Indian Journal of Dermatology Venereology & Leprology最新文献

Background Livedoid vasculopathy, characterised by painful ulcers and atrophie blanche, significantly affects the quality of life of patients. Data pertaining to the efficacy of various available treatment options for this condition is limited, especially in India. Aim The study aimed to evaluate the treatment outcomes, clinicodemographic features, and associated laboratory abnormalities in patients with livedoid vasculopathy at a tertiary care centre. Methods This retrospective observational study analysed the case records and clinical photos of all clinically and histologically proven cases of livedoid vasculopathy who received antithrombotic treatment and were followed up for a minimum of 6 months. The primary endpoint was the proportion of patients who achieved a pain visual analogue (VAS) score of zero and complete healing of livedoid vasculopathy ulcers at 3 months. The secondary endpoint was the proportion of patients who achieved a pain VAS score of zero and complete healing of livedoid vasculopathy ulcers at 6 months. Side-effects, improvements in the dermatological life quality index (DLQI), clinicodemographic features, and associated laboratory abnormalities were also analysed. Results Of the 26 patients who satisfied the inclusion and exclusion criteria, 20 were males. At 3 months, 65.3% (17) of patients achieved the primary endpoint. Of these, 11 had received rivaroxaban (10mg) once daily and six had received aspirin (150mg) once daily. At 6 months, 96.1% (25) of patients had complete ulcer healing and achieved a VAS pain score of 0. Of these, 11 patients had received rivaroxaban, eight had received a combination of rivaroxaban and aspirin, and six had received aspirin. The improvements in VAS and DLQI at 3 months and 6 months were significant. None of the patients had any adverse effects from the therapy. Limitations The small sample size and its retrospective nature were limitations of the study. Conclusion Monotherapy with rivaroxaban or aspirin can effectively heal the ulcers, successfully achieve pain control, and improve the quality of life in livedoid vasculopathy. However, a fraction of patients may need a combination of the two to achieve these therapeutic goals. Both monotherapy and combination therapy are safe and not associated with significant side effects.

Background Leprosy and tuberculosis (TB) share common characteristics, such as acid-fastness of causative bacteria, geographic endemicity, route of spread, large number of asymptomatic infections, and requirement of multiple drugs for long periods of time to prevent resistance and provide treatment. Being relatively common, co-infection with the two diseases should occur based on chance alone. However, coinfection is surprisingly rare, with less than 20 cases being reported in the last decade. Aim The purpose of this case series was to study the clinico-epidemiological profile of patients with leprosy and TB co-infection. Methods This prospective, descriptive, case series describes leprosy patients with a past or current diagnosis of TB who visited the leprosy clinic of a tertiary care hospital over 3 years. The demographic details of the patients, details about the type of leprosy, slit skin smear, lepra reaction, and use of corticosteroids were noted for all patients. The type of TB, chest X-ray findings, sputum positivity, Interferon gamma release assay (IGRA) test, and Mantoux test results were recorded. The gap between the two diagnoses, the first disease to be diagnosed, family history of either disease, and the presence of predisposing factors were noted. Results This case series describes a total of 20 patients with leprosy co-infected with TB. There were 11 (55%) males, and the mean age of patients was 32.7 years. Half of these patients had lepromatous leprosy, and a similar number had type 2 lepra reaction. Pulmonary TB was seen in 12 (60%) patients, and tubercular pleural effusion in two (10%) patients. Multidrug-resistant TB was seen in two patients, and only one patient had received the bacilli of Calmette-Guerin (BCG) vaccination. Of the two diseases, leprosy was diagnosed first in six (30%) patients, while it was TB in 12 (60%) patients, and two (10%) patients had a concomitant diagnosis. Limitations The small number of patients in this single-centre study from a tertiary care hospital may not be reflective of the general population. Conclusion Leprosy and TB co-infection may present several management issues involving diagnosis and treatment, including drug resistance to tubercular bacilli. Management guidelines for such coinfections are needed to facilitate treatment of such patients and prevent high mortality and morbidity associated with such coinfections. More studies are needed to correctly define the clinico-epidemiological parameters of patients with co-infection.

Background Atrophic acne scars are clinically classified as rolling, icepick, or boxcar, but there is scarce data on the histopathology and depth of these scars, particularly in skin of colour. Objectives Our objective was to assess the histological changes in atrophic acne scars and determine the vertical depth of each scar type. Methods A total of 32 boxcar, 10 ice-pick, and 7 rolling scars were biopsied. Tissue samples were stained with haematoxylin and eosin, Verhoeff-van Gieson, and Masson's trichrome stains. Acne scars were identified based on morphological changes in collagen and elastin, loss of pilosebaceous units in the scar area, and tilting of follicular units in the adjoining dermis. The depth of the scars was measured in µm. Results Atrophic acne scars revealed loose, haphazardly arranged collagen (71%) and reduced elastic tissue (96%). Appendageal tilting was noted in 44/49 (90%) biopsies, with consistent pilosebaceous unit loss in the scar. Mean depths of ice-pick, boxcar, and rolling scars were 1933.4 ± 1117.8 µm, 1327.88 ± 571.34 µm, and 1357.14 ± 578.3 µm, respectively. There was a significant difference in the mean depth of scars between ice-pick and boxcar scars (p=0.02). Additional findings noted were scar vascularisation (n=46), ectatic channels in the scar (n=18), mononuclear inflammatory infiltrates (n=43), calcinosis (n=3), demodex mites (n=2), solar elastosis (n=2), pigment-laden macrophages (n=2), granulomatous perifolliculitis (n=4), and pulled up eccrine glands (n=8). Based on existing data, the dose of fractional carbon dioxide (Fr: CO2) laser should be set to achieve an approximate depth of 1933.4 µm to address all atrophic scars. Limitations Small sample size and technical difficulties in histological sectioning of atrophic scar remain the main limitations of our study. Conclusion This study provides novel histological insights into facial atrophic acne scar characteristics and depth in skin of colour. Also, it gives data on the histological depth that needs to be achieved by energy devices, using the appropriate dose based published data.

Chimeric antigen receptor (CAR) T-cells are autologous T-cells genetically engineered to express an antigen receptor that can recognise and kill cells expressing that target antigen. Originally developed for refractory or relapsed B-cell and plasma cell malignancies, CAR T-cell therapy is now being explored as a promising treatment for B-cell-mediated autoimmune diseases. CAR-T cells produce 'deep' B-cell depletion and cause 'resetting' of the immune system, thereby achieving long-lasting remissions and potentially even 'cure', addressing some major limitations of current immunosuppressive and biological therapies. This narrative review discusses the current status of CAR T-cell therapy, along with its potential future applications, for dermatological disorders.

Background Various dermoscopy patterns and structures in infantile haemangioma (IH) can be used to identify its activity and assess the response to therapy. Aim To formulate and validate a scoring system for IH based on dermoscopy - dermoscopy haemangioma assessment index (DHAI). To compare DHAI with the haemangioma activity score (HAS). Methods Consecutive patients with IH were taken for the study. At the time of presentation, each IH was clinically and by dermoscopy assessed by the first dermatologist. Clinical and dermoscopic images were taken and retrospectively analysed by a second and third dermatologist. The agreement between the three dermatologists was assessed using the inter-class correlation coefficient. Results The study included 45 patients with IH. Among the three observers, reliability analysis showed satisfactory results for DHAI with a Cronbach's alpha coefficient of 0.983, indicating good reliability and consistency. Inter-item correlation between all three observers was found to be positive and statistically significant (p-value <0.001). Thus, there was good agreement between the three dermatologists. On comparing with Haemangioma Activity Score (HAS), the correlation between HAS and DHAI was 0.703, which implies a high positive correlation. Limitations The primary limitation in our study was the very small number of patients. Secondly, the scoring system was not assessed longitudinally, so improvement in parameters with time could not be measured. Thirdly, the scoring system was not able to accurately measure the depth of IH. Conclusion DHAI is a good, reliable, and valid scoring system to assess the activity of IH, and can be used for future interventional studies on IH. DHAI can simplify the scoring of IH using a dermoscope and can provide more objective information as compared to the previous scoring system.

Background Leprosy, caused by Mycobacterium leprae, remains a significant public health challenge, particularly in endemic regions. While multidrug therapy (MDT) has been effective, the emergence of antimicrobial resistance (AMR) to key drugs such as rifampicin, dapsone, and ofloxacin threatens leprosy control programs. Resistance mechanisms include mutations in genes such as rpoB (rifampicin), folP1 (dapsone), and gyrA (ofloxacin). Drug resistance contributes to treatment failures, prolonged transmission, and the emergence of severe complications, necessitating enhanced surveillance and diagnostic capabilities. Aims This study aimed to determine the rates of primary and secondary AMR in M. leprae among multi-bacillary leprosy patients attending a tertiary care institute in Uttarakhand. It also sought to identify patterns of genetic mutations associated with resistance. Methods This prospective, cross-sectional study was conducted from July 2022 to June 2024. Patients with a bacteriological index (BI) ≥2, fulfilling specific clinical criteria [treatment-naive, chronic or recurrent erythema nodosum leprosum (ENL), relapse or persistent positive morphological index (MI)] were recruited. Slit skin smears (SSS) were processed using polymerase chain reaction (PCR) -based gene amplification to detect mutations in rpoB, folP1 and gyrA. Amplified DNA samples were sequenced and analysed for resistance-associated mutations. Demographic and clinical data, including type of leprosy, BI, MI, and treatment history, were also collected. Results Out of 47 samples tested, 43 were successfully amplified. Resistance was detected in eight cases (17%). Primary resistance was noted in 4/20 treatment-naive patients (20%). Rifampicin resistance, attributed to the F439L mutation, was the most common (n = 4). Dapsone resistance due to P55L and P55S mutations was identified in two cases, while ofloxacin resistance associated with A91V and G89C mutations was seen in two cases. Limitations The study's findings are limited by its sample size and the focus on a single tertiary care centre, potentially restricting the generalisability of results. Additionally, not all samples were successfully amplified for analysis. Conclusion This study underscores the critical need for routine AMR testing in high-risk leprosy cases. Regional variations in resistance patterns necessitate localised surveillance to guide effective treatment strategies. Enhanced diagnostic capabilities, patient education, and policy-level interventions are essential to combat the rising threat of AMR in leprosy.