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 8 (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

1 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.