Nail fold capillaroscopy in leprosy: Unveiling the microvascular changes.

BACKGROUND: Leprosy, a chronic infectious disease, is associated with various nail changes. Its etiopathogenesis is multifaceted, with microvascular damage being crucial. Nail fold capillaroscopy (NFC) emerges as a novel tool for detecting early vascular deficits in leprosy. The study aimed to assess and provide a complete clinical characterization of NFC changes in leprosy patients. METHODS: It is an observational cross-sectional study, done over a period of 1.5 year (January 2021 to august 2022) in a tertiary care hospital, encompassing 60 patients diagnosed with leprosy (18-60 years). After obtaining informed consent; detailed history, complete cutaneous and neurological examinations were conducted. All fingernails and toenails were examined for clinical changes. Subsequently, onychoscopy was performed using USB type of video-dermatoscope (Model AM7115MZT Dino-lite), a non-invasive tool. This was followed by NFC which was done for all fingernails and images were recorded by single operator, which were then assessed for quantitative and qualitive changes and statistical analysis was conducted using SPSS v20, with mean capillary density compared using Student's t-test, morphological change frequencies assessed by proportions, and group comparisons made using Chi-square or Fischer exact tests, with a significance threshold of p < 0.05. RESULTS: Among the 60 patients, 39 were in the lepromatous group, which included both borderline lepromatous (BL) and lepromatous leprosy (LL) patients, and 17 were in the tuberculoid group, which included borderline tuberculoid (BT) leprosy patients; 23.3 % had Type 1 reactions, and 18.3 % had Type 2 reactions. Nail fold capillaroscopy (NFC) showed microvasculature changes in 93.3 % of patients. The average capillary density was 6.8 ± 1.5 capillaries per mm, with the lepromatous group having a lower density (6.5 ± 1.09) compared to the tuberculoid group (7.0 ± 0.86). The most common NFC changes in the tuberculoid group were tortuous capillaries (70 %), capillary dropouts, and dilated capillaries (both 64.7 %). In the lepromatous group, capillary dropouts (82 %) were most frequent, followed by tortuous (69 %), receding (69 %), and dilated capillaries (66 %). A dilated and prominent subpapillary plexus was more common in the lepromatous group (35 %, p = 0.04). Patients with trophic changes in the lepromatous group had more capillary dropouts and bizarre capillaries. Capillary dropouts, dilated capillaries, and visible subpapillary venous plexus were more prevalent in patients with Type 2 reactions. CONCLUSION: NFC changes are prevalent in both tuberculoid and lepromatous leprosy, which may be an indicator of peripheral vascular compromise and trophic changes, especially in lepromatous leprosy. NFC can be an auxiliary tool for detecting microvascular abnormalities in leprosy patients.

Solitary Cutaneous Mastocytoma in an Adult Diagnosed on Cytology: A Rare Case Report.

Mastocytosis is characterized by the proliferation of neoplastic mast cells in various organs, which can have either cutaneous or systemic presentation. Solitary cutaneous mastocytomas are most commonly seen in the pediatric age group but rarely present in adults. Histopathology of cutaneous mastocytoma is well described in the literature but only a few studies are available describing the cytomorphological features. We present a case of a 19-year-old female who presented with a 6-month history of a right supraclavicular single, 0.5 × 0.5 cm, well-defined, reddish-brown round nodule. The fine needle aspiration cytology (FNAC) smears were highly cellular showing monomorphic cells, predominantly dispersed singly and occasionally in small clusters. The cells were round to oval, with moderate cytoplasm containing coarse metachromatic granules. Toluidine blue stain and CD117 immunocytochemical stain confirmed the presence of mast cell granules. Based on the cytomorphology, staining, clinical history, and examination, a diagnosis of solitary cutaneous mastocytoma was rendered. FNAC plays a pivotal role in diagnosing mast cell tumors and even obviates the need for tissue biopsy in selected cases.

Oral Involvement in Borderline Tuberculoid Leprosy: Report of a Case with Review of Literature.

Leprosy is a chronic infectious granulomatous disease caused by Mycobacterium leprae, primarily affecting the skin and the peripheral nerves. Variable involvement of internal organs and mucosa has been reported with incidence ranging from 19% to 60%, more commonly seen in lepromatous spectrum of leprosy (LL and BL). We report a case of borderline tuberculoid (BT) leprosy presenting with oral mucosal lesions involving the gingival mucosa and lower lip.

Clinicoepidemiological characteristics of cutaneous tuberculosis in 1458 Indian patients: a retrospective analytical study from a tertiary care center.

BACKGROUND: Tuberculosis (TB) has been one of the most challenging infectious diseases globally. Cutaneous tuberculosis (CTB) accounts for 0.5-2% of extrapulmonary TB and is often missed owing to its varying morphology and paucibacillary nature. METHODS: In this retrospective analytical study, we share our 22-year experience to describe the clinicoepidemiological features and treatment response of CTB in 1458 Indian patients. In each patient, detailed history was followed by clinical examination, hematological and biochemical investigations, Mantoux testing, chest x-ray, and other specialized investigations to detect coexisting systemic foci. Clinical diagnosis of CTB was confirmed on histopathology/cytology and response to standard antitubercular treatment (ATT). All details were recorded on a predesigned proforma. RESULTS: Of 1458 eligible patients, 803 were children. The mean disease duration was 15.3 months. Lupus vulgaris (40.4%) was the most common clinical variant, followed by scrofuloderma (32.7%) and lichen scrofulosorum (15.2%). Other variants included tuberculosis verrucosa cutis, gumma, tuberculids, and inoculation TB. Multiple clinical variants were observed in 3.6% of patients. A total of 41.4% of patients had coexistent systemic foci; in lymph nodes (50.4%), lungs (35.6%), bone (10.3%), and abdomen (5.8%). TB foci were also observed at uncommon locations like the eye, central nervous system, and genital organs. Treatment response to ATT was favorable in 99.2%. INTERPRETATION: The burden of CTB still persists in developing countries. The diagnosis is often missed due to the wide spectrum of clinical and histological presentations. Awareness among clinicians of varying aspects of CTB is of paramount importance for early diagnosis and management and will significantly prevent morbidity and disease complications.

Eccrine Hidrocystoma: A Report of Two Cases with Special Reference to Dermoscopic Features.

Eccrine hidrocystomas (EHs) are benign tumors, which arise as cystic dilatation of the eccrine sweat duct. The lesions of EH have a chronic course with periodic flares in summer months, associated with exacerbation in sweating. Diagnosis is mainly clinical with histopathology being confirmatory. Dermoscopy is a noninvasive tool, which may confirm diagnosis of EH without subjecting the patient to a biopsy. We report two representative cases of EH, with emphasis on dermoscopic features and which well responded to topical botulinum toxin-like peptide.

Clinico-epidemiological profile of lichen scrofulosorum: a 22-year, single-center, retrospective study.

BACKGROUND: Lichen scrofulosorum (LS) represents immunologic reaction to the Mycobacterium tuberculosis antigen and presents with subtle, asymptomatic, grouped follicular papules over the trunk and shows good therapeutic response to antitubercular drugs. OBJECTIVE: To study the clinical and epidemiological characteristics of patients diagnosed with LS. MATERIALS AND METHODS: A single-center retrospective review of patients diagnosed with LS from 1997 to 2018 was conducted. The data pertained to clinico-epidemiological profile, BCG vaccination, Mantoux positivity, laboratory investigations, coexistent focus of tuberculosis, and response to antitubercular treatment (ATT). RESULTS: LS cases constituted 15.2% (221/1458) of all the patients diagnosed with cutaneous tuberculosis (CTB). Of these, 156 (70.5%) were pediatric patients. All patients presented with multiple follicular and perifollicular grouped papules. The trunk was the most common site involved (98.6%), followed by lower limb (25.33%), upper limb (15.83%), face (5%), and external genitalia (3.6%). Evidence of BCG vaccination and Mantoux test positivity was observed in 52.03 and 83.2%, respectively. Coexistent TB focus was detected in 134 (60.6%) patients in lymph nodes, lungs, abdomen, and unusual sites such as intracranial, endometrium, and eye. Twenty-eight patients (12.66%) had coexistent other clinical forms of CTB. Clinical diagnosis of LS was confirmed on histology that revealed chiefly periappendageal epithelioid cell granuloma. Response to ATT was good with complete resolution of lesion in 8-12 weeks. CONCLUSION: LS appears to be an underdiagnosed entity. Subtle and asymptomatic lesions of LS are often missed, thereby necessitating a high index of suspicion and appropriate evaluation of the underlying TB focus.

Psoriatic Nephropathy and its Correlation with hs-CRP: A Case Control Study.

BACKGROUND: Psoriasis is a multisystem disorder associated with various systemic diseases such as cardiovascular diseases, diabetes mellitus and metabolic syndrome. Renal involvement in patients with psoriasis is sparsely studied and its association is still unclear. AIM: The aim of this article was to study causal attributable renal involvement in patients with psoriasis and factors affecting the same. METHODS: Fifty patients with documented psoriasis were recruited after excluding any secondary causes of renal disease. They were subjected to routine investigations along with hs-CRP and specific investigations for kidney function including urine albumin creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). The eGFR and ACR of the patients were compared with 50 age- and sex-matched controls. Association with any disease-related factors such as severity and duration were assessed. Renal biopsy was planned in patient with ACR >500 mg/g creatinine. RESULTS: The mean eGFR (IQR) (ml/min/1.73 m2) of the case group was found to be 80.00 (71.00-95.75) and in the control group was 88.00 (75.25-99.00). This difference was not significant (P = 0.206). However, in the age group of > 30 years, the eGFR of disease group (78.50 ± 17.94) was significantly lower than that in the control group (88.96 ± 17.01, P = 0.023).The mean urine ACR (mg/g) in the disease group was found to be 13.359 ± 26.01 while that in the control group was found to be 5.66 (3.40-8.08), and the difference was not found to be clinically significant. Four patients with psoriasis had microalbuminuria as opposed to none of the controls. CONCLUSION: Subclinical albuminuria was found in 8 per cent of patients with psoriasis. Glomerular dysfunction with statistically significant reduction in eGFR was seen in psoriasis in age group of more than 30 years and those who had a long-standing disease. The renal involvement had positive correlation with hs-CRP indicating the role of inflammatory milieu. Further large-scale cohort studies would help assess this aspect in further details. LIMITATION OF THE STUDY: Sample size was small. Large-scale studies would be required to further substantiate these observations.

Calcium dobesilate (Cd) in pigmented purpuric dermatosis (PPD): a pilot evaluation.

Pigmented purpuric dermatosis (PPD) is a chronic disorder of unknown etiology. It is quite common, and no therapy is significantly effective. Calcium dobesilate (Cd) has been tried successfully in many vascular disorders. The aim of this study was to evaluate the usefulness and efficacy of Cd in PPD. Nine male patients (7 with Schamberg's and 1 each with lichenoid dermatosis of Gougerot and Blum and lichen aureus) were given Cd 500 mg twice daily for two initial weeks and then 500 mg once daily for a total period of three months. All the patients were followed up for one year after cessation of therapy. The improvement was moderate in 11.11% and mild in 66.67% of cases; 22.22% did not show any improvement. New lesions stopped appearing in two weeks in all patients, and itching also improved in symptomatic cases without any significant side effects. Based upon the results of this pilot study we recommend Cd as the first line therapy for PPD.

Exogenous ochronosis After Prolonged Use of Topical Hydroquinone (2%) in a 50-Year-Old Indian Female.

Ochronosis is a rare disease characterized by speckled and diffuse pigmentation symmetrically over the face, neck, and photo-exposed areas. It is characterized histologically by banana-shaped ochre-colored deposits in the dermis. It can present in exogenous or endogenous form. We report a case of exogenous ochronosis in a 50-year-old Indian woman after prolonged use of topical hydroquinone which is a rare complication with a commonly used drug which is available over the counter.