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.

Histopathological Spectrum of Cutaneous Reactions following COVID-19 Vaccine - An Observational Study.

Background: Owing to the myriad clinical presentations of COVID-19 vaccine-induced adverse events, clinicopathological correlation is the key to understanding the underlying pathophysiology of these reactions. However, there is still a dearth of such systematic studies across a wide spectrum of vaccine reactions. Aim and Objectives: This study provides a clinical and histopathological correlation of COVID-19 vaccine-induced mucocutaneous reactions. Materials and Methods: The study population included all the individuals developing any form of self-reported mucocutaneous adverse events within 4 weeks of receiving the COVID-19 vaccine. The clinical and histopathological features were recorded. Results: A total of 126 cases were identified. Seven histopathological patterns were recognized. The most common histopathological feature was spongiotic dermatitis, seen in all the patients with "vaccine-related eruption of papules and plaques" (VREPP). Other patterns included lichenoid or interface dermatitis, dermal hypersensitivity reaction, leukocytoclastic vasculitis, subepidermal blistering, psoriasiform hyperplasia, and dermal granulomatous reaction. Conclusion: Owing to such myriad clinical presentations, utilizing a histopathological classification could ease categorizing the vaccine-induced mucocutaneous eruptions.

Correlation of Vitamin D3 Levels with Disease Severity in Psoriasis Patients - A Case-Control Study.

Introduction: Vitamin D is involved in the activation of innate and adaptive immunity. In the epidermis, vitamin D is involved in the differentiation and maturation of keratinocytes. A fall in the vitamin D levels can activate auto-immunity. Aims and Objectives: This study was aimed at correlating the serum vitamin D level of psoriasis patients with disease severity. Materials and Methods: This case-control study included 50 newly diagnosed cases of psoriasis (group A) and 50 controls (group B). Serum vitamin D levels were assessed in both groups. The levels were correlated with the duration of disease, psoriasis area and severity index (PASI) score, and erythrocyte sedimentation rate (ESR) level. Results: Psoriasis patients had significantly lower vitamin D levels than controls. There was a significant negative correlation between serum vitamin D level and disease duration, PASI score, and ESR level (p-value <0.001). Rising age and female gender were also associated with significantly lower vitamin D. Conclusion: We found a high prevalence of vitamin D deficiency in psoriatic patients. The level is strongly associated with every aspect of disease severity. Its level can predict the course of disease and prognosis.

Estimating the Impact of Extragenital Warts versus Genital Warts on Quality of Life in Immunocompetent Indian Adult Patients: A Comparative Cross-Sectional Study.

BACKGROUND: Extra-genital warts (EGWs) affect 7-10% of population. Even though a plethora of studies have been conducted to assess the impact of genital warts (GWs) showing a significant impact on the quality of life but surprisingly, barely any data has been collected on the impact of EGWs on quality of life. AIMS AND OBJECTIVE: This cross-sectional study aimed at comparing the magnitude of EGWs on health-related quality of life and various variables with that of GWs. PATIENTS AND METHODS: The study consisted of two groups of immunocompetent adults, each with 100 patients aged 18 years or above, attending the skin outpatient department at our tertiary center between April 2018 and March 2019 and consented to participate. Group A consisted of patients with EGWs and group B comprised of patients with GWs. All patients were asked to fulfill the validated Hindi hard copy of the Dermatology Life Quality Index (DLQI) questionnaire. RESULTS: The mean DLQI score of patients with EGWs was 8.73 ± 0.84 and that of patients with GWs was 5.83 ± 0.83 (P = 0.026). In group A, those affected the most were patients with warts on multiple exposed sites (mean DLQI score of 14), followed by warts on feet (mean DLQI score of 10.69), followed by warts on hands (DLQI score of 9.12), and facial warts (DLQI score of 6.80). Patients with a prior history of failed treatment and/or a longer duration of illness had a higher level of dissatisfaction. To the best of our knowledge, no such study has been conducted in the past in our country. CONCLUSIONS: EGWs inflict a severe negative impact on the quality of life. Owing to its notorious persistence and recurrence, healthcare professionals must educate patients on how to prevent the spread and recurrence, discuss details of available treatment modalities while keeping in view the psychological and sociological impact.

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.

A Case of Scalp White Piedra Caused by Trichosporon Ovoides.

White piedra also known as trichomycosis nodularis or trichomycosis nodosa is a superficial fungal infection of the hair shaft caused by Trichosporon asahii. We are reporting a case of white piedra in a female for the rarity of such occurrence.

Falknor's needling method as a potential immunotherapy in palmo-plantar warts.

BACKGROUND AND AIM: Treatment of palmoplantar warts is a challenge for dermatologists. We aimed to study the efficacy and safety of Falknor's needling method in palmoplantar warts. METHODS: In an open, nonrandomized study, the index wart of eligible patients was punctured several times with a 26-gauge needle to produce a "beefy" red wound. Patients were followed up to 6 months. RESULTS: Out of 82 patients, complete resolution occurred in 58 (70.7%) and partial response in 5 (6.1%) patients. Nine (10.9%) patients developed secondary infection. LIMITATIONS: Small sample size, No comparison group. CONCLUSION: Falknor's needling method provides a high rate of complete resolution after a single treatment session. It is easy to perform and is cost effective.

A retrospective study of the pattern of sexually transmitted infections from a tertiary care hospital of Rajasthan.

BACKGROUND: Knowledge about the current patterns of sexually transmitted infections (STIs) is essential as they pose a major health problem worldwide and even more so in the developing countries like ours. Owing to the lack of advanced laboratory facilities at most of the centers, the cases are evaluated and managed as per the syndromic approach proposed by the National AIDS Control Organization. AIMS: We aim to study the patterns of STIs seen over the past 4 years based on the syndromic approach. MATERIALS AND METHODS: A retrospective analysis of the data of STI clinic over 4 years (April 2012-March 2016) was carried out. Showing all cases attending STI clinic are subjected to clinical examinations and investigated. Tests for HIV and venereal disease research laboratory were performed in all patients. STIs were categorized as per the syndromic approach. The proportions were calculated and data collected were analyzed. RESULTS: A total of 4847 cases (1845 males and 3002 females) were studied. The most common STI overall was cervicovaginal discharge followed by genital herpes, warts, molluscum contagiosum, genital ulcerative disease-nonherpetic, lower abdominal pain, and urethral discharge in decreasing order of frequency. Genital herpes was the most common STI in males. Collectively, the proportion of viral STI was more as compared to nonviral STI. The number of newly diagnosed HIV cases was 19 (0.4%). CONCLUSION: The contemporary trend of STIs is relative rise in the proportion of viral STIs including genital herpes, warts, and molluscum contagiosum. Since STIs and HIV perpetuate each other, prompt diagnosis and adequate treatment of all cases of STIs is necessary to prevent HIV transmission.

Woolly Hair with Systematized Epidermal Nevus.

Woolly hair is a hair shaft disorder characterized by fine and tightly curled hair. Woolly hair could be syndromic (associated with systemic disease) or non-syndromic (not associated with any systemic disease). Woolly hair is described in association with many skin, dental, ophthalmic and cardiac anomalies but association of woolly hair with bilateral systematized epidermal nevus described in our case is first of its kind.