Pregnancy is associated with complex of endocrinological, immunological, metabolic, and vascular changes that may influence the skin and other organs in various ways. Pregnancy is a period in which more than 90% women have significant and complex skin changes that may have great impact on the woman's life. The dermatoses of pregnancy represent a heterogeneous group of skin diseases related to pregnancy and/or the postpartum period. The dermatoses of pregnancy can be classified into the following three groups: Physiologic skin changes in pregnancy, pre-existing dermatoses affected by pregnancy, and specific dermatoses of pregnancy. Though most of these skin dermatoses are benign and resolve in postpartum period, a few can risk fetal life and require antenatal surveillance. Most of the dermatoses of pregnancy can be treated conservatively but a few require intervention in the form of termination of pregnancy. Correct diagnosis is essential for the treatment of these disorders. This article discusses the current knowledge of various skin changes during pregnancy and the evaluation of the patient with pregnancy dermatoses with special emphasis on clinical features, diagnostic tests, maternal and fetal prognosis, therapy, and management.

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.

Lupus vulgaris (LV), is a chronic and progressive form of secondary cutaneous tuberculosis. In India, it is commonly seen over buttocks, thighs, and legs whereas involvement of nose is quite rare. Ulcerative variant particularly over nose causes destruction of cartilage, leading to irreversible deformities and contracture. High-index of suspicion is required for early diagnosis and prevention of cosmetic deformity. A case of LV over nose in a young male with ulceration is reported who responded well to anti-tubercular therapy, but left with scarring of nose, which could have been prevented if adequate awareness regarding extra-pulmonary cases would have been practiced.

A 20-year-old female presented with non tender, fluctuant, soft swelling of left elbow, inability to flex elbows fully, plaques over both arms. On examination, there were 6 well defined erythematous scaly plaques, around 4-6 cm in diameter, involving both the arms. A single ulcer with purulent crust present over extensor aspect of left forearm. Atrophic scars were present over right elbow and right breast. Hyperpigmented puckered scar with multiple discharging sinuses were present over right forearm. There was no lymphadenopathy. On diascopy, "apple jelly" nodules were appreciated in form of yellowish discolouration after applying pressure with slide over the lesion. A fluctuant swelling of 8×11 cm size was present over extensor aspect of left arm along with swollen right elbow, due to which she was not able to flex her elbow completely [Table/ Fig-1]. Range of motion was 40 and 50 degree flexion at left and right elbow respectively. All lesions appeared in the span of 3 years. No past history of pulmonary TB. There was no history of trauma. She was vaccinated with BCG vaccine with a vaccine scar over her left deltoid. Her height was 137cm and weighed 42kg with significant undernourishment. She lives in overcrowded slum with poor hygienic conditions. Her aunt was suffering from pulmonary tuberculosis. Lupus vulgaris and scrofuloderma were suspected in the same case as erythematous plaques and puckered scar with sinus formation were there.Mantoux test was positive (>15mm induration and 22mm horizontal extension). Pus discharge from the ulcer was negative for grams and AFB stain didn't show any growth on routine culture. ELISA for HIV was nonreactive. Biopsy was taken from the erythematous plaque as well as puckered scar which showed mild hyperplasia of epidermis with multiple granulomas in dermis containing Langhans giant cells, epitheloid cells, lymphocytes and plasma cells suggestive of lupus vulgaris at both the sites. Reticular dermis was normal. No caseation necrosis was seen in both biopsies [Table /Fig-2 aBstRaCtMost common form of cutaneous tuberculosis (TB) is lupus vulgaris, which usually occurs in previously sensitized individuals who have a high degree of tuberculin sensitivity. Various forms including plaque, ulcerative, hypertrophic, vegetative, papular, and nodular forms have been described. We are reporting a case of a young female, who presented with 6 well defined erythematous scaly plaques involving both arms and a puckered scar on right forearm and right breast. Clinically, it was looking like lupus vulgaris with cold abscess, few lesions mimicking scrofuloderma, but skin biopsy from both the types of lesions revealed lupus vulgaris. Patient improved with Anti Tuberculous Therapy and surgical drainage of underlying cold abscess.[

Histoid leprosy is a rare form of multibacillary leprosy with distinct clinical and histopathological features. It is a variant of lepromatous leprosy with a very high bacterial index. It appears in patients as a relapse after dapsone monotherapy, in the presence of dapsone resistance or rarely ‘de-novo’. It is a matter of concern as we found three cases of de-novo Histoid that too in 3 months from February 2013 to April 2013; in post-global leprosy elimination era. We report three cases presenting with ‘de-novo’ Histoid Hansen's disease, with no history of leprosy or exposure to dapsone/multi-drug therapy, with heavy bacillary index. The above cases proved to be an eye opener to us in more than one senses. We are reporting these cases just to create awareness and avoid misdiagnosis which will help in prompt treatment and avoid its spread as well as avoid complications and deformities associated with it.

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