomas of infancy, 15 (88.2%) cases of superficial type and 2 (11.8%) cases of deep type were seen. The cutaneous complications included ulceration in four cases and infection in one.Conclusions: HOIs were the most common vascular nevi of childhood. [ABSTRACT FROM AUTHOR]

Background: Melanocytic nevi show different presentations in children which have not much studied in India. Purposes: To document the incidence and pattern of melanocytic nevi in children. Methods: A total of 4,256 paediatric cases attending the dermatology OPD, JIPMER during the study period from August 2002 to August 2004 were screened for melanocytic nevi. Findings: Out of these, 41 (0.96%) cases were found to have melanocytic nevi. The mean age of these cases was 1.4 years (range of 3 days to 14 years). Fourteen (34.1%) of them were males and 27 (65.9%) were females with male to female ratio of 1:1.9. Majority of these cases (32 cases, 78%) were in the age group of 0-1 year. Thirty-seven (90.2%) cases had single lesion and 4 (9.8%) cases had multiple lesions. The size of the nevi varied from 1.5 cm to 20 cm in 40 (97.6%) cases and more than 20 cm in 1 (2.4%) case. The most common site of involvement was the back (32 cases, 78%) followed by head and neck (6 cases, 14.6%). Out of the total of 41 cases, 30 (73.2%) were Mongolian spots, 8 (19.5%) were congenital melanocytic nevi, one case (2.4%) each had giant congenital melanocytic nevus, nevus spilus and nevus of Ota. Four cases had other associated cutaneous disorders. These included ashleaf macules in 2 cases, epidermolysis bullosa simplex in 1 case and a solitary case had both café-au-lait macule and mixed hemangioma. The systemic associations included seizures (suspected neurocutaneous melanosis) in a solitary case of congenital melanocytic nevi. Conclusions: The spectrum of melanocytic nevi seen in children in this study partially differs from this of abroad studies. Limitation: Unicentre hospital-based study which cannot be generalized. [ABSTRACT FROM AUTHOR]

Background: In Asia, HSV seroprevalence studies are sparse and they have recorded lower prevalence of HSV infection, especially HSV-2.Aims: To ascertain the seroprevalence of HSV-1 and HSV-2 in patients attending a STD clinic in a referral hospital in south India and to compare it with a control group.Methods: The study included 135 consecutive STD cases having history of ulcerative or non-ulcerative STD in the present or in the past 5 years and 135 age and sex-matched controls. Diagnostic serology was done for HSV-1 and HSV-2 using type specific IgG by indirect immunoassay using ELISA. The results were analyzed utilizing Chi- square test.Results: Amongst 135 STD clinic cases, 106 cases were males and 29 cases were females with male to female ratio of 3.65:1. The mean age was 32.2 years (range 16-65 years). Among study group cases, 112 (82.9%) cases were co-infected with HSV-1 and HSV-2, 11 (8.1%) cases were seropositive for HSV-1 alone and 3 (2.2%) cases were seropositive for HSV-2 alone. In the control group, 112 (82.9%) cases were co-infected with HSV-1 and 2, 12 (9.6%) for HSV-1 alone and 1(0.8%) for HSV-2 alone. Correlation of HSV-1 and HSV-2 serology with various demographic and behavioral factors was statistically insignificant.Conclusions: Seroprevalence of HSV-1 and HSV-2 in STD clinic cases and control group is high, similar to that recorded in sub-Saharan Africa. Thus, serological studies for HSV-1 and HSV-2 cannot be taken as a marker of sexual behavior in our set of population. [ABSTRACT FROM AUTHOR]

The efficacy of cyclosporine and related drugs in the treatment of psoriasis was the key to the development of the concept that psoriasis is an immune mediated disorder. These therapies demonstrably reduce the number of activated T-lymphocytes, which correlates with clinical remission. Monoclonal antibodies directed against key components of the inflammatory process have been studied in an attempt to produce safer, more effective and selective immunosuppressive agents. This review summarizes the information available on cyclosporine and related drugs, and cytokine therapy, including monoclonal antibodies directed against T-cell mediated inflammation. It should be realized that biologic therapies for psoriasis are very new and that efficacy and safety information from clinical trials is just becoming available. [ABSTRACT FROM AUTHOR]

Adverse cutaneous drug reactions (ACDRs) are caused by a wide variety of agents. Our objective was to ascertain the clinical spectrum of ACDRs and the causative drugs in this part of India and to find any risk factors. The mean age of the patients with cutaneous drug eruptions was 37.06 years. Most of them (52.2%) were in the age group of 20–39 years. The male to female ratio was 0.87: 1. The most common eruptions observed were fixed drug eruption (31.1%) and maculopapular rash (12.2%), and the most common causes were cotrimoxazole (22.2%) and dapsone (17.7%). The pattern of ACDRs and the drugs causing them is remarkably different in our population. Knowledge of these drug eruptions, the causative drugs and the prognostic indicators is essential for the clinician. [ABSTRACT FROM AUTHOR]

We report widely disseminated and disfiguring lesions of molluscum contagiosum occurring in a 4-year-old girl secondary to a primary immunodeficiency disorder. The child, born of consanguineous parents, had multiple, asymptomatic, raised, skin-colored and whitish lesions since 2 years of age. On physical examination she had growth retardation features with grade II protein energy malnutrition. Cutaneous examination revealed numerous, widespread, skin-colored to translucent, firm, umbilicated papules of varying sizes (pinpoint to larger than 10 mm). They were distributed bilaterally over all four limbs, including the dorsum of the hands and feet, trunk, face (including lips), eyelids, auriculae, and perineal and gluteal areas. In places, they were linearly disposed and had coalesced to form plaques. A biopsy specimen from a representative skin lesion (arm) demonstrated lobulated epidermal growth consisting of keratinocytes with large intracytoplasmic eosinophilic inclusion bodies and a central crater. These findings were consistent with the diagnosis of molluscum contagiosum. Topical therapies with phenol and trichloroacetic acid were ineffective The child succumbed to a fulminant systemic infection at home, 2 months after discharge from the hospital. The extent and distribution of molluscum contagiosum in our patient was remarkably vivid and has been hitherto reported only rarely. [ABSTRACT FROM AUTHOR]

Discusses the clinical syndrome of pellagra. Nutritional disorder that occurs as a result of niacin deficiency; Symmetric photosensitive skin eruptions; Gastrointestinal manifestations; Neurologic and psychiatric disturbances; Historical aspects; Sources of niacin, such as meat, poultry, fish, dry beans, nuts and eggs; Areas in Africa and Asia where pellagra is still endemic.

Background: Dermoscopy is useful in the diagnosis of basal cell carcinoma (BCC). However, most descriptions of the dermoscopic features of BCCs are in Caucasians (skin types I-III) and there is a paucity of data in dark-skinned Indian patients. Aims: The aim of this study was to describe the various dermoscopic features of BCC in dark-skinned patients from South India and correlate these with the histopathologic subtypes. Methods: A retrospective observational study of biopsy-proven cases of BCC was conducted at a tertiary care center in South India using nonpolarized contact dermoscopy. Results: Sixty BCCs in 35 patients predominantly of skin phototypes IV or V were studied. These included 32 nodular, 27 superficial and 1 infiltrative type of BCC. The most common dermoscopic features noted were maple leaf-like areas (61.7%), blue-white veils (53.4%), ulceration (48.4%) and short fine telangiectases (46.7%). Ulceration, blue-white veils and arborizing vessels were significantly associated with nodular BCCs, while maple leaf-like areas, red-white structureless areas, multiple small erosions and spoke wheel areas were noted with superficial BCCs. Limitations: The limitations of this study include its retrospective nature, the use of only nonpolarized light for examination, the lack of other histopathological variants of BCC as well as the lack of a comparison group. Conclusion: We report a dermoscopic study of BCC in dark-skinned patients from Puducherry, South India. The blue-white veil was observed in half of the patients and was significantly associated with nodular BCCs. The addition of the blue-white veil to the diagnostic criteria for pigmented BCC could improve the diagnostic accuracy of dermoscopy in Indian patients. [ABSTRACT FROM AUTHOR]

The article reports on the practice of cultural dermatology in India. Topics covered include skin problems that result from the presence of various socio-religious and cultural habits and the use of alternative medicine systems, reasons for the popularity of alternative medicine system in India, also known as ayurveda, yoga, and naturopathy, Unani, Siddha, homeopathy (AYUSH), as well as the adverse effects of AYUSH.

A 6-year-old girl presented to the pediatric surgery department with swelling of the right hand of 4 months’ duration. According to the patient’s parents, it started as a small nodule over the dorsum of the right hand which gradually increased in size covering nearly the whole of the hand. There was no history of preceding trauma or insect bite. She had no constitutional symptoms; however, she had limitation of movement of the fingers of the affected hand. The surgeon made a clinical diagnosis of synovial sarcoma. A biopsy specimen from the border of the lesion was obtained for histologic examination. Microscopic examination of the histologic section was not suggestive of this condition. Hence, she was referred to a dermatologist for expert opinion. On cutaneous examination, the right hand showed a single, large, well-defined, indurated mass involving the dorsal and ventral aspects, encircling the proximal portions of the fingers and thumb (Figs 1, 2). The skin over the swelling was nodular, shiny, and intact. On palpation, the mass was nontender, lying between the skin and the superficial fascia, and the examining fingers could be inserted under the smooth, well-defined upper edge. The patient’s general condition was good and regional lymph nodes were not enlarged. Laboratory data, including blood counts, erythrocyte sedimentation rate, stool examination for eggs and parasites, and fasting blood sugar, were all normal. X-Ray of the right hand showed soft tissue swelling without bone destruction or calcification. A repeat deep biopsy from the edge of the mass showed a dense granulomatous infiltrate in the dermis, consisting of plasma cells, histiocytes, neutrophils, and multinucleated giant cells, with a marked preponderance of eosinophils. A few large nonseptate hyphae were seen (Fig. 3), surrounded by bright granular eosinophilic material in the dermis. Culture for acid-fast bacilli and fungus was negative. The patient was treated with a saturated solution of potassium iodide. Initially, she was put on five drops of potassium iodide daily. Every week, the dose was increased by five drops until the patient started to complain of side-effects. The dose was then reduced by five drops and maintained. The maintenance dose was 30 drops, three times daily. There was complete regression of the mass after 3 months of therapy (Fig. 4). Maintenance therapy was continued for another 6 months. No recurrence of the lesion was noted during 11 months of follow-up. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses his career with the journal that started in January 2008, how he helped achieve their goals, the condition of the publication industry in India, and his achievements as the editor-in-chief.

The author reflect on whether adult onset atopic dermatitis(AD) is present in India. They say that adult onset AD's characteristic manifestation is inflammatory eczema with lichenification. They say that existing criteria for diagnosing AD must be validated and modified or else many AD cases would not be detected in adults.

A biography of Henry Vandyke Carter, a British national physician based in India, is presented. Carter was born in May 22, 1831 in Yorkshire, England and married to Mary Ellen Robison with two children. During his stay at St. George's Hospital, he worked with Henry Gray as illustrators of Gray's anatomy book where his expertise on drawing pictures was showed. Moreover, he also joined the Bombay Medical Service as assistant surgeon in January 1858. Carter died of tuberculosis on May 4, 1897.

The article presents a case study of a 4.5-year-old boy with a history of spontaneous and trauma-induced blistering in hands and feet since birth. It notes that examination reveals that there was multiple bullae and crusted ulcers in palms and palmar aspects of the fingers, as well as mild contractures and resorption of the terminal phalanges of the fingers. It reveals that the patient has dystrophic epidermolysis bullosa (DFB) which is evident in the linear arrangement of perforating lesions.

The article discusses the art and science of medical poster presentation. It stresses the importance of understanding the poster as a distinct form of research work presentation. It outlines the parts of a scientific poster, including the background, text and graphics. It notes that the title should be in the largest font which is proportional to importance. It suggests that the poster should be planned and prepared ahead of time for further editing of typographical and grammatical errors.

A 2-year-old male child was diagnosed with erythrokeratoderma variabilis, and showed an excellent response to low-dose isotretinoin, with remarkable improvement in all the affected areas within just 2 weeks of treatment. [ABSTRACT FROM AUTHOR]