Dermatophytosis: an Epidemiological And Clinical Comparative Study in a Tertiary Care Centre

Introduction: Dermatophytosis is a common superficialmycosis associated with significant morbidity. Dermatophytosis which are recurrent and clinically unresponsive totherapy are showing an alarming increase in the last fewyears. These patients are a potential source of infection to theirfamily members and others closely associated with them. Ourstudy aimed to investigate the risk factors, clinical patternsand causative dermatophyte species in patients with chronic/recurrent dermatophytosis and patients with first episode oftypical tinea.Material And Methods: The enrolled patients werecategorized as group I consisting of 81 cases of chronic/recurrent dermatophytosis and group II consisting of 81 casesof first episode dermatophytosis. After detailed history andthorough clinical examination, wet-mount preparation fordirect microscopic examination was done along with fungalculture using Sabouraud’s dextrose agar.Results: In group I, T.mentagrophytes (51.7%) was themost common species isolated followed by T tonsurans(26.7%) and T rubrum(18.3%) while in group II, T tonsurans(43.3%) was the most common species isolated followed byT rubrum (28.4%)and T mentagrophytes(23.9%). Injudicioususe of topical steroids, non-compliance with treatment andpresence of dermatophyte infection among family memberswere the major risk factors with significant association withchronic/recurrent infections. Limitations: Lack of follow upof cases, antifungal susceptibility with clinical outcome andImmunological profile of the patients was not studied.Conclusion: Chronic and recurrent dermatophytosis areemerging as a major problem in dermatology practice.Injudicious use of topical steroid containing preparations,non-compliance, presence of intrafamilial infection are majorfactors for chronic and recurrent infections.

Does systemic sclerosis affect thyroid functions? A study upholding association

Objective To study the association of clinical and subclinical thyroid dysfunction in patients of systemic sclerosis and compare with age and sex matched controls without systemic sclerosis

Methods This hospital-based study involved 56 patients of systemic sclerosis and 300 age and sex matched controls without systemic sclerosis. Thyroid function tests, such as thyroid-stimulating hormone [TSH], free tri-iodothyronine [T3], free thyroxine [T4], were advised in all cases, and anti thyroid peroxidase [anti-TPO] antibody, thyroid gland ultrasonography and fine needle aspiration cytology in selected patients only

Results Abnormal thyroid functions were found in 37.5% cases compared to 18.7% in control group, and 26.78% of cases had hypothyroidism compared to 16.7% among the controls. 21.4% patients among cases had subclinical hypothyroidism [SCH] compared to 13.33% among controls

Conclusion Thyroid dysfunctions are common in systemic sclerosis and the same should be evaluated as routine clinical profiling of patients with systemic sclerosis

Sweet's syndrome: an evidence-based report

Sweet's syndrome encompasses a variety of neutrophilic dermatosis characterized by acute onset of erythematous, edematous, painful papules, plaques and nodules associated with systemic symptoms, peripheral blood leukocytosis and histological findings of dense neutrophilic infiltrate. Ten patients were diagnosed during a period of one year. The patient population consisted of 7 females and 3 males with mean age of 47.6 years ranging from 32 to 60 years. An associated disorder was observed in 6 patients which were diabetes, hypothyroidism, hypertension and inflammatory bowel disease. Two cases of pregnancy associated disease were observed. Cutaneous lesions consisted of erythematous plaques or nodules. Lesions were located mainly on the face, neck and upper extremities. All biopsy specimens demonstrated a dermal infiltrate composed predominantly of neutrophils. Seven patients were treated by oral corticosteroids and three by oral dapsone, all for a period of 6 weeks

Generalized morphea and hypothyroidism: case report of a rare association

Morphea is a localized form of scleroderma in which there is predominant skin involvement, with occasional involvement of subjacent muscles and usually spares the internal organs. Thyroid dysfunction has been reported in systemic sclerosis but it has been rarely reported in morphea. There are few case reports of plaque-type morphea associated with autoimmune thyroiditis but generalized morphea with hypothyroidism has been rarely reported. We report a 55-year-old female with generalized morphea involving trunk and proximal limbs who revealed hypothyroidism on laboratory screening. Due to the rarity of this association we were obliged to report the same

Evaluation of ABO blood types in various dermatoses in Kashmiri population: a case control study

To evaluate any association between various ABO blood types and different dermatoses, viz, psoriasis, vitiligo, alopecia areata and pemphigus vulgaris. This hospital-based, case-control study involved evaluation of ABO blood typing of 140 cases of psoriasis, 76 vitiligo, 84 alopecia areata and 30 pemphigus vulgaris, and 2067 controls. O blood group was found in 37.1% patients of psoriasis, followed by blood type B [30%] and blood group A [25.7%], without any significant difference between cases and controls. In vitiligo patients, B blood group was found in 47.4% patients, followed by blood group O [36.8%] and blood group A [10.5%]. The results between vitiligo patients and controls regarding blood group A and B were statistically significant. In alopecia areata patients, blood group B was found in 45.2% patients, followed by blood group O [28.6%] and blood group A [19%], the difference being not statistically significant. In pemphigus vulgaris patients, O and B blood group were found in 40% patients each, followed by blood group A [20%], but this was not statistically significant. In psoriasis patients in our study, blood group O was the most common, but without any statistical significance than the controls. In vitiligo patients, B blood group was the most common and this was statistically significant. Difference in the blood group A, although found less frequently than B and O blood group, was also statistically significant between study group and controls. In alopecia areata, B blood group was the most common, but this finding was not statistically significant when compared to controls. In pemphigus patients, blood group O and B were equally common, but this was not statistically significant than the controls.

rare case of deep hemangioma presenting as a periorbital swelling and its excellent response to intralesional steroids

A hemangioma is a benign and usually self-involuting tumor of the endothelial cells of blood vessels, and is characterized by an increased number of normal or abnormal vessels. It usually appears in the first few weeks of life and grows most rapidly over the first six months. Usually, growth is complete and involution has commenced by twelve months. Half of all infantile hemangiomas involute by age five, 70% by age seven, and most of the remainder by age twelve. In more severe cases hemangiomas may leave residual tissue damage. The dermatologic indications for intervention in a case of hemangioma include maceration and erosion of the epidermis, infection, and cosmetic disfigurement. The treatment options include corticosteroids [oral], interferon, vincristine, propranolol, pulsed dye laser and surgery. The intralesional steroids are usually not recommended in the periocular region because of side effects like eyelid necrosis and central retinal vein occlusion. Here we report the case of a deep hemangioma in periorbital region with no overlying skin changes and its excellent response to intralesional steroids with no side effects.

Papillon-Lefevre syndrome: a case report of two siblings and review of the literature

Papillon-Lefevre syndrome is a rare autosomal recessive genodermatosis which is characterised by periodontitis, palmoplantar keratoderma and predisposition to pyogenic infections and occurs due to cathepsin C gene mutation [located on chromosome11].The loss of primary teeth usually occurs by the age of 4 years and secondary teeth by second decade. The disorder is associated with significant cosmetic and functional disability

case of cutis verticis gyrata associated with epilepsy

Cutis vertices gyrata [CVG] is characterized by thickening of the scalp, which becomes raised to form ridges and furrows resembling cerebral gyri that cannot be flattened by traction or pressure. The etiology is diverse, since different collections of cell types may be responsible for outward convoluted appearance. Herein a case of CVG associated with epilepsy is reported in a young girl in view of the clinical rarity of this association

Autologous noncultured epidermal cell suspension in case of resistant segmental vitiligo: a preliminary study

To assess the repigmentation efficacy of noncultured epidermal cell suspension [NCECS] in case of resistant segmental vitiligo. Three patients having resistant segmental vitiligo were treated with noncultured epidermal cell suspension at the Department of Dermatology, STD and Leprosy, SMHS Hospital [associated teaching hospital of Govt. Medical College, Srinagar] and were followed up for six months. Two patients showed more than 70% response, one patient more than 50% response. The pattern of pigmentation was uniform and aesthetically acceptable. Autologous non cultured epidermal cell suspension is one of the best modalities as far as segmental vitiliginous patches resistant to other treatment modalities are concerned and is one of the novel techniques as far as its outcome is concerned in the form of uniform pigmentation

Angiokeratoma corporis diffusum without systemic features in a young Kashmiri female: a rare occurrence

Angiokeratoma corporis diffusum [ACD] is a variety of angiokeratoma, characterized by diffuse cutaneous hyperkeratotic vascular lesions. ACD is usually associated with many lysosomal enzyme deficiencies, though it is not a rule. It is associated with systemic features along with skin lesions. It may also present as isolated cutaneous form. X-linked recessive form usually manifests in males and females act as carriers. We report a case of ACD without systemic features in a young Kashmiri female.

Blue rubber bleb nevus in zosteriform pattern: a rare case report

Blue rubber bleb nevus syndrome [BRBNS] is a rare condition with lesions in skin and/or other visceral organs, predominantly gastrointestinal tract. The condition is not fatal, unless associated with systemic involvement. BRBNS can also present as cutaneous lesions only. We report a classical case of BRBNS in zosteriform distribution, involving C6 and C7 dermatomes, in an adult Kashmiri male, a rare presentation.

Emergency dermatology and need of dermatological intensive care unit [DICU]

Dermatological emergencies comprise diseases with severe alterations in structure and function of the skin, with some of them leading to acute skin failure that demands early diagnosis, hospitalization, careful monitoring and multidisciplinary intensive care to minimize the associated morbidity and mortality. Prompt intensive management of acute skin failure in the ICU on the lines of 100% burns is mandatory; clearly establishing the necessity of a dedicated intensive care unit comprising of well synchronized team of dermatologist, internist, pediatrician, critical care physician and skilled nursing staff. In this article, we review the literature and discuss the major causes of dermatological emergencies, some of which lead to acute skin failure and lay stress for their management in ICU like set up attached to dermatology department itself, i.e., dermatological intensive care unit [DICU], so that such emergencies may be dealt with more effectively and without wastage of time. DICU should be equipped to such an extent that it provides initial, immediate and necessary support and it need not be as advanced and sophisticated as cardiac, surgical or neonatal ICU

Papuloerythroderma of Ofuji - a case report

Papuloerythroderma of Ofuji is an uncommon skin condition seen in elderly patients characterized by pruritic eruption of infiltrating papules with sparing of large folds of skin. Very few cases have been reported in the literature and the frequent association of this rare entity with laboratory abnormalities and malignancy points towards its heterogenous nature. We report a case of Papuloerythroderma of Ofuji having peripheral eosinophilia but not associated with any malignancy

Lipoid proteinosis: case report and a brief review

Lipoid proteinosis is a rare, autosomal recessive disorder, characterized by infiltration of periodic acid-Schiff positive hyaline material into the skin, oral cavity, larynx and internal organs. The clinical manifestations include hoarseness of voice, beaded papules along the eyelid margins, skin scarring and an inability to protrude the enlarged and thickened tongue. In this paper, we present a case of a young male with features suggestive of lipoid proteinosis. Clinical rarity of this condition prompted this communication

Monilethrix: a case report

Monilethrix is a genetic disorder of hair shaft characterized by a beaded appearance of the hair due to periodic thinning of the shaft, resulting in hair fragility and patchy dystrophic alopecia. We hereby report a case of monilethrix in an otherwise healthy seven- year old child. Clinical rarity of this disorder prompted this communication

Herpes zoster oticus masquerading as lateral pontomedullary syndrome

Ramsay Hunt syndrome, also known as herpes zoster oticus is usually caused by reactivation of preexisting varicella zoster virus in the geniculate ganglion. Here we report a case of herpes zoster oticus masquerading as lateral pontomedullary syndrome occurring during the pre-eruptive phase of chicken pox. The case is being reported for its rare and unusual clinical presentation.