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Onychomycosis is a chronic fungal infection of the nails that is largely underdiagnosed in developing countries such as India due to poor health care facilities. In this study, we evaluated the nails of 134 patients with a clinical suspicion of onychomycosis using direct microscopy and fungal culture techniques. The majority of participants (47.8%) were older than 40 years. On both direct microscopy and fungal culture, 71.6% of participants were confirmed with onychomycosis. Among the cases confirmed by laboratory testing, distal lateral subungual onychomycosis was the most common clinical pattern observed, followed by proximal subungual onychomycosis (PSO), candidal onychomycosis (CO), and white superficial onychomycosis (WSO). We concluded that laboratory examination is of great importance in the diagnosis and identification of the underlying pathogen in patients with onychomycosis as well as in the selection of a suitable antifungal agent for treatment.

Background: Despite repeated outbreaks of poxvirus infections unique to the Indian subcontinent region and veterinary research work in this field, much less diagnostic awareness with resultant treatment protocols have been formulated in the human medical field., Aims: With this objective in mind, a combined human medical and veterinary study was conducted on a recent outbreak of buffalopox infection in a village in northern India., Methods: A team of doctors did the clinical examination and collected swab and serum samples from both cattle and humans, and these were subjected to viral isolation, cell culture, plaque reduction neutralization test, polymerase chain reaction, and partial genome sequencing., Results: A clustered foci of 12 human patients aged 11-60 years, 12 buffaloes, and 10 cows were found to be affected with buffalopox infection with some atypical features., Conclusion: Awareness, diagnosis, education, early intervention, and formulation of disaster guidelines are needed in view of the potential epidemiologic outbreak, if this happens in the future., (© 2013 The International Society of Dermatology.)

Background: Hand eczema is a common distressing condition aggravated by a number of endogenous and exogenous factors. Various morphological forms of hand eczema have been described, but categorization into one of them is not always possible., Aims: To study the morphological patterns of hand eczema, relationship of atopy with hand eczema, and the implications of contact sensitization with respect to severity and diagnosis of hand eczema., Methods: Hundred consecutive patients of hand eczema attending the contact dermatitis clinic of the institute were recruited over a two year period from 2004-05. Objective assessment was done using hand eczema severity index (HECSI) and all the patients were patch tested using Indian standard series., Results: Unspecified type of hand eczema with no definite morphologic picture was seen in 62% followed by pompholyx in 14%. Hand eczema severity was not found to be statistically associated with age, sex, and atopic status of the patient. Positive patch test to one or more allergen was present in 65% of patients. The most common allergens were potassium dichromate (25%), fragrance mix (16%), nickel sulphate (14%), and PPD (13%). There was no significant correlation between patch test positivity and hand eczema severity or atopic status of the patient. Among the morphological patterns pompholyx was strongly associated with an atopic status (P=0.004)., Conclusions: Hand eczema was seen twice more commonly in men. Atopic and non-atopic patients of hand eczema had no difference in the severity of disease. Contact sensitivity to different allergens did not correlate with increased eczema severity.

Background: Onychomycosis is an important public health problem because of the increase in immunosuppressive states. Large-scale studies in India are scarce, and so the baseline incidence of onychomycosis is not firmly established., Methods: Three hundred and two clinically suspected cases of onychomycosis were included in this study. Nail samples were collected for direct microscopic examination and culture. Clinical patterns and associated relevant factors were noted according to a predetermined protocol., Results: The associated predisposing conditions included diabetes mellitus (3.9%) and systemic lupus erythematosus (2.3%). Distal and lateral subungual onychomycosis was the most common clinical pattern (62%), followed by total dystrophic onychomycosis (20.2%). The most common fungal isolates were dermatophytes (49.5%), followed by Candida spp. (40.4%) and nondermatophyte molds (10.1%). Of the dermatophytes, Trichophyton rubrum (47%) was the most common isolate, followed by Trichophyton tonsurans (20.4%). Of the Candida spp., Candida albicans was the most common (60%)., Conclusions: Until recently, yeasts and nondermatophyte molds were regarded as contaminants, but their emergence as a significant cause of onychomycosis in immunocompromised patients calls for mycologic diagnosis and antifungal susceptibility testing in onychomycosis. The recognition of the changing patterns of onychomycosis will aid in the therapeutic approach and the implementation of control measures.

Background: Onychomycosis is one of the early manifestations of HIV infection with a prevalence of 15-40%. Multiple nail involvement, isolation of both common and rare species and resistance to treatment are the characteristics of onychomycosis in HIV., Aim: To study the epidemiology, clinical manifestations of onychomycosis in HIV-infected individuals and to identify the various causative fungi microbiologically., Methods: A total of 250 HIV infected patients, diagnosed by ELISA, were screened for nail involvement; of which 60 patients i.e, 40 males and 20 females, who had clinically suspected untreated fungal infection were included in this study., Results: Of the 60 respondents, 34 (56.66%) were from the 31-40 years age group. Amongst the 40 males, there were 20 manual laborers and 14 farmers; while 18 of 20 females were housewives. Toenail involvement was seen in 38 patients (63.33%), fingernail in 12 patients (20%) while 10 (16.66%) patients had involvement of both. Twenty eight (46.66%) patients gave history of some trauma, 6 (10%) had diabetes mellitus and only 1 patient (1.66%) had history of peripheral vascular disease. Nineteen (31.66%) patients had associated tinea pedis, 5 (8.33%) had tinea manuum, 10 (16.66%) had tinea corporis and 7 (11.66%) had tinea cruris. Twenty one (35%) respondents had distal and lateral superficial onychomycosis (DLSO), 5 (8.33%) had proximal subungual onychomycosis (PSO), 1 (1.66%) had superficial white onychomycosis (SWO), while 33 (55%) had total dystrophic onychomycosis (TDO). Fungal elements were demonstrated by KOH mount in 49 patients (81.66%) and growth was seen in 32 (53.33%) cultures. Dermatophytes were isolated in 13 (21.66%) and nondermatophytic molds (NDM) in 19 (31.66%). Out of the 13 positive dermatophyte cultures, Trichophyton rubrum was isolated on 11 and Trichophyton mentagrophytes on 2 cultures. Of the 19 non-dermatophytic cultures, Aspergillus niger was isolated on 3 and Candida spp. on 12 while Cladosporium spp, Scytalidium hyalinum, Penicillium spp. and Gymnoascus dankaliensis on 1 each., Conclusions: Total dystrophic onychomycosis was the most common clinical type and NDM were the predominant causative organisms.

Background: Not many studies on pesticide allergic contact dermatitis are available from Himachal Pradesh (India)., Objective: We studied the role of commonly used pesticides in causing allergic contact dermatitis in fruit and vegetable farmers in the region., Methods: 30 fruit and vegetable farmer patients having dermatitis involving face, neck, hands, and feet and 20 controls comprising 2 groups of 10 subjects each: Group-1 had history of exposure to pesticides but no dermatitis and Group-2 having neither dermatitis nor history of exposure to pesticides, were patch tested with 10 most common pesticides used in the region., Results and Conclusion: These 30 patients (M : F 21 : 9) were between 22-81 years of age having dermatitis for 4 days to 20 years with relapses and remissions. 21 patients had seasonal exacerbation. 10 patients attributed exacerbation of dermatitis to exposure to pesticides. Positive patch test reactions from pesticides were observed in 8 patients only. Captan was the most common sensitizer (5 patients), 2 patients were sensitive to propargite. Chlorpyrifos, tree spray oil and thiuram gave positive reaction in 1 patient each. 3 controls from Group-1 showed positive reactions to multiple pesticides. Pesticide related contact dermatitis appears more common than expected.

Background: Onychomycosis is a common nail infection caused by dermatophytes, yeast or other nondermatophyte molds and has diverse clinical presentations. Although common in this part of the country, no significant clinico-mycologic data is available., Objectives: This study was carried out to document the clinico-mycologic pattern of onychomycosis in Himachal Pradesh (India)., Methods: All consecutive patients of onychomycosis diagnosed clinically during March 2005 to February 2006 were studied for clinical forms, number of nails involved and severity of infection. The clippings from the most severely affected nails were subjected to potassium hydroxide (KOH) mounts for direct microscopy and fungal culture on Sabouraud's dextrose agar., Results: These 130 patients (M:F 98:32) were between 8-76 years of age (mean 41.35 +/- 14.98 years). The prevalence of onychomycosis was higher among farmers and office workers (20% each). Finger or toe nails were exclusively involved in 56.9 and 32.3% patients respectively while these were involved concurrently in the rest of the 10.8% patients. Distal and lateral subungual onychomycosis seen in 73.1% of the specimens was the most common clinical type. KOH- and culture-positivity were recorded in 59.2 and 37.6% cases respectively. Dermatophytes and yeast (Candida albicans) were isolated in 40.8% each of the cultured nail specimens while nondermatophytic molds (NDM) were cultured in 18.6% of the samples. Various dermatophytes cultured were Trichophyton rubrum (32.6%), T. mentagrophytes (6.1%) and T. verrucosum (2.1%) respectively. Aspergillus spp. (6.1%) was the most commonly isolated NDM while other detected molds were Acremonium spp, Fusarium spp,, Scopulariopsis spp, Curvularia spp. and Penicillium marneffei. Peripheral vascular disorders (7.69%), occupational trauma (13.8%), close association with animals (60.78%) and a family history of onychomycosis (26.15%) were a few of the predisposing factors identified., Conclusion: Onychomycosis is not uncommon in this part of the country and has similar clinico-mycologic profiles in the different cases detected.

A mycological study of onychomycosis was undertaken in 88 patients. The nails were judged to be infected by their clinical appearance. Direct microscopy of the nail clips in 20% KOH solution was positive in 72 (81.8%) and culture was positive in 43 (48.8%) cases. Out of the samples cultured, dermatophytes were grown in 26 cases (29.5%), non dermatophyte moulds in 12 (13.6%) and Candida spp. in 5 (5.6%) while 45 (51.1%) samples yielded no growth. Amongst dermatophytes, T. rubrum was found to be commonest etiological agent (57.6%) followed by T. mentagrophyte. Amongst the non-dermatophyte mould (NDM), Aspergillus spp. was the most prevalent species followed by Alternaria spp, Curvularia spp. and Fusarium spp. Commonest age group affected was above 31 years. Males were predominantly affected (65%), male to female ratio being 1.8:1. Fingernails were affected more frequently than toe nails with the ratio of 3:1. Distal and lateral subungual onychomycosis (DLSO) was more common (50%) than other clinical pattern followed by proximal subungual onychomycosis (PSO) (20.4%), white superficial onychomycosis (SWO) (2%), total dystrophic onychomysosis (TDO) (14%) and paronychia (10.2%).

Cutaneous warts are caused by human papillomavirus (HPV). Prevalence studies of the types of HPV present in cutaneous warts have been carried out more frequently in immunosuppressed patients. The present study was designed to study the association of high-risk HPV in cutaneous warts of immunocompetent patients. A total of 45 cases of cutaneous warts from various sites in immunocompetent subjects were analyzed for HPV. Samples included both archival material i.e., paraffin embedded and fresh tissue. Highly sensitive and comprehensive polymerase chain reaction (PCR) methodology for detection of HPV of high oncogenic potential, HPV 16/18, was employed. Human papillomavirus 16 was detected in 3 (6.6%) patients. None of the lesions demonstrated HPV 18. None of the cutaneous warts demonstrated histopathological features associated with dysplasia or neoplasia. The identification of HPV 16 in cutaneous warts, which are benign proliferations of the skin, further expands the spectrum of HPV-linked lesions. It remains of critical interest to determine whether these types are specifically associated with the development of malignant lesions analogous to those seen in anogenital cancer.

Background: Paddy farming is one of the main occupations in coastal South India. Dermatological problems in paddy field workers have not received much attention., Aim: The purpose of this study was to study the dermatoses of the exposed parts of the body, viz. face, hands, and feet, in paddy field workers., Methods: Three hundred and forty-one workers were questioned and clinical findings noted. Scrapings for bacterial and fungal examination were taken by random selection., Results: Seventy-three per cent had work-related itching. Melasma was the commonest facial lesion (41.1%). The main problems on the hands were hyperkeratosis (26.4%), nail dystrophy (15.2%) and paronychia (8.8%). Common feet dermatoses included nail dystrophy (57.1%), pitted keratolysis (42.5%) and fissuring (23.5%). Common aerobic and anaerobic bacteria isolated from pitted keratolysis and intertrigo were Klebsiella and Clostridium species. Aspergillus species were the commonest fungus grown from intertrigo., Conclusions: Occupational dermatoses are common in paddy field workers.

One hundred consecutive patients with hand eczema were patch tested with the Indian Standard Series and indigenous antigens after a detailed history and clinical examination. Both sexes were involved and the majority of them were in the age group between 20-39 years (56%). Their occupational profile varied in order of frequency from household work (37%), to masons (14%), students (11%), factory workers (7%), and others (31%). Itching was the most common presenting complaint (93%). A history of atopy was found in 36% of the patients. The predominant sites involved were the palms (43%), followed by fingers (32%), dorsum (17%), and the entire hand (8%). Dry, scaly skin was the most common morphological picture, followed by hyperpigmentation, fissuring, and lichenification. Based on history, clinical examination and patch test results, the diagnosis was made as allergic contact dermatitis in 67% of cases and irritant contact dermatitis in 15% of cases. Positive patch tests with one or more allergens were noted in 67% of the patients. Vegetables (21%) were found to be the most common sensitizers, followed by nickel sulphate (20%), potassium dichromate (18%), and others. Wet work, soaps, and detergents were found to be the most offending irritants. The present study confirmed the fact that hand eczema is a multifactorial disease caused by both irritants and allergens.

Fifty patients of both sexes with clinically suspected discoid eczema were patch tested with the Indian Standard Patch Test Battery approved by the Contact and Occupational Dermatosis Forum of India (CODFI). Most of these patients were young adults between 20 and 39 years old, with a mean age of 36 years. The mean duration of symptoms was 21/2 years. The occupational profiles of the patients included farmers (24%), housewives (18%), students (14%), housewives engaged in farming (12%), shopkeepers (10%), and laborers (8%). The miscellaneous group, including technicians, drivers, cable operators, office workers, and computer operators, accounted for the remaining 14%. The common clinical patterns of presentation of discoid eczema included hands and feet (44%), hands and forearms' (30%), legs and feet (12%) and trunk and limbs (12%). Patch test analysis of these patients revealed that, out of the 50 subjects tested, 28 (56%) reacted to one or more allergens. Potassium dichromate was the most common allergen (20%), followed by nickel (16%), cobalt chloride, and fragrance (12% each) in decreasing order of frequency. Hence, it may be concluded that patch testing should be considered for all patients with severe or persistent discoid eczema because allergic contact dermatitis may be relatively common in such patients and the avoidance of offending allergens may be of substantial benefit to the patients.

Fungal agents causing onychomycosis in an Indian population were studied in a hospital based study. It revealed that onychomycosis is more common in adult males, and that finger nails were more often affected compared with toe nails. Occupation did not seem to be related to infection. Trichophyton rubrum was the commonest fungus isolated (49.3%) followed by Candida species (23.2%). Four morphological varieties of Tr. rubrum colonies were observed but the role of a particular variety in causing chronic infection could not be ascertained.