Indian Journal of Dermatology Venereology & Leprology最新文献

Background The inflammatory markers (IMs) are a set of biomarkers used clinically to assess a patient for the presence of an active inflammatory disease or disease activity. They are elevated in conditions like infections, malignancies, mental illness and drug reactions among others. Aim The study aimed at identifying the IMs that reflect the severity and recovery in severe cutaneous adverse drug reactions (SCARs). Methods A cross-sectional observational study was conducted among patients with SCARs (Stevens Johnson syndrome [SJS]/ toxic epidermal necrolysis [TEN] and drug reaction with eosinophilia and systemic symptoms [DRESS]) admitted to a tertiary care hospital over 18 months. Results Twenty SJS/TEN and 8 DRESS cases were included in the study. There were more females in the study (F: M = 2:1). Comparing the IMs of SJS/TEN and DRESS revealed that most markers on day 7 were lower as compared to day 0. There was a significant difference in eosinophil count (EC), procalcitonin (PCT) (p-value <0.05), and recovery time between the two groups. In the SJS/TEN group, markers like ferritin (>2000 ng/mL) and PCT (>2.0 ng/mL) were significantly higher, around the septic range, in patients with concurrent connective tissue disease and culture positivity. Ferritin (p-value- 0.025, rho- 0.578), PCT (p-value- 0.013, rho- 0.239), and ESR (p-value- 0.041, rho- 0.482) were associated with the severity of SJS/TEN. Patients with DRESS had an early recovery with a statistically significantly shorter hospital stay than SJS/TEN (p<0.005). Baseline severity-of-illness score for TEN levels, total counts, and day 7 PCT significantly reflected the time taken for recovery. Limitations Marker analysis was performed at baseline and on day 7 of admission, but not after complete clinical recovery, therefore indicating a trend but limited conclusive behaviour of markers at the time of recovery. Conclusion The progression of IMs in a SCAR follows the clinical course of the illness. IMs like ferritin and PCT, along with routine haematological investigation, aid in identifying the severity, differentiating it among patients with comorbidities, and helping predict the recovery time in SCARs.

Background Cutaneous and systemic plasmacytosis is a rare disorder predominantly observed in individuals of Asian descent. The aetiology, treatment modalities, and prognosis of this condition remain unclear. Objective To describe the clinicohistopathologic features and outcomes in patients with cutaneous and systemic plasmacytosis. Methods We analysed data from 21 patients treated at West China Hospital of Sichuan university from 2011 to 2022. Results All patients exhibited characteristic reddish-brown patches or plaques, primarily located on the trunk, head, face, and neck, with one patient also showing affected soles. Lymphadenopathy was present in 38.9% (7/18), and bone marrow involvement in 100% (7/7). Polyclonal immunoglobulinemia appeared in 91.67% (11/12), with elevated IgG4 in 87.5% (7/8) and IL-6 in 83.3% (5/6). Monoclonal gene rearrangements were observed in 54.5% (6/11) of patients. Over 5.3 years, 11.1% (2/18) partially remitted, while 44.4% (8/18) progressed, with four developing multicentric Castleman disease. Limitations This is a retrospective evaluation with a small number of cases; further prospective studies are warranted to support our inferences. Conclusions Cutaneous and systemic plasmacytosis often follows a chronic, progressive course. Our findings indicate an overlap in pathological features with cutaneous marginal zone B-cell lymphoma (MZBCL) and an association with IgG4-related disease. Additionally, some cases developed into multicentric Castleman disease. Currently, no effective treatment regimen has been established for this condition.

Leprosy represents a significant challenge in understanding the multiple immunological mechanisms that influence the distinct clinical forms. This integrative review used the electronic databases MEDLINE/PubMed and the Virtual Health Library (VHL), including 12 studies conducted predominantly in Brazil, China, India, and Ethiopia. We focused on the role of regulatory T (Treg) cells in Hansen's disease, specifically examining their frequency of expression and the functional characteristics of their subpopulations. Findings reveal the ubiquitous nature of Treg across clinical forms, particularly the CD3+CD4+CD25+FoxP3+ phenotype, with a pronounced frequency in multibacillary cases, including borderline-lepromatous and lepromatous leprosy. In these cases, a notable upregulation of inhibitory molecules (CTLA-4, PD-1) and the production of immunoregulatory cytokines (IL-10, TGF-β) are evident in skin lesions and/or in vitro-cultured cells. The intricate interplay of local stimuli, cytokine profiles, antigenic nature, receptor expressions, co-inhibitory molecules, and macrophage types modulates the cellular immune response, influencing disease severity. The increased presence of Treg and their associated products appears to contribute to bacillary multiplication in patients with the disseminated form, fostering disease persistence. This comprehensive review enhances our understanding of Hansen's disease pathogenesis, shedding light on potential avenues for targeted therapeutic interventions.

Child sexual abuse (CSA) is a serious public health issue in India, with long-lasting physical, emotional and psychological consequences. Dermatologists play a crucial, though often underappreciated, role in the identification and management of CSA due to expertise in recognising and interpreting cutaneous signs, which are the most common and visible indicators of abuse. The authors explore the pivotal role of dermatologists in the multidisciplinary approach to CSA, emphasising their involvement in history-taking, physical examination, injury interpretation, and forensic evidence collection. The article also discusses the importance of timely reporting to authorities and adhering to treatment protocols based on the prevalent guidelines. This article attempts to create awareness among practising dermatologists in India about their role in the early detection and comprehensive care of CSA survivors. We also believe that this article will act as a guiding force for them to manage CSA cases effectively.