Skin Outpatient Department Research Articles

A Clinico-dermatoscopic Study of Vulvar Dermatosis at Rural-based Tertiary Care Teaching Institute

Introduction: The frequency and importance of vulval diseases are often underestimated due to the multifactorial nature of disease on the vulva. Dermoscopy can help provide clues for early diagnosis and insight into dermoscopic patterns. The present study was done with the objective to study the clinico-dermoscopic pattern of dermatosis and correlate the dermatoses with the age of the patient. Materials and Methodology: This was a prospective cross-sectional observational study conducted in the department of dermatology at a tertiary health care center over a period of 1½ year. All females with dermatosis affecting genital areas attending the skin outpatient department or ward were recruited after taking written consent. A detailed history was taken to collect demographic data. A thorough clinical examination and dermatoscopy were done. Descriptive statistics was used to depict the profile and dermatoscopic pattern. Results: Out of the 103 patients with vulvar dermatoses, 24 (23.30%) patients were in the age group of 41–50 years. A total of 43 (41.74%) patients had infective conditions, followed by 16 (15.53%) patients of papulosquamous group of disorders and 11 (10.67%) patients of eczema. Dermatoscopic findings had a surface scale in 40 (38.83%), vascular patterns in 22 (21.36%), red dots in 19 (18.45%), and structureless patterns in 13 (12.62%) with different vulvar dermatosis. In tinea cruris, out of 30 cases, 28 (93.33%) had surface scales, followed by 5 (16.67%) showing vascular pattern, whereas in lichen sclerosus et atrophicus, out of total of 10 cases, 8 (80%) had structureless pattern and 6 (60%) had vascular patterns. Discussion and Conclusion: Genital diseases represent a diagnostic challenge for clinicians. The use of dermoscopy improves the diagnostic accuracy by recognizing specific dermoscopic patterns. Limitation: Small sample size was the only limitation.

A Cross-sectional Observational Study of Noninfectious Dermatoses in Geriatric Population

Abstract Introduction: The geriatric population is expected to constitute 21.1% of total population in India by 2051. Geriatric population is associated with increased prevalence of various chronic diseases, physical disabilities, mental illness, and comorbidities. The trend is changing towards dermatoses of noninfective etiology owing to factors such as increased literacy rates and hygienic practices. Thus, our study is to focus on pattern of dermatoses of noninfective etiology in the most neglected yet important section of our population, that is, geriatric population. Objective: The objective of this study was to measure the prevalence of various noninfectious dermatoses among geriatric patients attending the skin outpatient department (OPD) at a tertiary care center. Methods: Two hundred and seventy-seven geriatric patients visiting skin OPD at a tertiary care center presenting with various noninfectious dermatoses were included, and the prevalence of various noninfectious dermatoses in this section of population was studied. Results: Eczemas were the most common group of noninfectious dermatoses (29.6%), followed by papulosquamous disorders (20.6%). Simultaneously associated systemic diseases and physiological changes were studied. Out of 277 patients, 156 (56.3%) had associated systemic illness. Eighty-seven (31.4%) patients were hypertensive, followed by diabetes mellitus (18.4%). The most common physiological change observed was wrinkling (47.6%), followed by seborrheic keratosis (46.2%). The Dermatology Life Quality Index (DLQI) score between 2 and 5, i.e., small effect on a patient’s life, was significant in 100 (36.1%) patients, followed by moderate (DLQI 6–10 score), no effect (DLQI 0–1), very large (DLQI 11–20 score), and extremely large (DLQI 21–30) in 70 (25.3%), 57 (20.6%), 30 (10.8%), and 20 (7.2%) patients, respectively. Conclusion: In our study, eczemas were the most common group of noninfectious dermatoses in the elderly. So, simple measures such as diligent use of moisturizers, avoidance of harsh soaps and detergents along with adequate bathing time can decrease its prevalence.

Quality of Life of Patients with Scabies in an Urban Slum Area of Ludhiana

Abstract Introduction: Scabies affects 200–300 million individuals annually around the globe and it is a serious public health issue causing social stigmatisation in patients. With this background and its substantial impact on morbidity, this study was undertaken with the objective to find the demographic profile, clinical morphology and quality of life in patients suffering from scabies in urban slums of Ludhiana. Materials and Methods: A cross-sectional, time-bound hospital-based study was carried out for a period of 2 months. A total of 173 patients with a diagnosis of scabies comprising all adults and children >5 years of age attending skin outpatient department were included in the study. The collected information was entered in Microsoft Excel sheet and analysed using SPSS. Results: The mean age of the study population was 34.85 ± 17.48 years. The most affected age groups were 18–40 years (46.9%), followed by 41–60 years (26.0%) and 17.9% in children. The majority of patients had difficulty in working and feelings of embarrassment, and in three-fifths of patients, their sexual relationship was affected due to scabies. In children, more than half experienced teasing and feeling of embarrassment and their routine activities such as playing were affected. Conclusion: In the present study, scabies moderately affected the quality of life of the patients in the form of embarrassment and stigma associated with disease. As it is a contagious disease, early diagnosis and prompt treatment can be helpful in the prevention and control of disease.

Assessment of Psoriasis Severity Using Psoriasis Area and Severity Index (PASI) and its Association with Lipid Profile Parameters

Objective: To explore potential association between specific lipid profile parameters and PASI scores in psoriatic patients at a tertiary care Hospital. Methodology: A descriptive cross-sectional study was carried out on patients attending the skin outpatient department and the Diagnostic Research Laboratory of the Department of Physiology at Liaquat University of Medical & Health Sciences Jamshoro/Hyderabad, from February to August 2022. Diagnosed patients of Psoriasis between 18 and 50 years, male and female were included. A 5ml blood sample was taken from each participant in fasting and the samples were used to perform a lipid profile analysis. All financial costs related to the investigations were covered by the researchers. Results: The average age of patients with psoriasis was 45.99±10.33 (range 18-60 years). Out of the total 102 patients, 76 (74.5%) were male patients and 26 (25.5%) were female. The mean duration of psoriasis was 6.46 ± 4.49 years. For total cholesterol, 60 patients (58.8%) had increased levels > 200 mg/dL, in 68 patients (66.7%) low-density lipoprotein (LDL), increased levels > 130 mg/dL, in terms of high-density lipoprotein (HDL), in (57.8%) patients it was <40 mg/dL, while for triglycerides, in (87.3%) patients had increased levels > 150 mg/dL. Patients with moderate and severe psoriasis exhibited higher rates of abnormal lipid profiles compared to those with mild psoriasis. Significant p-values were found for total cholesterol, LDL, and HDL levels, indicating associations with psoriasis severity. However, triglyceride levels showed no significant difference across the severity groups. Conclusion: This study revealed elevated lipid profiles among psoriatic patients, potentially contributing to lipid profile abnormalities. The high frequency of dyslipidemia observed is closely linked to the severity of psoriasis.

Clinical study to evaluate the efficacy of autoinoculation in genital molluscum contagiosum in reproductive age group.

Molluscum contagiosum (MC) typically presents as asymptomatic or itchy, discrete, smooth, flesh-colored, dome-shaped papules with central umbilication. Lesions on the genitals are often sexually transmitted and tend to be seen in young adults. Homologous auto implantation is a simple technique which helps in inducing a cell-mediated immune response to the antigens, aiding clearance of both local and distant lesions. The aim of the study is to evaluate the efficacy and side effect of the technique of autoinoculation for the treatment of genital MC in terms of reduction in number of lesions. Thirty-one patients having >5 genital molluscum attending skin outpatient department were enrolled out of which 30 remain. A well-defined mc lesion was approached using an insulin syringe (30 G) and pierced from a site just adjacent to the lesion. Results were assessed every 2 weeks for 2 months. 60% (n = 18) patients showed excellent response, 20% (n = 6) patients showed very good response, 6.6% (n = 2) patients showed good response and 13.3% (n = 4) showed poor response at the end of the study. The autoinoculation technique is an effective technique in terms of excellent clearance of MC lesions with fewer chances of recurrence, side effects, and shorter duration taken to achieve a complete response to distant lesions.

Correlation of skin-related quality of life with anxiety and depression in chronic dermatoses: A cross-sectional study

BackgroundDermatology and psychiatry are two specialties which often have a bearing on each other. Multiple indices have been used to study the quality of life in skin diseases; however, very few studies have correlated these indices with questionnaires of common psychiatric comorbidities like anxiety and depression. MethodsThe study was conducted in a dermatology out patient department (OPD) of a tertiary care hospital. All patients with chronic dermatological conditions (meeting the inclusion criteria) were included, and each patient was made to fill two questionnaires that are Skindex-29 for skin-related quality of life and Beck Depression Inventory (BDI-II) for depression. They were also assessed for anxiety using the Hamilton Anxiety Scale (HAM-A), which was filled under the supervision of a psychiatrist. ResultsThe scores for the common diagnoses were collated and analyzed using SPSS 20.0 software, and the results were tabulated. It was found that both the HAM-A and BDI-II had a moderate positive correlation with the Skindex which was statistically significant. Also, on correlating the individual domains of the Skindex with the HAM-A and BDI, the domain of emotions depicted the best correlation. ConclusionThe study brings to light that a relatively easy to administer quality of life questionnaire can be used as a screening tool to identify psychiatric morbidity and in a busy skin OPD, questions from the emotion domain can only be asked for early referral to a psychiatrist.

Spectrum of Skin Changes in the Elderly Population at a Rural Tertiary Care Hospital in Northern India: A Cross-Sectional Study

Introduction: Ageing is a complex, natural process. Due to structural and physiological changes that occur as a consequence of intrinsic and extrinsic aging, the elderly population is highly susceptible to dermatological disorders. These changes are associated with significant morbidity and stress. Hence, it is important to have a better understanding of the dermatological needs of elderly patients. Aim: The aim of this study was to investigate the pattern and frequency of geriatric dermatoses in patients attending the Skin Outpatient Department (OPD) at a tertiary care centre. Materials and Methods: This cross-sectional observational study was conducted at the Department of Dermatology, Venereology, and Leprosy at BPS Government Medical College for Women, Khanpur Kalan (Sonepat), Haryana, India, from September 2022 to February 2023. A total of 300 patients aged 60 years and above, of either sex, who consented to participate were enrolled. Detailed history taking and dermatological examinations were performed, and relevant investigations were carried out. Data was collected, entered into a Microsoft Excel sheet, and analysed for frequency, percentage, and mean of variables. Results: Out of the total 300 patients, 155 (51.66%) were males and 145 (48.33%) were females. The majority of patients belonged to the age group of 60-69 years (n=171, 57%). Wrinkling (n=287, 95.66%) was the most common physiological skin finding, followed by dry skin (n=157, 52.33%). Among pathological dermatoses, infectious dermatoses were present in (n=134, 44.66%) patients, followed by eczemas (n=92, 30.66%). Papulosquamous disorders were seen in (n=17, 5.66%) patients. Hypertension was the most common systemic illness present in (n=53, 17.66%) patients. Conclusion: Physiological and pathological skin changes in the elderly are a common cause of consultation in dermatology OPD. Physiological changes were seen in all patients. Among pathological changes, infections were the leading dermatoses, followed by eczemas and papulosquamous disorders.

Genotype Study of Filaggrin Gene Loss-of-Function Mutations in Central India Population with Atopic Dermatitis and Ichthyosis Vulgaris.

A genotype study of filaggrin gene loss-of-function mutations in central India can provide valuable insights into the prevalence and association of these mutations with atopic dermatitis (AD) and ichthyosis vulgaris (IV) in the region. The FLG R501X and 2282del4 are both genetic variants in the human gene called filaggrin gene (FLG), which encodes a protein that plays an important role in the formation and maintenance of the skin barrier. In this study, we determined the FLG R501X and 2282del4 variants association with both AD and IV in Central Indian populations. This case-control study was conducted in the Departments of Dermatology and Molecular and Virology Research and Diagnostic Laboratory at Sri Aurobindo Medical College and Post Graduate Institute, Indore (Madhya Pradesh). The study was approved by the Clinical Research and Ethics Committee. A total of 180 patients aged between 3 months - 60 years who attended the skin outpatient department between March-2021 to June-2022 were recruited in this study. Among them, 60 patients were in AD-group, 60 patients in IV-group, and 60 patients were in the healthy control group. Polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP) was used in genotyping for FLG mutations (R501X and 2282del4). The most common FLG mutations were R501X (31.6% and 23.3%) and 2282del4 (18.3% and 13.3%) in AD and IV patients with heterozygous (AT) genotype, respectively. The combined mutation (FLG R501X and 2282del4) association was 10% and 5% in the AD and IV groups with heterozygous (AT) genotype, respectively, and in all the patients of control group with wild genotype (AA). There were no significant (P = 0.09) associations found with 2282del14 genotype. The R501X mutation in the gene encoding filaggrin is one of the robust genetic associations of AD and IV. The 2282del4 polymorphism was marginally less as compared to R501X.

ACROKERATOSIS VERUCIFORMIS OF HOPF CLINICALLY MIMICKING AS NECROLYTIC ACRAL ERYTHEMA

Acrokeratosis verruciformis is very rare genodermatosis that was originally described by Hopf in 1931. A 29-years-old male presented to skin outpatient department with brown-colored hyperkeratotic plaques on dorsum of both feet that clinically mimicked as necrolytic acral erythema in our case. Biopsy was taken from lesion that shows hyperkeratosis, acanthosis, and slight papillomatosis along with well-circumscribed elevation of epidermis resembling church spires. No dyskeratotic cells were seen.

Vulval dermatoses (venereal and nonvenereal) among female patients presenting to a tertiary care hospital in North India.

The skin and mucosa of the vulva are different from the rest of the human body, as it is derived from all three embryological layers. It is more prone to dermatological diseases, both infectious and noninfectious. Our study was a prospective descriptive study on female patients attending the skin outpatient department with complaints of vulval dermatoses. Our aim was to determine the prevalence of venereal and nonvenereal dermatoses (infectious and non-infectious) along with age-wise distribution of these in our area. All female patients presenting with visible skin lesions on the vulva from January 2019 to December 2019 were included in this study. Various diagnostic tests such as Gram staining, Tzanck smear, KOH mount, herpes simplex virus serology, and skin biopsy were performed wherever necessary. The study included 520 patients in whom 525 lesions were identified. These were grouped under venereal and non-venereal dermatoses. Nonvenereal dermatoses were further grouped under infectious and non-infectious conditions. Maximum patients were in the age group of 21-40 years (50.19%). The most common dermatoses were non-venereal infections, seen in 220 (42.30%) patients followed by non-venereal, non-infectious dermatoses seen in 177 (34.04%) patients whereas venereal dermatoses were seen in 128 (24.61%) patients. Most of the patients were in the reproductive age group, and the prevalence of infectious dermatoses both venereal and non-venereal was much more than that of non-infectious conditions affecting the vulval skin as per our study.

Assessment of Cell-mediated Immunity to Trichophyton Antigen in Patients with Dermatophytosis: A Case-control Study

Introduction: Dermatophytosis are presenting for longer durations and at atypical sites and are quite persistent. If changes in the Cell-Mediated Immunity (CMI) will be studied then it will help to set treatment guidelines for the management of dermatophytosis to certain extent considering the current changes in the resistance to dermatophytosis. There is paucity in literature regarding the CMI to Trichophyton antigen in dermatophytosis patients in the geographical region of Vidarbha, Maharashtra, India. Aim: To assess the CMI to intradermal Trichophyton antigen in dermatophytosis patients and to study its adverse reaction in these patients. Materials and Methods: The present prospective crosssectional case-control study will be conducted on patients of dermatophytosis attending skin Outpatient Department (OPD) in Acharya Vinoba Bhave Rural Hospital(AVBRH), Sawangi, Wardha, Maharashtra, India, during January 2022 to January 2023 (13 months). Patients will be enrolled following fulfillment of study’s eligibility criteria. Clearance has been acquired from the Institutional Ethical Committee (IEC). Participants will be required to sign a written informed consent form in their native language. A detailed history will be collected and cutaneous examination will be done before conducting the study. The area for intradermal injection will be marked. For the study 0.1 mL, Intradermal Trichophyton antigen will be injected in the patient’s forearm. Patient will be called after 48 hours to check for the CMI response (delayed response).

Warts on hand: a rare clinical image.

Warts are a type of skin infection caused by the human papillomavirus (HPV). The disease causes rough, skin-coloured bumps to form on the skin. The virus is contagious. Warts can be spread by touching someone who has them. We are presenting a case of 21 years old female who comes to the skin outpatient department with the complaint of skin-coloured bumps on the middle finger. The physician inspected the patient hand and suggested a skin biopsy of the infected area. A biopsy sample was taken for the skin growth test for the HPV, and it revealed the patient had an infection of HPV. After all examinations, the patient was diagnosed with warts and given medical management on that.

Clinical Descriptive Study of Psoriasis in India: Triggers, Morbidities and Coincidences

Background Psoriasis is a T-cell mediated chronic inflammatory, a papulosquamous disease involving complex interactions between the innate and adaptive immune system and commonly manifested by skin lesions. It is characterized by hyperproliferation of keratinocytes and inflammatory infiltration in the epidermis and dermis. Chronic psoriasis can be a risk factor for developing comorbid diseases that share common immune pathophysiology and can be triggered by environmental factors in genetically susceptible individuals. Aim To study the clinico-demographic profile, determine the most common triggering factors and determine comorbidities' coexistence in patients with psoriasis at a tertiary care centre. Study Design A cross-sectional study. Methods A teaching hospital-based cross-sectional study including 231 psoriasis patients visiting skin outpatient department (OPD) was conducted by the dermatology departmentat Sri Krishna hospital, Karamsad, India following acceptance of the study proposal by the human research ethics committee. This study was outcome of the dissertation topic of the author during dermatology residency. Total 5 qualified dermatologists working in the dermatology department and 3 resident doctors took part in the study as evaluators. After taking informed consent, detailed history regarding aggravating factors, progress and morbidities was taken with clinical examinations, and the diagnosis was purely clinical. Data were analysed using statistical package for the social sciences (SPSS). Result Our study revealed a peak incidence of psoriasis in the fourth and fifth decade of life with male preponderance (1.9:1). The most commonly found psoriasis type was psoriasis vulgaris, and chronic plaque psoriasis and the most common site of involvement was extensors and trunk. Pruritis was the most disabling complaint (91.34%), and the disease course was progressive. Aggravating factors included stress, winter season, implant insertion, smoking, alcohol consumption, tobacco chewing and obesity. Koebner phenomenon was commonly found with implant insertion in psoriasis patients (76.2%). Family history was one of the well established risk factors for developing psoriasis (14.2%). Our study's most commonly found nail changes were pitting (35.49%) and dystrophic changes (18.61%). Palmoplantar keratoderma (4.76%) and vitiligo (4.76%) were the most commonly found dermatological condition with psoriasis and have been associated with various comorbidities such as cardiovascular disorder, metabolic syndrome, psoriatic arthritis and psychiatric disorders. As it was a cross-sectional study, no controls were used. Conclusion The study shows male preponderance and extensors, trunk as common sites of psoriatic lesion presentation. Aggravating factors included stress, winter season, implant insertion, smoking, alcohol consumption, tobacco chewing and obesity. Screening is encouraged for symptoms of psoriatic arthritis, cardiovascular diseases and metabolic syndromes in psoriasis patients due to its predilection with systemic comorbidities.

A study using psoriasis knowledge assessment questionnaire in psoriasis affected patients

Psoriasis is a chronic disease, which is potentially controllable but cannot be cured. Treatment is long term and requires continuous effort by the patient. Patient education is important for a chronic disease like psoriasis and this involves acquiring knowledge about the disease. With knowledge gained, the patient will be able to cope better with improved decision making and comply with treatment. To assess the knowledge about psoriasis in patients diagnosed with psoriasis attending skin outpatient department (OPD) of Sree Balaji Medical College and Hospital, Chennai. This was a cross sectional study, which was conducted at dermatology OPD in Sree Balaji Medical College and Hospital, Chennai 2021 after ethical committee approval. About 80 patients with psoriasis attending OPD were included in study to whom questionnaire with sixteen questions was asked and data was collected and analysed. A total of 80 individuals were included in this study, out of which 43 were males and 37 were females .79% of study population answered that psoriasis is a long life disease. About 75% and 71% of patients answered that climatic conditions and stress aggravates psoriatic lesions respectively. Results were taken from various questions asked in survery and tabulated. The results of the present study suggest that an educational intervention may be helpful in improving the knowledge, give psychological relief to patients with psoriasis and improves quality of their life .

Knowledge, attitude and behaviour study of vitiligo among general population

Vitiligo is an acquired skin disorder caused due to destruction of melanocytes which clinically presents with well defined depigmented macules and patches with or without white hairs. The present study is an attempt to document the prevalent knowledge and attitude in the general public regarding this disease and to identify the determinants of good/poor knowledge and attitude. To assess Knowledge, attitude and behaviour study of vitiligo among general population attending skin outpatient department (OPD) of Sree Balaji Medical College and Hospital, Chennai. This was a cross sectional study, which was conducted at dermatology OPD in Sree Balaji Medical College and Hospital, Chennai 2021 after ethical committee approval. About 80 patients attending OPD were included in study to whom questionnaire was asked and data was collected and analysed.

English

BACKGROUND The present study was conducted to evaluate the incidence, clinical presentation, course and prognosis of physiological changes of pregnancy i.e. to study the incidence of different dermatoses during pregnancy, cutaneous manifestations associated with pregnancy according to trimester and parity of pregnancy, specific dermatoses of pregnancy, the presence of same or other diseases in the past pregnancy, and observe the relative effect of pregnancy on already existing dermatoses or which are basically not related to pregnancy. METHODS A random hospital based descriptive study of 80 patients with pregnancy, who attended skin outpatient department (OPD) in GMERS Medical College, Himmatnagar, Gujarat, India, was done. Detailed history was taken, and each patient was examined thoroughly. General- and systemic-examination were done and whenever necessary, relevant investigations were done. RESULTS A total of 80 patients were included in the study. Of them 39 (48.7 %) were primipara and 41 (51.3 %) were multipara. Skin changes were grouped into physiological changes (all cases), specific dermatoses (17 cases) and other dermatoses (52 cases). Most common physiological changes were related to pigmentation followed by striae gravidarum. Physiological changes were observed in almost all the patients. CONCLUSIONS Pregnant women are prone to suffer from a wide range of dermatological problems apart from the specific dermatoses of pregnancy. Detailed history and awareness of clinical presentation facilitates the confirmation of diagnosis and will direct the most appropriate laboratory evaluation in an effort to minimize maternal and foetal morbidity. KEYWORDS Pregnancy Dermatoses, Specific Dermatoses, Physiological Changes

English

BACKGROUND Cutaneous lesions of external ear are quite common in clinical practice. Patients often present with various cutaneous lesions of the external ear to various disciplines. They are often underdiagnosed as many lesions, though commonly diagnosed by our dermatologist colleague are missed by other clinicians. These lesions can be classified in various ways, according to the aetiology, and according to the anatomic sites. In the present study, we tried to assess the prevalence of different skin lesions affecting external ear presenting to an ENT and skin outpatient department of a tertiary care medical college in Eastern part of India. METHODS This is a descriptive observational study, cross sectional in design. 240 patients attended the outpatient department with cutaneous lesions affecting external ear from January 2019 to February 2020. The patients presenting in both ENT and skin outpatient department were chosen randomly. Cases were diagnosed based on history and clinical examination and appropriate investigation as required. All cases were categorised into 5 types (infective, inflammatory, autoimmune, neoplasm & naevi, and reactive & reparative) according to the aetiology. In each category, prevalence of various skin lesions was recorded. RESULTS A total number of 240 cases were detected during the study period. Among them, infective 43.33 %, inflammatory 30.83 %, autoimmune 9.17 %, neoplasm & naevi 4.17 % and reactive & reparative were 12.82 %. Taenia was the most common lesions encountered (20.51 %) followed by keloid (12.5 %). Impetigo and seborrheic dermatitis shared same number of cases (9.4 %). Neoplastic lesions were the least common. CONCLUSIONS With some awareness and basic knowledge, many of the cutaneous lesions of external ear can be diagnosed and treated whenever patients report to a clinician, thus saving valuable time, effort and money of the patient. KEYWORDS Cutaneous Lesions, Skin Lesions, External Ear

English

BACKGROUND “Skin is a mirror of internal diseases”. Diabetes mellitus (DM) is a metabolic disorder that needs considerations of many different specialities but the importance of dermatologist’s knowledge has not drawn much attention. As a result, we intend to study various cutaneous manifestation of diabetes mellitus. Prior to diagnosis of diabetes mellitus, patient may present with cutaneous manifestation. Thus, it can help in early diagnosis, management and prevention of complication and help in improvement of quality of life. METHODS This is a descriptive cross-sectional study. A total of 500 diabetic patients with cutaneous manifestations, who attended skin outpatient department (OPD) at Kempegowda Institute of Medical Sciences Hospital and Research Centre, Bengaluru, Karnataka, India, were evaluated. Detailed history was taken along with physical and mucocutaneous examination. Cutaneous manifestations, general description of diabetes mellitus like duration, type, and drug history as well as the demographic data were collected and analysed using descriptive statistics. RESULTS Among a total of 500 diabetes mellitus subjects, the most common cutaneous manifestations were infections (35 %) followed by pruritus (11 %). Among infections, tinea infections (48.29 %) were the most common followed by intertrigo (21 %). CONCLUSIONS The ignorance of skin manifestations in diabetes or improper treatment may worsen the condition. Early detection and treatment of common skin manifestations in diabetes will prevent further complications especially in cases of extensive tinea corporis, pruritus, psoriasis, lichen planus, macro and micro angiopathies, trophic ulcers etc. KEYWORDS Cutaneous manifestations, Diabetes mellitus

Dermoscopy in Leprosy: A Clinical and Histopathological Correlation Study

Leprosy, an insidious infectious granulomatous disease, is diagnosed traditionally through clinical examination coupled with skin smears and histopathology. It has myriad clinical presentations that pose diagnostic challenges. Lately, dermoscopy has emerged as a rapid, noninvasive diagnostic modality for many dermatoses. We evaluated the dermoscopic findings of various manifestations of leprosy and correlated them with clinical and histopathological features. This prospective, cross-sectional study was conducted in our skin outpatient department for a period of 1 year. Patients newly diagnosed as having leprosy or those undergoing leprosy treatment for less than 6 months were included. The most representative lesion was dermoscopically evaluated and later biopsied. We included 73 patients in the study. Results indicated an obvious correlation between dermoscopic findings and histopathology. We noted orangish yellow and white structureless areas, steadily throughout the spectrum, depicting dermal granuloma. Additionally, we observed focal vascular structures such as branching, linear, and crown vessels that result from the pressure of granuloma pushing the dilated vessels upwards. The relative absence of skin appendages aided in differentiating leprosy from other granulomatous disorders. Novel findings of our study were the detection of a branch-like pattern of clofazimine-induced pigmentation on dermoscopy and orange globules on onychoscopy. Other unique findings included violaceous structureless areas, characteristic large telangiectatic vessels, follicular plugging, star-shaped silvery-white scaling, and white globules in type 1 reaction; white shiny steaks were observed in patients with borderline lepromatous leprosy, and central white dots and keratotic plugs were observed in patients with histoid leprosy. Dermoscopy, as a noninvasive modality, could aid in the quick diagnosis of leprosy and should be used as a handy tool to complement other investigative tools for this disease.

Skin Prick Test Positivity in Chronic Urticaria.

Skin prick tests identify allergens for chronic urticaria. The objective of this study was to determine skin prick test positivity in patients with chronic urticaria visiting skin outpatient department in one of the tertiary referral centre of Nepal. This was a hospital based cross-sectional study conducted at Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital. All patients of chronic urticaria aged more than 16 years were taken into study and were prick tested with seven groups of 21 allergens, taking normal saline as negative control and histamine as positive control as per the standard protocol by the Global Allergy and Asthma European Network. Frequency of positivity to each allergen was assessed. Out of 62 patients of chronic urticaria enrolled in the study, 52% were females and 48% were males. Overall, 71% were positive for at least one allergen. The most common allergens which tested positive included Dermatophagoides farinae (50%), Cotton dust (17.7%), Mosquito (16%), hay dust (14.5%), Cladosporium herbarum (14.5%), Candida albicans (12.9%), Parthenium hysterophorus (9.6%), House fly (9.6%), Soya bean (9.6%) and fish sardine (8%). Out of all these patients, 55% patients showed positivity to more than one allergens. A significant proportion of cases with chronic urticaria demonstrated sensitivity to various allergens. Skin prick test can be considered as important diagnostic procedure in cases of chronic urticaria in our population.