Background:Melasma is a relatively common, acquired symmetric hypermelanosis characterized by irregular light to gray-brown macules involving sun-exposed areas. Kojic acid, with its depigmenting potential due to tyrosinase inhibition and suppression of melanogenesis, has become a vital component of the dermatologists’ armamentarium against melasma.Aim:To study and compare the efficacy of kojic acid 1% alone, vis-a-vis its separate combinations with 2% hydroquinone or 0.1% betamethasone valerate and a combination of all these three agents with respect to the duration of symptoms and level of pigmentation in the therapy of melasma.Materials and Methods:Eighty patients from a single tertiary care center objectively assessed by calculating the melasma area severity index (MASI) and randomized (simple randomization) into four parallel groups (A, B, C, and D) of 20 each were prescribed once daily local application at night, (participants blinded regarding the difference in identity of interventions), as follows:Group A – kojic acid 1% cream.Group B – kojic acid 1% and hydroquinone 2% cream.Group C – kojic acid 1% and betamethasone valerate 0.1% cream.Group D – kojic acid 1%, hydroquinone 2%, and betamethasone valerate 0.1% cream.Strict photoprotection and use of a SPF 15 sunscreen was advised during the day. Patients were evaluated every 2 weeks and a fall in MASI score was calculated at the end of the study period of 12 weeks by the same investigator.Results:The response was compared according to percentage decrease in MASI score. Efficacy was evaluated among the groups at the end of 3 months using bivariate analysis and calculated by using the paired ‘t’ test. The clinical efficacy of group B was the highest followed closely by group D and group A, that of group C being the lowest.Conclusion:Kojic acid in synergy with hydroquinone is a superior depigmenting agent as compared with other combinations.

Total dystrophic onychomycosis was the most common clinical type and NDM were the predominant causative organisms.

Disseminated cryptococcosis and recurrent oral candidiasis was presented in a-heterosexual AIDS patient. Candida tropicalis (C.tropicalis) was isolated from the oral pseudomembranous plaques and Cryptococcus neoformans (C. neoformans) was isolated from maculopapular lesions on body parts (face, hands and chest) and body fluids (urine, expectorated sputum, and cerebrospinal fluid). In vitro drug susceptibility testing on the yeast isolates demonstrated resistance to fluconazole acquired by C. tropicalis which was a suggestive possible root cause of recurrent oral candidiasis in this patient. Case ReportA 34-year-old heterosexual HIV-I positive male developed mucopurulent productive cough, recurrent oral plaques, occasional syncope, and neurological symptoms that included headache and dizziness. Physical examination revealed discrete erythematous maculopapular lesions on his face (Figure 1), neck, chest, and both hands. There were not any significant enlargement of the cervical lymph nodes, and oral examination revealed pseudo-membranous plaques (Figure 1). He was previously treated with antifungal drugs (fluconazole and amphotericin-B), primary anti-tuberculous drugs (isoniazid, rifampin, ethambutol, and streptomycin), and an antigiardial drug (tinidazole) for giardiasis, caused by, Giardia lamblia. The CD4+ lymphocyte count for this patient was 40 cells/μl with a CD4+/CD8+ ratio of 1:72. Despite a history of multiple unprotected sexual exposures, the patient tested negative for venereal disease.The skin biopsies and body fluids, such as, cerebrospinal fluid (CSF), urine, and mucopurulent expectorated sputum, showed encapsulated yeasts in India-ink-wet-mount preparation. The cultures for acid-fast bacilli (AFB) on Lowenstein-Jenson and non-selective Middle-brook 7H12 agar media were negative. Periodic-acid-Schiff and Grocott-Gomorimethylamine-silver-stained smears were negative for Pneumocystis carinii. Serum and CSF tested positive for capsular Cryptococcal polysaccharide antigen using the latex agglutination test with a titer of 1:1015. Skin sections revealed gelatinous troma ( Figure 2) filled with numerous encapsulated yeast cells (Figure 3). Biopsied specimens of skin and other body fluids (CSF, urine, and sputum) yielded the growth of C. neoformans on Sabouraud's dextrose agar (SDA) medium. The resultant mucoid-creamcolored colonies were negative for germ tube and positive for urease test. Colonies failed to grow on Cyclohexamide-supplemented SDA. Colonic growth at 37 o C on plain SDA was weakly positive. Microscopic examination of the Gram-stain preparation from a portion of scraped oral lesions showed Gram-positive yeasts and pseudo-hyphal forms. The remaining portion the scraped oral lesions were inoculated on SDA which then showed a typical growth of C. tropicals. Identification of C. tropicalis was further confirmed by the germ tube test; morphological characteristics were determined on cornmeal tween-80-agar and Vitek-32 and API 20C

Nappy rash or diaper dermatitis is common among neonates. It is seen as erythema, scaling and chafing on the convex surfaces of the buttocks and other areas in contact with nappies, with sparing of the deeper folds. It has a multifactorial aetiology. Factors which may contribute to nappy rash are water and ammonia in stool and urine, excessive wetness, friction between nappy and skin, soap and detergents, powders and creams and Candida albicans in faeces. Management includes use of good quality napkins, application of emollients, treatment of Candida and bacterial infection and avoidance of powders.

A survey on communicable dermatoses in economically weak villages in India showed wide variations in prevalence rates in similar ecologic setup. A skin diseases, on-spot-treatment, 1-day-camp was organized to treat 1787 subjects in five villages. Two applications of 1% lindane 1 week apart was the only treatment used without attending to hygiene for scabies and pediculosis. Application of 1% gentian violet with four daily doses of sulfamethoxy-pysidazine was administered for pyoderma. The cure rate for scabies and pediculosis was 86%. Epidemiologic determinants of communicable dermatoses are the most important factors in the practice of community dermatology.