Search

Author(s): Feroze Kaliyadan [1]; Anupam Das (corresponding author) [2]; Karalikkattil T. Ashique [3]; Puravoor Jayasree [4]; Maitreyee Panda [5]; Saumya Panda [6]; Manas Chatterjee [7]; Mahdi Al Dhafiri [8]; Preethy [...], 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 x (P + E + L + A) of patch 1 + BSA in hand units x (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 1/4[sup.th] 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. Keywords: Delphi, dermatophyte infections, severity score

Author(s): Richa Kumar (corresponding author) [1]; Manas Chatterjee [2]; R Ranjan [3] Sir, A 42-year-old male, resident of Ajmer district, Rajasthan, and armed forces personnel by occupation presented with complaints [...]

Pemphigus is an autoimmune blistering disorder characterized by the presence of intraepidermal blisters and erosions, primarily affecting the mucosa and/or skin. There are no established Indian guidelines for the management of pemphigus, and Western guidelines cannot be directly applied due to differences in clinicodemographic profiles, comorbidities, and resource limitations. These guidelines aim to provide Indian dermatologists with evidence-based and consensus-driven recommendations for the management of pemphigus vulgaris (PV) and pemphigus foliaceous (PF), taking into account the unique challenges posed by the Indian healthcare setting. The guidelines focus on the comprehensive management of PV and PF, addressing diagnosis, treatment, monitoring, and follow-up. It is intended for dermatologists working in both outpatient and inpatient settings across India. The first draft of the guidelines was prepared by the writing group and then reviewed by 19 national experts in pemphigus management, including inputs from allied specialties. Areas with limited evidence or anticipated variation in recommendations were subjected to rounds of voting, with responses categorized as "strongly agree," "agree," "neutral," "disagree," or "strongly disagree." Suggestions were incorporated, and statements were revised until a mean agreement score of 4 or higher was reached across 16 key areas after four voting rounds. These guidelines offer a structured approach to managing pemphigus in India, addressing the need for region-specific recommendations that account for unique challenges such as resource constraints and specific comorbidities in Indian patients. They serve as a valuable resource for dermatologists treating pemphigus in a range of clinical settings. [ABSTRACT FROM AUTHOR]

Author(s): Anupam Das [1]; Manas Chatterjee [2] Sir, Current therapeutic options for vitiligo are numerous, but physicians are still in desperate search of the magic molecule which can provide the [...]

Introduction: Paediatric dermatoses differ from adult dermatoses with respect to clinical presentation, treatment and prognosis. These can be transitory, chronic and recurrent. The chronic dermatoses are associated with significant morbidity and psychological impact. Diagnosing these conditions is at times a challenge and the use of dermoscope aids it. Dermoscopy in paediatric population has unique advantage as it poses neither physical discomfort nor emotional stress. Therefore this review was attempted to highlight the salient dermoscopy features of common dermatoses in paediatric age group. Methods: A systematic literature search using PubMed and Google scholar databases for English language articles published upto the end of May 2019 was done for paediatric dermatoses and dermoscopy. Relevant studies were included. Cross references from each study are also included. Results: The common dermoscopy features of atopic dermatitis", "lichen planus", "psoriasis", "paediatric dermatoses", "keratosis pilaris", "impetigo", "pityriasis rosea", "pityriasis versicolor", "granuloma annulare", "vitiligo", "hypomelanoses of Ito", "nevus achromicus", "molluscum contagiosum", "verrucae", "lentigenes", "freckles", "capitis", "pediculosis", "alopecia areata", "linear porokeratosis", "lichen sclerosus et atrophicus", "pityriasis alba", "acanthosis nigricans", "hand foot mouth", "seborrheic dermatitis" and "prurigo nodularis identified from literature search were included. Conclusion: Paediatric dermatoses are unique in presentation as they might overlap to some extent. The diagnosis of these conditions is complicated by the fact that a biopsy may not always be possible since children are not co-operative and more importantly, parents are reluctant to subject their children to an invasive procedure. It is in this perspective that dermoscopy assumes greater importance in pediatric dermatology as compared to that in adults. [ABSTRACT FROM AUTHOR]

A 45 year old male presented with dry skin, facial puffiness, weight gain, constipation and lethargy for five months. He had been diagnosed as thyrotoxicosis fifteen years back and improved after oral antithyroid drugs. General examination revealed bradycardia, obesity, hoarseness, proptosis and acropachy. Dermatological examination revealed pretibal as well as generalised myxoedema with cold, hyperpigmented and xerotic skin. Hair was thin, coarse and brittle and nails brittle. Face appeared puffy, expressionless and eyelids wrinkled and drooping. Palms, soles had a yellowish hue. The neck revealed a diffusely enlarged thyroid. Hormone profile revealed reduced T3, T4 and raised TSH. Thyroperoxidase antibody was positive. ECG showed low voltage sinus bradycardia. X-ray hands substantiated thyroid acropachy. Skin biopsy confirmed pretibial myxoedema. He was diagnosed as Graves disease with past hyperthyroidism and present hypothyroid state and managed with oral thyroxine with improvement. The pretibial myxoedema was successfully managed with intralesional and topical steroids.

A 58 year old male presented with multiple areas of painless purulent discharge from the buttocks. He had pallor and dermatological examination revealed multiple subcutaneus nodules and discharging sinuses over the buttocks with hyperpigmentation and indurated puckered scarring. Examination of the pus revealed ′sulphur granules′ and Gram stain showed narrow bacillary forms and elongated hyphae with occasional branching. Skin biopsy revealed granular colonies in which ′ray fungus′ were seen. In brain-heart glucose agar in anerobic environment, white spidery colonies of Actinomyces israelii were grown at 37o C in 4 days, confirming primary cutaneus actinomycosis. He was managed with capsule doxycycline with regression of pus discharge in 6 weeks and therapy is planned for 18 months.