Assessing the impact of childhood and adolescent chronic plaque psoriasis on parents/caregivers using the Family Dermatology Life Quality Index (FDLQI): A cross-sectional study.

Background Chronic childhood diseases are a burden for paediatric patients and their caregivers. Limited data are available on the effect of paediatric psoriasis on the caregiver's well-being and quality of life. Objective To assess the impact of childhood and adolescent chronic plaque psoriasis on parents/caregivers quality of life. Methods A single-centre cross-sectional study was performed which included 102 children with psoriasis and their caregivers. Clinico-demographic data of children and socio-demographic details of primary caregivers were collected. Out of pocket expenditure for treatment was calculated for all the patients. The quality of life of children was assessed using the Children's Dermatology Life Quality Index (CDLQI) and the caregiver's quality of life was assessed using the Family Dermatology Life Quality Index (FDLQI). Results CDLQI was impaired in 85.29 % of children with a median score of 7. The item 'symptoms' was most commonly affected (87.2%), followed by 'self-conscious' (70.5%) and 'treatment' (65.6%). FDLQI was impaired in 96.1% of caregivers with a median value of 11. The most affected FDLQI items were 'emotional' in 95%, followed by 'time-spent' in 78.4%. Almost 40% of patients had catastrophic health expenditure (CHE) and their FDLQI was significantly higher (p-0.014) compared to caregivers who did not experience catastrophic health expenditure. FDLQI had a positive relationship with the involvement of exposed body sites (p-0.003), CDLQI (p-0.000), treatment expense (p-0.031) and a negative correlation with duration of illness (p-0.04). Conclusion Childhood psoriasis has a negative impact on the quality of life of the children and caregivers highlighting the need for intervention strategies for both.

SARS-CoV-19 and Generalised Pustular Psoriasis: A Lethal Combination.

Generalised pustular psoriasis(GPP) is a rare, potentially life-threatening variant of psoriasis with acute onset, widely spread pustular lesions on an inflamed base associated with a systemic inflammatory state. In the setting of the current COVID-19 pandemic, flares in pustular psoriasis have been reported, however these flares leading to mortality in SARS-CoV-2 infected patients is hitherto unreported. We present two cases of GPP flare following SARS-CoV-2 infection with fatal outcome. A 20 year old male, known case of GPP since 5 years presented with an exacerbation of his existing disease for 2 months. He had received methotrexate, cyclosporine, acitretin, apremilast, infliximab and secukinumab in the past. He was admitted and started on inj. methotrexate (subcutaneous) and cap. acitretin. During admission, he developed COVID-19 associated severe acute respiratory distress syndrome(ARDS). Despite timely intervention with life-saving measures, the patient could not be saved. The second case was a 52-year-old female, a case of GPP on treatment for the last 10 years, being maintained on cap. acitretin and cyclosporine. She also developed ARDS due to COVID infection. Despite being on acitretin for GPP and the appropriate management of severe COVID infection, her condition worsened and she expired within one day of admission. Both of our patients were not vaccinated against COVID-19. Awareness of potential risk of mortality in patients of GPP getting co-infected by COVID-19 is thus essential for dermatologists.

Effect of Lockdown Due to COVID-19 on Health and Lifestyle of Psoriasis Patients: A Web-Based Survey.

Background: Chronic skin diseases like psoriasis affect a patient's physical, psychological, and social functioning as well as well-being, and the lockdown acted as a cofactor in further worsening the quality of life in psoriasis patients. Objective: The objective of the study is to assess the effect of lockdown on the health, lifestyle, and mental well-being of psoriasis patients. Methods: A cross-sectional study was done using an online questionnaire shared through messenger applications to the patients of chronic plaque psoriasis who registered in the psoriasis clinic between August 2020 and December 2020. Data regarding demographics, psoriasis, lifestyle changes, mental status, financial loss, and problems faced during lockdown were collected. Results: Our study included 181 completed questionnaires. The mean age was 37.7 (SD 13.9) years, and 124 (68.5%) were males. Sixty-five (35.9%) patients reported worsening of their psoriasis during the lockdown. Ordinal regression analysis revealed male sex had a higher proportion of worsening of psoriasis (OR 2.56, 95% CI 1.29-5.08, P < 0.007). Duration of illness <6 months (OR 0.14, 95% CI 0.02-0.98, P < 0.04) and feeling relaxed (OR 0.14, 95% CI 0.03-0.56, P < 0.005) were negatively associated with disease worsening. Conclusion: The findings of our study reveal the impact of coronavirus disease 2019 (COVID-19) lockdown on the life of people with psoriasis. A substantial number of patients had a flare of psoriasis during the lockdown. A shorter duration of illness and relaxed mental status was negatively associated with disease worsening. Individuals with financial loss felt anxious or depressed.

Drug-resistance and its impact on cutaneous tuberculosis.

Drug resistance in tuberculosis is a universal health problem, with India and China having the highest number of multidrug resistant tuberculosis (MDR-TB) cases globally. As cutaneous tuberculosis (CTB) accounts for 1.5% of all extrapulmonary tuberculosis, drug resistance in CTB remains less discussed and understood. The sensitivity and specificity of the routine diagnostic workup for CTB are low compared to pulmonary tuberculosis. Therefore, identifying drug resistance becomes challenging and needs a high index of suspicion. Molecular techniques such as polymerase chain reaction (PCR), line probe assays, DNA microarray, and sequencing help us to identify tubercular bacilli and drug resistance early. Prompt initiation of effective therapy reduces disease-related morbidity and mortality and makes the patient non-contagious. Lately, World Health Organization (WHO) has recommended using "all oral longer MDR TB regimen" for pulmonary and extrapulmonary drug-resistant TB instead of a painful older regimen requiring long term therapy with injectables. This review focuses on the drug resistance in CTB, various methods and newer techniques to diagnose them and recent updates on treatment guidelines.

Skin Changes in Cirrhosis.

Skin manifestations of systemic disorders give a clue to the organ involved and help identify the possible disease-causing injury. Skin changes of liver cirrhosis are not specific, as they may be seen in disorders not involving the liver. Thus, a constellation of skin changes along with systemic features may help us to identify the disease-causing liver cirrhosis. Pruritus is one of the most common and distressful symptoms of liver cirrhosis, severely affecting the quality of life, which further necessitates understanding cutaneous manifestations of cirrhosis. Other nonspecific cutaneous manifestations include spider telangiectasia, palmar erythema, paper money skin, xanthomas, pigmentation changes, nutritional deficiencies, hair changes, and nail changes. This review discusses the nonspecific skin manifestations associated with liver cirrhosis followed by specific cutaneous findings seen in common diseases causing liver cirrhosis, such as viral infections, biliary tract disorders, chronic alcoholism, and metabolic disorders. Early recognition of cutaneous features can help prevent or delay the development of complications and end-stage disease, decreasing morbidity and mortality.