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Background: Vitiligo is an acquired, idiopathic, and common depigmentation disorder. The values of various epidemiologic parameters are often doubtful due to the methodological weaknesses of the studies., Aims: To elicit the magnitude of various epidemiological parameters and important correlates of vitiligo., Materials and Methods: Every vitiligo patient attending the outpatient department of medical colleges spread over most of the Indian states were examined over a period of 1 year. Various epidemiological and clinical variables were examined and compared with age and sex-matched controls (registered in the Clinical Trial Registry of India CTRI/2017/06/008854)., Results: A total of 4,43,275 patients were assessed in 30 medical colleges from 21 Indian states. Institutional prevalence of vitiligo was 0.89% (0.86% in males and 0.93% in females, P < 0.001). The mean age at presentation and mean age at onset were 30.12 ± 17.97 years and 25.14 ± 7.48 years, respectively. Head-neck was the most common primary site ( n = 1648, 41.6%) and most commonly affected site ( n = 2186, 55.17%). Most cases had nonsegmental vitiligo ( n = 2690, 67.89%). The disease started before 20 years of age in more than 46% of cases. About 77% of all cases had signs of instability during the last 1 year. The family history, consanguinity, hypothyroid disorders, and depressed mood were significantly ( P < 0.001) higher among the cases. First, second, and third-degree family members were affected in 269 (60.04%), 111 (24.78%), and 68 (15.18%) cases, respectively. Work-related exposure to chemicals was significantly higher among cases ( P < 0.008). Obesity was less common among vitiligo cases [ P < 0.001, odds ratio (OR) 0.78, 95% confidence interval (CI): 0.71-0.86]., Conclusion: This is one of the largest studies done on vitiligo in India. The prevalence of vitiligo was found to be 0.89% among hospital attendees. Prevalence of vitiligo was higher among females than in males and prevalence of family history, consanguinity, hypothyroid disorders were higher in vitiligo than among controls., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Dermatology.)

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Competing Interests: There are no conflicts of interest.

Any drug can cause any rash! Cutaneous adverse drug reactions (CADRs) are great mimickers and can be included in the differential diagnosis of any inflammatory dermatoses. Several drugs can cause rash of similar morphology and the same drug can cause rash of different morphology. While some common and specific drug reaction patterns are recognized easily by the clinicians, many a times unusual and interesting patterns can be induced by drug(s), thus leading to erroneous diagnosis and mistreatment. This review aims to familiarize clinicians with some rare, yet interesting patterns of CADR., Competing Interests: There are no conflicts of interest. What is new? The presentation of cutaneous adverse drug reaction is not always typical. The clinician should therefore be familiar with unusual and rare presentations as well. Many drugs considered safe may cause adverse drug reactions, many of which may be serious.Many newer and targeted agents often believed to be safe, can have bizzare and unusual presentation of adverse drug reactions. A possibility of paradoxical drug reactions should be kept in mind when a primary disease gets worsened with a drug used to treat that disease; the examples include immune reconstitution inflammatory syndrome (IRIS) with antiretroviral therapy and induction and/or worsening of psoriasis by TNF-alpha inhibitors.

Background: Topical corticosteroids (TC) are one of the most widely used agents in dermatology practice. Misuse of these agents may lead to a wide range of adverse effects., Aim: This study was conducted to assess the magnitude of abuse of topical corticosteroids (TC) and clinical patterns of cutaneous adverse effects amongst patients attending dermatology department of a teaching hospital at South Rajasthan., Materials and Methods: All patients who reported with adverse effects of topical steroids during one year from September 2015 to August 2016 were evaluated. Patients fulfilling the study criteria were registered for further workup., Results: Out of the 85280 new patients, 370 (0.43%) presented with adverse effects of TC. Males (232/370;62.70%) outnumbered females (138/370;37.30). Age group 11-30 years was most commonly (74.05%) affected. The main reason for using TC was fungal infection (52.43%). Tinea incognito (49.46%) and acne (30.27%) were the most common adverse effects recorded., Conclusions: Abuse of TC, particularly the superpotent and potent is rampant amongst general population. Topical corticosteroids are frequently used for indications where they should be avoided., Competing Interests: There are no conflicts of interest. What is new? The TC abuse is not uncommon even in males and literate masses. The tendency to use TC in dermatophytic infection is rampant leading to modification in clinical picture and therefore posing difficulty in its successful treatment. Enhanced and concerted efforts on the part of patients, prescribers, and regulatory health agencies are needed to overcome the challenge of steroid abuse.

Competing Interests: There are no conflicts of interest.

The typical clinical presentations of cutaneous leishmaniasis are nodules, ulcer, nodulo-ulcerative lesions and crusted plaques. Besides classical clinical picture, several unusual and atypical clinical presentations of the disease have also been reported. Herein, we report three cases of lupoid cutaneous leishmaniasis to highlight the extended clinical spectrum of CL. Tissue smears were positive for Leishman-Donovan (LD) bodies. All patients were treated by azole antifungals with favorable response., Competing Interests: There are no conflicts of interest. What is new? The occurrence of cutaneous leishmaniasis is rare in non-endemic area of South Rajasthan.We reported a rare clinical variant; lupoid leishmaniasis from the non-endemic region of South Rajasthan.

Aims: Angiopoietin-like growth factors (ANGPTLs) regulate glucose, lipid homeostasis, and insulin sensitivity. This study aimed to find whether long-term glycemic control (glycated hemoglobin [HbA 1c ]) has any correlation with serum ANGPTL6 levels in patients of type 2 diabetes mellitus., Materials and Methods: It was an open-label, observational, prospective clinical study. Sixty-five participants (41 diabetic patients receiving daily dose of oral metformin for a minimum of 3 months and 24 matched controls) completed the study. A single venous blood sample was taken from each participant to determine serum HbA 1c and serum ANGPTL6 levels. Comparison of serum ANGPTL6 levels according to the HbA 1c levels, in groups A, B, and C ranging from 6.5%-8%, 8.1%-9.5%, and >9.5%, respectively, was done using Kruskal-Wallis H -test followed by pairwise comparisons., Results: Serum HbA 1c and serum ANGPTL6 levels were raised significantly ( P < 0.05) in diabetic patients when compared with control participants. A positive correlation was observed between serum HbA 1c and serum ANGPTL6 levels ( r = 0.88, 95% confidence interval 0.81, 0.92). Mean ANGPTL6 level for Group A ( n = 20) was 394.3 pg/ml, for Group B ( n = 8) 692.8 pg/ml, and for Group C ( n = 13) 896.2 pg/ml., Conclusions: Serum ANGPTL6 levels were significantly higher in type 2 diabetic patients in comparison with healthy controls. Poor glycemic control in diabetes mellitus as reflected by higher serum HbA 1c levels is associated with raised serum ANGPTL6 levels., Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Background: Cutaneous leishmaniasis (CL) usually occurs in areas with hot and dry climate. In India, the desert areas of Rajasthan, Gujarat, and the plains of Northwestern frontier are endemic for this disorder., Aims and Objectives: The present study was aimed to describe clinicoepidemiological profile of the cases of CL from South Rajasthan, which is a nonendemic area of Rajasthan., Materials and Methods: During a period of 4 years (2010-2014), a total of 23 patients with CL were diagnosed. All the suspected cases of CL were interrogated in detail regarding visit to areas where CL is known to occur. This was followed by clinical examination, relevant investigations, and treatment. All except one patient were treated with azole antifungals. In one patient, CO2 laser ablation was done., Results: There were 12 (52.17%) males and 11 (47.83%) females with age ranging from 3 to 72 years. Duration of disease ranged from 7 days to 10 months. Face (15; 65.22%) and extremities (12; 52.17%) were involved in majority of the patients. Common morphologies were noduloulcerative lesions and crusted plaques. Tissue smear for Leishmania donovani bodies was positive in all except one patient., Conclusion: The present report highlights occurrence of CL in nonendemic area. Further epidemiological studies are required for identification of vector and strain of Leishmania involved.

Background: The spectrum of pyoderma changes constantly, and so does the antibiotic susceptibility pattern., Aims: This study was done to assess the magnitude and clinical patterns of pyodermas, their causative micro-organisms, and the antibiotic susceptibility patterns., Materials and Methods: Five hundred consecutive, clinically diagnosed and untreated cases of pyoderma, attending the Dermatology OPD of RNT Medical College and MB Government Hospital, Udaipur, from October 2010 to September 2011 were the subjects of this study. A detailed clinical examination, and relevant investigations including bacterial culture and sensitivity, were carried out and recorded., Statistical Analysis: For statistical analysis of data, the software 'EPI-INFO Version 6' was used, and Chi-square (χ(2)) test was applied., Results: Of 19576 cases attending skin OPD during the study period, pyoderma was seen in 500 patients; the incidence being 2.55%. Males outnumbered females. The highest number of cases (109; 21.8%) was observed in 1st decade. Lower extremities were the commonest site of predilection. Primary pyodermas outnumbered secondary pyodermas. Furuncle (136; 27.2%) and infectious eczematoid dermatitis (62; 12.4%) were the commonest entities among primary and secondary pyoderma respectively. Staphylococcus aureus was the commonest causative agent in both primary and secondary pyoderma. It showed high susceptibility to amoxycillin + sulbactam, aminoglycosides and cefoperazone, moderate susceptibility to linezolid, while low susceptibility to fluoroquinolones and cephalexin., Conclusion: Such studies help to assess the changing trend of bacterial infections, their causative organisms and antibiotic susceptibility pattern.

Context: Onset of vitiligo during childhood is not uncommon but the data is limited on this subject., Aims: This study was planned to assess the magnitude of childhood onset vitiligo (COV) and adulthood onset vitiligo (AOV), and compare their clinical pattern., Settings and Design: A cross sectional hospital based clinical study., Materials and Methods: Consecutive patients with vitiligo attending the Dermatology OPD of RNT Medical College and MB Government Hospital, Udaipur, from April 2012 to September 2012 were the subjects of this study. A detailed history taking followed by general, systemic and cutaneous examination, and relevant investigations were carried out. The findings were recorded in a proforma for analysis and interpretation of data., Statistical Analysis Used: Statistical analysis of data was done using chi- square and Z test., Results: Of the 295 patients seen during the study period, 109 (36.95%) were patients with COV while 186 (63.05%) had AOV; the COV: AOV ratio being 1: 1.71. Amongst COV patients, females (65/109; 59.63%) outnumbered males (44/109; 40.37%). Maximum (51; 46.79%) patients of COV had onset of their disease on head and neck, out of which eyelid was the initial site of lesion in 29 (26.61%) patients. None of COV patients had universal and isolated mucosal vitiligo., Conclusions: Female predominance, affection of eyelids as initial site, and less frequent mucosal involvement in COV were the clinical features different from AOV.

Chromoblastomycosis belongs to the heterogeneous group of subcutaneous mycoses. It is caused by various pigmented (dematiaceous) fungi, which gain entry into the skin via traumatic implantation. We would like to share a case report of chromoblastomycosis in a 32-year-old male, who presented to us with 3 years history of slowly progressive, itchy, verrucous, crusted lesions over right forearm and arm. He is being treated with itraconazole 100 mg twice daily. The case is of interest because it has so far not been reported from our region- the northwest arid zone of India. The patient showed favorable response to itraconazole.

Background: The evaluation for skin disorders forms an important component of primary health care practice for all including children. The prevalence of certain skin diseases in children can reflect status of health, hygiene, and personal cleanliness of a community., Aims: This study was planned to evaluate the magnitude of skin diseases, pattern of various dermatoses, factors contributing to these dermatoses and concurrent systemic disease among children up to five years of age., Materials and Methods: Consecutive 1000 children, aged up to five years, attending the Dermatology OPD of RNT Medical College and MB Government Hospital, Udaipur were the subjects of this study. A detailed general, systemic and cutaneous examination followed by relevant investigations were carried out. The findings were recorded in a proforma for analysis and interpretation of data., Results: One thousand twenty seven (1027) diagnoses were made in 1000 children. Etiological analysis revealed that majority (417; 40.60%) of dermatoses belonged to infection and infestation group followed by eczematous (358; 34.86%) and hypersensitivity (105; 10.22%) groups. Of the infection and infestation group, bacterial infection (141; 13.72%) was the most common entity followed by scabies (107; 10.42%), fungal (67; 6.52%), and viral infection (35; 3.40%)., Conclusion: This study provides a preliminary baseline data for future clinical research. It might also help to assess the changing trends of pediatric dermatoses.

Background: Alopecia areata (AA) is a common, non-scarring, patchy loss of hair at scalp and elsewhere. Its pathogenesis is uncertain; however, auto-immunity has been exemplified in various studies. Familial incidence of AA is 10-42%, but in monozygotic twins is 50%. Local steroids (topical / intra-lesional) are very effective in treatment of localized AA., Aim: To compare hair regrowth and side effects of topical betamethasone valerate foam, intralesional triamcinolone acetonide and tacrolimus ointment in management of localized AA., Materials and Methods: 105 patients of localized AA were initially registered but 27 were drop out. So, 78 patients allocated at random in group A (28), B (25) and C (25) were prescribed topical betamethasone valerate foam (0.1%) twice daily, intralesional triamcinolone acetonide (10mg/ml) every 3 weeks and tacrolimus ointment (0.1%) twice daily, respectively, for 12 weeks. They were followed for next12 weeks. Hair re-growth was calculated using "HRG Scale"; scale I- (0-25%), S II-(26-50%), S III - (51-75%) and S IV- (75-100%)., Results: Hair re-growth started by 3 weeks in group B (Scale I: P<0.03), turned satisfactory at 6 weeks in group A and B (Scale I: P<0.005, Scale IV: P<0.001)), good at 9 weeks (Scale I: P<0.0005, Scale IV: P<0.00015), and better by 12 weeks of treatment (Scale I: P<0.000021, Scale IV: P<0.000009) in both A and B groups. At the end of 12 weeks follow-up hair re-growth (>75%, HRG IV) was the best in group B (15 of 25, 60%), followed by A (15 of 28, 53.6%) and lastly group-C (Nil of 25, 0%) patients. Few patients reported mild pain and atrophy at injection sites, pruritus and burning with betamethasone valerate foam and tacrolimus., Conclusion: Intralesional triamcinolone acetonide is the best, betamethasone valerate foam is better than tacrolimus in management of localized AA.