Search

Sexually transmitted diseases (STDs) in children are not uncommon in India, though systematic epidemiological studies to determine the exact prevalence are not available. STDs in children can be acquired via sexual route or, uncommonly, via non-sexual route such as accidental inoculation by a diseased individual. Neonatal infections are almost always acquired intrauterine or during delivery. Voluntary indulgence in sexual activity is also an important factor in acquisition of STDs in childhood. Sexual abuse and sex trafficking remain the important problems in India. Surveys indicate that nearly half of the children are sexually abused. Most at risk children are street-based, homeless or those living in or near brothels. Last two decades have shown an increase in the prevalence of STDs in children, though most of the data is from northern part of the country and from major hospitals. However, due to better availability of antenatal care to majority of women, cases of congenital syphilis have declined consistently over the past two-three decades. Other bacterial STDs are also on decline. On the other hand, viral STDs such as genital herpes and anogenital warts are increasing. This reflects trends of STDs in the adult population. Concomitant HIV infection is uncommon in children. Comprehensive sex education, stringent laws to prevent sex trafficking and child sexual abuse, and antenatal screening of all the women can reduce the prevalence of STDs in children.

Background: By direct immunofluorescence (DIF), presence of immune complexes in the skin biopsy at various locations such as the dermo-epidermal junction, dermal blood vessels, etc. help to arrive at a diagnosis., Aims: (1) To study the role of DIF in confirmation or exclusion of diseases involving skin vis-à-vis histopathology and clinical diagnosis, (2) to describe the annual spectrum of dermatologic conditions that present to a tertiary referral center and require DIF examination of skin biopsy for confirmation of diagnosis., Methods: A total of 267 biopsies received over a period of 16 months in the Department of Immunopathology were analyzed along with clinical and histopathological details and the correlation between them was studied., Results: DIF was positive in 204 skin biopsies. Of these, 127 biopsies showed good clinico-immuno-histopathological correlation. In 10 cases, only DIF could clinch the diagnosis. In another nine cases, immune deposits were noted, which were unexpected in light of clinical and histopathological diagnosis. The most common skin involvement was seen in vasculitides. DIF was, however, non-contributory in lesions like erythema multiformè, post Kala-azar dermal leishmaniasis, sarcoidosis, lupus vulgaris, pyoderma gangrenosum and prurigo nodularis., Conclusion: The DIF of skin in conjunction with histopathology gives the best diagnostic yield. It is invaluable in confirming the diagnosis of small vessel vasculitides and bullous lesions of skin and can be used as an additional tool to pinpoint the diagnosis of systemic and localized autoimmune diseases involving the skin.

Background: Topical therapies are the first line of treatment for patients with stable plaque psoriasis affecting a limited body surface area. Though in use for more than a decade, we could not find any reports of studies directly comparing calcipotriol and tazarotene., Aim: To evaluate the comparative efficacy and tolerability of calcipotriol and tazarotene in the treatment of stable plaque psoriasis., Methods: This was a prospective, right-left side intra-individual parallel 8-week study using calcipotriol 0.005% ointment applied twice daily (right side) versus tazarotene (left side) randomized to either 0.05% (group I) or 0.1% gel (group II) once daily in two groups, each of 10 patients. Efficacy was determined by the assessment of target psoriatic lesions under evaluation by using the severity scale (0-3) of erythema, scaling, and infiltration (ESI score). Evaluation was done at baseline (0 week), 4 weeks, and 8 weeks of treatment. At the end of 8 weeks, patients with more than 75% reduction in ESI score were considered to have marked improvement; 51% to 75%, moderate improvement; 26% to 50%, minimal improvement; and less than 25%, non-responders., Results: Seventeen patients (9 in group I, 8 in group II) completed the study. In group I, reduction in ESI score was significantly more at both 4 and 8 weeks on sides treated with calcipotriol, producing moderate-to-marked improvement (P<0.05). In group II, improvement was comparable in lesions treated with either calcipotriol or tazarotene (0.1%) at the end of 4 and 8 weeks. Adverse effects noted were mild--in the form of burning, pruritus, and irritation--and were observed more often in the lesions treated with tazarotene as compared to those in the lesions treated with calcipotriol, but the difference was not statistically significant. However, none of the patients discontinued the therapy because of adverse events., Conclusion: Topical calcipotriol 0.005% ointment is more effective than tazarotene 0.05% gel; however, its efficacy is comparable to tazarotene 0.1% gel in the treatment of stable plaque psoriasis.

Background: Atopic dermatitis is a chronic, relapsing disorder associated with significant morbidity. Growth retardation is known to occur in children affected with atopic dermatitis. However, there is not enough Indian data for this disorder., Aims: We conducted a longitudinal study to look for the effect of atopic dermatitis on growth attainment of Indian preschool children., Methods: The growth patterns of 62 children, aged 3-5 years and suffering from atopic dermatitis were studied in terms of body weight, height and head circumference. Sixty-eight normal healthy children matched for age, sex and socioeconomic status were taken as controls. Every child was followed up at intervals of three months following a mixed longitudinal study design for the duration of one year. Severity of the disease was determined by the scoring atopic dermatitis (SCORAD) index., Results: Growth velocities were lower in patients than in controls. Mean changes in body weight of patients of both sexes showed close similarity to controls. Mean values for height and head circumference were found to be significantly lower in girls than in the girls of the control group at majority of the age levels. In contrast, in boys, these values for the patients remained comparable or higher than in the boys of the control group at some of the ages. Girls had comparatively more severe disease than boys and they had lower values than boys for all the growth parameters assessed., Conclusion: Growth retardation was observed among children with a more severe form of the disease. Height of the affected children was compromised mostly, though a tendency for catch-up growth was observed. Severe forms of atopic dermatitis may impair a child's linear growth temporarily.

Objectives: To conduct a cross-sectional study to compare Dsg1 and Dsg3 antibody levels independently with severity of disease activity in pemphigus vulgaris (PV) and pemphigus foliaceus (PF)., Methods: Blood samples from 44 patients with pemphigus (PV-38, PF-6) were analyzed using ELISA. The severity of skin and mucosal disease was graded using a score from 0 to 3., Results: A statistically significant correlation between increase in Dsg 3 antibody titres with severity of oral involvement and Dsg 1 titres with severity of skin involvement was found in both PV and PF patients (p < 0.01). However, we were unable to demonstrate a relationship between increased titres of Dsg1 and Dsg 3 antibodies with oral and skin involvement respectively., Conclusion: This study suggests that the severity of skin and oral disease in pemphigus is determined by the quantities of Dsg1 and Dsg3 antibodies respectively.

Three women with large, mutilating genital ulcers of long duration, destroying almost the lower half of the external genitalia, are reported. They had a history of recurrent oral ulcers as well. All patients had been diagnosed as having 'genital ulcer syndrome' in the past and had been treated with antimicrobials. Histopathology of the biopsy from the margin of the ulcer revealed features of leukocytoclastic vasculitis. Considering the history, clinical features and histology, a diagnosis of bipolar aphthosis was made in all patients. All patients responded well to immunosuppressive therapy. The cases are reported because of the presence of genital ulcers of an unusually large size, mutilating character and their close similarity to genital ulcers due to sexually transmitted diseases, especially genital herpes and donovanosis.

The study was undertaken with the aim of evaluating the effect of associated atopy on severity and age at onset of alopecia areata in north Indians. Presence of atopy was elicited by detailed history, examination and intracutaneous tests. Chi square test was carried out to evaluate statistical significance. One hundred patients (76 males and 24 females) with alopecia areata were evaluated. Historical evidence of atopy was present in 50 including patients alone (23), patients and first degree relatives (11) and first degree relatives alone (16). Intracutaneous tests were positive in 23 out of 50 patients tested randomly. There was a trend towards increasing frequency of severe alopecia as evidence of atopy became stronger e.g. both patient and first degree relatives with atopy or positive intracutaneous test but the results did not attain statistical significance. Similarly the age at onset and duration of alopecia areata was not significantly related to the presence of atopy. It is concluded that in north Indians with alopecia areata, the presence of atopy is not significantly associated with severe alopecia or onset at younger age.

The overlapping clinical features of fixed drug eruption (FDE), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) make differentiation between them difficult, especially if FDE is multifocal and extensive. We present a case of multifocal bullous FDE mimicking SJS.

An unusual form--large linear lobulated--of naevus sebaceous on the ear is reported in a 40-year-old man. It simulated syringocystadenoma papillitferum clinically.

Autologous transplantation of melanocyte/melanocytes bearing epidermis for vitiligo can be done by mini-punch grafting (MPG), suction blister epidermal grafting (SBEG), thin split -thickness skin grafting (TSTG), transplantation of basal cell layer enriched suspension and cultured epithelial/melanocyte transplantation. To date no comparative study of these transplantation procedures has been published. Comparison of different studies carried out at different centers may be difficult in the absence of uniform evaluation criteria. In most of the published studies, the results were evaluated in terms of extent of pigmentation. Complictions and color match were evaluated separately. This approach, however, may not give a fair idea about the results. We have developed a scoring system with holistic approach considering the extent of pigmentation, color match and the complications of both the donor and the recipient areas, all taken together. In the scoring system, the score for individual criteria was multiplied with a factor, the value of which was decided on the basis of relative importance of each criteria. The use of this scoring system is exemplified in twelve patients who underwent TSTG, SBEG and MPG. In the scoring system the results were judged as excellent and fair in 3 patients each, as good in 4 patients and as poor in 2 patients.

The hypothesis of the role of Candida in the gut for provoking psoriasis was tested by treating 9 males and 6 females having stable psoriasis with 200,000 units of nystatin orally 4 times a day for a minimum of 6 weeks. Intradermal candidin test and throat swab and stool samples for culture of Candida were taken before and twice after (between 4 and 8 weeks) institution of the therapy. Various Candida species isolated before therapy in 11 patients, disappeared after the therapy in 6. In the other 5 the colony counts came down. Only scaling became less in 4 patients. More than 50% clearance was noted in 2 patients. No improvement occurred in 9 patients. No obivous correlation between isolation and disappearance of Candida and persistence or clearance of lesions was observed. Immediate (Type-1) hypersensitivity response to candidin was positive in only 3 patients. Immediate hypersensitivity to Candida antigens -or its metabolic products does not appear to have any role in the pathogenesis of psoriasis.

Twenty-nine (5.33%) out of 544 patients of scabies had persistent smbious nodules. Young adults (16-30 years) and children under 15 years constituted 48.27% and 34.48% patients respectively. All but one were males, scrotum (96.55%) and penis (69.0%) were the commonest sites affected, followed by axillaiy region (37.93%) and groins (17.24%). Nodules disappeared in all the patients within 4 months. Histopathlogical studies done in 11 patients showed intracellular or intercellular oedema, occasionally distinct vesicle formation and focal or dif fuse infiltrate by lymphomononuclear cells, plasma cells and eosinophils.

A 35 year old male having erythematous and verrucous plaques and scars on his right lower limb, diagnosed as a case of chromoblastomycosis is described. The importance of close scrutiny of lesions for brownish- black dots and their direct microscopic exarmination in 10% KOH for the causative fungus is highlighted. The causative fungus was identified as Cladosporium carrionni.

Psychological needs of 20 adult male patients with neurodermatitis circumscripta(lichen simplex chronicus) and 50 matched controls were studied using ten TAT cards.Need affiliation(100%) need achievement (95%),need superiority (55%) and need dominance(40%) were the predominant needs.In contrast to the findings in other studies where aggressive needs were high in patients with atopic dermatitis our study showed that it was a prominent need in only one patient with neurodermatitis circumscripta.

A retrospective,data analysis of sexually transmitted diseases was carried out to study the pattern of these diseases prevalent in the region. One thousand'five hundred and seventy,one patients'were seen from January 1977 to October 1985. Maks constituted 95.5% of this group and females the remaining 4.5%. Commonest age group affected was 20-29 years in both sexes. Condytoma acuminata was the commonest STD (21.40/o), followed by gonorrhoea (16.9%), chancroid (12.2%) genital herpes (11.4%), syphilis (10.4%), not'specific ulcers (7.1%), donovanosis (6.3%),mixed infections (5.3%) and NSU (4.1%) Secondary syphilis was the most common (48.6%) presentation of syphik and in women it od 75.8% of all the cases of syphilis. In'more than a quarter of patients, psycho- problems were the reason for attendance.

Oral dapsone 200 mg daily for 16 weeks was tried on 52 adult patients, of whom 33 patients (males 17, femals 16) completed the study. No other topical or systemic medication was permitted. All the patients tolerated the drug very well. In 22 (66.5%) patients there was complete healing with hyperpigmentaiion after 16 weeks of therapy. In 7 (21.5%) patients partial respone was seen. There were 4 (12%) treatment failures. In patients with hiucosal lesions, the response started early and was seen more often (80.0%) No relapse was seen in any of the patients followed-up for a preiod of one year.

Various old and new modalities available for the treatment of psoriasis are discussed. Advantages and disadvantages of various preparations are highlighted to help.

Levamisole, a wide spectrum antihelminthic has been compared for its, curative effect on condylomata acuminata with podophyhin when given alone or combind with podophylfin topically. A cure rate of83.6% was obtained with podophyllin alone after in average Of 1.6 applications. With combined therapy, comparable good, results- were. Obtained i.e. a cure rate of 79.0% after applications. Levamisole was found to tie completely disappointing and had no effect on warts either given alone or in combination with podophyllin. No serious local or system side effects were noted with podophyllin and levamisole. Perianal and intraameatal warts were found to be relatively resistant to therapy.

A study was conducted to compare the incidence of cutaneous lesions in 126 patients treated with lithium carbonate and in 64 patients treated with minor tranquilizers or other antidepressant drugs. Cutaneous eruptions were seen in 78 (61.90%) patients in the study group and in 18 (28.12%) patients in the control group.

Twenty two adult male patients of psoriasis and 100 normal Volunteers Were skin-tested ' with DNC-B, mumps skin antigen, candidin coccidiodin, PPD, croton Oil and histamine hate Except for 'decreased mine phosphate sensitization seen: with DNCB, the response of psoriabics to, skin testing was comparable with the normals.

Data on 66 patients with cutaneous tuberculosis seen over a period of 4 years was analysed. Males -predominated (71.6%) over females (28.4%). More than one f' patients were below the age of 10 years. Lupus vulgaris was the commonest type of disease pattern seen in 81.8% followed by scrofuloderma in 21.2%. Warty tuberculosis was the least common of all. Tuberculids seen were erythema nodosum in 3, papulonecrotic in 2, and lichen scrofulosorum in one. Face was involved most often (34.8%) followed by legs, buttocks, arms and neck. The number of legions varied from 2-7 in a quarter of patients. Organs other than skin were involved in 25.8% patients. Pulmonary involvement was the commonest followed by bone. CNS and lymph node involvement. , Almost half the patients were unvaccinated as were the BCG vaccinated patients. Mantoux test was negative in 27.2% patients. Characteristic tubercular histopathology was seen in 81.8% and in the rest it was non-specific.

Twenty five patients of viral warts were tested with various antigens of secondary,(recall antigens), primary delayed (DNCB) and inflammatory (croton oil) type. Significantly depresed responses were elicited with various antigens in patients with warts as compared to controls.

Plasma cortisol levels were estimated in 49 patients having pityriasis versicolor and compared with the values obtained in 50 healthy controls and 23 Patients (matched for age) with dermatological problems other than Pityriasis versicolor. Only healthy patients systemic disease and history of drug intake, were taken for this study. Mean plasma cortisol levels in the patients with pityriasis versicolor, (38.43 + 25.27 ug.dl) were significantly elevated as compared with normal Controls (18,8 + 3.16ug/dl) and dermatological patients without pityriasis versicolor (16.11 + 5.64 ug/dl).

Graded concentration of compound dithranol ointment were, tried' in 107 patients with plaque psoriais. The lowest concentration used was 0.05% which was gradully'mcreased, irrespective of the response. to the . um tolerable concentration. The ointment was applied over the patches in the evening and the lesions were exposed to the sun the next day. This was followed by a soap water bath. The process was repeated tiD 16 weeks or the disappearance of lesions whichever was earlier. A majority of the patients required a concentration of 0.25% for clearing and a few required 0.5% concentration. In 54 patients, there was complete clearing of the lesions and another 22% showed 75% clearance. Only 2% cases, there was no appreciable change in the skin lesions. Resistant sites were legs, elbows, lower back etc. Mild local side effm such as folliculitis, irritation of the surrounding normal skin and local pruritus occurred in some patients. In seven patients, c irritation required discontinuation of the therapy. Temporary staining of the fingertips and hair occurred as also staining of the No systemic side effects were observed.

Two hundred individuals including 127 apparently normal persons and 73 patients with non-eczematous minor dermatoses were patch tested with 26 commercially available topical antiseptic, anti-bacterial and antifungw preparations. Forty five persons showed 68 positive patch tests, 18 of which were positive for more than one preparation. Males and females showed positive patch test in 23.56 and 83% individuals respectively. Sensitivity to nitrofurazone (furster), benzoic acid, sodium thiosulphate, Multifungin and oxytetracycline (Terramycin) was found in 15 (7.5%), 13 (6.5%). 8 (4%) and 5 (2.5%) persons espectively. The study highlights contact sensitivity to benzoic, sodium thiosulphatc and hamycin for the first time. No person wasn found sensitive to sodium fusidate (Fucidin), gentamicin (Genticyn), toinaftate (Tolnaderm), miconazole (Micogel), clotrimazole (Mycocid), savlon and gentian violet. In view of the possibility of contact sensitivity developing in large number of apparently normal persons (22.50'/o) to a number of commercially available topical preparations, the risk should be weighed against the benefits derived from their use.

In eight patients having extensive psoriasis, treated with hemodialysis, serum levels of LH, FSH, testosterone, T3, T4, ISH prolactin, insulin and cortisol were estimated before and after clinical imprmement. No differences were observd in hormone levels before and after diabmis. Serum prolaction lewis which were high to begin with remained so even after dialysis although the value had decreased slightly.

A case of phaeohyphomycosis in a three-year-old female child born to consanguineous parents is reported. The causative agent was Exophiala jmmlmei. The lesions were found in skin, subcutaneous tissue, lymph nodes and limb bones, which makes it a rare case.

2.54 percent of patients attending the dermatology clinic were found to have neurodermatitis circumscripta. Twenty adult male patients with the disease who were p educated at least u to high school were p subjected to detailed psychological testing. They were administered 10 cards of TAT Sinha's anxiety scale,- self-rating depression scale of Zung and Wechsler adult intelligence scale tests. AU the patients were found to have high IO levels. Anxiety of a very high degree was observed in 55.8 percent of the patients. Anxiety levels were high in patients who were eldest in the family. Sixty five per cent of patients showed high degree of depression, which was more apparent in the younger age group. Patients with first and second ordinal position were more depressed. No relationship was found between the disease and the financial and cdcational status, duration and extent of disease and 1.Q., anxiety or depression levels. Need (n) affifiation and (n) achievement were the two most dominant needs expressed.

Bacillary index (BI) and morphological index (MI) in lymph nodes, have been studied in 30 patients with various types of leprosy by lymph node aspiration and impression smears, This comparatively safer, less traumatising out patient procedure, already established for the study of malignant cytology is recommended as a better alternative to the more time consuming and painful lymph node excision biopsy technique for the study of viability of lepra bacilli (MI) in patients undergoing anti-leprosy treatment.