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Imatinib mesylate (IM), a tyrosine kinase inhibitor, has become a standard of care for the management of chronic myeloid leukemia. The safety profile of IM is favorable; however, few adverse effects such as gastrointestinal disturbances, fluid retention, skin rashes, and myelosuppression have been reported. Hypopigmentation of the skin is a rare adverse effect of IM. In this report, we describe two cases of chronic myeloid leukemia who developed skin hypopigmentation while on IM.

Background: Vigorous administration of COVID-19 vaccines to tackle the ongoing pandemic has led to increasing research on adverse effects including both systemic and cutaneous. Objective: A prospective observational study to delineate the cutaneous adverse effects of two vaccines, namely Covishield and Covaxin, administered in two doses in northern India. Materials and Methods: The study was conducted in a tertiary hospital in northern India wherein patients were asked to report voluntarily any cutaneous adverse effects after COVID-19 vaccination to the dermatology department. The data were collected using excel sheets and later analyzed taking into consideration the age, vaccine types, and duration of onset of adverse effects. Results: Of the 19,672 vaccination jabs, 296 (1.5%) developed cutaneous adverse effects of which the incidence was higher in Covishield vaccine group compared to Covaxin vaccine group. The incidence of side effects was more with the first dose of either vaccine compared to the second dose. All the side effects were benign and were managed symptomatically or were self-limiting. Limitations: The number of vaccine recipients was limited and there was a considerable overlap of adverse effects with both vaccines. Voluntary reporting of cases is not an accurate representation of the scale of patients with adverse effects. Conclusion: Rampant administration of vaccines along with widespread advertisement of vaccine-induced side effects via social media has created apprehension in the general population. This warrants studies improving awareness about the most vital preventive measure available to halt and eventually end the COVID-19 pandemic.

Background: Pigmentary disorders on the face are frequently encountered in all age groups and both genders but are more common in pediatric patients. These lesions can be isolated incidental findings or indicative of a congenital or acquired systemic or genetic disorder. Aims and Objectives: The aim and objective of this study is to study the frequency and pattern of pigmented orofacial lesions in the pediatric age group and to describe the underlying associated condition if any. Materials and Methods: A descriptive study was conducted over a period of 6 months (June–November 2018) in the dermatology department of a tertiary care hospital in Eastern Uttar Pradesh. All the children from 2 to 14 years of age who reported to us with complaints of pigmentary lesions on the face or oral cavity were included, and attempt was made to find out if any underlying conditions. Results: A total of 207 children were included in the study. Pityriasis alba was the most common pigmentary disorder on the face in the study population in 146 (70.5%) children, while pityriasis versicolor was noted in 21 (10.1%). Other facial dermatoses noted were vitiligo, congenital melanocytic nevus, and postinflammatory hypopigmentation and hyperpigmentation. Eight (3.8%) children had associated underlying diseases such as xeroderma pigmentosum, dyskeratosis congenita, Vitamin B12 deficiency, Laugier–Hunziker syndrome, and juvenile dermatomyositis. Conclusions: Pigmentary disorders of the face and oral cavity are frequently seen in children which forms a major part of dermatology consultation. Although most of these disorders are of cosmetic concerns, few conditions are associated with systemic conditions. A thorough investigation and management are the keys to manage such cases.

Introduction: Nail toxicity is a relatively uncommon cutaneous adverse effect of chemotherapeutic agents. Rapidly dividing cells of the nail matrix are perturbed by the antimitotic activity of these agents. Although most of these changes are cosmetic and regress once the therapy is completed, a few of these adverse effects are challenging to manage and require temporary or permanent suspension of chemotherapeutic agents. Materials and Methods: A total of 205 patients with various malignancies and under chemotherapy in oncology ward of the hospital over a period of 3 months were screened for nail involvement postchemotherapy. Relevant details, protocol of chemotherapeutic agents were assessed. Nail examination was carried out in daylight and the changes were analyzed. Results: A total of 124 (60.4%) patients had nail changes due to chemotherapeutic agents. The most common change was diffuse hyperpigmentation in 101 (81.4%) patients commonly due to a combination of cyclophosphamide and adriamycin in 43 (42.5%) patients. Longitudinal melanonychia was seen in 36 (29%), Beau's lines in 31 (25%), onychomadesis in 17 (13.7%), Mees' lines in 15 (12%), paronychia in 12 (9.6%), subungual hyperkeratosis in 10 (8%), and Muehrcke's lines in 4 (3.2%) patients. All the patients who developed Muehrcke's lines were on a combination of cyclophosphamide/doxorubicin/5 FU. Exudative onycholysis was observed in 2 (1.6%) patients; both these patients were on paclitaxel therapy. A total 2 (1.6%) patients who developed exudative onycholysis were advised discontinuation and another substitute chemotherapy was advised. Therapy for 2 (1.6%) patients who developed acute paronychia due to gefitinib was temporarily suspended. Unfortunately, most of the patients were on multiple chemotherapeutic agents hence, we could not pinpoint one drug as a cause. Therefore, a combination of agents was implicated in most cases. Conclusion: Nail toxicities are common with chemotherapeutic agents, however less importance is given to nail involvement. Apart from being cosmetically significant, a few adverse effects may warrant modification of the chemotherapy.

Skin and subcutaneous diseases affect millions of people worldwide, causing significant morbidity. Biologics are becoming increasingly useful for the treatment of many skin diseases, particularly as alternatives for patients who have failed to tolerate or respond to conventional systemic therapies. Biological therapies provide a targeted approach to treatment through interaction with specific components of the underlying immune and inflammatory disease processes. Advances in the understanding of disease pathophysiology for inflammatory skin diseases and in drug development have ushered in biologic therapies in dermatology. Biologic therapies are molecules that target specific proteins implicated in immune-mediated disease. This review article highlights the increasing evidence base for biologics in dermatology for off-label use.

Introduction: Head louse infestation is a common parasitic disease in pediatric age group. It is common in collective centers such as schools, garrisons, campuses and old age homes. It is worldwide in distribution with no strict limitation with respect to age, gender and race. Aims: Present study was conducted to investigate the socio-economic and lifestyle risk factors for head louse infestation in pediatric patients. Materials and Methods: An observational descriptive study at a tertiary care hospital in rural Uttar Pradesh over a period of 1 year wherein measurement of disease/risk factors associated with head louse infestation was performed. It was carried out in all children between 5 and 15 years of age using a pre-validated questionnaire. The method of convenience sampling was used and multiple logistic regression was run to account for potential confounding variables using SPSS software. Results: A total of 165 (71.1%) females and 67 (28.8%) males were infested. Most common age group affected was between 5 and 7 years where 97 (41.8%) children were infected. Ninety-five (40.9%) children were in fourth to seventh standards. Parents of 137 (59%) children were not formally educated. Eighty-one (34.9%) children had six members in the family while per capita income was between 5000 and 2500 in families of 139 (59.9%) children. Eighty-seven (37.5%) children had hair length up to shoulders. One twenty-eight (55.1%) children had no family member affected. Seventy-six (32.7%) children took bath twice a week only. Conclusion: Social and economic factors as well as lifestyle and education level of patients play a significant role in epidemiology of head lice.

Background: Fungal infections are increasingly encountered in the pediatric age group for the past few years. Majority of children at some point in time suffer from one or other clinical form of these infections. Although encountered in healthy patients also, an increase in immunocompromised patients is thought to be the major reason responsible for its increased prevalence world over. Indiscriminate use of irrational over-the-counter steroid combination has increased the menace of dermatophytes in children. Aims: The aim of the study was to describe the common clinical types of superficial fungal infections in children and to assess the use of topical steroid and its source. Materials and Methods: An observational study was done over a 5-month duration, wherein all children in the age group of 3–14 years with superficial fungal infection were examined and the data regarding the use of any topical steroid, and its source was accessed. Results: A total 313 children were included. One hundred twenty-nine (41.2%) children were between the age of 7–10 years, 194 (61.9%) were male, while 119 (38%) were female. Ninety-seven (30.9%) children were in the class 4th–6th. The duration of infection ranged from 30 to 60 days in 86 (27.4%) children. There was no significant association between steroid use and duration of infection as well as steroid use and gender (P value + 0.845 and 0.567, respectively). Conclusion: This study aims to highlight the common clinical type of superficial fungal infection. Type of topical steroid used and its source in these children was inquired.

Background: Alopecia areata (AA) is a common form of nonscarring alopecia characterized by patchy loss of hair from the scalp and body. It is a complex outcome of factors such as autoimmunity, genetic factors, infectious diseases, as well as psychological factors, such as stress, personality type, familial conditions. Around 20% of patients are in the pediatric age group, and 60% of the patients develop AA before the age of 20 years. Aim: The present study looked into the impact of psychosocial factors in AA. Materials and Methods: This was a case-control study conducted over a period of 1 year. One hundred and two patients and age and gender-matched control group between the ages of 2 and 14 years were included. A questionnaire was administered to identify the stress arising due to personal or familial conditions, school-related issues, psychotrauma or illness, and accidents prior to developing AA. Age and gender-matched patients with other dermatoses with low psychosomatic component to it and unlikely to be influenced by stress were selected as control. Result: Fifty-three patients (52 %) were male and 49 were female (48 %). Fifty-five (53.9%) patients were in the age group of 10 to 14 years. Forty (39.2%) children had multiple patches. Onset was

Background: Epidermal growth factor receptor (EGFR) inhibitors are an extensively utilized class of chemotherapeutic agents which form an integral component of treatment in solid organ malignancies such as non-small-cell lung carcinoma, pancreatic carcinoma, colorectal carcinoma, and head and neck carcinoma. It has two subclasses: epidermal growth factor inhibitors (erlotinib) and monoclonal antibody (cetuximab). A wide array of cutaneous adverse effects has been attributed to this class of drugs, such as papulopustular eruptions, paronychia, xerosis, and changes in hair and nails. Materials and Methods: A total of 76 cases of various malignancies on EGFR inhibitors who developed cutaneous side effects while on therapy and reported or referred to us by oncologists from January 2017 to January 2018 were included in the study. All the patients who were on other associated medications or radiotherapy were excluded. Result: In all, 45 (59.2%) were males and 31 (40.7%) were females. Non-small-cell lung carcinoma was the most common carcinoma in 32 (42.1%) patients, and cetuximab was the most common drug in 29 (38.1%) cases. Papulopustular eruptions were seen in 61 (80.2%) patients, xerosis in 31 (40.7%), mucositis in 6 (7.8%), hair growth problems in 4 (5.6%), and paronychia and pyogenic granuloma in 2 (2.6%) patients each. Conclusion: Although most of the skin toxicities associated with EGFR inhibitors can be managed conservatively, a critical analysis of the cases that are significantly affected due to these side effects is required in cohesion with the treating oncologist to improve the therapeutic compliance of the drug.

Background: A large number of skin diseases have the potential to culminate into potentially fatal “acute skin failure.” The concept of dermatological intensive care unit (ICU) has largely evolved as a result of increased number of emergencies encountered by dermatologists these days. Dermatological emergencies comprise 8–20% of cases presenting to the emergency department. A wide variety of these conditions require a collective effort by intensivists, surgeons, physicians, and nursing staff in association with the treating dermatologist to reduce the associated mortality and morbidity. Dermatology ICU along with state-of-the-art nursing care is required to manage these cases, which result in acute skin failure. Materials and Methods: A prospective study conducted in a tertiary care center with a round the clock emergency department and a state-of-the-art dermatology ICU over a period of 12 months. Patients requiring primary dermatological consultation in the emergency department and patients admitted in the dermatology intensive care unit were evaluated, and their clinical variables were statistically analyzed. Results: In total, 327 cases were seen in the emergency department, out of which 54 (16.5%) cases were admitted in dermatology ICU, 239 (73.1%) were treated as outpatient cases, and 34 (10.4%) were managed as inpatients in other wards of the hospital. The most common condition in out-patient cases was acute urticaria and angioedema in 71 (29.7%), while vesiculobullous disorders in 16 (29.6%) patients was the most common condition requiring admission in dermatology ICU. Conclusions: At present, only few studies are available in the literature on the spectrum of dermatological disorders reporting to emergency department, and further requiring intensive care under ICU setting. This prospective study highlights the varied patterns of dermatosis reporting to emergency outpatient department and those managed in the ICU.

Background: Hair loss is one of the most commonly reported and psychologically distressing adverse effects of chemotherapeutic agents. Studies on its impact on psychosocial aspect of cancer patients are lacking at present. Objective: To study the chemotherapeutic agents causing hair loss and its psychosocial implications in adults. Materials and Methods: Observational study was done for a period of 1 year, wherein all cancer patients, more than 18 years of age who developed hair loss while on chemotherapy were assessed for type of malignancy, details of chemotherapy protocol, their knowledge about chemotherapeutic agents induced hair loss, and its impact on their social life and patterns of adjustment to deal with it. A prevalidated closed-ended questionnaire was used as a data collection tool. Results: Out of 179 patients, 96 (53.6%) were males as against 80 (44.6%) females, and 49 (27.3%) patients were between 18 and 30 years of age. Carcinoma lung was the most common malignancy seen in 46 (25.6%) patients followed by rectosigmoid carcinoma in 41 (22.9%) patients. Combination of cyclophosphamide and doxorubicin was the most common combination resulting in hair loss in 49 (27.3%) cancer patients. A total of 101 (56.4%) patients felt that hair loss was the worst side effect of chemotherapy, while 29 (16.2%) had to continue because it was life-saving. A total of 129 (72%) patients said hair loss is affecting their social life; 37 (20.6%) patients were using hair accessories while 69 (38.5%) did not even attempt to hide hair loss as they were too occupied with fear of disease. Conclusion: Chemotherapy-induced hair loss is a common adverse effect in cancer patients undergoing treatment. A thorough counseling about it and methods to deal with it should be a part of management of the patients.

Introduction: The term “serodiscordant couples” refers to an intimate partnership in which one partner is human immunodeficiency virus (HIV) positive and the other HIV negative. They form a special population which are constantly at risk of acquiring infection, require safer sexual and reproductive options, and are in constant psychological and emotional distress. Aims: To describe the social, sexual, and reproductive issues and their impact on serodiscordant couples. Materials and Methods: A cross-sectional study was conducted on HIV-serodiscordant couples, admitted or attending our outpatient department, where the couples had not separated. A detailed interview of the partners on social, sexual, and reproductive issues was conducted and the data were endorsed in the pro forma. Results: Sixty-four serodiscordant couples were included in the study. Sixty-two (96.8%) males were seropositive compared to 2 (3.1%) females. Sixty-one (95.3%) patients were married and 3 (4.6%) were unmarried. Thirty-six (56.2%) patients were between the age group of 21 and 35 years, 21 (32.8%) between 36 and 55 years, and 7 (10.9%) between 56 and 70 years. Sixty-two (96.8%) patients had a heterosexual orientation compared to 2 (3.1%) patients who were homosexual. Twenty-one (32.8%) patients had a history of sexual encounter outside the relation while 27 (42.1%) were not aware of the source of infection. Fifty-one (79.6%) patients were on antiretroviral therapy (ART) compared to 13 (20.3%) patients who were not on ART. Thirty-one (48.4%) patients admitted to have a constant strain in relation while 16 (25%) were practicing safe sex. Thirty-nine (60.9%) patients had fear of disease transmission while 26 (40.6%) had fear of pregnancy. Forty-nine (76.5%) patients had children at the time of detection while 15 (23.4%) had no issue. Forty-one (64%) patients expressed desire to have children as compared to 23 (35.9%). Conclusion: The unique requirements of serodiscordant couples in terms of providing them safer sexual and reproductive options to prevent the transmission of HIV to the seronegative partner or the child during pregnancy need to be addressed for better patient management.

Introduction: Geriatric dermatoses are one of the most common reasons for day-to-day consultation in the elderly. Over the past few years, understanding of the pathophysiology of skin changes in the geriatric age group has improved and has paved the way for better therapeutic options. There are only a few studies conducted in India about the geriatric dermatoses. This article reviews the various physiological and pathological changes of aging, dwelling on the role of intrinsic and extrinsic factors in the pathogenesis of aging skin thus better understanding of this emerging branch in dermatology leading to enhance resource management for elderly population. Materials and Methods: This is a cross-sectional observational study carried out on 500 consecutive patients aged 60 years and above in Department of Dermatology of a Tertiary care hospital of Northern India after meeting the inclusion and exclusion criteria. Results: Out of 500 patients studied with male to female ratio of 1.4, wrinkles followed by cherry angiomas were the most common physiological cutaneous manifestations, and infective dermatoses followed by allergic contact dermatitis were the most common pathological conditions seen. Few rare cases were also seen during the study such as cutis marmorata, delusion of parasitosis, and sweet syndrome in case of acute myeloid leukemia. Conclusion: Geriatric dermatology is an emerging branch in dermatology, and an update on this, will go a long way to effectively manage these patients. A thorough knowledge of the epidemiology as well as gender distribution of dermatological diseases in geriatric population in the tertiary care hospital will help in assessing health status and health care needs related to skin for better allocation of resources, distribution of material and manpower, and help health care providers in better decision-making resulting in higher clientele satisfaction.

Background: Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. It is diagnosed based on clinical features and confirmed on the histological findings and peripheral slit-skin smear staining. Dermoscopy is a handy, easily accessible tool to diagnose this granulomatous disease and classify patients based on the immunological and clinical response. Methods: A single spot observational analysis was conducted in a tertiary hospital in North India. Patients attending the leprosy clinic and admitted patients for institutional therapy on the day of the study were enrolled in the cohort. The clinical and histological findings were correlated with the characteristic dermoscopy findings. A total of 50 patients were included in the study. All patents included in the study were on multidrug therapy and anti-lepra reaction drugs for a duration of less than 6 months. Results: The dermoscopy findings correlated with the clinical and histological findings. Tuberculoid poles of leprosy classically showed loss of hair and skin pigment along with absence of white dots as sweat glands in dermoscopy. Lack of blood vessel changes ruled out any lepra reaction. Lepromatous pole of leprosy on the other hand showed characteristic xerosis and white scaling on dermoscopy in the background of hypotrichosis and hypopigmentation. Leprosy reactions were characterized by blood vessel changes and arborizing blood vessels were characteristic in erythema nodosum leprosum, and a diffuse erythema was a clue toward diagnosing type I lepra reaction. Interestingly, clofazimine-induced pigmentation was picked up characteristically on dermoscopy as a “honey comb pattern”. Conclusion: Dermoscopy is certainly a handy tool in aiding the diagnosis of leprosy, lepra reactions, and course of therapy. Characteristic patterns during the course of leprosy would certainly facilitate a quick and definitive diagnosis of patients suffering from leprosy. Also, patient drug compliance particularly to clofazimine can also be picked up objectively on dermoscopy.

Introduction: Skin and mucosa are most susceptible to the adverse effects of chemotherapeutic agents due to rapid rate of proliferation. A wide array of these adverse effects has been reported in patients undergoing chemotherapy. Although mostly of cosmetic significance, few of these side effects may require alteration or suspension of therapy and reduce the likelihood of therapy completion. This study was undertaken to know the spectrum of skin pigmentary issues seen in these patients. Material and Methods: A total of 153 patients on chemotherapy for various malignancies from oncology department of the hospital were screened for cutaneous adverse effects over a period of 3 months. Relevant details and chemotherapy protocol followed were assessed. Cutaneous examination was done in daylight and photographs were taken. The data was analyzed at the end of 3 months. Results: Ninety-one (59.4%) patients had cutaneous adverse effects due to chemotherapeutic agents. Colorectal carcinoma was most common malignancy seen in 27 (29.6%) patients. Hand–foot hyperpigmentation was most common adverse effect seen in 67 (73.6%) patients followed by supravenous hyperpigmentation in 14 (15.3%), oral hyperpigmentation in four (4.3%), and flagellate hyperpigmentation and melisma-like pigmentation in three (3.2%). Capecitabine was most common drug resulting in hand–foot hyperpigmentation in 29 (43.2%) patients whereas docetaxel resulted in supravenous hyperpigmentation in five (35.4%) patients. Flagellate hyperpigmentation was seen with bleomycin and oral pigmentation exclusively noticed with capecitabine. Conclusion: Cutaneous adverse effects of chemotherapy are common but rarely reported. It is important to understand the entire spectrum of these side effects and allay the anxiety associated with them.

Laryngo-onycho-cutaneous (LOC) first described by Shabbir in 1986 in Muslim families from Punjab is a rare autosomal recessive disorder characterized by increased skin and mucous membrane fragility associated with exuberant granulation. The 4th International Consensus Meeting on “Diagnosis and Classification of Epidermolysis Bullosa” classifies it as a localized form of Junctional Epidermolysis Bullosa (JEB-LOC Syndrome) with mutations in α3 chain of Laminin 332. While laryngeal, ocular, and cutaneous involvement in these cases has been widely reported, urinary tract involvement is relatively rare. We report a case of JEB-LOC syndrome in a child from South India with extensive urethral involvement.

Herpes zoster (HZ) is a viral infection believed to be caused by the re activation of varicella zoster virus (VZV) or human herpes virus type 3 (HHV 3) that persists in the posterior nerve root ganglion. HZ is rarely reported in the pediatric age group with an intact immunity. Past infection with VZV and immunization with chickenpox vaccine are key markers in the onset of varicella zoster in children. Our aim was to study the clinicoepidemiological pattern of HZ infection in children aged less than 12 years and to start an early management to prevent long term complications. A prospective observational study over a total duration of 2 years was conducted in a tertiary hospital, and all children less than 12 years of age with diagnosed HZ were included in the study. A total of 39 children were diagnosed to have pediatric HZ infection during the study period. The children were followed up over 4 weeks post diagnosis and were treated with oral acyclovir therapy along with symptomatic management. All children had an uneventful benign course, and their siblings and close pediatric contacts were also screened for the development of HZ or chickenpox during the incubation period. All children were screened for an underlying immunodeficiency and two cases of HIV co infection were detected. HZ is a rare disease in childhood. Varicella in early childhood is a risk factor for HZ in both immunocompromised and immunocompetent children. The appearance of HZ in a young child does not always imply an underlying immunodeficiency or malignancy, but the children should be screened for immunodeficiency. In general, the prognosis is good in healthy children.