Leprosy control programs, including multi-drug therapy for leprosy, have undergone significant changes over the last few years. With the process of integration of leprosy into general health services taking place all over India, dermatologists are more responsible for the care of leprosy patients than ever before. This article attempts to highlight some of the important changes in control programs and advances in the therapy of leprosy.

BACKGROUND: Phototesting is an essential tool in the investigation of photodermatoses. AIMS: The main aim was to study the cutaneous response to UVR in terms of minimal erythema dose (MED) to both UVA and UVB in normal Indian subjects with a solar simulator and to study the relationship of skin type to MED. METHODS: One hundred healthy volunteers not on any medication and without any history of photodermatoses were phototested using a solar simulator with whole spectrum irradiation (UVA, UVB and visible light) and only visible and UVA radiation. The tested areas were marked with gentian violet and readings were taken after 24 hrs. RESULTS: Of the 100 volunteers, 48% were males and 52% were females, with a mean age of 36.6 ± 11.6 yrs. The most common skin type among Indians was type 5 (46%) followed by type 4 (41%). The mean MED for UVB was 61.5 ± 17.25J/cm2. The MED for UVA could not be determined as none of the patients showed any erythema after irradiation for 45 minutes. CONCLUSIONS: As the MED is found to be low in idiopathic acquired photodermatoses, the MED in the normal population could serve as a baseline data in the investigation.

BACKGROUND AND AIMS: Lesions of post-kala-azar dermal leishmaniasis (PKDL) usually affect the skin. Uncommonly, the involvement of oral and genital mucosae has been reported. METHODS: Twenty five patients clinically diagnosed as post-kala-azar dermal leishmaniasis were studied for periorificial and mucosal lesions. Clinical examination, skin smears and biopsy were done for the patients with periorificial or mucosal lesions. RESULTS: Out of 25 patients of PKDL, seven patients had lesions on the oral and/or genital mucosa. Three cases had oral lesions; two had only genital lesions and three patients had both sites involved. All the patients were having skin lesions elsewhere too either as nodules and/or plaque or macules. Conclusion: While examining a case of PKDL, mucosal involvement must also be examined carefully.

BACKGROUND AND AIMS: Chronic urticaria has a spectrum of clinical presentations and causes. About 25%-45% of patients have histamine releasing autoantibodies in their blood. The term autoimmune urticaria is increasingly being accepted for this subgroup of patients. The term autoimmune urticaria is used to reflect advances in knowledge about functional autoantibodies that activate mast cells and basophils through cross linking high affinity IgE receptors to secrete histamine. This study was started to find out incidence of autoimmune urticaria in Indian patients. METHODS: The autologous serum skin test was done in 45 patients with chronic urticaria of more than six weeks duration. Physical urticaria patients were not included in the study. RESULTS: Twelve patients had positive autologous serum skin test suggestive of autoimmune urticaria. CONCLUSIONS: Positive autologous serum skin test was seen in 26.67% of patients which is less than reports from Western literature. This is a useful screening test for autoimmune urticaria.

BACKGROUND AND AIMS: Dermatology consultation occurs mainly in the outpatient setting. The reasons for inpatient dermatologic consultation by other specialties in a hospital, its frequency and its impact on health care are largely unrecorded. METHODS: We retrospectively studied the records of 971 hospitalized patients or patients being evaluated in emergency services for which a dermatologist's consultation was requested over a 5 - year period in a medium sized military hospital. The demographic details, specialties requiring consultation, provisional diagnosis and dermatological investigations done were tabulated. RESULTS: Dermatologic consultation changed the dermatologic diagnosis and treatment in more than 2/3rd of the patients. Generally, the dermatologic diagnoses most frequently missed by the referring service were common conditions with established treatment. CONCLUSION: The overall impact of dermatologic consultation on health delivery to patients was substantial. Important recommendations to any health care system are offered.

BACKGROUND: Desonide, a non-halogenated, low-potency topical steroid, is indicated in the treatment of steroid-responsive dermatoses. AIMS: A post-marketing surveillance study was conducted to evaluate the efficacy and safety of DesowenTM (Desonide 0.05%) cream and lotion in Indian patients for the treatment of steroid-responsive dermatoses of mild to moderate severity. METHODS: A 3-week, multicenter, open-label, non-comparative Phase IV trial involving 1789 patients from 229 centers across India was conducted between January and August 2003. RESULTS: Of the 1789 patients, 1483 patients completed the treatment as per protocol. At the end of the therapy, 98.5% of the patients showed an improvement in their dermatitis from baseline. More than half of the patients showed a greater than 75% improvement in their signs and symptoms. No adverse effects were noted in any of the patients. Both the lotion and cream were found to be equally effective. CONCLUSIONS: Desonide 0.05% is a safe and effective low-potency corticosteroid for the treatment of mild to moderate dermatoses in Indian patients. No clinically apparent side-effects were observed in infants less than 1 year of age.

BACKGROUND: The skin occupies a powerful position as an organ of communication and plays an important role in socialization throughout life. The interface between dermatology and psychiatry is complex and of clinical importance. AIMS: To document the incidence of cutaneous disorders in patients with primary psychiatric conditions. METHODS: Three hundred patients with a primary psychiatric condition who had cutaneous disease were entered into the study group. The patients were classified appropriately based on the classification of psychocutaneous disorders. The control group included 300 patients presenting with a skin disorder and without any known psychiatric complaint. RESULTS: The majority of the cases in the study group were in the 3rd-5th decade. In this study, the most common primary psychiatric conditions were manic depressive psychosis (53.33%), depression (36.33%), schizophrenia (8.33%) and anxiety (2%). Of the study group, 68.66% patients had infective dermatoses and the rest had non-infective dermatoses. A high incidence of pityriasis versicolor and dermatophyte infections was noted in males from the study group. Among non-infective dermatoses, 8% had eczema, and psychogenic skin disorders were seen in 4.67% of the study group. Of these, delusions of parasitosis were the commonest (2%) followed by venereophobia (1%). CONCLUSIONS: A statistically significant higher incidence of tinea versicolor and dermatophyte infections was seen in the study group. Delusion of parasitosis was the most common psychogenic skin disorder seen in the study group, followed by venereophobia.

Delusional parasitosis (Ekbom syndrome) is an uncommon psychiatric disorder that presents with a delusion of being infested with parasites. Treatment of this condition is difficult as patients with this paranoid disorder reject psychiatric diagnosis and treatment and often consult a dermatologist. Sharing the delusional beliefs of the paranoid patient by other people living in close emotional bonding with him/her could occur. We report here the clinically interesting phenomenon of delusion of parasitosis occurring simultaneously in all the members of a family. There was a pathological bonding between the members of the family who all presented to the dermatologist and rejected treatment. Dermatologists need to be aware of this uncommon clinical picture.

Wheat is widely consumed all over India in various forms - flour, daliya, maida, suji and wheat bran. Very few cases of wheat induced urticaria have been reported. This may be due to unusual features of wheat related hypersensitivity. A 35 year old female presented to us with history of chronic urticaria and angioedema. History revealed correlation between wheat intake and urticaria episodes. Prick testing was done with wheat antigen in the standard series and derivatives of raw wheat. Normal saline and histamine were used as controls. Prick testing was positive. Oral challenge induced urticaria within half an hour. This report discusses clinical features of wheat related hypersensitivity.

Darier-White disease is due to a defect in the ATP2A2 gene encoding the sarcoplasmic/endoplasmic reticulum Ca2+ ATPase (SERCA2b). We report a case of carcinoma cervix in whom Darier's disease manifested after the initiation of radiation therapy. Conventional cytogenetics on peripheral blood revealed non-clonal constitutional autosomal and X chromosome abnormalities suggesting radiation induced gene toxicity. Occurrence of Darier's disease in our case could be due to treatment induced sustained differentiation in the Darier's affected skin by an unknown mechanism. Late onset or sporadic Darier's disease is the other possibility.

Mycosis fungoides (MF), the commonest variant of primary cutaneous T cell lymphoma (CTCL), is relatively uncommon among the Asians. Hypopigmented mycosis fungoides is a rare variant usually observed in dark-skinned individuals, especially children. Hypopigmented MF usually responds well to therapy, particularly to PUVA, and has a comparatively benign course. Mycosis fungoides in a 16-year-old boy, with extensive asymptomatic hypopigmented lesions developing gradually all over the body over eight years and vitiligo-like skin lesions developing for seven years, with no systemic features, is presented for its unusual clinical features and conspicuous histopathological findings of prominent epidermotropism. The case showed fairly good response to PUVASOL therapy.

Lithium is known to cause a variety of dermatological problems, common ones being acneiform eruptions, folliculitis and psoriasis including its pustular form. Hidradenitis suppurativa and acne conglobata are lesser known side effects, with only three reports so far. We report a patient, who had bipolar affective disorder, was on lithium for a long duration and developed hidradenitis suppurativa and acne conglobata during therapy, which subsequently decreased once lithium was stopped. We describe this case for its rarity and analyze its pathogenesis.

Dermatofibrosarcoma protuberans (DFSP) is a rare, slow growing, locally aggressive dermal tumor of disputed histogenesis with a tendency for local recurrence. A 16-year-old female presented with hyperpigmented macules, papules, plaques, erythematous nodules and atrophic, indurated lesions ranging from a few millimeters to a few centimeters. Biopsy revealed thinned out epidermis and a diffuse dermal infiltration by fascicles of spindle cells arranged in storiform pattern. The pseudoseptae formed by the tumor cells interdigitating between the subcutaneous adipocytes resulted in a honeycomb pattern. Histochemical findings are helpful, but the chronicity, size, indolent nature, recurrence after surgery and histopathology are more important to arrive at a diagnosis. Wide and deep surgical excision is the treatment of choice.