Shwitra or Shwet-Kushtha can be co-related with skin disease "vitiligo" in biomedicine. According to Ayurveda, the skin is one of the essential sense organs. Vata and bhrajaka pitta reside in the skin (called twak in Sanskrit). As the skin covers the whole body, bhrajaka pitta should be maintained in a proper state, and it needs continuous care. An imbalance in Vata and bhrajaka pitta may cause skin diseases. The first step (Step 1) in Ayurvedic management of vitiligo is purification therapies (shodhana karma) using herbal decoction of Psoralea corylifolia (bakuchi kwatha) and Euphorbia neriifolia (snuhi) aimed to induce multiple bouts of purgation. In the next step (Step 2), oil massage using oil selected on the basis of patient examination (rogi pariksa) and disease (roga). Step 3 is the exposure of lesions to the sun rays as long as the patient can tolerate (Soorya pada santhapam in Ayurveda). Herbomineral preparations include topical application of herbal Lepa, powders made up of medicinal plants (Curna), herbalized ghee preparations similar to paste (Ghrita, semi-solid preparations taken orally, by licking (Avaleha), herbalized oil preparations (Thaila), fermented solutions (Asava-Arista), and tablets (Vati/Gutika). Various minerals and metallic salts (Rasousadha) are also used. Bakuchi oil is Ayurvedic medicinal oil prepared from the dried fruits of P. corylifolia, and sesame oil is a popular therapy for vitiligo in Ayurveda that contain psoralen to stimulate melanocytes when exposed to ultraviolet light exposure. Details of above-mentioned therapy are discussed. Scientific rationale behind the use of these medications needs to be further explored with modern methods and research.

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Introduction: Topical mupirocin, fusidic acid, and nadifloxacin are used in the treatment of superficial bacterial infections. This study was undertaken to assess the efficacy and safety of these three topical antibiotics in the treatment of superficial bacterial infection of the skin. Aims: To compare the efficacy and safety profile of 2% mupirocin versus 2% fusidic acid versus 1% nadifloxacin cream in the treatment of superficial bacterial infections. Materials and Methods: A randomized study in treatment-naive cases of uncomplicated bacterial skin infections attending the out-patient Department of Dermatology was done. A total of 90 patients of bacterial infections of the skin were included, which were randomly allocated to three different study groups. After diagnosis was confirmed clinically, grading of the lesions was done with regard to parameters such as erythema, edema, vesiculation, pustulation, crusting, and scaling. Score was applied to each parameter as 0-absent, 1-mild, 2-moderate, and 3-severe. Gram staining was performed. The lesions were graded on subsequent visits on day 4, day 18, and day 14. The results were subjected to analysis of variance test, followed by the Dunnett's test. Results: Fusidic acid cream showed faster reduction of the scores at the end of the first visit. The differences noted in the efficacy of the three drugs were not statistically significant. No significant side effects were observed. Conclusion: This study documents the equality in the comparative safety and efficacy of mupirocin, fusidic acid, and nadifloxacin in the treatment of uncomplicated superficial bacterial infections at our center.

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Clofazimine is a synthetic dye that has been used in the treatment of leprosy since many years. Its role in the treatment of lepra reactions was subsequently recognized. When the dose of 300 mg/day is used, it doubles the serum concentration of the drug and supposedly exerts potent anti-neutrophilic effect and inhibits of prostaglandins. Our personal experience with high dosages of clofazimine in type II lepra reactions and review of the literature suggests that clofazimine has been extremely useful in providing good and satisfactory results in leprosy patients suffering from these embarrassing conditions. The anti-inflammatory effect of clofazimine is greatly useful in managing recurrent and chronic type II reactions with its steroid-sparing effect and providing an alternate and in expensive option.

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Contour defects such as linear morphea are difficult to treat and can be a cause for great cosmetic and sociopsychological morbidity. The pivotal discovery of platelet-derived growth factors in promoting wound healing, angiogenesis, and tissue remodeling has paved the way for various uses of platelet-rich plasma (PRP). We report a novel indication for this promising therapeutic modality with satisfactory results. A 24-year-old female presented with nonprogressive linear hyperpigmented atrophic lesion over the left supraorbital region and scalp of 15 years duration was diagnosed as linear morphea. She had taken immunosuppressants over the last 3 years with minimal improvement. PRP was obtained with a platelet count up to 2.5 times the baseline count. Calcium chloride (1:9) was added as an activator. About 3 ml of PRP was injected into the linear contour defect every week for a total duration of 12 weeks. The results were corroborated quantitatively by a repeat high frequency focal ultrasound which showed focal minimal irregularity over frontoparietal region of scalp corresponding to bony lesion measuring 0.5 cm × 1.8 cm (original defect of 1.4 cm × 1.8 cm). A remarkable reduction in hyperpigmentation of overlying skin was noted which further enhanced the cosmetic outcome. The effect was sustained until the end of follow-up period of 6 months after the last PRP sitting. No secondary changes or side effects were noted during the entire course of treatment. PRP therapy is safe and effective in the treatment of linear morphea over face and scalp as demonstrated in this case.

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Introduction: High-dose corticosteroids are used for various autoimmune and inflammatory diseases. When supra-pharmacologic doses of corticosteroids are used intravenously for the treatment of immunobullous diseases such as pemphigus, it is likely to be associated with side effects such as electrolyte disturbances, hypertension, and psychosis. Case Reports: In these case series, we report five patients receiving high-dose of dexamethasone with or without cyclophosphamide pulse, developing an unusual form of late onset bradycardia. Details of these patients developing bradycardia after dexamethasone pulse therapy are presented here. In all of these cases, bradycardia can be attributed to high-dose intravenous dexamethasone therapy. Bradyarrhythmias and sinus bradycardia may occur as an adverse effect of pulse therapy. Conclusion: Late onset of bradycardia is usually delayed in comparison to steroid infusion and frequently not apparent even after the 3^rd day. Bradycardia may be associated with dizziness and may lead to fall and unnecessary trauma. Dermatologists should be aware of this complication, and timely referral to physician is essential.

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Introduction: Moisturizers are routinely prescribed so for adequate hydration of the skin. There are various preparations of these moisturizers in the market making it difficult for a dermatologist to choose the most effective moisturizer. Objectives: To compare the efficacy of six different commonly used commercial and prescription based skin moisturizers. Materials and Methods: A total of 30 human healthy volunteers of the same age group were enrolled in a study. We selected six sites on the dorsum of hand (A, B, C, D, E, and F) for the application of moisturizers. In this study, we used six different commercially available moisturizers namely Emoderm^® cream, Secalia^® cream, Amylac^® 12% cream, Ponds^® cream, Nivea^® cream, Dove^® cream. Baseline moisture level reading of the areas selected was taken (A, B, C, D, E, and F) with the help of digital skin moisture analyzer. Digital skin moisture analyzer is a portable device that uses bioelectric impedance analysis technology. Readings were taken at the end of 15 min, 30 min, and 1 h after application of the cream. Results: At the end of 15 min, only Dove moisturizer could retain the baseline moisture level in the skin without positive or negative change. Moisture levels were reduced in other groups. At the end of 30 min, Secalia^® moisturizer produced an increase in moisture level over the baseline - 4.76%. Moisture levels were below baseline in other groups. Secalia^® moisturizer produced the maximum increase in moisture level over the baseline at the end of 1 h - 21.99%. The only other moisturizers to produce moisture level above baseline after 60 min were Dove^® 5.02% and Amylac^®- 5.66%. Conclusion: We conclude that epidermal hydration produced by moisturizers influences the electrical properties of skin. Humectants cause a significant increase in moisture levels as assessed by digital skin moisture analyzer.

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Adalimumab is a biological agent which acts by inhibiting tumor necrosis factor-alpha. It has been used for the treatment of rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, and moderate to severe chronic plaque psoriasis. Various studies show good efficacy in psoriasis cases, unresponsive or partially responsive to other systemic therapies and even cases of resistance to other biologics. It has helped reduce the morbidity significantly and improved the quality of life of psoriatics. Although majority of the experience of this drug is from its use in rheumatoid arthritis, this biologic has generally been considered safe even for psoriasis and other dermatologic conditions.

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Hand foot syndrome (HFS) or palmar-plantar erythrodysesthesia (PPE) is a relatively frequent and often a serious side effect of anti-cancer drugs including liposomal doxorubicin. Hyperpigmentation as a part of HFS is infrequently reported. A 51-year-old woman on treatment with pegylated liposomal doxorubicin for recurrence of adenocarcinoma of ovary presented with history of itching and burning sensation in her hand and feet. She also noted hyperpigmentation of palms more than soles and discoloration of finger and toe nails. Physical examination revealed diffuse hyperpigmentation of both the palms and soles. This was accompanied by a bluish discoloration of lunulas of finger and toe nails. She was diagnosed with HFS and started on pyridoxine and emollients. The finding of hyperpigmentation noted in our patient is not commonly seen in HFS and believed by many authors to be an initial manifestation of HFS.

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Histoplasmosis is a deep fungal infection with a worldwide distribution that can affect both immunocompromised and immunocompetant individuals. The majority of cases with cutaneous involvement also have systemic disease. Intravenous amphotericin is commonly employed for its treatment which is associated with significant side effects. We hereby report a of case cutaneous histoplasmosis in a human immunodeficiency virus (HIV) positive female who was treated successfully with oral itraconazole monotherapy along with anti-retroviral therapy. A 38-year-old HIV-positive female presented with multiple asymptomatic skin colored umbilicated papular eruptions over face, neck, trunk, and upper extremities of two and half months duration. She did not have any systemic complaints. Histopathology of the lesion showed a diffuse dermal granulomatous inflammation with 2–4 µ sized round organisms in macrophages with a clear halo suggestive of histoplasmosis. Her CD4 cell count was 38 cells/mm3. She was started on highly active antiretroviral therapy (tenofovir 300 mg OD, lamivudine 300 mg OD, and nevirapine 200 mg BID) along with cotrimoxazole prophylaxis. The patient was also prescribed oral itraconazole 100 mg twice daily. After 20 weeks of therapy, the patient showed complete resolution of lesions with minimal scarring. Histoplasmosis in retrovirus positive patient is frequently treated with intravenous amphotericin. Our patient responded to long-term itraconazole monotherapy.

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