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Bullous pemphigoid is a subepidermal blistering disease that rarely involves the mucous membranes and possesses circulating antibodies against BP antigen II (BP180) and BP antigen I (BP230). Rheumatoid arthritis (RA) is a progressive inflammatory autoimmune disease that is characterized by joint inflammation and systemic involvement. The co-occurrence of RA, which is likewise linked to autoimmunity, with bullous pemphigoid may not be merely coincidental. A 55-year-old female, a known case of RA for 25 years, presented to us with multiple pruritic vesiculobullous lesions. After a thorough clinical and laboratory assessment, she was diagnosed with bullous pemphigoid. This emphasizes the significance of the simultaneous occurrence of autoimmune disorders and the need for vigilant and timely identification.

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Background: Nail disorders account for about 10% of all dermatological conditions. Onychoscopy is useful not only for their diagnosis but also for assessing severity/progression and monitoring the response to therapy. Aims and Objectives: Describing dermoscopic features of nail disorders in patients reporting to the dermatology OPD of our tertiary care hospital and recording the sociodemographic profiles thereof. Materials and Methods: This cross-sectional observational study was carried out on 176 patients with effect from August 2019 to August 2021. Results: Males (99; 56.25%) outnumbered females (77; 43.75%); males: female: 1.28: 1; their mean age was 35.8 years. Fingernails were affected more oftener (84.09%) than toenails (38.64%). Onychomycosis, the commonest (58;32.95%) condition, revealed findings of aurora borealis pattern (75.86%), subungual hyperkeratosis (72.41%), and onycholysis with jagged edges and spikes (68.97%). The next frequent (32;18.18%) condition was nail psoriasis which revealed pits (81.25%); onycholysis (62.5%) and dilated globose nail fold vessels on capillaroscopy (25%). Limitations: The small sample size proved inadequate for the evaluation of statistical significance in the less common conditions and the correlation of disease severity of many. Ideally, confirmatory diagnostic tests should have been done in every patient, as indicated. The magnification of our dermoscopy was 10X; 20- and 40X permit better capillaroscopy. Conclusions: Onychocopy can minimize the need for biopsy by highlighting subtle changes and helps narrow down the differentials. It is potentially a diagnostic test of choice in younger children. Our study helped to grade the severity of connective tissue disorders and establish the benignity of melanonychia. Photographic documentation facilitates record-keeping.

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Background: A sustained inflammatory state of psoriasis causes comorbidities such as psoriatic arthritis, metabolic syndrome (MetS), and cardiovascular disease. Aims: To note the duration and severity of psoriasis, assess prevalence of MetS, and correlate these with indicators of sub-clinical atherosclerosis. Methodology: Thirty-two patients of chronic plaque psoriasis were enrolled in the study. Their demographic particulars, clinical details, results of investigations to assess MetS, and indicators of sub-clinical atherosclerosis, namely, carotid intimal media thickness (CIMT) measured using B-mode USG and epicardial fat thickness (EFT) using 2-D ECHO, were recorded. Results: The study participants were predominantly male (2.5:1); their mean age was 40.45 ± 12.42 years, the median disease duration (DD) was 2 years, and the mean psoriatic area severity index (PASI) score was 8.62 ± 7.49. Mild disease (PASI <5) was present in 12 participants (37.5%), and shorter DD (<5 years) was present in 16 (50%) participants. MetS, detected in 11 (37.5%) study participants, was not significantly associated with CIMT, EFT, DD, and PASI. CIMT and EFT too did not correlate significantly with DD, PASI, or measures of MetS. Neither did there exist any significant correlation between CIMT and EFT. Conclusion: Sub-clinical atherosclerosis in our study participants was not significantly associated with either measures of MetS or duration/severity of psoriasis.

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Background: Substantial evidence suggests a higher risk of metabolic syndrome as a result of persistent inflammation in patients with psoriasis. Psoriasis may also be associated with vitamin D deficiency. Aim: To correlate vitamin D deficiency with psoriasis and metabolic syndrome. Materials and Methods: Serum vitamin D levels were quantified, and metabolic syndrome was assessed in 42 cases whose psoriasis severity had been measured by PASI and in an equal number of age/gender-matched controls. The resultant data were analyzed statistically. The odds ratio was calculated wherever applicable and a two-tailed P < 0.05 was considered statistically significant. Results: Vitamin D deficiency (<20 ng/ml) occurred in 43 subjects [(51.19%); 26 (62%), patients and 17 (40.4%), controls] and was statistically significant in patients (OR: 2.39, P = 0.044) though lacking correlation with disease severity. Metabolic syndrome seen in 25 (30%) subjects-15 (36%) patients and 10 (24%) controls-emerged to be significant (OR: 3.71, P = 0.047) in cases with vitamin D deficiency. Hypertension-observed in 31 (37%) subjects; 18 (43%) cases, 9 each (21.4%) with/without metabolic syndrome and 13 (31%) controls, 7 (16.6%) with and 6 (14.3%) without metabolic syndrome (P = 0.25)-correlated independently with vitamin D deficiency in patients (P = 0.009). Conclusions: Despite limitations of small sample size and observational nature, our study-probably the first such hereto from India-showed statistically significant associations between vitamin D deficiency, metabolic syndrome, and hypertension in patients with psoriasis. Future larger studies are needed for strengthening this evidence prior to the recommendation of its clinical application in the optimum management of patients.

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Although the impairment of quality of life (QoL) in individuals with keloids is profound, it has neither been well quantified nor correlated with severity in people with skin of colour. This cross-sectional, questionnaire-based study comprised 110 patients with keloid(s). A physician measured the severity of keloids using the Vancouver Scar scale and impairment of QoL using the patient-filled Hindi version of Dermatology Life Quality Index questionnaire. The relationship among QoL and severity score as well as with components of demographic data was analysed using SPSS. Our study found the severity of keloid(s) to be moderately but significantly correlated with the QoL of its sufferers. Individuals with multiple keloids were found to be significantly younger than those with solitary ones. Itching, pain, along with restricted mobility significantly impacted the QoL as well as severity of keloids. Individuals who had undergone prior treatment were found to have a worse QoL than the treatment naive. Recurrence was found to be associated with lower scar severity, multiple keloids, and younger age. Increasing age, though associated with greater scar severity, lacked any relationship with the QoL. Our study also found that individuals with bigger keloids sought treatment earlier and more often. Hyperpigmented keloid(s), more common in individuals with skin of colour, were associated with a significantly worse QoL and a higher scar severity.

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The prescription of antibiotics empirically without confirmation of an infective etiology is on the rise. Administration of appropriate antibiotics can be guided by real-time fluorescence imaging using a point-of-care device. These composite images show the presence, type and the burden of infection. The time saved by this method over microbiological testing, especially in resource-poor settings, can lead to a paradigm shift in treatment by facilitating prompt and adequate antimicrobial therapy, surgical debridement as well as follow-up. Thumbnail sketches of a series of four cases highlighting different scenarios in which a fluorescent imaging device utilizing artificial intelligence and machine learning was found useful is presented in this report.

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BACKGROUND: Eczema of foot adversely impacts daily activities, work productivity, and interpersonal relationships. MATERIALS AND METHODS: This cross-sectional, questionnaire-based study collated epidemiological data of 70 outpatients of foot eczema, evaluated their quality of life by 10-item dermatology life quality index (DLQI) questionnaire, and undertook the correlation thereof. RESULTS: Cases were predominantly males (48; 68.5%); 26 (37.1%) belonged to fifth decade of life and 47 (67%) presented within 12 months of onset. Dorsa of feet was involved in most (59; 84.2%) cases. Itching was a universal complaint followed by scaling (51; 72.9%), dryness (22; 31.4%), and oozing (21; 30%). History of atopy was reported by 15 (21.4%) patients; tobacco and/or alcohol abuse 32 (45.7%) patients; past treatment was received by 37 (52.9%) patients; and winter aggravation in 9 (12.3%) patients. Mean DLQI score was 13.64; with very large effect (11-20) on QoL in 38 (54.3%) patients; moderate (6-10) in 15 (21.4%) patients; extremely large (21-30) in 9 (12.9%) patients; and small (2-5) in 8 (11.4%) patients. Mean scores of questions of DLQI tool were 2.46 in first question (symptoms), 1.99 in fifth (social activities); 1.81 in seventh (working/studying); and 0.17 in fourth (clothes) question. Significant (P < 0.05) impairment of quality of life emerged with respect of burning, scaling, oozing, history of atopy, seasonal variation, and past treatment. CONCLUSION: Our study reports significant association of atopy, winter aggravation, past treatment, burning, scaling, and oozing with adverse quality of life in our study on cases of foot eczema and appears to be first study from India.

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BACKGROUND: Polycystic ovarian disease (PCOD) is characterized by oligo/anovulation, ultrasonographic evidence of polycystic ovaries and cutaneous features such as hirsutism, acne, acanthosis nigricans, androgentic alopecia, and signs of virilization. AIM: Correlation of dermatological manifestations with body mass index (BMI), blood glucose, and levels of free testosterone, dehydroepiandrosterone sulfate (DHEAS), follicle stimulating hormone (FSH), and luteinizing hormone (LH) in patients of PCOD hailing from Pimpri, Pune. SUBJECTS AND METHODS: This observational study was carried out from November 2015-April 2017 on 102 patients (aged 12-45 years, non-pregnant) of PCOD, attending dermatology/gynecology outpatient departments. After recording socio-demographic/menstrual and medical history, BMI was calculated and examination of cutaneous manifestations were done. Participants were then subjected to pelvic ultrasonography and blood sugar/hormonal estimation. STATISTICAL ANALYSIS: By using statistical package for the Social Sciences 17.0 software, Chi-square test, and Fisher's exact test. RESULTS: Age: 59.80% belonged to the third decade (range,12-40; mean, 26.27 ± 5.05 years); ultrasonography revealed polycystic ovaries in 79.41%. Cutaneous manifestations recorded were - acne (74.50%); acanthosis nigricans (50%); striae (49.02%); hirsutism (40.19%); acrochordons (36.27%); seborrheic dermatitis (32.35%), and androgenetic alopecia (30.39%). Free testosterone (35;34.31%), DHEAS (9;8.82%), LH and FSH (2;1.96% each), and LH: FSH ratio (51;50%) were raised. Statistical association of acanthosis nigricans emerged with free testosterone (P = 0.034), DHEAS (P = 0.016), fasting blood sugar (P = 0.01), and raised BMI (P = 0.002) and of hirsutism with raised DHEAS (P = 0.016), free testosterone (P = 0.012), and BMI (P = 0.022). CONCLUSION: Significant correlations demonstrated were acanthosis nigricans with free testosterone, DHEAS, FBS, and BMI and hirsutism with DHEAS, free testosterone, and BMI.

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CONTEXT: Eczema of hand or foot though not life-threatening, not only impacts daily activities and work productivity adversely, but also impairs interpersonal relationships. MATERIALS AND METHODS: Cross-sectional study of 100 outpatients of hand and foot eczema at a tertiary care teaching institute. Epidemiological data was collated and quality of life (QoL) evaluated by dermatology life quality index (DLQI) score. RESULTS: Forty seven had hand eczema, 45; foot eczema and 8; both. Peak incidence of hand eczema (38.2%) was in fourth decade and foot eczema (33.3%), fifth decade. Hand eczema was more frequent in females (32; 68%) and foot eczema in males (32; 71.1%). Hand eczema was more common among housewives (14; 29.7%) and foot eczema among manual labourers (26; 57.7%). A persistent course was seen in foot (44; 83%) whereas recurrent course in hand eczema (21; 38.1%). Aggravation on contact with irritants/allergens was associated more with hand (32; 58.1%) than with foot eczema (18; 33.9%). Association with atopy was not significant. Substance abuse was associated more with foot eczema (25; 47.1%). Impairment in QoL was significantly higher in hand eczema (mean DLQI, 16.33) as compared to foot eczema (12.83). CONCLUSION: Hand eczema prevalent among females showed a high rate of recurrence whereas foot eczema in males, has a persistent course. Atopy is not significantly associated. The impairment in QoL is much greater in hand eczema as compared to foot eczema. The studies on comparative analysis of hand vis-à-vis foot eczema do not appear to exist in literature whereas studies of QoL impairment on hand eczema are abound.

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Ectodermal dysplasias are a complex group of heterogenous, heritable disorders entailing two or more developmental abnormalities in ectodermal structures, such as hair, teeth, nails, and/or sweat glands. The most common subtype of these disorders is X-linked hypohidrotic that significantly impairs the quality of life of its sufferers. A 15-year-old boy, who sought the treatment for protuberant lips, saddle nose, dental anomalies, fine sparse hair, decreased sweating, intolerance to heat and photosensitivity, experienced dramatic improvement in his quality of life and confidence with aesthetic correction comprising autologous fat grafting, rhinoplasty, lip reduction, microblading and comprehensive prosthodontic and orthodontic treatments undertaken in collaboration with dental and plastic surgery departments and expert psychological counseling.

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BACKGROUND: The relationship between impaired quality of life (QoL) due to melasma and its clinical severity remains equivocal despite several studies. AIM: The aim was to study the correlation, if any, between the clinical severity and the impairment in QOL due to melasma. METHODS: This cross-sectional, questionnaire-based study was conducted on a cohort of 141 patients of melasma attending the outpatient department of our referral hospital. A physician measured the severity of melasma using the melasma area and severity index (MASI), while melasma-related QoL (MELASQOL) score was calculated utilizing the validated Hindi version of the MELASQOL questionnaire filled by the patients. Correlations of these two scores with each other and with components of the demographic data were attempted using the Statistical Package for the Social Sciences, version 20. RESULTS: Significantly greater impairment in QoL was found in patients with a history of prior use of triple combination therapy and in patients with hirsutism and/or polycystic ovarian disease. The severity of melasma was found to be significantly higher in patients with a history of recurrence and tobacco chewing. LIMITATIONS: The sample size could have been larger. Ultrasonography could have been carried out in all cases of hirsutism. CONCLUSION: The severity of melasma does not correlate with the impairment in QoL.