Utility of 30% hydrogen peroxide in the treatment of seborrheic keratosis.

BACKGROUND: Hydrogen peroxide (H2 O2 ) has been used in medicine as an antiseptic, but at a higher concentration of 40%, it is used as a chemical cauterant for seborrheic keratoses (SKs). Its action and hence utility at 30% is unexplored. It can serve as a relatively inexpensive modality of treatment for SKs. OBJECTIVES: To evaluate the efficacy and side effects of 30% H2 O2 as a chemical cauterant in SKs. METHODS: Seborrheic keratoses were treated with 30% H2 O2 methodically. Posttreatment assessment was done for the lesion thickness, patient satisfaction, and side effects like burning, itching, edema, crusting, vesiculation, erosion, ulceration, and pigmentary changes. RESULTS: Complete clearance was noted in 25 (49%) lesions, after a single session. Five (9%) lesions responded poorly. Patient satisfaction was excellent with 34 (66.7%) lesions. Side effects noted were burning, pruritus, erythema, edema, and crusting. However, none of them was severe. Dryness, vesiculation, and scarring were reported by none. CONCLUSIONS: H2 O2 30% can be used as a chemical cauterant with minimal side effects.

Nail dermoscopy (onychoscopy) findings in the diagnosis of primary onychomycosis: A cross-sectional study.

BACKGROUND: Diagnosis of onychomycosis involves direct microscopic examination with potassium hydroxide, culture or histopathology with periodic acid-Schiff staining. Nail dermoscopy (onychoscopy) is a noninvasive, rapid and easily available diagnostic tool though its utility in onychomycosis remains unexplored. OBJECTIVE: To describe the various onychoscopic patterns and compare its percentage positivity with that of standard potassium hydroxide examination, culture and histopathology in patients with a clinical diagnosis of onychomycosis. METHODS: The study recruited 100 patients with a presumptive clinical diagnosis of onychomycosis. A detailed history, physical examination including that of nails and clinical photography was followed by onychoscopy with DermLite DL3. The nail clippings were sent for direct microscopic examination with potassium hydroxide, mycological culture and histopathology with periodic acid-Schiff stain. The patient was said to have onychomycosis if at least one of the three tests was positive. RESULTS: Onychomycosis was confirmed by potassium hydroxide and/or culture and/or histopathology in 88 patients. Onychoscopic features were identified and their association with different clinical variants of onychomycosis was attempted. Percentage positivity for diagnosing onychomycosis in decreasing order was: direct microscopic examination with potassium hydroxide followed by spiked pattern, subungual hyperkeratosis, distal irregular termination on onychoscopy, histopathology, mycological culture and ruins aspect again observed on onychoscopy. LIMITATIONS: Small sample size. CONCLUSIONS: Many onychoscopic features are highly specific for different variants of onychomycosis so onychoscopy may serve as an important and quick adjunct to diagnose onychomycosis until other time-consuming investigations, such as culture and periodic acid-Schiff become available. Studies on a larger population will help arrive at a logistic conclusion.

Impact of Onychomycosis on the Quality of Life: Dermatology Life Quality Index-Based Cross-Sectional Study.

BACKGROUND: Onychomycosis (OM) is a common fungal infection of the nail unit with a worldwide prevalence of 5%. Though apparently a benign and innocuous entity, it carries significant psychosocial morbidity. The Dermatology Life Quality Index (DLQI) is based on a simple practical questionnaire that considers multiple psychological and social domains. Its utility in OM by far remains unexplored. OBJECTIVE: To determine the DLQI in patients suffering from OM. METHODS: The DLQI questionnaire was answered by 100 patients with an established diagnosis of OM. RESULTS: The mean DLQI of our study subjects was 6.1 ± 3.3. Most patients (46%) belonged to the DLQI 2 group (moderate effect). Among these, most patients reported disease duration of 1-5 years (50%). Among patients responding to DLQI 3 (very large effect), a higher significant proportion were females (66.7%). The most inconvenient domain was seeking treatment for OM and social embarrassment due to the disease. CONCLUSION: As DLQI is an easy scoring method, it can be used for assessing quality of health in OM. OM causes moderate effect on quality of life (mostly DLQI 2), thereby making its treatment mandatory.

Clinico-mycological study of onychomycosis in a tertiary care hospital-A cross-sectional study.

Onychomycosis (OM), has a worldwide prevalence of 5% and 0.5%-5% in India. Trichophyton. rubrum (T rubrum) and T mentagrophytes are the most commonly isolated fungi. As the clinical and mycological characteristics change with time and geographical region; it is important to study the temporal and topographic patterns periodically. The study was conducted to identify the epidemiological and clinico-mycological characteristics of patients with OM attending a tertiary care hospital in Delhi. Hundred patients with clinical diagnosis of OM were recruited. Among these, 88 patients who tested positive for OM on direct microscopy with KOH, culture and/or histopathology with periodic acid-Schiff were included in the study. The clinico-mycological characteristics and risk factors associated with OM were evaluated. OM was more common in males (M:F = 2.5:1). The mean age of patients with OM was 39 ± 15.3 years (SE 1.52) with mean disease duration of 27.6 ± 46.1 months (SE 4.9). Seventeen (19.3%) patients had concomitant diabetes mellitus. The patients displayed mean body mass index (BMI) of 25.67 ± 1.35 kg/sq m. Concurrent dermatophytosis of skin was present in 35 (39.77%) patients. Two feet-one hand syndrome was present in 5 patients. Fingernail involvement without toenail involvement was more common than toenail involvement alone. (43.18% vs 38.63%). Distal and lateral subungual OM (DLSO) was the commonest clinical variant (81.8%). Mycological culture showed growth in 47 (53.40%) patients. Dermatophytes were isolated in majority, that is in 30 (63.82%) patients followed by non-dermatophytic moulds (NDM) in 7 (14.8%) and Candida spp. in the remaining 10 (21.27%) patients.

The chik sign in dengue.

The "chik sign" is considered to be one of the most common cutaneous features of chikungunya fever and has been considered unique to this disorder. It consists of brownish hyperpigmentation involving the nose. We report a case of a 3-year-old boy with dengue infection who presented with macular hyperpigmentation of nose simulating the chik sign. Hyperpigmentation is an unusual cutaneous manifestation in cases of dengue.