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Cancer metastasis is quite devastating to the patient as well as the physician and may herald the onset, dissemination or recurrence of malignancy. Breast carcinoma metastasis is the most common carcinoma encountered by dermatologists and it presents in various morphological and histological forms. Here, we present two varied cases, the first being the common nodular metastasis from a previously treated intraductal carcinoma and the second, the rarer variant, carcinoma erysipeloides as a heralder of the invasion of an incompletely treated disease.

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The discovery of the key enzymes, receptors, and transporters in cholesterol biosynthesis has enabled us to assemble fragments of knowledge concerning lipids and lipoproteins into dynamic pathways, leading to the development of a multitude of lipid-lowering drugs. After a brief recapitulation of the pathways of cholesterol metabolism and the dermatologic manifestations of lipid derangement, we shall review drugs which modify intestinal cholesterol and bile-acid reabsorption, and hepatic lipoprotein biosynthesis and catabolism. The current literature is examined to determine future therapeutic targets in lipid metabolism, as well as the role of traditional foods as lipid-lowering agents. The latest National Cholesterol Education Program guidelines for managing hypercholesterolemia are also discussed.

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The metastasis of a visceral malignancy to the umbilicus is known as "Sister Mary Joseph's nodule". It is a rare clinical sign indicating advanced, metastasizing intraabdominal cancer. We report a 50-year-old man who developed metastatic skin cancer in the form of semicircular indurated plaque on top of which was a firm mobile rounded nodule at the umbilical area. Histopathological examination demonstrated diastase-resistant periodic acid-Schiff and mucicarmine positive signet ring cells, suggesting gastric carcinoma. Immunohistochemical staining showed that these cells were positive for cytokeratins and epithelial membrane antigen, suggesting epithelial origin.

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Giant congenital melanocytic nevi are rare and occur in about one out of every 2,00,000 to 5,00,000 births. There is a significant association between bathing trunk nevus and neurofibromatosis and lipomatosis. Apart from this, association of bathing trunk nevus with abnormalities like spina bifida occulta, meningocele, club foot and hypertrophy or atrophy of deeper structures of a limb, have been described. We are herewith reporting two cases of bathing trunk nevi. In our first case, an eight-year-old girl presented with a bathing trunk nevus studded with multiple, large nodules. Histopathological examination of the biopsy taken from one nodule revealed features of both neurofibroma and lipoma. To the best of our knowledge, features of both these hamartomas in one nodule of a single patient are probably not reported in the literature. In our second case, a 12-year-old girl presented with bathing trunk nevus and she had spina bifida occulta. She also had lipoma in the lesion of bathing trunk nevus. Both of our patients had satellite melanocytic nevi over the face, forearm, upper back and legs. Our second patient, in addition, had small melanocytic nevi over the medial canthus and sclerocorneal junction of the right eye. By the time this girl presented to us, the melanocytic nevus started fading in color and it had become brownish. We are reporting these cases for their peculiarities and for their rare features.

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Background: In various case series, pulse therapy has shown good results in pemphigus vulgaris (PV), with long-term remissions. Aims: To compare the efficacy and side-effects of dexamethasone-cyclophosphamide pulse and daily oral cyclophosphamide (DCP+C) versus cyclophosphamide pulse and daily oral prednisolone (CP+P) in PV. Methods: Twenty-eight active PV patients were randomized to receive either DCP with daily oral cyclophosphamide (Group A, n = 15) or CP with tapering doses of daily oral prednisolone (Group B, n = 13) for 12 months and followed-up for at least 3 months after stopping therapy. They were compared for time taken to achieve mucocutaneous disease control, achieve remission, relapse during treatment period, relapse after stopping therapy and side-effects. Results: Of 28 cases, 25 (Group A - 15, Group B - 10) completed the study period and were analyzed. The time for initiation of cutaneous response and time to achieve complete disease remission were significantly lesser in group B. However, other efficacy parameters were comparable. In Group A, significant adverse events were dysgusea, hiccups, palpitation, nail discoloration, bone pain and urinary tract infection while in Group B, they included nausea, moon facies, flushing, secondary amenorrhea, steroid withdrawal symptoms and dyspnea due to weight gain. Conclusions: Early remission was achieved in group B but the relapse rates during the treatment phase or after stopping therapy were comparable. Both therapies had comparable side-effect profiles, although Group B showed greater steroid-induced adverse events.

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Background: In the present scenario, wrinkle formation, prominent sign of skin ageing, is one of the most demanding areas of research. This burgeoning research demand to reduce, delay and restore the effects of skin ageing has led to the study of various signaling pathways leading to wrinkle formation. Wrinkles appear on skin due to influence of intrinsic and extrinsic factors on mitogenic reactions and signal transduction pathways. Aim: The aim of the present study is to analyze each protein involved in the signaling pathway leading to dilapidation of collagen and an attempt has been made to compare different signal transduction pathways to identify a common target for skin ageing. Methods: In the present work, bioinformatics tools have been used to extract information from already existing experimental data. The statistical techniques are used for further analysis and make useful predictions for skin ageing. Results: Stressors like UV irradiation, osmotic stress and heat shock have been reported to activate epidermal growth factor receptor, interleukin 1 receptor, tumor necrosis factor receptor, platelet-derived growth factor receptor and platelet activation factor receptor signaling pathways, which lead to the production of matrix metalloproteinases, collagen degradation and, consequently, wrinkle formation. When all the five signaling pathways were modeled, the c-jun part of the AP-1 transcription factor was found to be a common intermediate protein involved in all the signaling cascades. Moreover, it shows differential expression in the skin on response to stressors. Conclusion: We proposed c-jun to be the most potent target for drug designing against wrinkle formation.

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Background: Pruritus is a common symptom of many dermatological and systemic diseases. It is a common complaint among patients with psoriasis of the chronic plaque type. Patients with pruritus suffer from more severe psoriasis although some authors did not find a significant relationship between pruritus intensity and psoriasis severity. Aims: In this study, we aimed to investigate the relationship between clinical features and symptoms among psoriasis patients. And also we aimed to evaluate whether the severity of disease, depression and quality of life scores could effect these symptoms or not. Methods: Eighty seven patients with psoriasis were enrolled in this study. Epidemiological data of patients were noted. Clinical symptoms, such as pruritus, pain, burning, exudation, bleeding, weakness, etc. were interrogated. The answers to these questions were classified as 'never', 'rare', 'sometimes', 'often' and 'all the time'. Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), Hamilton Anxiety-Depression Scale (HAD) were calculated for each patient. PASI and DLQI scores were classified as ≥ and <10. Results: We found that the most frequent symptom was pruritus (96.6%). Other frequent symptoms were burning (56.3%), exudation (56.3%) and bleeding (49.4%). Hurting, sensitiveness and bothering were more frequent in women. Percentages of hurting, pain, exudation and weakness symptoms had been increasing with age. Frequency of weakness was significantly high in PASI ≥ 10 patients. Conclusion: Pruritus is a very common symptom in psoriasis. Burning, exudation and bleeding are also common symptoms seen in psoriasis. New scoring systems including symptoms of psoriasis patients may be developed for evaluating the severity of the disease.

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Porokeratosis is a disorder of keratinization showing a well-defined lesion with a hyperkeratotic ridge on the border that contains the coronoid lamella. We report familial (autosomal dominant with reduced penetrance) disseminated plaque type (Mibelli's type) porokeratosis in a father and son. In the father, there were multiple horns and a large squamous cell carcinoma in a large lesion over the perianal region that reached up to the squamo-columnar junction of the anal mucosa and even invaded the anal sphincteric muscles. Disseminated lesions of the Mibelli's type, development of horns, and malignancy in this unusual location have not been previously reported.

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Background: Photodermatitis is an abnormal response to ultraviolet radiation (UVR). The photoallergic contact dermatitis caused by plant allergens is a serious cause of morbidity in India. Airborne contact dermatitis is the classical presentation of plant-induced dermatosis, which may become difficult to differentiate from chronic actinic dermatitis in chronic cases. The rapid growth of parthenium weed in India and its ill effects on the population make it important to detect all cases of parthenium sensitivity, which in some cases might simulate photodermatitis. Aims: This study aims to detect the occurrence of plant sensitivity and photosensitivity in idiopathic-acquired photodermatoses, airborne contact dermatitis and general population taken as controls. Methods: One hundred and fifty six consecutive patients suffering from polymorphic light eruption (PMLE), chronic actinic dermatitis (CAD) and airborne contact dermatitis (ABCD) were enrolled in the study over a period of three years (June 2004 to May 2007). An equal number of age and sex matched healthy subjects were enrolled in the study as controls. All the patients were subjected to detailed history taking, clinical examination and histopathological examination for diagnosis. Patch and photopatch testing were perfomed in all the patients and healthy controls for detection of allergic and photoallergic reactions to parthenium, xanthium and chrysanthemum plant antigens and control antigens. Results: Out of 156 patients enrolled in the study, 78 (50%) had CAD, 67 (42.9%) had PMLE and 11 (7.05%) had ABCD. The occurrence of parthenium/xanthium allergy and photoallergy, either to parthenium or both was most commonly found in ABCD (72.7%), followed by CAD (32%). In PMLE 4.5% cases showed photoallergy. Only 1.9% in the control group showed sensitivity to parthenium and xanthium. Conclusion: This study indicates that parthenium (and possibly xanthium) may act as important environmental factors in the initiation and perpetuation of not only ABCD but of CAD as well. Photoexacerbation to UVA at positive parthenium/xanthium sensitivity sites in ABCD and CAD indicates that ABCD with photosensitivity to compositae can lead to CAD.

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Background: Laboratory diagnosis of syphilis is usually accomplished by serology. There are currently a large number of different commercial treponemal tests available that vary in format, sensitivity and specificity. Aim: To evaluate the ID-PaGIA Syphilis Antibody Test as an alternative to other specific treponemal tests for primary screening or confirmation of diagnosis. Methods: Serum samples from healthy adults (n = 100) were used for detection of specificity of ID-PaGIA. To evaluate sensitivity of ID-PaGIA serum samples (n = 101) from patients with confirmed or suspected syphilis were tested for syphilis antibodies with FTA-Abs IgM, ID-PaGIA, ELISA IgM and TPHA tests. Results: No false-positive results were found with ID-PaGIA. Sensitivity of various treponemal tests was the following: FTA-Abs IgM: 95.5%, ID-PaGIA and ELISA IgM: 94%, and TPHA 75%. The positive and negative predictive values of ID-PaGIA were 100 and 89.5%, respectively. Conclusions: Compared with other treponemal tests ID-PaGIA has excellent sensitivity and specificity.

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Trichoblastoma is a rare benign trichogenic tumour with epithelial and mesenchymal components recapitulating the germinal hair bulb and associated mesenchyme. A 50- year- old male patient presented with slowly enlarging circumscribed solid nodule measuring 4x3x4.5 cm over the tip of the nose. Microscopy of tumour revealed nodular tumour spanning the entire dermis with collection of mesenchymal cells resembling follicular papilla. Areas of pigmentation and sebaceous hyperplasia were noted. There is a need for differentiation of this tumor which is benign, from other pigmented tumors having basaloid arrangement of cells such as basal cell carcinoma.

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Background: The World Health Organization targeted to eliminate leprosy from the world with multidrug therapy (MDT) by 2000. But, leprosy remains a problem in Essimbiland of Menchum Division of Cameroon, with a prevalence of 1.7/10,000 and high rate of case detection in children. Aims: To assess knowledge and practices on the cure of leprosy, treatment duration, drug availability and problems faced by leprosy patients acquiring drugs in order to enhance MDT implementation and leprosy elimination in Menchum and Boyo divisions. Methods: Observational study in which a structured questionnaire was administered to leprosy patients, their contacts and a control group. Results: 480 respondents were interviewed and 405 (84.8%) (95% confidence interval [CI]: 81.6-87.2%) knew that leprosy can be cured. These respondents comprised 166 (92.2%) of 180 contacts, 129 (93.5%) of 138 patients and 110 (67.9%) of 162 controls. Two hundred and fourteen (44.6%) (95% CI: 40.1-48.9%) respondents knew that leprosy treatment is free, comprising of 110 (51.4%) patients, 99 (46.3%) contacts and five (2.3%) controls. A statistically significant difference in the knowledge on free treatment of leprosy was found to exist between leprosy patients, contacts and controls, with leprosy patients having a better knowledge (79.71%) (95% CI: 73-86.42%), followed by contacts (55.0%) (95% CI: 47.73-62.26%) and controls (3.1%) (95% CI: 0.43-5.77%) (P = 0.00). Pertinent problems faced by patients in getting MDT included distant health facilities and poor road network (91[19.0%]), lack of confidence in treatment (56 [11.7%]), MDT shortage (45 [9.4%]), few health facilities (52 [10.8%]), gratification demands (25 [5.2%]), disturbance from other illnesses (24 [5.0]), ignorance (21 [4.4%]) and poor relationship with nurses (24 [5.0%]). Conclusion: Patients still face problems in getting free MDT. Better MDT implementation and leprosy elimination strategies are proposed.

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Background: Progress in science takes place when investigators build on the work of others. Therefore, in scientific communications, it is very important that others' work is correctly noted and understood. Cited references have been found to be inaccurate in every journal in which they have been examined. Aim: To analyze references cited in articles published in Indian Journal of Dermatology, Venereology and Leprology for their citation and quotation precision as an indicator of the quality of articles. Methods: Twelve citation and five quotation errors were identified and defined. Fifty cited references were selected randomly from the May-June 2008 issue of the journal. For these citations, we obtained 44 full texts of papers and two abstracts. In one case, only citation errors could be verified from the Internet. Three citations of books could not be verified. Thus, citation errors were examined in 47 and quotation errors in 46 citations. Results: Thirteen cited references (28.3%; 95% confidence interval [CI] 15.3-41.3%) were error-free. Twenty-eight citations (59.6%; 95% CI 45.5-73.6%) contained citation errors and 20 (43.5%; 95% CI 29.2-57.8%) quotation errors. Conclusion: Results of this pilot study suggest that improving accuracy of the references is important. Solutions to this problem are suggested.

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