Childhood pemphigus is a rare diasease and comprises only a minority of immunobullous diseases seen in children. Almost all variants of pemphigus in childhood have been described in literature. Pemphigus vulagaris is the most common type seen, after excluding endemic foliaceus. The clinical features are essentially similar to that of adults. Special consideration is required while treating children so as to use drugs which are less carcinogenic and do not affect fertility. We present here a review of cases of childhood pemphigus vulgaris, pemphigus foliaceus, pemphigus vegetans, pemphigus erythematosus, paraneoplastic pemphigus, IgA pemphigus and neonatal pemphigus.

The association of thyroid disorders with skin manifestations is complex. Both hypothryoidism and hyperthyroidism are known to cause these changes. In order to study this association of skin changes in relation to hypothyroidism, a study was carried out in the outpatients department of Dermatology of Dayanand Medical College and Hospital, Ludhiana, over a period of 3 months from Jan-March 2005. Thirty two patients were enrolled in the study and parameters were noted regarding history, general symptoms, cutaneous signs and associated diseases. We found gain in weight (71.85%) and lethargy (65.62%) to be the most common complaints. On cutaneous examination, dry, coarse texture of the skin (56%), pigmentary disorders (37.5%) and telogen effluvium (40.62%) were the most common findings. Other associated disorders were vitiligo, melasma, pemphigus, alopecia areata, xanthelasma palpebrarum, etc.

Purpose: Vitiligo is an acquired depigmentary condition involving a progressive loss of melanocytes from the epidermis and hair follicles We have earlier reported impairment of systemic antioxidant status of Baroda vitiligo patients ( Pigment Cell Res 2004; 17; 289-94) and we now show analysis of the clinical profiles of these patients. Procedure: The study comprised of 424 vitiligo patients. Clinical and demographic details of all the patients were obtained from the vitiligo clinical proformas. Lipid peroxidation levels (LPO) in erythrocytes of vitiligo patients and healthy controls were estimated. Result: Out of four hundred and twenty four outpatients, males constituted 38.44% and females were 61.56%. Mean age of the patients was 25.59 years. The sites of onset were the lower limb, face, trunk, upper limb, genital, hand, labia and scalp in the descending order of frequency. Koebner's phenomenon was observed in 12.74%, diabetes mellitus in 1.18%, leukotrichia in 9.2% and premature graying of hair in 23.11% patients. A family history of vitiligo was present in 21.93% of the patients. Significant increase ( P <0.002) in the LPO levels of the vitiliginous patients was observed compared to the controls. Conclusion: Vitiligo vulgaris was the most common form of the disease which constituted 52.36% of the patients followed by focal vitiligo (28.54%), segmental vitiligo (6.84), acrofacial (7.55%), mucosal (2.83%) and universal vitiligo (1.89%). Systemic oxidative stress may have a pathophysiological role in precipitating all clinical types of vitiligo in Vadodara vitiliginous patients.

About 39330, new patients were examined over a period of two years and it was revealed that 104 patients (0.26%) had cutaneous tuberculosis. Most of the tuberculosis patients (61.52%) were between the age of 5 to 25 years. Lupus vulgaris was the commonest variant (57.69%), followed by scrofuloderma (21.15%). Males suffered more than females (2.25:1) and all patients belonged to lower socio-economic class. 62 cases (59.61%) showed evidence of BCG vaccination that failed to protect cutaneous tuberculosis. Mantoux test was positive in all cases except 4. Bacteriological examination was negative in all cases. Response to antitubercular therapy was very good except in two cases which required addition of an extra drug and also took more time.

Warts are common dermatologicals disorder which are dificult to treat. In the present study the efficacy of topical 5% 5-fluorouracil was evaluated in various types of warts and compared with the conventional electrosurgical method which included both electrodessication and electrofulguration. 50 patients clinically diagnosed as warts were enrolled. 25 patients were treated with topical 5% 5-fluorouracil applied for 4 hrs twice daily for 3 weeks, while another 25 were treated with electrosurgery. It was observed that electrosurgery yielded better initial results than 5-fluorouracil (72 and 52% respectively), but at the end of 6 months, the results were favourable for 5-fluorouracil as compared to electrosurgery (44 and 36% respectively). This was due to the signficantly low recurrence rate with 5-fluorouracil in contrast to electrosurgery (8 and 48% respectively). Though electrosurgery yielded quicker initial results but 5-fluorouracil was better as long term measurer because of its significantly lower recurrence rates.

Urticaria is one of the manifestations of a pattern of allergy. The associated disorders are vascular reaction and wheals. The objective of this study was to determine the prevalence of sensitivity to food allergens in Hyderabad in patients suffering from allergy. Four hundred and one patients attending the Allergy Clinic at BMMRC, with a confirmed diagnosis of bronchial asthma, rhinitis or urticaria were skin tested. Total sIgE levels were estimated by ELISA. Positivity to beans (53%) was highest, followed by mustard (41%) and cardamom (40%). Often patients having positive skin tests to food allergens which may have skin reactions to foods prove to be a problem. Foods that produce significant positive skin tests could be avoided in the diet; however, other foods that do not show skin reactions may contribute to the disease.

The hypopigmented variant of mycosis fungoides (MF) is charactrized by the presence of hypopigmented patches as the sole manifestation of the disease. This variant is usually observed in the dark skin of African or Asian individuals particularly children, but nevertheless is an uncommonly reported presentation of the disease. The incidence of hypopigmented MF in Caucasian patients and others of fair skin color is rare. We describe hypopigmented lesions arising in a twenty-year-old Saudi woman with type IV skin color. The diagnosis of mycosis fungoides stage IA was made based on the clinico-radiological and histological features. The patient responded well to PUVA therapy and is currently clear of lesions. MF should be considered in the differential diagnosis of hypopigmented macular lesions in patients of any skin color and age. Multiple skin biopsies must be performed on different occasions so as not to miss the diagnosis; and long term follow up is recommended since recurrence is common and occasional cases behave aggressively.

A case of steroid acne sparing a patch of Hansen's disease on the forehead of an 18 year old girl is presented here for its unique presentation.

Mycosis fungoides is the commonest type of primary cutaneous T cell lymphoma. Hypopigmented mycosis fungoides is an uncommon variant usually observed in dark-skinned individuals, especially children. Large plaque parapsoriasis, a disease of the middle-aged, and with no racial and geographical predilection, can be regarded as the clinically benign end of the mycosis fungoides disease spectrum. Case of a 24-year-old male, with asymptomatic hypopigmented lesions with characteristics of large plaque parapsoriasis, and vitiligo-like skin lesions with characteristics of mycosis fungoides developing over pre-existing hypopigmented lesions, with no systemic features, is presented for its unusual clinical features and conspicuous histopathological findings.

Pyoderma gangrenosum (PG) is a rare ulceronecrotic inflammatory cutaneous disorder and is frequently associated with systemic diseases. The authors report a 22-year-old male patient with pyoderma gangrenosum, thrombosis of both popliteal arteries, ischemic stroke and seropositivity for anticardiolipin antibody. Despite intravenous treatment with antibiotics, corticosteroid and heparin, pyoderma gangrenosum caused necrosis of his right lower limb which resulted in amputation. It was concluded that the anticardiolipin antibody may have contributed to the gravity of this case.

We report a case of a 70-year-old man who presented with a rapidly growing ulceroproliferative lesion on the right upper limb, clinically resembling a soft tissue sarcoma. The lesion turned out to be primary cutaneous CD 20 +, diffuse large B-cell lymphoma. There was no evidence of systemic involvement on computed tomography (CT) scans of the chest, abdomen and pelvis. Local radiotherapy induced complete remission of the B-cell lymphoma..

Acne fulminans is a rare and unique variant of acne vulgaris and is characterized by a sudden, violent onset of tender, nodulo-cystic and ulcerocrusted lesions over the back and chest, with fever, arthralgia and weight loss, affecting predominantly adolescent males. The exact etiopathogenesis is unknown although a hypersensitivity reaction is the most accepted hypothesis. Systemic steroids alone or in combination with isotretinoin are the cornerstones of its treatment. The successful management of Acne fulminans in an Indian boy with a combination of minocycline (200 mg once a day) and dapsone (200 mg once a day) daily is reported. The efficacy of minocycline as an alternative to steroids in the management of acne fulminans is highlighted.

A 45 year old male presented with dry skin, facial puffiness, weight gain, constipation and lethargy for five months. He had been diagnosed as thyrotoxicosis fifteen years back and improved after oral antithyroid drugs. General examination revealed bradycardia, obesity, hoarseness, proptosis and acropachy. Dermatological examination revealed pretibal as well as generalised myxoedema with cold, hyperpigmented and xerotic skin. Hair was thin, coarse and brittle and nails brittle. Face appeared puffy, expressionless and eyelids wrinkled and drooping. Palms, soles had a yellowish hue. The neck revealed a diffusely enlarged thyroid. Hormone profile revealed reduced T3, T4 and raised TSH. Thyroperoxidase antibody was positive. ECG showed low voltage sinus bradycardia. X-ray hands substantiated thyroid acropachy. Skin biopsy confirmed pretibial myxoedema. He was diagnosed as Graves disease with past hyperthyroidism and present hypothyroid state and managed with oral thyroxine with improvement. The pretibial myxoedema was successfully managed with intralesional and topical steroids.

Pyogenic granuloma is a benign vascular tumour of the skin or mucosa. We report two patients of pyogenic granuloma with spontaneous occurrence of multiple and satellite lesions, a rare occurrence.

Seven cases of histoplasmosis have been reported, 6 males and one female. Their ages ranged from 40 to 78 years. Of 7 patients, 5 had skin lesions, 4 with palatal ulcer, one with papules and nodules. None of the patients were HIV positive. In all patients either cytology, or skin biopsy or both revealed Histoplasma. Culture was positive in two patients.

Background: Vitiligo is a common skin disease; however it still remains a difficult disease to treat. Not all patients respond to current forms of treatment. Surgical techniques offer a potential solution for patients with vitiligo who fail to respond to medical treatments. Aims: Aims of the study were to evaluate response of transplantation of melanocyte keratinocyte cell suspension in patients of stable vitiligo. Materials and Methods: Total 10 patients of stable localized vitiligo were included in the study and were treated with transplantation of autologous melanocyte keratinocyte suspension after motor/manual dermabrasion. Results: Out of total 10 patients, 40% [4 patients] had excellent [95 to 100%] response, 30% [3 patients] had good [65 to 94%] response, 20% [2 patients] had fair [20 to 64%] response and 10% [1 patient] had poor response [0 to 19%]. Age and sex of the patients and size and location of lesions, did not show significant influence on results of transplantation. Conclusion: Autologus melanocyte keratinocyte suspension combined with motor/manual dermabrasion is an effective affordable treatment for patients with stable vitiligo who fail to respond to medical treatments.

Malassezia furfur, a lipophilic, dimorphic and yeast-like fungus, occurring in human skin as an opportunistic pathogen, causes diseases such as dandruff, pityriasis versicolar, seborrheic dermatitis, etc. Suitable media for culturing the organism were standardized. A modified medium for the culturing of M. furfur has been proposed. Growth of the fungus was also determined in the presence of different carbon sources under the influence of different temperature, pH and salinity. Plant extracts of 19 species were screened against the growth of the fungus by using disc diffusion method and the results are discussed.

Background and Aims: It is generally agreed that the pattern of skin diseases differs in different countries, and within various regions of a country depending on social, economic, racial and environmental factors. Many workers have reported various patterns of skin diseases in different parts of India. So far no such report is available for this border state of North East India. To fill the lacunae we decided to undertake a retrospective study of the skin disease pattern in this premier hospital of Manipur. Materials and Methods: All the newly diagnosed cases attending the OPD of Dermatology and Venereology, RIMS Hospital Imphal, during the period of 2 years starting from 1st January 1999 to 31st December, 2000 were included in the study. Diagnosis was done on clinical grounds and laboratory investigations were done whenever required. Results: Eczema (17.48%), fungal infections (17.19%), pyodermas (9.10%) and scabies (8.97%) were the major skin diseases. STD's accounted for (3.60%) of the cases. Genodermatoses (0.01%) formed the minimal number of cases. Conclusion: Eczema was the commonest group of disorders. Out of the infective skin disorders fungal infections were the commonest group. Genodermatoses formed the least number of cases.