Quality of Life and Perceived Stress in Chronic Spontaneous Urticaria: Counting the Burden.

Background: Chronic spontaneous urticaria (CSU) is a dermatosis with a significant psychological component. Only a few studies have assessed the quality of life (QoL) and perceived stress in CSU patients. Objectives: To evaluate the QoL and perceived stress in patients with CSU. Materials and Methods: A cross-sectional study was done on 54 patients of CSU attending the Urticaria clinic of the Dermatology department in a tertiary care postgraduate teaching hospital in North Kerala. QoL in chronic urticaria was assessed using the Chronic Urticaria-Quality of Life (CU-QoL) questionnaire and perceived stress was assessed using the Perceived Stress Scale (PSS). Results: The mean scores of CU-QoL and PSS were 55.78 and 16.31, respectively. Out of 54 patients, 26 (48.1%) had mild impairment, 26 (48.1%) had moderate impairment, and 2 (3.7%) had severe impairment of QoL. Low stress was seen in 20 (37%) patients, moderate stress in 28 (51.9%), and six (11.1%) patients had high stress. Conclusion: This study shows that more than half of the patients with CSU had moderate to severe impairment of QoL and had moderate to severe stress.

Hypopigmented Skin Lesions with Doubtful/Minimal Sensory Impairment: A Histopathology-Based Analysis.

Background: Cardinal criteria proposed by the World Health Organisation (WHO) lack sensitivity to diagnose indeterminate leprosy. Aims: To estimate the frequency of hypopigmented skin lesions with doubtful/minimal sensory impairment showing histopathology features of indeterminate leprosy. To compare between the histopathology findings noted in specimens showing features suggestive of indeterminate leprosy and those showing a non-specific dermatitis pattern. Materials and Methods: Data on patients who attended our department with hypopigmented patches with doubtful/minimal sensory impairment from January 2018 to December 2019 and who underwent a skin biopsy were collected. A pathologist blinded to the clinical findings reviewed the histopathology specimens using a pre-set questionnaire. Results: We studied sixteen biopsy specimens from 14 patients. Eight specimens (50%) showed histopathology suggestive of indeterminate leprosy and the remaining eight showed a non-specific dermatitis pattern. A higher percentage of patients with indeterminate pattern showed mast cells (87.5% vs 25%) and fibrosis around nerve twig or sweat duct (75% vs 12.5%) when compared to those who showed a non-specific dermatitis pattern. Limitations: Small sample size and retrospective study design were the limitations. Conclusions: We found histopathology features of indeterminate leprosy in 50% of the skin biopsy specimens from hypopigmented lesions with doubtful/minimal sensory impairment. The present study highlights the need to improve the diagnostic definition of indeterminate leprosy.

Impact of Lockdown Restrictions on Treatment of Leprosy: A Retrospective Analysis.

Context: Coronavirus disease 2019 (COVID-19) has shown the potential to affect the life of people all over the world either directly or indirectly. Aim: To assess the impact of lockdown measures on treatment of leprosy among patients who received treatment from a tertiary referral centre. Settings and Design: A retrospective study was conducted at the dermatology department of a tertiary referral centre. Materials and Methods: We did a retrospective analysis of case records of patients with leprosy who received treatment from our tertiary referral centre from 01 March 2020 to 31 May 2021. Results: During the 15-month period, 59 patients received multi-drug therapy (MDT) for leprosy from our centre. Thirty-two patients (54.2%) were already receiving MDT as on March 2020, and 27 others (45.8%) were diagnosed with leprosy and started on MDT during the period from March 2020 to May 2021. Two patients (3.4%) developed COVID-19 while on MDT. When lockdown measures were implemented, 12 patients (12/59, 20.3%) discontinued treatment, citing conveyance difficulties. Three patients (3/59, 5.1%) were lost to follow-up. Limitations: Small sample size and reliance on retrospective data from a single centre were the major limitations of the study. Conclusion: A conscious effort is needed from healthcare professionals and the government to ensure that implementation of national programmes is not adversely affected by the ongoing COVID-19 pandemic.

Autoimmune Diseases, End Organ Dysfunction and Adverse Drug Reaction Following Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A Retrospective Cohort Study.

CONTEXT: Autoimmune diseases, organ dysfunction and new drug allergies are mentioned as long-term complications after DRESS. There is scarcity of data on this from the country. AIMS: To determine the frequency of autoimmune diseases, organ dysfunction, and new drug allergies after the resolution of DRESS. SETTINGS AND DESIGN: This retrospective cohort study was carried out among patients who received treatment for DRESS in a tertiary referral center. MATERIALS AND METHODS: In this retrospective cohort study, DRESS patients who received inpatient care in the dermatology department of our tertiary referral center from August 2014 to February 2017 were included. We excluded patients aged 12 years or below and those who had not completed minimum two years after the resolution of DRESS as on December 2019. We collected information on new onset autoimmune disease, end organ damage and new drug allergies detected after the resolution of DRESS through a telephonic interview. Those who consented were evaluated in our department. RESULTS: We could contact 40/50 (80%) identified individuals and all of them consented for telephonic interview. 17 patients gave consent for revaluation in our department. There were 22 females and 18 males. 17 had definite and 23 had probable DRESS. The frequency of detection of a new disease and a new drug allergy after DRESS was 10% (4/40) and 7.5% (3/40), respectively. We noted three (7.5%) autoimmune diseases (rheumatoid arthritis 1, alopecia areata 1, chronic autoimmune urticaria 1) and one end organ damage (chronic kidney disease) among the study participants. LIMITATIONS: Small sample size and retrospective study design were the limitations. CONCLUSIONS: Prospective studies with large sample size are needed to delineate the link between DRESS and autoimmunity, end organ damage, and new drug allergies.

Psychiatric morbidity, stress and quality of life among geriatric dermatology patients: Therapeutic considerations from an Indian perspective.

We aimed to determine the prevalence of psychiatric morbidities, stress and quality of life, the pattern of skin diseases and associated psychosocial factors in geriatric population. Patients aged 60 years and older were recruited. Demographics and dermatological history and findings were collected using a preset Proforma. Geriatric depression scale (GDS), hospital anxiety and depression scale (HADS), perceived stress scale (PSS), and dermatology life quality index (DLQI) were instituted in all the patients. A total of 310 patients were included in the study, 173 males and 137 females. Infectious diseases (39.6%), papulosquamous diseases (17.1%), and eczema (15.5%) were common disorders. 45.5% were depressed and 43.2% had anxiety (hospital anxiety and depression scale). 55.8% had depression (geriatric depression rating scale), 20.3% had high stress and 11% had extremely large effect on DLQI. Divorced/widowed patients experienced more depression (p = 0.037) and had more impairment in quality of life (p = 0.05). Patients living in three generation family experienced more impairment in quality of life (p = 0.000). Our study demonstrated high prevalence of psychiatric morbidities in geriatric dermatology patients. It implies the need of special care with more attention to psychiatric co morbidities. The role of psychiatry-dermatology liaison clinic may benefit these patients.

The association of HLA B*15:02 allele and Stevens-Johnson syndrome/toxic epidermal necrolysis induced by aromatic anticonvulsant drugs in a South Indian population.

BACKGROUND: The presence of HLA-B*15:02 allele is considered a risk factor for development of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) in patients taking aromatic anticonvulsant drugs like carbamazepine and phenytoin. The genetic association is ethnicity specific. Testing for HLA-B*15:02 allele is suggested as a prerequisite before starting carbamazepine in certain ethnic groups. There are only a few/no studies from south India on HLA association of SJS/TEN. AIMS: To identify any association between HLA-B*15:02 allele and SJS/TEN induced by carbamazepine/phenytoin among native population. METHODS (INCLUDING SETTINGS, DESIGN, AND STATISTICAL ANALYSIS USED): A case-control study done in a tertiary care center at Kottayam in Kerala state of south India. Cases were 12 native patients who developed SJS/TEN owing to aromatic anticonvulsant drugs (phenytoin - 8; carbamazepine - 4), and controls were 11 persons tolerant to these drugs from unrelated families of the same ethnic group. HLA-B typing was done by PCR SSP method. RESULTS: There was only one HLA-B*15:02 carrier among cases and controls. He/she had SJS/TEN induced by carbamazepine. CONCLUSIONS: Association of HLA-B*15:02 with phenytoin-induced SJS/TEN is rare in the population studied. The one limitation of the study was the small sample size.