BackgroundDermatophytosis management has become an important public health issue, with a large void in research in the area of disease pathophysiology and management. Current treatment recommendations appear to lose their relevance in the current clinical scenario. The objective of the current consensus was to provide an experience-driven approach regarding the diagnosis and management of tinea corporis, cruris and pedis.MethodsEleven experts in the field of clinical dermatology and mycology participated in the modified Delphi process consisting of two workshops and five rounds of questionnaires, elaborating definitions, diagnosis and management. Panel members were asked to mark “agree” or “disagree” beside each statement, and provide comments. More than 75% of concordance in response was set to reach the consensus.ResultKOH mount microscopy was recommended as a point of care testing. Fungal culture was recommended in chronic, recurrent, relapse, recalcitrant and multisite tinea cases. Topical monotherapy was recommended for naïve tinea cruris and corporis (localised) cases, while a combination of systemic and topical antifungals was recommended for naïve and recalcitrant tinea pedis, extensive lesions of corporis and recalcitrant cases of cruris and corporis. Because of the anti-inflammatory, antibacterial and broad spectrum activity, topical azoles should be preferred. Terbinafine and itraconazole should be the preferred systemic drugs. Minimum duration of treatment should be 2–4 weeks in naïve cases and > 4 weeks in recalcitrant cases. Topical corticosteroid use in the clinical practice of tinea management was strongly discouraged.ConclusionThis consensus guideline will help to standardise care, provide guidance on the management, and assist in clinical decision-making for healthcare professionals.

The cutaneous findings hitherto not reported may be the result of the African genotype of the virus detected during this outbreak in India.

Background. Cutaneous alterations are common in neonates. The majority of lesions are physiological, transient, or self-limited and require no therapy. Although much has been reported on the various disorders peculiar to the skin of infant, very little is known about variations and activity of the skin in neonates. Objective. To study the various pattern of skin lesions in newborn and to estimate the prevalence of physiological and pathological skin lesions in newborn. Methods. A total of 1000 newborns were examined in a hospital-based, cross-sectional prospective study in the period of November 2007 to May 2009. Results. The physiological skin changes observed in order of frequency were sebaceous gland hyperplasia (89.4%), Epstein pearls (89.1%), Mongolian spot (84.7%), knuckle pigmentation (57.9%), linea nigra (44.5%), hypertrichosis (35.3%), miniature puberty (13.3%), acrocyanosis (30.9%), physiological scaling (10.8%), and vernix caseosa (7.7%). Of the transient noninfective conditions, erythema toxicum neonatorum was seen in 23.2% newborns and miliaria crystallina in 3% newborns. The birthmarks in descending order of frequency were salmon patch (20.7%), congenital melanocytic nevi (1.9%), and café-au-lait macule (1.3%). Cutaneous signs of spinal dysraphism were sacral dimple (12.8%), meningomyelocele (0.5%), acrochordons (0.1%), and dermoid cyst (0.1%). Conclusion. The physiological and transient skin lesions are common in newborns particularly sebaceous gland hyperplasia, Epstein pearls, Mongolian spots, and erythema toxicum neonatorum. It is important to differentiate them from other more serious skin conditions to avoid unnecessary therapeutic interventions.

Acute skin failure is a state of total dysfunction of the skin resulting from different dermatological conditions. It constitutes a dermatological emergency and requires a multi-disciplinary, intensive care approach. Its effective management is possible only when the underlying pathomechanism of each event is clear to the treating clinician. The concept of skin failure is new to non-dermatologist clinicians and sketchy among many dermatologists. Here the pathomechanism of skin failure has been analyzed and a guideline for monitoring has been provided. There is a need for intensive care units for patients with acute skin failure.