Clinical and Demographic Patterns of Vulval Dermatoses and Their Impact on Quality of Life.

Background: Vulval dermatoses may present with varied manifestations ranging from asymptomatic to chronic disabling conditions. The multifactorial nature of symptoms and physical expression of the disease on the vulva complicate the evaluation and management of genital dermatoses, thereby severely impairing the quality of life of patients. Objectives: To study the clinical patterns and socio-demographic features of vulval dermatoses and their impact on the quality of life using the dermatology life quality index (DLQI) questionnaire. Materials and Methods: Female patients of all age groups who attended our outpatient department (OPD) from October 2019 to March 2021 with vulval lesions were included in the study after a detailed history and complete examination. Based on sites of involvement, the lesions were classified as genital lesions alone, genital and skin lesions, oro-genital lesions, and oro-genital and skin lesions. DLQI score was assessed using the DLQI questionnaire. Results: In total, 520 patients were recruited for the study after following the inclusion and exclusion criteria. The most common age group was 31-40 years (33.65%). The majority of the patients were married (91.92%), housewives (82.88%), and illiterate (49.61%) women. The most common presenting symptom was itching (43%). The most common vulval dermatoses were infections, seen in 401 (77.11%) patients, followed by inflammatory diseases in 78 (15%) patients, and immunobullous diseases (1.53%). Patients with genital, skin, and oral involvement showed statistically significant higher DLQI scores (P value < 0.05). Patients with immunobullous disorders had the highest mean DLQI scores. Limitations: As this study was a hospital-based study, the observations may not represent and reflect the general population. Conclusion: Patients with genital, skin, and oral lesions had the highest DLQI scores, indicating higher impact on the quality of life. Assessment of the disease's impact on the quality of life is essential because it not only aids in early management but also helps in minimizing the duration of the ailment.

Clinical and Dermoscopic Evaluation of Periorbital Melanosis.

Background: Periorbital melanosis (POM) describes the light-to-dark-colored, brownish-black pigmentation surrounding the eyelids. It can affect an individual's quality of life. Dermoscopic features of POM are not frequently reported in the literature. Materials and Methods: This study comprised 100 patients aged above 16 years, who attended our outpatient department (OPD) from November 2018 to October 2019. A detailed history, clinical features, and the dermoscopic study of color, pattern of pigment, and pattern of the blood vessel were recorded with the Dermlite-3N dermoscope (3Gen, San Juan Capistrano, California). On the basis of the eyelids' pigmentation and involvement, patients were clinically graded as Grade 0 to 4, with 4 being deep dark color extending beyond the infraorbital fold. The clinical patterns and the dermoscopic features were correlated. Results: Most patients were women (76) and the common age group was 16-25 years. Most of the patients had both the eyelids involved (58%), followed by lower eyelids (28%). The majority of the patients were having POM of grade 2 (47%). Seventeen patients (17%) had a positive family history of POM. The most common clinical form of POM observed was constitutional type (77) followed by postinflammatory type (12). Of 100 patients, 52 had pigmentary, 15 had vascular, and 33 had mixed pigmentary-vascular pattern. Cell phone usage (>4 h) and refractory errors (38% each) were the common risk factors observed. Stress and respiratory allergy were significantly associated. In the pigmentation patterns, epidermal (54%), dermal (14%), and mixed (17%) subsets were observed. The reticular pattern was the most common vascular pattern (65%). Conclusion: POM is a multifactorial entity. Multiple risk factors play a role in the pathogenesis and aggravation. Clinical forms did not show any specific dermoscopic patterns. Dermoscopy of POM helps to know the underlying pathology, which in turn paves the way to the effective treatment.

Cotton fiber ball as an unusual cause of vaginal discharge in a 5-year-old child.

Vaginal discharge in children can be due to many causes. Foreign body in vagina is an unusual cause. Foul-smelling, blood-stained vaginal discharge should raise the suspicion of foreign body in vagina. Magnetic resonance imaging (MRI), vaginal examination under general anesthesia may detect foreign bodies in vagina. We found a cotton fiber ball in vagina, probably caused by the child's teddy bear as a cause of vaginal discharge in a 5-year-old child. A repeat MRI suggested foreign body in the vagina and vaginal exploration under general anesthesia helped for the removal of cotton fiber ball, which led to complete clearance of the vaginal discharge in the child.

Efficacy of fluorescent microscopy versus modified Fite-Faraco stain in skin biopsy specimens of leprosy cases - a comparative study.

BACKGROUND: Histopathological examination of skin remains the cornerstone in the diagnosis of leprosy. At a few centers, fluorescent microscopy has been found to be useful in detecting more acid-fast bacilli (AFB) compared to modified Fite-Faraco staining but is sparsely documented. Hence, we studied the sensitivity of fluorescent microscopy and modified Fite-Faraco stain in the detection of Mycobacterium leprae in tissue sections. METHODS: Patients attending our outpatient department during January 2019 to June 2020 with the clinical features of leprosy were examined, and the diagnosis was confirmed by histopathology after informed consent. Tissue sections were stained by fluorescent stain and modified Fite-Faraco stain. Bacillary index was calculated for each case. RESULTS: Forty patients were recruited after following the inclusion and exclusion criteria. AFB were demonstrated in 20 patients by modified Fite-Faraco stain and in 27 patients with fluorescent stain. The sensitivity of fluorescent staining method (67.5%) was higher than modified Fite-Faraco stain (50%). Bacillary index was increased in 26 out of 40 cases by the fluorescent staining compared to the modified Fite-Faraco staining. Chi-square value was 69.3 and P value was 0.000, indicating a statistically significant correlation. LIMITATIONS: Fluorescent microscope is expensive, and trained people are needed to identify the bacilli. CONCLUSION: Fluorescent staining is more sensitive than modified Fite-Faraco staining in the detection of AFB in tissue sections. The bacilli detected per field were high with the fluorescent staining compared to the modified Fite-Faraco method.

Unusual presentations of cutaneous tuberculosis.

Cutaneous tuberculosis occurs in 1-2% of world cases of tuberculosis and more common in tropical countries. It presents with different clinical forms. Unusual clinical presentations are not uncommon and awareness of these will help in suspecting and managing these patients successfully. Lupus pernio like lupus vulgaris, tuberculosis of glans penis and lichen scrofulosorum on the distal parts of limbs are presented here because of their unusual clinical presentation.

Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) Task Force against Recalcitrant Tinea (ITART) Consensus on the Management of Glabrous Tinea (INTACT).

BACKGROUND AND AIMS: Dermatophytosis has always been a common superficial mycosis in India. However, the past 6-7 years have seen an unprecedented increase in the number of patients affected by recurrent, chronic, recalcitrant and steroid modified dermatophytosis involving the glabrous skin (tinea corporis, tinea cruris and tinea faciei). Importantly, there has been a notable decrease in clinical responsiveness to commonly used antifungals given in conventional doses and durations resulting in difficult-to-treat infections. Considering that scientific data on the management of the current epidemic of dermatophytosis in India are inadequate, the Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) Task force Against Recalcitrant Tinea (ITART) has formulated a consensus statement on the management of dermatophytosis in India. METHODS: Seventeen dermatologists with a focussed interest in dermatophytosis participated in a Delphi consensus method, conducted in three rounds. They responded as either "agree" or "disagree" to 132 statements prepared by the lead experts and gave their comments. Consensus was defined as an agreement of 80% or higher concurrence. Statements on which there was no consensus were modified based on the comments and were then recirculated. The results were finally analysed in a face-to-face meeting and the responses were further evaluated. A draft of the consensus was circulated among the participants and modified based on their inputs. RESULTS: Consensus was achieved on 90 of the 132 statements. Direct microscopy using potassium hydroxide mount was recommended in case of diagnostic difficulty on clinical examination. Counselling of patients about strict adherence to general measures and compliance to treatment was strongly recommended as the key to successful management of dermatophytosis. A combination of systemic and topical antifungal drugs was recommended for the treatment of glabrous tinea in the current scenario. Topical corticosteroid use, whether used alone or in combination with other components, was strongly discouraged by all the experts. It was suggested that topical antifungals may be continued for 2 weeks beyond clinical resolution. Itraconazole and terbinafine were recommended to be used as the first line options in systemic therapy, whereas griseofulvin and fluconazole are alternatives. Terbinafine was agreed to be used as a first line systemic agent in treatment naïve and terbinafine naïve patients with glabrous tinea. Regular follow-up of patients to ensure compliance and monitoring of clinical response was recommended by the experts, both during treatment and for at least 4 weeks after apparent clinical cure. Longer duration of treatment was recommended for patients with chronic, recurrent and steroid modified dermatophytosis. CONCLUSION: Consensus in the management of dermatophytosis is necessary in the face of conventional regimens proving ineffective and dearth of clinical trials re-evaluating the role of available antifungals in the wake of evolving epidemiology of the infection in the country. It needs to be backed by more research to provide the required level of evidence. It is hoped that this consensus statement improves the quality of care for patients with dermatophytosis, which has emerged as a huge public health problem, imposing considerable financial burden on the country.

Dermatoses Occurring after Parlor Procedures.

BACKGROUND: Cosmetic procedures are on the rise and practiced by all age groups, especially by teenagers. These procedures enhance the individual appearance and confidence levels, but they are not without side effects. AIMS AND OBJECTIVES: The aim of this study was to evaluate the side effects occurring after various parlor procedures such as facials, threading, waxing, and laser hair reduction. SETTING AND DESIGN: A prospective study for 12 months in a tertiary hospital. MATERIALS AND METHODS: Patients attending the department of dermatology at a tertiary care hospital for 12 months (July 2018-June 2019) were evaluated for any skin lesions, developed after one of the above parlor procedures. Detailed history, clinical examination, and correlation with the parlor procedure were noted. RESULTS: A total of 102 patients were found to have dermatoses after various parlor procedures during the 1-year study period (81 F and 21 M). Acneiform eruptions 26 (25.4%), followed by post-waxing folliculitis 17(16.7%), and hyperpigmentation of face 15 (14.7%) were the most common dermatoses. Molluscum contagiosum, verrucae plana, and tinea faciei were observed in 11, 6, and 3 patients, respectively. CONCLUSION: Side effects are not uncommon after parlor procedures. Awareness of these is necessary and educating the patients is extremely important to avoid these unwanted complications.