Psoriasis is a common inflammatory disorder of the skin. Although a lot is known regarding its pathogenesis, much remains to be elucidated and understood. Psoriasis is a disease of multifactorial origin where certain environmental factors acting on individuals with specific genetic predisposition leads to an immune dysregulation. Till now no single genetic or environmental entity has been found to be consistently associated with all cases of psoriasis. Hence, psoriasis has been considered by some to be a heterogeneous group of disorders where several disparate pathological processes result in a similar outcome. There is a huge array of potential genes now implicated and an equally large array of molecules (chemokines, cytokines, inflammatory mediators, signal transduction molecules, and transcription factors) found to be involved. Although new therapeutic options have opened up as a result, our inability to solve the puzzle and thoroughly understand the disease prevents their optimal utilization.

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Background: Hypopigmentory and depigmented lesions are common among children and adolescent group. The parents are very much concerned about the condition and they seek dermatologist advice without fail. Aims and Objectives: To evaluate the Epidemiology and clinical characteristics of Hypopigmented and Depigmented Lesion in patients of Children and Adolescent age group in Hadoti region in Rajasthan. Materials and Methods: The study was conducted for the period one year from April 2015 to March 2016. This planned study is to be undertaken in children age 0-19 yr with hypopigmented and depigmented lesions irrespective of sex. Results: The most common disorder was Pityriasis alba, seen in 27.33%, followed by Pityriasis versicolor in 21%, Vitiligo 19.33%, Post inflammatory hypopigmentation in 14%, Primary disorders of hypopigmentation in 13%, Hansen's disease in 1.33%, and miscellaneous conditions in 4% of the cases. Conclusion: The most common hypopigmentary disorders are seen in our study is Pityriasis alba and other causes of hypopigmentary and depigmentory disorders are in decreasing order are Pityriasis versicolor, Vitiligo, Postinflammatory hypopigmentation, Primary causes of hypopigmentation and less common are Leprosy.

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Cutaneous larva migrans or creeping eruptions is a parasitic skin infection caused by hookworm larva. It is common in warmer tropical and subtropical countries. Here, we report four patients aged between 7 months and 14 years presented to outpatient Department of Paediatrics with cutaneous lesions over buttocks, right hand, right foot, and left thigh. Wandering threadlike progressive lesions were noticed on cutaneous examination, consistent with a diagnosis of cutaneous larva migrans. Complete resolution seen after treatment with oral albendazole.

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Erythromelanosis follicularis faciei (EFF) is a rare sporadic condition of unclear etiology and is distinctive by well-demarcated reddish-brown patches and follicular papules that appear often on the face and seldom on the neck. Herein, I report a case of a 15-year-old female who had asymptomatic facial skin discoloration since early childhood. Skin examination revealed confluent nonscaly rough brownish red patches on both cheeks without telangiectasia and a barely thick scaly brownish patch over her entire forehead and both eyebrows with follicular plugging. A summary of preceding reports of EFF in the literature is presented in this report.

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Cutis verticis gyrata (CVG) is a long-lasting and progressive condition in which there is hypertrophy and folding of the scalp skin. Cerebriform intradermal nevus (CIDN) is a rare cause of CVG. Here, we report a case with CIDN of the scalp in a 12-year-old girl. Dermatological examination showed a cerebriform appearance with accentuating folds and deep furrows, thickening in the temporal regions. We want to emphasize that CIDN should not be forgotten in the differential diagnosis of the causes of CVG.

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Background: Obesity is a chronic disorder with rising prevalence that affects several organs, including the skin. Although it is more common in adults, the prevalence in the pediatric population is growing rapidly. Obesity is associated with a large number of cutaneous manifestations which are directly related to the age of onset and duration of obesity. Materials and Methods: This was a prospective study in which children aged 3 years or more with body mass index (BMI) >30 kg/m² were included in the study. After informed consent from the parents/attendants, demographic details, height, and weight were documented. All the children were subjected to a detailed dermatological examination by an experienced dermatologist, and all the cutaneous changes were carefully recorded in a predesigned pro forma. Results: A total of 100 children (male: 61, female: 39) were included in the study. The mean age of the participants was 11.3 ± 1.3 years and the mean BMI was 32.6 ± 1.36 kg/m². Majority of the patients (71%) had Class I obesity (BMI 30.00–34.99) while 27% had Class II obesity (BMI 35.00–39.99). The most common cutaneous manifestations among the children were acanthosis nigricans (42%), striae (19%), fungal infections and intertrigo (16%), acrochordons (12%), acne (10%), hirsutism (8%), and viral and bacterial infections (5%). Other less common associations were psoriasis, xanthomas, corns, plantar hyperkeratosis, and miliaria. Conclusion: Likewise in adults, obesity is associated significantly with certain dermatoses in children also. As the prevalence of obesity is increasing each day, understanding of these dermatoses is necessary both for the pediatricians as well as for dermatologists for early diagnosis and management.

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Background: Currently, very few studies exist regarding the use of systemic methotrexate (MTX) in childhood psoriasis. Aim: The aim is to study the effect of systemic MTX with respect to overall efficacy and safety in varied spectrum of severe childhood psoriasis patients and to assess the degree of improvement objectively by measuring psoriasis area severity index (PASI) at each visit. Materials and Methods: All patients <18 years of age having PASI >10, not responding to topical therapy and without having any contraindication to systemic MTX use were included in the study done during a period of two years. MTX was prescribed orally at a dose of 0.2–0.4 mg/kg/week and folic acid on daily basis except on the day of MTX to all the patients. Both clinical and laboratory follow-ups were done weekly for the first 2 weeks and then at 15 days interval for 1 month and monthly after that for measuring PASI and to rule out any side effects of MTX. After 75% improvement in PASI score the dose was decreased at rate of 2.5 mg/week and stopped after complete resolution of the lesions. Results: Out of nine cases (M/F - 6/3), quickest response to MTX was seen in pustular psoriasis (4.5 weeks) and one case of plaque psoriasis (5 weeks) and slowest response was seen in rupoid variant (13 weeks). Mean duration to achieve 50% and 75% improvement in PASI overall were 4.6 ± 2.46 weeks and 7.6 ± 3.36 weeks, respectively. The mean cumulative dose of MTX in all cases was 231.1 ± 176.1 mg without any major side effects. Conclusion: MTX is a safe therapeutic option in severe refractory cases of childhood psoriasis if used with proper monitoring and follow-up.

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Background: Emergence of methicillin-resistant Staphylococcus aureus (MRSA) infections among previously healthy persons in community settings (without exposure to healthcare facilities) has been noted recently. Limited studies have been carried out from India in an exclusive pediatric population on MRSA in community-acquired pyoderma. Aims: The objective of this study was to evaluate different types of primary pyoderma in children caused by S. aureus and to determine the incidence of MRSA in community-acquired primary pyoderma in children. Materials and Methods: Children aged ≤ 16 years with pyoderma caused by S. aureus who attended camps conducted in schools around Bengaluru were inducted. They were evaluated for a variety of skin infections which were cultured and analyzed for antimicrobial susceptibilities. Swabs from the anterior nares were also collected from each patient. Results: Of the total 372 children with pyoderma caused by S. aureus studied, 232 were boys and 140 were girls. Impetigo contagiosum (47%) was the most common form of pyoderma, followed by ecthyma (19.9%) and folliculitis (18.5%). The most common site involved was face in 48.4% patients, followed by legs in 32.5% patients. MRSA was isolated in 6.5% patients. Nasal colonization with S. aureus was observed in 59.7% patients. Conclusion: MRSA in community-acquired pyoderma in children was 6.5% and nasal colonization with S. aureus was 59.7% in our study. High resistance to commonly used antimicrobials in methicillin-sensitive S. aureus was also observed. Judicious use of antimicrobials is essential to control the emergence and spread of antimicrobial resistance.

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Introduction: The prevalence of leprosy in the pediatric age group indirectly points to active disease in the community. Aim: The main objective of this study was to study the clinico-epidemiological features and prevalence of pediatric leprosy cases in our urban leprosy care center. Materials and Methods: This is an 18-year retrospective descriptive study of pediatric leprosy cases (1997–2014) done in the urban leprosy center of a tertiary care institute. Results: There were sixty cases of pediatric leprosy (n = 60) in this study. There were 41 males (68.33%) and 19 females (31.67%). The mean age was 8.34 years. The age group of 10–12 years accounted for the maximum number of cases, 25 (41.67%). The mean duration of illness was 0.89 year. Family history of leprosy was present in four cases (6.67%). The most common primary skin lesion was macule present in 43 cases (71.66%), with the upper extremities being the most common site involved. Sensory impairment was present in 39 cases (65%). Peripheral nerve thickening was present in 27 cases (45%). Borderline tuberculoid (BT) was the most common type of leprosy seen in 33 cases (55%). Lepra reactions were present in three cases (5%) and Grade 2 deformity was present in three cases (5%). Conclusions: This study showed a prevalence of 6.65% of pediatric leprosy cases. BT was the most common type of leprosy, and the prevalence of lepromatous leprosy, lepra reactions, and deformity was low.

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Background: Neonatal dermatoses constitute an important category of cutaneous disorders. They range from physiological transient conditions at one end to serious pathological entities at the other. Any of these could be a source of immense anxiety to the parents, and therefore the significance of their adequate awareness amongst dermatologists. Aim and Objective: To study the clinical pattern of various dermatoses in neonates at a tertiary health care center in Chennai. Materials and Methods: This was a descriptive, cross-sectional, and observational study conducted at our institute which included a detailed dermatologic examination of each neonate followed by recording each finding and their statistical analysis. Results: In the 220 neonates analyzed, 97 were females (44.1%) and 123 males (55.9%), with 126 being term babies (57.3%), 86 preterm (39.1%), and 8 postterm (3.6%). Physiological skin changes (52.7%) were the most common cutaneous change identified, followed by transient non-infective dermatoses (20%), developmental defects (7.3%), birth marks (7.3%), eczema (6.8%) and infections (5.9%). Conclusion: Studying neonatal dermatoses holds significance to all dermatologists so that they are able to differentiate physiological and pathological conditions, thereby relieving unnecessary therapy for neonates in circumstances not requiring any and also facilitating to allay undue anxiety among parents.

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Adams Oliver syndrome (AOS) is a rare autosomal dominant congenital disorder characterized by absence of skin and or underlying structure over scalp along with transverse limb defect. It was first described by Adam and Oliver in 1945. We report a rare case of adams oliver syndrome with limited expression involving scalp, transverse limb defects along with unreported truncal involvement.

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We hereby report a case of a male child who presented with multiple brown to red papules and plaques in a seborrheic distribution. Histology and immunohistochemistry findings were consistent with a diagnosis of Langerhans cell histiocytosis with multifocal and multisystem involvement (Letterer–Siwe type). The case is being reported for its rarity.

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Dyschromatosis universalis hereditaria (DUH) is a rare genodermatoses characterized by hyperpigmented and hypopigmented macules inherited most commonly in autosomal dominant manner. We hereby report a case of DUH in an adolescent male with palmo-plantar involvement and no family history of the disorder.

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