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Background: Substance use has turned out to be one of the growing social problems of the present society cutting across all sorts of boundaries of the world with Kashmir Valley being no exception to this growing pathological phenomenon. Aims and Objectives: To find the prevalence and pattern of dermatological manifestations among substance users across Kashmir Valley. Materials and Methods: Cross-sectional study where patients of all age-groups, irrespective of gender, were enrolled in the three largest districts of Kashmir Valley over a span of 18 months. Results: Sample size was 710 with a male/female ratio of 12.4:1. The mean age of the cases was 25.2 ± 7.05 years. Heroin, one of the opioids, was the most common substance used (n = 515), followed by cannabis (n = 334). Pruritus was found to be the most common dermatological manifestation overall and statistically significant among heroin users. Stigmata of injection drug use (IDU) with the presence of track marks and sooting tattoos (93.1%), atrophic scars secondary to skin popping (30.7%), active skin ulcers (18.8%), and puffy hand syndrome (8.7%) were specifically seen among injection drug users. Oral involvement was seen in 48.5%, including periodontal disease, oral thrush, and stomatitis nicotinica. Hyperhidrosis was present in 30%, and hesitation cuts over arms in 16.3% of all substance users. Conclusion: Dermatological manifestations are quite prevalent among substance users in the population of Kashmir. Pruritus with temporal relation to substance use, stigmata of injectable drug use including track marks and sooting tattoos, atrophic scars at injection sites, active skin ulcers, and skin and soft tissue infections, and hyperhidrosis are among important dermatological clues for detecting substance use. Recognition of such cutaneous signs is important in these cases for more effective diagnosis and treatment.
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Background: Pemphigus is a group of potentially fatal autoimmune mucocutaneous blistering diseases. Rituximab (RTX) is a chimeric anti-CD20 (anti-cluster of differentiate 20) monoclonal antibody being increasingly used and becoming the first-line therapy in the management of pemphigus. Aims and Objectives: This was an observational study to evaluate the efficacy and safety of rituximab in patients of pemphigus vulgaris (PV) who either did not respond or relapsed after conventional therapeutic regimens and in treatment naive pemphigus patients. Materials and Methods: The study included pemphigus patients coming to our immunobullous clinic who did not respond to conventional therapy or relapsed after receiving conventional therapy as well as fresh cases between January 2019 and October 2021. All enrolled patients received two doses of rituximab (1 gram in each) as intravenous infusions two weeks apart as per the rheumatoid arthritis protocol. The efficacy and safety were evaluated by assessing pemphigus area and activity score (PAAS) before and after the therapy, clinical response, and any adverse events during follow-up. Results: Sixteen (ten males and six females) patients were included in the study. The age of these patients ranged from 27 to 60 years, with a mean of 43.8 ± 9.8 years. There were 15 (93.75%) patients with PV (14 mucocutaneous type and 01 mucosal) and one (6.25%) with pemphigus foliaceus. Among these patients, nine (56.25%) were relapse cases, four (25%) were non-responders, and three (18.75%) were fresh cases who received rituximab as first-line therapy. Fourteen (87.5%) patients reached complete remission off therapy over a median time of 6.36 months (ranging from 18 weeks to 35 weeks). Rituximab was well-tolerated by our patients, and no serious adverse events were observed. The main limitation of our study was the small sample size and the lack of a comparison group. Conclusion: Rituximab is a safe and effective treatment for pemphigus.
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Background: Cutaneous warts are common benign skin lesions caused by human papillomavirus. Various treatment options are available for these but immunotherapy is becoming more and more popular over the past few years. It stimulates cell-mediated immunity causing clearance of warts. Aims and Objectives: The aim is to determine the role of intralesional vitamin D3 in the treatment of warts. Materials and Methods: Consecutive patients with verruca vulgaris attending OPD were included. Around two to three warts were injected first with 0.2 mL of lignocaine (20 mg/mL). After a few minutes, the same warts were injected with 0.2 mL (4 U) of vitamin D3 (15 mg/mL). The injections were given2 weeks apart for a maximum of six sessions, and the patient was followed up 3 months after the last injection. Results: A total of 41 patients of cutaneous warts completed the study. Complete clearance was seen in 27 (65.85%) patients, partial response was seen in 11 (26.83%) patients, and three patients (7.32%) showed no response at all. The mean number of injections required for complete response was four. Recurrence was seen in two patients (4.88%) and one patient had keloid formation at the sight of injection. Limitation: This is a small sample sized study and lacks a control group. Conclusion: Intralesional vitamin D3 is an effective treatment option for common warts.
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The COVID-19 pandemic has directly or indirectly affected every human being on this planet. It's impact on the healthcare system has been devastating. The medical fraternity across the world, including India, is facing unprecedented challenges in striving to cope up with this catastrophic outbreak. Like all other specialties, dermatology practice has been profoundly affected by this pandemic. Measures have been taken by dermatologists to control the transmission of the virus, whereas providing health care to patients in the constrained environment. Preventive measures such as social distancing and hand hygienic practices along with patient education is being prioritized. Dermatological conferences and events scheduled across the globe in the first half of year 2020 have been either cancelled or postponed to discourage gatherings. Rationalization of resources and practice of teledermatology are being encouraged in current scenario. Non-urgent visits of the patients are being discouraged and elective dermatology procedures are being postponed. Many national and international dermatology societies have recently proposed recommendations and advisories on usage of biologicals and immunomodulators in present context of COVID-19 pandemic. Urticarial, erythematous, varicelliform, purpuric and livedoid rash as well as aggravation of preexisting dermatological diseases like rosacea, eczema, atopic dermatitis, and neurodermatitis rash have been reported in Covid-19 patients. Self medications and poor compliance of dermatology patients in addition to lack of proper treatment protocols and monitoring are a serious concern in the present scenario. Strategies for future course of action, including the dermatology specific guidelines need to be framed. This issue includes a special symposium on dermatology and COVID-19 having recommendations from special interest groups (SIGs) of Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) Academy on leprosy, dermatosurgery, lasers and dermoscopy.
