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Background: Lichen planus pigmentosus (LPP), a rare variant of lichen planus, is reported in various ethnic groups, more often from the Indian subcontinent and the Middle East. Aims: Although the condition is encountered quite often by dermatologists of this region, the data on the clinical, pathological, and immunohistochemical (IHC) aspects of LPP are limited. This prospective study is aimed towards filling this lacuna. Materials and Methods: Data were collected from thirty clinically diagnosed cases of LPP who presented to the dermatology outpatient department. Skin biopsy and blood investigations were conducted and the specimens were further analyzed for their histopathological features and IHC staining for CD4+, CD8+ T-lymphocyte subsets along with CD45RO (UCHL-1), and CD68. The results were statistically analyzed. Results: The study showed a female preponderance (56.7%). Photo aggravation as a precipitating cause was seen in 40% of the individuals. The lesions with duration

Context: The uncontrolled use of antibiotics has resulted in a relentless spread of multiresistant strains of Staphylococcus aureus. There are studies conducted in medical colleges in Chandigarh, Chennai, Mumbai and Vellore comparing pyodermas in the community and hospital setting based on clinical and bacteriological parameters. Aims: This study, conducted over 1½ years from March 2009 to August 2010, aimed at analyzing the clinical spectrum and antibiotic sensitivity pattern of community and hospital-associated (HA) staphylococcal pyoderma. It also assessed the prevalence of methicillin-resistant S. aureus (MRSA) in the community and hospital cohort settings. Subjects and Methods: The study comprised of 200 cases of staphylococcal pyodermas, derived from the community (150 cases) and hospital (50 cases). Patients were evaluated based on their clinical presentation; antibiotic susceptibility was tested using the Kirby-Bauer disk diffusion method. Statistical Analysis Used: Statistical significance between individual attributes between the community and HA staphylococcal pyoderma groups was analyzed using Chi-square test and mean differences using student′s t-test. Results: Factors associated with community-associated (CA) pyodermas were young age (P = 0.0021), primary pyodermas, and involvement of extremities, while those with HA pyodermas were middle age, secondary pyodermas, and significantly increased body surface involvement (P = 0.041). Incidence of CA-MRSA was 11.3%, while that of HA-MRSA was 18%. Conclusions: A high level of resistance to first-line drugs such as penicillin, ciprofloxacin and cotrimoxazole was observed, more so in the hospital strain than in the community strain. S. aureus demonstrated good susceptibility to cephalosporins. Though the two strains of MRSA differed clinically, they showed 100% sensitivity to vancomycin and linezolid.

Acquired bilateral nevus of Ota-like macules (ABNOM) or Hori′s nevus, a rare form of acquired dermal melanocytoses, presents as bilateral facial blue-gray macules without ocular or mucosal involvement. This condition is mostly found in women of Asian descent and usually appears in the fourth or fifth decade of life. Pathogenesis is unknown, though few theories have been proposed. Effective treatment has been found to be achieved with pigment-specific lasers. Herein, we report a case of Hori′s nevus with mucosal involvement. A 42-year-old male patient, presented to us with blue-gray discoloration on either side of his face, both eyes, and in the mouth since the age of one year. Histopathological examination showed clusters and singly dispersed pigmented melanocytes within the upper and mid-dermis regions. Special staining of melanocytes using Masson-Fontana stain was positive. Diagnosis of Hori′s nevus was made by correlating clinical and histopathological findings. Patient was informed of his treatment options, but refused treatment. A similar case of Hori′s nevus with mucosal involvement has not been reported so far.

Background: Dermatophytoses refer to superficial fungal infection of keratinized tissues caused by keratinophilic dermatophytes. According to observations worldwide, dermatophytoses are the most common of the superficial fungal infections. It is common in tropics and may present in epidemic proportions in areas with high rates of humidity. Although common, the precise size of the problem defies measurement. Aims: The present study was undertaken to assess the clinical profile of dermatophytic infection and to identify the species of fungi that are prevalent in this region. Materials and Methods: A total of 100 patients clinically suspected for dermatophytoses were selected for the study. Direct microscopy in 10% potassium hydroxide (KOH) and culture was done in each case. Results: Out of 100 patients, the maximum were seen in the age groups of 16-30 years. Tinea corporis was the most common clinical type (44.3%) followed by tinea cruris (38.2%). Overall positivity by culture was 39% and by direct microscopy 96%. Conclusion: Trichophyton rubrum was the predominant species isolated (67.5%) in all clinical types followed by Trichophyton mentagrophytes. Culturing the fungus may identify the species, but it is not essential for the diagnosis as it is not a sensitive test.

Background : Chikungunya fever (CF) epidemic has recently re-emerged in India affecting large population. Mucocutaneous manifestations are an important clinical feature of the disease. We have reviewed mucocutaneous manifestations of the disease during a recent epidemic in coastal Karnataka. Patients and Methods Seventy-five "suspect cases" of CF with dermatological manifestations were examined. Results : We categorized the mucocutaneous manifestation into six groups: 1. skin rash, 2. apthae like ulcers, 3. pigmentary changes, 4. desquamation, 5. exacerbation of the existing dermatoses, 6. miscellaneous. Skin rashes were the most commonly observed skin changes followed by apthae like ulcers and pigmentary changes. Desquamation of the skin over the face is a new manifestation observed by us. Conclusion : wide spectrum of mucocutaneous manifestations is observed in CF. We have provided a classification for these manifestations, which may help in better recognition and uniform recording in future.

A 27 year old male employed in a paint industry who developed airborne contact dermatitis to epoxy resin is being reported.

Mastocytosis is a disorder characterized by the clonal proliferation of mast cells and their accumulation in skin, bone marrow, liver, and spleen. Cutaneous mastocytosis presents in children in over 90% of the cases and any cutaneous manifestation in an adult is the earliest sign of the systemic disease. A 45-year-old patient presented with itchy dark lesions over the body since childhood and Darier's sign was positive. Skin biopsy showed features of mastocytosis and immunohistochemistry was positive for CD34. Since the patient was refractory to treatment with antihistamines and psoralen-ultraviolet A therapy, injections of interferon alpha were given – 3 million IU twice weekly subcutaneously as they have been proven to improve constitutional symptoms. Very few reports of successful treatment of cutaneous mastocytosis using interferon alpha have been published.

Surgical treatment for vitiligo has been ever evolving. Each surgical modality has its own benefits and limitations. Miniature punch grafting is the most extensively performed surgery, which gives good results in stable vitiligo. Herein we report an unusual type of repigmentation observed after minipunch grafting in a patient of stable vitiligo, which resembled target-like lesions with a "perigraft halo" surrounding individual grafts. Such pigment spread occurred despite the use of 0.5 mm larger graft from the donor site.

Background: Isotretinoin is indicated for moderate to severe cases of acne which are unresponsive to conventional therapy. The classical recommended dose is 0.5 to 1.0 mg/kg/day. As the side effects are dose related, low-dose isotretinoin therapy for acne is an attractive option; however, but little data exists on the safety and efficacy of this strategy. Materials and Methods: In this prospective, non-comparative study, 50 participants, both male and female, having moderate to severe acne vulgaris were enrolled and treated with isotretinoin at a dose of 20 mg/day (approximately 0.3-0.4 mg/kg/day), for a period of 3 months. Participants were evaluated by means of clinical and laboratory investigations before starting isotretinoin. Investigations were repeated at the end of the first and third months following completion of treatment, and participants were followed up for 6 months to look for any relapse. Results: At the end of the treatment, very good results were observed in 90% of participants. Cheilitis was the most common among the side effects observed and was seen in 98% of the participants. One participant developed vitiligo as a side effect, which is a new finding, and has not reported in literature before. Elevated serum lipid levels were observed in 6% of the participants, and relapse occurred in 4% of the participants over a 6 month follow up period. Conclusion: Three months of treatment with low-dose isotretinoin (20 mg/day) was found to be effective in the treatment of moderate to severe acne vulgaris, with a low incidence of serious side effects. This dose also was more economical than the higher doses.

Background: Melasma is a common acquired cause of facial hyperpigmentation seen predominantly among females with significant psychological and social impact. It is often recalcitrant to treatment. Several topical hypopigmenting agents have been used to combat melasma. Hydroquinone and Kojic Acid are well established monotherapeutic agents for treating melasma. Objectives: This study focuses mainly on the efficacy of once daily application of 4% Hydroquinone and 0.75% Kojic Acid cream (containing 0.75% Kojic acid and 2.5% vitamin C) so as to determine an effective modality of treatment for facial melasma. Materials and Methods: A total number of 60 patients with facial melasma attending the Out-patient department of Dermatology, Venerology and Leprosy, Fr. Muller Medical College Hospital, Mangalore from Oct 2008-April 2010 were studied. Patients were allocated alternately to group A and group B. Group A patients received 4% Hydroquinone cream and group B patient received a Kojic Acid cream (which contained 0.75% Kojic acid and 2.5% vitamin C) and were advised to apply topically once daily at night. Patients were followed up on 4 th , 8 th and 12 th week. At each visit side effects were noted and clinical response to treatment was calculated using the MASI score. Statistical Methods: Chi square test, student ′t′ test. Results: At the 4 th week post treatment evaluation, facial hyperpigmentation responded early to 4% Hydroquinone cream than to 0.75% Kojic Acid cream. At the end of 12 week treatment period, 4% Hydroquinone cream had an overall superiority to 0.75% Kojic Acid cream as a topical hypopigmenting agent. Conclusion: The results of the study show that 4% Hydroquinone cream is a better topical hypopigmenting agent with rapid rate of clinical improvement when compared to 0.75% Kojic Acid cream.

An open uncontrolled trial, to assess the efficacy of ketoconazole 2%+zinc pyrithione 1% shampoo was conducted in patients with extensive tinea versicolor. The results show that this is an effective and well tolerated combination in the management of tinea versicolor.

Background: Lichen planus pigmentosus (LPP), a rare variant of lichen planus, is reported in various ethnic groups, more often from the Indian subcontinent and the Middle East. Aims: Although the condition is encountered quite often by dermatologists of this region, the data on the clinical, pathological, and immunohistochemical (IHC) aspects of LPP are limited. This prospective study is aimed towards filling this lacuna. Materials and Methods: Data were collected from thirty clinically diagnosed cases of LPP who presented to the dermatology outpatient department. Skin biopsy and blood investigations were conducted and the specimens were further analyzed for their histopathological features and IHC staining for CD4+, CD8+ T-lymphocyte subsets along with CD45RO (UCHL-1), and CD68. The results were statistically analyzed. Results: The study showed a female preponderance (56.7%). Photo aggravation as a precipitating cause was seen in 40% of the individuals. The lesions with duration <4 months had a more intense inflammatory infiltrate on histology. CD4+ and CD8+ cells showed very good Pearsons correlation on statistical analysis. CD45 was seen in association with CD8+, and staining for CD68 to assess the macrophage density showed a close correlation with CD45RO. Limitations: Small sample size. Conclusion: LPP represents a misguided lesional immune response pattern. The intense inflammatory infiltrate seen in the early lesions necessitates prompt treatment to arrest progression which may prevent the chronic pigmentary phase of the disease. [ABSTRACT FROM AUTHOR]

Mastocytosis is a disorder characterized by the clonal proliferation of mast cells and their accumulation in skin, bone marrow, liver, and spleen. Cutaneous mastocytosis presents in children in over 90% of the cases and any cutaneous manifestation in an adult is the earliest sign of the systemic disease. A 45-year-old patient presented with itchy dark lesions over the body since childhood and Darier's sign was positive. Skin biopsy showed features of mastocytosis and immunohistochemistry was positive for CD34. Since the patient was refractory to treatment with antihistamines and psoralen-ultraviolet A therapy, injections of interferon alpha were given - 3 million IU twice weekly subcutaneously as they have been proven to improve constitutional symptoms. Very few reports of successful treatment of cutaneous mastocytosis using interferon alpha have been published. [ABSTRACT FROM AUTHOR]

Background: Isotretinoin is indicated for moderate to severe cases of acne which are unresponsive to conventional therapy. The classical recommended dose is 0.5 to 1.0 mg/kg/day. As the side effects are dose related, low-dose isotretinoin therapy for acne is an attractive option; however, but little data exists on the safety and efficacy of this strategy. Materials and Methods: In this prospective, non-comparative study, 50 participants, both male and female, having moderate to severe acne vulgaris were enrolled and treated with isotretinoin at a dose of 20 mg/day (approximately 0.3-0.4 mg/kg/day), for a period of 3 months. Participants were evaluated by means of clinical and laboratory investigations before starting isotretinoin. Investigations were repeated at the end of the first and third months following completion of treatment, and participants were followed up for 6 months to look for any relapse. Results: At the end of the treatment, very good results were observed in 90% of participants. Cheilitis was the most common among the side effects observed and was seen in 98% of the participants. One participant developed vitiligo as a side effect, which is a new finding, and has not reported in literature before. Elevated serum lipid levels were observed in 6% of the participants, and relapse occurred in 4% of the participants over a 6 month follow up period. Conclusion: Three months of treatment with low-dose isotretinoin (20 mg/day) was found to be effective in the treatment of moderate to severe acne vulgaris, with a low incidence of serious side effects. This dose also was more economical than the higher doses. [ABSTRACT FROM AUTHOR]

Acquired bilateral nevus of Ota-like macules (ABNOM) or Hori's nevus, a rare form of acquired dermal melanocytoses, presents as bilateral facial blue-gray macules without ocular or mucosal involvement. This condition is mostly found in women of Asian descent and usually appears in the fourth or fifth decade of life. Pathogenesis is unknown, though few theories have been proposed. Effective treatment has been found to be achieved with pigment-specific lasers. Herein, we report a case of Hori's nevus with mucosal involvement. A 42-year-old male patient, presented to us with blue-gray discoloration on either side of his face, both eyes, and in the mouth since the age of one year. Histopathological examination showed clusters and singly dispersed pigmented melanocytes within the upper and mid-dermis regions. Special staining of melanocytes using Masson-Fontana stain was positive. Diagnosis of Hori's nevus was made by correlating clinical and histopathological findings. Patient was informed of his treatment options, but refused treatment. A similar case of Hori's nevus with mucosal involvement has not been reported so far. [ABSTRACT FROM AUTHOR]

Background: Dermatophytoses refer to superficial fungal infection of keratinized tissues caused by keratinophilic dermatophytes. According to observations worldwide, dermatophytoses are the most common of the superficial fungal infections. It is common in tropics and may present in epidemic proportions in areas with high rates of humidity. Although common, the precise size of the problem defies measurement. Aims: The present study was undertaken to assess the clinical profile of dermatophytic infection and to identify the species of fungi that are prevalent in this region. Materials and Methods: A total of 100 patients clinically suspected for dermatophytoses were selected for the study. Direct microscopy in 10% potassium hydroxide (KOH) and culture was done in each case. Results: Out of 100 patients, the maximum were seen in the age groups of 16-30 years. Tinea corporis was the most common clinical type (44.3%) followed by tinea cruris (38.2%). Overall positivity by culture was 39% and by direct microscopy 96%. Conclusion: Trichophyton rubrum was the predominant species isolated (67.5%) in all clinical types followed by Trichophyton mentagrophytes. Culturing the fungus may identify the species, but it is not essential for the diagnosis as it is not a sensitive test. [ABSTRACT FROM AUTHOR]

Context: The uncontrolled use of antibiotics has resulted in a relentless spread of multiresistant strains of Staphylococcus aureus. There are studies conducted in medical colleges in Chandigarh, Chennai, Mumbai and Vellore comparing pyodermas in the community and hospital setting based on clinical and bacteriological parameters. Aims: This study, conducted over 1½ years from March 2009 to August 2010, aimed at analyzing the clinical spectrum and antibiotic sensitivity pattern of community and hospital-associated (HA) staphylococcal pyoderma. It also assessed the prevalence of methicillin-resistant S. aureus (MRSA) in the community and hospital cohort settings. Subjects and Methods: The study comprised of 200 cases of staphylococcal pyodermas, derived from the community (150 cases) and hospital (50 cases). Patients were evaluated based on their clinical presentation; antibiotic susceptibility was tested using the Kirby-Bauer disk diffusion method. Statistical Analysis Used: Statistical significance between individual attributes between the community and HA staphylococcal pyoderma groups was analyzed using Chi-square test and mean differences using student's t-test. Results: Factors associated with community-associated (CA) pyodermas were young age (P = 0.0021), primary pyodermas, and involvement of extremities, while those with HA pyodermas were middle age, secondary pyodermas, and significantly increased body surface involvement (P = 0.041). Incidence of CA-MRSA was 11.3%, while that of HA-MRSA was 18%. Conclusions: A high level of resistance to first-line drugs such as penicillin, ciprofloxacin and cotrimoxazole was observed, more so in the hospital strain than in the community strain. S. aureus demonstrated good susceptibility to cephalosporins. Though the two strains of MRSA differed clinically, they showed 100% sensitivity to vancomycin and linezolid. [ABSTRACT FROM AUTHOR]

Background: Melasma is a common acquired cause of facial hyperpigmentation seen predominantly among females with significant psychological and social impact. It is often recalcitrant to treatment. Several topical hypopigmenting agents have been used to combat melasma. Hydroquinone and Kojic Acid are well established monotherapeutic agents for treating melasma. Objectives: This study focuses mainly on the efficacy of once daily application of 4% Hydroquinone and 0.75% Kojic Acid cream (containing 0.75% Kojic acid and 2.5% vitamin C) so as to determine an effective modality of treatment for facial melasma. Materials and Methods: A total number of 60 patients with facial melasma attending the Out.patient department of Dermatology, Venerology and Leprosy, Fr. Muller Medical College Hospital, Mangalore from Oct 2008.April 2010 were studied. Patients were allocated alternately to group A and group B. Group A patients received 4% Hydroquinone cream and group B patient received a Kojic Acid cream (which contained 0.75% Kojic acid and 2.5% vitamin C) and were advised to apply topically once daily at night. Patients were followed up on 4th, 8th and 12th week. At each visit side effects were noted and clinical response to treatment was calculated using the MASI score. Statistical Methods: Chi square test, student 't' test. Results: At the 4th week post treatment evaluation, facial hyperpigmentation responded early to 4% Hydroquinone cream than to 0.75% Kojic Acid cream. At the end of 12 week treatment period, 4% Hydroquinone cream had an overall superiority to 0.75% Kojic Acid cream as a topical hypopigmenting agent. Conclusion: The results of the study show that 4% Hydroquinone cream is a better topical hypopigmenting agent with rapid rate of clinical improvement when compared to 0.75% Kojic Acid cream. [ABSTRACT FROM AUTHOR]

Background: Chikungunya fever (CF) epidemic has recently re-emerged in India affecting large population. Mucocutaneous manifestations are an important clinical feature of the disease. We have reviewed mucocutaneous manifestations of the disease during a recent epidemic in coastal Karnataka. Patients and Methods Seventy-five "suspect cases" of CF with dermatological manifestations were examined. Results: We categorized the mucocutaneous manifestation into six groups: 1. skin rash, 2. apthae like ulcers, 3. pigmentary changes, 4. desquamation, 5. exacerbation of the existing dermatoses, 6. miscellaneous. Skin rashes were the most commonly observed skin changes followed by apthae like ulcers and pigmentary changes. Desquamation of the skin over the face is a new manifestation observed by us. Conclusion: wide spectrum of mucocutaneous manifestations is observed in CF. We have provided a classification for these manifestations, which may help in better recognition and uniform recording in future. [ABSTRACT FROM AUTHOR]

The article presents a quiz about the diagnosis for a patient with persistent lesions over his body for 25 years.

Surgical treatment for vitiligo has been ever evolving. Each surgical modality has its own benefits and limitations. Miniature punch grafting is the most extensively performed surgery, which gives good results in stable vitiligo. Herein we report an unusual type of repigmentation observed after minipunch grafting in a patient of stable vitiligo, which resembled target-like lesions with a "perigraft halo" surrounding individual grafts. Such pigment spread occurred despite the use of 0.5 mm larger graft from the donor site. [ABSTRACT FROM AUTHOR]

Foot dermatitis refers to the predominant involvement of feet in the eczematous process. This study is undertaken to determine the clinical pattern and causative agent in foot eczema and to evaluate the role of patch testing in determining the causative agent of foot eczema. Data was collected from 50 patients with foot eczema, who attended the out-patient department. The patch test was performed using Indian standard series. Patch test was positive in 88% of the patients. The most common site affected was the dorsal aspect of the foot (48%) and scaly plaque was the predominant morphological pattern. The highest number of patients (24%) showed positive reactions to mercaptobenzothiazole (MBT) and the lowest (4%) to neomycin sulfate. Rubber and rubber chemicals have been reported worldwide to be the most common sensitizer causing foot eczema. Thus, patch test has a major role in finding out the cause of foot eczema. [ABSTRACT FROM AUTHOR]

A young adult female patient of connective tissue naevus presented with papules and indurated plaques on both les and left arm. Histopathology showed increased amount of collagen in the dermis. Osteopoikilosis was absent.

Isotretinoin, an oral vitamin A derivative, used to treat severe treatment-resistant acne. Psychiatric side effects of isotretinoin particularly depression and suicidal thoughts have been well documented. We report a case of isotretinoin-induced manic psychosis in a young female without a family history and history of mental illness.

Surgical treatment for vitiligo has been ever evolving. Each surgical modality has its own benefits and limitations. Miniature punch grafting is the most extensively performed surgery, which gives good results in stable vitiligo. Herein we report an unusual type of repigmentation observed after minipunch grafting in a patient of stable vitiligo, which resembled target-like lesions with a "perigraft halo" surrounding individual grafts. Such pigment spread occurred despite the use of 0.5 mm larger graft from the donor site.