Urticaria is a fairly common condition characterized by transient swellings of the skin. This could be an extremely disabling and difficult-to-treat condition. Chronic urticaria has multifactorial aetiologies including intolerance to food or drugs, infectious diseases, and autoimmune processes. With the demonstration of auto antibodies against IgE receptor or IgE itself, a new subset of chronic urticaria has been identified as autoimmune urticaria. Further studies in this field in the recent past have contributed considerably in understanding the pathomechanism of urticarias in a better way. Controlled trials with immunomodulator drugs have further broadened our pharmacologic approach, especially in patients with severe refractory urticaria. This article reviews the types of urticaria, its causes, pathophysiologic basis and current approaches in its management.

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Granular cell tumors originate from neural elements. These distinctly rare tumors usually appear as solitary nodular growths and run a benign course. Although internal organs are rarely involved, skin and oral cavity are the commonest sites of affection. Their peak occurrence is in middle age. We present a case of a large solitary granular cell tumor occurring on the upper arm of a young girl at the site of a vaccination scar. Histopathology showed sheets of polyhedral cells with indistinct cell boundaries containing abundant eosinophilic fine granules. Excision of the lesion appeared to have cured the condition.

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A 23-year-old pregnant woman with an asymptomatic unilateral, bluish, pigmented lesion on her left periocular skin was referred from the obstetrics department for dermatological evaluation. Dermatologic examination revealed unilateral, blue-gray, poorly defined macule on the periorbital skin of the left side of the face mainly over the malar prominence and left temple not crossing the midline, conforming to the maxillary division of trigeminal nerve distribution. The pigmentation was speckled with interspersed dark-brownish elements. Her father, a 47 - year- old man had a similar pigmentation at the same site over the malar prominence of face not extending onto the forehead. Here we report two cases of nevus of Ota occurring in 2 generations of the same family for its rarity.

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Neonatal and infantile erythroderma or "the red baby" is a rare condition. It can be potentially life-threatening and requires urgent attention of the dermatologists. The causes of erythroderma in this age group are different from that in adults and distinctive, but maybe difficult to establish due to poor specificity of clinical and laboratory findings. Careful monitoring and management of the patient may improve the final outcome. In this review, the various causes of "the red baby" is discussed along with its prognosis and management.

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Out of a total of 1147 patients on antihypertensive drugs, 23 (2.04%) developed adverse cutaneous drug reactions (ACDR). The commonest antihypertensive drug group causing ACDR was beta-blockers of which atenolol was the commonest culprit. The second most common group was calcium channel blockers with amlodipine as the commonest offender. The most common patterns of ACDR observed included urticaria followed by lichenoid drug eruption (LDE). We noted 2 new patterns of reactions; (i) one patient developed brownish blue pigmentation of nails while on atenolol for 3 years, which resolved in 4 months after withdrawal and (ii) another patient on amlodipine for 8 years developed Schamberg's like purpuric pigmentation, which resolved on withdrawal of drug within 3 months. These findings have not been reported in the literature earlier. This study is presented for paucity of Indian data on ACDR due to antihypertensive drugs, and remarkable advancement in area of cardiovascular and antihypertensive pharmacology and a large number of population taking antihypertensive drugs.

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Granulomatous dermatitis frequently presents a diagnostic challenge to dermatopathologists as an identical histologic picture is produced by several causes. Present study aims at classifying infectious granulomatous dermatitis based on etiology and morphology of granulomas, and to highlight significance of clinical correlation in making a specific diagnosis. A retrospective analysis of skin biopsies was done and cases of infectious granulomatous dermatitis diagnosed on histopathological examination were retrieved. A total of 586 cases of granulomatous dermatitis were retrieved; out of these, on the basis of clinico-pathological findings, 515 cases (87.8%) were categorized as infectious granulomatous dermatitis. The age of the patients ranged from 7-80 years with a male to female ratio of 1.5:1. Majority of the cases were of leprosy (373 cases, 72.4%) which were further classified into sub-groups according to Ridley and Jopling. Second largest group was of cutaneous tuberculosis including tuberculids (119 cases, 23.1%). Fungal dermatitis was diagnosed in 17 cases (3.3%) and 6 cases (1.16%) were diagnosed as post kala-azar dermal leishmaniaisis based on the lympho-histiocytic and plasma cell inflitrate. Infections form an important cause of granulomatous dermatitis with leprosy and tuberculosis as the leading causes. Adequate clinical data and workup in combination with pathological resources can help in elucidation of specific etiology and good clinicopathologic correlation.

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The study was planned to find out commonest sites of scabies in Indian patients. Attempt was made to study the demographic profile i.e., the common age groups, affection of family members, friends or sexual partners, type of skin lesions, history of previous affection of scabies, coassociation with STDs, and to find out the most effective treatment of scabies. Our study showed that genitalia and finger webs were the most common sites and papular lesions were by far the commonest lesion in scabies. Oral lvermectin remained the most effective drug closely followed by topical 5% permethrin cream.

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Disseminated cryptococcosis is one of the acquired immune deficiency syndrome defining criteria and the most common cause of life threatening meningitis. Disseminated lesions in the skin manifest as papules or nodules that mimic molluscum contagiosum (MC). We report here a human immunodeficiency virus positive patient who presented with MC like lesions. Disseminated cryptococcosis was confirmed by India ink preparation and histopathology. The condition of the patient improved with amphotercin B.

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An interesting episode of homozygous familial hypercholesterolemia affecting four children born to a consanguinous parents belonging to two different families is reported for its rarity. The patients had multiple cutaneous xanthomas including the characteristic xanthoma tendinosum, xanthoma interosseum, xanthoma tuberosum, and xanthelasma palpebrarum. Prominent corneal arcus juvenalis has been noted in three children. Gross elevation of serum levels of low density lipoprotein cholesterol (LDLc) with normal values of triglycerides have been found in all patients. They have been prescribed medication with oral tablets of simvastatin and advised fat restricted diet and regular follow up in the clinic at periodic intervals.

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Aneurysmal benign fibrous histiocytoma is a rare variant of benign fibrous histiocytoma. Clinically it has varied appearances and mimic benign and malignant vascular tumors and malignant melanoma resulting in diagnostic difficulties. Histopathological examination is mandatory for diagnosis.

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Background: There have been few isolated studies on alteration of salivary electrolytes in psoriasis but this subject has not been pursued extensively. Purpose: The present study was conducted to assess any alteration in the levels of salivary electrolytes in psoriasis and to correlate the same with type and severity of the disease. Materials and Methods: Fifteen patients of uncomplicated psoriasis and 12 age and sex matched controls attending the outpatient department of R.L.J.H. and S.N.R. Hospitals, Kolar, India were included for analysis of salivary electrolytes. PASI scoring was used to assess the severity of the disease. Student's t-test ( P <0.05; significant) was utilized for statistical evaluation of results. Results: Salivary sodium levels were significantly elevated in psoriasis ( P value 0.002), whereas there was no significant rise in levels of salivary potassium. However, potassium levels correlated significantly with severity of the disease ( P value 0.043). Conclusion: There was elevation of salivary sodium levels in patients of psoriasis and potassium levels correlated with severity of the disease. Limitation: Unicentre hospital based study with small sample size; hence the results cannot be generalized.

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A sporadic case of sporotrichosis restricted to the primary site of inoculation in a fifty one years old farmer from a non-endemic region of West Bengal has been described. The significance of the report is that most cases of the fixed variant of sporotrichosis had hitherto been reported from the endemic belt of sub-Himalayan region. That the fixed variant is limited to the endemic region is probably a myth.

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A forty-three year old house-wife developed dermatitis over the center of forehead following application of kumkum, bindi and sticker (except one brand) since six months. Patch testing with various brands of kumkum and regularly available sticker used by the patient elicited positive reaction except one brand used by the patient. Kumkum is made by mixing turmeric (Curcuma longa) powder with small amount of lime (calcium hydroxide). She was patch tested with turmeric, to which she developed positive reaction. Subsequently she was patch tested with turmeric powder boiled and air-dried and also the acetone-extract and precipitate of the powder. She tested positive to all the extracts and precipitates, but the turmeric powder which was dried by boiling did not elicit positive reaction. She was advised to use boiled and dried turmeric to make kumkum for use. However, the kumkum powder prepared following boiling had lost its adhesive property and hence was unacceptable. She was offered Castellani's paint and eosin with starch for application. Both were acceptable for 2 months, but she subsequently developed irritant reaction to the paint with starch. She continues to use the non-allergic sticker (Kanchan sticker kumkum) while we are trying to find other alternatives to kumkum.

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Background: The optimal treatment for cutaneous leishmaniasis (CL) is not known. Topical paromomycin is one of the many drugs that have been suggested for the treatment of CL caused by Leishmania major. Recently, topical photodynamic therapy (PDT) has been reported to be effective in the treatment of CL. This study aimed to compare the parasitological and clinical efficacy of PDT versus topical paromomycin in patients with old world CL caused by L. major in Iran. Materials and Methods: In this trial, sixty patients with the clinical and parasitological diagnosis of CL were recruited and were randomly divided into three treatment groups with twenty subjects in each group. Group 1 was treated with weekly topical PDT and groups 2 and 3 received twice daily topical paromomycin and placebo, respectively. The duration of treatment was four weeks for all groups. These groups were followed up for 2 months after the end of treatment. Results: 57 patients with 95 lesions completed the study. At the end of the study, complete improvement was seen in 29 of 31 (93.5%), 14 of 34 (41.2%) and 4 of 30 (13.3%) of the lesions in group 1, 2 and 3 respectively ( P <0.001). At the same time point, 100%, 64.7 and 20% of the lesions had parasitological cure in group 1, 2 and 3, respectively ( P <0.001). Conclusion: Topical PDT can be used safely as a rapid and highly effective alternative choice for treatment of old world CL in the selected patients.

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