Marking nut dermatitis: A case series on factitious dermatitis.

Marking nut or Bhilawa is the fruit of plant Semecarpus anacardium Linn (Family; Anacardiaceae). It belongs to Semecarpus genera which also includes cashew nuts. It is closely related to Rhus and Toxicodendron genera, which includes poison ivy and poison sumac and causes similar skin reaction due to the presence of compound urushiol. Marking nut dermatitis is an uncommon problem but has special importance in military dermatology. Individuals can get exposed to this plant during camping which can result in an irritant or allergic contact dermatitis. It can also be applied deliberately to cause factitious dermatitis. We present 5 cases of factitious dermatitis resulting from application of marking nut.

Anxiety, depression and harmful use of alcohol in severe chronic plaque psoriasis: A cross-sectional study.

Background: Psoriasis is a common, chronic T cell-mediated disease characterised by erythematous, scaly plaques. Psoriasis is associated with depression, anxiety, poor quality of life, harmful use of alcohol and suicidal ideation. We performed this study to find out prevalence of psychological morbidity in our patients with severe psoriasis and to know clinical variables associated with higher risk of psychological morbidity. Method: This study is a cross-sectional, observational study conducted in a dermatology outpatient department (OPD) of a tertiary care centre. Study population included patients with severe psoriasis area severity index (PASI>10). Clinical and epidemiological data, Patient health questionnaire-9, Generalised anxiety disorder-7, Dermatology life quality index (DLQI) and Alcohol Use Disorders Identification Test questionnaires were recorded. Data were analysed using SPSS, version 24. Chi-square test and Spearman's rank correlation test (ρ) were performed, and p value of <0.05 was considered statistically significant. Result: A total of 140 patients were included in the study and consisted of 67 men and 73 women. The median age was 44 years, median duration of disease was 10 years and median PASI was 13.6. Scoring revealed moderate-to-severe depression in 69 (49.3%) patients, moderate-to-severe anxiety in 40 (28.6%), severe impairment in quality of life in 98 (70%), harmful use of alcohol in 23 (16.4%) and suicidal ideation in 11 (7.8%) patients. Young age, recent onset, higher PASI and facial involvement show significant association with depression, anxiety and poor quality of life. Conclusion: Screening for psychological morbidity should be performed in patients with severe psoriasis especially younger patients with recent onset disease. Higher DLQI points to concomitant psychological morbidity and it should be performed in all the patients.

Multicentric reticulohistiocytosis: A diagnostic challenge.

Multicentric reticulohistiocytosis, also called as lipoid dermato-arthritis is a rare form of non-Langerhans cell histiocytosis characterised by nodular and papular skin lesions containing characteristic bizarre multinucleate giant cells with ground glass cytoplasm. The disease commonly involves the skin, mucosa, synovium, and internal organs with cutaneous nodules and progressive erosive arthritis being the most common presenting features. We report a case of a 61-year-old male presenting with multiple swellings over distal part of fingers for 6 years without involvement of joints. A diagnosis of multicentric histiocytosis was made based on typical histopathological features of sheets of histiocytes and multinucleate giant cells with ground glass eosinophilic cytoplasm. The disease has a low incidence and about 300 cases have been reported so far in literature. The present case is being reported as it is uncommon for the disease to present in absence of arthritis.

Infrared thermography in the diagnosis of palmar hyperhidrosis: A diagnostic study.

Background: Primary hyperhidrosis is a common condition affecting 1-3% of the general population. Excessive sweating leads to reduced surface temperature due to evaporation that can be captured using a thermal camera. We performed this study to find the utility of thermography in the diagnosis of palmar hyperhidrosis. Methods: This was a cross-sectional diagnostic study conducted in a tertiary care dermatology center during the study period Apr 20-Mar 21. Adult patients with palmar hyperhidrosis diagnosed by expert dermatologists were recruited. The severity was assessed using the hyperhidrosis disease severity scale (HDSS). The measurements were done using a FLIR™ thermal camera. A pilot study, including 30 patients and 30 controls were performed. The results of the pilot study were used for the calculation of sample size. Result: The study included 55 patients and 110 controls. The mean age of the patients and controls was 22.4 (±3) years and 21.7 (±2.5) years, respectively. The mean temperature difference in the patient and control group was found to be 19.6 (±3.3)0 F and 5.8 (±2.9)0 F, respectively (p < 0.001). A receiver operating characteristics curve (ROC) to assess the discriminatory ability of mean temperature difference in diagnosis of hyperhidrosis found the area under the curve (AUC) to be 0.995 and a temperature difference of 11.5 °F provides sensitivity and specificity of 98.2% and 97.3% for the diagnosis of hyperhidrosis. Conclusions: Thermal imaging is a simple, noninvasive, and objective tool for the diagnosis of hyperhidrosis. It has potential utility in monitoring the effect of the treatment.

Chronic venous disease. Part 2: diagnosis and treatment.

Chronic venous disease (CVD) is a common medical condition that results from venous hypertension of the limbs, leading to significant morbidity. The diagnosis is quite straightforward from patient history and obvious clinical manifestations. In the recent past, the availability of various invasive and noninvasive treatments has assisted in evaluation of such cases. Although compression therapy is the mainstay of management, newer surgical and other interventional techniques are now being considered for patients who do not respond to conventional medical management. The second part of this two-part review article will outline a diagnostic approach in cases of CVD and discuss the management principles encompassing conservative, pharmacological and interventional options.

A multicentric study on dermoscopic patterns and clinical-dermoscopic-histological correlates of basal cell carcinoma in Indian skin.

BACKGROUND: Literature on the dermoscopic patterns of basal cell carcinoma (BCC) in India is limited. AIM: To describe the dermoscopic pattern and dermoscopic-histopathological correlation in a large cohort of patients with BCC from India, with a particular focus on skin of colour (SOC). METHODS: This retrospective study was conducted under the aegis of the Dermatoscopy Society of India. Clinical details were collected, and two lead authors independently analysed dermoscopic images of BCC for a predefined set of characteristics. Histopathological slides/blocks were reviewed, and dermoscopic-histological correlation attempted. RESULTS: In total, 143 patients with BCC and skin phototypes IV-VI were included. The mean largest BCC diameter was 3.10 ± 3.68 cm and there was a significant but weak association between duration and largest dimension of the lesion (Spearman ρ = 0.33, P < 0.01). Nearly half of the cases were diagnosed with pigmented BCC and the most common histological subtype was nodular BCC (37.9%). Dermoscopically, blue-grey dots and arborizing vessels were the most common features (60.0%). Pigmentary changes were found in the majority of cases, and included blue-white veil, blue-grey ovoid nests and maple leaf-like areas. A third of our patients had short linear telangiectasia, polymorphic vessels and regular dotted vessels, and another third exhibited a dermoscopic rainbow effect. Arborizing vessels were significantly more common with micronodular (78.9%) and nodular variants (74.1%, P = 0.05), whereas regular dotted vessels (68.4%, P = 0.04), blue-white veil (84.2%, P = 0.02) were significantly associated with micronodular variant. CONCLUSION: The dermoscopic patterns of blue-white veil and regular dotted vessels are indicators towards micronodular BCC in SOC and can help in prioritizing treatment.

Awareness of Leprosy in an urban slum of Western Maharashtra Post 35 Years of the National Leprosy Eradication Program (NLEP).

Background: Even after 35 years of the National Leprosy Eradication Program (NLEP) and 15 years post-elimination, leprosy continues to be a public health challenge in India. This paper discusses the current awareness of leprosy among people living in urban slums of western Maharashtra. Methods: The study was conducted in an urban slum of western Maharashtra with 400 participants. A closed-ended questionnaire regarding the knowledge, attitude, practices, and stigma existing among the people was administered, followed by a small awareness talk and screening for leprosy. Results: Of the total 400 participants, 205 (51.25) were females and 195 (48.75) were males. Only 154/400 (38.5%) people were aware of leprosy. 130/400 (32.5%) people thought that it is treatable; however, 71/130 (54.6) of them thought that it would recur even after completing the treatment. Only 103/400 (25.75) said that they would marry a person with leprosy, denoting prevalent stigma in the society, and 79/400 (19.75) were aware of government services for leprosy and NLEP. Screening of all the participants surveyed did not reveal any new or doubtful cases of leprosy. Conclusion: The present study shows a lack of awareness and knowledge of leprosy among the target population. With only 20% of them being aware of government services and the NLEP, combined with an extremely low knowledge about the disease; it shows the need to further augment the government programs. There is also an increasing need to educate people to accomplish a positive attitude of the community towards leprosy patients.

Drug reaction with eosinophilia and systemic symptoms: A single center descriptive observational study.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse cutaneous drug reaction with mortality up to 10%. It is a rare condition with risk varying between 1 in 1000 and 1 in 10 000 drug exposures. The aim of the study was to describe clinical features, management and drugs responsible for causing DRESS. The study was retrospective, observational study. The data of patients admitted to hospital with diagnosis of DRESS during study period (March 2018 to February 2020), were retrieved and analyzed. The descriptive data of patients were summarized. The continuous variables were summarized as mean ± SD and/or median, depending on the skewness of the data. The categorical variables were expressed as absolute numbers, frequency, and proportions (%). The data was tabulated and analyzed in Microsoft Excel 2019 version. A total of 20 patients who met inclusion criteria (probable or definite DRESS as per RegiSCAR criteria) were included in the study. The mean age of the patients was 41.2 ± 15.7 years. The average latency period was 26.45 ± 5.65 days (range: 7-60). The commonest culprit drugs were dapsone and phenytoin, each in five (25%) patients. Commonest morphology of rash was morbilliform in 13 (65%) patients. One patient with targetoid rash had multi-organ involvement. Facial edema, periorbital edema, and conjunctival injection were seen in 17 (85%), seven (35%), and six (30%) cases, respectively. Eosinophilia was present in 18 (90%) patients with mean (±SD) value of 1976 ± 840 cells/µl. Liver was the commonest internal organ involved in 14 (70%) patients and kidney in three (15%) patients. The initial dose of prednisolone for treatment varied from 0.75 to 2 mg/kg/day. The mean duration of steroid treatment was 64 ± 21 days. Two patients were treated with intravenous methylprednisolone and one with intravenous immunoglobulin. Two patients (10%) had recurrence of adverse drug reaction >6 months after completion of initial treatment and two (10%) developed autoimmune thyroiditis during follow-up. Small sample size and retrospective nature of the study were main limitations. Selection bias is a possibility as study was carried out in tertiary care center. Tests for incriminating culprit drugs such as patch test, intradermal test, and lymphocyte transformation test were not performed. DRESS is a rare disease that can be diagnosed early with high index of suspicion and treated successfully with steroids. The internal organ involvement is common in DRESS and requires a thorough evaluation.

Comparison of electrosurgery by electrodessication versus cryotherapy by liquid nitrogen spray technique in the treatment of plantar warts.

BACKGROUND: Warts or verrucae are benign proliferations of the skin and mucosa resulting from infection with papilloma viruses. Warts form a small subset of patients attending skin out-patient department (OPD), out of which the plantar warts are one of the common presentation. The present study is an attempt to compare two modalities of treatment that is electrosurgery and cryotherapy in patients with plantar warts. There are no studies available where comparison of complications between two modalities has been done in plantar warts thus making it one of unique studies of its kind. METHODS: A prospective, comparative study was conducted over a period of 6 years. After exclusion criteria, one hundred forty-seven male patients having plantar warts were included in the study. Selection of patients suffering from warts subjected to treatment was done by simple random selection. After treatment, 39 patients were lost to follow-up, and finally 48 patients treated by electrosurgery and 60 by cryotherapy were compared and analysed statistically for response to treatment and incidence of complications. RESULTS: The overall clearance rate was 75% in electrosurgery versus 73.3% in cryotherapy patients. The pain, delayed wound healing and scarring were observed significantly in more patients treated with electrosurgery than cryotherapy. In our study, recurrence at 24 weeks was observed in 21.9% of the electrosurgery patients which was slightly higher than cryotherapy, where it was 16.6%. CONCLUSION: This study highlighted that cryotherapy is quick, safe and comparatively painless procedure with less complications with success almost similar to electrosurgery making it more suitable for plantar warts.

Hair transplantation by follicular unit extraction for male androgenetic alopecia: A retrospective observational study from two centers.

BACKGROUND: Follicular unit extraction (FUE) is the most popular method of hair transplantation in today's world. Hair transplantation in androgenetic alopecia (AGA) in males can restore the frontal hairline and provide hair density in alopecic areas to the satisfaction of most patients. METHODS: Consecutive male patients of AGA who underwent hair transplantation by FUE method in two centers between the period of January 2016 and June 2017 have been included in this study based on inclusion and exclusion criteria. Photographic images, trichoscopy and Likert's scale were used to assess patient's improvement in hair density after the transplantation procedure. Statistical methods using SPSS software was used to analyze the results. Institutional ethical clearance and patients' written consent for procedure and images was obtained. The study was an observational retrospective study using data and images from records for which consent and ethical clearance was obtained from patients and the institution. RESULTS: Average number of follicular units transplanted in patients was 1290 (improvement in hair density: of 30.61 follicular units/sq cm). There was a statistically significant difference in improvement in hair density in patients younger than 33 years and in patients with Norwood classification below stage 4a. Forty-nine patients were satisfied with the results after assessment by the Likert scale. CONCLUSION: Hair transplantation by follicular extraction method provides good hair cover in AGA in males. This modern dermatosurgical technique with its many innovations is a very helpful technique to improve quality of life in male pattern baldness.

A unique association of unilateral idiopathic calcinosis cutis with ipsilateral porokeratotic eccrine ostial and dermal duct nevus.

An 11-year-old boy presented with complaints of multiple skin-colored hard lumps on the right side of his body and progressive deformity of the right leg of 7-years duration. His parents had also noticed multiple asymptomatic pits over his right arm, palms, and soles since childhood. Examination revealed skin-colored nontender nodules on the right half of his body and shortening of his right leg. The multiple hyperpigmented pits over the right arm, palm, and sole raised diagnostic difficulties, but histopathologic, radiologic, and biochemical investigations confirmed the features of idiopathic calcinosis cutis and porokeratotic eccrine ostial and dermal duct nevus. Unilateral idiopathic calcinosis cutis has not been previously reported in the literature, and the association with ipsilateral porokeratotic eccrine ostial and dermal duct nevus makes this case unique. Diagnostic difficulties and limited options for treatment make this case interesting academically.

Vitamin D Deficiency After Oral Retinoid Therapy for Ichthyosis.

Oral retinoids are being increasingly used to treat ichthyotic disorders in children. We report on two children with ichthyotic disorders who developed unusual manifestations after they were started on oral retinoids. The first case is a 10-year-old girl with nonbullous ichthyosiform erythroderma and the second is a 2-year-old girl with lamellar ichthyosis. The child with ichthyosiform erythroderma developed features of rickets within months of initiation of systemic retinoids. Her baseline examination before initiation of oral retinoids was normal. The second patient with lamellar ichthyosis was found to have low vitamin D levels after 6 months of retinoid therapy, and prompt supplementation reversed the levels in 2 months. These cases are being reported to bring attention to the probable need for initiation of vitamin D supplementation with systemic retinoid therapy in ichthyotic disorders in children.