Dermatophytes can survive solely on outer cornified layers of the skin. The ability of certain fungi to adhere to particular host arises from numerous mechanisms and host factors, including the ability to adapt to the human body. Natural infection is acquired by the deposition of viable arthrospores or hyphae on the surface of the susceptible individual. After the inoculation in the host skin, suitable conditions favor the infection to progress through the stages of adherence and penetration. Development of host response is mostly by a T-cell mediated response of delayed-type hypersensitivity. Antibody formation does not seem to be protective. Natural defenses against dermatophytes depend on both immunological and nonimmunological mechanisms.

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Background: Increased reactive oxygen species (ROS) and lipid peroxidation are seen in many dermatologic disorders, for example, atopic dermatitis, psoriasis, vitiligo, acne vulgaris, pemphigus vulgaris (PV), lichen planus, and alopecia areata. ROS has an important role in the inflammation process. In PV, increased production of ROS leads to decline of antioxidants in plasma and red blood cells which results in oxidative stress. We aimed to evaluate the level of these antioxidants in PV patients and compare it to the controls. Materials and Methods: Among patients attending the dermatology clinics, 30 patients with PV, who had never been on treatment, were enrolled to the study. The control group consisted of 30 age- and sex-matched healthy non-smoker individuals. Venous blood was collected from the subjects for the evaluation of plasma levels of glutathione peroxidase, vitamin C, selenium, bilirubin, and uric acid. Results: Age mean and standard deviation of the patients (40.83, 12.74) was comparable to the controls (41.96, 13.08). Mean level of uric acid was significantly lower in PV patients compared to the controls (P = 0.006). Other antioxidants were not different between the two groups. Uric acid of the patients with mucosal involvement was significantly lower than patients with mucocutaneous involvement (P = 0.049). Limitations: The blood level of other antioxidants (e.g. malondialdehyde) was not evaluated. Conclusions: Uric acid as an antioxidant in our study had similar changes to previous studies in the field of other diseases but selenium, bilirubin, and glutathione peroxidase did not differ between patients and controls.

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Onset of psoriasis in childhood is quite common. Chronicity, inflammation and hyperproliferation are the cardinal features by which the condition establishes its uniqueness. Clearance of disease may be farfetched in most patients and relapse is frequent. Early recognition and management of psoriasis in children and adolescents is vital in therapy in children.

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Folliculitis et perifolliculitis capitis abscedens et suffodiens is a rare disease of unknown etiology. It is a suppurative process that involves the scalp, eventually resulting in extensive scarring and irreversible alopecia. The condition is also known as 'acne necrotica miliaris' or 'Proprionibacterium' folliculitis. Most often the disease affects men of African-American or African-Caribbean descent between 20 and 40 years of age. The clinical picture is determined by fluctuating painful fistule-forming conglomerates of abscesses in the region of the occipital scalp. The cause of scalp folliculitis is not well understood. It is generally considered to be an inflammatory reaction to components of the hair follicle, particularly the micro-organisms. These include: bacteria (especially Propionibacterium acnes, but in severe cases, also Staphylococcus aureus), Yeasts (Malassezia species) and mites (Demodex folliculorum). The initial histopathologic finding is an exclusively neutrophilic infiltration followed by a granulomatous infiltrate. The treatment of the disease is usually difficult and often disappointing. Successful treatment with isotretinoin 1 mg/kg body mass could be achieved only after regular systematic administration in the course of 3-4 months. Here we describe a patient with eruptive purulent form of the disease, which has been controlled with combination therapy: systemic antibiosis with metronidazole and clindamycin, dermatosurgical removal of single nodular formations, and isotretinoin 1 mg/kg body mass for 3-5 months.

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Background : Cutaneous manifestations of deep mycotic infection are fraught with delayed or misdiagnosis from mainly cutaneous neoplastic lesions. Aim: This study is designed to present our experience of these mycoses in a pathology laboratory in the tropics. Materials and Methods : A clinicopathologic analysis of deep mycotic infections was conducted over a 15 years period Formalin fixed and paraffin wax processed biopsies were stained with hematoxylin and eosin, periodic acid Schiff (PAS), and Grocott's methenamine silver (GMS) for the identification of fungus specie. Patients' bio-data and clinical information were obtained from records. Results : Twenty males and seven females presented with 6 months to 6 years histories of varying symptoms of slow growing facial swellings, nodules, subcutaneous frontal skull swelling, proptosis, nasal blockage, epistaxis, discharging leg sinuses, flank mass, convulsion and pain. Of the 27 patients, four gave antecedent history of trauma, two had recurrent lesions which necessitated maxilectomy, two presented with convulsion without motor dysfunction while one had associated erosion of the small bones of the foot. None of the patients had debilitating illnesses such as diabetes mellitus, tuberculosis, and HIV infection. Tissue histology revealed histoplasmosis (10), mycetoma (9), subcutaneous phycomycosis (6), and phaeohyphomycosis (2). Conclusion : Deep mycoses may present primarily as cutaneous lesions in immunocompetent persons and often elicit distinct histologic inflammatory response characterized by granuloma formation. Diagnosis in resource constraint setting can be achieved with tissue stained with PAS and GMS which identifies implicated fungus. Clinical recognition and adequate knowledge of the pathology of these mycoses may reduce attendant patient morbidity.

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Background : Chikungunya fever (CF) epidemic has recently re-emerged in India affecting large population. Mucocutaneous manifestations are an important clinical feature of the disease. We have reviewed mucocutaneous manifestations of the disease during a recent epidemic in coastal Karnataka. Patients and Methods Seventy-five "suspect cases" of CF with dermatological manifestations were examined. Results : We categorized the mucocutaneous manifestation into six groups: 1. skin rash, 2. apthae like ulcers, 3. pigmentary changes, 4. desquamation, 5. exacerbation of the existing dermatoses, 6. miscellaneous. Skin rashes were the most commonly observed skin changes followed by apthae like ulcers and pigmentary changes. Desquamation of the skin over the face is a new manifestation observed by us. Conclusion : wide spectrum of mucocutaneous manifestations is observed in CF. We have provided a classification for these manifestations, which may help in better recognition and uniform recording in future.

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Tuberculosis has been a well-known affliction of human kind, since antiquity. Cutaneous tuberculosis constitutes only a small proportion of extra pulmonary tuberculosis and multifocal involvement of cutaneous tuberculosis is an even rarer manifestation. We report one such case of multifocal tuberculosis verrucosa cutis in a 17-year old male patient in the absence of any primary tuberculous focus.

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Hyaluronic acid is a hygroscopic macromolecule formed by the polymerisation of glucuronic acid and N-acetylglucosamine disaccharide. It is a primary component of the extracellular matrix in various body tissues. Ihe use of topical Hyaluronic acid in the treatment of oral ulcers has been recently reported. This article reviews the mechanism of action, indications and efficacy of topical Hyaluronic acid gel in the management of oral ulcers.

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Background: Psoriasis is a chronic inflammatory skin disease with an immunogenetic background. This work was planned to check for the association of polymorphisms related to cytokine genes TNF-α^-308 (G/A), IL-10 ^-1082 (G/A), IL-6 ^-174 (G/C), and IL-1Ra (VNTR) with psoriasis in cases from Egypt. Materials and Methods: This work included 46 cases with psoriasis recruited from the Dermatology Departments, University Hospitals, Nile Delta region of Egypt. They included 14 males and 32 females with an age mean ± SD of 46.68 ± 12.16 years and range of 15-70 years. Their genotypes were compared to 98 healthy controls of matched age and sex from the same locality. Genotyping was done through deoxyribonucleic acid amplification using PCR with sequence specific primers for polymorphic alleles. Results: Compared to controls, cases showed significant higher frequency of certain genotypes including IL-6 ^-174 CC (P < 0.001, OR = 6.7), IL-10 ^-1082 GG ( P < 0.05, OR = 5.1), and TNF-α^-308 GG ( P < 0.05, OR = 3.7). TNF-α^-308 GG and IL-10 ^-1082 GG genotypes were higher among cases with plaque subtype of moderate severity. Combined heterozygosity for IL-10 GA, IL-6 GC with TNF GA showed a significant low frequency among studied cases. Conclusion: Genetic polymorphisms related to IL6, IL10, and TNF-α genes showed a particular pattern of association with psoriasis that may have a potential impact on disease counseling and management.

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Introduction: Vitiligo is an acquired autoimmune disease of unknown etiology showing depigmentation of the skin due to the absence of melanocytes. Familial vitiligo suggests a genetic origin to this disease. Chromosome 17 was recently demonstrated to harbor the gene coding for NALP1. Patients and Methods: A total of 18 patients of vitiligo were selected on the basis of clinical history. Group 1 (N=8) showing segmental or localized vitiligo with one or two macules on the body. Group 2 (N=10) with generalized or whole body vitiligo. A control group of 10 healthy individuals were selected from our laboratory persons with no history or any infections or skin disease. NALP1 gene expression was studied using RT-PCR assay and the bands quantitated as intensity using volume as measurement and comparison of results was done using SPSS 16 version for statistical analysis. NALP1 gene expression was observed in vitiligo patients with different intensities. Results: Greater reduction in the intensity was seen in Group I, which was inversely proportional to the volume of the band. The intensity of the NALP1 and the GAPDH gene expression was more in Group 2 patients than that shown by Group 1. Conclusion: This study shows expression of NALP1 gene in patients as well as normals. NALP1 is widely expressed at low levels but is expressed at high levels in immune cells, particularly T cells and Langerhans cells, in which different patterns are seen that are consistent with the particular involvement of NALP1 in skin autoimmunity.

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Primary cutaneous actinomycosis caused by Actinomyces israelii occurs most commonly in the cervicofacial area. It commonly presents as "lumpy jaw" with draining sinuses which discharge the characteristic "sulfur granules". A low index of suspicion and a low sensitivity in culturing the organism, due to its fastidious nature often delays the diagnosis. An atypical clinical presentation mimicking lymphangioma circumscriptum with grouped papulovesicular and nodular lesions along the lower jaw extending from skin to the inner buccal mucosa, confirmed on histology and an excellent therapeutic response to penicillin is reported.

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Aplasia cutis congenita is a rare condition characterized by the absence of skin and sometimes other underlying structures such as bone or dura. It can be a part of various syndromes and can be associated with multiple genetic diseases, malformation patterns, or a combination of all. It is even considered as a form frustre of a neural tube defect in several literatures. Bullous aplasia cutis congenita is a clinical subtype of the condition, with extremely few cases reported in the literature. It presents as a cystic or bullous lesion at birth, which eventually transforms into an atrophic, flat scar covered by a thin epithelium. Some cases present with a dark collar hair sign around the lesion, which can be even more indicative of an underlying neural tube defect. Management remains controversial and depends on the characteristics of the lesion, but conservative treatment is usually chosen.

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A young apparently healthy, non-diabetic, HIV non-reactive woman presented with a mycetoma-like lesion on right buttock. Discharge was scanty, and mycotic grains were not seen. Biopsy of sinus track was obtained for microscopy and culture. Microscopic examination revealed plenty of fungal hyphae in direct microscopic examination of grounded tissues in saline; KOH, Gram's, and H and E-stained smears. All the three inoculated slants of Sabouraud's media yielded heavy growth of Fusarium solani. Presence of numerous hyphal fragments in direct microscopy and heavy growth of F. solani in all three slants indicative of etiological role of fungus in the present case. It is probably a first report of F. soloni mycetoma from India.

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A 27-year-old healthy man presented with non-itchy hyperpigmented skin lesions involving the trunk of duration 3 years. Examination revealed numerous coalescing, rough, slightly elevated brownish papules involving large areas of back, chest, and abdomen. There were no other cutaneous or systemic findings. Cutaneous biopsy was suggestive of verruca plana, which confirmed our clinical diagnosis. Here, we report this case of verruca plana due to its rare extensive involvement and unusual site in a non-immunocompromised individual.

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Brucellosis is a common worldwide zoonotic disease. Cutaneous manifestations are not specific and affect 1-14% of patients with brucellosis. Here, we describe 49-year-old female with fever and a diffuse maculopapular rash due to Brucella melitensis infection. Histopathology of skin biopsy revealed leukocytoclastic vasculitis; positive blood cultures for B. melitensis established the diagnosis of brucellosis. We provide a review of the relevant literature.

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Waterhouse-Friderichsen syndrome is one of the fatal complications of meningococcal infection. Here we report a fatal case of this syndrome due to Neisseria meningitidis in a 29-year-old male patient who was admitted with high-grade fever and chills and vomiting since 7 days, a skin rash over the abdomen and trunk, and altered sensorium since 2 days. On examination, the signs of meningitis were present along with the hemorrhagic rash. The diagnosis of adrenal hemorrhage was confirmed by computerized tomographic scan findings. The patient was started on intravenous ceftriaxone, and the cerebrospinal fluid was processed for bacterial culture, which yielded growth of N meningitidis. The patient's condition deteriorated; he developed purpura along with a fall in platelet count, and died due to shock. This case is being reported as such a complication is comparatively rare in this antibiotic era, especially in adults, and starting steroids like dexamethasone prior to antibacterial therapy may be useful to diminish the inflammation brought about by bacterial cell death and thus help in reducing the otherwise high mortality in these cases.

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Background: Psoriasis, a common papulo-squamous disorder of the skin, is universal in occurrence and may interfere with the quality of life adversely. Whether extent of the disease has any bearing upon the patients' psychology has not much been studied in this part of the world. Aims: The objective of this hospital-based cross-sectional study was to assess the disease severity objectively using Psoriasis area and severity index (PASI) score and the quality of life by Psoriasis quality-of-life questionnaire-12 (PQOL-12) and to draw correlation between them, if any. Materials and Methods PASI score denotes an objective method of scoring severity of psoriasis, reflecting not only the body surface area but also erythema, induration and scaling. The PQOL-12 represents a 12-item self-administered, disease-specific psychometric instrument created to specifically assess quality-of-life issues that are more important with psoriasis patients. PASI and PQOL-12 score were calculated in each patient for objectively assessing their disease severity and quality of life. Results: In total, 34 psoriasis patients (16 males, 18 females), of age ranging from 8 to 55 years, were studied. Maximum and minimum PASI scores were 0.8 and 32.8, respectively, whereas maximum and minimum PQOL-12 scores were 4 and 120, respectively. PASI and PQOL-12 values showed minimal positive correlation (r = +0.422). Conclusion: Disease severity of psoriasis had no direct reflection upon their quality of life. Limited psoriasis on visible area may also have greater impact on mental health.

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Epidermolytic hyperkeratosis presents with perinuclear vacuolization of the keratinocytes in spinous and granular layers, keratinocytes with ill-defined limits, which leads to a reticulate appearance of the epidermis, an increased number of variously shaped and sized basophilic keratohyalin granules and the same sized eosinophilic trichohyalin granules, at any level of epidermis, mainly in the stratum granulosum, and compact hyperkeratosis. This minor reactive pathologic reaction pattern of skin is found in large variety of diseases. This paper is the first case report of such pattern in inflammatory linear verrucous epidermal nevus. Our case is of a 23-year-old man with pruritic verrucous lesions of trunk and extremities initiated since 13 years ago. Physical examination revealed white linear hyperkeratotic lesions, some of them on erythematous background and also classic epidermal nevus. No skeletal, ophthalmic, and nervous system involvement was detected. Microscopic study of pruritic verrucous lesions showed psoriasiform acanthosis, mild papillomatous, hyperkeratosis, and epidermolytic hyperkeratotic changes in hair follicles and acrosyrinx accompanied with moderate perivascular inflammation.

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Imiquimod is a small molecule with adjuvant pro-inflammatory effects that can be topically delivered as a cream for treating external genital and perianal warts. In our report, two Chinese males at the ages of 25 and 22 years were treated with imiquimod 5% cream for recurrent condyloma accuminatum, three times per week for 18 and 12. weeks, respectively. Depigmentation were noted and gradually enlarged in the treated areas after the two patients discontinued imiquimod. Therefore, clinicians should be made aware of the possible pigmentary changes associated with application of this cream.

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Cytophagic histiocytic panniculitis (CHP) was first described in 1980 by Winkelmann as a chronic histiocytic disease of the subcutaneous adipose tissue, which is characterized clinically by tender erythematous nodules, recurrent high fever, malaise, jaundice, organomegaly, serosal effusions, pancytopenia, hepatic dysfunction, and coagulatory abnormalities. CHP may occur either isolated or as part of cutaneous manifestations of hemophagocytic syndrome. Here, we report two different presentations of CHP.

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A 24-year-old female presented to the clinic complaining of bizarre patterns and linear streaks of hyperpigmentation on her legs and bizarre alutaceous patches on the neck and upper breast of her son for 7 days. Physical examination showed sharply demarcated hyperpigmented streaks on the extensor aspects of legs and bizarre brown maculae and patches on the right neck and upper chest of her son. Considering the history of Chinese herbal medicine decoction had been splashed onto these sites, phytophotodermatitis was definitely diagnosed.

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The importance of laboratory experiments in the formation of physicians is well recognized since they facilitate scientific development and enhance technical skills. Dermal filling procedures are performed for the correction of wrinkles, rhytids, scars, and lipodystrophy. Till date, experimental models for the training of dermal filling techniques have not been studied. To demonstrate an experimental laboratory model for the training of dermal filling techniques in an animal model. The heads of pigs were used for this purpose, together with Carbopol gel at different densities, which was used to simulate the fillers available in the market. Needles and specific cannulas were used to apply the fillers into the creases and other areas of the pig skin. The pig head appears to be a suitable model for this training. Carbopol gel is a good choice for simulating fillers. This model of laboratory experiment requires a minimum of infrastructure; it is a low-cost alternative and facilitates practical training in the application of dermal fillers.

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Primary mammary fibromatosis is a rare skin condition which can arise after trauma or previous surgery. The exact etiology is unknown. Very few cases have been reported in literature and the main emphasis is to differentiate this condition from breast carcinoma. We report here an unusual case of a 60 year old female who presented with skin lesion which clinically looked sarcoid with history suggestive of sarcoidosis, but on histopathology fibromatosis of breast was revealed. Complete work up ruled out any carcinomatous changes. Surgical excision of the lesion was done with no recurrence seen in one year follow up period.

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It is observed that adequate iron intake and status can limit nickel absorption from the diet in the human body. Chronic vesicular hand eczema (CVHE) due to nickel sensitivity is a common dermatological condition where the dietary nickel acts as a provocating factor. Such patients are usually treated with low nickel diet (LND). The present study was conducted to observe the result of addition of oral iron with LND in the treatment of CVHE in patients due to nickel sensitivity. 23 patients with CVHE due to nickel sensitivity were taken for this study. Study group (12 patients) were advised LND with oral iron for a period of 12 weeks. Control group (11 patients) were advised LND alone for a period of 12 weeks. Fast improvement noted in the skin lesions of the study group patients; 10 (83.33%) patients had complete clearance of their hand eczemas at the end of 12 weeks. There were significant reductions in the blood level of nickel in those patients. Moderate improvement noted in the skin lesions of the control group patients; 5 (45.45%) patients showed complete clearance of hand eczema at the end of 12 weeks. This study showed that oral iron helped to reduce nickel absorption from the diet. The study also showed that combination of LND and oral iron can bring a faster reduction in the severity of clinical symptoms of CVHE in a nickel sensitive individual.

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