Pyoderma gangrenosum is a neutrophilic dermatosis with distinctive clinical manifestations. It is frequently associated with systemic diseases like inflammatory bowel disease, rheumatoid arthritis and myeloproliferative diseases. The etiopathogenesis of pyoderma gangrenosum is still not well understood. Clinically it is classified into ulcerative, pustular, bullous and vegetative types. The diagnosis mainly depends on the recognition of evolving clinical features as there are no specific investigations for the diagnosis. It is essential to exclude other infectious diseases before therapy is initiated as corticosteroids and immunosuppressant therapy are the mainstays in the treatment of this disease. Recently, drugs like tacrolimus, mycophenolate mofetil and infliximab have shown promising results in this condition. Recent concepts regarding the various types of pyoderma gangrenosum and its management are reviewed.

BACKGROUND: We have been observing that a significant proportion of our patients, especially females, have certain pigmentary demarcation lines (PDL) over the face. However, systematic studies of the subject are lacking. AIMS: We categorized the different clinical patterns of facial PDLs in the Indian subpopulation and assessed their prevalence in this study. METHODS: About 4000 consecutive patients, both males and females, attending our skin clinic were examined for the presence of any pigmentary demarcation lines on the face, from October 1998 to February 2000. RESULTS: Out of the study population of 4037 patients, 243 (6%) were found to have demarcation lines on the face. The demarcation lines were far more common in women (9%) than in men (0.75%). These lines could be classified into three patterns that we would like to label as F, G, H as PDLs A to E have already been described. CONCLUSIONS: Pigmentary demarcation lines are fairly common in the Indian population especially amongst the females. Hormonal influences could possibly explain the female preponderance. Aggregation of cases within families or among close relatives suggests a genetic background.

BACKGROUND: The common causes of textile dermatitis are formaldehyde resins and disperse dyes. There are various methods to detect the presence of formaldehyde in clothing. AIM: To detect the presence of formaldehyde in various types of textiles by the chromotropic acid method and to assess the effect of washing on the formaldehyde content. METHODS: Twenty randomly selected textiles from a local cloth store were tested for formaldehyde by the chromotropic acid method. A purple ring indicated a positive reaction. The intensity of the purple ring was graded from 1+ to 3+ and reassessed after washing the clothes. RESULTS: Eleven out of the 20 textiles tested positive for formaldehyde. The fully synthetic clothes were free from formaldehyde. After the first and second washes the majority did not show a reduction in the formaldehyde content. CONCLUSIONS: This is a simple and rapid test which can be used in the practical management of patients with textile allergy. Washing the clothes may not have an effect on the formaldehyde content.

BACKGROUND: Premenstrual acne is poorly understood, the accepted hypothesis is 30 years old. AIMS: Here we test the hypothesis that premenstrual acne can be suppressed using Cox-2 inhibitors. METHODS: Eighty women with premenstrual acne were enrolled in a trial where they were given rofecoxib, a Cox-2 inhibitor or placebo for 10 days for two cycles and were evaluated using acne severity index and inflammatory acne counts. RESULTS: Rofecoxib was more effective than the placebo. CONCLUSIONS: Although the number studied is small, the results suggest that rofecoxib is effective in the management of premenstrual acne and that prostaglandin PGE2 may be involved in its pathogenesis.

BACKGROUND: Extensive alopecia areata is known to respond to daily oral corticosteroids. To minimize the side effects of daily corticosteroids, oral mini-pulse therapy with betamethasone has been used in vitiligo and other dermatoses. There are a few studies in alopecia areata also. AIM: To evaluate the efficacy of oral mini-pulse therapy in extensive alopecia areata. METHODS: It is an open study on sixteen adolescents and adults with alopecia areata/ totalis/universalis treated with oral mini-pulse therapy for a minimum period of six months. The patients were evaluated clinically and with serial photographs for response and periodical investigations were undertaken to look for the side effects. All the patients were followed up for 5-8 months to look for any relapse. RESULTS: Seven (43.7%) patients showed an excellent response and five (31.2%) patients had good response. Two patients (12.5%) had unsatisfactory response and another two (12.5%) were non-responders. There were insignificant / minimal side effects. CONCLUSION: Oral mini-pulse therapy with betamethasone is a safe and effective therapeutic modality for extensive alopecia areata.

BACKGROUND AND AIMS: Certain endocrinological disturbances are assumed to exacerbate psoriasis. In this study we compared the serum thyroid hormone levels of a group of psoriasis patients with that of a control group. METHODS: The total T3 (TT3), free T3 (FT3), total T4 (TT4), free T4 (FT4) and TSH levels obtained from the sera of 103 psoriatics (37 males and 66 females) and 96 controls (40 male and 56 female) were measured by immunological assay. RESULTS: Statistical assessments displayed no differences in TT3, FT4 and TSH serum levels for the two groups. Differences between the means of serum TT4 (P=0.033) and serum FT3 (P=0.041) levels showed statistical differences among the groups. We also found that at least one thyroid hormone level in the blood was increased in 23 patients of the psoriatic group compared to 9 patients in the control group (P=0.022). The average Psoriasis Area and Severity Index scores in this patient group were significantly higher than in those with normal hormone levels (P<0.001). CONCLUSIONS: The role of thyroid hormones in the etiopathogenesis of psoriasis and the effects of such differences in psoriatic patients must be investigated with wider and comprehensive laboratory and clinical studies.

Three women with large, mutilating genital ulcers of long duration, destroying almost the lower half of the external genitalia, are reported. They had a history of recurrent oral ulcers as well. All patients had been diagnosed as having 'genital ulcer syndrome' in the past and had been treated with antimicrobials. Histopathology of the biopsy from the margin of the ulcer revealed features of leukocytoclastic vasculitis. Considering the history, clinical features and histology, a diagnosis of bipolar aphthosis was made in all patients. All patients responded well to immunosuppressive therapy. The cases are reported because of the presence of genital ulcers of an unusually large size, mutilating character and their close similarity to genital ulcers due to sexually transmitted diseases, especially genital herpes and donovanosis.

Neurofibromatosis (NF), one of the commonest phakomatoses, is characterized by varied clinical manifestations. Segmental NF is one of the uncommon subtypes of NF. We report a young adult presenting with asymptomatic skin lesions- neurofibromas and café-au-lait macules- over localized areas of the lower back, affecting more than one segment. None of the family members were found to have features of segmental NF. Segmental NF may be misdiagnosed as a birthmark or remain undiagnosed for long periods of time, as the patients are often asymptomatic. Moreover, the clinical features are highly variable and range from a small area of skin involvement to involvement over the entire half of the body. This variation is explained by the fact that segmental NF is thought to arise from a postzygotic NF1 gene mutation, leading to somatic mosaicism. We have also reviewed the relevant literature on this subject.

Porokeratosis is a genodermatosis characterized by abnormal epidermal keratinization with the histological feature of cornoid lamella. There are many clinical variants, but two or more of these variants rarely occur in a single patient. This variation in clinical presentation may be due to the different phenotypic expression of a common genetic abnormality or may be the consequence of abnormalities in closely linked genetic loci or genes. Here we report about a child who showed simultaneous occurrence of disseminated, linear and hypertrophic verrucous lesions of porokeratosis. He also had genital lesions, reported uncommonly in the medical literature.

Eccrine hidrocystomas are rare, benign, cystic lesions with a lining that resembles that of the eccrine sweat gland and may be solitary or multiple. Multiple eccrine hidrocystomas occur predominantly on the face as asymptomatic, skin-colored to bluish lesions associated with a chronic course and seasonal variability. Treatment of multiple lesions on the face is challenging. Efficacy with atropine ointment is variable. Botulinum toxin and pulsed dye laser are reported to be beneficial. Two cases of multiple eccrine hidrocystomas are reported who showed no response to 1% atropine ointment.

A 28-year-old man came to us with a solitary skin colored, mildly tender nodule of 6 months duration on the dorsum of the right hand. On histological examination, multiple dilated ducts without apparent continuity with the surface were found in the dermis. These dilated ducts had branching tubules with eosinophilic amorphous material filling most of the lumina. The peripheral cells of the tubules resembled myoepithelial cells, whereas the luminal border cells were cuboidal or low columnar. Papillary projections arising from the inner cells were seen extending into the lumen. These features were diagnostic of a rare tumor, papillary eccrine adenoma.

Larva migrans is characterized by tortuous migratory lesions of the skin caused by larvae of nematodes. A 26-year-old fisherman presented to us with complaints of an itchy eruption on his back and arms of two months' duration. Clinical examination revealed multiple wavy serpentine tracts and fork like lesions with a raised absolute eosinophil count of 3800 cells/cmm. Biopsy was inconclusive. This case is reported to highlight the extensive involvement by larva migrans.

Soft tissue augmentation has revolutionized the treatment of the aging face. It is a technique in which a substance is injected under the skin. The concept of utilizing materials for soft tissue augmentation actually began around 1950 with the use of fluid silicone. Today we have a large armamentarium of implant materials to delay the tell tale signs of aging. Filling has replaced conventional surgery in facial rejuvenation. In this article, the emphasis will be on hyaluronic acid as this substance is easily available in India and ranks among the most widely used dermal fillers.