Indian Dermatology Online Journal最新文献

Background: Purpura fulminans (PF) is a potentially fatal disease characterized by rapidly progressive purpura that evolves into cutaneous necrosis and gangrene.

Patients and methods: This was an observational, retrospective study based on the review of case records of children with PF at a tertiary care children's hospital in Karnataka.

Results: Twenty-two cases seen over a period of four years were included. The age of the study population ranged from 11 days to 13 years (mean age: 4.21 years) and a male to female ratio of 1:1.2. Fever with purpura (86.3%) was the most common presenting symptom followed by swelling of the face and limbs (27.2%), altered sensorium (27.2%), convulsions (22.7%), abdominal distension (4.5%), respiratory distress (4.5%), myalgia (4.5%), and jaundice (4.5%). Cutaneous features included reticulate purpura (100%), necrosis (45.4%), ulcers (18.2%), maculopapular lesions (9.1%), and bullae (9.1%). Peripheral gangrene developed in eight children ( 36.3%). Lower limbs (90.9%) and upper limbs (86.3%) were the most common sites of involvement. The common causes were rickettsial fever (63.6%), Moraxella (4.5%), Leptospira (4.5%), multisystem inflammatory syndrome in children (4.5%), co-infections with Klebsiell a and Acinetobacte r (4.5%), Klebsiell a and Citrobacte r (4.5%), rickettsial fever with multisystem inflammatory syndrome (4.5%) and protein C deficiency (4.5%). The mortality rate was 4.5%.

Limitations: The retrospective nature of the study and the single-institution cohort were the limitations of this study.

Conclusion: Rickettsial infection was the most common etiology, while reticulate purpura, necrosis, and ulcers were the commonly seen cutaneous features of PF.

Background: Isotretinoin is a highly effective treatment for acne but poses significant teratogenic risks. In India, due to the absence of stringent prescription guidelines for isotretinoin, the responsibility for preventing isotretinoin embryopathy falls on treating physicians.

Aim and objectives: To assess dermatologists' knowledge, prescribing practices, and adherence to international Pregnancy Prevention Program (PPP) guidelines when prescribing isotretinoin.

Materials and methods: A cross-sectional survey was conducted among qualified dermatologists using a validated online questionnaire based on components of the iPLEDGE program. The questionnaire was distributed via email and WhatsApp. Data were analyzed using Statistical Package for the Social Sciences (SPSS) for Windows.

Results: A total of 189 dermatologists responded. Among them, 91.5% had prescribed isotretinoin, and 78% had done so for women of reproductive age. Although 94.7% of the respondents were aware of PPP guidelines, only 33.3% consistently conducted pretreatment pregnancy testing. While 74.8% of the dermatologists advised dual contraception, only 12.6% of them obtained written consent regarding teratogenic risks, and 19.3% regarding contraception. Six dermatologists reported isotretinoin exposed pregnancies, which resulted in two spontaneous abortions, three medical terminations, and one healthy live birth. After the survey, 91.3% of the respondents reported improved awareness, and 85% of them expressed willingness to follow PPP guidelines.

Limitation: Regional variations in practice may limit the generalizability of findings to the nation.

Conclusion: Despite high awareness, significant lapses exist in the implementation of pregnancy prevention practices while prescribing isotretinoin, highlighting a need for formulating prescription guidelines to standardize its use in India.

Background: Bilastine 20 mg daily is a second-generation antihistamine (sgAH) approved for chronic spontaneous urticaria (CSU). Up-dosing to 40 or 80 mg daily is recommended in uncontrolled patients.

Aim and objectives: Evaluating the effectiveness, safety, and tolerability of bilastine at 20, 40, and 80 mg daily in CSU patients uncontrolled with licensed doses of other sgAHs.

Patients and methods: In this institution-based, open-label, longitudinal trial, CSU patients were evaluated for demography, angioedema, and symptomatic dermographism. Urticaria disease severity was assessed by urticaria activity score (UAS7) score on days 0, 14, 28, and 42. All patients received bilastine 20 mg daily for two weeks. Non-responders (UAS7 > 0) were up-dosed to 40 or 80 mg. Laboratory tests were conducted at baseline and on day 42.

Results: Thirty-five CSU patients (mean age 34.5 years, median duration six months) were included. Bilastine 20 mg reduced mean UAS7 score from 25.7 to 6 at day 14 ( P < 0.001), with 16 achieving complete resolution (UAS7 = 0). Among non-responders, up-dosing to 40 mg further reduced UAS7 to 1.9 ( P < 0.001), with 15 more patients achieving UAS7 = 0. Only four required 80 mg, showing minimal additional benefit. ( P = 0.1). Overall, 94% achieved complete control. Somnolence (22%) and headache (50%) occurred at higher doses, but with good tolerability. A higher baseline UAS7 score increased the odds for up-dosing (OR 1.2, P = 0.001).

Limitations: Our study is limited by its small sample size, single-center design, and absence of a control group. Additionally, lack of information on prior antihistamine use or compliance may have confounded the assessment of refractoriness.

Conclusion: Up-dosing of bilastine is effective, safe, and tolerable in CSU patients uncontrolled with licensed doses of other sgAHs. Almost 90% patients responded to 20-40 mg, while 80 mg did not show a significant additional benefit. A higher baseline UAS7 score may indicate the need for up-dosing.

Background: Sleep disorders in psoriasis and their improvement with treatment have not been evaluated in the Indian subcontinent. The aim of the study was to assess the extent of sleep impairment and the effect of treatment on sleep impairment in patients with psoriasis.

Patients and methods: This was a prospective, observational study with 59 participants of chronic plaque psoriasis, receiving standard non-biological treatment. Psoriasis Area Severity Index (PASI) score, 5D Itch Score, Pittsburg Sleep Quality Index, and Insomnia Severity Index were calculated at baseline, 4 weeks, and 12 weeks of follow-up. The primary outcomes were changes in sleep quality and insomnia at week 4 and week 12 compared to baseline.

Results: Poor sleep quality and clinical insomnia were noted in 6 (10%) and 15 (25.4%) participants, respectively. Sleep quality was associated with body mass index ( P = 0.01) and pruritus ( P < 0.001), while insomnia showed an association with PASI ( P < 0.001). With treatment, poor sleep quality decreased to 5% at week 12 and this decrease was significant between weeks 4 and 12 ( P < 0.001). Insomnia decreased to 3.4% at week 12. This improvement was significant between baseline and week 4 ( P = 0.01) and between weeks 4 and 12 ( P = 0.005). The improvement in sleep quality had a positive correlation with a decrease in pruritus at 4 weeks ( P < 0.001) and 12 weeks ( P = 0.005).

Limitation: Follow-up of 12 weeks only and missing values are drawbacks.

Conclusion: Sleep quality and insomnia improved with standard non-biological treatment and correlated with a reduction in psoriasis-induced pruritus. This finding is important as the treatment of psoriasis in resource-poor and developing countries mainly involves non-biological options.