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Background: Patch test is the gold standard for diagnosing allergic contact dermatitis. Conventionally, the patches are applied for 48 h, which in tropical weather conditions causes excessive sweating, leading to irritation, and sometimes the patches come off, making the test inconclusive. Objective: To compare the patch test positivity after 24 and 48 h of occlusion time in patients of allergic contact dermatitis, using standard allergen concentration. Materials and methods: Clinically suspected patients of allergic contact dermatitis were enrolled and patch tested using the Indian Standard Series, parthenium acetone extracts (1:50, 1:100 and 1:200 dilutions) and patient material. Patches were applied in duplicate on either side of the back, using a random number table. One set of patches was removed after 24‐h of occlusion, while the other set after 48‐h. Readings were performed at 48‐ and 96‐h by two independent dermatologists, blinded to the duration of occlusion. Results: The study had 97 adult patients (58 males and 39 females; mean age: 48.12 ± 13.07 years). A total of 133 and 142 positive reactions were observed after 48 h occlusion at 48 and 96 h reading, respectively. Of these 117 (87.9%) and 132 (92.9%) patches were positive and concordant and noted at 24 h occlusion time. The Cohen's kappa coefficient were 0.94 for 48 h and 0.97 for 96 h reading, hence showing an almost complete agreement (ⱪ > 0.81) between patches occluded for 24 and 48 h. Conclusion: Though there is no significant difference in patch test positivity among ISS allergens after either occlusion time, 48 h occlusion performs significantly better compared with 24 h, when reactions of all allergens (ISS, patient material and parthenium acetone extract) are analysed together. [ABSTRACT FROM AUTHOR]

Vascular malformations are intricate anomalies of the circulatory system, presenting a diverse array of clinical manifestations, and posing significant challenges in diagnosis and treatment. The pathogenesis of vascular malformations is explored through the lens of genetic and molecular mechanisms, shedding light on the pivotal role of somatic mutations and dysregulated signaling pathways. Clinical presentations of vascular malformations are widely variable, ranging from cosmetic concerns to life‑threatening complications. The utility of imaging techniques, such as magnetic resonance imaging (MRI), computed tomography (CT), and angiography, are discussed in detail, emphasizing their role in precise delineation and characterization. Therapeutic strategies for vascular malformations are multifaceted, considering factors such as lesion size, location, potential complications, and patient‑specific factors. Traditional interventions, including surgical excision and embolization, are appraised alongside emerging approaches like targeted molecular therapies and minimally invasive procedures. The manuscript underscores the need for an individualized treatment approach, optimizing outcomes while minimizing risks and complications. In summation, this manuscript offers a comprehensive analysis of vascular malformations, encompassing their underlying pathogenesis, clinical nuances, diagnostic methods, and therapeutic considerations. By synthesizing current knowledge and highlighting gaps in understanding, this review serves as a valuable resource for clinicians, researchers, and medical practitioners, fostering an enhanced comprehension of vascular malformations and paving the way for improved patient care and innovative research endeavors. [ABSTRACT FROM AUTHOR]

Background: Rituximab infusion and dexamethasone‑cyclophosphamide pulse (DCP) are the two most popular regimens used in pemphigus vulgaris (PV) in India. Objective: The present study compared the clinical efficacy of rituximab and DCP in Indian PV patients and their effects on serum Th1,2, and 17 cytokine levels. Materials and Methods: A total of 37 patients received DCP (Group A, n = 22) or rituximab (Group B, rheumatoid arthritis protocol (n = 15)) as per patients’ preference. They were monitored for clinical response, adverse events (AEs), changes in serum anti‑desmoglein‑1,3 antibody titers and Th1,2 and 17 cytokine levels at baseline and weeks 20 and 52. Results: The proportion of patients attaining disease control, remission, and relapse in groups A and B were 82% and 93%; 73% and 93%; and 27% and 50%, respectively, after a median duration of 2 months each for disease control; 4 and 4.5 months for remission; and 5 and 7 months for relapse post remission. The musculoskeletal AEs were the highest in the two groups. Significant and comparable decreases in anti‑dsg1 and 3 titers from baseline to weeks 20 and 52 were observed in both groups. Th1 and Th17 cytokine levels decreased, while Th2 cytokines increased post‑treatment in both groups. However, no correlation was found between change in body surface area of involvement by PV and anti‑dsg titers and cytokine levels before and after therapy in both groups. Conclusion: Comparable clinical efficacy between DCP and rituximab was observed. [ABSTRACT FROM AUTHOR]

Palisaded encapsulated neuroma (PEN) is a benign circumscribed nerve sheath tumor usually seen as a solitary painless papule on the face in middle‐aged adults. We report a 22‐year‐old male with multiple adolescent‐onset PENs distributed extensively, including the oral cavity and palms, contrary to the typical presentations. The lesions formed cobblestoned plaques and were confirmed through a skin biopsy, showing characteristic nodules of wavy spindle cells forming interlacing fascicles with interspersed clefts, and positive staining for specific markers, including markers for axons and perineurium. Notably, this case deviates from the usual presentation, shedding light on atypical manifestations of PEN in a young individual without any features suggestive of a neurocutaneous syndrome or multiple endocrine neoplasia syndrome. [ABSTRACT FROM AUTHOR]

This article discusses a case of a 13-year-old child with previously undiagnosed HIV who presented with pyoderma gangrenosum-like ulcers caused by herpes simplex virus (HSV) infection. The ulcers were initially misdiagnosed and treated with antibiotics, but did not improve. Histopathology and microbiology tests confirmed the presence of HSV-1, and the patient was started on intravenous acyclovir and prednisolone. The patient's HIV infection was subsequently discovered, and antiretroviral therapy was initiated. The ulcers showed significant healing after treatment with acyclovir. The article emphasizes the importance of considering atypical presentations of herpes in patients with immunodeficiency, such as HIV, and highlights the need for screening for HIV infection in patients with non-responding or unusual manifestations. [Extracted from the article]

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]

Cardiomyopathy (particularly dilated cardiomyopathy (DCM)) significantly contributes to development and progression of heart failure (HF), and inflammatory factors further deteriorate the symptoms. Morphological and functional defects of the heart in doxorubicin (DOX)-induced cardiomyopathy (cardiotoxicity) are similar to those of DCM. We used anagonist of PGC-1α (PPAR (peroxisome proliferator-activated receptor-gamma)-γ coactivator-1α) that is considered as the 'master regulator' of mitochondrial biogenesis with an aim to rescue the DOX-induced deleterious effects on the heart. Forty male C57BL/6J mice (8 weeks old) were divided in four groups, Control, DOX, ZLN005, and ZLN005 + DOX (n = 10 each group). The DOX-induced (10 mg/kg, single dose) cardiomyopathy mimics a DCM-like phenotype with marked morphologic alteration in cardiac tissue and functional derangements. Significant increased staining was observed for Masson Trichrome/Picrosirius red and α-Smooth Muscle Actinin (α-SMA) that indicated enhanced fibrosis in the DOX group compared to the control that was attenuated by (peroxisome proliferator-activated receptor-gamma (PPAR-γ) coactivator) (PGC)-1α (alpha) agonist (four doses of 2.5 mg/kg/dose; cumulative dose = 10 mg/kg). Similarly, elevated expression of necroptosis markers along with enhanced oxidative stress in the DOX group were alleviated by PGC-1α agonist. These data collectively suggested the potent therapeutic efficacy of PGC-1α agonist in mitigating the deleterious effects of DOX-induced cardiomyopathy, and it may be targeted in developing the future therapeutics for the management of DCM/HF. [ABSTRACT FROM AUTHOR]

Byline: Prashant. Bharti, M. Ramam, Neetu. Bhari A 4-year-old boy presented with a vertically oriented, linear, erythematous atrophic plaque of size 4.5 × 0.5 cm in the midline of the [...]

Byline: Sanjay. Singh, Neha. Taneja, Subuhi. Kaul, Sudheer. Arava, Neetu. Bhari Sir, A 24-year-old woman presented with progressively increasing itchy, erythematous lesions on the face, trunk and arms since the [...]

This article discusses two cases of vulval extramammary Paget's disease and their treatment with topical imiquimod cream. The patients experienced symptoms such as itching, skin-colored plaques, and erosions, and their diagnosis was confirmed through skin biopsies. Imiquimod cream was used as a treatment, resulting in a good response in one case and a partial response in the other. Surgical excision was recommended for the patient with a partial response. The article also provides information on the prevalence, diagnosis, and treatment options for extramammary Paget's disease. The Indian Dermatology Online Journal has released its January-February 2024 issue, which can be accessed and downloaded online. [Extracted from the article]

Background: Moisturizers are first‐line therapy for treatment of atopic dermatitis (AD). Although there are multiple types of moisturizers available, head‐to‐head trials between different moisturizers are limited. Objective: To evaluate if a paraffin‐based moisturizer is as effective as ceramide‐based moisturizer in children with AD. Materials and Methods: In this double‐blind, randomized comparative trial of pediatric patients with mild to moderate AD, subjects applied either a paraffin‐based or ceramide‐based moisturizer twice daily. Clinical disease activity using SCOring Atopic Dermatitis (SCORAD), quality of life using Children/Infants Dermatology Life Quality Index (CDLQI/IDLQI), and transepidermal water loss (TEWL) were measured at baseline and at follow‐up at 1, 3, and 6 months. Results: Fifty‐three patients were recruited (27 ceramide group and 26 paraffin group) with a mean age of 8.2 years and mean disease duration of 60 months. The mean change in SCORAD at 3 months in the ceramide‐based and paraffin‐based moisturizer groups was 22.1 and 21.4, respectively (p =.37). The change in CDLQI/IDLQI, TEWL over forearm and back, amount and days of topical corticosteroid required, median time to remission and disease‐free days at 3 months were similar in both groups. As the 95% confidence interval (CI) of mean change in SCORAD at 3 months in both groups (0.78, 95% CI: −7.21 to 7.52) was not within the predefined margin of equivalence (−4 to +4), the conclusion of equivalence could not be proven. Conclusion: Both the paraffin‐based and ceramide‐based moisturizers were comparable in improving the disease activity in children with mild to moderate AD. [ABSTRACT FROM AUTHOR]

Background: Narrow‑band ultraviolet B (NB‑UVB) is the standard therapy for vitiligo. Objective: The objective of this study is to compare the safety and clinical efficacy of a handheld NB‑UVB comb device with the standard whole‑body NB‑UVB therapy in localized stable vitiligo. Materials and Methods: Thirty‑one vitiligo patients were allocated to either daily therapy with a home‑based handheld comb device (group A, n = 17) or thrice‑weekly hospital‑based whole‑body NB‑UVB therapy (group B, n = 14) for 4 months, based on their preference. The primary and secondary outcomes were assessed at each follow‑up, and appropriate statistical tools were used for analysis. Results: Of the 31 patients enrolled, 26 patients (study groups A/B: 15/11) completed the study. Primary outcome: Median percentage repigmentation of the representative patch in groups A and B were 51.35% and 63.85%, respectively (P = 0.64). The median size reduction of the representative patch in both groups was statistically significant (P < 0.05). The mean difference between “per protocol analysis” and “intention to treat” showed noninferiority. Secondary outcomes: Both groups were comparable on Lund and Browder score, patient global assessment and investigator global assessment scores, adverse events, color match, and change in the quality of life. The comparison group had a significantly greater number of missed sessions (P = 0.02). The majority of patients had a “good” response in both groups. Conclusion: Handheld NB‑UVB comb device daily with a fixed dose of fluence was found to be noninferior with better compliance to standard whole‑body NB‑UVB therapy [ABSTRACT FROM AUTHOR]

Byline: Suman. Patra, Neetu. Bhari, Pratik. Mohta, Sanjay. Singh, M. Ramam, Shipra. Agarwal Sir, A 17-year-old girl presented to the dermatology department with fever, moderately itchy rash on the trunk, [...]

Byline: Vinod. Sharma, Neetu. Bhari, Suman. Patra, Anita. Parihar Indian J Dermatol 2019:64(5):417-9 Sir, Platelet-rich plasma (PRP) means 'abundant platelets that are concentrated into a small volume of plasma.' The [...]

Byline: Prashant. Gupta, Kaushal. Verma, Sujay. Khandpur, Neetu. Bhari Background: Corticosteroids are the most common agents used in the treatment of alopecia areata (AA), however, their long-term use is associated [...]

Byline: Sanjay. Singh, Sheikh. Naveed, Nikhil. Mehta, Sudheer. Arava, Neetu. Bhari A 26-year-old man presented with a single, asymptomatic, slowly progressive, firm swelling on the epigastrium, of 18 months' duration. [...]

Byline: Sanjay. Singh, Neetu. Bhari, Snehal. Agrawal, Kaushal. Verma Sir, A 4-month-old male child presented with rapidly progressing, tender, erythematous edematous swelling on the left side of the face and [...]

Byline: A. Narayanan, M. Ramam, Neetu. Bhari A 17-year-old boy presented with multiple, well-defined, erythematous plaques of variable sizes with fine scales on the forehead, supraorbital area, nose, cheeks, chin [...]

Symmetrical peripheral gangrene is a rare condition characterized by the simultaneous development of gangrene in multiple extremities. It can be caused by various conditions, including peripheral vascular disease, sepsis, infections, and hypercoagulable states. This article reports a case of symmetrical peripheral gangrene in a 13-year-old girl due to antiphospholipid antibody syndrome. Early recognition and treatment are crucial to prevent serious consequences, and individuals at higher risk should be educated about the symptoms and advised to seek immediate medical attention. [Extracted from the article]

Byline: Neetu. Bhari, Banwari. Jangid, Piyush. Pahadiya, Sanjay. Singh, Sudheer. Arava, Atin. Kumar, Vinod. Sharma, Gomathy. Sethuraman Sir, A 5-month-old male child presented with an erythematous plaque on the right [...]

Byline: Kaushal. Verma, Arika. Bansal, Neetu. Bhari, Gomathy. Sethuraman Background: Parthenium dermatitis is the most common type of airborne contact dermatitis in India. It is a chronic disease of a [...]

Background: Melanoma is associated with poor prognosis in its advanced stages. Potential influence of estrogen and its metabolites on melanoma growth has been suggested. Aims: The objective of this review was to provide an overview on the evidence related to estrogen in malignant melanoma. Materials and Methods: Literature search using PubMed, Google Scholar and relevant cross‐references of the retrieved articles was performed to review relevant published articles related to estrogen and its effects in malignant melanoma. Results: Effect of estrogen signaling on a tissue largely depends on the relative expression of estrogen receptors (ER) α and β. Gender differences in melanoma may be explained by the difference in expression of these receptors. ERβ is the principal ER in melanoma. Discussion: Although there is uncertainty about role of estrogen in pathogenensis and progression of melanoma, evidence suggests that its growth and metastasis are influenced by estrogen stimulation. Role ER on the proliferation of melanoma cells is well described. Conclusion: There is a need of safe and effective therapy for melanoma, especially for advanced cases. After the establishment of specific role of estrogen and its receptor, analysis of specific genetic mutation can be performed for proper utilization of targeted therapies. [ABSTRACT FROM AUTHOR]

Byline: Vinod. Sharma, Neetu. Bhari, Sweta. Subhadarshani, Neha. Taneja, Rakesh. Deepak A 70-year-old woman presented with generalized reticulate pigmentation, scarring alopecia, and few discrete, violaceous plaques over the trunk and [...]

Byline: Vinod. Sharma, Neetu. Bhari, Somesh. Gupta, Kanika. Sahni, Neena. Khanna, M. Ramam, G. Sethuraman Sir, We thank the authors for their interest in the article “Clinical efficacy of rituximab [...]

Byline: Vinod. Sharma, Neetu. Bhari, Somesh. Gupta, Kanika. Sahni, Neena. Khanna, M. Ramam, G. Sethuraman Background: Pulsed corticosteroids have been used successfully for the management of pemphigus. However, prolonged use [...]

Byline: Neetu. Bhari, Kanika. Sahni, Kaushal. Verma, Neena. Khanna, Sudheer. Arava, Somesh. Gupta Sir, A 54-year-old man with a 7 year history of vitiligo vulgaris presented with three pigmented plaques [...]

A case study illustrates two distinct reactions post ChAdOx1 COVID-19 vaccination: one presenting as erythema multiforme major and the other as vasculitis with an erythema multiforme-like appearance. Both cases differed in pathology and management approaches, emphasizing the need for awareness of varied cutaneous reactions post-vaccination for appropriate patient counseling and management strategies.