Background:Melasma is a common acquired cause of facial hyperpigmentation seen predominantly among females with significant psychological and social impact. It is often recalcitrant to treatment. Several topical hypopigmenting agents have been used to combat melasma. Hydroquinone and Kojic Acid are well established monotherapeutic agents for treating melasma.Objectives:This study focuses mainly on the efficacy of once daily application of 4% Hydroquinone and 0.75% Kojic Acid cream (containing 0.75% Kojic acid and 2.5% vitamin C) so as to determine an effective modality of treatment for facial melasma.Materials and Methods:A total number of 60 patients with facial melasma attending the Out-patient department of Dermatology, Venerology and Leprosy, Fr. Muller Medical College Hospital, Mangalore from Oct 2008-April 2010 were studied. Patients were allocated alternately to group A and group B. Group A patients received 4% Hydroquinone cream and group B patient received a Kojic Acid cream (which contained 0.75% Kojic acid and 2.5% vitamin C) and were advised to apply topically once daily at night. Patients were followed up on 4th, 8th and 12th week. At each visit side effects were noted and clinical response to treatment was calculated using the MASI score.Statistical Methods:Chi square test, student ‘t’ test.Results:At the 4th week post treatment evaluation, facial hyperpigmentation responded early to 4% Hydroquinone cream than to 0.75% Kojic Acid cream. At the end of 12 week treatment period, 4% Hydroquinone cream had an overall superiority to 0.75% Kojic Acid cream as a topical hypopigmenting agent.Conclusion:The results of the study show that 4% Hydroquinone cream is a better topical hypopigmenting agent with rapid rate of clinical improvement when compared to 0.75% Kojic Acid cream.

Background:Although Molluscum contagiosum (MC) is a self-limiting condition, active therapy could prevent further spread and improve cosmesis. Most of the available treatment modalities traumatize the lesions and have to be undertaken in the hospital, therefore evoking panic in children. In the quest for an alternative therapy, this study comparing 10% potassium hydroxide (KOH) solution and 5% imiquimod cream was taken up.Aims and Objectives:To compare the efficacy and tolerability of 10% KOH and 5% imiquimod in the treatment of MC.Materials and Methods:This comparative study was conducted over a period of 18 months from October 2011 to March 2013, 40 patients between the age group of 1-18 years with clinically diagnosed MC were divided into two groups (lottery method), 20 patients were treated with 5% imiquimod cream (Group A) and the other 20 were treated with 10% KOH solution (Group B). Patients were followed up on the 4th, 8th and 12th week of treatment.Results:At the end of 12 weeks, out of 20 patients who received 10% KOH, 17 patients showed complete disappearance, whereas out of 20 patients who received 5% imiquimod, only 10 patients showed total clearance of the lesions. Adverse events were more frequent with 10% KOH, pigmentary disturbances being the most common.Conclusion:With only minor adverse effects, 10% KOH is an inexpensive and efficient modality for the treatment of MC in the pediatric age group. Although 5% imiquimod was effective in clearing the lesions with minimal adverse effects, the longer duration required for its efficacy may deter its wider use.

Subcutaneous mycoses are a rare group of disorders. Chromoblastomycosis is the most frequent subcutaneous fungal infection in south India. Morphologically, chromomoblastomycoses present as verrucous, ulcerative, nodular, or eczematous lesions. Clinical diagnosis is important as culture is often negative. The incidence of infection is higher among rubber tappers. It is important to clinically differentiate chromoblastomycosis from tuberculosis verrucosa cutis. Most of the subcutaneous mycoses respond well to treatment, with the exception of rhinoentomophthoromycosis, which is a rare form of deep mycosis with associated mutilation. Eumycetomas are not observed in this part of India.

Context: Psoriasis is a common papulosquamous disorder characterized by increased epidermal turnover resulting in excessive skin shedding and a compromised barrier function of the skin. Transepidermal water loss (TEWL) is an effective and non-invasive way to measure the barrier function in this condition. Aims: To measure the physiological changes in the skin barrier function in psoriasis by measuring the extent of TEWL. To study the differences in TEWL in pathologically involved and uninvolved skin in psoriasis. To compare the TEWL in skin lesions in psoriatic patients and site matched controls. Subjects and Methods: To determine the barrier quality of the stratum corneum, we performed TEWL measurements using the closed chamber evaporation method (VapoMeter Delfin Technologies, Kuopio, Finland). The ambient temperature ranged between 21°C and 24°C, with a mean relative humidity range of 39%–50%. In total, four sites were measured for all the 50 cases, two involved plaques on the body were selected for the study of lesional psoriatic skin, and the standard sites of ankle and elbow were measured irrespective of being involved or uninvolved with psoriatic skin. TEWL measurements in controls were site matched. Statistical testing was done using SPSS ver. 17. The interval scale data were tested for normality using Shapiro-Wilk test, and between groups testing was done using Mann-Whitney test. Results: The TEWL was higher among the cases in all the four measured areas compared to the controls, thus showing overall impaired skin barrier function in psoriatic skin. In addition, among the cases, the involved sites show higher TEWL in comparison to the uninvolved skin. This is highly suggestive that plaques of psoriasis have reduced water holding capacity. Conclusions: Psoriasis is a dermatosis with overall compromise of the skin barrier function exhibiting exponential TEWL in lesional skin, with increased TEWL over non-lesional skin as well. Thus, it may be concluded that TEWL is an effective, non-invasive and objective method in assessment of skin barrier function.