The Impact of Tofacitinib on Quality of Life in Patients with Moderate-to-Severe Psoriasis- An Observational Study.

Background: Global phase III trials have established the effectiveness and the safety profile of 5 and 10 mg twice-daily regimens of Tofacitinib for the management of psoriasis. Aims and Objectives: This study was aimed at assessing the improvement in quality of life in patients suffering from moderate-to-severe psoriasis following 12-week Tofacitinib therapy. Materials and Methods: 50 adults with moderate to severe plaque psoriasis enrolled with informed consent. Tofacitinib was given orally for 12 weeks, as 5 mg or 10 mg twice daily based on weight. Improvement in PASI and DLQI was recorded. Results: We observed a statistically significant improvement in PASI (p-value < 0.001) and DLQI (p-value < 0.001) following Tofacitinib therapy. The 3 domains of DLQI with the most significant improvement were symptoms and feelings (items 1 and 2) (p-value-0.001), daily activities (items 3 and 4) (p-value-0.0001), and treatment (item 10) (p-value-0.0001). Conclusion: Tofacitinib demonstrated a significant improvement in psoriasis disease severity and symptoms with 12 weeks' therapy.

Hand Foot Mouth Disease During the SARS-CoV-2 Pandemic: A Multicentric Study.

OBJECTIVES: This prospective observational study aimed to identify the current trend of the circulating viral strains responsible for HFMD outbreak in four tertiary care centers in Rajasthan, amidst the COVID-19 pandemic (April-October 2022). METHODS: Cases with suspected HFMD, presenting to our skin outpatient department were assessed clinically and serologically (IgM antibodies against coxsackie virus (CV) A6, A16 and enterovirus 71) for evidence of the disease. RESULTS: We identified 718 new HFMD patients (161 adults) with peaks in May and August, 2022. Male:female ratio decreased with increasing age. Most children were asymptomatic. A total of 385/409 patients assessed serologically, were found positive, most commonly against CV-A6. CONCLUSION: Though HFMD typically affects young children, an unusually higher proportion of adults were affected during the current pandemic. There were some subtle differences between pediatric and adult presentation of HFMD.

Intralesional Purified Protein Derivative of Tuberculin Versus Intralesional Mycobacterium W Vaccine in Treatment of Recalcitrant Extragenital Warts: A Randomized, Single-Blinded, Comparative Study.

Introduction: Of late, immunotherapy has emerged as a promising therapeutic modality for the treatment of recalcitrant and difficult to treat warts. Purified protein derivative of tuberculin (PDD) and mycobacterium w (Mw) vaccine hold promising prospects for the treatment of verruca, especially in a country like ours where a majority of the population is already sensitized to mycobacterium tuberculosis both due to disease endemicity and Bacillus Calmette-Guérin (BCG) vaccination. Aims and Objectives: We aimed at evaluating the treatment outcome of intralesional PPD tuberculin and Mw vaccine in the treatment of recalcitrant extragenital warts in immunocompetent subjects. Materials and Methods: The patients included immunocompetent subjects between the ages of 16 and 65 years with two or more extragenital warts. The patients were randomized into two groups, namely A (PPD Tuberculin) and B (Mw vaccine). In both groups, 0.1 mL of active intralesional immunogen was injected at the base of the largest wart. The doses were repeated at 4 weeks' intervals for a maximum of 5 injections. Additionally, the improvement in quality of life was measured using the Hindi-validated version of the Dermatology Quality of Life Index (DLQI) questionnaire. Results: Ninety-seven patients completed the study, with 46 in group A and 51 in group B. In group A, 24 (52.17%) patients had complete clearance in all warts, and in group B, 32 (62.75%) (P = 0.38). The most common adverse event in patients of group A was transient injection site erythema and swelling, whereas that in group B was mild transient fever. None of the patients showed any signs of recurrence in the ensuing follow-up period. There was a statistically significant improvement in the mean DLQI scores after treatment in both groups (P < 0.0001). Conclusion: Both PPD Tuberculin and Mw vaccine are effective in the treatment of recalcitrant warts with minimal recurrence rate. The safety profile of PPD is superior to Mw vaccine. We suggest both to be used as first-line therapy in the treatment of difficult to treat warts.

Evaluation of the Knowledge, Attitude and Practice of Patients on Immunosuppressive Drugs Towards COVID-19 Attending Dermatology Department- A Multicentric Cross-Section Study.

BACKGROUND: The deadly COVID-19 (Coronavirus Disease 2019) or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) was identified for the first time in December 2019 from Wuhan, China, and by the beginning of March 2020, it was declared a pandemic by the World Health Organization (WHO). Despite so many government regulations and awareness measures, there is still a lacuna between the gravity of illness and the knowledge of the average person toward it. OBJECTIVE: We aimed at assessing the knowledge, attitude, and behavioral practice (KAP) of patients on immunosuppressive medication attending the dermatology department toward, COVID-19. MATERIAL AND METHODS: A self-designed printed/digital questionnaire consisting of 30 questions (Hindi and English) was supplied to patients being treated with any systemic immunosuppressives (for at least 3 weeks), for any dermatological ailment. The questionnaire consisted of 12 questions assessing the knowledge, 11 for attitude, and 7 for practices of patients toward COVID-19. RESULTS: The study included 237 patients with a mean age of 44.57 ± 13.72 years. The correct knowledge toward COVID-19 was present in 126 (53.16%) patients with a mean score of 7.79 ± 3.08 out of 13. The mean attitude score was 8.35 ± 2.16 (out of 11) while the mean score of practice was 5.64 ± 2.03 (out of 8). Increased hygiene levels were seen in 220 (92.83%) patients. Sixty-six (27.85%) patients admitted to stopping their prescribed immunosuppressives by themselves during COVID-19 and a significant proportion agreed to the use of alternative medicines with questionable efficacy (n = 91; 38.39%). A significant difference in KAP was found across various strata of society like gender, age, socioeconomic status, literacy, and residence (P < 0.001). LIMITATIONS: Our study was limited by small sample size, absence of a control group with healthy individuals, and short duration of the study. CONCLUSIONS: Most of the participants had poor knowledge, a positive attitude, and good practices toward COVID-19. Proper counseling of patients and the use of telemedicine could help combat the gap in KAP without compromising the healthcare facilities needed for the management of such patients.

An Observational Study of Mucocutaneous Manifestations among SARS-CoV-2 Patients from Three COVID-19 Dedicated Tertiary Care Centers.

INTRODUCTION: Ever since the outbreak of COVID-19, the respiratory system has been the chief focus of researches, however, understanding the impact of this disease on the integumentary system is just as essential. OBJECTIVES: We aimed at collecting data on any cutaneous manifestation arising in patients with active and recovering COVID-19 infection, or a direct consequence of the infection's treatment, and correlating these findings with systemic disease severity and duration. MATERIALS AND METHODS: A prospective observational study was conducted in three tertiary care centers from Rajasthan, India, to acquire data of laboratory-confirmed cases of COVID-19 presenting with any mucocutaneous manifestation. RESULTS: Eight predominant patterns of dermatological involvement were seen, namely, maculopapular (14.59%), urticarial (13.17%), perniotic (12.1%), pityriasis rosea (11.74%), acral erythema/edema (10.3%), petechial (4.63%), vesicular (2.49%), and livedo (1.78%). Rare findings included eruptive pseudoangioma, eruptive hypomelanosis, alopecia parvimaculata, geographic tongue, chikungunya-like hyperpigmentation, and nail changes. On correlating these findings with the gradient of the disease, livedo, vasculitis, exfoliation, and erythroderma were associated with severe disease, whereas perniosis and eruptive pseudoangioma were seen in mild illness. CONCLUSION: We reported a few previously unpublished skin manifestations of COVID-19, namely, geographic tongue, chikungunya-like pigmentation, eruptive hypomelanosis, and alopecia parvimaculata. This study provides a visual description of the muco-cutaneous manifestations of COVID-19 disease which could aid a dermatologist or physician in early diagnosis of this novel infection, especially in a resource-poor setting.

Dermoscopy in Leprosy: A Clinical and Histopathological Correlation Study.

BACKGROUND: Leprosy, an insidious infectious granulomatous disease, is diagnosed traditionally through clinical examination coupled with skin smears and histopathology. It has myriad clinical presentations that pose diagnostic challenges. Lately, dermoscopy has emerged as a rapid, noninvasive diagnostic modality for many dermatoses. OBJECTIVES: We evaluated the dermoscopic findings of various manifestations of leprosy and correlated them with clinical and histopathological features. METHODS: This prospective, cross-sectional study was conducted in our skin outpatient department for a period of 1 year. Patients newly diagnosed as having leprosy or those undergoing leprosy treatment for less than 6 months were included. The most representative lesion was dermoscopically evaluated and later biopsied. RESULTS: We included 73 patients in the study. Results indicated an obvious correlation between dermoscopic findings and histopathology. We noted orangish yellow and white structureless areas, steadily throughout the spectrum, depicting dermal granuloma. Additionally, we observed focal vascular structures such as branching, linear, and crown vessels that result from the pressure of granuloma pushing the dilated vessels upwards. The relative absence of skin appendages aided in differentiating leprosy from other granulomatous disorders. Novel findings of our study were the detection of a branch-like pattern of clofazimine-induced pigmentation on dermoscopy and orange globules on onychoscopy. Other unique findings included violaceous structureless areas, characteristic large telangiectatic vessels, follicular plugging, star-shaped silvery-white scaling, and white globules in type 1 reaction; white shiny steaks were observed in patients with borderline lepromatous leprosy, and central white dots and keratotic plugs were observed in patients with histoid leprosy. CONCLUSIONS: Dermoscopy, as a noninvasive modality, could aid in the quick diagnosis of leprosy and should be used as a handy tool to complement other investigative tools for this disease.

Endocrinological Testicular Dysfunction in Patients with Lepromatous Leprosy and the Impact of Disease on Patient's Quality of Life.

INTRODUCTION: Leprosy or Hansen's disease poses a drastic impact on the quality of life in affected patients even after successful completion of treatment. The involvement of the endocrine system in leprosy is usually insidious, silent, and under-reported, especially the testicular dysfunction. AIMS AND OBJECTIVES: The present study was aimed at evaluating the abnormalities of the primary testicular hormone testosterone and the gonadotrophins LH and FSH in male patients affected with lepromatous leprosy and assessing the impact of the disease on quality of life (QOL). MATERIALS AND METHODS: The study included 43 married male patients diagnosed with lepromatous leprosy. Careful history taking and examination for symptoms of testicular dysfunction were done. Serum concentrations of total testosterone, FSH, and LH were noted. The QOL was evaluated using the WHO Quality of Life-BREF (WHOQoL-BREF). RESULTS: The most common clinical manifestation of testicular dysfunction was reduced or loss of libido reported in 12 (27.9%) patients followed by gynaecomastia in 7 (16.3%). Ultrasonographic (USG) analysis revealed reduced testicular volume in 31 (72.1%) patients, and average testicular volume was 11.9 ± 4.9 mL each. Seventeen (39.5%) patients had low serum testosterone levels, 9 (20.9%) had high serum FSH level, and 11 (25.6%) high LH levels. There was a significant negative correlation between testosterone level and FSH as well as LH. There was also a significantly positive correlation between testicular volume and testosterone level. Symptomatic patients with gynaecomastia/gynaecothelia had higher hormonal derangement than those who had other symptoms. On QOL, most patients scored lowest on the domain of "social relationships" (including sexual wellbeing) followed by "psychological health". CONCLUSION: We found a high rate of USG diagnosed testicular atrophy in lepromatous leprosy patients. Therefore, every leprosy patient should be thoroughly examined clinically to rule out features of testicular dysfunction. Testicular function tests should be routinely carried out in all leprosy patients to arrive at an early diagnosis. Leprosy is found to affect all domains of a patient's quality of life.

Anterior Ectopic Cilia with Myopia and Lichen Nitidus: A Rare Case Report with Dermoscopic Findings.

Ectopic cilia, or lash follicles situated over abnormal sites, are an extremely rare entity. Here, we report the case of a 6-year-old-boy who presented with ectopic cilia over the left upper eyelid along with a positive family history. Dermoscopy revealed discreet terminal hair emerging from the individual hair follicles surmounted over a diffuse structureless whitish-yellow zone and a few vellus hairs in the surrounding normal skin. These hairs, on histopathological examination, had multiple pilosebaceous follicular units embedded in a desmoplastic stroma with multiple eccrine sweat glands. Other incidental findings included lichen nitidus and myopia.

A comparative study of the efficacy and safety of intralesional measles, mumps, and rubella vaccine versus intralesional vitamin D3 for the treatment of warts in children.

BACKGROUND: Intralesional vitamin D3 has recently emerged as a new treatment for cutaneous warts. The use of the measles, mumps, and rubella (MMR) vaccine for this purpose is an established modality. However, relevant data on the efficacy of either the MMR vaccine or vitamin D3 as immunotherapy for cutaneous warts in the pediatric population are limited. OBJECTIVES: To compare the efficacy and safety of intralesional injections of MMR vaccine to intralesional injections of vitamin D3 in children aged 8-16 years with multiple warts. METHODS: A total of 74 children were randomly allocated into two groups. Group A patients received intralesional MMR vaccine into the largest wart, and group B received intralesional vitamin D3 into the largest wart. The injections were repeated every 4 weeks until clearance or for a maximum of three treatments. After the last injection, children were followed up every 2 weeks for 3 months, and at the sixth month, a final clinical assessment was conducted. RESULTS: Of 74 children, 60 completed the study, with 30 children in each group. Complete clearance of the injected wart was observed in 26 (86.67%) patients in the MMR group (group A) and 23 (76.7%) patients in the vitamin D3 group (group B). Distant warts cleared in 23 (76.7%) patients in group A compared to 20 (66.6%) patients in group B. There was no significant difference between groups. No recurrence was seen in group A, whereas two (6.6%) children in group B exhibited recurrence in the ensuing 6-month follow-up. The most common adverse events were injection site pain and swelling. CONCLUSION: Both intralesional MMR and vitamin D3 are safe, generally well-tolerated, and equally effective in children for the treatment of cutaneous warts.

Evaluation of Impact of Tinea Capitis on Quality of Life in Pediatric Patients Using Children's Dermatology Life Quality Index and Its Correlation with Disease Duration.

INTRODUCTION: The superficial fungal infection of the scalp caused by dermatophytes is called tinea capitis. It has a predilection for the pediatric age group. In developing countries like India factors such as overcrowding, inadequate hygiene, and low literacy rate contribute to its high incidence. AIMS AND OBJECTIVE: This study aimed at identifying and grading the psychosocial impact of tinea capitis in children and correlating it with disease duration and socioeconomic status of patient's family. MATERIALS AND METHODS: This was a cross-sectional study conducted in our skin outpatient department involving children aged 6-16 years with clinical diagnosis of tinea capitis. We used the children's dermatology life quality index (CDLQI) instrument to observe the psychological implications in these children. RESULTS: The study included 134 patients, with a mean CDLQI score of 6.01 ± 4.17. There was a male preponderance in our study with 112 (68.3%) male patients and 52 (31.7%) female patients. The age group affected most commonly was 6-8 years (37.8%). The domains affected most severely were symptoms and feelings (Q1 and Q2) followed by sleep (Q 9). The psychological implications were higher in patients suffering from kerion, older children, and female patients. There was a statistically significant correlation between the impact on quality of life (QOL) and disease duration as well as disease severity; however, no correlation could be made between QOL and socioeconomic strata of family. CONCLUSION: The study brings into question the overlooked psychological implications of tinea capitis which are often overlooked by the dermatologist and parents as a mere dermatological disease. Instead a holistic approach including a complete psychological evaluation of children and appropriate counseling of both patients and their parents must be done.