Assessment of response of microdermabrasion with 2% kojic acid in melasma

Background: Melasma is an acquired disorder of hypermelanosis and several therapeutic modalities is in use to treat melasma. Kojic acid is a popular depigmenting agent, but its hydrophilic nature limits its transepidermal penetration. Microdermabrasion has been reported to increase the penetration of topical preparations. The objective of the study was to compare the efficacy of daily kojic acid (2%) gel along with biweekly microdermabrasion versus daily kojic acid (2%) gel alone in Indian patients.Methods: This study was carried out in 60 patients with melasma which were randomised into 2 groups of 30 patients each. The group I patients were treated with kojic acid 2% gel along with biweekly microdermabrasion, and group II patients were treated with kojic acid 2% gel alone. The results were assessed and compared after 12 weeks.Results: Both objective assessment and subjective assessment did not reveal a statistically significant difference in the treatment efficacy of two groups. However, the patients who received biweekly microdermabrasion were significantly more satisfied than those who did not.Conclusions: Microdermabrasion does not appear to have any synergistic effect with kojic acid in decreasing pigmentation in melasma. However, it does have a placebo effect on the patient.

Autoimplantation therapy for the management of extensive molluscumcontagiosum: a novel treatment approach

Background: Molluscumcontagiosum (MC) is a common cutaneous viral infection which usually affects children. Inspite of the multiple treatment options such as curettage, expression, electrodessication and different topical agents, in some cases lesions become extensive and persist for more than 3 to 4 years. The role of immunomodulatory therapy in management of MC has been well documented. Autoimplantation has emerged as a useful immunomodulatory therapy for warts. The objective of the study is to assess the efficacy and safety of autoimplantation in treatment of extensive MC.Methods: Patients of   either sex having more than six MC lesions were included. Molluscum body removed, crushed & implanted in a small dermal pocket as described in cases of warts. Patients were evaluated at four weeks, 12 weeks & subsequent 24 weeks.Results: Twenty two patients completed the study. Complete clearance of the MC was seen in 17 (77.2%) patients, 2 (9.1%) had no response, 1 (4.5%) had partial remission & 2 patients (9.1%) showed recurrence.Conclusions: Autoimplantation may be effective& alternative modalities for extensive MC. However, more randomized controlled trial for automplantation therapy in extensive MC need to be warranted

Autoimplantation therapy for the management of extensive molluscumcontagiosum: a novel treatment approach

Background: Molluscumcontagiosum (MC) is a common cutaneous viral infection which usually affects children. Inspite of the multiple treatment options such as curettage, expression, electrodessication and different topical agents, in some cases lesions become extensive and persist for more than 3 to 4 years. The role of immunomodulatory therapy in management of MC has been well documented. Autoimplantation has emerged as a useful immunomodulatory therapy for warts. The objective of the study is to assess the efficacy and safety of autoimplantation in treatment of extensive MC.Methods: Patients of   either sex having more than six MC lesions were included. Molluscum body removed, crushed & implanted in a small dermal pocket as described in cases of warts. Patients were evaluated at four weeks, 12 weeks & subsequent 24 weeks.Results: Twenty two patients completed the study. Complete clearance of the MC was seen in 17 (77.2%) patients, 2 (9.1%) had no response, 1 (4.5%) had partial remission & 2 patients (9.1%) showed recurrence.Conclusions: Autoimplantation may be effective& alternative modalities for extensive MC. However, more randomized controlled trial for automplantation therapy in extensive MC need to be warranted

Dyskeratosis congenita presenting with dysphagia

Dyskeratosiscongenita (DKC) is a genetically heterogeneous disease of defective telomere maintenance that may demonstrate different patterns of inheritance. It is characterized by thetriad of dystrophy of the nails, leukokeratosis of the oral mucosa, and extensive net-like pigmentation of the skin. We report a case ofDKC who presented with a chief complaint of dysphagia

Chromoblastomycosis from a non-endemic area and response to itraconazole

Chromoblastomycosis belongs to the heterogeneous group of subcutaneous mycoses. It is caused by various pigmented (dematiaceous) fungi, which gain entry into the skin via traumatic implantation. We would like to share a case report of chromoblastomycosis in a 32-year-old male, who presented to us with 3 years history of slowly progressive, itchy, verrucous, crusted lesions over right forearm and arm. He is being treated with itraconazole 100 mg twice daily. The case is of interest because it has so far not been reported from our region- the northwest arid zone of India. The patient showed favorable response to itraconazole

Morphological patterns of balanoposthitis and their correlation with final etiological diagnosis

Background: Balanoposthitis is a common dermatological condition across the globe, but studies describing clinico-morphologic features and their diagnostic correlates are scarce. Objective: To study various morphological patterns of balanoposthitis and their correlation with etiological diagnosis. Materials and Methods: A cross-sectional study was conducted on all patients with balanoposthitis visiting the dermatology out-patient department and sexually transmitted disease (STD) clinic over a period of 8 months. Detailed history, demographic data, and clinical features were recorded. Relevant investigations were performed. Results: A total of 129 patients of balanoposthitis were studied. Common causes were because of candida (33.3%), bacteria (17.1%), irritants (13.3%), herpes (11.4%), drugs (8.6%), and lichen sclerosus (6.7%). Common morphological patterns were erosion/confluent wet erythema with sub-preputial discharge (24.81%), fissure with superficial pustules (15.5%), fissure alone (13.18%), patchy dry erythema (11.63%), and superficial pustules (intact or exfoliated) with or without underlying erythema (10.85%). Fissure and superficial pustules were the most common presentation of candidal balanoposthitis (51.43%), erosions/confluent wet erythema with sub-preputial discharge of bacterial balanitis (55.56%), and patchy dry erythema of irritant balanitis (50%). Limitations: Detailed investigations such as fungal culture, herpes serology, real-time polymerase chain reaction and histopathology could not be performed. Conclusion: Certain morphological patterns of balanoposthitis strongly point toward final diagnosis which can help in quick diagnosis and early treatment in resource poor settings, especially in STDs