A 34 year old female had vascular, keratotic papules on her external genitalia for 4 years. The histopathology was diagnostic of angiokeratoma. The case is being reported because of its uncommon occurrence.

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A total number of 15,955 (31.4%) children attended the paediatric dermatology OPD of the kalawati saran children hospital, new Delhi during 1992 to 1994. Out of these, 8176(51.24%) patients were having various infections and parasitic infestations. Majority (38.7%) of the patients were in the school going age group. There were 58% male and 42% female children. The incidence of parasitic infestations was the highest (53.66%) with scabies as the major infestation (46.44%), followed by pyodermas (34.05%), fungal infections (8.42%) with candidal intertrigo as the commonest infection. Incidence of viral infections was 3.85% where molluscum contagiosum was the commonest manifestation.

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Patient with extensive alopecia areata (>30% scalp involvement) were given 32mg of dexamethasone in 200 ml of 5% dextrose intravenously on three consecutive days (total 96mg) every four weeks. Response was quantified as 1 to 25%, 25% to 50%, 50 to 75% and 75 to 100% of terminal hair growth by mapping and serial photographs. They were examined monthly for side effects of steroids. Six patients (5 male and 1 female) with a mean age of 32 years were recruited. They had alopecia areata for a period ranging from 3 months to 2.5 years. All the six cases did not show further worsening of alopecia after 3 pulses. However, two of them showed less than 25% hair growth after 4 pulses and did not turn up for follow up. In 2 cases, 25 to 50% growth was observed an 50 to 75% growth was seen in 2 patients (one of them with ophiasic pattern) after 6 pulses. The results were cosmetically acceptable for three of them. No adverse effect to steroids was encountered and the patients are still under follow up. The preliminary results show that dexamethasone pulse therapy is safe and effective for extensive alopecia areata.

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Reticulate acral and flexural pigmentary disorders are a rare group of pigmentary genodermatoses. We report a family showing a combination of features described in the two disorders; reticulate acropigmentation of kitamura (RAPK) and Dowling Degos disease, along with palmoplantar keratoderma. We speculate that RAPK and DD are part of a spectrum of reticulate pigmentary disorders with varied phenotypic expression.

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A 5 year old child with genital wart without history of sexual abuse is presented for clinical interest

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Eumycetoma of the right foot caused by madurella mycetomatis with infection to regional inguinal lymph nodes has been described in a male patient along with the clinical, mycological and mycopathological features. The lesions never recurred in the follow up period of four years, after the excision of the sole lesions along with block dissection of the involved lymph nodes.

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Three diabetic patients with rhinocerebral zygomycosis are described here with the characteristic clinical and histological features. Rhizopus spp. was isolated in two of the cases and both of them succumbed within a week after the diagnosis. The other patient is being treated with oral itraconazole in a dose of 200 mg/day with moderately good response.

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A case of lupus vulgaris at a rare site-eyelid is reported here. Delayed diagnosis of the condition affecting the left eyelid in a female patient aged 78 years, led to scarring and fixity of eyelids with resultant exposure keratitis and dimness of vision. Antitubercular therapy improved skin condition but dimness f vision persisted.

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Seventeen cases of actinomycotic mycetoma caused by actinomadura madurae, nocardia spp. And A. pelletierii has been described. Actinomadura madurae was the commonest organism (ten) detected followed by norcardia spp. (four) and A. pelletierii (three). Males were commonly involved. Large soft white grains of A. madurae and small firm red grains of A. pelletierii were consistently seen. Histopathological examination was diagnostic in all the cases showing grains with scalloped margin with pale center and deeply stained periphery with prominent eosinophilic club in A. madurae, deep stained grain with smooth margin and horizontal cracks in A. pelletierii and the pale stained small grain of other norcardia spp. Bone involvement varied from osteolytic to osteosclerotic changes. Actinomadura madurae commonly involved the feet which was by far the commonest site of mycetoma. Combined drug regimens like streptomycin along with cotrimoxazole and amikacin with cotrimaxazole were found to be effective in cases of mycetoma due to A. Pelletierii. Norcardia spp. Responded well to the oral cotrimoxazole given as a monotherapy. The need to start the patient on multi-drug therapy in cases of A. pelletierii and A. madurae especially with bone involvement is stressed. Rare sites like antecubital, popliteal fossae, posterior aspect of trunk, shin and scalp were also involved by actinomycotic species.

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A 91/2 year old female born of a nonconsanguineous marriage presented with macrodactyly, hypertrophy of the limb, lymphangioma circumscriptum and varicosities. Lymphangioma circumscriptum was confirmed by histopathology. X-ray of the right foot revealed hypertrophy of both subcutaneous tissue and the underlying bone. This is the second case report from India with the characteristic macrodactyly.

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A 40 year old man presented with cutaneous horn overlying a lichen simplex chronicus lesion on right leg of 6 years duration.

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A patient with tuberculous ulceration of the vulva is reported. Tuberculosis of the external genitalia is unusual and primary infections are rare. Venereal transmission of the infection could not be proved in the patient. Healing of the ulcer followed antitubercular chemotherapy. The importance of biopsy in the diagnosis of chronic genital ulcer is emphasized.

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Total one thousand one hundred fifty sexually transmitted disease (STD) clinic attendees from different medical colleges and hospitals of Calcutta were examined for HIV antibodies first with ELISA and if positive, were confirmed by western blot. In the first phase, which constituted of four hundred cases from march ’97 to April ’97, 2.25% cases showed seropositivity. The second phase which consisted of five hundred cases between September ’97 to October ’97, 2.4% cases showed seropositivity. The third phase which consisted of two hundred fifty cases between February ’98 and March ’98, 3.2% of cases showed seropositivity. Thus, a slowly but steadily increasing rate of seropositivity to HIV was noted.

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Three patients of Hansen's disease, presenting with hyperpigmented macules, instead of the usual hypopigmented of erythematous lesions, are reported.

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A case of subcutaneous sarcoidosis is being reported here because of its rarity.

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