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Byline: Myfanwy. D'Souza, Ganesh. Hundi, Sukumar. Dandekeri, Jyothi. Jayaraman Context: Many therapeutic modalities have been reported for the treatment of warts: a common bothersome condition; however, no single treatment is [...]

Background: Dermatophytosis impacts a significant portion of the global population. Recent shifts in the disease's presentation, severity and response to treatment, primarily due to emerging drug resistance, underscore the need for reliable assessment tools. The Dermatophytosis Severity Score (DSS) aims to standardise the evaluation of the disease's severity and monitor therapeutic responses. Methods: In a cross‐sectional pilot study, 25 adults with clinically diagnosed dermatophytosis were evaluated using the DSS. The study also aimed to establish the correlation of DSS with different stages of treatment, dermatophyte species and patient‐reported outcomes. Participants were recruited from a dermatology outpatient clinic, and the DSS was applied at baseline, Weeks 4 and 8. The validity and reliability of the DSS were assessed using statistical measures, including Cronbach's alpha and intraclass correlation coefficient. Results: The study comprised of a near‐equal distribution of male (52%) and female (48%) patients, primarily within the age group of 20–39 years. A high recurrence rate of dermatophytosis (60%) was noted, and more than half of the patients (56%) had used topical steroids before presentation. The mean DSS significantly decreased from baseline to the final visit, mirroring the substantial reduction in the 5D itch scale and Dermatology Life Quality Index, with strong positive correlations observed between these measures. Conclusion: The DSS demonstrated high inter‐rater reliability and internal consistency, indicating its utility as a reliable clinical tool for assessing dermatophytosis severity. The strong correlation of DSS with itch intensity and quality of life validates its role in patient‐centered care. Continued use and further validation of the DSS are recommended to enhance dermatophytosis management and treatment outcomes. [ABSTRACT FROM AUTHOR]

The physiological functions of natural killer (NK) cells in human immunity and reproduction depend upon diverse interactions between killer cell immunoglobulin-like receptors (KIRs) and their HLA class I ligands: HLA-A, HLA-B, and HLA-C. The genomic regions containing the KIR and HLA class I genes are unlinked, structurally complex, and highly polymorphic. They are also strongly associated with a wide spectrum of diseases, including infections, autoimmune disorders, cancers, and pregnancy disorders, as well as the efficacy of transplantation and other immunotherapies. To facilitate study of these extraordinary genes, we developed a method that captures, sequences, and analyzes the 13 KIR genes and HLA-A, HLA-B, and HLA-C from genomic DNA. We also devised a bioinformatics pipeline that attributes sequencing reads to specific KIR genes, determines copy number by read depth, and calls high-resolution genotypes for each KIR gene. We validated this method by using DNA from well-characterized cell lines, comparing it to established methods of HLA and KIR genotyping, and determining KIR genotypes from 1000 Genomes sequence data. This identified 116 previously uncharacterized KIR alleles, which were all demonstrated to be authentic by sequencing from source DNA via standard methods. Analysis of just two KIR genes showed that 22% of the 1000 Genomes individuals have a previously uncharacterized allele or a structural variant. The method we describe is suited to the large-scale analyses that are needed for characterizing human populations and defining the precise HLA and KIR factors associated with disease. The methods are applicable to other highly polymorphic genes.

Itraconazole (ITZ) has been the mainstay of oral antifungal treatment for the current epidemic of recalcitrant dermatophytosis (RD) in India. Recently, a newer formulation of ITZ, super bioavailable itraconazole (SUBA-ITZ), is made available in the market by many pharmaceutical companies. It is important for dermatologists to understand the pharmacokinetic properties of SUBA-ITZ vis-a-vis conventional pellet formulation to use it effectively and safely. Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) has established a special interest group for recalcitrant dermatophytosis (SIG-RD) to strengthen research, continuing medical education, and industry collaboration on the subject. This position statement on SUBA-ITZ by SIG-RD is an attempt to address current pieces of evidence and the position of this new formulation in the management of RD. [ABSTRACT FROM AUTHOR]

The rising prevalence of dermatophytosis in tropical countries coupled with drug resistance necessitates an objective scoring system to define the severity, monitor therapeutic response and predict prognoses. We attempted to establish and validate a new scoring system – Dermatophytoses Severity Score (DSS), for dermatophytoses affecting non‐glabrous skin. A consensus group was convened to develop an objective and reproducible scoring system to describe the extent and severity of dermatophytosis of 200 consecutive patients with dermatophytosis. A second assessment entailed independent DSS scoring of the same patients by dermatologists and residents who were not part of the consensus group. The main outcome measured was index reliability, assessed in two steps, between the observers. A two‐step assessment and DSS grading of 200 consecutive patients with clinically diagnosed dermatophytoses showed high reliability (Cronbach's α test and intraclass correlation coefficient). The DSS has demonstrated high reliability, and it could serve as a novel, reproducible and objective scoring tool for dermatophytosis. [ABSTRACT FROM AUTHOR]

Byline: M. Bhat, Anusha. George, Jyothi. JayaramanAcronymsThe acronyms for painful tumors of the skin always evoke an interest among students and teachers of dermatology. In fact, the main author of [...]

Background: Dermatophytosis is a common dermatological condition in children. Recent trends indicate increasing occurrence of dermatophytic infection in the paediatric age group and with growing anti-fungal resistance; however, more studies describing clinic-epidemiological and mycological pattern in paediatric population are needed. Aims and Objectives: The present study was undertaken to assess the clinical pattern and mycological isolates from the lesions of dermatophytosis involving the glabrous skin and to assess the association of fixed dose combinations creams with clinical and mycological pattern of cutaneous dermatophytosis. Materials and Methods: Paediatric patients (ages 1 -14) with suspected tinea infections presenting in the Department of Dermatology at a tertiary care medical college hospital in South India for a duration of four months, in 2020, were included in this study. Samples were collected and tested for potassium hydroxide (KOH) positivity. Additionally, the scales were also sent for fungal culture. Results: Out of 45 patients, 29 (64.4%) were male and 16 (35.6%) were female. The groin was the most common site affected in 89.65% patients. Around 57% of the study participants (21/45) have used corticosteroid-containing creams. Out of the 45 study participants, KOH mount was positive in 39(86.7%). Fungal Culture revealed Trichophyton mentagrophytes (55.6%) as the most common species isolated. Conclusion: Our study illustrates a major epidemiological shift of dermatophytosis causing species from Trichophyton rubrum to Trichophyton mentagrophytes among paediatric patients akin to that observed in adults. It is also observed that there is an increase in an atypical presentation owing to topical steroid use. The present study provides evidence that a high index of suspicion in needed to effectively curb the rising incidence of dermatophytosis in paediatric patients. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to evaluate the spectrum of skin diseases among older patients in a coastal city of Southern India and its association with systemic illness. Materials and Methods: In this retrospective, cross-sectional study, medical records from the dermatology outpatient clinics were assessed. Patients over 60 years old and attending the dermatology outpatient clinic between November 2021 and June 2022 were included in the study. Results: Of 1182 records, 663 were male (56%) and 519 were female (43.9%). Most of the patients were in the age group between 60 and 70 years (71.7%). Overall, the most frequent dermatologic diseases in this cohort of patients were infections (41.37%), eczematous dermatitis (30.02%), and papulosquamous disorders (9.39%). Among the physiological changes of aging skin, xerosis was the most common manifestation observed in 66 (5.5%) cases, followed by seborrheic keratosis in 24 (2%) cases. Twelve (1.01%) individuals had premalignant and malignant lesions identified. Bowen's disease (n = 5, 0.4%), basal cell carcinoma (n = 6, 0.5%), and leukoplakia (n = 1) were the most prevalent. Conclusion: Dermatoses in the older population are among the most common causes of daily consultations. In our study, infectious causes of dermatoses are more common than eczematous diseases. We discovered a higher prevalence of premalignant diseases like Bowen's disease, emphasizing the need for screening in people of skin color. [ABSTRACT FROM AUTHOR]

Abstract Background It is unclear whether the high rates of low birth weight in South Asia are due to poor fetal growth or short pregnancy duration. Also, it is not known whether the traditional focus on preventing low birth weight has been successful. We addressed these and related issues by studying births in Kaniyambadi, South India, with births from Nova Scotia, Canada serving as a reference. Methods Population-based data for 1986 to 2005 were obtained from the birth database of the Community Health and Development program in Kaniyambadi and from the Nova Scotia Atlee Perinatal Database. Menstrual dates were used to obtain comparable information on gestational age. Small-for-gestational age (SGA) live births were identified using both a recent Canadian and an older Indian fetal growth standard. Results The low birth weight and preterm birth rates were 17.0% versus 5.5% and 12.3% versus 6.9% in Kaniyambadi and Nova Scotia, respectively. SGA rates were 46.9% in Kaniyambadi and 7.5% in Nova Scotia when the Canadian fetal growth standard was used to define SGA and 6.7% in Kaniyambadi and < 1% in Nova Scotia when the Indian standard was used. In Kaniyambadi, low birth weight, preterm birth and perinatal mortality rates did not decrease between 1990 and 2005. SGA rates in Kaniyambadi declined significantly when SGA was based on the Indian standard but not when it was based on the Canadian standard. Maternal mortality rates fell by 85% (95% confidence interval 57% to 95%) in Kaniyambadi between 1986–90 and 2001–05. Perinatal mortality rates were 11.7 and 2.6 per 1,000 total births and cesarean delivery rates were 6.0% and 20.9% among live births ≥ 2,500 g in Kaniyambadi and Nova Scotia, respectively. Conclusion High rates of fetal growth restriction and relatively high rates of preterm birth are responsible for the high rates of low birth weight in South Asia. Increased emphasis is required on health services that address the morbidity and mortality in all birth weight categories.

Background: Stevens Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) represent adverse drug reactions characterized by generalized rash, blisters, epidermal detachment, mucosal and systemic involvement presenting as dermatological emergencies. Drugs are the most common culprits implicated in the pathogenesis of SJS/TEN. The primary step in the management of SJS/TEN is identification and stopping the offending drug. Materials and methods: This was a multi-centric retrospective as well as prospective observational study conducted in 7 tertiary care hospitals including Father Muller Medical College Hospital, Mangalore, India. A detailed evaluation of the hospital in patient record for 10 years retrospective from September 2015 and all new cases of SJS/TEN as well as SJS-TEN overlap presenting to these centres for 1 year prospective was performed. Detailed history was taken and clinical examination was recorded and different modalities of treatment was noted and compared. Results: A total of 152 patients with clinical diagnosis of SJS, TEN and SJS-TEN overlap were analysed. Males were more commonly affected than females and history of drug intake was present in 118 patients (77.6%). The most common drugs which caused SJS/TEN in our study were antibiotics in 40 patients (26.3%) followed by anti epileptics in 35 patients (23%) and nevirapine in 10 patients (6.5%). In our study the most common finding on cutaneous examination was maculopapular rash (19.3%). Conclusion: SJS and TEN form part of a spectrum of severe cutaneous drug reactions that can lead to high morbidity which can be reduced by early withdrawal of the offending drug and timely intervention. Individuals with known drug allergies need to be educated and drug allergy card has to be carried. [ABSTRACT FROM AUTHOR]

Introduction: Cutaneous mycosis is one of the most common dermatological conditions seen in children. In the recent past, there has been an increased incidence and unresponsiveness to various antifungal agents. Itraconazole is an effective and safe antifungal agent used, especially in adults; however, there are only a few studies in the literature for the treatment of dermatophytosis in children with oral itraconazole solution. Objective: The objective of this study is to assess the safety, effectiveness, and tolerability of oral itraconazole solution in children with recurrent and extensive dermatophytoses. Methods: This is a hospital-based prospective, longitudinal, open-labeled study conducted in a tertiary care hospital over a period of 3 months at the Department of Dermatology Venerology and Leprosy. A total of 30 children with recurrent and extensive dermatophytoses were recruited for the study. All were assessed for history, clinical features, and potassium hydroxide (KOH) mount for fungus. Itraconazole oral solution was given at a dosage of 5 mg/kg body weight for a duration of 4 weeks and evaluated for safety, effectiveness, tolerability, and mycological cure (KOH mount) after 4 weeks. Results: There were 30 cases in the study comprising 18 males and 12 females. The age group 6–10 years constituted a maximum number of cases. All of these cases had more than 10% body surface area involvement. Twenty-six patients had both clinical and mycological cure, whereas four patients still demonstrated fungal elements on KOH examination. All patients demonstrated excellent safety and tolerability except one who complained that the preparation was unsavory. Conclusion: Oral itraconazole solution is effective in chronic and recurrent dermatophytoses in children. [ABSTRACT FROM AUTHOR]

Background and Aims: Dermatophytosis has always been a common superficial mycosis in India. However, the past 6-7 years have seen an unprecedented increase in the number of patients affected by recurrent, chronic, recalcitrant and steroid modified dermatophytosis involving the glabrous skin (tinea corporis, tinea cruris and tinea faciei). Importantly, there has been a notable decrease in clinical responsiveness to commonly used antifungals given in conventional doses and durations resulting in difficult-to-treat infections. Considering that scientific data on the management of the current epidemic of dermatophytosis in India are inadequate, the Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) Task force Against Recalcitrant Tinea (ITART) has formulated a consensus statement on the management of dermatophytosis in India. Methods: Seventeen dermatologists with a focussed interest in dermatophytosis participated in a Delphi consensus method, conducted in three rounds. They responded as either "agree" or "disagree" to 132 statements prepared by the lead experts and gave their comments. Consensus was defined as an agreement of 80% or higher concurrence. Statements on which there was no consensus were modified based on the comments and were then recirculated. The results were finally analysed in a face-to-face meeting and the responses were further evaluated. A draft of the consensus was circulated among the participants and modified based on their inputs. Results: Consensus was achieved on 90 of the 132 statements. Direct microscopy using potassium hydroxide mount was recommended in case of diagnostic difficulty on clinical examination. Counselling of patients about strict adherence to general measures and compliance to treatment was strongly recommended as the key to successful management of dermatophytosis. A combination of systemic and topical antifungal drugs was recommended for the treatment of glabrous tinea in the current scenario. Topical corticosteroid use, whether used alone or in combination with other components, was strongly discouraged by all the experts. It was suggested that topical antifungals may be continued for 2 weeks beyond clinical resolution. Itraconazole and terbinafine were recommended to be used as the first line options in systemic therapy, whereas griseofulvin and fluconazole are alternatives. Terbinafine was agreed to be used as a first line systemic agent in treatment naïve and terbinafine naïve patients with glabrous tinea. Regular follow-up of patients to ensure compliance and monitoring of clinical response was recommended by the experts, both during treatment and for at least 4 weeks after apparent clinical cure. Longer duration of treatment was recommended for patients with chronic, recurrent and steroid modified dermatophytosis. Conclusion: Consensus in the management of dermatophytosis is necessary in the face of conventional regimens proving ineffective and dearth of clinical trials re-evaluating the role of available antifungals in the wake of evolving epidemiology of the infection in the country. It needs to be backed by more research to provide the required level of evidence. It is hoped that this consensus statement improves the quality of care for patients with dermatophytosis, which has emerged as a huge public health problem, imposing considerable financial burden on the country. [ABSTRACT FROM AUTHOR]

Fine-tuning CD8+ T cell responses: Human cytotoxic CD8+ T cells are important for defense against viral infections. Boelen et al. investigated whether inhibitory killer cell immunoglobulin-like receptors (iKIRs) carried by patients with chronic viral infections affected the efficacy of their CD8+ T cell responses. Possession of an iKIR gene along with a gene encoding a KIR ligand enhanced protective and detrimental HLA class I associations for HIV-1, HCV, and HTLV-1. Analysis of virus dynamics, in vitro survival assays, and mathematical modeling suggested that iKIR ligation enhances HLA associations by increasing T cell survival. In contrast to many reported iKIR-disease associations, these observations applied to all iKIRs and the three viral infections studied. This analysis reveals a consistent ability of iKIRs to influence clinical outcomes in human chronic viral infection. Killer cell immunoglobulin-like receptors (KIRs) are expressed predominantly on natural killer cells, where they play a key role in the regulation of innate immune responses. Recent studies show that inhibitory KIRs can also affect adaptive T cell–mediated immunity. In mice and in human T cells in vitro, inhibitory KIR ligation enhanced CD8+ T cell survival. To investigate the clinical relevance of these observations, we conducted an extensive immunogenetic analysis of multiple independent cohorts of HIV-1–, hepatitis C virus (HCV)–, and human T cell leukemia virus type 1 (HTLV-1)–infected individuals in conjunction with in vitro assays of T cell survival, analysis of ex vivo KIR expression, and mathematical modeling of host-virus dynamics. Our data suggest that functional engagement of inhibitory KIRs enhances the CD8+ T cell response against HIV-1, HCV, and HTLV-1 and is a significant determinant of clinical outcome in all three viral infections. [ABSTRACT FROM AUTHOR]