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Background: Palmoplantar keratoderma (PPK) is a heterogeneous group of hereditary or acquired disorders characterised by excessive epidermal thickening of the palms and soles. Proper knowledge about the aetiology of the disease and clinico-demographic profile helps in planning management and predicting outcomes. Aims and Objective: To determine the prevalence of different dermatoses and describe their clinico-histological correlation in acquired palmoplantar keratoderma. Materials and Methods: An institution-based cross-sectional study conducted after obtaining Ethics-Committee permission and consent from participants. Patients of any age or gender presenting with acquired PPK were recruited. The calculated sample size was 67 by using the prevalence rate (p) of 22.2%, allowable error (L) of 10%, the confidence level of 95% (z = 1.96), and an infinite population size of 20,000. Patients were evaluated by taking demographic and clinical data in a pre-designed case record form, necessary laboratory investigations and histopathological examination that wereevaluated by three blinded experts. The pooled data were analysed with statistical software. Results: Among the 67 participants, Psoriasis was diagnosed clinically in 39 (58.2%) and histologically in 7 (10.4%), Lichen planus (LP) clinically in 16 (23.9%) and histologically in 9 (13.4%), Pityriasis rubra pilaris (PRP) in 8 (11.9%) patients clinically and 7 (10.4%) histologically and Hyperkeratotic eczema (HKE) in 4 (6%) clinically and 43 (64.2%) histopathologically. There was very poor inter-rater agreement (Kappa = 0.148, SE 0.0047, 95% CI 0.057 to 0.24). The clinico-pathological correlation was found to be agreeable in 17.9% Psoriasis, 56.2% LP and 87.5% PRP. HKE was commonly misdiagnosed as Psoriasis in 65.1% of patients. Conclusion: Hyperkeratotic lesions of the palm and sole often present with overlapping clinical features and a skin biopsy has to be done to aid in diagnosis. Limitation: Stratification of the clinical expertise of clinicians was done during the analysis.
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BACKGROUND: Recalcitrant dermatophytosis has become a menace in recent times. The perception of the hosts or patients regarding the disease gives a real-life picture of the deep-rooted host-factors and the way to overcome the socio-economic and cultural milieu that becomes a hindrance in preventing the relapse and recurrence of this infection. AIMS: This qualitative study was conducted to assess the perception regarding the patients' understanding of causation and prevention of dermatophytosis, role of personal hygiene, and healthcare seeking behavior, and consequently, exploring the socio-economic and cultural milieu that contributes to the menace of recalcitrant dermatophytosis. MATERIALS AND METHODS: Two focus group discussions (FGDs) consisting 12 patients with recalcitrant dermatophytosis, who speak the vernacular, were conducted with the help of a predetermined FGD-guide. Both FGD sessions were recorded, transcribed, and translated into English. These verbatims were thematically analyzed and emerging themes were identified with illustrative quotations. Free listing and pile sorted data obtained were analyzed by Visual Anthropac version 1.0 software for Smith's salience value, cognitive mapping with two-dimensional scaling and hierarchical cluster analysis. RESULTS: Washing of clothes with soap antiseptics and drying the clothes under the sun prevents diseases, whereas, not changing undergarments for prolonged periods of time, bathing in ponds using mustard oil spreads the disease, furthermore, staying in wet clothes, working for more than five hours under sun, playing outdoors, household jobs cause tinea, etc. were the most common reported perceptions. Overall, five themes emerged after pile sorting the data, namely, ignorance about the disease, understanding of the predisposing factors of the disease, prevention, role of personal and traditional belief, and care-seeking behavior. CONCLUSIONS: There is a dire need to address the myths or traditional beliefs, which are not supported by scientific evidence. Expense of the treatment of dermatophytosis calls for price control of the commonly prescribed antifungals. Poor socio-economic conditions and professional responsibilities hinder people from implementing the preventive measures in spite of their knowledge.
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INTRODUCTION: Leprosy in pediatric population continues to remain as one of the major public health problems in India. BCG vaccination has been implicated in producing some protection against leprosy. OBJECTIVES: The present study intended to find out the patterns of leprosy in the pediatric age group (<12 years) and to determine the proportion of paucibacillary (PB) and multibacillary (MB) leprosy cases among the BCG-vaccinated and nonvaccinated groups. METHODOLOGY: It is a cross-sectional study among patients with leprosy up to the age of 12 years attending a tertiary care hospital in Eastern India by comprehensive history taking and through clinical examination. The history of BCG vaccination was enquired and the BCG scar was looked for to determine the BCG-vaccinated and nonvaccinated group. After collecting the data in a predesigned case sheet, the data were analyzed. RESULT: Of the 137 patients included in this study, 71.53% belonged to the 11-12 years age, 27.74% the 5-10 years age, and 1 patient the <5 year age group. The sex ratio was 1:1.63. PB leprosy was more common than MB leprosy. Smear positivity, deformity, and reaction were not very frequent. Among the vaccinated patients, the ratio of PB and MB leprosy was 5.3:1, while in the nonvaccinated group the ratio was 1.2:1. Data analysis showed that the proportion of MB leprosy was statistically significant in the nonvaccinated group than in the vaccinated group (p = 0.0352). CONCLUSION: Our study pointed that BCG vaccination might have a role in enhancing the cell-mediated immunity (CMI).
