considerable costs. [1] The prevalence of leg ulcers is well documented to be vary between 0.18% and 1%. [2] The three major causes of lower extremity ulcers are venous, arterial, and neuropathic. Chronic nonhealing ulcers lack the necessary growth factors (GFs) and hence do not heal well. Conventional recombinant GF products, including becaplermin (recombinant platelet-derived GF) have been approved by the Food and Drug Administration for the treatment of chronic wounds. However, the medication is in a liquid form, and, therefore, easily dissipates following wound application. In addition, it is expensive and is unaffordable in developing countries such as India. [3] Platelet-rich plasma (PRP) enhances wound healing through promotion of the healing process by the presence

Background:Venous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs. They are the major cause of chronic wounds, occurring in 70% to 90% of chronic wound cases. The treatment of venous ulcers also entails substantial costs. Autologous platelet rich plasma (PRP) is a simple office based procedure which helps in enhancing the wound healing by releasing many growth factors like platelet derived growth factors, fibroblast derived growth factors and epidermal growth factors.Aim:To study the efficacy of autologous platelet rich plasma in the management of chronic venous ulcer.Methodology:12 patients with 17 venous ulcers were treated with PRP and treatment outcome was measured by percentage of improvement in area and volume of the ulcer.Results:12 patients with 17 ulcers were treated with PRP. The mean age of the patients was 33.5 years (SD 9.82). 10 were males and 2 were females. The mean duration of the healing of the ulcers was in 5.1 weeks (SD 3.1). The mean percentage improvement in the area and volume of the ulcer was 94.7% (SD 11.12) and 95.6% (SD 10.19) respectively.Conclusions:PRP is safe, simple and effective procedure in treating chronic venous ulcers

Background:Hair restoration surgery (HRS) is a very promising and sought after aesthetic procedure with very few complications. Complications may occur in the donor or the recipient area, and it may be due to surgical or idiopathic causes.Aim:The aim was to analyze the complications in male patients who underwent HRS for androgenetic alopecia (AGA).Materials and Methods:We conducted a retrospective analysis of male patients who underwent HRS for AGA from December 2010 to August 2014. Data were collected from the registers, telephonic enquiry and electronic mails. All complications during and after surgery, and their subjective feeling about hair growth was recorded.Results:Seventy-three patients were included in the analysis. A total of 65 patients had undergone follicular unit transplant, 7 patients underwent FUE, and one patient had body hair transplantation. Postoperative edema was found in 42.47% of patients, followed by sterile folliculitis in 23.29% of patients, wide donor scar in 15.07% of patients, bacterial folliculitis and numbness/paresthesia in 10.96% of patients. Other complications such as raised scar, hiccups, pruritus, excessive bleeding were found in isolated cases.Conclusion:Thorough preoperative evaluation, skillful surgical techniques, good communication and postoperative follow-up go a long way in giving satisfactory outcome with fewer complications in HRS.

Lower extremity ulcers and amputations are an increasing problem among individuals with diabetes. Among diabetes mellitus-related complications, foot ulceration is the most common, affecting approximately 15% of diabetic patients during their lifetime. The pathogenesis of diabetic ulcer is peripheral sensory neuropathy, calluses, oedema and peripheral vascular disease. Diabetic ulcer is managed by adequate control of infections and blood sugar levels, surgical debridement with various dressings and off loading of the foot from pressure. In spite of these standard measures, some recalcitrant non-healing ulcers need additional growth factors for healing. Autologous platelet-rich plasma is easy and cost-effective method in treating diabetic ulcers as it provides necessary growth factors which enhance healing.

There is an unmet need for psoriasis therapies that provide long-term remission. Itolizumab is a humanized recombinant anti-CD6 monoclonal antibody shown to be effective in psoriasis. We report a patient who received itolizumab in a phase 2 clinical trial, and experienced long-term remission. At baseline, the patient's Psoriasis Area and Severity Index (PASI) was 12.2, and Physician's Global Assessment (PGA) score was 3. After 8 weeks of treatment, the patient achieved 97% improvement in PASI. She continued to have ≥ 90% improvement, initially for 4 weeks (follow-up phase), and later for 20 weeks (follow-up extension phase). She continued to visit the hospital after the final study visit; her most recent visit was on 10 May 2013. PGA results during the visits revealed sustained response for 4 years and 5 months after stopping itolizumab. Itolizumab could be therefore an important treatment option for moderate to severe psoriasis, with potential to provide long-lasting remission.

The skin punch or surgical punch is an instrument which is used almost exclusively by dermatologists. It is a circular hollow blade attached to a pencil-like handle ranging in size from 0.5 to 10 mm. It is available as a disposable, reusable, and automated instrument. The punch can be used as a diagnostic, therapeutic, and cosmetic tool in dermatology. We have used punch as a diagnostic, therapeutic, and cosmetic tool in our dermatosurgery practice in our hospital. Various original research articles, text book publications, and review articles were studied and compiled. Techniques used by various authors and our own experiences with punch have been described. This article aims at providing the novel usefulness of skin biopsy punch in dermatology as the basic punch surgery is quick and easy to learn. Complications such as bleeding and infection are minimal.

Introduction:Flap surgeries are an excellent choice for closing large defects following trauma, excision of carcinomas or removal of large lesions. This article is a prospective interventional study of various flap surgeries performed at a tertiary care centre with their outcome in dermatosurgical unit.Materials and Methods:A total of 35 flap surgeries performed from January 2012 to December 2014 formed part of the study. Data were recorded for each case including age, sex, indications and type of flap surgery and any occurrence of complications.Results:Out of the 35 patients, basal cell carcinoma was the most common indication for surgery in 22 patients, followed by Bowen's disease in five, dermatofibroma in three and porocarcinoma in two. Other indications were squamous cell carcinoma, tuberous xanthoma, myxoid cyst and nevus sebaceous. Rhomboid flap and rotaion flap were done in 12 patients each, V-Y plasty in three patients, advancement flap, crescentic advancement flap and O-Z plasty were done in two patients each, O-Z plasty was done in two patients, A-T plasty and H plasty were done in one patient each. Common complications observed were flap necrosis seen in three patients and one patient developed hematoma on the second post-operative day, hypertrophic scar in one case and recurrence of BCC.Conclusion:Malignant and pre-malignant lesions were common indications in our study. Excellent outcome of flap surgeries promises to be a birdie stroke in the armamentarium of dermatosurgeons.

Nevirapine, a non-nucleoside reverse transcriptase inhibitor (NNRTI) is one of the important components of highly active antiretroviral therapy. It is sometimes associated with life-threatening adverse reactions. Here we report one such patient who developed toxic epidermal necrolysis (TEN), leucopenia and hepatotoxicity secondary to intake of nevirapine. This patient was also diagnosed to have non-Hodgkin lymphoma grade IV of anal canal for which he was given radiotherapy and two cycles of chemotherapy. The treating physicians should carefully monitor patients on NNRTI-based antiretroviral therapy so that fatalities due to adverse drug reactions can be prevented with timely intervention.