Objectives: Collision tumours are rare situations characterised by the coincidence of two different skin neoplasms in the same lesion. Methods: We have analyzed 41 collision skin tumours from one department in the clinical-dermoscopic-histopathologic correlations. Results: We present 41 collisions tumours. The mean age of our patients was 67.9 years, the mean diameter of the lesion was 11.6 mm. The most frequent locations were trunk (27 lesions) and head/neck (11 lesions). The collisions were classified as benign/benign (13 cases), benign/malignant (25 cases) and malignant/malignant (3 cases). The most frequent participants were seborrheic keratosis (24 cases), malignant melanoma (17 cases), melanocytic nevus (14 cases), basal cell carcinoma (12 cases) and heamangioma (10 cases). Thirty cases were of “dominant/minor” type and 11 cases of “half to half” type. Malignant tumours were a part of 28 collisions; these lesions were larger, patients were older and the malignant part was dominant in most cases. More than half of the collisions were unexpected by the initial clinical examination. Six collisions were missed by the initial histopathological examination. Conclusions: Collision tumours can be missed by clinical or even histopathological examination. Dermoscopy is very helpful in the recognizing of difficult cases and cooperating with the histopathologist.

Background: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease. Hanifin and Rajka's criteria is the most common diagnostic criteria used for the clinical diagnosis of this condition. However, many find that it is too exhaustive to be used in routine practice, and the specificity of many of the minor criteria poses challenges, particularly from Asian countries with type III, IV, and V skin. Aims and Objectives: The aim of the study is to evaluate the effectiveness of the minor features of the Hanifin and Rajka criteria for AD in comparison to the UK working party's diagnostic criteria in pediatric populations of India. Methodology: A hospital-based cross-sectional study of 100 patients in the pediatric age group (3 months–12 years) with AD was conducted based on history, clinical, and laboratory evaluation. An age-matched control group of 100 pediatric patients who did not have a personal or family history of atopic dermatitis was included after obtaining informed consent to find out the prevalence of minor criteria among the control group. Results: Mean of the number of minor clinical criteria found positive in our study population in the infantile and toddler (below 2 years) and childhood groups (2–12 years) was (4.72 ± 1.75) and (5.67 ± 1.78), respectively. Early-onset of disease was the most consistent feature among the minor criteria found in 83% of patients, followed by xerosis (71%), hyperlinearity of palm (56%), pityriasis alba (54%), Denny Morgan fold (52%), elevated serum IgE (47%), perifollicular accentuation (37%), and tendency toward cutaneous infections (37%). Conclusion: We found that though some of the minor criteria are highly sensitive and specific to the diagnosis of AD (xerosis, ichthyosis, palmar hyperlinearity, tendency of cutaneous infections, Dennie–Morgan infraorbital fold, pityriasis alba, and perifollicular accentuation), some other criteria were either very rare or nonspecific for AD. We suggest that many of the minor criteria of Hanifin and Rajka may not have much significance for Indian patients and a multicentric nationwide study with a larger patient pool is required to create a trimmed and improved version of Hanifin and Rajka criteria.

Background: Recent highlights have investigated the possible roles of molecular chaperons like heat shock proteins (HSPs) into Lichen Planus (LP)-onset and pathogenesis. This study for the first, determine the expression of both HSP60 and HSP70 genes in cutaneous LP (CLP) and oral LP (OLP) lesions compared to normal healthy cases and between different subtypes of OLP lesions by real-time (RT)-PCR. Materials and Methods: Paraffin blocks of LP lesions including 56 OLP and 56 CLP samples were selected from theMashhad University of Medical sciences, Mashhad, Iran. Also 56 biopsy samples of healthy normal participants were selected. The demographic and clinical characteristics were extracted from their medical records. The expression of HSP60 and HPS70 genes were evaluated using the real-time RT-PCR method. Results: The comparison of the expression of HSP60 and HSP70 genes among the patients with CLP and OLP showed a significant overexpression of HSP60 and HSP70 genes in both groups compared to the normal participants (P = 0.001). The expression of HSP60 and HSP70 genes was high in both the groups of CLP and OLP patients, but the amount was not significantly different between the two groups. Comparing the two mucosal subgroups of OLP lesions (non-erosive and erosive) showed that the expression of the HSP60 and HSP70 in erosive subtypes of OLP was significantly higher than the non-erosive subtypes of OLP (P = 0.001). Conclusion: Regarding the overexpression of HSP60 and HSP70 in the LP lesions compared to healthy biopsies, we conclude that HSP60 and HSP70 could have key roles in the etiopathogenesis of the OLP and CLP lesions. The overexpression of both HSP60 and HSP70 in the erosive OLP group compared to the non-erosive OLP group emphasized the possible roles of HSPs in the pathogenesis and premalignant changes of OLP lesions.

Background: Psoriasis is a chronic inflammatory skin disease with an unknown pathogenesis. Recently, miR-31 have been shown to play an important role in psoriasis. Moreover, STAT3/p53 pathway has been used in tumor studies, but rarely in psoriasis studies. Aims: The present study aimed to investigate the role of STAT3/p53 pathway in psoriasis-like lesions in a mouse model of miR-31 overexpression. Methods: All mice (n = 44) were divided into four groups: normal mice treated with Vaseline® (NV; n = 10), normal mice treated with imiquimod (NI; n = 12), miR-31-overexpressing mice treated with Vaseline® (MV; n = 10), and miR-31-overexpressing mice treated with imiquimod (MI; n = 12). Then, we assayed the expression of STAT3 and p53. Results: Our results showed that at the protein level (P < 0.01) and gene level (4.45 times), the expression of STAT3 in the MV group was higher than that in the NV group, and at the protein level (P < 0.01) and gene level (11.43 times), the expression of STAT3 in the MI group was higher than that in the NI group. At the protein level, the expression of p53 in MV group was higher than that in the NV group (P < 0.05), and the expression of p53 in MI group was higher than that in the NI group (P < 0.01). Conclusions: Our findings indicate that overexpression of miR-31 causes upregulation of STAT3, which further brings about upregulation of p53, and eventually leads to serious psoriasis skin lesion.

Background: Warts are a common dermatologic complaint with an increased incidence within the pediatric population. Warts are caused by multiple strains of the human papillomavirus (HPV). There is little research on how a patient's HPV immunization status affects the response to treatment of warts in pediatric patients. Aims: The purpose of this study is to investigate the relationship between HPV vaccination status and wart resolution. Materials and Methods: This is a retrospective chart review that investigates the relationship between response to routine treatment of warts and a subject's HPV vaccination status. Results: There was no significant relationship found between HPV vaccination status and resolution of warts (p = 0.797). However, there was a significant positive correlation between having the HPV vaccine and number of visits for the treatment of warts (r = 0.180, P = 0.024). Conclusion: This study did not show a significant correlation between HPV vaccination status and wart resolution, although it demonstrated a significant positive relationship between those immunized with the HPV vaccine and an increased number of treatment visits. Possible explanations for this unexpected correlation include the variation in HPV vaccine formulation, vaccination status, and frequency of office visits, since vaccinated patients are more likely to be compliant with office visits.

Background: Melatonin is a hormone that regulates the sleep–wake cycle and has immunomodulatory and anti-inflammatory roles. Aims: The aim of this study is to assess melatonin levels and investigate the association with pruritus severity, sleep quality, and depressive symptoms in dermatoses with nocturnal pruritus. Methods: The study was a prospective study with 82 participants, including 41 patients and 41 healthy volunteers. The visual analog scale (VAS), Pittsburg Sleep Quality Index (PSQI), and Beck Depression Inventory (BDI) were recorded for each patient. To assess the melatonin levels, urinary 6-sulfatoxymelatonin levels in the first urine in the morning were measured. Results: Melatonin concentrations were significantly lower (P = 0.007), while the BDI (P = 0.001) and PSQI (P = 0.001) scores were significantly higher in the patients with pruritus than in the healthy control subjects. There was an inverse correlation between melatonin levels and PSQI scores (r = −0.355, P = 0.023), and a positive correlation was detected between BDI scores and PSQI scores (r = 0.631, P = 0.001) in the pruritus group. Conclusion: Melatonin levels were found to decrease in relation to sleep quality in nocturnal pruritus patients. Low melatonin levels in these patients may be associated with sleep disorders and pruritus.

Background: Persulfate is an oxidizing agent used for multiple purposes, including bleaching hair, bleaching flour, and as pool/spa water disinfectant. Objective: To identify the prevalence and clinical characteristics of patients allergic to ammonium persulfate (APS) among patients who underwent patch testing in our clinic. Methods: A retrospective chart review of 2138 patients who underwent patch testing at Brigham and Women's hospital in Boston between July 2015 to November 2019. All patients were tested to our standard series including APS 2.5% petrolatum. Given the irritant nature of APS, we included for analysis only patients with 2+ or 3+ reactions. Results: Among 2138 patients, 61 (2.85%) had 2+ or 3+ reactions to APS. In this study, 72% were female. 75% had an atopic diathesis; 56% had 2+ reactions, and 44% had 3+ reactions. Clinical relevance was definite in 11%, probable in 10%, and unknown/possible in 79%. In patients with definite clinical relevance, 6/7 had occupational allergic contact dermatitis: 4 hairdressers, 1 hair salon cleaner, and 1 aquarium worker; 1/7 was bleaching her hair. Conclusion: Prevalence of 2+ or 3+ APS reactions in this single-center study was higher than that reported by the North American Contact Dermatitis Group, 2015–2016, (0.75% vs. 2.85% in our study). APS is an important occupational allergen, and clinicians should be aware of this when treating patients with exposure to APS.

Context: A non-healing ulcer occurs due to multiple causes and possesses a great impact on the quality of life. Autologous platelet-rich fibrin and the application of a triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) have emerged with a good response in the treatment of non-healing ulcers. Aims: To compare the therapeutic efficacy of autologous platelet-rich fibrin matrix versus the triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) in non-healing ulcers. Settings and Design: Hospital-based interventional comparative study. Materials and Method: Twenty-four patients with non-healing ulcers were randomly divided into two groups. One group received platelet-rich fibrin (PRF) therapy every week for up to 5 weeks and the second group applied triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) again for 5 weeks. In the end, the ulcer area was measured. Statistical Analysis Used: Student's paired t-test was used to evaluate the correlations between variables. A P-value of < 0.05 was considered significant. Results: Group A showed a mean reduction in the ulcer area by 8.26 mm² (75.99%). Group B showed a mean reduction in the ulcer area by 4.799 mm² (47.75%), which was statistically significant with a P-value of 0.004. Conclusion: We conclude that autologous platelet-rich fibrin matrix is much more effective than the triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) in the treatment of non-healing ulcers.

Context: Dermatoscopy has been used recently for identifying the specific features of onychomycosis. Very few studies have used it as a diagnostic tool. Our study highlights the specific patterns in different clinical types of onychomycosis and the novel features that have never been reported previously. Aims: To study the dermatoscopic patterns in patients with onychomycosis and determine the sensitivity, specificity, positive, and negative predictive values of the different features. Study Design: A cross-sectional study. Materials and Method: Dermatoscopic picture using dinolite video dermatoscope was taken in patients diagnosed with onychomycosis either with a positive KOH, culture, and/or PAS. Result: A total of 80 patients were included. Onychomycosis was identified in 68 individuals. Clinically, 73.52% presented with distal lateral subungual onychomycosis (DLSO) and 26.47% had total dystrophic (TD). PAS was positive in 85.29% of patients, KOH in 75%, and culture in 66.17%. Trichophyton species were isolated in 53.33%, whereas Candida species in 40% of patients. Dermatoscopic features were seen in all 68 patients (100%). The most common finding in decreasing order includes spike pattern, ruin appearance, distal irregular terminations (DIT), longitudinal striations, chromonychia, focal homogeneous opacities, microsplitting, and uniform homogeneous pattern. Three novel patterns were observed: homogeneous opacity with a-z pattern border, microsplitting in a Christmas tree pattern, and focal homogeneous opacities. Conclusion: To our knowledge, this is the first study conducted in northeast India where dermatoscopy was used as a diagnostic tool and it was found to have the highest sensitivity. New features that have not been described before have been identified.

Background The number of treatment options in psoriasis has increased considerably, so biomarkers should be searched to assist in the selection of the optimal treatment agent. The most common of these biomarkers is HLA-Cw6. Objective: The aim was to determine whether there is a relationship between HLA-Cw6-positivity (HLA-Cw6-POS) and the response of treatment agents in psoriasis. Methods: Blood samples of 124 patients were subjected to genetic study for HLA-Cw6. Results: Psoriasis area severity index (PASI) score of more than 75% (PASI75) response was received in 34 (73.9%) of the HLA-Cw6-POS methotrexate-treated patients, 30 (78.9%) of the HLA-Cw6-POS cyclosporine-treated patients, and 8 (37.5%) of the HLA-Cw6-POS acitretin-treated patients. The differences were not statistically significant (P = 0.634-0.071-0.409). PASI75 response was received in 73 (68.2%) of the HLA-Cw6-POS patients in patients treated with conventional agents. In adalimumab-treated patients, PASI75 response was received in 8 (53.3%) of the HLA-Cw6-POS patients, 6 (75%) of the HLA-Cw6-POS infliximab-treated patients, and 4 (57.1%) of the HLA-Cw6-POS ustekinumab-treated patients. The differences were not statistically significant (P = 0.245-1.00-0.322). PASI75 response was received in 24 (64.9%) of the HLA-Cw6-POS and 33 (84.6%) of HLA-Cw6 negative (HLA-Cw6-NEG) patients with biological agents. The biological agent response was statistically significantly lower in HLA-Cw6-POS. Conclusion: None of the agents were affected by HLA-Cw6. When biological agents were evaluated collectively, the treatment response of HLA-Cw6-POS patients was lower.

Background: Prurigo nodularis (PN) is a chronic dermatologic condition presenting as multiple papulonodular lesions occurring with intense pruritus. Though numerous agents (topical, systemic, phototherapy and biological drugs) have been tried, the outcomes are variable. Objectives: The aim of this study was to assess the role of topical and systemic therapies in primary PN by comparing the Pruritus Grading System (PGS) score at baseline and 1 month post-therapy. Materials and Methods: Of 86 diagnosed cases of PN, 49 cases of primary PN were clinically graded by Pruritus Grading System Score (PGSS), and assessed histopathologically by IHC staining (STAT-1, 3, and 6). Apart from topical agents, oral nortriptyline (mild grade), methotrexate (moderate grade) and thalidomide (severe grade) were administered, whereas doxepin was administered for itching. The PGSS was assessed after 1 month of therapy. Results: Among 49 patients of PN, the majority of patients showed a significant decrease in PGSS (P = <0.001) in 1 mont, which correlated with STAT-6 expression. The combination of different topical and oral agents resulted in a statistically significant change in severity, though individual drugs did not achieve statistically significant results. Conclusion: A combination of selected oral and topical agents can effectively control the severity of PN within one month, and this was found to correlate with STAT 6 expression.

Background: Staged purse-string suturing has been recently introduced for the reconstruction of round or oval defects following tumor excision. Objective: The aim of this study was to evaluate the clinical advantage of staged purse-string suturing for the reconstruction of relatively large skin defects. Materials and Methods: Twenty-one patients who received staged purse-string sutures were included in the study. To evaluate the defects and scar sizes objectively, computer-based image analysis was used. A modified observer scar assessment scale (OSAS) was applied for evaluating the clinical efficacy. Results: The mean primary postsurgical defect size in the total 21 cases was 1446.2 ± 1187.2 mm², and the mean final scar size was about 268.1 ± 252.3 mm². The defect area decreased gradually as staged purse-string suturing was performed. The mean total modified OSAS was 7.96 ± 1.69. Conclusion: Staged purse-string sutures might be an alternative reconstructive method for relatively large round or oval skin defects.

Our skin is the largest organ and is composed of the dermis and epidermis. The skin surface has lines in the direction of elastic tension. The palmar and plantar skin lines are established before birth in the intrauterine development of the embryo. Dermatoglyphics is the study of epidermal lines on the palmar and plantar surface. It is a branch of biology, anthropology, genetics, and dermatology. Dermatoglyphics are closely associated with genetic factors. These attributes once formed in the womb remain unique and persist throughout the life of an individual unless the dermis is damaged. Digital and palmar dermatoglyphics are represented by fingerprint patterns, atd angle, a, b, c, d triradii, mail line index, etc. Sometimes either due to hereditary reasons, the pressure of intrauterine factors, or external environmental factors, chromosomal aberrations occur in the fetus. These aberrations are reflected in the form of increased angle of atd, variation in pattern frequency or ridge count between a-b triradii (ABRC), presence of unnatural flexion creases, and others in the fingerprints, palmprints, or footprints. These aberrations in dermatoglyphics are useful in studying the genetic abnormalities in ailments, personality disorders, and criminal tendencies.

Lichen planus (LP) is an autoimmune, mucocutaneous, T-cell mediated chronic inflammatory disease that involves the oral mucosa. The prevalence of LP is 0.04–2% in general population with a female predilection. Patients with skin lesions also manifest oral lesions predominantly and about 25% present with only oral lesions. The aim of the systematic review is to analyze the serum cortisol levels in LP patients to elucidate the role of cortisol in pathogenesis of the lesion. A comprehensive search was done using electronic data bases such as PUBMED, EMBASE, SCIENCE DIRECT, COCHRANE, GOOGLE, manual search, and back references of the articles were extracted. A total of seven relevant articles were reviewed and analyzed. Electronic database and manual search identified 55 articles. Out of which, 33 were excluded after reading titles and removing duplication and 23 studies were evaluated in detail after reading the abstract and full text. A final of seven studies were included based on the inclusion criteria to meet the research question. All the studies analyzed the serum cortisol levels in LP patients and also in healthy subjects. Within the limitations of this review, it can be inferred that Cortisol is an established stress hormone and Serum cortisol estimation could be an important indicator in identifying susceptible oral lichen planus patients.

Xeroderma pigmentosum (XP) is an autosomal recessive genetic disease caused by a defect in the DNA repair system, exhibiting skin cancer on sun exposure. As it is an incurable disease, therapeutic strategies of this disease are critical. This review article takes an attempt to explore the current therapeutic advancements in XP. Different approaches including sun avoidance; surgical removal of cancerous lesions; laser and photodynamic therapy; use of retinoid, 5-fluorouracil, imiquimod, photolyase, and antioxidant; interferon therapy and gene therapy are chosen by doctors and patients to lessen the adverse effects of this disease. Among these options, sun avoidance, use of 5-fluorouracil and imiquimod, and interferon therapy are effective. However, some approaches including laser and photodynamic therapy, and the use of retinoids are effective against skin cancer having severe side effects. Furthermore, surgical removal of cancerous lesions and use of antioxidants are considered to be effective against this disease; however, efficacies of these are not experimentally determined. In addition, some approaches including oral vismodegib, immunotherapy, nicotinamide, acetohexamide, glimepiride-restricted diet are found to be effective to minimize the complications secondary to defects in the nucleotide excision repair (NER) system and also enhance the NER, which are under experimental level yet. Besides these, gene therapy, including the introduction of missing genes and genome edition, may be a promising approach to combat this disease, which is also not well established now. In the near future, these approaches may be effective tools to manage XP.

Background: Polymerase chain reaction (PCR) is the most optimized method for the rapid detection and analysis of any environmental or clinically significant organism. While PCR amplification directly from samples has been shown effective for several bacteria and viruses, for filamentous fungus and yeast, extraction of genomic DNA is a must. The extraction of DNA from fungal cultures is often reported using user-friendly commercially available kits, which are designed to decrease the time, extensive manual work in extraction procedures but are often expensive. Dermatophytes pose an added drawback to efficient DNA extraction due to their poor recovery on culture media and slow growth rate. Aims and Objectives: In the present study, we developed and validated a method for effective genomic DNA extraction from dermatophytes. Materials and Methods: DNA yield from standard dermatophytes extracted from spore suspensions and mycelia mat by commercially available kits was compared. A modified method using lyticase buffer and phenol-chloroform extraction was developed. The yield obtained was compared with the existing methods (kit-based method and cetyl trimethyl ammonium bromide method). The yield and quality of the total genomic DNA were estimated spectrophotometrically and by successful PCR amplification of the ITS region. The results were validated using 21 clinical isolates from recalcitrant dermatophytosis. Results: Minimal fungal DNA was obtained from the spores compared to that obtained from mycelial mat. Commercially available kits yielded lower amounts of DNA compared to the CATB method. The modified method developed in this study yielded better quality and quantity of DNA. Conclusion: Of the three extraction methods evaluated, the developed method gave significantly higher total genomic DNA yield and better purity than the reference methods. In addition, the turnaround time for DNA extraction was reduced to half based on modifications in culture conditions.

Folliculosebaceous cystic hamartoma (FSCH) is a rare cutaneous hamartoma that consists of follicular, sebaceous, and mesenchymal elements. These lesions are mostly seen on the central face and scalp of adults and mostly present as single 0.5-1.5 cm papules or exophytic nodules. A 17-year-old female patient presented at our clinic with the complaint of swelling, pain and discharge in front of the left ear, which had been recurrent since childhood. The lesion was clinically suspected to be an infected preauriculer sinus cyst. After the medical treatment, the patient was operated on with a pre-diagnosis of preauricular sinus cyst. Histopathological findings revealed FSCH. To the best of our knowledge, this is the first reported case of FSCH originating from the preauricular region, located subcutaneously.

Biologics which are given subcutaneously are usually injected at certain prementioned sites such as the upper arms, thighs, or any quadrant of the abdomen. In erythrodermic patients, these conventional sites are usually affected. In our series of six patients of psoriatic erythroderma, we selected unconventional apparently spared sites to inject secukinumab subcutaneously which returned similar results as compared to injecting at conventional sites as reported by other studies.

Background: Oral lichen planus (OLP) is a chronic autoimmune disease, which annoys the patients for several years. It presents with various clinical forms. Although plaque-like form of OLP is usually asymptomatic, it could transform to a malignant lesion. Therefore, treatment considerations are essential to reduce the development of oral cancer. Laser therapy is a newer modality for treatment of plaque-like lesions. Aims: This study aimed to perform laser therapy for plaque-like lesions of OLP. Methods: We described some plaque-like OLP lesions evaporated with CO2 laser. The power of 4–7 watt as continuous wave (CW) and defocused mode was employed for evaporation. The complications and recurrence were evaluated in the follow-up sessions. Results: In some patients, mild keratotic lesions were observed in the follow-up sessions. Most patients were satisfied with treatment process and reported mild burning after treatment. No complication was observed in the patients. Conclusion: CO2 laser could be employed for OLP lesions; however, some degrees of recurrence may occur.

Backgrounds: Mutation of protein-coding genes and non-coding genes is a factor in psoriasis etiology. Non-coding RNA (ncRNA), which does not have protein-coding capacity, is available in the human genome. HOTAIR (HOX Antisense Intergenic RNA) and 7SL-RNA are known as ncRNA. They may play a role in psoriasis pathogenesis. Aims: In our study, we aimed to investigate the level of HOTAIR and 7SL-RNA gene expression in the lesional and perilesional healthy skin of psoriasis patients. Methods: Total RNA isolation from the skin samples was achieved by modifying the RNeasy Mini Kit (Qiagen, Cat No: 74104) protocol. Real Time Polymerase Chain Reaction (qPCR) phase was performed in accordance with the protocol of the relevant brand (WizPure qPCR). Results: 7SL-RNA gene expression decreased in the skin with psoriatic lesions (FC: 0.01; p: 0.028), and this decrease was statistically significant. HOTAIR gene expression decreased (FC: 0.92; p: 0.218), but this decrease was not statistically significant. Conclusions: lncRNAs may play a role in the pathogenesis of psoriasis disease.

Background: Skin is the largest organ of the human body, and one of the most sensitive indicators of a child's general health. Skin disorders, especially among children, may cause an additional emotional and psychological stress to the patients and their family. Aim: We aim to compare the extent to which various skin diseases affect the quality of life among the pediatric age group (5–12 years) based on Children's Dermatology Life Quality Index (CDLQI) scores. Materials and Methods: A cross-sectional study of 453 patients who attended skin clinic at a regional hospital in Northern India between November 2015 and May 2017. The study consists of questions regarding dermatoses. Patients were evaluated using a standardized pro forma and a CDLQI questionnaire. The diseases with abnormal high proportions were evaluated by the control chart technique. Results: Out of a total of 453 pediatric patients identified for dermatoses, the average quality of life based on the CDLQI score did not show significant variation across different seasons (P < 0.522). Although the type of skin disorders (P < 0.001) had a significant effect on the quality of life of the children. Based on the CDLQI scores, following diseases have a significant adverse effect on quality of life of the patients – miliaria, atopic dermatitis, scabies, impetigo, and pediculosis capitis. Conclusion: Our study has shown that skin diseases, irrespective of the type, adversely impair the quality of life of the child and in turn the family, therefore, calls for an enhanced level of compassion and care.

Background: Chronic Idiopathic Urticaria (CIU) is a debilitating disease characterised by almost daily presence of urticarial symptoms like short-lived wheals, itching, and erythema for at least 6 weeks without an identifiable cause there by leading to impairment of quality of life of the patient. Aim: To evaluate the efficacy and safety of loratadine and rupatadine in chronic idiopathic urticaria. Methods: This is a prospective, randomized, single-blind, parallel arm study conducted to evaluate the efficacy and safety of loratadine and rupatadine in patients with CIU. The study was registered prospectively with Clinical Trial registry of India (CTRI/2017/05/008624). Institutional Ethics Committee clearance was obtained. Written informed consent was obtained from all the participants before enrolment into the trial. The study was conducted in the outpatient department of Dermatology, SRM Medical College, Kattankulathur, Tamil Nadu, India, during the period from June 2017 to August 2018. Patients with CIU enrolled into the study based on inclusion-exclusion criteria were given the intervention drugs; Loratadine 10 mg once daily or rupatadine10 mg once daily orally for 6 weeks. Results: Rupatadine is more efficacious than loratadine in the reduction of Total Leucocyte Count, Differential Count and Absolute Eosinophil Count, the key determinants of allergy. Rupatadine also produced better improvement in Total symptom Score, Dermatology Life Quality Index in patients with CIU. Conclusion: Analysis of all the parameters of efficacy and safety establishes the probable superiority of rupatadine over loratadine for the treatment of urticaria.

Background: Dermoscopy can reliably predict the diagnosis of plaque psoriasis. Ultrasonography has been increasingly used in dermatology in inflammatory diseases like psoriasis as a tool for evaluation. Hence, this study was done to evaluate the role of dermoscopy and ultrasonography as prognostic aid in plaque psoriasis. Aims and Objectives: To study the sonographic and dermoscopic findings of clinically diagnosed psoriatic lesions and the changes in the psoriatic lesions if any, with the treatment. How these findings can be utilized to assess the prognosis in these patients. Materials and Methods: The present study comprised 50 patients with clinically diagnosed plaque psoriasis. Lesions were assessed with Dino-Lite digital microscope AM7515MZT, followed by ultrasonography using a 15 MHz probe, and findings were recorded. All the patients included in this study were given appropriate treatment (topical/systemic) for 6 weeks and were followed up twice i.e., at 3 weeks and 6 weeks after initiating treatment. Results: Whitish scales were the most common scale color seen in our study seen in 35/50 patients (70%). All the vascular structures were reddish, red dots and globules being the predominant type and with the improvement of the lesions, brown structures increased. A total of 28 (56%) patients had a regular pattern of vessel arrangement. Mean capillary size was 0.097 ± 0.012 mm that reduced to 0.075 ± 0.019 mm at the end of the third week and 0.027 ± 0.032 mm at the end of 6 weeks. In ultrasonographic assessment, mean epidermal thickness reduced from 0.1008 to 0.0764 cm at third week and 0.068 cm at the sixth week, and mean dermal thickness reduced from 0.2692cm to 0.1906cm at the third week and then to 0.1906cm 0.1806cm at the sixth week. In our study, clinical improvement preceded dermoscopic improvement. Newer structures identified in the study are a perifollicular arrangement of capillaries and the presence of lacunar structures in the healing lesions. Conclusion: The scale distribution, capillary number, and capillary size in dermoscopic assessment, and epidermal and dermal thickness in ultrasonography showed statistically significant changes with treatment and thus may be taken as the prognostic indicators. Thus, both these noninvasive modalities may be useful in the therapeutic monitoring of plaque psoriasis.

Background: Psoriasis is a chronic inflammatory diseaseresulting from a complex interplay of genetic and environmental factors affecting the skin, nail and joints. Two distinct types of psoriasis are said to exist (i) early onset psoriasis (EOP), beginning before the age of 40 years and (ii) late onset psoriasis (LOP), beginning ≥40 years; with the presence of Human lymphocyte antigen (HLA) Cw6, present in majority of patients with early onset. Several studies demonstrated clinical and genetic differences between EOP and LOPamong European and East Asian populations. Lack of similar study in the Indian population has prompted us to undertake the present work. Aims and Objectives: (i) To compare the clinical patterns of early onset and late onset psoriasisin patients attending the Dermatology outpatientdepartment (OPD) and admitted in the in-patient department (IPD). (ii) To analyze the association age of onset with presence of HLA Cw6. Materials and Methods: It was an institution-based, descriptive, cross-sectional study. Consecutive patients with psoriasis at the OPD and IPD of the department of Dermatology during the study period, were recruited in the study after obtaining informed consents. Detailed history was obtained regarding the disease, co-morbidities and complications. Through physical examination was carried out, PASI was calculated and blood samples were drawn fromconsenting adult patients (age>/=18 years) to study the presence of Cw6. Results: The study population (n=250) wasbroadly divided into “Early onset psoriasis(EOP)” (n=138) and Late onset psoriasis (LOP)” (n=112).Significant higher occurrence of positive family history, nail involvement and koebnerization were found in EOP, but such differences were absent considering the types, patterns, joint involvement, severity and HLACW6 positivity. Conclusion: This study supports the concept of two subtypes of psoriasis based on age of onset showing different clinical and evolutionary features.

Background: As generalized pruritus can be a symptom of a systemic disease, iron deficiency may be the underlying internal cause of its symptoms. Because data on the relationship between iron deficiency and generalized chronic pruritus are limited, more research is needed to ensure proper diagnosis and management. Aims: To evaluate the prevalence of iron deficiency in patients with generalized chronic pruritus in the southeast region of Rajasthan and to assess the correlation of serum ferritin with iron deficiency variables. Materials and Methods: An observational, analytical study was conducted among a total of 200 patients complaining of itching all across the body without any skin lesions for more than 6 weeks and enrolled in the outdoor and indoor Dermatology, Venereology, and Leprology departments of the Government Medical College, Kota. The duration of the study experiment was 1 year from June 2018 to May 2019. Results: Females (108; 54%) were more than males (92; 46%) with a ratio of 1.17:1. The mean age of the patients was 37.35 ± 13.56. S. ferritin was found to be below 15 g/L in 58 (29%) patients. Significant correlation was found between S. ferritin and hemoglobin, MCV, MCH, and MCHC, and the P value was <0.05. Maximum number of patients (70; 35%) achieved visual analog scale (VAS) scores between 4 and 9, followed by 50 (25%) patients obtaining scores >9. Similarly, a correlation was found between the VAS score and hemoglobin, MCV, MCH, and MCHC and a statistically significant P value was obtained. Limitations: The sample size was small in the study. The overall levels of iron and serum transferrin were not checked, keeping patients' compliance in mind. Conclusion: Although statistically significant results were found, limitations were also present in our study; so, further studies for proper diagnosis and management should be conducted in greater depth.

Background: Chronic urticaria is a heterogenous skin disorder representing one of the important reasons for consultation with a dermatologist. Dermatology post-graduate students play an importanrt role in the treatment of patients with chronic urticaria. Objective: The objective of the study was to describe clinical characteristics of patients with chronic urticaria and assess adherence to the guidelines by postgraduate students in the department of dermatology of a tertiary care center. Materials and Methods: In this retrospective study, prescriptions of patients with chronic urticaria and/or angioedema presenting to the outpatient department for 5 months were analyzed. Percentage of prescriptions adhering to international urticaria management guidelines was calculated. Urticaria Activity Score, percentage of patients receiving second-generation antihistamines, first-generation antihistamines, and other drugs was recorded. Comorbidities in patients with chronic urticaria were also noted. Results: A total of 60 patients (mean age 32.1 years; 58.3% male) were included in. Mean (SD) duration of urticaria at the time of study was 4.7 (2.7) months. Demographism and history of allergy to drugs was present in 45 (75%) and 4 (6.7%) patients. Mean (SD) Urticaria Activity Score was 12.5 (6.5). A total of 12 (20%) patients had comorbidities. Mean number of drugs received per patient was 1.7 (0.5). A total of 47 (78.3%) patients received second-generation antihistamines, whereas 11 (18.3%) received first-generation antihistamines. Two (3.3%) patients received combination of first-generation and second-generation antihistamines. Fexofenadine, levocetirizine, bilastine, and cetirizine was prescribed to 24 (40%), 26 (43.3%), 18 (30%), and 14 (23.3%) patients. There was no significant difference in male and female patients receiving fexofenadine (P = 0.59) or levocetirizine (P = 0.13). Conclusion: Adherence to urticaria management guidelines by resident doctors in dermatology department in our institute was satisfactory.

“The eye sees only what the mind is prepared to comprehend.” The term “sign” refers to an objective physical finding observed by the examiner. In dermatology, the diagnosis mainly depends on the examiner and certain physical signs serve as an important clue to diagnosis of the disease. The objective of this review is to bring to light certain lesser-known signs in dermatology.

Ever since the beginning of COVID-19 pandemic, mucocutaneous manifestations started being noticed and are still being documented. Many of these have been described with the prefix “COVID” and may occur due to the infection (e.g., COVID rash), use of personal protective equipment in healthcare workers (e.g., COVID hand dermatitis) or extensive use of novel vaccines (e.g., COVID arm). This article attempts to summarize such entities with clinical relevance to dermatologists and physicians in general and to create awareness about this fast-evolving COVID lexicon.

Basal cell carcinoma (BCC) is the most frequent histological type of cancer in the world and accounts for approximately 80% of all skin cancers. In the majority of cases, they are slow-growing, low metastatic potential tumors, easy to cure by surgical or nonsurgical procedures. Giant BCC (GBCC) is a rare variant of BCC and according to the American Joint Committee on Cancer, this includes lesions with a diameter larger than 5 cm. GBCC's incidence has been reported to be less than 1%, and it displays a more aggressive behavior with both local invasion and higher metastatic potential. Archodaki et al. specifically reported that metastasis was present in 17.6% of GBCC patients during the primary examination. Patients with GBCC who are not suitable for either surgery or radiotherapy since 2012 seem to have another therapeutic option. Vismodegib is an oral small-molecule inhibitor of the Hedgehog pathway (HPI) that was approved for treating metastatic or locally advanced BCC in patients who are poor candidates for surgery or radiotherapy. In this case, we present a woman with two simultaneous facial GBCCs who was treated successfully using vismodegib as a monotherapy.