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Introduction There is ambiguity regarding usage of tranexamic acid for melasma in India, be it in its pre-administration evaluation, administration route, dosing or monitoring. Hence, we conducted this study to understand various tranexamic-acid prescribing patterns and provide practical guidelines. Materials and methods A Google-form-based questionnaire (25-questions) was prepared based on the key areas identified by experts from the Pigmentary Disorders Society, India and circulated to practicing dermatologists across the country. In rounds 2 and 3, the questionnaire was re-presented to the same group of experts and their opinions were sought. The results of the practitioners' survey were denoted graphically alongside, to guide them. Consensus was deemed when at least 80% of respondents chose an option. Results The members agreed that history pertaining to risk factors for thromboembolism, cardiovascular and menstrual disorders should be sought in patients being started on oral tranexamic-acid. Baseline coagulation profile should be ordered in all patients prior to tranexamic-acid and more exhaustive investigations such as complete blood count, liver function test, protein C and S in patients with high risk of thromboembolism. The preferred oral dose was 250 mg orally twice daily, which can be used alone or in combination with topical hydroquinone, kojic acid and sunscreen. Repeated dosing of tranexamic-acid may be required for those relapsing with melasma following initial tranexamic-acid discontinuation. Coagulation profile should ideally be repeated at three monthly intervals during follow-up, especially in patients with clinically higher risk of thromboembolism. Treatment can be stopped abruptly post improvement and no tapering is required. Limitation This study is limited by the fact that open-ended questions were limited to the first general survey round. Conclusion Oral tranexamic-acid provides a valuable treatment option for melasma. Frequent courses of therapy may be required to sustain results and a vigilant watch is recommended for hypercoagulable states during the course of therapy. [ABSTRACT FROM AUTHOR]

With changing times various newer topical agents are introduced in the field of dermatology. Tacrolimus and pimecrolimus are immunisuppressants, which are effective topically and are tried in the management of atopic dermatitis as well as other disorders including allergic contact dermatitis, atrophic lichen planus, pyoderma gangrenosum. Imiquimod, an immune response modifier, is presently in use for genital warts but has potentials as anti- tumour agent and in various other dermatological conditions when used topically. Tazarotene is a newer addition to the list of topical reginoids, which is effective in psoriasis and has better effect in combination with calcipotriene, phototherapy and topical costicosteroids. Tazarotene and adapelene are also effective in inflammatory acne. Calcipotriol, a vitamin D analogue has been introduced as a topical agent in the treatment of psoriasis. Steroid components are also developed recently which will be devoid of the side effects but having adequate anti-inflammatory effect. Topical photodynamic therapy has also a wide range of use in dermatology. Newer topical agents including cidofovir, capsaicin, topical sensitizers, topical antifungal agents for onychomycosis are also of use in clinical practice. Other promising developments include skin substitutes and growth factors for wound care.

Neurofibromatosis type 1 (NF-1) is the most common form of neurofibromatosis. Since the significance of various cutaneous manifestations of NF-1 has not been known in Indian population, hence, the present study was undertaken. A total of 40 patients with NF-1 were identified between August 1998 to June 2000 with a prevalence rate of 20.4 per 10,000 individuals attending our clinic. Male to female ratio was 2.3: 1. The age of the patients ranged from 15 to 70 years with a mean age of 29.57 years. Most patients (18 cases) belonged to age group of 21-30 years followed by 11-20 years age group (11 cases). Twenty four cases had onset of disease between 11-20 years of age and ten cases in 21-30 years age group. Thirty one of 40 cases presented with asymptomatic nodules, three sought medical opinion for cosmetic reasons and another three for hyper pigmented patch. Analysis of cutaneous manifestations showed, 39 of 40 cases (97.5%) had neurofibromas. Palmar melanotic macules were noted in 36 (90%) cases whereas café â€" au-lait macules were seen in 33(82.5%) cases. Subsequent, less common findings were intertriginous freckles in 31(77.5%) cases, plantar melanotic macules in 18(45%) cases and generalized freckles in 4(10%) cases. Statistical analysis of cases and controls revealed significant association of NF-1 with neurofibromas, palmar melanotic macules, café-au-lait macules, intertriginous freckles and plantar melanotic macules(p

Tuberous sclerosis is now frequently designated as the tuberous sclerosis complex (TSC) Its inheritance is autosomal dominant, but upto 70% of the cases are new mutations. Its prevalence was found to be 4.50 per 10.000 cases attending our dermatology outpatient department. A total of 9 patients attended the out patient department between August 1998 to June 2000. Five were males and 4 females. Eight cases were having definite TSC, whereas a single had suspect TSC. The age of our patients ranged from 10 months to 50 years. A positive family history was available in 4 cases. Most common cutaneous manifestation of TSC was adenoma sebaceum (8 cases) followed by shagreen patches (7 cases) and Koenenâ€s tumour (6 cases). Ash leaf macules and forehead plaques were seen in 5 cases each. Other findings were skin tags (3 cases), café-au-lait macules(2 cases), enamel pits (2 cases), portwine stain (1 case) and subconjunctival naevus (1 case). Classical triad of epilepsy, mental retardation and adenoma sebaceum was seen in one case only.

A retrospective analysis of all cases of dapsone syndrome, which presented to us between January 1997 to June 2002, was done using the patients case records. An attempt was made to characterize the clinical profile, therapeutic and prognostic aspects of each case. Overall, sixteen cases of dapsone syndrome were seen. The male to female ratio was 1.3:1 (males-9, females-7). The mean age of these cases was 34.8 years(range 11 to 57 years). All patients had taken dapsone for periods ranging form 2 to 300 days, average being 60.2 days. Of the sixteen cases, 7 had confirmed Hansenâ€s disease (borderline tuberculoid leprosy-5, borderline lepromatous leprosy-1, indeterminate leprosy-1), 8 cases had been suspected of having leprosy while one case had lichen planus. Mucocutaneous manifestations were present in all cases. Systemic manifestations included fever, pallor, icterus, lumphadenopathy, hepatomegaly splenomegaly and ascites. Of the sixteen cases with dapsone syndrome, 14 had a favourable outcome. Of the two patients who expired, one developed septicaemia with nephrotic syndrome while the other progressed to toxic epidermal necrolysis and succumbed to complications thereof (septicaemia)

Three cases of Sturge â€" Weber syndrome are being reported. All our cases had incomplete form of Sturge- Weber syndrome. They had cutaneous facial angiomas and leptomeningeal agiomas evidenced by central nervous system manifestations (seizures) and /or computerized axial tomography showing typical gyriform calcification. None of our cases had glaucoma. The cases are being reported for its rarity.

Toxic epidermal necrolysis following ATT in HIV patient is reported. The role of HIV in drug reactions is discussed .

Cutaneous horns are rare horny excrescences which occur in various dermatoses. We report a girl with prurigo nodularis who developed a horn on one of the nodules. This unique association has not been reported so far.

Background: Several dermoscopic findings in alopecia areata (AA) are characteristic and aid in the diagnosis of this disease. Studies evaluating the clinical significance of these findings in AA in dark-skinned individuals are sparse. There is no literature of correlation of dermoscopic findings to severity of disease. Aims: The aim was to determine the dermoscopic findings of AA in dark skinned individuals and to assess whether certain dermoscopic findings correlate with disease activity and severity. Materials and Methods: Totally 116 patients with AA were included in the study. After a thorough clinical history and examination to note type, severity and activity of the disease, dermoscopy was performed using a Heine Delta 20 dermoscope (Heine optotechnik,Herrsching, Germany) and the results were noted in a proforma. Statistical analysis was performed using SPSS13 software using appropriate statistical tools. Results: Dermoscopic findings were nearly similar to that described in western literature. Yellow dots (YDs) were found to be highly sensitive for diagnosis, increased frequency being seen in Indian prepubertal patients when compared with western literature. YDs/field of vision (FOV) were found more frequently in severe types of AA. There was no correlation of dermoscopic findings to severity of disease. Conclusion: Dermoscopic features are similar to that described in the literature. However, YDs are seen in higher frequency. YDs/FOV could serve as dermoscopic criteria to grade severity of AA. [ABSTRACT FROM AUTHOR]

Introduction: Vaginal discharge is one of the common reasons for gynecological consultation. Many of the causes of vaginitis have a disturbed vaginal microbial ecosystem associated with them. Effective treatment of vaginal discharge requires that the etiologic diagnosis be established and identifying the same offers a precious input to syndromic management and provides an additional strategy for human immunodeficiency virus prevention. The present study was thus carried out to determine the various causes of vaginal discharge in a tertiary care setting. Materials and Methods: A total of 400 women presenting with vaginal discharge of age between 20 and 50 years, irrespective of marital status were included in this study and women who had used antibiotics or vaginal medication in the previous 14 days and pregnant women were excluded. Results: Of the 400 women with vaginal discharge studied, a diagnosis was established in 303 women. Infectious causes of vaginal discharge were observed in 207 (51.75%) women. Among them, bacterial vaginosis was the most common cause seen in 105 (26.25%) women. The other infections observed were candidiasis alone (61, 15.25%), trichomoniasis alone (12, 3%), mixed infections (22, 5.5%) and mucopurulent cervicitis (7 of the 130 cases looked for, 8.46%). Among the non-infectious causes, 72 (18%) women had physiological vaginal discharge and 13 (3.3%) women had cervical in situ cancers/carcinoma cervix. Conclusion: The pattern of infectious causes of vaginal discharge observed in our study was comparable with the other studies in India. Our study emphasizes the need for including Papanicolaou smear in the algorithm for evaluation of vaginal discharge, as it helps establish the etiology of vaginal discharge reliably and provides a valuable opportunity to screen for cervical malignancies. [ABSTRACT FROM AUTHOR]

Leprosy has been considered a curable disease after the implementation of multidrug therapy (MDT), which has been proven to be safe and effective, by bringing about a significant change in the global and national scenario of leprosy by upgrading the control of leprosy to the next stage of eradication. Since its introduction, the MDT regimens for the treatment of leprosy have undergone several changes especially with regard to the duration of treatment. The advantages of shortened duration of treatment need to be balanced against the risk of relapse and a lot of controversies exist pertaining to this aspect. The fixed.duration (FD) therapy is not popular among academicians and private practitioners who prefer precise diagnosis and treatment with superior MDT regimens and for a longer duration. On the contrary, from a public health.care point of view, precise diagnosis and a longer treatment schedule are not cost effective and not feasible to be implemented in elimination programs. Hence, a fine balance needs to be maintained between achieving a cure for the patient and protecting the society at risk, and this review discusses the various limitations and opportunities of FD therapy with a note on the newer MDT regimens. [ABSTRACT FROM AUTHOR]

The authors reflect on the development of treatment modalities for slowing down the aging process. They provide an overview on the different types of medical treatments to prevent aging which include the use of sunscreens, antioxidants and 5-flourouracil. They describe various anti-aging procedures including endermalogie, chemical peeling and microdermabrasion.

Background: Skin is a window to aging changes, a biological reality. There is a dearth of studies regarding the various chronological (intrinsic) aging and photoaging (extrinsic) changes seen in Asians. This study was undertaken to detect the clinical pattern of aging skin changes and dermatoses seen in the elderly. Materials and Methods: This was a descriptive study conducted on 500 consecutive elderly individuals attending the Dermatology out-patient department. The severity of photoaging was graded using Glogau scale. Results: Most of the population had skin type IV and V. Majority (415, 83%) of our cases had chronological aging without photoaging and the remaining 85 (17%) individuals had photoaging along with chronological aging. The common skin changes due to chronological aging were thin skin, fine wrinkles, xerosis, and loss of elasticity. Photoaging changes such as dyspigmentation, freckles, thick skin, deep wrinkles, melasma, citrine skin, senile purpura, pseudostellate scar, acrokeratoelastoidosis marginalis, and lentigines were less frequent in our study. Smoking and prolonged sun exposure was the risk factors aggravating photoaging. The most common dermatosis was pruritus in 248 (49.6%) individuals, of which 149 (29.8%) had pruritus associated with xerosis. Contact dermatitis was more common in males. Fungal infections were frequently seen in females. Seborrhoeic keratosis (253, 50.6%) was the most common benign neoplasm more commonly seen in males. Cutaneous malignancies were less common in our study population. Conclusion: Photoaging changes were less common than chronological aging changes in skin type IV. Chronological changes were more frequent in females than males, while photoaging was more frequent in males. [ABSTRACT FROM AUTHOR]

Mal de Meleda is a rare autosomal recessive transgradient palmoplantar keratoderma characterized by transgradient keratoderma with associated scleroatrophy, nail changes, pseudoainhum around digits and perioral erythema, without a tendency for spontaneous resolution. Involvement of the lip by keratoderma has not been reported in the English literature. Here we present two cases of Mal de Meleda with unusual lip involvement. The first case was a 15-year-old girl, born of second-degree consanguineous marriage, who presented with transgradient palmoplantar keratoderma from 6 months of age, with lichenoid papules and plaques on the elbows and knees, conical tapering of the distal digits, flexion deformity of several fingers, digital constriction, knuckle pads and lip involvement. The second case was a 24-year-old male with transgradient palmoplantar keratoderma since birth. He also had scaly plaques on the extensors of bilateral knees and elbows, knuckle pads, pseudosclerodermatous fingers with conical tapering, digital constrictions at various places with mild flexion deformity and lip involvement. Both patients were otherwise normal without any family history. [ABSTRACT FROM AUTHOR]

Eccrine syringoibroadenoma (ESFA) is a rare cutaneous tumor with eccrine differentiation with varied clinical manifestations. We report a case of reactive eccrine syringofibroadenomatosis associated with chronic bilateral plantar ulcers in a patient with diabetes mellitus presenting as plantar hyperkeratosis and verrucous growth at margins. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about a case of a 50 year-old female with bilateral keratoconus with oculocutaneous albinism.

An introduction is presented in which the editor discusses the performance of the journal after engaging in the online market under the guidance of Dr. Uday Khopkar in 2003.

A letter to the editor is presented about circinate pustular psoriasis localized to glans penis.

A letter to the editor is presented about anti-aging therapies.

A letter to the editor is presented concerning pigmentary demarcation lines associated with pregnancy by Rashmi Kumari, Chandrashekar Laxmisha, and Devinder Mohan Thappa.

Background: During pregnancy profound immunologic, metabolic, endocrine and vascular changes occur, that are responsible for the changes of the skin and its appendages, both physiologic and pathologic.Aims: We undertook a clinical study to find out the frequency and pattern of skin changes in pregnant women.Methods: All consecutive pregnant women were included in the study.Results: A total of 607 pregnant women were included in this study. Of these, 303 (49.9%) pregnant women were primigravida and 304 (51.1%) were multigravida. Skin changes grouped into: physiological changes (all cases), specific dermatoses (22 cases) and other dermatoses affected by pregnancy (125 cases). Most common physiological changes were pigmentary alterations seen in 555 (91.4%) followed by striae seen in 484 (79.7%) cases. Of the various specific dermatoses of pregnancy, pruritic urticarial papules and plaques of pregnancy (PUPPP) was the most common disorder (14 cases) followed by pruritus gravidarum (5 cases). The most common dermatoses affected by pregnancy were candidal vaginitis (17 cases), acne vulgaris (15 cases), skin tags (15 cases), eczemas (14 cases).Conclusion: This study brings into focus various skin changes during pregnancy in south India. [ABSTRACT FROM AUTHOR]

Objectives: Psoriasis is a chronic inflammatory skin disease. Chronic inflammation results in increased oxidative stress and oxidizes lipoproteins, increasing their atherogenicity. This study sought to estimate the levels of oxidized low-density lipoprotein (ox-LDL) and antibodies against oxidized LDL (anti-ox-LDL) and compute the ratio of anti-ox-LDL/ox-LDL as a single composite parameter to assess the oxidative lipoprotein burden as an indicator of cardiovascular risk in patients with psoriasis., Methods: This cross-sectional study included 45 patients with psoriasis. All patients were given a psoriasis severity index score and their ox-LDL and anti-ox-LDL estimated using ELISA., Results: The results of this study show an elevation in the ratio of anti-ox-LDL to ox-LDL in patients with psoriasis, which initiate and perpetuate the pathogenesis of psoriasis and its comorbidity, atherosclerotic cardiovascular disease., Conclusions: Our results suggest that an elevated ratio of anti-ox-LDL/ox-LDL can serve as a composite parameter reflecting the total oxidative lipoprotein burden and cardiovascular risk in psoriasis patients.