In recent time, significant progress has been made to elucidate the pathogenesis of psoriasis: still the molecular basis of the inflammatory and proliferative processes of psoriasis is largely unknown. Role of neurogenic inflammation has provided a new dimension in understanding the pathogenesis of various cutaneous and systemic inflammatory diseases, such as atopic dermatitis, urticaria, rheumatoid arthritis, ulcerative colitis and bronchial asthma. In this article we have addressed certain key events responsible in the development of a psoriatic lesion. Significant are the proliferation of nerves, upregulation of neuropeptides and increased levels of nerve growth factor (NGF). In immunoperoxidase studies, we found that keratinocytes in lesional and non-lesional psoriatic tissue express high levels of NGF. In the terminal cutaneous nerves of psoriatic lesions, there is a marked upregulation of NGF receptors (NGF-R): p75 neurotrophin receptor (p75NTR) and tyrosine kinase A (TrKA). As keratinocytes of psoriatic plaques express increased levels of NGF, it is likely that murine nerves will promptly proliferate into the transplanted plaques on a severe combined immunodeficient (SCID) mouse. Indeed, we have noted marked proliferation of nerve fibers in transplanted normal human skin. These observations, as well as recent findings about NGF –induced chemokine expression in keratinocytes, further substantiate a contributing role of NGE and its receptor system (p75 NTR /TrkA) in the pathogenesis of psoriasis. A new discipline has emerged in clinical pharmacology focusing on development of drugs targeting the neuropetides (NP), NP receptors and the NGF/NGF-R system. Currently, we are evaluating antagonists to selected neuropeptides and NGF/NGF-R, with the expectation of identifying pharmacological agents to counter neurogentic inflammation in psoriasis.

The central part of the face is characterized by peculiarities in embryology and tissue composition. The outer nose is the most prominent part of the mid face exposed to UV- irradiation and sunlight. Tumors of the outer nose are not uncommon. There is a variety of nevi that may occur on the nose, but benign tumors and malignancies are also not uncommon. The most frequent malignant tumor of the region is basal cell carcinoma that needs micrographic control in case of surgical excision since frequent relapses can lead to an ulcus terebrans that may completely destroy the mid face. Most tumors need a diagnostic excision to diagnosis, some need radical excision.

In a cross-sectional study severity scores of atopic dermatitis (AD) were measured in children of Indian parents but born and brought up in UK and USA and in children of Indian parents born and brought up in India. In each group there were 33 children matched in age, sex, personal and family history of atopy. The mean severity scores in two groups were 8.64 and 6.34 respectively. Statistical analysis revealed significant difference (p<0.005) in severity scores of the two groups suggesting a more severe form of AD seen in the former.

Pregnant women may contaminate new borns and babies with vaginal candidiasis and ringworms, thus the choice of this group for our study. Cases were recruited at the UHC Yaounde from June 2001 to September 2002. Four hundred and thirty (29.3%) out of 1467 examined presented at least one mycosis. The principal lesions were vaginal thrush 44% and athlete’s foot 22%. The causal fungi were essentially yeasts with the predominance of candida albicans (72%) and for the dermatophytes, Trichophyton rubrum (71.84%). The other species were Candida tropicalis, Candida Krusei, Candida parapsilosis, candida glabrata, Malassezia furfur, Trichosporon sp., Trichophyton soundanense, Trichophyton interdigitale, Thrichophyton mentagrophytes and scytalidium dimidiatum. Because these infections affect up to 30% of pregnant women, they should be taken into consideration during prenatal care.

Vitiligo is a common, often heritable, acquired disorder. Although vitiligo does not cause any physical problem but it surely is a psychosocial disaster. Depigmented patches resistant to medical treatment need to be managed surgically. Surgically. Surgical procedures usually performed lead to unsatisfactory results and that too at the cost of scarring of normal donor site. Here we describe our experience with grafting of non-cultured autologous melanocytes, which is not associated with any scarring. We tried this method in 16 lesions in 8 patients of stable vitiligo. Due to its advantages, like no scarring at recipient sites, ability to re-pigment large area with small piece of skin graft, simplicity and feasibility in Indian conditions, this is a good alternative in the treatment of vitiligo.

The treatment of vitiligo involving the mucosae, acral areas, palms and soles is an arduous challenge. No definite treatment guideline exists for these patients. The preliminary results of evaluation of four different treatment regimens in these patients are presented. Forty patients were alternatively assigned to 4 regimens comprising of PUVASOL: PUVASOL with levamisole: topical corticosteroids and topical corticosteroids with levamisole. All the four regimens gave comparable results. PUVASOL and topical corticosteroids used alone or in combination with levamisole are all equally effective in treating the so called “difficult to treat or resistant� sites in vitiligo with cosmetically acceptable results (25.50% pigmentation) after 6 months of therapy.

Zygomycosis broadly consists of mucormycosis and subcutaneous zygomycosis. Subcutaneous zygomycosis can further be subdivided into conidiobolomycosis and basidiobolomycosis. We have done retrospective analysis of data of cases of subcutaneous zygomycosis (basidiobolomycosis), diagnosis based on clinical features, histopathology and/or culture. The cases were treated in Dermatology and STD department of Jawaharlal Institute of postgraduate Medical Education and Research (JIPMER), Pondicherry between 1990 to 2002. Case reported in India has been summarized and relevant literature on this entity has been reviewed.

This report describes a rare form of initial presenting feature of scleroderma. A 28 year old female with no personal or family history of keloid, presented with multiple keloids on trunk and extremities three years prior to the development of systemic scleroderma. Histopathology of a nodule showed atrophic epidermis, thick compact collagen bundles arranged in whorl like pattern throughout the dermis.

Lymphagioma circumscriptum is a rare disorder of lymphatic channels, characterized by occurrence of thin walled frogspawn like vesicles. We report 2 cases of lymphangioma circumscriptum as a late sequel to radiotherapy.

The ectodermal dysplasias are congenital, non-progressive and diffuse disorders affecting primarily the tissues derived from ectoderm. Over a period, their classification has become confusing due to indiscriminate use of them “ectodermal dysplasia� for numerous syndromes with a defect in one or more epidermal defect in each element of skin; their precise classification appears difficult as yet. Only X-linked recessive ectodermal dysplasia (Christ-Siemens-Touraine syndrome) remains best defined. This paper describes three cases of ectodermal dysplasias highlighting their overlapping features.

Angiotensin converting enzyme inhibitors (ACEI) are now well established and commonly used drugs in the treatment of hypertension and congestive cardiac failure. Recurrent and delayed angio-edema is an uncommon but potentially serious adverse effect of ACEI therapy especially because it often goes unrecognized due to lack of correlation between the long term medications the patients is on and the angio-edema. Our 82 year old patient with recurrent delayed angio-edema was diagnosed 5 years after ACE inhibitor was started. Prompt withdrawal of the drug resulted in complete resolution of the symptoms.

We report a 26 year old female patient of Kindler syndrome associated with squamous cell carcinoma of the leg. This syndrome is a rare inherited disorder characterized by trauma induced acral blistering, photosensitivity, poikiloderma and cutaneous atrophy. Occurrence of overt cutaneous malignancy on glabrous skin in this syndrome has not been reported before.