A Cross-Sectional Study Comparing Application of Hanifin and Rajka Criteria in Indian Pediatric Atopic Dermatitis Patients to that of Other Countries.

Background: Hanifin and Rajka criteria are considered to be the gold standard for atopic dermatitis diagnosis. However, the exhaustive nature limits its use in clinical settings. Objective: To determine the frequency of Hanifin and Rajka criteria commonly found in Indian pediatric atopic dermatitis patients and variation from the findings of other studies. Material and Methods: An observational, descriptive study with a sample size of 52 pediatric atopic dermatitis patients. Patients were divided into infantile, childhood, and adolescent. Results: Overall, xerosis, early age of onset, Dennie-Morgan fold, aggravation because of environmental factors, palmar hyper-linearity, ichthyosis vulgaris, keratosis pilaris, pityriasis alba, and orbital darkening were found in more than 50% of patients. Dennie-Morgan fold was more commonly found in Indian pediatric atopic dermatitis patients. Peri-follicular accentuation was less prevalent in Indian patients as compared to other Asian studies. None of the parents reported food intolerance, which was seen in studies from other countries. Limitations: A small sample size and ophthalmological evaluation was not performed in all patients. Conclusion: The frequency of different Hanifin and Rajka minor criteria varies widely among different study populations. Hence, the criteria specifically applicable to the Indian population need to be derived for ease of diagnosis.

Therapeutic application of machine learning in psoriasis: A Prisma systematic review.

Dermatology, being a predominantly visual-based diagnostic field, has found itself to be at the epitome of artificial intelligence (AI)-based advances. Machine learning (ML), a subset of AI, goes a step further by recognizing patterns from data and teaches machines to automatically learn tasks. Although artificial intelligence in dermatology is mostly developed in melanoma and skin cancer diagnosis, advances in AI and ML have gone far ahead and found its application in ulcer assessment, psoriasis, atopic dermatitis, onychomycosis, etc. This article is focused on the application of ML in the therapeutic aspect of psoriasis.

Therapeutic Inertia in the Management of Psoriasis: A Quantitative Survey Among Indian Dermatologists and Patients.

Purpose: The primary objective of the study was to understand the therapeutic inertia in treatment and management of plaque psoriasis among dermatologists, along with determining the preferred treatment choices for management of plaque psoriasis; it also included the resulting treatment satisfaction among patients. The secondary objective was to identify the gaps in terms of knowledge and attitude among dermatologists and the expectations of patients. Patients and Methods: A multicentre, cross-sectional quantitative survey was conducted among dermatologists and patients with moderate to severe plaque psoriasis across India. The interviews were conducted either face to face or via telephone between September and November 2020, using structured and validated questionnaires based on specific themes. The data obtained were statistically analysed, wherever applicable. Results: Overall, 207 adult patients with moderate-to-severe plaque psoriasis and 303 dermatologists were interviewed. Post experiencing symptoms, 44% of the patients visited general physicians for treatment and there was an average 7.8-month delay by the patients to consult a dermatologist. Approximately one-fourth of patients used home remedies before seeking medical help. One-third of dermatologists used the Psoriasis Area and Severity Index (PASI) for assessing the disease severity. Majority of dermatologists preferred combination therapy for their patients. The lack of quick resolution and side effects were the major reasons for changing the treatment. Overall, only 35% of the patients complied to current treatment. Satisfaction with existing forms of therapies was highest for mild plaque psoriasis (62%) as confirmed by dermatologists, while 52% of the overall patients were satisfied with their therapy. Majority of the patients (64%) affirmed living with plaque psoriasis impacted their lives. Conclusion: This first-of-its-kind survey in India highlighted the gaps in terms of the disease journey between dermatologists and patients. The survey emphasises the need for shared decision-making and may benefit dermatologists in suggestive modifications of the treatment algorithm and disease management in clinical settings.

Factors responsible for difficult to treat superficial fungal infections: A study from a tertiary healthcare centre in India.

BACKGROUND: Recurrent and clinically unresponsive dermatophytosis is being increasingly observed in India. However, there is little information regarding the extent of the problem and the factors responsible for these difficult to treat superficial fungal infections. AIM: To identify factors contributing to difficult to treat recurrent superficial fungal infections. MATERIALS AND METHODS: This prospective cross-sectional study enrolled 105 patients of all age groups presenting with either recurrent or long-standing dermatophyte infection attending the outpatient department of Dermatology, Venerology and Leprosy of Bharati Hospital, Pune, India, between September 2018 and March 2020. Patients were clinically examined, clinical history was taken and questions were asked regarding their current complaints and recorded in a proforma. Data were analysed using the SPSS software package. RESULTS: The males outnumbered females (74.3% vs 25.7%). A strong association was observed between the presence of past history and duration of disease (p = .007). The association of use of topical steroids or keratolytic agents with the duration of disease was statistically significant (p = .022). There was a statistically significant inverse association of duration of disease with dermatologist consultation (p < .001). The association between consultation with non-dermatologist and the duration of disease was statistically significant (p = .035). CONCLUSION: Hyperhidrosis, obesity, positive family history, tight clothing and chronic diseases may be considered important factors in acquiring dermatophytic infection. However, when it comes to difficult to treat tinea infections, irrational usage of topical steroids, treatment from non-dermatologists and a past history of tinea appear to be more critical causative factors. Treatment of dermatophytosis by dermatologists/ trained physicians and increasing general awareness of the public regarding the current situation about tinea in the country would help to alleviate the current crisis.

Comparison of Intralesional Measles, Mumps, Rubella Vaccine and Needling in the Treatment of Recurrent Warts.

CONTEXT: Warts constitute 21% of all the cases in a dermatology clinic. Their causative agent is the human papillomavirus (HPV). Most of the cutaneous warts are cosmetically disfiguring and their treatment requires patience by both the practitioner and the patients. AIM: This study aimed to compare the efficacy of intralesional measles, mumps, rubella (MMR) vaccine and needling in the treatment of recurrent warts. SETTINGS AND DESIGN: This was a prospective, comparative, and interventional study. SUBJECTS AND METHODS: This hospital-based study was conducted in a tertiary health-care center from September 2017 to August 2019. Overall 40 patients of recurrent warts were included in the study. STATISTICAL ANALYSIS: Fisher test, Student t test, and chi-square test were used for statistical analysis. RESULTS: Improvement was noted in patients belonging to both the groups. However, after applying chi-square test, it was found that results were statistically significant in the needling group only. When both the groups were compared using chi-square test, needling showed statistically significant results after 4 and 6 weeks. CONCLUSION: Needling was observed to be a better treatment modality as compared to intralesional MMR vaccine at the end of 4 and 6 weeks. More number of sessions were required in the intralesional MMR vaccine group for complete clearance of the lesions as compared to needling. Hence, the response was better and faster in the needling group as compared to the intralesional MMR group.

Awareness of needle-stick injuries among health-care workers in a tertiary health-care center.

CONTEXT: Needle-stick injuries (NSIs) pose a great occupational risk of blood-borne disease transmission in health-care workers (HCWs). Diseases of primary significance include hepatitis B, hepatitis C, and human immunodeficiency virus infection. AIMS: This study aimed to check the awareness regarding the health hazards associated with NSIs and awareness regarding postexposure prophylaxis (PEP) and hepatitis B vaccination in HCWs. SETTINGS AND DESIGN: This is a cross-sectional study conducted in a tertiary care government hospital. SUBJECTS AND METHODS: A sample size of 100 HCWs, which consisted of 20 residents, 20 interns, 20 lab assistants, 20 nurses, and 20 Class IV workers, was taken. A predefined questionnaire was used and answers were documented. STATISTICAL ANALYSIS USED: Chi-square test was used for statistical analysis. RESULTS: Out of the 100 HCWs enrolled in the study, 45% had a history of NSI during their career, the highest count was seen in Class IV workers i.e. 14 [70%]. Only 21% of the HCWs knew about the diseases transmitted by NSI. Only 30% of Class IV workers were aware of hepatitis B vaccination and none of them were vaccinated. Quite a good number of HCWs were aware regarding the first step to be undertaken in case of NSI. However, their knowledge regarding PEP was not up to the mark. CONCLUSIONS: NSIs were seen in all the categories of HCWs, but the awareness regarding health hazards due to NSI was inadequate. Except Class IV workers, rest of the HCWs were overall aware regarding hepatitis B vaccination. There is a need to give emphasis as regards to awareness of PEP in case of a NSI.

Steroid-resistant autoimmune thrombocytopenia in systemic lupus erythematosus treated with rituximab.

Systemic Lupus Erythematosus (SLE) is a multisystem disorder characterized by production of numerous autoantibodies, some of which have pathogenic consequences and result in considerable morbidity. Herein, we present a case of 48-year-old female with SLE having autoimmune hemolytic anemia, autoimmune thrombocytopenia, renal involvement, and recurrent flares of skin manifestations. She did not respond to the conventional therapy and was controlled and treated with Rituximab, a chimeric, monoclonal antiCD20 antibody, which specifically depletes B lymphocytes.

Extra Mammary Paget's Disease: A Rare Case Report.

Extramammary Paget's disease is a marginated plaque resembling Paget's disease but occurring in anogenital area, axilla or most commonly on the vulva. A 62-year-old postmenopausal woman presented with extremely pruritic plaque on the perineal skin which progressed gradually over 3 years and did not respond to any topical/systemic steroids, antibiotics, and antifungals. Examination revealed 7 × 8 cm. hypertrophic, verrucous plaque with erosions, and crusts at places. There was no evidence of visceral malignancy. Biopsy showed Paget's cells which were positive for Periodic Acid Schiff and alcian blue stain. Surgical excision was done considering the premalignant potential.

Dermatofibrosarcoma protuberans at an uncommon site.

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive, cutaneous, malignant tumor characterized by high propensity for local relapse and low metastatic potential. It is seen mainly in the age group of 6-65 years over the trunk and extremities. Immunohistochemically it diagnosed by marker human progenitor cell Ag CD 34. Herein, we present a 40-year-old male with DFSP over the pubic area and extending up to the proximal penile shaft. The biopsy revealed intervening bundles of spindle-shaped cells in the dermis and the diagnostic marker human progenitor cell Ag CD 34 was positive. The patient underwent wide local surgical resection.

Pseudoepitheliomatous keratotic and micaceous balanitis with malignant transformation.

Pseudoepitheliomatous, keratotic and micaceous balanitis (PKMB) is a non-venereal and extremely rare pre-malignant condition characterized by silvery white plaque with micaceous scaling on glans seen in elderly uncircumcised men. Symptoms include phimosis, pain, and interference with sexual activity. Herein we present a young, 40-year-old male with PKMB of 5 years duration with deviation of urinary stream and histology showing acanthosis, hyperkeratosis with features of cellular atypia and abnormal mitosis suggestive of malignant transformation.

A clinical study of melasma and a comparison of the therapeutic effect of certain currently available topical modalities for its treatment.

BACKGROUND: Melasma is a common acquired facial hypermelanosis. Conventional treatment of melasma includes a sunscreen and hypopigmenting agents. The treatment of this recalcitrant disorder is often difficult and unsatisfactory. AIMS: The objective is to carry out a detailed clinical study of melasma and to assess the therapeutic effect and side effects of certain currently available topical modalities for the treatment of melasma. MATERIALS AND METHODS: 160 patients of all age groups and both sexes were treated sequentially with five different combination regimes for 3 months. Assessment of the response was done subjectively as well as by melasma area and severity index (MASI). RESULTS: Out of the five modalities studied, the modified Kligman's formula was the most effective. However, it had comparatively higher incidence of side effects. CONCLUSIONS: Among the currently available topical modalities for the treatment of melasma, the most effective combination is the modified Kligman's formula. However, in view of the side effects it causes, it must be used with caution and proper counseling.

A study to evaluate the efficacy of various topical treatment modalities for alopecia areata.

CONTEXT: Alopecia Areata (AA) is a common form of non-scarring hair disorder of unclear etiology. The disease may have serious psychological effect. AIMS: The objective is to assess the therapeutic effect and side effects of various topical modalities for the treatment of AA. SETTINGS AND DESIGN: Open, randomized, comparative study. MATERIALS AND METHODS: For this study, 30 patients were included of all age groups and both sexes having localized (<5 patches and <25% scalp involvement) alopecia, with no underlying disease or family history, and who had not received any treatment before. They were treated sequentially with 5 different combination regimes for 3 months. The response was assessed subjectively as well as objectively by the "Severity of Alopecia Tool Score". STATISTICAL ANALYSIS: Chi-square test. RESULTS: Out of the 5 modalities studied, the Intralesional and Topical Steroids were the most effective with no significant side effects. CONCLUSIONS: Among the various topical modalities used for the treatment of AA, the most effective are the Intralesional and Topical steroids with no significant side-effects.

Lymphoedema - distichiasis syndrome with recurrent abortions.

Lymphoedema-distichiasis syndrome, a type of familial lymphoedema praecox, is a rare, primary lymphoedema of pubertal onset associated with distichiasis and other associations including congenital heart disease, ptosis, varicose veins, cleft palate, and spinal extradural cysts. We report a case of familial lymphoedema with associated distichiasis, atrial septal defect, varicose veins, and recurrent abortions in a 29-year-old female.