Case Report: Plantar Cyst Caused by Phaeoacremonium inflatipes in an Immunocompetent Male, Resolving with Combination Potassium Iodide and Itraconazole Therapy.

Phaeohyphomycosis is a subcutaneous mycosis presenting as verrucous or ulcerated plaques/nodules/cysts. We report here, a case of cystic plantar phaeohyphomycosis in a 72-year-old immunocompetent man. On examination, an asymptomatic, skin colored, firm-to-soft, fluctuant, cystic lesion was seen over the left forefoot. Aspirate of lesion yielded velvety grayish-brown colonies on fungal culture, with septate, branched, phaeoid hyphae with lateral and terminal conidiophore noted on microscopic examination, and identified as Phaeoacremonium inflatipes. Due to the ongoing pandemic and advanced age, the patient declined surgical intervention and we started him on a supersaturated solution of potassium iodide (SSKI) (starting at 5 drops thrice a day and gradually increasing 1 drop per day to 20 drops thrice a day) and itraconazole (100 mg twice daily) in combination. An encouraging response was seen at 6 weeks, with complete resolution at 6 months follow-up. We report this case for the unusual fungus isolated (i.e., P. inflatipes) as well as a robust response to a combination of SSKI and itraconazole. In cases where patients refuse or are unfit for surgical excision, this combination maybe an effective therapeutic alternative.

Corona Chronicles: A Cross-sectional Survey of Practices, Challenges, and Dermatological Impact of the COVID-19 Pandemic.

Objective: Mask usage and hand hygiene are the pillars of defense against the novel pathogen causing COVID-19. This study was conducted to compare these practices among healthcare workers (HCWs) and nonhealthcare workers (nonHCWs) and to examine the outlook toward the healthcare sector among the two. Methods: A cross-sectional online survey (via Google forms) using snowball sampling was conducted. Appropriate ethical clearance was taken from the Institutional Ethical Committee (IEC). HCWs and nonHCWs 18 years of age or older with basic literacy in English and with internet access were included. Results: There were 404 total respondents (M:F ratio: 0.87:1; mean age: 30.16±9.63 years). Among the respondents, 63.3 percent were HCWs while 35.6 percent were nonHCWs. Persons performing hand hygiene more than10 times/day were found to be almost three times more likely to develop skin dryness (odds ratio [OR]: 2.95, 95% confidence interval [CI]: 1.372, 6.362). Female participants were found to be 2.5 times more likely to develop dryness (odds ratio: 2.594, 95% CI: 1.590, 4.234). Use of gloves was found to be a protective factor against development of dryness (odds ratio: 0.485,95% CI: 0.287, 0.818). A statistically significant correlation was found between mask acne and female respondents (p-value=0.000), HCWs (p-value=0.000), and use of N95 mask in combination with surgical mask (p-value=0.04). Limitations: Being an online survey, responses could not be captured from people with limited internet access and of lower socio-economic strata. Conclusion: There is a considerable burden of preventive measures on HCWs and nonHCWs alike. Significant dermatological implications are seen with frequent hand hygiene and mask usage.

The therapeutic role of methotrexate in chronic urticaria: A systematic review.

BACKGROUND: Chronic urticaria, in many cases, has an unsatisfactory response to antihistamines. The current recommendations in urticaria do not mention the dose and duration for methotrexate. AIMS: This study aims to systematically review the use/efficacy of methotrexate in chronic urticaria. METHODS: A systematic search in four databases, that is, PubMed/Medline, Cochrane central, Google Scholar and Clinicaltrials.gov was done to identify studies on the use of methotrexate in chronic urticaria using key words "methotrexate [MeSH terms]" and "urticaria" or "urticaria, chronic" or "urticaria, chronic spontaneous." RESULTS: Nine articles (study participants 127), including three randomized control trials, one prospective interventional trial without control, three retrospective reviews and two case reports, were identified and finally included in the systematic review. There was a paucity of literature and the three randomized control trials did not show any benefit of methotrexate over antihistamines alone. However, in studies where steroid-dependent cases were given methotrexate, marked benefit was reported with steroid-sparing effect, particularly on methotrexate dose escalation. LIMITATIONS: Due to a paucity of published literature on methotrexate in urticaria, a meta-analysis could not be done. CONCLUSION: In chronic recalcitrant or steroid-dependent cases, methotrexate may be a therapeutic agent of interest; however, current evidence does not point to any added advantage in efficacy over antihistamines. More evidence based on larger, well-executed randomized control trials is needed in the future to get more definitive answers.

Linear Lichen Nitidus with Onychodystrophy in a Child.

Lichen nitidus is a common dermatosis described classically as shiny, skin-colored, nonfollicular, flat-topped papules. A number of variants have been described in literature including localized, generalized, actinic, vesicular, perforating, hemorrhagic, palmar/plantar, purpuric, and linear forms. Here, we report an unusual case of linear lichen nitidus in an 11-year-old boy mimicking lichen striatus along the left thumb with isolated nail involvement of the affected digit. Nail involvement in lichen nitidus is very rare; there are only seven cases of lichen nitidus associated nail changes reported in the literature. To the best of our knowledge, this is the first such case reported from India.

Childhood Leprosy: A Retrospective Descriptive Study from Delhi.

BACKGROUND: Childhood leprosy is an important marker of the status of the ongoing leprosy control programme, as it is an indicator of active disease transmission in the community. Despite achievement of elimination status of leprosy in 2005, the reported prevalence of childhood cases continue to be high. METHOD: A retrospective analysis of 11 year records of leprosy patients aged less than 15 years in a tertiary care hospital of central Delhi was carried out from 2005-2015. Data were analysed using SPSS 22.0 system. RESULT: A total of 113 (7.6%) cases of childhood leprosy were reported during the 11 year period from 2005-2015. Multibacillary cases constituted a total of 57 (50.4%), while paucibacillary constituted 56 (49.6%) cases. The M:F ratio noted was 2.5:1. Signs of reaction were found in 15% cases, while deformity was noted in 24.7% cases. CONCLUSION: The rate of childhood leprosy continues to be high. Lack of proper access to health facilities, ignorance among the general population, high susceptibility due to immature immune system etc make this population highly vulnerable. LIMITATIONS: Limited data of 11 years from an urban center were analyzed.