Background:Chronic renal failure (CRF) is associated with a variety of cutaneous manifestations as a result of underlying etiology as well as the various treatment modalities.Aim:To evaluate the prevalence of various dermatoses in patients with CRF on hemodialysis and to study the effect of hemodialysis on the intensity of pruritus.Materials and Methods:A total of 35 patients of CRF on hemodialysis having at least one cutaneous manifestation were included in the study.Results:Twenty-four (68.71%) cases in our study belonged to the age group of 50-69 years, out of which 16 cases were in the sixth decade. Xerosis and pruritus occurred in 80% and 65.71% of cases, respectively. Other common findings included pallor (68.57%), dyspigmentation (34.29%), cutaneous infections (34.39%), acquired perforating dermatosis (17.4%), and nail changes (60%). Hemodialysis failed to improve pruritus in 17 (73.9%) of our patients. Twenty-six patients (74.28%) suffered from hypertension, 13 of them also were known cases of type II diabetes mellitus. Five patients suffered exclusively from type II diabetes mellitus.Conclusions:In our small study, xerosis was the commonest finding and pruritus, the commonest symptom. The intensity of pruritus was largely unaffected by hemodialysis.

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.

The severity of acne vulgaris does not correlate with impairment in quality of life.

A 20-year-old male presented with multiple eruptions on his right leg since birth; these bled and were painful on trivial trauma. Examination revealed dark brown, hyperkeratotic, indurated, verrucous linear plaques with irregular borders. Histopathological evidence of hyperkeratosis, acanthosis, and extensive vascular proliferation in papillary dermis confirmed clinical suspicion of angiokeratoma circumscriptum (AKC). Excision and skin grafting yielded a cosmetically favorable outcome. Angiokeratomas, first described by Mibeli in 1889, are a group of vascular ectasias involving the papillary dermis. Angiokeratomas are more common in males; however, AKC–the rarest of its five variants–exhibits a female preponderance (F:M:3:1). AKC is an extremely rare nevoid disorder, only 100 of its cases having been reported in the world literature until 2006. Herein, we have reported a typical case of AKC in a young male that was previously misdiagnosed, and the patient wrongly counseled about the likelihood of its spontaneous regression.

Background:The spectrum of dermatological manifestations during neonatal period varies from transient self-limiting conditions to serious dermatoses; the latter, fortunately few, are disproportionately stressful to the parents, who due to lack of specialized pediatric dermatology clinics frequently get tossed between a dermatologist and a pediatrician.Objectives:This study was formulated to record cutaneous changes over the first five postnatal days of life and to statistically correlate those changes occurring in ≥ 11 neonates with three (parity, associated illnesses, and mode of delivery) maternal and three (sex, birth weight, and gestational age) neonatal factors.Methods:This descriptive, cross-sectional study at a tertiary care hospital entailed recording detailed dermatological examination of 300 neonates having some (physiological and/or pathological) cutaneous changes and their statistical evaluation using the Chi-square test and significance (P < 0.05) as above.Results:Superficial cutaneous desquamation (SCD), Mongolian spots (MS), and erythema toxicum neonatorum (ETN) were the first three common changes among a total of 15 conditions observed overall; these three, as also milia and icterus, revealed statistical significance with both maternal as well as neonatal factors. Lanugo and napkin dermatitis (ND) were statistically significant with respect to two neonatal factors and cradle cap (CC), a single maternal factor. Gestational age was of statistical significance regarding five cutaneous changes, associated maternal illness during pregnancy regarding four, birth weight as well as parity regarding three each, and sex of the neonate as well as mode of delivery regarding two each.Conclusion:Despite observing a statistically significant correlation of eight cutaneous changes with three maternal and/or three neonatal factors, more extensive studies in neonatal dermatology are required for validation of these unique statistical correlations.

Cowden syndrome (CS) is an infrequent autosomal dominant multisystem genodermatosis, generally involving the skin, oral mucosa, thyroid, breast and gastrointestinal tract. It is characterized by a late onset in the 2nd or 3rd decade of life, an extraordinary potential for malignant transformation, especially of breast and thyroid, and an identifiable germline mutation. In 80% cases, the human tumor suppressor gene, phosphatase and tensin homolog (PTEN) is mutated; mutations involving KILLIN, SDH B/D, PIK3CA and AKT1 genes account for the rest of the cases. Its clinical signs are not only the “essential pearls” for early and accurate diagnosis of CS but also help timely detection of neoplasia as they precede development of cancer by several years. We describe the first Indian and the third world report of polydactyly with CS, review this entity highlighting on recent clinical developments and emphasize on regular and thorough screening for prompt identification and management of the potentially malignant growths. We have also designed a baseline workup routine as well as a detailed screening program for these patients.

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Cancer metastases represent the most devastating aspect of malignancy, since the mortality of cancer patients is mainly related to the metastatic behavior of the primary neoplasm. Skin metastases are usually late events in the course of tumor progression. Excluding melanoma, the most common tumor to metastasize to the skin is breast cancer. Patients who develop cutaneous metastases rarely present with a zosteriform distribution. Herein, we present a 60-year-old female, an undiagnosed case of breast cancer, with zosteriform metastases along her right T2-T3 dermatome.