Indian Journal of Dermatology, Venereology and Leprology

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Mimickers of erysipelas and cellulitis: A narrative review
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-06) Gowda, SK; Garg, S; Behera, B; Thakur, V; Sahu, DK.
A diffuse erythematous, edematous tender swelling with a distinct border and local rise in temperature suggest a morphological diagnosis of erysipelas-like eruption. While cellulitis and pseudocellulitis have an ill defined tender erythematous plaque. Erysipelas, and cellulitis are not a straightforward diagnosis as multiple cutaneous eruptions mimic erysipelas. It is important to have comprehensive knowledge about the different causes of erysipelas-like eruptions and pseudocellulitis to reach a diagnosis and treat appropriately. Many infectious diseases such as histoplasmosis, leishmaniasis, dermatophytosis, and infusion of chemotherapeutic agents result in erysipelas-like eruptions and pseudocellulitis. Malignancy-related dermatoses such as carcinoma erysipeloides, erysipeloides melanomatosum, and inflammatory dermatoses such as sweet syndrome, well syndrome, and Crohn’s disease present as erysipelas-like eruption.
Cardiac involvement in dermatological disorders: A narrative review
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-06) Pathania, YS.
Recent studies have highlighted several pathogenic connections between skin disorders and cardiac manifestations. Dermatologists frequently encounter several genetic or inherited skin conditions that can have significant cardiac implications, including septal defects, cardiomyopathy, and valvular heart disease, which may sometimes be life-threatening. In this review, primary cutaneous disorders having cardiac manifestations are described. A comprehensive narrative review of the literature was conducted by searching articles published through November 2023 in the PubMed and Google Scholar databases. Original research articles, review articles, case reports, case series and other relevant English-language publications were included. The review identified several congenital diseases, inflammatory conditions, connective tissue disorders, and adverse drug reactions that have both skin and cardiac involvement. Diagnosing these cardiac manifestations in patients with skin conditions is crucial for appropriate management, timely intervention and effective patient counselling.
Indian expert Delphi consensus on the diagnosis and management of flares of generalised pustular psoriasis
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-06) Aithal, VV; Bhat, R; Das, S; Dogra, S; Godse, K; Shankar, DSK; Nayak, CS; Pai, SB; Parasramani, SG; Parthasaradhi, A; Shah, B; Tahiliani, ST; Toms, T; Dahiya,? AK.
Generalised pustular psoriasis (GPP) is a chronic, multisystemic, autoinflammatory disease with predominantly cutaneous manifestations, characterised by recurrent episodes of widespread, macroscopic and aseptic pustules. It has a highly unpredictable, heterogeneous and unstable clinical course. There are no consensus guidelines in India for the management of GPP. The objective of this Delphi panel study was to achieve consensus on problem areas in the understanding and management of GPP. Based on the inputs from an expert panel, 19 topics across six domains were identified as being important regarding the understanding and management of GPP. Statements were developed for these 19 topics, and consensus for the statements was sought using the modified Delphi method. Twelve experts evaluated the statements, indicating their agreement or disagreement. Consensus was considered to be reached when ?80% of experts agreed with a statement. After two rounds of discussion, consensus was reached for 17 out of 19 (89%) statements and no consensus was achieved for two (11%) statements. We have presented the statements along with the respective degrees of consensus. Wherever relevant, clarifications or additional comments by experts are provided in the document.
Clinico-histopathological review of cutaneous sarcoidosis: A retrospective descriptive study
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-06) Chandra, AD; Khandpur, S; Ramam, M; Bhari, N; Gupta, V; Agarwal, S.
Background: Sarcoidosis is a systemic, non-caseating granulomatous disease characterised by clinical and histopathological variability. Objective: To review cases of cutaneous sarcoidosis and describe their clinical and histopathological features. Methods: A retrospective study was conducted to analyse the clinical and histopathological frecords of all available skin biopsy slides signed out as ‘sarcoidal tissue reaction’ or ‘sarcoidosis’ from 2014 till 2022. Results: A total of 25 cases were studied. The lesions were most commonly located on the head and neck (18 cases, 72%). Morphologically plaques (20%) were the most common, and the majority of cases had lesions of ?2 distinct morphologies (44%). Histologically, classical naked granulomas were observed in 72% of cases. The granulomatous infiltrate was pandermal in 56% of cases, perivascular and interstitial in 16%, and perivascular, perieccrine, and interstitial in 12%. Granulomas with a ‘leprosy’ pattern were observed in 20% of cases. High-density granulomas (occupying >30% of the dermis) were present in 64% of cases. Fibrinoid necrosis and fibrosis between granulomas were observed in 16% and 8% cases, respectively. Inclusion bodies, such as asteroid and Schaumann bodies, were seen in 24% and 4% cases, respectively. Reticulin-rich granulomas were observed in 54% cases, while reticulin-poor granulomas were seen in 8.3%. Elevated serum ACE levels were found in 14 cases, and tuberculin skin test, conducted in 22 cases, was negative. Extracutaneous involvement was found in 11 cases, with 10 having pulmonary and 1 with pulmonary and splenic involvement. Limitation: Retrospective nature of the study and small sample size. Conclusion: Cutaneous sarcoidosis presents with a wide range of clinical and histomorphological features, necessitating clinico-histopathological correlation and ancillary investigations to establish the diagnosis and rule out mimickers.
Syphilis renaissance: Truth or mirage. Analysis of syphilis trends and possible factors from a tertiary care centre in North India
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-06) Baskaran, N; Kumaran, MS; Narang, T; Handa, S.
Background: Syphilis has shown a recent resurgence globally, including in India. However, inconsistency in the data and diagnostic criteria used, especially in India and developing countries, hinders ideal understanding. Factors responsible for this surge need to be explored. Objectives: This study aimed to assess the trends and describe the clinicodemographic characteristics of syphilis cases seen in a tertiary care health centre from Northern India. Methods: This is a retrospective chart review of syphilis patients registered in our sexually transmitted infection (STI) clinic spanning 13 years from January 2011 to December 2023. Complete demographic details, sexual history, clinical examination and laboratory investigations of all syphilis cases, including associated STIs, were retrieved. Results: The retrospective analysis included 2000 records, of which 324 were confirmed syphilis cases (16.2% of total STI cases). Patients’ mean age was 30.9 ± 9.9 years, of which 80.9% were male and 64.2% were married. Education level varied, with professionals comprising 22.2% of the total cohort. Premarital and extramarital exposure were present in 35.8% and 32.7% patients, respectively; over half (56.8%) reported multiple partners and 13% were homosexual. There was an initial plateau in the number of confirmed syphilis attending the clinic (2011–2019), a decrease during 2020–2021 due to COVID and significant increase from 2022 onwards. Latent syphilis was the most common (66.7%), followed by secondary (18.8%) and primary (8.9%). In all, 36.1% of syphilis patients had associated STIs, with human immunodeficiency virus (HIV) infection being the most prevalent (25.0%). Limitation: Retrospective nature of the study is major limitation. Rising trend needs validation with population-based studies to establish if the rise is true or a shadow phenomenon. Conclusion: A resurgence of syphilis cases has appeared in the past two years, with latent syphilis contributing to the majority of cases. Possible factors for the surge include changing sexual behaviour, including male having sex with male (MSM), early adolescent sexual exposure, increased screening for latent syphilis, increased healthcare accessibility post- COVID-19 pandemic, and HIV co-infection.
Cold urticaria in tropics: A clinico-epidemiological study from North India
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-06) Mehta, H; Janaani, P; Vinay, K; Bishnoi, A; Parsad, D; Kumaran, MS.
Background: Cold urticaria (ColdU) is classified as a subtype of chronic inducible urticaria characterised by recurring pruritic wheals and/or angioedema upon exposure to cold stimuli. However, very limited data is available on ColdU specifically among Indians. Objectives: The aim of this study was to describe the clinico-epidemiological characteristics and treatment response in North Indian patients diagnosed with ColdU. Methods: The clinical records of patients diagnosed with ColdU past 5 years (January 2018 to December 2022) were retrospectively reviewed. Data including patient demographics, clinical manifestations, comorbidities, laboratory findings, and treatment response were collected and analysed. Results: Among the 1780 urticaria patients included in our study, only 15 cases of cold-induced urticaria were identified. ColdU was classified as typical in all but three patients. The mean age of affected individuals was 36 ± 18 years (20–65 years) and eight patients (53.3%) were males. Mean disease duration at presentation was 18 ± 27 months (3 months–4 years). Two patients experienced cold-induced angioedema and one patient had hypotensive episodes following cold exposure. Twelve patients demonstrated positive results in the ice cube provocation test. Of 15, only 6 (40%) achieved complete control of symptoms with standard dosing of second generation anti-histamines while six patients (40%) required titration to higher doses and three patients (20%) were initiated on cyclosporine therapy, resulting in remission. Limitations: Retrospective study design and possibility of selection bias. Conclusion: Due to India’s predominantly tropical climate, ColdU prevails at lower levels compared to the western regions. ColdU is likely underdiagnosed in India, possibly dismissed as chronic spontaneous urticaria. The management of ColdU involves a combination of protective measures against cold exposure and the use of anti-histamines to control disease activity. This retrospective study provides valuable insights into the clinico-epidemiological characteristics and treatment response of north Indian patients with ColdU.
The utility of dermoscopy in pediatric vascular anomalies
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-06) Bhagwat, A; Mehta, N; Goyal, A; Arava, S; Ramam, M; Sethuraman, G; Gupta, S; Bhari, N.
Background: Vascular anomalies show highly variable morphology, making clinical identification difficult. Dermoscopy is a non-invasive tool which can aid in their diagnosis, but studies of dermoscopy in vascular anomalies are limited. Aim: This study aimed to describe the dermoscopic findings in vascular anomalies in children and evaluate their usefulness over clinical examination alone. Methods: Consecutive children with congenital or acquired vascular lesions diagnosed by two experienced dermatologists after detailed history and examination were recruited. Predominant dermoscopic findings of a representative lesion were recorded in a pre-designed proforma with a consensus of two dermatologists trained in dermoscopy. In cases of clinical diagnostic uncertainty, suitable histopathological and radiological investigations were done. Results: Sixty-one patients (33 tumours, 26 malformations, and 2 unclassified anomalies) were recruited. The most observed condition was infantile haemangioma (IH) (37.7%) which showed red lacunae and irregularly branched thick-tortuous and thin-serpentine vessels in mixed haemangiomas (30.4%), prominent lacunae in superficial haemangiomas (34.8%) and only branched vessels in deep and treated/involuting (34.8%) haemangiomas. Lacunae were predominantly seen in superficial haemangiomas (p=0.0498) and were missing in deep and involuting haemangiomas (p=0.0027). Port-wine stain (13.1%) showed irregular reticular vessels along with dots and globules with thickness of the network being proportionate to the darker shade clinically. In all, there were nine (14.75%) cases where there was diagnostic uncertainty using clinical features alone and histopathological/radiological investigations were required to establish the final diagnosis. In them, dermoscopy showed findings (as described in previous literature) suggestive of the correct final diagnosis. Limitations: Histopathological and radiological investigations were done only in cases where the clinical diagnosis was uncertain. Conclusion: Dermoscopy is a useful tool in differentiating between different vascular anomalies such as IH and capillary malformations (CMs) which have different management strategies. Dermoscopy may also be useful in differentiating superficial from deep haemangiomas and proliferating from involuting haemangiomas. It can also help in determining the depth of CMs. Thus, it can obviate the need for invasive diagnostic procedures in paediatric vascular lesions and can guide appropriate treatment and prognosis.
Use of multivariant enzyme-linked immunosorbent assay (ELISA) in the diagnosis of autoimmune bullous disorders in a resource-limited setting: A single-center experience
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-06) Kumar, V; De, D; Gupta, S; Narayan, R V; Mahajan, R; Chatterjee, D; Handa, S.
Background: Autoimmune blistering disorders (AIBD) result from the formation of auto-antibodies against adhesion proteins of the skin/mucosa(e). These auto-antibodies can be detected in the bound form in the tissue using direct immunofluorescence (DIF) or blood circulation using enzyme-linked immunosorbent assay (ELISA) or other methods. Objectives: The objective of this study was to evaluate the concordance rate between the results of multivariant ELISA and the diagnosis of AIBD made using DIF and histopathology in an appropriate clinical context. Methods: This was a retrospective study (December 2020 to April 2023) in which the multivariant ELISA assay (able to detect antibodies against desmoglein 1, desmoglein 3, BP180, BP230, envoplakin, and collagen VII) data were retrieved from the dermatology laboratory. Corresponding clinical and histopathology data were searched from relevant institutional databases. As per routine practice, the final diagnosis was assigned based on the clinical presentation, histopathology features and corresponding DIF report. Results: After screening the records of 338 patients during the study period, 253 patients were included. Of them, 194 had AIBD and 59 had non-AIBD. In the autoimmune blistering disorder group, 122 and 72 patients had pemphigus and pemphigoid, respectively. Overall, a good level of agreement was found between multivariant ELISA results and the final diagnosis (Fleiss kappa = 0.631, p-value < 0.001). The pemphigus vulgaris group exhibited good agreement (kappa = 0.796, p < 0.001), while pemphigus foliaceous, bullous pemphigoid and non-autoimmune blistering disorders demonstrated moderate agreement (kappa = 0.641, 0.651, 0.533, respectively; p < 0.001). The mucous membrane pemphigoid group had a fair agreement (kappa = 0.289; p < 0.001). Limitations: The limitations for the study were its retrospective design, fewer number of patients in certain groups like paraneoplastic pemphigus and gold-standard single antigen specific ELISA was not done. Conclusion: Considering good agreement between the multivariant ELISA and the gold-standard diagnosis (clinical findings plus histopathology plus DIF), multivariant ELISA can be used for the diagnosis of AIBDs in places where facilities for DIF are unavailable. Multivariant ELISA can improve etiological diagnosis for a set of autoimmune blistering disorders whose target antigens are represented in the multivariant panel.
Atopic diseases and the risk of alopecia areata among pre-teens and teenagers in Taiwan
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-06) Lu, YY; Wu, MK; Lu, CC; Wang, WT; Wu, CH.
Background: Alopecia areata (AA), a disorder of non-scarring hair loss with a variable relapsing and remitting course, is a common autoimmune disease in children. Although it often presents as several focal small patchy bald lesions, early onset AA can lead to a total loss of scalp hair, even body hairs, a severe subtype. Atopic diseases are common concurrent disorders in AA, especially among those with early onset severe type of hair loss. Whether atopic diseases increase the risk of AA in the paediatric population of Taiwan, remains unclear. Objective: To identify if atopic diseases increase the risk of AA among pre-teens and teenagers in Taiwan. Methods: From Taiwan National Health Insurance Database 2010, we used the claims data to clarify the risk of AA in pre- teens and teenagers with atopic diseases (atopic dermatitis, allergic conjunctivitis, asthma, allergic rhinitis and food allergy) as compared to the general population. Cox proportional hazards model yielded hazard ratios (HRs) to address the impact of atopic diseases, sex and age on AA risk after adjusting for covariates and subsequent stratified analyses. Results: Overall, 21,070 children (10,535 patients with atopic diseases and 10,535 normal cohort) aged over nine years were recruited. During a follow-up of 15 years, 39 (0.37%) cases were identified to have AA in the atopic diseases group, while 11 (0.10%) had developed AA in the normal cohort. As compared with the normal population, the paediatric population with atopic diseases had a 9.66-fold higher risk of developing AA. The risk was greater for boys and increased with advanced age. In the atopic diseases group, pre-teens and teenagers with food allergies and Sjogren’s syndrome were more likely to have AA. Limitations: Only one ethnic group. Conclusion: All atopic diseases enhanced the risk of developing AA in Taiwan pre-teens and teenagers. Children with atopic diseases should be monitored to look for the development of AA.
Antibiotic resistance and biofilm formation in Cutibacterium acnes: A descriptive cross-sectional study
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-06) Paul, NA; M., Ramesh Bhat; Antony, B; Jayaraman, J.
Background: The issue of antibiotic resistance in acne vulgaris has emerged as a significant concern in recent times. Though the ability of Cutibacterium acnes to form biofilms have been established, its role in acne vulgaris has yet to be ascertained. Aims: This descriptive cross-sectional study was aimed to investigate the ability of C. acnes to form biofilms and its potential association with resistance to the commonly used antibiotics. Methods: A total of 88 patients with acne vulgaris were selected for this study. Clinical examination and severity grading was done. The collected samples were analysed with Matrix-Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF-MS) and further subjected to biofilm testing using the microtiter plate assay. Results: C. acnes were isolated from 43.1 of the samples (n = 38). The highest resistance was observed with azithromycin (73.7%) followed by clindamycin (65.8%), doxycycline (15.8%), ampicillin (31.6%) and minocycline (5.3%). Thirty-seven per cent of the isolates were resistant to at least two antibiotics, 63.2% of C. acnes had a weak capacity to form biofilms and more than 60 percent of the isolates showed resistance to atleast two types of antibiotics as well as weak biofilm forming capacity. Limitations: Single-centre study, small sample, long-term follow-up of the patients was not done. In addition, this study is representative of only C. acnes species. Conclusion: While C. acnes have the ability to create biofilms, its effectiveness in antibiotic resistance can be deemed as modest based on the findings of this study. It is important to consider alternative mechanisms such as genetic or biochemical plasticity that may contribute to antibiotic resistance.
Clinical efficacy and safety profile of handheld narrow band ultraviolet B device therapy in vitiligo – Systematic review and meta-analysis
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-06) Khandpur, S; Singh, S; Paul, D.
Background: Handheld narrowband ultraviolet B (NB-UVB) device is a portable, home-based, patient-friendly equipment used in vitiligo. It is a newer promising treatment that lacks generalised consensus due to heterogenicity among studies. Objective: To determine the clinical efficacy and safety profile of handheld NB-UVB devices in the treatment of vitiligo. Methods: Following the PRISMA guidelines and using appropriate keywords, the Embase, PubMed and Scopus databases were searched on 28 November 2023. Data on the proportion of patients with a percentage of re-pigmentation and toxicity were extracted from the included studies. Random effects and fixed model were utilised to generate pooled estimates via meta-analysis. Results: Out of 250 articles, 13 studies (557 patients) were included. The extent of repigmentation achieved over a median duration of 6 months (range 3-12 months) was quantified to be > 25%, > 50%, and >75 % in 63.6% (95% CI: 51.0–75.3%), 40.8% (95% CI: 30.4–51.6%) and 15.4% (95% CI: 7.6–25.3%) of patients respectively. After 12 weeks of treatment, the proportions of patients achieving > 25%, > 50%, and >75% re-pigmentation were 31.1% (95% CI: 9.6–58.3%), 12.9% (95% CI: 3.1–28.1%) and 6.5% (95% CI: 1.7–14.1%), respectively. Similarly, at 24 weeks, these proportions were 53.2% (95% CI: 24.5–80.7%), 36.7% (95% CI: 15.8–60.5%), and 11.1% (95% CI: 2.9–23.7%). Minimal erythema dose (MED) calculation-based therapy was not significantly better than therapy given without MED calculation (p = 0.43). The studies with only stable vitiligo patients did not achieve significantly greater > 25% (p = 0.06), > 50% (p = 0.80), and > 75% (p = 0.25) re-pigmentation compared to the studies that also included active or slowly progressive vitiligo. Three sessions per week resulted in significantly higher > 50% (p < 0.01) and > 75% (p = 0.01) re-pigmentation. Totally, 11.3% (38/334) of patients showed no response to therapy. The most commonly reported adverse event was erythema in 33.4% (95% CI: 19.3– 49.2%) of patients, with grade 3 and 4 erythema in 27 and 15 patients, respectively. Other adverse events included pruritus, burning, hyperpigmentation, dryness, and blister formation observed in 22.1%, 16.4%, 19.1%, 9.8%, and 9.7% of patients, respectively. Conclusion: Handheld NB-UVB portable home-based devices are an efficacious and safe treatment option in vitiligo patients even without MED calculation, when the treatment frequency is three to four sessions per week.
Assessing the impact of childhood and adolescent chronic plaque psoriasis on parents/caregivers using the Family Dermatology Life Quality Index (FDLQI): A cross-sectional study
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-06) Bhandari, A; Narang, T; Panjiyar, R; Dogra, S; Handa, S.
Background: Chronic childhood diseases are a burden for paediatric patients and their caregivers. Limited data are available on the effect of paediatric psoriasis on the caregiver’s well-being and quality of life. Objective: To assess the impact of childhood and adolescent chronic plaque psoriasis on parents/caregivers quality of life. Methods: A single-centre cross-sectional study was performed which included 102 children with psoriasis and their caregiv- ers. Clinico-demographic data of children and socio-demographic details of primary caregivers were collected. Out of pocket expenditure for treatment was calculated for all the patients. The quality of life of children was assessed using the Children’s Dermatology Life Quality Index (CDLQI) and the caregiver’s quality of life was assessed using the Family Dermatology Life Quality Index (FDLQI). Results: CDLQI was impaired in 85.29 % of children with a median score of 7. The item ‘symptoms’ was most commonly affected (87.2%), followed by ‘self-conscious’ (70.5%) and ‘treatment’ (65.6%). FDLQI was impaired in 96.1% of caregivers with a median value of 11. The most affected FDLQI items were ‘emotional’ in 95%, followed by ‘time-spent’ in 78.4%. Almost 40% of patients had catastrophic health expenditure (CHE) and their FDLQI was significantly higher (p?0.014) compared to caregivers who did not experience catastrophic health expenditure. FDLQI had a positive relationship with the involvement of exposed body sites (p?0.003), CDLQI (p?0.000), treatment expense (p?0.031) and a negative correlation with duration of illness (p?0.04). Conclusion: Childhood psoriasis has a negative impact on the quality of life of the children and caregivers highlighting the need for intervention strategies for both.
Mycosis fungoides and Sézary syndrome – Simplifying the approach for dermatologists. Part 1: Etiopathogenesis, clinical features and evaluation
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Singh, GK; Das, P; Sharma, P; Srivastava, S; Singh, V; Singh, K; Barui, S; Mulajkar, D; Dubey, IP.
Cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of extranodal non-Hodgkin’s lymphomas characterised by a cutaneous infiltration of malignant monoclonal T lymphocytes. While this broad spectrum of disease with its varied etiopathogenesis, clinical features and management options are well characterised, an approach from a dermatologist’s perspective is lacking in the literature. We strive to elucidate the approach from a clinician’s point of view, especially in respect of clinical examination, investigations, staging and management options that are available in the realm of the dermatologists. This review article is the first part out of the two, covering the etiopathogenesis, clinical features and evaluation.
Therapeutic success of tofacitinib in granuloma annulare: A retrospective case series of 15 patients
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Dev, A; Keshavamurthy, V; Chatterjee, D.
Background: Granuloma annulare (GA) is a necrobiotic granulomatous disorder that may sometimes be resistant to treatment, especially the generalised form. Tofacitinib has recently shown promise in the treatment of non-infective granulomatous dermatosis. Objectives: In this study, we aimed to evaluate the response of generalised GA to oral tofacitinib. Methods: This was a retrospective case series in patients of generalised GA who were treated with oral tofacitinib 5 mg twice a day in a tertiary care centre in north India. Baseline clinical details and histopathological findings were reviewed. Treatment response was noted in the form of clearance of lesions (complete or partial) along with the time taken to achieve the maximum response. Results: A total of 15 patients of generalised GA were included in this study, amongst whom nine patients were resistant to conventional therapies whilst the remaining were treatment naïve. Complete clearance of lesions was noted in 11 patients at a mean treatment duration of 4.4 ± 2.1 months whereas clearance was partial in four, with a mean follow-up duration post- treatment in patients who had partial clearance, which is 7.3 ± 2.8 month, with a reduction in erythema and infiltration in those lesions. Adverse effects in the form of hyperlipidemia were observed in two patients. Conclusion: Tofacitinib, a JAK-STAT inhibitor is beneficial in treating GA, especially in those with generalised and recalcitrant disease.
Recurrence rates after functional surgery versus amputation for nail squamous cell carcinoma not involving the bone: A systematic review
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Wong, H-S; Li, F; Jiang, J-Y; Huang, S-D; Ji, X; Zhu, P; Wang, D-G.
Background: Nail unit squamous cell carcinoma (nSCC) is a malignant subungual tumour. Although it has a low risk of metastasis and mortality, the tumour has a significant local recurrence rate. There is insufficient data to determine whether functional surgery is less effective than amputation for nSCC that does not involve the bone. Objectives: We aimed to investigate existing data on the outcomes of functional surgery and amputation for nSCC without bone invasion. Materials and Methods: We carried out an extensive search in PubMed, Embase, Cochrane Library, Web of Science, and Scopus for appropriate English-language academic papers, starting with the creation of individual resources until February 23, 2023. The main outcome was local recurrence. Initially, 2191 studies related to nSCC were selected. Information from every research study was retrieved and subdivided, comprising the year of publication, period, number of patients, age, gender distribution, tumour stage, type of intervention, number of recurrences, and follow-up period. Results: Ten independent studies (319 lesions) were finally selected. Mohs micrographic surgery was the most reported surgical modality, followed by wide surgical excision and amputation. Local recurrence rates between Mohs micrographic surgery, wide surgical excision and amputation treatment were nearly identical. Other surgical methods included limited surgical excision, partial ablation, and limited excision until the clearing of margins, with recurrence rates up to 50%. Conclusions: Given the functional impairment and psychological distress associated with phalanx amputation, functional surgery, including Mohs micrographic surgery and wide surgical excision , should be the preferred therapy for nSCC without bone involvement. Amputation should remain the preferred therapy for nSCC that involves the bone. Partial excision should be avoided. Further studies on whether Mohs micrographic surgery or wide surgical excision is a better option for nSCC not involving the bone are required.
High level of gamma-glutamyltransferase is a possible risk factor for psoriasis: A nationwide population-based cohort study
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Oh, JW; Han, KD; Doh, JY; Gee, HY; Lee, JH.
Background: Gamma-glutamyl transferase (GGT) has been associated with coronary heart disease, diabetes mellitus, and hypertension, but its association with psoriasis has not yet been elucidated. Aims: We conducted this study to determine the association between the risk of psoriasis and the serum GGT. Methods: We conducted a nationwide population-based study. A total of 9,939,350 people met the enrolment criteria. The study population was classified into four groups based on GGT levels and the risk of psoriasis was calculated for each group. Results: The incidence rates of psoriasis per 1,000 person-years were 2.96105 and 3.68577 in the lowest and highest GGT groups, respectively. After adjusting for age, sex, income, diabetes mellitus, hypertension, dyslipidemia, smoking, alcohol intake, exercise, and body mass index, the highest GGT group showed a significantly increased risk of developing psoriasis (hazard ratio: 1.057, 95% confidence interval: 1.044–1.07). This risk of psoriasis was significantly higher among the old age group (hazard ratio: 1.162, 95% confidence interval: 1.128–1.197) and women (hazard ratio: 1.14, 95% confidence interval: 1.117–1.164). Limitations: The limitations of this study included the retrospective design, International Classification of Diseases code- based diagnosis, small hazard ratio, and non-availability of data on covariates. Conclusion: The GGT level was found to be an independent risk factor for developing psoriasis.
Comparative study of the efficacy of azathioprine, dapsone, and NB-UVB phototherapy as steroid-sparing modalities in generalised lichen planus
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Mithra, S; Parimalam, K; Sowmiya, R.
Background: Generalised lichen planus (GLP) is a chronic disease with an overall prevalence of 1% requiring longer treatment. Limited studies are available on GLP and its treatment in the literature, unlike oral lichen planus. Objectives: To determine the best steroid-sparing treatment modality for GLP by comparing the efficacy, response, safety, side effects, and remission with azathioprine, dapsone, and narrowband UV-B (NB-UVB) along with their impact on itching severity and life quality. Methodology: Open-label, prospective, comparative, interventional study on generalised lichen planus patients treated with systemic steroids along with one of three steroid-sparing modalities. Totally 90 patients were studied including 30 patients each who received azathioprine (Group A), dapsone (Group B), and narrow band UVB (NB-UVB) (Group C), respectively, for 16 weeks. Itch severity index (ISI) and Dermatology life quality Index (DLQI) were assessed at baseline and week 24. All patients received oral prednisolone until there was no more active disease. Response was assessed in terms of occurrence of new lesions, flattening of lesions, post-inflammatory hyperpigmentation (PIH), and grading of lesions two weeks once for 6 months followed by six months of follow-up after treatment completion. Results: Females outnumbered males in all 3 groups. Mean patient ages (34, 38, and 34) and the presence of one or more co-morbidities (50%, 42.3%, 37.5%) in Groups A, B, and C, respectively, were comparable. ISI and DLQI improvement at 24 weeks were greatest with NB-UVB, followed by azathioprine and dapsone in that order; the differences in improvement between groups showed high statistical significance. At week 24, occurrence of new lesions (0%, 0%, 3.8%), flattening (100% – all groups), PIH (100% – all groups), grade 3 lesions i.e. poor response, resolution of 20-50% of lesions (7.1%, 11.5%, 0%), grade 2 lesions i.e. partial response, resolution of 50-90% of lesions (35.7%, 76.9%, 8.3%) and grade 1 lesions i.e. complete response, resolution of >90% lesions (57.1%, 11.5%, 91.3%) were noted in Groups A, B and C, respectively; the differences in the extent of resolution of lesions between the groups were highly significant statistically. Remission was seen in 100%, 76.9%, and 87.5% in Groups A, B, and C, respectively, after six months. Limitations: The sample size was small. Only 3 treatment options were compared in this study but many more options have been used for lichen planus. Long term follow-up is required. Conclusions: NB-UVB with oral steroids showed a better response in terms of improvement in DLQI, ISI, disease control, and side effects than azathioprine and dapsone. Azathioprine showed a faster response and more prolonged remission. Dapsone showed poor response with multiple side effects.
High-frequency ultrasonography for the detection of subclinical arthritis in chronic plaque psoriasis patients – A cross-sectional study
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Vendhan, S; Vasudevan, B; Rai, R; Neema, S; Krishnan, LP; Kamboj, P.
Background: Psoriatic arthritis (PsA) is seen in almost 30–40% cases of psoriasis. Psoriasis precedes the onset of PsA in 85% of cases. Delay in the diagnosis of PsA may lead to poor functional outcomes and morbidity. Screening psoriasis patients with high-frequency ultrasound helps to diagnose arthritis at an early stage leading to prompt intervention and possible reduction in the morbidity associated with the disease. Objectives: To determine the role of high frequency ultrasonography (USG) in the detection of subclinical PsA. Methods: A cross-sectional study was conducted in a dermatology and radiology department of Armed Forces Medical College, Pune between July 2021 and December 2022. Patients of chronic plaque psoriasis with no clinical evidence of arthritis were assessed using high-frequency USG. Various parameters such as bony erosions, synovial thickening, tendon thickening, tendon hypo-echogenicity, calcifications and power doppler signals were assessed. Results: A total of 117 patients were included in the study. The distal interphalangeal joint (DIP) and Achilles tendon were the most commonly affected sites. Synovial thickening in DIP was observed in 67 (57%) patients and Achilles tendon thickening was observed in 39 (33%) patients. Limitations of the study: The cross-sectional nature of the study is the major limitation. A longitudinal study will be required to understand the clinical relevance of ultrasonographic changes in these patients. Another limitation of the study is the lack of age and gender-matched controls. Future research should include such controls to ensure more accurate results. Conclusion: Subclinical arthritis is common in patients with chronic plaque psoriasis. High-frequency ultrasound is a useful tool for detecting subclinical synovitis and enthesitis in asymptomatic patients. The DIP joint and Achilles tendon ultrasound can be used for screening for early detection of PsA.
Efficacy and safety of combinations of H1 antihistamines in the treatment of urticaria: A scoping review
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Luo, M; Shen, K; Dong, X; Zhang, W; Tang, F.
The efficacy and safety of combining H1 antihistamines (AHs) for treating urticaria are currently unclear. This scoping review aims to provide a comprehensive overview of the evidence regarding the efficacy and safety of H1 AH combinations in the management of urticaria up to May 2023. The search encompassed databases such as PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and the China Biological Medicine Database. The inclusion criteria comprised randomised controlled trials (RCTs), non-randomised trials (NRTs), case reports, and case series focusing on urticaria treatment. Initially screening 12,887 studies, this review ultimately selected 109 studies involving 11,435 patients. These studies documented 43 different combination treatments across 11 types of urticaria. In comparison to monotherapy, combination therapy exhibited superior efficacy in 94 studies that reported treatment efficacy. Regarding adverse drug reactions (ADRs), 67 studies disclosed ADR incidences, with combination therapy showing lower ADR rates in 32 studies. Additionally, 7 studies reported similar ADR rates between combination therapy and monotherapy with AHs. Common ADRs included symptoms such as drowsiness, nausea, fatigue, dry mouth, dizziness, and headache, while less frequent side effects encompassed hypotension, otitis media, polyuria, rhinorrhoea, abnormal liver function, and rash. ADR rates ranged from 0% to 21% in the treatment group, and from 0.5% to 75% in the control group. Importantly, patients generally tolerated these ADRs well, with symptoms resolving upon discontinuation of treatment. The study’s findings suggest that combining AHs leads to enhanced efficacy and reduced safety risks compared to monotherapy in the context of urticaria treatment. These results advocate for considering combination therapy as a viable option in clinical practice, especially for chronic urticaria cases. Nonetheless, caution is advised, and close monitoring for potential ADRs is crucial during treatment.
High serum total IgE levels correlate with urticarial lesions and IgE deposition in perilesional skin of bullous pemphigoid patients: An observational study
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-04) Ngan, GP; Nguyen, VTH; Huu, DL.
Background: In the pathophysiology of bullous pemphigoid, besides IgG, there has been evidence that supports the role of IgE antibodies. However, there have been no studies to evaluate total serum IgE levels or detect IgE deposits in the skin of Vietnamese patients. Aim: To analyse the association between IgE levels in the serum and disease severity as well as eosinophils and IgE basement membrane zone (BMZ) deposition in Vietnamese bullous pemphigoid patients. Methods: A single-centre observational research on 35 newly diagnosed and untreated bullous pemphigoid patients. Total serum IgE levels were analysed using enzyme?linked immunosorbent assay (ELISA). For controls, we collected sera of 30 pemphigus patients and 30 elderly patients with pruritus. Perilesional skin biopsies underwent direct immunofluorescence (DIF) staining, with biopsies of pemphigus patients as controls. Results: Elevated total serum IgE was observed in 60% of bullous pemphigoid patients, the percentage in the pemphigus group and pruritus group was 20% and 40%, respectively. The mean total serum IgE level among the bullous pemphigoid group was higher than that of the pemphigus group (123.3 ± 102.4 IU/mL vs. 64.3 ± 45.1 IU/mL, p = 0.010). Total serum IgE levels of bullous pemphigoid patients correlated with higher eosinophil counts (r = 0.61; p = 0.018) and urticaria/erythema (U/E) Bullous Pemphigoid Disease Area Index (BPDAI) score (r = 0.50; p = 0.035). Among 35 bullous pemphigoid patients, 5 patients showed positive IgE DIF staining, accounting for 14.3%. Higher serum IgE levels correlated with the deposition of IgE in patients’ perilesional skin (p = 0.037). Limitations: Due to the rarity of bullous pemphigoid, the effect of the COVID-19 pandemic, and self-treatment issues in Vietnam, we could not recruit a larger number of participants. Conclusions: Total serum IgE values correlated with urticarial lesions and IgE deposition in perilesional skin of Vietnamese bullous pemphigoid patients. IgE autoantibodies present in the skin of bullous pemphigoid patients support the role of IgE in bullous pemphigoid pathogenesis.

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