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The majority of treatments for skin warts include destructive techniques like electrocautery and cryotherapy. These techniques of treatment frequently result in recurrence and scarring. Examining the safety and efficiency of intralesional vitamin D3 injection in cutaneous warts is the goal of this study.Total 50 people with recalcitrant warts of different dimensions, frequencies, and longevity participated in the study. 0.2 to 0.5 ml of vitamin D3 (600,000 IU, 15 mg/ml) were injected into the bases of warts. A maximum of 5 warts were administered per session, with sessions occurring every 2 weeks till the warts vanished, or for a total of 3 sessions. Following the final injection, individuals were monitored for six months to look for any recurrence.The trial was completed by 50 patients. Out of 50 patients, 35 (or 70%) showed a complete reaction, five (10%) showed a partial response, and ten (10%) showed no response. In every case, the distant warts completely disappeared.A safe, effective, and affordable therapy option for resistant warts is intralesional vitamin D3.

Non-healing ulcers are a major cause of disability and impairment, interfering with physical and mental well-being of patients with Hansen’s disease. They are difficult to manage having longer duration of treatment and increased financial burden. Minimizing the duration of healing can be a major step in rehabilitation of such patients. Platelet rich fibrin (PRF) is a newer modality to hasten wound healing. It is a concentration of platelets suspended in plasma extracted after centrifuging patient’s own blood.: To study the efficacy of platelet-rich fibrin (PRF) in management of non-healing ulcers.: 13 patients with 16 non-healing ulcers of more than 8 weeks duration were included in our study but 2 patients were lost to follow up after first sitting. Written consent for the procedure and ethical clearance from Institutional Ethical Committee was taken. Detailed history was noted, baseline photographs and measurement of area and volume were done at every sitting at an interval of 1 week. An average of 2-3 sittings of PRF was done in each patient and then the ulcer was spontaneously allowed to heal with regular dressing till complete closure was achieved.: The mean age of cases in our study was 39.4 years. The average percentage improvement in area and volume was 97.12% and 98.72% respectively. Out of 14 ulcers, 12 (85.71%) ulcers showed complete healing within 4 weeks. The mean duration of healing was found to be 2.41 weeks. The procedure was safe with no noted adverse events. The limitation of our study was small sample size. More studies are needed with larger sample size to confirm the results.: PRF is an inexpensive, safe, feasible and effective procedure in the management of non-healing ulcers.

Cytolytic vaginosis is a condition that symptomatically mimics vulvovaginal candidiasis. It was reported for the first time by Cibley and Cibley, in 1991. The authors stressed the need to distinguish cytolytic vaginosis from vulvovaginal candidiasis since the symptoms were attributed to hyperacidity created by the overgrowth of resident lactobacilli of the vagina. Patients show lack of response to antifungals and therapy aimed at increasing the vaginal pH offers relief. Since then there were conflicting opinions regarding the existence of the entity “cytolytic vaginosis.” This review aims to give a brief overview of the condition termed “cytolytic vaginosis.”

Vitiligo is a common form of localised depigmentation. It is a non-contagious acquired condition resulting from the progressive loss of melanocytes which is characterised by totally amelanotic, non scaly, chalky-white macule with distinct margins.To study the clinical and epidemiological profile of vitiligo patients.: In this observational cross-sectional study total 40 vitiligo patients were included in this study. Detail history and clinical examination of patients were done.: In this study majority of the vitiligo patient belonged to the age group of 21-40 years. The mean age of vitiligo cases in this study was 24 years. In the present study the male: female ratio was 1:1. Among 40 cases, about 26 cases were unstable and only 14 were stable. In the present study, the most common type of vitiligo found was vulgaris type and the mean duration of disease in vitiligo cases was around 9 years. In our study, 10 patients had positive family history of vitiligo. Our observations are essentially consistent with the literature, there was no difference in clinico-epidemiological features of vitiligo.

Female pattern hair loss (FPHL) is explained by decrease in hair fiber production and their eventual miniaturization. It is considered a counterpart of male androgenetic alopecia but the role of androgens in its pathogenesis is yet to be proven. To evaluate the trichoscopic features in females with patterned hair loss. Inclusion and exclusion criteria were applied and 37 cases were enrolled in our study. Detailed history and clinical examination were done to establish the diagnosis. Trichoscopic examination was done after taking consent in diagnosed cases. On trichoscopy, hair diameter variability, peri pilar sign, white dots, scalp pigmentation and focal atrichia was observed in 62.2%, 62.2%, 40.5%, 45.9% and 40.5% respectively. Most common trichoscopy finding observed was peri pilar sign and hair diameter variability in 23/37 females. Definitive diagnosis of FPHL is difficult to be established solely on the basis of clinical examination. Thus, trichoscopy serves as a non-invasive tool to ascertain the diagnosis in these patients.

The metabolic syndrome is the term used to describe a constellations of metabolic derangements that includes insulin resistance, hypertension, Dyslipidemia, central or visceral obesity, type 2 DM & accelerated cardiovascular disease. An oxidative imbalance is responsible for the development of both metabolic syndrome & vitiligo. In the present study we have evaluated the association of metabolic syndrome with Vitiligo.In this observational cross-sectional study we selected 40 subjects attending skin OPD with age matched 40 controls and assessed the waist circumference, blood pressure, serum triglyceride level, cholesterol and high-density cholesterol along with Fasting blood glucose level at tertiary care Hospital. A detailed history including age, gender, diabetes mellitus, hypertension, smoking and onset of vitiligo was taken. The MetS criteria were defined by National Cholesterol Education Program Adult Treatment Panel III 2005 (ATP III) guidelines.We identified metabolic syndrome in 15 subjects with vitiligo and 6 subjects without vitiligo. The P value came 0.022 which is statistically significant. Active vitiligo, segmental vitiligo and increased duration of vitiligo were determined to be independent predictors of metabolic syndrome.The risk of developing metabolic syndrome is increased in patients of vitiligo. Screening and the close follow up of the patients of vitiligo with clinical feature such as in unstable, segmental vitiligo with increased duration is necessary for the early diagnosis of the metabolic syndrome to reduce the morbidity & mortality of the patients

Psoriasis is an immuno-mediated chronic systemic disease involving cytokines of helper Th1 pathway. Vitamin D has an effect on keratinocyte proliferation, differentiation and immune modulation of immune system especially Th1 pathway, which is altered in psoriatic skin suggesting that Vitamin D may have a role in pathogenesis of psoriasis. To study correlation between psoriasis vulgaris and serum vitamin D. To evaluate serum vitamin D level in psoriasis cases and in control group and correlating vitamin D level with severity and duration of the psoriasis. 57 cases (>15years of age) with psoriasis and 57 healthy subjects were recruited. Psoriasis was clinically diagnosed and severity evaluated by PASI scale. Vitamin D was analysed by enhanced chemilumine scence on vitrus Eci autoanalyzer of Orth clinical diagnostic. Vitamin D deficiency defined as Vitamin D deficiency in the study was 22.8% in patients and 14% in control group. Vitamin D insufficiency was found in 42.1% of cases and 19.3% of control. According to chi-square the p-value is 0.003 showing significant association. There was a tendency towards decrease in vitamin D level with increase in disease duration. There was negative correlation between vitamin D and PASI score. The study found a significant relationship between vitamin D and psoriasis. Further metanalysis involving larger study population will be required to establish whether vitamin D levels benefits patient with psoriasis vulgaris.

Introduction: Dermatophytes are fungi that can cause infections of the skin, hair & nails due to their ability to invade keratin. Dermatophytosis is the most common superficial fungal infection worldwide; it is common in tropics and subtropical regions. It may present in epidemic proportions in areas of high humidity. Objective: The present study aimed to identify various species causing dermatophytosis & to determine the invitro susceptibility pattern against commonly used systemic antifungal agents in our tertiary care center. Material and Methods: A total of 149 samples were collected of infected skin, hair and nails in a period of 1 year from January 2020 to December 2020. Samples were collected under aseptic condition by skin scrapping, nail and hair clipping by using scalpel or forceps. Identification of the causative pathogen was done by performing slide culture, lacto-phenol cotton blue mount, hair perforation tests and urease tests. We adopted a newly developed agar based disk diffusion assay to test susceptibility of clinically isolated dermatophytes for antifungal susceptibility testing. Results: Microbiological investigations revealed the presence of dermatophytic fungi in 71.8% of the samples. Trichophyton rubrum was the predominant pathogen isolated. The study showed Itraconazole to be most effective antifungal drugs against dermatophytes followed by terbinafine and fluconazole. Conclusions: Further intensive epidemiological and invitro antifungal susceptibility studies of dermatophytes are required which will have more public health significance. Keywords: Dermatophytes, Antifungals, Susceptibility

Background : Nail diseases have always been a challenge for dermatologists. Because diagnosis is not always based on clinical examination and time taken for histopathology KOH or culture examination is long, there has always been a quest for easy and faster method. Onychoscopy, a rapid office-based technique helps see miniscule details, can hence aid in diagnosis. Aim : To study dermoscopic features in various nail disorders. Materials and Methods : 126 patients with clinically evident nail diseases were recruited in the crosssectional descriptive study. After clinical examination, all nails were subjected to dermoscopic examination. Fischer’s exact test was applied with a significance threshold of p Results : Onychomycosis (n=49) was the commonest nail disorder having spiked pattern as the most common (91.8%) dermoscopic feature. Nail psoriasis (n=32) had onycholysis (84.4%) as the most frequent feature. Nail lichen planus (n=5) had longitudinal fissures (80%) while chronic paronychia (n=5) had erythema and scaling on the PNF (100%). Longitudinal melanonychia (n=5) was associated with regular parallel grey/ brown lines in all cases while trachyonychia had longitudinal ridges in 75% cases. Dilated capillaries (75%), microhemorrhages (75%), capillary dropouts (75%) were seen commonly in systemic sclerosis (n=4). Periungual verruca (n=4) had dermoscopic brownish black dots or globules in 100% cases. Alopecia areata (n=4) showed superficial small pits (100%) most commonly. Conclusion : Dermoscopy helps in picking minute details not visible to the naked eye and hence could serve as an important diagnostic tool. Keywords: Dermoscopy, Longitudinal melanonychia, Nail, Nail lichen planus, Nail psoriasis, Onychomycosis, Onychoscopy, Scleroderma.

Background: Leprosy, also well-known as Hansen’s disease, is a chronic granulomatous infectious disease caused by Mycobacterium leprae. In spite of having been declared eliminated in December 2005 from India as a public health problem, India has still 60% of the entire global case load. This study entailed the epidemiological, clinical features and histopathological findings of new leprosy patients and assessing the current situation of leprosy at a tertiary level referral center in central India. Materials and Methods: A total of 60 Leprosy patients belonging to Ujjain and its adjoining districts attending the out patient Department of Dermatology at R.D Gardi Medical College, Ujjain (M.P.), over a period of 12 month i.e. Jan-2019 to Dec-2019 constituted the subject material for study. The data was analysed for Clinico-epidemiological and histopathological characteristics. Results: Out of all leprosy outpatients, Maximum number of patient belonged to age groups of 21-40 years and 2 cases of childhood leprosy were recorded. Male preponderance with M: F ratio was 3:1. Family history was seen in 3 patients (5.0%). 73.3% patients hailed from rural area. Borderline Tuberculoid (19 patients) was commonest clinical presentation. The overall clinico-histopathological concordance observed was 75%. Conclusions: The present study gives a general picture about the current trends of Leprosy in this particular region and highlights the importance of both clinical & histopathological examination and determining parity between their findings. This study emphasizes the need of spread of awareness about the disease, facilities for investigation and early diagnosis. Keywords: Leprosy, Central India, Epidemiology, Clinico-histopathological.

Introduction: Vitiligo: An autoimmune disorder of pigmentation characterised by loss of functional melanocytes and melanin in epidermis. The disease has incidence of 0.5%–2% with no ethnic/sex predilection. Aim: Morphological dermoscopic patterns in vitiligo and its correlation with stability. Setting & Desing: An observational study conducted on patients attending C. R. Gardi Hospital, Ujjain during January’19-December’19. Materials and Methods: Dermoscopic examination was done after taking consent in 50 clinically diagnosed cases of vitiligo including stable vitiligo and unstable vitiligo. Statistical Analysis Used : Fisher’s Exact Test Sig. Results: On dermoscopy, patterns like perifollicular pigmentation (44%), perilesional/marginal hyperpigmentation (50%), intra/perilesional erythema with telangiectasia (86%), perifollicular depigmentation (64%), trichrome pattern (50%), leukotrichia (46%), starburst appearance (24%), comet tail appearance (48%), micro-koebner’s phenomenon (42%), tapioca sago appearance (28%) were observed. Perilesional/marginal hyperpigmentation was observed more frequently in stable disease. Perifollicular depigmentation, trichrome pattern, comet tail appearance, micro koebner’s phenomenon and tapioca sago appearance are the findings significant in unstable disease. Perifollicular pigmentation and intra/perilesional erythema with telangiectasia though are findings of stable disease, were observed in both stable and unstable disease in similar numbers. Leukotrichia and starburst appearance were present in both stable and unstable disease despite being the findings of unstable disease. Conclusion: Dermoscopy serves as an auxiliary tool in confirming the diagnosis and assessing stability of the disease. Dermoscopy allows appreciation of subtle features invisible to naked eye. This is the first ever study to find out the statistically significant findings in stable and unstable vitiligo. We conclude that dermoscopic st

Pseudoxanthoma elasticum (PXE) is a hereditary systemic connective tissue disease affecting mainly the skin, retina and cardiovascular system. Pathologically, it is characterized by mineralization and fragmentation of elastic fibers (so-called "elastorhexia"). PXE is associated with mutations in the ABCC6 (ATP binding cassette subtype C number 6) gene. Women are affected more than men. A 22-year-old woman came to our department with complaints of small, yellowish raised lesions in rows or lacy pattern on her neck since 2 years, some of which coalesced to form larger lesions. She also complains that the skin has been soft, flabby, and wrinkled since 2 years in the armpits, trunk, groin, and knees. On examination, the lesions were slightly pebbly in appearance; such papular lesions tend to coalesce gradually to form plaques with a cobblestone appearance. On histopathological examination, elastic fibers appear basophilic due to calcium deposition. The fibers were fragmented, swollen, and clustered in the middle and deep reticular dermis. The collagen fibers were split. Based on the above findings, a diagnosis of PXE was made. Due to the rarity of the disease, we are reporting this case. The course and prognosis were explained to the patient. Most of the pathological changes associated with PXE are irreversible, but prophylactic measures can be taken to minimize the course of the disease.

Background: Objective of the research was to study the efficacy and safety of measles, mumps and rubella (MMR) vaccine in the treatment of warts.Methods: 53 patients with single or multiple warts in all age groups were included in the study. The patients received intralesional MMR vaccine 0.5ml into a single wart or the largest wart in case of multiple lesions at interval of 3 weeks for 3 treatments. All patients were followed up every 2 months up to 6 months regarding relapses. side effects and therapeutic outcomes were evaluated.Results: Out of 53 patients, 50 completed the study. Complete response was seen in 36 (72%), partial response in 09 (18%) and no response in 05 (10%) patients. 3 out of 36 patients with complete response were having recurrence of warts. Pain at the site of injection and flu like symptoms were the main side effects observed.Conclusions: Intralesional immunotherapy with MMR vaccine was found to be a simple, effective, and safe treatment for warts. This study proved to be cost effective as patients can be treated with just 03 doses of MMR vaccine given at the interval of three weeks.

Background: Alopecia areata remains one of the common cases presenting in clinical practice. Considering the anxious state of patients it becomes very important to correctly diagnose the cause and type of alopecia followed by the appropriate treatment. Trichoscopy is a novel, sensitive, non invasive modality which provides rapid detection of alopecia areata with advanced diagnostic accuracy, predicts the cause of disease and decreases unnecessary biopsies. Aim and Objectives: To determine the Trichoscopic findings in alopecia areata in adult population. Materials and Methods: 122 patients with clinically diagnosed alopecia areata were enrolled. After taking proper history and consent trichoscopy was done using a Dinolite digital microscope system in both non polarized and polarized modes and their photographs were taken. Result: 122 patients with alopecia areata were enrolled. Yellow dots were the most common trichoscopic findings observed in 108 (88.5%) patients followed by short vellus hair 66 (54.1%), short regrowing hair 58 (47.5%), exclamation mark hair 56 (45.9%), black dots 44 (36.1%) and broken hair 34 (27.9%). Keywords: Trichoscopy, Alopecia areata, Exclamation mark hair, Black dots, Yellow dots.

Elastosis perforans serpiginosa is a rare primary perforating disorder. In EPS, there is elimination of altered elastic fibres from papillary layer of dermis to epidermis which is described as transelimination disorder. It is characterized as multiple hyperkeratotic umbilicated papule which are arranged in annular or serpiginous pattern with raised edge and central plug. These are more commonly distributed over back, sides of neck and extremities in bilateral symmetrical pattern. It is common in age group of 5 to 20 years with male predominance. Lesions are generally self limiting in nature. Isotretinoin is used in penicillamine induced disease. A 45 year old diabetic female presented with chief complaints of asymptomatic dark coloured raised lesions on face, sides of neck and upper extremities in bilateral symmetrical pattern for last four years. On cutaneous examination multiple asymptomatic hyperpigmented keratotic papular lesions, coalescing to form plaques were arranged in annular, serpiginous and polycyclic pattern over face, sides of neck, chest and forearms distributed in bilaterally symmetrical pattern with central sparing and atrophy. Patient underwent general and systemic examination followed by routine and histopathological examination. Routine investigations were normal except random blood sugar and HBA1C levels were raised. Histopathological examination revealed hyperkeratotic and acanthotic epidermis with transepidermal channels having nuclear debris and elastic fibres. Patient was explained about course and prognosis of disease and was stared on topical and oral retinoids. Later, she was lost follow up. Keywords: Elastosis perforans serpiginosa, Perforating disorder, Rare.

Introduction: Dermatophytes are fungi that can cause infections of the skin, hair & nails due to their ability to invade keratin. Dermatophytosis is the most common superficial fungal infection worldwide, more common in tropics and subtropical regions. It may present in epidemic proportions in areas of high humidity. Aims and Objectives: The present study is aimed to determine the distribution and to identify the clinical types of dermatophytosis that are prevalent in Malwa region. Materials and Methods: A total of 298 samples were collected from infected skin, hair and nails for a period of 1 year.Samples were collected under aseptic condition by skin scrapping, nails and hairs clipping by using scalpel or forceps and were then subjected to direct microscopy by potassium hydroxide (KOH) mount. Results: Dermatophytosis manifested more in the age group of 21-30 years, with male predominance. Among various clinical types, tinea cruris was the commonest type. Direct microscopy on KOH mount revealed the presence of dermatophytic fungi in 71.8% of the samples. Conclusions: Dermatophytosis is the commonest disease presenting in dermatology clinics and are responsible for myriad of clinical manifestations in human. Empirical use of steroid/mixed preprations, poor patient compliance due to high cost and changing dress sense are some important contributing factors for the real upsurge in incidence and prevalence of dermatophytosis in the last few years. Keywords: Dermatophytoses, Tinea cruris, Tinea corporis. Introduction Dermatophytes are a group of closely related filamentous fungi that can cause infections of the skin, hairs & nails due to their ability to utilize keratin.[1]They are classified into three genera: Microsporum, Trichophyton, and Epidermophyton. Trichophyton rubrum has been the most common isolates. These superficial cutaneous mycoses affect 20% to 25% of the world’s population.[2]In the present scenario of India, dermatophytoses

Blastomycosis-like pyoderma is a very rare, chronic inflammatory disorder, which is also known as pyoderma vegetans (PV). It is commonly seen in middle aged males. It is found to be associated with reduced immunity like primary immunodeficiency syndromes, nutritional deficiencies, HIV infection, diabetes mellitus, chronic myeloid leukemia and alcoholism. It tends to have a link with inflammatory bowel diseases. We report a 41-year-old male who presented with pus filled lesions over his left shoulder, axilla and left elbow for last 4 months. Initially, it was a painless pea-sized lesion, which gradually enlarged to form a larger lesion with central ulceration and peripheral extension. He had consulted a couple of doctors and took multiple courses of antibiotics, which had failed to comfort him of the lesions. Cutaneous examination revealed a well‑defined large plaque, sized 16×14cm over the left shoulder extending to the axilla with few pustules, which had erythematous base with serous-purulent discharge. The plaque was nontender and ulcerated, with uneven surface, elevated edges and yellowish crust. There was a similar smaller (sized 5×3cm) plaque over the left elbow. Colonoscopy was not suggestive of either Crohn’s disease or ulcerative colitis. Histopathological examination revealed pseudoepitheliomatous hyperplasia and upper dermal abscesses with predominantly neutrophilic infiltrate. He was further started on prednisolone 40mg once a day in the morning hours after breakfast along with antibiotic for 10 more days. Corticosteroid was tapered by 10mg every 10 days and 10mg was given for a period of 1 month. Resolution of vegetating granulation tissue was observed within 10 days month and complete remission in 1 month. It is very essential to be familiar with PV, as correct diagnosis may reveal an underlying inflammatory bowel disease.

Background: Hair has no vital functions in humans but its loss from the scalp can create a sense of negative body image and anxiety. The term ‘female pattern hair loss’ is explained by decrease in hair fiber production and their eventual miniaturization. To evaluate the clinicopathological, trichoscopic and biochemical parameters in females with patterned hair loss.Methods: 37 females in age group of 18-45 years complaining of reduction in hair volume with diffuse thinning over the crown were included in our study after applying inclusion and exclusion criteria. Detailed history was taken and clinical examination was done. Written consent and ethical clearance from Institutional Ethical Committee was taken. Ludwig grading, evaluation of other clinical signs of hyperandrogenism and trichoscopy was done. These females then underwent histopathological examination. 10 ml blood was withdrawn to assess anemic, thyroid and hormonal profile in these females.Results: Out of 37 females examined majority of the females had Ludwig grade 1 hair loss. Serum levels of testosterone were found significantly related to clinical signs of hyperandrogenism. Hair diameter variability and peri pilar sign formed the majority in trichoscopy (62.2% each). The most common histopathological finding was perifollicular infiltrate (70.3%).Conclusions: FPHL can contribute to severe psychological distress. Despite its high prevalence, its diagnosis and treatment still impose several difficulties in clinical practice. Although hormonal factors are believed to contribute, its pathogenesis still remains elusive.

Mastocytosis is a rare, acquired multisystem disorder of increased number of mast cell in the skin and other tissues. Mastocytosis is caused by several activating mutations in the KIT gene.1 Although mastocytosis is primarily a systemic disorder, it often presents with skin lesions to dermatologists. Urticaria Pigmentosa is the most common pattern of cutaneous mastocytosis in adults and children. Keywords: Urticaria Pigmentosa, Mastocytosis.

Bowen’s disease also known as squamous cell carcinoma in situ, a rare form of progressive, intraepidermal carcinoma, first described by John T. Bowen in 1912.We report a case of 62-year-old elderly male, retired teacher who presented with history of gradually expanding, asymptomatic, Pinkish-reddish raised lesion present on right thigh and left lumbar region since five years. Examination revealed sharply-demarcated, slightly elevated, erythematous, scaly and crusted plaque with dry and rough surface. Histological examination showed Hyperkeratosis, parakeratosis, with moderate lymphocytic infilterate in upper dermis. There was full Thickness anaplasia of the epidermis and atypical keratinocytes which are disorderly arranged. Keywords: Squamous cell carcinoma in situ, Erythroplasia of Queyrat, Solar damage, Arsenic, Cauasian.

It is also known as nodular elastosis with cyst and comedones. The pathophysiology of disease causation is unknown, the condition may arises due to prolonged sun exposure. We report a case of 68 year old male agriculturist who presented with dark colored raised lesions along with thickening of facial skin which was increasing progressively since past three years. Physical examination showed the presence of thickened inelastic skin along with deep furrows and wrinkles involving the entire face, along with multiple open and closed comedones yellowish papules and nodules clustered especially around periocular region and dorsum of nose. On histopathological examination epidermis showed epidermal cyst formation containing laminated keratin and superficial dermis shows follicular infundibular plugging and large nodules filled with keratinous material. Keywords: Prolonged sun exposure, Bilateral, Nodular elastoidosis with cyst and comedones.

Porphyrias are group of inherited and acquired disorders resulting from enzyme deficiency in the metabolic pathway of haem biosynthesis. Among all types of porphyria, the most common type is porphyria cutanea tarda in adults, occurring due to deficiency of enzyme uroporphyrinogen decarboxylase in the metabolic pathway ofm heme biosynthesis. A 35‑year old man presented in opd with chief complaints of recurrent episodes of vesicles, blisters, erosions, raw areas on dorsum of hand and face for 2 years. Local examination revealed multiple erosions with adherent crusting, atrophic plaques of healed lesions over the face and multiple hyperpigmented macules with scaring, erosion and raw areas present overe dorsum of the hands. Laboratory findings showed abnormal liver profile and elevated zinc protoporphyrin and coprophyrin levels. Urine revealed coral pink fluorescence under woods lamp. Histology of the skin showed epidermal spongiosis, subepidermal blister with minimal inflammatory cell infilterate in the dermis. Treatment given were sun screen lotions, hydroxy-chloroquine, avoidance of triggering factors and alcohol discontinuation. Patient showed marked improvement in skin lesions. Keywords: Porphyria, Gunther?s disease, Uroporphyrinogen III synthase deficiency.

Background: Acne scars are the most common sequele of the inflammatory process of acne and affects almost 95 percent of the patients with acne vulgaris. Hypertrophic scars and keloid scars result from excessive tissue formation; atrophic scars are characterized by loss or damage of tissue, which are further categorized into ice pick, rolling, and boxcar scars. Method: A total of 45 patients underwent four sessions, four weeks apart, of subcision and microneedling and were assessed for scar grading three months after the final treatment session. Results: Overall improvement was seen in 95.6 percent of patients (improvement by at least 1 grade) with slight erythema, edema and pain for 1 to 2 days. The improvement correlated with the patient-reported assessment of improvement in scars; 17.8 percent of patients perceived a 75- to 100-percent improvement in their acne scars, while 24.4 percent of patients perceived an improvement of 50 to 74 percent. The majority of the patients (55.5%) perceived an improvement of 25 to 49 percent in their scars. Conclusion: Rolling and boxcar scars show more improvement compared to ice-pick scars. This combination is well tolerated in Fitzpatrick Skin Types III, IV and V, with no failure rates. We observed a high level of patient satisfaction and minimal downtime.

Background Multimodality therapies including minimally invasive modalities are increasingly used in atrophic scarring. Objective To evaluate the role of platelet-rich plasma (PRP) as adjunctive therapy to a combined subcision and needling treatment in severe (grade 4) atrophic acne scarring. Methods A total of 30 patients with grade 4 acne scars were randomly divided into two groups, 15 patients each: Group A underwent three sequential treatments of subcision and needling while Group B, three sequential treatments of subcision, needling, and topical application of PRP that were performed at 3-week intervals. Scar grading was assessed 3 months following the final session. Participant's assessment of treatment response was registered. Results Scar improvement ≥50% was reported significantly more often by Group B than Group A patients (P = 0.025). Regarding physician-based assessment of scar grading post-therapy (number of patients with two grades improvement vs one grade or no improvement), there was a trend toward more improvement in Group B (P = 0.195). Physician's evaluation of acne scar improvement correlated with the patient's assessment of improvement: 60% of Group A and 66.6% of Group B patients appreciated an improvement of 25%-49% and 50%-74%, respectively. Mean duration of postprocedure erythema/edema was shorter among Group B than Group A patients (16.1 vs 32.9 hours, respectively). Overall, substantial improvement was noticed in rolling and boxcar scars with only a mild change in icepick scars. Conclusion Platelet-rich plasma appears to add to the improvement of grade 4 atrophic acne scars when combined with needling and subcision. These findings require further evaluation by future studies.

Background: Vitiligo is an acquired disorder; characterised by well-defined depigmented macules and patches. Its diagnosis is clinical but histopathology aids in doubtful cases, histopathological findings depend on the duration of clinical lesions. Dermoscopy serves as an auxiliary tool for diagnostic confirmation and additionally aids in the evaluation of disease activity. Methods: It’s the hospital based observational study of 50 vitiligo patients. After ethical committee approval and patient’s consenting, detailed history with clinical and dermatological examination was performed using a dermoscope (10X) and biopsy sample was sent for examination. The results were statistically analysed, discussed and their correlation with clinical diagnosis was established.Results: Generalised vitiligo was the most common presentation found, with koebnerization signifying progressive disease. Epidermal hyperkeratosis and absence of melanocytes were found to be significant in stable disease. Perilesional/marginal hyperpigmentation was observed in stable disease, while perifollicular depigmentation, trichrome pattern, comet tail appearance, micro koebner’s phenomenon and tapioca sago appearance were the findings significant in unstable disease.Conclusions: Vitiligo is primarily a clinical diagnosis; additional modalities may be required either to confirm the diagnosis like histopathology or to assess the progression of disease with dermoscopy. Unstable disease display perifollicular depigmentation whereas stable disease display perifollicular pigmentation, and can be compared with epidermal hyperkeratosis and absence of melanocytes in the lesions of stable vitiligo on histopathology. Such studies with a greater number of cases are recommended for having better understanding of the findings.

Background: Psoriasis is a chronic inflammatory immune mediated disease that can involve skin, nails, scalp, etc. Nails can be involved in up to 90% of psoriatic patients in their lifetime. Also, psoriatic arthritis is commonly found in patients having nail involvement. Nail changes in psoriasis can be imperceptible to the unaided eye and easily missed on clinical examination. Onychoscopy has helped in improving diagnosing these subtle clinical features. Aim of the research was to study dermoscopic features in nails involved in psoriasis.Methods: 50 patients having clinically evident nail psoriasis, of which 2 were excluded due to positive KOH examination were recruited in the cross-sectional descriptive study. After clinical examination, all the nails were subjected to dermoscopic examination. The findings were tabulated in Excel and comparisons were made.Results: The common dermoscopic findings were pits (79.2%), splinter haemorrhage (72.9%), onycholysis (68.8%), subungual hyperkeratosis (50%), nail plate scales (50%), dilated PNF/LNF capillaries (20.8%), ridges (18.8%), leukonychia (14.5%), salmon spots (10.4%), fuzzy lunula (8.3%), and dilated hyponychial capillaries (6.3%).Conclusions: Dermoscopy is a simple, easy, rapid and an office-based technique. It helps in picking up subtle nail changes not visible to the naked eye. It also precludes from doing painful nail biopsy in nail disease without its skin manifestation. Onychoscopy helps in picking up early nail findings in psoriasis and thereby warning the patients against impending disease severity.

Background: Many patients of alopecia are encountered in daily practice with diagnostic dilemma. Trichoscopy is a sensitive, non-invasive tool which aids in clinical diagnosis.Methods: An observational study performed in adult patients with alopecia attending R.D. Gardi Medical College, Ujjain, over a period of one year. Trichoscopy was performed using a Dinolite digital microscope with both polarized and non polarized modes.Results: 269 patients of alopecia (257 non cicatricial, 12 cicatricial) aged 18-50 years were enrolled. The diagnosis was made after detailed history and clinical examination. 173 (64.3%) males and 96 (35.7%) females. 45.4% patients were diagnosed to have alopecia areata in which yellow dots were the most common trichoscopic finding observed in 88.5% patients. 37.2% patients were diagnosed with androgenetic alopecia with hair diameter diversity >20% observed in all the patients. 9.3% patients were diagnosed to have telogen effluvium with short vellus hair seen in 64% patients. 3.7% of the patients were diagnosed to have seborrheic dermatitis with arborizing vessels being the most common finding seen in 90% patients. 2.9% patients were diagnosed with lichen planopilaris in which loss of follicles and peritubular white casts were seen in all the cases. 0.9% patients were diagnosed to have discoid lupus erythematosus with hyperkeratotic follicular plugging seen in all the cases. Overall yellow dots were the most common trichoscopic findings seen in 61% cases.Conclusions: Trichoscopy is a reliable diagnostic tool in hair and scalp disorders. Hence trichoscopic evaluation should be done in every case of alopecia.

Background: Papulosquamous dermatoses is a complex group of disorder characterized by scaly papules and plaques. There is a need to study the exact, pattern and prevalence of this disorder in different age groups and their line of treatment. Objective of the study was to observe the clinical pattern of various papulosquamous dermatoses and their prevalence at tertiary care center, Ujjain.Methods: This was an observational study done in R.D. Gardi Medical college, Ujjain over a period of one year. A total of 229 cases including male and female of papulosquamous dermatoses were enrolled from the outpatient department. All patients were studied clinically and relevant data was recorded. Microsoft excel was used for data entry and analysis was done using SPSS version 23.Results: There were 139 (60.7%) males and 90(39.3%) females with overall male to female ratio was 1.54:1. Most common age group affected with papulosquamous dermatoses was 31-50 years. The clinical pattern observed was psoriasis 49.3%, lichen planus 24.5% followed by pityriasis rosea 10.5%. The least common papulosquamous diseases were pityriasis rubra pilaris (1.3%) and lichen nitidus (1.3%). Most common variant of psoriasis and lichen planus was chronic plaque and classical respectively. Classical juvenile variant of pityriasis rubra pilaris was seen in our study. A single rare case of lymphomatoid papulosis was noted in our study.Conclusions: Psoriasis, lichen planus and pityriasis rosea were commonest papulosquamous diseases were observed but still we need more longer duration of observational studies on papulosquamous dermatoses to understand the morphological features for the effective management of these diseases.

Background: Nail apparatus forms an integral part to be examined for all dermatological conditions. Nail changes are seen in various dermatosis like psoriasis, onychomycosis, lichen planus, collagen vascular disease, vesicobullous diseases and other papulosquamous diseases. Aims and objective of the study was to determine the prevalence of nail changes in various dermatological conditions.Methods: After applying inclusion and exclusion criteria, 269 cases with various nail changes were enrolled in the study. Detailed history and thorough nail examination was carried out along with other necessary investigations like CBC, RFT, LFT, nail clipping for fungal hyphae culture and microscopy.Results: Out of 269 cases with nail disorders, male to female ratio was 1.5:1 and most common age group was 31-40 years. The most common abnormality observed was onychomycosis (34.2%) followed by nail changes in psoriasis (30.4%), LP (18.5%), eczema (4%), trachonychia (3.3%), paronychia (2.9%), lichen striatus (2.2%) and darier’s disease (0.37%). Among onychomycosis most common pattern observed was DLSO (82.6%) followed by PSO (7.6%), SWO (5.4%) and TDO (4.34%). The pattern of nail changes in psoriasis patients was pitting (30.4%), subungual hyperkeratosis (21.9%) and onycholysis (10.9%). Cases with LP had longitudinal striations (52%), thinning of nail plate and trachonychia (10% each). V shaped notching and distal splitting was seen in one of the Dariers’ disease patient.Conclusions: Nail changes form an indispensible part of various dermatological conditions. The pattern of involvement is unique in each and every disease. Hence examination of all the 20 nails should never be missed.

Sweet syndrome (acute febrile neutrophilic dermatosis) is not a common disease, etiology of which is unknown. It is an inflammatory neutrophilic dermatosis characterized by non?itchy, tender, erythematous papules and plaques most commonly distributed on the arms, upper body, head and neck. It commonly affects adults in between 30- 60 years with female predominance with 4:1 sex ratio. The disease is associated with fever, peripheral leukocytosis and wide variety of diseases. It shows excellent response to systemic corticosteroids. A 28 year old female presented with multiple red elevated lesion over face, back, upper and lower limbs, which were associated with pain and fever. She gave history of sore throat before appearance of lesions. On cutaneous examination erythematous papules and plaques, plaques were studded with pseudovesicles were seen on face, back, upper and lower limbs. They were tender and associated with fever. Patient underwent clinical and systemic examination followed by routine and histopathological investigations. Complete blood picture showed neutrophilia (94%) and histopathological examination showed dense neutrophilic infiltrate with oedema in dermis. The patient was prescribed topical steroids, oral Dapsone and corticosteroids, but patient did not show any improvement. Later on patient was put on Dexamethasone pulse therapy along with oral Azathioprine for 18months. Lesions resolved and no recurrence was observed in months. Keywords: Sweet syndrome, Neutrophilic dermatosis, Recurrent.

Cutaneous metastasis in anorectal adenocarcinoma is a rare entity. Here, we report the case of a 40-year-old female who presented with yellowish-brown, irregular, solid, elevated rashes over the pubis with a recent history off palliative colostomy for anorectal adenocarcinoma. Clinically, we suspected metastasis that was proved on biopsy. We report this case due to the rare presenting site (i.e., perineum) of a metastatic adenocarcinoma.

INTRODUCTION: Porokeratosis is an autosomal dominant genodermatosis with variable penetrance, characterized by a clonal disorder of keratinization with one or more atrophic patches surrounded by a clinically and histologically distinctive hyperkeratotic ridge like border called the cornoid lamella. Multiple clinical variants of porokeratosis are recognized. The original description of this entity was given in 1893 by Mibelli.[1]

INTRODUCTION: Dominant dystrophic Epidermolysis Bullosa (EB) is a subtype of dystrophic type of Epidermolysis Bullosa. Dystrophic EB are caused by mutations in a single gene, COL7A1, which encodes the anchoring fibril protein, type VII collagen. Immunofluorescence staining of the skin of patients using antitype VII collagen antibodies showed that the normal bright linear staining is absent in severe generalized recessive dystrophic EB, but present in dominant dystrophic EB.[1-3] The main feature of dominant dystrophic EB is that the skin is generally less fragile than in severe generalized recessive dystrophic EB. Blisters usually follow sharp knocks or glancing blows rather than mild friction, Blisters mainly occur in skin overlying bony prominences, such as the knees, ankles and dorsa of the hands or feet. The most consistent findings are localized scarring with milia formation and dystrophic nails. Nail dystrophy is probably the most important diagnostic feature of the disease, especially in adults, because many patients have only limited scarring, which becomes less noticeable with age.

Background: Skin diseases in pediatric age are common health problem with wide variation in the presentation in various regions. Association of seasonal variation in skin disease has been studied for centuries. Environmental factors plays significant role in skin disease. Different climatic factors that may decide the incidence of skin diseases. Cold, warmth, light and humidity play direct or indirect role in occurrence of various dermatosis. Many studies have been done to study pattern of skin disease in pediatric population but only few studies are done for its clinical correlation of seasonal variation. Hence we decided to study seasonal variation in pediatric dermatoses. The objective of the study was to study the seasonal variation, age-wise variation and distribution of common dermatoses in pediatric population in 0-15 years.Methods: This was a retrospective study done in R.D. Gardi Medical College, Ujjain over a period of one year. A total of 1110 cases of age 0-15 years, who presented in out-patient clinic of dermatology deparment were included in this study. Demographic profile and clinical details were recorded. Data were collected and patient’s details were categorized according to four seasons summer, autumn, winter and spring. Microsoft excel was used for data entry and analysis was done using SPSS version 22.Results: Out of all the subjects recruited, 55.7% were males and 44.3% were females with M:F ratio1.25:1. The maximum numbers of patients were in the age group of 10-15 years (43.3%). Majority of visits were in summer (n=360, 32.43%) followed by winter and spring season. Most common dermatosis seen during summer was bacterial infection (n=93, 8.37%) and during winter was eczema (n=62, 5.58%).Conclusions: Dermatoses in children are wide spread problem responsible for significant morbidity in them. In the present study there is seasonal variation of dermatological diseases in pediatric age group.

Nevus comedonicus is a rare skin disorder due to defect in development of hair follicle presenting as groups of closely set, dilated follicular openings with dark keratin plugs resembling comedones. The lesions may be distributed in a linear, interrupted, unilateral or bilateral pattern and sometimes follow the lines of Blaschko. It may develop inflammatory acne-like lesions leading to cysts, abscesses and scarring. A 36 year-old woman presented with multiple pits on left half of the body involving the face, upper limb, shoulder, back and buttock since the age of 4 years. She also had a painful swelling over the back. There was no history of cranial, skeletal or ocular involvement. Physical examination revealed multiple circular honeycomb-type pitted scars sized from 0.1×0.1 to 0.5×0.5 mm present unilaterally along lines of Blaschko in an interrupted pattern over the left half of the body as mentioned above. Among these pitted scars few scattered comedones were present with interfollicular normal skin. There was an abscess along the margin of one of the lesions over the back which was tender, indurated and with local rise of temperature. Histopathological examination revealed deep, wide invagination of acanthotic epidermis, filled with concentric lamellae of keratin. Hair shafts were occasionally seen in the dermis, below the lower part of invagination. Based on clinical and histopathological picture a diagnosis of nevus comedonicus was made. She was treated with topical tretinoin and oral retinoids without much improvement. Nevus comedonicus in itself is a rare epidermal nevus, its multi-dermatomal unilateral distribution along the lines of Blaschko is even rarer.