The Special Interest Group (SIG) on leprosy thought it to be prudent to revisit its previous practice recommendations through this update. During this period, the pandemic course shifted to a 'second wave' riding on the 'delta variant'. While the number of cases increased manifold, so did the research on all aspects of the disease. Introduction of vaccination and data from various drug trials have an impact on current best practices on management of diseases including leprosy. The beneficial results of using steroids in management of COVID-19, gives elbow room regarding its usage in conditions like lepra reactions. On the other hand, the increase in cases of Mucormycosis again underlines applying due caution while recommending immunosuppressants to a patient already suffering from COVID-19. This recommendation update from SIG leprosy reflects current understanding about managing leprosy while the dynamic pandemic continues with its ebbs and flows.

Adams-Oliver syndrome is a congenital condition comprising congenital scalp defects and distal limb abnormalities. We report a child with the sporadic form of the disease who had minimal disease expression, illustrating the wide clinical spectrum of the syndrome.

Background: The prevalence of skin diseases has increased over the last few decades, and they contribute to a significant burden on health-care systems across the world. Aims/Objective: This report looks at the burden of skin and subcutaneous diseases in terms of years lived with disability and agestandardised years lived with disability in India using the Global Burden of Disease Study results from 2017. Methods: Data were obtained from the Global Burden of Disease online interactive tool. Updated estimates of the world’s health for 359 diseases and injuries and 84 risk factors from 1990 to 2017 are available in this interactive tool. Results: Years lived with disability due to skin and subcutaneous diseases accounted for 4.02% of the total years lived with disability in India in 2017. There was an increase of 53.7% in all age standardised years lived with disability for all the skin and subcutaneous diseases from 1990 to 2017. Among skin and subcutaneous diseases, dermatitis contributed maximum years lived with disability (1.40 million; 95% uncertainty interval, 0.82–2.21) in 2017, followed by urticaria (1.02 million; 95% uncertainty interval, 0.06–1.44) with percentage increases of 48.9% and 45.7% respectively. Conclusion: The burden due to infectious skin diseases (e.g., scabies, fungal skin disease and bacterial skin disease) and non-infectious diseases (e.g., dermatitis, urticaria and psoriasis) has increased over the past three decades, however the age-standardised years lived with disability for leprosy, scabies, fungal infections, sexually transmitted infections and non-melanoma skin cancer (basal cell carcinoma) has decreased. The high burden of skin and subcutaneous diseases demand that they be given due importance in the national programmes and health policy of India.

Subcision is a simple and safe procedure used to correct atrophic scars and wrinkles. This technique is one of the common procedural modality in the management of atrophic postacne scars. The technique was introduced by Orentreich and Orentreich in 1995 as a subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles. It involves the use of a tri-bevelled hypodermic needle inserted subcutaneously to release the tethered skin from the underlying fibrotic attachments which also promotes connective tissue formation at the site. 1 Since then, it has undergone several modifications to simplify the procedure as well as to improve the outcome. We present a simple modification to avoid blood spillage during the procedure thus attain a bloodless treatment area. | TECHNI Q U EWith the patient in supine position, the treatment area was prepared using povidone-iodine and surgical spirit and anaesthetized with a subcutaneous injection of lidocaine. Eighteen-gauge needle was used for the procedure. The needle was inserted 1-2 mm away from the target area with the bevelled edge pointing upward. It was inserted into the superficial dermis in a plane horizontal to the skin surface. Initially, the needle was advanced in a to and fro motion and then in a horizontal fanning motion to release the fibrotic strands attaching the skin surface to the dermis. There was immediate gushing of the blood through the hub of the needle on to the surgeon's gloves and treatment area making it difficult to continue the procedure smoothly, ( Figure 1A). The assessment of the endpoints of the procedure which included free sweeping movement of the needle Abstract Background: Subcision is a simple such procedure with considerable efficacy especially in the management of the rolling type of atrophic post-acne scars. Since its introduction in 1995, the technique has undergone several modifications to enhance its results as well as to improve the ergonomics. However, 'gushing' of blood through the hub of the needle smears the surgeon's gloves and the treatment field, which is not desirable both aesthetically and hygienically. Aim:To describe a simple technique to avoid blood spillage to the treatment field while doing subcision. Method: While doing subcision, the open hub of the needle used was plugged with a button of sterile cotton and cyanoacrylate glue. The new technique was demonstrated on a patient with atrophic post-acne scars.Results: There was no blood spillage through the hub of the needle. Conclusion:This simple modification of subcision helps to attain a bloodless treatment area which also has an added advantage of better assessment of the targeted endpoints at the treatment site. K E Y W O R D Sbloodless field, cotton, cutaneous atrophic scars, cyanoacrylate glue, subcision How to cite this article: Afra T P, Razmi T M, Tarun N, Dogra S.Plug the needle hub during subcision for a bloodless field.

Summary Background Barraquer‐Simons syndrome (BSS) or acquired partial lipodystrophy is a disorder of loss of subcutaneous fat from the upper part of the body. The resulting cosmetic disfigurement causes significant psychological distress in the affected individuals. Fillers, autologous fat transplant or cosmetic surgeries can be used to correct the volume deficit. Methods The authors report a case of a young woman, who presented with gradual loss of subcutaneous fat from the face, upper limbs, and trunk. On evaluation, she had low complement C3 levels, but there were no features to suggest any metabolic complication. She was diagnosed with BSS. Her volume deficit in the midface area was managed with hyaluronic acid (HA) filler. Results The treatment has resulted in the correction of her facial volume loss immediately following the procedure with a maintained effect at follow‐up visits. She experienced no major adverse events. Conclusion Hyaluronic acid filler is safe and effective for the management of volume loss in BSS. It gives a long lasting result and an added self‐confidence to the patient.

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There is ample evidence suggesting the presence of various multisystemic comorbidities in patients with schizophrenia. However, data on dermatological comorbidities in these patients are scarce. The present study aimed to analyze the profile of cutaneous conditions in patients with schizophrenia and contribute to the existing evidence in this area. A total of 102 consecutive adult patients with schizophrenia, who were attending the follow-up service at the outpatient clinic of the Department of Psychiatry in a tertiary hospital in North India, were evaluated by a dermatologist for the presence of any skin disorder. Dermatological findings were noted in 70% of patients and 38% had multiple skin conditions. Infections were the most prevalent diagnosis, with fungal infections being commonly observed. Other common dermatoses included nevi, age-related cutaneous changes, dyschromia, and drug-induced acne. The present study concluded that there is a high prevalence of dermatological diseases in patients with schizophrenia. Caregivers and psychiatrists managing these patients should familiarize themselves with these conditions, and dermatology consultation should be sought for prompt diagnosis and management.

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