Mucocutaneous manifestations of COVID-19-related multisystem inflammatory syndrome in adults: an update.

Multisystem inflammatory syndrome in adults (MIS-A) is an inflammatory condition that affects multiple extrapulmonary organ systems (cardiac, gastrointestinal tract, dermatological and/or neurological), attributed to a postinfectious and atypical complication occurring weeks to months after infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The diagnosis is primarily based on findings encompassing persistent fever, elevated inflammatory markers, multiorgan involvement and a temporal relationship with COVID-19 infection. The existing literature on MIS-A, although growing, is limited to case reports and small case series. It is imperative that dermatologists be aware of this entity and aid the critical care team to ensure timely diagnosis and early therapeutic intervention. In this review, we concisely highlight the varied presentations, pathogenesis and treatment options in MIS-A.

Trichophyton: Changing Nomenclature and Practical Implications.

Trichophyton interdigitale had been regarded as anthropophilic, mainly causing non-inflammatory tinea unguium and tinea pedis. T. mentagrophytes, thought to be zoophilic, were regarded as responsible for more inflammatory dermatophytosis. Indian terbinafine-resistant strains, identified with ribosomal internal transcribed spacer as 'genotype VIII', have recently been termed Trichophyton indotineae based on clinical and mycological features. Some of these have shown selective azole resistance as well. Phenotypic studies have shown some similarities and some differences between Trichophyton indotineae, T. mentagrophytes, and T. interdigitale, which are optimally distinguished with HMG locus analyses as three main genotypic groups containing the type strains of T. indotineae (CBS 146623), T. interdigitale (CBS 428.63), and T. mentagrophytes (IHEM 4268) and having approximate differences in geographic distribution. Trichophyton interdigitale was prevalently isolated from superficial infections on exposed body sites such as the scalp and face, while also feet and nails. Trichophyton mentagrophytes has a similar predilection but are also often found on the trunk and genitals. Trichophyton indotineae is mostly restricted to the trunk and groin. T. indotineae lesions are generally highly inflammatory, strongly associated with tinea cruris, corporis, and faciei and less commonly with fingernail onychomycosis and tinea pedis. They cause papulosquamous, pustular, pseudo-imbricata (tinea faciei), lichenoid, and pityriasis rosea (tinea corporis of the neck) types of lesions and spread rapidly to multiple sites and cause painful lesions with itching or burning. Lipolytic abilities of T. mentagrophytes and T. interdigitale are very similar and are higher than those of T. indotineae, which is associated with a higher prevalence of T. mentagrophytes on the human scalp, which is relatively rich in lipids. Keratin degradation is significantly larger in T. interdigitale due to location (tinea pedis and tinea unguium). Identification of T. indotineae through culture alone may not be sufficient for effective treatment decision-making; genetic analysis for resistance profiles is needed for optimum treatment selection. In India, steroid-induced suppression of local cellular immunity as well as an altered cutaneous microbiome provided a window of opportunity for the unique, multidrug-resistant species Trichophyton indotineae.

Skin as an endocrine organ: A narrative review.

Skin being the largest organ of the body, is equipped with numerous functional properties. Over the past few years, intricate research into the biology of skin has led to a gamut of discoveries. Skin is now regarded as one of the most vital endocrine organs. The skin contains equivalents of the hypothalamo-pituitary-adrenal axis, hypothalamo-pituitary-thyroid axis and the appendages produce multiple hormones such as Vitamin D, sex steroids, retinoids and opioids. In this article, we will explore the role of skin as a target and source of some of the hormones of the human body, and briefly touch on the clinical applications.

Psoriatic Arthritis: A Comprehensive Update for Dermatologists with Review of Literature.

Psoriatic arthritis (PsA), an inflammatory seronegative spondyloarthropathy is the most common co-morbidity of psoriasis (PsO), in almost 30% of cases. Delayed diagnosis and treatment of PsA may result in irreversible joint damage, significant morbidity, impaired quality of life, and several cardiometabolic and cerebrovascular co-morbidities. Dermatologists are uniquely privileged to be able to diagnose latent PsA at an early stage, as almost 80% of these patients present with pre-existing cutaneous PsO. This review provides a detailed overview of PsA along with its salient clinical features, classification criteria, screening tools, simple physical examination maneuvers, imaging findings, and therapeutic options to acquaint dermatologists and other clinicians with this morbid musculoskeletal disorder. We hope to generate awareness about this condition among dermatologists to enable proactive screening of all PsO patients for early diagnosis, initiation of appropriate treatment, and prompt referral to a rheumatologist; thus, helping to arrest PsA disease progression, irreversible joint damage, and subsequent permanent disability.

Parental Stress and Quality of Life in Chronic Childhood Dermatoses: A Review.

Chronic dermatoses, such as atopic dermatitis, vitiligo, and psoriasis, can affect children. Apart from impacting the pediatric patient's quality of life, these disorders can also have a profound impact on the quality of life of their parents or closest caregivers and other family members. In an effort to better understand the relationship between parental stress and chronic dermatoses in children, we reviewed the available literature, which is scarce. Data indicate that the negative impact that chronic dermasoses in children can have on their parents is often overlooked during dermatologic consultation. Increased parental/caregiver stress can contribute to poor psychological adjustment of the parent to the child, potentially leading to a decreased level of childcare. Financial burden caused by prolonged therapy may further impact the parental care of the child. We as healthcare professionals should address parental and caregiver stress and incorporate appropriate measures to ensure optimal care of children with chronic dermatoses.

Skin and Metabolic Syndrome: An Evidence Based Comprehensive Review.

Metabolic syndrome is currently considered to be a global epidemic, causing a significant increase in the cost of health care, apart from deteriorating the quality of life. Skin serves as a mirror of underlying metabolic sinister. Various dermatological conditions like psoriasis, acanthosis nigricans, lichen planus, acne vulgaris, acrochordons, atopic dermatitis, etc. have been reported to be associated with metabolic syndrome. We hereby present an evidence-based review of the various dermatological conditions and their association with the development of metabolic syndrome.

Acute encephalopathy in children in Muzaffarpur, India: a review of aetiopathogenesis.

The acute encephalopathy occurring in children in Muzaffarpur, India, also recognised in other litchi-cultivating areas of India, Bangladesh, Vietnam and China, had previously been linked to litchi consumption. Recently, it has been identified as hypoglycaemic encephalopathy of an unusual aetiology with three key factors: undernutrition, prolonged fasting and litchi consumption. A second set of investigators has independently reconfirmed the diagnosis and the three-factor aetiology. Skipping the evening meal with an intake of large amounts of litchi in undernourished children is causative. Early-morning hypoglycaemia with an inadequate glycogen store leads to initiation of gluconeogenesis and fatty acid ß-oxidation, but methylene cyclopropyl alanine and glycine present in the litchi aril block the fatty acid ß-oxidation cycle. The outcomes are uncorrected hypoglycaemia and encephalopathy due to the entry of metabolic intermediates that cross the blood-brain barrier and affect neuronal function. Suggested measures include early 10% dextrose infusion. Awareness about the disease is of prime importance. The diagnosis and aetiopathogenesis are still under question from a part of the scientific community. This review was undertaken to present a comprehensive view of hypoglycaemic encephalopathy and to remove some of the lingering doubts.

Acanthosis nigricans: A review.

BACKGROUND: Acanthosis nigricans (AN) is a cutaneous disorder characterized by symmetric velvety hyperpigmented plaques on intertriginous areas like axilla, neck, inframammary, and groin. AIMS: To summarize the pathophysiology and classification of AN, provide an update of diagnostic testing strategies, and describe the current therapeutic options described so far in the literature for this disease. METHODS: A comprehensive english language literature search across multiple databases (PubMed, EMBASE, MEDLINE, and Cochrane) for keywords (alone and in combination) was performed. MeSH as well as non-MeSH terms such as "acanthosis nigricans," "classification," "pathophysiology," "diagnosis," "treatment," "topical drugs," "systemic drugs," "chemical peeling," and "lasers" were taken into consideration. RESULTS: The pathophysiology of AN revolves around a multifactorial stimulation of proliferation of epidermal keratinocytes and dermal fibroblasts. Various types of AN include benign, obesity-associated, syndromic, malignant, acral, unilateral, medication-induced, and mixed-type. Homeostasis model assessment-insulin resistance (HOMA-IR) is a good tool for assessment of insulin resistance. Management involves general measures (weight reduction and addressing the underlying cause, if any), topical drugs (retinoids, vitamin D analogs, and keratolytics), oral drugs (retinoids and insulin sensitizers), chemical peels (trichloroacetic acid), and lasers (Long pulsed alexandrite, fractional 1550-nm erbium fiber, and CO2 ). CONCLUSION: Acanthosis nigricans is a treatable condition; however, complete cure and disappearance of lesions are difficult to achieve. Weight reduction is the most scientific and practical management strategy. Long-term studies and further research is warranted in the pathophysiology and treatment of this common condition.