Proposal for a Severity Score (DeASI, Dermatophytosis Area and Severity Index) for the Evaluation of Dermatophyte Infections - A Delphi Consensus Study.

Background: There has been a significant increase in the incidence of recurrent, resistant, and extensive dermatophyte infections worldwide recently. This menace has spurred the need for more well-designed randomized controlled trials to optimize the treatment of dermatophyte skin infections. One of the limitations in designing such studies is the limited availability of standard and validated score, to measure the severity of dermatophyte infections. Aims: To create a severity score for the evaluation of dermatophyte infections. Materials and Methods: A Delphi consensus model was used to frame a severity scoring tool for superficial dermatophyte skin infections. Fourteen experts participated in the first round and twelve experts participated in the second round. Results: Based on the expert consensus, a final scoring system proposed was: Final Severity Score (FSS) = Sum total of Body Surface Area (BSA) in hand units for each patch multiplied by the sum of the scores for pruritis (P), lichenification (L), and actively raised borders (A) for each patch (FSS = BSA in hand units × (P + E + L + A) of patch 1 + BSA in hand units × (P + E + A) of patch 2 …etc.). For measuring hand units more accurately fractional values of 0.25 can be used (0.25 corresponding to an approximate 1/4th of a hand unit). A score of +1 will be added in case of the following - 1) Close contact/family member affected, 2) History of at least one recurrence in the previous 6 months after a course of oral antifungals, 3) History of immunosuppression (on immunosuppressive medication or having underlying immunosuppressive disease). The scores will be valid only if the patient has not used any treatment topical or systemic, for at least 2 weeks before enrolment. Conclusion: The proposed Dermatophytosis Area and Severity Index (DeASI) score will help the physicians and researchers standardize the treatment protocol for dermatophytosis, henceforth, assessing the response to therapy. This will also help to standardize the parameters of effectiveness while designing any clinical trial.

Add-on Plastic Tips for Cryogen Administration in Difficult-to-access Areas.

Targeted cryotherapy of lesions in difficult to access location is a challenging scenario. We propose the use of add-on tips fashioned from disposable micropipettes, needle caps, and syringe barrels as a solution.

Clinical Images in Dermatology Manuscripts - A Study of Journal Submission Guidelines.

Background: Images are an important element of any scientific publication, more so for a very visual specialty such as dermatology. Dermatology journals generally include detailed instructions related to images submitted with the manuscripts, including technical aspects such as file format, resolution, and editing. We aimed to review and critically analyze instructions for images in the top 50 dermatology journals [as per the latest Clarivate journal citation report (JCR) ranking]. Methods: The top 50 journals as per the latest Clarivate JCR were included in the study. Instructions for images were reviewed for each of the journals. The main points analyzed included file type, resolution, size limits, editing limits, support for post-processing of images and details regarding patient consent. Results: Only half the journals (25) had clear, detailed, and specific instructions for the images. Only one journal specifically mentioned pixels per inch (PPI) as the descriptive term, and the remaining used dots per inch (DPI), whereas 6 did not mention either. Twenty-three journals did not mention the recommended size of the image. The most common minimum resolution mentioned was 300 DPI (41 journals). Although 24 of the journals mentioned editing limits, none of the journals elaborated on image plagiarism in the instructions. Twenty-one of the fifty did not mention a clear policy on patient consent. Conclusions: Image submission guidelines for dermatology journals need to be made more elaborate yet easier to understand. Developing a consensus, followed by standardization of these submission guidelines, can help both authors and journals.

Localized alopecia with itching on the scalp.

We describe the use of trichoscopy to arrive at a diagnosis, and discuss the possible differential diagnoses in a patient presenting with localized itching and alopecia of the scalp.

Window Approach in Conventional Phototherapy to Protect Non-lesional Skin.

We propose the use of protective coverings-gloves, socks, or clothing, with windows cut out into them, to ensure that the phototherapy targets only the affected areas.

Practical suggestions to improve standardization of repeated open application testing (ROAT) for daily use products.

Introduction: Repeated open application testing (ROAT) is an important adjuvant in the evaluation of allergic contact dermatitis. There are variations in the way ROAT is used by practitioners and standardizing the method, in terms of the area and amount of the antigen applied, could help improve the validity of the process. Aim: Our study attempts to address ways in which part of the ROAT technique can be standardized - with respect to the area and amount of application and validation of the same through consensus opinion. Material and methods: Two proposed modifications - one for the area of application (using waterproof surgical markers and a stencil to mark the area of application) and one for daily amount applied (using easily available 1 cm3 syringes), for the ROAT technique were drafted. The same was discussed with a total of 10 dermatologists. The participants were given four statements and were asked to choose one option for each statement (strongly agree - agree - neutral - disagree - strongly disagree). All the respondents were also asked to give their opinion on possible limitations and problems of the proposed modifications and possible solutions for the same. Results: There was generally a consensus among the 10 dermatologists, with the majority agreeing that the proposed modifications were both effective and practical. Conclusions: Simple practical modifications of the ROAT technique like marking the area to be applied using a waterproof skin marker and stencil, and the use of 1 cm3 syringes to dispense the test product, can improve the standardization of the process.

Increased incidence of facial pityriasis versicolor in children during the COVID-19 pandemic-A consequence of mask usage?

We describe a case series of seven children presenting with pityriasis versicolor on the face, localized to the area of coverage by the mask. The increased use of face masks after the opening up of schools, combined with a humid environment and associated sweating might be responsible for an increased presentation of facial pityriasis versicolor in children in our community.

Cryotherapy: Tips and Tricks.

Cryotherapy using liquid nitrogen as cryogen is a well-established therapeutic modality in dermatology. In recent times, there have been many innovations and improvisation of cryotherapy for various dermatological disorders. In this article, we present a short comprehensive collation of practically useful points of cryotherapy covering the various aspects of procedure-planning, patient selection, storage and delivery techniques, and challenging clinical scenarios which can enhance the utility of this efficacious and economic treatment option.

Clinical and onychoscopic characteristics of subungual glomus tumor: a cross-sectional study.

BACKGROUND: Subungual glomus tumor is a relatively uncommon entity with varied clinical presentations which may lead to diagnostic delays. Onychoscopy can be used as an evaluation tool in routine evaluation of glomus tumors. OBJECTIVES AND METHODS: With an aim to characterize the onychoscopic features of subungual glomus tumors, we analyzed 15 cases presenting over 3 years, in this observational study. The clinical, onychoscopic, radiological, and operative findings in these patients were evaluated and correlated depending on the location and extent of the lesions. RESULTS: All 15 patients (11 female and 4 male) had pain as the presenting symptom and fulfilled the classic triad of paroxysmal pain, cold sensitivity, and positive Love's pin test. Clinical nail plate findings included onycholysis, onychorrhexis with distal splitting, and onychoschizia, while nail bed and matrix findings included localized erythematous and bluish patches, longitudinal erythema, and altered lunula. Onychoscopy corroborated the clinical findings and revealed a more extensive area of involvement in five cases. Definitive onychoscopy findings included a localized structureless erythema interspersed with bluish and patchy whitish areas (five cases of nail bed and six nail matrix tumors) and a "candy-cane appearance" (six cases, all large and lobulated nail matrix tumors). MRI reported the tumor in 13 cases, while two nail matrix tumors were missed. Transungual excision revealed tumors larger in size than predicted by MRI. The presence of candy-cane appearance was consistent with lobulated matrix tumors. CONCLUSION: Onychoscopy improves the intraoperative detection of location and extent of subungual glomus tumors. Nail bed and nail matrix glomus tumors can have distinctive onychoscopic features that may help in better surgical planning.