Introduction:Vitiligo is an acquired depigmentary condition caused by inactivation or destruction of melanocytes in epidermis and hair follicle. Worldwide incidence of 1% has been reported; similar to various dermatological clinics in India. Widespread prejudice, ignorance, taboos, lack of scientific appraisal, and confusion of vitiligo with leprosy makes it an immense psychological stress.Aim:To know the clinical profile of vitiligo patient with associated cofactors.Materials and Methods:Total 1,010 patients of vitiligo attended in outpatient department at Shree Krishna Hospital (SKH) and Matar camp, Gujarat over 1 year period from August 2011 to July 2012 were included in this study. Detail history and clinical examination of patients were done.Results:Out of 1,010 patients 57.3% were females and 42.7 % were males. Most cases developed vitiligo by 2nd decade of life. Progressive course was found in 60.9 % of patients. Vitiligo vulgaris (57.8%) was most common morphological type. Most common site of onset (41.5%) and involvement (75.7%) was lower limb. Family history was present in 20.4%.Conclusions:Vitiligo constitutes important dermatological disease especially in India. The data suggest that local epidemiological behavior of vitiligo need not be the same across different regions. Vitiligo differs substantially in various clinical aspects.

A 63-year-old woman presented with a six month history of a large pruritic plaque which was present over both her legs and feet. The lesions had first appeared over her right leg, followed by involvement of left leg. She denied fatigue, heat intolerance, hand tremor, constipation, unexplained weight gain or change in voice. Her past medical history included Type-2 diabetes mellitus, which was currently diet controlled and hypertension, of two year's duration. Her current medications included an angiotensin receptor blocker. Her physical examination revealed a non-tender, firm, nodular thyroid swelling and exophthalmos. Her cutaneous examination showed a well defined, indurated, erythematous to skin coloured non-tender plaque over both anterolateral aspects of legs. On left side, lesions extended upto middle of the leg and on the right side, just above the ankle, extending to involve bilateral feet, but sparing the toes [Table/ Fig-1]. There was no clubbing, hyperhidrosis or hypertrichosis.Thyroid function test showed thyroid-stimulating hormone (TSH)-2.25 mu/L (0.27-4.20 mu/L), free triiodothyronine (T3) -1.54 nmol/L (1.3-3.1 nmol/l), free thyroxine (T4) -93.62 nmol/l (66-181 nmol/l), thyroglobulin antibodies (AbTG) titre-190 IU/mL(0-35 IU/mL) and Anti-TPO antibody levels of >1000 IU/mL (0-35iu/ ml). Other haematological and biochemical investigations, including serum creatinine, lipid profile and plasma glucose were within normal limits. Keeping in mind PM, chronic dermatitis and lichen myxedematosus as differentials, a skin biopsy was taken from left leg. Histopathology showed a normal epidermis, collagen fibres in reticular dermis, which were mildly separated by deposits of mucin, and mild perivascular lymphocyte infiltration. These changes were suggestive of PM [Table/ Fig-2].Ultrasound examination of thyroid showed diffusely heterogeous and bulky cystic areas with increased vascularity. Few subcentimetric sized lymph nodes were noted, which were bilateral at level 2 and level 3, which suggested a possibility of Thyroiditis. Fine needle aspiration biopsy taken from thyroid swelling showed oxyphilic cells with round nuclei and moderate to marked anisocytosis, prominent nucleoli and abundant eosinophilic granular cytoplasm. Few multinucleated giant cells with occasional clusters of epitheloid histiocytes were present, which favoured changes of Hashimoto's thyroiditis. The lesions regressed after 4 sittings, with monthly intralesional triamcinolone acetonide injections, 10 mg/ml, 0.5-1.0 ml per lesion. DisCussionPM is a well-defined cutaneous mucinosis which is characterized by increased amounts of acid glycosaminoglycans in the dermis. It is a rare clinical finding which is often referred to as localized myxedema or thyroid dermopathy. It is an autoimmune manifestation seen in 5 -10% of patients with Graves thyrotoxicosis [1]. PM has a gradual onset and it typically develops 12 to 24 months after the diagnosis of thyrotoxicosis. It tends to affect older adults, showing a peak incidence in the sixth decade of l...

Sweat gland adenocarcinoma is a rare tumor particularly over scalp. They have potential to be benign as well as distant metastasis. Usually presents with papules or nodules. Ulcerative morphology is uncommon. Wide surigical excision with regional lymph not dissection is the treatment of choice. A 42-year-old female with sweat gland adenocarcinoma of scalp is reported with cervical lymph node involvement.

Visceral leishmaniasis (VL), also known as kala-azar, is a life-threatening systemic disease caused by the obligate intracellular protozoan, Leishmania, and transmitted to humans by the female phlebotomine sand fly (Phlebotomus argentipes). The disease is fatal, if left untreated. We report a case of a patient clinically suspected of disseminated tuberculosis, but fine needle aspiration cytology of cervical and axillary lymph nodes yielded a diagnosis of leishmaniasis. Diagnosis of VL was challenging as the disease closely mimicked tuberculosis in the setting of extensive lymphadenopathy including conglomerate of mesenteric lymph nodes, on and off fever, and granulomatous lymphadenitis on aspiration. Bone marrow examination was further performed. A detailed workup revealed patient to be severely immunocompromised and newly diagnosed human immunodeficiency virus (HIV) positive. Worldwide, India has the largest number of VL cases, accounting for 40%–50% of world's disease burden and the second largest HIV-infected population, accounting for approximately 10% of the global disease burden. HIV increases the risk of developing VL by 100–2320 times in endemic areas and concurrently VL promotes the clinical progression of HIV disease. Co-infection with HIV alters the body's immune response to leishmaniasis thus leading to unusual presentations. This case highlights the diagnostic problem in the aforesaid setting. Moreover, co-infection with HIV in VL can be a potential source of drug resistance. An early diagnosis and intensified treatment is the key to patient management.

The anti-inflammatory and vasoconstrictive properties of topical corticosteroids (TCs) contribute in providing therapeutic benefits in several skin conditions, including atopic eczema, localized vitiligo, psoriasis, and chronic hand eczema. Clobetasol propionate (CP) is the most common topical agent used for psoriasis management and demonstrates an efficacy superior to other TCs. A new CP 0.025% cream formulation has demonstrated hypoallergenic effects due to the absence of known contact allergens, such as propylene glycol, short-chain alcohols, and sorbitol-based emulsifiers. Lower CP serum levels and less hypothalamic–pituitary–adrenal axis suppression with CP 0.025% cream formulation than with CP 0.05% ensure better safety. The present case series discusses the clinical experience of using CP 0.025% cream in various dermatological conditions.