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Skin lesions occurring over the knuckles can be a primary or characteristic manifestation of a disorder. Characteristic knuckle lesions may also be important cutaneous features of various internal disorders when they serve as useful clinical pointers, as well as may speak of the disease severity in certain instances. Furthermore, knuckle lesions also speak of various external factors as the underlying cause of the disease/lesions, such as trauma – occupational or otherwise, and contact dermatitis. Although knuckles essentially imply dorsal aspect of the metacarpophalangeal joints, many of the lesions described as those 'involving the knuckles' are seen over the proximal and/or less frequently, the distal interphalangel joints as well. This review presents a compilation of various inherited and acquired dermatoses and dermatological manifestations of various internal disorders associated with different forms of knuckle lesions.

Background: Vitiligo is known to have major psychosocial impact among the sufferers. “Vitiligo impact scale-22 (VIS-22)” is a recently developed specific scale to measure quality of life (QOL) in these patients. It was found effective in evaluating QOL among north Indian patients with vitiligo. Since the effect of vitiligo on QOL is variable, it is prudent to validate VIS-22 in various populations. Aim: This study aims to validate VIS-22 among south Indian patients with vitiligo. Methods: Vitiligo patients with education up to 10th standard were included as cases. Patients suffering from short-term illnesses served as controls. Cases and controls were given visual analog scale (VAS), dermatology life quality index (DLQI), Skindex-16 and VIS-22 to respond at 1st, 2nd, and 12th weeks. The criterion and construct validities of the scales were evaluated using Spearman's correlation coefficient (r). Student's t-test was used for disease specificity of VIS-22. Spearman's rank coefficient, paired t-test, and ANOVA were used to estimate first, second, and third measures of responsiveness, respectively. Results: A total of 153 cases and 155 controls were enrolled. The criterion validity showed strongest correlation with Skindex-16 (r = 0.832) and convergent validity with both DLQI (r = 0.752) and Skindex-16 (r = 0.832). It also showed strong correlation with emotional and functioning domain of Skindex-16 at baseline (r = 0.713 and 0.702, respectively) and at 12 weeks (r = 0.770 and 0.789, respectively). The scales were reliable at baseline and 2 weeks with excellent correlation between scores (r = 0.954). The VIS-22 scores were responsive at week 12 and similarly in VAS, DLQI, and Skindex-16. Conclusion: VIS-22 has vitiligo-specific questions and better QOL measurement properties compared to DLQI and Skindex-16. This study results found VIS-22 to be a valid, highly reliable, and responsive QOL-measurement tool among south Indian patients with vitiligo.

Background: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease characterized by intense pruritus. Hanifin and Rajka's criteria is the most common diagnostic criteria used in the hospital setup, which consists of 4 major and 23 minor criteria. The frequency of minor criteria may vary population wise. Aims: The aim of the study is to estimate the frequency of minor diagnostic criteria of Hanifin and Rajka in children with AD. Methodology: A hospital-based cross-sectional study of 174 children (≤16 years) with AD, was conducted based on history, clinical, and ophthalmological examination. Blood test to assess serum immunoglobulin E (IgE) level was conducted. Results: The most common minor criteria observed were Dennie–Morgan infraorbital fold (71.8%), early age of onset (67.8%), palmar hyperlinearity (67.8%), xerosis (67.2%), pityriasis alba (57.5%), and perifollicular accentuation (47.7%). Out of 143 cases whose serum was tested for IgE level, elevation was seen in 92. History of winter exacerbation was seen in 8% of the cases, while summer exacerbation was seen in none. On the ophthalmological examination of 111 cases, “high reading with no obvious keratoconus” was present in two cases while three cases were labeled as “keratoconus suspect.” Conclusion: Clinical features of AD vary with geographical location. The prevalence and severity of AD are influenced by several factors such as ethnic/racial, environmental, and dietary factors. Therefore, it is relevant for dermatologists to have a knowledge regarding common clinical features of AD in a given population for the diagnosis and thereby provide treatment to reduce the morbidity along with appropriate counseling.

Background: Basal cell carcinoma (BCC) is a common malignancy among light-skin races. Chronic solar exposure is the most important precipitating factor. In India, BCC is the second in order among the nonmelanoma skin cancers, the first being squamous cell carcinoma. Actual incidence and prevalence of this tumor in various geographical regions of India remain undefined. Aim: The aim is to study the demographic, clinical, and histopathological parameters of the patients suffering from BCC residing in a rural area of northern Karnataka. Materials and Methods: Retrospective data analysis of the patients suffering from BCC was performed from the records of dermatology outpatients' department of a tertiary healthcare center in north Karnataka. Results: A total of 41 cases of BCC were examined during 12 years. The duration of the lesions varied from 6 months to 20 years. Female patients outnumbered males in a ratio of 3.36:1. Majority of the patients were homemakers and agricultural workers. Nodular, noduloulcerative, and pigmented BCC were the most common clinical pattern and 9 (28.1%) cases of morpheaform BCC were recorded. Four patients had genodermatoses; three were xeroderma pigmentosum and one case of nevoid BCC syndrome. These patients had multiple lesions of BCC. Classical histopathological features were recorded in all cases. One specimen showed evidence of metatypical epithelioma. Conclusion: Most of the patients in this series belonged to the rural part of North Karnataka, predominantly homemakers and agricultural workers. Females were more commonly affected, attributable to the intermittent type of solar exposure. Morpheaform BCC accounted for less than a quarter of cases, and multiple BCCs associated with genodermatoses were seen in four cases.

Lepromatous leprosy (LL) is a systemic illness which involves various organs either directly due to Mycobacterium leprae or as a part of lepra reaction. Nail changes occur in leprosy with variable frequency but may not have a direct causal relationship with leprosy. Hereby, we are describing a case of untreated LL presenting with twenty nail dystrophy and a direct causal relationship of the same due to M. leprae.

Compensatory mechanisms in the human body are generally set in action when there is an absence or deficiency of an attribute to make up for the same. Such mechanisms may be intended to compensate for either the quantitative deficiency or functional impairment of an attribute performing a particular function. Frequently, in an attempt to normalize the homeostatic milieu, the compensatory mechanisms may work more than necessary producing undesired effects as well. In this review, we describe some of such compensatory phenomena in relation to clinical, immunological, pathological, and few other aspects of dermatology, as well as such phenomena characterizing some of the dermatotherapeutics.

Dilated pore of Winer is a benign tumor of infundibulum of the pilosebaceous unit. The morphological features of this condition are characteristic enough to allow a clinical diagnosis. It generally presents as an enlarged solitary open comedone-like lesion on the head and neck region or the trunk of elderly individuals. Although the diagnosis is mainly clinical, dermoscopy may be of further assistance. However, to the best of our knowledge, there are no documented dermoscopic features of the classical type of this disorder as in our cases. We report the dermoscopic findings of two cases along with clinical and histopathological correlation.

Necrolytic acral erythema (NAE) is a newly described entity, seen in patients infected with hepatitis C virus. It is characterized by its distinguishing acral distribution, psoriasiform skin eruption and histological features. Its etiopathogenesis is not fully understood though hypo amino academia, hyperglucagonemia and zinc deficiency are considered as probable causes. In 1996, El Darouti and Abu el Ela first described this entity in seven Egyptian patients with hepatitis C virus (HCV). Since then, several small studies and cases have been reported around the world. Nevertheless, it may occur independently without HCV association as a few cases have been reported recently. We report two seronegative cases of NAE, which responded dramatically with oral zinc therapy. This suggests that NAE could be an isolated clinical subset.

The term "reticulate" is used for clinical description of skin lesions that are configured in a net-like pattern. Many primary and secondary dermatoses present in such patterns involving specific body sites. Certain cutaneous manifestations of systemic diseases or genodermatoses also present in such manner. This review classifies and describes such conditions with reticulate lesions and briefly, their associated features.

Many paradoxical phenomena related to clinical, immunological, and therapeutic dermatology have been described. While some of them can be explained logically, the cause for others can only be speculated. Whenever encountered in clinical practice, background knowledge of such paradoxes may be useful to the clinician.

Of the various collagen vascular diseases seen in pediatric age group, discoid lupus erythematosus, systemic lupus erythematosus, neonatal lupus erythematosus, juvenile dermatomyositis and childhood scleroderma are common and of practical importance to clinicians. Various treatment modalities of these conditions have been discussed at length. Of these, some are conventional and routine,while others are used in challenging situations of these diseases. Autologous stem cell transplant, biological therapies, intravenous immunoglobulin and narrow band ultraviolet B are among the latest therapeutic options for these difficult-to-treat conditions in children.

Use of immunohistochemical technique is increasing in diagnosing various diseases. In many situations it may not be possible to differentiate entities with overlapping clinical and histopathological features. Immunostaining of cellular antigens is immensely helpful in such cases. Immunohistochemistry (IHC) has also been in use for targeted cancer therapy. In this article, the discussion will be restricted to use of IHC in dermatological disorders and use of classical antigens with brief updating of some important newly discovered antigens.

Background: The metabolic complications and pathologic changes that occur in diabetes mellitus (DM) influence the occurrence of various dermatoses. Aim: To study the impact of control of diabetes on the pattern of cutaneous disorders. Materials and Methods: A cross-sectional descriptive study of patients attending diabetic clinic in a tertiary care hospital. A total of 500 consecutive patients were studied. Detailed history, clinical examination and relevant investigations were done to diagnose diabetic complications and cutaneous disorders. Dermatoses with or without known pathogenesis were correlated with age, gender, fasting plasma glucose (FPG), duration of diabetes, and complications of DM. Statistical analysis was carried out using Student "t" test and Chi-square test with 5% confidence interval (P value 0.05). Results: Majority of patients had well-controlled (FPG0.05) between the patients with or without DM specific cutaneous disorders was noticed with reference to age and gender distribution, duration of DM and FPG. Signs of insulin resistance, acrochordon (26.2%), and acanthosis nigricans (5%) were common, followed by fungal (13.8%) and bacterial (6.8%) infections. Eruptive xanthoma (0.6%), diabetic foot (0.2%), diabetic bulla (0.4%), diabetic dermopathy (0.2%), generalized granuloma annulare (0.2%), and insulin reactions (6.2%) and lipodystrophy (14%) were also seen. Conclusion: Well-controlled diabetes decreases the prevalence of DM-specific cutaneous disorders associated with chronic hyperglycemia. It is necessary to have a dermatologist in the diabetic clinic for early detection of potentially grave or predisposing conditions.

A 7-day-old premature female infant presented with rapidly progressive, erythematous, annular skin lesions from the 5 th day of life. She was diagnosed provisionally as a case of neonatal lupus erythematosus and was investigated accordingly. Histopathological examination of the skin biopsy specimen revealed presence of hyphae of dermatophytes in the stratum corneum, and the diagnosis was changed to tinea corporis. Differential diagnosis of the annular erythema of infancy has been discussed and the importance of scraping a scaly lesion for KOH preparation in the diagnostic work-up of such a patient has been highlighted.