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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: 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.

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.

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.

A 45 year old female presented with a pigmented lesion in the right periocular region. The mass was present on the lateral 1/3 of the lower eyelid and involving the lateral 1/8 of the upper eyelid. Full thickness excision with wide tumor-free margins was done and the residual defect was repaired. Histopathological examination confirmed the diagnosis of nodulo-ulcerative basal cell carcinoma. In this report, we describe a novel technique for reconstruction of large lateral canthus defect by using three local flaps. With triple-flaps technique extensive defects involving the lateral canthus can be repaired without difficulty with a good functional and aesthetic outcome.

A 52-years-old female presented with a history of a painless, progressive swelling in the left lower eyelid of one-year duration. The lesion was excised twice as a chalazion and recurred. Excisional biopsy of the mass was performed and histopathological findings were consistent with those of trichilemmal cyst. We report a rare case of trichilemmal cyst of the eyelid which was masquerading as chalazion for which the patient had undergone multiple surgeries. Wide excision was done and diagnosis was confirmed on histopathology. There was no recurrence seen till 2 months of postoperative period. Trichilemmal cyst, although rare, should be considered as differential diagnosis of recurrent chalazion.

Medial canthal dystopia with canalicular obstruction is a common presentation following injury to the medial canthal region. Conjunctivodacryocystorhinostomy with Lester′s Jones tube is considered as the standard treatment in such cases. Alternatively, these patients can be managed by retrograde intubation dacryocystorhinostomy with medial canthoplasty. We herein describe the modification of retrograde bicanalicular intubation, combined with medial canthoplasty (monopedicle flap) which gives good cosmetic results.

Abstract This research investigated the determinants of electronic word-of-mouth (eWOM) sharing intentions in personal and public online networks among domestic tourists. Using a quantitative research design, this study surveyed domestic tourists visiting five major tourist destinations in India. Six hundred thirty valid responses were subjected to principal component analysis, confirmatory factor analysis, and structural equation modeling to examine the relationships among destination attributes, tourists’ psychological processes, and their intentions to engage in eWOM. The findings show that destination inhabitants’ friendliness and the natural beauty of the destination influence tourists’ overall destination experience. The overall destination experience and personal pleasure from vacations impact eWOM sharing with friends and family (personal networks) and with strangers (public networks). The results also indicate that the overall destination experience mediates the relationship between destination attributes (destination inhabitants’ friendliness and the natural beauty of the destination) and online sharing intent with friends and family. The overall destination experience also mediates the path between personal pleasure from vacations and eWOM sharing intent in personal networks. For tourism developers and destination managers, this study underscores the importance of enhancing the natural appeal of destinations and fostering positive interactions between tourists and locals. It also suggests creating authentic experiences at the destination so that tourists with high involvement generate eWOM about the destination.