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Probiotics are viable microorganisms that confer health benefits when administered to the host in adequate amounts. Over the past decade, there has been a growing demand for the use of oral and topical probiotics in several inflammatory conditions such as atopic dermatitis, psoriasis, acne vulgaris, etc., although their role in a few areas still remains controversial. The objective of this article is to shed light on understanding the origin and implications of microbiota in the pathophysiology of these dermatological conditions and the effect of probiotic usage. We have conducted a comprehensive search of the literature across multiple databases (PubMed, EMBASE, MEDLINE, and Google Scholar) on the role of probiotics in dermatological disorders. Commensal microbes of the skin and gastrointestinal tract play an important role in both health and disease. Increased use of probiotics has asserted a good safety profile, especially in this era of antibiotic resistance. With the advent of new products in the market, the indications, mechanism of action, efficacy, and safety profile of these agents need to be validated. Further studies are required. Oral and topical probiotics may be tried as a treatment or prevention modality in cutaneous inflammatory disorders, thus facilitating decreased requirement for topical or systemic steroids and antimicrobial agents. Tempering microbiota with probiotics is a safe and well‑tolerated approach in this era of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Itraconazole (ITZ) has been the mainstay of oral antifungal treatment for the current epidemic of recalcitrant dermatophytosis (RD) in India. Recently, a newer formulation of ITZ, super bioavailable itraconazole (SUBA-ITZ), is made available in the market by many pharmaceutical companies. It is important for dermatologists to understand the pharmacokinetic properties of SUBA-ITZ vis-a-vis conventional pellet formulation to use it effectively and safely. Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) has established a special interest group for recalcitrant dermatophytosis (SIG-RD) to strengthen research, continuing medical education, and industry collaboration on the subject. This position statement on SUBA-ITZ by SIG-RD is an attempt to address current pieces of evidence and the position of this new formulation in the management of RD. [ABSTRACT FROM AUTHOR]

Background: Obesity is considered one of the risk factors for dermatophytosis and warrants systemic therapy. Itraconazole is the most commonly used antifungal, but owing to pharmacokinetic challenges, super-bioavailable itraconazole (SITZ) was approved globally, recently. For the management of dermatophytosis in obese patients, there are mixed opinions regarding the dosing of systemic antifungals. Materials and Methods: This study was conducted to compare the efficacy and safety of SITZ-130 mg once daily in glabrous tinea or dermatophytosis in obese and non-obese patients for a total duration of 10 weeks on 87 eligible patients. Efficacy and safety assessments were done at weeks 3 and 6 with follow-up at week 10 for relapse. The primary objective was to assess the proportion of patients achieving complete cure at week 6 with the assessment of safety, clinical, and mycological cure rates as secondary objectives. Results: Out of 87 patients, 80 were considered for analysis. At week 6, 22/35 (63%) and 33/45 (73%) patients in obese and non-obese groups were completely cured (P = 0.47). Similarly, there was no statistically significant difference for mycological and clinical cure in both the groups (P = 0.17 and P = 0.61, respectively). Four patients in the obese group (18% of completely cured), while one patient in the non-obese group (3% of completely cured), relapsed within 4 weeks of completion of treatment (P = 0.14). The therapy was well tolerated by both groups, with only one patient in the non-obese group experiencing pruritus. Conclusion: SITZ-130 mg once daily achieved desired and similar clinical response in obese patients as of non-obese patients suffering from dermatophytosis, and hence, a higher dose may not require in obesity. [ABSTRACT FROM AUTHOR]

Introduction: Melasma is an acquired disorder, which presents with well-demarcated, brown-colored hyperpigmented macules, commonly involving the sun-exposed areas such as the face. It is a chronic and distressing condition, affecting the patients' quality of life, and has been conventionally treated with "first-line" agents including hydroquinone (HQ) alone or as a part of a triple combination cream (TCC), while "second-line" options include chemical peels, and third line options include laser therapy. Materials and Methods: A systematic search was performed for all topical and systemic treatments for melasma up till May 4, 2021, using the PubMed and EMBASE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The search terms "melasma" and "treatment" were used to search for the relevant articles on both these databases, and a total of 4020 articles were identified. After removing the duplicate entries and screening the titles, abstracts, and full-text articles, we identified 174 randomized controlled trials (RCTs) or controlled clinical trials. Results: Based on our review, HQ, TCCs, sunscreens, kojic acid (KA), and azelaic acid receive grade A recommendation. Further large-scale studies are required to clearly establish the efficacy of topical vitamin C, resorcinol, and topical tranexamic acid (TXA).Several newer topical agents may play a role only as an add-on or second-line drugs or as maintenance therapy. Oral TXA has a strong recommendation, provided there are no contraindications. Procyanidins, Polypodium leucotomos (PL), and even synbiotics may be taken as adjuncts. Discussion: Several newer topical and systemic agents with multimodal mechanisms of action have now become available, and the balance seems to be tipping in favor of these innovative modalities. However, it is worth mentioning that the choice of agent should be individualized and subject to availability in a particular country. [ABSTRACT FROM AUTHOR]

Background: Impact of COVID-19 pandemic has been immense. An innocent casualty of this disaster is medical education and training. Dermatology, which primarily deals with out-patient services, medical and surgical interventions, and in-patient services, was one of the worst hit. The National Medical Commission of India has implemented competency-based medical education (CBME) in Dermatology, Venereology, and Leprosy since 2019. The new curriculum relies on acquiring practical and procedural skills, training skills in research methodology, professionalism, attitude, and communication. Objectives: The study was undertaken to understand the implications of the COVID-19 pandemic on postgraduate dermatology CBME training in India. Materials and Methods: A questionnaire-based survey was carried out on postgraduate dermatology teachers and residents in India after obtaining ethics committee approval. An online semi-structured English questionnaire was administered by Google Forms. The calculated sample size was 366 dermatology faculty and 341 postgraduate students. Validity (Content validity ratio (CVR) ≥0.56) and reliability (Cronbach's alpha coefficient 0.7249) of the questionnaire were determined. Results: Among the 764 responses received, 51.4% reported that their institutes were converted to exclusive COVID hospitals. Domains of dermatology education affected were procedural training (n = 655), bedside clinical teaching (n = 613), outpatient department-based clinical teaching (n = 487), bedside laboratory procedures (n = 463), research activities (n = 453), histopathology (n = 412), and theory classes (n = 302). To keep up with the teaching-learning process, online platforms were mostly utilized: Zoom Meeting (n = 379), Google Meet (n = 287), and WhatsApp Interaction (n = 224). Teaching during ward rounds was significantly more affected in exclusively COVID institutes than non-exclusive COVID institutes (P < 0.001). Psychomotor skill development suffered a major jolt with 26.7% of respondents reporting a standstill (P < 0.001). Communication skills among students suffered due to social distancing, mask, and poor attendance of patients. According to 23.84% of respondents, formative assessment was discontinued. Conclusion: Online seminars, journal clubs, and assessments have been incorporated during the pandemic. Online modalities should be used as a supplementary method as psychomotor skills, communication skills, research work, and bedside clinics may not be replaced by the e-learning. [ABSTRACT FROM AUTHOR]

Mentoring albeit is a recently described and popular phenomenon in medicine, is not a new one. All medical specialties have a complex, intertwined relationship between their physicians and trainees who are in different stages of their careers. How a specialty evolves depends on the thread woven by these relationships. This article outlines the concept of mentorship and introduces its various aspects in dermatology. This article attempts to answer what, why, how, when, and where related to mentoring in dermatology, including e-mentorship. The article also includes personal reflections of the authors who are involved in this process. [ABSTRACT FROM AUTHOR]

Case report is regarded as one of the first line of evidence in medical science. There have been numerous circumstances, where the initial dissemination (and breakthrough) of scientific knowledge had been done, with the help of case reports. Case report is a particular variety of manuscript that showcases the unusual features and management of a patient. The words of William Osler (Father of modern medicine) "Always note and record the unusual...publish it. Place it on permanent record as a short, concise note. Such communications are always of value," still hold relevance in today's era. In this article, we shall discuss the keys to draft a case report worthy of publication. [ABSTRACT FROM AUTHOR]

Background: Given the all-encompassing foothold of COVID-19, it is plausible that the pandemic would have a long-lasting impact on medical training programs, including dermatology. We conducted a survey amongst the residents of dermatology (across India) to assess the impact of COVID-19 pandemic on their teaching and education programs. Materials and Methods: An online semi-structured English questionnaire was prepared on the Google-forms platform and the link was circulated among the residents. The questionnaire comprised of five sections (demographic details, impact on clinical training, procedural training, academic curriculum, and research activities). Appropriate statistical tests were carried out to analyze the data obtained. Results: Three-hundred and seventy-eight responses were taken into consideration. A majority of the respondents (63.5%) were engaged in both COVID-19-related duties and departmental work (out-patient and in-patient duty). Around two-thirds of the trainees (65.1%) claimed a reduction in patient footfall (greater than 50% compared to pre-COVID times). Sixty-nine percent reported a decline of more than 50% in in‑patient admission; 47.6% felt that the discontinuity in patient care had severely affected their residency training; 50.8% highlighted that no procedures were being performed in their department; 54.5% opined that academic activities were relatively unhampered as regular seminars were being conducted through online web-based applications; and 65.1% of the trainees were not able to devote any time to their thesis-related work. Conclusion: Since the after‑effects of this pandemic will last long, it is advisable that residents and faculties adapt themselves to web-based learning programs in the academic curriculum so that the training of the future consultants does not get jeopardized. Our survey, being the first of its kind in dermatology, will throw some light on the perspective of residents and the way forward to combat the untoward consequences on their training programs. [ABSTRACT FROM AUTHOR]

Introduction Dermatologists have the skill to identify the conditions by the visual appeal of it. J Dermatol 2020;47:41-6. 20 Ilgen U, Turan S, Emmungil H. Bull's head sign in a patient with SAPHO syndrome. The ever increasing conditions in dermatology and their closeness to a number of other conditions make dermatology an extremely challenging field. [Extracted from the article]

The article presents a case series of four patients presenting with erythema multiforme (EM)-like pityriasis rosea (PR) and discusses case history, examination and treatment of the patients with betamethasone.

Cutaneous squamous cell carcinoma, characterized by malignant transformation of normal epidermal keratinocyte is the second most common nonmelanoma skin cancer that has many predisposing factors. Tuberous xanthomas have not yet been reported as a predisposing factor. We report here the case of long-standing tuberous xanthoma in a middle-aged gentleman complicated by cutaneous squamous cell carcinoma, probably the first such report in the Indian literature. [ABSTRACT FROM AUTHOR]

Based on the history, clinical features, and histology, a diagnosis of the inflammatory verrucous epidermal nevus with lobster claw hand was done. Sir, Inflammatory linear verrucous epidermal nevus (ILVEN) is a type of epidermal nevus characterized by linear, pruritic, erythematous, and hyperkeratotic papules that often coalesce into plaques, with a raised scaly surface, which may be unilateral or bilateral and usually follows the lines of Blaschko. [Extracted from the article]

Garlic burn was first described by Parish I et al i . in 1987.[[5]] Garlic burns may develop in other circumstances as well, including occupational dermatitis and factitious dermatitis. Sir, Skin acts as a barrier against external injurious stimuli including heat, friction, chemicals, etc., However, in many circumstances, patients land up to our clinic with self-inflicted injuries on the skin. [Extracted from the article]

Background: Pityriasis rosea (PR) is an acute inflammatory dermatosis. The association of human herpes virus 6 and 7 suggests the utility of use of antiviral agents in this disease. Aims and Objectives: To evaluate the effectiveness and safety of acyclovir in the treatment of PR. Methods: An observer-blind, randomized (1:1), parallel group, add-on trial was conducted on 24 adult patients with PR. Subjects of both Group A and B received the standard of care in the form of cetirizine 10 mg OD and calamine. Group A in addition received acyclovir 400 mg tablets thrice daily for 7 days. Both groups were followed up for four consecutive weeks for assessment of effectiveness and adverse events. Results: Group A complained of significantly fewer new lesions than Group B (P = 0.046). A complete response was obtained in all patients of Group A and 83% patients of Group B at the end of the follow up period. There was significant reduction in both lesional score and pruritus at second week follow-up in Group A and third week follow-up in Group B (P < 0.05). Minor adverse effects were observed in both treatment arms. Conclusion: Acyclovir offered rapid resolution of clinical severity of PR from second week onwards without significantly increased adverse events as compared to supportive therapy alone. [ABSTRACT FROM AUTHOR]

Acanthosis nigricans (AN) is a fairly common dermatosis characterized by hyperpigmented velvety plaques, having a predilection for the intertriginous areas. We herein present a case of unilateral nevoid acanthosis nigricans over the left lateral chest, in an adult male. The rarity of documentation of this entity in the world literature prompted us to report the case. [ABSTRACT FROM AUTHOR]

A 32-year-old lady presented with an asymptomatic, linear pigmented lesion on the forehead and left side of nose, of 2 months duration. Sir, Linear cutaneous lupus erythematosus is an uncommon variant of lupus erythematosus (LE) presenting along the lines of Blaschko. Linear lichen planus and lichen planus pigmentosus were considered as differentials and a punch biopsy from the active part of the lesion over the nose was done. [Extracted from the article]

Azithromycin-induced FDE is a rare condition.[[7]] Herein we report an interesting case of FDE due to azithromycin, with a peculiar linear non-dermatomal non-blaschkoid clinical pattern located over the lower back, in the midline. As the consumption of these drugs increases, the risk of drug reactions also increases and hitherto unseen reactions to drugs may be observed.[[1]] We hereby report a case of azithromycin-induced linear fixed drug rash. REFERENCES 1 Sehgal VN, Srivastava G. Fixed drug eruption (FDE): Changing scenario of incriminating drugs. [Extracted from the article]

A quiz concerning the sudden appearance of numerous small nonpruritic eruptions or generalized papules all over the body of a pubertal female is presented.

The article presents a case study about a 60-year-old man presented with a solitary, nonhealing fragile mass over the abdomen and have been diagnosed with a basal cell carcinoma, the most common malignancy of skin worldwide.

The article presents a case study about a 10-month-old female infant with an amniotic band syndrome or a congenital depressed scar over her face and scalp leading to facial asymmetry.

A letter to the editor is presented related to case study of a 30-year old woman suffering with aneurysmal benign fibrous histiocytoma (BFH).

Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. Laser epilation was offered, but the parents refused.{Figure 1} Anterior cervical hypertrichosis is an uncommon variant of primary localized hypertrichosis.[[1]],[[2]]Commonest accompanying anomaly is peripheral neuropathy.[[3]] Active non-intervention with periodic follow-up is the best therapy. Cutaneous examination revealed localized tuft of hair over the laryngeal prominence [Figure 1].There was no hypertrichosis or any other anomaly in other parts of the body. [Extracted from the article]

The article presents the case of a 40-year-old lady with a painful ulcerated plaque over the sole of the right foot. Topics discussed include differential diagnoses considered including Bowen's disease, lupus vulgaris, and atypical mycobacterial infection, the treatment of oral prednisolone given to the patient, and characteristics of ulcerative or erosive lichen planus (LP).

Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare nevoid condition characterized by asymptomatic grouped keratotic papules and plaques with a linear pattern on the extremities, having distinct porokeratotic histopathological features. The lesions usually present at birth or in childhood. We present here a case of late-onset PEODDN in a 23-year-old man who had lesions on the palm, forearm, arm and the chest along the lines of Blaschko, strictly localized to the left side of the body. [ABSTRACT FROM AUTHOR]

The generalized form of acanthosis nigricans, especially in infants, is extremely rare. Herein we report a 1-year-old female child who developed generalized acanthosis nigricans without any evidence of internal malignancy or endocrine disorder. This case is being reported for its rarity. [ABSTRACT FROM AUTHOR]

Angiokeratomas are a group of vascular ectasias that involve the papillary dermis and may produce papillomatosis, acanthosis and hyperkeratosis of the epidermis. Angiokeratoma circumscriptum is the least common variant among many types. Angiokeratoma circumscriptum neviforme is a still rarer variety of angiokeratoma, which is classically seen at birth. We report here a case of congenital, linear, unilateral, verrucous plaques on the leg of a young girl, diagnosed as angiokeratoma circumscriptum neviforme (ACN). [ABSTRACT FROM AUTHOR]

Pseudoxanthoma elasticum (PXE) is an inherited disorder characterized by generalized fragmentation and progressive calcification of elastic tissue. We report two sporadic cases of PXE, both of whom presented with asymptomatic yellowish papules over the flexural sites for cosmetic reasons. Histopathological findings on hematoxylin and eosin and Verhoeff-Van Gieson (VVG) staining were classical of PXE. In addition to this, renal calcification was documented on plain radiography of kidneys, ureters, and bladder (KUB) in both the cases. Paucity of literature describing the association of nephrocalcinosis with PXE prompted the present report. [ABSTRACT FROM AUTHOR]

The article discusses a case study of a 35-year-old female patient of human immunodeficiency virus (HIV)-negative, presented with recurrent papulonodular lesions on lower leg, fingers and elbows.

The article discusses the case of a 35-year-old lady with the complaints of increased sweating on right side of her face and upper trunk and was diagnosed of Ross syndrome. Topics covered include the medical history of the patient, characteristics of Rose syndrome, and how demonstration of anhidrosis can be done.

The article presents a case of porokeratotic eccrine ostial and dermal duct nevus (PEODDN), a rare disorder of keratinization, with unique clinical and histopathological findings. Topics discussed include the characteristics of PEODDN, diseases reportedly associated with PEODDN, and the limited treatment options for PEODDN.

The article describes the case of a 28-year-old female who was diagnosed to be suffering from acral acanthosis nigricans (AN) for three years, based on clinical and histopathological findings. Topics discussed include which part of the body AN affects, its eight types, and its clinical significance. Also mentioned are the reported successful treatments of AN in individual cases including etretinate, metformin and urea.

The article discusses the case of a man with a solitary painful mass on his chest diagnosed as eccrine spiradenoma. A description of the lesion and nodule, the patient's history, and the mass and epithelial cords found under histopathological examination are presented. The nine unique tumors to be considered when diagnosing painful skin tumors, the occurrence of spiradenomas in Brooke-Spiegler syndrome, and the treatment option are discussed.