Background: Periocular hyperpigmentation is a condition in which skin of eyelids become darker in color than the normal surrounding skin. Lead and other heavy metals produce increased pigmentation because of deposition of metal particles in the dermis and increased epidermal melanin production. Aims: This study was conducted to evaluate the dual effect of chelation therapy in treating periocular hyperpigmentation and lead toxicity. Methods: The study population consisted of nine females complaining from dark coloration of their eyelids. The nine females were continuously using kohl as eyeliner. Lead levels in conjunctiva and serum before and after D-penicillamine (D-PCN) oral administration were estimated in relation to vertical, horizontal length, and degree of hyperpigmentation score. Results: Highly significant P values (0.000) were obtained as regard to the conjunctival lead levels, serum lead levels, horizontal length, and degree of darkness score before and after D-PCN therapy. A less significant P value (0.040) was recorded as regard to the vertical length. Conclusion: Regardless other causes, this study spots the light on a new concept for periocular hyperpigmentation from lead toxicity in adult females using kohl and suggests D-PCN in a low divided dose (750 mg/day) for its treatment.

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Steroids form an important component of dermatological therapy and are used since very long time for different conditions in different forms. Though very few molecules are used since very long time, the side effect associated with this group of drugs are almost always there. Recently a new molecule deflazacort has been introduced into Indian market, is a glucocorticoid and a derivative of old molecule prednisolone. Though claimed to be having less side effect, very few studies have been done in Indian prospective. This review will highlight the very basics of this drug and its advantages and disadvantages.

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Malassezia furfur, a lipophilic, dimorphic and yeast-like fungus, occurring in human skin as an opportunistic pathogen, causes diseases such as dandruff, pityriasis versicolar, seborrheic dermatitis, etc. Suitable media for culturing the organism were standardized. A modified medium for the culturing of M. furfur has been proposed. Growth of the fungus was also determined in the presence of different carbon sources under the influence of different temperature, pH and salinity. Plant extracts of 19 species were screened against the growth of the fungus by using disc diffusion method and the results are discussed.

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Vernix caseosa is a white, creamy, naturally occurring biofilm covering the skin of the fetus during the last trimester of pregnancy. Vernix coating on the neonatal skin protects the newborn skin and facilitates extra-uterine adaptation of skin in the first postnatal week if not washed away after birth. It consists of water-containing corneocytes embedded in a lipid matrix. The strategic location of the vernix on the fetal skin surface suggests participation in multiple overlapping functions required at birth, such as barrier to water loss, temperature regulation, and innate immunity. Vernix seems to perform various integral roles during transition of the fetus from intra-uterine to extra-uterine life. It has also found various interesting diagnostic and prognostic implications in this arena. Thus, it continues to be an intriguing topic of interest among the medical fraternity to understand its detailed biology and function in the fetus and also to put its naturally endowed characteristics to use in the adult population.

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The importance of sunlight has been recognized since long. Ultraviolet light which comprises a small proportion of sunlight is therapeutically useful. Phototherapy is the use of ultraviolet irradiation with or without exogenous photosensitizer. It can be administered as photochemotherapy, Broadband UVB and narrowband UVB therapy, Excimer laser, UVA1 phototherapy and photodyanamic therapy. In India, photochemotherapy and narrowband UVB therapy are widely used for treatment of various dermatological problems. This article discusses the treatment protocols and the various modalities of treatment by phototherapy.

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Melasma is a common hypermelanotic disorder affecting the face that is associated with considerable psychological impacts. The management of melasma is challenging and requires a long-term treatment plan. In addition to avoidance of aggravating factors like oral pills and ultraviolet exposure, topical therapy has remained the mainstay of treatment. Multiple options for topical treatment are available, of which hydroquinone (HQ) is the most commonly prescribed agent. Besides HQ, other topical agents for which varying degrees of evidence for clinical efficacy exist include azelaic acid, kojic acid, retinoids, topical steroids, glycolic acid, mequinol, and arbutin. Topical medications modify various stages of melanogenesis, the most common mode of action being inhibition of the enzyme, tyrosinase. Combination therapy is the preferred mode of treatment for the synergism and reduction of untoward effects. The most popular combination consists of HQ, a topical steroid, and retinoic acid. Prolonged HQ usage may lead to untoward effects like depigmentation and exogenous ochronosis. The search for safer alternatives has given rise to the development of many newer agents, several of them from natural sources. Well-designed controlled clinical trials are needed to clarify their role in the routine management of melasma.

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Sexually transmitted infections (STIs) are more dynamic than other infections prevailing in the community. It is important that such dynamic epidemiological changes in STIs are acknowledged and kept track of in a vast and populous developing country like India, particularly in this HIV era. It is with this aim that the authors have reviewed the relevant literature in STI epidemiology in India during the past 25 years. Admittedly, there has been heterogeneity of data to account for the subcontinental dimension of this country. But a basic pattern in the changing epidemiology is discernible. Like the developed countries, in India too the bacterial STIs like chancroid and gonorrhea are declining, while viral STIs like HPV and herpes genitalis are on an upswing. The overall decline in the prevalence of STIs has to be interpreted with caution, however. This may partially reflect the improved facilities of treatment in the peripheral centres that obviates the need of many patients in attending the STD clinics in the tertiary centres. Also, the improved pharmacotherapy of many of the bacterial STIs may result in partial clearance and non-reporting of many of these infections.

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Background: Acne vulgaris is a common skin disease that involves pilosebaceous units. Oral antibiotics are the most widely administered drugs, which are prescribed as systemic therapy for treatment of moderate to severe acne vulgaris. Azithromycin is one of the antibiotics that has been recently used for acne treatment. There are several protocols of oral azithromycin in the treatment of acne. Objective: To compare three various regimens of oral azithromycin in the treatment of acne. Materials and Methods: Sixty-four patients with moderate to severe acne were divided into three groups randomly. First group (21 patients) received azithromycin as follow: five consecutive days, 500 mg on the first day and 250 mg daily for a further four days per month. Second group (22 patients): 500 mg daily for four consecutive days per month and the last group (21 patients): 250 mg daily thrice weekly. After the baseline visit, patients were scheduled to return at four-weekly intervals among 12 weeks. Result: There were no differences between three groups in decreasing of acne grading score. ( P >0.05). Efficacy of minimal dose was equal to maximum dose of azithromycin in treatment of acne. Oral azithromycin in all groups resulted in a significant decrease in acne grading score in each consecutive visit ( P <0.001). Conclusion: Because of expensiveness of azithromycin,, we recommend azithromycin in low dose (1500 mg monthly) which is as effective as a high dose (3000 mg monthly) with lower cost, has more compliance and fewer side-effects.

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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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Mycosis fungoides (MF) is the most common group of cutaneous T-cell lymphomas. It is a rare non-Hodgkin's lymphoma of mature, skin-homing, clonal, malignant T lymphocytes, usually observed in mid to late adulthood, that initially presents in the skin as patches, plaques, tumors, or generalized erythema (erythroderma) and can involve the lymph nodes and peripheral blood. Much progress has been made in recent years in understanding the origin of the malignant T cell in MF and the patho-physiology and immunology of the disease. This recent work has made a great impact on diagnosis, prognostication, and treatment. In this review, we survey the MF literature of the last decade and highlight the major trends.

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The association of thyroid disorders with skin manifestations is complex. Both hypothryoidism and hyperthyroidism are known to cause these changes. In order to study this association of skin changes in relation to hypothyroidism, a study was carried out in the outpatients department of Dermatology of Dayanand Medical College and Hospital, Ludhiana, over a period of 3 months from Jan-March 2005. Thirty two patients were enrolled in the study and parameters were noted regarding history, general symptoms, cutaneous signs and associated diseases. We found gain in weight (71.85%) and lethargy (65.62%) to be the most common complaints. On cutaneous examination, dry, coarse texture of the skin (56%), pigmentary disorders (37.5%) and telogen effluvium (40.62%) were the most common findings. Other associated disorders were vitiligo, melasma, pemphigus, alopecia areata, xanthelasma palpebrarum, etc.

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Eighty male patients with AGA, not treated in the previous 6 months were enrolled in this randomized, double blind, placebo controlled trial to assess the safety and efficacy of finasteride, 1mg daily, on hair growth. Patients were randomized into 2 groups: Group 1 received 1 mg of finasteride daily and Group 2 received a placebo for a period of 12 months. Efficacy was assessed by hair counts, photographic records, patient's self-assessment questionnaire and clinical assessment. Safety was assessed by history taking and laboratory parameters. A total of 39 patients completed the study. Finasteride was rated superior to placebo with respect to all efficacy measures. At the end of study, finasteride treated patients had a mean increase of 20.56±4.73 hairs compared to a decrease of 9.56±5.53 hairs in placebo treated patients. Photographically, 69.56% of finasteride treated patients were rated as improved at 12 months compared to only 6.25% of placebo treated patients. Ten (25%) of finasteride treated patients developed adverse effects (5-decreased libido as well as erectile dysfunction, 4-erectile dysfunction, 1-decreased libido). Finasteride in comparison to placebo was effective in promoting hair growth in male patients of AGA. However, the side effects to the drug were high in this study.

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Radiofreqeuency ablation is a versatile dermatosurgical procedure used for surgical management of skin lesions by using various forms of alternating current at an ultra high frequency. The major modalities in radiofrequency are electrosection, electrocoagulation, electrodessication and fulguration. The use of radiofrequency ablation in dermatosurgical practice has gained importance in recent years as it can be used to treat most of the skin lesions with ease in less time with clean surgical field due to adequate hemostasis and with minimal side effects and complications. This article focuses on the major tissue effects and factors influencing radiofrequency ablation and its application for various dermatological conditions.

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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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Toxic epidermal necrolysis (TEN) is a severe cutaneous adverse reaction to drugs, characterized by extensive detachment of epidermis and mucous membranes with a mortality of 30-40%. An increased occurrence of cutaneous drug reactions is seen in patients with human immunodeficiency virus (HIV) infection. We present this case of TEN caused by ondansetron in an HIV-infected patient. A 24-year-old HIV-1-infected man on antitubercular therapy and cotrimoxazole, presented with extensive and confluent erosions involving the face, trunk, extremities and mucous membranes following the intake of oral ondansetron, ofloxacin and ornidazole. All the drugs were withdrawn and he was treated with intravenous dexamethasone and antibiotics with consequent healing of the erosions. However, the lesions recurred on inadvertent intake of oral ondansetron. He was treated with intravenous antibiotics, fluid resuscitation and supportive care. The skin lesions healed completely over 2 months with postinflammatory depigmentation and scarring, and the eye lesions healed with corneal opacities. We would like to emphasize that the drug most frequently associated with adverse drug reactions may be innocent in a given patient and the physician dealing with a suspected drug reaction must always remain unbiased regarding the causative drug.

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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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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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Keloids and hypertrophic scars are abnormal responses of body to skin injuries. Overproduction of compacted fibrous tissue is the basic cause of these lesions. In this study the result of treatment of these skin conditions with bleomycin tattoo are compared with cryotherapy and triamcinolone injection. This study involved 45 patients with hypertrophic scar or keloid. Patients were divided into two groups consecutively. Group A (23 patients) was treated with bleomycin tattoo and the group B with cryotherapy and triamcinolone injection. There were four therapeutic sessions one month apart. All patients were followedup for three month after the end of treatment .The therapeutic response was determined as reduction of lesion size or flattening relative to initial size. Therapeutic response was 88.3±14% in group A and 67.4 ±22.5% in group B (p<0.001). In group A 69%, but in group B only 49% of patients were asymptomatic after the end of treatment. In group A there was no relation between therapeutic response and lesion size (p=0.58) but in group B lesions those were smaller (<100mm2) had better therapeutic response than larger ones (p=0.007). It was concluded that bleomycin tattoo is more effective in treatment of hypertrophic scar and keloid than traditional treatment, cryotherapy plus triamcinolone injection especially in larger ones.

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