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The technique of dermoscopy has come a long way since its inception for characterization of suspicious nevi for early detection of dysplastic changes in predisposed individuals. Not only has its scope expanded to aid in quick diagnosis of a majority of nonmelanocytic disorders of the skin, hair, and nails, but it is being rightfully exploited for a plethora of nondiagnostic uses. Its use in the diagnosis of various pigmentary, papulosquamous, and infectious disorders and disorders of the scalp and hair, nails, and mucosa bears testimony to the ongoing expansion of its protean indications across skin types. Dermoscopy has transformed the conventional approach to dermatological diagnosis from clinicopathological correlation to clinico-dermoscopic-pathological correlation. It aids in convincing an otherwise reluctant patient to agree to biopsy and guides the selection of optimum site for the same. Dermoscopic clues suggestive of stability or activity of the lesion and/or disease in various dermatoses are being accrued. Early assessment of therapeutic response to treatment is helpful for physicians, patients, and researchers conducting clinical studies. Aesthetic uses of dermoscopy are opulent and being explored. Dermoscopy has also provided the much-needed balancing act of interaction between practitioners and the new generation of patients. Last but not the least, dermoscopy has resulted in patients’ better understanding of their disorders and improved compliance with treatment protocols.

The injudicious use of antifungals, indiscriminate use of corticosteroids for instant relief, persistence of predisposing factors like sweat retention and uncontrolled diabetes, and emerging resistance to antifungals across the globe have rendered the management of an erstwhile simple infection, the superficial cutaneous mycoses highly complicated and tricky. Ciclopirox is an old yet efficacious, versatile, and safe topical antifungal of the hydroxypyridone family. Despite its numerous beneficial properties over the majority of other topical antifungals, it remains underutilized.

Age-related cutaneous manifestations are definitive pointer to the diagnosis of atopic dermatitis, the confirmation of which is solicited by 3 major and 3 minor criteria. Its unpredictable course is punctuated by exacerbations and remissions. Several treatment options, namely: 1st, 2nd and 3rd line are in vogue ever since. The 1st line envisages general measures, 2nd encompasses topical applications, while the 3rd take into account drug therapy comprising, systemic Corticosteroids, Cyclosporin, Azathioprine, Thymopentin, Interferon–therapy, Topical Calcineurin inhibitors: Tacrolimus and Pimecrolimus. The mode of action, their dosages and adverse drug reaction (ADR), in particular, have been focused in this paper with special attention to refresh their drug delivery (management) approaches (strategies) in perspective. An endeavor to focus attention to emerging etio-pathogenesis, and its application in the contemporary context has also been made.

Spiegler–Fendt sarcoid/lymphocytoma cutis, presenting as an asymptomatic, slowly progressive, erythematous macule of the size of a guinea over the left cheek, is presented in a 7-year-old girl, the diagnosis of which was complimented by lymphocytic exocytosis with spongiosis of the epidermis. Immunohistochemistry revealed wide-ranging T-cell variations, which was more positive for T-cell markers, CD3, of which predominance of CD4 subset was seen, emphasizing its role as a diagnostic tool.

Background: Hair transplantation in the current context has emerged as one of the most sought after treatments for andro-genetic alopecia. In conventional FUE technique of hair transplantation graft damage may occur due to various factors which can be eliminated by Instant Follicular Hair Unit Transplant (IFHUT), an innovative technique which involves extraction of hair follicle one by one from the safe donor area and implanting them immediately after extraction. Methods: 10 patients of andro-genetic alopecia were inducted to the study. One half of the donor area was utilized for IFHUT, while the other for conventional FUE and the implantation results were compared pictographically as well as with trichoscopy and documented at each follow up. Results: Significantly, better growth was seen by the naked eyes, pictographic comparison and hair scope examination in the IFHUT site in 9 patients. Conclusion: Although this technique presents a steeper learning curve for the surgeon, need for clear protocols and proper execution, the efficacy and superiority of results presented by the IFHUT method show the potential of this technique to reshape the future of the hair transplant industry.

Epidermolysis bullosa pruriginosa, a rare variant of dominant inheritance pattern, characterized by itchy, papules and/or nodules coalescing to form plaque(s), studded by blisters, is describe in a young man an index case. In all 12 afflicted individuals of the 27 family members was interesting, the diagnosis of which was made by its morphology and inflammatory changes in the epidermis, comprising hyperkeratosis, moderate acanthosis, presence of inflammatory cells, and above all inflammatory cell containing sub-epidermal cleavage or cleft.

Background/purpose To plan a quality improvement project, we need to understand the practice patterns of physicians. We undertook an online survey of systemic lupus erythematosus (SLE) patients and physicians providing care to SLE patients to determine the patterns of medical care provided to SLE patients. Materials and methods Two self-report surveys were developed. A 12-item survey for the patients and a 13-item survey for physicians enquired about longitudinal care for SLE. Surveys were administered online to physicians providing care to SLE patients, and to patients who self-identified as having SLE, through the Lupus Society of Illinois. Patient and physician data were analyzed for physician practice patterns for SLE care, using chi square tests and t tests. A P value of 0.05 or less was considered significant on two-tailed tests. Results A total of 283 patients completed the survey. Mean (SD) age and disease duration of patients were 45.9 (13.2) and 12.7 (9.7) years. Half of the participants were being seen at 3–4-month intervals. More than 70% of patients reported being tested for antinuclear antibody (ANA), and 20–30% anti-ENA antibody and Sjögren’s (SSA/SSB) antibodies, respectively, at each follow-up visit. Eighty-six rheumatologists completed the surveys. Mean (SD) age was 55 (12) years and 56% were men. More than half (54%) provided care only in a private practice setting. More than 80% of physicians reported seeing their SLE patients at 3–4-month interval. Only 2% reported performing ANA tests at each visit, while 4–5% performed anti-ENA and anti-SSA/SSB antibody tests at each visit for their SLE patients. More than 75% of physicians in private practice also ordered sedimentation rate at each visit for their SLE patients. Conclusions Unnecessary laboratory investigations may be being ordered routinely for patients at every visit. These results indicate a need for physician education on indications and utility of some of the laboratory tests such as ANA.

Erythroderma/generalized exfoliative dermatitis, presenting with intensely itchy, dry, scaly, widespread erythema covering whole of the skin surface is reported, the diagnosis of which was primarily clinical but was supplemented by histopathology. Other investigations such as hemogram, immunoglobulin E (IgE), and serum fluorescent enzyme immunoassay (FEIA) were supportive; while IgE was high, serum FEIA was extraordinary high. Identifying it as a clinical pearl of hyper-IgE syndrome, recovery of heavy coloniz ation of Klebsiella pneumoniae, anaerobic Gram-negative bacteria, was contrastingly unique responding affectively to metronidazole, a drug specific for the purpose.

Erythema annulare centrifigum emphasizing the role of beta cell of head of pancreas in its plausible causation is describe, the features of which conformed to non-insulin dependent diabetes mellitus type 2.

A rare association of herpes zoster/shingles concomitantly occurring in a heavy weight elderly man with established non-insulin dependent (Type 2)/ adult onset diabetes mellitus is reported, highlighting the cardinal clinic features apparent has numbness, tingling, painful, group of vesicle / blister over an erythematous background occupying the left cheek ipsilaterally conforming to the distribution of branches of the facial nerve. The relevant citations were taken cognizance of and incorporated in the text. The response to acyclovir 800 mg 5 times in a day for period of 10 ten days was gratifying.

Background The role of IL-17 immunity is well established in patients with inflammatory diseases, such as psoriasis and inflammatory bowel disease, but not in asthmatic patients, in whom further study is required. Objective We sought to undertake a deep phenotyping study of asthmatic patients with upregulated IL-17 immunity. Methods Whole-genome transcriptomic analysis was performed by using epithelial brushings, bronchial biopsy specimens (91 asthmatic patients and 46 healthy control subjects), and whole blood samples (n = 498) from the Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED) cohort. Gene signatures induced in vitro by IL-17 and IL-13 in bronchial epithelial cells were used to identify patients with IL-17–high and IL-13–high asthma phenotypes. Results Twenty-two of 91 patients were identified with IL-17, and 9 patients were identified with IL-13 gene signatures. The patients with IL-17–high asthma were characterized by risk of frequent exacerbations, airway (sputum and mucosal) neutrophilia, decreased lung microbiota diversity, and urinary biomarker evidence of activation of the thromboxane B2 pathway. In pathway analysis the differentially expressed genes in patients with IL-17-high asthma were shared with those reported as altered in psoriasis lesions and included genes regulating epithelial barrier function and defense mechanisms, such as IL1B, IL6, IL8, and β-defensin. Conclusion The IL-17–high asthma phenotype, characterized by bronchial epithelial dysfunction and upregulated antimicrobial and inflammatory response, resembles the immunophenotype of psoriasis, including activation of the thromboxane B2 pathway, which should be considered a biomarker for this phenotype in further studies, including clinical trials targeting IL-17.

Introduction Transition is defined as the purposeful and planned movement of adolescents and young adults with chronic physical and medical conditions from child centred to adult orientated health care services.1 Evidence supports that poorly planned transition in asthma is associated with an increased risk of non-adherence and loss to follow-up during a highly vulnerable period. It is essential that the transition process is co-ordinated and matched to developmental abilities of individuals and care not simply transferred at the age of 16 as has historically been the case. In line with NICE guidance on transition planning, we aimed to set up a regional transition service for severe asthma engaging young adults and their carers in service design and delivery. Methods A questionnaire aimed at exploring concerns and issues surrounding transition planning was developed and sent to asthmatics aged 14–16, on step 4 or 5 treatments under paediatric services across the region. Two focus discussion groups were held inviting families of those due to transition shortly and those who had recently transferred care. Results 17 completed questionnaires were analysed: median age 15 years, 9 male, average number of admissions per year 3.3. 71% expressed worries about their care moving to adult services and 94% felt that it was important that they were prepared for the move. Effective information sharing and communication were considered key, along with the provision of a named transition co-ordinator, meeting the adult team early and a gradual process of transition over 2 years. 8 families participated in the focus groups and similar themes emerged. Those who had recently transferred care felt unsupported and vulnerable, expressing anxiety surrounding emergency admissions. Shared pre-planned care pathways, asthma passports and alerts linked to health records were considered important. Conclusion Based on this feedback, we co-produced a patient-centred transition model with our young adults (figure 1) and at North Manchester have established a young adult severe asthma clinic. To date, 31 young adults are currently transitioning to one of 3 adult centres in the region and evaluation of services and patient experience are under review. Reference Blum RW. Journal Adolescent Health1993;14(7):570–6.

Biologics are a group of drugs that precisely affect certain specific steps in the immune response and are an extremely useful group when used in an appropriate setting. However, their use can often be a double-edged sword. Careful patient selection and thorough knowledge of adverse effects is a key to their successful use in various disorders. The initial enthusiasm has gradually given way to a more cautious approach wherein a balance is sought between clinical usefulness and expected side effects. The adverse effects of the biologics most commonly used in dermatology have been carefully listed for ready reference. The plausible causes of the adverse reactions are succinctly outlined along with their incriminating factor(s). Besides, in brief, the attention has been focused on their management. The content should provide an essential didactic content for educating the practitioner.

Atopic dermatitis is well-known age-related/oriented caption recognized through well-defined clinical features usually having an onset in infancy invariably marching towards childhood, adolescent adult and elderly (senile) phases. This particular aspect seems unique, and was succinctly explored through literature, the highlights of which form the position paper for vivid comprehension of evolving clinical spectrum, which might add up to elevation of dreaded symtomatology, a part component of the entity. The criteria for intrinsic and extrinsic variant of AD, in particular, are emphasized.

Multiple/overlap autoimmune syndrome, comprising systemic lupus erythematosus, dermato-polymyositis, and non-insulin dependent/adult onset diabetes mellitus is being reported in a 53-year-old woman. The diagnosis of each of them was based on cardinal clinical criteria supplemented by laboratory undertones. The drug delivery (management) and approaches (strategies), in particular takes cognizance of stability and acceptable improvement, but for abrupt multiple group vesicular eruption over the erythomatosus base accompanied by numbness, tingling and pain essentially afflicting the right forehead and the face for which acyclovir was administered in recommended dosages for herpes zoster vericella (shingles).

Atopic dermatitis is a well-recognized clinical entity, several facets of which continue to be mystified. Accordingly, its etio-pathogenesis is largely elusive. It appears to be an outcome of interplay of several undertones, namely: genetics, maternal factor and inheritance, pregnancy/intrauterine, environmental factors, immune dysregulation, immuno-globulins, role of diet, and infection. Besides, recent innovative breakthroughs consisting of nutritional supplementation, the highlights of which were considered worthwhile to take stock of to define its current status. An endeavor to enlighten the audience has been made for their benefit.

Introduction Anxiety and depression correlate with poor asthma control. There is a cyclical relationship: poor asthma control increasing likelihood of emotional distress, which in turn reduces patient adherence and healthcare utilisation. In this study we assessed quality of life and the prevalence of depression and anxiety in patients with severe asthma. Methods 55 patients on step 4–5 therapy attending the severe asthma clinic at North Manchester General Hospital, completed two questionnaires anonymously: Hospital Anxiety and Depression Scale (HADS) and Health Survey Short-Form (SF-36). The HADS yields scores for anxiety and depression with scores greater than or equal to 8/21 in either domain considered clinically significant. SF-36 scores were transformed into composite mental and physical component scores, with scores Results 49% and 31% of the sample had clinically significant anxiety and depression respectively. 33% had scores falling in the moderate-severe range for anxiety and/or depression with 5 patients having co-existing moderate-severe anxiety and depression. Patients reported poor quality of life relating to their physical (50%) and mental health (33%). Conclusion The prevalence of anxiety in patients with severe asthma is significantly higher than in patients with chronic respiratory disorders (49% cf. 29%) 1 and is linked to poorer health and quality of life outcomes. Extrapolating from our findings, we expect a third of patients in the asthma service (≥500 patients seen per year including 125 new referrals), to benefit from individual psychological support. NICE guidance recommends each should receive initial assessment and 12 therapy sessions (cognitive behavioural therapy/psychodynamic psychotherapies). The position paper by the Kings Fund 2 argued that mental health services should be delivered as part of an integrated approach to health. This study supports a clear role for an integrated physical health clinical psychology service as part of routine care for patients with severe asthma. References Naylor, Haines, Vyas, Fowler. M3 anxiety and depression in patients with breathing pattern disorders or chronic respiratory disease. Thorax2015;70:A227–A228. Naylor, Das, Ross, Honeyman, Thompson, Gilburt. (2016). Bringing together physical and mental health . A New Frontier for Integrated Care . London: The Kings Fund.

Anthralin (1,8-dihydroxy-9anthrone, dithranol) was first synthesized as a derivative of chrysarobin, prepared from the araroba tree in Brazil over a century ago. Drawbacks to the use of anthralin include irritation and discoloration of the skin. This property of the molecule prompted workers to investigate details of its pharmacology, mode of action, and indications. The major point of this article is to highlight and revisit these aspects for pertinent future use. Therefore, it is worthwhile to consider that the drug is relatively innocuous, yet effective, and is devoid of any systemic side effects in contrast to a wide variety of systemic and topical therapies available for psoriasis and other dermatoses.

Acute scrotum, an unusual manifestation of non-gonococcal urethritis (NGU), epididymitis and orchitis, in a middle aged man is described with cardinal clinical features characterizing it as a syndrome. Investigations were corroborative to conform to non sexually transmitted disease. E. Coli, sensitive to levofloxacin, was recovered on culture, which showed an affirmative response to levofloxacin intravenous infusion, uriliser and urispas.

The narrative of applied anatomy of scrotum, a protective reservoir for the testis and related anatomical constituent of reproduction are formed, emphasizing its nerve, blood supply and lymphatic draining system. Its salient physiological characteristics too are described. The role of magnetic resonance imaging (MRI) in evaluating applied anatomical status in, particular, is define. Scrotum, plural scrotums or scrota, adjective scro’tal, a bag of skin and muscle that contains the testicles in males. The scrotum has its origin (borrowing) from Latin scrA tum[1]. *Corresponding author: Prof. Virendra N Sehgal, MD, FNASc, FAMS, FRAS (Lond), Dermato Venerology (Skin/VD) Center, Sehgal Nursing Home, A/6 Panchwati, Delhi-110 033(India), Tel: 011-27675363; 98101-82241/ Fax: 91-11-2767-0373; E-mail:drsehgal@ndf.vsnl.net.in; sehgalvn@yahoo.co.in Citation: Sehgal, V.N., et al. Scrotal swellings: Scrotal anatomy and physiology (part I). (2016) Invest Dermatol Venereol Res 2(2): 1-3. Scrotal Swellings: Scrotal Anatomy and Physiology (Part I) Ashna Malhotra1, Virendra N Sehgal2*, Jangid B. Lal3 Received date: September 16, 2015 Accepted date: February 15, 2016 Published date: February 19, 2016 DOI: 10.15436/2381-0858.16.008 Invest Dermatol Venereol Res | Volume 2: Issue 2 Sehgal, V.N., et al. a b

Melasma, a hypermelanosis of the face, is a common skin problem of middle-aged women of all racial groups, especially with dark complexion. Its precise etio-pathogenesis is evasive, genetic influences, exposure to sunlight, pregnancy, oral contraceptives, estrogen-progesterone therapies, thyroid dysfunction, cosmetics, and drugs have been proposed. Centro-facial, malar, and mandibular are well-recognized. Epidermal pigmentation appears brown/black, while dermal is blue in color, and can be distinguished by Wood's lamp illumination. The difference may be inapparent with mixed type of melasma in skin types V and VI. An increase in melanin in epidermis: basal and suprabasal layers and/or dermis is the prime defect. There is an increased expression of tyrosinase related protein-1 involved in eumelanin synthesis. The use of broad-spectrum sunscreen is important, lightening agents like retinoic acid (tretinoin), azelaic acid, and combination therapies containing hydroquinone, tretinoin, and corticosteroids, have been used in the treatment of melasma, and are thought to have increased efficacy as compared with monotherapy. Quasi-drugs, placental extracts, ellagic acid, chamomilla extract, butylresorcinol, tranexamic acid, methoxy potassium salicylate, adenosine monophosphate disodium salt, dipropyl-biphenyl-2,2'-diol, (4-hydroxyphenyl)-2-butanol, and tranexamic acid cetyl ester hydrochloride, in addition to kojic and ascorbic acid have been used. Chemical peeling is a good adjunct. Laser treatment is worthwhile.

Ever since its inception, acrodermatitis continua of Hallopeau, has been recognized as an uncommon clinical entity which has been sparingly reported from across the globe. The attempt to have cumulative information on prevalent nomenclature, definition, reminiscences, and clinical overtures has brought differential diagnosis and diagnosis in sharp focus, the highlights of which are outlined. Hence, it was considered important to review the evolution of treatment options available thus far including use of biologics.

Juvenile insulin-dependent diabetes mellitus type 1 (IDDM) is a well-recognized worldwide entity, the significance of which has increased because of its recent upsurging trends, warranting attention on variety of its clinical expressions, in particular, pertaining to skin, an aspect seldom taken cognizance of. Hence an endeavour to recap the related dermatoses, such as limited joint mobility syndrome including sclerodermoid (scleroderma-like) changes, xerosis, necrobiosis lipoidica diabeticorum, granuloma annulare, diabetic foot syndrome, has been made. Complexities relating to the recently explored issues of atopic dermatitis and drug hypersensitivity syndrome have also been covered adequately. In addition, the current concepts of the physiopathology of type 1 diabetes-related dermatoses are briefly recapitulated for clarity.

Ever since its inception a couple of centuries ago, hand dermatitis/eczema has been in the reckoning. Idiosyncrasies continued to loom large thereafter, till it acquired its appropriate position. Dermatitis/eczema are synonymous, often used to indicate a polymorphic pattern of the inflammation of the skin, characterized by pruritus, erythema and vesiculation. A spectrum delineated into acute sub-acute and chronic dermatitis of the hands. Pompholyx, recurrent focal palmer peeling, ring, wear and tear and fingertip eczema, apron, discoid eczema, chronic acral dermatitis, gut and patchy papulosquamous eczema are its clinical variants. Occupational dermatitis/eczema may be contributory. Etiological definitions are clinched by detailed history of exogenous and endogenous factors. However, scientific confirmation of the entity is through patch testing by using available antigens.

This article presents a detail histopathological study of secundines from 70 patients with premature rupture of the membranes and from 32 patients in whom the membranes ruptured during labour. Inflammatory reactions of varying degrees from mild, moderate to severe were found both in the control and study groups. But there was a higher incidence of inflammatory changes in the study group than in the control group. Moreover the inflammatory changes in the study group were more intense particulary when there were gross evidence of roughnened and meconium stained secundines. In this study, one case of placenta bipartita, one case of congenital anomaly of the umbilical vessels one placenta with retroplacental clots were detected.

Plexiform neurofibroma developing in neurofibromatosis type 1 is a fascinating overture whereby diagnosis is primarily based on clinical characteristics, the details of which are outlined. Nonetheless, it is imperative to establish a clear-cut clinical status vis-á-vis the adjoining tissues. Magnetic resonance imaging (MRI) may provide an additional supplement to the diagnosis and an aid to further management of the condition.

Background In view of the potentially serious side-effects of standard isotretinoin (0.5-1.0 mg/kg per day) therapy for acne, we studied the safety and efficacy of low-fixed dose isotretinoin plus topical 1%clindamycin gel in the treatment of moderate grade of acne. Methods In this prospective, non-comparative study, 320 adult patients, with moderately severe acne were enrolled and treated with fixed-dose isotretinoin at 20 mg every alternate day (approximately 0.15 mg/kg/day to 0.28 mg/kg/day) for 6 months along with topical clindamycin gel. All female patients were assessed for polycystic ovarian disease. Patients were followed up for 6 months. Results A total of 305 patients completed the study. Overall, patients received a mean of 38.4 mg/kg cumulative dose of isotretinoin, and very good results were observed in 208 (68.20%), while good response was seen in 59 (19.34%) of patients. Failure of the treatment occurred in 38 (12.46%), while relapses occurred in 50 (16.39%) of patients. Relapses were commoner in females, and 37 of 43 (86.04%) patients had polycystic ovarian disease. Though mild chelitis (91%) and xerosis (43%) were common, laboratory abnormalities in the form of elevated hepatic enzymes (5%) and elevated serum lipids (6%) were rare. Conclusion Six months of treatment with fixed-dose, alternate-day isotretinoin (20 mg) plus topical 1%clindamycin gel was found to be effective in the treatment of moderate acne in adult patients, with a low incidence of side-effects.

A reappraisal of histoid leprosy in the contemporary postglobal leprosy elimination era, a fallout of the World Health Organization leprosy elimination program, is succinctly outlined. The cardinal clinical expression, differential clinical diagnosis, the cytodiagnosis, and diagnostic salient histopathological features are highlighted.

Plexiform neurofibroma in neurofibromatosis type 1, an autosomal-dominant genetic disorder, is characterized by a combination of interlacing components or a network. The prominent enlargement of a nerve with tumor nodules results in the gross pathologic appearance termed "bag of worms." Plexiform neurofibroma was found in two of seven family members with neurofibromatosis type 1 in three generations. Ultrasonography/color doppler and magnetic resonance imaging, in addition to microscopic pathology, were used as diagnostic tools, and their indications for future use in the diagnosis of plexiform neurofibroma are highlighted.

Paraneoplastic pemphigus is the term used for an exclusive subset of pemphigus. The clinical lesions may resemble pemphigus, pemphigoid, erythema multiforme, graft-vs.-host disease, or lichen planus. A common denominator in all patients is the concomitant occurrence of either occult or confirmed systemic neoplasm. It is imperative to confirm the diagnosis through microscopy, where intraepidermal suprabasal cleavage, epidermal acantholysis, dyskeratotic keratinocytes and vacuolar changes in the basal epidermis, interfacial dermatitis, and epidermal exocytosis can be seen. Furthermore, the deposition of immunoglobulin G (IgG) and complement in the epidermal intercellular spaces, detected by direct and/or indirect immunofluorescence, is equally crucial for confirming the diagnosis.

Tacrolimus has been a useful therapeutic tool in dermatology practice ever since its inception. Accordingly, many "off-label" applications have been reported. Thus, its local immunosuppressive and steroid-sparing action stands recognized. Hence, its indications/uses were extended beyond atopic dermatitis to cover several dermatoses including other types of eczema, papulosquamous disorder of cornification, rosacea, other inflammatory skin conditions, vesicobullous disease, connective tissue disease, graft versus host disease, and follicular disorders. Many such diseases found to respond to tacrolimus therapy have been briefly recounted. It is worthwhile to conceive, however, that this topical immunomodulator should be reserved for use only as an alternative, should the conventional treatment be unresponsive. Hence, guarded use is warranted.

The morphological diagnosis of the plaque form of lupus vulgaris was made on the basis of distinct clinical features. An endeavor to supplement this diagnosis was made through laboratory investigations comprising total differential leukocyte count,erythrocyte sedimentation rate (ESR), immunoglobulin M (IgM), and polymerase chain reaction (PCR); the results of which were largely ambiguous. Regimented anti-tubular therapy (ATT) was utilized to arrive at the diagnosis. A perceptible regression of the lesions over the course of 6 weeks was remarkably beneficial to completing the treatment subsequently. ATT seems to bea feasible and well-conceived tool in the diagnosis of lupus vulgaris tuberculosis verrucosa cutis and pediatric scleroderma.

A study of 50 patients with tinea capitis revealed that it affects school children of low socioeconomic status. Clinical diagnosis of grey patch, black dot, seborrheic, kerion, and pustular inflammatory varieties was made. In all, 37 cultures were positive for dermatophytes, wherein most were Trichophyton violaceum. Some grew T. rubrum, T. mentagropytes, and T. verrucosum. A correlation between the clinical variants and fungi was also attempted.

Background Androgenetic alopecia (AGA) has received scant attention, despite it being a common entity that may result in significant psychosocial morbidity. There are some patients who do not fit into any of the proposed types. Moreover, there have been no published studies of pattern and prevalence of AGA in males in an Indian context. Hence, the present study was an attempt to classify AGA in males with the aim of producing a simple, effective and easily reproducible classification. Methods In total, 150 male patients were clinically diagnosed as AGA. After obtaining informed consent from all patients, a detailed history/examination was carried out, including a hair pull test, a trichogram investigation and a biopsy. Classification of AGA was subsequently attempted across Norwood guidelines. Results A gradual shift in the type of AGA from the earlier types (II and III) to more severe types (VI) with increasing age was significant. Twenty-seven patients did not fit into specific patterns according to Hamilton and Norwood classifications. In addition, type ‘a’ variant was recorded in 20% of patients, clearly indicating limitations of the existing classifications. Conclusions It was possible to classify 80% of the AGA, with II (28%) and III (15%) being the most common types of AGA. Twenty-seven patients (18%) could not be classified as a significant finding. There was considerable overlap in types IV, V and VI in the Norwood classification with the ‘a’ variants further confusing the picture.

Background and objectives. Although alopecia areata is a well-recognized entity, it is riddled with issues that need to be addressed; therefore, the epidemiology, clinical data, and psychological impact of alopecia areata were investigated. Materials and methods. An observational study was performed in 65 consecutive patients in the Indian subcontinent. Physical examination and questionnaires on medical, socioeconomic, and psychological status were performed. Results. The data observed in the present study revealed that socioeconomic factors and stress play a significant role in the initiation, development, and persistence of alopecia areata. This assumes greater importance in resource-poor settings where due attention to this disease can improve the management of this benign yet frustrating condition. Further studies may be warranted.

Background. Despite onychomycosis being an established entity, only a few studies are available from the Indian subcontinent. Hence, the authors investigated the comprehensive pattern of the condition. Aim. To investigate the epidemiologic, clinical, and mycologic factors associated with onychomycosis in 50 patients using a prospective study design. Methods. Fifty patients with potassium hydroxide–positive tests were evaluated according to a predetermined protocal recording details of epidemiologic, clinical, and mycologic characteristics. The collected data were analyzed to determine the correlation of various parameters. Results. Distal and lateral subungual onychomycosis, total dystrophic onychomycosis, and superficial white onychomycosis variants of onychomycosis were identified, mostly in men 21–30 years of age (mean age, 34.5 years). Epidemiologic characteristics were instrumental to either initiate, perpetuate, or disseminate the disease process. Trichophyton rubrum and Trichophyton mentagrophytes were the main causative dermatophytes; yeasts and molds were less common. Conclusions. Recognition of onychomycosis is less difficult providing the clinician is aware of the entity. Should the etiologic diagnosis be made, its eradication is desirable to surmount its implication in the society at large. (SKINmed. 2007;6: XXX–XXX) ©2007 Le Jacq

Tuberous sclerosis complex (TSC) is a well-known clinical entity, characterized by facial angio-fibroma, shagreen patch, and hypo-melanotic, and confetti-like skin lesions. An exquisite fresh case is being narrated, emphasizing its microscopic pathology. The role of magnetic resonance imaging of the brain, in particular, is highlighted to define the large variety of neurological abrasions for determining its future progression.

Background Although cutaneous tuberculosis (CTB) is well described, it is wise to periodically revisit the prevailing clinical and epidemiological features, of this somewhat uncommon entity in developed nations that is also usually neglected in national tuberculosis control programs in countries where tuberculosis is a major health problem, to maintain heightened awareness as the HIV pandemic runs its course. Methods Medical records of 165 cases of CTB, diagnosed from 2007 to 2010, were studied. The diagnosis in each was made on the basis of well-conceived and described criteria. All patients had earlier been immunized with Bacillus Calmette-Guerin soon after birth. Patients were evaluated by routine hematology, Mantoux test, screening for HIV status in addition to fine-needle aspiration cytology, and/or histopathology of the lesion. Results Of the 165 cases (94 males and 71 females, male:female ratio of 1.32:1; age range, 1-64), 85 were lupus vulgaris, 11 tuberculosis verrucosa cutis (paucibacillary), and 39 scrofuloderma (multibacillary). The remaining 17 were tuberculids comprising 24 lichen scrofulosorum, 3 papulonecrotic tuberculid, 2 erythema induratum, and 1 erythema nodosum, afflicting children and young adults (age range, 0-10; 21-30). Fine-needle aspiration cytology was diagnostic in 39 cases, histopathology in 117, and their combination in 9. Clinicopathologic correlation and response to antituberculosis treatment were additional diagnostic adjuncts. Conclusions CTB has a varied clinical and morphological spectrum. Cytology and histopathology play a key role in its diagnosis. An additional adjunct is the clinical response to antituberculosis treatment.

Genital elephantiasis is an important medical problem in the tropics. It usually affects young and productive age group, and is associated with physical disability and extreme mental anguish. The majority of cases are due to filariasis; however, a small but significant proportion of patients develop genital elephantiasis due to bacterial sexually transmitted infections (STIs), mainly lymphogranuloma venereum (LGV) and donovanosis. STI-related genital elephantiasis should be differentiated from elephantiasis due to other causes, including filariasis, tuberculosis, haematological malignancies, iatrogenic, or dermatological diseases. Laboratory investigations like microscopy of tissue smear and nucleic acid amplification test for donovanosis, and serology and polymerase chain reaction for LGV may help in the diagnosis, but in endemic areas, in the absence of laboratory facilities, diagnosis largely depends on clinical characteristics. The causative agent of LGV, Chlamydia trachomatis serovar L1–L3, is a lymphotropic organism which leads to the development of thrombolymphangitis and perilymphangitis, and lymphadenitis. Long-standing oedema, fibrosis and lymphogranulomatous infiltration result in the final picture of elephantiasis. Elephantiasis in donovanosis is mainly due to constriction of the lymphatics which are trapped in the chronic granulomatous inflammatory response generated by the causative agent, Calymmatobacterium (Klebsiella) granulomatis. The LGV-associated genital elephantiasis should be treated with a prolonged course of doxycycline given orally, while donovanosis should be treated with azithromycin or trimethoprim-sulphamethoxazole combination given for a minimum of three weeks. Genital elephantiasis is not completely reversible with medical therapy alone and often needs to be reduced surgically.