Cutaneous tuberculosis. Part I: Pathogenesis, classification, and clinical features.

Tuberculosis is an ancient disease that continues to affect an estimated 10 million people per year and is responsible for 1.4 million deaths per year. Additionally, the HIV epidemic and multidrug resistance present challenges to disease control. Cutaneous tuberculosis is an uncommon, often indolent, manifestation of mycobacterial infection that has a varied presentation. Its diagnosis is challenging, as lesions mimic other, more common conditions and microbiological confirmation is often not possible. Cutaneous tuberculosis can be broadly categorized into multibacillary and paucibacillary forms. Approximately one-third of skin tuberculosis is associated with systemic involvement. By recognizing cutaneous tuberculosis early, dermatologists can play an important role in disease control. The first article in this 2-part continuing medical education series describes the latest epidemiology, microbiology, and pathogenesis of tuberculosis. Furthermore, we review the classification, clinical manifestations, common clinical differentials, and systemic involvement that occur in cutaneous tuberculosis.

The diverse methods of bleomycin delivery in cutaneous warts: A literature review.

Bleomycin is a useful treatment option for recalcitrant verrucae. Several different methods of bleomycin delivery have been described, including intralesional injection, intralesional injection combined with laser, microneedling, multiple puncture and adhesive tape. We reviewed the literature to evaluate the various methods of bleomycin administration to treat warts, including the different doses, instruments and procedures used. Intralesional injection (cure rate ranged from 67.8% to 99.23%) and topical bleomycin with multipuncture or microneedling methods (63.6% to 100%) were found to be effective in the treatment of warts. Overall, pain is significantly less with microneedling and multipuncture techniques compared with intralesional injection. Bleomycin injection combined with pulsed dye laser, electroporation, or by other methods, such as, microneedle patches or adhesive tape do not seem to be more beneficial than bleomycin administered by intralesional injection, multipuncture or microneedling techniques.

Mesococktails and mesoproducts in aesthetic dermatology.

Mesotherapy is a convenient, safe and relatively painless non-surgical procedure. It has found its way into the aesthetic world and is employed for various indications such as lipolysis, skin rejuvenation, pigmentation and hair loss. The procedure involves delivery of mixture or cocktail of different compounds (plant extracts, nutrients, enzymes, homeopathic agents, pharmaceuticals, vitamins, amino acids and other bioactive substances) into the dermis or subcutaneous layer. A variety of techniques have been employed. The newer no-needle and micro-needle techniques are less invasive. Ingredients of the chosen mesococktail depend on the indication and play a major role in the outcome. Despite its popularity, mesotherapy has a scarcity of large scale studies on its efficacy and safety profile. Nevertheless, the choice of the mesoproduct and technique must be done with great detail to achieve the best desired effect.

Coronavirus disease (COVID-19): An updated review based on current knowledge and existing literature for dermatologists.

The world entered the year 2020 with reports of the emergence of a new viral illness in Wuhan city, Hubei province, China. In January 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified to be the causative novel coronavirus for the cluster of patients suffering from pneumonia in China. The disease was later named as coronavirus disease (COVID-19) and was declared a pandemic by the World Health Organization on March 11, 2020. Several studies, since then, have tried to study and explain the origin of SARS-CoV-2, its structure and pathogenicity, epidemiology, modes of transmission, spectrum of illness and causes of mortality and morbidity. The current management strategies focus on supportive care and prevention of complications. With no definite treatment, as of now, encouraging reports of some anti-viral and anti-malarial drugs in the management of COVID-19 generate some hope. This review intends to cover the current known aspects of COVID-19 and SARS-CoV-19, based on the available literature.

A Muselet and USB dermatoscope: A precise way to mark a site for biopsy.

Precise marking of the biopsy site is essential for histoapthological evaluation. Naked eye examination, sometimes, does not help in identifying an appropriate lesion for biospy. Dermoscopy enhance surface and subsurface features in a lesion and can thus be helpful in selecting the most appropriate lesion for biopsy. This manuscript describes the use of a muselet to mark a biopsy site under the vision of a dermatoscope.

Hangnails: Paste them back.

Hangnails are short torn down part of skin surrounding the nails. At times they are very painful. The usual treatment advised is cutting the excess skin with clippers or scissors. To provide an instant relief to the patients, we describe a simpler and effective way to use a surgical glue to paste them back in their original position.

Precalcaneal congenital fibrolipomatous hamartoma: Rare or under-reported?

Precalcaneal congenital fibrolipomatous hamartoma (PCFH) is a benign under-reported condition of infancy characterized by the presence of soft nodules on precalcaneal plantar surface of the heel. These lesions are usually bilateral solitary and asymptomatic. We present a 2-month-old infant with solitary skin-colored nodules present on precalcaneal plantar aspect of bilateral heels.

Intramatricial platelet-rich plasma therapy: A novel treatment modality in refractory nail disorders.

Two patients, one with nail lichen striatus and second with idiopathic trachyonychia were treated with intramatriceal injections of platelet-rich plasma. A total of 0.1 ml of the plasma solution was injected into the matrix of the involved nails at three weekly intervals. Follow-up was done at each sitting and thereafter at 16 and 20 weeks. Assessment was done both photographically and by dermoscopy. Case 1 showed marked improvement within 3 weeks and Case 2 showed improvement within 6 weeks. No relapses were seen at 16 and 20 weeks of follow up. Intramatricial PRP is a safe and effective therapeutic modality in nail lichen striatus and idiopathic trachyonychia refractory to other treatment options. Further studies with larger sample size and controls are required to validate the results.

Dermatoscopic features of lichen nitidus.

Dermatoscopy is a noninvasive, painless, and easily repeatable technique that reveals interesting and characteristic features associated with various cutaneous conditions. Lichen nitidus is a rare dermatosis of childhood. We describe the dermatoscopic features in 8 cases of lichen nitidus, which can aid noninvasive diagnosis. The report serves to emphasize the need for examining these lesions using both polarized and nonpolarized modes.