Linear focal elastosis (LFE) is an uncommon, benign, acquired elastotic condition with uncertain pathogenesis. It is characterized clinically by asymptomatic, multiple, yellowish, elevated, irregularly indurated, striae-like lines or bands distributed horizontally across the lower and middle part of the posterior trunk. The histopathological hallmark of LFE is a focal increase of elastic fibres in the dermis. The differential diagnosis is varied, and striae distensae is the closest mimic of LFE. Response of LFE to treatment is often poor. The focus of this article is to provide insights into this condition for dermatologists.

Background: Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe cutaneous adverse reactions of major concern because of its high mortality. The prognosis of SJS and TEN is widely assessed with SCORTEN (SCORe of TEN). Although, it is a largely useful scale, the predictive ability is still variable. Aims and Objectives: This study was conducted to assess the clinicoetiological profile and outcome of SJS and TEN and to evaluate the validity of SCORTEN in assessing the prognosis in South Indian population. Methods: This prospective observational study was conducted in the Department of Dermatology, Venereology and Leprosy in a Tertiary care hospital from January 2016 to June 2017. Detailed history, examination findings, treatment and SCORTEN scores were recorded. SCORTEN's accuracy in predicting the mortality was assessed on day 1, 3 and 5 of admission. Results: The incidence of SJS/TEN among other drug reactions was 29.5%. The most common age group affected was 30-49years (41.1%), with male preponderance (76.5%). The age range of patients was 6 and 67 years. TEN (64.7%) was the predominant spectrum followed by SJS and SJS-TEN overlap in 17.6% each. Anticonvulsants (47%) were the commonest causative drug, followed by analgesics (35%) and antibiotics (11%). The validity of SCORTEN was the same on days 1, 3, and 5. There was good agreement between the actual and predicted mortality on all three days. A mortality of 17.6% (3 cases) was recorded in this study. Three patients (17.6%) died in our study. All survivors had a score of 4 or less. The predicted mortalities were 0.417, 1.836, and 2.574 and the observed mortalities were 0, 2, and 1 in SJS, SJS-TEN overlap, and TEN respectively. Analysis of SCORTEN on a single day, either day 1, 3, or 5 was found to be as useful as the serial analysis. Conclusion: SCORTEN gave a significant estimation of mortality in SJS-TEN overlap patients, whereas it overestimated mortality in TEN patients. An increase in individual scores for the elevation of blood urea nitrogen (BUN) in existing SCORTEN and the inclusion of new parameters like raised liver enzymes, thrombocytopenia, and pulmonary infiltrates aided in proposing a modified SCORTEN for the South Indian population. Further studies on a larger scale, are needed to validate the modified SCORTEN proposed by us.

Background Hair dye is a concoction of various ingredients that can result in allergic contact dermatitis (ACD) which is a common problem encountered by dermatologists. Objectives To find out the presence of potent contact sensitizers in commercially available hair dyes in Puducherry, a union territory in South India, and to compare the findings with similar studies conducted in different countries. Methods Ingredients labels of 159 hair dye products from 30 brands that were manufactured and marketed in India screened for the presence of contact sensitizers. Results A total of 25 potent contact sensitizers were found in 159 hair dye products. p‐Phenylenediamine and resorcinol were the most frequent contact sensitizer found in the study. The mean contact sensitizer concentration in a single hair dye product is 3.72 ± 1.81. The number of potent contact sensitizers in individual hair dye products ranged from 1 to 10. Conclusion We observed that most of the consumer‐available hair dyes contain multiple contact sensitizers. Also, an inadequacy in mentioning the p‐Phenylenediamine content, and appropriate warning contents regarding hair dye use were not mentioned in the cartons.

Pitted keratolysis (PK) is a common superficial bacterial skin infection confined to the stratum corneum. It is clinically characterized by multifocal, discrete, pits or crater-like punched-out lesions, commonly over the pressure-bearing aspects of the foot. It is asymptomatic and associated with malodor. The surface is often moist and macerated. The diagnosis of PK is often clinical and unnecessary diagnostic procedures are not warranted. Lifestyle modifications form the cornerstone of the management of PK. It responds well to topical antimicrobials.

Background: Cutaneous adverse drug reactions (CADRs) are among the most frequently reported adverse drug reactions (10 to 30%) with overall incidence of 6.2/1000 cases in India and 8% of hospitalisation among Dermatology inpatients. The aim was to analyse the CADRs with reference to its prevalence, causative drugs, morphological patterns, polypharmacy and drug reaction severity by Hartwig’s severity assessment scale.Methods: This study was a retrospective study done in the Department of Dermatology, Venereology and Leprosy (DVL) over a period of 5 years (2015 to 2019) from CADR registers. Mean, standard deviation and chi square test were used for statistical analysis. P≤0.05 was considered as statistically significant.Results: A total of 134 cases of CADRs were encountered which comprised 0.2% (2/1000) of total OP census with equal gender ratio and involved most commonly the younger adults. The drug groups mainly responsible were anticonvulsants (24.7%) followed by non-steroidal anti-inflammatory drugs (NSAIDS) (22.5%), antibiotics (20.9%) followed by antiretrovirals (ART) and antituberculous drugs (ATT). The common morphological patterns were acute exanthem (32.2%), exfoliative dermatitis (14.9%) and toxic epidermal necrolysis (14.2%). Over the counter drugs accounted for 25.6% of cases. Around 38.1% were on polypharmacy. In this study, 15.7% had mild CADR, 53.7% had moderate and 30.6% had severe drug reactions with 2.2% mortality based on the Hartwig’s severity assessment scale. Commonest cause of severe CADRs was anticonvulsants and benign CADRs was NSAIDS.Conclusions: Proper history taking and documentation of data, recollection of sequence of events by the patient and drug re-challenge will help us in deciding the causative drug preventing further occurrence.