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Fixed duration multidrug therapy (FDT–12 months) is recommended by the WHO for multibacillary (MB) Hansen's disease (HD). However, highly bacillated patients tend to experience problems such as painful neuritis, worsening nerve function, delayed regression of lesions, and relapses. There is also concern about the increasing rate of relapse and antimicrobial resistance. Persistent or slowly regressing skin lesions and disabilities can occur even after completion of treatment. The decline in expertise to diagnose and treat Hansen's disease and poor treatment adherence are additional challenges. It is suggested that prolonging antimicrobial therapy, adding immunotherapy, increasing the dosage of rifampicin, adding more potent bactericidal drugs, and improving diagnostic services and treatment adherence may help manage highly bacillated patients. [Extracted from the article]

This letter to the editor responds to a study on the laboratory detection of bacterial pathogens and the clinical and laboratory response of syndromic management in patients with cervical discharge. The authors express concerns about the study's methodology and results, particularly regarding the identification of ureaplasma as the cause of cervicitis based solely on isolation. They argue that ureaplasma may be a commensal organism rather than a pathogen, and that its presence does not necessarily indicate infection. The authors also highlight the lack of a control group and suggest that further research is needed to better understand the role of ureaplasma in cervicitis. [Extracted from the article]

A letter to the editor is presented in response to the article "Clinical and epidemiological profile of sexually transmitted infections in a tertiary care centre in Kerala: A 1-year observational study" by P. Jayasree and others, published in a 2015 issue, along with a response from the authors.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The author reflects on psoriasis. He enumerates several treatments for the disease and its alternative therapies as well. He notes that the articles published in the journal "Indian Journal of Dermatology, Venereology, and Leprology" will improve the readers' knowledge and understanding of psoriasis which aids them in making informed decision about these treatments as the situation demands.

A letter to the editor is presented in response to the article "Syphilis among sexually transmitted infections clinic attendees in a tertiary care institution: A retrospective data analysis," by S. Sasidharanpillai and colleagues in the 2014 issue.