Characterization of HIV Recent Infection Among High-Risk Men at Public STI Clinics in Mumbai.

We examined associations with HIV recent infection and estimated transmitted drug resistance (TDR) prevalence among 3345 men at sexually transmitted infection clinics in Mumbai (2002-2005). HIV seroincidence was 7.92% by the BED-CEIA and was higher at a clinic located near brothels (12.39%) than at a hospital-based clinic (3.94%). HIV recent infection was associated with a lifetime history of female sex worker (FSW) partners, HSV-2, genital warts, and gonorrhea. TDR prevalence among recent infection cases was 5.7%. HIV testing services near sex venues may enhance case detection among high-risk men who represent a bridging population between FSWs and the men's other sexual partners.

The story of a deformed leprous foot.

Eccrine syringofibroadenoma (ESFA) is a rare adnexal tumour of eccrine ductal proliferation. A 50 year old treated case of leprosy presented with a chronic non healing ulcer of 5 years duration on the deformity laden right foot. Multiple verrucous papules and plaques were seen surrounding the ulcer which showed histopathological findings consistent with ESFA. Although ESFA constitutes a rare association with leprosy, considering the load of treated cases in our country and elsewhere, it may represent an under-reported entity which requires more attention in the post elimination era.

Is there a role for rifampicin, ofloxacin and minocycline (ROM) therapy in the treatment of leprosy? Systematic review and meta-analysis.

BACKGROUND: A combination of rifampicin, ofloxacin and minocycline (ROM) is one of the newer recommendations for treatment of leprosy. We performed a systematic review and a meta-analysis of studies that had evaluated the efficacy of ROM therapy in treatment of paucibacillary and multibacillary leprosy patients. METHODS: Studies were identified by searching the PubMed, Embase, LILACS and Cochrane databases. Data were abstracted from all relevant studies, and fixed effects models were used to calculate the summary estimate of effect in paucibacillary and multibacillary leprosy patients. RESULTS: Six studies comparing ROM therapy to multidrug therapy and eight studies that evaluated the effect of ROM therapy alone (no comparison group) were included in the review and meta-analysis. The combined estimate for single dose ROM vs. multidrug therapy in paucibacillary leprosy patients suggested that ROM was less effective than multidrug therapy in these patients [relative risk: 0.91, 95% confidence intervals (CI): 0.86-0.97]. However, the combined estimate for multiple doses of ROM vs. multidrug therapy in multibacillary leprosy patients suggested that ROM was as effective as multidrug therapy in reducing bacillary indices in these patients (proportion change: -4%, 95% CI -31% to 23%). No major side effects were reported in either the ROM or the multidrug treatment groups. CONCLUSIONS: Single-dose ROM therapy was less effective than multidrug therapy in paucibacillary patients. However, there are insufficient data to come to a valid conclusion on the efficacy of multidose ROM therapy in multibacillary leprosy, and additional studies with ROM therapy in multibacillary leprosy are needed. Furthermore, multiple doses may be considered as another alternative even for paucibacillary patients, and randomised controlled trials of this therapy may be useful to understand its contribution in the treatment and control of leprosy.

Patch Testing With Formaldehyde 2.0% (0.60 mg/cm2) Detects More Contact Allergy to Formaldehyde Than 1.0.

BACKGROUND: The International Contact Dermatitis Research Group increased the patch test concentration of formaldehyde from 1.0% aqueous (aq) to 2.0% aq (in 2011). OBJECTIVE: This study was designed to investigate the outcome of the decision. METHODS: Consecutive dermatitis patients in 8 different clinics were patch tested with formaldehyde 1.0% aq and 2.0% aq. The test solutions were applied with a micropipette to the filter paper discs in the respective chamber. RESULTS: A total of 2778 patients were tested with 1.0% aq and 2766 to 2.0% aq. Sixty-five patients (2.3%, calculated from 2766 tested, to 2.0% aq) had positive patch test reactions interpreted as contact allergy to formaldehyde. This is a rather low frequency. Of these 65, 46 were women (46/1703 [2.7%]) and 19 were men (19/1063 [1.8%]). Thirty-six reacted only to 2.0% aq, 21 patients reacted to both concentrations, and 8 patients reacted only to 1.0% aq. Significantly, more patients reacted to 2.0% aq compared with 1.0% aq (P < 0.001). There was no significant sex difference. A total of 0.8% irritant reactions were recorded to formaldehyde 2.0% aq and 0.1% to 1.0% aq. CONCLUSIONS: The increased formaldehyde patch test concentration to 2.0% aq revealed more formaldehyde contact allergy.

A Real-World, Non-interventional Indian Study Evaluating Intensive Plant-Based Butter Moisturizing Cream in Psoriasis.

INTRODUCTION: Psoriasis is estimated to affect 0.44-2.8% of the Indian population. Moisturizers are a key adjuvant psoriasis treatment strategy, but data regarding their effectiveness, safety and compliance pattern in an Indian context are lacking. Hence, this real-world study on an intensive plant-based butter moisturizing cream (Venusia ® Max) was conducted among Indian patients with psoriasis. METHODS: This was an observational, patient-reported outcomes (PRO) study in patients with psoriasis aged 18-75 years who were prescribed the cream in routine clinical practice, as per clinician's discretion, over 4 weeks. The primary outcome measure was improvement from baseline in quality of life assessed using the Dermatology Quality of Life Index (DLQI) at 4 weeks of the study period. The secondary outcome measures were improvement in dryness using the Dry Skin/Ichthyosis Area and Severity Index (DASI) score at 4 weeks, safety and compliance. The DLQI and DASI scores were recorded by the clinicians at baseline and after 2 (optional) and 4 weeks of starting the cream. Safety was assessed throughout the study. RESULTS: The study included 400 patients from 9 outpatient dermatology centers across India. Of 400 patients, 384 completed the study. A significant reduction in both the mean DLQI score (66.7%; p < 0.001) and mean DASI score (84.6%; p < 0.001) was observed at week 4 after starting the cream vs. baseline in the overall population. Overall, the cream showed a good safety and compliance profile during the study period. There were no serious adverse events or deaths. CONCLUSIONS: The evidence from the PRO study suggests that use of the intensive plant-based butter moisturizing cream in a real-world scenario has a noticeable impact on improving the quality of life and reducing the skin dryness associated with psoriasis over 4 weeks. The moisturizing cream may serve as a valuable adjuvant treatment option for the management of psoriasis. TRIAL REGISTRATION NUMBER: CTRI/2017/03/008023. FUNDING: Dr. Reddy's Laboratories Ltd.

Real-World, Non-Interventional, Observational Study of Hydroxyzine Hydrochloride in Chronic Pruritus: a Prospective, Non-Comparative Study.

INTRODUCTION: Although hydroxyzine is widely used for symptom relief in pruritus, its clinical safety and efficacy data in the Indian setting are scarce. We conducted a study to assess the effectiveness and tolerability of hydroxyzine in the management of Indian patients with chronic pruritus in a real-world setting. METHODS: This was a prospective, observational, patient-reported outcomes (PRO) study in patients with chronic pruritus due to dermatological causes treated with hydroxyzine as per the clinician's discretion for a period of up to 12 weeks. The primary outcome was improvement in quality of life from baseline, assessed using the 10-point Dermatology Quality of Life Index (DLQI) at week 12 of the study period. Secondary outcomes were improvement in the pruritus scores (5-D itch scale) at 12 weeks, improvements in the DLQI and 5-D itch scores at 2, 4 and 8 weeks and safety. RESULTS: The study included 400 patients (179 males, 221 females) from 7 dermatology centres across India. Of the 400 patients recruited, 391 patients completed at least 2 weeks of treatment. There was significant (p < 0.0001) improvement from baseline in the DLQI scores and 5-D itch scores at 2, 4, 8 and 12 weeks; 189/391 (48.34%) patients had symptom relief leading to early termination. Overall, the treatment was well tolerated with a total of 11 mild-to-moderate adverse events reported during the study, which included dizziness, constipation, drowsiness, dry mouth and sedation. All events resolved without any intervention. There were no serious adverse events. CONCLUSION: This real-world, observational, PRO study demonstrates that hydroxyzine significantly improves symptoms of pruritus and quality of life in patients with chronic pruritus due to dermatological causes over 12 weeks. Despite the sedating potential of the drug, hydroxyzine is well tolerated in real-world settings. TRIAL REGISTRATION: CTRI/2017/06/008847. FUNDING: Dr. Reddy's Laboratories.

Utility of high-frequency ultrasonography in the diagnosis of benign and malignant skin tumors.

Various benign and malignant tumors may arise from the skin. These may be of epidermal, dermal, subcutaneous or appendageal origin. Skin biopsy is the gold standard for diagnosis of skin tumors. There is paucity of published data on the role of imaging modalities in diagnosis of skin tumors. High-frequency ultrasonography (7-50 MHz) is a potential non-invasive, objective modality which can be utilized in the diagnosis and localization of skin tumors. It provides valuable information about the tumor characteristics such as size, shape, depth, consistency and vascularity before invasive skin biopsy or surgery is planned. Sentinel lymph nodes in malignant melanoma can be well visualized and studied by this technique. It is also a good modality to detect local recurrence of tumors during post-operative follow up, especially those with a high likelihood of local recurrence or lesions excised with inadequate margins. High-frequency ultrasonography is additive to clinical diagnosis and can be considered a useful non-invasive method to plan the management of various skin tumors and is of prognostic value in some cases.

Multicenter Patch Testing With Methylchloroisothizoline/Methylisothiazolinone in 100 and 200 ppm Within the International Contact Dermatitis Research Group.

BACKGROUND: The preservative methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) is a well-known contact sensitizer. Historically, there have been different opinions on the optimal patch test concentration of MCI/MI, and both 0.01% and 0.02% aqueous (aq.) have been proposed. In 2011, based on literature reviews, it was recommended that the concentration of 0.02% aq. should be used in the international baseline series. OBJECTIVES: The aim of this study was to verify the recommendation from 2011 by comparing the patch test results from consecutive patch testing with MCI/MI 0.01% and 0.02% in clinics representing countries around the world. PATIENTS AND METHODS: Two thousand seven hundred three consecutive patients with dermatitis in 8 dermatology clinics representing 8 countries were patch tested with MCI/MI 0.01% aq. and, in parallel with MCI/MI 0.02% aq., provisionally included in the baseline series. RESULTS: Contact allergy to MCI/MI at 0.01% and 0.02% was found in 3.7% and 5.6% of the patients, respectively (P < 0.001). CONCLUSIONS: Methylchloroisothiazolinone/MI 0.02% aq. (dose, 6 µg/cm) diagnoses significantly more contact allergy than 0.01% (dose, 3 µg/cm), without resulting in more adverse reactions. Methylchloroisothiazolinone/MI at 0.02% aq. should therefore be continuously used in the international baseline series.

Multicenter Patch Testing With Methylisothiazolinone and Methylchloroisothiazolinone/Methylisothiazolinone Within the International Contact Dermatitis Research Group.

BACKGROUND: The preservatives methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and MI are well-known contact sensitizers. Recently, an increase in the contact allergy frequency for MI 0.2% aqueous (aq) has been seen in many European countries paralleled with an increase in MCI/MI allergy. Many of the MI-allergic patients do not react to MCI/MI 0.01% or 0.02% because the concentration of MI in these preparations is too low (25 and 50 ppm, respectively) to elicit a positive patch test reaction. OBJECTIVES: The aims of this study were to investigate the prevalence of contact allergy to MI in the participating clinics representing various countries all over the world, to assess how many additional individuals with contact allergy are found by testing MI 0.2% aq in parallel with MCI/MI 0.02%, and to assess the clinical relevance of MI and MCI/MI allergies. PATIENTS AND METHODS: In 9 dermatology clinics representing 9 countries, 3865 consecutive patients with dermatitis were patch tested with MI 0.2% aq and in parallel with MCI/MI 0.02% aq, provisionally included into the baseline series. An assessment of clinical relevance in those allergic to MI was also made. RESULTS: Contact allergy to MI was found in 284 patients (7.3%). The frequency of contact allergy varied from 0.8% to 10.9% in different centers. Simultaneous reactivity to 200 ppm of MCI/MI was found in 67.3% of the MI-positive patients. Contact allergy to MI alone without any simultaneous contact allergy to 200 ppm of MCI/MI was diagnosed in 93 patients (32.7%; 2.4% of all tested patients). The contact allergy to MI and/or MCI/MI could explain or contribute to dermatitis in more than 60% of the MI-allergic patients. CONCLUSIONS: Methylisothiazolinone of 2000 ppm needs to be patch tested on its own to not miss contact allergy.

Multiple Cutaneous Reticulohistiocytoma.

Multicentric reticulohistiocytosis is a rare non-Langerhans cell histiocytosis characterized in its full form by severe destructive arthritis, cutaneous nodules, and systemic manifestations. Cutaneous lesions may precede, accompany, or more commonly develop later than other features in this disease. We describe a case of multiple cutaneous reticulohistiocytoma without any systemic associations after thorough investigations.

Keratoelastoidosis marginalis of the hands: A report in two farmers.

Keratoelastoidosis marginalis of the hands (KEMH) is a distinct solar elastotic dermatosis belonging to the group of marginal keratoderma. It is characterized by linear plaques on the hand and calcified dermal elastotic masses predominantly affecting the radial side of the index finger, first web space, and ulnar side of the thumb. It is predominantly seen in the middle-aged and elderly age group. We report the occurrence of KEMH in two farmers with other cutaneous features of chronic actinic damage.

Proposed ICDRG Classification of the Clinical Presentation of Contact Allergy.

The International Contact Dermatitis Research Group proposes a classification for the clinical presentation of contact allergy. The classification is based primarily on the mode of clinical presentation. The categories are direct exposure/contact dermatitis, mimicking or exacerbation of preexisting eczema, multifactorial dermatitis including allergic contact dermatitis, by proxy, mimicking angioedema, airborne contact dermatitis, photo-induced contact dermatitis, systemic contact dermatitis, noneczematous contact dermatitis, contact urticaria, protein contact dermatitis, respiratory/mucosal symptoms, oral contact dermatitis, erythroderma/exfoliative dermatitis, minor forms of presentation, and extracutaneous manifestations.

Giant cell tumor of the tendon sheath mimicking a plexiform neurofibroma.

Giant-cell tumor of the tendon sheath (GCTTS) is a benign soft tissue tumor of the limbs arising from the complex of the tendon sheath and periarticular soft tissues of small joints. It is the second most common benign space occupying lesion in the hand and usually presents as a painless soft tissue mass, which grows slowly in size for many years. We present an interesting case of an enormous GCTTS presenting as a slowly growing mass over left sole of a 52-year-old woman. The duration of GCTTS may range from a few weeks to 30 years but in our case the duration of tumor was almost 48 years, which could be the longest reported duration of GCTTS.

Patch testing to a textile dye mix by the international contact dermatitis research group.

BACKGROUND: Disperse dyes are well-known contact sensitizers not included in the majority of commercially available baseline series. OBJECTIVE: To investigate the outcome of patch testing to a textile dye mix (TDM) consisting of 8 disperse dyes. METHODS: Two thousand four hundred ninety-three consecutive dermatitis patients in 9 dermatology clinics were patch tested with a TDM 6.6%, consisting of Disperse (D) Blue 35, D Yellow 3, D Orange 1 and 3, D Red 1 and 17, all 1.0% each, and D Blue 106 and D Blue 124, each 0.3%. 90 reacted positively to the TDM. About 92.2% of the patients allergic to the TDM were also tested with the 8 separate dyes. RESULTS: Contact allergy to TDM was found in 3.6% (1.3-18.2) Simultaneous reactivity to p-phenylenediamine was found in 61.1% of the TDM-positive patients. Contact allergy to TDM and not to other p-amino-substituted sensitizers was diagnosed in 1.2%. The most frequent dye allergen in the TDM-positive patients was D Orange 3. CONCLUSIONS: Over 30% of the TDM allergic patients had been missed if only the international baseline series was tested. Contact allergy to TDM could explain or contribute to dermatitis in over 20% of the patients. Textile dye mix should be considered for inclusion into the international baseline series.

Multicenter Patch Testing With a Resol Resin Based on Phenol and Formaldehyde Within the International Contact Dermatitis Research Group.

BACKGROUND: Contact allergy to phenol-formaldehyde resins (PFRs) based on phenol and formaldehyde is not detected by a p-tertiary-butylphenol-formaldehyde resin included in most baseline patch test series. OBJECTIVE: The aims of this study were to investigate the contact allergy rate to PFR-2 in an international population and to investigate associated simultaneous allergic reactions. METHODS: Thirteen centers representing the International Contact Dermatitis Research Group included PFR-2 into their patch test baseline series during a period of 6 months in 2012. RESULTS: Of 2259 patients tested, 28 (1.2%) reacted to PFR-2. Of those 28 individuals, one had a positive reaction to formaldehyde and 2 to p-tertiary-butylphenol-formaldehyde resin. Simultaneous allergic reactions were noted to colophonium in 3, to Myroxylon pereirae in 5, and to fragrance mix I in 8. CONCLUSIONS: The contact allergy frequency in the tested population (1.2%) merits its inclusion into the international baseline series and possibly also into other baseline series after appropriate investigations. Significantly, overrepresented simultaneous allergic reactions were noted for M. pereirae and fragrance mix I.

Staphylococcal scalded skin syndrome.

Staphylococcal Scalded Skin Syndrome (SSSS) is a disease primarily of young children, characterized by exfoliative dermatitis caused by exfoliative toxin producing Staphylococcus aureus. We had three cases of SSSS with varied dermatological manifestations-diffuse/scarlitiniform erythema, generalized exfoliation, sand paper skin texture, flaccid bullae, erosions, seborrheic dermatitis like scaling and cracking in skin creases which can be confused with other skin conditions. Hence, a high index of suspicion, early diagnosis and prompt treatment is imperative.

Evaluation of utility of phenol in alopecia areata.

BACKGROUND: Alopecia areata (AA) is a common hair disorder of unknown etiology and prognosis with no definitive cure. AIMS AND OBJECTIVE: (i) To study the efficacy and immunomodulatory action of 88% phenol on hair growth on test area in AA. (ii) To study various epidemiological factors in relation to AA. MATERIALS AND METHODS: A total of 50 subjects presenting with nonscarring patchy hair loss on scalp were enrolled in this prospective open label study to receive 88% phenol at 3 weekly intervals in a tertiary care hospital. Efficacy was assessed using scoring system for density, pigmentation, and texture of growing hair. RESULTS: Texture and pigmentation of hair growth was significantly improved at 9 week, while density of hair growth showed steady improvement, which was significant from 9 week onwards. About 78% of patients showed good to excellent response while none of them showed poor response. CONCLUSION: 88% phenol was found to be efficacious with all patients showing hair regrowth. 88% phenol can be considered as a treatment of choice for stable AA due to its ease of application, easy availability, and low cost.

Dermatomyositis associated with malignancy: A report of 3 cases.

The association between dermatomyositis (DMS) and various types of malignancies has been reported in several studies, with an estimated frequency of 20-25%. DMS may precede, accompany or follow the diagnosis of malignancy. In the present report, we have discussed three cases of dermatomyositis associated with malignancy. In the first case, DMS preceded the diagnosis of gastric adenocarcinoma while in the second and third cases, it followed the diagnosis of ductal carcinoma of the breast and transitional cell carcinoma of the bladder respectively. In all three patients, cutaneous and musculoskeletal features of DMS showed very good response to the treatment, irrespective of the course of malignancy.