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Background: Allergic contact dermatitis (ACD) is a disease characterised by an immune mediated response to a substance. The primary prevention remains avoidance of the implicated allergen. This is done with the help of patch test using the Indian Standard series (ISS).Methods: Out of the 246 cases of ACD that came to our Dermatology department, 92 patients were selected and subjected to patch testing using the ISS. Results were read after 48 and 96 hours, interpreted as per ICDRG criteria and were analysed.Results: From 92 patients 59.8% were males and 40.2% were females. Majority of the individuals with ACD who were patch tested belonged to the age range of 21-60 years accounting to 72.8%. The most affected site was the foot. 26.7% showed positivity to Black rubber mix, followed by potassium dichromate 20% and nickel 14.4%. 7.8% produced delayed reactions with positivity revealed at the final reading. One patient gave multiple positive reactions to paraben, PPD and chlorocresol.Conclusions: In the study middle aged males were mostly affected which may be influenced by the sample selected. Black rubber mix was identified as the most frequent sensitizer followed by potassium dichromate which was also implicated as the sensitizer most seen in the unskilled generally. Fragrance mix was responsible for all delayed responses yielding positivity in the second reading. When not considering the negligible left, patch tests’ results could be correlated with the clinical presentations. Patients were treated, educated on ACD and advised to refrain from exposure with suggestions of possible alternatives.

Rituximab is a newly approved biological wonder drug in pemphigus vulgaris -an autoimmune mucocutaneous blistering disease due to antibodies produced against the epidermal adhesion molecules dsg 1 and dsg 2. The conventional therapy included high dose steroids or immunosuppressants that though effective had significant adverse effects that necessitated an alternate path in treatment. We present a case series of five patients in different clinical scenarios diagnosed with pemphigus vulgaris and treated with Rituximab by RA protocol either sole or in combination with other treatment strategies. Our experience with this drug has paved way to immense possibilities and outcomes that are in favour of using Rituximab as first line option. We have encountered prolonged remission in cases that were treated with Rituximab by Rheumatoid arthritis (RA) protocol. The sustained response has helped in reducing the dose of steroids and other immunosuppressants substantially. These facts are reinforced through our observations. But there is need to standardize the dosage of Rituximab in pemphigus.

Background: Treatment of chronic nonhealing cutaneous ulcers is a challenge to clinicians. When wounds fail to achieve sufficient healing after 4 weeks of conventional therapy reassess the underlying pathology and consider advanced therapeutic options. Autologous platelet rich plasma is a novel treatment for nonhealing cutaneous ulcers, which can provide growth factors directly onto the wound.Methods: 34 patients with non-healing cutaneous ulcers satisfying inclusion and exclusion criteria were included in the study. All patients were treated with PRP therapy weekly for 6 weeks. Every week ulcer area and volume was measured and outcome expressed as improvement in area and volume of ulcers before and after PRP therapy.Results: In our study majority were males (64%) and the mean age of population was 51.0±10.4 years. Of 34 patients 18 had venous ulcers. All ulcers healed within 12 weeks and mean duration of healing was 7.51±2.9 weeks. 8 (24.24%) patients had their ulcer completely healed within 6 weeks. Larger ulcers took long duration to heal and smaller ones healed within short duration. The total improvement in area and volume of ulcers was 85.7% and 90.7% (median) respectively at the end of 6 weeks.Conclusions: PRP is an effective, safe, readily available and cheap outpatient procedure which can be widely used for the treatment of chronic recalcitrant ulcers which improves the quality of life and reduces the financial burden of patients. Further research and controlled, randomized prospective clinical trials on larger population are necessary to validate the results.

Mycetoma or Madura foot is a chronic localized granulomatous infection caused by varied species of fungi or actinomycetes clinically diagnosed by active discharging sinuses containing ‘grains’. In atypical presentations or patients unwilling for invasive investigations, imaging essentially plays a key role in diagnosis and helps to differentiate actinomycetoma from eumycetoma. Here we present such an atypical case of unilateral foot swelling without sinuses–cryptic mycetoma. This 69 year old male from Kerala had a swelling over the left foot following trauma initially painless. An x-ray taken showed normal underlying bones with mild soft tissue swelling. To evaluate further USG was taken which showed fine hyperechoiec foci settled at the bottom of cavities highly suggestive of mycetoma. For confirmation USG guided biopsy was taken but was inconclusive. As patient was not willing for repeat biopsy, we advised non invasive MRI that revealed classical ‘Dot In Circle’ sign specific for mycetoma. The distinction that makes the case stand out is its absence of classical picture of discharging sinuses and the fact that imaging rather than histopathology helped confirm the diagnosis in mycetoma.