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Introduction: With an improvement in medical services and with increased life expectancy, in both developed and developing nations, the geriatric population is increasing and with this their medical needs including their cutaneous problems are also gaining more attention. This study highlights the various dermatoses prevalent in the geriatric population. Early detection of few of the dermatoses not only helps in their early treatment but also prevents further progression. Skin being the mirror of the internal body system often gives definitive clues for diagnosing several systemic ailments which are quite common in this age group. On the other hand skin is also at the receiving end and many systemic illnesses and medications modify the dermatological presentation in the elderly population. Methods: The geriatric patients (aged 60 years and above), attending Dermatology Outpatient Department in a tertiary hospital over a period of one year were included in this study. About 360 patients were included in this study. Results: Itching was the commonest presenting complaint and wrinkles were the commonest dermatological finding. Disorders of hair and nails was also were very common. A total of 7 patients out of the study group had malignant skin cancers and they were managed and followed up after the end of the study period to note any recurrence. Conclusion: The 60 and older patient population is a rapidly growing dermatology clientele with unique skin, hair, and nail issues. This study highlights the various dermatoses peculiar to the geriatric population and aims at sensitizing the fraternity to the specific needs of this special age group.

Background:Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. It is diagnosed based on clinical features and confirmed on the histological findings and peripheral slit-skin smear staining. Dermoscopy is a handy, easily accessible tool to diagnose this granulomatous disease and classify patients based on the immunological and clinical response.Methods:A single spot observational analysis was conducted in a tertiary hospital in North India. Patients attending the leprosy clinic and admitted patients for institutional therapy on the day of the study were enrolled in the cohort. The clinical and histological findings were correlated with the characteristic dermoscopy findings. A total of 50 patients were included in the study. All patents included in the study were on multidrug therapy and anti-lepra reaction drugs for a duration of less than 6 months.Results:The dermoscopy findings correlated with the clinical and histological findings. Tuberculoid poles of leprosy classically showed loss of hair and skin pigment along with absence of white dots as sweat glands in dermoscopy. Lack of blood vessel changes ruled out any lepra reaction. Lepromatous pole of leprosy on the other hand showed characteristic xerosis and white scaling on dermoscopy in the background of hypotrichosis and hypopigmentation. Leprosy reactions were characterized by blood vessel changes and arborizing blood vessels were characteristic in erythema nodosum leprosum, and a diffuse erythema was a clue toward diagnosing type I lepra reaction. Interestingly, clofazimine-induced pigmentation was picked up characteristically on dermoscopy as a “honey comb pattern”.Conclusion:Dermoscopy is certainly a handy tool in aiding the diagnosis of leprosy, lepra reactions, and course of therapy. Characteristic patterns during the course of leprosy would certainly facilitate a quick and definitive diagnosis of patients suffering from leprosy. Also, patient drug compliance particularly to clofazimine can also be picked up objectively on dermoscopy.

Immune reconstitution inflammatory syndrome (IRIS) is a condition during the clinical course of HIV infection in which there is paradoxical worsening and/or new onset of opportunistic infections in a HIV-positive patient who has recently been started on anti-retroviral therapy (ART). We present a case of AIDS with CD4 count of 20 cells/μl who presented within 6 weeks of starting ART with a CD4 count of 160 cells/μl and a painless solitary genital ulcer along with annular dark-colored plaques over soles. His screening test for syphilis was negative both during baseline evaluation, prior to initiation of ART, and during his clinical presentation. His disease was confirmed based on a positive treponema pallidum hemagglutination test report and a suggestive skin biopsy. He responded well to three doses of Benzathine Penicillin and continuation of ART. There are very few case reports of syphilis presenting as IRIS and this case is all the more unique as he had features of both primary and secondary syphilis occurring together within 6 weeks of starting ART. This report would reiterate the fact that syphilis and HIV co-infection can alter the natural course of both the diseases and a high index of suspicion is required for treating them.

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