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Background: Cutaneous adverse drug reactions (CADRs) are common among adverse drug reactions (ADRs). Early identification of ADRs can reduce the morbidity and mortality rates. Objectives: To know the pattern of various types of CADRs and to find out the causative drugs involved. Materials and Methods: Retrospective analysis was performed from ADR register, kept in Dermatology department in a tertiary care center. Naranjo's algorithm was used to determine the causality assessment. Details regarding drug intake, morphology of eruption, offending drugs, history regarding hospitalization, drug rechallenge or drug dose modifications, and treatment given to the patients were assessed. The data were subjected to descriptive analysis. Results: A total of 216 patients were recruited into the study, of which 118 were male and 98 were female. Antimicrobials (30.1%) were noted to be the most common offending drugs, followed by antiepileptics (18.1%), analgesics and antipyretics (11.1%), and anticancer drugs (11.1%). The most common presentation of CADR was maculopapular drug eruption (31.5%), followed by fixed drug eruption (13.4%). Conclusion: Among the antimicrobials, penicillins (13.9%) were the most common cause of CADR, followed by cephalosporins (8.8%) and fluoroquinolones (6.9%). A total of 28 patients (13%) were found to have severe cutaneous adverse reactions to drugs. It is important to closely monitor the patient, when a new drug is introduced, which will aid in detecting and preventing of CADRs.

Background: Vitiligo is a common, acquired, idiopathic, depigmenting disorder with a profound effect on the patient's quality of life (QoL). Purpose: The objective of the study was to measure the QoL of patients with vitiligo using the dermatology life quality index (DLQI) and to assess psychiatric comorbidity in vitiligo patients using the General Health Questionnaire-28 (GHQ-28). Methods: Sixty patients above 16 years of age with vitiligo were enrolled. Age, sex, occupation, marital status, duration of disease, extent of involvement, visibility of lesions, details of treatment, duration of treatment, and response to treatment were collected. Independent t-test and ANOVA were used to test for significance of continuous variables and Chi-square test for categorical variables. Correlation between DLQI and GHQ-28 was assessed using Spearman's rho correlation coefficient. Results: Females scored higher than males on overall GHQ-28 scores and in individual domains of anxiety/insomnia, social dysfunction, and severe depression. Unmarried participants had higher scores compared to married subjects in all dimensions of DLQI and GHQ-28, indicating worse QoL and mental health. Conclusion: More than half of vitiligo patients had psychiatric comorbidity. There was a strong correlation between DLQI and GHQ-28 score, indicating strong association of QoL impairment with psychological problems. Proper counseling of patients of vitiligo along with specific treatment may be prudent.

Background: Alopecia areata (AA) is a chronic nonscarring alopecia that involves hair follicles and is characterized by patchy areas of hair loss without any signs of clinical inflammation. Platelet-ri-ch plasma (PRP) has a high platelet concentration. Anti-inflammatory effect of PRP may be of great help in AA. Aims and Objectives: Study was conducted to compare the outcome of treatment and side effects of intralesional PRP versus triamcinolone in AA. Materials and Methods: 40 patients with alopecia areata were allocated into 2 groups and treated with triamcinolone and PRP injections. The response was analyzed by SALT score (severity of alopecia tool score) and hair regrowth grade (HRG) scale. Inferential statistical tools such as t-test, Mann–Whitney U test, and Chi-square test were used. Results: 16 patients in each group completed the study. While comparing the decrease in SALT score at different intervals of time, there was a significant difference in SALT score reduction during the second review between PRP group and triamcinolone group (P = 0.028). After the first and final review, results did not show any statistically significant difference between the two groups. While comparing the hair regrowth scale between treatments, there was no statistical significance. 12.5% patients in PRP group reported excellent response after final review (HRG scale 4), compared to none in triamcinolone group. Conclusions: Platelet-rich plasma is a safe, effective, steroid sparing, and suitable alternative in AA. Only side effect noted was pain during injections in both the groups.

Background: Allergic contact dermatitis (ACD) is a major cause for foot wear dermatitis. Patch testing is the standard investigation for diagnosis of ACD. Identification of the causative allergen and avoidance of the same is the most important for patient management. Aims: This study was conducted to find the common allergens in footwear, causing ACD, by retrospective analysis of the data of patients who had undergone patch testing with footwear series (FWS), approved by the Contact and Occupational Dermatoses Forum of India. Materials and Methods: A total of 276 cases with footwear dermatitis who underwent patch test with FWS using Finn chamber method were studied. Statistical analysis was done using statistical package for social sciences (SPSS) version 24. Data was described using frequency and percentages. P value of less than 0.05 was considered significant. Results: In this study 101 (36.5%) patients had positive patch test to at least one allergen. Among this, 43 (15.6%) were positive for single allergen only and 58 (21.01%) patients had positive patch test reactions to multiple allergens. The most common allergens with positive patch test were black rubber mix, mercapto benzo thiazole, and thiuram mix. Patients with either a positive or negative patch test had no statistically significant difference in the history of atopy. The limitations of this study include the lack of patch testing with the patient's own footwears and lack of follow-up after informing patients regarding allergen avoidance. Conclusions: Patch test must be done for all foot eczema cases for early identification of the causative allergen and also to provide suitable alternatives.

Background: In the pathogenesis of atopic dermatitis (AD), immune sensitization to food-derived allergens has a role. However, the evidence of allergen sensitization is not a proof of clinically relevant allergy and it has to be confirmed by food challenges so that unnecessary food restrictions in growing children can be avoided. Aims and Objectives: This study was conducted to assess the clinical severity of AD in children after certain dietary modifications and to correlate absolute eosinophil count (AEC) with dietary modification. Materials and Methods: A total of thirty AD children were enrolled randomly into a trial period of egg and cow's milk exclusion diet or control period of egg and cow's milk inclusion diet of 3 weeks. At the end of 3 weeks, patients resumed their normal diet to minimize any carryover effect for next 3 weeks. In the last 3 weeks, the trial and the control groups were crossed over. Patients were assessed at baseline and at the end of each 3-week period using SCORing AD (SCORAD) index and AEC. The data were analyzed using paired t-test. Results: The mean SCORAD at the end of control and trial period was 18.3 and 14.3, respectively, with a mean difference of 3.4, which is statistically not significant (P = 0.165). The mean AEC at the end of control and trial period was 836.5 and 799.6, respectively, the reduction being statistically not significant. Conclusion: Our study could not confirm the beneficial effects of an allergen avoidance diet in AD. We propose that dietary elimination advices should be given only to patients with a definite history of food-induced exacerbations of the disease.

Context: Dexamethasone-immunosuppressant pulse therapy introduced by Pasricha et al. in 1981 as a treatment for long-term remission in pemphigus group of disorders has gained wide acceptance in many places, especially India. Since the overall duration of treatment is determined by the duration of phase 1 of the regime, identification of factors that influence phase 1 may be particularly helpful in addressing patient's concerns and apprehensions before initiation of treatment so that compliance can be improved. Aims: To find out factors that affect the duration of phase 1 of dexamethasone-immunosuppressant pulse therapy. Subjects and Methods: A 10-year retrospective study from medical records of 37 patients was conducted. The severity of pemphigus was assessed using Kumar's scoring system. The mean duration of phase 1 compared between the variables and significance of association was found out using Student's t-test. Patients were further classified in to two groups: with phase 1 duration ≤6 months and >6 months. Chi-squared and Fisher's exact tests were done to find out factors which significantly contribute to prolonged induction phase. Results: A significant association was noticed between total severity score and mean duration of phase 1 (P = 0.031). Significant association was also noticed between prolonged induction phase of >6 months and oral mucosal severity score >2 (P = 0.017). Other patient factors, type of pulse therapy, and comorbidities had no effects on the duration of phase 1. Conclusions: Duration of phase 1 is expected to prolong if the total severity score is >3, and when oral severity score is >2 it is likely to be more than 6 months.

Background: Although acne is principally a disorder of adolescence, the number of adult patients with acne is increasing. Adult acne is defined as the presence of acne beyond the age of 25 years. There is relatively few data on the prevalence and studies of acne in adult population. Aim and Objectives: To analyze the various factors that aggravate or precipitate acne vulgaris in Indian adults. Materials and methods: The study was done at the Department of Dermatology at a tertiary care center in Kerala for a period of 1 year. A total of 110 patients above the age of 25 year diagnosed clinically as acne vulgaris were included in the study. A detailed history regarding age of onset, duration, type of acne, family history, whether there was any exacerbation related to food, cosmetics, drugs, emotional stress, seasonal variation, sunlight, sweating, pregnancy, menstruation and smoking was taken. Results: Majority of patients with adult acne were in the age group 26-30 years and there was a clear female preponderance. Persistent acne was more common than late onset acne. Food items and cosmetics were attributed to exacerbation by 47.3% and 40% of patients respectively; 32.7% patients had exacerbations during stress, 26.4% following sun exposure and 23.6% after sweating. About 48% patients had first degree relatives with present or past history of acne. Most of the female patients had premenstrual flare of acne, which was much more common among patients with persistent acne. Pregnancy had no effect on acne in majority of patients. Seasonal variation was observed in 44.5% patients, most of them showing exacerbation in summer months. Conclusion: Acne as a disease lasts longer, persists into adulthood and requires treatment well into the forties. Unlike teenage acne, where males tend to be affected more commonly, post adolescent acne mainly affects females. It is therapeutically rewarding to identify the concerned triggers and aggravating factors and be able to deal with them.

Paraganglioma-like dermal melanocytic tumor (PDMT) is a rare subtype of benign dermal melanocytic tumor, first described in 2004. Its histopathologic features resemble those of paraganglioma, showing presence of a distinctive partitioning of the tumor into small and large packets, nests, or short cords by delicate fibrous septa (zellballen pattern). But the immunostaining characteristics are those of melanocytic lesions, as PDMT express S-100, melan A, HMB 45 and lack pancytokeratin markers. It has a benign course, although a lesion of low malignant potential cannot be excluded. We describe a case of 60-year-old female who presented with three PDMT lesions on her right leg. To the best of our knowledge this is the first case reported from India.

Introduction: The combination of adapalene (ADA) benzoyl peroxide (BPO) offers a safe and effective alternative avoiding long-term antibiotic use in the management of acne vulgaris. Aims: The aim of this study was is to compare the clinical efficacy and tolerability of 0.1% ADA with combination of 0.1% ADA and 2.5% BPO in the treatment of mild-to-moderate acne vulgaris. Methods: All patients were instructed to apply the given topical medications to whole face, excluding lips and eyelids, once a day at night after washing and moistening the facial skin. Follow-up was done once every 4 weeks up to 12 weeks from the start of treatment. Efficacy of treatment arms was assessed by 4 parameters, namely percentage change of total lesion counts (TLCs), Acne severity index, success rate, and response rate. Statistical analysis was performed using the SPSS software version 16.0. Data were analyzed using the Chi-square test, Fisher's exact test, and Mann-Whitney U test. P < 0.05 was considered to indicate statistical significance. Results: Thirty-eight patients were in Group A (ADA-BPO) and 38 patients in Group B (ADA alone). At the end of 12 weeks, Group A had significantly less TLC as well as significant percentage change in total lesions than Group B. Group A was significantly better than Group B in TLC response rate also. Conclusions: The combination gel of 0.1% ADA and 2.5% BPO was superior to 0.1% ADA gel in terms of efficacy. Tolerability was comparable for both the drugs. [ABSTRACT FROM AUTHOR]

Introduction: Skin diseases are a major health problem in the pediatric age group. Aim: To determine the prevalence and clinical characteristics of different pediatric dermatoses in a tertiary care centre in Kerala. Materials and Methods: Children with age 18 years and below with clinical evidence of cutaneous disorders were studied. Results: 500 cases were studied which showed a female preponderance of 51.4%. The most common dermatoses was infections and infestations (33.8%) followed by eczemas (32.6%), disorders of sweat and sebaceous glands (7.4%), keratinisation and paulosquamous disorders (4%). Nutritional disorders were seen in 1% of children. 3.6% had photodermatoses, 2.6% had hair and nail disorders and 0.4 % had adverse cutaneous drug reactions. Conclusions: Fungal infection was the most common infection noted in the study, followed by viral and bacterial infection. Allergic contact dermatitis was the commonest exogenous eczema and juvenile plantar dermatosis was the commonest endogenous eczemas. Acne, insect bite reaction and miliaria were the other common dermatoses. [ABSTRACT FROM AUTHOR]