Dermatological disorders can be grouped into various groups like connective tissue disorder, vesiculo bullous disorder, autoimmune disorder like vitiligo alopecia, papulosqamous disorder like psoriasis etc.  These disorders require long term management making it impractical for these patients to be seen in general OPD Hence to cater for the needs of these patients, specialized clinics have been started The details of which are as follows.

SPECIAL CLINICS ACTIVITIES

1. Leprosy clinic

Patients with hypopigmented & hypoaesthetic patches are evaluated in Hansen's clinic based on clinical parameters like thickened nerves, morphology of patches, deformities & tropic ulcers and bacteriological parameter like positive slit skin smears for bacteriological & morphological indices. Depending on the above the patients are classified according to Ridley -Jopling's classification into paucibacillary and multibacillary cases and are treated accordingly.

Treatment protocol

MDT-MB for one year in cases with more than five patches &/ or more than two nerves/ or positive smears. Surveillance period -5 years.

MDT-PB for six months in cases with less than 5 patches &/or one nerve &/or smear negative cases. Surveillance period-2 years.

ROM single dose for single patch.

Referring of patients for continued therapy to treatment center near their residence
Treatment of reactions in leprosy
Referring patients to Ackworth Leprosy Hospital for MCR footwear
Co-ordination with physiotherapists & plastic surgeons for management of deformities.

2. Steroid follow up clinic

The most commonly encountered Vesiculobullous disorders are pemphigus vulgaris, bullous pemphigoid, linear IgA dematosis, erythema multiforme, and dermatitis herpetiformis & cicatricial pemphigoid.  Patients are valuated with regards to duration & episode of disease, causes of relapse, past & present treatment, morphology lesions, scoring of skin & mucosal lesions.

Investigation -
Routine biochemical analysis
Ophthal examination
Bone densitometry

Specific investigations

- Tzanck smear
- Histopathology
- Direct Immunofluorescence
- Indirect Immunofluorescence
- ELISA for Desmoglein 1 & 3

Treatment protocol:
Prednisolone (2 mg/kg) with cyclophasphasmide (2 mg/kg)
Prednisolone (2 mg/kg) with IV gamaglobulin (20 mg/kg X 3 days in a month)
Prednisolone (2 mg/kg) with Dapsone
Monthly pulse therapy of dexamethazone 100 mg and cyclophasphasmide 500 mg

3. Contact Dermatitis Clinic:

Various eczematised dermatoses including housewife eczema are recurrent and resistant to treatment.  In such situation a patch test is important role in diagnosing suspected allergens.  Such patients are evaluated with reference to duration of disease, exacerbating factors, history of atopy or allergy in the patient & his family, site & morphology of skin lesions.

Investigation
Patch testing with universal/shoe/cosmetic/plant series

Treatment protocol

Systemic & topical steroids
Barrier cream

4. Alopecia Clinic

In this clinic patients of alopecia areata, alopecia universals, alopecia totalis, cicatricial alopecia & patients with diffuse hair loss are evaluated with reference to duration of hair loss, precipitin factors, history of atopy, vitiligo, hypertension, diabetes & tuberculosis, morphology along with pattern of hair loss.

Investigation:

Trichogram
Routine biochemical analysis
X-ray chest
Mountex test
Ultra sound of pelvis & abdomen
Serum free testosterone
Thyroid function tests
Biotinidase level
Serum lactic acid
Serum pyruvic levels
Serum ferritin level

Treatment protocol:
Minipulse therapy with Betnesole forte tablet 5 mg/week
88% phenol application once in 3 weeks
Application of Anthralin
Application of dihitrochlorobenzene
Tablet biotin in-patients with low levels of Biotinidase
Treatment of cicatricial alopecia: Plastic surgical scalp reduction
Treatment of diffuse of hair loss: Oral finasteride 1 mg/day
Topical 4% minoxidil

5. Vitiligo Clinic:

As Vitiligo is a common & socially disabling disease requiring special attention to the patient with regards to social & psychological support, treatment & a prolonged follow up a separate vitiligo clinic was started in June 2001.

Protocol followed in this clinic is detailed cutaneous & examination with regards to morphology, Ophthalmologic examination to look for uveitis, irits, iridocyelitis, choroidal & retinal pigment abnormalities, ENT examination for evidence of deafness.

Investigations:
A complete blood counts
Blood sugar
X-ray chest
Renal & Liver function tests
Thyroid function test
Antigliadin antibodies
Antipariental cell AB
Serum Vit B12 level
Duodenal biopsy in cases of raised antigliadin antibodies

Treatment protocol:
Mini-pulse therapy with betnesol forte 5mg per week
Oral & topical PUVA therapy
Topical steroids
Placentrex lotion

6. Psoriasis Clinic:

In this clinic patients of psoriasis are valuated with regards to duration, site & progression of disease, factors for exacerbating & remissions, family & personal history, cutaneous exacerbating with calculation of baseline psoriasis area severity index.

Investigation:
A complete blood counts
Blood sugar
X-ray chest
Renal & Liver function Tests
Antigliadin antibodies
Duodenal biopsy in cases of raised antigliadin antibodies
Skin biopsy
 

Treatment protocol:
Oral Methotrexate
Topical &/ systemic PUVA therapy
Topical &/ systemic steroid
Topical emollients
Gluten free diet in-patients with raised antigliadin antibodies

7. HIV Clinic

Patients with high risk factors are screened for HIV infections.  Infected patients are evaluated with regards to social, family history, physical examination.

Investigation -

Complete haemogram

Routine biochemical analysis

X-ray chest

Mountex test

Ultra sound for pelvis & abdomen

CD4/CD8 count

Viral load

Mobilized sputum study for fungi, PCP, APB, routine culture

CT scan +- MRI

Tissue biopsy

Treatment protocol -

Fluconazole

Acyclovir

Higher oral IV antibiotics

Anti TB drugs

8. STD Clinic

Investigation:

Dark ground microscopy

Gram stain

Tzanck smear

Gonococcal culture

PCR for H. duoreyi

Herpes

Chlamydia

9. Genodermatoses & Pediatric Dermatology Clinic:

Many genetic conditions are recognized due to their multiple cutaneous manifestations.  Therefore Dermatology Department decided to initiate a clinic to give special attention to these cases, as they require elaborate and highly Specialised investigations to reach the final diagnosis.  Hence the special clinic of Genodermatoses and pediatric Dermatology was started in June 2001.  The clinic has set up protocols for recording the data and has Dr. Anil Jalan, a Geneticist as an advisor.  We have received encouraging response from various departments especially the Paediatrics and neonatology. The biochemistry department has given invaluable support to undertake biochemical tests for inborn errors of metabolism.  In a short span, we have picked up elusive cases such as partial Biotinidase deficiency, homocystinuria, Hartnup's disease and many more rare cases.  We intend to collaborate with other centers for Specialised tests within and outside the country.

10 Dermatosurgery Clinic:

Various condition in dermatology especially malignant and vascular tumours require surgery as modality of treatment. Surgeries are also carried out for diagnostic, therapeutic & cosmetic purposes. Minor surgical procedures are done in dermatology O.P.D. like biopsies, mole removal etc, while procedures requiring cosmetic expertise, lesions requiring deeper and complete removal like malignancies are referred to plastic surgeon. Dermatosurgery clinic is run in association with plastic surgery

Dept. Patients presented with vascular tumours, carcinomas, cicatricial alopecia are evaluated by team of plastic surgeons and treated accordingly. A detailed record of patients likes name, age etc., photographic evidence and long-term follow up is maintained.