Indian Journal of Dermatology最新文献

The rippled pattern of basal cell carcinoma (BCC) is a very uncommon variant and poses a diagnostic challenge. A 52-year-old male presented with an ulcerated lesion over the scalp for 8 years. The wedge biopsy of the lesion showed an infiltrating tumour in the upper dermis and mid-dermis with focal attachment with the epidermis. The tumour was arranged in a rippled pattern. The tumour cells were monomorphic with a round to oval nucleus, arranged parallelly with fine chromatin and inconspicuous nucleoli. Brisk mitosis, apoptotic bodies, and necrosis were noted. Immunohistochemically, the tumour cells were positive for p63; focally positive for androgen receptor, Bcl-2, and CD10; and negative for epithelial membrane antigen and CK20. We report this rare case of BCC because of its peculiar pattern, discuss the differential diagnoses, and review the clinicopathological features of reported cases.

Autohemotherapy is a commonly used treatment for recalcitrant chronic urticaria in some countries. Herein we report our experience using autologous serum therapy in eight patients with recalcitrant chronic spontaneous urticaria. Autologous serum therapy was initiated weekly for nine weeks followed by every fortnightly. Urticaria Activity Score (UAS) 7, Dermatology Life Quality Index (DLQI), and reduction of antihistamine usage were used to assess the treatment response. Eight patients (age range: 25-76 years old; four females and four males) had one to ten years of duration of recalcitrant chronic spontaneous urticaria. All failed to respond to high doses of second-generation antihistamines and five to immune-modulating agents. Three did not respond to omalizumab. At week nine, the reduction of UAS7 ranged from 76.2% to 100%. There was more than an 80% improvement in DLQI in all patients. The number of wheals seemed to be reduced first followed by pruritus. Three patients had stopped antihistamines by week eight of treatment. No adverse events were reported in all eight patients. Autologous serum therapy may serve as an alternative treatment for recalcitrant chronic spontaneous urticaria. Apart from the practicality, which requires frequent clinic visits, venipuncture, and centrifugation, it is cheap and effective with minimal adverse events.

Verruciform xanthomas are rare lesions affecting 0.025-0.5% of the population. They present as an asymptomatic, slow growing solitary lesion on the oral mucosa. Commonly misdiagnose as squamous cell carcinoma, verruca vulgaris, leukoplakia, and lichen planus. Presented is a 22 year old male with a painful verruciform xanthoma on the posterior ear lobe in a prior ear piercing.

Many articles have been published on actinic keratosis. Bibliometric analysis helps identify the most influential studies in a particular field, Our article was to identify the 100 most frequently cited references on actinic keratosis through bibliometric analysis. As of March 1, 2020, actinic keratosis was searched in the Web of Science database and ranked in order of the total number of citations. The top 100 most cited articles in actinic keratosis were analysed. The top 100 most cited articles on actinic keratosis were published between 1982 and 2020. The largest number of articles were published in a single interval in 2001-2005. The average annual citations increased first and then decreased. The total citations were positively correlated with annual citations. The 100 articles were classified into different research focuses: pathogenesis (33%), treatment (24%), clinical features and diagnosis (15%), pathophysiology (8%), epidemiology (5%), associated diseases (2%) and others (13%). Among these 100 articles, 5 were clinical trials, 14 focused on the association between actinic keratosis and P53, and 9 reported the association between actinic keratosis and 5-aminolevulinic acid. The 100 articles were published in 38 journals by 87 different first corresponding authors from 15 different countries, mostly in the USA and Australia. Stockfleth, E from the University of Berlin published the most articles as the corresponding author. The top 100 cited references of actinic keratosis were identified and their bibliometric characteristics were analysed to lay a foundation for further research.

Background: Psoriasis (PS), vitiligo (VT), and Pityriasis rosea (PR) are chronic skin diseases often occurring as a consequence of exaggerated immune responses. These skin manifestations can be triggered as a result of the molecular mimicry between viral protein (s) and host protein (s), which could generate auto-antibodies. In addition, it can be hypothesised that skin diseases are manifestations of the reduced immunity that is observed in chronic hepatitis B virus (HBV)-infected individuals.

Aims and objective: To investigate the presence of HBV in PS, VT, and PR cases and Human Herpes Virus (HHV) 6 and 7 in PR cases.

Materials and methods: DNA extracted from healthy controls (n = 20), PS (n = 10), VT (n = 11), and PR (n = 12) were subjected to HBV-S gene-specific polymerase chain reactions (PCRs) and HHV 6-UL57 and HHV7-UL10 gene-specific PCRs. PCR products of positive samples (HBV and HHV 6 and 7 DNA) of expected length were bi-directionally sequenced using overlapping primers. Sequence identification was performed by NCBI BLAST and analysed by multiple sequence alignment. HBV DNA copy number was determined through quantitative real-time PCR. The blood samples were also tested for HBV serological markers and Interferon gamma (IFN-γ) by enzyme immunoassays.

Results: The PCR data and Immunoassay study revealed that seven out of 12 PR, six out of 10 PS, and six out of 11 VT cases had signs of HBV infection. HHV 6 DNA was detected in four, whereas HHV 7 DNA was found in two of the 12 PR blood samples. PR6 presented the evidence of both HHV 6 and 7 co-infections.

Conclusion: Observing the correlation of HBV with skin diseases, albeit at the pilot level, a larger study is warranted to identify HBV infection in skin disease patients. The evidence of HHV 6 and HHV 7 DNA in PR cases supports the HHV infection linkage with PR.

Background: In a small state like Tripura, a surge in prevalence of superficial dermatophytosis has been observed from April to September among the population of both tribal and non-tribal groups having different lifestyle, different food habit, and different socioeconomic status. Studies from different region reveal varying pattern of etiological distribution of the disease. But till date no research study has been initiated in Tripura on clinicomycological profile of dermatophytosis.

Objectives: This study was undertaken with the objectives to estimate the proportion of different fungal species associated with dermatophytosis among the patients attending Dermatology Outpatient Department of a Tertiary care hospital of Tripura and also to determine possible association of different clinical parameters with fungal species if any.

Materials and methods: A total of three hundred and ninety-one (391) new cases of dermatophytosis attending Dermatology Outpatient Department of a Tertiary care teaching hospital of Tripura were included in this study from June, 2021 to May, 2022. All the specimens were assessed by direct microscopic examination and in vitro culture. Fungi were identified on the basis of their macroscopic and microscopic features with the help of lactophenol cotton blue staining and urease test.

Results: There was a male preponderance among cases and maximum patients belonged to 21-40 years age group. Trichophyton schoenleinii was the most common fungal species (52.1%) grown in culture followed by Trichophyton rubrum (26.9%).

Conclusion: In contrast to previous study results from different parts of India, Trichophyton schoenleinii was the most common isolated fungal species from this part of northeast India, and Tinea corporis (41.3%) was the most prominent clinical manifestation of dermatophytosis.

Post-kala-azar dermal leishmaniasis (PKDL) is a neglected skin disease that has tremendous epidemiological significance as a reservoir of Leishmania parasites. Relapse, drug resistance, non-compliance to prolonged treatment, poor health-seeking behaviour, along with limited therapeutic options pose a significant impact on the management of PKDL. In this study, we aimed to review the efficacy, safety and tolerability data of combination therapies for PKDL in the published literature. We have also described patients' compliance with treatment and associated co-infections in PKDL. A comprehensive literature search was conducted in PubMed, Scopus and Google Scholar to identify the relevant articles. A total of nine studies were eligible for inclusion in this review. Drug combinations used in India were miltefosine-liposomal amphotericin-B, miltefosine-paromomycin, miltefosine-amphotericin-B, sodium stibogluconate (SSG)-immunotherapy and SSG-rifampicin. However, in Sudan, except one, all studies have used SSG-based combinations viz. SSG-rifampicin, SSG-paromomycin and SSG-immunotherapy. The efficacy and safety of miltefosine in combination with liposomal amphotericin-B as well as conventional amphotericin-B were found to be excellent in a limited number of patients. These combinations are said to have better patient compliance and shorter treatment duration. Another combination of miltefosine and paromomycin was found to be satisfactory with a final cure rate of 83.3%. SSG in combination with paromomycin had a good clinical outcome among severe PKDL patients in Sudan, though pain at the injection site was experienced by all patients. There is a lack of data on combination therapies for PKDL through large-scale randomised controlled trials (RCTs). Therefore, multicentric randomized controlled trials with a sufficiently large sample size are urgently needed to verify the efficacy, safety, and other advantages of combination therapies for PKDL. With the availability of liposomal amphotericin-B, miltefosine and immunotherapy, clinical management of PKDL appears promising.