Indian Academy of Pediatrics Guidelines for Pediatric Skin Care.

OBJECTIVE: To develop standard recommendations for skin care in neonates, infants and children to aid the pediatrician to provide quality skin care to infants and children. JUSTIFICATION: Though skin is the largest organ in the body with vital functions, skin care in children especially in newborns and infants, is not given the due attention that is required. There is a need for evidence-based recommendations for the care of skin of newborn babies and infants in India. PROCESS: A committee was formed under the auspices of Indian Academy of Pediatrics in August, 2018 for preparing guidelines on pediatric skin care. Three meetings were held during which we reviewed the existing guidelines/ recommendations/review articles and held detailed discussions, to arrive at recommendations that will help to fill up the knowledge gaps in current practice in India. The initial draft of the manuscript based on the available evidence and experience, was sent to all members for their inputs, after which it was finalized. RECOMMENDATIONS: Vernix caseosa should not be removed. First bath should be delayed until 24 hours after birth, but not before 6 hours, if it is not practically possible to delay owing to cultural reasons. Duration of bath should not exceed 5-10 minutes. Liquid cleanser with acidic or neutral pH is preferred, as it will not affect the skin barrier function or the acid mantle. Cord stump must be kept clean without any application. Diaper area should be kept clean and dry with frequent change of diapers. Application of emollient in newborns born in families with high risk of atopy tends to reduce the risk of developing atopic dermatitis. Oil massage has multiple benefits and is recommended. Massage with sunflower oil, coconut oil or mineral oil are preferred over vegetable oils such as olive oil and mustard oil, which have been found to be detrimental to barrier function.

Rituximab: A Magic Bullet for Pemphigus.

INTRODUCTION: Pemphigus, an autoimmune disease, was fatal before the era of corticosteroids. With the advent of steroids, mortality decreased but morbidity was present due to the side effects of high dose steroids. Newer drugs targeted at the molecular level are said to have fewer side effects and improved effectiveness. AIM: The aim of our study was to assess the effectiveness of one such drug, Rituximab, a biological, in treating pemphigus vulgaris and to identify common adverse events. MATERIALS AND METHODS: It was an open label prospective interventional study, conducted from September 2013 to May 2015, in the Department of Dermatology, Stanley Medical College, Chennai, Tamil Nadu, India. Twenty patients with pemphigus were included in the study. Ten were refractory to conventional therapy and 10, new cases. Patients who satisfied inclusion and exclusion criteria were included in the study after informed, written consent. Rituximab was administered according to Rheumatoid arthritis protocol. The patients were followed up as out patients after discharge, end points and adverse events were noted. RESULTS: There were 14 females (70%) and six males (30%). The mean age of the study group was 41.35 years. The mean disease duration was 11.7 months. The mean duration of follow up being 14.25 months. After rituximab, 13 patients remained in remission for varying periods of 3-22 months. The mean duration of complete remission off- treatment with Dexamethasone Cyclophosphamide Pulse (DCP) was 3.6 months; with rituximab it was 8.8 months. Seven (35%) patients relapsed during the study of whom six had received rituximab after being refractory to conventional treatment. Patients who relapsed had higher mean disease duration (21 months) than the remission group (6.384 months). Two patients (10%) developed immediate adverse events. Six patients (30%) developed late adverse events the commonest being reactivation of herpes labialis. CONCLUSION: Rituximab was effective in treating pemphigus vulgaris, was significantly better than conventional treatment, decreased the need for additional steroids and other immunosuppressants and induced prolonged remission. Rituximab was more effective when given early in the disease process. Further studies may highlight the need for additional cycles of rituximab to maintain sustained remission.

Platelet Rich Plasma: Efficacy in Treating Trophic Ulcers in Leprosy.

INTRODUCTION: Trophic ulcers secondary to leprosy pose a great stigma to the patients and remain a challenge to the treating dermatologists. The discovery of Platelet Rich Plasma (PRP) with its favourable role in wound healing is a boon for the patients. PRP introduces the growth factors directly into the wound and aids in rapid healing. AIM: To study the efficacy and safety of PRP in the healing of trophic ulcers secondary to Hansen's disease in a tertiary care centre in Southern India. MATERIALS AND METHODS: Based on inclusion and exclusion criteria, 50 patients were enrolled in the study. PRP was prepared by manual double spin method. After wound bed preparation, activated PRP was sprayed over the ulcer and occlusive dressings were applied. Same procedure was repeated every week until complete re-epithelisation or up to six sittings whichever occurred earlier. RESULTS: In our study, 46 patients (92%) showed complete healing. In 4 patients (8%), there was marked reduction in wound size with partial re-epithelization. In 88%, complete healing was seen after the fourth sitting. Mean time for ulcer healing was around 4.38 weeks. CONCLUSION: PRP therapy leads to faster rate of induction of granulation tissue with rapid healing. Healing had no direct statistical correlation with the size, site and duration of ulcer, the leprosy spectrum and associated motor deformities. It is a simple, safe and cost effective in-office procedure, albeit requiring an optimal set-up and expertise.

A Case Report of Dyschromatosis Universalis Hereditaria (DUH) with Primary Ovarian Failure (POF).

Dyschromatosis Universalis Hereditaria (DUH) belongs to a group of congenital diffuse reticulate pigmentary disorders characterised by both hypo and hyper pigmented macules. It is both hereditary and sporadic. A number of associated cutaneous and systemic diseases have been reported. The recent discovery of the mutation in ATP binding cassette protein, ABCB6 in DUH attempts to explain the reason behind the pigmentary abnormalities and varied associations. We add a new association by reporting a case of DUH with primary ovarian failure (POF) and hypothyroidism.

An association of Alternaria alternata and Scopulariopsis brevicaulis in cutaneous phaeohyphomycosis.

Rare molds are increasingly emerging as a cause of deep and invasive fungal infections. We report here a rare case of cutaneous phaeohyphomycosis of the lower limbs due to Alternaria alternata associated with extra-ungual localization of Scopulariopsis brevicaulis. Diagnosis was made based on repeated, direct, microscopic mycological and histological examinations. The study revealed hyphae and fungal cells in a granulomatous dermal infiltrate. Identification of the molds was based on macroscopic appearance on culture of samples from the lesions on Sabouraud's dextrose agar and microscopic appearance on Lactophenol cotton blue following slide culture.