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This article takes a critical look at the pros and cons of human papillomavirus (HPV) vaccines. There is enough evidence to suggest that the prophylactic vaccines are efficacious in preventing various benign and malignant conditions (including cervical cancers) caused by HPV. Even though the vaccine is costly, hypothetical analysis has shown that HPV vaccination will be cost effective in the long run. Therapeutic HPV vaccines used to treat established disease are still undergoing evaluation in clinical studies, and results seem to be encouraging. Although several countries have started mandatory vaccination programs with the prophylactic HPV vaccines, conservatives have voiced concerns regarding the moral impact of such vaccination programs. [ABSTRACT FROM AUTHOR]

The article discusses the scoring systems that dermatologists used to measure acne vulgaris based on clinical examination and photographic documentation. Since the acne lesions may vary in number during the natural course of the disease, it notes that various measurements have been developed in order to assess the clinical severity of acne vulgaris. It stresses that an ideal grading system should be accurate and reproducible, and should be capable of documentation for future verification.

The article offers information on the history of the Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) in India. The association was established on January 28, 1973. U. B. Narayan Rao began the publication "Indian Journal of Venereology" in 1935. He was the brainchild of the creation of the association of dermatologists and venereologists. The association was inaugurated by Home and Revenue Minister Shri Morarji M. Desai.

Leprosy is unique in terms of the nature of the causative organism (Mycobacterium leprae), the chronicity of the disease, its prolonged treatment and the definitions of "cure" and "relapse." The principal mode of assessing the efficacy of therapeutic regimens in leprosy is the "relapse rate." There are wide variations in estimates of relapse rates after the World Health Organization (WHO) multidrug therapy in different regions. The important predisposing factors for relapse include the presence of "persister" bacilli, monotherapy, inadequate/irregular therapy, presence of multiple skin lesions/thickened nerves and lepromin negativity. The conventional methods of confirming activity or relapse in an infectious disease (demonstration and/or culture of the etiologic agent) have limited utility in leprosy because of the difficulty in demonstrating bacilli in paucibacillary (PB) cases and absence of a method of in vitro cultivation of M. leprae. Bacteriological parameters are useful in multibacillary (MB) leprosy, whereas in PB leprosy, the criteria for relapse depend primarily on clinical features. Although there are no widely available serologic tests for leprosy other than in a research setting, various immunological tests may be useful for monitoring patients on chemotherapy as well as for confirming suspected cases of relapse. The main differential diagnoses for relapse are reversal reactions, erythema nodosum leprosum and reactivation/ resistance/reinfection. The most reliable criteria for making an accurate diagnosis of relapse include clinical, bacteriological and therapeutic criteria. Additional ones that may be used, depending on the setting, are histopathological and serologic criteria. Relapsed cases of leprosy should be identified and put back on chemotherapy as soon as possible to prevent further disability and transmission of infection. Factors that should be considered in choosing an appropriate regimen are the type of leprosy (PB or MB), previous treatment and drug resistance. Occasionally, clinicians may need to use their judgement to modify the standard WHO treatment regimens according to the scenario in each patient. [ABSTRACT FROM AUTHOR]

The article discusses the emergence of dermatology in India. Dermatology as a specialty came into prominence only in the twentieth century, although skin diseases like leprosy, viral fevers like measles and chicken pox, psoriasis, and vitiligo were recognized long back. The incidence and etiology of endemic skin diseases in the country is reviewed. The start of postrgraduate teaching in the specialty is included.

Rhinosporidiosis is a chronic granulomatous disorder caused by Rhinosporidium seeberi . It frequently involves the nasopharynx and occasionally affects the skin. We report a case of 45-year-old man who had disseminated cutaneous rhinosporidiosis with cutaneous pseudohorn, its base arising from rhinosporidiosis. The case presented with multiple reddish lesions over the nose of six years duration. In the past year, he developed skin lesions over the left arm, forearm, back, and chest. On examination, polymorphic lesions of rhinosporidiosis in form of verrucous plaque, unulcerated tumor, granulomatous growth, and furunculoid lesions were observed. Interestingly, there was a cutaneous horn over the chest which on histopathological examination showed hyperplastic epithelium with numerous globular cysts of varying shape, representing sporangia in different stages of development and transelimination. Computerized tomography scan of the chest showed bilateral opacities suggestive of lung involvement. On the basis of these clinical and histopathological findings, a diagnosis of nasal rhinosporidiosis with cutaneous and systemic dissemination was made. [ABSTRACT FROM AUTHOR]

Background: The pattern of eczema is altered by geography, habits of people and environmental factors and regional variation in skin structure and function. Aims: Our study was done to estimate frequency and patterns of lower leg and foot eczemas. Methods: A total of 200 patients with various types of lower leg and foot eczemas were recruited over a period of 2 years. Demographic and clinical characteristics were noted. Suspected cases of allergic contact dermatitis were patch tested. Results: The frequency of these eczemas was 2.5 per 1000 out patients. Mean age of patients was 40.49 years. Female to male ratio was 1.6:1. Sixty (30%) patients were farmers, sixty (30%) were housewives, forty (20%) were students, nineteen (9.5%) were daily laborers, nine had sedentary jobs and three were teachers. Most eczemas were bilateral (72%). Mean duration of eczema was 36.6 months. Most common type of eczema was lichen simplex chronicus (36%) followed by discoid eczema (18.5%), allergic contact dermatitis (14.5%) and stasis eczema (7.5%). Other eczemas noted were juvenile plantar dermatosis, cumulative irritant contact dermatitis, infected eczema, hyperkeratotic eczema, asteatotic eczema, pompholyx, infective eczema and unclassified endogenous eczema. Common sites of involvement were dorsa of feet (49.5%), followed by lateral aspect of lower leg (31%), medial aspect of lower leg (17.5%) and ankle (12%). Conclusion: Our study highlights lichen simplex chronicus as the most common eczema affecting the lower legs and feet. [ABSTRACT FROM AUTHOR]

We describe two cases of methotrexate toxicity occurring due to inappropriate self-medication with the drug. The first patient was a 57-year-old man with plaque-type psoriasis on intermittent methotrexate therapy. He discontinued his medications for 2 months and had exacerbation of psoriasis for which he self-medicated with methotrexate following which he developed ulceration of the psoriatic plaques accompanied by bone marrow suppression. The second patient was a 68-year-old man with chronic plaque-type psoriasis for 20 years and was being treated with intermittent methotrexate for 15 years. He also self medicated with oral methotrexate 15 mg daily for 7 days for exacerbation of psoriasis and developed ulceration of the psoriatic plaques with bone marrow suppression and evidence of gastrointestinal erosions. [ABSTRACT FROM AUTHOR]

BACKGROUND Among surgical methods, punch skin grafting (PSG) and suction blister epidermal grafting (SBEG) are simple, inexpensive, and effective treatment methods for resistant lip vitiligo cases, but there is a lack of comparison between these procedures for lip vitiligo. OBJECTIVE The objective was to compare the outcome following PSG and SBEG in stable lip vitiligo. METHODS Eighteen patients with stable lip vitiligo were randomly selected. Eight patients were included in PSG group and 10 patients in SBEG. All patients were kept on PUVA-SOL (psoralen+ultraviolet A therapy of solar origin) treatment after grafting. The results were evaluated after a follow-up period of 6 months. RESULTS At the end of 6 months of grafting in PSG group, two patients had a repigmentation of 50% to 75%, one had 75% to 90%, and three had 90% to 100% in the recipient site in lip. In SBEG group, one patient had repigmentation of 50% to 75%, three had 75% to 90%, and two had 90% to 100%. The color match was statistically significant in PSG when compared to SBEG. In the recipient site, cobblestone appearance was the predominant complication in PSG whereas hyperpigmentation and thickening of grafts were common in SBEG. In the donor site, superficial scarring and hypopigmentation were the common findings in PSG group whereas hyperpigmentation was the main problem in SBEG group. CONCLUSIONS Although both the procedures are effective in lip vitiligo, PSG gives a better color match than SBEG. [ABSTRACT FROM AUTHOR]

The author reflects the medical study for onychomycosis treatment in India. He describes onychomycosis as one of the intergumental fungal infects and nail disease in the country. Dermatophytes is demonstrated as the common cause in onychomycosis disease. He cites some alternative therapies of onychomycosis disease such as palliative care, mechanical/chemical debridement and other antifungal agents. He also illustrates some of the antifungal drug agents including terbinafine and itraconazole.

Lichen sclerosus (LS) is a chronic inflammatory dermatosis that causes substantial discomfort and morbidity, most commonly in adult women. The objective of our study is to study the pattern of vulval LS and to correlate LS with various clinical parameters. The study included 26 female patients with vulval LS presenting over a period of 22 months, starting from September 2005 to June 2007. Demographic characteristics and clinical findings were recorded. The mean age of LS patients was 44 years (range 3-65 years). Lichen sclerosus was most commonly observed in postmenopausal women (18, 69.2%), followed by women in reproductive age group (5, 19.23%), and prepubertal girls (3, 11.5%). All patients presented with ivory white atrophic plaque. Surface of the plaque showed telangiectasia in one patient; both erosions and fissuring in two patients, erosions in four patients, fissuring in two patients, and wrinkling in all patients. Introitus was stenosed in five (19.2%) patients, out of which three (11.5%) patients also had perianal involvement leading to "figure of 8" appearance. Three patients had atrophy of labia minora and clitoris to an extent that labia minora appeared merged with labia majora and clitoris was buried. This study highlights the importance of diagnosing LS as it is associated with considerable morbidity. [ABSTRACT FROM AUTHOR]

Prostitution describes sexual intercourse in exchange for remuneration. The legal status of prostitution varies in different countries, from punishable by death to complete legality. The great degree of social stigma associated with prostitution, of both buyers and sellers, has lead to terminology such as 'commercial sex trade', 'commercial sex worker' (CSW), female sex worker (FSW) or sex trade worker. Organisers of prostitution are typically known as pimps (if male) and madams (if female). Brothels are establishments specifically dedicated to prostitution, often confined to special red-light districts in big cities. The devadasi (handmaiden of god) system of dedicating unmarried young girls to gods in Hindu temples, which often made them objects of sexual pleasure of temple priests and pilgrims, was an established custom in India by 300 AD. An estimated 85% of all prostitutes in Calcutta and Delhi enter the sex work at an early age. The causes of prostitution include ill treatment by parents, bad company, family prostitutes, social customs, inability to arrange marriage, lack of sex education, media, prior incest and rape, early marriage and desertion, lack of recreational facilities, ignorance, and acceptance of prostitution. Truck drivers engaging in unprotected sexual intercourse with multiple partners in rural India could be major vectors of HIV transmission. The commercial sex industry is a multibillion dollar Indian and global market which now includes strip clubs, massage brothels, phone sex, adult and child pornography, street brothel, and escort prostitution. So long as men want to buy sex, prostitution is assumed to be inevitable. [ABSTRACT FROM AUTHOR]

Sexually transmitted infections (STIs) are more dynamic than other infections prevailing in the community. It is important that such dynamic epidemiological changes in STIs are acknowledged and kept track of in a vast and populous developing country like India, particularly in this HIV era. It is with this aim that the authors have reviewed the relevant literature in STI epidemiology in India during the past 25 years. Admittedly, there has been heterogeneity of data to account for the subcontinental dimension of this country. But a basic pattern in the changing epidemiology is discernible. Like the developed countries, in India too the bacterial STIs like chancroid and gonorrhea are declining, while viral STIs like HPV and herpes genitalis are on an upswing. The overall decline in the prevalence of STIs has to be interpreted with caution, however. This may partially reflect the improved facilities of treatment in the peripheral centres that obviates the need of many patients in attending the STD clinics in the tertiary centres. Also, the improved pharmacotherapy of many of the bacterial STIs may result in partial clearance and non-reporting of many of these infections. [ABSTRACT FROM AUTHOR]

The article discusses the methods of specimen collection for the diagnosis of sexually transmitted infections (STIs). According to the authors, the correct method of specimen collection facilitates in achieving desirable goals in the laboratory diagnosis of STIs. They stress that if simple precautions are taken, it will avert spurious results. They also note that the collection of specimens and use of the appropriate swab and transport media are critical in the success of tissue culture.

Background: During pregnancy profound immunologic, metabolic, endocrine and vascular changes occur, that are responsible for the changes of the skin and its appendages, both physiologic and pathologic. Aims: We undertook a clinical study to find out the frequency and pattern of skin changes in pregnant women. Methods: All consecutive pregnant women were included in the study. Results: A total of 607 pregnant women were included in this study. Of these, 303(49.9%) pregnant women were primigravida and 304(51.1%) were multigravida. Skin changes grouped into: physiological changes (all cases), specific dermatoses (22 cases) and other dermatoses affected by pregnancy (125 cases). Most common physiological changes were pigmentary alterations seen in 555 (91.4%) followed by striae seen in 484(79.7%) cases. Of the various specific dermatoses of pregnancy, pruritic urticarial papules and plaques of pregnancy (PUPPP) was the most common disorder (14 cases) followed by pruritus gravidarum (5 cases). The most common dermatoses affected by pregnancy were candidal vaginitis (17 cases), acne vulgaris (15 cases), skin tags (15 cases), eczemas (14 cases). Conclusion: This study brings into focus various skin changes during pregnancy in south India. [ABSTRACT FROM AUTHOR]

The article talks about the evolution of venereology in India. It discusses venereal diseases, such as syphilis, gonorrhea, chancroid, donovanosis, lymphogranuloma venereum, and other STDs. India's STD control measures, advent of the acquired immune deficiency syndrome (AIDS), and status of human immunodeficiency virus (HIV) epidemic are offered. The emerging sexually transmitted infections (STIs) in India and the academic developments in treating STDs are also discussed.

Background: Vascular nevi are cutaneous anomalies of angiogenesis and vasculogenesis resulting in various different clinical presentations.Aim: The purpose of our descriptive study was to observe the various types of vascular nevi in children and their features.Methods: A total of 4256 pediatric cases attending the dermatology OPD during the study period from August 2002 to August 2004 were screened for vascular nevi.Results: Out of these, 19 children (0.44%) had vascular nevi-17 hemangiomas of infancy (HOIs) and 2 port-wine stains. The mean age of the affected children was 1.3 years (ranging from 2.5 months to 8 years). There were 13 girls and 6 boys. Seventeen (89.5%) patients had progressing lesions and two (10.5%) had non-involuting ones. A solitary lesion was seen in ten (52.6%) cases and two to five lesions were present in five (26.3%) cases. The nevi were distributed over multiple sites in seven (36.8%) cases, the head and neck in six (31.6%) cases, the chest and lower limb in two (10.5%) cases each, and the upper limbs and genitalia in one (5.3%) case each. Among the hemangiomas of infancy, 15 (88.2%) cases of superficial type and 2 (11.8%) cases of deep type were seen. The cutaneous complications included ulceration in four cases and infection in one.Conclusions: HOIs were the most common vascular nevi of childhood. [ABSTRACT FROM AUTHOR]

Background: Melanocytic nevi show different presentations in children which have not much studied in India. Purposes: To document the incidence and pattern of melanocytic nevi in children. Methods: A total of 4,256 paediatric cases attending the dermatology OPD, JIPMER during the study period from August 2002 to August 2004 were screened for melanocytic nevi. Findings: Out of these, 41 (0.96%) cases were found to have melanocytic nevi. The mean age of these cases was 1.4 years (range of 3 days to 14 years). Fourteen (34.1%) of them were males and 27 (65.9%) were females with male to female ratio of 1:1.9. Majority of these cases (32 cases, 78%) were in the age group of 0-1 year. Thirty-seven (90.2%) cases had single lesion and 4 (9.8%) cases had multiple lesions. The size of the nevi varied from 1.5 cm to 20 cm in 40 (97.6%) cases and more than 20 cm in 1 (2.4%) case. The most common site of involvement was the back (32 cases, 78%) followed by head and neck (6 cases, 14.6%). Out of the total of 41 cases, 30 (73.2%) were Mongolian spots, 8 (19.5%) were congenital melanocytic nevi, one case (2.4%) each had giant congenital melanocytic nevus, nevus spilus and nevus of Ota. Four cases had other associated cutaneous disorders. These included ashleaf macules in 2 cases, epidermolysis bullosa simplex in 1 case and a solitary case had both café-au-lait macule and mixed hemangioma. The systemic associations included seizures (suspected neurocutaneous melanosis) in a solitary case of congenital melanocytic nevi. Conclusions: The spectrum of melanocytic nevi seen in children in this study partially differs from this of abroad studies. Limitation: Unicentre hospital-based study which cannot be generalized. [ABSTRACT FROM AUTHOR]

Background: Suction blister grafting is a useful modality of treatment of patients with resistant and stable vitiligo. However, there have been no detailed studies to find out the best donor site for blister formation.Methods: The study was conducted between the period of October 2004 and February 2005 in the dermatology department at a tertiary care center. Nine patients with vitiligo (focal vitiligo, 3; mucosal vitiligo, 2; acrofacial vitiligo, 2; vitiligo vulgaris, 1; and segmental vitiligo, 1) were selected for blister harvesting and grafting. The blisters were raised using the method described by Gupta et al.Results: Suction blisters were attempted to be raised at 52 sites, but only 38 blisters could be raised, 24 complete and 14 incomplete. Blisters were raised in all the three cases on the flexor aspect of the arm (100%), 15 of 17 cases (88.2%) on the flexor aspect of the forearm, 4 of 5 cases (80%) on the abdomen, 11 of 16 cases (68.7%) on the anterolateral thigh, and less frequently over leg or foot. Complete blisters were formed in 13/15 cases (86.6%) on the flexor aspect of the forearm, 6/11 cases (54.5%) on the anterolateral thigh, and in all cases over leg.Conclusion: The flexor aspect of the forearm is a good site for suction blister harvesting. [ABSTRACT FROM AUTHOR]

Background: In Asia, HSV seroprevalence studies are sparse and they have recorded lower prevalence of HSV infection, especially HSV-2.Aims: To ascertain the seroprevalence of HSV-1 and HSV-2 in patients attending a STD clinic in a referral hospital in south India and to compare it with a control group.Methods: The study included 135 consecutive STD cases having history of ulcerative or non-ulcerative STD in the present or in the past 5 years and 135 age and sex-matched controls. Diagnostic serology was done for HSV-1 and HSV-2 using type specific IgG by indirect immunoassay using ELISA. The results were analyzed utilizing Chi- square test.Results: Amongst 135 STD clinic cases, 106 cases were males and 29 cases were females with male to female ratio of 3.65:1. The mean age was 32.2 years (range 16-65 years). Among study group cases, 112 (82.9%) cases were co-infected with HSV-1 and HSV-2, 11 (8.1%) cases were seropositive for HSV-1 alone and 3 (2.2%) cases were seropositive for HSV-2 alone. In the control group, 112 (82.9%) cases were co-infected with HSV-1 and 2, 12 (9.6%) for HSV-1 alone and 1(0.8%) for HSV-2 alone. Correlation of HSV-1 and HSV-2 serology with various demographic and behavioral factors was statistically insignificant.Conclusions: Seroprevalence of HSV-1 and HSV-2 in STD clinic cases and control group is high, similar to that recorded in sub-Saharan Africa. Thus, serological studies for HSV-1 and HSV-2 cannot be taken as a marker of sexual behavior in our set of population. [ABSTRACT FROM AUTHOR]

Adverse cutaneous drug reactions (ACDRs) are caused by a wide variety of agents. Our objective was to ascertain the clinical spectrum of ACDRs and the causative drugs in this part of India and to find any risk factors. The mean age of the patients with cutaneous drug eruptions was 37.06 years. Most of them (52.2%) were in the age group of 20–39 years. The male to female ratio was 0.87: 1. The most common eruptions observed were fixed drug eruption (31.1%) and maculopapular rash (12.2%), and the most common causes were cotrimoxazole (22.2%) and dapsone (17.7%). The pattern of ACDRs and the drugs causing them is remarkably different in our population. Knowledge of these drug eruptions, the causative drugs and the prognostic indicators is essential for the clinician. [ABSTRACT FROM AUTHOR]

The efficacy of cyclosporine and related drugs in the treatment of psoriasis was the key to the development of the concept that psoriasis is an immune mediated disorder. These therapies demonstrably reduce the number of activated T-lymphocytes, which correlates with clinical remission. Monoclonal antibodies directed against key components of the inflammatory process have been studied in an attempt to produce safer, more effective and selective immunosuppressive agents. This review summarizes the information available on cyclosporine and related drugs, and cytokine therapy, including monoclonal antibodies directed against T-cell mediated inflammation. It should be realized that biologic therapies for psoriasis are very new and that efficacy and safety information from clinical trials is just becoming available. [ABSTRACT FROM AUTHOR]

We report widely disseminated and disfiguring lesions of molluscum contagiosum occurring in a 4-year-old girl secondary to a primary immunodeficiency disorder. The child, born of consanguineous parents, had multiple, asymptomatic, raised, skin-colored and whitish lesions since 2 years of age. On physical examination she had growth retardation features with grade II protein energy malnutrition. Cutaneous examination revealed numerous, widespread, skin-colored to translucent, firm, umbilicated papules of varying sizes (pinpoint to larger than 10 mm). They were distributed bilaterally over all four limbs, including the dorsum of the hands and feet, trunk, face (including lips), eyelids, auriculae, and perineal and gluteal areas. In places, they were linearly disposed and had coalesced to form plaques. A biopsy specimen from a representative skin lesion (arm) demonstrated lobulated epidermal growth consisting of keratinocytes with large intracytoplasmic eosinophilic inclusion bodies and a central crater. These findings were consistent with the diagnosis of molluscum contagiosum. Topical therapies with phenol and trichloroacetic acid were ineffective The child succumbed to a fulminant systemic infection at home, 2 months after discharge from the hospital. The extent and distribution of molluscum contagiosum in our patient was remarkably vivid and has been hitherto reported only rarely. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented on the effectiveness of isotretinoin drug for treatment of keratosis follicularis spinulosa decalvans skin disease. [ABSTRACT FROM AUTHOR]

The article reports on the practice of cultural dermatology in India. Topics covered include skin problems that result from the presence of various socio-religious and cultural habits and the use of alternative medicine systems, reasons for the popularity of alternative medicine system in India, also known as ayurveda, yoga, and naturopathy, Unani, Siddha, homeopathy (AYUSH), as well as the adverse effects of AYUSH.

The article focuses on miliaria rubra which is a skin disease marked by small and itchy rashes formed like a white bull's-eye. It mentions that miliaria is a common disease in the tropics, and the summer season. It notes that miliaria is a skin disease caused by the obstruction of sweat glands and the extravasation of sweat into the dermis.

A letter to the editor is presented which discusses a case of a 10-year-old girl, who was diagnosed with nevus lipomatosis cutaneous superficialis.

The article describes the case of a 28-year-old man with a birthmark of hypopigmented areas on his back, hand tremors, and generalized tonic clonic seizures. He was diagnosed to have pigmentary twin spotting. It discusses the concept of twin spotting, nevus depigmentosus and nevus of Ito, and the difference of allelic and non-allelic twin spots.