DERMATOLOGY AND VENEREOLOGY

 

 

FACULTY

  

Professor and Head V.K. Sharma
Professors Neena  Khanna
  K.K. Verma
Additional Professors M. Ramam
Associate Professor Binod K Khaitan
Assistant Professor Sujay Khandpur
  G. Sethuraman

 

 

History

The department was set up in1950s under the Chairmanship of Late Prof K C 
Kandhari and subsequently stalwarts like Prof LK Bhutani (1974-1996 ), Prof JS Pasricha ( 1996-8 )and Prof RK Pandhi (1998-2001)headed the department. Prof KC Kandhari and Prof LK Bhutani laid the basic foundation of the department and started dermatolgic training module which is being followed still with minor modifications.

       

 

Facilities      The department caters to the needs of more than 30,000 outpatients and 3000 
                       inpatients per year. The following facilities are availlable for patients
:

                        Treatment of skin diseases

                        Treatment of diseases of hair, alopecia etc,

                        Treatment of Sexually transmitted diseases

                        Treatment of leprosy

                        Treatment of vitiligo, psoriasis, eczemas

                        Surgical Treatment of Skin problems

Specialised treatment of Pemphigus

 

Equipment and Facilities Available

 

PUVA Chambers

CO 2 Laser

Electrocautery

Pulse dye laser Coming soon

Hitopathology and Immunofluorescence

Mycology and fungal culture

AIDS testing and counselling and beds

 

 

TRAINING

 

 

Undergraduate  Training for MBBS students and Interns

Postgraduates      MD Dermatology and Venereology

Foreign Graduates Training in Tropical Dermatology and Venereology 

 

Short term Refresher training for those holding MD Dermatology

IADVL Fellowships in Contact Dermatitis, Pulse Therapy

         . 

 

Achievements of department

 

New inventive technologies introduced in our Institute

 

(i)             Innovative management of skin diseases

 

·        Pemphigus:      Dexamethasone cyclophosamide pulse therapy

                                 Oral betamethasone pulse therapy

 

·        Collagen vascular diseases: Dexamethasone pulse therapy

 
·       Azathioprine in treatment of airborne contact dermatitis, lichen planus,

Atopic dermatitis

 

·        Alopecia areata:          Treatment with diphencyprone

300 mg oral prednisolone bolus

 

·        Mycetoma:                 2 step treatment for mycetoma

 

(ii)             Innovations

Indian standard series for patch testing

 

New investigative procedures introduced by your Institute

 

·       Touch, pain & thermal sensation testing and grading devices, nasal filter

·       Dermograder

·       Cryostimulation test

·       Complete diet elimination for food allergy

·       A four week therapeutic test for cutaneous TB

·       Titre of contact hypersensitivity

·       Provocation test for severe drug reactions

·       Aluminium Patch Test Chambers

 

 

Research Completed 2000-2001

 

A       Broad Band UV-B in the treatment of Vitiligo

 

Seventeen patients (9 males, 8 females) between ages of 10 to 40 years were treated with
broad band UV-B twice a week by Waldmann’s UV 7001 K unit.  Eleven patients received 
25-44 (mean 33) exposure of UV-B over 4-6 months.  Repigmentation was observed in 
(72.7%) out of 11 patients and remaining 3 showed no response. Repigmentation was 
diffuse and to the extent of 10-25% only and none of the patients had satisfactory cosmetic
improvement.  It was concluded that broad band UV-B given twice a week over 4 months 
was not effective in vitiligo.

 

 

 

Research Continuing

 

 

A.    Role of contact allergens in the etiology of pompholyx.

B.    Natural history of parthenium dermatitis

C.   Hydroxyurea in the treatment of psoriasis

D.   Minodixil and betamethasone dipropionate combination in the treatment of extensive 
alopecia areata

E.    Diphencyclopropenone in the treatment of alopecia universalis and totalis

F.    Identification of risk factors for extensive vitiligo

G.   Evaluation of the effficacy of intravenous cyclophosphamide monthly pulse (15 mg/kg ) 
with daily oral prenisolone (1 mg/kg) in the therapy of pemphigus.

H.   Reproducibility of patch test at upper back, lower back and forearm in patients with
parthenium dermatitis.

I.      Effectiveness of CO2 laser in benign vascular lesions, epidermal and sebaceous nevi, 
angiofibromas & keloids

J.     Azathioprine  as  a  corticosteroid  sparing  agent  in   the treatment   of   air  borne  contact     dermatitis.     

K.    To  evaluate  the  role  of  immunosuppressive drugs for the treatment of chronic idiopathic 
urticaria.

L.     Long-term safety and toxicity of azathioprine in patients of air-borne contact dermatitis.

M.    Evaluation of efficacy of fixed duration (12 weeks) multidrug therapy with newer antileprosy 
 bactericidal drugs in multibacillary leprosy.

N.   A comparative study of punch grafting followed by topical conticosteroids vs punch grafting 
 followed by PUVA therapy in stable vitiligo.

O.    Further evaluation of Dexamethasone Cyclophosphamide Pulse therapy in pemphigus.

P.     Evaluation of punch grafting in halo naevi with/without limited vitiligo.

 

 

 

Collaborative research project completed

 

A.             Evaluation of PCR in the diagnosis of cutaneous tuberculosis (Microbiology, Pathology
and Biostatistics).

 

          The laboratory diagnosis of tuberculosis rests on the direct demonstration of Mycobacterium 
           tuberculosis in smears or biopsies and culture of the organism.  However, because most type
           of cutaneous tuberculosis are paucibacillary, it is often difficult to demonstrate or grow the 

           organism from the skin.  Over the last few years, some reports have documented the use of 

           PCR in identifying M. tuberculosis DNA in lesions of cutaneous tuberculosis.  However, the 

           test has not been prospectively evaluated in the diagnosis of the disease.  We performed PCR

           using primers and probes based on the published sequence of immunogenic protein MPB64,

           a gene unique to the M. tuberculosis complex.  The test was performed in 64 cases and 45 

           controls.  For the purposes of this study, cases were defined as patients who had all of the 

           following: skin lesions morphologically suggestive of cutaneous tuberculosis, a positive 

           Mantoux test, skin biopsy showing granulomatous dermatitis and  a clinical response to 

           standard anti-tubercular therapy.  Controls were defined as those patients who showed clinical

           and/or biopsy findings definitely indicative of a diagnosis other than cutaneous tuberculosis.

           Eighteen out of 64 cases and 11 out of 45 controls showed a positive result on PCR. Thus, 

           the test had a sensitivity of 28.1% a specificity of 75.6% and a likelihood ratio of a positive
           result of 1:1.  PCR for cutaneous tuberculosis does not appear to be a useful test in our hands.

           The search for a reliable diagnostic test for cutaneous tuberculosis must continue.

 

B.             Clinical evaluation of the efficacy and safety of topical butenafine in comparison with topical

          clotrimazole in tines cruris and tines corporis (Microbiology, Laboratory Medicine). 

 

          Butenafine hydrochloride is a new benzylamine derivative which has primary fungicidal activity
          against dermatophytes. We evaluated the efficacy and safety of butenafine in comparison with
          topical clotrimazole in the treatment of tinea cruris and tinea corporis in patients attending the 
          skin OPD at our hospital during the study period (February to December 2000).  All patients 
          who fulfilled the inclusion criteria for the study were randomly allocated to treatment with butenafine

          once daily for 2 weeks or clotrimazole twice daily for 4 weeks in a double blind manner. 
         
Clinical examination and microscopy of potassium hydroxide preparations of scrapings and 

          culture for dermatophytes were conducted at baseline and at 1 week, 2 weeks, 4 weeks, 6 weeks
          and 8 weeks following initiation of therapy.  Efficacy was evaluated by the presence of mycological 

          and clinical cure.  Adverse reactions, if any, were recorded at each visit.  Seventy-five patients

           were enrolled into the study, 37 were in the butenafine group and 38 in the clotrimazole group. 

           Fourteen patients in the butenafine group and nine in the clotrimazole group were lost to follow-up
        .  The sign and symptom score declined significantly in both the groups.  At the end of 8 week the 
           number of patients showing mycologic cure (on KOH preparation) in the butenafine and clotrimazole

           treatment groups was 20/22 patients and 27/28 patients respectively.  Three patients in each group

           showed relapses after treatment cessation.  Butenafine 1% cream is as effective as topically 

           applied  clotrimazole 1% cream in the treatment of tinea cruris and corporis with the advantage

           of once-daily application and shorter duration of treatment.

 

C.            A two-step schedule for the treatment of actinomycotic mycetomas (Microbiology)

 

 

Actinomycotic mycetomas usually respond slowly to treatment with antibiotics.  In an attempt to

hasten clinical resolution, we used a 2-step regimen consisting of an intensive phase of therapy 
with penicillin, gentamicin and co-trimoxazole for 5-7 weeks followed by maintenance therapy with amoxycillin and co-trimoxazole.  Seven patients were treated, all of whom showed significant 

reduction in discharge and swelling after the intensive phase.  Maintenance therapy was continued 

until the lesions completely healed clinically and upto 6 months beyond that maintenance therapy 
was given for 6-16 months (mean 10.7 months),  and patients remained free of disease during a
 mean post-treatment follow up of 6-4 months. The other 2 patients have also responded 
satisfactorily and continue to receive maintenance therapy.  Side effects necessitating a 

modification of the treatment schedule occurred in 2 patients but reversed on stopping the 
responsible drugs. This treatment schedule produces a rapid clinical response during the initial intensive phase and promotes compliance with the longer maintenance phase of treatment necessary to achieve a complete cure.   

 

 

Collaborative research continuing

 

 

A.    Dermatological  complications in renal transplant  recipient patients - A follow up study of 500 

      patients (Department of Nephrology).

 

B.     Role of electron beam radiation therapy for the treatment of mycosis fungoides (Department of

       Radiation   Oncology).

 

Publications in Journals  2000-2001

 

1.       Sharma VK.  Patch testing with European standard series and compositae extracts in patients 

           with air borne contact dermatitis. Contact Dermatitis 2001:44:49-50.

2.       Penchalaiah S, Handa S, Bijaya Lakshmi, Sharma VK, Kumar B. Sensitizers commonly causing 

          allergic contact dermatitis from cosmetics. Contact Dermatitis 2000; 43:311-312. 

3.             Sharma VK, Sahoo B.  Prurigo-nodularis like lesion in parthenium dermatitis.  Contact Dermatitis 2000;42 (4):235.

4.             Sood A, Sharma S, Sharma VK.  Morphoea with mucin deposits masquerading as scleromyxoedema.  Indian J Dermatol Venereol Leprol 2000;66:109.

5.             Vatve M, Sharma VK, Sawhney IMS, Kumar B.  Evaluation of patch test in identification of causative agent in drug rashes due to antiepileptics. Indian J Dermatol Venereol Leprol 2000; 66:132-135.

6.             Sharma VK, Prasad HRY. Management of Androgenic Alopecia.  Indian J Dermatol 2000:45:54-61.

7.             Sharma N, Sharma VK, Gupta A, Kaur I, Ganguly VK.  Immunological defect in leprosy patient altered T-lymphocyte signals.  FEMS Immunol Microbiol. 1999; 23 (4):355-62.

 

8.             Sarkar R, Kaur I, Das A, Sharma VK.  Macular lesions in leprosy: a clinical, bacteriological and histopathological study.  J Dermatol. 1999 26(9):569-76.

 

 

9.             Gupta A, Sharma VK, Vohra H, Ganguly NK.  Inhibition of apoptosis by ionomycin and zinc in peripheral blood mononuclear cells (PBMC) of leprosy patients. Clin Exp Immunol. 1999 117 (1):56-62.

 

10.          Srinivasan S, Nehru VI, Bapuraj JR, Sharma VK, Mann SB.  CT findings in involvement of the paranasal sinususes by lepromatous leprosy.  Br J Radiol. 1999; 72(855):271-3.

11.          Gupta A, Sharma VK, Vohra H, Ganguly NK.  Spontaneous apoptosis in peripheral blood mononuclear cells of leprosy patients: role of cytokines. Immunol Med Microbiol. 1999 24(1):49-55.

 

12.          Soni A, Mittal BR, Kaur I, Sharma VK, Pathak CM, Kumar B. Bone scintigraphy in leprosy. Int J Lepr 1998; 66(4):483-4.

 

13.     Sirka CS, Ramam M, Mital R, Khaitan BK, Verma KK.  Olmsted syndrome.  Indian J Dermatol Venereol Leprol 1999; 65:237-239.

 

14.          Ramam M, Manchanda Y, Verma KK, Sharma VK.  Reproducibility of titre of contact hypersensitivity to Parthenium hysterophorus.  Contact Dermatitis 2000; 42:366.

 

15.          Ramam M, Garg T, D’Souza P, Verma KK, Khaitan BK, Singh MK, Banerjee U. A two-step schedule for the treatment of actinomycotic mycetomas.  Acta Derma-Venereol, 2000; 80:378-380.

 

16.          Verma KK, Lalhanpal S, Sirka CS, Khaitan BK, Ramam M, Banerjee U.  Primary cutaneous actinomycosis.  Acta Derm-Venereol,1999;78:327.

 

17.          Grover JK, Vats V, Gopalakrishna R, Ramam M.  Thalidomide: a relook. Natl Med J india 2000; 13:132-141.

 

18.          Sharma VK, Achar A, Ramam M, Singh MK.  Multiple cutaneous horns overlying lichen planus hypertrophicus. Br J Dermatol 2001; 144:424-425.

 

19.          Ramam M, D’Souza P, Ravindraprasad JS, Iyer KV, Singh MK.  Mycosis fungoides treated with PUVA and topical corticosteroids.  Ind J Dermatol Venereol Leprol 2000;66:251-253.

 

20.          Ramam M, Kumrah L.  Systemic corticosteroid therapy and the hypothalamo-pituitary adrenal axis.  Ind, J. of Dermatol, 2001; 46:1-7.

 

21.          Verma KK, Mittal R, Manchanda Y Khaitan BK : Lichen planus treated with betamethasone oral mini pulse therapy. Indian  J Dermatol Venereol Leprol 2000; 66: 34-35.

 

22.          Verma KK, Rathi S, Pasricha JS: Failure of pentoxifylline to affect airborne contact dermatitis caused by Parthenium. Ind J Dermatol Venereol Leprol 2000; 66: 129-131.

 

23.          Verma KK, Lakhanpal S, Sirka CS, Khaitan BK, Banerjee U: Disseminated  mucocutaneous            blastomycosis  in  an    immunocompetant Indian  patient  treated with ketoconazole.  J Euro  Acad Dermatol Venereol 2000; 14: 332-333.

 

24.          Verma KK, Parida DK, Rath GK: Cutaneous T-cell lymphoma treated with electron beam radiation - Indian experience. J Euro  Acad  Dermatol Venereol 2000; 14 (suppl 1): W 41 (Abst).

 

25.          Verma K and Verma KK: Infantile periocular haemangioma treated with betamethasone oral mini pulse therapy. Ind J Ped 2001; 68: 367-368.

 

26.          Khaitan BK, Mittal R, Ramam M, Jain Y. Flexural keratoderma, recurrent purpura, gastroenteritis and respiratory tract infection. Indian J Pediatr Dermatol, 2000; 3: 23-24.

 

27.          Sood A, Khaitan BK, Khanna NK, Kumar R, Singh MK. Syringocystadernoma papilliferum at unusual sites.  Indian J Dermatol Venereol Leprol 2000; 66:328-329.

 

 

Chapters in books and monographs

 

 

1.             Sharma VK, Treatment of Cutaneous tuberculosis and Mycobacterial Infections.  In, Workbook of 4th National CME on Dermato Pathology, New Delhi, 2000.   

 

2.             Sharma VK: Treatment of Difficult Psoriasis, In, Dermatology Update-2000, Edited by Col. S.K. Sayal, Base Hospital, Delhi Cantt.

 

3.             Ramam M, Satish D, Thomas J,  Parikh DA, Skin diseases in children, In:Parthasarathy A, Menon PSN, Nair MKC, Lokeshwar MR, Srivastava RN, Bhave SY et al, Editors, IAP Textbook of Pediatrics New Delhi, 1999, p 814-820.

 

4.             Ramam M. Cutaneous tuberculosis.  In: Sharma SK, Mohan A, Editors, Tuberculosis, New Delhi, Jaypee brothers Medical Publishers (P) Ltd., 2001, P 261-272.

 

 

5.             Ramam M, Gupta LK, Dermatologic Emergencies in Children. In: Singh M, Editor, Medical Emergencies in Children, 3rd edition, New Delhi, 2000, p 587-601.

6.             Khaitan BK, Mittal R. “Role of vitamin E as an antioxidant in Dermatology.

In, Sacchinand S, Editor, “Role of Antioxidants in Dermatology” published by 28th National conference of IADVL, 2000: 57-60.

 

7.             Khaitan BK. Pulse Therapy in Dermatology

In, ‘Dermatology Update-2000’ Edited by Col. S.K. Sayal, Base Hospital, Delhi Cantt.

 

8.             Khaitan BK, Dattagupta, S, D’Souja P. Fungal Infections

In, Workbook of 4th National CME on Dermatopathology, New Delhi, 2000.

 

9.        Current Literature Dermatology 1999-2000.

           Pasricha JS, Misra RS, Ramesh V, Ramam M, Khaitan BK et al.

     IADVL (Delhi State Branch), New Delhi.

 

10.    Verma KK and Singh MK: Vesiculobullous Disorders,  in  Work-book - 4th National CME on Dermatopathology, AIIMS, New  Delhi, 2001;
          p 1-6.

 

 

Significant events

 

            Indo US workshop on Sexually Transmitted Diseases and Reproductive Tract Infections, New Delhi (Nov. 8-10,2000) in colloboration with Department of Biotechnology & Department of Pathology.

 

 

2.       4th National CME on Dermatopathology in collaboration with Department of pathology on  Feb. 24=25th, 2001.

 

4.             Prof. V.K. Sharma received Indian Council of Medical Research “Lala Ram Chand Kandhari” award for Dermatology and Sexually Transmitted Diseases.

 

 

5.             Prof. V.K. Sharma served as President, Indian Association of Dermatologists, Venereologists  & Leprologists(Delhi State Branch) for the Year 2000 and Honorary Secretary – Contact and Occupational Dermatoses Forum of India (CODFI) for the year 2000.

 

6.             Dr. B.K. Khaitan served as Vice-President, Indian Association of Dermatologists, Venereologists & Lepropolgists (DSB) for the year 2000.

 

7.             Dr. K.K. Verma served as Honorary Secretary – Indian Association of Dermatologists, Venereologists and Leprologists (DSB) for the year 2000.