Squamous cell carcinoma arising from tissue affected by chronic lymphedema is rare, though it is recognized that a variety of malignant tumors can arise in chronic congenital or acquired lymphedema. We describe, a case of scrotal and penile squamous cell carcinoma arising in a patient with a history of chronic scrotal and penile lymphedema of filarial origin. We here discuss the management and possible etiology of this unusual case.

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Kindler's syndrome is a very rare genodermatosis characterized by acral blistering starting in infancy, photosensitivity, progressive poikiloderma, cutaneous atrophy, and various forms of mucosal involvement. A large number of other cutaneous and extracutaneous features have also been described. We report here three cases of Kindler's syndrome from eastern India for the rarity of the syndrome and to emphasize the importance of considering this condition in the differential diagnosis of disorders that can cause blistering, cutaneous atrophy, and/or poikilodermatous skin changes.

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Background: Cutaneous leiomyomas are benign smooth muscle tumors that comprise three distinct types such as piloleimyoma, angioleiomyoma, and genital leiomyoma. Aim: The objective of this study was to report a series of cases seen in last 8 years in a tertiary care hospital in north India and to discuss their clinicopathologic findings. Material and Methods: Paraffin-embedded blocks of cases reported as cutaneous leiomyoma from 1999 to 2007 were retrieved from the Institute of Pathology, New Delhi, and their clinical parameters were noted. Their histopathological features were reviewed on hematoxylin-eosin stained slides. Immunohistochemistry was performed where necessary. Results: Twenty-seven cases of piloleiomyoma, three cases of angioleiomyoma, five breast leiomyomas, and two scrotal leiomyomas were seen in patients ranging from 21 to 65 years of age, with an average of 38.2 years at presentation. There was a male predominance with 26 males and 11 females (M:F = 2.2:1). Solitary lesions (n = 21) were more common than multiple ( n = 16). The trunk and upper limbs were involved most commonly, comprising 23 of 37 (62.2%) cases. This was followed by lower limb, face, breast, and scrotum. Conclusion: Cutaneous leiomyomas are rare lesions and form an important clinical differential diagnosis of painful papulonodules. These must be biopsied in order to differentiate them from other spindle cell lesions.

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Pilomatricoma (PMC) is a relatively uncommon benign skin neoplasm arising from the skin adnexa. Since the first description of PMC in 1880, there has been a gradual increase in understanding of the morphologic features and clinical presentation of this tumor. However, difficulties still persist in making clinical and cytologic diagnosis. We report the clinical and histopathological findings of two cases of pilomatricoma. In case 1, a 10-year-old girl presented with a right upper back mass. In case 2, a nine-year-old girl presented with a left ear lobe mass. The clinical findings in both the cases were suggestive of epidermoid/dermoid cyst. However, subsequent histopathologic examination confirmed these cases as pilomatricoma. This report reveals that pilomatricoma is a frequently misdiagnosed entity in clinical practice. The purpose of this article is to create awareness among clinicians on the possibility of pilomatricoma as a cause of solitary skin nodules, especially those on the head, neck or upper extremities.

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Leprosy remains an important problem globally. Timely detection of new cases and prompt treatment with MDT continue to be the main intervention strategies. We review the various issues related to classification, treatment, drug resistance and the possible steps to eliminate the disease in the near future. The need for newer anti leprosy agents has been felt and various agents like fluroquinolones, macrolides and minocycline have all been tried in various combinations and duration. Uniform MDT in all leprosy patients might be a logical one too. Drug resistance can be identified by PCR based DNA sequence analysis which saves much time. Drugs like thalidomide analogues, pentoxifylline, selective cytokine inhibitory drugs have proved effective in controlling type-2 reaction in leprosy patients. New drugs for leprosy reactions are still needed. Far from being eliminated as a public health problem, leprosy still causes a considerable long term morbidity in both developing and developed world. New treatment and the optimal length of MDT requires further research. We need genome based technology to address the unresolved issues of transmission of M. leprae.

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Background: Kligman's triple combination formula has been one of the most popular treatment options in melasma over the last three decades. The original Kligman's formula has been modified in many ways over the years and the most recent modification that has been introduced is a triple combination of 2% hydroquinone, 0.025% tretinoin, and 1% mometasone. The use of this triple combination in patients with melasma has seen a sharp rise over the last few years and with this rampant use the side-effect profile of this triple combination has also come to the fore. Aim : The aim of the present study was to assess the overall safety of the mometasone-based triple combination treatment in the management of melasma. Materials and Methods: This retrospective study was performed on 60 patients of melasma who had used a mometasone-based triple combination treatment for at least 3 weeks anytime in the previous 1 year. The patients were given a preformed questionnaire wherein they assessed the overall effect of the triple combination treatment on their melasma during its use as well as after its withdrawal. The patients were specifically asked about the status of their disease as well as the sun sensitivity of their skin before and after the use of triple combination treatment. In addition, the patients were assessed by a single trained dermatologist for the presence of any adverse effects arising out of the triple combination treatment in the form of telangiectasia, hypertrichosis, acne, skin atrophy, etc. Results: Majority of patients (51.7%) had used the combination treatment well beyond the recommended duration. About one-third (36.7%) of the patients rated their melasma as worse at the time of filling the questionnaire as compared with their disease before the use of triple combination treatment. On clinical examination, the evidence of steroid side effects was seen in 26 patients (43.3%). Steroid-induced telangiectasia was the commonest finding, seen in all of these 26 patients. Steroid-induced skin atrophy, hypertrichosis, and acneiform eruption were seen in 19, 17, and 11 patients, respectively. Conclusions: The propensity of a mometasone-based triple combination treatment to cause steroid adverse effects on the facial skin should always be borne in mind when the same is prescribed as a treatment option in melasma.

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Background: Direct immunofluorescence (DIF) is the gold standard in the diagnosis of immunobullous diseases. However, it cannot reliably differentiate various subtypes of subepidermal immune- bullous diseases (SIBD). Salt split technique (SST) could be used under such circumstances to differentiate them. There is paucity of reports in the Indian literature regarding the SST. Aim: This study was designed to evaluate the utility of direct SST in subepidermal blistering diseases. Materials and Methods: Fourteen clinically diagnosed cases of subepidermal blistering diseases were included in the study. Two perilesional punch biopsies were taken one each for DIF and salt split study. Results: Linear basement membrane zone band with IgG and/or C ₃ was seen in 14 cases of patients BP. Salt split study showed epidermal or mixed pattern of deposits in 12 patients and exclusive floor pattern in two patients. The diagnosis was revised in these two patients to epidermolysis bullosa acquisita. Conclusion: SST is a simple, inexpensive procedure and should be routinely employed in the diagnosis of subepidermal bullous diseases.

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Incidence of skin cancers has been increasing since the last few decades worldwide. Nonmelanoma skin cancer (NMSC) is the commonest variety of cutaneous malignancy. Conventional wisdom has it that the incidence of all varieties of skin cancers is lower among Indians due to the protective effects of melanin. Though national surveys and cross-country data in India are unavailable, there are indirect indications from several smaller reports that NMSCs may be on the rise in India. Reports of quite a few atypical cases lead us to hypothesize that factors other than ultraviolet radiation may be important in the occurrences of these cancers, particularly in the skin types prevalent in India. The descriptive epidemiology and clinical characteristics of squamous and basal cell carcinoma in India, including their variants, are discussed here along with hypotheses on their etiopathogenesis. Novel management techniques currently available in India are also highlighted.

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Background: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous units, which chiefly involves face and upper part of the trunk. Its prevalence is highest in adolescence, where the individual counters several psychosocial changes. Depression, suicidal thoughts, and low self esteem are reported in the patients with this disease. Aim: The goal of this study is to compare prevalence of anxiety and depression in the patients with acne vulgaris and normal population. Materials and Methods: In this cross-sectional study, 82 patients with acne vulgaris and 82 persons without acne who referred to a dermatology clinic and a specialized office for skin diseases in Rasht were studied. Anxiety and depression were evaluated by Hospital Anxiety and Depression Scale (HADS) questionnaire and severity of acne was evaluated by Global Acne Grading System (GAGS). Data were analyzed by SPSS ver. 14.0 software, independent T-test, multi variate analysis of covariance (MANCOVA) and chi-square test for comparison the quantitative and ordinal data, respectively; with α=0.05. Results: Prevalence of anxiety and mean of anxiety scores were 68.3% and 9.17 ± 3.52, respectively, in patients group and 39.1% and 7.10 ± 3.07, respectively, in control group in which there was a significant difference (P = 0.001). Prevalence of depression and mean of depression scores were 25.6% and 5.34 ± 3.29, respectively, in patients group and 28.1% and 5.01 ± 3.32, respectively, in control group in which there was no significant difference. Conclusion: According to high prevalence of anxiety in patients with acne vulgaris, assessment of the screening mental status of the patients by simple questionnaire such as HADS is suggested.

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Chicken pox is a common viral infection presenting with fever and discrete vesicular lesions. This infection can be widely detected in developing countries, especially for those tropical countries. The pregnant can get chicken pox, and this becomes an important obstetrical concern. In this specific paper, the author hereby details and discusses on chicken pox in pregnancy. Clinical presentation, diagnosis, treatment, and prevention are briefly summarized. In addition, the effects of chicken pox on pregnancy as well as the vertical transmission are also documented.

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Background: Intense pulsed light (IPL) has been used for the treatment of facial acne. Modifications of various parameters allow flexibility in treatment, which include energy fluence, pulse duration, and pulse delay. We compared the efficacy of burst-pulse (multiple pulse) mode with single-pulse mode in treatment of acne. Objective: This study was designed to evaluate the efficacy of the IPL in treatment of facial acne and to compare burst-pulse and single-pulse mode in treatment of acne. Materials and Methods: Ten patients with facial acne were subjected to monotherapy with IPL. Baseline grading of acne was done with Michelsons acne severity index; however, right and left side of face were scored separately and a total score was also taken. IPL was administered once weekly for four sessions. Right side was subjected to IPL with burst-pulse mode, and left side was subjected to single-pulse mode. Severity score assessed after the end of treatment. Clinical photographs were also obtained for evaluation. Results: All patients revealed a reduction in number of acne for both single- and burst-pulse mode treated sides. The mean total score was 49.4 at baseline and showed 49.19% reduction after four sessions of IPL. Burst-pulse mode treated side showed a better control than that of single-pulse mode. Conclusion: IPL as a monotherapy showed beneficial effect in treatment of facial acne. Burst-pulse mode was better than the single-pulse mode in clearing acne.

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Background : Construction workers handle cement which has constituents to produce both irritant contact dermatitis and corrosive effects (from alkaline ingredients, such as lime) and sensitization, leading to allergic contact dermatitis (from ingredients, such as chromium). Aim: The present study has been carried out among unorganized construction workers to find the prevalence of skin problems. Materials and Methods: The present cross-sectional study was conducted in 92 construction workers of Ahmedabad and Vadodara. Results and Discussion: All the workers were subjected to clinical examination after collection of information regarding demographic characteristics, occupational characteristics and clinical history on a predesigned proforma. Of them, 47.8% had morbid skin conditions. Frictional callosities in palm were observed in 18 (19.6%) subjects while 4 (4.3%) subjects had contact dermatitis. Other conditions included dry, fissured and scaly skin, infectious skin lesion, tinea cruris, lesion and ulcers on hands and/or soles. Conclusion : The skin conditions were common in the age group of 20-25 years, males, those having ≥1 year exposure and those working for longer hours. Half of the workers not using personal protective equipment had reported skin-related symptoms.

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Necrotizing fasciitis is a rapidly progressive, potentially fatal infection of the superficial fascia and subcutaneous tissue. It is rare in children. We report three such cases in which differentiating from common soft tissue infection was challenging. High index of suspicion is important as management initiated at an early stage is rewarding.

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Background: Warts are caused by various strains of Human Papilloma Virus. They involve the epithelium of the skin and mucus membrane. Various treatment options are available, but extensive and recalcitrant warts not only cause distress to the patient cosmetically and psychologically but also pose a therapeutic challenge to the treating dermatologist. Aim: To evaluate the efficacy of autowart injection as a treatment option for extensive and recalcitrant warts. Materials and Methods: Autowart injection was prepared by removing 3 to 4 mm size wart with radiocautery which was crushed under aseptic condition and injected in the gluteal region by suspending in water for injection. Result: Results were evaluated in 53 available patients who turned up for follow-up; 35 patients (66.03%) had complete resolution in 2 months time, 12 patients (22.64%) showed partial improvement, whereas six patients (11.32%) had no improvement. Conclusion: Autowart injection is suggested as an effective and noninvasive therapeutic option in extensive and recalcitrant warts where most of the available therapies are inconvenient for both patient and treating dermatologist.

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Background: Topical corticosteroids used in various dermatological diseases several times a day led to an increase risk of side effects. By demonstrating a significant reservoir of corticosteroids in the stratum corneum, one can maximize their efficacy and safety as therapeutic agents. Aim: The study was designed to demonstrate a reservoir of topically applied corticosteroid clobetasol propionate cream experimentally in rabbits using histamine-induced wheal suppression test. Materials and Methods: The work was carried out on albino rabbits, as rabbit skin is akin to human skin, using a topical steroid. The topical steroid clobetasol propionate 0.05% cream was applied on the back of rabbit, and after 1-h occlusion histamine-induced wheal suppression test was performed and wheal area measured at 10 min till day 7. Statistical analysis was done by ANOVA followed by "Post Hoc" test. Results: Maximum wheal suppression was seen on day 1 (P < 0.001). Interday comparison of mean wheal size showed no significant difference (P > 0.05) on day 2, 3, and 4 as compared to day 1. Day 5-7 show highly significant difference (P < 0.001) as compared to day 1, thereby suggesting that the reservoir effect of topical clobetasol propionate 0.05% cream persisted till day 4. Conclusions: This work demonstrated that histamine-induced wheal by the topical steroid clobetasol propionate 0.05% cream was suppressed till day 4, indicating that the reservoir of topical corticosteroid persisted till day 4.

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Pyrazinamide is a commonly used first-line antitubercular drug. Gastric-related adverse drug reactions are common with pyrazinamide. Dermatological manifestations due to pyrazinamide are rare. This study aimed find out the dermatological manifestations/adverse drug reaction (ADR) due to pyrazinamide. We reported a case of maculopapular rash caused by pyrazinamide in a patient on antituberculosis treatment using structured questionnaires. The patient developed maculopapular rashes on receiving combination antituberculosis treatment. The rashes disappeared after stopping the suspected drug. The patient was rechallenged with pyrazinamide, which led to reappearance of a similar type of rash. The causality, preventability, and severity were assessed using the Naranjo algorithm and Hartwig scale. Since pyrazinamide is a commonly used drug in tuberculosis and which is a common infectious disease in developing countries, with the similar reports, we can predict early case detection and can prevent the occurrence of similar reactions in future.

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Background: In pemphigus, autoantibodies are directed against adhesion molecules, which make the junctions between keratinocytes, and thus determining their level can reflect the disease activity. Aim: The purpose of this study is to determine the clinical significance of the autoantibody levels in pemphigus management. Materials and Methods: The clinical features of 47 pemphigus vulgaris patients were assessed and patients' sera were investigated by indirect immunofluorescence using monkey esophagus as a substrate for autoantibody levels. Results: We found a significant correlation between antibody titers and mucosal severity scores. Initial antibody titers of the patients with at least one mucosal lesion at the end of the first month of the therapy were found significantly higher than the patients who had no mucosal lesion. With the therapy, lesions resolved earlier than the antibody titers. Conclusion: In patients with pemphigus, especially in cases who were not treated before, sera antibody levels are a valuable tool in evaluating disease severity and choosing initial treatment. In patients who had been taking any systemic treatment, it is difficult to make a relationship between antibody levels and disease severity, because therapy improves disease earlier than the antibody titers. However, estimating antibody levels can be helpful for clinicians in disease management, in reducing or ceasing treatment dosage and anticipating recurrence.

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Glomus tumors are relatively rare vascular tumors with reported incidence of 1.6% of all soft tissue tumors. It is variously regarded as a hamartoma or a neoplasm of neuromyoarterial glomus, which consists of dilated vascular channels, surrounded by proliferating glomus, nerve cells, and plays an important role in temperature regulation. We report the case of glomangioma in a 43-year-old male who came to dermatology OPD with a painful lesion over the right elbow of six months duration. Cutaneous examination revealed a single round reddish blue papule of about 0.5 cm in size on the flexor aspect of the right elbow. The papule was firm in consistency and tender. The excision biopsy showed stratified squamous lining with well circumscribed tumor in the dermis. The tumor consisted of sheets of uniform cells with pale cytoplasm; round to ovoid centrally placed punched out nuclei and well defined cell margins. There were numerous dilated thin walled vascular spaces surrounded by a layer of tumor cells and the histopathology was consistent with glomangioma.

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Background: Vitiligo is an acquired pigmentary disorder of the skin that is caused by unknown factors and is characterized by white and depigmented patches that enlarge and become more numerous with time. Genetic factors, oxidative stress, autoimmunity, and neurochemical agents, such as catecholamines might also contribute to vitiligo. Cutaneous pigmentation is determined by the amounts of eumelanin and pheomelanin synthesized by the epidermal melanocytes and interference of melanocortin-1 receptor (MC1R), a G-protein coupled receptor, its normal agonist, alpha-melanocyte stimulating hormone (α-MSH), and key enzymes, such as tyrosinase, to protect against sun-induced DNA damage. The MC1R, a 7 pass trans-membrane G-protein coupled receptor, is a key control point in melanogenesis. Loss-of-function mutations at the MC1R are associated with a switch from eumelanin to pheomelanin production, resulting in a red or yellow coat color. Aim: In this research, we aim to examine the genetic variety of MC1R and α-MSH gene in 20 Iranian vitiligo patients and 20 healthy controls. Materials and Methods: Analysis of the MC1R coding gene was performed with direct sequencing. Results: We found the following 9 MC1R coding region variants: Arg163Gl (G488A), Arg227Leu (G680A), Val 97Phe (G289T), Asp184Asn (G550A), Arg227Lys (G680A), Arg142His (G425A), Val60Leu (G178T), Val247Met (C739A), and Val174Ile (G520A). We also found 2 frameshift changes: one of them was the Insertion of C (frameshift in Pro136, stop at Trp148) and the other, Insertion of G (frameshift in Pro256, stop at Trp 333). Of all the changes, the most common was Val60Leu at 5% in patients vs 20% in controls, Val247Met at 15% in patients vs 0% in controls and Val174Ile at 15% in controls and 0% in patients. The other variants showed a frequency <5% in both patients and controls. Also in this study, we have examined the frequency of single nucleotide polymorphisms within the α-MSH genes with direct sequencing in 20 patients and 20 healthy subjects but found no changes along this gene. Conclusion: We could not find any relationship between MC1R and α-MSH genes and their effect on the disease in Iranian vitiligo patients.

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Background: Systemic sclerosis is a multisystemic autoimmune disorder. Intravenous dexamethasone pulse therapy has been used since 1998. Aim: The aim was to report the beneficial effects of dexamethasone pulse in patients of systemic sclerosis vis-á-vis the side effects. Materials and Methods: Forty-seven patients of systemic sclerosis were included. After looking at the history and physical examination, the patients were submitted to various relevant investigations. Clinical scoring of the patient was done at baseline and 6-month interval according to Furst's organ indices score. Results: A total of 47 patients of systemic sclerosis were included (45 females, 2 males). In majority, acrosclerosis was seen. Severe sclerosis and contractures were seen in two patients. Moderate proteinuria, restrictive lung disease, dysphagia, and valvular heart involvement were seen. A total of 13 patients on dexamethasone pulse therapy developed tuberculosis. Improvement in skin scoring and decreased severity of Raynaud's phenomenon was seen. No improvement in dysphagia, severe vascular symptoms, or restrictive lung disease was seen. Conclusion: Thus, beneficial effects of dexamethasone pulse therapy seem to be merely cosmetic.

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A 41-year-old male with known congenital IgA deficiency developed pyoderma vegetans during a subtropical holiday. He responded well to topical treatment with aluminium subacetate.

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Background: The non-surgical management of non-melanoma skin cancers is an area requiring clinical investigation. Radiotherapy has a role in treatment for a defined subset of patients. Aims: The application of radiotherapy is subject to availability of proper equipment, non-availability of which precludes appropriate radiotherapy in most centers in third world countries. Materials and Methods: The introduction of innovations is needed to circumvent this. Plesiotherapy is such a mode of therapy for non-melanoma skin cancer. Results: In this paper we present successful management of a cohort of non-melanoma skin cancer patients with plesiotherapy using stepping source ¹⁹² Ir HDR source. Conclusions: Plesiothrapy is an effective mode of therapy for non-melanoma skin cancer.

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Cryoglobulinemia is a rare condition. We report a case of cryoglobulinemia in 1.5-year-old boy, who presented with bluish black discoloration of hands and feet. Serum was positive for cryoglobulins. The serum cryoglobulin level was 70 μg/ml (normal <20 μg). Serum protein electrophoresis revealed the presence of M-spike. Serum immunofixation and assessment of clonality could not be done as these specialized investigations are not available here. Investigations did not reveal any systemic involvement. He was treated with anticoagulants, broad-spectrum antibiotics, and systemic steroids with which he recovered completely.

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