<p class="abstract"><strong>Background:</strong> Amyloidosis is defined as extracellular deposits of heterogenic, misfolded proteins, amyloid fibrils, in various tissues. The term primary cutaneous amyloidosis (PLCA) usually includes macular amyloidosis (MA), lichen amyloidosis (LA) and nodular amyloidosis. Primary cutaneous amyloidosis is very common in Kerala probably due to socio-cultural practices. There has been no published data on PLCA from Kerala thus we undertook this study. The objectives of the study were to correlate clinical features of primary localized cutaneous amyloidosis with histopathologic findings; to evaluate the sensitivity of Congo red staining with polarized light in histopathologically proven primary localized cutaneous amyloidosis)</p><p class="abstract"><strong>Methods:</strong> We undertook an observational analysis for a period of 2 years from May 2012 to April 2014 in the Department of Dermatology, Amrita Institute, Cochin. All cases clinically diagnosed as cutaneous amylodosis were included in the study. After informed consent, skin biopsy was taken. The histopathologic sections were stained with Congo red and seen under polarized microscopy for apple green birefrengance.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 70 patients were included in the study. Of the 70 cases, there were 20 males and 50 females. The most common clinical type was lichen amylodosis observed in 32 patients followed by macular amylodosis (28) and biphasic amyloidosis (10) cases. Histopathological compatibility was seen in 71% of MA and 89% cases of LA. Congored positivity was seen in 53.8%. Congored stain under immunofluorescence microscopy was done for 30 patients which gave a positivity of 85% which indicates that it is more sensitive that polarizing microscopy.</p><p><strong>Conclusions:</strong> Our study showed that the most common type is lichen amylodosis. Histopathology and congo red staining with polarized light is a valuable aid in diagnosis. Congo red stain under immunofluorescence microscopy has greater sensitivity and improves the diagnostic yield. </p>

Dermatophytosis is one of the leading causes of visits to the Dermatology department, especially in India, where the hot and humid climate favours fungal acquisition and perpetuation. Usual modalities of treatment include the use of either oral or topical antifungals or a combination of both, depending upon the severity and extent of infection as well as the type of causative organism. But lately, steroid-modified dermatophytosis, an iatrogenically perpetuated dermatophytosis caused by the indiscriminate use of topical corticosteroids has emerged as a troublesome pandemic. We planned a cost-of-illness analysis of superficial dermatophytosis assessing the direct costs of dermatophytosis treatment borne by the health system, comparing the direct costs in steroid-naïve and steroid modified dermatophytosis. In our study, the average total cost of treatment for steroid naïve and steroid-modified dermatophytosis was found to be Rs 2172.41 and Rs 3770.60 respectively meaning that the patients who used topical steroids spend additional 40% on an average for treatment, when compared to steroid-naïve patients. The need for more consultations, investigations (considering the atypical presentations) and extended duration of treatment with higher antifungals were found to contribute to the increased financial burden in steroid-modified dermatophytosis.

Gram staining is a differential staining technique performed when a bacterial infection is suspected. The technique classifies bacteria into two broad groups: Gram negative and gram positive bacteria. In this net educational video, we have demonstrated the method of Gram staining.

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Erythrokeratodermas are genodermatoses of keratinisation which usually presents in infancy. Erythrokeratoderma en cocardes is a rare variant of erythrokeratoderma which present as polycyclic hyperkeratotic plaques with a peripheral desquamation, forming a concentric appearance termed ‘en cocarde’. Here, we report a case of erythrokeratoderma en cocardes with onset in childhood showing excellent response after 2 months of acitretin therapy.