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Atypical Rare Presentations of Cutaneous Tuberculosis: A Report of Two Cases 皮肤结核的非典型罕见表现:两个病例的报告
Pub Date : 2024-04-01 DOI: 10.4103/cdr.cdr_17_23
Sahana Srihari, P. Ranugha, V. Shastry, J. Betkerur
Cutaneous tuberculosis (TB) is the result of a chronic infection by Mycobacterium TB. The clinical manifestations are variable and depend on the interaction of several factors. TB and malignancy present global threats claiming millions of lives and inflicting formidable suffering worldwide. We present two cases of atypical, rare presentations of cutaneous TB. Cases of concurrent scrofuloderma and lupus vulgaris (LV) with miliary tuberculosis of the lung and cutaneous tuberculosis; atypical presentation of LV with concurrent HIV in a 10 year old child. Concurrent presentation of cutaneous TB with internal organ involvement is a rare entity in an immunocompetent asymptomatic individual like our patient. HIV coinfection with cutaneous TB has not been described in any of the childhood series published from India and ours is probably the first report of its kind. It is imperative that physicians have a high index of suspicion to quickly and effectively diagnose and treat these substantially morbid skin conditions.
皮肤结核病(TB)是结核分枝杆菌慢性感染的结果。其临床表现多种多样,取决于多种因素的相互作用。结核病和恶性肿瘤是全球性的威胁,夺走了数百万人的生命,给全世界带来了巨大的痛苦。我们介绍了两例非典型、罕见的皮肤结核病例。瘰疬性皮肤病和寻常狼疮(LV)并发肺部粟粒性结核和皮肤结核的病例;一名 10 岁儿童 LV 并发 HIV 的不典型表现。像我们的患者这样免疫功能正常、无症状的人同时出现皮肤结核和内脏器官受累的情况非常罕见。在印度发表的儿童系列病例中,还没有人描述过皮肤结核合并艾滋病病毒感染的情况,我们的病例可能是首例此类报告。当务之急是,医生要有高度的怀疑精神,以便快速有效地诊断和治疗这些严重的皮肤病。
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引用次数: 0
Oral Lichen Planus-like Lesions in Pemphigus Vulgaris 天疱疮中的口腔扁平苔藓样病变
Pub Date : 2024-04-01 DOI: 10.4103/cdr.cdr_97_23
Anant Kumar Singh, Ravi Phulware, N. Hazarika, N. Kansal
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引用次数: 0
Clinicomycological Study of Dermatophyte Infections in Patients Attending Dermatology Outpatient Department in a Tertiary Care Hospital 一家三甲医院皮肤科门诊病人皮癣菌感染的临床真菌学研究
Pub Date : 2024-04-01 DOI: 10.4103/cdr.cdr_112_22
Prajna P Vernekar, Sweta R. Prabhu, Pavithra A Jain, K. Naveen
Dermatophytosis is a fungal disease characterized by the infection of skin, hair, and nails. There is an upsurge of complicated superficial dermatophytosis and an increase in the incidence of chronic, relapsing, recurrent cases in India that are also often unresponsive to conventional doses of drugs. The aim of this study was to study the prevalence of dermatophyte species in the particular study area and it is susceptibility to itraconazole, terbinafine, and fluconazole. All dermatophytes isolates obtained were subjected to 10% KOH mount, fungal culture, and antifungal sensitivity testing for fluconazole, itraconazole, and terbinafine. Newly diagnosed cases of dermatophytosis without treatment for the past 3 months were included in the study. KOH preparation was observed and subjected to fungal culture. Then, the susceptibility of the dermatophytes to oral antifungals (itraconazole, terbinafine, and fluconazole) was done. Out of 28 patients with tinea, 14 males and 12 females were tested KOH positive. Out of them, 23 patients showed positive for dermatophyte growth. In them, 15 isolates were Trichophyton mentagrophytes and 8 isolates were Trichophyton rubrum. Antifungal drug susceptibility testing data indicated that, for the two species, MIC of itraconazole ranged between 0.03 and 16 μg/ml, terbinafine between 0.03 and 16 μg/ml, and fluconazole between 0.25 and 64 μg/ml. The study provided information regarding the prevalent species of dermatophyte in our study area and it is high sensitivity to itraconazole compared to terbinafine and the lowest for fluconazole. This gives us guidance as to which antifungal to use empirically in our clinical practice to treat tinea infection.
皮癣是一种以皮肤、毛发和指甲感染为特征的真菌病。在印度,复杂的浅表性皮癣发病率激增,慢性、复发性和复发性病例的发病率也在增加,而且往往对常规剂量的药物无反应。 这项研究的目的是研究皮癣菌在特定研究地区的流行情况及其对伊曲康唑、特比萘芬和氟康唑的敏感性。 获得的所有皮癣菌分离物都要进行 10% KOH 涂片、真菌培养以及氟康唑、伊曲康唑和特比萘芬的抗真菌敏感性测试。 研究对象包括过去 3 个月未接受治疗的皮癣新确诊病例。观察 KOH 制剂并进行真菌培养。然后,测定皮癣菌对口服抗真菌药(伊曲康唑、特比萘芬和氟康唑)的敏感性。 在 28 名癣病患者中,14 名男性和 12 名女性的 KOH 检测呈阳性。其中,23 名患者的皮癣菌生长呈阳性。其中,15 个分离株为门冬癣菌(Trichophyton mentagrophytes),8 个分离株为红癣毛癣菌(Trichophyton rubrum)。抗真菌药物敏感性测试数据显示,对于这两种真菌,伊曲康唑的 MIC 值介于 0.03 至 16 微克/毫升之间,特比萘芬介于 0.03 至 16 微克/毫升之间,氟康唑介于 0.25 至 64 微克/毫升之间。 这项研究提供了有关我们研究地区皮癣菌流行种类的信息,与特比萘芬相比,伊曲康唑的敏感性较高,而氟康唑的敏感性最低。这为我们在临床实践中使用哪种抗真菌药物治疗癣菌感染提供了指导。
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引用次数: 0
Palmoplantar Erythrodysesthesia: An Unusual Side Effect of Lenvatinib 掌跖红细胞增多症:乐伐替尼的异常副作用
Pub Date : 2024-04-01 DOI: 10.4103/cdr.cdr_63_23
N. Dhinoja, Shubhangi Hirma, P. Bodar, Rita Vipul Vora
Palmoplantar erythrodysesthesia also known as hand-foot syndrome is an intense, painful erythema of the palms and soles due to chemotherapeutic drugs. The most commonly implicated drugs are multi-kinase inhibitors such as sorafenib, sunitinib, doxorubicin, cytarabine, and docetaxel. The most effective management is withdrawal or reduction of drugs. Oral and topical corticosteroids and dimethyl sulfoxide are other treatment options. A 67-year-old male patient of hepatocellular carcinoma taking tablet lenvatinib presented with multiple tender erythematous plaques and patches over the bilateral palms and dorsum of the fingers after 1 month of initiation of therapy. The patient was successfully treated with dose reduction of lenvatinib and topical corticosteroids and is maintained on medium potency corticosteroid.
掌跖红斑症又称手足综合征,是化疗药物引起的手掌和足底剧烈疼痛性红斑。最常见的药物是多激酶抑制剂,如索拉非尼、舒尼替尼、多柔比星、阿糖胞苷和多西他赛。最有效的治疗方法是停药或减药。口服和外用皮质类固醇以及二甲基亚砜也是其他治疗方法。一名 67 岁的男性肝细胞癌患者在服用来伐替尼片 1 个月后,双侧手掌和指背出现多发性触痛性红斑和斑块。患者通过减少来伐替尼的剂量和外用皮质类固醇激素获得了成功治疗,目前仍在服用中等药效的皮质类固醇激素。
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引用次数: 0
Unresolved Malady of Pyoderma Gangrenosum: A Study of its Profile and Outcome in a Tertiary Care Center 尚未解决的坏疽性脓疱病:一家三级医疗中心对其概况和结果的研究
Pub Date : 2024-04-01 DOI: 10.4103/cdr.cdr_113_22
JP Prathibha, J. Madhukara, Pernaje Ishwara Bhat, Inchara Gowda
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis of uncertain etiology characterized by rapidly progressive, painful skin ulcers, and is often difficult to diagnose. The common underlying disease associations include rheumatoid arthritis (RA), inflammatory bowel disease (IBD), autoimmune inflammatory conditions, and malignancies, both hematological and solid organ tumors. Assess the demographics, clinical presentation and associated systemic diseases, and response to treatment of patients with pyoderma gangrenosum. In this retrospective study, all cases diagnosed as PG were evaluated along with disease associations and outcomes over a 5-year period. A total of 42 patients’ charts were studied of which, ulcerative PG was seen in 86.4%, pustular in 16.8%, bullous in 14.4%, and vegetative in 2.4% patients, respectively. Thirty-six percentage of them had RA, 12% had non-RA connective tissue disease, 9.6% had IBD, 9.6% had chronic liver disease, and 4.8% had malignancy. Positive pathergy was seen in 57% of our study patients. Multiple morphological types with recurrences were more common in patients with positive pathergy. Mortality was seen in 9.6% of patients. Statistics: Descriptive statistics were reported as mean with standard deviation, number, and percentages. Association between the clinical characteristics of the variables was done using Chi-square test. PG with multiple morphological types with multifocality is frequently associated with exacerbation of the underlying disease. RA was the most common association found. Recurrent disease was more common in older patients (>40 years).
脓皮病(Pyoderma gangrenosum,PG)是一种病因不明的嗜中性皮肤病,以快速进展、疼痛的皮肤溃疡为特征,通常难以诊断。常见的潜在疾病包括类风湿性关节炎(RA)、炎症性肠病(IBD)、自身免疫性炎症以及恶性肿瘤(包括血液肿瘤和实体器官肿瘤)。 评估脓皮病患者的人口统计学特征、临床表现和相关系统疾病,以及对治疗的反应。 在这项回顾性研究中,对所有确诊为脓皮病疽的病例进行了评估,同时还评估了5年来的疾病关联和治疗效果。 研究共收集了 42 名患者的病历,其中溃疡性脓疱疮占 86.4%,脓疱性占 16.8%,牛皮癣占 14.4%,植物性占 2.4%。其中 36% 患有 RA,12% 患有非 RA 结缔组织病,9.6% 患有 IBD,9.6% 患有慢性肝病,4.8% 患有恶性肿瘤。在我们的研究中,57%的患者出现了拍片阳性。多种形态类型和复发的病例在淋巴结阳性患者中更为常见。9.6%的患者死亡。统计数据:描述性统计以平均数加标准差、人数和百分比的形式报告。变量的临床特征之间的关联采用卡方检验。 具有多形态类型和多病灶的 PG 常与基础疾病恶化有关。RA是最常见的关联。复发性疾病在年龄较大(大于 40 岁)的患者中更为常见。
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引用次数: 0
Dapsone – Reinventing the Wheel or Rekindling Possibilities? 达泊松 - 重塑轮子还是重燃希望?
Pub Date : 2024-04-01 DOI: 10.4103/cdr.cdr_109_21
Ramesh M Bhat, M. Madhumita, R. Monteiro
Dapsone, once a fabric dye, is a versatile pharmaceutical for treating diseases like leprosy, malaria, and HIV-AIDS-related pneumonia. Discovered in 1908 but not utilized for its antimicrobial properties until the 1930s, dapsone faced initial setbacks due to toxicity, prompting the development of a safer derivative, Promin. Chemically, dapsone's lipid-soluble nature allows for extensive distribution throughout the body and involves complex metabolism, with a variable elimination half-life. Its clinical efficacy is due to its bacteriostatic action, inhibiting dihydrofolic acid synthesis, and its anti-inflammatory effects on neutrophils. Dapsone's dosing is tailored to the individual's condition and is approved for various dermatological conditions. However, its use is limited by contraindications in certain anemic conditions and potential side effects such as hemolytic anemia and methemoglobinemia, necessitating careful monitoring and management strategies to mitigate risks. Despite these challenges, dapsone's broad therapeutic utility and ongoing research into its mechanisms maintain its status as a significant medical therapy.
达泊松曾是一种织物染料,是一种治疗麻风病、疟疾和艾滋病相关肺炎等疾病的多功能药物。多松于 1908 年被发现,但直到 20 世纪 30 年代才被用于抗菌。多松最初因毒性问题而遭遇挫折,促使人们开发出一种更安全的衍生物 Promin。从化学角度看,达哌酮的脂溶性使其能够广泛分布于全身,并涉及复杂的新陈代谢,消除半衰期也不尽相同。其临床疗效得益于其抑菌作用、抑制二氢叶酸的合成以及对中性粒细胞的抗炎作用。多apseone 的剂量可根据个人病情而定,已被批准用于治疗各种皮肤病。然而,它的使用受到某些贫血症的禁忌症以及溶血性贫血和高铁血红蛋白血症等潜在副作用的限制,因此有必要采取谨慎的监测和管理策略来降低风险。尽管存在这些挑战,但达帕松的广泛治疗作用和对其机理的持续研究使其继续保持着重要的医疗地位。
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引用次数: 0
Acute Methotrexate Toxicity Managed with Leucovorin and Pegylated Granulocyte Colony-stimulating Factor: A Report of Two Cases and Review of Literature 使用亮菌甲素和聚乙二醇化粒细胞集落刺激因子治疗急性甲氨蝶呤中毒:两个病例的报告和文献综述
Pub Date : 2024-04-01 DOI: 10.4103/cdr.cdr_35_22
Shiva Shankar Marri, Mohnish Sekar, Keshavmurthy A Adya, A. Inamadar, Ajit B Janagond
Acute methotrexate (MTX) toxicity is most commonly due to overdose of the drug, which may be due to the patient's noncompliance to doctor's orders or physician's prescription error. Other causes include acute renal failure, concomitant use of other drugs, and genetic susceptibility. MTX toxicity presents with pancytopenia, mucositis, hepatotoxicity, pulmonary toxicity, and acute renal failure. Treatment involves a polypragmatic approach which includes vigorous hydration, urinary alkalinization, administration of leucovorin, and glucarpidase. Administration of granulocyte colony-stimulating factor should be considered in cases of severe neutropenia. Here, we present two cases of acute MTX toxicity in chronic plaque psoriasis presenting with ulceration of psoriatic lesions and mucosal ulceration successfully treated with leucovorin and pegylated granulocyte colony-stimulating factor (G-CSF). This case report demonstrates that G-CSF might be lifesaving by contributing to rapid reconstitution of leukopoiesis.
急性甲氨蝶呤(MTX)中毒最常见的原因是药物过量,这可能是由于患者不遵医嘱或医生处方错误造成的。其他原因包括急性肾功能衰竭、同时使用其他药物和遗传易感性。MTX 的毒性表现为泛发性、粘膜炎、肝毒性、肺毒性和急性肾衰竭。治疗需要采取多管齐下的方法,包括强力补水、尿碱化、服用亮菌甲素和葡萄糖苷酶。如果出现严重的中性粒细胞减少症,应考虑使用粒细胞集落刺激因子。在此,我们介绍了两例慢性斑块状银屑病急性 MTX 毒性病例,这两例病例表现为银屑病皮损溃疡和粘膜溃疡,在使用白消安和聚乙二醇化粒细胞集落刺激因子(G-CSF)后均获得成功治疗。本病例报告表明,G-CSF 可促进白细胞生成的快速重建,从而挽救患者的生命。
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引用次数: 0
A Study of the Clinical Patterns of Hair Loss in Female Patients 女性脱发临床模式研究
Pub Date : 2024-04-01 DOI: 10.4103/cdr.cdr_97_22
Sweta R. Prabhu, M. Madhusudhana, Soumya Bhute, K. Naveen, S. Athanikar
Hair loss is the one of the most common complaints in dermatologic patients. The proper cause of female pattern hair loss is still unclear. Many studies have been done on the individual patterns of hair loss but there are very few studies available about the different clinical patterns of hair loss in females in a single study. To evaluate the clinical patterns of hair loss in females which manifest in various disorders. 120 subjects were studied in a hospital based descriptive study with detailed history, general physical examination, detailed hair, scalp, cutaneous examination, clinical tests, routine haematological investigations, biopsy where indicated. Maximum subjects were in the age group of 20 – 40 years (66.6%). Majority of the subjects presented with a diffuse hair loss (55.8%). In our study although majority of the cases were not associated with any illness (52.5%), among the ones associated with illness the most common associated illness was history of COVID-19 (25.8%). Very few presented with scarring hair loss (5%). Telogen Effluvium was the most common cause of hair loss with maximum prevalence among females aged 20 to 40 years, with majority having hair loss over a period of 6 weeks to 6 month without any concurrent illness. The findings of this study provide baseline information on common clinical presentation of hair loss among women in our setting, thus helping in early clinical diagnosis and planning appropriate treatment.
脱发是皮肤科患者最常见的主诉之一。女性脱发的真正原因仍不清楚。关于脱发的个体模式已有很多研究,但关于女性脱发的不同临床模式的单一研究却很少。 为了评估女性脱发的临床模式(表现为各种疾病)。 在一项以医院为基础的描述性研究中,120 名受试者接受了详细的病史、一般体格检查、详细的头发、头皮、皮肤检查、临床测试、常规血液学检查以及必要时的活组织检查。 最大受试者年龄段为 20-40 岁(66.6%)。大多数患者表现为弥漫性脱发(55.8%)。在我们的研究中,虽然大多数病例未伴有任何疾病(52.5%),但在伴有疾病的病例中,最常见的伴发疾病是 COVID-19 病史(25.8%)。极少数患者伴有瘢痕性脱发(5%)。 脱发是最常见的脱发原因,在 20 至 40 岁的女性中发病率最高,大多数人的脱发时间为 6 周至 6 个月,没有并发症。这项研究的结果为我们提供了女性脱发常见临床表现的基本信息,从而有助于早期临床诊断和制定适当的治疗计划。
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引用次数: 0
A Case of Herpes Zoster Simulating Pemphigus Vulgaris Flare 一个带状疱疹模拟丘疹性荨麻疹发作的病例
Pub Date : 2024-04-01 DOI: 10.4103/cdr.cdr_126_21
C. R. Babu, P. Mathew, Bifi Joy, Sridharan Rajiv, P. A. Praveen
Pemphigus vulgaris is an autoimmune bullous disorder caused by autoantibodies directed against desmogleins. There is an increased risk for developing herpes zoster in pemphigus vulgaris due to the prolonged and high doses immunosuppressant therapy. Here, we present a 52-year-old female patient with extensive pemphigus vulgaris who developed herpes zoster while on treatment which resulted in a diagnostic confusion and a Tzanck smear acted as a lifesaver revealing both multinucleated giant cells and acantholytic cells. Hence, a prompt decision of reducing the immunosuppressant and initiation of IV acyclovir helped the patient to recover faster. This case highlights the relevance of simple bedside investigation like Tzanck smear and reminds the clinician once again to be open to all possibilities.
寻常天疱疮是一种自身免疫性大疱性疾病,由针对去疱疹素的自身抗体引起。由于长期接受大剂量免疫抑制剂治疗,寻常天疱疮患者罹患带状疱疹的风险增加。在此,我们介绍了一位 52 岁的女性患者,她患有广泛的寻常型丘疹性荨麻疹,在接受治疗期间出现了带状疱疹,导致诊断混乱,而 Tzanck 涂片则成为了她的救命稻草,涂片显示了多核巨细胞和棘溶细胞。因此,及时决定减少免疫抑制剂并开始静脉注射阿昔洛韦有助于患者更快康复。本病例强调了简单的床旁检查(如 Tzanck 涂片)的重要性,并再次提醒临床医生对所有可能性持开放态度。
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引用次数: 0
Charles Bonnet Syndrome in Stevens–Johnson Syndrome: A Never Reported Phenomenon in Dermatology 史蒂文斯-约翰逊综合征中的查尔斯-博内特综合征:皮肤科从未报道过的现象
Pub Date : 2024-04-01 DOI: 10.4103/cdr.cdr_98_23
Siddharth Mani, Prateksha Golas, Aradhana Rout, Reetu Agarwal
{"title":"Charles Bonnet Syndrome in Stevens–Johnson Syndrome: A Never Reported Phenomenon in Dermatology","authors":"Siddharth Mani, Prateksha Golas, Aradhana Rout, Reetu Agarwal","doi":"10.4103/cdr.cdr_98_23","DOIUrl":"https://doi.org/10.4103/cdr.cdr_98_23","url":null,"abstract":"","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140787623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Clinical Dermatology Review
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