Introduction:The use of Ayurvedic medicines have been increasing for skin ailments. The medical fraternities are concerned about the safety and efficacy of Ayurvedic products. We conducted this study because there is a scarcity of data regarding the perception of dermatologists towards the Ayurvedic treatment for psoriasis. Objective:We would like to understand the perception of dermatologists regarding the outcome of Ayurvedic therapy for psoriasis. Method:This cross-sectional pilot survey was executed after an approval from the institutional ethics committee, in Mumbai metropolitan area in India using pre-validated questionnaire to collect the data from 100 dermatologists. The questionnaire consisted of 4 sections: 1) Dermatologists' demographics, 2) Dermatologists' perception regarding the Ayurvedic therapy, 3) Dermatologists' general attitude towards the use of the Ayurvedic therapy for psoriasis and 4) Their personal experiences about the Ayurvedic therapy. The data were analyzed by descriptive statistics. Results:The dermatologists perceived that the impact of the Indian culture and the desire for a better outcome were the primary reasons for the use of Ayurvedic medicines by the patients. 95% of the dermatologists were aware about the patients' use of the Ayurvedic medicines for psoriasis. 56% dermatologists observed various skin related untoward effects in the patients who claimed taking Ayurvedic medicines for psoriasis. 55% dermatologists did not comment on the effectiveness of the Ayurvedic therapy on scaling, thickness and the redness of skin. 57% dermatologists did not comment on the effectiveness of the Ayurvedic therapy on itching and the size of the affected areas in psoriatic patients. 22% Dermatologists strongly agreed and 55% agreed that they should have the knowledge of Ayurvedic drugs for psoriasis. As per the dermatologists (53% strongly agreed and 38% agreed), the patients should inform them about their use of Ayurvedic medicines. 36% dermatologists strongly agreed and 40% agreed that they should be able to advise their patients about the pros and cons of the concomitant use of the Ayurvedic therapy with the modern medicine. 56% dermatologists strongly agreed and 26% agreed that the Ayurvedic medicines not tested by modern scientific methods should be discouraged. 16% dermatologists reported that they used Ayurvedic medicines. Conclusion:The perception of dermatologists regarding the Ayurvedic drugs-use is mixed. Rigorous steps are needed to bridge the gap between dermatologists and their knowledge about Ayurvedic therapies for treating the patients suffering from incurable diseases like psoriasis. We provide recommendations to bridge this gap.

Background: Crusted scabies results from a failure of the host immune response to control the proliferation of the scabies mite in the skin, with resulting hyperinfestation and a concomitant inflammatory and hyper-keratotic reaction. However, it has also been recognised in people with no evident immunological deficit. Case history:We present a case report of apparently immunocompetent 16-year-old female presenting with multiple hyperkeratotic vegetating plaques over limbs, excoriated papules over trunk with minimal itching since 2 years without any positive family history. The microscopic examination of the skin scales with potassium hydroxide demonstrated numerous scabies mites and eggs. Histopathology showed hyperkeratosis with multiple mites in stratum corneum. Numerous mites were seen on biopsy of lesion. X-ray showed osteolysis of distal phalanges secondary to chronic pressure. Repeated topical treatments with permethrin and oral ivermectin led to the considerable resolution of her lesions. Conclusion:We present a rare case of crusted scabies with osteolysis in an immunocompetent female.

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Background: Systemic sclerosis (SSc) is an autoimmune chronic multisystem disorder with a plethora of cutaneous manifestations. These manifestations often may be the only presenting complaint. Early identification of these help in diagnosing grievous systemic manifestations and their prompt and appropriate treatment. Aims: To study the clinical profile of SSc, modified Rodnan’s skin scoring (mRSS), nailfold capillaroscopy (NFC) patterns, antibody profile in the western India population, and their association with cutaneous manifestations. Methods: Patients of SSc fulfilling the European League Against Rheumatism (EULAR) 2013 classification of SSc criteria, who attended dermatology outpatient department (OPD) between January 2017 and September 2018 were included in the study. The demographic data, cutaneous features, autoantibody profile, mRSS, and NFC pattern were noted Results: A total of 60 patients (57 females and 3 males; mean age years) of SSc were evaluated. Clinical subtypes were 40 diffuse cutaneous SSc and 20 limited cutaneous SSc. The most common presenting symptoms were Raynaud’s phenomenon (RP) (95%) and skin tightening (90%). The common cutaneous findings were sclerodactyly (86.7%), stellate scars (78.3%), parrot-beaked nose (76.7%), mask-like facies (75%), microstomia (56.7%), salt and pepper pigmentation (55%), puffy finger (46.7%), telangiectasia (46.7%), digital ulcer (38.3%), fixed flexion deformity (33.3%), and calcinosis cutis (8.33%). Limited cutaneous systemic sclerosis (lcSSc) had mRSS score of 8.3 ± 4.1 and diffuse cutaneous systemic sclerosis (dcSSc) subset had a score of 28 ± 10.4. Antinuclear antibody (ANA), Anti-topoisomerase antibody (ATA), and anti-centromere antibody (ACA) were positive in 59, 49, and 7 patients, respectively. The NFC patterns were early (23.3%), active (45%), and late (18.3%). Limitation: The sample size of the study was small. We were not able to determine the significance of other less common autoantibodies with scleroderma. Conclusion: The study highlights the importance of identifying early cutaneous findings and the role of a useful diagnostic and prognostic reproducible scoring system (mRSS) and NFC.