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Cleansers are agents responsible of cleansing the skin to get rid of the dust, dirt, sebum, and dead cells accumulated as a part of normal desquamation process. Cleanser technology has come a long way from the traditional soaps and detergents to the more modernized liquid cleansing agents and syndets. They have thereby helped in reducing the side-effect potentials of cleansers and improved the beneficial effects. Addition of newer molecules helps in maintaining the skin barrier integrity and moisture on the skin. However, although the bright side of cleansers shines there is a gray zone of controversies regarding its usage. Discrepancy between the claims and evidences herewith make it imperative to consider the pros and cons. This article aims at summarizing the points in favor and against the usage of cleansers.

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Verrucous epidermal nevus (VEN) is a common type of keratinocyte hamartoma present at birth or occurring later in life. It is seen at any site, but is less common on the head and neck, rarely seen on the face and very rarely involves the oral mucosa. Widespread multiple epidermal nevi may reflect genetic or chromosomal mosaicism. Blaschko has documented characteristic linear, zosteriform, unilateral or systematized patterns with streaks and swirls. They are resistant to treatment with risk of recurrence. A case of male child is presented here with extensive VEN with involvement of ear lobe and scalp of left side with cicatricial alopecia. Patient had delayed milestone development without any systemic involvement.

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Introduction: Dermatoses are a common occurrence in preschool paediatric population in Uttarakhand. Objective: The present study was conducted, to document prevalence and the type of skin disorders prevalent in preschool age group children, attending dermatology OPD in a medical college in Uttarakhand, India. Material and Method: A total of 721 children up to 5 years of age, who presented with dermatoses in pediatric dermatology clinic of department of Dermatolgy Venereology and Leprology (DVL), SGRRIM and HS and associated Shri Mahant Indiresh Hospital, Dehradun, Uttarakhand, India, were selected between 06 Sep 2013 to 05 Sep 2014 in this prospective study. The diagnosis was based upon detailed clinical examination, necessary investigations and dysmorphologic features, if any. Results: Infections and infestations were commonest disorders contributing to 36.46% of all cases. Major infections/ infestations were viral (9.76%) followed by scabies (9.29%), fungal (9.01%) and bacterial (8.46%). Higher incidence of viral infection was due to outbreak of HFMD in months of Sep and Oct I 2013 in Dehradun. There was significant change in bacterial infections according to season. Bacterial infections were more common in summers and mansoon seasons. Fungal and viral infections did not show this type of seasonal variation. In our study most of parasitic skin infestations were due to scabies (9.43 %).Other important groups of dermatological disorders were dermatitis in 29.63% cases out of which seborrheic dermatitis (10.12%), atopic dermatitis(5.96%), Ptyriasis alba (5.96%), non specific eczema (3.46%) and contact dermatitis (2.77%). Other skin diseases included papular urticaria / insect dermatitis (8.46%), naevi / developmental lesions (4.02%), pigmentary disorders (3.32%), sweat gland disorders (2.08%) and miscellaneous group (6.38%) respectively. Pigmentary lesions prevalence was higher in girls. Conclusions: Infections and infestations were commonest cause of dermatoses in preschool children (36.46%), followed by dermatitis (29.63%). Bacterial infection showed seasonal variation and pigmentary lesions were more prevalent in female children.

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Congenital melanocytic nevus is rare benign neoplasm which generally seen in one in 20,000 children. They vary in size from <1 cm. to covering almost the entire body. Giant congenital melanocytic nevus (GCMN), variant of congenital melanocytic nevus, involving much of the body surface area are less common, around one in 200,000-500,000. It is characterized by its extensive size and is defined as melanocytic nevus measuring more than 20 cm in its greatest dimension. Malignant changes of giant nevus can occur at any age but most often occur in infants or toddlers. We are here reporting a case of GCMN in a 3-day-old female child.

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Pretibial epidermolysis bullosa (EB) is a rare type of dystrophic EB characterized by itching, blisters, atrophy, and scarring localized to the shins. The term pretibial is used because of the localization of lesions to the shins. It has been rarely reported in the literature. There is no specific treatment for any form of EB, and the mainstay of clinical management is based on protection and avoidance of provoking factors. We report a case of pretibial EB in a 15-year-old ethnic Kashmiri girl who presented with a history of blisters over legs of 3 years duration.

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A young girl presented to us with a solitary asymptomatic pedunculated mass over her right arm. Histology of the excised mass revealed features suggestive of pedunculated lipofibroma. The paucity of documentation of pedunculated lipofibroma in this age group incited the present report.

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Blue rubber bleb nevus syndrome is a rare condition with multiple venous malformations of the skin, gastrointestinal tract, and other visceral sites. It typically appears during childhood, but occasionally may be present at birth. An 8-day-old female child presented with multiple bluish bleb like nodules on skin all over the body including involvement of oral cavity, nail bed since birth. Examination revealed multiple soft, compressible, tender bluish nodules, hepatosplenomegaly, and pansystolic murmur. Magnetic resonance imaging of the brain was suggestive of brain involvement. Ultrasound abdomen was suggestive of hepatic and splenic involvement. Chest X-ray and clinical findings were suggestive of congestive heart failure. This case is being reported because of its rarity, rare presentation of this disease at birth. It is important to identify this syndrome early so that appropriate investigations could be done to know the extent of visceral involvement and accordingly decide the management.

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Hypomelanosis of Ito is a heterogenous naevo-cutaneous disorder affecting the skin, brain, eye, skeleton, and other organs. The skin findings are very distinctive and constant. Here we report a 3-year-old boy with characteristic skin findings of hypomelanosis of Ito associated with cafe-au-lait macules and angiomatous nevi, but with no other systemic involvement.

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Infantile hemangiomas usually regress spontaneously and do not need treatment as "active nonintervention" is considered the gold standard. However, facial lesions cause significant distress to parents and are associated with a risk of scarring, disfigurement, and airway obstruction, apart from syndromic associations. The management of infantile hemangiomas has changed considerably in the last few years with the advent of topical timolol preparations. We describe the first case of an infant with an ulcerated, superficial, perioral, and segment three hemangioma, who responded dramatically to topical timolol 0.5% ophthalmic solution within 2 months. We suggest that timolol ophthalmic solution may be an option for such lesions under close monitoring.

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We report a case of incontinentia pigmenti in a 3-day-old male neonate presenting with multiple vesicular and hyperkeratotic papular crusted lesions over the right leg and trunk in a blaschkoid pattern since birth, with characteristic histopathological findings. A good clinical acumen is required for diagnosing a rare disorder in the absence of genetic analysis and karyotyping.

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Children ≤18 years of age have an overall prevalence of psoriasis ≈0.71%, the pustular type occurring in 0.6-7%. Out of the four distinct patterns of pustular psoriasis, annular type is the rarest and generalized pustular psoriasis/von Zumbusch (GPP), the severest. A 10-year-old girl presented with extensive crusted erosions-ostensibly a day after consumption of a solitary 250 mg tablet of azithromycin-over erythematous base symmetrically involving face, trunk, and extremities followed next day by innumerable pin-head sized pustules coalescing into lakes of pus. GPP was suspected clinically and corroborated histopathologically. The diagnostic criteria for GPP are, firstly; clinical findings as mentioned above, secondly; subcorneal spongiform pustules on histopathology, thirdly; any/ many of the laboratory alterations (leukocytosis with left shift, elevated ESR, C-reactive protein, antistreptolysin O antibodies, IgG or IgA, hypoproteinemia, hypocalcemia) and lastly; clinical/histopathological recurrence. After three days of prednisolone, a short course of cyclosporine followed by NB-UVB revealed an exceptionally prompt remission in this, probable de novo, case of pso- GPP without any family history which is being kept under follow up.

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Angiokeratoma circumscriptum neviforme (ACN) is an extremely rare cutaneous disorder, occurring due to congenital malformation of the papillary dermal blood vessels. Clinically, it presents as well circumscribed, hyperkeratotic papules, nodules or plaques, often resembling malignant tumors like malignant melanoma or pigmented basal cell carcinoma. Thus, this uncommon but significant lesion should be diagnosed at the earliest, to avoid unnecessary confusion. We report here a case of congenital, linear, unilateral, verrucous plaques on the leg of a young girl, diagnosed as ACN.

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Palmoplantar keratoderma (PPK) is a heterogeneous skin disorder caused by various hereditary and acquired conditions. One of the inherited PPK is Camisa syndrome (now known as loricrin keratoderma [LK]). It is clinically characterized by honeycomb-like PPK with constriction (pseudoainhum), hyperkeratosis overlying knuckles and dorsal hands and generalized ichthyosis. We, hereby, present a case of baby who presented with nonbullous ichythyosiform erythroderma and whose mother had all the characteristic features of LK involving hands and feet. Histopathological examination of palmar lesions was consistent with keratoderma. LK has been described as a cause of congenital ichthyosiform erythroderma and collodion baby. This may also explain the clinical presentation in the baby and mother in our case. Thus, our patients represent a rare presentation of LK in the form of ichthyosiform erythroderma. To the best of our knowledge, this is the first case of its kind being reported from India.

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Cockayne's syndrome is a rare, autosomal recessive disease with cutaneous, neurologic and ocular abnormalities. A 3 year old boy presented with photosensitive lesions on the face with mental retardation and delayed milestones. The disorders of childhood photosensitivity were kept as differential diagnosis. Fundoscopy revealed optic atrophy with CT brain showing bilateral basal ganglia calcification with cerebral parenchymal atrophy. Based on Clinical manifestations and CT scan features, the diagnosis of Cockayne's syndrome was made. Hence, we are reporting a rare classical case of Cockayne syndrome

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Myiasis is the infestation of live vertebrates (humans and/or animals) with dipterous larvae. It is known to infest patients with poor hygiene mostly in tropics with high fly population. The description of myiasis associated with cutaneous malignancy is infrequent in literature and very limited cases have been reported in patients of xeroderma pigmentosum (XP). We report a case of cutaneous myiasis complicating basal cell carcinoma (BCC) in a case of XP. The diagnosis of BCC was confirmed on histopathological evaluation. The maggots were identified as old world screwworm, Chrysomya bezziana Vill. of the fly family Calliphoridae. The malignant wounds were flooded with turpentine oil resulting in suffocation and death of maggots following which they were manually removed. Oral antibiotics and analgesics were given along with oral ivermectin.

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Verrucous epidermal nevi are congenital, noninflammatory, cutaneous hamartomas composed of keratinocytes. To the best of our knowledge, only single case of lichen planus (LP) arising in an inflammatory linear verrucous epidermal nevus has been reported. We herewith report a case of 10-year-old boy who developed LP over linear epidermolytic verrucous epidermal nevus.

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Phacomatosis pigmentovascularis (PPV) is a rare cutaneous congenital malformation syndrome, characterized by the simultaneous occurrence of cutaneous vascular and pigmentary anomalies. Only one case of phacomatosis cesioflemmea has been reported so far from India. We hereby report a second case of the disorder in a two year old boy, who presented with Mongolian spot and nevus flemmus. Our case had systemic involvement in the form of Sturge Weber Syndrome (SWS) with glaucoma, buphthalmos and MRI findings of cerebral cortical atrophy and enlarged choroid plexus.

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Juvenile xanthogranuloma is a benign, self-limited, rare group of disorders characterized predominantly by facial papules and plaques. It is seen in combination with juvenile chronic myelomonocytic leukemia and/or neurofibromatosis type 1. Children with multiple facial lesions are more prone to have ocular and extracutaneous manifestations. The predilection sites are head and neck, but it may occur on the extremities and trunk also. Histopathology along with immunohistochemistry forms the basis of diagnosis. Diagnosis of this entity remains important to avoid unnecessary investigations owing to the benign nature of the condition.

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Linear verrucous hemangioma (VH) is a rare congenital disorder of vascular malformation characterized by the presence of verrucous and vascular plaques or nodules arranged in a linear array. Clinically, the closest differential includes angiokeratoma which can be differentiated based on histopathology. We herein report a case of linear VH in a pediatric age group.

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Progressive symmetric erythrokeratoderma or Gottron's syndrome is a rare autosomal dominantly inherited disorder with <100 cases reported worldwide, of which <10 are from India. It is characterized by erythematous, well-defined, hyperkeratotic plaques distributed mainly on the knees, elbows, buttocks, scalp, and dorsal surfaces of the hands and feet. In general, the trunk is spared. The condition has a progressive course during early childhood, and then is usually stable. We report a case of symmetric progressive erythrokeratoderma in two male siblings, aged 11 years and 7 years born out of second degree consanguineous marriage who presented with erythematous, scaly plaques over the extensor aspect of both extremities.

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Infantile hemangiomas (IH) commonly a benign tumor may become life threatening and require immediate treatment. Previous standard therapeutic options included physical measures (laser surgery, cryosurgery) and systemic corticosteroids, all bearing the risk of serious side-effects. We report an unusual case of diffuse IH treated with propranolol and timolol.

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