Study of Haemolysis in Patients of Leprosy Being Administered Multi-Drug Therapy at a Tertiary Care Hospital in Western Maharashtra: A Prospective Study.

Introduction: Dapsone forms the backbone of multi-drug therapy (MDT) in leprosy and many other dermatological disorders. Haemolysis is its common side effect which often necessitates drug stoppage. Currently, wide variation in data of haemolysis with dapsone exists in literature ranging from 24.7% to 83% and none of the studies point towards the timing of onset of haemolysis/timing of maximal haemolysis which is important in therapeutic decision making regarding continuing or stopping the drug. This study aimed to answer such unanswered questions. Objectives: Primary: To estimate the fall in haemoglobin (Hb) levels after administering MDT for 3 months in patients with leprosy. Secondary: To determine factors associated with Hb change - age, glucose-6-phosphate dehydrogenase (G6PD) status, pole of leprosy and duration of MDT taken (if any). Materials and Methods: All freshly diagnosed cases of Hansen's disease were studied for 3 months. At baseline, demographic data (age, sex), skin biopsy, slit skin smear and G6PD were taken. Haemoglobin (Hb), serum glutamate oxaloacetate transferase (SGOT), serum glutamate pyruvate transferase (SGPT), serum bilirubin, lactate dehydrogenase (LDH), reticulocyte count, peripheral blood smear (PBS) along with clinical photography was done at baseline, 1, 2 and 3 months. Results: Out of the 48 patients who completed the study: Mean Hb (g/dL) decreased from 13.37 at baseline to a minimum of 12.08 at 2 months, and then increased to 12.34 at 3 months. Of 42 patients (87.5%) with a fall in Hb, 13 (27.1%) had severe (fall >20%), 17 (35.4%) had moderate (fall 10-20%), 12 (25%) had mild fall (fall <10%) and in 6 (12.5%), there was no haemolysis. Reticulocyte count, LDH, SGOT and SGPT were significantly associated with haemolysis. Severe haemolysis occurred more frequently in the lepromatous spectrum. Conclusion: Dapsone causes maximal fall of hemoglobin by 1.29 g/dl at two months following which it increases. The fall of hemoglobin is reversible and hemoglobin starts to increase by 3 months of therapy making cessation of the drug unnecessary in most of the patients.

Basal cell carcinoma at an eccentric location: A rare case report.

Basal cell carcinoma (BCC) is the most common form of skin cancer, which presents with local invasion, has low metastasizing potential and a cure rate of 100% after surgical excision. BCC commonly involves sun-exposed areas with approximately 80%-85% of BCC located on the head or neck, 15% on the trunk, and <2% in unusual areas such as the abdomen, genitals, perianal skin, lateral edge of the foot, axilla, superior or inferior lip.

A Case Series on a Rare Clinical Presentation of Lichen Planopilaris Restricted to the Face.

Lichen planopilaris (LPP) restricted to the face is extremely rare. This case series includes five unique LPP cases that presented with a varied degree of pigmentation and scarring alopecia restricted to the face. We herein describe the clinical characteristics, dermoscopy, and treatment of these histopathologically confirmed facial LPP cases. None of them had lesions anywhere else on the body.

Comparative Study Between Tacrolimus 0.1% Ointment Versus Topical White Soft Petrolatum Jelly in the Treatment of Oral Retinoid-Induced Cheilitis.

Retinoids are used topically as well as orally, and the most commonly used oral retinoids are isotretinoin and acitretin. Mucocutaneous adverse effects are frequently seen with the use of systemic retinoids, the most common being cheilitis, which is dose-dependent and seen in almost all patients using it. To study the comparative effect of topical tacrolimus 0.1% ointment versus topical white soft petrolatum jelly in the treatment of cheilitis due to retinoids. A total of 26 patients with cheilitis post-treatment with isotretinoin were enrolled in this cross-sectional study conducted over a period of 6 months. They were randomized into two groups of 13 patients each to receive topical tacrolimus 0.1% ointment and soft petrolatum jelly twice daily, respectively. Patients were followed up weekly with clinical photographs. Resolution of cheilitis was assessed on the basis of photograph and ICGS score. About 84.6% of patients of group A and 53.8% of patients of group B showed resolution of symptoms within 1 week of treatment. A significant difference was seen in duration for complete cheilitis resolution and relapse rate in the two groups. Our study concludes that oral retinoid-induced cheilitis shows faster and more significant resolution with twice-daily topical tacrolimus 0.1% ointment application compared to twice-daily topical petrolatum jelly.

Dermoscopy of Fixed Cutaneous Sporotrichosis With a Follow-Up Till Cure: A Case Report.

Fixed cutaneous sporotrichosis (FCS) is a rare and chronic infection. Its diagnosis requires a high degree of suspicion. The data on its dermoscopy and follow-up is limited in the literature. We herein report one such case with a follow-up till cure along with its dermoscopy to establish certain specific features that may be used to ascertain the response to treatment for this chronic infection and its prognosis. We found only three such cases following an extensive review of the literature, and this case emphasizes the importance of dermoscopy in recent times as the history, swab cultures, and smears may be misleading at times due to the chronic and long-standing nature of the condition.

Bilateral Naevus of Ito and Ota With Palatal Involvement.

Naevus of Ito and naevus of Ota are benign dermal melanocytoses with similar pathogenic mechanisms of failure in the melanocyte migration to typical locations within the basal layer from neural crest cells and differ in distribution. Bilateral and oral mucosal involvement of naevus of Ota can occur but is infrequent. Naevus of Ito is seldom associated with naevus of Ota and extracutaneous manifestations. A review of the English literature showed 14 cases of naevus of Ota with palatal involvement. None showed bilateral involvement of both naevi with oral involvement. Here we report the case of bilateral naevus of Ito and bilateral naevus of Ota with palatal involvement. A 32-year-old male came to us with naevus of Ito on both sides of his back and naevus of Ota on both sides of his face involving the sclera of both eyes with a bluish lesion along the midline of the hard palate.

Comparative evaluation of the efficacy of itraconazole with terbinafine cream versus itraconazole with sertaconazole cream in dermatophytosis: A within person pilot study.

Background: Current trend of rising drug-resistant dermatophyte infection is alarming and fretted by dermatologists. Dilemma prevails regarding use of the same or different class of antifungal agents topically and systemically. The aim was to study the efficacy of oral itraconazole 200 mg with 1% terbinafine cream versus oral itraconazole 200 mg with 2% sertaconazole cream in dermatophytosis. Methods: This within-person open-label pilot study enrolled 50 patients with dermatophytosis. Two lesions of comparable size within each patient were randomly allotted to group A and B and treated with 2% sertaconazole and 1% terbinafine cream, respectively. Both groups received itraconazole 200 mg once daily for 4 weeks. The remaining lesions received 1% terbinafine cream. Response and adverse effects were assessed at 2 and 4 weeks. Reduction in erythema, scaling, pruritus and clinical, and mycological cure constituted efficacy outcomes. Results: The mean duration of lesions was 2.82 ± 1.35 months. Complete clinical cure was observed in 50% and 48%, whereas mycological cure was attained in 56% and 52% patients in groups A and B, respectively, after 4 weeks, which was statistically insignificant. Reduction in erythema, scaling, and pruritus after 4 weeks when compared between the two groups, was also statistically insignificant. Conclusion: Same class of oral and topical antifungal agents has comparable efficacy with different classes of oral and topical antifungal agents in dermatophyte infection.