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.

Patterns of Occupational Exposure to Human Immunodeficiency Virus and Post-Exposure Prophylaxis Among Health Care Personnel in a Tertiary Care Institute in South India - A Retrospective Case Series.

Background: Post-exposure prophylaxis (PEP) for occupational human immunodeficiency virus (HIV) exposure involves the comprehensive measures used to prevent transmission of blood-borne pathogens such as HIV, hepatitis B virus, and hepatitis C virus through various strategies such as first aid, counseling, risk assessment, relevant laboratory investigations with informed consent, the provision of short-term anti-retroviral drugs, and follow-up testing. Aim and Objectives: We sought to investigate the patterns and causes of occupational exposure in health care workers (HCWs) in our institute and the usage of PEP in our center, a tertiary care hospital in south India. Materials and Methods: The study involved a retrospective analysis of data extracted from the records of PEP usage from the anti-retroviral treatment (ART) center attached to the dermatology, venereology and leprosy out-patient department of a tertiary care center in south India. The data were extracted into a pre-designed proforma and analyzed using descriptive statistics. Results: A total of 352 health care professionals reported to the ART center for PEP from 2010 to 2020. One hundred and thirty-four patients took only the first dose as the source patient later tested to be HIV-negative. Among the 218 remaining patients, 84 were male and 134 were female patients. Only 56 health care workers started the regimen within 2 hours. One hundred and thirty-four patients completed the full course of PEP. Most HCWs (n = 68, 31%) sustained the exposure while doing a procedure on the patient followed by re-capping a needle (n = 64, 29%). Gastritis and drowsiness were the most common adverse effects. Limitations and Conclusions: The study was limited by the retrospective nature of data collection and the lack of detailed interviews with HCWs. Knowledge about PEP, needle safety training, and training of early first aid measures should be increased among health care workers.

Expression of CD117 and platelet-derived growth factor receptor α in patients with alopecia areata.

BACKGROUND: Alopecia areata is a disease of uncertain, probably autoimmune etiology. The role of growth factors like platelet-derived growth factor and C-kit (CD117) in alopecia areata is unknown. AIMS: To compare the expression of CD117 and platelet-derived growth factor receptor α in tissue samples of alopecia areata and normal controls. METHODS: Thirty biopsy samples of alopecia areata and eighteen normal control samples were included in this cross-sectional study. Immunohistochemistry was done to detect the expression of CD117 and platelet-derived growth factor receptor α in cases and controls. The mean percentage of follicles expressing CD117 and platelet-derived growth factor receptor α was compared among cases and controls. RESULTS: The mean number of follicles expressing CD117 in anagen and catagen hairs differed significantly among cases and controls. The extent and intensity of staining with platelet-derived growth factor receptor α correlated significantly with the severity of alopecia areata based on the severity of alopecia tool score. LIMITATIONS: Confirmation of the expression pattern of molecules observed in immunohistochemistry with western blot or polymerase chain reaction would have strengthened the report. CONCLUSIONS: The expression of CD117 varied in cases and controls. The expression of platelet-derived growth factor receptor α correlated with the severity of the disease. This could explain how platelet-rich plasma works in the treatment of alopecia areata. Further studies are required to explore the role of these molecules in autoimmune pathogenesis.

Double trouble: Cyclosporine-induced thrombocytosis in a patient with methotrexate toxicity: Are they related?

Psoriasis is a common, chronic, disfiguring, inflammatory, and proliferative condition of the skin. It manifests with varying degrees of severity and can be treated with various immune modulators. This is a case report of a 57-year-old male patient of psoriasis on long-term oral methotrexate, who developed methotrexate toxicity when given an injection of methotrexate for unstable psoriasis. After recovery, the patient was started on cyclosporine 100 mg twice a day. After a week, he developed thrombocytosis, which reverted a week after cyclosporine was stopped. The patient is currently being managed with acitretin. The aim of this case report is to emphasize the various unpredictable adverse reactions encountered during treatment of psoriasis, especially when a combination or sequential treatment is used. There is a need for caution, as late sequelae of long-term administration of the systemic agents used in the treatment of psoriasis are still unknown.

Dermoscopic findings of alopecia areata in dark skinned individuals: an analysis of 116 cases.

BACKGROUND: Several dermoscopic findings in alopecia areata (AA) are characteristic and aid in the diagnosis of this disease. Studies evaluating the clinical significance of these findings in AA in dark-skinned individuals are sparse. There is no literature of correlation of dermoscopic findings to severity of disease. AIMS: The aim was to determine the dermoscopic findings of AA in dark skinned individuals and to assess whether certain dermoscopic findings correlate with disease activity and severity. MATERIALS AND METHODS: Totally 116 patients with AA were included in the study. After a thorough clinical history and examination to note type, severity and activity of the disease, dermoscopy was performed using a Heine Delta 20 dermoscope (Heine optotechnik,Herrsching, Germany) and the results were noted in a proforma. Statistical analysis was performed using SPSS13 software using appropriate statistical tools. RESULTS: Dermoscopic findings were nearly similar to that described in western literature. Yellow dots (YDs) were found to be highly sensitive for diagnosis, increased frequency being seen in Indian prepubertal patients when compared with western literature. YDs/field of vision (FOV) were found more frequently in severe types of AA. There was no correlation of dermoscopic findings to severity of disease. CONCLUSION: Dermoscopic features are similar to that described in the literature. However, YDs are seen in higher frequency. YDs/FOV could serve as dermoscopic criteria to grade severity of AA.

Extensive nevus comedonicus involving the palm: questionable role of the pilosebaceous unit in pathogenesis.

A 10-year-old boy had multiple grouped pits with black plugs arranged along the lines of Blaschko on his left chest, arm, and palm. Involvement of the palms is rarely reported in the literature. Recent reports have described mosaic acneiform conditions that could share pathogenetic mechanisms with nevus comedonicus. We briefly review the literature on mosaic conditions with acneiform lesions including nevus comedonicus.

Novel presentation of lepromatous leprosy in an erythema gyratum repens-like pattern.

OBJECTIVES: Leprosy can have diverse cutaneous and occasionally perplexing presentations. We report an unusual case of lepromatous leprosy (LL) with annular lesions resembling erythema gyratum repens. REPORT: A 55-year-old man presented with a symmetrical, hypopigmented, and erythematous rash of bizarre appearance over the lateral aspect of the upper arm, and anterior and posterior aspects of the trunk of two months' duration. He gave a history of self-resolving episodes of bilateral pedal edema, and numbness and pricking sensations in both the hands and feet, which had occurred intermittently over the previous six years. An ulcer measuring 2 cm in size was present over the adjacent surface of the right first and second toes. The bilateral ulnar and radial cutaneous nerves were symmetrically thickened. RESULTS: Slit-skin smears revealed numerous acid-fast bacilli. Skin biopsy from the trunk showed collections of histiocytes, lymphocytes, and plasma cells in the dermis and around the blood vessels. The patient was diagnosed with LL and started on multibacillary multi-drug therapy. CONCLUSIONS: Lepromatous leprosy can have varied clinical manifestations and is often a great imitator. However, the skin smear positivity, even in normal skin, symmetrical cutaneous and peripheral nerve involvement, and histopathology in the present patient were indicative of LL. This report highlights a rare presentation of leprosy. Clinicians should be aware of these rare manifestations as lepromatous cases still occur in certain regions.

A retrospective analysis of combination methotrexate-cyclosporine therapy in moderate-severe psoriasis.

BACKGROUND: Methotrexate-cyclosprine combination therapy has traditionally been discouraged in the treatment of moderate-severe psoriasis. However, recent reports indicate that the two may be used in combination in psoriasis. AIM: The retrospective study was undertaken to study the adverse effects and efficacy of the combination in Indian patients of psoriasis. METHODS: The records of all patients who received combination therapy between 2005 and 2010 were extracted. Demographic details, disease profile, presence of coexistent arthropathy, prior therapy, duration of combination therapy, body surface area involvement, Psoriasis Area and Severity Index (PASI), and adverse effects were recorded. Descriptive statistics were used to analyze the data. RESULTS: Eighteen patients received combination therapy during the study period. Fourteen patients received short-term combination therapy and four patients received long-term combination therapy. Twelve patients in the first group and all patients of the second group achieved the primary end point of PASI by 50% from baseline (PASI 50). Nine patients in the first group and all patients in the second group suffered from significant adverse effects; they were however reversible. CONCLUSION: Methotrexate-cyclosporine combination therapy can be used with adequate monitoring in the treatment of moderate-severe psoriasis. Adverse effects seen are usually reversible with reduction in dose and cessation of therapy. Adverse effects related to cyclosporine are a common problem.

Rabson-Mendenhall syndrome with recurrent cerebral infarcts caused by a novel INSR mutation.

Rabson-Mendenhall syndrome (RMS) is an autosomal recessive disorder characterized by extreme insulin resistance and certain characteristic phenotypic features. The primary defect lies in the insulin receptor and involves biallelic mutations that lead to a loss of function through various postulated defects. We present a 9-year-old female patient with RMS complicated by multiple cerebral infarcts, in whom genetic analysis revealed a novel insulin receptor mutation.

Use of intense pulse light for acne vulgaris in Indian skin--a case series.

BACKGROUND: Intense pulse light (IPL) has become extremely popular in Indian cosmetology circles. Yet, literature is silent on its effect in heavily melanized skin. OBJECTIVE: A descriptive study to gauge the effect of IPL on acne vulgaris in Indian patients done in a tertiary care center in south India. MATERIALS AND METHODS: Patients with moderate to severe acne vulgaris were given a maximum of five sittings of IPL treatment. Lesion counts were performed and photographs compared before and after treatment. RESULTS: IPL was offered to 10 patients with acne vulgaris. Two patients dropped out, seven patients had a good response after a mean of 3.4 sittings; 87.5% patients expressed satisfaction with the procedure. No adverse effects were noted. CONCLUSION: IPL serves a useful role in the treatment of acne vulgaris and could reduce treatment costs and pill burden. There is no increased risk of side effects with IPL on Indian skin with standard care.

New intense pulse light device with square pulse technology for hirsutism in Indian patients: a pilot study.

BACKGROUND: Intense pulse light (IPL) with square pulse technology is one of the latest hair removal technologies to be marketed in India. However, there is no literature on use of IPL in Indian skin. OBJECTIVE: A preliminary descriptive study to ascertain the efficacy of an IPL device with square pulse technology for hair removal in Indian patients. MATERIALS AND METHODS: The IFL i200 system (Cyden Ltd, Swansea, UK) was used for hair removal on 12 patients of skin type III, IV and V up to a maximum of six sessions. Hair removal efficacy (HRE) was calculated and photographs taken after each session. RESULTS: Treatment was done for 12 patients. Mean HRE was 69.6%; 83% were satisfied with the procedure; 66% had excellent results; 16% had good results. No permanent adverse effects were seen. CONCLUSION: With standard precautions, IPL is a safe and effective tool for hair removal in Indian patients. Further studies to compare square pulse technology with traditional IPL systems and lasers are required.