Lichen planus (LP) is a chronic, T-cell-mediated inflammatory dermatosis involving the skin and mucous membranes, with multiple clinical variants. Zosteriform lichen planus (ZLP) is a rare variant characterized by a unilateral, dermatomal or band-like distribution that may mimic herpes zoster. While mucosal LP, particularly oral lichen planus, has been associated with malignancy, the role of cutaneous LP, especially ZLP as a paraneoplastic manifestation remains unclear. A 54-year-old woman presented with a one-year history of asymptomatic violaceous papules and plaques arranged in a unilateral, band like pattern over the left chest extending to the neck, without crossing the midline. The distribution corresponded to C3-T2 dermatomes. Mucosa, scalp, and nails were uninvolved. Clinical findings suggested zosteriform lichen planus, which was confirmed on histopathology. During follow-up, six months after the onset of cutaneous lesions, the patient developed a palpable lump in the left breast. Imaging revealed a suspicious lesion, and histopathology examination confirmed invasive ductal carcinoma. Notably, the malignancy was ipsilateral to the cutaneous eruption. The temporal sequence, strict dermatomal localization, and absence of known triggers raised suspicion of a paraneoplastic association. The association between LP and malignancy is controversial, with stronger evidence for oral LP and lichen planus pemphigoides. In this case, a neuro-immunologic mechanism may be implicated, wherein tumour related immune activation selectively affects contiguous dermatomes, leading to a localized lichenoid eruption. To our knowledge, ZLP has not previously been reported as a paraneoplastic manifestation. This case highlights a rare presentation of ZLP potentially associated with underlying breast carcinoma and suggests a possible paraneoplastic role.

Background: Cutaneous adverse drug reactions (CADRs) are among the most frequently reported adverse drug reactions, ranging from mild skin eruptions to life-threatening conditions such as Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis. Identifying the causative drugs and understanding their clinical patterns are crucial for effective prevention and management. This study aimed to evaluate the epidemiological and clinical characteristics of CADRs and identify the most commonly implicated medications in a tertiary care center in Odisha. Subjects and Methods: This was a cross-sectional, observational study conducted in the Department of Dermatology at a tertiary care center over 18 months (July 2023–December 2024). A total of 94 patients with clinically diagnosed CADRs were included. Detailed medical history, clinical examination, and laboratory investigations were performed. The Naranjo Algorithm Scale was used to assess the causality of suspected drugs. Data were analyzed to determine the frequency, severity, and causative drug classes associated with CADRs. Results: Among the 94 patients, the highest incidence was observed in the 21–30-year age group. Fixed drug eruption was the most common CADR (40.42%), followed by SJS (18.1%) and maculopapular drug eruption (10.6%). Severe cutaneous adverse reactions were noted in 31.91% of cases. Fluoroquinolones in the antimicrobial (55.31%) group were the leading causative drugs, followed by Nonsteroidal anti-inflammatory drugs (12.76%) and anticonvulsants (5.31%). Conclusion: Antimicrobials, particularly fluoroquinolones, were the most frequently implicated drugs in CADRs. Strengthening pharmacovigilance, promoting rational drug use, and ensuring early detection and management of severe reactions are essential to reducing morbidity and improving patient safety.

Henoch–Schönlein purpura (HSP), a common vasculitis in children, typically presents with palpable purpura. We report the case of a 9-year-old girl with HSP exhibiting hemorrhagic bullous lesions, a rare manifestation in pediatric patients. The diagnostic evaluation confirmed the diagnosis, revealing small vessel leukocytoclastic vasculitis with linear immunoglobulin A deposition. Treatment with oral prednisolone led to symptom improvement, highlighting the importance of early intervention in managing atypical presentations of HSP.

Verruca or viral warts affect nearly 10% of the global population and are caused by human papillomavirus (HPV) infection, with more than 200 subtypes recognized to date. These lesions commonly involve the skin and mucous membranes and are transmitted through direct or indirect contact. Verruca plana, also known as flat warts, are typically smooth, flat-topped, reddish-brown or skin-coloured papules that often appear on the face, neck, and dorsal aspects of the hands. They are more frequent in children and young adults. While in most cases, verruca plana are self-limiting, disseminated or extensive presentations are uncommon and may indicate an underlying immune defect. Such widespread involvement warrants evaluation for immunosuppression due to conditions such as HIV infection, prolonged corticosteroid therapy, or other immunodeficiency disorders. Here, we present a case of disseminated verruca plana and outline the systematic clinical and laboratory approach undertaken to rule out any underlying immunocompromised state.

Microneedling is a well-established treatment for acne scars, but its cost and accessibility can be a barrier in the low-resource set-up. This new technique explores the innovative use of insulin syringes as a low-cost alternative for manual microneedling in atrophic acne scars. We present a series of 10 cases with acne scars who were treated with insulin syringe-assisted microneedling.

Abstract A rare co-infection of Haemophilus ducreyi and non-albicans Candida was identified in an immunocompetent 31-year-old woman presenting with painful vulvar ulcers and malodorous curdy discharge. Gram stain showed Gram-negative coccobacilli and budding yeast cells, whereas serology for herpes simplex virus, syphilis, and human immunodeficiency virus was negative. Culture confirmed Candida parapsilosis . The patient responded rapidly to azithromycin and weekly fluconazole. This case highlights the need to consider chancroid as a differential diagnosis in painful genital ulcers and underscores the importance of species-level Candida identification and evaluation for polymicrobial infections in persistent vulvovaginal conditions, given the rarity of such coinfections globally.

BACKGROUND:Alopecia areata (AA) is an unpredictable disease that manifests as rapid and patchy hair loss and may involve any hair-bearing part of the body. We used dermoscopy to compare the dermoscopic findings of AA in patients with and without poor prognostic indicators. AIMS AND OBJECTIVES:To compare the key variations in dermoscopic features between patients of AA with and without poor prognostic indicators. PATIENTS AND METHODS:This was a retrospective study carried out at a tertiary care teaching hospital in eastern Odisha. The study included the patients of scalp AA from October 2023 to October 2024. A total of 85 patients of AA were evaluated using the Severity of Alopecia Tool (SALT) score and Dermlite DL3 attached to iPhone 12. RESULTS:A total of 85 patients with AA were included in our study (male: female ratio ~ 2:1). The mean (± standard deviation) age of patients was 26.61 ± 9.82 years. The mean duration of the disease was 5.98 ± 11.74 months. Patchy AA was the most common. The most common dermoscopic feature observed was yellow dots (83.5%), followed by broken hairs (65.9%), black dots (51.8%), vellus hairs (51.8%), tapering hairs (50.6%), and coudability hairs (22.4%). Patients with poor prognostic markers had a substantially higher SALT score (34.99 ± 37.21) compared to those without (10.75 ± 14.08), with P = 0.002. A statistically significant high SALT score was recorded in patients with disease duration >3 months. The dermoscopic features that were significantly more frequent in patients having poor prognostic factors were yellow dots ( P = 0.000), black dots ( P = 0.02), broken hairs ( P = 0.03), and coudability hairs ( P = 0.000), while in patients without poor prognosis, vellus hairs ( P = 0.005) were more commonly seen. The finding of tapering hair ( P = 0.1) was not found to be significantly associated with either group. LIMITATIONS:Retrospective nature of the study and not assessing dermoscopic response to treatment. CONCLUSION:Ours is the first study to emphasize the comparison of dermoscopic features of AA in patients with and without poor prognostic indicators. Yellow dots, black dots, broken hairs, and coudability hairs were associated with adverse prognosis, while vellus hair indicated a favorable outcome. Identifying these key dermoscopic markers can help to assess the disease severity, potentially refine prognostic assessments, and guide treatment decisions.

The case report describes an atypical presentation of hand, foot, and mouth disease Hand Foot And Mouth Disease (HFMD) in a young child which mimicked the typical clinical picture of erythema multiforme. Usually, the atypical presentation of HFMD is reported in adults, here, we present the atypical presentation in a young child.

Leprosy, caused by Mycobacterium leprae, affects the skin and peripheral nerves. Pure neuritic leprosy (PNL) is a rare subtype, characterized by nerve involvement without skin lesions. We report a rare case of PNL progressing to lepromatous leprosy (LL) with erythema nodosum leprosum (ENL), with only one such case previously reported in the literature and reviewed herein. A 35-year-old male diagnosed with PNL on sural nerve biopsy showing acid-fast bacilli (3+) completed multidrug therapy for 12 months. Nine months later, he developed painful erythematous nodules and sensory-motor deficits. Slit-skin smear (bacteriological index 4+) and biopsy confirmed LL with ENL. He was treated with monthly pulses of rifampicin, minocycline, and moxifloxacin, along with thalidomide and corticosteroids. Significant improvement occurred after six months. This case illustrates the intricate clinical challenges associated with leprosy, particularly how PNL can progress into more severe forms such as LL. While Type 1 reactions are documented in PNL, only a single instance of a Type 2 reaction has been recorded in PNL. Persistent bacterial load, immune modulation, host factors, and drug resistance can all contribute to this shift, necessitating vigilant monitoring even after treatment completion. This case underscores the rare transformation of PNL to LL, possibly due to persistent bacilli and reduced cell-mediated immunity, emphasizing the importance of early diagnosis, complete therapy, and careful follow-up.

Pityriasis rosea (PR) is a self-limiting inflammatory skin condition primarily affecting adolescents, with a slight female predominance. It typically presents with a herald patch followed by smaller lesions in a characteristic “Christmas tree” distribution. Uncommon presentations localized to atypical sites are rarely reported. This case series highlights the potential for PR to present in atypical localized patterns. Dermatologists should consider PR in the differential diagnosis of localized erythematous plaques and rely mostly on histopathological confirmation for accurate diagnosis.

Background Erythema nodosum (EN) is a painful inflammatory disorder of the subcutaneous fat and the most common type of septal panniculitis. It often presents as erythematous, tender subcutaneous nodules, typically affecting the shins. EN is frequently a hypersensitivity reaction that can serve as a warning sign for an underlying systemic disorder, making it crucial to identify the cause. Though self-limiting in many cases, EN can sometimes become chronic, leading to significant discomfort. The pathogenesis of EN and the predictors of chronicity remain unclear, necessitating further investigation. Aims This study aimed to evaluate the various etiologies of EN and determine the clinical, laboratory, and immunohistochemical predictors of chronicity. Methods We conducted a prospective hospital-based study between July 2022 and June 2024 at a tertiary care centre in Eastern India. Clinical and histopathologically confirmed cases of EN presenting within 2-3 days of onset, without prior treatment, were enrolled. A detailed clinical examination and laboratory investigations were performed during the initial visit, including immunohistochemical analysis of skin biopsies. The total number of T cells (CD3+), helper T cells (CD4+), cytotoxic T cells (CD8+), CD4:CD8 ratio, and NK (natural killer) cells (CD56+) were quantified per skin biopsy specimen using a standardised technique. Patients were treated at the discretion of the treating physician. Patients were monitored monthly for three months and categorised as either having "Classic EN" (lesions resolving within three months) or "Chronic EN" (lesions persisting beyond three months). Data collected at the initial visit were correlated between the two groups to identify potential predictors of chronicity. Results Out of 63 suspected cases, EN was confirmed in 41 patients, who were predominantly females (65.85%), with a median age of 49 years (Q1 - Q3: 32 - 57). Pulmonary tuberculosis was the most frequent underlying condition (n = 15, 36.59%), followed by sarcoidosis (n = 8, 19.51%) and rheumatoid arthritis (n = 6, 14.63%). Chronic EN was observed in 36.59% of cases, with significantly elevated baseline C-reactive protein (CRP) levels (p = 0.003) and Mantoux test readings (p = 0.002). Immunohistochemistry revealed higher CD3, CD4, CD8, and CD56 levels in chronic EN cases (p < 0.05). Limitations The study's limitations include a small sample size and short follow-up duration. Multivariable analysis could not be performed due to the small sample size. Conclusion This study identified clinical and immunohistochemical markers associated with the chronicity of EN and highlighted pulmonary tuberculosis as the most common underlying cause. Elevated CRP levels, positive Mantoux test results, and increased expression of CD3, CD4, CD8, and CD56 observed at baseline were linked to chronicity. The findings suggest the predominant role of T helper 1 (Th1) cell response and innate immunity in the pathogenesis of chronic EN lesions. Understanding these predictors and underlying aetiologies can help clinicians identify high-risk patients and tailor management accordingly.

Primary cutaneous aspergillosis (PCA) is an uncommon manifestation of Aspergillus infection, typically occurring in immunocompromised individuals. We report a rare case of diffuse PCA in an immunocompetent patient who presented with multiple painless, discharging nodular lesions on the extremities over a 3-month period. Clinical examination revealed multiple nontender swellings with erythema, edema, desquamation, and purulent discharge. Direct microscopy with potassium hydroxide mount revealed thin septate hyphae with acute-angle branching. Fine-needle aspiration cytology and histopathology confirmed fungal elements consistent with Aspergillus . Fungal culture from the biopsy specimen yielded Aspergillus flavus . Based on clinical, cytological, histopathological, and microbiological findings, a diagnosis of PCA was established. The patient was treated with oral itraconazole 200 mg daily but was lost to follow-up. This case highlights the importance of considering fungal infections like PCA in immunocompetent individuals, especially when faced with atypical, nonhealing cutaneous lesions. Early recognition and appropriate antifungal therapy are crucial to prevent potential complications and dissemination.

Erythroderma is an extensive, scaly erythema, involving more than 90

Scabies is an infestation of the skin caused by the highly host-specific mite Sarcoptes scabiei var. hominis. Untreated cases cause various complications and secondary infections which include abscesses, lymphadenopathy, and poststreptococcal glomerulonephritis. Here, we report two cases of scabies associated with unilateral lymphadenopathy in the absence of any superadded infection, which has not been reported to the best of our knowledge.

Vitiligo and psoriasis are seldom encountered simultaneously. Follicular psoriasis is a lesser known presentation of psoriasis, occurring on hairy areas of the body. Locus minoris resistentiae, an age old postulation, where in a single site in the body is more prone to develop diseases as compared to other sites can be attributed to co-occurence of these two diseases. Here in, we report to you a case of vitiligo over a pre-existing follicular psoriasis lesion.

Objectives: Atopic dermatitis (AD) is a common occurrence worldwide, where topical corticosteroids and calcineurin inhibitors, along with antihistamines, are being used for the treatment of mild-to-moderate AD. Crisaborole 2% ointment, a phosphodiesterase-4 inhibitor, has been recently approved for AD treatment by the Food and Drug Administration. Crisaborole is proposed to have lesser side effects in comparison to its counterparts. However, the impact of crisaborole on the Indian population has only been studied in the paediatric population and has not been widely explored. We conducted this study to find the safety and efficacy of crisaborole 2% ointment in mild-to-moderate AD in the Indian population. Materials and Methods: Thirty consecutive mild-to-moderate AD patients were included in the study. The patients were advised to apply crisaborole 2% ointment at the site of involvement twice daily for 28 days. The evaluation was done at baseline and day 28 using the SCORing AD (SCORAD), investigator static global assessment (ISGA) and eczema-associated severity index (EASI) scores. The patients were followed up to report any side effects. Results: There was a statistically significant decrease in the mean SCORAD, ISGA and EASI scores after the end of treatment. According to SCORAD, there were 58.3% of patients with moderate AD which reduced to 41.6% at the end of treatment. ISGA defined treatment success as only being achieved by 36.6% of patients, out of which complete resolution was achieved only by 20% of patients at the end of treatment. The mean EASI scores showed a considerable decreasing trend from 8.47 at baseline to 4.73 at the end of the study. Six patients withdrew from the study due to exacerbation of symptoms, possibly burning at the site of application. Conclusion: Although crisaborole reduced symptoms, it did not provide any instant relief to symptoms of AD, leading to discontinuation in a few patients, making it a viable drug for maintenance rather than a first-line therapy.

Congenital vitiligo is a very rare entity, but cases in infancy have been reported. We are presenting the case of a 2-month-old male infant who came to us with complaints of multiple progressive white patches over the body since birth. The lesions showed white accentuation with fluorescence under a Wood’s lamp. There was a positive history of vitiligo in the maternal grandmother. The infant was successfully treated with topical pimecrolimus 1% cream. Our case in point contributes to the limited pool of studies on congenital vitiligo (nine cases reported till date) and lends credibility to the theory that, in genetically vulnerable individuals, the autoimmune process may begin in utero .