Prescribing Patterns in the Treatment of Topical Steroid Damaged Face Patients: A Cross-Sectional, Survey-Based Observational Study among Practicing Dermatologists in an Eastern State of India.

Introduction: Topical steroid damaged face (TSDF) is a common occurrence in the current scenario, where darker - skinned people believe having lighter-colored skin improves their prospects in all aspects of life. This has led to the abuse of topical corticosteroids with unrealistic expectations driven by ignorance of the adverse effects, particularly in the Indian population. As TSDF is virtually an epidemic in India and there is no treatment protocol for dermatologists, we conducted this study to find out what dermatologists prescribe and, in turn, serve as a foundation to develop guidelines in the future. Materials and Methods: Forty dermatologists from Odisha, India, were selected to complete the questionnaire, containing 18 questions about diagnosis, treatment and necessary referral for ocular complications. Results: All participants were frequently diagnosing and treating TSDF. A total of 92.5% of the participants preferred initiating systemic therapy with isotretinoin or doxycycline as the drug of choice. Clindamycin and tacrolimus were preferred by 55% and 50% of participants, respectively, as the topical drug of choice. A total of 62.5% of the participants advised physical sunscreens and mild cleansers to be used with water at room temperature to wash their face. To reduce facial erythema, brimonidine was advised by 45% of participants. Conclusion: Standardized guidelines for managing TSDF are the need of the hour.

Algorithmic approach toward diagnosis of patients with congenital photosensitivity disorders and review of literature.

The congenital photosensitivity disorders present as cutaneous signs and symptoms secondary to photosensitivity, extracutaneous manifestations, and a predisposition to malignancy. Diagnosis of these conditions mainly depend on clinical findings as the molecular analysis is not always feasible. A review of all the related articles collected after a thorough literature search using keywords, "congenital AND photosensitivity NOT acquired" and the individual diseases was done. A total of 264 articles were included in the review. An algorithm for diagnosis of the different congenital photosensitivity disorders based on the various clinical presentations has been proposed. An early suspicion and diagnosis of the different congenital photosensitivity disorders is the cornerstone behind prompt institution of prevention and treatment, and decreasing the associated morbidity.

A Retrospective Study of Demographic Profile and Management Appraisal Non-Gonococcal Urethritis in Male Patients Attending a Tertiary Care Hospital in Odisha.

Background: Male urethritis is primarily sexually transmitted in India and has also shown a high rate. Urethritis or inflammation of the urethra is a multifactorial condition. It is called gonococcal urethritis (GU) when Neisseria gonorrhoeae is detected in a urethral smear of the patient and non-gonococcal urethritis (NGU) when this organism cannot be visualized. Aims and Objectives: To study the demographic profile and management pattern of NGU retrospectively in male patients. Materials and Methods: Urethritis cases were identified from the dermatology outpatient record. A retrospective study of data of patients diagnosed with NGU was done for 5 years from August 2015 to July 2020. We included only male patients more than 10 years of age. Results: Chlamydia trachomatis (CT, 48%) was the most common causative organism found. The diagnosis was confirmed by demonstrating ≥5 polymorphonuclear lymphocytes (PMNLs) from the anterior urethra using a Gram-stained urethral smear followed by the polymerase chain reaction (PCR.) of urine. The most common age group affected was 21-30, (30, 46%) years with a mean ± standard deviation (SD) of 30.32 ± 10.80. Most patients were from low socioeconomic status, labourers (36, 55%). A history of heterosexual behaviour, (57, 88%) was the most common and it had been seen that sexual exposure was more common in unmarried patients (38, 59%). Associated features were seen in 18 patients. Among recommended initial therapies for NGU, doxycycline and azithromycin might be improved by the addition of antimicrobial coverage for Trichomonas vaginalis (T. vaginalis). Further, it was seen that response to doxycycline therapy was better than azithromycin. Conclusions: Though there is an increased incidence of Herpes infections, we found Chlamydia infection to be the most common cause of NGU. Doxycycline showed better results in NGU due to Chlamydia infection.

Dermatological impact of hand hygiene practices during COVID-19: A cross-sectional web-based survey among doctors in a tertiary care hospital in Eastern India.

BACKGROUND: The COVID-19 pandemic continues to persist throughout the world with intermittent exacerbation. The changing trend of hand hygiene practices during this pandemic has led to new onset or aggravation of pre-existing hand eczema, especially among doctors. There is a paucity of studies regarding skin changes seen with changing hand hygiene practices in the Indian subcontinent. OBJECTIVES: To estimate the frequency of various cutaneous manifestations and associated factors with hand hygiene practices in doctors during COVID-19 via a web-based online questionnaire survey. METHODS: It was a cross-sectional web-based survey conducted at a tertiary care teaching institute from July 2021 to September 2021. Those doctors (faculty, residents, and interns) of the hospital completing the questionnaire with electronic informed consent were included in the study. RESULTS: A total of 143 doctors completed the survey. The most common symptoms were dryness in 60 (42%) and itching in 25 (17.5%) doctors. The most common skin changes were scaling in 30 (21%) and redness in 16 (11.2%) doctors. There was a significant association between skin changes and frequency of hand washing and hand sanitizer use (p value < 0.05). CONCLUSION: The prevalence of hand changes and symptoms was 77% in doctors in our study. The most commonly seen hand changes were scaling followed by redness and symptoms observed were dryness and itching.

Apremilast in Paediatric Dermatoses - A Comprehensive Review.

Apremilast has recently garnered attention in the management of multiple dermatological conditions including psoriasis. The comparable effectiveness with immunosuppressive drugs and a favorable side effect profile makes the drug, a prudent alternative for managing a gamut of dermatoses. In this article, we have reviewed the literature on apremilast use in children.

Mask-induced skin changes during COVID pandemic: A cross-sectional web-based survey among physicians in a tertiary care teaching hospital.

BACKGROUND: The COVID pandemic has affected the human race both physically and mentally. Mask use remains the standard way of preventing the spread of this virus. The continuous mask use has led to the emergence of various dermatoses like acne, pigmentation, and seborrhea in mask contact areas. The present survey has been undertaken to describe the various dermatoses encountered in the medical fraternity especially doctors, who are frequently exposed to prolonged mask use. AIMS: To estimate the frequency of various cutaneous manifestations seen among doctors following mask use via web-based online questionnaire survey. METHODS: It was a cross-sectional web-based study conducted at a tertiary care teaching institute from June 2021 to August 2021. All the doctors of the hospital completing the questionnaire were included in the study with informed consent. RESULTS: A total of 178 participants completed the survey. The most common complaint was increased sweating (55.6%) followed by acne (34.3%) and oily skin (34.3%). Significant association was found between skin changes and duration (>6 h/day) of mask use, increasing number, and type of mask (N 95) used (p value <0.05). CONCLUSION: The knowledge of various mask-induced/aggravated dermatoses will help formulate proper precautionary protocols enhancing efficient mask usage for prolonged periods.

Congenital ichthyosiform erythroderma: A rare neonatal dermatoses responding to acitretin.

Congenital ichthyosiform erythroderma is a rare and severe form of ichthyosis manifesting in the neonatal age group. We report a child with diffuse peeling of skin and erythroderma presenting on the 2nd day of birth. With aseptic nursing care along with emollients and oral acitretin, the child's quality of life improved remarkably, hence highlighting the point of early and judicious use of acitretin in reducing disease morbidity.

The Menace of Superficial Dermatophytosis on the Quality of Life of Patients Attending Referral Hospital in Eastern India: A Cross-sectional Observational Study.

BACKGROUND: Superficial dermatophytic infections have come up with multiple challenges and comorbidities recently regarding its chronic and recurrent course. AIMS: The present study aims at measuring the impact of the disease on the quality of life (QoL) of the patients. METHODS: A cross-sectional observational study was conducted over 6 months. The patients attending the dermatology outpatient department were recruited after screening and were made to fill up the Dermatology Life Quality Index (DLQI) and 5D-pruritus scale questionnaires. The P value was calculated and data were compared using the Pearson's correlation coefficient. RESULTS: A total of 294 patients were studied. The effect on QoL was estimated to be moderate [males, ≤10% body surface area (BSA) involvement, ≤6 months duration, low and medium socio-economic status (SES)] to very large (females, >10% BSA involvement, >6 months duration, high SES, and medium and high educational status) according to the DLQI scoring and correlated strongly with the disability scoring in 5D-pruritus scale (r = 0.802, P < 0.0001). LIMITATIONS: Small sample size of the study may not reflect the impact on general population, urging the need for multicenter studies. CONCLUSIONS: Although considered previously as a simple fungal infection, the present state of superficial dermatophytosis has emerged as a social, psychological, and economic burden on the society.

Systemic Sclerosis: A Clinical Analysis of Foot Findings in 52 Cases.

INTRODUCTION: The diagnosis of systemic sclerosis is mostly clinical and is identified by the various cutaneous changes. The cutaneous changes in systemic sclerosis are already well established and supported by a large number of studies and textbooks. Very few literatures describe foot findings in patients with systemic sclerosis. This study was aimed at identifying the various changes in plantar aspect of foot of patients with systemic sclerosis. METHODS: All patients diagnosed with systemic sclerosis were recruited. Apart from clinical examination, X - ray of both feet was done in all the patients. RESULTS: A total of 52 patients were recruited in the study period. Most of the patients (86.54%) were females and the mean age at presentation was 34.19 years. A history of Raynaud's phenomenon was present in 47(90.38%) patients. The foot findings were digital pitted scars in 44(84.61%) patients, macular hyperpigmentation in 40(76.92%) patients and corns in weight bearing areas were found in 40 (76.92%) cases. CONCLUSIONS: In our study corn was a common finding in the foot of patients of systemic sclerosis which has not been routinely documented.

Dermatitis neglecta as a complication after cataract surgery.

Dermatitis neglecta, a condition of the skin secondary to a primary underlying disease, is an important diagnosis to be kept in mind as the clinical presentation may mimic a severe disease, but the treatment basically includes patient counseling and personal hygiene.

Metabolic Derangements in Lichen Planus - A Case Control Study.

INTRODUCTION: An association between psoriasis and metabolic syndrome has been established in previous studies. Lichen Planus (LP) is also a chronic inflammatory disease morphologically related to psoriasis and few studies have shown association of metabolic derangements in LP. AIM: To study the association of metabolic derangements in LP. MATERIALS AND METHODS: A prospective case control study was undertaken for a period of one year. Age and sex matched patients of LP and other non-inflammatory diseases were taken as cases and controls respectively. Data on height, weight, lipid profile and fasting blood glucose levels were collected for all the patients. Body Mass Index (BMI) was calculated. RESULTS: A total of 80 patients were recruited, 40 cases and 40 controls. The mean values for all the lipid and glucose parameters were high in cases as compared to controls with significant p-values. CONCLUSION: In the present study metabolic derangements were seen in patients with LP.

Isolated case of mucosal histoid Hansen's disease of the nasal cavity in a post-global elimination era.

Histoid Hansen's disease is a rare form of multibacillary leprosy with distinct clinical and histopathological features. This type of leprosy is a variant of lepromatous leprosy with a very high bacterial reserve. Of alarming concern is the discovery of an isolated mucosal histoid leprotic lesion inside the nasal cavity of a patient in the post-global leprosy elimination era. Our case had no history of leprosy or exposure to dapsone/multidrug therapy but had a heavy bacillary index. We are reporting this case to highlight the rarity of mucosal lesions due to histoid leprosy and involvement of the nasal cavity, as well as to create awareness and avoid misdiagnosis. This will help facilitate prompt treatment to minimize the complications and deformities of the patient and prevent its spread throughout the community.

A study on the prescribing pattern of drugs for acne in a tertiary care teaching hospital in odisha.

BACKGROUND: Acne vulgaris is a common disease of the skin affecting the socially vulnerable young age group. There are multitudes of treatment options available but till now no studies have been reported to demonstrate the current prescribing pattern of drugs in acne vulgaris. AIM: To study the prescribing pattern of drugs in acne in a tertiary care teaching hospital in Odisha, India. MATERIALS AND METHODS: The study was an observational study conducted for a period of one year on patients more than 10 yeras age and having acne attending the Skin & VD OPD. Drug induced acne and acneiform eruptions were excluded. RESULTS: A total of 1210 prescriptions of acne were analysed. The male to female ratio was 1:1.29. Most patients presented with grade 2 (60%) acne followed by grade 3 (20.99%). Out of prescribed drugs, 47.44% were oral and 52.56% were topical formulations. Oral isotretinoin (68.10%) was the most frequently prescribed drug among oral formulations. Doxycycline (54.18%) was the most preferable oral antibiotic. The average number of drugs per prescription was 3.003. Polypharmacy was preferred over monotherapy. CONCLUSION: In the management of acne, judicious and early intervention with oral isotretinoin improves the overall treatment outcome, the fact which has increased its use in acne patients.

Pityriasis rosea like drug rash - a need to identify the disease in childhood.

Pityriasis rosea is a common dermatosis named by Gibert in 1860. It is an acute self limiting papulosquamous disease, probably infective in origin affecting healthy adolescents and young adults. It is characterized by distinctive skin eruptions and minimal constitutional symptoms. Drug induced pityriasis rosea tend to occur in older generation and resolution seen only after withdrawal of the offending drug. We report a case of 12-year-old boy with erythematous papules distributed over trunk and proximal arms after nimesulide therapy consistent with a clinical diagnosis of atypical pityriasis rosea. The relation of drug and development of pityriasis rosea is confirmed by dechallenge test of the suspected drug.

Cutaneous cholesterol embolization syndrome: A case report.

An 81-year-old woman with chronic kidney disease, systemic hypertension, and a large infra-renal abdominal aortic aneurysm, developed bilateral calf muscle pain, altered sensorium, and deterioration of renal function following endovascular aneurysmal repair. On the third post-operative day she developed symmetrical purpuric macules with erythematous margins on the gluteal region and bluish reticulated patches on the soles and tips of toes. This was followed by melena development on the seventh post-operative day. Histology of the skin confirmed the diagnosis of cutaneous cholesterol embolization syndrome (CES). She was treated with hemodialysis and supportive management and she recovered.