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Describes the skin disease known as multiple eccrine hidrocystoma observed in a male patient. Results of complete blood counts, blood sugar, serum biochemistry and urinalysis; Details of clinical differentiation; Examination of the risk factors that led to the condition.

Abstract A 70-year-old male with a superficial granulomatous ulcer is reported. Histopathological findings were the same as those described for superficial granulomatous pyoderma, a recognized variant of classic pyoderma gangrenosum. The differences between pyoderma gangrenosum and its variant superficial granulomatous pyoderma are highlighted. [ABSTRACT FROM AUTHOR]

Describes a patient with tuberculous lymphadenitis. Results of a lymph node biopsy showing multiple caseating epitheloid cell granulomas with Langhan's giant cells; Possibility of sexual transmission.

AbstractA case of plasma cell mucositis is described for its rarity. A probable aetiological correlation with periodontitis is discussed. The patient showed good response to intralesional and topical steroids. [ABSTRACT FROM AUTHOR]

Background: Narrow-band ultraviolet B (NB-UVB) is an effective and safe treatment for vitiligo. Calcipotriol, a synthetic analogue of 1,25 dihydroxyvitamin D3 may regulate melanin synthesis. Several clinical studies have been conducted but the synergistic effect of addition of calcipotriol to NB-UVB in the treatment of vitiligo is still debatable., Objectives: To compare the efficacy and safety of topical calcipotriol (0.005%) in combination with NB-UVB vs. NB-UVB alone in generalized vitiligo., Methods: A prospective right-left comparative study including 27 patients of vitiligo was conducted for 24 weeks. On one side, calcipotriol was applied twice a day. NB-UVB was administered thrice a week. Response to treatment was assessed using change in Lund and Browder (L&B) score for percentage reduction in body surface area, investigator's global assessment (IGA) and patient's global assessment (PGA) scores. Treatment related side effects were noted., Results: Mean percentage reduction in L&B score at 24 weeks was 51.4% on NB-UVB and 49% on NB-UVB plus calcipotriol side (P = 0.557), mean IGA score on NB-UVB was 2.7 ± 0.5 and on NB-UVB plus calcipotriol was 2.6 ± 0.4 (P = 0.821) and mean PGA score on NB-UVB side was 5.6 ± 3.4 and on NB-UVB plus calcipotriol side was 5.8 ± 3.2 (P = 0.706). Perifollicular repigmentation that matched with the surrounding normal skin colour was seen in majority of patients on both treatment sides. Calcipotriol produced mild local adverse effects., Conclusions: Addition of calcipotriol to NB-UVB probably does not enhance the efficacy of treatment including extent of repigmentation and time to initial repigmentation. Larger, randomized placebo-controlled trials are required to determine whether addition of calcipotriol has any utility when administered with NB-UVB in the treatment of vitiligo., (© 2014 European Academy of Dermatology and Venereology.)

Background: Autologous non-cultured outer root sheath hair follicle cell suspension (NCORSHFS) is a recently described novel cellular graft technique for the treatment of stable vitiligo. There is lack of data about various factors determining the repigmentation rate in vitiligo patients undergoing this novel surgical therapy., Objective: To study the clinical characteristics and treatment variables determining therapeutic outcome in patients of stable vitiligo undergoing NCORSHFS., Methods: Non-cultured outer root sheath hair follicle cell suspension was prepared from anagen hairs extracted from the occipital area. The number of melanocytes and hair follicle stem cells (HFSC) in the suspension was quantified by staining with anti-HMB45 and anti-CD200 antibody, respectively. In all patients, a 2 mm punch skin biopsy was taken from one of the vitiligo patch to be treated prior to surgery for assessment of histomorphological features. Post surgery patients were followed up at regular intervals for 24 weeks., Results: Thirty patients (21 females, 9 males) with a clinical diagnosis of stable vitiligo, with a total of 60 target lesions were included in this study. The mean age of the study population was 21.10 ± 5.64 years. The number of melanocytes (P = 0.04) and HFSC (P = 0.01) transplanted were significantly higher among patients achieving optimum repigmentation (>75% repigmentation). There was a strong correlation between repigmentation at 24 week and number of melanocytes and HFSC transplanted. Number of HFSC transplanted and absence of dermal inflammation were significant predictors of achieving optimum repigmentation., Conclusion: The number of melanocytes and HFSC transplanted and absence of dermal inflammation were important determents of optimal repigmentation in patients undergoing NCORSHFS for treatment of stable vitiligo. Hence, refining the technique of NCORSHFS on the basis of these factors would help in achieving better surgical outcomes., (© 2014 European Academy of Dermatology and Venereology.)

Background: Palmoplantar psoriasis (PP) is a chronic, inflammatory and proliferative dermatosis of the palms and/or soles with significant morbidity. It is notoriously difficult to treat and unresponsive to traditional topical agents. MATERIAL AND METHODS  This was a prospective, randomized study involving 111 patients of psoriasis with significant palmoplantar disease. Patients meeting the eligibility criteria were randomly assigned to one of the two treatment groups. Patients in Group I received methotrexate in doses of 0.4 mg/kg weekly, and patients in Group II received acitretin in doses of 0.5 mg/kg daily. Patients were evaluated by modified PPPASI (m-PPPASI) score for palm and sole involvement at baseline, at two weekly intervals for the first 4 weeks and then four weekly for next 8 weeks. Treatment protocol was continued for a period till patient achieved 75% reduction in m-PPPASI from baseline or 12 weeks whichever was earlier., Results: There was a statistically significant difference in reduction of m-PPPASI of patients on methotrexate at weeks 8 and 12. The mean m-PPPASI at week 8 was 15.38 ± 6.08 in methotrexate group and 17.23 ± 5.25 in acitretin group (P = 0.04). The mean m-PPPASI at week 12 was 10.30 ± 5.97 in methotrexate group and 12.40 ± 5.31 in acitretin group (P = 0.03). Marked improvement (m-PPPASI 75) was achieved in 12 (24%) patients in methotrexate group compared with 4 (8%) in acitretin group which was statistically significant (P = 0.029). Adverse events were generally mild and were seen in 14 patients in methotrexate group and 15 patients in acitretin group (P = 0.080)., Conclusion: Methotrexate is relatively inexpensive, safe and efficacious drug for the treatment of psoriasis patients with significant palmoplantar involvement. Acitretin can be used as an alternative therapy and with a good safety profile., (© 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.)

Treatment of generalized lichen planus is often disappointing and is associated with relapses. Though reports have suggested a beneficial role of various immunosuppressive and immunomodulatory agents, most of these reports are retrospective series or anecdotes. Oral methotrexate has been found to be useful in recent studies. In this study, we prospectively evaluated the role of low-dose oral methotrexate (15 mg/week in adults or 0.25 mg/kg/week for children) in generalized lichen planus. Mean improvement in 24 evaluated patients (two of them were of paediatric age group) at the end of 14 weeks of treatment was 79%. By the end of 24 weeks treatment, 14 of 24 (58%) patients had complete remission of their disease. Side effects were observed in 12 of 24 (50%) patients. Most of these adverse effects were mild; only one requiring treatment discontinuation due to significantly deranged liver function test. During post-treatment follow-up of 3 months, none had relapse of lichen planus. Overall, low- dose methotrexate is effective and reasonably safe option in treatment of eruptive lichen planus, provided haematological and biochemical parameters are regularly monitored., (© 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.)

Background: Acitretin is available for use in psoriasis since the late 1980s; however, there is no consensus on its optimum effective dose with acceptable side-effects., Objective: To evaluate the efficacy and safety of acitretin in three fixed doses in adult patients with severe plaque type psoriasis., Methods: This was a randomized, double blind, parallel group, dose ranging study. The study included patients of either gender (age range, 18-65 years) with severe chronic plaque type psoriasis. Of the 80 patients screened, 61 were randomly assigned to three groups: group A - 20 patients (acitretin 25 mg/day), group B - 20 patients (acitretin 35 mg/day) and group C - 21 patients (acitretin 50 mg/day) for 12 weeks. Forty-eight patients completed the study. The main outcome measure was change in Psoriasis Area Severity Index (PASI) score between the three groups from baseline to 12 weeks., Results: After 12 weeks of therapy, the percentage reduction in the PASI score was 54%, 76% and 54% in acitretin 25, 35 and 50 mg/day group respectively. PASI 75 was achieved in 47%, 69% and 53% patients in acitretin 25, 35 and 50 mg/day groups respectively. The majority of adverse events were mucocutaneous, mild-to-moderate severity and dose dependent., Conclusions: Acitretin 35 mg/day was observed to be more efficacious compared to 25 mg/day and 50 mg/day dosing, whereas its safety profile is better than 50 mg/day dosing in the management of severe plaque type psoriasis in adult patients., (© 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.)

Background: Pemphigus is a potentially fatal autoimmune epidermal bullous disorder. Various treatment modalities have been described to treat pemphigus. In cases where the disease fails to respond to conventional therapy, rituximab has been shown to be effective., Objective: To study the efficacy of rituximab in the treatment of resistant or severe pemphigus in Indian patients., Methods: Patients with pemphigus were treated with intravenous rituximab 1000 mg in adults or 375 mg/m(2) body surface area in children by two doses, 15 days apart in this open labelled pilot study. Anti-desmoglein1 (anti-Dsg1) antibodies and anti-desmoglein3 (anti-Dsg3) antibodies were measured at the start of therapy and at the end of the follow-up period. The outcome was studied in terms of control of disease activity (CD), complete remission (CR), partial remission (PR) and time to disease control (TDC) as defined by the consensus statement from the International Pemphigus Committee., Results: A total of 9 (90%) of 10 patients responded to the treatment. Three (30%) had CR of disease and were off all treatment. Four (40%) patients had CR and were on low dose oral prednisolone. Two (20%) patients had PR and were on low dose prednisolone. One patient died of sepsis. The mean TDC was 8 weeks. Response to treatment showed good correlation with index values of anti-Dsg1 antibody. Infusion-related angioedema and sepsis were seen as complications due to rituximab administration., Conclusion: Rituximab is effective in treating resistant and severe pemphigus in Indian patients. Acute complications can occur during rituximab infusion and require close monitoring., (© 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology.)

Background: Atopic dermatitis (AD) is a chronic recurrent disease of childhood. The therapeutics of AD needs to be more tailored given the new cytokine antibodies available. In this scenario we considered interleukin 1 beta (IL-1β) levels before and after therapy with topical corticosteroids., Objectives: To measure the IL-1β levels before and after treatment in patients with AD after 75% improvement in scoring for atopic dermatitis index., Methods: Forty-five subjects with AD were treated with betamethasone ointment and their IL-1β level was measured prior to and following treatment., Results: The IL-1β levels were raised during disease activity and following improvement they decreased in a statistically significant manner. Also the IL-1β levels corresponded with the severity of disease activity., Conclusions: Newer modalities of therapy in the form of cytokine monoclonal antibodies should be studied in a larger scale in AD., (© 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology.)

Background: Psoriasis is a chronic, recurring inflammatory disease affecting the skin, joints and nails that has a significant negative impact on the quality of life. Efficacy of combination of methotrexate/narrowband ultraviolet B (NBUVB) phototherapy in the treatment of psoriasis has been rarely assessed., Objectives: To compare the efficacy of methotrexate/NBUVB phototherapy combination vs. NBUVB phototherapy in the treatment of chronic plaque psoriasis., Methods: Forty patients with chronic plaque-type psoriasis (body surface area involvement >10%) were randomized to receive either methotrexate/NBUVB phototherapy (group A) or placebo/NBUVB phototherapy (group B). End point of treatment was 75% reduction in Psoriasis Area and Severity Index (PASI) Score or upto 6 months, whichever was earlier. Patients were then followed up for a period of 12 weeks for assessment of relapse., Results: Of 40 patients, 37 completed the treatment period and 29 both the treatment period and follow-up. PASI 75 was achieved in 19/20 patients in group A and 14/20 patients in group B (P < 0.04). The mean number of weeks(P = 0.001), the mean cumulative dose of NBUVB (P = 0.001) and the mean number of phototherapy sessions (P = 0.0001) required to achieve PASI 75 were significantly less in group A compared with group B. There was no significant difference in the number of patients who relapsed during the follow-up period (P = 0.68)., Conclusion: Combination of methotrexate and NBUVB phototherapy provides more rapid clinical improvement compared with NBUVB monotherapy in the treatment for chronic plaque-type psoriasis.

Background: Vitiligo is a common pigmentary disorder with great cosmetic and psychological morbidity and an unpredictable course. No treatment available is a definitive cure. Systemic psoralen and ultraviolet A (PUVA) has been the mainstay of treatment. Narrow-band UVB (NBUVB) was later introduced. In this study, we have compared the phototherapy modalities PUVA and NBUVB in inducing stability in vitiligo, assessed by using vitiligo disease activity score (VIDA), for the first time., Aims: To investigate the position of NBUVB vis-à-vis PUVA in terms of stability achieved during therapy as indicated by the VIDA scores., Subjects and Methods: It was an open, prospective study of 50 patients divided equally in PUVA and NBUVB groups. The study period was from January 2004 to June 2005. This study was done as a part of a larger project to compare the efficacy of mentioned modalities in degree of repigmentation., Results: In the NBUVB group, disease activity was present in 40% patients before commencement of therapy, which was reduced to 16% at the end of therapy (statistically significant, P = 0.049). In the PUVA group, similar figures were 20% and 16%, respectively. In the NBUVB group, 50% of patients whose disease was active prior to commencement of therapy had less than 50% repigmentation, whereas an equal number of patients had repigmentation of more than 50%. Almost an equal number of stable patients had less than and more than 50% repigmentation. In the PUVA group, 4 of the 5 (80%) patients who had active disease had less than 50% repigmentation, whereas only 1 patient (20%) with active disease obtained more than 50% repigmentation. The time to attain stability was 3.6 +/- 2.1 months in the NBUVB group and 3.22 +/- 3.1 months in the PUVA group. Eight of the 10 (80%) patients with unstable disease in the NBUVB group achieved stability, whereas 2 of the 5 (40%) patients of similar pre-treatment status in the PUVA group achieved stability., Conclusion: NBUVB was in a more statistically advantageous position vis-à-vis PUVA, in respect to stability achieved and efficacy in both active and stable disease in a comparable time period.

Background: Vitiligo is a common pigmentary disorder with great cosmetic and psychological morbidity. No treatment available is a definitive cure. Systemic psoralen and ultraviolet A (PUVA) has been the mainstay of treatment. Narrow-band ultraviolet B (NB-UVB) has been recently introduced. Although retrospective comparative study of systemic PUVA and NB-UVB has been published from our centre, no prospective study has been reported to date., Aims: To investigate the position of NB-UVB vis-à-vis PUVA in terms of efficacy, time to repigment and adverse effects and to help decide if one therapy has an advantage over another in the treatment of vitiligo., Subjects and Methods: It was a randomized, open, prospective study of 50 patients divided equally in TMP PUVA and NB-UVB groups. The study period was from January 2004 to June 2005., Results: The mean degree of repigmentation attained in the NB-UVB group was 52.24% over a mean treatment period of 6.3 months, whereas in the PUVA group it was 44.7% in a mean period of 5.6 months (P=0.144). After excluding the results of therapy-resistant sites, that is, hands and feet, the mean degree of repigmentation in the NB-UVB group was 67.57%, whereas in the PUVA group it was 54.2% (P=0.007)., Conclusions: NB-UVB performed better in comparison to TMP PUVA in terms of mean total repigmentation when traditionally considered therapy-resistant sites were excluded.

Background: Diagnosis of atopic dermatitis (AD) depends on clinical features because no definitive diagnostic test exists. Criteria proposed by Hanifin and Rajka (Acta Derm Venereol (Stockh) 1980; Suppl 92: 44-47) were acceptable for hospital-based studies but were found not to be suitable for field studies. A UK working party formulated clinical diagnostic criteria that could be used in both hospital and epidemiological settings. Validation studies of the criteria showed widely variable results, probably due to different clinical settings and ethnicity., Aim and Objective: This study was undertaken to validate Hanifin and Rajka's criteria and to assess the comparative efficacy of their criteria and the UK working party's diagnostic criteria in the diagnosis of AD in a hospital setting in North India., Subjects and Methods: This study serially included 101 patients with AD and 48 controls of paediatric age group. The study period was from July 2003 to December 2004., Results: Hanifin and Rajka's criteria (sensitivity 96%, specificity 93.75%, positive predictive value 97% (PPV) and negative predictive value (NPV) 91.84%) had a statistical advantage over the UK working party's diagnostic criteria (sensitivity 86%, specificity 95.83%, PPV 97.75% and NPV 76.67%), with a P-value < 0.005.

Background: Although many treatment modalities have been tried for the treatment of vitiligo, none is uniformly effective. Psoralen phototherapy (psoralen ultraviolet A (PUVA)) is established as efficacious treatment for vitiligo. Recently, narrow-band UVB (NBUVB) has been reported to be an effective and safe therapeutic option in patients with vitiligo., Objective: To compare the efficacy of PUVA and NBUVB in the treatment of vitiligo., Design and Setting: Retrospective analysis of 69 patients with vitiligo who were treated either with PUVA or NBUVB at the pigmentary clinic of the Dermatology Department of the Postgraduate Institute of Medical Education and Research, Chandigarh, India., Outcome Measures: The following variables were compared between the two groups of patients: repigmentation status, number of treatments for marked to complete repigmentation in existing lesions, appearance of new lesions or increase in size of existing lesions, adverse effect of therapy, stability of repigmentation and colour match., Results: In PUVA-treated group, 9 patients showed marked to complete repigmentation (23.6%) and 14 patients showed moderate improvement (36.8%), whereas in NBUVB-treated group, 13 patients showed marked to complete repigmentation (41.9%) and 10 patients showed moderate improvement (32.2%). A statistically significantly better stability and colour match of repigmentation with surrounding skin was seen in NBUVB-treated patients., Conclusion: We showed that NBUVB is more effective than PUVA and repigmentation induced with NBUVB is statistically significantly more stable.

Dowling-Degos disease is a rare autosomal dominant inherited pigmentary disorder characterized by reticulate pigmentation of the flexures, prominent comedone like lesions and pitted scars. Dyschromatosis universalis hereditaria is characterized by the presence of hypopigmented as well as hyperpigmented macules. We report a family showing features of both these diseases.

Although the link between atopic dermatitis (AD) and emotional disturbance is well known, there have been only a few studies assessing the extent of these disturbances in affected children and the problems experienced by their parents. Furthermore, these studies are mostly from western countries, where atopic dermatitis is seen in a more severe form than in India. The purpose of this study was to determine whether there is an excess of psychological disorders in Indian children with AD as compared to healthy controls and whether their mothers showed higher levels of emotional or mental distress than a comparison group. Twenty-two children, aged 3-9 years, with atopic dermatitis, twenty age and sex matched controls, and their mothers were selected for the study. The personalities of the mothers were assessed from a standard and valid questionnaire, the Hindi adaptation of Personality Trait Inventory, which explored nine areas of the maternal personality and mental distress as well as negative traits of some of these. The two groups were compared using the Chi-square test. To assess the psychopathology of the children, the mothers were made to answer parts of a valid, well-developed questionnaire, the Childhood Psychopathology Measurement Schedule, which enabled the assessment of the following factors: low intelligence with behaviour disorders, conduct disorders, anxiety, and depression. The means of each factor in both the groups were compared using the Students' t-test. Out of all the maternal personality traits, an increased number of mothers of affected children, 13 (59%) were found to be submissive as compared to the mothers of the controls i.e. 2 (10%), which was statistically significant (p<0.01). The children with AD had a higher frequency of low intelligence with behaviour disorders (5.9+/-2.9) as compared to controls and also of conduct disorders (2.1+/-1.4), which were both statistically significant (p<0.01). The results of this pilot study, although small in number, suggest that increased psychological disorders are observed in Indian children with AD as compared to controls, despite the fact that the disease is of a milder variety in this country as compared to its western counterparts. More mothers of children with AD were submissive, which could contribute to the psychological disorders and maintenance of eczema in the children. We suggest that children with AD may benefit if such psychological dimensions are considered as a part of their treatment.

Lichen sclerosus et atrophicus (LSA) is an uncommon disease of the skin and mucosae of either sex. Apart from a number of complications, SCC developing from a lesion of LSA in males is rare, although it is well known in females. We report two cases recently seen by us to alert clinicians of this potentially fatal complication in males.

A 16-year-old girl presented with multiple, yellowish, elastic, non-tender cysts on the face, trunk, arms and axillae for the last 3-4 years. On pricking, yellowish fluid could be expressed from the lesions. Clinically and histopathologically, the lesions were suggestive of steatocystoma multiplex. There was a family history of similar lesions in five members over four generations.

Annular erythemas are distinct cutaneous eruptions associated with a variety of causes. Occurrence of erythema annulare centrifugum, a variant of annular erythemas, in the immediate post-operative period in a patient with surgical intervention in the gall bladder and pancreas region is being described for the first time. Its probable association with surgical trauma is discussed.

Angiotensin converting enzyme inhibitors like captopril, enalapril, lisinopril, trandopril and ramipril may rarely induce a life threatening angioedema. We present two cases of severe angioedema induced by enalapril and ramipril along with possible precipitating factors observed in these patients. The importance of prompt recognition and early management of such cases is emphasized.

Rarely, different variants of porokeratosis may coexist in an individual patient or their family members. A patient with the linear form of porokeratosis present since birth subsequently developed the disseminated superficial actinic form at a later age. A review of the literature pertaining to the coexistence of variants of porokeratosis suggests a significant association between the linear and disseminated superficial actinic forms. Genetic linkage between different variants and the basis for their association is discussed.

Segmental vitiligo is rather refractory to medical treatment. The paucity of literature on the results of autologous miniature punch grafting in segmental vitiligo in dark-skinned patients led us to conduct such a study in 15 dark-skinned patients of North Indian origin to observe the repigmentation response to this technique at different sites. The age range was 16-42 years (mean 23.08 years). There were four males and eleven females (M:F ratio being 1:2.75) who had the disease for 3-15 years. After autologous miniature punch grafting, a remarkable repigmentation was obtained in 12 (80%) cases with 90% to 100% improvement. About 40-60% repigmentation was observed within 3-6 months in the majority (66.6%) of cases and near total to total repigmentation was observed within 2 years. The maximum pigment spread was observed over the face (cheeks) and neck, and the minimum pigment spread was observed over the left arm and right upper eyelid. Complications were minimal. The present study demonstrates that autologous miniature punch grafting is a safe and easy technique, that produces good cosmetic results in the unsightly depigmenting lesions of segmental vitiligo, especially on the face and exposed areas, even in dark-skinned races if patients are selected carefully. This can be of great benefit to patients who are psychologically disturbed by their disease.

Laugier-Hunziker syndrome is a benign pigmentary disorder which manifests as macular hyperpigmentation of the lips and buccal mucosa. Some patients have longitudinal pigmented bands of nails. The syndrome has no systemic associations. Two patients of this rare syndrome are reported. Disorders producing similar pigmentary changes which must be differentiated are discussed.