Vitiligo is an acquired depigmentary disorder involving a progressive loss of melanocytes from the epidermis and hair follicles. Gujarat has a high prevalence of vitiligo. One of the major hypotheses in the pathogenesis of vitiligo is the neurochemical hypothesis. According to the neural hypothesis neurochemical mediator/s such as acetylcholine secreted by the nerve endings cause the destruction of melanocytes. Acetylcholine esterase (AChE) activity has been found to be lowered in vitiligo patients during the process of depigmentation. We have earlier reported impairment of systemic antioxidant status in Baroda vitiligo patients, and we now show analysis of blood AChE activity in these patients. The study consisted of 121 vitiligo patients and 126 age and sex-matched healthy controls. Acetylcholine esterase activity showed significant decrease in vitiligo patients. However, there is no significant difference in AChE activity in segmental and non-segmental types as well as in active and stable types of vitiligo. The age group 16-25 showed a significant decrease in AChE activity. This study suggests that AChE may be inactivated due to high systemic oxidative stress in these patients. This is the first report showing that AChE may be playing a role in the pathogenesis of vitiligo in Baroda patients.

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Background: Dermatophytosis is an infection of skin, hair and nails of the human and animals which is caused by a large group of the fungi named dermatophytes. Purpose: The aim of our study was to determine the prevalence and causative agents of dermatophytosis in Karaj city. Materials and Methods: During five years, a total of 3475 patients clinically suspected to dermatomycoses referred to Ebnesina Diagnostic Medical Laboratory in Karaj city entered our study and samples were taken from the infected area of the skin and appendages. Results: 887 cases of dermatophytosis (806 culture proved) were diagnosed among the suspected cases. The species of dermatophytes were identified as Epidermophyton floccosum 311 (38.6%), Trichophyton mentagrophytes 197 (24.5%), Trichophyton verrucosum 125 (15.5%), Trichophyton rubrum 48 (5.9%), Trichophyton violaceum 34 (4.2%), Microsporum canis 29 (3.6%), Microsporum gypseum 26 (3.2%), Trichophyton tonsurans 20 (2.5%), Trichophyton schoenleinii 3 (0.4%) and unknown dermatophytes 13 (1.6%). Epidermophyton floccosum and tinea cruris were the most common etiological agents and clinical types of dermatophytosis, respectively. Conclusion: Dermatophyte species could transmit to human by direct or indirect contact with infected human and animals and their subjects. Promotion of public health care and self-hygiene may play an important role to control this disease.

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A 36-year-old male came to us with a six months history of a generalized, itchy, pus-filled eruption and a change in voice of five months duration. Healthy looking male on cutaneous examination revealed numerous isolated and grouped vesicles and vesiculopustules ranging from 5-10 mm on both normal and erythematous skin over the face, trunk, buttocks and extremities. Both flaccid and tense vesicles were seen along with some of them coalescing to form circinate or polycyclic patterns with crusting. Most of these lesions showed hypopyon formation. Nikolsky's sign and bulla-spread sign were negative. Histopathology and direct immunofluorescence substantiated our clinical diagnosis of subcorneal pustular dermatosis (SCPD). On investigation, he was found to have thymoma. We herewith report an association of SCPD with thymoma in this case report, not yet reported in the literature.

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The primary aim of this study was to determine the prevalence of Pseudomonas aeruginosa in wound infections and its sensitivity to the commonly used antibiotics at SS Hospital, Varanasi, India. We received 940 relevant clinical specimens among, which 301 (32%) was P. aeruginosa . Antibiotic susceptibility was determined by the disc diffusion method where cefoperazone/sulbactam was found to be most effective (74%) followed by ciprofloxacin (58%) and ceftazidime (54%). Rest of the antibiotics showed a very low level of susceptibility pattern. A total of 54 (18%) isolates were resistant to all the antibiotics tested in vitro .

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Immune reconstitution inflammatory syndrome describes a collection of inflammatory disorders associated with paradoxical deterioration of various pre-existing processes following start of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV)-infected patients. Leprosy as an opportunistic infection in immune reconstitution syndrome has been rarely reported in literature. A case of a 30-year-old HIV positive man with extrapulmonary tuberculosis of left foot on HAART having developed borderline tuberculoid leprosy as opportunistic infection in immune reconstitution syndrome has been reported.

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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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Background: Allergic contact dermatitis is a common inflammatory skin disease, which may occur as a result of exposure to specific allergens. Genetic and allergen exposure variations are determinants of different frequency of sensitization in different countries. The objective of this study was to determine the frequency of sensitization to contact allergens in the Iranian patients with dermatitis. Materials and Methods: We analyzed our patch-test database in a referral skin clinic in Tehran, Iran, retrospectively. All patients patch-testing with a clinical diagnosis of contact dermatitis and/or atopic dermatitis over a 10-year period (1993 to 2002) were included. The 23-allergen European standard series (ESS) screening has been used for evaluation in all the patients. Results: Data were available from a total of 222 patients. Out of them, 145 patients (65.3%) showed at least one positive reaction and 34 patients (15.3%) had more than two positive reactions. The five most common allergens were: nickel sulfate 50 (22.6%), cobalt chloride chloride 32 (14.5%), fragrance mix 30 (13.6%), potassium dichromate 21 (9.5%) and neomycin sulfate 20 (9.0%). Contact allergy to nickel sulfate was significantly more common in females and in younger patients ( P <0.05). Fragrance mix was the most common allergen in male patients, but there was no significant difference in its frequency between males and females. Conclusion: The ESS seems to be suitable for patch testing patients in Iran. Nickel sulfate was found to be the most common contact allergen in Iran, mostly affecting women and younger patients probably due to more exposure.

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Partial albinism with immunodeficiency is a rare and fatal immunologic disorder characterized by pigmentary dilution and variable cellular immunodeficiency. It was initially described in 1978. Primary abnormalities included silvery grayish sheen to the hair, large pigment agglomerations in hair shafts and an abundance of mature melanosomes in melanocytes, with reduced pigmentation of adjacent keratinocytes. We describe a child with Griscelli syndrome who presented with hepatitis, pancytopenia and silvery hair. The diagnosis was confirmed by microscopic skin and hair examination.

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Autosomal recessive Lamellar ichthyosis (LI) is a rare condition with the birth frequency of 1:300,000. We describe two sibs of LI born to the nonconsanguineous parents. DNA was isolated from the peripheral blood and CVS were processed for mutation search in transglutaminase gene (TGM 1) has revealed parental mutation in exon 4 at nucleotide 705 (705delC) causing frame shift leading to a premature termination codon and amino acid change (K487R) in exon 10 in mother. Absence of both mutations confirmed the normal status of the fetus and delivered a normal baby at full term. Thus early prenatal diagnosis can assure the couple for a normal healthy baby.

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Venous malformations are one of the commonest anomalies of the vascular tree and their management has always remained a major challenge. Surgery and other treatment modalities are not always satisfactory and have a higher morbidity, recurrence and complication rate. The author retrospectively analyzed 40 patients of venous malformations who underwent sclerotherapy with sodium tetradecyl sulfate solely or as an adjunct to surgery. The purpose of the study was to evaluate the efficacy and safety of sodium tetradecyl sulfate sclerotherapy in the treatment of venous malformations.

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Majocchi disease, purpuric annularis telangiectodes, is an uncommon pigmented purpuric dermatosis. It is usually observed in young adult males, but is very uncommon in childhood. In this paper, a ten-year-old female patient having very number of annular eruptions, surrounded by petechiae on her legs, diagnosed as Majocchi disease, is presented and discussed and the literature discussed.

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Background: Abnormalities of the nail unit are common in patients with connective tissue diseases. Clinical examination of the nail unit, coupled with biopsy of proximal nail fold offers an additional advantage in the diagnosis. Purpose: Our aim was to record clinical changes of the nail unit in connective tissue diseases and to study the histopathological (both H and E and periodic acid Schiff and direct immunofluorescence (DIF) findings of nail-fold biopsy. Materials and Methods: Thirty-eight confirmed cases connective tissue diseases attending skin OPD were enrolled in the study. After detailed clinical examination of the nail unit, a crescentric biopsy was taken from the proximal nail fold (PNF). Histopathological and DIF studies were was carried out. Findings: Nail changes could be demonstrated in 65% connective tissue diseases. Specific histopathological (H and E) and immunofluorescence findings were also encountered in many patients. Conclusion: Clinical examination of the nail unit offers additional clue in the diagnosis of connective tissue diseases. Though DIF of PNF biopsy is useful in the diagnosis, it is not an ideal site for H and E study, as the yield is very low. Limitations: Lack of adequate comparison group and non-utilization of capillary microscopy for the detection of nail fold capillary abnormalities.

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