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Objective The pathophysiology of polymorphic light eruption (PMLE) is uncertain; however, it is considered to commonly involve an autoimmunological mechanism. It is a common condition, usually affecting subjects staying at temperate latitudes, and presents with eruptions post-exposure to sunlight and artificial UVR (ultraviolet radiation), lasting from hours to, in rare cases, days of exposure. This present study aims to compare biochemical thyroid function tests in cases of PMLE. Methodology The present case-control study was conducted with a total of 120 participants. Patients with polymorphic light eruption aged 18 years or above of either sex attending the dermatology outpatient department were included in the study. TSH (thyroid-stimulating hormone), T3 (triiodothyronine), and T4 (thyroxine) were analyzed among the participants. The data was recorded on a Microsoft Excel spreadsheet and analyzed using SPSS Statistics v. 21 (IBM Corp., Armonk, NY). The qualitative data was assessed in the form of numbers and percentages and the quantitative data was assessed using measures of central tendency such as mean and standard deviation. A chi-square test was applied to find out the association and their strength between the variables to validate the findings of the study. A p-value0.05 was considered to be statistically significant. Results The TSH was elevated in 56 (93.3%) cases and two (3.3%) among the controls; T3 and T4 were low in 24 (40%) cases, and in seven (11.7%) among the controls. Conclusion PMLE usually has an autoimmune basis for its occurrence; similarly, thyroid disorders being themselves autoimmune in origin might lead to hypersensitivity reactions and generation of autoantibodies. We suggest that screening for thyroid should be conducted for all PMLE patients as they are at higher risk of developing thyroid disorders. The relationship between the two should be studied with a much larger cohort of participants to evaluate whether this is autoimmune-related or accidentally related.

Neurofibromatosis type 1 (NF1) is an inherited neuroectodermal abnormality with multisystem effects, which can have heavy psychological and physical burdens, especially in countries like India, wherein skin disease is significantly stigmatized. This study was performed to understand the clinical and epidemiological trends of NF1 at a tertiary care center in India and evaluate the association between clinical severity and quality of life in these patients. We conducted a cross-sectional study of 40 patients with NF1 over a period of two years at a tertiary hospital in western India. After obtaining consent, demographic and clinical information was collected from the patients and recorded in a pre-designed proforma. Quality of life was assessed by a validated Dermatology Life Quality Index (DLQI) questionnaire in languages understood by the patients and subsequently analyzed. This study included 40 patients at a mean age of 28.6 years, with a slight male predominance. The most frequently occurring lesions were café-au-lait macules, followed by neurofibromas and intertriginous freckling. The mean DLQI score was 12.35, implying a large effect on most patients' lives. Questions related to self-consciousness, embarrassment, and the influence of skin lesions on clothing choices had the highest scores, indicating a significant effect on social perception. NF1 has a profound impact on a patient's quality of life, as evidenced by the high DLQI scores in our patient cohort. The early identification and management of such patients can help prevent further deterioration of their quality of life.

Background: Chronic kidney disease (CKD) is associated with several cutaneous manifestations as a result of CKD per se, underlying disease(s) leading to it or the treatment thereof. Cutaneous manifestations get altered following hemodialysis. We studied the prevalence of various dermatoses and the effect on pruritus in patients with CKD on hemodialysis.Methods: Seventy-three patients with CKD having at least one cutaneous manifestation undergoing hemodialysis in Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pune were included.Results: Sixty-four (87.67%) of the participants belonged to the age group of 40-69 years; 28 (38.35%), to the sixth decade. The male to female ratio was 1.8:1. Forty-eight patients (65.75%) suffered from diabetes mellitus, 37 of these also from hypertension. Xerosis (72.6%), pallor (65.8%) and pruritus (60.3%) were the common manifestations. The intensity of pruritus remained unchanged in 82% of those affected. Nail changes were seen in 47.9% cases (half-and-half nail, 19.2%; subungual hyperkeratosis, 11%; leukonychia, 6.8%; melanonychia, 6.8%; Beau’s lines, 4.1%). Infections were observed in 32.8% cases (superficial mycoses, 19.2%; bacterial, 6.8%; scabies, 4.1%; viral, 2.7%). Dyspigmentation was documented in 30.1% (hyperpigmentation, 21.92%; yellow tinge, 8.22%), hair changes in 23.3% (sparse scalp hair,16.4%; lusterless hair, 6.9%), acquired perforating dermatoses in 19.2%, and arteriovenous shunt dermatitis in 2.7% cases.Conclusions: Xerosis was the commonest finding and pruritus, the commonest symptom; the intensity of the latter remained largely unaffected by hemodialysis. Half-and-half nail was the most common nail change and superficial mycoses, the most common infection.

Background: Quality of life in patients with premature graying of hair is an under studied topic in Indian population. Its onset in adolescence may have a significant effect on the developing psyche of an individual sufferer impairing academic and work related performance and can be associated with low self esteem, low confidence which can further be associated with depression. Aim was to objectively evaluate the impact of premature canities on QoL and early identification of patients in need of medical and psychological intervention.Methods: The impact on QoL was calculated with the help of a modified and prevalidated questionnaire based on the dermatology life quality index proposed by Finley and Kahn. One hundred patients with onset of canities before the age of 25 years were enrolled, after approval by the institutional ethical committee.Results: The mean modified DLQI score recorded was 14.3±6.76. Total of 71% patients were found to have a very large to extremely large effect on the QoL. Guilt, mood fluctuation and need for medical intervention were reported frequently. The comparison between DLQI scores of boys and girls was not significant.Conclusions: Patients of premature canities were found to have profound impact on their QoL, attributable to their perception of the disease. Considering the age group affected, it could have a long‑term detrimental effect on their psychological and social wellbeing.

Background: The high burden of menopausal symptoms notwithstanding, there is a paucity of published work evaluating its impact specifically on the skin and mucosa. With high incidence of underreported cases in developing countries, active screening of all women is essential for accurate assessment of prevalence of cutaneous features, as highlighted by this study. The objective of this study is to assess clinical patterns of dermatosis in menopausal women.Methods: A cross‑sectional study conducted in the dermatology department conducted on postmenopausal patients below 65 years having dermatoses after taking their written consent. Data analysis using SPSS 20.0.Results: Of 350 postmenopausal women, 165 had genital involvement, atrophic vaginitis (41.21%) being the most common manifesting typically as vaginal dryness. Of 82 women having oral complaints, 42.7% women had complaints of pain or difficulty swallowing in the absence of mucosal lesions. Of the total sample size, 34% women had had female pattern hair loss, maximum women with grade I-2 (45.4%) and I-3 (36.13%). Two key findings which we did not find previous records of included incidence of keratoderma climactericum (2.29%) and hirsutism in early menopause which we found to be 8%. It is important to note that only 28% of women were aware that their complaints were related to menopause or chose to seek active treatment for existing complaints.Conclusions: This study highlights the various clinical patterns of postmenopausal dermatoses to raise awareness in dermatologists and gynecologists for prompt diagnosis, treatment and patient education.

Singh, G.K., Mahendra Singh Deora, Rajan Grewal, A. Kushwaha, and Sukhmeet Minhas. Is high altitude a risk factor in development of herpes zoster? High Alt Med Biol. 19:244-248, 2018.Old age immune-compromised states are known to increase the risk of herpes zoster (HZ). The aim of this study was to find out whether arrival into high altitude poses a risk for the development of HZ in lowlanders.A retrospective study of 173 cases of HZ was carried out between January 1, 2005 and December 31, 2010 in people working at high altitude areas of Leh. Data of lowlander people working at high altitude were compared with that of high altitude native and similar group of people working at plains during the same period.HZ constitutes 2.36% (95% confidence interval [CI], 2.04-2.73) of total skin outpatient department cases at a hospital at high altitude, whereas it was 0.23% (95% CI, 0.18-0.29) at a tertiary hospital at plains. In lowlanders working at high altitude, frequency of herpers zoster varied between 2.63% and 3.59% with mean of 3.07%. Frequency of HZ in persons presenting to a tertiary dermatological center at plains varied from 0.19% to 0.26% (mean of 0.23%). Presence of high altitude posed a risk of almost seven times in developing HZ in comparison with its absence with odds ratio of 7.21 and 95% CI varying from 5.42 to 9.60. This result was statistically very significant with p value0.0001.Lowlanders working at high altitude are at high risk to develop HZ in comparison with persons working at plains. However, a large population-based study is required to investigate and establish the same.

Background: Genetic diseases causing abnormalities in structure and/or function of skin are termed as genodermatoses. As there is paucity of epidemiological data of genodermatoses from our country, this study was conducted to determine the latest clinical and epidemiological trends of pediatric genodermatoses.Methods: A hospital-based observational study consisting of 35 clinically diagnosed pediatric genodermatoses cases, who reported to the Dermatology OPD, Dr. D.Y. Patil Medical College, Pune, was conducted for a period of two years. Socio-demographic and clinical information was collected and clinical examination was performed on all patients to record any cutaneous/extra-cutaneous abnormality. The participants were then subjected to necessary investigations to elucidate the additional disease components. The data was evaluated using appropriate statistical methods.Results: Out of 4032 pediatric patients, 35 were found to have genodermatoses. Majority (57.14%) cases belonged to the first decade of life. There was no sexual predilection (male:female - 0.94:1). The commonest genodermatoses detected were neurofibromatosis and tuberous sclerosis (17.14% each). Most common mode of inheritance seen was autosomal dominant (57.14%). Family history and consanguinity were recorded in 45.71% and 22.86% cases respectively. Café-au-lait macules seen in 22.86% cases and ocular anomalies recorded in 34.38% cases were the commonest cutaneous and extracutaneous manifestations, respectively.Conclusions: Genodermatoses are rare skin disorders with systemic involvement at times, resulting in poorer prognosis. This necessitates more focus on this speciality.

Background: Alopecia areata (AA) is a chronic inflammatory disease characterized by nonscarring hair loss involving any hair-bearing surface of the body. The current therapy for AA is not curative but rather aimed at controlling or limiting the pathogenic process. Corticosteroids are the most popular drugs used, however localized atrophy is a common complication, particularly with triamcinolone. Promoting hair growth by application of autologous blood extracted platelet rich plasma (PRP) is a simple, yet effective procedure. The aim of the study was to evaluate and compare the efficacy of intralesional triamcinolone acetonide (5 mg/ml) with intralesional PRP in the treatment of two different scalp AA patches of same individual.Methods: A total of 30 patients having ≥2 patches of AA were randomized and given two separate modalities of treatment in two different patches and divided in Group I, treated with intralesional triamcinolone acetonide (5 mg/ml) and Group II, treated with PRP. Interval time between every follow-up was 3 weeks and four such follow-ups were done. Hair regrowth was calculated according to Mac Donald Hull and Norris grading system at every follow-up and was compared with the initial grading.Results: Group I patches, treated with triamcinolone acetonide have the significantly higher mean grading score than the group II patches, treated with PRP at each follow up.Conclusions: Intralesional triamcinolone acetonide is more efficacious than intralesional PRP in the treatment of scalp alopecia areata with no recurrences and very few adverse effects like atrophy and hypopigmentation.

Background: The dropout of outpatients on antifungal therapy for recalcitrant tinea incognito is attributable to the flare on withdrawal of topical corticosteroids and the virulence of pathogens. The objective of the study was to evaluate the role of topical tacrolimus in adherence to antifungal therapy in recalcitrant tinea incognito.Methods: 28 cases of topical corticosteroid induced tinea incognito of more than 6 months duration were enrolled and topical and systemic antifungal therapy instituted for 8 weeks. Topical tacrolimus was also instituted in the test cohort. The end point for resolution was the absence of raised margins, erythema, induration and scaling.Results: 17 patients were male while 11 were female and their age ranged from 16-45 years (mean 26.5). Two patients were from upper-middle; 5 from lower-middle and 21 from upper-lower socioeconomic class. Their occupations included shop assistants, security guards, drivers and labourers and the duration of illness ranged from 7-36 months. Topical corticosteroids were obtained on prescription by 5 and over the counter by 23 patients. Out of the test cohort of 14, all lesions had resolved in 10 patients who had adhered to therapy and were reviewed at the end of 8 and 10 weeks. While 5 reported burning on application of tacrolimus 1 developed folliculitis. Out of the control cohort of 14, though 5 had adhered to therapy all lesions had resolved only in 3 patients at the end of 8 and 10 weeks.Conclusions: Topical tacrolimus facilitates adherence to antifungal therapy in recalcitrant tinea incognito.