Nephrogenic systemic fibrosis (NSF) is a relatively new fibrosing disorder which has caught the attention of various specialities in the past decade. NSF is an extremely disabling and often painful condition, affecting up to 13% of the individuals with chronic kidney disease. The administration of a gadolinium chelate contrast agent has been reported to induce the development of NSF, particularly in patients who have acute or chronic renal disease with a glomerular filtration rate (GFR) lower than 30-mL/min/1.73 m ² and in those with acute renal insufficiency. Mass spectroscopy studies have demonstrated particles of gadolinium in the lesional tissue. The exact pathogenesis of this curious sclerosing condition is unknown. The role of the aberrant targeting of 'circulating fibrocytes' to the peripheral tissues and viscera has been hypothesized. NSF has distinct clinicopathological features in the setting of renal failure and needs to be looked upon as a new entity on the block. The condition is characterized by irregular indurated plaques, with amoeba-like projections and islands of sparing, chiefly on the trunk and extremities. Flexion contractures of fingers, knees, and elbow joints are known to occur in advanced cases of NSF. The course is frequently associated with painful episodes and loss of ambulation. Histopathology shows haphazard arrangement of thickened bundles of collagen, varying amount of mucin, and increased population of fibroblast-like cells in the dermis. Immunohistochemistry shows increased deposition of type-I procollagen and CD 34+ cells having fibroblastic activity. The condition is refractory to treatment with corticosteroids and immunosuppressive agents. Various modalities of therapy such as UVA1 phototherapy, imatinib mesylate, photodynamic therapy, plasmapheresis, extracorporeal photochemotherapy, and high-dose intravenous immunoglobulin have shown a moderate degree of improvement in skin thickness scores. A prudent option is restoration of renal function to normalcy via renal transplantation but to date the outcome of renal transplantation is unknown.

Psoriatic arthritis (PsA) is a psoriasis-associated inflammatory disease of the joints and enthuses. The occurrence of PsA is linked to the complex interplay of gene environment, and immune system. Genetic factors have long been recognized to play an important role in PsA. Genes within the major histocompatibility complex (MHC) region have been shown to be associated with PsA. These include genes coded in the HLA region, (especially Class I antigens) and non-HLA genes (i.e., MHC class I chain-related antigen A, MICA, and TNF-α genes). Association studies in PsA have also identified a number of genes outside MHC region, including interleukin-1 (IL-1) gene cluster, killer-cell immunoglobulin-like receptors (KIRs), and IL-23R genes. Established systemic treatments for moderate-severe psoriasis and PsA may be potentially dangerous and usually time consuming for the patient and often expensive for the National Health Systems. Tests which could predict which subset of psoriatic patients could develop the most severe forms of the disease (i.e., PsA) or will respond to well-established (UVB irradiation) or other systemic treatments are now required. The goal of genetic test screening is to rapidly and safely identify subjects for preventive or early treatment or extended surveillance prior to the onset of signs and symptoms. Genetic tests today represent a reliable investigation procedure which could rapidly and consistently improve the diagnostic ability of the dermatologist and contribute to the early and correct treatment of the different subsets of PsA.

Background: Urticaria is a common dermatological manifestation in adults with relatively infrequent occurrence of chronic urticaria (CU) in childhood. The etiology of urticaria in childhood remains incompletely understood because of limited data on children. Objective: We carried out this retrospective data-based study to determine different etiological factors and response to treatment in pediatric patients presenting with urticaria. Materials and Methods: Eighty children (M : F 49 : 31) between the ages of 1 and 14 years, who presented with urticaria excluding patients of physical urticaria attending the Outpatient Department of Pediatrics and Dermatology were included in the study. Patients were evaluated after taking a detailed history, doing a thorough physical examination, and basic laboratory investigations. Specific in vivo and in vitro tests were performed after the initial evaluation and consent of patients. Results: Out of eighty patients, 35 (43.75%) presented with acute urticaria and 45 (56.25%) gave a history of chronic urticaria.CU. An underlying cause was suspected in 53 cases (66.25%), although a definite association with response to a specific treatment was correlated in 30 (37.5%). Infection was the most common underlying causative factor. Underlying thyroid dysfunction was observed in 12 patients, of whom two had thyroid anti peroxidase antibodies. Autologous serum skin test was positive in 17 patients. Conclusions: In the present study infections were the most common etiological factor for urticaria in children.

Background: Long-term use of topical and systemic steroids produces secondary open-angle glaucoma similar to chronic simple glaucoma. The increased intraocular pressure [IOP] caused by prolonged steroid therapy is reversible but the damage produced by it is irreversible. Materials and Methods: In this study, we analyzed 200 patients with steroid-induced glaucoma, who were on systemic and topical corticosteroids for various dermatological conditions. The variation in IOP caused by different steroid preparations was studied. Results: Two hundred patients who were on systemic steroids for more than 8 weeks developed raised IOP. Three of these patients also developed bilateral posterior subcapsular cataract. Conclusion: We conclude that systemic steroids can induce rise of IOP and cataract formation. If it is not detected and treated in time, rise in IOP can lead to irreversible damage to the eyes.

This preliminary presentation based on extensive field studies carried out by Bombay Leprosy Project, a research-oriented NGO, portrays the alarming dimensions of the disease burden felt by rural communities and recommends a cost effective field model. This study in an adopted rural population in Shahapur "taluka" of Thane District assumes tremendous significance and is worthy of replication in comparable situations. This is particularly so in the background of the absence in the literature of any similar field studies based entirely on community care of the physically disabled due to leprosy. The magnitude of the problem posed by leprosy patients with disabilities and their rehabilitation is highly challenging and is expected to pose a heavy burden on the community as well as unprecedented strain on the PHCs managed by the government. The health planners should rethink on future strategies in such a manner that human rights of the downtrodden patients suffering from the "neglected disease" of leprosy are not sidelined

Pilomatricoma is a benign skin neoplasia, which is not commonly encountered in general practice. The diagnosis is often made only after histopathology. The present case report is of a 30-year-old woman who presented with swelling in neck, which was diagnosed as pilomatricoma only after excision. The idea of reporting this case is that pilomatricoma is not rare in occurrence but rarely diagnosed because of lack of confirmation of excised swelling and it is imperative that it should be kept in the differential diagnoses of all superficial skin tumors by dermatologists and surgeons.

We report a case of a 34-year-old woman presenting with an erythema multiforme (EM)-like eruption. Lesions developed after a 12-day treatment with a slimming drug preparation (food integrator with thermogenic activity) and a herbal remedy (pilosella tincture). Serological investigations excluded viral or bacterial infections. Patch testing with galenic preparations of both drugs demonstrated sensitization to the slimming drug preparation. According to literature reports and immune-chemical properties, those components that are likely to have triggered the skin eruption are clorazepate dipotassium and theobromine. Their interaction with other two constituents such as pseudoephedrine hydrochloride and dehydrocholic acid may have caused the adverse reaction by means of a summation effect. There are no reports specifically about EM caused by a slimming drug preparation and no studies have identified thermogenic pills as cause of EM/EM-like eruption. Weight-loss compounds in slimming preparations should be kept in mind as a possible cause of drug-induced EM-like eruption.

Primary mucinous carcinoma of the skin is a rare adnexal tumor of sweat gland origin. A case report is presented of a 70-year-old male, who presented with a slow growing mass near the lateral canthus of his left eye. The case was clinically diagnosed as a fibroma. An excisional biopsy of the lesion revealed mucinous carcinoma of the skin. Investigations excluded the possibility of metastatic mucinous carcinoma. Thus, the lesion in the lateral canthus region was diagnosed as Primary Mucinous Carcinoma of the skin, a rare site of occurrence.

Multicentric reticulohistiocytosis is a rare systemic granulomatous disease of an unknown cause, characterized by distinct histopathology. The skin, mucosa, synovial, bone, and internal organs may be involved. Cutaneous nodules and distinctive arthritis are the most prominent clinical features. A 55-year-old female was referred from Orthopedic Outpatient Department, with multiple, painful and tender nodules on the dorsum of her hands, forearms, elbows, back, and neck. The lesions were present predominantly around the joints with associated arthropathies. Smaller nodules were seen on the ear helices. There was no other clinically evident or investigative abnormality. A histopathological study confirmed the diagnosis of multicentric reticulohistiocytosis.

Dapsone, a potent antiparasitic and anti-inflammatory compound, is mainly used in the treatment of leprosy and a variety of blistering skin diseases. It may cause a severe adverse drug reaction with multiorgan involvement known as dapsone hypersensitivity syndrome. We report an unusual case of dapsone hypersensitivity, manifesting as bone marrow suppression and peripheral pancytopenia in addition to fever, rash, and hepatosplenomegaly.

Extra ocular Sebaceous Carcinoma is a rare malignancy when compared to Peri ocular variant and these are derived from sebaceous gland epithelium. The aggressive types of extra ocular sebaceous neoplasm are reported with lymph node and visceral metastasis associated with poor prognosis. Here we report a case of extensive cutaneous extra ocular sebaceous cell carcinoma confined to large area of scalp proven by Immunohistochemistry without intra cranial involvement, distant metastases or evidence of Muir-Torre syndrome.

Porokeratosis represents a heterogeneous group of disorders characterized clinically by a distinctive ridge-like border and histologically by cornoid lamellae. Gardner's syndrome, a variant of familial adenomatous polyposis (FAP), is an autosomal dominant disease characterized by colorectal polyps, osteomas, epidermoid cysts and soft tissue tumors. Here we report a case of 18 yr old female who presented with porokeratosis of Mibelli with osteoma, multiple epidermoid cytsts, and solitary rectal polyp.

Parthenium dermatitis is a widespread and distressing dermatoses in rural and urban India caused by the air borne allergen of the Compositae weed Parthenium hysterophorus. Parthenium dermatitis has been thought to be mediated solely by type IV hypersensitivity, but recently a combined immediate (type I) and delayed (type IV) hypersensitivity mechanism has been postulated in the initiation and perpetuation of parthenium dermatitis, especially in sensitized subjects with an atopic diathesis. Initially, the exposed sites of the body are involved. Later in the course of the disease, unexposed sites may get involved. Various clinical presentations have been described in parthenium dermatitis. Typically, it presents as an air borne contact dermatitis (ABCD) involving the eyelids and nasolabial folds Other presentations include a photodermatitis (essentially a pseudo photodermatitis), atopic dermatitis, seborrheic dermatitis, exfoliative dermatitis, hand dermatitis. Photosensitive lichenoid dermatitis and prurigo nodularis are rarer presentations. Uncommon presentations have been described in parthenium dermatitis. They include prurigo nodularis-like lesions and photosensitive lichenoid eruption. Three cases are presented, two of whom presented as polymorphic-like lesions and one as prurigo nodularis. All three patch tested positive to parthenium on Day 2. Prick testing was positive in two of the three patients. Parthenium dermatitis mimicking polymorphic light eruption has not been reported. Histopathology revealed vasculitis in the lesional skin in two of the patients. Although leukocytoclastic vasculitis has been reported earlier from the prick-tested site, this is the first report demonstrating the presence of vasculitis in lesional skin of parthenium dermatitis.

We present a case of an otherwise healthy 10-year-old girl who presented with asymptomatic brown macules over the trunk and proximal extremities, of three months' duration. The cutaneous examination revealed multiple, dark brown, discrete, round to oval macules and a few mildly elevated lesions over the trunk and proximal limbs. The individual lesion was 1-3 cm in diameter and a few showed velvety appearance over the surface. Darier's sign was negative. The histopathological study from the velvety lesion showed acanthosis, papillomatosis and increased melanin in the basal layer. The upper dermis showed sparse perivascular infiltrate of lymphocytes without any dermal melanophages. It fulfilled the criteria for idiopathic eruptive macular pigmentation with additional histological finding of papillomatosis.

This report describes an unusual case of bilaterally symmetrically occurring hyperpigmented itchy popular lesions on both forearms of a 50-year-old woman. The woman had antecedent hyperkeratotic eczema of the feet and she had a similar eruption in the past which had cleared with topical steroid application. Biopsy of the lesion showed syringomas. We present this case to highlight an unusual case of bilaterally symmetrical papular pruritic eruption against a background of hyperkeratotic eczema. Some syringomas are supposed to be a response to an inflammatory trigger and we wonder if in this case the eczema acted as an inflammatory trigger.

Fumaric acid esters (FAE) are substances of interest in dermatology. FAE exert various activities on cutaneous cells and cytokine networks. So far only a mixture of dimethylfumarate (DMF) and three salts of monoethylfumarate (MEF) have gained approval for the oral treatment of moderate-to-severe plaque-type psoriasis in Germany. DMF seems to be the major active component. There is evidence that FAE are not only effective and safe in psoriasis but granulomatous non-infectious diseases like granuloma annulare, necrobiosis lipoidica and sarcoidosis. In vitro and animal studies suggest some activity in malignant melanoma as well.