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Background: Idiopathic guttate hypomelanosis (IGH) is a common benign acquired leukodermic dermatosis characterized by multiple, discrete, hypopigmented-to-depigmented macules. Various treatment modalities were tried for this condition with varied results. Purpose: This study was conducted to compare the efficacy and safety of fractional carbon dioxide laser and 88% phenol in the treatment of IGH. Methods: A total of 40 patients with five IGH macules on each side were treated with one session of fractional carbon dioxide laser on the right side and a single application of 88% phenol on the left side and were assessed monthly for 3 months. The improvement in pigmentation was graded as ≤25% - poor, 26%–50% - minimal, 51%–75% - good, and >75% - excellent response. Results: A total of 32 patients completed the study. Out of the 160 macules treated with laser, 16 (10%) macules showed an excellent response and 40 (25%) showed a good response, and 40 (25%) and 48 (30%) macules in the phenol group showed excellent and good improvement, respectively. Side effects such as persistent scabbing and ulceration were seen only on the phenol side. Conclusion: Single application of 88% phenol was more efficacious than one session of fractional carbon dioxide laser in inducing pigmentation in IGH macules in this study. However, fractional carbon dioxide laser can be considered a safer alternative modality.

Background: Confluent and reticulate papillomatosis (CRP) is an uncommon benign, acquired keratinization disorder. Studies on this disorder are lacking except for a few case reports and there is a paucity of Indian literature on the condition. Objectives/Methods: To study and describe the various morphological patterns and histopathological findings, as well as assess the response to treatment of 30 patients diagnosed with CRP. Results: Thirtypatients with a diagnosis of confluent and reticulate papillomatosis were included in the study. The male to female ratio was 1:1.5. Mean age at onset of skin eruptions was 27.3 years and mean duration of skin eruptions was 8.2 months. Most of the patients (60%) were asymptomatic. The majority (66.7%) had lesions distributed over upper trunk. Two-thirds of patients had typical brown macules in confluent and reticulate pattern.KOH mount was done in 24 cases and was positive in three cases (12.5%) for yeast-like hyphae. Biopsy demonstrated variable degrees of hyperkeratosis, papillomatosis, and moderate acanthosis. Thirteen out of eighteenpatients on minocycline showed complete clearance within 3 weeks andthreepatients had more than 50% improvement at the end of 3 weeks. Doxycycline showed satisfactory response but results were less satisfactory with azithromycin. Conclusion: CRP is an uncommon condition. There is a paucity of large studies in Indian literature.The present study highlightssuch a large cohort of cases. Prevalence of CRP was more in female in contrast to western studies. Association of CRP with hyperthyroidism was described in many studies but the present study highlights the association with hypothyroidism. Morphological variants like shiny atrophic lesions, verrucous lesions, and involvement of atypical sites like forearm have been described. Role of minocycline in the management of chronic and recurrent cases has been reinforced.

Subcutaneous granuloma annulare is an uncommon, benign self-limiting cutaneous disease, almost exclusively seen in young children. We report a case of 31-year-old male patient, presented with asymptomatic firm plaques over the left lateral malleoli and dorsum of the feet. Histopathological examination was done to confirm the diagnosis and the lesions responded well to monthly doses of the combination of rifampicin, ofloxacin, minocycline (ROM) therapy and intralesional steroid therapy. This case is reported for its unusual presentation of very large plaque in an adult male and its resolution after combined ROM and intralesional steroid therapy.

Background: Increased enthusiasm toward newer fashion trends among rural India along with the lack of government regulation has led to increased tattoo reactions. Objective: The objective of this study is to describe various clinical manifestations of hypersensitive reactions to tattoo ink reported at a tertiary care hospital in Mandya district. Materials and Methods: An observational study was carried out over a period of 1 year from June 2014 to May 2015 at Mandya Institute of Medical Sciences, Mandya. All the patients reporting with allergic reaction due to tattooing were included in the present study after obtaining informed consent. Transient acute inflammatory reaction, infections, and skin diseases localized on tattooed area were excluded from this study. A detailed history regarding the onset, duration and color used for tattooing were collected. Cutaneous examination and biopsy was to done to know the type of reaction. Results: Fifty cutaneous allergic reactions were diagnosed among 39 patients. Mean age of subjects was 22 years and mean duration before the appearance of lesion was 7 months. Common colors associated with reactions were red (53.9%), black (33.3%), green (5.1%), and multicolor (7.7%). Itching was the predominant symptom. Skin lesions mainly consisted of lichenoid papules and plaques, eczematous lesions, and verrucous lesions. Lichenoid histopathology reaction was the most common tissue allergic reaction. Conclusion: Increasing popularity of tattooing among young people has predisposed to parallel increase in adverse reactions. Red pigment is most common cause of allergic reaction in the present study, and lichenoid reaction is the most common reaction.

Cutaneous pseudolymphoma, also called lymphoid infiltrates of the skin mimicking lymphomas, is defined as reactive polyclonal benign lymphoproliferative process predominantly composed of either B-cells or T-cells, localized or disseminated. A 62-year-old male presented with multiple asymptomatic swellings over the posterior aspect of the left ear of 1-year duration. On examination, multiple nodules were present over the left retroauricular area, 2 of which were skin colored, firm, and nontender. Histopathology revealed pseudolymphoma with the features of a dense diffuse and nodular infiltrate of small and large lymphocytes and histiocytoid cells involving the whole of reticular dermis and extending to subcutis. A patch test was done using Indian standard battery series showed positive reaction - 2+ for paraphenylenediamine. A diagnosis of cutaneous pseudolymphoma was made. The lesions were treated with intralesional Triamcinolone acetonide injection 10 mg/ml for 2 sittings, 3 weeks apart following which there was remission of the nodules. Pseudolymphomas are benign but persistent lymphoid proliferations in the dermis, which may be difficult to distinguish from a low-grade malignant lymphoma. Pseudolymphomas are classified according to the histological components into B-cell and T-cell variants. So far no case of cutaneous pseudolymphoma suggestive of insect bite with coincidental paraphenylenediamine allergy has been reported. Hence, this case is reported as its histopathology was suggestive of pseudolymphoma secondary to insect bite reaction.

Angina bullosa hemorrhagica (ABH) is a disorder of unclear aetiology characterized by abrupt and unprovoked presentation of blood-filled blister over the oral mucosa. Histopathology reveals sub epithelial blister containing erythrocytes with superficial perivascular lymphocytic infiltrate. We report two cases of ABH of which one was idiopathic and other was associated with chronic renal failure on hemodialysis.

Background: Idiopathic guttate hypomelanosis (IGH) is a common pigmentary disorder encountered in older age group, causing cosmetic disfigurement with considerable psychological impact. Diagnosis is generally based on history and clinical features. In the situation of diagnostic dilemma, dermoscopic examination is the quick and easiest method to solve the clinical uncertainty and thereby avoid unnecessary biopsies. Objectives: The aims of the study were to describe the varied clinical presentations and to enumerate the dermoscopic features of IGH. Methods: Study was conducted after obtaining approval from Institutional Ethics Committee. All the patients presenting with IGH attending the Department of Dermatology were examined and enrolled for the study after taking written informed consent. Each subject was evaluated by detailed personal history, clinical examination and dermoscopic examination. Results: A total of 100 patients of IGH were included in the study. The most affected age group was 46-65 years (52%). Females were most commonly affected with M: F ratio 1:1.17. Different dermoscopic patterns of IGH documented were amoeboid (58.2%), feathery (19.1%), petaloid (14.5%) and nebuloid (8.2%). Ten percent of the patients showed more than one patterns. Conclusion: Dermoscope aids in evaluation of different patterns of IGH lesions, which helps to differentiate it from other hypopigmented conditions with considerable overlap in the site, morphology and clinical features. Dermoscopic analysis makes it easier to diagnose the disorder and subsequently plan for the appropriate treatment. [ABSTRACT FROM AUTHOR]

Background: Targeted phototherapy is a new form of phototherapy which has many advantages and disadvantages over conventional phototherapy. This article reviews the different technologies and outlines recommendations based on current evidence.Methods: A literature search was performed on targeted phototherapy to collect data. Relevant literature published till March 2014 was obtained from PubMed, EMBASE, and the Cochrane Library. Keywords like "targeted phototherapy", "excimer laser", "excimer lamp", "Nonchromatic ultraviolet light", "vitiligo", and "psoriasis", were used for literature search. All systematic reviews, meta-analysis, national guidelines, randomized controlled trials (RCT), prospective open label studies and retrospective case series in English were reviewed.Results: Three hundred and forty studies were evaluated, 24 of which fulfilled the criteria for inclusion in the guidelines.Conclusions and Recommendations: All forms of targeted phototherapy are useful in vitiligo. Good responses were seen in localized involvement, resistant lesions and in children in whom their use is more accepted and convenient (Level of evidence 2+, Grade of recommendation B). Similarly it is useful in psoriasis, either alone or in combination with drugs, even in resistant forms such as palmoplantar psoriasis. In view of expense and practical application, their use is limited to resistant lesions and localized disease. (Level of evidence 2+, Grade of recommendation B). But in other conditions there is no convincing evidence for its use. (Level of evidence 3+, Grade of recommendation C). [ABSTRACT FROM AUTHOR]

Background & Objective: Integration of complementary or alternative medicine (CAM) with allopathy medicine is a feasible solution to the human resource shortage in India. The scope of this integration will be influenced by the acceptance of CAM by allopathic practitioners. Objective is to assess the knowledge, attitude and practice regarding AYUSH system of medicine among medical officers in Mandya district. Methodology: A cross-sectional study was carried out over a period of 3 months involving 70 medical officers from various PHC in Mandya district. A pretested and structured questionnaire about the knowledge, attitude and practice regarding AYUSH was administered to all the medical officers. Data was entered in excel sheet and results were expressed in terms of percentage and proportions. Results: The average age of the study subjects was 34.85 ± 5.58 years. The most common source of information about AYUSH among study subjects was from colleagues/friends/ relatives. Only 35% of them had referred a patient to an Ayurveda practitioner and 35% had prescribed ayurveda medicines. Regarding the safety of ayurvedic medicine, 65% felt that ayurveda medicines need more scientific testing. Only 30% felt that AYUSH and allopathy should be integrated. Conclusion: The study concludes that the knowledge of the study subjects was inadequate; majority of them felt that ayurveda medicines need more scientific testing. Most of them were of the opinion that AYUSH and allopathy should not be integrated. But in practice nearly half of them were prescribing ayurveda medicines in their routine practice. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 9-year-old boy with brownish patch over the left flank since birth and with darker brownish dots appearing over the patch. The patient had no history of same lesions and that the lesions were identified as asymptomatic. Examinations reveal that the patient had a light brown macule with multiple dark brown macules measuring 1-4 millimeter in diameter that resembled lentigines. The patient was diagnosed with giant zosteriform nevus spilus.

The article focuses on the condition of the Pseudo-Kaposi sarcoma and skin ulceration of a patient with Klippel-Trenaunay syndrome. It cites the case of a 48-year-old male farmer presented with the history of reddish patches on his trunk and limbs. It also mentions the result of the patient's clinical data and investigation findings, which indicate that he has Klippel- Trenaunay syndrome, ulcerations, and solitary pseudo-Kaposi sarcoma.

The article describes the case of a giant, pendunculated, soft fibroma in an 18-year-old girl with tuberous sclerosis. The patient was presented with history of large, cauliflower-like, asymptomatic mass over the left side of the neck since ten years. Clinical examination revealed ash-leaf macuoles over the lumbo-sacral region, facial angiofibroma and shagreen patch over the back. Dermatologists planned excision of the mass and skin grafting.