Terminological confusion with benign dermatosis, such as parapsoriasis en plaques, makes it difficult to diagnose mycosis fungoides in the early patch stage. Early diagnosis of mycosis fungoides (MF) is important for deciding on type of therapy, prognosis and for further follow-up. However, until recently, there has been no consensus on criteria that would help in diagnosing the disease early. Some believe that large plaque parapsoriasis (LPP) should be classified with early patch stage of MF and should be treated aggressively. However, there is no firm clinical or laboratory criteria to predict which LPP will progress to MF and we can only discuss about statistical probability. Moreover, long-term outcome analysis of even patch stage of MF is similar to that of control population. We therefore believe that LPP should be considered as a separate entity at least to prevent the patient from being given a frightening diagnosis. We also feel that patients need not be treated with aggressive therapy for LPP and will need only a close follow-up. This article emphasizes the criteria for diagnosing early MF and has highlighted the importance of considering LPP as a distinct benign entity.

Human papillomavirus (HPV) is one of the most common sexually transmitted infections world-wide. Low-risk HPV-types are associated with genital warts. Persistent infection with high-risk HPV-types is associated with genital cancers. Smoking and HIV infection have consistently been associated with longer duration of HPV infection and risk for genital cancer. There is an increasing incidence of anal cancers, and a close association with HPV infection has been demonstrated. Receptive anal sex and HIV-positive status are associated with a high risk for anal cancer. Two HPV vaccines are now available and offer protection from infection by the HPV-types included in the vaccine. This benefit is maximally seen in young women who were uninfected prior to vaccination.

This article takes a critical look at the pros and cons of human papillomavirus (HPV) vaccines. There is enough evidence to suggest that the prophylactic vaccines are efficacious in preventing various benign and malignant conditions (including cervical cancers) caused by HPV. Even though the vaccine is costly, hypothetical analysis has shown that HPV vaccination will be cost effective in the long run. Therapeutic HPV vaccines used to treat established disease are still undergoing evaluation in clinical studies, and results seem to be encouraging. Although several countries have started mandatory vaccination programs with the prophylactic HPV vaccines, conservatives have voiced concerns regarding the moral impact of such vaccination programs.

Background: The chronic use of immunosuppressants in renal transplant recipients (RTRs) predisposes them to a variety of skin manifestations. Studies on skin lesions in RTRs from India have been limited. Aim: To study the prevalence and clinical spectrum of skin diseases in RTR in patients attending the Nephrology clinic of a tertiary care hospital in South India. Methods: Between October 2002 and June 2003, 365 RTRs were evaluated for skin lesions, including 280 examined after renal transplant (group A) and 85 examined once before and then monthly after transplant for a period of 6 months (group B). Results: A total of 1163 skin lesions were examined in 346 RTRs (94.7%) including lesions of aesthetic interest (LAI) [62.3%] followed by infections [27.3%]. All LAI were drug-related manifestations, making it the most common skin lesion, while fungal (58.7%) and viral (29.3%) infections constituted majority of lesions caused by infection. Lesions related to neoplasms were relatively uncommon (2.1%) and all lesions were benign. Miscellaneous lesions constituted 8.3% of skin lesions, which included vaccine-induced necrobiotic granulomas at the site of Hepatitis B vaccination and acquired perforating dermatoses. Conclusion: Skin lesions among RTRs from India consist predominantly of drug-related LAI and infections and are different from the West in view of the paucity of neoplastic lesions.

Background: Though not in regular practice, intralesional (IL) bleomycin has been used for the treatment of warts since the 1970s and on the other hand, till now cryotherapy is quite regularly used to treat warts. Aim: Our aim was to assess the evidence for the efficacy of IL bleomycin, in comparison with a control group of similar sample receiving cryotherapy, in the treatment of cutaneous warts. Methods: Patients were randomized using computer-generated codes to receive either cryotherapy (double freeze-thaw cycle) or IL bleomycin (0.1% solution with concurrent anesthesia) for a maximum of four treatments 3 weeks apart and a maximum of five warts treated in each visit for both groups. Patients had their warts measured at base-line and with each return visit including a post treatment follow-up that was 8 weeks apart from last treatment taken. Results: Of the 73 patients completing the study, 39 (53%) were treated with IL bleomycin and 34 (47%) were treated with cryotherapy. Out of 155 treated warts, 87 (56%) were treated with IL beomycin and 68 (44%) were treated with cryotherapy. The clearance rates in context of number of patients and number of warts were 94.9% and 97% for bleomycin and 76.5% and 82% for cryotherapy respectively ( P < 0.05 by x ² analysis and RR = 7.67). Conclusion: IL bleomycin injection was significantly more effective than cryotherapy for treatment of cutaneous wart.

Background: Vitiligo is an acquired disorder characterized by circumscribed depigmented macules devoid of identifiable melanocytes. Complex genetic, immunological, neural and self destructive mechanisms interplay in its pathogenesis. According to autocytotoxic hypothesis, oxidative stress has been suggested to be the initial pathogenic event in melanocyte degeneration. Aims: The aim of our investigation was to evaluate the role of oxidative stress by measuring levels of the antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) in lesional and normal skin of patients with vitiligo and in the skin of normal controls. Methods: We determined the activity of SOD in lesional and non-lesional skin and CAT in lesional skin only of 25 vitiligo patients and 25 controls by using the spectrophotometric assay and Aebi's method, respectively. Results: There was statistically significant increase in the levels of SOD in vitiliginous and non vitiliginous skin of patient group compared to the control group ( P < 0.001). No significant difference was found between the levels of SOD in lesional skin and non-lesional skin of vitiligo patients. The levels of CAT in the skin of patients were found to be significantly lower than those of controls ( P < 0.001). Conclusions: There is increased oxidative stress in vitiligo as is indicated by high levels of SOD and low levels of CAT in the skin of vitiligo patients.

Background: Acne vulgaris is believed to be the most common disease of the skin. There is no Indian study on the profile of acne vulgaris, markers of severe forms of acne vulgaris and a possible correlation between acne vulgaris and markers of androgenicity in females. Aim: To study the profile of acne vulgaris, its seasonal variation, relationship with smoking and possible correlation between acne vulgaris and markers of androgenicity in females. Methods: The study was conducted between August 2006 and June 2008. All patients with acne vulgaris who consented to participate in the study were included. The parameters evaluated included age, gender, age of onset, duration of lesions, site of lesions, grade, relation with menstrual cycle, markers of androgenicity, number of acne lesions such as comedones, papules pustules and nodules, number and site of post-acne scarring, post-acne hyperpigmentation, seasonal variation and history of smoking. Results: A total of 309 patients with acne vulgaris were included in the study. The frequency of acne vulgaris in our study was 1.068%. Mean age of the study group was 19.78 years. Male to female ratio was 1.25:1. The most common age group involved was 16 to 20 years (59.8%). Mean age of onset was 15.97 years. Face was involved in all the patients, followed by back (28.2%), chest (20.1%), neck (9.4%) and arms (10%). In the older age groups, women were more likely to report having acne vulgaris than men ( P = 0.01). The closed comedones outnumbered open comedones by a factor of 4.9:1. A total of 186 patients (60.2%) had grade 1 acne vulgaris, 85 (27.5%) had grade 2 acne, 8 (2.6%) had grade 3 acne and 30 (9.7%) had grade 4 acne vulgaris. There was a higher incidence of scarring (39.5%) and post-acne hyperpigmentation (24.6%) in our study. In female patients, 57.7% had premenstrual flare and 12.4% had cutaneous markers of androgenicity. There was no association between severity of acne vulgaris and other markers of androgenicity ( P = 0.108). Seborrheic dermatitis (21.35%) was the most common disease associated. Seasonal variation was observed only in 80 patients (25.9%); 71 patients (23%) exacerbated in summer and 9 patients (2.9%) in winter. Smokers had more severe grade of acne vulgaris compared to nonsmokers ( P = 0.001). Conclusion: This study brings out the clinical profile of acne vulgaris in a tertiary care hospital in South India.

Background: Acne vulgaris is a common skin disease that affects 85% to 100% of people at some time during their lives. It is characterized by noninflammatory follicular papules or comedones and by inflammatory papules, pustules, and nodules in its more severe forms. Aims: To compare the efficacy of combination treatment of clindamycin+salicylic acid, versus clindamycin+tretinoin versus clindamycin alone in the treatment of the mild-to-moderate acne vulgaris. Methods: This was a single-blinded, randomized clinical trial.Forty-two female patients (age range: 15-25 years) with mild-to-moderate acne vulgaris were selected randomly and subsequently randomized to 3 groups. Group A patients were treated with 1% clindamycin lotion (C lotion) twice daily. Group B patients were treated with 1% clindamycin+0.025% tretinoin lotion once nightly (CT lotion). Group C patients were treated with 1% clindamycin+2% salicylic acid lotion twice daily (CS lotion) for 12 weeks. For comparison of efficacy of these treatments, and regarding the skewed distribution of the data, Kruskal-Wallis Test and Mann-Whitney U test were used. SPSS software was used for statistical analysis. Results: There was a significant difference between 3 types of treatment in the respect of the total lesion count (TLC) improvement ( P = 0.039). The efficacy of treatment on Acne Severity Index (ASI) was maximum for CS lotion (81.80% reduction in ASI). CT lotion reduced ASI by as much as 73.73% during 12 weeks of treatment. The efficacy of C lotion was calculated to be 37.87% in the reduction of ASI. Conclusions: Our data suggested that the efficacy of CS lotion was significantly more than C lotion with respect to the TLC and ASI, although there was no significant difference between CS and CT lotion.

Background and Aims: Skin and mucocutaneous disorders are common in HIV infection and may be the earliest manifestation of the disease. The spectrum of these disorders is wide and may vary in different regions due to varying prevalence of various microbial agents. Therefore, we studied the seroprevalence of HIV infection in patients presenting with skin and mucocutaneous disorders and clinical and regional epidemiological profile of seropositive patients. Methods: Eleven hundred and seventy patients having any type of skin or mucocutaneous disorders were screened for HIV infection (NACO guidelines) after recording their clinical and epidemiological profile. Results: Of the 1170 patients screened, 38 (3.24%) were found to be positive for HIV 1 and none for HIV 2 antibodies. Seropositive patients belonged to the age group of 9 to 48 years, with a male:female ratio of 0.9:1. Heterosexuality was the most common mode of transmission (86.8%). A wide range of infectious and noninfectious lesions were observed and herpes zoster was the most common infectious disease (31.5%) followed by mucocutaneous candidiasis (26.3%). The most common noninfectious manifestation was seborrhoeic dermatitis (18.4%) followed by pruritic papular eruptions (7.9%). Conclusion: High prevalence and wide variety of skin and mucocutaneous disorders in HIV-positive patients highlight the importance of better vigilance and early suspicion of HIV infection in such patients.

Granuloma annulare is a granulomatous disorder of the dermis and subcutaneous tissue, with different clinical types. Generalized granuloma annulare is a rarely encountered clinical entity. We describe a 60-year-old woman with a 4-month history of generalized annular lesions. She had a history of myelocytic leukemia and chronic hepatitis B virus infection. To date, both acute myelocytic leukemia and hepatitis B virus infection have been described independently in association with generalized granuloma annulare but have never been described together in association with generalized granuloma annulare. Probable etiological causes of granuloma annulare are discussed in our patient.

Epidemic Kaposi's sarcoma is one of the malignant neoplasms, which can develop in HIV-infected patients. Although the prevalence of HIV infection is reported to be high in Asian countries, Kaposi's sarcoma is rarely reported. We report a case of Kaposi's sarcoma involving the skin and oral mucosa along with extensive bilateral lymphedema of lower extremities, treated successfully with paclitaxel and antiretrovirals.

White piedra is a superficial fungal infection of the hair shaft, caused by Trichosporon beigelii . We report two cases of white piedra presenting as brown palpable nodules along the hair shaft with a fragility of scalp hairs. T. beigelii was demonstrated in hair culture of both the patients and T. ovoides as a species was confirmed on carbohydrate assimilation test. The first patient responded to oral itraconazole and topical ketoconazole, with a decrease in the palpability of nodules and fragility of scalp hairs at the end of two months.

Granuloma multiforme (GM) is a reactive skin disorder of unknown etiology, characterized clinically by confluent annular lesions and histologically by focal necrobiosis and histiocytic granulomas. GM is significant because of its clinical resemblance to tuberculoid leprosy, with which it can be confused. Here, we report a case of granuloma multiforme from India in a 70-year-old male farmer, with multiple asymptomatic large annular rings of papules over the back and thighs on photodistributed sites. Histopathology helps to clinch the diagnosis and differentiate from similar clinical and histologic mimics such as granuloma annulare, tuberculoid leprosy, actinic granuloma and annular sarcoid. Nevertheless, a very high degree of suspicion is required to diagnose GM.

Background: Sexually transmitted diseases (STDs) including AIDS are becoming a major public health problem in developing countries worldwide. Aims: All the adult patients attending VCTC and STD clinics of Assam Medical College between May 2002 and December 2005 were enrolled in the study. Methods: Records of patients with high-risk sexual behavior and presence of STD on clinical examination were recorded in a predesigned proforma. Results: Of 479 individuals, 186 (38.8%) had evidence of STD and 70 were positive for HIV. Most (64%) were in the age group of 15 to 30 years. Candidiasis (vulvovaginal candidiasis in women and candidal balanitis/balanoposthitis in men) was the most common finding on clinical examination (21.5%) followed by syphilis (17.2%), genital warts (15%), herpes genitalis (11.3%), non-gonococcal urethritis (10.8%), and gonococcal urethritis (7%). Conclusion: High percentage of unmarried people (>45%) reporting with STD, which points to potential danger of HIV transmission in the region.

A 58-year-old, gravida 6, obese woman presented with a pruritic yellowish plaque around the umbilicus, which first appeared about 3 years ago. She also had flat yellow papules on the axilla and neck. After a burn from a heating device, a few perforating papules and a violaceous hue occurred on the plaque. Histological examination revealed pathological elastic fibers with a keratotic plug and perforation in the deep dermis, which was consistent with perforating pseudoxanthoma elasticum. This case indicates that perforating pseudoxanthoma elasticum, a variant of hereditary pseudoxanthoma elasticum may perforate due to mechanical factors.

Acrokeratosis paraneoplastica of Bazex is rare condition, characterized with scaly hyperkeratotic psoriasiform plaques on acral parts of body (helices, nose, and malar and acral surfaces), and in later stages propagation to the limbs and trunk.This syndrome is distinct marker for different neoplastic conditions, predominantly squamous cell carcinoma of the upper aerodigestive tract with possible cervical lymph node metastases.In this paper we present 56 years old male patient, with hyperkeratotic plaques on the skin of his palms, soles, ear lobes and apex of the nose. Detailed examination found tumorous swelling on the left side of his neck. Histopathologic examination revealed solid anaplastic metastatic tumor. Patient died before primary tumor could be found. Bazex syndrome can appear before the diagnosis of internal malignancies, and thus is important for dermatologists to recognize it in favor of early diagnosis of specific malignant process.