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Background: Facial contact dermatitis is an emerging skin disorder due to the use of a large array of materials over the face. It leads to psychological distress in patients, impacting their quality of life. Most of the allergens applied over the face vary as per cosmetic or herbal products' availability, usage, or religious practices. Identifying and discontinuing the implicated allergens will lead to a better prognosis and reduced morbidity in clinical practice. Objectives: To determine the frequency of different allergens responsible for causing facial contact dermatitis, in an urban part of central India, using patch test with the help of Indian standard and cosmetic series. Materials and Methods: All suspected patients (>18 years) of facial contact dermatitis visiting the outpatient department of dermatology were patch tested with both Indian standard and cosmetic series. Results: Out of 38/58 patch-test-positive patients, 71.06% were females, and 28.94% were males. Most patch-test-positive females were housewives. The most common allergens implicated were thiomersal (17.24%), followed by fragrance mix (15.51%), and paraphenylene diamine (12.06%). Conclusion: In our study, forehead and malar areas were most commonly involved indicating fairness creams and perfumes as the important contributors to facial contact dermatitis. Antigen batteries need to be updated with changing social and cultural trends, as many with a consistent history of aggravation with some products tested negative in patch tests. [ABSTRACT FROM AUTHOR]

To quantify the PPD content in hair dyes by measuring the PPD concentration after mixing the ingredients of commercial hair dyes. Methods: A total of 290 permanent hair dyes were tested. RP-HPLC-DAD analysis was performed to determine and quantify the PPD content. Results: The estimated mean of the PPD limit was 0.89 (95% CI [0.81– 0.96]). Of the 290 tested hair dyes, 7.2% (n = 21) exceeded the recommended PPD concentration after mixing. Significantly more hair dyes manufactured in India and China had a PPD content exceeding 2% after mixing compared to dyes from other regions (P = 0.001). Moreover, hair dyes manufactured in India and the UAE were more likely to have incomplete descriptions of the conditions of use and warnings on the label (P = 0.002). Conclusion: The effectiveness of the current regulations relevant to these products should be reevaluated. Moreover, through the use of good manufacturing procedures (GMPs), research, and the reporting of adverse reactions, hair dyes should be subjected to better control and monitoring in terms of their safety and quality. [ABSTRACT FROM AUTHOR]

Background: Hair dye is a concoction of various ingredients that can result in allergic contact dermatitis (ACD) which is a common problem encountered by dermatologists. Objectives: To find out the presence of potent contact sensitizers in commercially available hair dyes in Puducherry, a union territory in South India, and to compare the findings with similar studies conducted in different countries. Methods: Ingredients labels of 159 hair dye products from 30 brands that were manufactured and marketed in India screened for the presence of contact sensitizers. Results: A total of 25 potent contact sensitizers were found in 159 hair dye products. p‐Phenylenediamine and resorcinol were the most frequent contact sensitizer found in the study. The mean contact sensitizer concentration in a single hair dye product is 3.72 ± 1.81. The number of potent contact sensitizers in individual hair dye products ranged from 1 to 10. Conclusion: We observed that most of the consumer‐available hair dyes contain multiple contact sensitizers. Also, an inadequacy in mentioning the p‐Phenylenediamine content, and appropriate warning contents regarding hair dye use were not mentioned in the cartons. [ABSTRACT FROM AUTHOR]

Background: Textile is one of the important sectors in the Indian economy. The use of synthetic chemicals is maximum during the wet processing technique, which consists of dyeing, printing and finishing. Aims and Objectives: This study was conducted to find out the prevalence of occupational dermatological symptoms among the workers employed in the dyeing and printing unit of the textile industry. Materials and Methods: A cross-sectional study, with a sample of 242 workers, was conducted in three different dyeing and printing factories. The workers were interviewed using a semi-structured questionnaire adapted from the Nordic Occupational Skin Questionnaire. Results: The prevalence of dermatological symptoms on the hands was found to be 51.7%. The various pattern of lesions included redness in 0.4% to itching in 26% of dyeing and printing workers. Those working for >5 years had 2.21 times higher risk as compared to those working for ≤5 years Odds Ratio (OR): 2.21; 95% Confidence Interval (CI): 1.19–4.11). Similarly, those working in the dyeing section were at 2.94 times higher risk as compared to those working in the printing section (OR: 2.94; 95% CI: 1.58–5.47). Conclusion: The workers working in the printing and dyeing industry were at risk of developing skin lesions, which can partly be attributed to reactive chemicals used and partly to poor handling practices of the workers. [ABSTRACT FROM AUTHOR]

Background: Commonly used cosmetics such as soaps, face creams, lipsticks, sunscreens, perfumes, and eye, hair, and nail cosmetics can cause allergic contact dermatitis (ACD). Gold standard for diagnosis of ACD is the patch test. Aim: We conducted this retrospective study to find the common allergens in cosmetics causing ACD. Methods: Patients who underwent patch test with both cosmetic and fragrance series as well as Indian standard series, for suspected cosmetic dermatitis were included in this study. Data were collected from patch test register maintained in the department of dermatology. Results: The study included a total of 74 patients out of which 45 (60.8%) were males and 29 (39.2%) were females. Patients with positive and negative patch test had no statistically significant difference with respect atopy (P=0.521). Of 74 patients included in the study, 59 patients (79.7%) had positive patch test to at least one allergen. In our study, the most common allergen with positive patch test was fragrance mix (n =19; 25.7%) followed by paraphenylenediamine (PPD) (n=18; 24.3%) and thiomersal (n=10; 13.5%). A significant correlation was observed between suspected hair-dye allergy and PPD positivity (P < 0.001). Conclusion: Cosmetics are not very safe as claimed by the manufacturers, as it may contain many allergens. Contact sensitivity from cosmetics is becoming an important health problem. [ABSTRACT FROM AUTHOR]

Background: Although well known in clinical practice, research in lichen planus pigmentosus and related dermal pigmentary diseases is restricted due to lack of consensus on nomenclature and disease definition. Aims and Objectives: Delphi exercise to define and categorise acquired dermal pigmentary diseases. Methods: Core areas were identified including disease definition, etiopathogenesis, risk factors, clinical features, diagnostic methods, treatment modalities and outcome measures. The Delphi exercise was conducted in three rounds. Results: Sixteen researchers representing 12 different universities across India and Australia agreed to be part of this Delphi exercise. At the end of three rounds, a consensus of >80% was reached on usage of the umbrella term ‘acquired dermal macular hyperpigmentation’. It was agreed that there were minimal differences, if any, among the disorders previously defined as ashy dermatosis, erythema dyschromicum perstans, Riehl’s melanosis and pigmented contact dermatitis. It was also agreed that lichen planus pigmentosus, erythema dyschromicum perstans and ashy dermatosis did not differ significantly apart from the sites of involvement, as historically described in the literature. Exposure to hair colours, sunlight and cosmetics was associated with these disorders in a significant proportion of patients. Participants agreed that both histopathology and dermatoscopy could diagnose dermal pigmentation characteristic of acquired dermal macular hyperpigmentation but could not differentiate the individual entities of ashy dermatosis, erythema dyschromicum perstans, Riehl’s melanosis, lichen planus pigmentosus and pigmented contact dermatitis. Limitations: A wider consensus involving representatives from East Asian, European and Latin American countries is required. Conclusion: Acquired dermal macular hyperpigmentation could be an appropriate conglomerate terminology for acquired dermatoses characterised by idiopathic or multifactorial non-inflammatory macular dermal hyperpigmentation. [ABSTRACT FROM AUTHOR]

Introduction: Skin disorders represent a major proportion of occupational disorders. Dermatoses are becoming a source of concern in various population groups. In Kashmir valley, a large number of people are associated directly or indirectly with horticulture. Fruit cultivation is the main occupation of around 33 lakh people in the Union Territory. Aim: To study the profile of dermatological disorders in workers involved in fruit growing industry of Kashmir valley. Materials and Methods: This study was a cross‑sectional observational study, carried out over a period of 2 years, in which 701 workers of fruit growing industry of Kashmir valley were screened. Results: 276 (39.37%) of these workers were found to have skin lesions while the rest, that is, 425 (60.63%) were not found to have any dermatoses. Out of the total dermatological lesions observed, occupational dermatoses contributed to 94 cases (34.05%), while non‑occupational dermatoses accounted for 182 cases (65.94%). Among the occupational dermatoses, friction‑related disorders (callosities and cuts) were predominant (15.9%) followed by allergic (12%) and irritant contact dermatitis (6.2%). Out of the non‑occupational dermatoses group, the major portion was comprised by polymorphic light eruption (6.2%) in non‑infectious type while in infectious type, onychomycoses predominated (3.3%). Conclusion: Dermatological conditions form a major group of occupational dermatoses among workers involved in fruit cultivation. [ABSTRACT FROM AUTHOR]

Background Psoriasis is a chronic papulosquamous disorder of skin associated with systemic manifestations. Genetic and environmental factors play a major role in the development of psoriasis. Studies in India reveal a prevalence of 0.44 to 2.8%. Updated data of clinical trends will help in the diagnosis and management. Methods To calculate hospital-based prevalence and the clinical patterns of psoriasis among patients attending dermatology out patient department, Kakinada, Andhra Pradesh, India, a descriptive cross-sectional study was designed and conducted for 6 months from October 2020 to March 2021. A total of 430 patients with psoriatic features attended our OPD during this 6 months' period. Histopathological examination was done for relevant cases. Results A total 9821 patients attended to the dermatology out patient department during this period. Out of which 430 patients had psoriatic features, so it gives a hospital based prevalence of 4.4%. Out of 430 patients, 58% were males and the disease was most common in 25 -50 years' age group (53%). Most common clinical pattern observed irrespective of age and sex was Chronic Plaque psoriasis. Palmoplantar psoriasis (35%) and Scalp psoriasis (10.1%) were also common. Obesity, diabetes mellitus, hypertension, dye allergy and detergent allergy were frequently associated with the disease. Conclusion There is a slight increase in the hospital-based prevalence of psoriasis in our study which may be attributed to the lifestyle changes and comorbidities like obesity, diabetes and hypertension. Increased incidence of allergic contact dermatitis with use of dyes, detergent and cosmetics may be the trigger for scalp and palmoplantar psoriasis. [ABSTRACT FROM AUTHOR]

This article discusses a series of 15 cases of dermatophytosis (a fungal infection of the skin) complicated by irritant contact dermatitis (ICD) in India. The cases were caused by the use of over-the-counter (OTC) irritants, such as dithranol and salicylic acid. The patients experienced symptoms such as burning sensation, hyperpigmented patches, erythema, erosions, and scaling. The diagnosis was challenging because the lesions mimicked other skin conditions. The main treatment approach involved the use of topical steroids and antifungal medications. The article highlights the need for public awareness about the inappropriate use of OTC medications and irritants. [Extracted from the article]

BACKGROUND: Lower legs and feet eczema may be due to exogenous causes such as allergic contact dermatitis (ACD) or endogenous cause such as atopy. Currently, patch testing is the only scientific proof of contact allergy. AIMS: The aim was to study the clinicodemographic profile and to evaluate the role of patch testing in lower leg and feet eczema. MATERIALS AND METHODS: This was a cross-sectional study conducted among 60 patients with lower leg and feet eczema. They were subjected to patch testing with Indian standard series and readings were interpreted according to the International Contact Dermatitis Research Group scoring system. RESULTS: Our study included 32 (53.3%) males and 28 (46.7%) females (M: F = 1.1:1). The mean age was 42.61 ± 13.40 years corresponding to occupationally active age group. Construction workers (10 [31.25%]) were the most common occupational group affected among males (P = 0.007). Among females, most commonly affected were housewives (10 [35.71%]) (P = 0.0002). The most common pattern of eczema seen was ACD (22 [36.7%]). Positive patch test response was recorded in 17 (28.3%) patients and the most common allergen found to be positive was potassium dichromate (6 [35.3%]). Correlating the morphology with patch test results, ACD (13 [59.1%]) was significantly positive when compared to other eczemas (4 [10.53%]) (P = 0.000). CONCLUSION: Patch testing is a valuable diagnostic aid in lower leg and feet eczema. It plays a pivotal role in identifying causative allergens associated with ACD from which allergen avoidance can be advised for a better clinical outcome and quality of life. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate clinical and occupational profile and common allergens in patients with occupational contact dermatitis (OCD). Materials and Methods: The records of 455 (M:F 2:1) patients aged 18-85 years with allergic contact dermatitis were analyzed retrospectively. The diagnosis of OCD and patterns of dermatitis were defined by standard criteria. Indian standard series comprising 20 allergens and when suspected patient's own products were patch tested by Finn chamber method as per European Society of Contact Dermatitis guidelines and relevance of positive results was defined clinically. Results: Airborne contact dermatitis (27.7%), acral dermatitis (14.1%), hand dermatitis (12.9%), acrofacial dermatitis (12.7%), and facial dermatitis (10.5%) were the common patterns. Agriculturists (51.2%), homemakers (27.9%), office workers (24.6%), and construction workers (4.6%) comprised the majority. Positive patch test results in 58% cases were from parthenium (31.7%), p-paraphenylenediamine (PPD) (22.9%), nickel (16%), fragrance mix (11%), potassium dichromate (10.7%), cobalt (7.6%), and mercaptobenzothiazole (4.9%). Hair colorants, shoe chips, and shaving cream also produced relevant positive reactions. Parthenium, PPD, fragrance mix, and potassium dichromate in agriculturists; nickel, parthenium, PPD, fragrance mix, and potassium dichromate in women, and potassium dichromate and parthenium in construction workers elicited the most positive reactions. PPD and hair colorants elicited positive reaction mainly in office workers. Conclusions: The agriculturists, homemakers, and construction workers have OCD most frequently. Parthenium in farmers, potassium dichromate in construction workers, nickel in women, and PPD in office workers were the major contact allergens. The study is limited by its retrospective design, small number of patients, and limited number of patch test allergens. [ABSTRACT FROM AUTHOR]

Background: Pigmented contact dermatitis (PCD) is a non-eczematoid variant of contact dermatitis, mainly characterised by hyperpigmentation. It occurs due to contact with a low amount of allergen over a long duration of time. PCD is frequently seen in Indians but is often misdiagnosed or underdiagnosed because of the asymptomatic nature of the entity. The aetiology and the allergens implicated in PCD in the Indian subcontinent is still an enigma because of the limited studies done. Materials and Methods: This was an institution-based cross-sectional study, done at a tertiary hospital. Patch testing with Indian Cosmetic Series was conducted in a standardised method. Readings were taken at 48 hrs/72 hrs and on the 7th day [Figure 2]a and [Figure 2]b. The International Contact Dermatitis Research Group (ICDRG) scoring system was used to grade the readings. Results: Out of the 38 biopsy proven cases of PCD, 18 (47%) showed lichenoid features, 17 (45%) showed spongiotic features, 3 (8%) showed a mixed lichenoid and spongiotic pattern. Among total 1216 (32 patches × 38 patients) patch applied, 42 (3.4%) showed positivity in 30 patients. Among allergen categories, colorant (PPD) was found to be most common (37%) followed by fragrances (18%), preservatives (15%), anti-microbial (11%) and emulsifier and anti-oxidants (each 8%). Conclusion: It is important to identify the allergens implicated in PCD to help in better management of the condition. Patch testing proves to be a non invasive, low cost method and its role is indispensable in identifying the correct allergen. [ABSTRACT FROM AUTHOR]

Background: Hair dyes are commonly used for the concealment of grey hair in India. The pigmentary alterations produced by hair dyes on the face and neck have not received sufficient attention. Aims: To study the pigmentary alterations on the face and neck in hair dye users, and identify possible risk factors associated with the face and neck hyperpigmentation. Methods: A hospital-based descriptive cross-sectional study was done on consecutive hair dye users. A detailed history was taken, and a clinical examination was done to record the pigmentary alterations. The patterns, areas affected, the intensity of hyperpigmentation, percentage of the area involved and risk factors were noted. Results: One hundred and twenty patients were included in the study. Around 118 (98.3%) patients had hyperpigmentation over face and/or neck: 16 (13.3%) barely perceivable, 40 (33.3%) mild, 44 (36.7%) moderate, and 18 (15%) severe pigmentation. The lateral forehead (106, 88.3%), the helix of the ear (106, 88.3%), central forehead (97, 80.8%), and zygomatic area (92, 76.7%) were the most frequently affected areas in our study. Fourteen patients (11.7%) had depigmented macules on the scalp and/or lips. Conclusion: Pigmentary alterations, particularly hyperpigmentation over the upper face and ears are common with the use of hair dyes. The skin type may play a role in the intensity of hyperpigmentation. [ABSTRACT FROM AUTHOR]

Background: Allergic contact dermatitis (ACD) is a major cause for foot wear dermatitis. Patch testing is the standard investigation for diagnosis of ACD. Identification of the causative allergen and avoidance of the same is the most important for patient management. Aims: This study was conducted to find the common allergens in footwear, causing ACD, by retrospective analysis of the data of patients who had undergone patch testing with footwear series (FWS), approved by the Contact and Occupational Dermatoses Forum of India. Materials and Methods: A total of 276 cases with footwear dermatitis who underwent patch test with FWS using Finn chamber method were studied. Statistical analysis was done using statistical package for social sciences (SPSS) version 24. Data was described using frequency and percentages. P value of less than 0.05 was considered significant. Results: In this study 101 (36.5%) patients had positive patch test to at least one allergen. Among this, 43 (15.6%) were positive for single allergen only and 58 (21.01%) patients had positive patch test reactions to multiple allergens. The most common allergens with positive patch test were black rubber mix, mercapto benzo thiazole, and thiuram mix. Patients with either a positive or negative patch test had no statistically significant difference in the history of atopy. The limitations of this study include the lack of patch testing with the patient's own footwears and lack of follow-up after informing patients regarding allergen avoidance. Conclusions: Patch test must be done for all foot eczema cases for early identification of the causative allergen and also to provide suitable alternatives. [ABSTRACT FROM AUTHOR]

Background: There is a trend of increase in number of contact dermatitis cases. Studies on the prevalence and epidemiological pattern of allergic skin disorders in Indian scenario are not much available. The present study was designed to assess the epidemiological pattern of contact dermatitis in rural and urban areas in a peripheral district in eastern India. Aims and Objectives: This study was undertaken to find the prevalence of contact dermatitis and to assess the epidemiological pattern of contact dermatitis both in rural and urban community. Materials and Methods: The study was conducted in a medical college located at a semi-urban area in eastern India with written informed consent obtained from each participant. This hospital-based cross-sectional study was done from May 2017 to April 2018. Study population consisted of patients attending the dermatology OPD and having lesions clinically suggestive of contact dermatitis and there were 268 such patients. Patients attending the OPD were divided into urban and rural as per their address. Data analysis was done using suitable, standard, and appropriate statistical methods. Results: The prevalence of contact dermatitis was 4.38% among the dermatology OPD attendees. Urban prevalence was statistically significantly (P < 0.05) higher than rural prevalence. Contact dermatitis was common in the age group of 41–50 years. In urban areas, females were more affected than those in rural areas. Occupationally, the difference between urban and rural patients of contact dermatitis was statistically significant (P < 0.05). Cosmetic history in the urban group was significantly more (P < 0.05). Conclusions: Contact dermatitis prevalence and patient profile in certain factors showed a statistically significant difference between urban and rural patients. [ABSTRACT FROM AUTHOR]

Introduction: Allergic contact dermatitis (ACD) is a growing concern due to increased use of cosmetics and topical medications routinely and exposure to a large number of allergens on day-to-day basis. Patch testing is a reliable method for detecting the causative antigens in suspected cases. Aims and Objectives: To assess the demographic profile, pattern of ACD, and patch test profile of suspected cases of ACD attending contact dermatitis clinic of our department. Materials and Methods: It was a retrospective study in which all the data enrolled in the contact dermatitis clinic of our department over a 7-year period were analyzed. Patch testing was done using the Indian Standard Series of 20 antigens primarily, and other batteries were used depending on patient requirement and availability. Results: A total of 582 patients were enrolled in the contact dermatitis clinic over a period of 7 years. Hand eczema was the most common pattern seen in 268 cases followed by feet eczema, hand and foot eczema, facial eczema, forearm and leg eczema and photoallergic contact eczema. A total of 177 patients (30.4%) gave positive patch test results, with nickel sulfate being the most common allergen identified followed by potassium dichromate, cobalt sulfate, paraphenylenediamine, neomycin sulfate, and fragrance mix. Conclusion: Common allergens identified in our study were more or less similar to studies from other parts of India. However, due to the unique climate of the valley, the profile of parthenium sensitivity was low in our study when compared to the rest of the country. [ABSTRACT FROM AUTHOR]

Background: Majority of the cosmetics are synthetic in nature and capable of causing dermatitis among frequent users. Some cosmetics (bindi, sindoor, etc.) that cause serious skin inflammation are specific to Indian culture. Aim: To study the prevalence of contact dermatitis due to various cosmetics indigenous among Indian users. Materials and Methods: A cross-sectional study of 2,150 patients who attended dermatitis clinic at a regional hospital in north India. A total of 400 of these were suspected of cosmetic dermatitis based on clinical grounds and were subjected to patch test using Indian Standard Series and Cosmetic series kit. Results: Among the 400 patients identified for cosmetic dermatitis, 352 (88%) were female and 326 (81.5%) between 20 and 49 years of age. Bindi/kumkum (30%), hair dye (18%), and deodorant/perfume (14%) were primary cosmetics causing contact dermatitis. Patch test with the suspected cosmetics was positive in 52.75% cases. Patients who visited their doctor in the early stages of appearance of symptoms (<3 months) were more likely to have positive patch test. Conclusion: Higher incidence of cosmetic dermatitis is observed in adult females aggravated by use of inferior quality cosmetics. Early detection of the disease can be helpful. [ABSTRACT FROM AUTHOR]

Parthenium dermatitis is the commonest form of plant dermatitis in India, caused by the plant Parthenium hysterophorus. Systemic immunosuppressives are commonly employed in its treatment. However, there is a relative lack of comparative head-to-head trials. This study was done to assess the relative efficacy and safety of systemic treatments in Parthenium dermatitis. We systematically reviewed all the published studies investigating the safety and efficacy of systemic treatments for Parthenium dermatitis in the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and clinical trial registries. Treatment benefit data were tabulated based on outcome measures of scoring systems. The quality of evidence for each outcome was assessed by Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria for meta-analysis. The pooled Standardized mean difference (SMD) for case series and comparative studies based on clinical severity score (CSS) for azathioprine was 4.007 (95% CI (Confidence interval): 3.141, 4.873) and 0.746 (95% CI: 0.139, 1.352), respectively. About 88.8% (95% CI: 76.8%, 100.8%, p = 0.076) of the patients had excellent or a good response to azathioprine. Our meta-analysis shows that azathioprine has the highest level of evidence in the treatment of Parthenium dermatitis., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Common pesticides used in the region by agricultural workers may cause contact allergy. Methods: Thirty agricultural workers with a history of pesticide exposure and dermatitis involving the face, neck, trunk or extremities, and 20 controls comprising 2 groups of 10 subjects each, group 1 with dermatitis and no exposure to pesticides, and group 2 with neither exposure to pesticides nor dermatitis, were patch tested with 10 pesticides commonly used in the region by use of the Finn Chamber method. Results: The 30 patients, 20 of whom were male, aged 30‐77 years, had dermatitis for 1 month to 18 years, with relapses and remissions. Seasonal exacerbation was present in 18 patients. Six patients attributed aggravation of their dermatitis to pesticide exposure, and 2 of these reacted positively to propiconazole. Positive patch test reactions to pesticides occurred in 10 patients, but not in controls. Thiuram was the commonest sensitizer (4 patients). Three patients were sensitized to propiconazole, and 2 patients reacted positively to metaldehyde. Formaldehyde, mercaptobenzothiazole, cypermethrin and isoproturon gave positive reactions in 1 patient each. Conclusion: The sensitizing potential of pesticides remains a concern. Apparently, pesticide contact dermatitis is more common than expected, but remains under‐reported, as the implicated pesticides vary across regions and according to the crop patterns. [ABSTRACT FROM AUTHOR]

Venous leg ulcers are the most common form of non‐healing leg ulcers. They are subjected to treatments such as topical medications, dressings, and compression therapies. This can lead to exposure to a number of allergens with subsequent sensitisation and contact dermatitis of the regional skin. This may contribute to the poor ulcer healing. To detect the various contact sensitisers in patients with venous leg ulcers through patch testing, patients from 6 centres across India with venous leg ulcers of longer than 6 weeks duration were enrolled for the study. They were patch tested using a special parch test kit with 27 antigens. A total of 172 patients were included in the study; 82 (48.2%) tested positive for at least 1 antigen. Among them, polyvalent sensitisation was noted in 71% of patients. Wood tar mix (10.4%) and the framycetin (8.7%) were the most common allergens. There is a high frequency of allergic sensitisation to various ingredients of topical therapies used in the venous ulcer management, which may interfere with wound healing. Avoiding them can help obtain a better therapeutic outcome. [ABSTRACT FROM AUTHOR]

Introduction: Ageing is an irreversible and continuous process which results in a decline of functioning in all systems including the skin, thereby predisposing the elderly persons to develop various skin ailments. Proper knowledge of different dermatoses prevalent in this population in different geographic regions help the health care providers in better health care policymaking. Objective: The present study was conducted to delineate the spectrum of various dermatoses and the factors contributing to those dermatoses amongst the geriatric patients in a Tertiary care hospital, Salem. Material and Method: This was a cross-sectional prospective study, conducted in Dermatology Out-Patient department in a tertiary care hospital between March 2015 and June 2016. A total of 250 patients of age sixty years and above were included in the study. They were examined for diseases of the skin and appendages. Data were coded and analyzed. Results: Almost 84 types of skin lesions were identified among the geriatric age group. Nail disorders (48.8%), Degenerative conditions (42.4%) and Eczema (29.2%) occupied the top three common dermatoses in our study. Regarding specific disorders loss of nail lusture (17.6%) was the most common dermatoses followed by Allergic contact dermatitis (16%), Seborrhoeic keratosis (14.8%), Pruritus (12%) and Fungal infections (11.6%). Conclusion: Nail disorders(48.8%), Degenerative conditions(42.4%), and eczema(29.2%) occupied the top three common dermatoses in our geriatric study population. [ABSTRACT FROM AUTHOR]

Background: Construction industry is the second largest employment giving industry in India with many semi-skilled or unskilled workers taking up the occupation for livelihood without any training and proper guidance. Aim: To evaluate the pathogenic association of cement exposure to occupational contact dermatoses as evidenced by immune markers and to correlate their pulmonary functions with years of exposure to cement. Setting and Design: This was a cross-sectional study conducted among randomly selected cement workers. Methods and material: Evaluation of socioeconomic status (SES) and years of exposure of cement workers was done using a questionnaire. Clinical examination of skin lesions and strip patch test with application of potassium dichromate on unexposed skin was performed. Results were interpreted after 48 hours. Absolute eosinophil count (AEC) and IgE levels measured, and spirometric evaluation was performed. Statistical Analysis: Analysis of variance and Pearson's correlation test were used for data analysis. P< 0.05 was considered to be statistically significant. Results: Clinically, skin lesions were noticed in 51%, elevated AEC in 47%, and raised Anti IgE in 73%. Two participants developed positive reactions to the skin strip patch test. Duration of exposure to cement and SES were compared with clinical skin lesions. Spirometry result was normal in 81%, obstruction in 8%, restriction in 10%, and mixed pattern in 1%. Forced expiratory volume at 1.0 second, forced expiratory flow (25-75%), and (PEFR) Peak Expiratory Flow Rate were markedly reduced with years of exposure. Workers who had greater skin lesions and with increase in exposure had increased AEC and IgE levels, although statistically not significant. Conclusions: Exposure to cement and poor SES is strongly correlated to increased prevalence of skin lesions and reduced pulmonary functions. [ABSTRACT FROM AUTHOR]

Background: Hand eczema is one of the commonest eczemas encountered in dermatology practice. Contact allergens responsible for causing hand eczema vary from one geographical area of the world to another. Aim: The study tries to identify the commonest allergens causing hand eczema in ethnic Kashmiri population. Material and Methods: A total of 800 patients were patch tested at a sole patch testing facility for the local population over a 7-year period out of which 278 were diagnosed with hand eczema. The morphological type of hand eczema was noted and the patch testing results were analyzed. Past or present relevance of the patch-test result to the clinical diagnosis was also analyzed. Results: Hand eczema was the most common type of eczema patch tested over the 7-year period, constituting 34.75% of the patch-tested population. A positive patch-test result was obtained in 135 patients (48.5%) out of which it was found to be clinically relevant in about 65% cases. Nickel and potassium dichromate were found to be the two commonest allergens causing hand eczema in our population with positive patch test reactions in 45 and 27 patients respectively. Females showed a much higher incidence of hand eczema as well as higher patch test positivity than males (54.1% vs. 38.1%). Conclusions: Hand eczema with a positive patch-test report was found to be much more common in females than males and nickel and potassium dichromate were seen to be the commonest allergens causing hand eczema in ethnic Kashmiri population. [ABSTRACT FROM AUTHOR]

Parthenium dermatitis is an immuno-inflammatory disease caused by Partheniumhysterophorus and is the most common cause of plant dermatitis in India. Contact sensitivity to parthenium is everlasting, and hence the disease runs a chronic course with exacerbation during summers. Patch testing with acetone or aqueous plant extract is the simplest way of confirming parthenium contact allergy. We report a case of 40yr old female who presented with generalised erythematous and lichenified plaques and was managed effectively with topical corticosteroid and avoidance of allergens. [ABSTRACT FROM AUTHOR]

Background: India being a developing country has tremendous demand of physical infrastructure and construction work as a result there is a raising demand of construction workers. Workers in construction industry are mainly migratory and employed on contract or subcontract basis. These workers face temporary relationship between employer and employee, uncertainty in working hours, contracting and subcontracting system, lack of basic continuous employment, lack basic amenities, and inadequacy in welfare schemes. Objective: To estimate the prevalence of respiratory and dermatological symptoms among migratory construction workers. Materials and Methods: This cross-sectional study was conducted in Manipal, Karnataka, among 340 male migratory construction workers. A standard modified questionnaire was used as a tool by the interviewer and the physical examination of the workers was done by a physician. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 15.0. Result: Eighty percent of the workers belong to the age group of 18-30 years. The mean age of the workers was 26 ± 8.2 years. Most (43.8%) of the workers are from West Bengal followed by those from Bihar and Jharkhand. The rates of prevalence of respiratory and dermatological symptoms were 33.2% and 36.2%, respectively. Conclusion: The migrant construction workers suffer from a high proportion of respiratory and dermatological problems. [ABSTRACT FROM AUTHOR]

Machaerium scleroxylon commonly grows in East India, West India, Cava, Ceylon and Brazil. In Turkey, it is known as "pelesenk." It is commonly used in interior architecture, decorative furniture, flooring, and cabinet making. Pelesenk is a very hard wood that causes systemic contact dermatitis. This case series evaluates six cases of contact dermatitis that were exposed to pelesenk grinding powder for the first time in the same factory. [ABSTRACT FROM AUTHOR]

Background: Rapid urbanization, westernization of lifestyles, poor quality of objects available and extremely relaxed vigilance on adherence to 'product safety guidelines' make any developing country like India highly susceptible to allergic contact dermatitis (ACD) even in children. There has been no previous attempts to assess the magnitude of childhood ACD in India. Aims: To assess the clinico-allergological profile of ACD in Indian children. Methods: All consecutive children up to 15 completed years of age who were patch tested over the last 3 years were analyzed from the records. Results: A total of 70 children were studied (average age of disease onset 8.39±3.59 years [SD], range 1-15 years and average age of presentation 10.8±2.99 years [SD], range 5-15 years). Relevant allergy was noted in 48.6% of the patients. Age and sex had no significant role on the prevalence of ACD. Common allergens were paraben (43%), potassium dichromate (27%) and fragrance mix (26%). Most relevant allergens were potassium dichromate, paraben and fragrance. Foot was the most commonly involved site (25.7% of patients). Atopy was present in 18 patients (25.7%). A total of 22 irritant reactions were noted in 13 patients. Conclusion: This study refl ects the current status of childhood ACD of this region. [ABSTRACT FROM AUTHOR]

Background: Allergic contact dermatitis is one of the important occupational hazards in construction workers and it often leads to poor quality of life of the workers with substantial financial loss. However, this is often a neglected entity. There are no past studies on the construction workers in Indian subcontinent. Objective: This pilot study has been done to assess the allergological profile among the workers engaged in construction of roads and bridges. Materials and Methods: The study was conducted among the workers working on construction of a bridge, flyover, and roads in West Bengal, India. Sixteen workers were selected on clinical suspicion. Ten were selected randomly and patch tested with Indian standard battery of patch test allergens. Analysis of reactions and relevance of positive test was assessed as per standard guidelines. Results: All the workers were men. Average age of workers was 24.8 years (range, 19-34 years). Dermatitis affected exposed parts in 93.75% and covered areas in 62.5%. Total positive test was 24 and relevant 11. Most common allergens were chromate (relevant allergy/RA: in 60% of patch tested workers), epoxy resin (RA: 30%), cobalt (RA: 20%), nickel (RA: 20%), thiuram mixture (RA: 10%) and black rubber mix (RA: 10%). Two cases (20%) had irritant contact dermatitis. Conclusion: The result indicated that chromate is the most frequent allergen among construction workers in this part of India. High frequency of involvement of the covered areas as well as the exposed areas highlighted the fact that the allergens had access to most body parts of the workers. [ABSTRACT FROM AUTHOR]

Background: Parthenium hysterophorus is the commonest cause of airborne contact dermatitis in India. Azathioprine has been shown to be effective and safe in parthenium dermatitis, but there are no reports of comparison of steroids and azathioprine in this condition. Aims: To study the therapeutic efficacy of azathioprine versus betamethasone in patients having contact dermatitis to parthenium and compare the side effects of the drugs. Methods: Fifty-five patients of airborne contact dermatitis to parthenium were randomly assigned to treatment with azathioprine 100 mg daily (group A) or betamethasone 2 mg daily (group B), for 6 months in a blinded manner. The patients were evaluated every month for 6 months to determine the response to treatment and side effects and then further followed up for another 6 months to determine any relapse. Results: There were 26 patients in group A and 29 in group B, of which 20 patients of group A and 21 of group B completed the study. Nineteen (95%) patients in group A and all 21 (100%) patients in group B had an excellent response (complete remission) to treatment (P = 0.0156 vs. 0.0005). The patients in group B, however, had more adverse effects (Fisher exact, P=0.05). Nine (45%) patients in group A and 14 (67%) patients in group B relapsed during the post-treatment follow-up. Conclusions: Azathioprine and betamethasone appear to be almost equally effective (P = 0.0156 vs. 0.0005) in the treatment of parthenium dermatitis. However, adverse effects and relapses were observed to be more frequent in patients treated with betamethasone. [ABSTRACT FROM AUTHOR]

Background: Contact dermatitis is the most common immunological disorder encountered by the dermatologist and it arises when a person develops delayed type of hypersensitivity reaction to a substance coming in contact with his skin. The patch test is at present a helpful test for demonstrating contact type of allergy that identifies the cause of allergic contact dermatitis. Aim: To study the common topical medicaments and cosmetics capable of producing contact dermatitis and value of patch testing in these situations. Materials and Methods: One hundred patients suspected of having contact sensitivity to topical medicaments and common cosmetics were subjected to patch testing with the finished commercial product being used by the patient and the antigens of the Indian Standard Series and Cosmetic series kit. Results: Positivity with patch test of 96.65% was observed in patients with contact dermatitis to topical medicaments, whereas 85% of the patients with cosmetic dermatitis were tested positive. Among the cases with contact dermatitis to topical medicaments, Neomycin was tested positive in more number of patients and among the patients with cosmetic dermatitis; Kum-Kum powder and Fairness cream were tested positive in more number of patients. Conclusion: It is well known that topical medicaments are known to produce contact dermatitis; the cosmetics that are claimed to be very safe by their manufacturers do not stay much behind in doing so. [ABSTRACT FROM AUTHOR]

Background: Patch testing is a definitive tool for diagnosing allergic contact dermatitis (ACD). It reveals the prevalence and trends of contact sensitization in the community, thereby paving the way for better standard series. There is paucity of large series of patch-tested patients from India.Aim: To report the 9-year patch-test data from a single general dermatology centre in North India.Methods: Consecutive patients presenting with signs/symptoms of suspected ACD were patch tested from May 1997 to April 2006. The Indian Standard Series was used. Parthenium was tested only in selected patients and cetrimide and chloroxylenol were added to the series.Results: In total, records of 1000 patients (566 male, 434 female) were analyzed, yielding 1155 positive reactions in 590 (59%) patients. Footwear dermatitis was the commonest suspected diagnosis, followed by ACD to medicaments, cosmetic dermatitis and plant dermatitis. Out of the allergens that were tested in all the patients, positivity to nickel was the commonest (12.9%), followed by potassium dichromate (11.1%) neomycin (7%), mercaptobenzthiazole (6.6%), nitrofurazone (6%), colophony (5.7%), fragrance mix (5.5%) and cobalt chloride (5.4%). However, parthenium was the commonest allergen based on the proportion of patients tested with it (14.5%). In men, potassium dichromate (30%) was the commonest sensitizer and in women, nickel (43%) was the commonest to show patch-test positivity.Conclusion: Our study revealed higher prevalence of footwear and medicament dermatitis in comparison to existing data. Allergy to antiseptics is significant in our patients. Further collaborative studies involving patients from other parts of India are required to have an overall view of ACD in India. [ABSTRACT FROM AUTHOR]

Background: Footwear dermatitis represents a distinct and common group among all types of contact dermatitis cases seen in India. This ailment, however, often remains undiagnosed, misdiagnosed or empirically diagnosed without pinpointing the contributory allergens.Aims: This study was undertaken to detect the epidemio-allergological pattern of footwear dermatitis in India.Methods: A total number of 155 cases with footwear dermatitis were evaluated from July 2005 to June 2006, by detailed history and clinical examination. They were patch tested using Indian Standard Battery (ISB) approved by the Contact and Occupational Dermatoses Forum of India (CODFI) with pre- and post patch-test counseling.Results: The proportion of footwear dermatitis was 24.22% (n=155) among a total of 640 patients patch tested during that period. Females [61.93% (n=96)] were commonly affected than males [38.06% (n=59)]. The ages ranged from 8 to 75 years. The age group that predominantly involved was the fifth decade [24.52% (n=38)]. Occupationwise housewives were most commonly involved [47.48 (n=66)]. Contributory allergens in order of frequency were: potassium dichromate, 45.8% (n=71); cobalt chloride, 38.06% (n=59); paraphenylenediamine, 32.25% (n=50); epoxy resin, 20% (n=31); black rubber mix, 20% (n=31); nickel sulfate, 14.83% (n=23); mercaptobenzothiazole, 12.9% (n=20); colophony, 11.6% (n=18); thiuram mix, 10.32 % (n=16); p-tert-butyl-formaldehyde resin, 9.67% (n=15); and formaldehyde, 4.5% (n=7). Among the different categories of footwear allergens, the highest positivity was shown by leather and leather-related chemicals in 61.9% cases (n=96).Conclusion: Footwear dermatitis, a common dermatosis, is mostly caused by leather processing chemicals, metal buckles, black dyes of shoes and socks, adhesives, plastic, rubber shoes and polishing agents in order of frequency. [ABSTRACT FROM AUTHOR]

Background: Dyeing is an age-old process and forms an integral part of textile industries. Tying is a process by which a particular part of cloth is prevented from the process of dyeing. The skin diseases in workers engaged in the 'tie and dye' industry have not been extensively studied.Aims: To study the prevalence of contact dermatitis among workers engaged in the 'tie and dye' industries in and around Jodhpur (Western Rajasthan).Methods: One thousand three hundred workers engaged in 'tie and dye' work were evaluated for occupation-related dermatitis. Those with skin lesions were subjected to patch tests using 2% aqueous solution of the dyes and chemicals commonly used by them. These included direct dyes, VAT dyes, sulfur dyes and azo dyes. Fifty workers without skin lesions served as controls.Results: One hundred patients (7.69%) had dermatitis involving the exposed sites, mainly the hands and forearms. Eighty-one patients showed positive reactions to one or more dyes, most commonly Red RC base (azo dye), followed by naphthol.Conclusion: Red RC base and naphthol were the commonest allergens in the 'tie and dye' industry. [ABSTRACT FROM AUTHOR]

Parthenium hysterophorus is the commonest cause of airborne contact dermatitis (ABCD) in India. The disease usually manifests as itchy erythematous, papular, papulovesicular and plaque lesions on exposed areas of the body. Rarely, however, the disease may present as actinic reticuloid or photocontact dermatitis. We have observed a different clinical variant of this disease where certain patients with Parthenium dermatitis have presented with discrete, flat, violaceous papules and plaques on exposed areas of the body closely simulating photosensitive lichenoid eruption. We had 8 patients, 6 males and 2 females between 30 and 62 years of age, with itchy, violaceous, papules and plaques on the face, neck, ears, upper chest and dorsa of the hands for 6 months to 6.5 years. Four of these patients had a history of improvement of the lesions up to 30% in winter and aggravation of lesions on exposure to sunlight. There was no personal or family history of atopy. Cutaneous examination in all patients revealed multiple flat, violaceous, mildly erythematous papules and plaques on the forehead, sides and nape of neck, ears, ‘V’ area of the chest, and extensor aspects of the forearms and hands. Skin biopsies from these lesions showed features of chronic non-specific dermatitis. Patch testing with standardized plant antigens showed a positive patch test reaction to Parthenium hysterophorus in all patients, with a titre of contact hypersensitivity (TCH) varying from undiluted to 1 : 100. We conclude that Parthenium dermatitis may occasionally present with lesions very similar to the lesions of photosensitive lichenoid eruption in morphology and distribution. This clinical presentation of Parthenium dermatitis needs to be recognized to avoid misdiagnosis. [ABSTRACT FROM AUTHOR]

60 patients (45 male and 15 female) with suspected airborne contact dermatitis from Compositae (Asteraceae) plants and 20 age-matched controls (15 male and 5 female) were investigated. Patch tests were performed with ethanolic plant extracts of 4 Compositae plants, Parthenium hysterophorus. Chrysanthemum morifolium, Dahlia pinnata and Tagetes indica, all prevalent in northern India. 55 (92%) patients showed positive patch tests, with 35 (64%) demonstrating positive tests to extracts of only 1 of the 4 plants tested. No positive patch tests were seen in the controls. Parthenium hysterophorus (78%) was the most frequent plant reacting, followed by Chrysanthemum morifolium (42%), Dahlia pinnata (18%) and Tagetes indica (7%). [ABSTRACT FROM AUTHOR]

105 patients with foot dermatitis, seen over a period of 18 months, were patch tested with various shoe allergens, 47 showed a positive reaction to 1 or more allergens. The majority of the cases (37-47) were chrome-positive, Positive to plastic material was observed in 8, whereas, rubber and rubber chemicals accounted for 5 cases. Of special interest were positive reaction to 1,3-diphenylguanidine in 3 and N-cyclohexyl-2-benzothiazolessulfenamide in 2 cases. [ABSTRACT FROM AUTHOR]

A survey of the 'Tie and Dye' industry of Jodhpur City in India was made to investigate occupational dermatoses. 49 (16.6%) of 250 workers had incapacitating dermatitis. Skin lesions were seen mostly over the dorsa of the hands and fingers. 26 patients were patch tested with various dyes and chemicals; 14 were positive. Fast Red RC salt was the most potent sensitizer. Other dyes showing positive reactions were Orange GC salt, Bordeaux GP salt, Blue B salt, Red B base and naphthol. [ABSTRACT FROM AUTHOR]

The naturally-occurring sesquiterpene lactone, parthenin, is responsible for a high incidence of allergic contact dermatitis in India. Cross-sensitivity tests on guinea pigs sensitized to parthenin indicate a relatively high immunological specificity for this low molecular weight hapten. Coronopilin and damsin, sesquiterpene lactones most similar to parthenin, gave positive reactions but other structurally related lactones such as dihydroisoparthenin, tetrahydroparthenin, tetraneurin-A, hysterin, helenalin, and tenulin, or hymenin, a diastereoisomer of parthenin, were negative. [ABSTRACT FROM AUTHOR]

Erythema multiforme (EM) is an acute mucocutaneous hypersensitivity reaction with varying degrees of blistering and ulceration. Common causes of EM are herpes simplex virus infection, mycoplasma infection, drug hypersensitivity, vaccination and drug-virus interaction. EM induced by contact dermatitis is rare. Paraphenylene diamine, a common ingredient in many hair dyes, is well known to produce allergic contact dermatitis. We report a 35-year-old lady presenting with EM following severe contact dermatitis to hair dye. So far as we know, this is the first report from India describing EM following contact dermatitis. [ABSTRACT FROM AUTHOR]

We report a 41-year-old woman who developed contact depigmentation at several body sites after using lipstick, liquid kumkum (a colouring usually made from turmeric or saffron used for social/religious markings), and plastic or rubber slippers (flip-flops). Propyl gallate, a common ingredient to all and a previously undocumented depigmenting agent, was incriminated on patch testing with the Indian standard series. [ABSTRACT FROM AUTHOR]

The article discusses the seborrhoeic pattern of parthenium dermatitis on patients with contact allergy to Parthenium hysterophorus in New Delhi, India. The first patient was diagnosed with the disease which first appeared on the face and later gradually spread to involve the neck. The second patient was diagnosed with a history of erythematous, exudative papules, which started around the perioral area and cheeks and subsequently involved the antecubital and popliteal fossae.

Background: Parthenium dermatitis is a major problem in urban and rural India. Patients with severe allergic rhinitis due to exposure to pollens of parthenium are reported to have parthenium specific IgE and IgG antibodies. Parthenium induces contact dermatitis by Type IV hypersensitivity and allergic rhinitis by Type-I hypersensitivity.Aims: The study was undertaken to detect Type-I and Type-IV hypersensitivity amongst patients with parthenium dermatitis.Methods: Fourteen patients with clinical features of parthenium dermatitis who patch tested positive to parthenium were included in the study. Patch testing was done by standard method and results interpreted as recommended by the ICDRG. Serum IgE was determined by chemiluminescence immuno assay system (CLIA). Prick testing was performed and interpreted by standard method.Results: Twelve out of the 14 patients included, showed a positive prick test. Serum IgE was elevated in all patients to varying degrees (mean IgE-1279.9 IU/ml; N--up to 100 IU/ml).Conclusion: The positive patch test, prick test and elevated serum IgE suggest that both Type-I and Type-IV hypersensitivity may play a role in the induction and perpetuation of parthenium dermatitis in most patients. To date, delayed hypersensitivity was thought to be solely responsible for parthenium dermatitis. This study suggests that a combined type-I and type IV hypersensitivity mechanisms may be operational. [ABSTRACT FROM AUTHOR]

Focuses on the research about the sensitizers of allergic contact dermatitis of the hands and feet in India. List of allergens detected; Outpatient incidence of hand and foot dermatitis; Rate of positivity.

This article cites a study focusing on patch testing with the Indian standard series (ISS) in New Delhi, India. Patch testing in 220 patients aged between 11 and 70 years with suspected allergic contact dermatitis (ACD) was done with the ISS. ACD is an abnormal reaction pattern of the skin in response to various external agents, which is mediated by cellmediated immune response. In conclusion, the common contact sensitizers in Delhi, India are nickel, parthenium, chromate, cobalt and fragrance. Relevance of such positive patch test reactions was seen in 82.1% of patients, and hence, the ISS is suitable for diagnosis of most of our cases of ACD.

Background/objectives: It is a common Indian custom to tie threads on the hip, neck, or wrist of infants and children., Methods/results: A retrospective registry review was performed for 23 children (age range 5-18 months) with threads tied around the hip/neck/forearm who presented with dermatitis. Analysis of one of the threads revealed the presence of three banned azo dyes and disperse yellow 3 (category 2B possible carcinogens)., Conclusion: Thread dermatitis is a unique cultural dermatosis. Dermatitis caused by threads may have multifactorial causes including friction, maceration, and contact dermatitis (allergic and/ or irritant) to the thread contents. Use of banned dyes still used to color these threads may be contributory to dermatitis, but there is also concern for health and environmental hazards to children. Strict regulation is needed in the manufacture of these threads to protect the health and welfare of young children., (© 2020 Wiley Periodicals LLC.)

32 patients (24 male, 8 female) with contact dermatitis from Chrysanthemum morifolium are reported. 24 (75%) patients gave a history of seasonal variation and 16 (50%) of photoaggravation and/or photosensitivity. Exposure to chrysanthemums was occupational in 18 and recreational in 12. The common clinical presentations were hand and face dermatitis in 13 (41%) and airborne contact dermatitis in 10 (31%) patients. All 32 patients demonstrated positive patch tests to ethanolic extracts of the flowers, 30 to the leaves. 28 to the whole plant, and only 6 to the stems, in that order of intensity. [ABSTRACT FROM AUTHOR]

Since 1881, surgeons from the Kashmir Hospital have reported a high incidence of epitheliomas of the skin, particularly in the region of the lower abdomen and thigh. The first systematic scientific report on this subject was prepared by a missionary physician, Ernest Neve. He stated that the essential cause of the disease is a constant irritation by intense heat from the Kangri being held against the body. Heat is the prime factor. Products of combustion, wood ash, and volatile substances may play a secondary part. The term "kangri" is derived from a basket which the people of Kashmir, India use to warm their bodies during the severe winter.

A letter to the editor about the fragrance from the Ylang-ylang oil extracted from the flower of Cananga odorata is presented.