Hand eczema is often a chronic, multifactorial disease. It is usually related to occupational or routine household activities. Exact etiology of the disease is difficult to determine. It may become severe enough and disabling to many of patients in course of time. An estimated 2-10% of population is likely to develop hand eczema at some point of time during life. It appears to be the most common occupational skin disease, comprising 9-35% of all occupational diseases and up to 80% or more of all occupational contact dermatitis. So, it becomes important to find the exact etiology and classification of the disease and to use the appropriate preventive and treatment measures. Despite its importance in the dermatological practice, very few Indian studies have been done till date to investigate the epidemiological trends, etiology, and treatment options for hand eczema. In this review, we tried to find the etiology, epidemiology, and available treatment modalities for chronic hand eczema patients.

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Background: Isotretinoin is indicated for moderate to severe cases of acne which are unresponsive to conventional therapy. The classical recommended dose is 0.5 to 1.0 mg/kg/day. As the side effects are dose related, low-dose isotretinoin therapy for acne is an attractive option; however, but little data exists on the safety and efficacy of this strategy. Materials and Methods: In this prospective, non-comparative study, 50 participants, both male and female, having moderate to severe acne vulgaris were enrolled and treated with isotretinoin at a dose of 20 mg/day (approximately 0.3-0.4 mg/kg/day), for a period of 3 months. Participants were evaluated by means of clinical and laboratory investigations before starting isotretinoin. Investigations were repeated at the end of the first and third months following completion of treatment, and participants were followed up for 6 months to look for any relapse. Results: At the end of the treatment, very good results were observed in 90% of participants. Cheilitis was the most common among the side effects observed and was seen in 98% of the participants. One participant developed vitiligo as a side effect, which is a new finding, and has not reported in literature before. Elevated serum lipid levels were observed in 6% of the participants, and relapse occurred in 4% of the participants over a 6 month follow up period. Conclusion: Three months of treatment with low-dose isotretinoin (20 mg/day) was found to be effective in the treatment of moderate to severe acne vulgaris, with a low incidence of serious side effects. This dose also was more economical than the higher doses.

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Introduction: Dermatophytosis is defined as the fungal infection of the skin, hair and nails by a group of keratinophillic fungi known as dermatophytes. Aims and Objectives: This study is an attempt to find out various species of dermatophytes in clinically suspected cases of dermatophytosis. Materials and Methods: One hundred samples were subjected to direct microscopy by potassium hydroxide wet mount (KOH) and isolation on culture with Sabourauds dextrose agar. Results: Out of these 80 (80%) samples were KOH positive while 20 (20%) were KOH negative. Overall culture positivity rate was 68%. Dermatophytosis was more common in males, the M:F ratio was 4:1. Conclusion: Total seven species were isolated on culture. Trichophyton rubrum (66.17%) was the commonest isolate followed by Trichophyton mentagrophytes (19.11%), Trichophyton violaceum (7.35%), Trichophyton tonsurans (2.94%) and one isolate each of Epidermophyton floccosum and Microsporum gypseum (1.47%).

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Reticulate hyperpigmentary disorders are a group of rare genetic pigmentary abnormalities which includes reticulate acropigmentation of Kitamura (RAPK), Dowling-Degos disease (DD), reticulate acropigmentation of Dohi (RAPD), Haber's syndrome, and Galli-Galli disease. A 25-year-old male presented with asymptomatic dark-colored lesions on his hands and feet with light-colored skin lesions involving the trunk since three years. Dermatological examination revealed hyperpigmented macules in a reticulate pattern involving the dorsa of the hands and feet, front and sides of the neck, axillae, periorbital region, and groin. Multiple pits were present over both palms, with breaks in dermatoglyphics. He also had multiple nonacne facial scars predominantly on the nose and malar areas. The patient had overlapping features of RAPK and DDD. In addition, he also had hypopigmented macules and acneiform facial scars. Such an overlap of features of reticulate pigmentation has not been previously reported in the literature.

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Acquired bilateral nevus of Ota-like macules (ABNOM) or Hori's nevus, a rare form of acquired dermal melanocytoses, presents as bilateral facial blue-gray macules without ocular or mucosal involvement. This condition is mostly found in women of Asian descent and usually appears in the fourth or fifth decade of life. Pathogenesis is unknown, though few theories have been proposed. Effective treatment has been found to be achieved with pigment-specific lasers. Herein, we report a case of Hori's nevus with mucosal involvement. A 42-year-old male patient, presented to us with blue-gray discoloration on either side of his face, both eyes, and in the mouth since the age of one year. Histopathological examination showed clusters and singly dispersed pigmented melanocytes within the upper and mid-dermis regions. Special staining of melanocytes using Masson-Fontana stain was positive. Diagnosis of Hori's nevus was made by correlating clinical and histopathological findings. Patient was informed of his treatment options, but refused treatment. A similar case of Hori's nevus with mucosal involvement has not been reported so far.

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Epidermal growth factor receptor (EGFR) inhibitor therapy has become the standard treatment for non-small cell lung cancer and head neck malignancy. This class of drug comprises EGFR inhibitors (erlotinib and gefitinib) and monoclonal antibody (cetuximab). Use of this class of drugs has been associated frequently with dermatological side effects termed as PRIDE complex-Papulopustules and/ or paronychia, Regulatory abnormalities of hair growth, Itching, Dryness due to EGFR inhibitors. We hereby report the cutaneous side effects of EGFR inhibitor therapy in 15 patients of lung and head/neck cancer. The major clinical findings being acneiform eruption and severe xerosis of skin. Management of these dermatological adverse effects rarely requires discontinuation of targeted therapy and can be managed symptomatically.

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Background: Dermatophytoses refer to superficial fungal infection of keratinized tissues caused by keratinophilic dermatophytes. According to observations worldwide, dermatophytoses are the most common of the superficial fungal infections. It is common in tropics and may present in epidemic proportions in areas with high rates of humidity. Although common, the precise size of the problem defies measurement. Aims: The present study was undertaken to assess the clinical profile of dermatophytic infection and to identify the species of fungi that are prevalent in this region. Materials and Methods: A total of 100 patients clinically suspected for dermatophytoses were selected for the study. Direct microscopy in 10% potassium hydroxide (KOH) and culture was done in each case. Results: Out of 100 patients, the maximum were seen in the age groups of 16-30 years. Tinea corporis was the most common clinical type (44.3%) followed by tinea cruris (38.2%). Overall positivity by culture was 39% and by direct microscopy 96%. Conclusion: Trichophyton rubrum was the predominant species isolated (67.5%) in all clinical types followed by Trichophyton mentagrophytes. Culturing the fungus may identify the species, but it is not essential for the diagnosis as it is not a sensitive test.

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Pityriasis rosea (PR) is a common benign cutaneous disorder of children and young adults. The etiology of this condition is still unknown. Despite the common occurrence, second episode of PR is noted only in 1-3% of the cases. Multiple recurrences (three or more episodes) are extremely uncommon and to the best of our knowledge, only few patients have been reported in the literature. Due to the benign nature of the disease, these recurrences may be either underestimated or unreported. Till date, there are no predisposing factors identified for the occurrence of these multiple episodes. We report a case of pityriasis rosea in an 11-years-old male with three episodes with review of the literature.

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"Wolf's isotopic response" refers to the occurrence of a new dermatosis at the site of previously healed dermatosis. A number of factors including viral, neural, vascular, and immunologic factors have been implicated in the causation of this peculiar response but none has been proven conclusively. Here, we report a case where lichen planus developed at the site of dermatofibrosarcoma protruberans that had been previously treated with surgery and radiotherapy. We also put forth a hypothesis on the genesis of isotopic response considering the above mentioned factors.

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Herbal and Ayurvedic medications, believed to be "mild" and "natural" are usually sought as the first line of treatment before resorting to "stronger" allopathic medication. There are very few reports of adverse reactions to either topical and/or systemic Ayurvedic medications. Massage aromatherapy with ayurvedic oils plays an important role in alleviation of pain, but may cause allergic contact dermatitis. This is the second case report of allergic contact dermatitis to ayurvedic oil.

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Background: Direct immunofluorescence examination is an important technique in the diagnosis of cutaneous inflammatory disorders including lichen planus, especially in clinically and histopathological doubtful cases. Objective: To study the diagnostic utility of intensity, number, and subtypes of positive immuno-reactants found in lichen planus. Materials and Methods: A detailed analysis of clinical as well as immuno-histological features of lichen planus cases was carried out. Results: The male to female ratio was 1:1.1. The largest number of patients was in 31-50 year age group. Itching was the most common presenting symptom. Papular lesions were seen in 53% cases. Remaining had hypertrophic (6), follicular (3) and mucosal (9) variants. Clinico-pathological discrepancies were observed in 3 patients. The characteristic histopathological changes including basal cell vacuolization, band-like lymphocytic infiltrate at dermo-epidermal junction were seen in all the biopsies while Civatte bodies were detected in 29% cases. The overall positive yield of direct immunofluorescence microscopy was 55%. Immune deposits at Civatte bodies and dermo-epidermal junction were detected in 47% and 8% of cases, respectively. Immunoglobulin M was the most common immunoreactant followed by immunoglobulin G. Conclusions: There was no correlation found between the number and intensity of Civatte bodies with clinical variants of disease and also between the number of positive immunoreactants and clinical severity of the disease. The frequency, number, and arrangement of Civatte bodies in clusters in the papillary dermis as well as multiple immunoglobulins deposition at the Civatte bodies on direct immunofluorescence of skin biopsies are important features distinguishing lichen planus from other interface dermatitis.

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Erythema multiforme (EM) is an acute, self-limited, mucocutaneous disorder regarded as a hypersensitivity reaction which is triggered by various factors like infection, drugs, and food. Infectious agents are considered to be a major cause of EM other than idiopathic cause. A young girl presented with fluid-filled lesions all over the body of 3 days duration with history of similar lesions with fever in her sibling 2 weeks prior to admission. This was followed by large fluid-filled lesions with halo 3 days thereafter over the trunk, extremities suggesting target lesions of EM. The diagnosis was confirmed by cytology and positive serology. Varicella zoster virus (VZV) has rarely been reported as an etiological agent, despite its high incidence in childhood. VZV as an etiology of EM in a young girl has not been reported so far. This case was reported for its rare association of EM and varicella zoster and also for its rare presentation in a young girl.

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Reactive perforating collagenosis (RPC) is a rare form of transepithelial elimination, in which genetically altered collagen is extruded through the epidermis. Of the acquired and inherited form, inherited form is extremely rare. Here, we present two cases of inherited form of RPC in a family.

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Background: Aeroallergens are airborne substances present in the environment with the potential to trigger an allergic reaction in the respiratory tract, mucosae, or skin of susceptible individuals. The relevance of aeroallergens in the pathogenesis of atopic dermatitis has been reported by many investigators. However, very few studies have been conducted to investigate their role in the production of allergic contact dermatitis (ACD). Aims: To determine the prevalence of aeroallergen patch test positivity in patients of suspected ACD and to study the clinical characteristics of patients testing positive with aeroallergens. Materials and Methods: Patients presenting to our department with suspected contact allergy and undergoing patch testing with Indian Standard Series (ISS) between January 2010 and June 2011 were studied. After a detailed history and clinical examination, patients were patch tested with ISS and aeroallergen series. Based on the history and clinical suspicion, patients were additionally patch tested with 15% Parthenium. Prior tape stripping was done in some patients. Results: Out of total 114 patients, 26 (22.8%) showed sensitivity to aeroallergen series. Parthenium was the commonest aeroallergen being positive in all 26 patients followed by Xanthium in two. None reacted to other allergens. Although positivity was more in patients with prior tape stripping, the difference was not statistically significant. Conclusion: Most common aeroallergen found to be positive in our study was Parthenium hysterophorus. In view of low positivity to other allergens, routine aeroallergen patch testing in patients with suspected contact dermatitis may not be necessary.

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Disabling pansclerotic morphea (DPM) is a rare, severe, and mutilating form of morphea, involving the dermis, subcutaneous tissue, fat, muscle, and even bone. It is usually seen before the age of 14 years, with the patient complaining of arthralgia and stiffness at the time of onset. We report a case of unilateral adult-onset DPM with sparing of the face. Within a few months of onset, painful contracture deformities of the hand, elbow, and shoulder joints developed, impairing the patient's normal daily activities. We are reporting this case because of the unusual presentation: DPM in an adult, with history of trauma in childhood and rapid onset of complications, is rare.

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Background: Cutaneous melanoma (CM) has a high propensity for regional and systemic spread. This is one of the largest series of CM reported from India. Aims: To predict factors for loco regional recurrence (LRR) and distant metastasis in patients with CM primarily treated with surgery. Study Design: Retrospective analysis of patient database at a tertiary care cancer center with evaluation of factors for LRR and distant metastasis for CM. Materials and Methods: Data from 68 patients treated for CM between January 2006 and December 2010 were reviewed. Data recorded included age, sex, symptoms, investigations, treatment given, histopathology, recurrence and follow-up. Patient factors, tumor factors, pathologic variables, and adjuvant treatment were investigated as predictors' of LRR and distant metastasis. Results: Mean age of patients was 54 years. Melanoma was more common in males (44). Tumor thickness > 4 mm was found in 43 patients. Lymph node involvement was found in 43 patients. Adjuvant radiotherapy was given in seven patients. At mean follow-up of 16.5 months, LRR was seen in 34 patients and distant metastasis in 28 patients. LRR and distant metastasis were more commonly found in females, age > 40 years, Clark's level IV and V, Breslow's depth > 4 mm, patients with lymph node involvement and extra-capsular spread. Conclusion: The age, sex, site, thickness of lesion, involvement of lymph node, and extra-capsular spread were important factors in predicting LRR and distant metastasis. Distant metastasis was also more commonly found in patients with LRR.

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A two-year-old girl child was admitted with complaints of diarrhoea of one week duration in the paediatric ward. She was referred to the skin OPD for gradually progressive skin rashes on both lower limbs noticed since two days. Dermatological examination revealed finding of livedo reticularis. Dietary history revealed maize forming a significant portion of the child's diet since the age of nine months. The child was treated with a course of Niacin in the form of Nicotinamide 50 mg twice a day for 4 weeks and the parents were advised not to give her maize in the diet. The skin lesions and diarrhoea regressed in duration of two weeks. This is probably the first time that a case of pellagra causing livedo is being reported, that too in a child.

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Context: Lifestyle factors such as tobacco smoking and alcohol use can affect the presentation and course of psoriasis. There is a paucity of data on this subject from India. Aims: To find out whether increased severity of psoriasis in adult Indian males is associated with tobacco smoking and alcohol use. Settings and Design: Cross-sectional study in the Department of Dermatology of a Tertiary Care Teaching Hospital. Subjects and Methods: Male patients above 18 years of age attending a psoriasis clinic between March 2007 and May 2009 were studied. Severity of psoriasis (measured using Psoriasis Area and Severity Index - PASI) among smokers and non-smokers was compared. We also studied the correlation between severity of psoriasis and nicotine dependence (measured using Fagerström Test for Nicotine Dependence) and alcohol use disorders (measured using Alcohol Use Disorders Identification Test- AUDIT). Statistical Analysis: Z-test, Odd's ratio, Chi-square test, Spearman's correlation coefficient. Results: Of a total of 338 patients, 148 were smokers and 173 used to consume alcohol. Mean PASI score of smokers was more than that of non-smokers (Z-test, z = −2.617, P = 0.009). Those with severe psoriasis were more likely to be smokers (χ² = 5.47, P = 0.02, OR = 1.8, Confidence Interval 1.09-2.962). There was a significant correlation between PASI scores and Fagerström score (Spearman's correlation coefficient = 0.164, P < 0.01). Mean PASI scores of persons who used to consume alcohol and those who did not were comparable.(Z-test, z = −0.458, P = 0.647). There was no association between severity of psoriasis and alcohol consumption.(χ² = 0.255, P = 0.613, Odds Ratio = 1.14, CI 0.696-1.866). There was no correlation between PASI scores and AUDIT scores (Spearman's correlation coefficient = 0.024, P > 0.05). Conclusions: Increased severity of psoriasis among adult males is associated with tobacco smoking, but not with alcohol use.

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Background: Caveolin-1 is a key structural and functional protein. Caveolin-1 is known to modulate multiple signal-transducing pathways involved in cell differentiation and proliferation. Psoriasis is viewed as a multifactorial pathology characterized by keratinocyte hyperproliferation and abnormal cell maturation. Objectives: To examine the expression of caveolin-1 in skin biopsies from normal subjects, patients, and subjects with the three respective isoforms of psoriasis (psoriasis vulgaris, localized pustular psoriasis, and erythrodermic psoriasis). The expression level of caveolin-1 was compared among psoriasis vulgaris, localized pustular psoriasis, erythrodermic psoriasis, and normal subjects. Materials and Methods: Using immunohistochemical methods, caveolin-1 protein expression was assayed in four groups. An analysis was conducted on skin samples obtained from 22 normal subjects and 28 patients with psoriasis vulgaris, 22 patients with localized pustular psoriasis, and 16 patients with erythrodermic psoriasis. The statistical analysis of the scoring criteria reflecting the level of Caveolin-1 immunostaining between different groups was determined using the Mann-Whitney U-test. Results: In the normal skin, intense and consistent caveolin-1 staining was present in 22 cases. The Caveolin-1 protein was significantly reduced and showed very weak or absent staining within the tissues of psoriasis vulgaris, localized pustular psoriasis, and erythrodermic psoriasis (respective P < 0.001). Caveolin-1 protein expression in psoriasis vulgaris was higher than that in localized pustular psoriasis and erythrodermic psoriasis (respective P < 0.05). Caveolin-1 protein expression was no different in localized pustular psoriasis and erythrodermic psoriasis (P > 0.05). Conclusion: The finding of this study was consistent with a downregulation of Caveolin-1, which might serve as an etiological factor in the development of psoriasis vulgaris, localized pustular psoriasis, and erythrodermic psoriasis. Further mechanistic investigations are required to prove that Caveolin-1 protein has the potential and may be a novel target for therapy of psoriasis vulgaris, localized pustular psoriasis, and erythrodermic psoriasis.

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Background: It has been proposed that hepatitis C virus (HCV) antigens are involved in the pathogenesis of psoriasis and may contribute to severity of the disease. Increased expression of the apoptosis-regulating proteins p53 and tTG and decreased levels of bcl-2 in the keratinocytes of the skin of psoriatic patients have been reported. Aim: This study aims to identify the serum levels of apoptosis-regulating proteins in patients with psoriasis and without HCV infection and to study the relation between clinical severity of psoriasis and the presence of HCV infection. Materials and Methods: Disease severity was assessed by psoriasis area severity index score (PASI) of 90 patients with psoriasis grouped as mild (n = 30), moderate (n = 30) and severe (n = 30); 20 healthy individuals were used as controls. All groups were subjected for complete history taking, clinical examination, and tests for liver function and HCV infection. The serum levels of apoptosis related proteins: p53, tTG and bcl-2 were estimated by enzyme linked immune sorbent assay (ELISA). Results: There was a statistically significant (P < 0.001) correlation between clinical severity of psoriasis and presence of HCV antibodies and HCV-mRNA. In addition, significantly (P < 0.001) raised serum p53 and tTG, and reduced bcl-2 were observed among HCV-positive patients as compared to HCV-negative patients and control patients. Conclusion: These results conclude that clinical severity of psoriasis is affected by the presence of HCV antibodies and overexpression of apoptotic related proteins. In addition, altered serum levels of apoptosis-regulating proteins could be useful prognostic markers and therapeutic targets of psoriatic disease.

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Context: Hepatitis-C virus (HCV) infection and diabetes mellitus (DM) have a significant association with skin disorders. Aims: The aim of this study was to assess the impact of HCV infection on the pattern of cutaneous infections among diabetic patients. Methods and Material: A prospective study included diabetic patients who attended Al-Hussein University hospital, Cairo during the period from 2008 to 2010. Patients were examined for skin infections, and investigated for HCV infection. Statistical Analysis Used: SPSS (version 11.5). Results: The study included 163 patients (102 males and 61 females) with a mean age of 46.2 ± 4.83 years. Ninety five patients (58.3%) were HCV+ve (group A) while 68 patients (41.8%) were HCV-ve (group B). Skin infections in group A included fungal (48.4%), viral (26.3%), bacterial (22.1%) and parasitic (3.2%) while in group B, the spectrum included bacterial (41.2%), fungal (39.7%), viral (11.7%) and parasitic (7.4%). Onychomycosis was the commonest infection in group A (25.2%) compared with folliculitis in group B (19.1%). Cutaneous infections in HCV+ patients were more characterized by increased severity, aggressive course, resistance to treatment and rapid relapse. Conclusions: HCV infection has a significant impact in increasing and changing the spectrum of skin infections in diabetic patients. Severe and resistant infections in diabetics could be an important sign of HCV infection.

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Background: leishmaniasis infection might manifest as sarcoidosis; on the other hand, some evidences propose an association between sarcoidosis and leishmaniasis. Most of the times, it is impossible to discriminate idiopathic sarcoidosis from leishmaniasis by conventional histopathologic exam. Aim: We performed a cross-sectional study to examine the association of sarcoidosis with leishmaniasis in histopathologically diagnosed sarcoidal granuloma biopsy samples by polymerase chain reaction (PCR). Materials and Methods: We examined paraffin-embedded skin biopsy samples obtained from patients with clinical and histopathological diagnosis as naked sarcoidal granuloma, referred to Skin Research Center of Shaheed Beheshti Medical University from January 2001 to March 2010, in order to isolate Leishmania parasite. The samples were reassessed by an independent dermatopathologist. DNA extracted from all specimens was analyzed by the commercially available PCR kits (DNPTM Kit, CinnaGen, Tehran, Iran) to detect endemic Leishmania species, namely leishmania major (L. major). Results: L. major was positive in PCR of Eight out of twenty-five examined samples. Conclusion: Cutaneous leishmaniasis may be misinterpreted as sarcoidosis; in endemic areas, when conventional methods fail to detect Leishmania parasite, PCR should be utilized in any granulomatous skin disease compatible with sarcoidosis, regardless of the clinical presentation or histopathological interpretation.

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Myxoinflammatory fibroblastic sarcoma is a low grade sarcoma that is composed of a mixed inflammatory infiltrate along with spindled, epithelioid and bizarre appearing cells in a background of hyaline and myxoid zones. Seen affecting the distal extremities commonly, with an equal sex predilection, these tumors are rare and require an extensive immunohistochemical work up for proper diagnosis. They have a tendency to recur.

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Background: Patients suffering from atopic dermatitis often describe food hypersensitivity. Rising prevalence of food hypersensitivity and severe allergic reactions to foods have been reported, but the data are scarce. Aims and Objectives: Evaluation of food hypersensitivity reactions in patients suffering from atopic dermatitis. Materials and Methods: The dermatological examination was performed in patients of age 14 years and above and the detailed history was taken concerning the food hypersensitivity. Results: A total of 228 patients were examined-72 men, 156 women, average age 26.2 (SD 9.5) years. The food hypersensitivity reactions were recorded in 196 patients from 228 (86%), no reactions were recorded in 32 patients (24%). Foods with the most often recorded reactions are: Nuts (in 35% of patients), tomatoes (in 20%), and kiwi (in 17, 5%), apples and spices (in 16%), tangerines and oranges (in 15%), capsicum (in 13%), fishes (in 12%), celery (in 9%), and chocolate (in 7%). Conclusion: Food hypersensitivity reactions are recorded in 86% of patients suffering from atopic dermatitis. Nuts, tomatoes, and pollen-associated foods play a role in the majority of patients suffering from atopic dermatitis.

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