Coronavirus disease 2019 vaccination in patients with psoriasis: A position statement from India by SIG psoriasis (IADVL Academy).

Coronavirus disease 2019 (COVID-19) pandemic has affected every sphere of life including management of psoriasis. The availability of COVID-19 vaccines has given rise to hope and at the same time some apprehensions as well. With the general population becoming eligible for vaccination, there is some confusion, on the eligibility of patients with different medical conditions and patients on immunosuppressive or immunomodulating medications for COVID-19 vaccination. Dermatologists treating psoriasis patients frequently face questions from them, whether they can undergo coronavirus disease 2019 vaccination. A PUBMED search was performed using the following strategy: 'COVID-19' AND 'Vaccine' AND 'Psoriasis'. We also performed a PUBMED search using the following strategy: 'SARS-CoV-2' AND 'Vaccine' AND 'Psoriasis'. All articles irrespective of language and publication date were included to arrive at this position statement. This position statement deals with the safety, eligibility and modifications of treatment, if needed among psoriasis patients with regards to the coronavirus disease 2019 vaccines currently available in India.

Dapsone-induced photosensitivity: a rare clinical presentation.

Dapsone is an efficient anti-inflammatory and antimycobacterial agent. It is one of the main constituents of multidrug therapy (MDT). It acts by interference with folate metabolism. Dapsone-induced photosensitivity is a rare, non-dose-related adverse effect of the sulfone and can occur in patients with inflammatory skin disorders treated with dapsone. So far, only 12 cases seem to have been reported in the literature. We report a case of dapsone-induced photosensitivity in an Indian patient with leprosy.

Comparison of clinical efficacy of topical tazarotene 0.1% cream with topical clobetasol propionate 0.05% cream in chronic plaque psoriasis: a double-blind, randomized, right-left comparison study.

BACKGROUND: No controlled data is available till date comparing topical tazarotene and clobetasol in Indian psoriatic patients. OBJECTIVE: The aim was to compare the clinical efficacy of 12 weeks of once-daily tazarotene 0.1% cream with that of once-daily clobetasol propionate 0.05% cream in the treatment of patients with chronic plaque psoriasis. METHODS: About 36 patients with bilaterally symmetrical lesions were enrolled in this double-blind randomized controlled study. A left-right randomized study was conducted. RESULTS: Clobetasol cream was better than tazarotene cream in reducing the erythema throughout the treatment period with statistically significant differences favoring clobetasol at weeks 2, 4, 6 and 8 ( P <0.05). Tazarotene was better in reducing the induration at weeks 2 ( P <0.05), 4, 10 and 12. Clobetasol cream was better in reducing the scaling throughout the treatment period with statistically significant differences favoring clobetasol over the entire treatment period. Treatment success rate was 100% with clobetasol and 88% with tazarotene at the end of week 12 with clobetasol achieving 100% success rate at the end of week 6. Treatment with tazarotene resulted in uniform reduction of plaque elevation and was not associated with the development of hot spots. CONCLUSION: Topical tazarotene 0.1% cream is less effective than topical clobetasol propionate 0.05% cream in the treatment of plaque psoriasis. It has more effect on induration than on erythema and scaling of psoriatic lesions.

Reversal reaction and Mitsuda conversion in polar lepromatous leprosy: a case report.

A 22-year-old male polar lepromatous leprosy patient who became Mitsuda positive after 36 months of multidrug therapy (MDT) is reported. Lepromatous leprosy (LL) is a state of specific immunosuppression and is invariably irreversible. The finding of Mitsuda positivity in histopathologically proven polar lepromatous leprosy is extremely uncommon, and conversion of lepromin status following MDT has not so far been reported. This case reports confirms the observations made by Waters et al. regarding lepromin conversion in lepromatous patients.

Visible deformity in childhood leprosy--a 10-year study.

Deformity seen in children with leprosy has not often been studied, as the disease itself is less common in children. Deformity, being synonymous with the stigma of leprosy, is a definite social problem in children. In this study we have focused on the burden of deformity in children with leprosy, and various factors responsible for the deformities are discussed. We have observed an incidence of 10.5% of Grade II deformities in children with leprosy, which is very high compared to the community rate of 1.4%. Various factors which contributed significantly to the deformities in our study were: increasing age of children, delay in accessing health care, multiple skin lesions, multibacillary disease, smear positivity, multiple nerve involvement, and reaction at the time of presentation to the hospital. Logistic regression analysis showed that children with thickened nerve trunks had 6.1 times higher risk of developing deformities compared to those who did not have nerve enlargement. Children with the above risk factors should be followed up more frequently so as to detect any deformity as early as possible.

Penile tuberculoid leprosy in a five year old boy.

A 5-year-old contact of a lepromatous leprosy patient with a tuberculoid lesion on the anterior aspect of the shaft of the penis is reported. The child was clinically suspected to have borderline tuberculoid leprosy during a survey of contacts of leprosy patients, which on histopathology revealed features of subpolar tuberculoid leprosy. The father of the child was recently detected as a case of lepromatous leprosy and was started on multibacillary regime of WHO multidrug therapy. The reason for the localization of the lesion to the shaft of the penis is also suggested. Skin as a route of transmission of tuberculoid leprosy is also emphasized.

Presence of Mycobacterium leprae in epidermal cells of lepromatous skin and its significance.

A 49-year-old man with lepromatous leprosy treated with dapsone monotherapy for 12 years (1967 to 1979) reported in the hospital in 2003, with relapsed disease. A slit skin smear showed a bacteriological index of 4+. Biopsies from skin lesions before and after anti-leprosy therapy showed features of lepromatous leprosy. Both biopsies showed unusual features of bacillary clumps in epidermal cells demonstrating clearly that dissemination of M. leprae can take place even through unbroken skin. The presence of lepra bacilli in clumps in the epidermis is an indicator that the skin is a potential route of transmission of the disease.

Single lesion borderline lepromatous leprosy.

A patient is reported who presented with a single lesion on the face which, on histopathological examination, was found to be borderline lepromatous leprosy. The importance of doing skin smears as a routine in all patients to differentiate Multibacillary from Paucibacillary disease is emphasized.

Methotrexate in resistant ENL.

This is a report of a case of steroid resistant severe Type 2 reaction that was managed with methotrexate and prednisolone. Synergistic action of both the drugs in severe Type 2 reaction make them one of the preferred combinations in the absence of other agents such as thalidomide.

Squamous cell carcinoma of the scalp arising from chronic cutaneous lupus erythematosus: report of two Indian patients.

Squamous cell carcinoma (SCC) usually arises in skin damaged by actinic rays. Exposure to chemicals like coal tar, soot, arsenic and a variety of oils and distillation products is also implicated in its pathogenesis. It occasionally occurs in scars following inflammatory or degenerative processes. It is an end stage complication of a wide array of inflammatory skin conditions. SCC complicating chronic cutaneous lupus erythematosus (CCLE) in Indian patients is rarely reported. Here we report two such Indian patients with long standing CCLE in whom the diagnosis of CCLE and SCC was confirmed by histopathology.