Although malignant melanoma is not the most common type of skin cancer, it is the most aggressive and fatal type as it can spread out and metastasize progressively. Early diagnosis and interventions lead to improved patient survival. The incidence rate of melanoma is dramatically increasing, with a few newer therapeutic options available. Therefore, establishing a reliable genetic or epigenetic-based diagnostic and prognostic tool is really important. In this review, we highlight the underlying epigenetic mechanisms involved in melanoma. Furthermore, the epigenetic-based therapeutic options will be also discussed. One of the key areas of discussion will be microRNA which is a small, single-stranded RNA molecule that serves as a regulatory element and found to regulate nearly a third of human genes. MicroRNAs play a role in a wide range of diseases including cancer. In malignant cells, it regulates cell proliferation, invasion, and metastasis.

Introduction: Leprosy or Hansen's disease is a chronic debilitating disease caused by Mycobacterium leprae. Host genetics are believed to strongly influence the course of the disease. It is known that cytokines play an important role in leprosy and cytokine gene polymorphisms probably influence the course of the disease. Methods: In the present study, we evaluated 70 patients with leprosy and 243 controls. DNA was extracted from the peripheral blood and genotyping was done for the following polymorphisms: IL-1 RA intron 2, IL-1β-511 C/T and TNF-α A/G. Results: A strong association of TNF-α-308 G/A polymorphism with Hansen's disease with both genotypes and alleles was found. However, no correlation was identified between the other two polymorphisms and Hansen's disease. A strong association between the IL-1β gene polymorphisms and the type of reactions seen in leprosy was found. In contrast, the other two polymorphisms did not show any such association. Limitations: Genetic polymorphisms are association studies. They are not a direct reflection of the transcriptome or proteome and this is a major limitation of this study. Conclusion: In conclusion, cytokine gene polymorphisms appear to influence the susceptibility and course of Hansen's disease. An evaluation of the cytokine levels in the skin during lepra reactions would confirm this observation. Possibly, in future, this would be a guide to therapeutic decisions in cases of lepra reactions.

Background: Vitiligo is an autoimmune depigmentation disorder caused by multiple etiologies. Genetic polymorphisms in cytokine genes influence their expression and augment disease development. Analyzing the influence of genetic polymorphisms will help in better understanding of the complex etiopathogenesis of vitiligo. Aim: To study the influence of interleukin IL-10 (rs1800896) and IL-13 (rs1800925) polymorphisms on vitiligo risk in South Indian population. Methods: Two hundred and sixty-four vitiligo patients and 264 controls were recruited in this study. Genotyping was done by quantitative PCR and plasma cytokine levels were measured by ELISA. Results: Allele frequencies of IL-10 (rs1800896) and IL-13 (rs1800925) SNPs were observed to be equal in the groups. Mutant allele G of IL-10 (rs1800896) enhanced the familial inheritance of vitiligo (P < 0.0001, OR-25.1, 95% CI-7.64–82.7) and influenced the development of vulgaris type of vitiligo (P = 0.034, OR-1.83, 95% CI-1.07–3.13). Ancestral allele A of IL-10 (rs1800896) conferred protection against development of acrofacial vitiligo (P = 0.04, OR-0.56, 95% CI-0.33–0.95). Circulatory IL-10 levels in vitiligo patients were higher than controls (P < 0.0001). Individuals with genotype GG of IL-10 (rs1800896) had the highest circulatory levels of IL-10 (P < 0.0001). Among the genotypes of IL-13 (rs1800925) variant, none influenced the phenotype of nonsegmental vitiligo such as gender, family history, age of onset and types of vitiligo (P > 0.05). In addition, no difference was noted in the circulatory levels of IL-13 between patients and controls (P = 0.48). Within patients, CC genotype of IL-13 (rs1800925) was observed to enhance the circulatory IL-13 levels (P < 0.0001). Limitation: Replication group analysis in a larger multicentric cohort in future would validate further understanding of vitiligo susceptibility in South Indian ethnics. Conclusion: IL-10 (rs1800896) and IL-13 (rs1800925) polymorphisms did not confer risk to develop vitiligo in South Indian population.

Background: Indian data on potential hepatorenal toxic effects of highly active antiretroviral therapy (HAART) in HIV/AIDS-affected persons is lacking. Objectives: To assess hepatorenal abnormalities in HIV-infected persons on HAART in a hospital-based mixed cohort study using concurrent and nonconcurrent data analysis. Methods: Hepatorenal function tests, urinalysis and ultrasonogaphy for liver/kidneys (when applicable) were assessed in 400 (men 185; women 215) persons aged 2–84 (mean 47.8) years on HAART. Acute liver toxicity, acute kidney injury and chronic kidney disease were defined depending upon abnormal serum alanine aminotransferase, urea and creatinine levels/clearance as per standard guidelines. Results: The duration of HAART was 1 month to 9 years (mean 3.7 years) with 284 (71%) individuals being on treatment for ≤5years. The major HAART regimens included zidovudine + lamivudine + nevirapine in 175 (43.8%), tenofovir + lamivudine + efavirenz in 174 (43.5%) and zidovudine + lamivudine + efavirenz in 20 (5%) individuals and were associated with grade-1 hepatic dysfunction in 57 (14.3%) individuals, with men aged between 31 and 45 years on antiretroviral therapy for >5 years being mainly affected. Forty two (17.1%) of 246 individuals with anemia and 15 (9.7%) of 154 individuals without anemia showed hepatic dysfunction. None had acute kidney injury, chronic kidney disease or abnormal urinalysis or ultrasonography. In contrast, the pretreatment elevated serum alanine amiotranerase in 99 (22.3%) and blood urea and/or creatinine levels in 16 (4%) individuals decreased significantly post highly active antiretroviral therapy. Conclusions: The study reflects the low frequency of regimen based highly active antiretroviral therapy-associated hepatic or nephrotoxicity despite prolonged use, especially in the absence of other risk factors. Preexisting anemia appears an important risk factor for highly active antiretroviral therapy-induced hepatotoxicity (OR 1.90, Cl 95% CI 1.02–3.57, P = 0.04). Highly active antiretroviral therapy-associated nephrotoxicity was not a significant problem. Study of viral load or other risk factors and potential of each drug for hepatorenal toxicity/dysfunction in HIV affected were not part of the study. A small number of subjects and retrospective analysis of biochemical parameters were other important limitations.

Background: Long-term low-dose methotrexate therapy is associated with liver fibrosis. Although liver biopsy is the gold standard for detecting fibrosis, it is an invasive procedure associated with morbidity and mortality risks. Hence noninvasive imaging techniques such as transient elastography (TE) and shear wave elastography (SWE) have been studied to measure liver stiffness. Aims: To assess the utility of TE and SWE in detecting fibrosis in patients with psoriasis and reactive arthritis on long-term methotrexate therapy. Methods: A cross-sectional prospective study was undertaken on 54 patients with psoriasis and reactive arthritis who had received ≥1.5 g of methotrexate. Various clinical and biochemical [fibrosis 4 index (FIB4), aspartate-transaminase-to-platelet ratio index (APRI)] parameters were calculated and liver stiffness measurement (LSM) was done with TE and SWE. The degree of steatosis was measured using controlled attenuation parameter (CAP). Liver biopsy was done when indicated and was interpreted by a pathologist blinded to clinical and imaging results. Results: Fifty four patients with a mean age of 40.3 years and a male-to-female ratio of 5:1 were included. The mean cumulative methotrexate dose was 3.04 g. The median FIB4, APRI, and gamma-glutamyl transpeptidase-to-platelet ratio values were 0.75, 0.23, and 0.15, respectively. The median LSM for TE and SWE was 5.3 and 7.32 kPa, respectively. SWE and TE showed a weak positive correlation (r = 0.26, P = 0.053). The mean CAP was 217 dB/m (area under the receiver operating characteristic = 0.70). In the 19 of 26 cases whose liver biopsies could be assessed, only 4 (21%) showed F1 fibrosis (Ishak staging). The median LSM on SWE was significantly higher in patients with a cumulative methotrexate dose ≥ 4 g when compared with those with a dose <4 g (9.85 vs 7.1, P = 0.02). Other parameters did not correlate with TE and SWE. Limitations: The small sample size and the low number of cases with significant fibrosis on histopathology were the major limitations of this study. Conclusion: Histologically detectable LF is uncommon in patients with psoriasis and reactive arthritis on long-term methotrexate therapy. Both TE and SWE are good at detecting the absence of fibrosis in these patients. In our study, SWE and TE values did not correlate with clinical, biochemical, or histopathological parameters.

We report a case of a patient with Cushing's disease with oseltamivir-induced toxic epidermal necrolysis, who was treated with cyclosporine with favorable evolution. There is only one case reported of Cushing's disease and toxic epidermal necrolysis and very few oseltamivir-induced toxic epidermal necrolysis cases in literature. This report also discusses the role that the preexisting hypercortisolism condition may have played in the development and favorable resolution of the toxic epidermal necrolysis.

Background: Despite an interest in the editorial process at biomedical journals, not much information is available on this topic. Aims: To study the characteristics of the submissions to the Indian Journal of Dermatology Venereology and Leprology (IJDVL) and analyze the editorial and peer-review process and factors influencing the final outcome. Methods: Retrospective review of the manuscripts submitted to the IJDVL from January 1, 2016, to June 30, 2016. Results: The IJDVL received 639 manuscripts during the study period, most being Case reports (35%), Research articles (30%), and Letters to editor (20%). The proportion of submissions from Indian (53%) and foreign (47%) authors was comparable. About 55% (n = 353/639) of the submissions were editorially rejected. Some of the common reasons for editorial rejection included “sub-optimal images,” “no novelty,” “incomplete information or results,” and “incorrect diagnosis or interpretation of results.” The acceptance rate during this period was 19%. The median number of days to reach the final decision was 14 days for editorial rejection, 146 days for acceptance, and 85 days for rejection after external peer-review. The acceptance rates were higher for submissions from Indian authors [odds ratio (OR) 1.96], those submitted as Letters (OR 2.06), or in the area of tropical infections (OR 2.17). Submissions as research articles (expB = 1.23), those from Indian authors (expB = 1.15), final decision being acceptance (expB = 1.56), and those requiring preliminary author revisions (expB = 3.34), external re-reviews (expB = 2.22), and repeated author re-revisions (expB = 2.34) were associated with longer times to reach final decision. Limitations: A relatively short study period of 6 months. Conclusion: The IJDVL attracts submissions both from India and abroad. Articles submitted in the Letters category or related to tropical infections were most likely to be accepted. There is scope for improving the time taken for editorial processing of manuscripts.

Introduction: Submission and publishing of research articles in scientific journals is a multistep process that should be efficient and swift. Objective: To compare the editorial, peer review and publication time between Indian dermatology journals and international dermatology journals. Methods: Three Indian (Indian Journal of Dermatology, Venereology and Leprology; Indian Journal of Dermatology and Indian Dermatology Online Journal) and three international (International Journal of Dermatology; the Australasian Journal of Dermatology and Dermatology [Karger]) dermatology journals were identified for this study. Information pertaining to time to acceptance, time to publication and the total time to publication were extracted for original articles, case reports and letters to the editor published in issues from January 2017 to December 2017. Results: The mean total time to publication in the order for Indian Journal of Dermatology, Venereology and Leprology, Indian Dermatology Online Journal, Indian Journal of Dermatology, International Journal of Dermatology, Dermatology and Australasian Journal of Dermatology were 12.61, 12.50, 9.14, 7.92, 7.13 and 6.52 months respectively. While time to acceptance and time to publication were the longest in Indian Journal of Dermatology (7.01 months) and Indian Dermatology Online Journal (8.99 months), respectively, Indian Journal of Dermatology, Venereology and Leprology was found to have the maximum overall total time for publication i.e. 12.61 months. The differences among the journals were found to be significant for all three time measures (P < 0.0001, ANOVA). On comparison of Indian and international journals, all three time measures were found to be higher in Indian journals (5.81 vs 4.96 months, 6.75 vs 3.59 months and 11.53 vs 7.51 months, respectively) with the differences being significant (P < 0.0001, independent samples t-test). Limitation: This data does not represent the performance status of rejected manuscripts, the information of which was not available in the public domain. Conclusion: An effective editorial screening, fast-tracked editorial and peer review process and regulation on turnover time of submissions by Indian dermatology journals are imperative in improving the impact of research publication.

Background: Objective structured clinical examination (OSCE) is being increasingly used as an assessment tool for undergraduate dermatology courses. One of the practical difficulties in conducting OSCEs in dermatology is getting patients with typical skin lesions which can be used for the whole group to ensure uniformity of assessment. We present a study on the use of simple moulage techniques to create uniform and standardized skin lesions for OSCEs in dermatology. Methods: As a first step, the dermatology faculty in our department chose the clinical conditions which could be covered by using moulages. The main criteria considered were the importance of the condition to the exam blueprint, ease of making and resistance to handling (should not require frequent retouching). Moulages were created on volunteers after taking consent and the same were used in OSCEs s for a group of 5^th-year students (N = 102). Difficulty and discrimination indices were compared between the stations using the moulage and the other stations. Qualitative feedback was obtained regarding the same from both the faculty and the students. Results: There was consensus among the faculty and the majority of the students that the lesions were clearly recognizable. As far as other psychometrics were concerned, average difficulty and discrimination of the stations using the moulage were good (average difficulty index—0.78 and average discrimination index—0.68) and compared favorably with the other stations (average difficulty index—0.77 and average discrimination index—0.57). Limitations: Limited number of stations included, lack of detailed item analysis and lack of feedback from the simulated patients were the main limitations in this study. Conclusion: For most common skin conditions creating moulages to simulate the corresponding lesions is an easy procedure and can be an effective tool to standardize dermatology OSCEs for undergraduates, especially in resource-poor settings.