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Introduction Hidradenitis suppurativa (HS) is a multifactorial chronic inflammatory follicular disorder affecting apocrine gland-bearing areas of the body. We conducted an observational study to assess the ultrasonography (USG) findings in suspected HS patients at a tertiary care center in North India over 6 months. Aim The aim of this article was to study the USG findings in HS and correlate clinical and USG findings and scoring systems in HS with stage wise treatments. Materials and Methods All patients with a clinical suspicion of HS underwent an USG examination after clinical examination with a probe of 18 Hz frequency. Hurley's staging of patients was used to stage clinically, and the HS-SOS scoring and Doppler changes were assessed on USG. The treatment was revised in case of a change in the USG grading of severity. Results A total of 23 patients suspected of HS underwent USG evaluation, of which 12 (52%) were male and 9 (48%) were females, with the mean age being 25.3 years (range: 14–40 years). Based on the HS clinical grading, eleven patients (47.8%) were Hurley's stage I, six patients (26%) were stage II, and six patients (26%) were stage III. USG demonstrated that three patients had been misdiagnosed and had folliculitis (8.6%) and Crohn's disease (4.3%). Out of the remaining twenty patients with USG features of HS, based on HS SOS grading, three patients (15%) were grade I, seven (35%) were grade II, and ten (50%) were grade III. Of these, nineteen patients (95%) had axillary involvement, which was bilateral in 84% of cases. The other region affected was the groin in five patients (26.3%), while two had inframammary involvement (10.5%). On further characterization of the type of lesion, nodules (41; 40.6%) were the most common type of lesion by sinuses and thickened hair follicles in 31 (30.6%) patients. Based on USG findings, the management of 26% of patients was changed from medical to surgical intervention. Conclusion USG and Doppler are noninvasive bedside tools for the examination of HS, which helps to rule out differentials and delineate the extent and depth of the disease better by picking up subclinical lesions and help in determining disease activity by Doppler, which in turn helps in planning appropriate medical and surgical management of patients. It also identifies radiological parameters that help identify patients who could fail medical management. [ABSTRACT FROM AUTHOR]

Background: Dermatitis cruris pustulosa et atrophicans (DCPA) is a distinctive type of chronic superficial folliculitis, with a number of unique features such as its peculiar symmetric localization to legs, extreme chronicity, resistance to therapy, and inevitable alopecia and atrophy., Methods: All patients with DCPA, attending the Dermatology Outpatient Department at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Hospital, Pondicherry, from December 2006 to June 2008 were included. Parameters recorded were detailed history and examination, hemogram, erythrocyte sedimentation rate, random blood sugar, skin biopsy and cultures from pus and carrier sites (nares, axillae and gluteal fold)., Results: 37 patients were studied (35 males and 2 females). Sixteen patients (43.24%) belonged to the 21-30 year-old age group. The disease most commonly began on the legs (81.1%). Majority (78.38%) had a disease duration of less than 5 years. Itching was the most common symptom (89.19%), followed by bleeding and scaling, with no significant systemic symptoms. The lower limbs were involved in all patients. Eleven patients (29.73%) had involvement of other sites--beard, axillae, chest, moustache, abdomen, and eyebrows. Pustules, papules, and scaling were seen in all patients, followed by wiry roughness, atrophy, alopecia, and pigmentation. Aggravating factors included use of full-length synthetic trousers, occupational exposure to potential irritants, and season (summer). Pus culture from the folliculitic lesions grew Staphylococcus aureus in 32 (86.49%) patients. Twenty one patients (56.75%) were carriers of S. aureus in one or more sites., Conclusion: DCPA is a chronic folliculitis of the legs, with a multifactorial etiopathogenesis, in which staphylococcal carrier status may be a new potential pathogenetic factor.

Background: Primary scarring alopecias (PSAs) are a rare group of dermatological disorders with overlapping clinical features. They result in permanent hair loss and significant psychological morbidity. Aims: To analyze the clinico-epidemiology of PSAs of the scalp, along with clinico-pathological correlation. Methods: We conducted a cross sectional, observational study including 53 histopathologically confirmed cases of PSA. Clinico-demographic parameters, hair care practices, and histologic characteristics were noted and statistically analyzed. Results: Among 53 patients (mean age 30.9 ± 8.1 years, M: F 1:1.2, median duration 4 years) with PSA, lichen planopilaris (LPP) was most common (39.6%, 21/53), followed by pseudopelade of Brocq [30.2%, 16/53], discoid lupus erythematosus (DLE) [16.9%, 9/53], and non-specific scarring alopecia (SA) (7.5%, 4/53), while central centrifugal cicatricial alopecia (CCCA), folliculitis decalvans, and acne keloidalis nuchae (AKN) accounted for 1 case each. Forty-seven patients (88.7%) demonstrated predominant lymphocytic inflammatory infiltrate, while basal cell degeneration and follicular plugging were the commonest histological changes. Perifollicular erythema and dermal mucin deposition were noted in all patients with DLE (both P < 0.05). Nail involvement (P = 0.004) and mucosal involvement (P = 0.8) were more common in LPP. Single alopecic patches were characteristic of DLE and CCCA. Hair care practices (non-medicated shampoo > oil) had no significant association with the subtype of PSA. (P = 0.4) Conclusion: PSAs are a diagnostic challenge for dermatologists. Thus, histology and clinico-pathological correlation should be performed in all cases for proper diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: Androgenetic alopecia (AA) is one of the common cosmetic concerns. It affects more than 50% of adults. AA alopecia is a benign condition and it affects the psychology of patients. Microneedling (MN) - minimally invasive procedure. Minoxidil is an antihypertensive and causes vasodilation. Aims and Objectives: The present study was aimed to compare the efficacy of MN with minoxidil solution versus MN with hair multivitamin solution of male androgenetic alopecia. Materials and Methods: The study was conducted in the Department of Dermatology, Akash Institute of Medical Sciences and Research Centre, Devanahalli, Bengaluru, Karnataka, India. After following inclusion and exclusion criteria, 50 subjects were involved. Subjects were divided into two groups, 25 in each group. Group I, MN with dermaroller having needle length of 1.5 mm was done and minoxidil solution was applied over the scalp and the again MN was done. Group II, MN was done and hair multivitamin solution was used. MN was done for every 3 weeks and a total of nine sessions were done. From the last session, all the study subjects were followed for 6 months. Baseline investigations were done. Side effects such as pain, bruising, and folliculitis were recorded and monitored. Response of the patients to the treatment (hair growth) was assessed by physician global assessment scores. Visual analog scale score was done to assess the subjective improvement of the patients. Results: In this study, 50 male androgenetic alopecia patients were involved. In this, 21 (42%) were in the age group of 20-40 years and 29 (58%) were in the 41-60 years of age group. In Group I, excellent response was seen in 19 (76%), very good response in 4 (16%), good response in 2 (8%) patients, and none of the patients showed average response. In Group II, excellent response was seen in 10 (40%), very good response in 4 (16%), good response in 6 (24%) patients, and average response in 5 (20%). Following side effects were observed in the study subjects, pain in 6 (24%), bruising 4 (16%), and folliculitis 2 (8%). Conclusion: MN is safe and cost-effective procedure, which causes stimulation of hair follicles and improves hair growth. [ABSTRACT FROM AUTHOR]

Objectives: Diagnosis of scarring alopecias (SAs) are challenging, especially when lesions late in the process of development are met with. There is a paucity of literature that profiles the role of histopathology in unscrambling this puzzle, especially in Indian patients. Our aim is to review the histological features of SA in Indian patients and attempt to assign a specific diagnosis., Materials and Methods: We reviewed 37 cases of SA from 2005 to 2009. Sections were assessed for various histological parameters., Results: There were 18 of 37 cases (49%) of lupus erythematosus, 15 of 37 (41%) lichen planopilaris (LPP), 1 folliculitis, and 3 alopecia areata. The important findings in lupus erythematosus are epidermal atrophy, papillary dermal fibrosis, mucin, peribulbar inflammation, and haphazard spacing of scars. LPP shows an essentially normal epidermis, peri-infundibular infiltrate, and even spacing of scars. Twelve cases had total absence of follicles and yet could be classified based on the connective tissue changes. Alcian blue-periodic acid-Schiff stain highlighted follicular remnants within scars in 9 cases. Three cases of alopecia areata demonstrated peribulbar inflammation, evenly spaced scars, and remnants of catagenic basement membrane. Cases termed as "pseudopelade" clinically were predominantly LPP on histology., Conclusions: Histopathology is a dependable tool in identifying the underlying cause in SA. Even in cases that show a complete loss of follicles, it is possible to suggest the etiology based on epidermal and connective tissue changes.

Background: The primary cicatricial alopecias (PCAs) are a rare group of diseases where hair follicle is the primary target of destruction. There are a few studies on histopathological and trichoscopic features of PCA. Aims: To study the clinical, trichoscopic, and histopathological characteristics of PCAs of the scalp and to find out the concordance between trichoscopic and histopathological diagnosis. Materials and Methods: We retrospectively analyzed the clinical, trichoscopic, and histopathological features of 24 PCA patients. Fisher's Chi-square exact test was done to find the significant trichoscopic and histopathological features. Cohen's kappa coefficient was used to determine the agreement between histopathological and trichoscopic diagnosis. Results: A total of 24 patients of PCA were seen with a male: female ratio of 2:1. There were 10 (41.7%) patients of discoid lupus erythematosus (DLE), 5 (20.8%) of lichen planopilaris (LPP), 3 (12.5%) of dissecting cellulitis of scalp, and 2 (8.3%) each of pseudopelade of brocq, folliculitis decalvans, and frontal fibrosing alopecia. The important histopathological findings of DLE were follicular plugging, vacuolar changes in the basal layer, necrotic keratinocytes, and superficial and deep perifollicular and perivascular lymphocytic infiltrate. Histopathology of LPP showed vacuolar changes in the basal layer and lichenoid infiltrate involving the infundibulum and isthmus. Trichoscopy of DLE showed follicular plugging, yellow dots, and thick arborizing blood vessels. The peripilar cast was important finding in LPP. The characteristic yellow dot with three-dimensional structure was noted in dissecting cellulitis of the scalp. The Cohen's kappa agreement was 0.89 between histopathological and trichoscopic diagnosis. Conclusion: The diagnosis of PCA is challenging because of overlapping features clinically and histopathologically. Trichoscopy may provide quick and reliable diagnosis and obviate the necessity of scalp biopsy in busy clinics. [ABSTRACT FROM AUTHOR]

Background Community associated Methicillin resistant Staphylococcus aureus (MRSA) are common among Staphylococcal isolates from skin and soft tissue infections (SSTI). We intended to find the current status of SA primary skin infection and the antibiotic resistance patterns of SA isolates in India. There is a paucity of data on the significance of nasal SA carriage in the pathogenesis of skin infections. Hence, we investigated the presence and association between nasal SA carriage and staphylococcal primary pyoderma. Methods Hundred consecutive patients of primary pyoderma of all age groups and both sexes were recruited. Nasal swabs and pus samples from pyoderma lesions were taken for Gram's stain and bacterial culture. Antibiotic sensitivity patterns of nasal and pyoderma isolates were compared in patients with Staphylococcal primary pyoderma. Results Furuncle was the most common presentation seen in 56%, followed by folliculitis (17%) and impetigo (15%). Of the various organisms isolated from pus and nose, SA (58% and 50% respectively) and Coagulase negative staphylococci (CONS) (22% and 36% respectively) were the most predominant. MRSA infection and MRSA nasal carriage were found in 35% and 25% of cases respectively. Nasal carriage of SA and MRSA were found to be significant risk factors for the development of SA (p-0.015) and MRSA pyodermas (p<0.0001) respectively. Phenotypic concordance of nasal and pus isolates were seen in 34.5% (20/58) of SA-pyodermas, 70% of which were MR. Conclusion A high incidence of MRSA with resistance to commonly used antibiotics and high nasal SA carriage rates were observed by us, which is disturbing. Avoidance of inappropriate antibiotic usage is the need of the hour. Screening for nasal SA carriage may prevent recurrences and spread of CA-MRSA strains. [ABSTRACT FROM AUTHOR]

Background To assess the prescription pattern of antibiotics in dermatology OPD of a teaching tertiary care hospital. Methods All the prescriptions issued to the patients attending the DVL OPD from October 2019 to January 2020 were recorded and evaluated for antibiotics used. Results Out of the total number of prescriptions (21,015) issued in dermatology OPD in the study duration, prescriptions including antibiotics were 3,010. Antibiotics were most commonly prescribed for steroid induced rosacea followed by acne vulgaris followed by secondary infection over primary dermatosis. Oral, topical and injectable modes were used to administer antibiotics. The most common mode of administration was combination of oral and topical antibiotics. Total of 5,768 antibiotics drugs were prescribed in 3,010 prescriptions. Oral antibiotic drugs used in 2,679 prescriptions were 3,267, most common being doxycycline followed by cefadroxil. Injectables were prescribed only in 3 patients. Topical antibiotic prescriptions were 2,437. Total number of topical antibiotics drugs used were 2498, most common being metronidazole followed by clindamycin. Conclusion A good prescribing pattern was found in our study resulting in rational use of antibiotics in dermatology OPD. It was found that alternate therapy was considered wherever possible. Such study conducted periodically helps in identifying the mistakes and correcting them. Hence, aids in preventing antibiotic resistance. [ABSTRACT FROM AUTHOR]

Background: CKD is associated with various mucocutaneous manifestations that impair the quality of life. The objective was to study the incidence of various cutaneous manifestations in CKD patients. Materials and Method: 130 (M:F = 4.2:1) patients aged 15-78 (Mean age- 50.32 years) having CKD for 3 month to 5 years were studied for mucocutaneous manifestations. Forty (30.7%) patients were on hemodialysis for 1-3 months. Detailed medical history, clinical and mucocutaneous examination and lab investigations were performed. KOH mounts, skin biopsy, Gram's and Giemsa staining, bacterial or fungal cultures were performed as required. Results: Xerosis in 104 patients (80%), skin pallor in 76(58.4%), pruritus in 52 (50.9%) patients, pigmentation in 45(34.6%) and purpura in 12 (9.2%) patients were the major dermatoses. Perforating folliculitis occurred in1 (0.76%) patient..Mucosal findings included coated tongue in14(11.66%), xerostomia in 11(9.16%) and macroglossia with teeth markings and fissured tongue in 9 (7.5%) patients each, angular cheilitis in 3 (2.5%), and aphthous stomatitis and black pigmented tongue in 1 (0.83%) patients each. Hair abnormalities included sparse scalp and body hairs in 43 (33%), 11 (8.4%), respectively and lusterless hair in 22 (16.9%) patients. Major nail abnormalities were half and half nails or Linday's nails in 33(25.3%), longitudinal ridging in 29(22.3%), leuconychia in 13(10%), onycholysis in 9(6.9%), Beau's lines in 6(4.6%), koilonychias in 4(3.07%), Mee's lines in 1(0.76%) and Meuhrcke's lines in 1(0.76%). Conclusions: Xerosis, pruritus, skin pallor/pigmentary changes, half and half nails, longitudinal ridging, discoloration, sparse hairs, coated tongue, xerostomia, macroglossia, and infections were the most common mucocutaneous manifestations in the studied patients irrespective of hemodialysis status. [ABSTRACT FROM AUTHOR]

Dermatological disorders constitute a significant proportion of primary health care (PHC) setups. The pattern of dermatological disorders varies among different countries and different parts of the same country owing to climatic and geographical variations, level of education, access to health care, etc. To study the clinical spectrum of patients presenting with dermatological disorders at an urban health center (UHC) in East Delhi. To identify the various risk factors associated with dermatological disorders in study subjects. A total of 1,148 patients who reported skin diseases for the first time at the Dermatology Outpatient Clinic at UHC in East Delhi were recruited. Detailed demographic data, history, and examination and potential risk factors of skin diseases (socioeconomic status, level of education, occupation, comorbidities, and addictions) were recorded on a predesigned proforma. A total of 616 (53.7%) patients had infectious dermatoses and 532 (46.3%) had non-infectious dermatoses. Among the infectious dermatoses, fungal diseases (44.8%) were the most common followed by parasitic infections (31.17%) and bacterial infections (9.74%). Among the non-infectious group, eczematous disorders (28.01%) were the most common, followed by pigmentary disorders (21.62%) and acne (19.55%). A significant association between level of education, occupation, and comorbidities with the distribution of infectious and non-infectious dermatoses was found. As a significant proportion of patients with a vivid spectrum of dermatological disorders present at the PHC setups, therefore dermatologists supervise that specialty clinics should be held regularly at these centers along with the availability of all the basic investigations to aid diagnosis and management. [ABSTRACT FROM AUTHOR]

Bauhinia purpurea L. is a medium-sized tree from the family Fabaceae. The plant is traditionally used as medicine by different tribes in Sikkim. The present study aimed to evaluate the modulation in minimum inhibitory concentration (MIC) of the bark methanol extract of Bauhinia purpurea L. against the clinical isolates of multidrug resistant Staphylococcus aureus. The synergistic activity of the test plant extract with different classes of antibiotics was also evaluated. The methanol extract of Bauhinia purpurea exhibited modulation by a 16-fold reduction in the MIC of clindamycin against both resistant and susceptible isolates, followed by penicillin and gentamicin, whereas a maximum of only a 4-fold MIC reduction was observed with ciprofloxacin. The lowest minimum inhibitory concentration and minimum bactericidal concentration showed by the plant extract was 0.48 and 0.97 mg/mL, respectively. The methanol extract of Bauhinia purpurea exhibited synergistic activity with penicillin, gentamicin, ciprofloxacin, and clindamycin against most of the tested isolates of multidrug-resistant Staphylococcus aureus (MDR-SA). Gas chromatography-mass spectrometry analysis of Bauhinia purpurea L. bark methanol extract revealed 16 phytocompounds. The results provide an insight into the potential antibacterial property of the plant extract in terms of its antibiotic MIC modulation and synergistic properties with the selected antibiotics. This is the first report of the antibiotic potentiation property of Bauhinia purpurea L., collected from Sikkim, India. [ABSTRACT FROM AUTHOR]

Context: Scarring is a biological process of wound repair which leads to a difference in the normal structure and function of the skin and manifests as a depressed or raised area. Treatment of scars is challenging. A number of therapeutic approaches like surgical techniques and non-surgical techniques are performed to improve scarring. Aims and Objectives: The aim of this study was to compare the outcome of subcision followed by microneedling versus subcision followed by microneedling and topical platelet-rich plasma (PRP) in atrophic scars. Materials and Methods: A comparative prospective study was conducted at a tertiary care hospital in North India to compare the efficacy of subcision followed by microneedling versus subcision followed by microneedling and topical PRP. A total of 40 cases were taken and were randomly divided into two groups, A and B of 20 patients in each group. Topical PRP was applied as an additional therapy in Group B in the same sitting. Minimum three sittings were done in each patient at an interval of 4 weeks and results were assessed after 1 month of the third session. The statistical software used is Microsoft Excel and SPSS software program, version 24.0 for analysis of data and Microsoft Word to generate graphs and tables. Results: Improvement in scar grading was more in Group B as compared to Group A with statistically significant difference (P = 0.032). There was an improvement in scar grading from grade 4 scar to grade 2 in 15% and 30% patients of Groups A and B, respectively, with improvement in skin texture and pigmentation more in Group B. Conclusion: PRP proved to add to the improvement of grade of atrophic scars when combined with subcision and microneedling. [ABSTRACT FROM AUTHOR]

Introduction: Nonvenereal skin diseases are often confused with sexually transmitted diseases. It is responsible not only for the physician's diagnostic dilemma but also for significant patient concerns. Identifying the cause or aggravating factors can save the patient from distress. Therefore, this study was conducted to determine the clinical pattern and prevalence of nongenital diseases. Methods: All males attending the dermatology outpatient department in our hospital are included in the study after getting informed consent. Detailed history, including demographic data, chief complaints related to skin, any symptoms in genitalia, drug history, and history of sexual exposures, was recorded. Results: The prevalence of nonvenereal genital lesions during the period was 8.2% of patients attending the dermatology department. A total of 21% of nonvenereal genital dermatoses were studied in 82 patients. The most common ones encountered are pearly penile papules and tinea cruris, contributing 19.5% each. Vitiligo is the following most expected condition, involving 13.4% of patients. Among the total 82 patients with nonvenereal genital dermatoses, 65.8% had symptoms in external genitalia, and the rest of the 34.2% of patients did not have any complaints in genitalia. Conclusion: Among the 82 patients with nonvenereal dermatoses, 54 (65.85%) had symptoms in external genitalia. The study helped us understand the pattern and clinical characteristics of various nonvenereal genital dermatoses. [ABSTRACT FROM AUTHOR]

Background: Traumatic anserine folliculosis (TAF) is an uncommon follicular dermatosis. It is characterized by multiple closely set grouped follicular papules with goose skin appearance. There are few publications about this condition, and little is known about the incidence and peak age and sex groups. Aims and Objectives: The aim of this study is to describe the various pattern of TAF in children of 6 years to 18 years of age group. Methods: A retrospective study was conducted to identify cases of TAF in 26 patients at the dermatology department of our tertiary care hospital. The study population was 6–18 years age group children. History, variables, cutaneous and systemic examination, and routine laboratory investigations data were collected from previously recorded forms. Results: Twenty-six patients with TAF were identified. Of these, 19 were male and 7 were female. The mean age was 12.11 ± 2.2 years, ranging from 8 to 16 years. Only four patients were older than 14 years. The mean duration of lesions was 10.23 ± 7.2 months. We classified the clinical patterns as mental, mandibular, and malar according to anatomic location. The most common lesion locations were the chin in 20 (76.7%) followed by the body of mandible in 4 (15.38%) and cheek in 2 (7.69%) cases. Friction and pressure were the predisposing factors in most of the cases. Conclusion: The most commonly affected age group was 8–14 years in 22 (84.6%) children, and the most common predisposing factors were friction and pressure. Therefore, early diagnosis with proper counseling and lifestyle modification of TAF provides rapid relief for patients and avoid unnecessary tests and treatments. [ABSTRACT FROM AUTHOR]

Background: Although prevalence of MRSA strains is reported to be increasing, there are scanty studies of their prevalence in community acquired pyoderma in western India. Aims: This study aimed at determining clinicobacteriological profile & prevalence of Methicillin Resistant Staphylococcus aureus (MRSA) infections in community acquired pyoderma. Materials and methods: Prospective study was carried out in tertiary care hospital in Baroda.100 patients with pyoderma, visiting outpatient department of dermatology, were studied clinically and microbiologically. Sensitivity testing was done for gram positive & gram negative organisms by disc diffusion method. MRSA were detected by Agar dilution method. Result: Primary pyoderma accounts for 64% of cases with highest number of cases were of Impetigo (26%). The culture positive rate was 83% with Staphylococcus aureus being the major pathogen. (78.82%) Out of these 10.45% strains of Staphylococcus aureus were Methicillin Resistant Staphylococcus aureus. (MRSA) Conclusion: MRSA as a cause of pyoderma is a reality albeit in present study group. All the MRSA isolated were sensitive to Vancomycin. Sensitivity to Amoxyclav, Fluoroquinolones & Macrolides is quite good, which can be used for treatment. [ABSTRACT FROM AUTHOR]

Background: Dermatosis neglecta (DN) is an acquired skin condition that occurs due to unconscious neglect of self-cleaning in individuals with some underlying risk factor. Aims and Objectives: The purpose of this study was to summarize the demographic, clinical characteristics, and treatment outcomes of patients with DN in a tertiary care center. Methods: We evaluated the medical records of 28 patients with DN who were diagnosed and treated in our center between August 2020 and July 2022. The retrospective data related to demographic details, duration of lesions, morphology, distribution of lesions, associated symptoms, history of cleanliness, a risk factor for the development of the condition, treatment provided, and the details of follow-up were taken into account and analyzed. Results: Of the 28 patients, there were 19 males and nine females. The most common site in our study was the anterior trunk (n = 7) followed by the posterior trunk (n = 6). The most common site to develop DN was a recent surgical site. Soap and water cleansing resulted in the removal of lesions in the majority of the patients. Recurrence was observed in two patients. Conclusion: Our study indicates that the frequency of this condition is often underestimated and under-reported. To the best of our knowledge, this is the largest case series of DN in the medical literature. [ABSTRACT FROM AUTHOR]

Background: Apremilast regulates several pro‐inflammatory signals involved in atopic dermatitis (AD). Methods: A randomized, open‐labelled study was conducted at a tertiary care centre in India. Fifty patients with AD of >1 year duration were randomly assigned in a 1:1 ratio to receive either apremilast (30 mg twice daily after initial titration) or cyclosporine (5 mg/kg/day) for 24 weeks, followed by a 12‐week follow‐up period. Primary outcome was mean percentage change in Eczema Area and Severity Index (EASI) from baseline to week 24. Secondary outcome measures were proportion of patients achieving EASI 75, EASI 90, ≥2‐point improvement in Investigator's Global Assessment (IGA), SCORing Atopic Dermatitis (SCORAD) 75 at week 24 and percentage of patients experiencing ≥1 adverse effect (AEs). Results: Mean percentage change in EASI (standard deviation) was −67.79% [22.44] in the apremilast treatment group and −83.06% [21.20] in the cyclosporine treatment group (p < 0.05). At week 24, 52.38% of patients in the apremilast group and 78.26% in the cyclosporine group achieved EASI 75 (p < 0.05); 14.29% in the apremilast group and 52.17% in the cyclosporine group achieved EASI 90 (p < 0.05) and 80.95% in the apremilast group and 82.60% patients achieved ≥2 point reduction in IGA (p > 0.05). 57.14% of patients achieved SCORAD 75 in the apremilast group and 69.56% in the cyclosporine group (p > 0.05). Mean time taken to achieve EASI 75 in the apremilast group was 4.50 ± 4.62 weeks, while it was 3.96 ± 3.43 weeks in the cyclosporine group (p > 0.05). Incidence of AEs was 28.57% in the apremilast group and 21.74%) in the cyclosporine group. Conclusions: Apremilast demonstrated lesser efficacy in comparison to cyclosporine; it has the advantage of a favourable safety profile and requires no laboratory monitoring. [ABSTRACT FROM AUTHOR]

Objective To study and document the epidemiological data, various morphological expressions, and causative medications for tinea incognito, to identify the causative agent, and also to evaluate the laboratory methods' efficacy in substantiating the diagnosis clinically. Methods It was conducted over a period of two years with a sample size of hundred cases of tinea incognito who had used topical or systemic steroids, topical immunosuppressants, and other indigenous preparations for a period of at least four weeks. Skin scrapings from the patients were examined for fungal elements under KOH mount, and fungal cultures were performed for species identification, and the derived results were analyzed. Patients at the end of three weeks and six weeks were re-assessed. Results In our study, clinical presentation mimicked various dermatoses, of which eczematous like was the most common type, followed by psoriasiform. KOH was positive among 69% of the patients, and positivity for fungal culture was seen in 48%, out of which Trichophyton mentagrophytes constituted 56.25% of the cases, followed by Trichophyton rubrum (25%). Conclusion Although this entity has been known for years, it still causes perplexity in diagnosis and treatment. Health education in order to create public awareness about dermatophytosis is indeed the need of the hour. [ABSTRACT FROM AUTHOR]

Introduction: Ageing is a complex, natural process. Due to structural and physiological changes that occur as a consequence of intrinsic and extrinsic aging, the elderly population is highly susceptible to dermatological disorders. These changes are associated with significant morbidity and stress. Hence, it is important to have a better understanding of the dermatological needs of elderly patients. Aim: The aim of this study was to investigate the pattern and frequency of geriatric dermatoses in patients attending the Skin Outpatient Department (OPD) at a tertiary care centre. Materials and Methods: This cross-sectional observational study was conducted at the Department of Dermatology, Venereology, and Leprosy at BPS Government Medical College for Women, Khanpur Kalan (Sonepat), Haryana, India, from September 2022 to February 2023. A total of 300 patients aged 60 years and above, of either sex, who consented to participate were enrolled. Detailed history taking and dermatological examinations were performed, and relevant investigations were carried out. Data was collected, entered into a Microsoft Excel sheet, and analysed for frequency, percentage, and mean of variables. Results: Out of the total 300 patients, 155 (51.66%) were males and 145 (48.33%) were females. The majority of patients belonged to the age group of 60-69 years (n=171, 57%). Wrinkling (n=287, 95.66%) was the most common physiological skin finding, followed by dry skin (n=157, 52.33%). Among pathological dermatoses, infectious dermatoses were present in (n=134, 44.66%) patients, followed by eczemas (n=92, 30.66%). Papulosquamous disorders were seen in (n=17, 5.66%) patients. Hypertension was the most common systemic illness present in (n=53, 17.66%) patients. Conclusion: Physiological and pathological skin changes in the elderly are a common cause of consultation in dermatology OPD. Physiological changes were seen in all patients. Among pathological changes, infections were the leading dermatoses, followed by eczemas and papulosquamous disorders. [ABSTRACT FROM AUTHOR]

Introduction: Dermatoses are common among schoolgoing children and lead to significant morbidity. Objective: The present study was conducted to find the prevalence of various dermatoses in children studying in residential schools of remote tribal areas. Materials and Methods: A cross-sectional study was conducted on 1943 children studying in eight residential government schools over a period of 2 months (August and September 2016). Diagnosis of various dermatoses was made on the basis of detailed clinical examination and necessary investigations. Data analysis done by SPSS version 21.0 and Chi-square test was used to analyze categorical variables. Results: The prevalence of dermatoses was 72.1%. Majority had single skin lesion. Among infections and infestations, scabies (13.6%), pediculosis capitis (9.2%), and pyoderma (7.5%) were most prevalent. Among the noninfective conditions, xerosis (32.63%), pityriasis alba (18.9%), acne (8.6%), and atopic dermatitis were most prevalent. The prevalence of pyoderma, tinea corporis, pityriasis versicolor, scabies, and xerosis was higher in boys while pediculosis capitis and pityriasis alba were more prevalent in girls. The prevalence of xerosis, pityriasis alba, and phrynoderma was higher in primary school students while tinea corporis, scabies, acne, and pediculosis capitis were more prevalent in high school students. Conclusions: The burden of dermatoses in residential school children is very high. Health education of children, teachers, and caregivers regarding signs and symptoms of dermatoses is warranted for early detection and timely intervention. There is urgent need to address dermatoses under school health program. [ABSTRACT FROM AUTHOR]

The incidence and prevalence of recalcitrant cutaneous fungal infections is on the rise. Terbinafine‐resistant Trichophyton has not only been widespread in India, but has also been reported in countries spread throughout the globe. Strains of yeasts such as Malassezia and Candida, which exist both as commensals and as pathogens to the human skin, have also been found to develop resistance to antifungals. Non‐dermatophyte moulds which can colonize and infect damaged nails are especially difficult to treat, not only due to resistance, but also because of poor drug penetration of hard keratin. Psychosocial factors such as the indiscriminate broad‐spectrum antifungal use in agriculture and in medicine, and poor adherence to hygienic measures to break the chain of infection contribute to the development of antifungal resistance. Such environments encourage fungi to develop various resistance mechanisms to withstand antifungal treatment. These include: (a) alteration of the drug target, (b) increasing efflux of drug/metabolites, (c) inactivation of drug, (d) bypass mechanisms or substitution of the pathway affected by the drug, (e) stress adaptation mechanisms and (f) biofilm formation. Understanding of such mechanisms and how they arise are crucial for development of new ways to prevent or overcome resistance. Novel antifungal treatments have recently been approved in the United States of America for treatment of vulvovaginal candidiasis. Ibrexafungerp (enfumafungin derivative) and oteseconazole (tetrazole) differ from their respective related drug classes of echinocandins and triazoles by having different structures, which lend these medicines advantage compared to traditional treatment by having a different binding site and more selectivity for fungi respectively. Other drugs designed to circumvent the known mechanisms of antifungal resistance are also at various phases of development. Concurrent measures at an institutional and individual level to address and limit inappropriate antifungal use to reduce development of antifungal resistance should be undertaken in a concerted effort to address this epidemic. [ABSTRACT FROM AUTHOR]

Introduction: Dermatological manifestations are common manifestations of human immunodeficiency virus (HIV) disease, seen in 80% to 95% of HIV-infected patients. Dermatological manifestations are considered clinical indicators to predict and assess the underlying immune status. Aim: This study aims to document the dermatological manifestations in relation to CD4 count in people living with HIV (PLHIV). Materials and Methods: Cross-sectional study in 250 PLHIV fulfilling inclusion–exclusion criteria was conducted. Variables including sociodemographic profile, recent CD4 count (data from antiretroviral therapy center), and dermatological manifestation (physical examination) were collected. Clinical diagnosis was established, and patients were grouped according to the World Health Organization immunological staging Results: Majority of PLHIV (39.6%) were in the age group of 31–40 years. Males were affected more than females (1.6:1). A total of 364 dermatoses were observed; dermatological manifestation per patient ranged from 1 to 4. 32.80%. PLHIV had CD4 count >500 cells/mm3, 15.60% had CD4 count between 200–349 cells/mm3. Majority of dermatosis had infectious etiology (77.6%), out of which dermatophytosis (27.2%) was the most common infectious condition, whereas pruritic papular eruption was the most common (11.6%) noninfectious condition. A statistically significant association of CD4 count was found with dermatophytosis (P ≤ 0.001) and candidiasis (P = 0.001). Conclusion: The study showed a significant association between the number of dermatological manifestation and CD4 count as majority of study participants (67.2%) had CD4 <500 cells/mm3 at the time of episode of dermatosis. [ABSTRACT FROM AUTHOR]

Background: Chronic renal failure (CRF) is manifested by various skin symptoms. New changes have been described continuously since the advent of hemodialysis, which increases life expectancy and allows time for these changes to occur. Objective: The aim of this study was to determine the frequency of skin manifestations in chronic renal failure (CRF) patients receiving hemodialysis. Methods: it was a cross sectional observational study in which skin changes were studied in a total of 500 CRF patientsreceiving hemodialysis attending dermatology OPD in a tertiary hospital in central India. Results: 80% of the patients complained of some skin problems. However, at examination, all patients had at least one skin condition caused by CRF. The most common finding was xerosis (80%), followed by pallor (70%), itching (50%), and skin hyperpigmentation (40%). Other skin manifestations include Kell's disease (20%), fungal (40%), bacterial (15%), purpura (10%) and dermatitis (2%). Nail changes include koilonychia (25%), onychomycosis (20%), subungual hyperkeratosis (10%), onycholysis (10%) and hemorrhages (5%), Mee's line (5%), Muehrcke lines (5%) and Beau's lines (2%). Hair changes include thinning hair (35%) and brittle and dull hair (15%). Oral changes include striated macroglossia (40%), xerostomia (30%), ulcerative stomatitis (30%), angular cheilitis (15%), and uremic breath (10%). Some rare side effects of CRF have also been observed, such as uremic frostbite, gynecomastia, and pseudoKaposi's sarcoma. Conclusion: CRF is associated with a complex set of cutaneous manifestations caused by disease or treatment. The most common are xerosis and pruritus, and early recognition of skin symptoms can reduce pain and morbidity. [ABSTRACT FROM AUTHOR]

After the total excision of keloids, radiation therapy has been demonstrated as one of the most effective treatment methods to prevent a recurrence. This study was aimed to compare the effectiveness and side effects of single fraction electron beam radiotherapy (EBRT) and intra-lesional steroids (ILS) in preventing the recurrence of keloids postoperatively. Those patients who received EBRT within 24 h after the completion of keloid excision from the Plastic Surgery Department in a tertiary care institution in Southern India constituted the first group. The second group consisted of patients who received triamcinolone acetate injection intraoperatively along the wound edges and postoperatively into the scar every 3 weeks for 5 cycles. Both groups of patients were prospectively followed up. Out of 101 patients enrolled in the study, six patients were lost to follow-up. Ten patients developed postoperative complications. At the end of 1 year, 48.4% of all the patients were having a recurrence. The incidence of recurrence in the radiation group and steroid group were 56.5% and 40.8% respectively. Keloids of the ear lobe were having a significantly less number of recurrences at 1 year (8.3% vs 72.9%). There is no statistically significant difference between the outcomes of postoperative EBRT and ILS injection in the recurrence of keloids, although the steroid group had a 15.7% less incidence of recurrence. Keloids of the ear lobe and keloids with lengths less than 2 cm were having significantly less recurrence. About 10% of patients had mild postoperative complications. [ABSTRACT FROM AUTHOR]

Occupational and recreational aquatic activity predisposes our population to a wide variety of dermatoses. Sunburn, urticaria, jellyfish stings, and contact dermatitis to rubber equipment are common allergies that are encountered in the aquatic environment. Among the infections, tinea versicolor, intertrigo, and verruca vulgaris are widespread. Swimmer's itch may occur due to skin penetration by schistosome cercariae, while free-floating nematocysts of marine coelenterates may precipitate seabather's eruption. "Suit squeeze" due to cutaneous barotrauma and lymphoedematous peau d'orange due to decompression are rare, described entities. This review serves as a ready reckoner for Indian dermatologists and medical practitioners to identify and manage these conditions. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus can have varied cutaneous manifestations. Aims and Objectives: This study aims to explore the plethora of dermatoses among the geriatric diabetic population and evaluate their association with the socioeconomic conditions of the patients. Materials and Methods: This is a cross-sectional observational study carried out on 300 diabetic patients aged 60 and above in department of dermatology of a tertiary care hospital in Eastern India. Data were collected in a pre-designed proforma, and all findings were recorded. Results: Three hundred diabetic patients aged 60 and above were evaluated; 42% were male, 58% were female. About 61.33% belonged to lower socioeconomic status (SES), 24% to middle, and 14.67% to upper SES. Xerosis (66%) and generalized pruritus (44%) were the most common skin manifestations. Among the infective dermatoses, fungal infections (49.3%) were the most common followed by bacterial (29.3%). There was statistically significant correlation of diabetic dermatoses with SES, female gender, obesity, increased intake of junk food, active smokers for more than 10 years, living singly, sedentary lifestyle, and hypertension. Conclusion: An in-depth knowledge of diabetic dermatoses in the elderly and the role of SES and demographic parameters accounting for their increased prevalence has not been sufficiently studied among the Indian population. This study will shed some light on the same and bring in awareness among the doctors and policymakers alike to enhance the health-care needs of the elderly. [ABSTRACT FROM AUTHOR]

Justification: The diagnosis of Down syndrome (DS) is easily made clinically but the management is multi-disciplinary and life-long. There is no standard protocol available for its management in India. Process: A committee was formed under the Indian Academy of Pediatrics (IAP) chapter of Neuro developmental pediatrics consisting of 20 experts working in the related field. The various aspects of the condition were discussed and allotted to the concerned experts related for preparing the guidelines. The material received was collated to form a set of guidelines, which were reviewed by the committee, and a consensus statement made. The guidelines were then approved by the chapter, and by the IAP. Objectives: To define the condition and to look into the various aspects of antenatal and postnatal diagnosis. To explain briefly about the involvement of the various systems that are involved and formulate recommendations for management. To recommend early and sustained interventional therapies to enable children with DS lead an independent life. Recommendations: The stress on bio-psycho-social strategy for the management of children with DS is reiterated, and the need for a medical, social and rights model is recommended after each section. The age-wise recommendations are also highlighted in addition to the recommendations under each system. [ABSTRACT FROM AUTHOR]

Background: Skin diseases occur in all age groups in developed and developing countries. Various types of skin diseases are found worldwide and depend on factors like environment, surrounding ecology, dietary habits, socioeconomic status, mental health, and literacy. Health-related quality of life (HRQOL) improves after treatment or cure of the diseases. Objectives: To estimate the pattern of skin disease. To find out the quality of life and association of skin disease with sociodemographic factors among patients. Methods: This observational cross-sectional study was done in skin OPD at the tertiary care center, Banda district of Uttar Pradesh, India from May 2022 to July 2022. All patients who attended to skin OPD during study period were included in the study after taking informed verbal consent. Results: Skin diseases had further divided in subcategories which were infectious conditions, pigmentary disorders, inflammatory dermatoses, miscellaneous skin conditions, benign tumor and other lesions with their percentage 44.8, 10.5, 28.6, 7.1, 2.9 and 6.2%, respectively in this study Classes of DQLI where major portion of patients (49.52%) were in 'Small effect on patient's life' category. The relation of age, religion, education and member of household with history of skin disease were found to be highly statistically significant. Conclusion: Infectious skin diseases were found more common in study area. Male populations were more commonly affected. Skin diseases were more common in age group of 18-60 years. Study participants showed no predominant effect on quality of life. But small effect class had major effect on participant's quality of life. [ABSTRACT FROM AUTHOR]

Background: Chronic alcoholism is a multifactorial condition predisposed by environmental, social, and psychological factors. Alcohol dependence syndrome (ADS) can present with varied cutaneous and systemic manifestations. The effects of alcohol use include cutaneous infections, infestations, features of malnutrition, exacerbation of pre-existing dermatoses, and alcoholrelated dermatoses. This study aimed to analyze and document cutaneous manifestations secondary to infections, infestations, malnutrition, and modifications of pre-existing dermatoses in ADS patients and investigate the correlation between the presence of cutaneous manifestations and duration and quantity of alcohol intake. Methods: The present observational study was carried out in the Department of Dermatology for a period of one year. A total of 172 male patients with ADS presenting with skin manifestations were included in the study. Detailed analysis of history, clinical examination, and relevant investigations were conducted. Findings: Out of 172 male patients with ADS, the most common dermatoses noted were infections (166, 96.5%) and features of malnutrition (161, 93.6%). Exacerbation of pre-existing dermatoses (101, 58.7%) and alcohol-related dermatoses (85, 49.4%) were also observed. Conclusion: Most of the dermatoses were significantly correlated with the quantity of alcohol intake than with its duration, implying that higher quantity of alcohol intake has more impact on cutaneous and systemic manifestations. Identifying the cutaneous manifestations in ADS patients plays an important role in recognizing the underlying systemic disorders which in turn facilitates early intervention and thereby prevents complications. [ABSTRACT FROM AUTHOR]

Context: The protean mucocutaneous manifestations of HIV and the resultant opportunistic infections are well documented. Genital dermatoses can be either venereal or nonvenereal in origin. As the presence of HIV infection greatly increases the chances of acquiring another sexually transmitted pathogen, these are often presumed to be venereal in origin. Aims: The aims of the study were to record the different morphologies of genital skin lesions in seropositive patients and to classify them as venereal or nonvenereal in origin. Settings and Design: This was an observational study undertaken in seropositive patients with genital skin lesions attending the outpatient department of dermatology at a tertiary health-care center. Subjects and Methods: One hundred and seventy-seven seropositive patients with genital lesions were enrolled. A detailed history was taken; the genital and dermatological examination was performed. Statistical Analysis Used: None. Results: Males predominated the study population with the majority (79.1%) falling into the reproductive age group of 15-49 years. Nonvenereal genital dermatoses (59%) outnumbered sexually transmitted infections (STIs) (41%) out of which the most frequently encountered were dermatophytosis, scabies, and intertrigo. Other entities recorded were inflammatory dermatoses, cutaneous adverse drug reactions, and tumors. The most common STIs were herpes genitalis (55.4%) and anogenital warts (32.5%). Conclusion: This study showed that nonvenereal genital dermatoses are more common than STIs in people living with HIV. Our findings reiterate the fact that genital lesions should be approached with caution as a presumptive and hasty diagnosis of STI adds greatly to the morbidity of the patient in terms of guilt and shame, and adversely affects the quality of life. [ABSTRACT FROM AUTHOR]

Introduction: Lithium has been used in the treatment of mood disorders for more than five decades. Despite a few studies focusing on the relationship between the dose of lithium, serum lithium levels, duration of therapy, and cutaneous side-effects, results remain inconclusive. Lithium is known to cause multiple cutaneous side-effects like acneiform eruptions, psoriasiform eruption, seborrheic dermatitis, and follicular keratitis. Aim: To evaluate the relationship between cutaneous side-effects of lithium with the serum lithium levels, dosage and duration of lithium therapy in bipolar affective disorder patients. Materials and Methods: An ambispective observational study conducted among 52 bipolar affective disorder patients on lithium therapy recruited by convenient sampling methods from both Inpatients and Outpatient Psychiatry Units of PSG Institute of medical sciences and research, Coimbatore, Tamil Nadu, India, June 2014 to August 2014. The patients with bipolar affective disorder who are either newly started on lithium or already on lithium therapy were included in the study. They were followedup to assess the effect of lithium dosage, duration of lithium and serum lithium level with skin lesions, once a month for six months and once in two months for one year. Kaplan-Meier survival analysis was done with varying lithium dosages and serum lithium levels. Association between the lithium dose and serum lithium levels with the cutaneous side-effects were calculated using the survival analysis with the p-value of <0.01. Results: Out of the total, 59.6 % of the participants were in the age group less than 40 years and 34.6 % were in the age group 40-60 years. There was almost equal distribution of males and females, 51.9% and 48.1%, respectively. Overall, 38.46% participants had cutaneous lesions. Various lithium dosage and serum lithium levels did not correlate statistically with skin reactions upto one year. Survival analysis at the end of 10 years revealed that participants with higher dosage and serum levels had higher prevalence of skin lesions (40% vs 4%: 47.1% vs 6.6% respectively, p-value <0.001). The cumulative proportion of skin lesions at the end of three, five, seven and 10 years for higher dose (>800 mg/day) was 38%, 46.9%, 52.2%, 59% and for higher lithium levels (>0.8 mEq/L) was 41%, 58.2%, 65.2%, 73.9%. Conclusion: The patients who were treated with lower dosage and who had lower serum lithium level had reduced risk for cutaneous lesions. Lithium continued to exert its mood stabilisation property even when the serum level was maintained less than 0.8 mEq/L. This resulted in better compliance. [ABSTRACT FROM AUTHOR]

Background: Snow skiers are directly exposed to a variety of extreme environmental conditions, which may lead to numerous physiological and pathological changes in the skin, and potentially increased chances of various specific and non-specific skin diseases. Although there are studies on skin diseases caused by exposure to cold and high altitudes, yet those on snow skiers are scarce as the study population is small. Objective: This study was undertaken to observe various dermatoses existing exclusively in snow skiers. Methods: It was a descriptive, cross-sectional, community-based study conducted at the world-famous ski resort Gulmarg Kashmir in North India. The initial questionnaire-based assessment and the subsequent examination of those exhibiting skin involvement were undertaken by visiting places of accommodation for snow skiers as well as on-spot visits to skiing slopes. Result: The most common dermatological manifestations in our study were dryness (xerosis) and its related aftereffects such as pruritus and chapping of the lips, followed by UV-related skin damage such as whole-face tanning, various types of infections and infestations, and endogenous eczema, including seborrheic and xerotic eczema. Direct cold-related injuries such as perniosis and various forms of urticaria were also common presentations. Conclusion: Snow skiers are especially susceptible to a variety of dermatoses because of exposure to cold conditions and direct contact with the snow. Proper protective measures against cold and snow and awareness about preventive strategies may decrease the chances of snow skiers developing various dermatoses, thereby reducing morbidity and work and economic loss. [ABSTRACT FROM AUTHOR]

Background: Topical corticosteroids (TCs) are one of the most frequently prescribed medications by dermatologists, yet may lead to an array of side effects due to prolonged and improper use. Because of the easy availability of topical corticosteroids as over-the-counter medications in India, these drugs are misused and abused. Objective: The objective was to determine the extent and the side effect profile of topical corticosteroid misuse/abuse in patients attending the OPD, to determine the demographic data and the reason and source of procuring TCs, and to characterize the dermoscopic findings of TSDF. Materials and Methods: This was a prospective, cross-sectional, clinical study conducted over a period of two years in which a predesigned, questionnaire-based proforma was employed. Patients above the age of fifteen reporting to the OPD giving a history of the application of a steroid cream continuously or intermittently for the minimum duration of four weeks were included in the study. A total of two hundred patients who met the clinical criteria were subjected to dermoscopic examination with a handheld dermoscope (DermLite DL4; 3Gen, U.S.; 10×). Results: A total of 2400 patients (fifteen-year-old or older) were enrolled in the study, in which 65% of the patients were females while 35% were males. Mostly, the patients procured these medicines from the pharmacist or paramedic, followed by general practitioners. The most common indications for which topical preparations were used included acne, followed by photodermatoses and ephelides. Most of the patients used combination creams, followed by potent steroids such as clobetasol propionate and betamethasone valerate. The most common side effects were erythema (74%), followed by photosensitivity (49%), hypertrichosis (47%), telangiectasia (42%), acneiform eruption (33%), contact dermatitis (21%), wrinkles (23.50%), etc. The main findings noticed on dermoscopy were irregularly dilated, branching, tortuous vessels almost interconnecting with each other in 79.78%, followed by hypertrichosis in 56.34%, white structureless areas representing atrophy in 42.33%, red dots in 7.22%, and a reddish background in 92.20%. Conclusion: The rampant use of TCs by patients for a prolonged period of time leads to a variety of side effects. Due to the topographical location, the climate of the valley, and the lighter skin type of the local population, the indications for which TCs were employed in our study group and the side effect profile were unique from the rest of the country. Dermoscopy may play a vital role in improving the diagnostic accuracy of TSDF and help us to differentiate it from close mimics. [ABSTRACT FROM AUTHOR]

Introduction: Skin disorders are common in paediatric age group and are associated with significant morbidity and stress. These differ from adults in clinical presentation, treatment and prognosis. Data on pattern of paediatric dermatoses can be used in planning healthcare programs. Aim: To study the clinical pattern and prevalence of various skin conditions in paediatric age group in tertiary care centre of rural Haryana, India. Materials and Methods: The present cross-sectional observational study was conducted in Bhagat Phool Singh Government Medical College (W) Khanpur Kalan, Sonepat, Haryana, India. A total of 1,003 consecutive Outpatient Department (OPD) patients upto age of 14 years presenting with skin conditions were included in study from a period May 2021 to January 2022. Various parameters like age, gender, pattern of distribution and type of skin lesions were assessed. Results were entered in excel sheet and frequency, percentages were calculated. Results: Out of 1,003 patients 56.53% were males and 43.47% were females. Maximum number (33.20%) of patients were in the age group of 1-5 years. Scabies (24.12%) was the most reported dermatological condition. Majority of dermatoses belonged to infections (32.40%) and infestations (24.83%) followed by eczemas (17.34%). Bacterial infections (15.25%) were most common infections followed by fungal (10.37%) and viral (6.78%) infections. Conclusion: In the present study, infections and infestations were most common dermatological conditions. This study provides insight about the pattern of various dermatoses among children in rural setting. [ABSTRACT FROM AUTHOR]

Background: In developing countries, pediatric dermatoses cause significant morbidity and are a major public health problem. Parental socioeconomic status (SES) is an important underlying factor. Aim: The aim of the study is to estimate the prevalence and disease characteristics of pediatric dermatoses at a tertiary care center in Eastern India. Materials and Methods: Patients aged 19 years and below, presenting with at least one skin disorder were included in this cross-sectional study. All patients were subjected to detailed history including parental SES and clinical examination. Results: We evaluated 525 subjects (mean age 9.9 ± 6.2 years; M:F 1:1.1), majority being adolescents (>12–19 years) (40.6%) and belonging to upper-lower socioeconomic class (69.3%). Infections and infestations were most frequent (56.6%), followed by skin appendageal disorders (22.7%), eczema and dermatitis (8.8%), miscellaneous disorders (6.9%), pigmentary and nevoid disorders (3.4%), and papulo-squamous disorders (1.7%). Among infections, dermatophytosis was most common, followed by scabies and impetigo; while acne vulgaris was the most frequent noninfectious disorder followed by seborrhoeic dermatitis. Skin disorders were significantly associated with parental SES (P = 0.04). Infections showed a significant inverse association with parental SES (P = 0.003) while eczematous disorders demonstrated a positive dose-response association (P = 0.005). Higher parental SES increased the risk of acne vulgaris but reduced the risk of impetigo. Conclusion: Infectious diseases occurred most frequently, followed by pilosebaceous disorders. Parental SES is a significant determinant of pediatric dermatoses. Increased awareness is needed to prevent and treat these disorders. [ABSTRACT FROM AUTHOR]

Sarcoidosis affects different systems of the body including the skin where it can affect various cutaneous sites. Among these sites, the scalp is a very unusual location for lesions of sarcoidosis. Sarcoidosis of the scalp can very rarely be accompanied by cicatricial alopecia. We report here a rare case of sarcoidosis of scalp with cicatricial alopecia. To the best of our knowledge, this is the first such report from India. [ABSTRACT FROM AUTHOR]

Background: Adolescence describes the age group between 10 and 19 years. This is the transitional stage of physical and physiological human development generally occurring between puberty and adulthood. Hormonal changes occurring during puberty result in various physical and psychological changes, affecting their social relationship. At this stage, external appearance is of immense concern to them. As such, any dermatological condition can extremely affect their psychological status. This study was conducted to give an insight on the various dermatological conditions of the adolescent age groups and their incidence. Methods: Study design: Descriptive study – Cross‐sectional study. Three hundred patients between the ages of 10 and 19 years, attending the tertiary care center in South India, were included in the study. A detailed history, clinical examination, and appropriate laboratory investigations were carried out. Results: Out of 300 patients, females (52.7%) more commonly presented with dermatoses than males (47.3%). Most of the 300 patients belonged to the age group of 17–19 years (50.33%). Infections/infestations (39%) were the most predominant dermatoses followed by acne (17.67%), eczema (9.67%), insect bite reactions (IBRs) (7%), keratinization disorders (6.67%), polymorphic light eruptions (PLEs) (4.33%), urticaria (4.33%), and pigmentary disorders (4.33%). Conclusion: This study gives an insight of various dermatological conditions among the adolescent age groups. Females more commonly presented with dermatoses. The most common dermatoses were infections. Since very few studies regarding dermatoses in adolescents are available in the literature, this study is distinctive in this regard. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease. Hanifin and Rajka's criteria is the most common diagnostic criteria used for the clinical diagnosis of this condition. However, many find that it is too exhaustive to be used in routine practice, and the specificity of many of the minor criteria poses challenges, particularly from Asian countries with type III, IV, and V skin. Aims and Objectives: The aim of the study is to evaluate the effectiveness of the minor features of the Hanifin and Rajka criteria for AD in comparison to the UK working party's diagnostic criteria in pediatric populations of India. Methodology: A hospital-based cross-sectional study of 100 patients in the pediatric age group (3 months–12 years) with AD was conducted based on history, clinical, and laboratory evaluation. An age-matched control group of 100 pediatric patients who did not have a personal or family history of atopic dermatitis was included after obtaining informed consent to find out the prevalence of minor criteria among the control group. Results: Mean of the number of minor clinical criteria found positive in our study population in the infantile and toddler (below 2 years) and childhood groups (2–12 years) was (4.72 ± 1.75) and (5.67 ± 1.78), respectively. Early-onset of disease was the most consistent feature among the minor criteria found in 83% of patients, followed by xerosis (71%), hyperlinearity of palm (56%), pityriasis alba (54%), Denny Morgan fold (52%), elevated serum IgE (47%), perifollicular accentuation (37%), and tendency toward cutaneous infections (37%). Conclusion: We found that though some of the minor criteria are highly sensitive and specific to the diagnosis of AD (xerosis, ichthyosis, palmar hyperlinearity, tendency of cutaneous infections, Dennie–Morgan infraorbital fold, pityriasis alba, and perifollicular accentuation), some other criteria were either very rare or nonspecific for AD. We suggest that many of the minor criteria of Hanifin and Rajka may not have much significance for Indian patients and a multicentric nationwide study with a larger patient pool is required to create a trimmed and improved version of Hanifin and Rajka criteria. [ABSTRACT FROM AUTHOR]

Background: Dermatological problems in pediatric population constitute at least one third of all outpatient visits to pediatricians and dermatologists, associated with significant morbidity. There is a relative paucity of data calculating the prevalence of pediatric dermatoses in developing countries like India with low socioeconomic factors, poor hygiene and malnutrition being the contributing factors. Aim and Objectives: To study the prevalence and pattern of dermatoses in pediatric attendees of our tertiary care hospital. Material and Methods: Nine hundred four pediatric patients aged 0-18 years attending the dermatology outpatient department and those from emergency referral of our tertiary care hospital were enrolled in this cross-sectional type of observational study carried over a period of two years. Results: Our study included 497 males and 407 females aged 0-18 years. Patients with non-infectious dermatoses: 555 (61%) and those with infectious dermatoses: 349 (39%). Fungal infections (156, 45%) were the most common finding in infectious dermatoses; atopic eczema (99, 17.84%) being the commonest in non-infectious dermatoses. Conclusion: Our study reflects the various patterns of dermatoses among paediatric patients. This information would further help in creating awareness about common dermatoses that are easily preventable by maintaining proper self-care and good personal hygiene. [ABSTRACT FROM AUTHOR]

Introduction: Ever since the outbreak of COVID-19, the respiratory system has been the chief focus of researches, however, understanding the impact of this disease on the integumentary system is just as essential. Objectives: We aimed at collecting data on any cutaneous manifestation arising in patients with active and recovering COVID-19 infection, or a direct consequence of the infection's treatment, and correlating these findings with systemic disease severity and duration. Materials and Methods: A prospective observational study was conducted in three tertiary care centers from Rajasthan, India, to acquire data of laboratory-confirmed cases of COVID-19 presenting with any mucocutaneous manifestation. Results: Eight predominant patterns of dermatological involvement were seen, namely, maculopapular (14.59%), urticarial (13.17%), perniotic (12.1%), pityriasis rosea (11.74%), acral erythema/edema (10.3%), petechial (4.63%), vesicular (2.49%), and livedo (1.78%). Rare findings included eruptive pseudoangioma, eruptive hypomelanosis, alopecia parvimaculata, geographic tongue, chikungunya-like hyperpigmentation, and nail changes. On correlating these findings with the gradient of the disease, livedo, vasculitis, exfoliation, and erythroderma were associated with severe disease, whereas perniosis and eruptive pseudoangioma were seen in mild illness. Conclusion: We reported a few previously unpublished skin manifestations of COVID-19, namely, geographic tongue, chikungunya-like pigmentation, eruptive hypomelanosis, and alopecia parvimaculata. This study provides a visual description of the muco-cutaneous manifestations of COVID-19 disease which could aid a dermatologist or physician in early diagnosis of this novel infection, especially in a resource-poor setting. [ABSTRACT FROM AUTHOR]

Background: Hidradenitis suppurativa (HS) is a chronic debilitating disease with a relapsing and remitting course. Due to delay in diagnosis, patients are often referred when the disease is very severe. Management strategies vary across multiple guidelines. Aims: The aim of this study was to analyze the demographic and clinical characteristics of patients with HS among our outpatient attendees and to study the outcomes of various treatments offered. Methodology: This was a retrospective cohort study analyzing case files and photographic records of all patients diagnosed with HS, presenting to our tertiary care institute over 18 months. Results: A total of 22 patients (10 males and 12 females) of HS were studied with majority having Hurley stage 2 and 3 diseases. The most common site affected was axilla. Overweight and obese patients were 45.4% and 18.1%, respectively. Rifampicin–clindamycin combination or doxycycline was the first line therapy offered. Adalimumab was given in only two patients but could not be continued for long term due to financial issues. Surgery was performed in six patients. Procedures included wide local excision and deroofing which is left to heal by secondary intention. Least number of remissions and most satisfactory improvement was seen with a combination of antibiotics and surgery compared to medical treatment alone. Limitations: Retrospective nature and a single center study were the major drawbacks. Conclusion: Patients undergoing procedural intervention in addition to pharmacotherapy have best overall outcomes and involvement of a multidisciplinary team plays a key role, however a larger follow-up study is required. [ABSTRACT FROM AUTHOR]

Purpose: Infliximab (IFX) therapy in inflammatory bowel disease (IBD) is associated with loss of response in half the patients, due to complex pharmacokinetic and immunological factors. Dashboard's Bayesian algorithms use information from model and individual multivariate determinants of IFX concentration and can predict dose and dosing interval. Aim: To compare measured IFX concentrations in our laboratory with values predicted by iDose dashboard system and report its efficacy in managing patients not responding to conventional dosing schedule. Method: Clinical history, demographic details, and laboratory findings such as albumin and C-reactive protein (CRP) data of IBD patients (n = 30; median age 23 years (IQR: 14.25 – 33.5)) referred for IFX drug monitoring in our laboratory from November 2017 to November 2019 were entered in iDose software. The IFX concentration predicted by iDose based on this information was compared with that measured in our laboratory. In addition, a prospective dashboard-guided dosing was prescribed in 11 of these 30 patients not responding to conventional dosing and was followed to assess their clinical outcome. Result: IFX monitoring in our 30 patients had shown therapeutic concentration in 12, supratherapeutic in 2 and subtherapeutic concentration in 16 patients. The iDose predicted concentration showed concordance in 21 of these 30 patients. Of 11 patients managed with iDose-assisted prospective dosing, 8 achieved clinical remission, 2 showed partial response, and one developed antibodies. Conclusion: Retrospective data analysis showed concordance between laboratory measured and iDose-predicted IFX level in 70% of patients. iDose-assisted management achieved clinical remission and cost reduction. [ABSTRACT FROM AUTHOR]

Introduction: Pyogenic infections are characterised by acute and chronic inflammation with exudate formation. It is a serious threat leading to sepsis with gram positive organism being the major cause. The source of infection could be either endogenous or exogenous. There is a recent change in the spectrum with gram negatives being the most common cause than the gram positives. Aim: To analyse the aerobic organisms involved in causing the various pyogenic infections with their current susceptibility pattern. Materials and Methods: A retrospective analysis of 750 culture positive pus and wound swabs received in the Department of Microbiology from various Departments of the hospital between June 2018-June 2019 was done and data was recorded. results: Out of 942 total samples analysed, 750 were culture positive with gram negative being 508 and gram positive being 242. The predominant organism of pyogenic infection was Pseudomonas aeruginosa. Among gram positive, the most common organism was Methicillin-Resistant Staphylococcus aureus (MRSA). Pyogenic infections were predominant in males and monomicrobial was common over polymicrobial infections. Extended Spectrum Beta Lactamases (ESBL) was seen highest in Escherichia coli at the rate of 47.8% and Multi Drug Resistance (MDR) was high among Klebsiella species and nonfermenting Gram Negative Bacilli (GNB) other than Pseudomonas spp and Acinetobacter spp. conclusion: There is a changing trend with gram negative organisms being the commonest cause of pyogenic infections as evidenced across India. Spurious use of drugs would help in reducing the spread of drug resistant isolates. Antibiotic policy formulation would help in empiric therapy with reduction in infection rates. [ABSTRACT FROM AUTHOR]

Aim and objective: This systematic review and meta-analysis was conducted to assess the prevalence, burden and epidemiology of methicillin-resistant S. aureus (MRSA). This systemic review was also aimed to highlight the challenges in the diagnosis and management of methicillin-resistant S. aureus (MRSA) in India (for all age groups). We also examined the published literature on the available treatment options and the role of prevention in the management of MRSA in India. By summarizing the currently available data, our objectives were to highlight the need for the prevention of MRSA infections and also emphasize the role of vaccination in the prevention of MRSA infections in India. Methodology: Electronic databases such as PubMed and databases of the National Institute of Science Communication and Information Resources and Indian Council of Medical Research Embase were searched for relevant literature published from 2005/01/01 to 2020/05/13 in English language, according to the predefined inclusion and exclusion criteria. A manual search was also conducted using the key term "MRSA 'or' Methicillin Resistant Staphylococcus aureus 'and' India." An independent reviewer extracted data from the studies using a structured Microsoft Excel spreadsheet, and a meta-analysis of proportion for MRSA prevalence with a corresponding 95% confidence interval (CI) for all included individual studies were performed. Result: A total of 34 studies involving 16 237 patients were included in the final meta-analysis. The pooled proportion of patients with MRSA infection was 26.8% (95% CI: 23.2%-30.7%). The MRSA infection was more prevalent among male patients (60.4%; 95% CI: 53.9%-66.5%) as compared to female patients (39.6%; 95% CI: 33.5%-46.1%), while the prevalence of MRSA was higher among adults (18 years and above; 32%; 95% CI: 5%-80%) in comparison to pediatric patients (0-18 years; 68%; 95% CI: 20%-94.8%). The degree of heterogeneity was found to be significant. Conclusion: The prevalence of MRSA in India was relatively high at 27% with a higher proportion observed among men aged >18 years. The high prevalence of MRSA infections in India necessitates the implementation of surveillance and preventive measures to combat the spread of MRSA in both hospital and community settings. [ABSTRACT FROM AUTHOR]

Coronavirus disease of 2019 (COVID-19) pandemic has affected India and world as a whole, like nothing in the recent history and we, dermatologists, are also affected directly or indirectly. In this review, we have tried to address all COVID-19-related information we need to be aware of as a health-care professional. We have discussed the relevant details of the disease: the agent, the symptomatology, common preventive measures, investigations, and management outline. We have also discussed the implications of COVID-19 in dermatology practice and given a basic guideline for dermatology practice during the pandemic [ABSTRACT FROM AUTHOR]

Background: Resistance to antimicrobial agents led to the usage of macrolide-lincosamide-streptogramin B (MLSB) family to treat staphylococcal infection. Methods: One hundred and ninety one isolates obtained from various clinical samples such as pus, wound, swab, blood urine, and other body fluids were processed, and staphylococci were isolated as per standard bacteriological techniques. The antibiotic sensitivity was tested by Kirby--Bauer disc-diffusion method. Results: Out of 191 isolates, 32% were coagulase-negative staphylococci (CoNS). Of these, 48% and 65% were resistant to erythromycin, respectively. Among erythromycin-resistant S. aureus, 30% each showed constitutive resistance and inducible clindamycin (CL) resistance, and 60% showed MS phenotypes by the D-test. Of the CoNS, 18% showed inducible CL resistance. Among 130 S. aureus isolated, 15% each had constitutive macrolide-lincosamide-streptogramin B resistance (MLSBc), inducible macrolide-lincosamide-streptogramin B resistance (MLSBi) and 25 (19%) were D test-negative, were resistant to macrolides, streptogramins, sensitive to lincosamides. Among 61 CoNS isolated 9 (15%) were MLSBc resistant, 7 (11%) were MLSBi resistant and 24 (39%) were D-test negative (MS phenotype). Resistance MLSBi percentage was more among S. aureus 15% compared to CoNS 11%. Conclusions: The ER-CL disc-approximation test (D-test) emerged as a simple, auxiliary, easy to perform, reliable method and can be used as routine laboratory method for detecting inducible, constitutive and MS phenotypes. [ABSTRACT FROM AUTHOR]

Background: The prevalence and pattern of skin diseases are influenced by the overall ecosystem of the region. There is a dearth of research about prevalence, health-care seeking, compliance, and treatment outcome in skin diseases among scheduled tribes. Objectives: The aim of this study is to understand the magnitude of skin diseases in tribal area of Dahod, Gujarat using a simple "Store and Forward" technique of teledermatology. Materials and Methods: A cross-sectional study was conducted in 10 randomly selected villages of Dahod and Jhalod blocks of Dahod district of Gujarat during June–August 2017. Trained surveyors visited households randomly in different localities (called Faliya) of each village ensuring representativeness. Survey responses were captured on mobile-based MAGPI portal, and images of skin conditions were capture on smart phones, and de-identified images were transferred over WhatsApp. Results: A total of 781 households were approached in 10 villages and 2214 participants consented. Among them, 549 were identified with suspected skin diseases, but 520 consented for photograph. The skin diseases were more prevalent among males, children, and elderly. Of 520, 44 (8.5%) could not be assess due to poor quality photograph and 35 (6.7%) did not have any clinically significant condition. Thus, of 2214 participants, 441 (20%) had skin diseases, and infections and eczema were major conditions constituting two-third of the skin diseases in the study population. The treatment-seeking behavior and compliance to treatment was poor. Conclusion: Considering the high prevalence of skin diseases in tribal villages of Dahod, Gujarat coupled with limited availability of trained dermatologist, new innovative avenues like teledermatology should be explored. [ABSTRACT FROM AUTHOR]