A rare case of subungual malignant melanoma in a 43-year-old male, with black dystrophic left middle finger nail plate with positive Hutchison sign is presented. Patient underwent disarticulation at the proximal interpholangeal joint. Histopathology confirmed malignant melanoma, and resection free of tumour cells.

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Rheumatoid nodules occur usually in advanced seropositive rheumatoid arthritis, signifying poor prognosis. However rarely rheumatoid nodules can be encountered in patients with no antecedent evidence of arthritis. Herein a case of an arthritic benign rheumatoid nodules is described.

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Recent studies suggest that salt split skin is a more sensitive substrate than intact skin for immunofluorescence diagnosis of bullous pemphigoid. We undertook this study to define the role of salt split technique of immunofluorescence findings in 32 clinical and histopothology confirmed cases of bullous pemphigoid. Both direct and indirect immunofluorescences were performed using normal and split skin. Direct immunofluorescence positivity of 100% was noted with both routine and salt split method. Additional immunoreadont deposition was noted with direct method on split skin in 5 cases. Patterns of fluorescence in the latter were roof (40.60%), floor (9.4%) and combined roof and floor (50%). On indirect immunofluorescence, positivity was almost doubled with salt split technique ( 68%) as compared to routine method (36%). Thus, salt split technique was equivalent to routine on direct method in positivity with additional immunoreactant deposits noted in some and had double the sensitivity of the indirect method in detecting immunofluorescence in bullous pemphigoid.

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Five hundred unselected newborn babies delivered in the Department of Obstetrics and Gynaecology, Unit II of SGBT Hospital attached to Government Medical College, Amritsar during April 2000 to October 2000 were examined for cutaneous lesions daily for the first five days after birth. Different cutaneous lesions were seen in 474(94. 8%) newborns. The physiological skin changes observed in order of frequency were Epstein pearls in 305(61%), Mongolian spot in 301(60. 2%), superficial cutaneous desquamation in 200(40%), icterus in 128(25. 6%), milia in 119(23. 8%), sebaceous gland hyperplasia in 107 (21. 4%), occipital alopecia in 94(18. 8%), lanugo in 72(14. 4%), peripheral cyanosis in 47(9. 4%), breast hypertrophy in 29(5. 8%) and miniature puberty in 28(5. 6%) newborns. Of the transient non-infective skin diseases, erythema toxicum neonatorum was observed most commonly in 105(21 %), followed by miliaria rubra in 103(20. 6%) and acne neonatorum in 27(5. 4%) newborns. The naevi and other developmental defects in the descending order were salmon patch in 69(13. 8%), congenital melanocytic noevi in 10(2%), accessory tragi in 3(0.6%), spina bifida in 2(0.4%), hydrocephalus in 1(0.2%) and poliosis in 1(0.2%) newborns. Cradle cap was the only dermatitis observed in 50(10%) newborns. One (0.2%) case each of Harlequin ichthyosis and labial cyst was seen.

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The significant inter-patient variability in progression, and response to therapy makes it a great challenge for the physician to predict the outcome of vitiligo at the very outset. Subjective factors like stress, pregnancy, sunburn and illness have been identified as aggravating factors for vitiligo. However, a few studies have evaluated the statistical significance of objective clinical parameters in predicting the outcome of vitiligo. Our retrospective analysis of 199 consecutive patients with vitiligo who presented to our OPD was aimed at evaluation of these objective clinical parameters utilizing a standard proforma. Patients already on treatment, and those with duration of disease less than 6 months were excluded from the study. Progression was defined as an increase in size or number of lesions in the 3 months prior to presentation. In all 76. 9% patients had progression of vitiligo. The clinical parameters significantly associated with progression were a positive family history (p=0. 027), mucosal involvement (p=0. 032), Koebner's phenomenon (p=0. 036) and nonsegmental vitiligo (p=0. 033). Thrichrome sign, leucotrichia, longer duration and higher age at onset did not correlate significantly with progression. The one significant observation that we found to have the poor prognostic implication in vitiligo is the presence of mucosal vitiligo. The clinical prediction of disease progression at the outset enables the physician to set realistic treatment goals and optimize the therapeutic regimen for the individual patient.

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A case of generalized malignant acanthosis nigricans of 2 years duration is reported. In spite of the long duration of this cutaneous marker of internal malignancy, the patient was completely asymptamatic and extensive investigations revealed the presence of widespread metastasis of mucin secreting signet cell adenocarcinoma from an unknown primary site. In addition the patient also had acquired hypertrichosis lanuginose and florid cutaneous papillomatosis which are also markers of internal malignancy.

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Painful bruising syndrome is a distinctive but rare clinical entity. A case of this condition in a psychiatrically normal teenage girl is reported

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Even though pityriasis alba is commonly encountered in dermatological practice, there is paucity of Indian studies on the subject. A clinico epidermiological study was carried out in 200 patients attending the skin department of Command Hospital, Air Force, Bangalore. Atopic background was detected in 85.5% of cases. Bacterial and fungal culture studies failed to reveal any infective aetiology. Helmenthiasis and iron deficiency anaemia were detected in 15.5% and 16.5% of patients respectively. However no other nutritional deficiency was observed in the present study. Majority (84.5%) of patients had lesions of less than 6 months duration at the time of presentation. Face was involved in 91% of patients and generalized pityriasis alba was observed in 3 patients, all of them being infants. Pigmenting pityriasis alba was observed in 7 patients. Hyperkeratosis, parokeratosis, ocanthosis, spongiosis and perivasculor infiltration were the consistent histological features of pityriasis alba.

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The importance of onychomycosis is often underestimated. Far more than being a simple cosmetic problem, infected nails serve as a chronic reservoir of infection which can give rise to repeated mycotic infections of the skin. 448 patients with nail abnormalities attending Skin O. P. D of King George Hospital, Visakhapatnam during a 1(one) year period between November'98 - October'99, were subjected to detailed clinical, epidemiological study. Diagnosis was confirmed in 204 cases by direct microscopy or culture or by both. Females (51. 96%) were slightly more than the males (48. 04%). Majority of the cases were between 21-40 years age group. Housewives (33. 33%) were most frequently affected. Trauma was a predisposing factor in 11. 27% of the cases. The duration of lesions varied from 3 months to 15 years. In the majority (38. 23%) it was less than one year. Candidal onychomycosis was the most prevalent clinical type (58. 82%) followed by distal subungual onychomycosis (38. 72%). Disease was limited only to finger nails in 57. 35% and toe nails in 32. 35%. Ptedominant isolates obtained were condida spp. (56. 7%), followed by dermatophytes (38. 2%) and non-dermatophyte molds (3. 37%). 26. 96% of the patients had experienced physical, psychosocial and occupational problems.

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b-carotene, a structural analogue of vitamin A, works as an agonist of this vitamin, by reversibly sticking the chemical mechanism of melanogenesis by saturating the nuclear receptors of melanocytes and/or binding protein. To study the safety and efficacy of b-carotene lotion on topical application in melasma, clinically diagnosed 31 adults (26F and 5M) with melasma were included in this trial. All of them applied b-carotene lotion daily, morning and evening to the affected areas. Twenty six of them completed regular 8 weeks treatment. Nine of them continued same treatment for 16 more weeks. All cases were evaluated clinically using melasma intensity (MPi) index (Grade I, II, III) and size of the lesion. Clinical photograph was taken for each case at 0 week, 8'h week and 24th week. Initial 8 weeks treatment revealed that the single case with grade-I pigmentation included in this study recovered completely. Two out of 13 cases with grade-II pigmentation, showed no change, in 10 cases, pigmentation became lighter to grade-I (76. 9%) and one case recovered completely. Out of 12 grade-III cases, one did not show any change, 10(83. 3%) converted to grade-II and one to grade-I. At the end of 24 weeks, all the nine cases (2 grade-II and 7 grade III) showed further clearing of the pigmentation to the next lower grade. Side-effects like mild erythema and local irritation were observed in two cases each, who were advised to discontinue treatment as per the protocol. In conclusion, topical application of b-carotene lotion appears to bean effective and safe for melosma. Longer duration of application is associated with better result.

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A 23-year old man presented with firm cutaneous and subcutaneous nodules of histoid leprosy. Some of the nodules suppurated after multidrug therapy (MDT) and these nodules showed features of erythema nodosum leprosurn (ENL) on histopathological examination. ENL is a rare phenomenon observed in histoid leprosy.

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A lady presented with multiple, tender discharging noduloulcerative lesions on the abdomen, following laparoscopic cholecyslectomy. Histopathological features were suggestive of panniculitis. Screening of the serum for alpha-1 antitrypsin levels revealed a partial deficiency.

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A case of lupus erythematosus profundus, with associated mastitis, but without any lesions of discoid lupus erythematosus or systemic lupus erythematosus is being reported.

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Intralesional corticosteroid administration is a commonly used therapeutic modality in dermatology. PeriIesionoI streaky depigmentation and/or atrophy is a distinct, though rare adverse effect resulting from lymphatic uptake of corticosteroid crystals. The pathogenesis and its self-limiting clinical course are discussed.

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Congenital melanocytic naevus is hamortomatous or non-neoplastic proliferation of abnormal mixture of tissue's or non-neoplastic proliferation of abnormal mixture of tissue's normal components. Cutis verticis gyrata is hypertrophy with parallel or gyrate folds of skin of scalp. We report a young man who presented to us with hair loss on the back of the head and increased growth of hair over the upper back since birth. A biopsy proved the diagnosis of congenital melanocytic naevus.

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Two cases of rare presentation in the form of basal cell carcinoma for 2-3 years and squamous cell carcinoma for 8-9 years after prolonged sun exposure are being reported. Both responded to surgical excision and 5-FU application.

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Bilateral inguinal adenitis and penoscrotal elephantiasis are uncommonly encountered presentations of Lymphogranuloma venereum. Herein, we report a male who presented with bilateral inguinal bubos alongwith penoscrotal elephantiasis that developed within 6 months of the primary lesion.

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A 70-year-old woman was having bullous pemphigoid. The blood tests revealed leucocytosis and eosinophilic leukemoid picture, confirmed later on with bone marrow aspiration.

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A 23-day-old male infant had hairy 'bathing trunk' naevus covering, neck and upper trunk along with multiple congenital melanocytic naevi scattered all over the body.

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A 19 - year-old salesman presented with multiple fusiform, fluctuant, non-tender swellings involving dorsum of the left hand, left index finger and little finger. He also had multiple sinuses with puckered scars on the right thumb, left little finger and right elbow. He was provisionally diagnosed as tuberculous gumma. X-ray chest showed apical cavity and infiltration suggestive of tuberculosis X-ray both hands showed osteolytic lesions with pathological fracture. AFB was cultured on Lowenstein Jensen medium and the patient was given antituberculosis treatment with clinical improvement.

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A patient with filariasis, taking treatment in the form diethyl carbamazime citrate developing "de-novo" histoid leprosy during the course of the disease is being reported.

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A case of recurrent vesiculobullous eruptions over shins, clinically diagnosed as epidermolysis bullosa of pretibial variety confirmed by electron microscope is reported here as a rare variety of localised epidermolysis bullosa (EB).

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