Subcutaneous Basidiobolomycosis Treated Successfully with Oral Itraconazole: A Case Report.

Basidiobolomycosis is an opportunistic fungal infection with a high morbidity and mortality rate. It is known to cause invasive disease in immunocompromised persons but it may produce only cutaneous or subcutaneous infections in an immunocompetent patient. Treatment is difficult due to its fulminant course and lack of effective anti-fungal drugs. But here, we report a rare case of Basidiobolomycosis detected in an immunocompetent patient-without any debilitating illness, which showed a complete response to itraconazole 200 mg daily without any surgical intervention.

Preparation of Platelet-rich Fibrin Membrane over Scaffold of Collagen Sheet, its Advantages over Compression Method: A Novel and Simple Technique.

INTRODUCTION: Platelet-rich fibrin (PRF) is compressed by using various tools to make platelet-rich fibrin membrane (PRFM). Preservation of platelets and plasma content of PRFM depends on the compression method used. To overcome limitations of compression method, we prepared PRFM over scaffold of collagen sheet without using any compression device. AIMS AND OBJECTIVE: To prepare PRFM without using any compression device over a scaffold of collagen sheet and to evaluate its efficacy in chronic nonhealing ulcer. MATERIALS AND METHODS: PRFM was prepared, with minor modification in Choukron's protocol, over a collagen sheet without using compression device. To study its efficacy and reproducibility, total 15 patients over 18 years of age with chronic, nonhealing ulcers of more than 3 months of various causes were included and patients with active wound infection were excluded. RESULTS: We were able to prepare and reproduce PRFM by our technique. It overcomes the limitations of compression method with comparable efficacy to compression method. Results obtained on comparison at week 0, 3, and 6, by paired t-test, were found to be statistically significant (P < 0.0001). CONCLUSION: Preparation of PRFM with the method described is easy and reproducible. Use of collagen sheet synergistically improved wound healing.

Prescription and Usage Pattern of Topical Corticosteroids among Out-patient Attendees with Dermatophyte Infections and Its Analysis: A Cross-sectional, Survey-based Study.

BACKGROUND: There is scarce scientific data on topical corticosteroids (TCS) prescription by non-dermatologists including registered medical practitioners, ayurvedic, homeopathic practitioners, and over-the-counter (OTC) use of TCS-containing creams. OBJECTIVE: The main objective of this study is to analyze the prescription and usage pattern of topical steroids among out-patient attendees with dermatophyte infection. To study health-seeking behavior of patients with dermatophyte infections. MATERIAL AND METHODS: An open, cross-sectional, duration-based study of 3 months. Inclusion criteria: Patients with dermatophytosis having a history of topical steroid application; either prescribed or purchased OTC and used themselves. Exclusion criteria: Patients who were not willing to give informed consent. Patient's data like socio-demographic profile, duration, frequency, site of application, contents of the topical cream used, prescriber information, and patients' desire to continue the use of topical steroids were recorded. RESULTS: Total of 18.40% (n = 503) patients were already using cream-containing TCS at the time of presentation to the tertiary dermatology care center. The study shows that almost half of the patients (48.90%) were using unprescribed TCS. Registered medical practitioners were the most common source of TCS creams prescription (59.92%) in the prescribed group, while 26.07% patients were prescribed TCS by dermatologists. Clobetasol propionate (47.91%), was most common steroid agent used. CONCLUSION: Patients are able to get "prescription-only" drugs as OTC products. Such OTC use of TCS puts patients at risk of steroid modified dermatophytosis and topical steroid damaged skin. Even dermatologists may be culprit in creating menace of steroid abuse.

Oral Antifungal Therapy: Emerging Culprits of Cutaneous Adverse Drug Reactions.

INTRODUCTION: Antifungals are one of the most widely used drugs in dermatology practice for dermatophytosis. Oral antifungal therapy against superficial dermatophytosis is generally associated with a low incidence of adverse events in an immunocompetent population. However, lately, cutaneous adverse drugs reactions (CADRs) have been reported with varying incidence rates in the patients on oral antifungal therapy with many uncommon morphological patterns. The present, observational study was conducted over a period of 4 months to report the cases which presented with antifungal therapy-associated CADRs. MATERIALS AND METHODS: It was an observational, prospective study carried out at a tertiary care center in Western India over a period of 4 months. All patients diagnosed with superficial dermatophytic infections (clinically and fungal hyphae seen on 10% potassium hydroxide mount) started on oral antifungal therapy, presenting with cutaneous manifestation other than the primary dermatophytosis were included. The incidence of CADRs due to oral antifungal agents and the percentage of each clinical type of the CADR observed was calculated. RESULTS: The incidence of CADRs due to antifungal drugs was 8.3 per 10,000 patients. In total, 35 cases were reported out of 4,208 cases of dermatophytosis. Terbinafine was the most common causative drug, accounting for nearly 83% of cases, followed by itraconazole for 14% cases, and griseofulvin for 2.8% of cases. CONCLUSION: The role of systemic antifungals must not be overlooked in any patient with a CADR and should be reported as a trend indicator.

Monoclonal Gammopathy of Undetermined Significance-associated Scleromyxoedema.

Scleromyxoedema is a rare generalized cutaneous mucinosis, which in absence of thyroid disease, occurs almost invariably in patients with monoclonal gammopathies. A 54-year-old female patient presented with complaint of tightening of skin on the extremities, abdomen, forehead, gradually progressive since 1 year, episodes of generalized tonic-clonic convulsions, and acute psychosis since 5 days. Cutaneous examination revealed nonpitting edema over the face and sclerodermoid changes over extremities. Laboratory investigations showed presence of M-band on serum-protein electrophoresis and monoclonal spike of IgG lambda component on immunofixation. Magnetic resonance imaging of the brain showed periventricular subcortical lacunar infarcts. Skin biopsy with mucin staining was suggestive of scleromyxoedema. All other investigations were normal. Bone marrow biopsy showed a mild focal increase in plasma cells. The cutaneous, serological, and electrophoretic findings as well as the clinical profile of the patient were consistent with the diagnosis of monoclonal gammopathy of undetermined significance associated with scleromyxoedema. This case is presented because of its rare occurrence.

Diffuse cutaneous leishmaniasis: co-infection with human immunodeficiency virus (HIV).

Cutaneous leishmaniasis is a disease caused by intracellular protozoal parasites belonging to the genus Leishmania. Immune suppression caused by HIV infection is an important factor for atypical presentation and widespread progression of cutaneous leishmaniasis. Diffuse (disseminated) cutaneous leishmaniasis and HIV co-infection is emerging as an extremely serious new disease. A 38-year-old HIV-positive man presented with a 12-month history of a progressive papule and nodular eruptions on face and extremities with infiltrations of nasal and oral mucosa. We report the case due to its atypical, widespread muco-cutaneous presentation masquerading as lepromatous leprosy.