A multicentric clinical and epidemiological study of chronic and recurrent dermatophytosis in India.

BACKGROUND: There has been an alarming increase in the prevalence of chronic, recurrent and steroid modified dermatophytosis of the glabrous skin in the recent years in India. There is paucity of literature on the magnitude of this major public health problem. OBJECTIVE: To estimate the prevalence of dermatophytosis and clinico-epidemiological features of chronic and recurrent dermatophytosis (CRD) across India and to evaluate the associated risk factors. METHODS: This is a multicentric descriptive cross-sectional study conducted in 13 centres situated across India in two phases during dry and rainy seasons. All consecutive patients presenting with dermatophytosis were screened during the study period of 14 consecutive working days. Patients with CRD of the glabrous skin as per the case definition were included after exclusion of isolated hair and nail infections. Demography, clinical findings and results of potassium hydroxide wet mount were recorded. RESULTS AND CONCLUSION: A total of 41,421 patients were screened, out of which 7174 (17.31%) patients had glabrous dermatophytosis. CRD was observed in 1999 (27.86%) patients with 78.08% and 21.95% of chronic and recurrent dermatophytosis, respectively. Family history was present in 50.03% of patients. History of sharing of fomites was present in 50.37% of them. Synthetic tight clothes were worn by 43.47%, while 50.9% gave history of misuse of topical corticosteroid creams. Multiple site involvement was common (69.58%) with tinea cruris (79.99%) and tinea corporis (75.69%) being the most common clinical types. CRD is associated with sharing of fomites, topical corticosteroid misuse and involvement of multiple sites.

H Syndrome - A Case Report.

This case report describes a case of H syndrome with characteristic cutaneous hyperpigmentation, hypertrichosis, sclerodermatous thickening, and multisystem involvement such as hearing loss and heart anomaly in an Indian patient. There are around 100 cases of this rare, autosomal recessive genodermatosis reported in the literature, out of which 10 cases are from the Indian population. The aim of this paper is to increase awareness about this novel inherited form of histiocytosis and insist on the role of dermatologists to identify such patients in our population where consanguinity is prevalent.

Cosmetic camouflage in vitiligo.

Vitiligo is not a life-threatening nor a contagious disease. But the disfigurement of vitiligo can be devastating to its sufferers, especially dark-skinned individuals. Available treatment options are disappointing and sufferers often use various forms of camouflage. Remedial cosmetic cover creams help conceal the blemish of vitiligo at least temporarily. A high concentration of pigment is incorporated into water-free or anhydrous foundations to give a color that matches the patient's skin, thereby concealing vitiligo patches. The article highlights the content and technique of application of these creams.

Reverse-Namaskar: a new sign in Ehlers-Danlos syndrome: a family pedigree study of four generations.

Ehlers-Danlos Syndrome (EDS) is a rare group of inheritable connective tissue disorder of defective collagen. Skin, joints and blood vessels are most commonly affected. Clinical signs such as Gorlin sign and Metenier sign have been described in this syndrome. We report another new clinical sign called 'Reverse-Namaskar' sign as an important clinical finding in EDS, based on the family pedigree study of the proband.

The conundrum of parapsoriasis versus patch stage of mycosis fungoides.

Terminological confusion with benign dermatosis, such as parapsoriasis en plaques, makes it difficult to diagnose mycosis fungoides in the early patch stage. Early diagnosis of mycosis fungoides (MF) is important for deciding on type of therapy, prognosis and for further follow-up. However, until recently, there has been no consensus on criteria that would help in diagnosing the disease early. Some believe that large plaque parapsoriasis (LPP) should be classified with early patch stage of MF and should be treated aggressively. However, there is no firm clinical or laboratory criteria to predict which LPP will progress to MF and we can only discuss about statistical probability. Moreover, long-term outcome analysis of even patch stage of MF is similar to that of control population. We therefore believe that LPP should be considered as a separate entity at least to prevent the patient from being given a frightening diagnosis. We also feel that patients need not be treated with aggressive therapy for LPP and will need only a close follow-up. This article emphasizes the criteria for diagnosing early MF and has highlighted the importance of considering LPP as a distinct benign entity.

An aetiological analysis of erythema nodosum in a community hospital.

Erythema nodosum (EN) is a reaction pattern in the skin characterized by septal panniculitis. Infectious diseases are most common cause of EN. This study was aimed to find out the most common causes for EN as seen in a community hospital over a period of two years. Fifteen patients with EN were subjected to detailed clinical and laboratory investigations to establish the etiology. Immuno - fluorescence and PCR for Mycobacterium tuberculosis were performed in relevant patients. Seven cases were diagnosed to be secondary to tuberculosis that was confirmed by a complete resolution of the lesions after a full course of anti TB chemotherapy. In one patient, the EN was drug induced, two were due to polyarteritis nodosa, one was due to SLE, one was due to streptococcal infection, and three were idiopathic in aetiology. Though the number of patients is small, it still establishes the fact that tuberculosis continues to be the most common cause of EN.

Delusion of Parasitosis.

Delusion of parasitosis is a type of mono-symptomatic hypo-chondriacal psychosis common in elderly females whose response to drug therapy, usually pimozide, is variable. Two male patients presented with the delusion on their skin being infested with minute insects. One of them experienced presence of the inside the body cavities and spreading all over the body. They were treated satisfactorily with the neuroleptic drug, trifluoperazine.