In the recent past, there has been an alarming rise in patients presenting with atypical clinical types of dermatophytosis. These patients require prolonged treatment with systemic and topical antifungal agents. In majority of patients, close household contacts are affected. Frequent relapses and extensive disease affect the quality of life of the patient significantly. The emergence of such a challenging scenario is attributed to complex interplay of host, environment, and agent factors. The change in prevalence of dermatophytes causing the disease; host factors such as comorbidity and immunosuppression; and hot and humid climate, lifestyle changes, and poor hygiene are responsible for atypical dermatophytosis. Several atypical clinical types such as psoriasis-like, eczematous dermatitis-like, seborrheic dermatitis-like, and rosacea-like have been reported. Hence, dermatophytosis has been suggested to be included in the list of great imitators. The collaborative effort involving dermatologists, microbiologists, and public health professionals is required to address this emerging public health problem.

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Dermatophytosis, caused by dermatophytes is becoming difficult to treat due to various reasons. Accurate diagnosis is essential for the accurate management of this infection and prevention of relapse or recurrence. Although this condition is easy to diagnose clinically, due to overlapping signs and symptoms of few dermatological conditions it may be misdiagnosed necessitating laboratory confirmation. Isolation, identification of the dermatophytes and the antifungal susceptible profile may further help to initiate appropriate antifungal agent. The classical conventional techniques such as direct microscopic examination and isolation of fungi from the clinical specimens are still considered as an important modality of diagnosis. With the rise of the molecular era, molecular techniques are increasingly being applied to diagnose dermatophytosis and identify the dermatophytes. The present review provides an overview and update on the laboratory diagnosis of dermatophytosis.

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We hereby describe a case series of eczematous dermatitis in a peculiar clinical setting. The cases presented with eczematous dermatitis at the site of surgical incision and adjoining skin after a varying lag period. Clinically, all patients presented with xerosis and eczematous rashes around the surgical sites. In our observation, the time taken to develop skin rashes around the surgical sites ranged from 6 months to 3 years. We believe that denervation injury due to dermal nerve transections may lead to autonomic disturbance in the involved area and contribute to the development of dermatitis. Treatment is essentially medical with topical emollients and judicious use of topical corticosteroids. Through this case series, we propose to introduce a new dermatological entity - “autonomic denervation dermatitis” in postsurgical patients.

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Superficial dermatophytosis caused by dermatophytes belonging to the three genera, “Trichophyton, Microsporum and Epidermophyton” is the most common fungal infection seen in human beings, worldwide. Medical fraternity in India has been observing an increase in the prevalence of dermatophytosis and that too of the difficult to treat recalcitrant, recurrent and chronic dermatophytosis, over the last 3-4 years. This change in the clinical scenario with increasing frequency of treatment failures has given rise to innumerable treatment options mainly based on individual's experience, as the therapeutic regimens given in the standard textbooks, both Western and Indian, have ceased to result in a good clinical response. With this background, this article will focus on the treatment schedule given in standard textbooks and the current modifications that have evolved to treat dermatophytosis of the glabrous skin.

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Background: Various modalities of treatment have been used in the treatment of acne and nowadays, clinicians seek to employ new technologies in acne care like chemical peeling. Objectives: The objective of this study is to compare the efficacy of salicylic acid and mandelic acid peel in the treatment of mild to moderately severe acne vulgaris. Methodology: A total of fifty patients with mild to moderately severe acne graded based on Global Acne Grading System were divided randomly into two groups of 25 patients each. Group A patients were treated with 20% salicylic acid and Group B patients were treated with 30% mandelic acid every 15 days for six sessions. Pre- and post-peel sunscreen and moisturizer were prescribed. Percentage of improvement in inflammatory and noninflammatory lesions at the end of six sessions was the primary endpoint measure. The improvement was graded as mild, moderate, good, and significant. Results: All the patients showed improvement of acne at the end of the treatment. The mean improvement of inflammatory acne in Group A was 73.3% and in Group B was 65.4%. The mean improvement of noninflammatory acne in Group A was 39.4%, and Group B was 27.9%. In both groups, the improvement in both inflammatory and noninflammatory lesions was found to be statistically significant (P < 0.05). Conclusion: Salicylic acid peel was found to be more efficacious than mandelic acid peel. However, the side effects were less common with no postinflammatory hyperpigmentation with mandelic acid peel.

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Background: Patients attending the dermatology outpatient department (OPD) come with varied presentations. It is a challenge for a dermatologist to make a right diagnosis in a short time noninvasively. Hence in such conditions, dermoscope provides a rapid handy diagnostic aid. Objectives: The aim is to evaluate and compare the dermoscopic features of common dermatological conditions in an Indian population with brown skin. Materials and Methods: A total of 475 dermatoses including inflammatory, infectious, vesiculobullous, vascular, benign face tumors, hypopigmentary, drug reactions and miscellaneous conditions attending the OPD between March 2011 and January 2013 were enrolled in the study after obtaining informed consent. Detailed history and thorough dermatological examination were conducted to reach the final diagnosis. Dermlite II PRO dermoscope was used for the study. Data collected was analyzed by frequency and percentage. P value for each dermoscopic parameter in three groups was calculated using Chi-square test for independence using graph pad where the value of P < 0.05 was considered statistically significant. Results: Red dotted vessel was a prominent feature in inflammatory conditions (P < 0.0003), which was found to be regular in a pattern in psoriasis (100%). The unique feature of lichen planus was Wickham's striae (P < 0.0001). Collarette scales were observed in 93% of cases of pityriasis rosea. Live nymphs depicting as brown oval structure (46.67%) were observed. Scabies mites head was characterized using “Triangular sign” (93%). Red brown dots and papilla-like structure were observed in most of the cases of warts. Comedo-like opening (P = 0.024) and milia-like cyst (P = 0.0495) are typical features of seborrheic keratosis. Conclusion: Dermoscopy findings provide an extra clue for the diagnosis of common dermatoses and it also helpful in prognostic evaluation and monitoring response to treatment.

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Background: Vitiligo is a common skin disorder causing depigmented macules that can impair a patient's quality of life. There are number of treatment modalities are available but at the present, there are no studies compairing betamethasone pulse therapy versus azathioprine daily therapy in treatment of vitiligo. Objectives: To compare the safety and efficacy of Azathioprine daily and Betamethasone pulse therapy in the treatment of in vitiligo. Materials and Methods: We included two vitiligo patient groups. namely group A and group B Patients of group A were given oral Azathioprine to be given 50mg twice daily and those of second group B, Betamethasone were given as a single oral dose of 5 mg on two consecutive days per week. Therapy in both groups was given for a total of 6months with follow up at 1, 3 and 6th month. Clinical photographs were taken at each visit. Side-effects if any were noted. Results were calculated with help of VASI score (vitiligo area severity index). Results: At the baseline: The patients to group A (SD 3.81± 2.3) and of group B (SD 3.76± 2.28) were having depigmented patches (P = 0.90). At the first follow up: Although there was significant improvement with perifollicular repigmentation started in both groups but the patients are of group B (SD 3.38±2.06) were showing slower response as compared to oral group A (SD 3.70± 2.28). At the second follow up: Remarkable improvement is seen in both groups compared (P = 0.17). At the third follow up: Significant improvement is seen in both groups compared (P = 0.09). Conclusions: Azathioprine and betamethasone pulse therapy are equally effective in treatment of vitiligo.

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Acne vulgaris (acne) is a common chronic skin disease and affects over 90% of teenagers worldwide. Despite its prevalence, acne vulgaris is shrouded in multiple misconceptions that are widespread in the general public, among acne patients, and even in health-care professionals. This article reviewed six common misconceptions about acne vulgaris: (1) acne is a trivial condition and does not require medical attention; (2) acne is a transitory disease of adolescence; (3) dietary factors cause acne; (4) acne is caused by uncleanliness; (5) acne improves rapidly upon treatment; and (6) acne can be treated by sunlight. These misconceptions span across the natural history, etiology, and treatment of acne vulgaris. The paucity of knowledge about acne has potentially severe consequences and should not be overlooked. Underestimating the severity and progression of acne may delay treatment, while misinterpreting the etiology of acne could lead to unnecessary and disruptive lifestyle changes. Unrealistic expectations about therapy will lead to dissatisfaction, which may decrease treatment compliance. Actions in public health, medical education, and research are warranted to eradicate these misconceptions about acne vulgaris.

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Autoimmune inflammatory rheumatic diseases, also termed as autoimmune collagen vascular diseases, as the name suggests are the group of illness arising from a combination of loss of tolerance to self-antigens and shifting of the immune system into self-destructive overdrive. These are commonly classified under six mutually exclusive diseases which include systemic lupus erythematosus (SLE), systemic sclerosis (SSc), dermatomyositis, polymyositis, rheumatoid arthritis (RA), and primary Sjögren syndrome, the so-called definitive connective tissue diseases. Undifferentiated and mixed connective tissue disease and overlap syndrome have also been added to the classification. An initially undifferentiated connective tissue disease may later evolve into a differentiated connective tissue disease. Here, we define the various connective tissue diseases and elaborate more upon SLE and its overlap, including the overlap of RA (RHUPUS).

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Syringoma is a benign adnexal tumor of intraepidermal portion of the eccrine sweat ducts. Eruptive syringoma is a rare clinical variant characterized by small, flesh-colored papules with both follicular and nonfollicular distribution that occur in successive crops on the anterior body surface. We report a case of 35-year-old female with familial eruptive syringoma with predominant acral distribution. We report this case because of the rarity of disorder and acral predominance.

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Background: Cancer is a leading cause of mortality and morbidity in both developed and developing parts of the world with the disease burden projected to grow exponentially in future. Over the past several decades great advances have been made in the area of cancer chemotherapy. Objectives: To study the various cutaneous adverse events associated with cancer chemotherapy. Methodology: 100 patients diagnosed with cancer attending the departments of a tertiary hospital who underwent chemotherapy and satisfied the inclusion and exclusion criteria were included in this study. It is a hospital based observational study. All patients were counselled about the study and informed written consent was obtained. Patients were examined before start of chemotherapy treatment and after every cycle of chemotherapy. Data collected was analysed using SPSS version 16.0. Results: In this study, 100 patients including 37 females and 63 males were included in this study. Majority (56%) of the patients belonged to the age group of 41-60 years. The common indications for chemotherapy were carcinoma oropharynx (24%), carcinoma breast (18%), tongue and stomach. Among the cutaneous adverse events noted, hair changes were the most common presentation and were reported in 68 patients. Skin changes were seen in 65 cases, nail changes in 30 cases and mucosal changes in 12 patients. Xerosis (26%) and hyperpigmentation (22%) were the most commonly observed adverse event affecting skin. Cisplatin, cyclophosphamide, 5 fluorouracil, carboplatin, paclitaxel and doxorubicin were the most frequently prescribed chemotherapeutic drugs. Conclusion: Our observations necessitate a joint effort between dermatology and oncology for the early recognition and adequate treatment of the cutaneous adverse effects associated with cancer chemotherapy which may help in reducing morbidity and improving compliance.

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Context: Foot eczema is a common complaint encountered in dermatology outpatient department. Footwear dermatitis forms an important exogenous cause of foot eczema. Patch testing helps in identifying possible allergens causing footwear dermatitis. Aims: This study aims to study the clinical profile of foot eczema and to evaluate patch test results in these patients. Subjects and Method: Fifty patients with foot eczema were included in the study and underwent patch testing with Indian standard series and footwear series. Patch test results were read as per International Contact Dermatitis Research Group guidelines. Statistical Analysis Used: Descriptive data are given as mean standard deviation. Differences between patients were assessed by unpaired “t”-test and frequency of parameters by the Chi-square test. Linear regression analysis was used, and correlation coefficients were calculated by Pearson's method. P <0.05 was considered statistically significant. Results: Foot eczema was most common in the 18–29 years of age group (48%), with a male:female ratio of 1.78:1. Office workers (50%), followed by students (24%) were the common occupational groups affected. Allergic contact dermatitis (ACD) (60%), followed by discoid (10%) and forefoot eczema (10%) were the common morphological types. Parthenium (13.8%), diphenylguanidine (10.3%), and potassium dichromate (10.3%) were common allergens seen. Parthenium was the most common allergen identified by patch testing in our study. Conclusion: Patch testing may be used as a valuable and safe additional tool to aid the clinician's diagnosis and help in the treatment of ACD.

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Background: Facial melanosis in tropics presents as a diagnostic and therapeutic challenge. We report characteristic patterns of facial pigmentation following vigorous rubbing or cleaning of the face in Indian patients. Awareness of the condition shall guide the clinician to a specific diagnosis. Objective: To study clinicohistopathological profile and patterns of facial frictional melanosis (FFM). Materials and Methods: A multicenter clinicohistopathological hospital-based cross-sectional case descriptive study of sixty patients with characteristic patterned facial melanosis underwent a detailed history taking and clinical examination over a period of 5 years. Biopsy specimens of thirty patients were analyzed for histopathology with hematoxylin-eosin stain. Ten biopsy specimens were also processed for both Fontana Mason and Congo red staining. Results: Sixty patients (males n = 48, females n = 12) with typical clinical features of FFM were studied. Ages of patients varied from 16 to 68 years. Patients on direct questioning confirmed history of vigorous rubbing with hand/handkerchief to clear the face of sweat and grime. Pigmentation was distributed symmetrically over the bony prominences with several characteristic patterns. Histology showed epidermal hypermelanosis, dermal melanin incontinence, and consistent absence of amyloid deposits. Conclusion: We present characteristic facial melanosis in Indian patients due to friction as a specific type of benign friction melanosis. We aim to bring to notice; friction as a distinct etiology of patterned facial hyperpigmentation.

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Background: The treatment of chronic venous leg ulcer (CVLU) is a major challenge. Much scientific advancement was made. Chitosan, derived from N-deacetylation of chitin, has been successfully used to promote wound healing. Silver nanoparticles (AgNPs) are used as bactericides. The aim of this work is to evaluate the efficacy and safety of chitosan alone or that impregnated with AgNPs compared to traditional compression bandage dressing in the treatment of CVLU. Materials and Methods: Thirty-eight CVLU patients completed the treatment for 3 months. They were treated with compression bandage and categorized into three groups: Group A included 12 patients used chitosan impregnated with the AgNPs, Group B included 11 patients used chitosan alone, and Group C included 15 patients used compression bandage alone. For all patients, routine investigations, lower limbs Duplex ultrasound and bacterial culture and sensitivity from the ulcers before and after treatment were done. Results: The healing of ulcers in the treated groups was mostly apparent in Groups A and C. Conclusions: Chitosan impregnated with AgNPs can be a hopeful treatment for CVLU. However, compression bandage alone is also effective for the treatment of CVLU.

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Background: Acne vulgaris is a common skin disease seen primarily in adolescents and young adults. As the treatment involves long-term therapy with antibiotics, an agent with a long half-life can be very useful in increasing the compliance. Objectives: The objective of this study was to evaluate the efficacy of a pulse dose of azithromycin and compare it with daily dose of minocycline in the treatment of acne vulgaris. Materials and Methods: This prospective, randomized, open-label, comparative study was conducted on sixty patients with moderate-to-moderately severe (Grade II and III) acne vulgaris. Patients were randomly assigned to two treatment groups, A and B. Patients in Group A received 50 mg minocycline orally daily whereas patients in Group B were given 500 mg azithromycin orally once a day for 3 consecutive days/week. Both the groups were advised topical application of 2.5% topical benzoyl peroxide gel in the night. The total duration of treatment was 3 weeks. All the patients were evaluated at the end of 3 weeks. Statistical analysis was done using Wilcoxon signed-rank test and Mann–Whitney U-test. Results: Group A showed a reduction in lesional count of 39.7% for noninflammatory papules, 65.11% for inflammatory papules, and 52.22% for pustules. Similarly, Group B showed 30.39%, 54.69%, and 57.76% reduction in lesional count for noninflammatory papules, inflammatory papules, and pustules, respectively. Conclusions: Both minocycline and azithromycin were equally effective and safe for the treatment of acne vulgaris.

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Background: Diabetes mellitus is a metabolic disorder characterized by raised fasting and postprandial blood glucose levels and a variety of multisystem complications. The prevalence of skin manifestations seems to be similar between type 1 and type 2 diabetes mellitus patients. Cutaneous manifestations usually develop following the diagnosis of diabetes, but in some patients, they are the initial presenting signs, thereby helping in the early diagnosis of diabetes mellitus. Objectives: The objective of this study is to describe the cutaneous lesions in patients with type 2 diabetes mellitus and to compare the pattern of skin manifestations in diabetics and nondiabetics in coastal Karnataka and neighboring districts of Kerala. Methodology: This case-control study included 400 patients with type 2 diabetes mellitus and cutaneous manifestations attending the outpatient Departments of Dermatology and General Medicine and those admitted under these departments. A total of 400 age and sex-matched nondiabetic patients were included as controls. Results: Cutaneous infections were noted in 148 (37%) diabetics of which fungal infections were the most common seen in 106 (26.5%) patients, followed by xerosis in 121 (30.25%) and acrochordons in 71 (17.75%) patients. Other dermatoses associated with diabetes mellitus noted were acanthosis nigricans (5.5%), scleredema diabeticorum (0.25%), diabetic bullae (0.5%), and Kyrle's disease (1%). Cutaneous changes associated with neurovascular complications included diabetic foot in 3%, diabetic dermopathy in 2%, and pigmented purpuric dermatosis in 0.25% of the diabetics. Conclusion: A joint effort between dermatology and general medicine is necessary for the early recognition and treatment of the skin conditions and also to ensure adequate metabolic control.

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Topical antifungals are an important adjuvant in treatment of dermatophytosis. Also specific situations such as dermatophytoses in pregnancy and infants often warrant topical therapy. Several new topical antifungals and newer formulations hold out the promise of enhanced effectiveness of topical therapy in dermatophytosis. This article reviews the entire spectrum of topical antifungals and formulations and their role in management of dermatophytosis.

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