Search

Becker’s nevus (BN) is an acquired unilateral hyperpigmented hairy macule, whereas morphea is a chronic connective tissue disease of unknown etiology, characterized by skin thickening with increased quantities of collagen in the indurated lesion, usually involving the upper trunk and proximal extremity. The occurrence of both disease in the same anatomical site and individual was not reported previously. We report this rare case in a 17-year-old, Indian girl and was diagnosed after clinical histopathology and dermoscopic correlation. Morphea can be an interesting incidental occurrence within a large plaque of BN.

A sharp rise in the number of hepatitis C patients has been observed worldwide in the last decades. This has attracted the attention of researchers and medical professionals to provide cheap and effective treatment options for the eradication of hepatitis C. The present study describes the synthesis of a number of novel molecules which may be capable of inhibiting progression of the virus. The molecules were synthesized using the general techniques of the peptide bond preparation. Synthesized molecules were characterized by elemental analysis and spectral studies such as Mass, UV/Vis, IR and NMR. Purity of the molecules was determined by HPLC. Molecules with purity more than 98.5 % were selected for further docking studies to determine their interaction with binding site of NS3/4A protease on HCV RNA.

BACKGROUND Vitamin D deficiency had been associated with various hair loss disorders, such as telogen effluvium, alopecia areata, and female pattern hair loss. However, previous studies have not found a correlation between serum vitamin D levels and the severity of androgenetic alopecia. METHODS A case-control study was conducted for a period of one year in a public tertiary care hospital. Fifty males clinically diagnosed with androgenetic alopecia and 50 age-matched healthy controls were recruited. Serum vitamin D levels in both cases and controls were measured by radioimmunoassay technique, and the results were compared. RESULTS A total of 50 cases and 50 controls were recruited and analyzed. The mean age of the cases was 23 years and that of controls was 24.2 years. The mean levels of serum vitamin D significantly decreased in cases, compared to controls (20.10 vs. 29.34 ng/mL; P ≤ 0.001). Eighty-six percent of the cases had deficiency of vitamin D (

Background: Treatment of childhood lichen planus (LP) is challenging owing to high rate of relapses. Moreover, majority of treatment options for LP have been extrapolated from studies done in adults. Topical corticosteroid remains the first line of treatment in localized classic form of LP, but till date, no consensus exists regarding standardized therapy in children. Hence, we conducted this study to evaluate the efficacy of mid-potent topical steroid fluticasone propionate 0.005% in childhood LP. Aims and Objectives: The aim of this study was to evaluate the therapeutic efficacy of fluticasone propionate ointment 0.005% in childhood LP. Materials and Methods: Thirty-one patients (6 months to 18 years of age) with clinical and histopathologically confirmed diagnosis of LP were subjected to routine baseline severity assessment, patient/parent assessment, pretreatment photographic record of the fixed anatomical site under treatment, and then received topical mid-potent steroid therapy (fluticasone propionate ointment 0.005%) twice daily and cetirizine dihydrochloride in predefined doses for 8 weeks. Follow-up was done at the end of 2 weeks, 4 weeks, 6 weeks, and 8 weeks. After 8 weeks, a proportion of patients achieving clinical improvement and side effects were assessed. Observation and Results: The difference between pre- and posttreatment induration was not statistically significant (P = 0.336). The mean number of lesions before the start of treatment was 50.29, which reduced to 14.77 (P = 0.000) after treatment, and the mean of patients' itching score before treatment was 6.74 ± 1.6, which reduced to 2.61 ± 2.3 (P = 0.000) following treatment, which was statistically significant. Clinical improvement was seen in 67.7%, whereas 32.3% showed no improvement over a period of 8 weeks. Conclusion: Mid-potency steroid fluticasone propionate ointment twice daily is an effective therapeutic agent for localized childhood LP, with minimal side effects.

Background: Worldwide, limited studies have been done to study the spectrum of dermatological referrals in children. Aims and Objectives: The aim of this study was to analyze the spectrum of dermatological disorders in children referred from pediatrics department. Materials and Methods: It was a hospital-based observational study. Five hundred twenty-five children of either sex or age ≤18 years, in whom, parents had given written informed consent, and referred to Dermatology from Pediatric medicine department were included in this study. The diagnosis was made based on clinical features supported by necessary investigations. Working hours were considered as routine and emergency. Nelson' severity scoring system was used to classify children as sick. Results: Most of the children were referred during routine hours (85.7%), maximally from inpatient department (46%) followed by outpatient department (37%). Most common diagnosis was viral infections (21.2%), closely followed by eczematous disorders (17.6%) and disorders due to arthropods (17.1%). Majority of patients were not sick (83.61%). Pediatricians did not suggest any diagnosis in 70.85% of referrals followed by doubtful diagnosis in 26.85% and definitive diagnosis in 2.28% of patients. Conclusion: Majority of referrals were done during routine hours in nonsick patients. As many common easily treatable dermatoses were observed in all the referrals reiterating the fact that these referrals should be sought as early as possible to prevent unnecessary delays in the diagnosis and patient management. Furthermore, a robust dermatological training should be provided to undergraduates and interns to better equip the nondermatologists to diagnose common dermatological disorders.

Introduction: Lichen planus pigmentosus (LPP) is a distinct clinical entity commonly encountered in the Indian population. Aim: To study the clinicoetiological profile of LPP at a tertiary care hospital. Methods: A total of 100 patients with clinically and histopathologically confirmed diagnosis of LPP were included. Demographic details including the age of onset, duration of disease, symptoms, and family history were obtained. History regarding any precipitating factors, cosmetics, drug intake, and associated cutaneous or systemic diseases was taken. Clinical examination of the skin, oral cavity, hair, and nails was carried out. Results: Of the total 100 patients, 56 (56%) were females and 44 (44%) males with age ranging from 18 to 54 years (mean age - 31.23 years). The duration of disease ranged from 2 to 60 months with a mean of 19.31 months. Cosmetic disfigurement (68%) was the commonest complaint, followed by itching (41%) while, 30% of the patients were asymptomatic. History of topical mustard oil and hair dye application was present in 62% and 48% of the cases each. Other topicals included perfumes (24%), aftershave lotion (36%), and cosmetics (20%). Face (54%) and neck (48%) were the commonest sites affected, followed by upper back (36%), upper limbs, and chest (each 32%). A total of 11 patients showed only flexural involvement. The commonest pattern of pigmentation was diffuse (56%) followed by reticular in 16%. The color of the pigmentation varied from slate grey to brownish-black in varying proportions. A positive association was found between hypothyroidism with diffuse LPP where the P value was

Hypomelanosis of Ito (HOI) is a sporadic disorder characterized by naevoid hypomelanosis in association with neurological, musculoskeletal, and other systemic defects. Localized hypertrichosis has been reported in HOI, however, multifocal hypertrichosis along with hirsutism in HOI are rare. We report an interesting coexistence of multifocal hypertrichosis and hirsutism in a 7-year-old girl with HOI.

Systemic lupus erythematosus (SLE) is a connective tissue disorder with a high prevalence in certain races like Africans. It also has a female predilection. The pathogenesis of SLE is a complex interplay of genetic and environmental factors. Familial presentation of SLE has been well documented. We herein illustrate a scenario of SLE presenting in related females (mother and daughter) concurrently with similar clinical features and fulfilling the Systemic Lupus Collaborating Clinics criteria. Stress was identified as a common possible triggering factor.

Introduction: Periorbital hyperpigmentation (POH) is one of the common conditions seen in outpatient department. Despite of its huge prevalence, clinical data regarding its etiology and associations are still insufficient. Materials and Methods: We conducted a clinico-investigational study in 50 patients of periorbital pigmentation. A detailed clinical history was recorded, clinical examination and laboratory investigation including complete blood count, vitamin B12 level, and thyroid profile are done. Results: The mean age of the patients presenting with periorbital hyperpigmentation was 29.5 years, out of 50 patients 42 (84%) were females and 8 (16%) were males. About 14% patients give positive family history of POH, history of atopy was positive in 30% of patients. History of various other habits like lack of adequate sleep, prolonged exposure to computers, rubbing eyes, and application of various cosmetics were also found to be positive in these patients. The other associated clinical findings were freckles (12%), telengectesia (2%), erythema (2%), and melasma (2%). In maximum (90%) number of patients, both upper and lower eyelids were involved and pigmentation involving >1 cm of eyelid margin was seen in 62% of patients. Laboratory investigations showed anemia in 10% of patients and low serum vitamin B12 in 12%; however, none of the patients has deranged thyroid profile. Conclusion: POH has a multifactorial etiology and role of correcting various faulty habits is important factor in its management. Presence of anemia and low serum vitamin B12 levels also points toward need of detailed laboratory evaluation in these patients.

Purpose: Leser-Trélat syndrome consists of appearance of a solid tumor-like carcinoma breast, colon, or stomach following eruption of multiple seborrheic keratoses (SK) of the skin. We present an unusual and possibly the first case report of Leser-Trélat syndrome in a male patient with a history of mastectomy for breast carcinoma who presented to us with a second malignancy in the form of basal cell carcinoma (BCC) of the lower eyelid. Procedure: A 75-year-old male presented in 2014 with a history of modified radical mastectomy for infiltrating ductal carcinoma of the left breast which was performed 11 years prior to the day of presentation. Breast carcinoma was diagnosed following eruption of multiple SK at the same time. In the previous 3 years he noted a nodulo-ulcerative growth over the lateral aspect of the right lower eyelid which was clinically diagnosed as BCC. Mass excision under frozen section control and lid reconstruction was performed. Diagnosis of BCC was confirmed on histopathological examination of the excised specimen. Results and Conclusions: Though a previously unobserved entity, our case supports the importance of Leser-Trélat sign and its relevance to affected individuals, as early recognition and prompt treatment of a low-stage cancer offers good prognosis.

SummaryBackground Microneedling with dermaroller and glycolic acid peels is commonly used for treatment of acne scars. Objective To compare efficacy of microneedling alone versus combination of microneedling with serial 70% glycolic acid peel in management of atrophic acne scars. Methods & Materials Sixty patients with atrophic acne scars were randomized into group 1 receiving microneedling at 0, 6, and 12 weeks and group 2 receiving microneedling at 0, 6, and 12 weeks along with 70% glycolic acid peel at 3, 9, and 15 weeks. Acne scar scoring was performed by a blinded observer using ECCA (Echelle d'evaluation clinique des cicatrices d'acne) scoring at baseline and after 22 weeks. Additionally, patients were asked to grade the improvement in acne scars and skin texture on visual analogue scale (VAS). Results Of 60 patients, 52 completed the 22-week study period. The decrement from baseline in mean ECCA score was more in group 2 as compared to group 1 (39.65±2.50 vs 29.58±0.18; P

Introduction: there are various possible etiology for chronic back pain and malignancy is one of them. Extraskeletal Ewing’s Sarcoma usually involves sacrum while dorsolumbar junction involvement is uncommon. We are reporting a case of Extraskeletal Ewing’s Sarcoma with rare presentation related to the age, site of lesion and unusual extension. Case presentation: 35 year old male presented to casualty with urinary retention and paraplegia of sudden onset with history of chronic back pain of 6 months. We investigated him and diagnosed extra skeletal Ewing’s Sarcoma of paravertebral origin along D12-L1 spine with intaspinal intadural extension. Patient was given palliative chemo-radiotherapy. Conclusion: Chronic back pain of unknown etiology should be evaluated properly and while making diagnosis possible malignant etiology should be kept in mind even in young patient to prevent undue morbidity and mortality.

Background: Footwear dermatitis represents a common but often undiagnosed or misdiagnosed condition. Patch testing aids in its confirmation and identification of the offending allergen. Aims: This study aimed to find the frequency of positive patch test reactions in cases with suspected allergic contact dermatitis (ACD) to footwear, as well as the common responsible allergens. Materials and Methods: This is a retrospective record based study of 37 patients, with suspected ACD to footwear, who underwent patch testing with Indian standard series and Indian footwear series from July 2012 to July 2015. Results: The majority of patients (45.94%) belonged to the age group of 20–40 years. Dorsal aspects of feet (81.08%) and soles (18.92%) were the common sites involved. Patch test was positive in 18.92% patients. The most common causative allergens were hydroquinone monobenzylether (8.11%) and 4-aminoazobenzene (5.41%). Conclusion: Common chemicals implicated in ACD were rubber, rubber additives, and dyes. The principal culprit allergens were hydroquinone monobenzylether and 4-aminoazobenzene.

Adams Oliver syndrome (AOS) is a rare autosomal dominant congenital disorder characterized by absence of skin and or underlying structure over scalp along with transverse limb defect. It was first described by Adam and Oliver in 1945. We report a rare case of adams oliver syndrome with limited expression involving scalp, transverse limb defects along with unreported truncal involvement.

Molluscum contagiosum (MC) is most frequently a self-limiting benign viral skin disease. Transmitted by direct skin contact, it is characterized by flesh-colored, dome-shaped, umbilicated lesions. Diagnosis of MC is often done clinically, but when needed, biopsy can be performed, in which characteristic Henderson-Patterson bodies, representing intracytoplasmic assemblies of the virus, are pathognomonic. Atypical presentations of MC are rare in immunocompetent individuals and are challenging to diagnose. We report a case of giant MC, presenting as an ulcero-proliferative growth, in neck of an 8-month-old female child. Fine-needle aspiration cytology smears revealed characteristic intracytoplasmic molluscum bodies. The diagnosis was subsequently confirmed by histopathology. In this case, cytological examination helped in reaching the correct diagnosis, in a clinically unsuspected case.

PURPOSE Oxidative stress (OXS) plays critical role in the development of diabetic retinopathy (DRP). Increased concentrations of serum ischemia-modified albumin (IMA) have been demonstrated as a novel and inexpensive measure of oxidative stress. Although few pilot studies have reported increased IMA in DRP, the available literature is limited to comprehensively describe the potential significance of IMA in predicting DRP. METHODS The authors performed a meta-analysis to investigate IMA in DRP compared with control and diabetes mellitus subjects. The authors also performed a meta-analysis of area under curve for IMA. PubMed (Medline), Embase, Scopus, Web of Science, Science Direct, Springer Link, and Google Scholar databases were searched for relevant studies in serum IMA in DRP. The authors obtained five observational studies. Meta-analysis was performed using Review Manager 5.3 and MEDCALC 15.8 software to present the pooled-overall effect size as standardized mean difference and overall area under curve value of IMA. RESULTS Random-effects meta-analysis indicated a significant increase in serum IMA in patients with DRP compared with control (standardized mean difference = 2.48, P < 0.0001) and diabetes mellitus groups (standardized mean difference = 1.43, P < 0.0001). Our results also show that IMA can significantly predict the development of DRP (area under curve = 0.86, P < 0.001). CONCLUSION Serum IMA may be useful as a simple marker in monitoring of oxidative stress status in DRP and showed significant discriminatory ability in DRP. Future comparative studies in large are needed to further investigate IMA in different types of DRP; proliferative and nonproliferative.

Background: Melasma, a multifactorial disease, constitutes the most common facial melanosis in Indian population.Methods: 119 cases of melasma aged 18 years or above were enrolled. Detailed history, examination and laboratory investigations were done.Results: 20 (16.8%) were males and 99 (83.2%) females. Mean age was 35.25 years. Disease duration was more than 1 year in 102 (85.7%), 6 months to 1 year in 10 (8.4%) and less than 6 months in 7 (5.9%). 22 (18.49%) had occupation-related increased duration of sun-exposure 19 (86.3%) or heat-exposure 3 (13.6%). 79 (66.4%) had skin type IV, 26 (21.8%) type III, 14 (11.8%) type V. Centrofacial was commonest distribution pattern in 87 (73.1%), malar in 30 (25.2%), mandibular in 2 (1.7%). Mean duration of daily sun-exposure was 53.36 minutes (male-124.75, female-38.94). Mean Melasma Area and Severity Index (MASI) score was 11.602. There was significant association between MASI and skin type (pConclusions: Higher skin phototypes should be cautious about general measures and associated risk factors (hair dye/oils, cosmetics). Increased daily sun-exposure, OCPs use, pregnancy, thyroid disorders are risk factors. Housewives and indoor occupations should be advised physical sunscreens for protection against infra-red radiation. Anemia, dyslipidemia, thyroid dysfunction, vitamin D and B12 levels can be assessed although their exact role in perpetuating/precipitating melasma needs further studies

Chikungunya fever is a benign, self-limiting, acute viral illness. An epidemic occurred in New Delhi, India, in August and September 2016. We observed many cases with atypical cutaneous features mimicking Stevens-Johnson syndrome and toxic epidermal necrolysis during this epidemic, especially in infants and children. Twenty-one children (13 [61.9%] boys, 8 [38%] girls) presenting with vesico-bullous and necrotic lesions were reviewed. Cutaneous presentation included vesicles and bullae with purpuric macules and necrosis, seen in 16 (76%) patients. Skin lesions resolved in 5-7 days, leaving behind hyperpigmentation in seven (33.3%) patients and hypopigmentation in three (14.2%). Minor oral erosions were observed in three (14.2%) patients, and palmoplantar erythema was seen in four (19.04%). It is essential for dermatologists to understand the Stevens-Johnson syndrome and toxic epidermal necrolysis-like presentation of chikungunya and not to misinterpret it as true Stevens-Johnson syndrome and toxic epidermal necrolysis, which will lead to unnecessary intervention and management.

Tubercular gummas and splenic tuberculomas are rare forms of extrapulmonary tuberculosis, usually occurring in immunocompromised individuals. We hereby report a rare combination of multiple tubercular gummas and splenic tuberculoma secondary to TB lymphadenitis in an immunocompetent individual. The patient responded to antitubercular therapy. Thus, in a developing country like ours, tuberculosis can present in a wide clinical spectrum even in an immunocompetent individual.

SummaryBackground Growing use of cosmetics has led to an increase in the incidence of allergic contact dermatitis (ACD) to cosmetics. Patch testing helps to confirm allergy to cosmetics and pinpoint the exact offending allergens. Aims and Objectives The study aimed to find the frequency of positive patch test reactions in cases with suspected ACD to cosmetics, and the common allergens responsible for it. Methods This is a retrospective record-based study of 58 patients, with suspected ACD to cosmetics, who had undergone patch testing with Indian standard series and Indian cosmetic and fragrance series from January 2013 to December 2015. Results The majority of patients (60.34%) belonged to the age group of 20-40 years. The most common site of involvement was face (94.8%) followed by neck (22.4%). The most commonly implicated cosmetics in history were soaps (53.4%), and face creams (24.1%). The most common allergens detected on patch testing were cetrimide (20.7%) and thimerosal (15.5%) followed by paraphenylenediamine (6.9%), and fragrance mix (5.2). Positive allergic reactions were obtained in 2.12% of the patches. Conclusion Most common cosmetic products implicated for causing ACD were face creams, soaps, and hair dyes. The principal culprit allergens were cetrimide and thimerosal.

Primary localized cutaneous amyloidosis refers to a group of disorders characterized by deposition of amyloid in the dermis without any systemic involvement. It comprises the following clinical types: macular, lichenoid, nodular, and biphasic. There are also rare variants such as amyloidosis cutis dyscromica and poikiloderma-like cutaneous amyloidosis. We report a case of primary cutaneous amyloidosis in a 17-year-old boy with unusual pigmentation of various patterns (reticulate and diffuse pigmentation with mottling and rippling at places) and hypopigmented atrophic macules. Our patient also had nail, oral, and mucosal pigmentation that have not been described. Amyloid deposits were shown histopathologically in both hyperpigmented and hypopigmented macules.

Background: Lichen planus (LP) is a papulosquamous disease of unknown etiology that is relatively uncommon in children. There is a paucity of data on the clinical profile of LP in children. Available case series are few and majority being retrospective. A cross-sectional observational study to evaluate the clinical profile of childhood LP was performed. Materials and Methods: All childhood cases (

The liver is the most frequently affected visceral organ in leprosy, particularly in the multibacillary group. Administration of hepatotoxic drugs may also affect liver function. We report the case of a male patient, diagnosed as borderline lepromatous leprosy with Type 2 reaction, who was managed with multibacillary multidrug therapy and steroids, and who then developed acute hepatitis and succumbed to sudden cardiac death. Although erythema nodosum leprosum has been described as a rare cause of death in the literature, such an occurrence in the present era when leprosy has been eliminated needs a special mention.