Mixed dermatophytic infections: a learning perspective and report of ten cases

Background: Isolation of two or more than two pathogenic fungi from the same body site in a patient is considered as a rare entity and very few cases have been reported in literature. These types of infections are called as mixed/ combined fungal infections. Author are enumerating ten cases of superficial mycoses in which two different dermatophytes were grown from the same focus.Methods: From clinically suspected cases of dermatophytosis, skin and hair samples were collected from the affected sites and examined by standard mycological procedures. Microscopy was done by using 10% KOH wet mount. Culture was put on Sabouraud’s dextrose agar with cyclohexamide medium. Growth was identified by lactophenol cotton blue mount.Results: Mixed dermatophytes were obtained from tinea corporis (five cases), tinea capitis (four cases) and tinea cruris (one case) patients. Fungal combinations from given cases involved two different species of genus Trichophyton which were as follows: T. violaceum+T. tonsurans, T. verrucosum+T. tonsurans, T. violaceum (violet) and T. violaceum (white), T. mentagrophytes+T. Violaceum, T. rubrum+T. tonsurans, T. violaceum+T. rubrum, T. rubrum+T. mentagrophytes, T. verrucosum+T. mentagrophytes, T. mentagrophytes+T. tonsurans, Malassezia+T. mentagrophytes.Conclusions: Inspite of the frequent occurrence of dermatophytic infections worldwide, reports on mixed dermatophytes are very few. With proper sample collection and proper identification procedures, more cases can be identified and added to the existing literature.

Tazarotene gel with narrow-band UVB phototherapy: a synergistic combination in psoriasis

Abstract: BACKGROUND: Narrow-band UVB (NB-UVB) has been shown to be one of the most effective treatment modalities for psoriasis. Tazarotene, a known effective anti-psoriatic modality, when combined with NB-UVB may enhance the therapeutic success. OBJECTIVE: To study clinical efficacy and safety of combination of NB-UVB with topical tazarotene 0.05% gel in psoriasis. METHOD: Thirty patients with plaque psoriasis having symmetrical lesions were enrolled for 12 weeks. All patients were instructed to apply tazarotene gel on target plaque on left side of body once daily. In addition, the whole body was irradiated with NB-UVB twice weekly. Efficacy was assessed by target plaque scoring and number of treatment sessions for clearance. RESULT: Our study resulted in 3 key findings: Firstly, therapeutic efficacy of NB-UVB was enhanced by addition of tazarotene. This enhanced efficacy was more apparent in decreasing scaling and thickness as compared to decrease in erythema. Secondly, combination therapy showed faster clearance of target plaques, with reduction in mean number of treatment sessions. Thirdly, mean cumulative NB-UVB dose needed to achieve clearance of target plaques was significantly reduced with combination therapy. STUDY LIMITATIONS: The study was not randomized or controlled, but an open-label trial. The study period was relatively short, i.e., 12 weeks, without any follow-up period. CONCLUSION: Tazarotene gel significantly enhances the therapeutic efficacy of NB-UVB irradiation with faster clearance and without serious side effects.

Narrowband UV-B phototherapy in childhood atopic dermatitis: efficacy and safety

Abstract: Background: Narrow-band UVB is the most innovative steroid sparing treatment in atopic dermatitis. There are studies showing efficacy of Narrow-band UVB in childhood atopic dermatitis, but there is lack of clinical trials in the literature determining the length of remission. Therefore, we sought to highlight its efficacy, safety and its post-treatment efficacy in childhood atopic dermatitis. Objective: To assess the clinical efficacy, safety of Narrow-band UVB in the treatment of paediatric atopic dermatitis and length of remission during 2 years of post-treatment follow-up. Methods: Thirty children (4-14 years) having moderate to severe AD (SCORAD index > 25) were enrolled for 12 weeks. Narrow-band UVB phototherapy was administered twice a week on non-consecutive days for three months. SCORAD index was calculated by the same dermatologist at baseline, 6th, 12th, 18th and 24th treatment session. Secondary outcomes were measured using visual analog scale for pruritus and sleep loss. Patients were also followed-up for 2 years to know the length of remission after end of therapy. Results: There was a significant reduction in SCORAD index at 6th, 12th, 18th and 24th treatment session in comparison to baseline. This improvement in SCORAD was also maintained during the 2 years of post-treatment follow-up period. Consequently, pruritus and sleep loss improved significantly from baseline to end of therapy and even during the 1st and 2nd year of follow-up. Study limitation: Open-label trial without control group. Conclusions: Narrow-band UVB is an efficacious and safe modality of treatment in childhood atopic dermatitis with good therapeutic index and minimal side effects.

Dyshidrosiform pemphigoid localized on the hands in a child: a rare occurrence

Abstract: Dyshidrosiform pemphigoid is an acquired autoimmune variant of bullous pemphigoid with persistent vesicobullous eruptions localized on the palms or soles, or both. It generally occurs in the elderly and is rarely reported in childhood. Hereby, we describe the first case of dyshidrosiform pemphigoid in a 12-year-old child, which was limited to the dorsal hands and treated successfully with dapsone (diaminodiphenyl sulfone). Along with this report, we also review the clinical features of various types of dyshidrosiform pemphigoid.