Marking nut dermatitis: A case series on factitious dermatitis.

Marking nut or Bhilawa is the fruit of plant Semecarpus anacardium Linn (Family; Anacardiaceae). It belongs to Semecarpus genera which also includes cashew nuts. It is closely related to Rhus and Toxicodendron genera, which includes poison ivy and poison sumac and causes similar skin reaction due to the presence of compound urushiol. Marking nut dermatitis is an uncommon problem but has special importance in military dermatology. Individuals can get exposed to this plant during camping which can result in an irritant or allergic contact dermatitis. It can also be applied deliberately to cause factitious dermatitis. We present 5 cases of factitious dermatitis resulting from application of marking nut.

Synthesis of novel ciprofloxacin-avibactam conjugates for the development of second-generation non-ß-lactam-ß-lactamase inhibitors.

To overcome the antibiotic resistance challenge, we synthesized a novel class of conjugates based on ciprofloxacin and avibactam, covalently linked by diverse amino acids. In vitro studies of these conjugates have shown improved antibacterial efficacy of avibactam when used alone against some ESKAPE pathogens, i.e., S. aureus, E. coli, and A. baumannii. Further, ceftazidime was screened in combination with all conjugates and found to be less synergistically effective than avibactam-ceftazidime co-dosing against K. pneumoniae and E. coli bacterial strains. Subsequently, the top-ranked active conjugates were investigated against the commercially available ß-lactamase-II (Penicillinase from Bacillus cereus) through in vitro studies. These studies elucidated two conjugates i.e, 9 (IC50 = 1.69±0.35 nM) and 24b (IC50 = 57.37±5.39 nM), which have higher inhibition profile than avibactam (IC50 = 141.08±12.20 nM). These outcomes allude to avibactam integration with ciprofloxacin is a novel and fruitful approach to discovering clinically valuable next-generation non-ß-lactam-ß-lactamase inhibitors.

DRESS, the maverick among SCARS: A case series-based review of literature.

DRESS is a potentially life-threatening severe cutaneous adverse reaction (SCAR). Historically, it was most frequently linked with phenytoin and was initially described as phenytoin hypersensitivity syndrome; however, it was later found to be caused by various other medications, with the commonest been aromatic anticonvulsants, allopurinol and sulfonamides. The severity of this entity is related to systemic involvement, which can result in multiorgan failure and death. The diagnosis of DRESS, especially in the early stages, remains challenging and elusive due to its heterogeneous clinical presentation and the complex course of the disease with different patterns depending on the causal drug. The most important step in the management of DRESS is early diagnosis and immediate cessation of the suspected offending drug along with oral steroids or immunosuppressants to control the disease. We describe the varying presentation and management of six adults with DRESS from a tertiary care hospital, observed over a two-year period with a brief review of the literature.

Randomized control trial to study the efficacy and safety of platelet-rich plasma as intraoperative holding solution in hair restoration surgery: A pilot study.

Background: Hair restoration surgery is a definitive surgical procedure undertaken for androgenetic alopecia (AGA). Platelet-rich plasma (PRP) therapy has gained importance in recent times as a valuable adjunct to therapy in hair restoration. However, the various beneficial effects of PRP as intraoperative holding solution hair restoration surgery remain to be objectively defined. Methods: Twenty cases of AGA were allocated into two groups (PRP and non-PRP). The follicular grafts harvested were stored in platelet-rich plasma/chilled ringers lactate solution depending on subject/control and were implanted in receding hairline using hair implanters. Patients were reviewed at the end of 2 weeks, 4 weeks, 8 weeks, 3 months, and 6 months using clinical and folliculoscopic images. The analysis was performed using SPSS version 20.0. Results: Follicular growth as assessed using the percentage of grafts in actively growing phase posttransplant showed faster recovery from 'shock effluvium' in the PRP group when compared with the non-PRP group from Week 4, through Week 8 and 3 months with the 'lead' increases of percentage growth difference being statistically significant(P = 0.02) between the two groups. At the end of 6 months, 100% of patients recorded a hair shaft length of >10 mm in the PRP group, whereas only 20% achieved >10 mm length. The difference in hair densities between PRP and the non-PRP group from 4 weeks up to 6 months in the non PRP group remained significant (P < 0.05). Conclusion: Intraoperative PRP as a holding solution improves outcome in hair restoration surgery by a significant improvement in the mean density of the implanted follicular unit grafts at 6 months.

Comparative study of the efficacy and safety of two grafting procedures (an automated epidermal harvesting system and non-cultured epidermal cell suspension) in the treatment of stable vitiligo.

Background The non-cultured epidermal cell suspension method is a well-established but tedious grafting modality in the management of stable vitiligo. Recently a more user-friendly automated epidermal harvesting system has been introduced. Aim This was a pilot study to compare the efficacy and safety outcomes of the above two grafting procedures. Study design The study was a single-blinded split-body randomised controlled trial. After scientific and ethical clearance, the trial was registered with CTRI (CTRI/2018/05/014225). Thirty consenting patients of stable vitiligo with 60 near-symmetrical patches were recruited. Block randomisation was done using computer-generated randomisation software and each patch was allocated either of the two grafting modalities. Efficacy was assessed by the Physician Global Assessment Scale on serial images and pain by the Numerical Rating Pain Scale. Results and conclusion The non-cultured epidermal cell suspension was found to be an overall statistically superior technique to the automated epidermal harvesting system in terms of efficacy (re-pigmentation). Both donor and recipient site complications were significantly less with the automated epidermal harvesting system grafting and this method had the distinct advantage of being a painless and easy technique with minimal recovery time. A novel observation was that a good colour match and near-complete re-pigmentation occurred in patients with a darker skin colour with both techniques. Limitations The main limitation of our study was the small sample size. Also, the size of the treated patches was limited such that they could be covered by the 5 × 5 cm size of the automated epidermal harvesting system blade. However, a larger area can be covered with multiple sessions.

Gaussian field-based 3D-QSAR and molecular simulation studies to design potent pyrimidine-sulfonamide hybrids as selective BRAFV600E inhibitors.

The "RAS-RAF-MEK-ERK" pathway is an important signaling pathway in melanoma. BRAFV600E (70-90%) is the most common mutation in this pathway. BRAF inhibitors have four types of conformers: type I (αC-IN/DFG-IN), type II (αC-IN/DFG-OUT), type I1/2 (αC-OUT/DFG-IN), and type I/II (αC-OUT/DFG-OUT). First- and second-generation BRAF inhibitors show resistance to BRAFV600E and are ineffective against malignancies induced by dimer BRAF mutants causing 'paradoxical' activation. In the present study, we performed molecular modeling of pyrimidine-sulfonamide hybrids inhibitors using 3D-QSAR, molecular docking, and molecular dynamics simulations. Previous reports reveal the importance of pyrimidine and sulfonamide moieties in the development of BRAFV600E inhibitors. Analysis of 3D-QSAR models provided novel pyrimidine sulfonamide hybrid BRAFV600E inhibitors. The designed compounds share similarities with several structural moieties present in first- and second-generation BRAF inhibitors. A total library of 88 designed compounds was generated and molecular docking studies were performed with them. Four molecules (T109, T183, T160, and T126) were identified as hits and selected for detailed studies. Molecular dynamics simulations were performed at 900 ns and binding was calculated. Based on molecular docking and simulation studies, it was found that the designed compounds have better interactions with the core active site [the nucleotide (ADP or ATP) binding site, DFG motif, and the phospho-acceptor site (activation segment) of BRAFV600E protein than previous inhibitors. Similar to the FDA-approved BRAFV600E inhibitors the developed compounds have [αC-OUT/DFG-IN] conformation. Compounds T126, T160 and T183 interacted with DIF (Leu505), making them potentially useful against BRAFV600E resistance and malignancies induced by dimer BRAF mutants. The synthesis and biological evaluation of the designed molecules is in progress, which may lead to some potent BRAFV600E selective inhibitors.

Falkner's needling technique for the treatment of warts: Minimum investment, maximum benefit.

Background: Verruca vulgaris is a viral infection with high recurrence rates and is very difficult to treat. It occurs due to the ability of the virus to evade immune recognition. This immune evasion by the human papillomavirus (HPV) can be circumvented by injecting HPV antigens subcutaneously and inducing inflammation and a systemic immune response. Falkner technique is an approved technique for the treatment of warts. In this observational study, we analyzed the recovery rate among patients undergoing this technique as part of their routine treatment. The aim of this study is to study the clinical outcome of Falkner's needling technique that is being used for the treatment of verruca vulgaris. Methods: Under local anaesthesia, only a single wart was vertically punctured using a 26-gauge needle up till the subcutis multiple times till bleeding was observed. No treatment was done for other warts. Patients were advised not to take any anti-inflammatory medications for pain and were observed for responses after 1 week as well as 1 and 3 months. Results: Of 41 patients included in this study, the total resolution of both the punctured and distant warts occurred in 28 patients (68.29%) and partial response in 7 patients (17.1%) by the end of 3 months. Interestingly, individual warts that were subjected to needling showed complete resolution in 35 patients (85.4%). Conclusion: Falkner's needling method provides a high rate of complete resolution of multiple warts at both the needled and distant sites after a single treatment session of only a single lesion. This modality has a high cure rate, is easy to perform, requires minimal infrastructure support, is cost-effective, and can be undertaken at most peripheral settings with minimal training.

Cutaneous aspergillosis masquerading in sporotrichoid morphology in an immunocompetent host.

Primary cutaneous aspergillosis is an uncommon opportunistic infection, generally seen in immunocompromised individuals. However, many atypical presentations have been reported recently particularly with the increased domain of immunosuppression. Sporotrichoid pattern of aspergillosis where it invades deep lymphatics have rarely been reported and never in immunocompetent individuals previously. We hereby report a case of a 29 years old immunocompetent individual with no comorbidities who presented with multiple painful erythematous papules and nodules over the left upper limb in a sporotrichoid pattern. Microscopy revealed branched septate hyphae and culture on Sabouraud dextrose agar grew powdery greenish colonies which showed hyaline branched septate hyphae with brush-like conidiophores and globose conidia in chains. Histopathology from one of the nodules was consistent with deep fungal infection. A diagnosis of Aspergillus chivalieri was made based on 18S rRNA sequencing of the isolate. The patient showed a satisfactory response to oral Itraconazole over 12 weeks.

Photo-thermally enhanced antimicrobial efficacy of silver nanoplates against Gram-negative, Gram-positive bacterial and fungal pathogens.

AIM: This paper aims to investigate the photo-thermally enhanced antimicrobial efficacy of triangular silver nanoplates for a broad range of harmful pathogens viz., Gram-negative bacteria (Escherichia coli), Gram-positive bacteria (Staphylococcus aureus), and fungus (Candida albicans). METHODS AND RESULTS: Triangular silver nanoplates were synthesized using the chemical method and were characterized for optical absorption, size and morphology, surface charge and concentration via UV-Vis spectroscopy, transmission electron microscopy, zeta potential analysis and inductively coupled plasma mass spectrometry, respectively. Furthermore, the photo-thermally enhanced antimicrobial efficacy of the triangular silver nanoplates (10 µg/ml concentration) was evaluated on broadband near-infrared irradiation. The photothermal response shows that for the fixed concentration of silver nanoplates, the smaller-sized nanoplates (~52 nm) lead to higher temperature rise than larger-sized nanoplates (~68 nm). It is demonstrated that within a short exposure duration of 15 min, the photothermal activation of silver nanoplates led to ~5 log10 CFU/ml reduction for E. coli and C. albicans, and ~7 log10 CFU/ml reduction for S. aureus from a considerably high initial load of 5 × 108  CFU/ml. CONCLUSIONS: The present study demonstrates that photo-thermally enhanced triangular silver nanoplates possess much stronger antimicrobial efficacy over a short exposure duration of few minutes and exhibits the applicability for a broad range of pathogens. SIGNIFICANCE AND IMPACT OF STUDY: The study is highly significant and explains the eradication of broad-spectrum of microbial pathogens by photo-thermally enhanced silver nanoplates in short exposure duration with low nanoparticle concentration, which is useful for diverse antibacterial and antifungal applications.

An atypical presentation of toxic epidermal necrolysis without mucosal involvement.

Toxic epidermal necrolysis (TEN) is a severe adverse cutaneous drug reaction with ubiquitous involvement of mucosa. Drugs are identified as the main etiology in most cases. Cutaneous involvement in TEN occurs in the form of widespread painful erythematous macules, targetoid lesions, full-thickness or focal epidermal necrosis, whereas mucosal involvement involves oral, genital, and ocular mucous membranes along with preceding prodromal flu-like symptoms. Atypical presentations include involvement of only mucosa without involvement of skin. We report a rare case of TEN without any mucosal involvement.

A Curious Case of Paroxysmal Painful Thumb: Glomus Tumor Re-visited.

Glomus tumor is a rare and benign vascular hamartoma originating from the neuro-myo-arterial apparatus of the glomus body in the reticular dermis. Most commonly, it presents as a solitary subungual lesion which is often painful and triggered by changes in temperature and pressure on the affected digit. However, multiple glomus tumors both digitally and elsewhere on the body which may or may not be painful are also known to occur. Due to its cryptic location and varied presentation, there is an invariable delay in the diagnosis and management of this condition. We report a case of glomus tumor in a 28-year-old woman presenting with paroxysmal painful lesion over her right thumb for 5 years.

Bridging the Gap: Innovative Use of Disposable Syringe and Platelet-rich Fibrin for Treating Planter Fissures.

Deep plantar fissures are a common, painful condition, which are often recalcitrant to multiple modalities. Autologous platelet-rich fibrin is a reservoir of supraphysiological concentration of platelets housing various growth factors shown to accelerate wound healing. This unique form factor affords a novel advantage of its ability to be applied over and within these fissures under occlusion. We report the innovative use of disposable syringes to fashion platelet-rich fibrin casts for management of these deeper fissures.

Copper-impregnated socks: A novel therapeutic option for combating occupational dermatophytosis.

BACKGROUND: Operational and training requirements of soldiers necessitate prolonged use of occlusive footwear which makes them susceptible to Tinea pedis and affects their performance. This study assesses copper oxide-impregnated socks as a treatment modality in soldiers with Tinea pedis. METHODS: Three hundred serving soldiers with Tinea pedis were randomly divided in two groups of 150 cases each. One group was supplied with 02 pairs of polyester copper oxide-impregnated socks and the second group was treated with oral terbinafine 250mg /day for two weeks and topical terbinafine twice a day for three weeks. Five end points viz. scaling, erythema, fissuring, vesicular eruptions and itching were monitored using the visual analogue score (VAS) weekly for 03 weeks. RESULTS: Copper oxide socks helped in reducing all the end points as assessed by VAS. The group treated with terbinafine showed better response; however test socks were as efficacious as oral and topical terbinafine in controlling fissuring and vesiculation. Safety profile of the copper impregnated socks was comparable with the conventional treatment. CONCLUSION: Copper-impregnated socks are effective and safe in treating Tinea pedis. They may also have prophylactic role in tinea pedis in susceptible serving soldiers deployed at remote locations in different terrain and weather conditions.

Dermatology practice in the times of the COVID-19 pandemic.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is implicated in the ongoing pandemic across the globe since December 2019. It was first notified by China from Wuhan on 31 December 2020 and transmission to healthcare workers was first reported on 20 January 2020. Human-to-human transmission is mainly by droplet infection. At present no effective vaccine is available. Our speciality needs to collectively address the urgent issue of risk of transmission in dermatology practice. A case series of Coronavirus Disease 2019 (COVID-19) from Wuhan described that 41.3% of their patients may have acquired the infection from the hospital. Of all the infected health care workers, 77.5% worked in general wards and departments. These data highlight the significant risk of nosocomial transmission of COVID-19 and also the higher risk in general wards and departments compared to the emergency room or intensive care unit. Dermatology patients are generally seen in clinics and in outpatient departments in hospitals. Patients wait together in the waiting area, intermingle and then are seen by the physician in their chamber. This can cause transmission of the pathogen among patients and from patient to physician. Social distancing, hand hygiene and the use of personal protective equipment are important for preventing the spread of infection and dermatology practices also have to incorporate these aspects. Telemedicine is becoming an important tool for the management of dermatology patients in these times. At-risk patients in dermatology also need to be given priority care. Protocols for the use of immunosuppressants and biologics in dermatology during the pandemic are being developed.