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Background: Pemphigus is a potentially life-threatening autoimmune blistering disease which characteristically affects skin and mucosae. Pulse therapy for the treatment of pemphigus has been in vogue for several years and considered better than conventional corticosteroids. Aims and objectives: This study was conducted to evaluate the efficacy and safety of pulse therapy in pemphigus patients treated over a period of 10 years. Materials and Methods: This retrospective study was based on medical records of Pemphigus patients treated at Department of Dermatology from January 2008 to December 2017. Diagnosis of pemphigus was made on clinical ground, Tzanck smear and histopathology of skin/mucous membrane lesions. Patients were put on DCP/DAP depending on the completion of family. Results: A total of 124 patients were included in the study. Age of patients ranged from 18 years to 72 years with mean of 41.21±12.71 years. Amongst 124 patients, 114 (92%) had pemphigus vulgaris and 10 (8%) had pemphigus foliaceous. 89 patients received DCP and 35 patients received DAP therapy. Number of pulses received by patients in phase I ranged from 4 to 27, average being 8.16±4.63. 106 patients completed the phase I of which 83 completed the phase II. 54 patients had successfully completed phase III of which 22 are currently in phase IV and 28 patients have completed their five year follow up period and considered as cured. Conclusion: Pulse therapy is a cheap and easily available mode of therapy in treatment of pemphigus in India even in the present era of modern molecules like Rituximab. With pulse therapy, it is now possible to induce and maintain remission, and achieve cure, provided the patients strictly adhere to the prescribed schedule.

Introduction: Tinea capitis (TC) is a common fungal infection of the scalp, especially in children. Trichoscopy is a noninvasive technique that allows rapid and magnified in vivo observation of the hair with the visualization of morphologic features that are often imperceptible to the naked eye. Aim: This study aimed to evaluate the usefulness of trichoscopy in clinical diagnosis and to study various clinico-morphological patterns of TC. Materials and Methods: This cross-sectional, observational study included 140 clinically diagnosed cases of TC seen during a period of 1 year (April 2021 to March 2022). All patients were evaluated using a dermoscope (DermLite DL4 Multispectral 3 Gen, San Juan Capistrano, CA, USA,10×). Results: The prevalence rate of TC in this study was 2.69 per thousand population. The most common clinical variant was gray patch followed by kerion and black dot, and the most common etiological agent was Trichophyton tonsurans. The characteristic trichoscopic features were as follows: comma hairs (80%), followed by corkscrew hairs (68.6%), bent hairs (54.2%), zigzag hairs (35.7%), and morse code-like hairs (15%). Other findings included scaling (89.2%), followed by black dot (67.1%), broken hairs (42.8%), and crusting and pustules (32.1% each). Comma and corkscrew-shaped hairs were most common in the black dot type, whereas zigzag, bent hairs, and morse code hairs were common in the gray patch type of TC. There was a significant association between trichoscopic findings and type of TC. Conclusion: Trichoscopy can be considered a novel tool for rapid diagnosis and selection of the appropriate therapy and in the monitoring of treatment efficacy in TC.

Introduction: Atopic dermatitis (AD) is one of the most common dermatoses in the pediatric population and pruritus is its leading symptom; however, the clinical aspect of pruritus has not been studied much. The aim of the study was to explore clinical aspect of pruritus in pediatric AD and to analyze correlation of intensity of pruritus to the severity of AD. Methods: A hospital-based cross-sectional study of 106 pediatric patients of AD, between the age group of 6 months and 16 years was conducted. Diagnosis was made using the UK Working Party's Diagnostic Criteria for AD. The severity of pruritus and sleep disturbances were assessed using the Numerical Rating Scale, and the severity of AD was assessed using SCORing of AD index. Results: Mean age at onset was 4.73 years and the mean duration of disease was 1.07 years. Pruritus was localized in 66.03%, intermittent in 89.7%, and continuous in 10.3%. Winter aggravation was observed in 36.8% and sleep disturbances were observed in 39.62%. “Pruritus intensity” was moderate or severe in 92% of patients and had significant correlation to the duration and severity of the disease, sleep disturbances, and coexistence of other atopic diseases. Conclusion: A pediatric patient with AD usually presents with localized or generalized, moderate or severe pruritus, and with sleep disturbances. Exacerbation of pruritus was the most common in winter and due to woolen garments and sweating. The intensity of pruritus was in direct proportion with the duration and severity of AD and coexistence of other atopic diseases.

Introduction: Cutaneous leishmaniasis (CL) is a vector-borne protozoal infection of the skin with variable clinical manifestations. In Rajasthan, western Thar desert is endemic for this disease. Aim: The present study was aimed to describe clinico-epidemiological features of cutaneous leishmaniasis cases from a non-endemic area of South Rajasthan.Materials and Methods: A hospital-based prospective study was carried out during a period of 3 years (2017-2019). Data regarding clinical profile and treatment outcome were recorded in a predesigned proforma for analysis. Diagnosis of CL was made clinically and confirmed by demonstration of amastigotes in microscopic examination of Giemsa stained tissue smear of lesions.Results: Out of 24 patients, 16 (67%) were females and 8 (33%) were males. The age ranged from 3 months to 68 years (median-25). Face (67%) and extremities (29%) were the common sites affected. The most common morphological form was crusted plaques (54%) followed by nodular lesions (38%). Slit skin smear for Leishmania donovani bodies was positive in all patients (100%).Conclusion: This study highlights a focus of CL in non-endemic areas of South Rajasthan. Of late leishmaniasis is breaking out of its classical boundaries and is increasingly being reported from new geographic locations with a possibility of a novel parasite variant. Therefore, a high clinical suspicion of CL should be kept in non-endemic area.

Background: Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, life-threatening mucocutaneous drug reactions with a high morbidity and mortality that require immediate medical care. Several immunomodulatory drugs are used for the treatment but evidence of their efficacy is limited. Cyclosporine has recently been found to have a promising role in SJS/TEN owing to its potent antiapoptotic activity. Aims: This open label prospective study was conducted to determine the efficacy, safety, and tolerability of cyclosporine in patients with SJS/TEN. Methods: This study was conducted at a tertiary care teaching hospital of South Rajasthan during a period of 4 years (August 2015 to July 2019). Data regarding clinical profile, causative drug(s), disease severity, associated comorbidities, treatment received, and outcome were recorded in a predesigned proforma. SCORTEN prognostic score was calculated for each patient at the time of admission. Cyclosporine was administered in a dose of 5 mg/kg body weight in two divided dosage until reepithelization. Results: Out of 16 patients 10 were males and 6 were females. Mean age of patients was 30.62 ± 16.98 years (range: 7–63). Most of the patients, i.e., 8 out of 16 had TEN, 5 patients had SJS, and 3 patients had SJS/TEN overlap. Mean ± SD delay between onset and admission was 3.812 ± 1.377 days (range: 2–7). Among the suspected drugs, antiepileptics (43.7%) formed the major group. Mean duration of reepithelization was 10.5 ± 3.46 days (range: 7–15). Based on the SCORTEN, the expected mortality was 2.55 with mean predicted mortality rate of 16.43% with SD of 19.3. Limitations: 1) Sample size was small. 2) Placebo control trial could not be done due to the severity of the disease. Conclusion: We recommend cyclosporine (5 mg/kg/day) as the first line-specific immunomodulatory agent in SJS/TEN on account of its efficacy, safety, rapid reepithelization, decrease hospital stay, and reduced morbidity and mortality.

CHILD syndrome is a rare unilateral icthyosiform naevus, characterized by congenital hemidysplasia with icthyosiform erythroderma and limb defect. It is inherited as X- linked dominant trait with lethality for male embryo. We report a case of 9-year-old female child with right sided patchy psoriasiform epidermal nevus and ipsilateral limb defect. The rarity of the syndrome prompted us to report this case.

Background: Cutaneous adverse drug reactions (CADRs) are probably the most frequent of all manifestations of drug sensitivity. As a considerable number of new drugs are periodically introduced into the market, the incidence of CADR is likely to increase. The pattern of CADR and the causative drugs is likely to change accordingly. There is no uniformly accepted and reliable method of objectively assessing the causal link between drug and adverse reaction. Aim: To study the clinical patterns and causative drugs and compare causality assessment [World Health Organization (WHO) and Naranjo algorithm] of CADR among patients attending the dermatology department. Materials and Methods: This is a cross-sectional hospital-based study in which all patients with suspected CADR attending the dermatology department of a tertiary care center over a 9-month period were evaluated using the causality assessment criteria recommended by the WHO-Uppsala Monitoring Centre (UMC) and Naranjo scale. The severity of the reaction was assessed using Adverse Drug Reaction Severity Assessment Scale (modified Hartwig and Siegel scale). Results: A total of 200 consecutive patients with CADR were evaluated. The causality assessment for a drug as per WHO scale yielded 63 (31.5%) cases as certain, 12 (6%) as probable, and 125 (62.5%) as possible, whereas Naranjo scale showed 26 (13%) cases to be definite, 138 (69%) as probable, and 36 (18%) as possible. There was poor agreement between the two scales. Fixed drug eruption was the most common pattern of CADR (82.41%). The average number of drugs received by patients was 2.09. The most common suspected drug group was antimicrobials (n = 170; 40.5%), followed by nonsteroidal anti-inflammatory drugs (n = 148; 35.3%) and antiretroviral drugs (n = 41; 9.7%). Fixed drug eruption was most commonly caused by paracetamol. Antiepileptics and antimicrobials were the most common suspects among severe cutaneous adverse reactions. Limitations: Multiple concomitant drug usage by patients and inability to provoke all patients/measure drug levels in blood resulted in higher number of drugs with causal association as probable/possible. Conclusion: WHO-UMC scale was found to be easier to apply and evaluate, with greater practical utility. Poor agreement between the two commonly used scales emphasizes the need for a consistent and uniform causality assessment tool.

Background: Geriatric health care has assumed worldwide importance due to increase in the life expectancy during the last few decades. Aging skin has a marked susceptibility to dermatologic disorders due to the structural and physiologic changes that occur as a consequence of intrinsic and extrinsic aging. Aim: This study was aimed to evaluate the magnitude, pattern, contributory factors and systemic association of various dermatoses among geriatric population. Materials and Methods: Patients aged 60 years and above attending the dermatology outpatient department during a period of one year were enrolled in the study. Detailed history taking followed by general, systemic and cutaneous examination, and relevant investigations were carried out. The findings were recorded in a proforma for analysis and interpretation of data. Results: Out of total 610 patients enrolled, 68.2% were males and 31.8% females. The male to female ratio was 2.14:1. Maximum (339; 55.6%) number of patients were in the age group of 60-69 years. Wrinkling (273; 44.8%) was the commonest physiological cutaneous finding. Among the pathological changes, benign tumors (620; 39.9%), nevus (253; 16.3%), infection and infestation (244; 15.7%), dermatitis (158; 10.1%), pruritus (78; 5.0%), pigmentary disorders (67; 4.3%) and papulosquamous disorders (62; 4.0%) were common conditions. Associated systemic illness was recorded in 180 (29.5%) patients, of which hypertension (96; 15.7%) was the commonest. Conclusion: With the expected increase in the geriatric population in the coming years, the dermatological problems in geriatric population assume great importance. Our study shows that physiological changes seen with ageing such as wrinkling, senile purpura, xerosis, senile comedone, atrophy and senile lentigens are major cutaneous findings. Eczemas of various types and fungal and bacterial infections are the common dermatological morbidities. These dermatological morbidities in geriatric population can be minimized by reassurance, regular use of emollients and proper education regarding routine care of skin.

Introduction. Skin tags are known to be associated with several systemic diseases such as diabetes mellitus, obesity, dyslipidemia and cardiovascular diseases. Only a few Indian studies have investigated patients with skin tags for underlying metabolic complications. Objective . To assess the clinico-epidemiological profile of patients with skin tags and evaluate them for underlying metabolic abnormalities. Material and methods . All the patients reporting skin tag(s) at the dermatology outpatient department from October 2013 to September 2014 were included in the study. A detailed general, cutaneous and systemic examination was carried out. The data were analyzed using the χ 2 test. A p-value < 0.05 was considered significant. Results. Out of 165 enrolled patients, 112 (67.88%) completed the study protocol. Females outnumbered males, the M : F ratio being 1 : 1.11. Most patients (32; 28.57%) were in the age group of 31–40 years. The majority of the patients (77; 68.75%) reported after 1 year of noticing the lesions. The most commonly affected site was the neck (99; 88.39%) followed by the axilla (53; 47.32%). Acanthosis nigricans was the most common skin disease associated with skin tags (37; 33.03%). The diagnostic criteria for metabolic syndrome were fulfilled by 47 (41.96%) patients. The majority of the patients (70; 62.5%) were either overweight or obese. Abnormal glucose tolerance and hypertension were found in 41 (36.6%) and 37 (33.03%) of the patients respectively. Above optimal LDL cholesterol was the most common lipid abnormality, detected in 64 (56.25%) of the cases. Patients with 11 or more skin tags lesions and those with involvement of the thigh, axilla or neck were more likely to have metabolic syndrome. Conclusions. Patients with skin tags should be screened for concomitant diseases such as diabetes, hypertension, dyslipidemia and cardiovascular disease. Early detection of these complications followed by appropriate lifestyle changes and/or drug therapy would be beneficial in terms of reducing the considerable morbidity and mortality.

Background: Dermatologists besides providing service to patients in the outdoors, also play a vital role in the care of inpatients admitted to dermatology unit and other departments. Aims: The aim of this study was to evaluate the pattern of referrals sent to the dermatology department by other departments. Materials and Methods: The study included all inpatients referred to dermatology department of a tertiary care centre of South Rajasthan during a 5-year period from October 2008 to September 2013. Results: A total of 1560 consultations with 1603 diagnoses were recorded. Most (770; 49.3%) consultations were received from internal medicine, followed by surgery (177; 11.3%), pediatrics (104; 6.7%), psychiatry (86; 5.5%) and gynecology (69; 4.4%) wards. Infectious skin diseases were most common (29.7%) followed by eczema (12.0%) and drug reactions (9.0%). Conclusion: Dermatology referrals can enhance the dermatological knowledge of non-dermatologists to diagnose and manage common dermatoses thus improving overall patient care.

Cutaneous leishmaniasis is caused by protozoan parasites of the genus Leishmania. Atypical presentation and widespread progression of the lesions may be seen in patients with HIV disease and diffuse cutaneous leishmaniasis and HIV co-infection is emerging as a serious new threat. We report a case of diffuse cutaneous leishmaniasis in a HIV- infected patient resembling Histoid Hansen.

Lipoid proteinosis is a very rare progressive autosomal recessive disorder characterized by deposition of hyaline material in the skin, upper aerodigestive tract, and internal organs. Patients present with a history of repeated blistering, skin scarring, beaded eyelid papules, waxy papules over the body, and laryngeal and tongue infiltration leading to hoarseness of voice. This disorder is caused by mutations in the extracellular protein 1 gene present on chromosome 1q21. We report three cases of lipoid proteinosis, who presented to our outpatient department with aforementioned features.

Background: Cutaneous leishmaniasis (CL) usually occurs in areas with hot and dry climate. In India, the desert areas of Rajasthan, Gujarat, and the plains of Northwestern frontier are endemic for this disorder. Aims and Objectives: The present study was aimed to describe clinicoepidemiological profile of the cases of CL from South Rajasthan, which is a nonendemic area of Rajasthan. Materials and Methods: During a period of 4 years (2010–2014), a total of 23 patients with CL were diagnosed. All the suspected cases of CL were interrogated in detail regarding visit to areas where CL is known to occur. This was followed by clinical examination, relevant investigations, and treatment. All except one patient were treated with azole antifungals. In one patient, CO2laser ablation was done. Results: There were 12 (52.17%) males and 11 (47.83%) females with age ranging from 3 to 72 years. Duration of disease ranged from 7 days to 10 months. Face (15; 65.22%) and extremities (12; 52.17%) were involved in majority of the patients. Common morphologies were noduloulcerative lesions and crusted plaques. Tissue smear for Leishmania donovani bodies was positive in all except one patient. Conclusion: The present report highlights occurrence of CL in nonendemic area. Further epidemiological studies are required for identification of vector and strain of Leishmania involved.

Background: The spectrum of pyoderma changes constantly, and so does the antibiotic susceptibility pattern. Aims: This study was done to assess the magnitude and clinical patterns of pyodermas, their causative micro-organisms, and the antibiotic susceptibility patterns. Materials and Methods: Five hundred consecutive, clinically diagnosed and untreated cases of pyoderma, attending the Dermatology OPD of RNT Medical College and MB Government Hospital, Udaipur, from October 2010 to September 2011 were the subjects of this study. A detailed clinical examination, and relevant investigations including bacterial culture and sensitivity, were carried out and recorded. Statistical Analysis: For statistical analysis of data, the software ′EPI-INFO Version 6′ was used, and Chi-square (χ2) test was applied. Results: Of 19576 cases attending skin OPD during the study period, pyoderma was seen in 500 patients; the incidence being 2.55%. Males outnumbered females. The highest number of cases (109; 21.8%) was observed in 1st decade. Lower extremities were the commonest site of predilection. Primary pyodermas outnumbered secondary pyodermas. Furuncle (136; 27.2%) and infectious eczematoid dermatitis (62; 12.4%) were the commonest entities among primary and secondary pyoderma respectively. Staphylococcus aureus was the commonest causative agent in both primary and secondary pyoderma. It showed high susceptibility to amoxycillin + sulbactam, aminoglycosides and cefoperazone, moderate susceptibility to linezolid, while low susceptibility to fluoroquinolones and cephalexin. Conclusion: Such studies help to assess the changing trend of bacterial infections, their causative organisms and antibiotic susceptibility pattern.

Linear lesions following the lines of Blaschko of chronic cutaneous lupus erythematosus is a highly unusual variant of cutaneous lupus, particularly in adult. The lesions are restricted to one anatomical site with facial predilection in most of the reported cases. We herein, report a case of chronic cutaneous lupus erythematosus due to rarity of presentation and later age of onset.

Two adult patients from a village of district Bhilwara, Rajasthan, consulted Skin Department of R. N. T. Medical College and Hospital, Udaipur, with complaints of thickening of the palms and soles and pigmentation of skin with a nonhealing ulcer on the palm. They also had complaints of loss of appetite, abdominal pain, nausea, vomiting, and loose motion. On examination, there were multiple 2–3 mm, keratotic papules on the palms, and soles on the background of diffuse keratoderma. Two irregular nonhealing ulcers were present on the hands which on excisional biopsy revealed squamous cell carcinoma. A generalized mottled pigmentation was present over the trunk and proximal parts of extremities. The clinical presentation was suggestive of arsenicosis. There was history of similar ailment in some of the fellow villagers as well. With the help of health authorities, a survey was conducted in the village and it was found that eight more villagers were suffering from similar kind of illness. The common source of arsenic was explored and found to be increased in drinking water that was taken out through hand pump. The level of arsenic in drinking water was significantly above the WHO safe limit for arsenic.

Background: The evaluation for skin disorders forms an important component of primary health care practice for all including children. The prevalence of certain skin diseases in children can reflect status of health, hygiene, and personal cleanliness of a community. Aims: This study was planned to evaluate the magnitude of skin diseases, pattern of various dermatoses, factors contributing to these dermatoses and concurrent systemic disease among children up to five years of age. Materials and Methods: Consecutive 1000 children, aged up to five years, attending the Dermatology OPD of RNT Medical College and MB Government Hospital, Udaipur were the subjects of this study. A detailed general, systemic and cutaneous examination followed by relevant investigations were carried out. The findings were recorded in a proforma for analysis and interpretation of data. Results: One thousand twenty seven (1027) diagnoses were made in 1000 children. Etiological analysis revealed that majority (417; 40.60%) of dermatoses belonged to infection and infestation group followed by eczematous (358; 34.86%) and hypersensitivity (105; 10.22%) groups. Of the infection and infestation group, bacterial infection (141; 13.72%) was the most common entity followed by scabies (107; 10.42%), fungal (67; 6.52%), and viral infection (35; 3.40%). Conclusion: This study provides a preliminary baseline data for future clinical research. It might also help to assess the changing trends of pediatric dermatoses.

A 5-week-old male infant presented with extensive lesions of nevus flammeus and Mongolian spots affecting the face, trunk, buttocks and extremities. In addition, the child had ocular melanosis and a café-au-lait spot on the trunk. The case is being reported on account of its rarity.

Background: Topical corticosteroids (TC) are one of the most widely used agents in dermatology practice. Misuse of these agents may lead to a wide range of adverse effects. Aim: This study was conducted to assess the magnitude of abuse of topical corticosteroids (TC) and clinical patterns of cutaneous adverse effects amongst patients attending dermatology department of a teaching hospital at South Rajasthan. Materials and Methods: All patients who reported with adverse effects of topical steroids during one year from September 2015 to August 2016 were evaluated. Patients fulfilling the study criteria were registered for further workup. Results: Out of the 85280 new patients, 370 (0.43%) presented with adverse effects of TC. Males (232/370;62.70%) outnumbered females (138/370;37.30). Age group 11-30 years was most commonly (74.05%) affected. The main reason for using TC was fungal infection (52.43%). Tinea incognito (49.46%) and acne (30.27%) were the most common adverse effects recorded. Conclusions: Abuse of TC, particularly the superpotent and potent is rampant amongst general population. Topical corticosteroids are frequently used for indications where they should be avoided.

The typical clinical presentations of cutaneous leishmaniasis are nodules, ulcer, nodulo-ulcerative lesions and crusted plaques. Besides classical clinical picture, several unusual and atypical clinical presentations of the disease have also been reported. Herein, we report three cases of lupoid cutaneous leishmaniasis to highlight the extended clinical spectrum of CL. Tissue smears were positive for Leishman-Donovan (LD) bodies. All patients were treated by azole antifungals with favorable response.