Clinical markers of herpes simplex virus infection in patients with pemphigus vulgaris.

BACKGROUND: Herpes simplex virus (HSV) is known to influence the course of pemphigus vulgaris. Relapse, exacerbation, and treatment resistance in patients with pemphigus vulgaris can be due to HSV infection. OBJECTIVES: To characterize the clinical markers of HSV infection among patients with pemphigus. METHODS: This was a hospital-based, descriptive study performed with 60 consecutive patients with pemphigus vulgaris. The clinical and laboratory features of patients with documented HSV infection were then compared with those of patients without infection. RESULTS: HSV infection was confirmed in 23 (38.33%) patients. On univariate analysis, it was noted that male sex (P = .03); presence of fissures (P = .001), hemorrhagic crusts (P = .003), erosions with angulated margins (P = .024), and linear erosions (P = .001); and raised erythrocyte sedimentation rate (P = .015) were found to be significantly associated with HSV infection. In a multivariate analysis, hemorrhagic crusts (P = .015) and linear erosions (P = .008) were found to be independent predictors of HSV infection. LIMITATIONS: We did not use polymerase chain reaction to detect HSV infection, which could have yielded more cases of HSV infection. CONCLUSION: In the clinical setting of pemphigus vulgaris, the presence of fissures, hemorrhagic crusts, linear erosions, erosions with angulated margins and raised erythrocyte sedimentation rate must alert the clinician to the possibility of HSV superinfection.

Hyalohyphomycosis (Fusariosis): Atypical Presentation in an Immunocompetent Individual Responding to Itraconazole.

Hyalohyphomycosis includes infections caused by various fungal species that produce hyaline, septate, branched hyphae. Fusarium is one such species which usually causes multiple papulo-nodules, ecthyma gangrenosum-like ulcers in immunocompromised individuals. Also, fusariosis is usually difficult to manage and responds favorably to amphotericin B, voriconazole, and posaconazole in disseminated cases. Here, we report an atypical case of cutaneous fusariosis in an immunocompetent individual who presented with multiple large cystic swellings, psoriasiform plaques, and palmoplantar keratoderma, and the patient responded completely to itraconazole.

Serotonin and interleukin-6: Association with pruritus severity, sleep quality and depression severity in Prurigo Nodularis.

Prurigo Nodularis (PN) is a chronic skin condition of unknown etiology. It is said to be associated with psychological factors. However, studies to identify the same are few. Hence, we undertook to assess the association between quality of sleep, depression, pruritus severity in cases of PN and to assess association of serum serotonin, interleukin (IL)-6 with sleep, depression and pruritus severity. This cross-sectional study involves 39 patients with PN and 39 age and gender matched healthy controls. Subjective quality of sleep, depressive symptom severity and pruritus severity were collected through clinician based interview. Serum serotonin and serum IL-6 were estimated by ELISA. Spearman correlation was used to assess the strength of association between biochemical parameters and clinical parameters. Cases had significantly higher percentage of depression, a higher score of depression severity, higher serum IL-6 level and lower serum serotonin levels. Serum serotonin and serum IL-6 showed significant correlation with the severity of pruritus (r=-0.66, p<0.01 and r=0.60, p<0.01). However, both these parameters showed a significantly negative correlation between them (r=-0.92, p<0.01). Though cause and effect cannot be established in this type of study, there is a disturbance of the inflammatory-neuroendocrine axis (interleukins-serotonin). PN is characterized by higher IL-6 and lower serotonin and greater depression severity than healthy controls. Findings of this study may have an influence on the treatment of PN.