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Background: Topical corticosteroids are the most commonly used drug and mainstay of dermatotherapeutics for many dermatoses. Topical corticosteroids are irrationally combined with other medications and widely available as the over the counter preparations (OTC) and are widely misused for various conditions. Dermatophytosis is a superficial fungal infection which is becoming resistant and difficult to treat because of inappropriate usage of irrational combination of topical corticosteroid containing preparations (ICSP). Aims and Objective: To study the prevalence and factors which promotes the abuse of Irrational combination of topical corticosteroid containing preparations(ICSP) in dermatophyte infection. Materials and Methods: A Prospective observational study conducted at department of Dermatology, Venereology & Leprosy in a tertiary care centre, South India. The sample size of this study is n=55. Results: Out of 55 patients most common age group is 15 -30 years (n=16,29.09%).Females (n=30,54.54%) predominated over males with male:female ratio of 0.83:1.The most common complaint was intractable itching (n=46,83.64%) .The majority of study group had disease duration was 0-1 months (n=27,49.1 %) with mean duration of 4 months. The main source of referral was Over the counter (OTC) (n=32,58.18%). The most common irrational combination was FDC 3 combination (30.9%). Most commonly abused brand was betnovate GM(n=17,30.9%).Most of the patients used Clobetasol propionate 0.05% (n=25,45.5%).Patients were using ICSP mostly for less than 1 month (n=27,49.1%),with intermittent(n=19,34.5%) frequency of application. Most common side effect was tinea incognita (n=33,60%).Potassium hydroxide mount was positive in 25 patients(45.45%).Fungal culture was done in all patients and 12 patients(21.81%) showed growth. The commonest organism isolated among culture positive specimen was Trichophyton rubrum(12.72%). Conclusion: Inappropriate usage of irrational combination

Background: Acne scars are one of the commonest skin diseases encountered in clinical practice. Management of acne scars ranges from simple subcision to laser resurfacing. Topical anaesthetics can provide, non invasive mode of adequate analgesia for the management of acne scars. In a properly selected patient setting, this can even replace the need of lignocaine infiltration. Commonly available local anaesthetics creams are Eutectic mixture of local anaesthetics (EMLA) (2.5% Lignocaine and 2.5% Prilocaine) and Lignocaine Tetracaine cream (LT) (7%Lignoaine and & 7% Tetracaine). Objective: To compare the anaesthetic efficacy of topical creams in the management of acne scars. Materials and Methods: This study enrolled 20 cases of acne scars planned for Microneedling, of which 10 patients received EMLA cream (group A) and 10 patients received LT cream (group B). Pain perception was recorded with Visual Analog Scale (VAS) at 30 minutes after application of the cream and during the procedure (60 minutes after cream application). Patient preference about the topical creams was asked for the next procedure. Results and Conclusion: The mean pain score after 30 minutes was 3.1 for group A and 2.1 for group B. The pain score recorded during the procedure was 2.1 for group A and 0.6 for group B. Patients had minimal and transient side effects. LT cream provided adequate and long lasting analgesia when compared to EMLA cream. Keywords: Anaesthetics, Acne, EMLA, LT, Microneedling, Scars, VAS.

Lymphoedema is a chronic, progressive debilitating disorder of lymphoreticular system, characterized by abnormal collection of excessive proteins, oedema, chronic inflammation and fibrosis.Primary lymphoedema, associated with underlying, but inherent malfunction of lymphatic channels, unilateral or bilateral. It can be further subdivided in to congenital lymphoedema, lymphoedema praecox and lymphoedema tarda. Depends on the age of onset or manifestation. Another genetic disorder of lymphatic dysfunction is Milroy disease. It is an autosomal dominant condition due to VEGFR3 mutation characterised by lymphatic hypoplasia. Secondary lymphoedemas are more frequent than primary to dysfunction of lymphatics. Mostly localised, follwing recurrent infections, trauma, surgery, obesity and malignancy.Inadequate drainage of lymphatics, leads to accumulation of lymph, interstitial fluid and proteins in skin and subcutaneous tissue. Elastic tissue disruption, fibroblast stimulation occurs and the resulting hypoxia causes chronic inflammation and fibrosis. Later adipocyte remodelling occurs and proinflammatory cytokines secreted.Starts as pitting non tender pedal oedema, later skin thickening and fibrosis which results in non-pitting oedema. Squared off appearance and Kaposi Stemmer sign are characteristic features. May develop lymphorrhoea and secondary infections may supervene. Chronic venous insufficiency, lipoedema, myxedema.Vicious cycle of infections and lymphedema.Lymphoscintigraphy, lymphoflouroscopy- gold standard.Depends on severity. Pneumatic compression garments, Low level light therapy (LLLT), Extracorporeal shock wave therapy (ESWT). Advanced stages may require surgical debulking, lymphatic reconstruction. But the results are mostly unsatisfactory, recurrences are inevitable. Combined multi-disciplinary approaches will be helpful and that should be continued throughout their life.

Aim of the study: To evaluate the repigmentation with non-cultured epidermal cell suspension followed by PUVA in patients with stable vitiligo. Materials and Methods: A prospective study conducted at the department of Dermatology, Venerology, Leprosy of Rajah Muthiah Medical College and Hospital. 26 cases of stable vitiligo were treated with non-cultured epidermal cell suspension followed by PUVA and were reviewed for a period of 20 weeks. Results: The results were assessed subjectively. 9 (34.6%) patients showed excellent response to our therapy, 7 (26.9%) patients had good response, 5 (19.3%) patients showed fair response and 3 (11.5%) showed very poor response. 17 (65%) patients showed a very good colour match when compared with the surrounding skin and 1 (3.8%) patients showed donor site scarring. Conclusion: Epidermal non cultured cell suspension followed by PUVA is a relatively safe method with superior quality of repigmentation. Keywords: Noncultured epidermal cell suspension, Vitiligo, Phototherapy, Hyperpigmentation.