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Epidermolysis bullosa (EB) is an autoimmune mucocutaneous disorder associated with abnormalities of the basement membrane zone of skin and mucous membranes, characterized by blister formation in response to minor trauma. Ocular involvement is common in autosomal dominant variant of dystrophic EB (DDEB), but the incidence of involvement of ocular structures varies widely among different patients as well as among different subtypes. Conjunctival blistering without eyelid or corneal disease is one of the most common ocular manifestations. Here, we present a rare case of DDEB in a 4-year-old boy with conjunctival blister formation without eyelid or corneal involvement. The patient was managed conservatively with lubricating eye drops, and the conjunctival blister resolved subsequently. The major treatment modality is the use of ocular lubricants. Protection of eye from minor trauma such as rubbing is most important to prevent ocular complications.

Chronic kidney disease (CKD) is a common medical problem with well‐known dermatologic manifestations, some of which highly disturb the patients' quality of life. This cross‐sectional study was designed to identify the prevalence and type of cutaneous involvement in CKD patients. The skin manifestations of 49 patients with CKD undergoing hemodialysis at Akhavan Hospital in Kashan, Iran, were recorded over 2 months. Diabetes (35%) was the most common cause of chronic renal failure in the patients, and the most common skin manifestations were xerosis (95.9%), uremic pigmentation (89.8%), scleral discoloration (87.8%), dental discoloration (85.2% among the patients with natural teeth), dry mouth (65.3%), varicosity (61.2%), pruritus (57.1%), skin atrophy (49%), lentigo (46.9%), subungual hyperkeratosis (42.9%), half and half nail dystrophy (34.7%), and purpura (26.5%). Mucocutaneous involvement has a very high prevalence in CKD patients undergoing hemodialysis, and some of the cases are medically and cosmetically disturbing; therefore, with better knowledge about the type and prevalence of these involvements, the consequences can be better predicted and managed. Further studies are recommended to be conducted on the association between these signs and CKD grade, and clinical trials are also required for establishing the treatment options available for these signs and then assessing the patients' quality of life as a primary outcome measure. [ABSTRACT FROM AUTHOR]

Introduction: Behçet's disease (BD) is a chronic inflammatory disease which can be limited to only mucocutaneous tissues or can affect different systems of the body. Aim: To investigate the association of endothelial and erectile dysfunctions with BD, on the basis of comparative analysis between mucocutaneous and systemic BD. Material and methods: Thirty-eight men diagnosed with BD were included in the present study. The patients were stratified into two groups as mucocutaneous BD (n = 20, MBD group), and systemic BD (n = 18, SBD group). Erectile dysfunction (ED) was assessed using the Erectile Function domain of the International Index of Erectile Function (IIEF-EF) questionnaire. The coronary flow reserve (CFR) assessment was done for analysing endothelial dysfunction (EnD), and CFR < 2 was defined as EnD. Penile Doppler ultrasonography (PDU) was performed for ED. The demographic and clinical parameters, IIEF-EF score ED classification, CFR and PDU test findings were compared between two groups. Results: The median age was 34 (22-52) years in the overall population, and there was no difference between two groups (p = 0.558). Time from diagnosis was significantly longer (24 vs. 102 months, p = 0.021) and the use of immunosuppressive therapies was higher (0 vs. 70.6%, p < 0.001) in the SBD group. In overall, median CFR was 1.92 (1.1-5.96), and there was no difference between two groups (1.88 vs. 1.97, p = 0.812). The percentage of patients with CFR < 2 was similar in two groups (52.6% vs. 52.9%, p = 0.985). The ED status according to IIEF-EF was similar in two groups (45% vs. 27.8%, p = 0.538) as well as according to PDU analyses (10% vs. 16.7%, p = 0.544). Conclusions: The increased risk of endothelial, and erectile dysfunctions should be considered in men who were diagnosed with mucocutaneous and systemic BD. [ABSTRACT FROM AUTHOR]

Introduction: Dengue, a viral illness, is a major public health problem. Mucocutaneous manifestations are known to occur in this illness. Over the past three decades, there has been a dramatic global increase in the incidence of dengue fever (DF). Our objective was to study the frequency and pattern of mucocutaneous manifestations of DF in children. Methodology: A total of 210 consecutive cases, which were serologically confirmed and admitted to pediatric ward over a period of 12 months (January to December 2018), were included. A detailed clinical history, examination and relevant investigations were carried out. Data were entered into a pro forma and analyzed using simple statistical methods and Chi-square test (wherever applicable). Results: The most common age group affected was 4.1–8 years with a mean age of 6.3 ± 3.9 years. Male children were more commonly affected, with majority from urban areas. Maximum cases were noted during the months from October to December, i.e., winter season. Mucocutaneous findings were noted in 112 (53.3%) cases. Cutaneous rash was present in 43 (20.1%) cases. The most common site involved was trunk, followed by face and others. Macular erythema was the most common type of rash. Onset of rash was more commonly seen in children with depleted platelet count. Ocular and oral mucosae were involved in 56 (26.7%) and 42 (20.1%) cases, respectively. Conclusion: Mucocutaneous manifestations are relatively common in children with dengue. Cutaneous rash may be a useful clinical clue for early diagnosis of dengue. Awareness of mucocutaneous manifestations helps in early recognition and proper management of dengue. [ABSTRACT FROM AUTHOR]

Erythema multiforme (EM) is an immunomediated mucocutaneous disorder of usually unknown etiology which has been known to occur following an infection like herpes virus or exposure to drugs. It primarily affects adolescents, young adults, but can occur at any age. Vaccines are also documented as precipitating factors for EM. In the year 2017, the case of a 25-year-old male patient with lesions of EM which appeared after 30 min of administration of tetanus toxoid vaccine is reported here.

Leishmania (Viannia) parasites are etiological agents of cutaneous leishmaniasis in the New World. Infection is characterized by a mixed Th1/Th2 inflammatory response, which contributes to disease pathology. However, the role of regulatory T cells (Tregs) in Leishmania (Viannia) disease pathogenesis is unclear. Using the mouse model of chronic L. (V.) panamensis infection, we examined the hypothesis that Treg functionality contributes to control of pathogenesis. Upon infection, Tregs (CD4(+)Foxp3(+)) presented with a dysregulated phenotype, in that they produced IFN-γ, expressed Tbet, and had a reduced ability to suppress T cell proliferation in vitro. Targeted ablation of Tregs resulted in enlarged lesions, increased parasite load, and enhanced production of IL-17 and IFN-γ, with no change in IL-10 and IL-13 levels. This indicated that an increased inflammatory response was commensurate with disease exacerbation and that the remaining impaired Tregs were important in regulation of disease pathology. Conversely, adoptive transfer of Tregs from naive mice halted disease progression, lowered parasite burden, and reduced cytokine production (IL-10, IL-13, IL-17, IFN-γ). Because Tregs appeared to be important for controlling infection, we hypothesized that their expansion could be used as an immunotherapeutic treatment approach. As a proof of principle, chronically infected mice were treated with rIL-2/anti-IL-2 Ab complex to expand Tregs. Treatment transitorily increased the numbers and percentage of Tregs (draining lymph node, spleen), which resulted in reduced cytokine responses, ameliorated lesions, and reduced parasite load (10(5)-fold). Thus, immunotherapy targeting Tregs could provide an alternate treatment strategy for leishmaniasis caused by Leishmania (Viannia) parasites.

Abstract Leishmaniasis is a tropical infectious disease caused by Leishmania spp. protozoa and is transmitted by insects from the Phlebotominae subfamily. It can manifest as cutaneous leishmaniasis, a painless ulcer that can develop into a more serious systemic affliction as the protozoa spreads lymphatically or hematogenously, depending on the host's immunity. In this case series, the authors present a rare form of genital mucocutaneous leishmaniasis, with consideration of epidemiologic characteristics, clinical presentation, differential diagnosis, and treatments offered.

Background Mucocutaneous manifestations and nail changes are commonly seen in renal failure, more so in end stage renal disease (ESRD). Duration and treatment for renal disease may influence the frequency and type of these manifestations. Our objectives were to find the prevalence and pattern of mucocutaneous manifestations, nail changes in patients with ESRD, and their relation to duration of disease and mode of treatment i.e. on hemodialysis or without hemodialysis. Methods A total of 170 consecutive patients with ESRD on hemodialysis or without hemodialysis, were examined for mucocutaneous manifestations and nail findings. Relevant investigations were done. Data collected was tabulated using simple statistical methods and chi-square test, wherever applicable. Results Among 170 patients, 130 were male and 40 were female patients (M:F 3.25:1). Pruritus was present in 59 (34.7%) patients and frequency was more in those not on hemodialysis. Further, pruritus was seen more frequently in patients with longer duration of renal disease and hemodialysis. All the patients had at least one dermatological manifestation. Xerosis /acquired icthyosis was the most common skin finding, observed in 132 (77.6%) patients, more frequently in patients with longer duration of disease and hemodialysis followed by diffuse pigmentation in 51(30%) patients . Acquired perforating dermatoses were seen in 4 (2.7%) patients and cutaneous infections in 30 (27.5%) patients. Oral pallor was seen in 149 (87.6%) patients. Absent lunula was the most common nail finding observed in 105 (61.7%), followed by half and half nails in 62 (36.6%) patients. Conclusion Mucocutaneous manifestations and nail changes are commonly encountered in ESRD. Frequency and spectrum of these changes may be related to duration of disease and treatment modality used. [ABSTRACT FROM AUTHOR]

Background: Limited information exists on mucocutaneous disease and its relation to course of COVID-19.Objective: To estimate prevalence of mucocutaneous findings, characterize morphologic patterns, and describe relationship to course in hospitalized adults with COVID-19.Methods: Prospective cohort study at 2 tertiary hospitals (Northwell Health) between May 11, 2020 and June 15, 2020.Results: Among 296 hospitalized adults with COVID-19, 35 (11.8%) had at least 1 disease-related eruption. Patterns included ulcer (13/35, 37.1%), purpura (9/35, 25.7%), necrosis (5/35, 14.3%), nonspecific erythema (4/35, 11.4%), morbilliform eruption (4/35, 11.4%), pernio-like lesions (4/35, 11.4%), and vesicles (1/35, 2.9%). Patterns also showed anatomic site specificity. A greater proportion of patients with mucocutaneous findings used mechanical ventilation (61% vs 30%), used vasopressors (77% vs 33%), initiated dialysis (31% vs 9%), had thrombosis (17% vs 11%), and had in-hospital mortality (34% vs 12%) compared with those without mucocutaneous findings. Patients with mucocutaneous disease were more likely to use mechanical ventilation (adjusted prevalence ratio, 1.98; 95% confidence interval, 1.37-2.86); P < .001). Differences for other outcomes were attenuated after covariate adjustment and did not reach statistical significance.Limitations: Skin biopsies were not performed.Conclusions: Distinct mucocutaneous patterns were identified in hospitalized adults with COVID-19. Mucocutaneous disease may be linked to more severe clinical course. [ABSTRACT FROM AUTHOR]

Introduction: Dermatomyositis is an uncommon inflammatory disease marked by muscle and joint weakness with skin rash. Dermatomyositis affects adults and children, with higher prevalence for females aged 40 to 60 years. Most common oral lesions include mucosal edema, erythema, and telangiectasia. Case Presentation: A 51‐year‐old white female with an unremarkable medical history presented for periodontal evaluation in 2010. She reported a 6‐month history of gingival inflammation and skin irritation on her hands and a rash on the center of her chest and forehead. Other complaints included fatigue, hot flashes, decreased appetite, and weight loss. Periodontal examination revealed generalized acute marginal erythema, with localized slight incipient bone loss. Oral hygiene was deemed good to fair. Oral hygiene instructions were reviewed and a prescription for chlorhexidine gluconate was given. The patient was then referred to an allergist and dermatologist where a diagnosis of dermatomyositis was made. After the initial diagnosis, localized scaling and root planing was performed using local anesthetic. The patient was managed medically using prednisone, mycophenolate mofetil, and methotrexate and a 3‐month periodontal maintenance recall interval. The patient remained stable over an 8‐year period. Conclusions: Dermatomyositis is an uncommon inflammatory disease that requires medical and dental teams for proper diagnosis and management. Although the condition is chronic in nature with no definitive cure, signs, and symptoms can be managed with steroids and immunosuppressants to delay progression of the disease and improve quality of life for the patient. [ABSTRACT FROM AUTHOR]

Dentists play a fundamental role in the early diagnosis of oral leishmaniasis. Although these lesions are rare at oral mucosa, this is one of the manifestations sites of the disease This study reports seven clinical cases of orofacial mucocutaneous leishmaniasis. All had leishmaniasis diagnosis confirmed by laboratory tests, with orofacial involvement. Five out of the seven cases were males, and in four cases, patients had associated comorbidities. Late diagnosis was observed, resulting in treatment delay and increased hospitalization stay. One patient had severe psychological consequences due to facial deformity. The lack of differential diagnosis due the great variability of clinical presentation of the lesions and frequent unspecific histopathology represent a challenge for the dentist. In two reported cases, there were unspecific biopsy results. This series of cases highlights the importance of a multidisciplinary approach in the diagnosis and treatment of oral and perioral leishmaniasis. Patients with atypical lesions, originating from or living in endemic regions, should be investigated for leishmaniasis. These procedures could avoid delays in diagnosis and decrease the risk of disease dissemination.

Dentists play a fundamental role in the early diagnosis of oral leishmaniasis. Although these lesions are rare at oral mucosa, this is one of the manifestations sites of the disease This study reports seven clinical cases of orofacial mucocutaneous leishmaniasis. All had leishmaniasis diagnosis confirmed by laboratory tests, with orofacial involvement. Five out of the seven cases were males, and in four cases, patients had associated comorbidities. Late diagnosis was observed, resulting in treatment delay and increased hospitalization stay. One patient had severe psychological consequences due to facial deformity. The lack of differential diagnosis due the great variability of clinical presentation of the lesions and frequent unspecific histopathology represent a challenge for the dentist. In two reported cases, there were unspecific biopsy results. This series of cases highlights the importance of a multidisciplinary approach in the diagnosis and treatment of oral and perioral leishmaniasis. Patients with atypical lesions, originating from or living in endemic regions, should be investigated for leishmaniasis. These procedures could avoid delays in diagnosis and decrease the risk of disease dissemination.

The dental surgeon plays a fundamental role in the early diagnosis of oral leishmaniasis. Although these lesions are rare at oral mucosa, this is one of the manifestations sites of the disease This study reports seven clinical cases of orofacial mucocutaneous leishmaniasis. All had mucocutaneous leishmaniasis confirmed by laboratory tests, with orofacial involvement. Five out of the seven cases were males, and in four cases, patients had associated comorbidities. Late diagnosis was observed, resulting in treatment delay and increased hospitalization stay. One patient had severe psychological consequences due to facial deformity. The lack of differential diagnosis due the great variability of clinical presentation of the lesions and frequent unspecific histopathology represent a challenge for the dental surgeon. In two reported cases, there were unspecific biopsy results. This series of cases highlights the importance of a multidisciplinary approach in the diagnosis and treatment of oral and perioral leishmaniasis. Patients with atypical lesions, originating from or living in endemic regions, should be investigated for leishmaniasis. These procedures could avoid delays in diagnosis and decrease the risk of disease dissemination.

Most of drugs could have certain mucocutaneous reactions and COVID‐19 drugs are not an exception that we focused. We systematically reviewed databases until August 15, 2020 and among initial 851 articles, 30 articles entered this study (20 case reports, 4 cohorts, and 6 controlled clinical trials). The types of reactions included AGEP, morbiliform drug eruptions, vasculitis, DRESS syndrome, urticarial vasculitis, and so on. The treatments have been used before side effects occur, included: antimalarial, anti‐viral, antibiotics, tocilizumab, enoxaparin and and so on. In pandemic, we found 0.004% to 4.15% of definite drug‐induced mucocutaneous reactions. The interval between drug usage and the eruption varied about few hours to 1 month; tightly dependent to the type of drug and hydroxychloroqine seems to be the drug with highest mean interval. Antivirals, antimalarials, azithromycin, and tocilizumab are most responsive drugs for adverse drug reactions, but antivirals especially in combination with antimalarial drugs are in the first step. Types of skin reactions are usually morbilliform/exanthematous maculopapular rashes or urticarial eruptions, which mostly may manage by steroids during few days. In the setting of HCQ, specific reactions like AGEP should be considered. Lopinavir/ritonavir is the most prevalent used drug among antivirals with the highest skin adverse reaction; ribarivin and remdisivir also could induce cutaneous drug reactions but favipiravir has no or less adverse effects. Logically the rate of dermatologic adverse effects among anivirals may relate to their frequency of usage. Rarely, potentially life‐threatening reactions may occur. Better management strategies could achieve by knowing more about drug‐induced mucocutaneous presentations of COVID‐19. [ABSTRACT FROM AUTHOR]

Introduction: Oral lichen planus (OLP), the mucosal counterpart of cutaneous lichen planus, present frequently in the fourth decade of life. It clinically presents itself as painless keratotic plaque erosions or ulceration. An important complication of lichen planus is oral squamous cell carcinoma which made it to be considered as a potentially malignant disorder. Hence we conducted the present study to assess the prevalence of oral lichen planus in patients visiting dental hospital. The aim of the study is to evaluate the clinical characteristics of lichen planus. Materials and Method: This study is a retrospective cross sectional study conducted over a 1 year period from June 2019-March 2020 in a private dental institution, Chennai, with a total of 63 patients. Demographic details like age, gender, clinical details of all patients were retrieved from patients records and analysed the data of 86,000 patients. All the data were transferred to the excel sheet. Data was analysed by SPSS software. Results: Out of 63 patients, 24 were males and 39 were females. Increased prevalence of oral lichen planus was among 51-60 years of age with female predominance. Bilateral buccal mucosa is the commonest site involved in OLP. Erosive type is the most prevalent type of oral lichen planus. Conclusion: Oral lichen planus is more common among 51 to 60 years of age and females were more commonly affected. Bilateral buccal mucosa is the commonest site involved in lichen planus and Erosive type is the most prevalent type of Oral lichen planus. [ABSTRACT FROM AUTHOR]

Oral pyogenic granulomas are relatively common benign mucocutaneous lesions commonly associated to local irritation or trauma. These are typically solitary and vascular. The condition is often associated with pain and sometimes with masticatory and esthetic difficulties. Since the atypical oral pyogenic granuloma is indistinguishable histopathologically from other lesions so immunohistochemical examination is required for final diagnosis. The authors present a case report of a large size (4 × 4 cm) atypical pyogenic granuloma that mimics malignant tumor in a 40-year-old man in the posterior maxilla, diagnosed through clinical, histopathological and immunohistochemical examination. Oral pyogenic granulomas are well documented in literature. However their occurrence in oral cavity can present with unusual clinical and histological features that appear as malignancies. Careful diagnosis of this benign tumor is important to avoid unnecessary aggressive therapy. [ABSTRACT FROM AUTHOR]

Background: Acne vulgaris has been a common clinical condition. Due to. high prevalence and unclear etio-pathogenesis of acne vulgaris, large number of treatment options have been available across the globe. Limited work has been done to explore the options which may manage or prevent these adverse effects and improve the adherence to the prescribed medications. We therefore conducted this trial to look for effectiveness of oral omega 3 in reducing mucocutaneous side effects of oral isotretinoin in patients with acne vulgaris. Objective: To look for effectiveness of oral omega 3 in reducing mucocutaneous side effects of oral isotretinoin in patients with acne vulgaris. It was a randomized control trial conducted at Department of Dermatology Pak Emirates Military Hospital Rawalpindi. Ten months, June 2019 to May 2020. Methods. A total of 60 patients of acne vulgaris put on oral isotretinoin by consultant dermatologist were included in the study. Patients were randomized into groups by lottery method. Group A received the placebo along with oral isotretinoin while Group B received oral omega 3 in standard dose in addition to oral isotretinoin. Comparison was made in both the groups regarding common mucocutaneous side effects. Results Out of 60patients with acne vulgaris and put on isotretinoin included in the study, 26 (43.3%) received placebo in addition to isotretinoin while 34 (56.7%) received omega 3 in addition to isotretinoin. Forty (66.7%) patients were female while 20 (33.3%) were male. Cheilitis 35 (58.3%) was the commonest side effect followed by lip dryness 33 (55%). Application of chi-square test revealed that cheilitis, lip dryness and xerosis were significantly found in more patients who received placebo as compared to those who received omega 3 along with isotretinoin. Conclusion Mucocutaneous side effects were a very common finding among patients of acne vulgaris managed with isotretinoin. Cheilitis was the most reported mucocutaneous side effects among the target population. This RCT demonstrated that omega 3 was superior to placebo in order to prevent or manage cheilitis, xerosis or dry lips. [ABSTRACT FROM AUTHOR]

Blood-borne pathogen exposures (BBPEs) pose a risk to health care workers (HCWs). Needlestick injuries (NSIs) have declined overall, but not for surgical HCWs. There are limited data regarding BBPEs among medical students (MSs) in their clinical years. We aimed to quantify this risk for third- and fourth-year MSs. A literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PUBMED database was searched to identify studies of third- and fourth-year MSs using the terms BBPE, NSI, and MS. Studies of other HCWs were excluded if MS data were not extractable. Additional studies were identified from references. Descriptive analysis was performed. Seven of 171 articles published from 2002 to 2018 met study criteria. All used self-reported data from surveys/questionnaires. One-third of MSs reported BBPEs (n = 194/600, 32.3%) with a mean of 1 in 3.09 and a median of 1 in 3.53 (range: 1 in 1.9-8.3 students). Most events were NSIs (144/194, 74%) with a mean of 1 NSI per 4.05 MSs and median of 1 in 4.625 (range: 1 in 2.47-10.71). The remaining BBPEs reported included blood and bodily fluid splashes (n = 37, 19%), other mucocutaneous exposures (n = 7, 3.6%), and uncategorized injuries (n = 2, 1%). One-third of senior MSs reported BBPEs during clinical rotations. Most BBPEs were NSIs. Quantifying this risk allows for anticipatory education and protocol development to protect students and other new HCWs. Educational efforts focused on NSI prevention before and during clinical rotations may help reduce BBPEs. [ABSTRACT FROM AUTHOR]

Abstract INTRODUCTION: As highly specific molecular biology-based techniques may not be sensitive enough for the diagnosis of American tegumentary leishmaniasis (ATL), clinicians frequently rely on immunological tests before treatment initiation. Hence, the correct combination of diagnostic tests is imperative for ATL diagnosis. We aimed to evaluate the accuracy of the Montenegro (Leishmanin) skin test (MST) in polymerase chain reaction (PCR)-negative patients to accurately detect ATL. METHODS: Patients with a clinical picture compatible with ATL were divided into ATL (confirmed by lesion smear, culture indirect immunofluorescence, and/or histopathology) and no-ATL (diseases that can mimic leishmaniasis) groups. Conventional PCR for the minicircle kDNA of Leishmania was performed, and the MST was carried out for PCR-negative patients. RESULTS: Ninety-nine patients were included in this study, including 79 diagnosed with ATL (6 with mucocutaneous leishmaniasis) and 20 without ATL (no-ATL group). The MST showed a high sensitivity of 90.0% (95% confidence interval [CI] = 69.90-97.21) in PCR-negative patients that was 10% higher than the sensitivity reported in PCR-positive population (79.66%; 95% CI = 67.73-87.96). CONCLUSIONS: One of the most important reasons for PCR negativity among patients with active ATL is the presence of a strong cellular immunological response, especially in chronic and mucocutaneous leishmaniasis. This reinforces the considerable utility of the tests that detect cellular responses against Leishmania antigens such as the MST in PCR-negative patients when the performance in screening situations is questionable.

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Mucous membrane pemphigoid has been documented previously in only 19 patients under the age of 20 years. We report a 14-year-old female who had erosions of the oral, ocular, anal and genital mucosa, congestion, hoarseness of voice, dysphagia, and recurrent cough. Symblepharon formation in both eyes necessitated surgical correction. Biopsy of tissue from a solitary cutaneous lesion demonstrated a subepidermal bulla. Direct immunofluorescence showed the deposition of IgG in linear pattern along the dermoepidermal junction. Therapy was begun, consisting of prednisolone at 1 mg/kg/day, in combination with dapsone at 2 mg/kg/day. Azathioprine was added later for control of the disease. The patient showed good clinical response.

Minipigs are commonly utilized in dermal toxicology studies, necessitating documentation of background findings, including neoplastic lesions. We describe a case of a Yucatan minipig with a squamous cell carcinoma at the mucocutaneous junction of the lip. The neoplasm appeared grossly as a slightly raised area of skin with ulceration. Histologically, there were nests and trabeculae of neoplastic squamous epithelial cells undergoing keratinization. Multifocally, rafts of these cells were within lymphatic vessels. Squamous cell carcinoma has not previously been reported in Yucatan or other laboratory minipigs, however, has been reported uncommonly in nonlaboratory pot-bellied pigs. Although squamous cell carcinoma has been associated with ultraviolet exposure or papillomavirus in various species, this was unable to be confirmed in this case. [ABSTRACT FROM AUTHOR]

Background Acquired immune-deficiency syndrome (AIDS) is a fatal illness caused by a retrovirus known as Human Immunodeficiency Virus (HIV) which breaks down the immune system of the body, leaving the victim vulnerable to a host of life-threatening opportunistic infections, neurological disorders, or unusual malignancies. Dermatological disorders are health problems among HIV positive patients which present with a variety of manifestations. Skin diseases cause significant morbidity and may be initial signs of immunosuppression. They affect between 80 and 95% of HIV-infected patients, occurring at any time in the course of infection. Objective 1- To study the pattern of mucocutaneous manifestation of HIV infected patients attending Dermatology Outpatient Department (OPD) of Karnataka Institute Of Medical Sciences (KIMS) Hubballi. 2- To assess the relation of mucocutaneous manifestations of HIV infected patients with CD4 count. Methods All HIV positive patients with mucocutaneous manifestation attending Dermatology OPD, KIMS, Hubballi from December 2017 to May 2019 were enrolled. Results In this study, the most common dermatosis was pruritic papular eruption (21%) with a mean CD4 count of 499.81±319.31 cells/mm³. Among viral infections, the most common infection was herpes genitalis (32.4%) with a mean CD4 count of 291.25±194.22 cells/mm³. The most common fungal infection was dermatophytosis (59.1%) with a mean CD4 count of 489.69±260.13 cells/mm³. The most common bacterial infection was pyoderma (73.7%) and the mean CD4 count was 485.21±308.30 cells/mm³. The most common parasitic infestation was scabies with a mean CD4 count of 375.60±117.59 cells/mm³. Among malignancies, only two cases of basal cell carcinoma was seen in this study and the mean CD4 count was 89.50±57.28 cells/mm³. Conclusion The skin manifestations in HIV can serve as an important marker for underlying immunodeficiency state. The CD4 count of a patient can be used to know the level of immunosuppression as different dermatosis are seen at various stages of HIV infection. [ABSTRACT FROM AUTHOR]

The gastric location of EBVMCU is extremely rare. The pathology examination and immunochemistry are mandatory for the diagnosis. It is essential that physicians be aware of this new entity to accurately diagnose and handle this disease. [ABSTRACT FROM AUTHOR]

Objective: To examine the results of various myocardial revascularization techniques in pediatric patients to better understand the strategies for surgical treatment of coronary artery pathologies. Methods: We analyzed 61 publications dedicated to the indications, methods, and results of coronary bypass surgery in children. Due to the small size of this cohort, case reports are also included in our review. Results: The main indications for coronary bypass grafting in children are Kawasaki disease, myocardial revascularization as a necessary procedure during the congenital cardiac surgery, to manage intraoperative iatrogenic damage to coronary arteries, and homozygous familial hypercholesterolemia. The use of internal thoracic arteries as conduits for coronary bypass grafting in children with Kawasaki disease showed significantly better results in long-term functionality compared to autovenous conduits (87% and 44%, respectively, P<0.001). Acute and late coronary events after arterial switch operation for the transposition of the great arteries, anomalous origin of the left coronary artery from the pulmonary artery, and left main coronary artery atresia are the main congenital heart diseases where surgical correction involves interventions on the coronary arteries. Conclusion: The internal thoracic artery is a reliable and durable conduit that demonstrates proven growth potential in children. [ABSTRACT FROM AUTHOR]

Systemic isotretinoin is the most effective acne treatment recommended for patients with severe papulopustular and nodulocystic acne who did not benefit from other topical and systemic therapies. It is recommended to start isotretinoin without delay in patients suffering from scars even if the severity of acne is mild or moderate. It affects all the factors involved in the aetiopathogenesis of the disease. It proves to be superior to other treatments by preventing relapses in a large majority of patients. Although there is no doubt about its efficacy, debates on its most effective dose and cumulative dose for preventing relapses still continue. Different approaches are recommended in guidelines on the length of cosmetic and surgical procedures and the intervals of laboratory monitoring in relation to isotretinoin. Although many side effects have been reported, most of them are reversible and not life-threatening, but it can cause serious side effects in rare occasions. This paper reviews information on clinical approaches to isotretinoin therapy and its side effects and monitoring of patients including some practical examples from our country. [ABSTRACT FROM AUTHOR]

Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious inflammatory response associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Mucocutaneous findings are often present but remain poorly defined overall, and more precise dermatologic descriptions are not only necessary to better characterize this syndrome, but may also aid in early diagnosis and prevention of severe deterioration or death. We report the case of a 16-month-old boy presenting with a diffuse maculopapular eruption, cheilitis, and vesiculobullous lesions of the scrotum, perianal region, and distal lower extremities. Tense bullae of the genitals and lower extremities have not been previously reported in MIS-C and add to the spectrum of skin findings associated with the disorder. [ABSTRACT FROM AUTHOR]

The dental surgeon plays a fundamental role in the early diagnosis of oral leishmaniasis, since oral mucosa may be the primary site of the disease manifestation. This study reports seven clinical cases of orofacial mucocutaneous leishmaniasis. All had mucocutaneous leishmaniasis with oropharyngeal involvement confirmed by laboratory tests. Five out of the seven cases were males, and in four cases, patients had associated comorbidities. Late diagnosis was observed, resulting in treatment delay and increased hospitalization stay. One patient had severe psychological consequences due to facial deformity. The lack of differential diagnosis due the great variability of clinical presentation of the lesions and frequent unspecific histopathology represent a challenge for the dental surgeon. In two reported cases, there were unspecific biopsy results. The multidisciplinary approach plays an important role in orofacial leishmaniasis diagnosis and treatment. Leishmaniasis should be investigated in case of atypical and persistent lesions in patients from endemic regions. This recommendation may avoid diagnosis delays and decrease dissemination of the disease.

Background: Cutaneous manifestations are fairly common in rheumatoid arthritis (RA) and they can help in early diagnosis, prompt treatment, and hence reduced morbidity from the disease. Aims: The objective of the present study was to find out the different patterns of dermatoses in a group of patients with RA from Eastern India. Methodology: Consecutive patients fulfilling the American Rheumatism Association 1987 revised criteria for the classification of RA and who had different dermatoses were included in this cross-sectional study done over a period of 8 years in a tertiary care hospital in Eastern India. Thorough clinical examination and appropriate laboratory investigations were performed as needed. Data were recorded in a predesigned schedule, and appropriate statistical analysis was done. Results: We studied 111 evaluable patients with an age range of 19–71 years and a female to male ratio of 7:1. The mean disease duration of RA was 6.5 years. Cutaneous infections as a group was the most common mucocutaneous manifestation (34.2%) followed by xerosis including ichthyotic skin changes (27%), pigmented purpuric dermatoses (14.4%), leg ulcer (9.9%), periungual telangiectasia (9.9%), rheumatoid nodules (RNs) (8.1%), purpura and ecchymoses (7.2%), small vessel vasculitis in (7.2%), corn and callosities (6.3%), palmar erythema (4.5%), and neutrophilic dermatosis (4.5%). Raynaud's phenomenon was found in 3.6% patients and panniculitis in (3.6%) patients. Rheumatoid factor (RF) and anti-cyclic citrullinated peptides antibody were positive in 74.8% and 88.3% patients, respectively. No statistically significant difference of incidence of leg ulcer, small vessel vasculitis, RN, or Raynaud's phenomenon could be noted between RF positive and negative groups. Limitations: Being an institution-based study, the study findings may not reflect the true situation in the community which remained a limitation of this study. Conclusion: While some of the features of this study were analogous to Western data, other features showed discordance which may be due to ethnic variations among the patients with RA.

Introduction: Mucosal leishmaniasis has a progressive course and can cause deformity and even mutilation in the affected areas. It is endemic in the American continent and is mainly caused by Leishmania (Viannia) braziliensis. Objective: To describe a series of mucosal leishmaniasis cases and the infectious Leishmania species. Materials and methods: Fifty patients with a clinical diagnosis of mucosal leishmaniasis and parasitological confirmation were included. We describe the clinical and laboratory results. Species typing was performed by PCR-RFLP using miniexon and hsp70 genes and confirmed by sequencing. Results: The median time of disease evolution was 2.9 years (1 month to 16 years). The relevant clinical findings included mucosal infiltration (94%), cutaneous leishmaniasis scar (74%), total loss of the nasal septum (24%), nasal deformity (22%) and mucosal ulceration (38%). The symptoms reported included nasal obstruction (90%), epistaxis (72%), rhinorrhea (72%), dysphonia (28%), dysphagia (18%) and nasal pruritus (34%). Histopathology revealed a pattern compatible with leishmaniasis in 86% of the biopsies, and amastigotes were identified in 14%. The Montenegro skin test was positive in 86% of patients, immunofluorescence in 84%, and culture in 8%. L. (V.) braziliensis was identified in 88% of the samples, L. (V) panamensis in 8%, L. (V.) guyanensis and L. (L.) amazonensis in 2%. Conclusion: In this study, we found a severe nasal disease with destruction and deformity of the nasal septum, in a quarter of the cases that was probably related to late diagnosis. L. (V.) braziliensis was the predominant species. A case of mucosal leishmaniasis in Colombia caused by L. (L.) amazonensis is described for the first time. [ABSTRACT FROM AUTHOR]

Primary classic Hodgkin lymphoma of the gastrointestinal tract represents a rare occurrence. A full patient's work-up is essential in order to exclude a secondary intestinal involvement. Histologically Epstein-Barr virus mucocutaneous ulcer closely resembles Hodgkin lymphoma. The differential diagnosis between these two entities is relevant, since both the therapeutic approach and the clinical behavior are different. Herein, we describe a case of primary classic Hodgkin lymphoma arising in the ileum and a case of Epstein-Barr virus mucocutaneous ulcer of the colon, focusing on the main clinicopathological differences. [ABSTRACT FROM AUTHOR]

Introduction: Many mucocutaneous conditions affect the skin and oral cavity. Common conditions include lichen planus, pemphigus, and pemphigoid. This case report shows an atypical presentation of a mucocutaneous condition wherein histopathology was required for definitive diagnosis and treatment. Case Presentation: A 51‐year‐old African American male self‐reported to a private periodontal practice with a chief complaint of sporadic painful oral lesions of about 2 months duration. The patient also reported painful throat lesions. He had been previously treated for a sore throat followed by unspecified inflammation of the epiglottis. Clinical examination revealed diffuse bilateral eye redness, numerous intraoral ulcerations on soft and hard palate and floor of the mouth with trouble swallowing. Oral and ocular presentation suggested a differential diagnosis of cicatricial pemphigoid. Pemphigoid and lichen planus were also considered. Ophthalmologic exam revealed only allergies and no other abnormality. Soft tissue biopsies showed intraepithelial separation between the spinous layer and basement membrane. Direct and indirect immunofluorescence showed strong immunoglobulin G and moderate C3 reactivity confirming a diagnosis of pemphigus vulgaris (PV). A rheumatologist initially treated the patient with a daily combination regimen of methylprednisolone and mycophenolate mofetil. Lesions improved after a few weeks on the regimen. Reduction of medications resulted in return of oral and throat lesions. Resumption of the regimen resulted in lesion remission. Azathioprine replaced the mycophenolate mofetil, and then was gradually stopped after methylprednisolone cessation. Lesions have not reappeared for 1 year. Conclusion: This case illustrates that early diagnosis of mucocutaneous lesions leads to proper treatment and possible remission. [ABSTRACT FROM AUTHOR]

Erythema multiforme is considered as an immunologic disease possibly occurring because of predisposition to certain microorganisms, radiotherapy, systemic diseases, malignancy, and food or drug allergy. Here we report a case of herpes-induced recurrent erythema multiforme primarily manifesting in oral mucosa during first two episodes and third episode was characterized by oral lesions followed by skin lesions and the severity was increased with the subsequent episodes, during each incident we have successfully managed the case.

Nasal angiomyolipoma (AML) are extremely rare tumors and so far

Although leishmaniasis is an endemic disease in Iran the mucosal involvement is rare. Mucocutaneous leishmaniasis (MCL) mainly caused by Leishmanial braziliensis infection, reported with other Leishmania species such as L. major. Herein a 78 yr old man with MCL from Iran is presented who referred to Razi Hospital Dermatology Clinic, Tehran, Iran, for multiple ulcerative lesions on mid face skin, mucosa of upper lip and anterior fossa of nose, dorsal aspect of the hands and the posterior aspect of heels. Skin biopsy revealed necrotizing and granulomatous tissue pattern that suggested infection pathogenesis but the smear for leishmaniasis, Mycobacterium spp, and fungal elements was negative at first. In order to a positive PPD test, he was treated by anti-tuberculosis treatment. A month after starting drugs for tuberculosis, the prepared microscopical smears were positive for Leishman bodies this time. The skin biopsy revealed amastigote forms of Leishmania sp. and the PCR assay on specimens of lesions proved L. major as the principal pathogenic agent. There was good response to systemic treatment with meglumine antimoniate (Glucantime®) 3 gr per day until one week followed by 4.5 gr per day for another week. We forced to discontinue of drug because of cardiac toxicity at the end of 2nd wk of treatment.

Bean syndrome or blue rubber bleb syndrome is a rare disorder of vascular channels with mucocutaneous manifestations. The clinical severity varies among patients from being totally symptom free to fatal bleeding resulting in anemia. As the histopathologic findings are not pathognomonic, diagnosis is usually made from the clinical presentation, though the imaging techniques reveal extension of the lesion. We report an asymptomatic case of blue rubber bleb syndrome who reported for dental treatment with oral and cutaneous manifestations.

The mouth is a mirror of health or disease, a sentinel or early warning system. The oral cavity might well be thought as a window to the body because oral manifestations accompany many systemic diseases. In many instances, oral involvement precedes the appearance of other symptoms or lesions at other locations. Oral lichen planus (OLP) is a chronic mucocutaneous disorder of stratified squamous epithelium of uncertain etiology that affects oral and genital mucous membranes, skin, nails, and scalp. LP is estimated to affect 0.5% to 2.0% of the general population. This disease has most often been reported in middle-aged patients with 30-60 years of age and is more common in females than in males. The disease seems to be mediated by an antigen-specific mechanism, activating cytotoxic T cells, and non-specific mechanisms like mast cell degranulation and matrix metalloproteinase activation. A proper understanding of the pathogenesis, clinical presentation, diagnosis of the disease becomes important for providing the right treatment. This article discusses the prevalence, etiology, clinical features, oral manifestations, diagnosis, complications and treatment of oral LP.

Background: More than 90% of HIV-infected patients present with at least one mucocutaneous manifestation during the course of their disease. Insufficient data are available regarding dermatologic findings among HIV-infected patients in Madagascar., Objective: This study aimed at evaluating the spectrum of mucocutaneous manifestations and their relationship with CD4 cell counts in HIV-infected patients in Madagascar., Methods: A cross-sectional study on HIV-positive patients attending the Department of Infectious Diseases in the University Hospital of Antananarivo in Madagascar was conducted from January 2013 to March 2020. HIV-positive patients older than 18 years and receiving antiretroviral therapy as well as those awaiting antiretroviral therapy commencement were included., Results: Among 328 patients enrolled in this study, 167 (51%) presented with at least one type of mucocutaneous lesion. Oral candidiasis was the most common presentation, followed by seborrheic dermatitis and Kaposi sarcoma. Decreases in CD4 cell counts were substantially correlated with oral candidiasis, syphilis, and condyloma acuminatum., Conclusions: According to our findings, oral candidiasis, syphilis, and condyloma acuminatum may serve as clinical indicators for predicting the immune status of patients. As HIV infection progressed and immune function declined, an increase in cutaneous manifestations was observed., (©Fandresena Arilala Sendrasoa, Volatiana Mercia Falimiarintsoa, Lala Soavina Ramarozatovo, Fahafahantsoa Rapelanoro Rabenja. Originally published in JMIR Dermatology (http://derma.jmir.org), 15.08.2023.)

Although leishmaniasis is an endemic disease in Iran the mucosal involvement is rare. Mucocutaneous leishmaniasis (MCL) mainly caused by Leishmanial braziliensis infection, reported with other Leishmania species such as L. major. Herein a 78 yr old man with MCL from Iran is presented who referred to Razi Hospital Dermatology Clinic, Tehran, Iran, for multiple ulcerative lesions on mid face skin, mucosa of upper lip and anterior fossa of nose, dorsal aspect of the hands and the posterior aspect of heels. Skin biopsy revealed necrotizing and granulomatous tissue pattern that suggested infection pathogenesis but the smear for leishmaniasis, Mycobacterium spp, and fungal elements was negative at first. In order to a positive PPD test, he was treated by anti-tuberculosis treatment. A month after starting drugs for tuberculosis, the prepared microscopical smears were positive for Leishman bodies this time. The skin biopsy revealed amastigote forms of Leishmania sp. and the PCR assay on specimens of lesions proved L. major as the principal pathogenic agent. There was good response to systemic treatment with meglumine antimoniate (Glucantime ®) 3 gr per day until one week followed by 4.5 gr per day for another week. We forced to discontinue of drug because of cardiac toxicity at the end of 2nd wk of treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: American tegumentary leishmaniasis has an annual incidence of 1 to 1.5 million cases. In some cases, the patient's immune response can eliminate the parasite, and the lesion spontaneously resolves. However, when this does not occur, patients develop the disseminated form of the disease. OBJECTIVE: To investigate the association between clinical, laboratory and pathological findings in cases of American tegumentary leishmaniasis. METHODS: A retrospective study of the medical records of 47 patients with American cutaneous leishmaniasis. Clinical, laboratory and epidemiological data were collected, and semi-quantitative histopathological analyses were performed using the Spearman correlation coefficient (p