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Aim: This study aimed to determine the clinical efficacy of the combination of microbiomes and 0.2% topical hyaluronic acid gel, alongside topical monotherapy with 0.2% hyaluronic acid gel and steroids, respectively, in minor aphthous ulcer management. Subjects and Methods: A total of 45 patients were divided into three groups: Group A (n = 15) –– a combination of microbiome therapy––pre- and probiotics capsules p. o. and topical 0.2% hyaluronic acid gel; Group B (n = 15)––topical 0.2% hyaluronic acid gel; and Group C (n = 15)––0.1% triamcinolone acetonide oromucosal paste. Numerical rating scale (NRS) for pain, ulcer dimensions measured by Digital Planimetry using android mobile application to determine the degree of ulcer healing (%) and occurrence of new ulcers were recorded on 0, third, and seventh days of treatment. Statistical Analysis Used: One-way ANOVA with post hoc Tukey test among the groups and independent t - test for the degree of ulcer healing between third and seventh days were applied. Results: NRS for pain at day 3 showed a statistically significant pain reduction in Group A compared with Groups B and C (P = 0.04, 0.01, respectively). Though Group A showed the highest grade of closure (93.4 ± 2.5%) and a greater decrease in mean NRS score (0.2 ± 0.42) on the seventh day when compared to Groups B and C, results were not statistically significant (P > 0.05). Conclusion: Microbiome and topical hyaluronic acid gel combination therapy helps in immediate pain relief and faster healing. Hence, it could be an excellent alternative for topical steroid management.

Background and Objective: Oral submucous fibrosis (OSMF) is a juxtraepithelial inflammatory reaction followed by fibro elastic change of lamina propria. Hence, the inflammation is a definite component of OSMF. Combinations of turmeric, Aloe vera, and honey have antioxidant and anti-inflammatory effects which may act synergistically to serve as beneficiary for treating OSMF disease. Hence, the present study aims to compare the efficacy of topical application of novel gel containing curcumin, Aloe vera, honey, and physiotherapy with 0.1% triamcinolone acetonide and physiotherapy in the reduction of clinical signs and symptoms of OSMF patients. Materials and Methods: A total of 20 clinically diagnosed OSMF patients were divided into two groups containing 10 patients each. Participants including in Group A were treated with topical application of novel gel-containing curcumin, Aloe vera, and honey along with physiotherapy. Group B patients were treated with the topical application of 0.1% triamcinolone acetonide along with physiotherapy. Participants were evaluated at baseline and at the 7th day, 14th day, and 21st day. They were evaluated for mouth opening (maximum interincisal distance) and burning sensation (Visual Analogue Scale). Results: The reduction in burning sensation and increase in mouth opening is observed in both the groups. Both groups showed no statistically significant difference. Thus, both are statistically equally effective. Reduction burning sensation at the 21st day was more in Group A than in Group B, but difference is not statistically significant. Conclusion: Novel gel is as effective as topical steroid triamcinolone acetonide in reducing the signs and symptoms of OSMF.

Anti-programmed cell death 1 (anti-PD-1) agent is a promise in cancer immunotherapy for various advanced malignancies, but dermatologic toxicities are common during therapy. We report one advanced transitional cell carcinoma patient who developed multiple bullous skin lesions over bilateral lower extremities after anti-PD-1 antibody pembrolizumab treatment. Skin biopsy revealed subepidermal cleft, wedge-shaped hypergranulosis, saw-tooth acanthosis, and presence of interface band-like lymphohistiocytic infiltrate compatible with bullous lichen planus-like reactions. Potent topical steroid and temporary cessation of pembrolizumab relieved the skin eruptions. Early recognition and appropriate management of rare bullous dermatologic toxicities are critical in patients receiving immune checkpoint blockade therapy.

Background: Treatment of childhood lichen planus (LP) is challenging owing to high rate of relapses. Moreover, majority of treatment options for LP have been extrapolated from studies done in adults. Topical corticosteroid remains the first line of treatment in localized classic form of LP, but till date, no consensus exists regarding standardized therapy in children. Hence, we conducted this study to evaluate the efficacy of mid-potent topical steroid fluticasone propionate 0.005% in childhood LP. Aims and Objectives: The aim of this study was to evaluate the therapeutic efficacy of fluticasone propionate ointment 0.005% in childhood LP. Materials and Methods: Thirty-one patients (6 months to 18 years of age) with clinical and histopathologically confirmed diagnosis of LP were subjected to routine baseline severity assessment, patient/parent assessment, pretreatment photographic record of the fixed anatomical site under treatment, and then received topical mid-potent steroid therapy (fluticasone propionate ointment 0.005%) twice daily and cetirizine dihydrochloride in predefined doses for 8 weeks. Follow-up was done at the end of 2 weeks, 4 weeks, 6 weeks, and 8 weeks. After 8 weeks, a proportion of patients achieving clinical improvement and side effects were assessed. Observation and Results: The difference between pre- and posttreatment induration was not statistically significant (P = 0.336). The mean number of lesions before the start of treatment was 50.29, which reduced to 14.77 (P = 0.000) after treatment, and the mean of patients' itching score before treatment was 6.74 ± 1.6, which reduced to 2.61 ± 2.3 (P = 0.000) following treatment, which was statistically significant. Clinical improvement was seen in 67.7%, whereas 32.3% showed no improvement over a period of 8 weeks. Conclusion: Mid-potency steroid fluticasone propionate ointment twice daily is an effective therapeutic agent for localized childhood LP, with minimal side effects.

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.

Purpose: To compare the effect of topical 1% prednisolone acetate and 0.09% bromfenac versus topical 1% prednisolone acetate alone on macular thickness following Nd: YAG laser capsulotomy. Materials and Methods: About 150 eyes with posterior capsule opacification following were included. All patients were treated with Nd: YAG laser posterior capsulotomy. Patients were randomly divided into two groups of 75. Group 1-Patients received: Topical 1% prednisolone acetate and Topical 0.09% bromfenac. Group 2-Patients received: Topical 1% prednisolone acetate alone. Outcome measures by an independent observer were BCVA by Snellen chart, IOP by NCT, and Central Macular Thickness (CMT) by Macular OCT. All patients were examined before the procedure, 1 h after the procedure, at 1 week, and at 6 weeks. Statistics: 1. Quantitative variables: Mann-Whitney Test and Wilcoxon ranked sum test. 2. Qualitative variables: Chi-square test. A P value of < 0.05 was considered statistically significant. Results: Mean IOP increase in both groups is statistically significant at 1 h and later decreases back to nonsignificant levels at 1 week and 6 weeks. No significant change in mean CMT was seen in the duration of 6 weeks neither in Group 1 nor Group 2. Conclusion: Prophylactic antiglaucoma medications are not recommended in patients undergoing Nd: YAG laser capsulotomy. No evidence of cystoid macular edema was recorded till the end of 6 weeks follow-up.

BACKGROUND: Dermatophytosis is a common skin infection, having recurrent and persisting course because of topical steroid abuse, irregular treatment, and poor hygiene. The aim of this study was to assess the quality of life (QoL) of patients diagnosed with superficial dermatophytosis. MATERIALS AND METHODS: Patients (n = 100) diagnosed with superficial dermatophytosis were recruited in the study. A pretested, structured questionnaire was used for recording patient's details. The observing dermatologist simultaneously assessed the clinical severity of the disease. Data were collected by a single examiner and recorded in a case record pro forma. Clinically doubtful cases were included after examining samples with 10% KOH. Correlation analysis was performed between the Dermatology Life Quality Index (DLQI) score and the study variables. RESULTS: Out of 100 patients, 42 had DLQI scores with moderate effect (score 6–10). A total of 19 patients had a very large effect on QoL and four patients had DLQI scores bearing an extremely large effect on QoL. Both males and females had similar mean DLQI values. A moderate correlation was found between DLQI scores and the use of topical steroids (r = 0.0002), and a slight correlation was found between duration of the disease and DLQI scores (r = 0.006). CONCLUSION: A high prevalence of the disease was found in males, and prolonged disease duration with use of topical steroids was observed. A significant impact was found in the QoL of the patients. Hence, proper counseling and treatment, along with early detection, is needed.

Immune recovery uveitis (IRU) is the ocular manifestation of immune reconstitution inflammatory syndrome in human immunodeficiency virus (HIV)-infected patients with cytomegalovirus (CMV) retinitis receiving highly active antiretroviral therapy (HAART). Here, we report the case of a 48-year-old HIV-infected patient, with poor adherence to HAART, who presented with gradual diminution of vision and pain in the left eye for 2 months. HAART was restarted along with anti-tubercular treatment for central nervous system tuberculosis 6 months ago. Clinical examination revealed the features of uveitis and active CMV retinitis. Laboratory investigations showed increased CD4+ T-lymphocyte count. We diagnosed the case as IRU associated with active CMV retinitis. The patient recovered with topical steroid and oral anti-CMV therapy. Although IRU is commonly seen in patients with inactive CMV retinitis, rarely this may be seen in association with active CMV retinitis, particularly when HAART therapy is initiated without treating CMV retinitis.

BACKGROUND: Urticaria affects one in every five persons in the population. OBJECTIVES: This study was done to study the risk factors, clinical presentation, and management practices among patients with urticaria. METHODS: Information from the medical case records of confirmed cases of urticaria at a government and private tertiary care hospital over the recent 4 years were recorded in a semi-structured pro forma. RESULTS: Mean age of 115 patients was 31.2 ± 20.7 years. Majority of patients (69, 60%) had acute urticaria. The most common risk factors of urticaria in this study were allergy to food substances (27, 23.5%) and allergy to medications (18, 15.6%), followed by insect bites (16, 13.9%). Family history of urticaria was present in 8 (7%) patients. The most common symptom in urticaria was pruritus (68, 59.1%) and the most common sign was hives (40, 34.8%). Lesions were present all over the body in 52 (45.2%) and were bilateral in distribution in 59 (51.3%) patients. Sixty-eight (59.1%) and 69 (60%) urticaria patients were prescribed nonsedating and second-generation antihistamine (sgAH) drugs, respectively. Among chronic urticaria (CU) cases, 35 (76.1%) each received nonsedating and sgAH. Systemic steroids and topical steroid creams were prescribed in 21 (18.3%) and 7 (6.1%) urticaria patients, respectively. Mean duration of application of the topical steroid creams was 10 ± 4.8 days. Leukotriene antagonists were used in the management of greater proportion of patients (54.5%) with dermographism in comparison to 16.1% without dermographism (P < 0.001). CONCLUSION: The study reported few important risk factors and certain common clinical presentation in urticaria. Second-generation nonsedating type of antihistamine drugs was the most preferred drug for the management of urticaria.

Purpose: To know the pattern of presentations and management outcome of steroid induced glaucoma in vernal keratoconjunctivitis (VKC). Methods: Children of VKC using steroid with two of the following criteria were enrolled: Intraocular pressure (IOP) >21 mm Hg, glaucomatous optic disc and visual field defects. Misused topical steroids were classified in 4 groups; A- Highly potent drugs (dexamethasone, betamethasone), B- Moderate (prednisolone), C- Weak (loteprednol, fluorometholone), D- Unknown drugs. Active/conservative interventions were done to control IOP. Corrected distance visual acuity (CDVA), IOP, anterior segment and fundus examinations were noted. One-way ANOVA test and post hoc Tukey HSD test were used to compare the groups. Results: Out of 1423 VKC patients, 240 were using topical steroid without prescriptions. 92 eyes of 47 patients had steroid induced glaucoma. Hence prevalence of this complication was 3.30% in this study population. Mean age was 14.1 ± 3.8 years. Mean IOP was 38 ± 12 mm of Hg and mean vertical cup disc ratio was 0.67 ± 0.25. IOP was controlled by withdrawal of steroids (9 eyes), with antiglaucoma medications (27), trabeculectomy (57) and glaucoma drainage device (1). Mean CDVA at presentation was better in group C (0.23 log MAR). Mean IOP was highest in group A (43.1 mm Hg) followed by group D (40.5 mm Hg). At presentation 17 were blind (CDVA

Acute generalised exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction and is attributed to drugs in more than 90% of cases. It is a rare disease, with an estimated incidence of 1-5 patients per million per year. The clinical manifestations characterised by the rapid development of sterile pustular lesions, fever and leucocytosis. Number of drugs has been reported to be associated with AGEP, most common being the antibiotics. Histopathologically there is intraepidermal pustules and papillary dermal oedema with neutrophilic and eosinophilic infiltrations. Systemic involvement can be present in more severe cases. Early diagnosis with withdrawal of the causative drug is the most important step in the management. Treatment includes supportive care, prevention of antibiotics and use of a potent topical steroid.

Background: Awareness against abuse of topical corticosteroids (TC), especially over the face, has been going on for last 5 years in India. In spite of that we are getting lots of cases in our hospitals. Aims: The aims of this study were to ascertain the demographics, magnitude and clinical features of TC misuse on the face among the dermatology outpatient department (OPD) attendees and to analyze its causes. Methods: This study was conducted in a tertiary care medical center of eastern India. Patients with relevant facial dermatoses were asked about their current use of topical formulations and confirmed to be TSDF were included in the study. Results: A total of 748 patients with facial dermatoses were screened, of which 271 (36.22%) were using TC. Of them mostly young adults between 20 and 29 years (37.10%) were using TC. Average duration between starting of use of medication and the onset of symptoms was 5 months. Ninety-eight (36.16%) patients were using topical corticosteroid for the treatment of acne and 74 (27.30%) were using as depigmenting cream. About 108 (39.85%) patients bought medicine over the counter being recommended by pharmacist/shop owner. Rosacea like features with photosensitivity was the most common adverse effect found in 79 (29.15%) patients whereas comedonal acne/acne exacerbation were found in 68 (25.09%) patients. Most of them (227, 83.76%) were unaware about the side effects of steroids. Conclusions: TC misuse in patients with facial dermatoses is still quite common even after efforts to grow the awareness among population.

In this report, we report the case of a 7-year-old boy with corneal neovascularization due to exposure keratopathy following cerebellar astrocytoma surgery. Corneal surface healing was achieved with topical treatment and therapeutic contact lens, after which topical steroid was administered for stromal haze and corneal neovascularization. After 2 months of steroid therapy failed, corneal neovascularization responded well to topical aflibercept administration, showing complete regression.

Chronic paronychia is an inflammatory disorder of the nail folds of a toe or finger presenting as redness, tenderness, and swelling. It is recalcitrant dermatoses seen commonly in housewives and housemaids. It is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens. Repeated bouts of inflammation lead to fibrosis of proximal nail fold with poor generation of cuticle, which in turn exposes the nail further to irritants and allergens. Thus, general preventive measures form cornerstone of the therapy. Though previously anti-fungals were the mainstay of therapy, topical steroid creams have been found to be more effective in the treatment of chronic paronychia. In recalcitrant cases, surgical treatment may be resorted to, which includes en bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail plate removal. Newer therapies and surgical modalities are being employed in the management of chronic paronychia. In this overview, we review recent epidemiological studies, present current thinking on the pathophysiology leading to chronic paronychia, discuss the challenges chronic paronychia presents, and recommend a commonsense approach to management.

Corticosteroids, one of the most widely prescribed topical drugs, have been used for about six decades till date. However, rampant misuse and abuse down the years has given the drug a bad name. Topical steroid abuse may lead to two major problems which lie at the opposing ends of the psychosomatic spectrum. Topical steroid addiction, a phenomenon that came to be recognized about a decade after the introduction of the molecule is manifested as psychological distress and rebound phenomenon on stoppage of the drug. The rebound phenomenon, which can affect various parts of the body particularly the face and the genitalia has been reported by various names in the literature. TC phobia which lies at the opposite end of the psychiatric spectrum of steroid abuse has been reported particularly among parents of atopic children. Management of both conditions is difficult and frustrating. Psychological counseling and support can be of immense help in both the conditions.

Porokeratosis is a rare specific disorder of keratinization with distinct clinical and histopathological features with rare malignant degeneration. Clinically, it is characterized by papular lesions or annular plaques with central atrophy and peripheral keratotic ridge and histologically with the presence of cornoid lamellae. It mainly presents on the extremities, trunk, face, and very rarely on genitals and mucous membrane. Very few cases of porokeratosis with oral mucosal involvement have been reported in the past. A 50-year-old female presented with a well-demarcated, irregular plaque with atrophic center and peripheral keratotic margin with a thin furrow involving the left side of the upper lip, angle of mouth, and adjacent labial mucosa. The patient had a history of application of topical steroid preparations intermittently over a period of 2 years. The histopathological features showed characteristic cornoid lamellae. The involvement of mucosa is uncommon, and local immunosuppression caused by topical steroids may act as a predisposing factor.

This patient is a 64-year-old man who presented with painless progressive blurring of vision for one year. After a routine fundoscopy preceded by dilatation of both eyes with a drop of topical tropicamide, the left eye was noted to have stromal edema temporally. This was attributed to the preservative (BAC) in the medication. The stromal oedema persisted over the following weeks despite administration of a topical steroid, and was associated with deterioration in visual acuity to 6/30 (PH 6/21). This case reminds us that clinicians should be vigilant during instillation of any preservative-containing drops, even in routine practices like dilatation. Far from being restricted to chronic use of preservative-containing drugs, toxicity with BAC can occur even upon a single application. Ideally, all eyedrops should be single-use topical drug formulations, but in the absence of this option, it is imperative that ophthalmic drug prescription be done with adequate clinical justification.

The clinical features of interface Candida keratitis after deep anterior lamellar keratoplasty (DALK), may imitate rejection or crystalline keratopathy. We report here an 18-year-old woman presented with red eye, 4 months after undergoing DALK. Slit lamp examination revealed keratic precipitates (KPs) and conjunctival injection. She was prescribed corticosteroid treatment for endothelial rejection by another ophthalmologist because of misdiagnosis, but suffered a recurrence of symptoms after reduction of the corticosteroid treatment. At that time, she was referred to our office. The recurrence persisted despite antibiotic and antifungal therapies. Ten days after treatment with interface irrigation with amphotericin, the infiltration and hypopyon were resolved. Topical steroid was added after 3 months of antifungal monotherapy. Irrigant cultures confirmed the presence of Candida albicans. The corneal graft appeared semi-clear with no signs of infection at 17-month follow-up. We recommend a close follow-up and a timely intervention to prevent the need for more invasive treatment such as penetrating keratoplasty.

Background: Topical corticosteroids were first introduced for use in 1951. Since then uncontrolled use (abuse) has caused many different reactions resembling rosacea – steroid dermatitis or iatrosacea. Multiple pathways including rebound vasodilatation and proinflammatory cytokine release have been proposed as the mechanism for such reactions. Aim: The aim was to study the adverse effects of topical steroid abuse and the response to various treatment modalities. Materials and Methods: Two hundred patients with a history of topical steroid use on face for more than 1 month were studied clinically and various treatments tried. Results: The duration of topical corticosteroid use varied from 1 month to 20 years with an average of 19.76 months. Majority of patients were using potent (class II) topical steroids for trivial facial dermatoses. The common adverse effects were erythema, telangiectasia, xerosis, hyperpigmentation, photosensitivity, and rebound phenomenon. No significant change in laboratory investigations was seen. Conclusion: A combination of oral antibiotics and topical tacrolimus is the treatment of choice for steroid-induced rosacea.

Tinea incognito is a dermatophytic infection, which mimicks other skin disorders because of the modified typical clinical presentation of ringworm by the improper use of topical and systemic steroids. In this report, the case of a 35-year-old woman with erythematous lesions on her face and right arm who had been diagnosed with eczema, contact dermatitis and had been treated with topical steroids for over a year is described. The culture performed from the lesions showed Trichophyton tonsurans. The presented case was found to be significant as being the first case of tinea incognito caused by Trichophyton tonsurans and has been discussed in the view of the literature

Background: A lot of cosmetic and Ayurvedic products containing unlabeled depigmenting agent and steroids are available readily over the counter sale. The side effects of these products are not documented and can lead to adverse effects of continuous usage. Objective: By this study, we aimed to find out the true nature of the above problem and it's implication in the Indian rural scenario. Methodology: All patients attending dermatology department during the period of 3 months from May to June 2013 for skin diseases were enquired about unsupervised use of any cosmetic product on their facial skin, duration of use, any side effect experienced through the prescribed questionnaire. Results: Total 50 patients were recruited for the study. Out of which, 48% were males and 52% were females. Seventy-four percent of people had applied topical products/steroids in an attempt of attainment of fair complexion, 14% for melasma, 8% for acne induced hyperpigmentation, and 4% for dark circles. About 80% people had obtained one or the other products over the counter sale, 8% had followed the attractive advertisements, 8% had started the application on the recommendation of friends/family while only 4% people had correctly gone through the proper channel to consult a dermatologist. Conclusion: The problem of topical products or steroids abuse is rampant and significant, and unless and until immediate steps are taken to root out this problem from our setup, the condition will become worse all the more.

We are reporting a case of 70-yr-old gentleman who presented to dermatology clinic with painful red rash which was confirmed to be a sweet's syndrome by biopsy . Further work up showed IgA myeloma. The patient showed good response to systemic and topical steroid. This case illustrate the need of considering paraneoplastic phenomenon in elderly with sweet's syndrome . Sweet's syndrome has been rarely reported as paraneoplastic phenomenon in of multiple myeloma.

Erosive adenomatosis of the nipple (EAN) is a rare, benign neoplasm of breast lactiferous ducts. Peak incidence is in the fifth decade in women. Clinically, it is mistaken for eczema during early stages and Paget's disease at later stages. We present a young lady with EAN who was advised mastectomy. It is important for dermatologists to be familiar with this entity to avoid topical steroid abuse and unwarranted breast removal. This case is presented for awareness and importance of correct and early diagnosis.

Dear Editor, An 8-year-old male child attended our outpatient department with complaints of left eye pain, redness and defective vision of 3 weeks duration. He gave history of bathing in the river 1–2 h per day for a period of 2 months prior to the onset of ocular symptoms. The patient had no systemic symptoms and his general examination was normal. His visual acuity was 20/20 OD and 20/60 OS. His intraocular pressure was 14 mmHg in both eyes by applanation tonometry. Slit lamp examination of the left eye revealed fine- and medium-sized keratic precipitates [Fig. 1], 2+ cells and flare, yellow-colored mass at 6 o″ clock position arising from the angle extending on the iris and endothelial surface confined to less than 1 o″ clock hour position [Fig. 2]. Rest of the ocular examination was normal. Blood smear study showed mild eosinophilia and normal morphology of neutrophils, basophils and lymphocytes. No microfilaria or malarial parasites were observed. Stool examination showed no ova, cyst, parasites, ameba or bacteria. Urine microscopic examination was normal. Mantoux was negative and chest X-ray PA view was normal. Based on clinical features and laboratory investigations [Table 1], his condition was diagnosed as presumed nonviable parasitic angle granuloma (PPG). He was treated with topical steroids (1%percent prednisolone acetate hourly), mydriatic eye drops and oral analgesics. Figure 1 Medium-sized keratic precipitates (white arrow) in granulomatous anterior uveitis Figure 2 Angle granuloma at 6 o″ clock position situated between iris (vertical arrow head) and cornea (horizontal arrow) Table 1 Biochemical values of the patient with acute granulomatous anterior uveitis After 3 weeks since topical steroids were not effective in controlling the inflammation, limbal cryotherapy (LC) was performed under short general anesthesia. Following peritomy, a 2-mm cryoprobe was placed 1 mm behind the conjunctivocorneal junction. Each cryofreezing lasted for 15 s. At the end of 15 s, rapid thawing was induced by irrigating the ice ball with normal saline. In total, three such applications were performed within the 1 o″ clock hour position at the base of the granuloma. Time interval between each application was 10 s. The tip of the probe was placed gently over the site, avoiding undue pressure. By this technique, approximately 1.3 clock hour area received cryotherapy at the base of the granuloma followed by topical steroids. Granulomatous anterior uveitis regressed completely in 6 weeks. Corneal opacity with peripheral anterior synechiae was observed at the site of PPG [Fig. 3]. At the end of 5 months follow-up, the treated eye had normal vision, tension and fundus. There was no recurrence of uveitis. Figure 3 (a) Angle granuloma not responding to steroid. (b) Two months after limbal cryotherapy granuloma regressed and uveitis controlled. Endothelial opacity seen at 6 o″ clock position Anterior granulomatous uveitis due to nonviable parasite is a recognized clinical[1] entity. Our patient's condition resembles trematode-induced granulomatous uveitis[2] described by Rathinam et al., but, in our experience, response of PPG to topical steroid eye drops or surgical excision was unpredictable and unsatisfactory. Because surgical manipulation of[3] nonviable parasite can cause exacerbation of inflammation, we performed limbal cryotherapy. Even though eosinophilia is a feature of visceral larva migrans,[4] decline of serum IgE following ocular cryotherapy rules out intraocular and visceral parasite. Our LC is different from[5] cyclodestructive cryotherapy. Limbal stem cells deficiency and hypotony are potential complications. In conclusion, LC along with topical steroids is effective in treating PPG involving less than 1 o″ clock hour position in angle.

Erosive pustular dermatosis of the scalp (EPDS) is a rare inflammatory disease with unknown etiology that usually occurs in the elderly. It is characterized by multiple sterile pustules, chronic crusted erosions, cicatricial alopecia, and skin atrophy. It typically develops in aged or sun-damaged skin and is most often accompanied by a history of local trauma. Histopathologically, non-specialized change manifests as atrophic epidermis and chronic inflammation. Although this disease mainly occurs in elderly white women, we here report a case of EPDS in a 35-year-old man, following hair transplantation as a local trauma, that was successfully treated with topical steroid.

Nevoid hyperkeratosis of the nipple and/or areola (NHNA) is a rare and benign disease, with poorly understood etiology and no definite therapeutic plan. Hereby, we report another case of NHNA, discuss about its clinical and histopathological features, differential diagnosis, and responsiveness to topical steroid.

Two topical antifungal agents (toinaftate and miconazole nitrate) and one topical corticosteroid antifungal (betamethasone with 3% chinoform) cream were evaluated in 58 patients of tinea cruris and tinea corporis to study their comparative clinical efficacy. Miconazole nitrate was found to be more efficaceous than toinaftate while betamethasone chinoform cream had no appreciable therapeutic effect on tinea cruris and tinea corporis.