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Antiretroviral therapy (ART) has transformed HIV infection into a treatable, chronic condition. However, the need to continue treatment for decades rather than years, calls for a long-term perspective of ART. Adherence to the regimen is essential for successful treatment and sustained viral control. Studies have indicated that at least 95% adherence to ART regimens is optimal. It has been demonstrated that a 10% higher level of adherence results in a 21% reduction in disease progression. The various factors affecting success of ART are social aspects like motivation to begin therapy, ability to adhere to therapy, lifestyle pattern, financial support, family support, pros and cons of starting therapy and pharmacological aspects like tolerability of the regimen, availability of the drugs. Also, the regimen's pill burden, dosing frequency, food requirements, convenience, toxicity and drug interaction profile compared with other regimens are to be considered before starting ART. The lack of trust between clinician and patient, active drug and alcohol use, active mental illness (e.g. depression), lack of patient education and inability of patients to identify their medications, lack of reliable access to primary medical care or medication are considered to be predictors of inadequate adherence. Interventions at various levels, viz. patient level, medication level, healthcare level and community level, boost adherence and overall outcome of ART.

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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.

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Clinicians always find it difficult to treat hypertrophic scars and keloids. Various treatment modalities are available. Intralesional corticosteroids, topical applications, cryotherapy, surgery, laser therapy, and silicone sheeting are the widely used options. Radiation therapy can also help in cases of recalcitrant keloids. Most recently, pulsed-dye laser has been successfully used to treat keloids and hypertrophic scars. There are no set guidelines for the treatment of keloids. Treatment has to be individualized depending upon the distribution, size, thickness, and consistency of the lesions and association of inflammation. A combination approach to therapy seems to be the best option.

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Nail disorders are frequent among the geriatric population. This is due in part to the impaired circulation and in particular, susceptibility of the senile nail to fungal infections, faulty biomechanics, neoplasms, concurrent dermatological or systemic diseases, and related treatments. With aging, the rate of growth, color, contour, surface, thickness, chemical composition and histology of the nail unit change. Age associated disorders include brittle nails, trachyonychia, onychauxis, pachyonychia, onychogryphosis, onychophosis, onychoclavus, onychocryptosis, onycholysis, infections, infestations, splinter hemorrhages, subungual hematoma, subungual exostosis and malignancies. Awareness of the symptoms, signs and treatment options for these changes and disorders will enable us to assess and manage the conditions involving the nails of this large and growing segment of the population in a better way.

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Introduction: Adapalene is a novel retinoid indicated for the topical treatment of acne vulgaris. The drug was introduced in India in 2001. Aims: A post-marketing surveillance study was conducted to assess the safety and efficacy of adapalene gel 0.1% when used as monotherapy or in combination with other anti-acne agents in Indian patients of acne vulgaris. Material and Methods: A 12-week, multicentre, open-label, non-comparative study involving 571 patients from 21 centers across India was conducted between January and September of 2002. Concomitant prescription of other anti-acne drugs was permitted, if needed. Results: Of the 571 patients, 441 completed the treatment as per protocol. At the end of therapy, 96.3% of patients showed an improvement in their acne from baseline, with greater than 75% improvement seen in two-thirds of patients. Adverse events were reported in 24% of the patients, none of which were serious. The tolerability of therapy was rated as excellent/good in 81% of patients by physicians and in 78% by the patients. Conclusion: Adapalene gel 0.1% is a safe and effective topical agent in the treatment of mild to moderate acne vulgaris in Indian patients. It may be safely combined with other topical and oral anti-acne agents.

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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.

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Photosensitivity disorders in children include a wide array of conditions, many of which are unique to this age group. Prompt diagnosis of these disorders becomes difficult at times because of the overlapping clinical pictures. Genodermatoses and metabolic disorders may have associated systemic involvement, which may lead to these children presenting to pediatricians who may overlook the photosensitivity. A dermatologist's consultation is essential in such cases for specific instructions and counseling of parents regarding photoprotection in these children. This intervention may improve the quality of life by reducing the morbidity and chances of early mortality. This review includes a comprehensive discussion of the distinguishing clinical features of childhood photodermatoses along with general guidelines regarding their investigation and treatment.

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Nickel is a ubiquitous trace element and it occurs in soil, water, air and of the biosphere. It is mostly used to manufacture stainless steel. Nickel is the commonest cause of metal allergy. Nickel allergy is a chronic and recurring skin problem; females are affected more commonly than males. Nickel allergy may develop at any age. Once developed, it tends to persist life-long. Nickel is present in most of the dietary items and food is considered to be a major source of nickel exposure for the general population. Nickel content in food may vary considerably from place to place due to the difference in nickel content of the soil. However, certain foods are routinely high in nickel content. Nickel in the diet of a nickel-sensitive person can provoke dermatitis. Careful selection of food with relatively low nickel concentration can bring a reduction in the total dietary intake of nickel per day. This can influence the outcome of the disease and can benefit the nickel sensitive patient.

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Two cases of Cornelia de Lange syndrome with similar phenotypic features are reported.

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The cutaneous and mucosal pain syndromes are characterized by pain, burning sensation, numbness or paraesthesia of a particular part of the skin or mucosal surface without any visible signs. They are usually sensory disorders, sometimes with a great deal of psychologic overlay. In this article various conditions have been listed and are described. The possible causative mechanisms are discussed when they are applicable and the outline of their management is described.

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Corticosteroids are potent drugs used in management of various inflammatory and autoimmune disorders. The antiinflammatory effects of corticosteroids cannot however be separated from their metabolic effects. Children are more vulnerable to their side effects, particularly the effects on growth, immunity and adrenal suppression. It is essential for the treating physician to be aware of the side effects and the measures to be taken to minimize them. A side effect that is unique to children is growth suppression, which is helped by alternate day treatment. Administration of small doses of prednisolone (10-15 mg/day or < 0.5 mg/kg/day single dose) on alternate days, does not slow growth velocity significantly. The potency of dexamethasone and betamethasone in suppressing growth is nearly 18 times higher than that of prednisolone. There is some evidence that the administration of growth hormone can reverse these changes.

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Background: Lichen simplex chronicus (LSC) of the anogenital region, is a benign, extremely uncomfortable disease. Aims: As very little is known about the cause of anogenital LSC (AGLSC), we undertook this study to determine various clinico-etiological factors involved in it and to assess the frequency of AGLSC. Methods: This was a descriptive study, including 105 patients with AGLSC, who attended the Dermatology clinic in our institute from September 2007 to June 2009. Detailed history, physical examination, and relevant investigations were done. The collected data were tabulated and analyzed. Results: The frequency of AGLSC among patients presenting with anogenital pruritus was 2.54%. Primary AGLSC was more common than secondary AGLSC (69.5% vs. 30.5%). AGLSC manifested more commonly in males than in females (56.2% vs. 43.8%). The mean duration of the disease was 30.6 months. The common triggering factors for itching were sweating (41.9%), rubbing of thighs while walking for long distances (9.5%), and mental stress (5.7%). Pruritus of AGLSC was related to the intake of various food items in 37.1% of patients. In males, scrotum was the predominant site involved (89.8%), whereas in females, labia majora was the predominant site involved (78.2%). Nearly one-third of cases (30.5%) of AGLSC had some other dermatoses in the anogenital region. Conclusions: Though psychological factors are thought to play an important role in disease causation and perpetuation among AGLSC patients, their significance could not be ascertained by us.

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Acute skin failure is a state of total dysfunction of the skin resulting from different dermatological conditions. It constitutes a dermatological emergency and requires a multi-disciplinary, intensive care approach. Its effective management is possible only when the underlying pathomechanism of each event is clear to the treating clinician. The concept of skin failure is new to non-dermatologist clinicians and sketchy among many dermatologists. Here the pathomechanism of skin failure has been analyzed and a guideline for monitoring has been provided. There is a need for intensive care units for patients with acute skin failure.

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Twenty patients with Schamberg's disease were started on pentoxifylline (400 mg once daily) for a period of 8 weeks. Improvement was assessed at 2 weekly intervals by two observers independently and graded as mild (<25%, moderate (25-50%) and marked (>50%). Marked improvement was observed in 10/20(50%) patients. We conclude that pentoxifylline should be considered as first line therapy in all patients with Schamberg's disease

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Fluticasone propionate is a new topical steroid developed as a result of modification of the 19-carbon androstane structure. In the present study, efficacy of this steroid was compared with betamethasone valerate cream in patients with psoriasis and eczema. Though fluticasone propionate was marginally more effective than betamethasone valerate, this difference was not statistically significant.

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A 24-year-old unmarried male presented with a rudimentary reduplicated penis. This case is reported for its rarity and exotic presentation.

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