RFP Journal of Dermatology

 Chronic lower limb ulcer is a wound that shows no tendency to heal after 3 months of appropriate treatment or is still not fully healed at 12 months. There are various causes of non-healing ulcer which include vascular insufficiency, diabetic ulcer and various infections. One such cause is Pyoderma gangrenosum, which is a chronic, relapsing, ulcerative inflammatory neutrophilic dermatosis with distinctive clinical manifestations. It shows a strong association with systemic diseases like inflammatory bowel disease, seronegative arthritis and lymphoproliferative disorders. No specific investigations are available for the diagnosis which mainly depends on clinical features. Corticosteroids and immunosuppressant therapy are mainstays in treatment. Here, we present a case of pyoderma gangrenosum in a 55 year old female over lower limb, treated with cyclophosphamide pulse therapy and showed good improvement.

Keywords: Pyoderma gangrenosum (PG); neutrophilic dermatoses; non healing ulcer.

 The source of infection is usually an active lesion on an animal, or on another humanand transmission is either by direct contact or indirect lyvia fomites.Fomites play an important rolein transmission, especially when combined with host risk factors such as immunological status, local trauma, excessive moisture or occlusive clothing. Use of contaminated combs, caps, towels, shoes, socks, pillows, beddings, and clothing include the common methods of indirect transmission. After the detailed history, clinical examination of patient was made in good light which included site of lesion, number of lesions, types, presence of inflammatory margin and extent of involvement. Most common clinical type being 42 cases (28%) in tinea cruris, then followed by 37 cases (24.67%) in tinea corporis, 36 cases (24%) in tinea cruris with corporis, 7 cases (4.67%) in tinea capitis, 8 cases (5.33%) in tinea pedis, 4 cases (2.67%) in tinea manuum, 13 cases (83.3%) in tinea unguium and 3 cases (2%) in tinea faciei.Middle class population was the most commonly affected socio-economic group compared to other studies which show low class. This may be due to the inability of the patients to reach to this hospital from far flung areas and poor patients may prefer home remedies.

Keywords: Tinea Cruris; Tinea Capitis; Dermatophytosis

 India is a large sub continent with remarkably varied topography, situated within the tropical and subtropical belts of the world. Its climate is conducive to the acquisition and maintenance of fungal infections. They are assuming greater significance both in developed and developing countries particularly due to advent of immunosuppressive drugs (steroids) and due to the increased prevalence of diseases like HIV. A total of one hundred and fifty clinically diagnosed randomly selected cases of skin, hair and nail infection, of all age groups and of both sexes, attending Dermatology out patient department were taken for the study. Out of 150 clinically suspected cases of dermatophytosis, fungi were demonstrated in 140 cases (93.33%) either by direct microscopy and/or culture. Eighty-five cases (58.67%) were positive by both microscopy and culture. Thirty-eight (25.33%) were positive by microscopy and negative by culture. Fourteen cases (9.34%) were negative by microscopy but culture positive. Ten cases (6.67%) were negative both by microscopy and culture.

Keywords: Dermatophytosis; Fungal Infections; KOH

 Context: Melasma is a common, acquired, symmetric hypermelanosis, characterized by irregular light to dark brown macules and patches commonly involving the cheeks, forehead, upper lip, nose, and chin. Aims: To study the clinical patterns of melasma in patients attending skin OPD and To study the effect of different therapeutic methods in treatment of melasma. Settings and Design: Prospective cohort. Materials and methods: Patients attending OPD were randomly divided into 3 equal groups to be treated with either topical hydroquinone or topical triple combination or chemical peeling. All patients were evaluated before treatment, followed up for 6 months, peel session done at an interval of 1 month and MASI score was calculated every time. Statistical analysis: Student t test Results: Among 150 patients studied, majority were in the age group of 20-30 yrs [38.7%], females [79%] and belonged to epidermal type [51.33%] of melasma based on woods lamp, centrofacial [74.7%] type of melasma based on clinical findings. There was improvement in the MASI score of all patients in all melasma type [both clinical and woods lamp] irrespective of treatment group and the difference seen was statistically significant in each group [p<0.05]. Conclusion: Triple combination showed better results compared to glycolic acid peels and hydoquinone with no significant side effects with short contact time. Considering the high prevalence of melasma among people with Indian skin type there is a need to study effect of various modalities of treatment used for the same.

Keywords: Melasma; chemical peeling; hydroquinone; triple combination

 Urticaria is a fairly common condition affecting 0.1% of the population characterized by transient swellings of the skin. Chronic Spontaneous urticaria has multifactorial aetiologies including intolerance to food or drugs, infectious diseases, and autoimmune processes. Skin prick testing or SPT demonstrates an allergic response to a specific allergen. In conjunction with an allergy focused history, SPT can help to confirm the presence of an allergy to either food, inhaled substance or any other allergen. Aims and Objective: To evaluate the types of chronic Spontaneous urticaria with reference to etiology from history and investigations and to identify the specific offending allergen and excluding it to reduce the severity and frequency of episodes of urticaria and angioedema. Materials and Methods: A total of 40 patients with chronic spontaneous urticaria of more than six weeks duration were studied. Skin test were performed according to history using Indian standard battery of prick test. Results: Out of 40 patients, 28 (60%) showed positive reactions to more than five antigens with maximum reaction to food (in 15 patients), of which sour and fermented foods were the commonest followed by dust and pollen (5 patients each), fungi (1 patient) and insect in 2 (1 each to cockroach & yellow flask) with 12 patients showing no reaction. Conclusion: Skin prick test is found to be a simple, quick and inexpensive method for identifying the causative allergen in a majority of the patients.

Keywords: Chronic Spontaneous Urticaria; Skin Prick Test

  The concept of Health related quality of life (HROQL) is important consideration in modern era and skin diseases have an definitive impact on HROQL amongst which psoriasis being an common, chronic, mamy times disfiguring and frustrating has very much negative impact on quality of life. This study was conducted keeping the same view which included the assessment of impact of pruritus on QOL with patients of chronic plaque  psoriasis to introduce timely psychological support to improve QOL. Three parameters with specifies and well documented evidence were used to assess the psoriasis severity, the degree of itch and QOL and these were Psoriasis area severity index, 5D ithch scale and DQLI repectively. It was found that pruritus severity has a significant and clinically important association with poorer HRQL in patients with CPP as measured by the DLQI. We also observed that pruritus is associated with determinants to emotional well-being as measured by the DLQI and with detrmnants to other realms of mental health, including social functioning. Study Design: Prospective Study. 

Keywords: Pruritus; Chronic; Plaque Psoriasis.