Erythema nodosum (EN) is a reaction pattern in the skin characterized by septal panniculitis. Infectious diseases are most common cause of EN. This study was aimed to find out the most common causes for EN as seen in a community hospital over a period of two years. Fifteen patients with EN were subjected to detailed clinical and laboratory investigations to establish the etiology. Immuno - fluorescence and PCR for Mycobacterium tuberculosis were performed in relevant patients. Seven cases were diagnosed to be secondary to tuberculosis that was confirmed by a complete resolution of the lesions after a full course of anti TB chemotherapy. In one patient, the EN was drug induced, two were due to polyarteritis nodosa, one was due to SLE, one was due to streptococcal infection, and three were idiopathic in aetiology. Though the number of patients is small, it still establishes the fact that tuberculosis continues to be the most common cause of EN.

Cleansers, commonly referred to as soaps (though all soaps are cleansers, all cleansers are not soaps), are an important adjuvant in the treatment of any dermatological condition. In order to recommend a cleanser, many aspect should be taken into consideration one important being its pH. pH of a cleanser tends to have an impact on the skin in several ways viz. alteration of bacterial flora and pH, moisture content and irritation. A study was conducted to evaluate the pH of various commonly available soaps/cleansers available in the Indian market. Most of the commonly used soaps have an alkaline pH.

Severity of psoriasis vulgaris is known to be modified by psychological stress. The objective of this study was to evaluate the role of fluoxetine in the PU VA treatment of psoriasis. Twenty patients with progressive disease having more than thirty per cent body area involvement were included in a randomized, double blinded, placebo- controlled, age and sex matched study. All patients were on PUVA treatment, half of patients were given fluoxetine 20 mgs daily whereas the ten were given placebo. Assessment was done by Psoriasis Area and Severity Index (PASI) scoring after every 5 exposures of PUVA treatment till 20 treatments. All ten patients who took fluoxetine along with PUVA treatment showed better response and quicker remission. Fluoxetine may be used as an adjuvant in PUVA treatment of psoriasis.

Cutaneous leishmaniasis presents a spectrum of manifestations both clinically and histologically. Several previous studies have established the value of histological examination in the diagnosis of cutaneous leishmaniasis. Different reaction patterns have been reported. Forty caes of cutaneous leishmaniasis were studied in the Sultanate of Oman, with particular reference to the different histological features. Clinical features were correlated with the histological patterns. Four histological patterns were identified-1) diffuse macrophage infiltration without necrosis, 2) macrophage infiltration with necrosis. 3) early reactive granuloma and 4) established epitheloid granuloma. LD bodies were identified in 65% of cases. Epidermal features were nonspecific. Though the patterns could be correlated with the duration and the clinical type of lesion in a few cases, the correlation was not consistent.

Histopathological correlation of skin biopsies in 372 leprosy patients was done with clinical diagnosis using Ridley Jopling classification. There was agreement in 62.63% of cases. The correlation was highest in LL (80%) followed by Bl. (70%), BT (66.34%), BB (50%) and TT (46.15%). The other interesting observation was that the number of IL cases diagnosed histopathologically were more when compared to that made clinically.

Vitiligo is a common pignientary disorder and of major social and cosmetic concern in India. Purpose of the study was to find out age at onset and sex incidence in vitiligo, role of hereditary factors and associations with other diseases. 120 self reporting vitiligo patients attending out patient department of a service hospital were selected for the study and this data was analysed. In the present series out of 120 cases 62 (51.6%) were males and 58(48.35%)were females. There was practically no difference in sex incidence. The lowest age of onset was two years and the oldest was 65 years. In the majority of patients,52(43.2%), disease started before twenty years of age.8 (6.6%) cases gave definite family history of vitiligo. Exposed areas of the body were commonly affected in majority (66.6%) of cases. The legs were commonest site of involvement in 60(50%) cases. Circunicript type of vitiligo (46.6%) was heading the list. Majority of patients (56.6%) had multiple lesions. Diabetes mellitus was found in 2 (2.6%) patients. Cause of vitiligo is still idiopathic. Hereditary factors hardly play any role in manifestation of vitiligo

In a random study of 150 patients with psoriasis vulgaris, oral psoralen photochemotherapy using natural sunlight (PUVASOL) used alone was compared to PUVASOL plus adjunctive topical therapy with tar. The combined PUVASOL and topical therapy with tar in 75 patients (group-I) with 30 minutes sunlight exposure done in every alternate day showed complete clearing of lesions in 68 (90.6%) patients. The average rate of clearance of lesions started to appear 12-24 days with a mean of 18 days. Group I patients who received topical therapy in conjunction with PUVASOL, their skin lesions cleared more quickly with fewer treatments at a lower final 15 PUVASOL doses as compared to 22 PUVASOL doses in the control patients. Ninety percent of 51 patients using topical therapy on their scalp cleared their psoriasis in this area by the time their body psoriasis had cleared. Only 2 of the 45 (4.4%) patients with scalp involvement cleared receiving PU VASOL alone. All 7 patients with psoriatic arthritis cleared their psoriasis, but none of them noted any symptomatic alteration in the severity of their arthritis during the course of treatment in both the groups.

Parthenium dermatitis is one of the most intractable problems in dermatology, the management of which poses a therapeutic challenge. The mainstay of treatment has been systemic corticosteroids for prolonged periods which may result in various side-effects.ln the present study, 30 patients of parthenium dermatitis were treated with oral azathioprine in a dose of 1-3 mg/kg/day. Assessment was done at monthly intervals using a clinical score. Azathioprine emerged as an effective and safe corticosteroid sparing agent in the treatment of parthenium dermatitis, provided the patients are carefully monitored for the side effects.

The isoprenoid pathway and its metabolites - digoxin, dolichol and ubiquinone were assessed in acquired immunodeficiency syndrome. Digoxin is an endogenous regulator of membrane Na+-K+ ATPase secreted by the human hypothalamus. The HMG CoA reductase activity was increased with increased digoxin and dolichol levels and reduced ubiquinone levels in AIDS. Membrane Na+-K+ ATPase activity and serum magnesium levels were reduced. The tryptophan catabolites were increased and the tyrosine catabolites were reduced. The glycoconjugate metabolites were increased and lysosomal stability was reduced. There was reduced incorporation of glycoconjugates into membranes and increased membrane cholesterol: phospholipid ratio. Lipid peroxidation products and NO were increased while free radical scavenging enzymes and reduced glutathione were reduced. The role of the isoprenoid pathway related cascade in the pathogenesis of AIDS is discussed.

Sixty patients of anticonvulsant hypersensitivity syndrome were studied. Fever and skin rash were present in all patients with peripheral blood leucocytosis and eosinophilia in 30 patients. Phenytoin was the commonest offending drug(39 patients) followed by carbamazepine (19 patients). AHS appeared after 2-12 weeks of the intake of offending drugs. Head injury was the primary illness in 43 patients (70 per cent) followed by brain tumors (9 patients). Cross reactivity between phenytoin and carbamazepine was seen in 3 patients. Most patients recovered well with withdrawal of the offending drugs and treatment with topical corticosteroids and antihistamines. There was only one fatality.

Palpable purpura is the clinical hallmark of leukocytoclastic vasculitis. Its etiology can be varied but often is elusive. Henoch- Schonlein purpura (HSP) is a distinct subtype of hypersensitivity vasculitis of unknown cause occurring primarily in children. IgA deposits in vessels is thought to be diagnostic of HSP. This study is aimed to evaluate the etiology, clinical manifestations and therapeutic outcome in patients with palpable purpura and to assess the relevance of IgA deposits in these patients. Thirty-six patients with palpable purpura were evaluated by history and laboratory investigations including biopsy for histopathology and direct immunotluorescence. Twenty-four patients received treatment with dapsone, steroids or a combination. All patients were followed up at first and third month and then at 6 monthly intervals for a maximum of 2 years.

Two hundred patients with alopecia areata who attended the Skin. O.P.D. were studied in respect to the age, sex and patterns and sites of involvement and other associated dermatoses.

Facial angiofibromas in systemic sclerosis cause significant cosmetic disfigurement and emotional distress. The treatment of these lesions have been a challenge because of the multiplicity of the lesions and the presence of the lesions at anatomically difficult sites. Four female patients between 12-22 years in age with extensive angiofibromas on face, nasolabial folds and chin for 2-10 years were treated with carbon dioxide (C02) laser. The lesions in all patients were vaporized with the indigenously developed C02 laser. All the patients were evaluated at 1 and 2 weeks and then every month for 6 months to assess the overall response to treatment and side effects. All the patients responded to the treatment and had an improvement of 50-80%. Transient erythema and hypopigmentation were seen in all the patients while post laser hyperpigmentation was seen in 2 patients. There were no other significant side effects. CO2 laser seems to be a good therapeutic tool for the treatment of extensive facial angiofibromas with good, cosmetically acceptable results even in dark (brown) skin patients with negligible side effects and minimal recurrences.

Aplasia cutis congenita is a rare congenital anomaly where skin is missing over part of the body. Most of the cases are present on the scalp. We present a case of ACC where skin was absent over the lumbosacral area. It was associated with meningomyelocoel.

Pretibial myxoedema presenting as a diffuse plaque form is being reported in a hypothyroid patient.

Rhinosporidiosis is a chronic disease, classically involving the nose and nasopharynx, clinically presenting as polypii. However,disseminated rhinosporidiosis, involving various other sites including lips, conjunctiva, uvula, vagina, larynx. trachea. scalp and skin is also known to occur. A case of rhinosporidiosis, with nasal, oropharyngeal and multiple cutaneous lesions, in a patient who is sera - positivafor HIV is reported.

A 1-year-old boy presented with recurrent pyoderma-like lesions and purulent ear discharge of 6 months duration. The biopsy helped to confirm Letterer Siwe disease. Purpuric lesion on palms and soles which is a reputedly lethal sign of the disease was also present in the child who died within a few days.