The measurement of the impact of skin diseases on patients' quality of life is important. This review explains the reasons for this, explains the main methods of measuring quality of life in dermatology and describes recent research in this area. Virtually all aspects of patients' lives can be affected by skin disease. It is important to be able to measure this effect for clinical, therapeutic and health service research, for political purposes and potentially to inform clinical decisions. Measurement techniques include general health, disease specific and dermatology specific questionnaires: experience with the Dermatology Life Quality Index (DLQI) is described. Utility measures can also be used to gain insight into the value that patients place on their disease. There are special issues relating to the assessment of quality of life in children: a cartoon version of a questionnaire has been developed to enhance patient friendliness. The lives of the families of patients with skin disease may be affected and this impact can also be measured. In the clinic, complex clinical decisions, for example relating to starting systemic therapy, may be aided by better knowledge of the impact of disease on individuals, but measures will only be helpful if clinicians can easily interpret scores: the concept of score banding to aid this is described.

BACKGROUND: PUVASOL therapy has an inherent drawback of patient compliance in that Indian female patients with psoriasis lesions on covered parts of the body are reluctant to expose themselves. In this study we tried to evaluate a new method of administering PUVA therapy wearing a fabric. AIM: To compare the efficacy and safety of PUVA administration with and without wearing clothes in psoriasis. METHOD: We first found the UV transmissibility of plain woven, lightweight cream colored cotton fabric with 30 x 30 threads per square cm. area and calculated its sun protection factor (SPF). A single blind, randomized, comparative, clinical trial was then conducted on 21 patients with psoriasis vulgaris who were treated with bath PUVA. The study group received ultraviolet light while wearing a gown made up of the above cotton fabric and the control group received ultraviolet light without wearing the gown. The study group was given an UV dose higher in proportion to the SPF of the worn fabric so that blockage caused by cloth could be neutralized. The cloth-uncovered areas were covered with a sunscreen. UVA from artificial light source was used for better patient monitoring. RESULTS: After 12 PUVA treatments both the treatments were found to be equally effective, and there were no differences in the side effects. Conclusion: Thus we conclude that PUVA can be given wearing a fabric provided the UV dosage is increased proportional to the SPF of the fabric. The same fabric may be used for PUVASOL therapy.

BACKGROUND: Punch grafting followed by PUVA/PUVASOL is an established mode of therapy in vitiligo including that on the lips. AIMS: To assess the efficacy of NB-UVB along with regrafting in patients in whom punch grafting had failed to evoke any response. METHODS: Five patients with stable and isolated lip vitiligo in whom punch grafting and PUVA had failed to produce pigmentation were treated by regrafting and subsequent NB-UVB (311 nm) phototherapy. RESULTS: Complete repigmentation was observed in three of the five cases after 16 weeks. In the remaining two, the results were mixed. CONCLUSIONS: Stable lip vitiligo usually responds very well to punch grafting and PUVA/PUVASOL. In patients who fail to respond to this treatment, complete repigmentation following regrafting and NB-UVB is an observation that needs to be explained.

BACKGROUND: Minipunch grafting has been successfully used for the treatment of stable vitiligo since several years. Post-operative immobilization at certain sites such as lips, areola & infralabial folds and joints is not easy to achieve. Putting stay sutures on the lips and areolae is difficult. Grafting over the joints may require hospitalization to ensure proper immobilization, and may discourage some patients. AIM: To study the efficacy of a tissue glue for immobilization of donor grafts at the above sites during minipunch grafting. METHODS: Ten cases with stable vitiligo over the lips, areolae, below the lower lip, and over different joints had tissue glue applied to the edges between the donor grafts and the recipient wells, after the grafting. RESULTS: The grafts adhered firmly within a minute and there was no need for a cumbersome dressing. Over the lips, the patients could resume talking and drinking fluids immediately. CONCLUSION: The glue was very helpful for immobilizing the grafts at these difficult sites.

BACKGROUND: Vitiligo affects melanocytes in the skin. Since melanocytes are present in other organs as well, it is plausible that they may be similarly affected. METHODS: A comparative study of audiological functions was carried out in 180 patients of vitiligo and 60 non-vitiligo controls in the age group of 5-40 years. RESULTS: In vitiligo patients sensorineural hypoacusis of mild degree was found in 18, moderate in 13 and mild conductive hypoacusis in 3. In controls sensorineural hypoacusis of mild degree was found in only 2 cases. CONCLUSION: The difference between the two groups was statistically significant. Vitiligo patients have a higher prevalence of sensorineural hypoacusis.

A 30 year old female presented with generalized stable vitiligo involving large areas of the body. Since large areas were to be treated it was decided to do meshed split skin graft. A phototoxic blister over recipient site was induced by applying 8 MOP solution followed by exposure to UVA. The split skin graft was harvested from donor area by Padgett dermatome which was meshed by an ampligreffe to increase the size of the graft by 4 times. Significant pigmentation of the depigmented skin was seen after 5 months. This procedure helps to cover large recipient areas, when pigmented donor skin is limited with minimal risk of scarring. Phototoxic blister enables easy separation of epidermis thus saving time required for dermabrasion from recipient site.

Cutaneous involvement in anaplastic large cell lymphoma may be in the form of primary cutaneous disease (primary cutaneous anaplastic large cell lymphoma) or secondary to involvement by systemic disease (systemic anaplastic large cell lymphoma). This case report, an example of the latter, describes a solitary cutaneous lesion as the first evidence of disseminated neoplastic disease. The histology of the lesion was identical to its primary cutaneous counterpart.

Non-Hodgkin's lymphoma (NHL) belongs to a group of lymphoid neoplasms that is diverse in manner of presentation, response to therapy and prognosis. Usually the oral manifestations of NHL are secondary to a more widespread involvement throughout the body. Though primary intraoral lesions in NHL are uncommon, it is important to be aware of them, since intraoral manifestations are the presenting symptom in these patients. A 55 year old woman presented with a swelling in the maxillary right alveolus and buccal vestibule. There were no palpable lymph nodes. A CT scan revealed a mass on the labial aspect of the right maxilla with no involvement of the maxillary sinus. Incisional biopsy of the lesion showed a dense lymphocytic infiltrate with formation of variably sized lymphoid follicles. The infiltrate showed a mixed neoplastic lymphocyte composition which was suggestive of follicular mixed type of malignant B cell primary extranodal lymphoma. The patient was treated with chemotherapy followed by radiation.

An adult female presented with a painful recurrent swelling on the posterior aspect of the scalp of six months' duration, which was clinically diagnosed as fibroma. An excision biopsy showed anaplastic epithelial cells arranged in irregular cords and trabeculae, mitosis, malignant chondroid areas, desmoplasia and perineural invasion, suggesting malignancy. Wide excision of the tumor was the only treatment given since there was no metastasis.

A young lady presented with progressive hypertrophy and lateral curvature of the left leg of long duration. The overlying skin showed remarkable vascular prominence. The limb involvement was asymptomatic except minor restriction of movements. Radiologically, there was diffuse osteolysis of the tibia and fibula suggestive of vanishing bone disease. This rare condition bears a clinical resemblance to other disorders with vascular malformations and limb hypertrophy. The differential diagnosis of vanishing bone disease, from the dermatologists' point of view has been discussed.

A young adult factory worker presented with a linear depigmented vitiliginous patch on his right arm at the site where a silver amulet had been fixed with a nylon thread. He claimed that it was occupational in origin and demanded compensation, but patch testing with the nylon thread of the amulet and its extracted dyes proved that the contact leukoderma was due to the thread.

The use of the internet in all fields of medicine is becoming more and more common in most areas of the world. The factors contributing to limited or no usage are difficulty of access due to poor IT infrastructure, paucity of time and lack of awareness and knowledge of the optimal use of the internet. For healthcare professionals, lack of time is one of the most common reasons for venturing into anything new. The only way to tackle this is to make a conscious commitment to learning how to use the Internet effectively. The least that one could strive to do is to learn enough to get internet usage handled by junior colleagues, secretaries and external resources, and expect the best of outputs from each. This article will focus on the internet for dermatologists. It will cover a range of resources and include search techniques and evaluation criteria.