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Background: There has been a significant increase in the incidence of recurrent, resistant, and extensive dermatophyte infections worldwide recently. This menace has spurred the need for more well-designed randomized controlled trials to optimize the treatment of dermatophyte skin infections. One of the limitations in designing such studies is the limited availability of standard and validated score, to measure the severity of dermatophyte infections. Aims: To create a severity score for the evaluation of dermatophyte infections. Materials and Methods: A Delphi consensus model was used to frame a severity scoring tool for superficial dermatophyte skin infections. Fourteen experts participated in the first round and twelve experts participated in the second round. Results: Based on the expert consensus, a final scoring system proposed was: Final Severity Score (FSS) = Sum total of Body Surface Area (BSA) in hand units for each patch multiplied by the sum of the scores for pruritis (P), lichenification (L), and actively raised borders (A) for each patch (FSS = BSA in hand units x (P + E + L + A) of patch 1 + BSA in hand units x (P + E + A) of patch 2 ...etc.). For measuring hand units more accurately fractional values of 0.25 can be used (0.25 corresponding to an approximate 1/4th of a hand unit). A score of +1 will be added in case of the following - 1) Close contact/family member affected, 2) History of at least one recurrence in the previous 6 months after a course of oral antifungals, 3) History of immunosuppression (on immunosuppressive medication or having underlying immunosuppressive disease). The scores will be valid only if the patient has not used any treatment topical or systemic, for at least 2 weeks before enrolment. Conclusion: The proposed Dermatophytosis Area and Severity Index (DeASI) score will help the physicians and researchers standardize the treatment protocol for dermatophytosis, henceforth, assessing the response to therapy. This will also help to standardize the parameters of effectiveness while designing any clinical trial. [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]

With the advent of newer drugs and formulations, the armamentarium to combat dermatophytosis is ever-expanding. However, we must be rational and scientific when choosing the drugs. This review is an attempt to summarise the recently approved and upcoming therapeutic options for dermatophytosis. [ABSTRACT FROM AUTHOR]

Dermatophytosis has acquired an epidemic-like proportion, fuelling a wide gamut of irrational, unethical and unscientific prescriptions. The menace can be attributed to poorly regulated legislative laws controlling the approval of molecules, unscientific marketing gimmicks by the pharmaceutical industry, over-the-counter availability of drugs and lack of awareness and knowledge among the prescribing physicians. In this review, we have attempted to enlist the irrational and unethical prescription patterns for dermatophytosis. [ABSTRACT FROM AUTHOR]

Psoriasis is a multisystem disorder with a significant impact on the quality of life (QoL) of the patient. QoL in psoriasis is influenced by epidemiological factors, the type and extent of the disease, and underlying comorbidities. Various tools have been developed to assess the QoL in patients with psoriasis, namely psoriasis specific, skin specific, generic QoL, and mixed measures. In this review, we present a concise overview of the different indices and the pros and cons of various tools to assess the impact of psoriasis on patients. [ABSTRACT FROM AUTHOR]

Background: Rising number of the nonresponding dermatophytic infections raises deep concerns among the dermatologists across the nation. Variations in the quality of itraconazole may be a contributing factor to nonresponse in certain dermatophytic infections. This article will address this issue in a simple way of analyzing things in an OPD and may help us in being aware and taking the right foot forward. Aims and Objectives: To assess the quality of itraconazole brands by observing the morphological properties of pellets/beads in different brands. Methods: In this study, 10 brands of itraconazole that are commonly used in clinical practice were randomly selected. Pellet counts and qualitative morphological analysis of pellets as size (small, large, or mixed), shape (uniform or nonuniform), and presence of amorphous material was performed by three independent observers. Also, dissolution profile of some brands was assessed by adding the pellets in equal quantity of water. Results: The pellet counts of brands varied from 856 pellets per capsule in brand 1 to 109 pellets per capsule in brand 8. Brand 1, brand 2, and brand 7 pellets were small and uniform in morphology. Brand 3, brand 4, and brand 10 pellets were mixed in size but uniform in morphology. Brand 9 pellets were mixed and nonuniform whereas brand 5, brand 6, and brand 8 pellets were mixed in size, nonuniform in shape, and had presence of amorphous material. Dissolution test revealed that brand 5 dissolved rapidly and turned clear water color to milky white. Conclusion: A simple dermoscopy examination of itraconazole pellets may provide thoughtful insights about the quality of itraconazole brand. It may be considered as routine practice for all dermatophytic infection planned for treatment with itraconazole. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 11-year-old boy with vitiligo who experienced significant improvement with topical tofacitinib gel, highlighting its potential as a promising treatment modality for vitiligo in pediatric patients. Topics discussed include the mechanism of action of tofacitinib in vitiligo treatment, the favorable response observed in younger patients with darker skin types, and the possibility of monotherapy with topical tofacitinib without the need for phototherapy.

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]

The article presents a case study of a 32-year-old man with pustules on the extremities of 1-month duration and recurrent oral erosions for 6 months. Topics include consulted dentists, ear-nose-throat specialists, and physicians for oral lesions; and examination showing a well-built lady with palatal erosions and targetoid lesions.

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: COVID-19 pandemic has changed the approach of dermatologists, with respect to management of numerous conditions, vitiligo being one of them. However, there is a lack of consensus on how to deal with patients of vitiligo, as we battle this pandemic. Aim: To conduct a questionnaire-based survey, amongst expert dermatologists; in order to understand the impact of COVID-19 on the management of vitiligo. Materials and Methods: An online semi-structured English questionnaire was prepared and the link was circulated among 50 pan-Indian expert dermatologists, through various platforms (snowball sampling). Confidentiality and anonymity were strictly maintained. Responses were analyzed at the end of the study and a consensus statement was generated. Results: 42.22% of the respondents believed that teleconsultation is adequate for the diagnosis and management of most cases of vitiligo. 64.44% were found to be comfortable in prescribing oral medications, even during the COVID-19 pandemic; of which 62% would prefer to prescribe systemic steroids; followed by 17%, 11%, 7%, and 3% who would prefer cyclosporine, azathioprine, mycophenolate mofetil, and methotrexate, respectively. 64.44% respondents would recommend phototherapy in their office and 80% would prefer home-based phototherapy (PUVAsol or handheld NBUVB devices). 86.67% would prefer to stop the oral immunosuppressive drugs, till the COVID-19 RTPCR positive patients are tested negative. Limitations: The results are based on a survey of a small albeit selected group of dermatologists who decided on the currently available information on COVID-19. The same may change depending on the nature of further available information on the virus and its effect on how we manage the patients. Conclusions: Cases for initial consultation may be seen physically, and those for follow-up may be scheduled for teleconsultation. Topical therapy may be used without any hesitation. Phototherapy may be best advised with either PUVAsol or home-based phototherapy units (handheld NBUVB devices). With regards to systemic immunosuppressives, oral minipulse therapy may be preferable in view of lesser requirement of monitoring. Surgery for vitiligo should be performed only if the psychological well-being is severely affected. [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]

Metabolic syndrome is currently considered to be a global epidemic, causing a significant increase in the cost of health care, apart from deteriorating the quality of life. Skin serves as a mirror of underlying metabolic sinister. Various dermatological conditions like psoriasis, acanthosis nigricans, lichen planus, acne vulgaris, acrochordons, atopic dermatitis, etc. have been reported to be associated with metabolic syndrome. We hereby present an evidence-based review of the various dermatological conditions and their association with the development of metabolic syndrome. [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]

Background: Elderly population is vulnerable to develop a multitude of dermatological diseases, owing to comorbidities and polypharmacies. Objective: To know the prevalence of dermatological conditions in elderly patients attending outpatient department, determine the pattern and relative frequency of skin diseases, and find the relation with associated comorbidities. Materials and Methods: We performed a cross-sectional study on 250 patients, aged ≥60 years. Clinical diagnosis was done, followed by appropriate investigations when required. Descriptive data was analyzed on the parameters of range, mean ± S.D., frequencies, etc., Continuous variables were analyzed using unpaired t-test/Mann–Whitney U test and categorical data by Fisher's exact test/Chi-square test. Statistical software Medcalc version 10.2.0.0 for Windows vista was used. P value =0.05 was considered statistically significant. Results: 250 patients were evaluated, 164 males (65.5%) and 86 females (34.4%). Mean age was 67.87 ± 7.29 years. Commonest disease category was infection (30%), followed by dermatitis (29.6%), papulo-squamous (18.4%), and immunobullous (6.4%). Difference in acute and chronic disease was significant (P = 0.0001). 30% had infections; fungal (50.66%), bacterial (32%), and viral (17.33%). 74 patients had dermatitis (29.6% of study population). Commonest systemic disease was hypertension (23.2%), followed by diabetes mellitus (19.6%). Association of diabetes mellitus was significant (P = 0.0014), more in infective dermatoses (P = 0.0007). All had signs of aging; idiopathic guttate hypomelanosis (51.2%), xerosis (45.2%), seborrheic keratosis (42.6%), cherry angioma (33.2%), senile acne (6.6%). Photoaging was noted as wrinkling (98.8%), freckles (35.6%), purpura (10.8%), telangiectasia (5.6%). People involved in outdoor activity had higher Glogau scale (3.01 ± 0.69) compared to those indoors (2.44 ± 0.74), statistically significant difference (P = 0.001). Conclusion: Our study is the first of its kind, in Eastern India, where we evaluated and explored the disease pattern and extent of geriatric dermatoses among patients attending dermatology OPD of a tertiary care hospital. [ABSTRACT FROM AUTHOR]

Acanthosis nigricans (AN) is a frequently encountered dermatological condition seen commonly in middle aged or elderly, but in the recent times, there has been an increase in the childhood cases, especially in the adolescent age group. AN clinically manifested as dark, velvety, and thickened skin, symmetrically distributed over the neck, axillae, other flexural regions of the body and face. Facial AN, a somewhat recent entity that has been described and significant association with obesity, hyperinsulinemia, and metabolic syndrome, has been established. AN was once considered a rare paraneoplastic dermatosis but is now frequently observed in obese adolescents. Obesity in adolescence is a public health priority because it usually tracks into adulthood, resulting in enormous medical and social costs. This underscores the importance of early identification and intervention. The purpose of this narrative review is to provide a comprehensive overview of AN in childhood, including history, definition, classification, its clinical significance, management challenges, and the direction of future research. [ABSTRACT FROM AUTHOR]

The article focuses on dermatophytosis, emphasizing its evolving nomenclature, the role of cutaneous microbiome in fungal infections, antifungal treatments, concerns regarding irrational prescription patterns, and the analysis of systemic antifungals for glabrous skin infections. Topics include the impact of topical steroids, resistance to terbinafine, the emergence of Trichophyton indotineae, dysbiosis's contribution to various fungal conditions, and the urgent need for antifungal stewardship.

The article focuses on a case report of acquired lymphangiectasia in the peno-scrotal area following hernia repair, detailing the clinical evolution, diagnostic approach, and therapeutic options available for managing this rare complication. It discusses the clinical presentation of lymphangiectasia, its association with various scarring processes, and the challenges in treatment due to a high recurrence rate despite multiple therapeutic modalities attempted.

Sir, PHACE syndrome is the conglomeration of a large hemangioma, located on the face or neck, along with posterior fossa brain malformations, hemangioma, arterial lesions, cardiac abnormalities/aortic coarctation, and eye abnormalities. PHACE syndrome in antenatally diagnosed posterior fossa anomaly. The criteria were graded into two categories, namely PHACE syndrome and possible PHACE syndrome. [Extracted from the article]

The article presents the COVID‑19 pandemic maintenance of hand hygiene has gathered unprecedented attention to prevent the spread of the virus. Topics include the no previous history of atopic dermatitis or hand eczema in any of the cases, the prescribed moisturizers and symptomatic treatment, and the hand hygiene involves washing with soap and water or alcohol‑based hand sanitizers but repeated hand washing can lead to irritant‑hand dermatitis.

Azygos or hemizygous continuation of inferior vena cava (IVC) is diagnosed in the presence of intrahepatic interruption of IVC. We report a case of a 4-year-old, male child presenting with a history of poor weight gain. A detailed evaluation of the child revealed a diagnosis of hemizygous continuation of uninterrupted, but severely obstructed, IVC. This incidental finding has rarely been reported in the literature. [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]

Peutz-Jeghers syndrome (PJS) is characterized by multiple hamartomatous polyps in the gastrointestinal tract and mucocutaneous pigmentation. Here we present, a case of multiple gastrointestinal hamartomatous polyps in a 22-year-old male who had been operated for intestinal obstruction due to ileocolic intussusception. Resection of the affected segment was done with proximal ileostomy and distal mucous fistula formation. Clinicopathological diagnosis of PJS was made. Later, during ileostomy closure, it was found that the patient had a transverse colonic mass which was resected. Histological examination with immunohistochemistry confirmed it to be a Mucosa-Associated Lymphoid Tissue Lymphoma (MALToma). Colonic MALToma in the background of PJS is a unique case for which it has been reported. [ABSTRACT FROM AUTHOR]

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions, which are mainly caused by drugs; and these are usually associated with high degree of morbidity and mortality. Recently, two detailed guidelines were published on the management of SJS/TEN, Indian guidelines and UK guidelines. Still, there is no consensus on the management of SJS/TEN. In this article, our aim is to conceptualize the management aspect of SJS/TEN considering Indian setup. Early discontinuation of all medicines, supportive measures (hydration, electrolytes, and care of denuded skin), corticosteroids and cyclosporine has been found to be useful. Oral provocation test is reserved for patients, who undergo complete remission and this is to be done after hospitalization, under strict vigilance. As there is no consensus, the treatment should be individualized on case to case basis. [ABSTRACT FROM AUTHOR]

Keratoacanthoma (KA) is a rapidly evolving benign cutaneous tumor, occurring in elderly individuals with a tendency towards spontaneous regression and histopathologic similarity to squamous cell carcinoma. Tumoral calcinosis is an uncommon condition, associated with the deposition of painless calcific masses. The occurrence of these two conditions in the same patient is a rarity itself, whereas deposition of calcium within the KA lesion in our 13-year-old patient makes it even more intriguing. Such an association has been seldom reported in the literature, and this prompted the current report. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of sexually transmitted infections (STIs) has been made easy for field workers due to syndromic approach. The etiological agent responsible for different STI syndromes needs to be validated from time to time so as to guide the therapeutic regimen. Aims and Objectives: The aim of this study was to evaluate the etiological agent for STI syndromes and correlate the syndromic diagnosis with etiological diagnosis. Materials and Methods: The study was conducted over 9 months in all patients attending the STI and Gynaecology Outpatient Department. Syndromic diagnosis was done by STI-trained medical officer of respective clinic. Sample was collected for etiological diagnosis and subjected to relevant investigations. Data were analyzed by applying statistical methods. Results: Among 308 patients (male:female = 1:3.5), no syndromic diagnosis could be made in 11 cases (all females and had premalignant changes on Pap smear). In 68 patients (22.08%), no etiological diagnosis could be arrived at (mostly genital ulcer disease [GUD]-herpetic [H] and vaginal discharge). In cervical discharge syndrome, six patients (16.7%) showed gonococcus. In GUD-H syndrome, 37 patients (27.027%) were tested positive. In GUD-nonherpetic syndrome, three patients (33.33%) were syphilis, granuloma inguinale, and chancroid (1 each). In urethral discharge syndrome, etiology could not be found in 33 cases (45.45%). In vaginal discharge syndrome (n = 217), etiologies were overlapping as follows: trichomonas vaginalis (76.04%), bacterial vaginosis (40%), gonococcus (24%), and undiagnosed (6.5%). Conclusion: The present tool for validation of GUD-H can validate only 27% of cases. Overlap of etiologies is mostly common in vaginal discharge syndrome, wherein malignancies and premalignant conditions are overtreated with kits. Validation can be done only in two-third of cases with the available resources. However, syndromic approach provides the opportunity of treating STI without delay. [ABSTRACT FROM AUTHOR]

Introduction: Acanthosis nigricans (AN) is a frequently encountered entity. Facial AN (FAN) is a subset of AN which is being increasingly recognized. Recently, reports hypothesizing the association of FAN with features of metabolic syndrome have been published. Aims and Objectives: The aim of this study was to study the clinicodemographic profile of patients with FAN, and to assess the correlation of hypertension, increased waist-hip ratio (WHR), increased body mass index (BMI), type 2 diabetes mellitus, deranged lipid profile, serum insulin, and impaired oral glucose tolerance test (OGTT) (parameters of metabolic syndrome) in these patients, as well as to determine the most significant predictor (highest relative risk) of development of FAN. Methods: A multicentric case-control study was conducted (123 cases in each group) over a period of 2 years. Data were obtained on the basis of history, examination, and relevant laboratory investigations. Statistical analysis was done using Statistica version 6 (StatSoft Inc., 2001, Tulsa, Oklahoma, USA), SPSS statistics version 17 (SPSS Inc., 2008, Illinois, Chicago, USA), and GraphPad Prism version 5 (GraphPad Software Inc., 2007, San Diego, California, USA). Results: Mean age of the patients with FAN was 38.83 ± 8.62 years. Mean age of onset of the disease was 30.93 ± 8.18 years. The most common site of face involved was the forehead and temporal region. The most common pigmentation was brown-black. Male sex, positive OGTT, increased WHR, and increased BMI were most significantly related to FAN. Smoking was found to have a protective effect against the development of FAN. Conclusion: Here, we document a significant association between male patients with positive OGTT, increased WHR, and BMI and FAN. Thus, we propose that FAN could be considered a morphological marker of metabolic syndrome. [ABSTRACT FROM AUTHOR]

Erythroderma in infants can be attributed to plenty of causes, the more common ones being nonbullous congenital ichthyosiform erythroderma, lamellar ichthyosis, bullous congenital ichthyosiform erythroderma, severe atopic dermatitis, etc., However, there can be circumstances where infantile psoriasis can present to us with erythroderma; this may be a diagnostic challenge to the clinician. Hereby, we present a case of a young boy with recurrent erythroderma. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 75-year-old male presented with asymptomatic rashes recurring for 15 years in which Cutaneous examination showed multiple arcuate erythematous plaques over the trunk, with central clearing and raised edematous borders, along with fine scaling on the inner side. It also discusses that Neutrophilic figurate erythema is a rarely reported disease, presenting with annular rash over the trunk or limbs, and histology shows neutrophil predominant infiltrate.

Topical corticosteroids (TCs) are the pillars of dermatotherapeutics. These drugs are the "magic molecules," provided they are used judiciously and appropriately, following a rational prescription. On exhaustive literature search in multiple databases, we found a significant evidence favoring the use of TCs in atopic eczema, localized vitiligo, psoriasis, chronic hand eczema, and localized bullous pemphigoid. However, contrary to conventional wisdom, we did not find any high-level scientific evidence in support of prescribing TCs in cutaneous lichen planus, sarcoidosis, and seborrhoeic dermatitis. Besides, evidence clearly advocates judicious use of mild-to-moderate corticosteroids (if required) in pregnancy and lactation and there is no risk of any fetal abnormality. [ABSTRACT FROM AUTHOR]

We hereby report a case of a male child who presented with multiple brown to red papules and plaques in a seborrheic distribution. Histology and immunohistochemistry findings were consistent with a diagnosis of Langerhans cell histiocytosis with multifocal and multisystem involvement (Letterer-Siwe type). The case is being reported for its rarity. [ABSTRACT FROM AUTHOR]

Cooling devices and methods are now integrated into most laser systems, with a view to protecting the epidermis, reducing pain and erythema and improving the efficacy of laser . On the basis of method employed, it can be divided into contact cooling and non-contact cooling. With respect to timing of irradiation of laser, the nomenclatures include pre-cooling, parallel cooling and post-cooling. The choice of the cooling device is dictated by the laser device, the physician's personal choice with respect to user-friendliness, comfort of the patient, the price and maintenance costs of the device. We hereby briefly review the various techniques of cooling, employed in laser practice. [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]

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.

A letter to the editor is presented on the necrolytic acral erythema (NAE), skin disease, patient, without Hepatitis C virus infection.

Background: Levosimendan a calcium ion sensitizer improves both systolic and diastolic functions. This novel lusitropic drug has predictable antiischemic properties which are mediated via the opening of mitochondrial adenosine triphosphate-sensitive potassium channels. This action of levosimendan is beneficial in cardiac surgical patients as it improves myocardial contractility, decreases systemic vascular resistance (SVR), and increases cardiac index (CI) and is thought to be cardioprotective. We decided to study whether levosimendan has any impact on the outcomes such as the duration of ventilation, the length of Intensive Care Unit (ICU) stay, and the hospital stay when compared with the nitroglycerine (NTG), which is the current standard of care at our center.Materials and Methods: Forty-seven patients undergoing elective coronary artery bypass surgery were randomly assigned to two groups receiving either levosimendan or NTG. The medications were started before starting surgery and continued until 24 h in the postoperative period. Baseline hemodynamic parameters were evaluated before beginning of the operation and then postoperatively at 3 different time intervals. N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) levels were also measured in both groups.Results: In comparison to the NTG group, the duration of ventilation and length of ICU stay were significantly less in levosimendan group (P < 0.05, P = 0.02). NT-proBNP level analysis showed a slow rising pattern in both groups and a statistically significant rise in the levels was observed in NTG group (P = 0.03, P = 0.02) in postoperative period when compared to levosimendan group of patients.Conclusion: Levosimendan treatment in patients undergoing surgical revascularization resulted in improved CI, decreased SVR and lower heart rate. And, thereby the duration of ventilation and length of ICU stay were significantly less in this group of patients when compared with NTG group. [ABSTRACT FROM AUTHOR]

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]

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]

The cutaneous microflora consists of various microorganisms which interact with host epithelial cells and innate and acquired immunity. This microbial milieu and its interaction with host cells prevent the growth of pathogenic organisms and educate host immunity to fight against harmful microorganisms. The microbial composition depends on various intrinsic and extrinsic factors and an imbalance in the cutaneous microflora predisposes the individual to both infectious and non-infectious diseases. Even though probiotics have been extensively studied in various diseases, their efficacy and safety profile are still unclear. A better understanding of the cutaneous microflora is required to develop newer therapeutic targets. In this review, we describe the commensal microbiome and its variation, the current role of the cutaneous microbiome in the pathogenesis of various dermatological diseases, and their therapeutic implications. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 35‑year‑old female suffering from herpes zoster and consulted for rash. Topics discussed include distribution of erythematous scaly papules coalescing to form plaques over the left T8–T10 dermatomes, initiation of the immunological cascade of the pathogenesis of the second disease from neuropeptides, and elevation of TNF‑alpha in psoriatic skin lesions as the factor for the development of psoriasis over the healed sites.

A case study of a 32‑year‑old man suffering from occasional breathlessness is presented, who is admitted for the evaluation of treatment resistant popular, and cystic lesions. It mentions diagnostic test of the patient revealed pulmonary sarcoidosis. It mentions patients was later diagnosed with multiple eccrine hydrocystoma. It discusses the use of atropine, and botulinum toxin Type A, as a treatment procedure.

There is a dearth of data regarding the safety and timing of the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) vaccination of patients on immunosuppressive or immunomodulatory therapies. However, data from other vaccine trials may be extrapolated to get an idea regarding the recommendation of SARS-COV-2 vaccines. All the novel SARS-COV-2 vaccines are non-live, thus ensuring the safety of the vaccines. However, the vaccines may not be able to generate an equipotent immunogenic response in patients receiving immunotherapeutics, in comparison to those who are not. We have attempted to put forward certain statements, with respect to SARS-COV-2 vaccination of patients who are on treatment for different dermatological conditions. However, the risk-benefit ratio must be discussed between the patient and the physician, and the final call should be individualized. [ABSTRACT FROM AUTHOR]

An editorial is presented on the COVID‑19 and Dermatology. The article discusses that the pathogenesis of the disease has been attributed to a multitude of propositions. Recent updates have hypothesized that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) likely targets and perturbs cellular PDZ proteins (postsynaptic density protein, Drosophila disk large tumor suppressor, and zonula occludens-1 protein).

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]