Dermatophytic infection of the skin and its appendages is a common occurrence. Though usually straightforward, treatment of dermatophytosis becomes notably challenging in certain population groups – pregnant women, children, and elderly. Treatment with topical azoles/allylamines alone is effective in limited cutaneous disease in all three groups. Terbinafine is the preferred oral agent in elderly population for treatment of extensive cutaneous disease and onychomycosis due to its lack of cardiac complications and lower propensity for drug interactions. If required, additional physical/mechanical modalities can be employed for symptomatic onychomycosis. Data for systemic therapy in children mainly pertains to the treatment of tinea capitis. At present, very little data exists regarding the safety of systemic antifungals in pregnancy and there is an effort to restrict treatment to topical therapies because of their negligible systemic absorption.

Background: Pemphigus is a chronic autoimmune bullous disorder characterized by autoantibodies directed against desmoglein 3 and/or 1. Demonstration of intercellular deposition of IgG on the cell surface of keratinocytes by direct immunofluorescence (DIF) of the skin is the gold standard in the diagnosis of pemphigus. Recently, DIF of plucked hair demonstrating intercellular deposition of IgG in the outer root sheath (ORS) has shown to be useful. Objective: To compare the DIF of plucked hair and skin for the evaluation of immunological remission in pemphigus vulgaris patients in clinical remission. Materials and Methods: A total of 30 patients with pemphigus vulgaris with positive DIF of the skin and hair at baseline were included, and DIF of skin and hair was repeated after 6 months or more of clinical remission (with no new/non-healing lesions). Presence of intercellular deposits of IgG and or C3 in skin and ORS of the hair was considered as positive. Results: Of the 30 patients, DIF of skin was positive in 10 patients and hair was positive 14 patients. The findings of hair and skin DIF correlated with each other in 22 patients. In 6 (20%) patients DIF of hair was positive even though the DIF of skin was negative. The sensitivity of hair DIF was 80% and specificity was 70%. Limitations: Small sample size. Conclusion: DIF of hair is a simple, non-invasive, and cost effective procedure and can be used as an additional procedure for the assessment of immunological remission in patients with pemphigus vulgaris.

Background: Footwear dermatitis represents a common but often undiagnosed or misdiagnosed condition. Patch testing aids in its confirmation and identification of the offending allergen. Aims: This study aimed to find the frequency of positive patch test reactions in cases with suspected allergic contact dermatitis (ACD) to footwear, as well as the common responsible allergens. Materials and Methods: This is a retrospective record based study of 37 patients, with suspected ACD to footwear, who underwent patch testing with Indian standard series and Indian footwear series from July 2012 to July 2015. Results: The majority of patients (45.94%) belonged to the age group of 20–40 years. Dorsal aspects of feet (81.08%) and soles (18.92%) were the common sites involved. Patch test was positive in 18.92% patients. The most common causative allergens were hydroquinone monobenzylether (8.11%) and 4-aminoazobenzene (5.41%). Conclusion: Common chemicals implicated in ACD were rubber, rubber additives, and dyes. The principal culprit allergens were hydroquinone monobenzylether and 4-aminoazobenzene.

Objectives: The primary objective of this retrospective study was to determine the prevalence of leprosy in families, and the secondary objective was to study the clinicoepidemiological features of leprosy in families. Results: There were a total of 901 cases of leprosy who attended our leprosy centre during this 18 year period. There were 49 cases of leprosy in this group whose family members also had documented leprosy (n = 49). A total of 61 family members of the index cases were affected by leprosy, thus making a total of 110 cases. There were 30 males (61.22%) and 19 females (38.78%) in the index cases. The age group of 21–40 years comprised the maximum number of cases in the index group, accounting for 24.49%. Borderline tuberculoid (BT) was the commonest type of leprosy in both the index cases and family members accounting for 48.98% and 55.74%, respectively. Conjugal leprosy was present in 16 couples. In 68.75% of leprosy in couples, one member was of the lepromatous type. Children (10–15 years age group) accounted for 10 cases in this study (9.09%). In children, 90% of the cases had one member with lepromatous leprosy. Conclusions: The prevalence of leprosy in families in this study was 5.44%. BT was the most common type of leprosy in both the index cases and family members. The prevalence of conjugal leprosy was 1.78%, with majority of the partners having the lepromatous type. Of the affected children, 90% had family members with lepromatous type of leprosy.

Background: Palms and soles are the readily visible areas of the body that are affected in various dermatoses. This may have considerable concern to the patient and can cause diagnostic dilemma. Moreover, palmoplantar dermatoses also limit our day to day activities with a significant impact on quality of life. Aim: To study the clinical profile of patients suffering from palmoplantar dermatoses at a tertiary care centre. Patients and Methods: A prospective observational study was carried out from June 2014 to May 2015 in the Department of Dermatology, Venerology and Leprosy at a rural tertiary care centre after taking approval from the institutional ethical committee. In total, 202 cases were enrolled. The study was analyzed using Chi-square test. Results: A total of 202 patients were enrolled, among which 53.46% were males. The most common age group affected was 17–40 years (42.57%). Duration of less than 1 month was seen in 31.7% cases whereas 29.7% showed seasonal variation. The most common chief complaint was itching (69.8%). Palmoplantar psoriasis was the most common dermatosis with 28.22% cases, followed by keratinizing disorders with 26.72% cases. Palms were involved in 66.34% cases, soles in 69.30%, and both palms and soles in 37.12% cases. Other body parts were involved in 15.34% of the cases. Diabetes and hypertension were common comorbid conditions seen in 11.4% of the cases each. Conclusion: Palmoplantar psoriasis was the most common disorder affecting palms and soles followed by palmoplantar keratoderma.

Background: Chikungunya fever is caused by chikungunya virus which is transmitted by the bite of infected Aedes aegypti and A. albopictus mosquitoes. Aims: To study the various mucocutaneous manifestations in suspected cases of chikungunya fever. Materials and Methods: The patients who attended our outpatient department from July 2016 to October 2016 and fulfilled the criteria for “suspect cases” of chikungunya infection stipulated by the National Institute of Communicable Diseases, Directorate General of Health Services, Government of India, were included in the study prospectively. A total of 112 patients (62 males and 50 females) with mucocutaneous manifestations of chikungunya fever were enrolled in the study. Results: Mucocutaneous manifestations were found more in males than females. Serological immunoglobulin M enzyme-linked immunosorbent assay (IgM ELISA) test for chikungunya virus was positive in 62 (55.3%) patients. Generalized erythematous maculopapular rash (53.5%) was the most common finding. Genital pustular rash with aphthae (4.4%), oral and intertriginous aphthae, red lunula, subungual hemorrhage, localized erythema of the ear pinnae, erythema, swelling, and eczematous changes over the preexisting scars and striae (scar phenomenon) were the other interesting findings. Various pattern of pigmentation (37.5%) were observed including striking nose pigmentation in a large number of patients, by looking at which even a retrospective diagnosis of chikungunya fever could be made. There was flare-up of existing dermatoses like psoriasis and dermatophytic infection. Conclusions: Wide varieties of the mucocutaneous manifestations were observed in our study, but the striking nose pigmentation was present irrespective of age and this peculiar pigmentation may be considered as a specific clinical marker of chikungunya fever. Chikungunya fever must be suspected in any patient with painful oro-genital and intertriginous aphthous-like lesions associated with febrile polyarthralgia with rash.

Background: Psoriasis is a chronic inflammatory disease of the skin that may affect the visible areas of body. Hence, the quality of life, self-esteem, and body image can be affected in psoriasis patients. Objectives: We aimed in the present study to assess the effects of psoriasis on the quality of life, self-esteem, and body image. Materials and Methods: The study included 92 patients with psoriasis, along with 98 control participants. The sociodemographic characteristics of the patients were assessed, their Psoriasis Area Severity Index (PASI) scores were calculated to determine the clinical severity of the psoriasis, and the values were recorded. In addition, Dermatology Life Quality Index (DLQI), Body Image Scale, and Rosenberg Self-Esteem Scale results were evaluated. Results: When the control and psoriasis groups were evaluated regarding the DLQI, self-esteem, and body image, quality of life was found to be more negatively affected in the psoriasis group than the controls, which was statistically significant (P < 0.001), and self-esteem (P < 0.001) and body image (P < 0.001) were found to be significantly lower. Educational status significantly affected self-esteem (P < 0.001) and body image (P = 0.021), however, quality of life was not significantly affected by this parameter (P = 0.345). PASI was positively correlated with the quality of life (r = 0.703) and self-esteem (r = 0.448), however, it was negatively correlated with the body image (r = −0.423). Conclusions: Psoriasis may negatively affect quality of life, self-esteem, and body image, and may also cause psychosocial problems. An assessment of new approaches on this issue may contribute to developments in the treatment of and rehabilitation from this disease.

Bullous hemorrhagic dermatosis induced by enoxaparin is a rare, self-limiting, cutaneous adverse reaction causing no complications. In this report, we present a case where bullous hemorrhagic dermatosis developed at a location distant from the site of injection after using enoxaparin for 5 days for pulmonary venous thrombosis.

Nicolau syndrome (Embolia cutis medicamentosa) is a rare complication following parenteral administration of a drug. It has been reported in association with intramuscular, subcutaneous, intravenous and intra-articular injections. However, Nicolau syndrome following intramatricial injection has not been described to the best of our knowledge. We report the case of an 18-year-old male who developed this complication following 7^th session of intramatricial injection. The patient was started on broad spectrum antibiotic coverage, vasodilator therapy, analgesics, and daily dressing. On day 21, the symptoms completely resolved with return of normal color of the digit. The case is being reported to make dermatologists aware of the possibility of Nicolau syndrome following intramatricial injection of triamcinolone acetonide.

Autosomal recessive cutis laxa type-II (ARCLII) is a spectrum of clinical disorders with prenatal and postnatal growth retardation, cutis laxa, dysmorphism, and skeletal abnormalities. We report the case of a 14-month-old boy with developmental delay, hypotonia, dysmorphism, and loose skin. A novel homozygous variant was observed in ATP6VOA2 gene. Clinical spectrum of ARCLII is highly heterogeneous and molecular analysis should be done to confirm the diagnosis.

A 49-year-old woman with a long history of a subcutaneous mass on the dorsal side of her 4^th finger of the right hand visited a dermatologist because of slight enlargement of the mass. Her past medical history was notable only for a mitral valvuloplasty performed 20 years earlier. Physical examination revealed a small, round, firm subcutaneous mass on the dorsal side of her proximal interphalangeal joint of the right 4^th finger. The mass was immobile and nontender and its overlying skin was intact. An excisional biopsy was done for the patient and the specimen was sent for pathologic evaluation. On microscopic examination, the final diagnosis of plexiform schwannoma was made for the lesion. The aim of this publication is to report a rare case of plexiform schwannoma of the soft tissue and a literature review to provide a better understanding about its characteristics including epidemiologic factors and pathologic evaluation.

Trichoepithelioma is a benign tumor of follicular unit. It has been rarely described as the cause of leonine facies. We are presenting a classical case of multiple familial trichoepitheliomas (MFTs) with characteristic histopathological features leading to leonine facies.

Vorderman (1901) was the first to record blisters caused by beetles in medical literature. Blister beetle dermatitis is a cutaneous condition caused by the toxins released by blister beetles. The vesicant chemical in the body fluids of these insects causes an acute irritant contact dermatitis characterized by erythematovesicular lesions associated with burning sensation on exposed parts of the body. The aim of this study was to investigate the morphological patterns of blister beetle dermatitis. We conducted a 1-year (January–December 2014) prospective study of the clinical presentation of Paederus dermatitis noticed in urban and semiurban areas close to paddy fields in the Cauvery Basin, Mysuru, Karnataka. All patients with Paederus dermatitis attending the outpatient department of Department of Dermatology were recruited in the study with a total of 37 patients. Diagnosis was made on detailed history regarding onset of lesions, symptoms, as well as thorough clinical examination of the lesions. The peak time of presentation was June–September, the monsoon season in this part of India. The average duration of lesions at the time of presentation was 2–5 days. All patients had a history of burning and itchy sensation at night followed by full blown lesions the next morning, with the face, neck, and arms being the most common sites. Patients were predominantly males with the age range of 13–55 years. The most common presentations were linear erythematous plaques and erythematovesicles with a “burnt” appearance and a gray necrotic centre. “Kissing” lesions and periorbital involvement were seen in 5 and 6 patients, respectively. Species identification of the Paederus beetles was not done. Paederus dermatitis occurs in tropical regions. Awareness about the morphological patterns of the condition will prevent misdiagnosis. Simple preventive measures can be undertaken based on the behavioral pattern of this nocturnal beetle.