1. Prof. G. K. Verma, IGMC Shimla

Highest-yield reading before practical

1. Photodermatitis and photopatch testing
   • Jindal N, Sharma NL, Mahajan VK, et al., including G. K. Verma. Evaluation of photopatch test allergens for Indian patients of photodermatitis: preliminary results. IJDVL, 2011. PubMed record
   • Practical pearls:
     • Photopatch testing is important in the work-up of suspected photoallergic dermatitis.
     • In their cohort, common relevant sensitizers included fragrance mix, PPD, and Parthenium.
     • Be ready to distinguish phototoxic from photoallergic reactions, explain patch versus photopatch testing, and discuss relevance of a positive test.
2. Amoebiasis cutis
   • Verma GK et al. Amoebiasis cutis: clinical suspicion is the key to early diagnosis. Australasian Journal of Dermatology, 2010. PubMed record
   • Practical pearls:
     • Consider in chronic painful, destructive ulcerative lesions of the perianal, perineal, gluteal region, especially with intestinal disease.
     • Demonstration of trophozoites in a fresh wet preparation from lesion margin can make the diagnosis.
     • Histology may show trophozoites on H&E and PAS.
     • Differential diagnoses: pyoderma gangrenosum, TB, deep fungal infection, malignancy, bacterial infection, Crohn-related ulcers.
3. Chromoblastomycosis
   • Verma GK et al. A case of extensive chromoblastomycosis from North India. Brazilian Journal of Microbiology, 2014. PubMed record and free article
   • Practical pearls:
     • Chronic verrucous or nodular plaque, often on lower limb.
     • Key diagnostic microscopy feature: muriform bodies or sclerotic bodies.
     • Culture in this report yielded Fonsecaea pedrosoi.
     • This is very suitable for a spot diagnosis, viva on deep fungal infections, and histopathology discussion.
4. Purpuric footwear contact dermatitis
   • Verma GK et al. Purpuric contact dermatitis from footwear. Contact Dermatitis, 2007. PubMed record
   • Practical pearls:
     • Footwear dermatitis is not always eczematous. It can mimic purpura or vasculitis.
     • Learn distribution patterns of footwear dermatitis and the role of patch testing, including footwear components such as rubber, adhesives, dyes, and leather chemicals.
5. Nocardial mycetoma
   • Sharma NL et al., including G. K. Verma. Nocardial mycetoma: Diverse clinical presentations. IJDVL, 2008. Journal article
   • Practical pearls:
     • Remember the triad: swelling, sinuses, and grains.
     • Differentiate actinomycetoma from eumycetoma clinically, microscopically, and therapeutically.
     • A chronic discharging sinus on the foot should trigger discussion of mycetoma.

Other papers/topics to know

• A rare case of extensive pemphigus vegetans - review clinical morphology, flexural vegetative plaques, eosinophilia, histology, and immunofluorescence.
• A clinico-epidemiological scenario of leprosy at a tertiary care centre in sub-Himalayan region - revise leprosy classification, slit-skin smear, reactions, disability grading, and MDT.
• The changing trend of syphilis: is it a sign of impending epidemic? - revise secondary syphilis, serological tests, prozone phenomenon, and treatment/follow-up.
• Current spectrum of dermatophytosis in a tertiary care hospital of North India - know chronic/recurrent dermatophytosis, KOH examination, rational antifungal use, and tinea incognito.

2. Prof. Davinder Parsad, PGIMER Chandigarh

Must-read publications

1. Vitiligo surgery guidelines
   • Parsad D, Gupta S. Standard guidelines of care for vitiligo surgery. IJDVL, 2008. PubMed record
   • This is the single most important paper for your practical.
   • Core viva points:
     • Surgery is for stable, treatment-resistant vitiligo.
     • A pragmatic definition of stability used in the guideline is no disease progression for one year.
     • A test graft can help in doubtful stability.
     • Know procedures: suction blister grafting, split-thickness grafting, punch grafting, miniature punch grafting, non-cultured epidermal cell suspension transplantation, and cultured melanocyte techniques.
     • Counsel for failure, cobblestoning, color mismatch, hyperpigmentation, Koebner phenomenon, and future progression.
2. Simplified non-cultured epidermal cell suspension transplantation
   • Kumar R, Parsad D, Singh C, Yadav S. Four compartment method: a simplified and cost-effective method of noncultured epidermal cell suspension for the treatment of vitiligo. British Journal of Dermatology, 2014. PubMed record
   • Practical relevance:
     • Understand the concept of non-cultured epidermal cell suspension.
     • The “four-compartment” technique was proposed to reduce dependence on costly laboratory equipment.
     • In a surgical-vitiligo viva, explain why cellular grafting can cover a recipient area larger than the donor area.
3. NB-UVB versus PUVA
   • Bhatnagar A, Kanwar AJ, Parsad D, De D. Comparison of systemic PUVA and NB-UVB in the treatment of vitiligo: an open prospective study. JEADV, 2007. PubMed record
   • Practical relevance:
     • NB-UVB showed better repigmentation than PUVA when therapy-resistant sites such as hands and feet were excluded.
     • Be prepared to discuss why NB-UVB is generally preferred in modern practice: practicality and a more favorable adverse-effect profile than systemic PUVA.
     • Know resistant sites: acral areas, bony prominences, lips, nipples, and distal digits.
4. Melanocytorrhagy and unstable vitiligo
   • Kumar R, Parsad D, Kanwar AJ. Role of apoptosis and melanocytorrhagy: a comparative study of melanocyte adhesion in stable and unstable vitiligo. British Journal of Dermatology, 2011. PubMed record
   • Practical relevance:
     • Melanocytorrhagy means detachment and transepidermal loss of melanocytes.
     • Their work found reduced melanocyte adhesion to collagen IV and greater apoptotic markers in unstable disease.
     • If asked pathogenesis: give an integrated answer incorporating autoimmunity, oxidative stress, melanocyte detachment, apoptosis, genetic susceptibility, and neural factors.
5. Oral Ginkgo biloba trial
   • Parsad D, Pandhi R, Juneja A. Effectiveness of oral Ginkgo biloba in treating limited, slowly spreading vitiligo. Clinical and Experimental Dermatology, 2003. PubMed record
   • Practical relevance:
     • This double-blind placebo-controlled trial reported reduced progression and some repigmentation.
     • Mention it as historical or adjunctive evidence, not as a replacement for established, current vitiligo management.
6. Phototherapy and disease stability
   • Bhatnagar A, Kanwar AJ, Parsad D, et al. Psoralen and ultraviolet A and narrow-band ultraviolet B in inducing stability in vitiligo, assessed by vitiligo disease activity score. JEADV, 2007. PubMed search record
   • Revise VIDA score and clinical signs of activity: new lesions, enlargement of existing lesions, trichrome appearance, inflammatory border, and Koebner phenomenon.
7. Childhood vitiligo and topical tacrolimus
   • Kanwar AJ, Dogra S, Parsad D. Topical tacrolimus for treatment of childhood vitiligo in Asians. Clinical and Experimental Dermatology, 2004. PubMed record
   • Practical relevance:
     • Useful for facial and intertriginous disease, especially where long-term potent topical steroid toxicity is a concern.
     • Know counseling points: burning/stinging initially, gradual response, and use with appropriate photoprotection.
8. Vitiligo surgery review
   • Holla AP, Parsad D. Vitiligo surgery: its evolution as a definite treatment in the stable vitiligo. Giornale Italiano di Dermatologia e Venereologia, 2010. PubMed record
   • Good overview for comparing grafting methods and patient selection.

What I would revise first

If Prof. Verma is examining

1. Photodermatitis: polymorphous light eruption, chronic actinic dermatitis, photoallergic dermatitis, phototoxicity, photopatch testing.
2. Contact dermatitis: patch-test technique, common allergens, footwear/cosmetic/hair-dye dermatitis.
3. Deep infections: chromoblastomycosis, mycetoma, sporotrichosis, cutaneous amoebiasis.
4. Leprosy and dermatophytosis.
5. Syphilis and STI case approach.

If Prof. Parsad is examining

1. Vitiligo classification, activity and stability assessment.
2. VIDA score, VASI, body-surface area assessment, Wood lamp examination.
3. Medical therapy: topical corticosteroids, topical calcineurin inhibitors, NB-UVB, excimer laser, systemic therapy for rapidly progressive disease.
4. Stable vitiligo surgery: indications, contraindications, techniques, complications, and postoperative care.
5. Vitiligo pathogenesis, especially autoimmunity, oxidative stress, apoptosis, and melanocytorrhagy.
6. Differential diagnosis of depigmented lesions: pityriasis versicolor, pityriasis alba, nevus depigmentosus, chemical leukoderma, post-inflammatory hypopigmentation, leprosy, and lichen sclerosus.

Important practical-exam caution

• Prof. Verma: “What is your diagnostic approach in an unusual inflammatory, contact-related, or infectious dermatosis?”
• Prof. Parsad: “Is this vitiligo active or stable, and which medical or surgical option is appropriate?”

What to prioritize

Prof. Ghanshyam K. Verma, IGMC Shimla

Likely main areas of interest

1. Allergic contact dermatitis, patch testing, and hair-dye dermatitis

1. Trends of common contact sensitizers in tandem with increased hair dye dermatitis in Shimla: a study of 521 patients
   • Focus: hair-dye dermatitis, PPD, Parthenium, nickel, dichromate, patch testing.
   • The article’s keywords and cohort design show a strong department-level interest in contact allergen patterns in the sub-Himalayan region. Read the full article page.
2. Pesticide contact dermatitis in fruit and vegetable farmers of Himachal Pradesh
   • G. Verma et al. Contact Dermatitis, 2007.
   • Focus: occupational dermatitis, agricultural exposure, relevant history, prevention, and patch testing.
   • Practical relevance: a farmer with hand/face dermatitis should trigger questions on pesticides, rubber gloves, plants, sunlight, and airborne contact dermatitis.
3. Purpuric contact dermatitis from footwear
   • G. K. Verma et al. Contact Dermatitis, 2007. PubMed
   • Focus: atypical morphology of footwear dermatitis and its distinction from vasculitis or purpura.
   • Learn: common footwear allergens, distribution by shoe component, patch testing with standard and patient’s own materials.

2. Photodermatitis and photopatch testing

1. Evaluation of photopatch test allergens for Indian patients of photodermatitis: preliminary results
   • Jindal N et al., including G. K. Verma. IJDVL, 2011. PubMed
   • This is a very high-yield paper for practicals.
   • Know:
     • Difference between phototoxic and photoallergic reactions.
     • Patch test versus photopatch test.
     • How relevance is assessed.
     • Common allergens in the study: fragrance mix, PPD, and Parthenium.
     • Differentials for chronic photosensitive dermatitis: chronic actinic dermatitis, polymorphous light eruption, lupus erythematosus, drug-induced photosensitivity, airborne contact dermatitis, porphyria.

3. Cutaneous infections, deep fungal infections, and mycetoma

1. Amoebiasis cutis: clinical suspicion is the key to early diagnosis
   • Verma GK et al. Australasian Journal of Dermatology, 2010. PubMed
   • Read for an approach to chronic destructive ulcers, especially perianal/perineal/gluteal lesions.
   • Must know: fresh wet mount from ulcer margin can demonstrate Entamoeba histolytica trophozoites; histology can show trophozoites.
2. A case of extensive chromoblastomycosis from North India
   • Verma GK et al. Brazilian Journal of Microbiology, 2014. PubMed and free full text
   • Must know:
     • Clinical morphology: chronic verrucous/nodular plaques, often on lower limb.
     • Histology/KOH: muriform bodies, also called sclerotic or Medlar bodies.
     • Culture in the case: Fonsecaea pedrosoi.
     • Differentiate from tuberculosis verrucosa cutis, verrucous carcinoma, chromoblastomycosis, mycetoma, and cutaneous leishmaniasis.
3. Nocardial mycetoma: diverse clinical presentations
   • Sharma NL et al., including G. K. Verma. IJDVL, 2008. Journal article
   • Revise:
     • Triad: tumefaction, sinuses, grains.
     • Eumycetoma versus actinomycetoma.
     • Grain color, microscopy, culture, imaging, and broad treatment principles.
4. Cutaneous leishmaniasis and Himachal Pradesh
   • His collaborative work includes vector and epidemiology studies in Himachal Pradesh, including sandflies in the Satluj valley and atypical cutaneous manifestations of Leishmania donovani.
   • Practical preparation: revise cutaneous leishmaniasis morphology, slit-skin smear and histology, differential from lupus vulgaris/chromoblastomycosis, and the relevance of geographic history.

4. Leprosy

1. A clinico-epidemiological scenario of leprosy at a tertiary care centre in the sub-Himalayan region: a seven-year retrospective study
   • Tegta GR et al., including G. K. Verma. Indian Journal of Leprosy, 2019.
   • Also review the later department report on clinico-epidemiological trends of leprosy.
   • Be ready for:
     • Cardinal signs and Ridley-Jopling classification.
     • Paucibacillary versus multibacillary operational classification.
     • Slit-skin smear.
     • Lepra reactions and neuritis.
     • Nerve examination, sensory testing, voluntary muscle testing, grade-2 disability, and prevention of disability.
     • MDT and reaction management.

5. STIs and syphilis

1. The changing trend of syphilis: is it a sign of impending epidemic?

• Gupta M et al., including G. K. Verma. Indian Journal of Dermatology, 2023.
• Revise:
  • Stages of syphilis and morphology of secondary syphilis.
  • VDRL/RPR versus TPHA/TPPA.
  • Prozone phenomenon.
  • HIV testing and contact tracing.
  • Follow-up using non-treponemal titres.

6. Other relevant clinical work

1. A rare case of extensive pemphigus vegetans

• Verma GK et al. Indian Dermatology Online Journal, 2019.
• Know flexural vegetative plaques, eosinophilia, histology, direct immunofluorescence, and differentiation from pyoderma vegetans and Hailey-Hailey disease.

1. Current spectrum of dermatophytosis in a tertiary-care hospital of North India

• A department-associated clinico-mycological study.
• Revise chronic/recurrent dermatophytosis, KOH technique, tinea incognito, steroid abuse, indications for systemic antifungals, and household contact assessment.

1. Clinico-investigative profile of patients of hirsutism in a tertiary-level institution

• Sharma D et al., including G. K. Verma. Free full text
• Revise Ferriman-Gallwey scoring, PCOS assessment, red flags for virilizing tumors, and initial laboratory work-up.

Prof. Verma: likely viva targets

• “How will you perform and interpret a patch test?”
• “Phototoxic versus photoallergic dermatitis?”
• “A farmer has facial/hand dermatitis. What is your differential and work-up?”
• “Chronic verrucous plaque on leg: approach?”
• “Discharging sinuses and grains on foot: diagnosis?”
• “Conduct a leprosy nerve examination.”
• “Approach to a suspected early-secondary syphilis case.”

Prof. Davinder Parsad, PGIMER Chandigarh

Confirmed areas of interest

1. Vitiligo pathogenesis and clinical research
2. Pigmentary disorders
3. Urticaria

Essential publications to read

A. Vitiligo surgery and stable disease

1. Standard guidelines of care for vitiligo surgery
   • Parsad D, Gupta S. IJDVL, 2008. PubMed
   • This is your single most important article.
   • Learn:
     • Surgery is for stable, treatment-resistant vitiligo.
     • Practical criterion: no new lesions or extension for around one year, with a test graft in doubtful cases.
     • Preoperative evaluation, counseling, consent, anesthetic issues, postoperative immobilization, and complications.
     • Why disease stability matters more than extent alone.
2. Vitiligo surgery: its evolution as a definite treatment in stable vitiligo
   • Holla AP, Parsad D. Giornale Italiano di Dermatologia e Venereologia, 2010. PubMed
   • Read this to compare tissue grafts and cellular grafts.
3. Vitiligo surgery: a journey from tissues via cells to the stems!
   • Razmi T, Afra TP, Parsad D. Experimental Dermatology, 2019. PubMed
   • Useful overview of the evolution from conventional grafting to cell suspension and regenerative approaches.
4. Four-compartment method: simplified and cost-effective non-cultured epidermal cell suspension
   • Kumar R, Parsad D, Singh C, Yadav S. British Journal of Dermatology, 2014. PubMed
   • Key message: non-cultured epidermal cell suspension transplantation can be simplified and performed with less reliance on expensive laboratory equipment.
   • Learn the principle of donor-to-recipient expansion ratio and why cellular grafting is useful for larger areas.
5. Non-cultured epidermal cell suspension transplantation in children and adolescents with stable vitiligo
   • Sahni K, Parsad D, Kanwar AJ. Clinical and Experimental Dermatology, 2011. PubMed
   • Important if a pediatric vitiligo case appears.
6. Acral vitiligo and lesions over joints treated with non-cultured epidermal cell suspension transplantation
   • Holla AP et al., including Parsad D. Clinical and Experimental Dermatology, 2013. PubMed
   • Revise why acral sites and joints are treatment-resistant and how expectations should be counseled.

B. Vitiligo phototherapy and medical therapy

1. Comparison of systemic PUVA and NB-UVB in vitiligo
   • Bhatnagar A, Kanwar AJ, Parsad D, De D. JEADV, 2007. PubMed
   • Randomized prospective study.
   • Key conclusion: NB-UVB gave better repigmentation after excluding therapy-resistant acral sites.
   • Viva point: NB-UVB is generally preferred to oral PUVA in modern routine care due to practicality and safety considerations.
2. PUVA and NB-UVB in inducing stability, assessed by VIDA
   • Bhatnagar A et al., including Parsad D. JEADV, 2007. PubMed
   • Know the Vitiligo Disease Activity score, VIDA:
     • +4: activity in past 6 weeks
     • +3: activity in past 3 months
     • +2: activity in past 6 months
     • +1: activity in past year
     • 0: stable for at least 1 year
     • -1: stable with spontaneous repigmentation for at least 1 year
3. Topical tacrolimus for childhood vitiligo in Asians
   • Kanwar AJ, Dogra S, Parsad D. Clinical and Experimental Dermatology, 2004. PubMed
   • Revise topical calcineurin inhibitors, especially for facial/intertriginous sites and children.
4. Effectiveness of oral Ginkgo biloba in limited, slowly spreading vitiligo

• Parsad D, Pandhi R, Juneja A. Clinical and Experimental Dermatology, 2003. PubMed
• This double-blind trial reported reduced progression and some repigmentation.
• Mention as historical or limited-evidence adjunctive research, not first-line current treatment.

1. Calcipotriol in vitiligo and combination of PUVAsol with topical calcipotriol

• Parsad D et al. Calcipotriol study and PUVAsol-calcipotriol study.
• Useful to know as early work in adjunctive topical treatment, but do not overstate their role in current standard management.

C. Pathogenesis and melanocyte biology

1. Role of apoptosis and melanocytorrhagy: melanocyte adhesion in stable versus unstable vitiligo

• Kumar R, Parsad D, Kanwar AJ. British Journal of Dermatology, 2011. PubMed
• High-yield mechanism paper.
• Explain that in unstable vitiligo, melanocytes may have impaired adhesion to collagen IV, greater apoptosis markers, and detachment, termed melanocytorrhagy.

1. Altered Ets-1 transcription factor and matrix metalloproteinases in melanocytes from patients with vitiligo

• Kumar R, Parsad D, Kanwar AJ. British Journal of Dermatology, 2011. PubMed
• Revise in broad terms: transcriptional regulation, MMPs, extracellular matrix interactions, adhesion, and melanocyte loss. You do not need molecular minutiae unless you are doing a dissertation in this area.

1. Eumelanin and phaeomelanin contents of depigmented and repigmented skin in vitiligo

• Parsad D et al. British Journal of Dermatology, 2003. PubMed
• Connect this with mechanisms and clinical pattern of repigmentation.

D. Urticaria

1. Stanozolol in chronic urticaria: a double-blind, placebo-controlled trial

• Parsad D, Pandhi R, Juneja A. Journal of Dermatology, 2001. PubMed
• Historical research interest. Do not present stanozolol as routine contemporary management.

1. Chronic idiopathic urticaria and thyroid autoimmunity: perplexing association

• Yadav S, Kanwar AJ, Parsad D. Indian Journal of Dermatology, 2013. PubMed
• Revise chronic spontaneous urticaria, thyroid autoimmunity, appropriate targeted investigations, and modern stepwise management.

Prof. Parsad: likely viva targets

• “Is this vitiligo stable or active?”
• “What are the signs of activity in vitiligo?”
• “How do you calculate or describe VIDA?”
• “How would you treat localized non-segmental vitiligo in a child?”
• “NB-UVB versus PUVA?”
• “When will you offer surgery in vitiligo?”
• “Compare suction blister grafting, miniature punch grafting, split-thickness grafting, and non-cultured epidermal cell suspension.”
• “Why does vitiligo recur after surgery?”
• “Explain melanocytorrhagy.”
• “Approach to chronic spontaneous urticaria and when would you screen for thyroid disease?”

Best use of your final revision time

If you have only one day

1. Vitiligo in full depth
   • Classification, active versus stable disease, VIDA, Wood lamp examination.
   • Medical therapy and NB-UVB.
   • Surgical indications, procedures, complications, counseling.
   • Vitiligo differentials.
2. Contact dermatitis and photodermatitis
   • Standard patch testing.
   • Photopatch test.
   • PPD/hair dye, Parthenium, footwear, occupational dermatitis.
   • Phototoxic versus photoallergic dermatitis.
3. Leprosy and infections
   • Leprosy examination, reactions, MDT and disability.
   • Chromoblastomycosis, mycetoma, sporotrichosis, cutaneous leishmaniasis, cutaneous amoebiasis.
   • KOH, slit-skin smear, fungal culture, biopsy findings.
4. Syphilis
   • Classic clinical morphology, tests, staging, treatment framework, follow-up.

Strong practical-answer format

1. Primary lesion and secondary changes
2. Distribution and configuration
3. Differentials
4. Targeted examination, including systemic/nerve/mucosal findings where relevant
5. Bedside and laboratory tests
6. Working diagnosis
7. Management and counseling
8. Follow-up markers

Current-evidence note