Ramesh Marne Bhat

Skin‐related neglected tropical diseases (skin NTDs) remain visible markers of health‐system inequity. The World Health Organization (WHO) road map for neglected tropical diseases 2021–2030, its 2022 strategic framework for skin NTDs, and the WHO Global Report on Neglected Tropical Diseases 2025 already establish integration, primary‐care mainstreaming, and improved access to diagnostics and medicines as global priorities. Drawing on Workshop 1 of the 4th International League of Dermatological Societies (ILDS) World Skin Summit, this viewpoint positions the Cape Town Action Plan not as a competing policy framework, but as an implementation compact for translating existing commitments into locally owned service readiness, accountable delivery, and measurable follow‐through.

Background: Acne vulgaris is a common skin condition that typically begins in adolescence but can often persist in adulthood, contributing to significant physical and psychosocial burden. Despite the availability of multiple treatment options, challenges such as poor adherence, treatment‐related side effects, and post‐inflammatory hyperpigmentation remain common in clinical practice. Dermocosmetics are increasingly used in acne management, either alone in mild cases or as adjuncts to medical therapy. Objectives: To assess acne prevalence, treatment practices, and key management challenges, along with the role of dermocosmetics, based on expert consensus from India. Methods: A panel of 10 dermatologists participated in a modified Delphi process comprising a pre‐meeting survey followed by a structured advisory board discussion, capturing clinical practice patterns, treatment approaches, and perspectives on dermocosmetic use in acne management. Results: Experts reported treating a high number of acne patients, primarily adolescents, with a higher proportion of females. Hyperpigmentation and scarring were common sequelae of acne, while treatment adherence and antibiotic resistance, particularly to erythromycin and azithromycin, were noted as key challenges. Procedural interventions, including chemical peels, lasers, and comedone extraction, were increasingly used in early acne management, especially in patients prone to post‐inflammatory hyperpigmentation and relapse. Low‐dose isotretinoin and hormonal therapies were commonly used in acne management, while dermocosmetics were utilized as monotherapy in mild cases and as maintenance therapy following treatment in more severe cases. Lifestyle factors such as high glycaemic diets, whey protein, multivitamins, and steroid‐like drugs were identified as potential contributors to acne exacerbation. Limitations: Findings are based on a small expert panel convened with industry support and reflect clinical opinion rather than primary patient data. Conclusion: Procedural interventions are becoming more popular, thereby providing an opportunity to incorporate dermocosmetics into acne treatment regimens.

We present a case of chromoblastomycosis with lobular lesions resembling lobomycosis over the forearm. A skin biopsy from the nodule revealed a mixed inflammatory infiltrate in the dermis with dark brown pigmented ovoid-to-spherical thick-walled spores known as copper pennies. There was a progressive decrease in the size of lesions within 3 months of therapy with oral itraconazole.

Neglected tropical skin diseases (NTDs) are a group of overlooked afflictions that affect marginalized populations and hinder the advancement of global health in the right direction. India, a significant hotspot, suffers immensely from these diseases, with South India providing a conducive environment for the spread and persistence of causative pathogens, leading to disastrous local and, ultimately, global consequences. Diseases such as leprosy, subcutaneous and deep mycoses, leishmaniasis, and filariasis are endemic to this region. Understanding the factors that make South India a hub for these diseases is crucial in getting to the heart of the problem. Despite notable progress, NTDs persist, sustained by the factors such as low socio-economic status, congested living conditions, and malnutrition. The challenges in NTD management encompass delayed diagnosis and resistance. However, initiatives such as the Kigali Declaration advocate for global collaboration, stressing prevention, treatment, and research. A thorough literature search was undertaken, concentrating on peer-reviewed articles and case reports published in English within the past decade. This systematic review aims to probe into the intricate facets of NTDs in South India, delving into each dermatological NTD in detail, spotlighting their essence, prevalence, socio-economic reverberations, hurdles, and the necessity for collective action. By prioritizing NTD control in South India, we can collectively alleviate local suffering and contribute to global health security and equity, charting a course toward a healthier, more resilient world.

Vitiligo is a depigmenting disorder characterized by melanocyte loss, which results in pigment dilution of the skin. Vitiligo is commonly associated with thyroid disorders and thyroid stimulating hormone (TSH) is a sensitive marker to detect thyroid disorders. S100B is damage associated molecular pattern (DAMP) molecule released when there is melanocyte damage. In this study, we are estimating the serum TSH and S100B levels in vitiligo patients and controls and correlating them with disease activity. A cross-sectional study was conducted on 39 cases of vitiligo and controls. Demographic details were collected, the cases were examined and Vitiligo European Task Force (VETF) scoring was performed. Serum S100B was analyzed using an ELISA kit and serum TSH levels were estimated. Age of the participants ranged from 14 to 81 years with a mean and standard deviation of 44.08 ± 16.078 years. Female preponderance was noted. Vitiligo vulgaris was the most common presentation. Serum TSH (p = 0.32) and S100B (p = 0.22) levels between cases and controls were not statistically significant. Serum S100B level had a weak positive correlation with the spreading component of VETF score and it was statistically significant (p = 0.004). Mucosal vitiligo had higher levels of serum S100B levels compared to other types of vitiligo. In our study both serum TSH and S100B levels have demonstrated limited utility in distinguishing between vitiligo patients and controls. S100B showed a weak correlation with VETF scores indicating its potential (though limited) as a disease activity marker. Therefore, the potential of using this as a biomarker is debatable, and further multicentric studies with a larger sample size are required to establish the correlation.

A much is known about the cutaneous side effects of topical corticosteroids (TCs) often neglecting their potential systemic adverse events, including Cushing’s syndrome (CS). Although cases of CS following TCs abuse are a well-documented entity in the pediatric population, similar instances in adults are less common and less discussed. Here, we describe a case of dermatophytosis where the patient developed multiple systemic adverse effects, including significant weight gain, numerous skin striations, and blurred vision, as a result of TCs misuse complicating the otherwise non-significant disease. Hence, it is crucial to emphasize the importance of consulting a dermatologist instead of relying on easily accessible over-the-counter medications from pharmacies, which many people in the general population often resort to.

Introduction Rapid progress made in the management of atopic dermatitis (AD) in recent years and the differences in patient journey between Asian and non-Asian populations call for a review of current atopic dermatitis landscape in Asia. Methods A roundtable meeting with nine regional dermatological experts was held in June 2023 to discuss the optimal management approaches for moderate-to-severe AD, focusing on the use of advanced therapies. Results Disease burden on patients’ quality of life, treatment adherence, and financial constraints were identified as major concerns when managing patients with moderate-to-severe AD in parts of Asia. It was agreed that the Hanifin and Rajka’s criteria or the UK Working Party’s Diagnostic Criteria for Atopic Dermatitis can be used to guide the clinical diagnosis of AD. Meanwhile, patient-reported outcome scales including the Dermatology Life Quality Index and Atopic Dermatitis Control Tool can be used alongside depression monitoring scales to monitor treatment outcomes in patients with AD, allowing a better understanding for individualized treatment. When managing moderate-to-severe AD, phototherapy should be attempted after failure with topical treatments, followed by conventional disease-modifying antirheumatic drugs and, subsequently, biologics or Janus kinase inhibitors. Systemic corticosteroids can be used as short-term therapy for acute flares. Although these advanced treatments are known to be effective, physicians have to take into consideration safety concerns and limitations when prescribing these treatments. Conclusions Treatments in AD have evolved and its management varies country by country. Unique challenges across Asian countries necessitate a different management approach in Asian patients with AD.

Background. Although leprosy, a neglected tropical disease, has been eliminated (<1 case per 10 000 population) in South Africa (SA) since 1926, according to the World Health Organization, new cases continue to be reported. The management of leprosy poses several challenges, including patient adherence, education and insufficient training of healthcare practitioners. Objectives. To describe the biographical profile, clinical manifestations and treatment outcomes in patients with leprosy in KwaZulu-Natal Province. Methods. This retrospective study aimed to analyse the clinical data of leprosy patients in SA from 2002 to 2022. Data collected included patient demographics, comorbidities, cutaneous and neurological manifestations of leprosy, complications, treatment and adverse reactions. Descriptive statistics were used to summarise the data. Results. The study analysed the clinical data of 194 leprosy patients from 2002 to 2022. The majority of patients were male and middle aged, with a disproportionate representation of black South Africans. Regarding socioeconomic status, 80% were unemployed and 40% were social grant recipients. Most cases were clustered in urban centres and diagnosed at secondary care facilities, with 15% being HIV positive. The majority of patients (90%) were classified as having multibacillary leprosy. Common symptoms included upper respiratory tract involvement, hair loss and painful nerves, with the face and limbs being most frequently affected. Cutaneous morphology predominantly included plaques and hypopigmented patches, while neurological signs included ulnar nerve tenderness, muscle weakness and sensory deficits. Debilitating neurological complications were found in one-fifth of patients. Despite initiation of multidrug therapy in most patients, a significant proportion (27.3%) did not complete the full course of treatment, and treatment reactions were noted in 33.5% of patients. Conclusion. These findings emphasise the urgent need for enhanced patient and healthcare worker education, particularly in primary healthcare settings, to improve adherence to treatment, advocate for prophylactic measures and prevent new cases. Achieving leprosy-free status in SA requires the collaboration of many role-players to address these challenges and improve healthcare practices.