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Background: Acne vulgaris is a very common skin disease with a significant detrimental effect on the quality of life of the patients., Aims: To assess the comparative efficacy and safety of a nano-emulsion gel formulation of adapalene and clindamycin combination with its conventional formulation in the treatment of acne vulgaris of the face. It was a prospective, randomized, open label, active-controlled, multicentric, clinical trial., Methods: Eligible patients suffering from acne vulgaris of the face were randomized to receive once-daily treatment with a nano-emulsion gel or conventional gel formulation of adapalene 0.1% and clindamycin (as phosphate) 1% combination for 12 weeks. Total, inflammatory and noninflammatory lesion counts, with grading of acne severity were carried out on a monthly basis. Safety assessments were done to determine the comparative local and systemic tolerability. Two-tailed significance testing was carried out with appropriate statistical tests, and P-values < 0.05 were considered as significant., Results: 209/212 patients enrolled in the study were eligible for efficacy and safety assessments in both nano-emulsion gel (118/119 patients) and conventional gel (91/93 patients) groups. Significantly better reductions in total (79.7% vs. 62.7%), inflammatory (88.7% vs. 71.4%) and noninflammatory (74.9% vs. 58.4%) lesions were reported with the nano-emulsion gel as compared to the conventional gel (P < 0.001 for all). Mean acne severity score also reduced significantly more with the nano-emulsion formulation (1.9 ± 0.9 vs. 1.4 ± 1.0; P < 0.001) than the comparator. Significantly lower incidence and lesser intensity of adverse events like local irritation (4.2% vs. 19.8%; P < 0.05) and erythema (0.8% vs. 9.9%; P < 0.05) were recorded with the nano-emulsion gel., Conclusions: The nano-emulsion gel formulation of adapalene and clindamycin combination appears to be more efficacious and better tolerated than the conventional formulation for the treatment of acne vulgaris in Indian patients. Further studies can elucidate the comparative treatment benefits of this nano-emulsion gel formulation.

Background: Laboratory tests for the diagnosis of cutaneous tuberculosis lack adequate sensitivity and specificity and a trial of therapy is often used as a diagnostic test in difficult cases. However, the duration for which the trial should be undertaken is not clearly defined. Our previous study indicated that one month of therapy was adequate to detect a clinical response to treatment. However, about half the patients first reported after one month of treatment, some much later., Method: We therefore analysed the treatment records of 107 patients who received four-drug, short course, antitubercular therapy for a diagnosis of cutaneous tuberculosis in our hospital and who were asked to return for follow-up at biweekly intervals in the first month of treatment., Result: Twenty-one patients did not return for any follow-up visit, nine patients did not respond to treatment and treatment was stopped in one patient. Of the remaining 76 patients, 72 patients were recorded to have distinct clinical improvement within five weeks of starting treatment while only four patients showed improvement after 60-123 (8-17 weeks) days of therapy., Conclusion: These findings indicate that five weeks appears to be an adequate duration of a therapeutic trial in patients suspected to have cutaneous tuberculosis, with the exception of tuberculids and patients showing minimal clinical activity before treatment. Patients who have not responded by this time are unlikely to do so with further treatment and should have their diagnosis reviewed.

Background: Extensive alopecia areata is known to respond to daily oral corticosteroids. To minimize the side effects of daily corticosteroids, oral mini-pulse therapy with betamethasone has been used in vitiligo and other dermatoses. There are a few studies in alopecia areata also., Aim: To evaluate the efficacy of oral mini-pulse therapy in extensive alopecia areata., Methods: It is an open study on sixteen adolescents and adults with alopecia areata/ totalis/universalis treated with oral mini-pulse therapy for a minimum period of six months. The patients were evaluated clinically and with serial photographs for response and periodical investigations were undertaken to look for the side effects. All the patients were followed up for 5-8 months to look for any relapse., Results: Seven (43.7%) patients showed an excellent response and five (31.2%) patients had good response. Two patients (12.5%) had unsatisfactory response and another two (12.5%) were non-responders. There were insignificant/minimal side effects., Conclusion: Oral mini-pulse therapy with betamethasone is a safe and effective therapeutic modality for extensive alopecia areata.

Chilblain lupus erythematosus with depigmentation is a rare presentation of lupus erythematosus that may simulate vitiligo. A 52-year-old lady with such a manifestation is being reported.

A 2-year-old mare child presented with multiple hypopigmented, flat topped papules with a bilateral distribution along the lines of Blaschko. A 7-year-old girl presented with multiple hypopigmented macules arranged linearly along the left upper and lower limb and also on the back along the lines of Blaschko. Three discrete lines in three distinct anatomical areas in a case of lichen striatus do not appear to have been described.

A 12-year-old girl presented with dull, opalescent, nails with a roughened surface. She was successfully treated with oral mini-pulse therapy, which consisted of 4 mg betamethasone as a single oral dose with breakfast on two consecutive clays every week.

Atopic dermatitis is a difficult disease to treat. A few reports suggest that azathioprine may be effective in the treatment of atopic dermatitis. We therefore, evaluated the role of azathioprine in adult atopic dermatitis not adequately controlled with conventional therapy. Four patients of adult atopic dermatitis were treated with azathioprine 50 mg twice daily orally for 3-4 months. All the patients had complete remission after therapy. There were no significant side effects. Therefore, azathioprine can be considered a better and safer alternative drug in recalcitrant adult atopic dermatitis.

Ten Patients, 6 males and 4 females between 7-60 years of age having lichen planus for I month to 2 years were treated with betamethasone 5mg orally on two consecutive days in a week for 3 months. There was excellent (75-100%) response in 6 (60%) patients and good (50-75%) in 4 (40%) patients. None of the patients had significant side effects of the therapy and there were no treat-ment failures. Betamethasone on two consecutive days in a week as oral mini pulse therapy may be a safe, effective and a better therapeutic alternative for the treatment of lichen planus.

A 20-year-old Sikh man had palmoplantar keratoderma, flexion deformity of digits, universal alopecia, keratotic plaques at the angles of mouth, gluteal cleft, knees and dorsal aspects of the metacarpophalangeal joints of the hand; features of Olmsted syndrome. He had normal nails, teeth, oral mucosa and normal joint movements. Treatment with acitretin, 25mg/day for three and a half months, followed by 25mg once daily alternating with 50mg once daily for 3 months resulted in significant improvement.

A case of bullous Darier's disease had typical brown follicular papules, greasy crusted papules discrete keratotic papules and vesiculo- bullous lesions on the dorsum of the hands and feet. In addition, characteristic lesions of xeroderma pigmentosum as extensivee, freekles intermingled with atrophic white, spots were present on the, face, trunk and limbs. This combination of bullous Darier's diseaese with xeroderma pigmentosum has not been reported earlier.

This is the first reported case from India of multicentric reticulohistiocytosis, manifesting as multiple cutaneous nodules on the face, ears, elbows, wrists, knees and hands with mild pruritus. Polyarthritis involved the small and bigjoints. Histopathology confirmed the diagnosis. All the lesions disappeared in 1 1/2 years time.

A 62 year old male patient had disseminated discoid lupus erythematosus and multiple nodules over the sun-exposed areas which were diagnosed as multiple keratoacanthomas. Nodules were asymptomatic and had a warty surface covered with thick scales.

A case of cutaneous periarteritis , nodosa had swelling and intense pain on right. lower leg followed by bullae. Incision of bullae resulted in chronic ulcers with peripheral, indurated,vialaceus discoloration, livido reticularis and multiple nodules.

An anaemic adult female developed granuloma multiforme characterised by, hypopigmented papules and annular plaques on her trunk and limbs. Histopathology revealed necrobiosis of collagen and palisading by histiocytes.

Two cases-had meningococcal septicemia with vasculitis of skin. Out 9 year old female developed generalised ,asymptomatic, purpuric atrophic plaques on the limbs, trunk and face on the fourth day of high fever. The second patient was 20 year old male who developed purplish plaques. Nodules, and bullae mainly on the extensor surface of the hands and feet on the tenth day, of high fever. Bullae had clear fluid and bluish-black peripheral rim.

Three young females developed plaque type erythema nodosum. The underlying causes in them were tuberculosis chest, recurrent furunculosis and malaria respectively. All the three cases were under treatment at the time of development of erythema nodosum plaques and the onset was acute.