Background Leprosy and tuberculosis (TB) share common characteristics, such as acid-fastness of causative bacteria, geographic endemicity, route of spread, large number of asymptomatic infections, and requirement of multiple drugs for long periods of time to prevent resistance and provide treatment. Being relatively common, co-infection with the two diseases should occur based on chance alone. However, coinfection is surprisingly rare, with less than 20 cases being reported in the last decade. Aim The purpose of this case series was to study the clinico-epidemiological profile of patients with leprosy and TB co-infection. Methods This prospective, descriptive, case series describes leprosy patients with a past or current diagnosis of TB who visited the leprosy clinic of a tertiary care hospital over 3 years. The demographic details of the patients, details about the type of leprosy, slit skin smear, lepra reaction, and use of corticosteroids were noted for all patients. The type of TB, chest X-ray findings, sputum positivity, Interferon gamma release assay (IGRA) test, and Mantoux test results were recorded. The gap between the two diagnoses, the first disease to be diagnosed, family history of either disease, and the presence of predisposing factors were noted. Results This case series describes a total of 20 patients with leprosy co-infected with TB. There were 11 (55%) males, and the mean age of patients was 32.7 years. Half of these patients had lepromatous leprosy, and a similar number had type 2 lepra reaction. Pulmonary TB was seen in 12 (60%) patients, and tubercular pleural effusion in two (10%) patients. Multidrug-resistant TB was seen in two patients, and only one patient had received the bacilli of Calmette-Guerin (BCG) vaccination. Of the two diseases, leprosy was diagnosed first in six (30%) patients, while it was TB in 12 (60%) patients, and two (10%) patients had a concomitant diagnosis. Limitations The small number of patients in this single-centre study from a tertiary care hospital may not be reflective of the general population. Conclusion Leprosy and TB co-infection may present several management issues involving diagnosis and treatment, including drug resistance to tubercular bacilli. Management guidelines for such coinfections are needed to facilitate treatment of such patients and prevent high mortality and morbidity associated with such coinfections. More studies are needed to correctly define the clinico-epidemiological parameters of patients with co-infection.

Ross syndrome, a rare neurological disorder, is characterized by the combination of three primary features: segmental anhidrosis, tonic pupils, and areflexia. The exact aetiology remains unclear, but it involves dysfunction in the autonomic nervous system, specifically affecting the sympathetic pathways. Patients often experience reduced sweating, particularly in specific body regions, alongside pupillary abnormalities and diminished reflex responses. Due to its rarity, further research is needed to understand its pathophysiology, optimize treatment strategies, and improve patient outcomes. In our case series of five patients, a diagnosis of 'complete' Ross syndrome was made for two patients, while the remaining patients were diagnosed with 'incomplete' Ross syndrome. The rarity of Ross syndrome underscores the importance of detailed clinical reporting, as it may lead to improved patient care and outcomes.

Introduction: Hypertrophic scars and keloids are the result of prolonged inflammation in the reticular dermis. There are various treatment options but none of them provides complete cure. Objective: 1) To study the clinical efficacy and adverse effects of intralesional triamcinolone acetonide in the treatment of keloids and hypertrophic scars. 2) To study the clinical efficacy and adverse effects of intralesional bleomycin in the treatment of keloids and hypertrophic scars. 3) To compare the clinical efficacy and safety of intralesional triamcinolone acetonide and intralesional bleomycin in the treatment of keloids and hypertrophic scars. Material and methods: This hospital-based prospective study included a total of 170 patients who attended the outpatient Department of Dermatology at a tertiary care center over a period of 2 years. After obtaining written informed consent, patients with keloids and hypertrophic scars were assigned to two groups. Group A received intralesional triamcinolone (40 mg/ml), and Group B received intralesional bleomycin (1.5 IU/ml). Treatment was repeated at 3-week intervals for up to 15 weeks or until clinical resolution, whichever occurred first. Treat-ment response was assessed using the Patient and Observer Scar Assessment Scale (POSAS) at baseline and prior to each session, continuing for up to 3 weeks after the completion of therapy. For each patient, both the absolute reduction in POSAS scores and the percentage reduction from baseline were calculated. Results and conclusions: Based on the results of our study, we conclude that both treatment options have comparable efficacy irrespective of the scar type.

Cutaneous lymphomas are a heterogenous group of neoplasm confined to skin at the time of diagnosis. These are extranodal non-Hodgkin lymphomas (NHLs). Here, we present a case of 58 years male who presented to the dermatology outpatient department with complaints of multiple painless nodules with petechial rashes over both arms, hand, trunk, body and legs, which were not associated with any other symptoms. A biopsy from one of the lesions was sent with clinical suspicion of sarcoidosis, pseudolymphoma and metastasis. On microscopic examination, diffuse infiltration of atypical cells in the dermis was seen with membranous positivity for CD45, CD3 and CD5. Based on the history, clinical examination and histopathological evaluation, a final diagnosis of T-cell NHL was given. Our patient was started on 6 cycles of 10 mg/m 2 of doxorubicin and 50 mg/m 2 of methotrexate per week. He is asymptomatic on 3 months of follow-up, with no new lesions and bearable side effects of chemotherapeutic agents.

A 35-year-old male presented with progressive polyuria and polydipsia over 6 months, accompanied by non-pruritic, hyperpigmented papulo-nodular skin lesions predominantly in flexural areas. Water deprivation test and response to vasopressin confirmed arginine vasopressin deficiency (AVP-D). Magnetic resonance imaging (MRI) revealed a thickened pituitary stalk with enhancement, suggesting infundibulo-neurohypophysitis. Skin biopsy identified foamy histiocytes with CD68 and CD163 positivity, consistent with a diagnosis of xanthoma disseminatum (XD). Treatment with desmopressin effectively managed polyuria, while cyclophosphamide and atorvastatin partially resolved skin lesions. This case underscores the importance of considering systemic causes of AVP-D, such as XD, when dermatological findings are present.

Aim: To study the immunoexpression of nerve growth factor (NGF) in Hansen’s disease to assess the diagnostic and prognostic significance. Objective: NGF is a neurotrophin and an important growth factor for the tissue remodeling process. Higher expression of NGF is observed in the lepromatous forms when compared to tuberculoid forms. Materials and Methods: The present prospective study was carried out in the Departments of Pathology and Dermatology at Aligarh Muslim University, Aligarh, Uttar Pradesh, India, in 50 patients of Hansen’s disease. Results: The study included 50 cases of Hansen’s disease. The majority of the cases were of borderline lepromatous, 15 (30.0%), followed by 12 (24.0%) cases each of borderline tuberculoid and tuberculoid leprosy. Higher staining intensity of NGF and a higher percentage of positive cells were observed in lepromatous leprosy (LL) cases as compared to tuberculoid leprosy (TT) cases. The highest number of cases with a high immunoreactivity score (IRS) was of LL, whereas TT cases showed a low IRS. Conclusion: The immunoexpression of NGF was more intense on the lepromatous side of the spectrum compared to the tuberculoid side, indicating the severity of the disease with less potential for cure.

Congenital Lipomatous Overgrowth, Vascular malformations, Epidermal nevus and Skeletal abnormalities (CLOVES) syndrome is characterised by congenital lipomatous overgrowth, vascular malformations, epidermal nevi and skeletal anomalies without progressive or distorting bony overgrowth. A 10-month-old boy, born to nonconsanguineous and healthy parents, presented with congenital lipomatosis of the left side of face and verrucous epidermal nevus extending from the left pre- and post-auricular area, neck and upper left shoulder. He also had sandal gap deformity in both feet between 1 st and 2 nd toe. This case is being reported on account of its rarity, as till now, <150 cases has been reported worldwide.

Introduction: Nail psoriasis is a relatively unexplored clinical feature in the Indian population. Its correlation with cutaneous, musculoskeletal, and serological manifestations was analyzed. Material and Methods: This study included 45 patients with clinically evident nail psoriasis. Clinical characteristics, Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), Nail Psoriasis Quality of Life Index 10 (NPQ10) scores and serological markers, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), and Rheumatoid Arthritis factor (RA factor) were documented, calculated, and assessed to study their correlation. Results: Mean age was 35.36 ± 13.26 years. Mean NAPSI and NPQ10 were 41.96 ± 29.38 and 5.44 ± 5.31, respectively. Common nail findings were onycholysis (80%), subungual hyperkeratosis (75.5%), and pitting (62.2%). Joint involvement was seen in 31.11% of patients. Positive associations of NAPSI with duration of illness (P < 0.001, β = 0.57) and PASI scores (P < 0.001, β = 0.56) were observed. NPQ10 demonstrated associations with NAPSI (P < 0.001, β = 0.83) and PASI (P = 0.001, β = 0.83). Elevated ESR and CRP levels were associated with higher NAPSI scores (P < 0.001, β = 0.55, and P = 0.003, β = 0.43, respectively). Furthermore, duration of illness, NAPSI, and NPQ10 scores were positively correlated with joint involvement (P < 0.05). Conclusion: A strong correlation between nail psoriasis severity, disease duration, skin involvement, and nail-specific quality of life was observed. Furthermore, severe nail psoriasis was linked to a higher likelihood of joint involvement and elevated serological markers. These findings emphasize the importance of integrated treatment strategies for affected patients.

Palmoplantar keratoderma (PPK) is a broad entity comprising wide range of hereditary and acquired disorders. Herein, we present a case of 18-year-old female who presented with complaints of palmoplantar thickening since birth and progressive constriction bands around digits for 3 years. On examination, diffuse transgradient honeycomb type of PPK was present. Fibrous constriction bands (pseudoainhum) were present circumferentially around the distal interphalangeal joint of fifth finger and metatarsophalangeal joint of fifth toe bilaterally. Punch biopsy from palms revealed hyperkeratotic, stratified squamous epithelium with vacuolar degeneration and prominent keratohyaline granules. Audiogram was normal. On the basis of history, clinical examination and investigations, a diagnosis of Camisa syndrome was made and the patient was started on oral retinoids. We also discussed case findings of Camisa Syndrome reported in Asian population.

Keratosis linearis with ichthyosis congenita and sclerosing keratoderma syndrome is a rare autosomal recessive disorder which is characterised by palmoplantar keratoderma, linear hyperkeratotic plaques, ichthyosiform scaling, pseudoainhum and plaques distributed linearly in the flexures. A 7-year-boy presented with ichthyosiform scaling over body since birth, hyperkeratotic plaques over palms and soles. On cutaneous examination, diffuse ichthyosiform scales were present all over body with non-transgradient type of palmoplantar keratoderma with bilaterally symmetrical linear hyperkeratotic plaques over 5 th metatarsophalangeal joint. In our case, hyperkeratotic plaque was seen in extensor region over the feet. This case is being reported on account of its rarity and rare presentation.

Background: Both extrinsic as well as intrinsic coagulation cascade are involved in the pathogenesis of Chronic spontaneous urticaria. This study was done to correlate the disease activity and markers of coagulation cascade in patients of CSU. Methods: A hospital-based, cross-sectional, descriptive study was carried out in 100 patients of chronic urticaria. Baseline D-Dimer, prothrombin time, activated partial thromboplastin time was performed. Disease activity was assessed using Urticaria activity score over 7 days. Results: Of total 100 patients, d-dimer was raised in 72 (72%) patients. Correlation between D-dimer and UAS-7 days showed significant covariance between D-dimer and UAS-7 (p<0.001, r=0.93). Prothrombin time was raised in 55 (55%) patients. Significant correlation was found between PT and UAS-7 (p<0.001, r=0.76). Raised APTT was observed in 61(61%) patients. Correlation between APTT and UAS-7 showed that there was a significant covariance between APTT and UAS-7 (p<0.001, r=0.59). Conclusions: A significant correlation between markers of coagulation cascade and the disease activity in patients of CSU was seen. These markers can help predict the disease severity and possibly monitor therapeutic response.

TGF-β is a pleiotropic cytokine that deploys several functions on different types of cells. In the lepromatous (LL) form of Leprosy, there is predominance of M2 macrophages, which induce the production of growth factors, such as TGF-β which is important for the mechanisms that cause apoptosis and healing. To study the immunoexpression of TGF-β in Hansen’s disease and to assess the severity of infection with potential response to treatment. The present study was carried out in 45 patients of Hansen’s disease after a detailed history and thorough physical examination performed in every subject and punch biopsies were performed. The specimens were fixed, paraffin embedded and sections of 3-5 microns thickness were cut and stained with hematoxylin and eosin stains. Additional sections of 3-4 microns thickness were cut and immunohistochemical staining by TGF-β antibody was performed. Of the 45 cases of Hansen’s disease, most of the cases were of Borderline Tuberculoid and Borderline Lepromatous, constituting 14 (31.1%) cases each, followed by 9 (20.0%) cases of Lepromatous Leprosy. Maximum cases, 12 (26.7%) each with intense reaction were of Borderline Tuberculoid and Borderline Lepromatous, followed by 6 (13.3%) cases of Lepromatous Leprosy. Most of the cases, 9 (20.0%) were of Borderline Lepromatous category with highest proportion score, followed by 7 cases (15.6%) of Borderline Tuberculoid. Highest number of cases, 9 (20.0%) with high immunoreactivity score were in Borderline Lepromatous, whereas most of the cases, 7(15.6%) with low immunoreactivity score were in Borderline Tuberculoid. The immunoexpression of TGF-β was more intense in lepromatous side of the spectrum as compared to the tuberculoid, which indicates the severity of the disease with less cure potential.

Degos-like lesions (DLL) have been associated with connective tissue diseases. Till date only twelve cases of systemic lupus erythematosus (SLE) with DLL have been published. We describe a rare case of SLE with leg ulcers and DLL. A 23-year-old male presented with malar rash, photosensitivity, leg ulcers, joint pain, oral ulcers, altered sensorium and dyspnea. Cutaneous examination also revealed atrophic, porcelain-white scars over body previously unnoticed by patient. Dermoscopy of atrophic lesions was pathognomonic of Degos disease. Histopathology from various lesions were consistent with Degos disease and SLE. Patient was admitted in intensive care unit but succumbed to multiorgan failure two days later. This case highlights the importance of dermoscopy for immediate diagnosis of DLL. Appropriate investigations for early diagnosis and timely management can decrease mortality. Also a thorough examination in cases of connective tissue diseases may reveal uncommon lesions that can alter clinical course and outcome of patients.

Background: Alopecia areata (AA) is an autoimmune disorder and exhibits non scarring alopecia. Currently, there is no definitive cure, platelet rich plasma (PRP) has emerged as a newer modality for non-cicatricial alopecias such as AA. This study was conducted to compare the efficacy and adverse effects of topical mometasone with PRP versus topical mometasone alone in the treatment of patients of AA. Methods: This study was conducted on a total of 100 clinically diagnosed cases of AA. Patients in group A were subjected to intradermal injection of autologous PRP every 3 weeks along with topical mometasone cream 0.1% daily for 12 weeks. Group B was treated with topical mometasone cream 0.1% once a day locally over affected site for 12 weeks. Results: Baseline SALT score of group A was 6.05±5.36 while that of group B was 6.62±4.39. The mean SALT score of group A declined to 0.94±1.69 and that of group B 2.19±1.76 over a period of 20 weeks. Excellent response was observed by 12 and 5 patients of group A and group B respectively. Minor side effects like pain was seen in 10 patients (20%) in group A, while atrophy was seen in 2 patients of group B. Conclusions: This is the first ever study evaluating the additional benefit of intralesional PRP. In this study, it was found that adding intralesional PRP with topical mometasone 0.1% cream has higher efficacy and early improvement than topical mometasone alone, in the treatment of AA.

Background: Androgenetic Alopecia is a hereditary androgen-dependent disorder characterized by a gradual conversion of terminal hair into miniaturized hair with typical bitemporal recession and balding vertex and is considered the most common type of baldness characterized by progressive hair loss. This study evaluated the hormonal profile in males with androgenetic alopecia. This study evaluated the hormonal profile of early androgenetic alopecia in males. Methods: This prospective study included 84 patients attending the outpatient Department of Dermatology. Forty-four cases and 40 controls were included in the study. The study had 44 male patients presenting with complaints of grade ≥ 3 androgenetic alopecia in the age group 19-35 years, whereas 40 age and sex-matched patients attending Dermatology OPD for unrelated complaints with no history of hair loss or clinical examination suggestive of androgenetic alopecia were included in the control group. After a detailed history, and examination, testosterone, LH, FSH, Prolactin, and SHBG were estimated. Results: The mean age of onset was found to be 24.29±3.28 years. Positive family history was seen in 65.90% of patients. The mean testosterone, LH, FSH, prolactin, SHBG and free androgen index in cases versus controls was 6.44±2.58 versus 3.32±1.53 ng/ml, 8.01±2.64 IU/l versus 3.01±1.16 IU/l, 3.82±1.33 IU/l versus 5.07±1.27 IU/l, 15.50±5.11 ng/ml versus 9.84±3.91 ng/ml, 12.72±2.63 nmol/l versus 29.18±4.90 nmol/l and 51.03±21.78 versus 11.40±4.66 respectively. LH/FSH ratio was 2.17±0.54 versus 0.63±0.27. These parameters had p values <0.05 and were statistically significant. Conclusions: Our study concluded that serum testosterone, prolactin, LH, LH/FSH, and FAI are increased whereas serum FSH and SHBG are decreased in cases of androgenetic alopecia compared to controls.

Introduction Molluscum contagiosum(MC) is a viral infection of the skin and mucous membrane characterized by single or multiple, pearly white to flesh-colored umbilicated papules. There are certain therapies that increase the cellular immune response either through a topical or systemic approach as cell-mediated immunity plays an important role in the regression of MC. Immunomodulatory medications are relatively newer modalities of treatment that have been more successful for patients with widespread and potentially disfiguring eruptions. Objective To study the effect and safety of Measles, Mumps, and Rubella (MMR) immunotherapy in patients with multiple Mollusca. Patients and methods The study included 200 patients with multiple MC. They were injected with the MMR vaccine intralesionally into 2-3 lesions including the largest mollusca up to a maximum of 0.3 ml in one sitting every 2 weeks for a maximum of 5 treatments at a 2-week interval (week: 0, 2, 4, 6, 8) or till the complete resolution of MC whichever was earlier. The action of the MMR vaccine was assessed by the reduction of the number of lesions and the day of resolution of lesions. The response of all patients at subsequent visits (at second, fourth, sixth, eighth, and 10th week from the initiation of therapy which was taken as week 0) was analyzed. All the patients were subjected to photographic documentation before the initiation of therapy, during therapy, and at 1 month (week 14) and 3 months (week-22) of the follow-up period. Results Out of 200 patients, 184 completed the study. There were 116 males and 84 females. The mean age of study participants was 17.17±12.64 years. At the end of the study complete resolution of MC was seen in 149 (81%) patients, 21 (11.4%) patients had relative response while a poor response was seen in 14 (7.6%) of patients. Mild tolerable pain was seen in 25 (12.5%) patients during injection followed by pigmentary changes in 17 (8.5%) patients and scarring in 12 (6%) patients. Conclusion Intralesional immunotherapy with the MMR vaccine is an effective and safe modality for the treatment of MC.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the apocrine glands characterized clinically by recurrent nodules, abscesses, and discharging sinuses which heal with a bridge or rope-like scars in the axilla, groin, and perineum. HS is seen to be associated with several other autoimmune and pilosebaceous structural disorders. We present the case of a 50-year-old obese female, known case of HS for 3 years who developed hyperpigmented indurated plaques over the breasts for the past 1 year. Histopathology from the plaques showed thickened and homogenized collagen bundles. A diagnosis of plaque morphea was made based on the clinical and histopathological findings. There are few case reports of HS associated with connective tissue diseases (CTDs) such as systemic lupus erythematosus, Sjogren's syndrome, and systemic vasculitis. We discuss the shared pathogenesis of HS and CTDs which may have led to morphea developing in our patient.

Background: Dermatophytosis is a common dermatological problem. Recent studies have reported an increase in the prevalence of the disease. Management of dermatophytosis thus has become challenging for both dermatologists and patients due to their resistance to treatment and their refractory nature. Currently the management of dermatophytic infection includes both oral and topical antifungals. The study compared the clinical efficacy and adverse effect profile of systemic with topical drugs. Methods: Patients were randomly divided into two groups of 90 each. They were given oral Itraconazole 100 mg twice daily with Sertaconazole 2 % cream twice daily (Group A) and oral Terbinafine 250 mg once daily with Sertaconazole 2 % cream twice daily (Group B) till complete resolution of lesions or a maximum of six weeks. The response was assessed by the improvement in signs and symptoms of each of the clinical parameter, pruritus, erythema, scaling. Results: At week 6, mycological cure was seen in 92.9% in Group A as compared to 86.9% of patients in Group B. There was a significant improvement in percentage change in pruritus, erythema, and scaling in both the groups from 0 to 6 weeks (p-value: <0.0001). Mild adverse effects such as gastrointestinal upset, headache, and raised transaminases were observed which were comparable in both the groups. Conclusions: On comparison of the groups, we observed that both were effective but Itraconazole with Sertaconazole 2% cream was more efficacious in terms of both clinical (pruritus, scaling, and erythema) and mycological cure.