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.

Palmoplantar Plaque Psoriasis is Associated with Diabetes, Hypertension, Obesity, and Metabolic Syndrome-A Case-Control Study.

Background: Palmoplantar plaque psoriasis is a regional variant of psoriasis, characterized by erythematous, indurated plaques with fissuring over palms and soles. Chronic plaque psoriasis is associated with various comorbidities such as obesity, diabetes mellitus, hypertension, dyslipidemia, metabolic syndrome, and cardiovascular disease. Body surface area involvement is an indicator of psoriasis severity, and most comorbidities are more strongly correlated with severe disease. Objectives: To estimate the prevalence of metabolic comorbidities in palmoplantar plaque psoriasis. Methods: It is a case-control study involving treatment naïve palmoplantar plaque psoriasis patients and age- and gender-matched healthy controls. Results: The study included 100 cases and 100 controls. The mean age among cases and controls was 45.4 ± 11.1 and 43.9 ± 10.3 years, respectively (P: 0.31). The gender ratio among cases and controls was 1.56 (61M: 39F) and 1.94 (66M: 34F), respectively. Comorbidities including metabolic syndrome (P: 0.001), obesity (P: 0.001), diabetes mellitus (P: 0.001), and hypertension (P: 0.001) were more common among cases as compared to controls. The odds of diabetes, metabolic syndrome, hypertension, and obesity in patients with palmoplantar psoriasis were 4.8 (95% CI 2.5-9.3), 3.7 (95% CI 2-6.9), 3.1 (95% CI 1.6-6), and 3.5 (95% CI 1.9-6.4), respectively. Conclusion: In this study, we found that palmoplantar plaque psoriasis is associated with metabolic comorbidities. Primary care physicians should screen patients with palmoplantar psoriasis for these comorbidities.

Mucormycosis: The Scathing Invader.

Mucormycosis is an invasive fungal infection that has been increasing in incidence over the years. Increase in the number of diabetics, malignancy patients, and use of immunosuppressants has mainly led to this gradual upward surge. Mucormycosis has various clinical forms, including rhino-orbito-cerebral, pulmonary, gastrointestinal, and cutaneous. Fungi belonging to Mucorales are thermotolerant and ubiquitous, found growing on organic substrates such as bread, decaying fruits and vegetables, crop debris in soil, compost, and animal excreta. During this second wave of the COVID-19 pandemic, the number of cases of mucormycosis has increased manifold in a short span of time. Associated comorbidity of diabetes mellitus, increased use of higher doses and prolonged duration of systemic corticosteroids, the glucogenic and prothrombotic propensity of the virus, hypoxic environment, COVID pneumonia, increased hospitalization, ICU admissions, and mechanical ventilation have all contributed toward this high rise in numbers. The rhin-orbito-cerebral form is the commonest manifestation of mucormycosis in COVID. Rhizopus oryzae, the main species causing mucormycosis, is identified by hyaline, sparsely-septate, broad, ribbon-like hyphae with irregular right-angle branching ribbon-like hyphae with rhizoids. For the early diagnosis of this infection, 10% KOH mount is very important. These fungi are very rapidly growing and thus can be differentiated from their main ally, Aspergillus. Treatment is mainly in the form of extensive surgical debridement along with liposomal amphotericin B. Posaconazole and isavuconazole are second-line agents, which can also be used for maintenance. Control of diabetes and COVID-19, along with judicious use of antibiotics and systemic corticosteroids, are equally important as management strategies in these pandemic times.