Indian Journal of Dermatology最新文献

Background: In India, Trichophyton mentagrophytes has emerged as the dominant cause of dermatophytosis, surpassing Trichophyton rubrum, contributing to an epidemic-like surge in cases. The Indian genotype "T. mentagrophytes ITS genotype VII" exhibits widespread resistance to terbinafine due to mutations in the squalene epoxidase gene. Rising instances of recurrent and chronic dermatophytosis highlight the urgent need to explore factors like host profiles, environmental influences, and antifungal resistance, including the role of biofilms.

Objective: This study aimed to evaluate biofilm formation in dermatophyte isolates and explore its correlation with demographic factors, disease duration, steroid misuse, and antifungal resistance to facilitate future management strategies.

Materials and methods: A total of 65 patients with clinically diagnosed dermatophytosis were included in this tertiary care center-based study. Detailed clinical histories were documented, and biofilm formation was quantified using crystal violet staining. Antifungal susceptibility testing was performed according to CLSI M38-A2 guidelines. Clinical improvement was assessed using the Clinical Assessment Severity Score, and statistical analysis was performed to explore associations between biofilm formation, clinical response, and antifungal resistance.

Results: T. mentagrophytes/Trichophyton interdigitale complex was identified in 98.46% of cases, with significant antifungal resistance to fluconazole and griseofulvin. The mean biofilm optical density was significantly higher in isolates from patients using oral antifungal treatments, especially those with poor clinical responses. Biofilm density was also significantly associated with antifungal resistance, particularly against fluconazole and griseofulvin (P < 0.001).

Conclusion: Our findings underscore the role of biofilm formation in contributing to chronic and recurrent dermatophytosis, particularly in patients with a history of oral antifungal use. Biofilm density correlates significantly with antifungal resistance, which may hinder clinical outcomes. These results highlight the need for tailored treatment strategies targeting biofilm-associated resistance to improve the management of chronic dermatophytosis.

The philtrum is the most important aesthetic unit of the upper lip. For the repair of defects in philtrum, it is a difficult challenge for surgeons. A 35-year-old male presented with a round black papule, approximately 1 cm in diameter, on his philtrum that had persisted for over 30 years. The diagnosis is nevus. Surgical resection was performed to remove the papule, reaching the subcutaneous fat layer. Subsequently, a circular defect of approximately 1 cm in diameter was evident. We employed an encircling skin flap technique. Surgical resection achieved satisfactory results. Local skin flap is the preferred method to repair the skin and soft tissue defect in the Middle Region of human body.

Extramammary Paget disease (EMPD) is a rare intraepithelial adenocarcinoma primarily affecting apocrine-rich areas, most commonly the vulva in elderly women. While surgical excision is the gold standard, its limitations in extensive disease necessitate alternative therapies. We report a case of a 75-year-old woman with a 2-year history of progressive vulvar erosion diagnosed histologically and immunohistochemically as primary EMPD. Owing to the lesion's extent and the patient's preference to avoid surgery, she was treated with a combination of ablative carbon dioxide (CO₂) laser therapy and topical 5% imiquimod. Four biweekly sessions of CO₂ laser therapy yielded significant resolution in the upper vulva, while residual disease in the lower vulva responded completely to a three-month course of imiquimod cream applied thrice weekly. Follow-up biopsy at six months confirmed histological remission, and no recurrence was observed at 12 months. This case highlights a successful, non-invasive treatment approach combining laser ablation with immunomodulatory therapy, offering a promising alternative to surgery in extensive EMPD with favorable outcomes and cosmetic acceptability.