Background: Alopecia areata (AA) shows several well-defined dermoscopic features which may help in confirming diagnosis in AA. Aims: We carried out a study to examine the dermoscopic features of AA and develop a protocol for diagnosis of AA by dermoscopy. Materials and Methods: Dermoscopy was performed in 66 patients with AA. Hanse HVS-500NP dermoscope (magnification of ×32 and ×140) was used. Results: The mean age of the patients (46 males and 20 females) was 26.85 years. The mean age of onset was 25.15 years. The mean duration of alopecia was 10.3 months. Most common AA in our study was patchy type (57/66, 87.7%). Single patch was seen in 24 patients and multiple patches in 33 patients. Diffuse AA was seen in five patients. Ophiasis and alopecia universalis were seen in two patients each. Nail changes were fine pitting (4), ridging (2), thinning of nail plate (2). Twenty nail dystrophy, distal onycholysis, striate leukonychia and coarse pitting were seen in one patient each. Intralesional triamcinolone acetonide was the most common therapy offered. Others were oral betamethasone minipulse therapy, dexamethasone pulse, minoxidil, anthralin and corticosteroids. The most common dermoscopic finding was yellow dots seen in 54 patients (81.8%), followed by black dots (44 patients, 66.6%), broken hairs (36 patients, 55.4%), short vellus hair (27 patients, 40.9%) and tapering hairs (8 patients, 12.1%). Conclusions: The most common dermoscopic finding of AA in our study was yellow dots, followed by black dots, broken hairs, short vellus hair and tapering hairs. Dermoscopic findings were not affected by the type of AA or the severity of the disease.

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Background: Phrynoderma is a type of follicular hyperkeratosis. Various nutritional deficiency disorders have been implicated in the etiology of phrynoderma. Aim: To determine clinical features of phrynoderma and its association with nutritional deficiency signs. Materials and Methods: A cross-sectional descriptive study of 125 consecutive patients with phrynoderma attending the outpatient department (OPD) of dermatology was conducted in a tertiary care hospital. In all patients, a detailed history was taken and cutaneous examination findings such as distribution, sites of involvement, morphology of the lesions, and signs of nutritional deficiencies were noted. Results: The proportion of patients with phrynoderma attending the OPD was 0.51%. There were 79 males and 46 females. Age of the patients was in the range of 3-26 years with a mean of 10 ΁ 4.3 years. The lesions were asymptomatic in 114 (91.2%) patients. The distribution of lesions was bilateral and symmetrical in 89 (71.2%) patients. The disease was localized (elbows, knees, extensor extremities, and/or buttocks) in 106 (84.8%) patients. The site of onset was elbows in 106 (84.8%) patients. The lesions were discrete, keratotic, follicular, pigmented or skin colored, acuminate papules in all patients. Signs of vitamin A and vitamin B-complex deficiency were present in 3.2% and 9.6% patients, respectively. Epidermal hyperkeratosis, follicular hyperkeratosis, and follicular plugging were present in the entire biopsy specimen. Conclusion: Phrynoderma is a disorder with distinctive clinical features and can be considered as a multifactorial disease involving multiple nutrients, local factors like pressure and friction, and environmental factors in the setting of increased nutritional demand.

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Background: Melasma is an acquired increased pigmentation of the skin, characterized by gray-brown symmetrical patches, mostly in the sun-exposed areas of the skin. The pathogenesis is unknown, but genetic or hormonal influences with UV radiation are important. Aims: Our present research aims to study the clinico-epidemiological pattern and the precipitating or provocation factors in melasma. Materials and Methods: A total of 312 patients were enrolled for the study over a period of one year. Results: The mean age of patients with melasma was 33.45 years, ranging from 14 to 54 years. There was female preponderance with a female to male ratio of approximately 4 : 1. The mean age of onset was 29.99 years, with the youngest and oldest being 11 and 49 years, respectively. The patients sought medical treatment on an average of 3.59 years after appearance of melasma. About 55.12% of our patients reported that their disease exacerbated during sun exposure. Among 250 female patients, 56 reported pregnancy and 46 reported oral contraceptive as the precipitating factors. Only 34 patients had given history of exacerbation of melasma during pregnancy. A positive family history of melasma was observed in 104 (33.33%) patients. Centrofacial was the most common pattern (55.44%) observed in the present study. Wood light examination showed the dermal type being the most common in 54.48% and epidermal and mixed were seen in 21.47% and 24.03% of the cases, respectively. We tried to find an association with endocrinal diseases and observed that 20 of them had hypothyroidism. Conclusion: The exact cause of melasma is unknown. However, many factors have been implicated in the etiopathogenesis of this disorder. Here we try to identify the causative factors and provocation to develop melasma.

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Cytokines are non-immunoglobulin proteins and glycoproteins produced by a wide variety of cells, in response to any immune stimulus. Cytokines are signaling molecules that send downstream signals to various cells through a number of signal transduction pathways and act further by binding to specific membrane receptors (cytokine receptors) on the cell surface. They are emergency molecules, which are released transiently. Cytokines play an important role in cellular communication. They regulate immunity, inflammation, cell activation, cell migration, cell proliferation, apoptosis, and hematopoiesis. However, when released persistently they can produce chronic disease

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Background: Neurocutaneous syndromes (NCS) are a group of genetic disorders that produce a variety of developmental abnormalities of the skin along with an increased risk of neurological complications. Cutaneous manifestations usually appear early in life and progress with time, but neurological features generally present at a later age. There is a paucity of data regarding the evolution of skin lesions and their correlation with the central nervous system involvement in children. Aim: The primary objective was to track the course of skin lesions in various forms of NCS in the pediatric age group. Our secondary aim was to assess whether there was any predictive value of the lesions in relation to the neurological manifestations. Materials and Methods: This prospective longitudinal study was conducted at a tertiary care pediatric dermatology referral clinic of the Institute of Child Health, Kolkata, West Bengal. Children between the age group 0 and 12 years were included in the study on the basis of standard diagnostic criteria for different NCS, during the period from March, 2000 to February, 2004, and each of the enrolled cases were followed up for a duration of six years. Results: The study population comprised of 67 children (35 boys, 32 girls).The mean age of presentation was 33.8±27.8 months (range 10 days to 111 months). The various forms of NCS observed was neurofibromatosis 1(NF1) (n=33), tuberous sclerosis complex (TSC) (n=23), Sturge Weber syndrome (n=6), ataxia telangiectasia (n=2), PHACE syndrome (n=1), incontinentia pigmenti (n=1), and hypomelanosis of Ito (n=1). The presentations were varied, ranging from predominantly cutaneous to primarily neurological, depending on the disease entity and age group concerned. There was a significant increase in the number of café au lait macules (CALMs) with time (P=0.0002) in NF1, unlike that of hypopigmented macules of TSC (P=0.15). Statistically, no relation was documented between the evolution of skin lesions and neurological manifestations in the major groups. Conclusion: As NCS is not an uncommon disease in children, it is always necessary to find out the subtle neurological signs, whenever we observe any case with cutaneous markers suggestive of NCS. In addition, it is a must to do a detailed dermatological examination in a child with central nervous system involvement, in the pediatric population. However, the neurological course cannot be predicted from skin lesions.

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Five Chinese patients were found to have a linear, splayed, vertical pattern of lesions on their back, chest and abdomen. These lesions were clinically and pathologically diagnosed as seborrheic keratosis. The mean age of our patients was 77.6 years. During the follow-up period of 12-20 years, the lesions appeared to increase with age, and no malignant changes were observed on these sites. These patients had no serious underlying medical problems or malignant neoplasm, except for one patient with duodenal ulcer. While we are uncertain as to the cause of this patterning of seborrheic keratoses, we believe that it is distinct from previously reported patterns; this will contribute to research on the pathogenesis of seborrheic keratosis.

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Diagnosed cases of sexually transmitted diseases (STD) represent tip of the iceberg and Donovanosis in one of them. Donovanosis, in most cases is obvious clinically, but rely for its confirmation on the demonstration of donovan bodies in histological sections and cytological preparation. In an extremely rare setting, this disease may get complicated by the development of squamous cell carcinoma. We report this occurrence in an 18-year-old girl to review the currently forgotten status of donovanosis amongst the STDs and the poor outcome of the disease if left untreated.

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A 52-year-old female presented to our out patient department with asymptomatic, hypopigmented lesions on the neck and back since 2 months. There was a history of taking antitubercular treatment for suspected pulmonary tuberculosis 2 years back. On blood investigations, the serum angiotensin converting enzyme levels were increased and the skin biopsy revealed a naked granuloma in the dermis. A diagnosis of systemic sarcoidosis was made and the patient was started on oral corticosteroids and Methotrexate, with clinical improvement.

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Background: Skin tags (STs) have been investigated as a marker of type 2 diabetes mellitus (DM), yet the relation of STs to obesity is still a matter of controversy. Aim : The aim of the study is to explore the relation of number, size and color of STs to obesity, diabetes, sex and age in one study. Methods: The study included 245 nondiabetic (123 males and 122 females) and 276 diabetic (122 males and 154 females) subjects. We recorded age, sex, body mass index (BMI), relevant habits, STs color, size, and number in different anatomical sites. Results: The presence and the mean number of STs was more in obese than nonobese participants (P = 0.006 and P < 0.001, respectively) and was not affected by sex. However, the number increased significantly with age. The presence of mixed-color STs was related to obese (P < 0.001) participants. Multivariate logistic regression revealed that only BMI was significantly associated with the mixed-color STs (OR = 3.5, P < 0.001). The association of DM (OR = 1.7) with mixed-color STs was nonsignificant (P = 0.073). Neither age nor sex had any association with mixed-color STs. Within cases that developed mixed-color STs, the multivariate analysis showed that only BMI had a significant correlation to the number of STs (beta = 0.256, P = 0.034). Conclusion: The study showed that not only the number but also the presence of mixed-color ST was related to obesity, but not to diabetes. The presence of mixed-color STs in nondiabetic subjects needs close inspection of BMI.

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Keratoacanthoma (KA) is a relatively common skin lesion. We report a case of KA-mimicking squamous cell carcinoma in a 40-year old smoker, who was also having speckeled leukoplakia on the buccal mucosa. The present case highlights the importance of histopathological diagnosis, as the treatment in latter case is aggressive, which is unnecessary if attempted with KA. Moreover, the present report provides an overview of such lesions, which could be encountered in clinical situations for which definitive diagnosis is of paramount importance before the starting of treatment plan.

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Venereology-the study of venereal diseases or more recently, the sexually transmitted infections (STI) includes a variety of pathogens namely viruses, bacteria, fungi and protozoa for which the common factor is the mode of transmission and acquisition: Sexual relations between human beings. Medical and other historians have often suggested that well-known diseases such as syphilis, gonorrhea, chancroid and lymphogranuloma venereum have existed since earliest times. However, it is difficult to identify modern disease entities based on written historical record. Studying the origin of STIs helps us to learn the political, economic and moral conditions that led to the disease. Effective management of STI rests on three pillars of diagnosis, prevention and treatment. For most of past 50 years in India, the diagnostic pillar has been the least well-supported. Until well into present century, diagnosis of STI in India was clinical. Treatment of STIs in India followed the methods used in England. Of course in the 19^th century, in many parts of the world, only a few had access to modern methods of treatment; in India, there was extensive use of Ayurvedic treatment with traditional medicines. This article thus gives just an overview and evolution of venereology in India with regard to venereal diseases (now more often known as STIs/disease), control measures, academic, association and journal development and finally future perspective.

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Background: Psoriasis is a chronic skin disease which has an impact on health-related quality of life (QoL). The psoriasis disability index (PDI) is a simple 15-item questionnaire which is used to assess overall psoriasis disability. Objectives: (1) To assess the health-related QoL among patients with psoriasis, attending dermatology OPD of Medical College Hospital, Kottayam. (2) To find out the association of QoL with age and gender. Materials and Methods: This was a descriptive case series study conducted in Dermatology OPD of Medical College Hospital, Kottayam, Kerala. Psoriasis patients attending the Dermatology OPD of Medical College Hospital for 2 months were assessed. Results: Out of the total 32 patients, 56.2% were males, whose mean age was 45; 72% were married, 47% had education above plus two and were employed. Also, 34% had income above Rs. 3000 per month. Among the PDI subsets, daily activities were affected the most (90.6%), followed by work (84.4%), leisure activities (71.9%), problems with treatment (68.7%) and the least affected was personal relations (62.5%). Overall PDI score (median 14.5, interquartile range 4.5-22) showed that the QoL was affected in 75% of which 9.4% were mild (score < 9), 31.2% were moderate (score 10-18) and 34.4% were severe (score > 18). There was no association between the total PDI score and age or gender. Conclusion: QoL was affected in 75% of psoriasis patients. There was no association between QoL and age or gender.

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Background: Plants are ubiquitous in nature and are essential for human life, though some do have detrimental effects. In India, there are various indigenous and foreign plants that are well known to cause dermatitis, Parthenium hysterophorus being the foremost. Aims of the Study: To study the clinical features of patients presenting with plant dermatitis and evaluate plant allergen series patch test results. Materials and Methods: 50 patients with suspected plant dermatitis were evaluated regarding evolution of dermatitis, precipitating factors and contact with various plants. 31 patients (62%) complained of photo sensitivity and 24 (48%) had involvement of sun-exposed areas. Our provisional diagnoses included allergic contact dermatitis in 16, air borne contact dermatitis in 9, phytophotodermatitis in 7, photodermatitis in 6, airborne contact dermatitis to other causes in 4, phytodermatitis in 3. Patients were patch tested with Indian standard series of allergens as well as plant allergen series consisting of common allergenic plants of local flora in and around Manipal and also with plants strongly suspected by the patient. 35 tested positive with maximum positives (26 patients, i.e., 52%) to Parthenium hysterophorus (Compositae). Results: The result of patch testing was correlated with the history and clinical examination and relevance established. Conclusions: Majority of the patients with clinically suspected plant dermatitis belonged to 3 ^rd or 4 ^th decade and Parthenium was the leading plant allergen Sensitization to Leguminosae plants and Hopea ponga, seen in 9 cases, have not been reported earlier in literature.

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Tufted angioma (TA) is a rare benign vascular neoplasm, localized to the skin and subcutaneous tissues, occurring primarily on the trunk and extremities of children. The lesions are usually asymptomatic but, rarely, paroxysmal painful episodes may be associated. The occurrence of eruptive TA is still rarer and had been described almost exclusively in association with immunocompromised states. We report here a case of acquired painful multifocal tufted angiomas on the face and neck in an immunocompetent young adult.

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The auricle is an extremely rare site for cutaneous leishmaniasis (CL) in Old World, which tends to be a benign disease with self-healing small nodules such as the "oriental sore". However, in the New World, there is a type of CL of the ear, named as "chiclero's ulcer" which is caused by Leishmania mexicana. Herein, we describe a case of massive auricular enlargement due to Old World CL.

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Psoriatic onycho-pachydermo-periostitis (POPP) is a rare subset of psoriatic arthritis. It is usually localized to the hands and it is characterized by onychodistrophy, soft tissue thickening above the distal phalanx and periosteal reaction. The resolution is very slow due to the involvement of nails and bone. Low dose methotrexate and anti-tumor necrosis factor-α (anti-TNF-α) agents are the suggested therapies. We report a case of a 53-year-old man affected by palmo-plantar slight psoriatic dermatitis, who presented a rapid onset of POPP. Rx imaging showed enthesitis and a moderate phalanx erosion with articular spaces narrowing and swollen periosteal reaction. A magnetic resonance imaging test of the hands showed an initial stage of synovitis and extensive periostitis of the distal phalangeal tufts. The patient has been treated with oral methotrexate for a month with a rapid clinical improvement and pain reduction. As POPP at first manifests as a painful onycodistrophy, it can easily be confused with bacterial perionyxis. The delay in making the correct diagnosis, and therefore, the delay in giving a proper treatment would mean the progressive articular erosion and the permanent invalidation of the patient's ability to use his hands.

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Background: Basal cell carcinoma (BCC) is the most common malignant skin tumor. Although mortality attributable to BCC is not high, the disease is responsible for considerable morbidity. There is evidence that the number of patients who develop more than one BCC is increasing. Aims: The aim of this study was to elucidate possible risk factors for developing Multiple BCC. Patients and Methods: Patients with histologically proven BCC ( n = 218) were divided into two groups (single BCC and Multiple BCC) according to the number of their tumors and their profile were reviewed. Probable risk factors were compared between these two groups. Results: Among 33 evaluated risk factors, mountainous area of birth, past history of BCC, history of radiotherapy (in childhood due to tinea capitis), abnormal underlying skin at the site of tumor, and pigmented pathologic type showed significant differences between the two groups. Conclusions: The high rate of additional occurrences of skin cancers among patients with previously diagnosed BCC emphasizes the need of continued follow-up of these individuals. Those with higher risk require closest screening.

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The authors report on a case of a 65-year-old man with pigmented clear-cell acanthoma located on the right thigh. Dermoscopy disclosed a peculiar picture consisting of diffuse black pigmentation with a superficial greyish veil in the central portion, dotted-to-globular dark red-black structures mainly located at the periphery with a homogenous regular reticular arrangement; peripheral translucid desquamation. Dermoscopic features are correlated with the histology, where hemosiderin deposits present in a sheet-like arrangement in the perivascular papillary dermis and in a band-like disposition in the reticular dermis at the base of the lesion can account for the pigmented picture. The lesion arose on a trauma-prone skin site; thus the authors believe that traumatic irritation may be responsible for the clinical and dermoscopic pictures, giving rise to a reaction similar in a way to the Auspitz's sign provocated by trauma for psoriasis. Red blood cells extravasation from extremely superficialized capillaries may have led to hemosiderin deposition in the papillary and the reticular dermis.

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Topiramate is an antiepileptic medication frequently used for the management of alcohol dependence and in other psychiatric disorders. Though cutaneous side effects are known to occur with it, isolated pure pruritus is rarely reported with topiramate in the literature. We wish to report a case of pruritus associated with topiramate use in a male with alcohol dependence syndrome.

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Patients with neurofibromatosis type 1 (NF1), a common, progressive, autosomal dominant neurocutaneous disorder, are predisposed to malignancies. Several types of hematologic malignancies have been described in them. However, to date there has been no report to the best of our knowledge of a patient with NF1 developing chronic myeloid leukemia (CML). We present an adult Ghanaian with NF1, who subsequently developed CML. Relevance of the case report is discussed.

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Cutaneous B-cell lymphoma (CBCL) is an unusual skin neoplasm with a great range of clinical presentations. Here, we report a case of CBCL in an AIDS patient presented as a single and nodular/ulcerative lesion in the perianal area. The patient was started on highly active antiretroviral therapy alone with a good clinical and oncological response. Two years later, the patient is asymptomatic with undetectable viral load and immune reconstitution.

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