Eritrodermia posterior a infección por Chikungunya: un reto diagnóstico / Erythroderma after Chikungunya infection: a diagnostic challenge

RESUMEN La eritrodermia es un síndrome inflamatorio cutáneo grave que se caracteriza por eritema y descamación generalizada en más del 90 % del cuerpo. Este síndrome puede ser la etapa final de diversas enfermedades dermatológicas o el inicio de ciertas patologías como la psoriasis, que es la causa más común. Las enfermedades febriles son causa de exacerbaciones de psoriasis. Se cree que el virus actúa como un superantígeno y activa la inmunidad celular causando cambios inmunológicos con clínica variada en individuos predispuestos. Presentamos el caso de un paciente de sexo masculino que debuta con una forma grave de psoriasis posterior a infección por chikungunya.

ABSTRACT Exfoliative dermatitis is a severe cutaneous inflammatory syndrome characterized by generalized erythema and scaling over more than 90 % of the body. This syndrome can be the final stage of various dermatological diseases or the beginning of certain pathologies such as psoriasis, which is the most common cause. Febrile illnesses are cause of psoriasis exacerbations. It is believed that the virus acts as a superantigen and activates cellular immunity causing immunological changes with varied symptoms in predisposed individuals. We present the case of a male patient who presented with a severe form of psoriasis after chikungunya infection.

Insuficiencia respiratoria en una paciente con síndrome de Sézary / Respiratory failure in a patient with Sézary syndrome

Paciente de 44 años de sexo femenino, sin ninguna enfermedad de base preexistente, con una historia de aproximadamente diez meses de presentar lesiones eritemato-descamativas pruriginosas inicialmente localizadas en extremidades inferiores y que luego se generalizaron en todo el cuerpo, asociándose a la pérdida de peso de aproximadamente 15 kg. El manejo inicial consistió en corticoides tópicos y antihistamínicos orales con poca respuesta clínica. Se inició el estudio por dermatología y se confirmó el diagnóstico inicial de neoplasia cutánea maligna de células T. Luego se realizó el frotis de médula ósea, en el que se identificaron células «cerebriformes¼ que confirmaron el diagnóstico de síndrome de Sézary. La paciente recibió esquema de quimioterapia ciclofosfamida, doxorrubicina, vincristina, etopósido y prednisona. La respuesta inicial fue favorable, con alta hospitalaria y seguimiento en la consulta externa. Transcurridos tres meses de tratamiento, la paciente consultó por episodio febril, tos productiva más distrés respiratorio asociado a estertores basales bilaterales, presentó insuficiencia respiratoria y durante la inducción a la ventilación mecánica sufrió un paro cardiorrespiratorio y falleció

44-year-old female patient, with no preexisting underlying disease, with a history of approximately ten months of presenting pruritic erythematous-desquamative lesions initially localized in the lower extremities and later generalized throughout the body, associated with weight loss of 15 kg. Treatment. Initial management consisted of topical corticosteroids and oral antihistamines with little clinical response. A dermatology wok-up was initiated, and the initial diagnosis of malignant T-cell neoplasm was confirmed. A bone marrow smear was performed, in which "cerebriform" cells were identified, confirming the diagnosis of Sézary syndrome. The patient received cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone chemotherapy. Outcome. The initial response was favorable, with hospital discharge and outpatient follow-up. After three months of treatment, the patient consulted for a febrile episode, productive cough plus respiratory distress associated with bilateral basal rales, presented respiratory failure, and during induction of mechanical ventilation suffered cardiorespiratory arrest and died.

Detection and Comparision of Cytopathological Changes in Smokers and Non-Smokers: A Comparative Study

Background: Oral cancer is one of the sixth most common cancers in the world. Oral exfoliative cytology is one of the popular screening tool for oral cancer. Use of tobacco in any form are documented as the most common cause as initiators for dysplastic changes in oral mucosa. The purpose of the study was to detect the cytological changes in buccal mucosa, tongue and palate among non-smokers & smokers. Material & Methods: Smears sample were collected according to site (buccal mucosa, tongue & palate) from 100 subjects among smokers & non-smokers. Smears were then stained using Papanicolaou staining technique. Results: Among the smokers and non-smokers the results were statistically significant. Conclusion: Recent advances in the clinical visualization and detection of the oral mucosa have made the viability of cytological procedures more specific and sensitive. Contact endoscopy and use of autofluorescence devices are the forerunners in this group. The fluorescence characteristics of tissues depend upon their biochemical composition and histomorphological architecture, both of which undergo a change during malignant transformation. These changes are detectable as an alteration in the fluorescence spectral profile of the tissues21. Due to low feasibilities of such devices the benchmark of diagnosis will be microscopic tissue examination. Hence cytological smears will always be highly specific, sensitive, easy to use and reproducible procedures in routine screening of population for potentially and malignant conditions of the oral cavity.

Cytomorphometry in Oral Lesions - An Objective Approach to Cytological Diagnosis.

Objectives: The present study focusses on cytomorphological evaluation of the scrapings and cytological appearance of a spectrum of lesions of the oral cavity, Morphometric nuclear and cytoplasmic parameters were used to distinguish between benign, premalignant and malignant lesions. Material and Methods: The samples were obtained by scraping the lesion firmly till tiny pin point bleeding points were seen to ensure adequate sampling. Adequate sampling was defined as 50 cells consisting of transepithelial cytology specimen (superficial, intermediate and basal cells). Results: A total of 80 patients were evaluated with predominance in males and mean age of presentation was 45.05± 12.8 years. Cytomorphomteric analysis revealed an increasing trend in nuclear parameters as the spectrum of oral lesion moved from benign to malignant category while a decline was observed in cellular parameters. A significant p value of <0.0001 was found between cytomorphometrical parameters and histopathological subtypes. Sensitivity and specificity of conventional exfoliative cytology in conjunction with cytomorphometry was 100% and 94.74% respectively. Negative predictive value and positive predictive value of cytology for malignant lesions was 100% and 93.75% respectively. Diagnostic accuracy of cytology in predicting malignancy taking histopathology as gold standard was 97.0. Conclusion: Grading and scoring of oral cytosmears according to morphology showed a positive correlation with histopathological diagnosis. In addition, cytomorphometry increases the diagnostic accuracy of oral conventional exfoliative cytology and hence is seen to have an impact on early detection of cellular alterations and prompt treatment. Therefore, it is a sensitive and useful adjunct to monitor the cellular transformation.

Research progress in infection-associated virulence factors of Staphylococcus aureus / 中华临床感染病杂志

Staphylococcus aureus is an important pathogen of human infectious diseases, which can cause skin and soft tissue infections, endocarditis, necrotizing pneumonia, myelitis and other serious infectious diseases. With the use of antibiotics, Staphylococcus aureus is evolving to develop drug resistance; at the same time it produces a variety of virulence factors to attack the host. This article will review the recent advances of Staphylococcus aureus virulence factors associated with the three stages of infection and introduce the detection methods of virulence factors briefly.

Descripcion Fisiopatológica de la Descamacion Cutanea por Toxinas Exfoliativas Estafilococicas, Nuevo Enfoque de Diagnostico Diferencial

Resumen El síndrome de piel escaldada estafilocócica, la escarlatina estafilocócica y el impétigo ampollar son patologías que tienen en común el mecanismo de lesión de la piel por toxinas exfoliativas producidas por estafilococos, su presentación y manifestaciones clínicas son difíciles de diferenciar de otras patologías sistémicas como la enfermedad de Kawasaki, el síndrome de Steven Johnson y diferentes farmacodermias. En los últimos años se ha podido explicar el mecanismo molecular de lesión cutánea, lo que ayudo de manera importante a interpretar y poder realizar un adecuado diagnóstico diferencial entre estas patologías. Los pediatras necesitan múltiples herramientas para llegar a un diagnóstico certero de las noxas que producen lesiones en piel y manifestaciones sistémicas. Una buena anamnesis y el conocimiento de un abanico de diagnósticos diferenciales son importantes para el tratamiento médico.

Abstract Staphylococcal scalded skin syndrome, staphylococcal scarlet fever and bullous impetigo are pathologies that have in common the mechanism of skin injury by exfoliative toxins produced by staphylococci, their presentation and clinical manifestations are difficult to differentiate from other systemic pathologies such as Kawasaki disease, the syndrome of Steven Johnson and drug induced skin diseases. In recent years, it has been possible to explain the molecular mechanism of skin injury, which has helped in an important way to interpret and be able to make an adequate differential diagnosis between these pathologies. Pediatricians need multiple tools to reach an accurate diagnosis of the disease that produce skin lesions and systemic manifestations. A good history and knowledge of a range of differential diagnoses are important for medical management.

Soothing moisturizing repair cream in promoting wound repair of acne depressed scar after laser operation: a clinical analysis / 中华医学美学美容杂志

Objective:To investigate the effectiveness and safety of soothing moisturizing repair cream on acne depressed scar exfoliative fractional laser wound repair.Methods:From October 2018 to June 2020, the Department of Dermatology, Qingdao Haici Hospital Affiliated to Qingdao University took 33 patients with acne depressed scars as the research object, including 8 males and 25 females, aged from 20 to 36 years (29.6±8.6) years. The left and right face comparison method was adopted. After laser operation, the trial side was given a soothing moisturizing repair cream, and the control side was given a placebo. By collecting the patient's facial pictures and objective skin data before and after the laser operation, 1 h, 1 d, 3 d, 7 d, 21 d, and combined with the researcher's semi-subjective evaluation and patient's subjective evaluation the wound skin reaction and wound healing were observed.Results:At 1, 3, 7, 21 days after laser operation, the skin water content of the test side was higher than that of the control side ( P<0.05), and the skin water loss was lower than the control side ( P<0.05); at 3, 7, 21 days, the skin pigment of the test side was lower than the control side ( P<0.05); at 3, 7 d, the test side skin erythema index was lower than the control side ( P<0.05); at 1, 3, 7 d, the test side wound skin erythema, edema, dryness and tightness, etc. were better than the control side ( P<0.05). The duration of pain, crusting time, scab removal time, and complete healing time of the wound on the test side were shorter than those on the control side ( P<0.05). The patient's satisfaction with the moisturization and comfort of the nursing products on the trial side was better than that on the control side ( P<0.05). Conclusions:There is no adverse reaction to the soothing moisturizing repair cream after laser surgery, which can better inhibit skin inflammation, reduce post-inflammatory pigmentation, promote skin healing, and help repair the wound after laser surgery.

Câncer de Mama e Eritrodermia: Relato de Caso / Breast Cancer and Erythroderma: Case Report / Cáncer de Mama y Eritrodermia: Relato de Caso

Introdução: A eritrodermia esfoliativa é um evento raro que está associado a diversas doenças como psoríase, eczemas, neoplasias malignas, uso de medicamentos, entre outras. Relato do caso: Paciente de 63 anos apresentou quadro de exantema difuso iniciado em janeiro de 2018, evoluindo com descamação generalizada da pele e formação de úlceras, sentindo calafrios. Não referiu histórico de câncer na família. Na anamnese, não houve relato de nenhum tipo de eczema, doença de pele preexistente ou uso de plantas medicinais. Foi identificada neoplasia maligna de mama do subtipo molecular luminal A, posteriormente. Após mastectomia com linfadenectomia, houve apenas melhora parcial do quadro da eritrodermia. Atualmente, em uso de doxorrubicina. Conclusão: A paciente apresentou quadro clínico inicial condizente com o que se espera de eritrodermia, que pode estar associada ao surgimento de neoplasia maligna de mama. O presente relato é importante, pois pode auxiliar em diagnósticos diferenciais para a eritrodermia, mesmo na vigência de um quadro clínico atípico.

Introduction: Exfoliative erythroderma is a rare event associated with several diseases such as psoriasis, eczema, malignant neoplasms, medication use, among others. Case report: A 63-year-old patient presented diffuse rash that started in January 2018, evolving with generalized skin desquamation and ulcer formation, with chills. Did not report family history of cancer. In the anamnesis, there was no report of any type of eczema, preexisting skin disease or use of medicinal plants. Malignant breast cancer of luminal A molecular subtype was identified later. After mastectomy with lymphadenectomy, there was only partial improvement in erythroderma. Currently using doxorubicin. Conclusion: The patient presented an initial clinical condition consistent with what is expected from erythroderma, which may be associated with the emergence of malignant breast neoplasm. The present report is important because it can help in differential diagnoses for erythroderma, even in the presence of an atypical clinical case.

Introducción: La eritrodermia exfoliativa es un evento raro asociado con varias enfermedades como psoriasis, eccema, neoplasmas malignos, uso de medicamentos, entre otros. Relato del caso: Paciente de 63 años presentó una erupción cutánea difusa que comenzó en enero de 2018, que evolucionó con descamación generalizada de la piel y formación de úlceras, con escalofríos. No informó antecedentes familiares de cáncer. En la anamnesis, no hubo informes de ningún tipos de eccema, enfermedad cutánea preexistente o uso de plantas medicinales. La neoplasia de mama maligna del subtipo molecular luminal A se identificó más tarde. Después de la mastectomía con linfadenectomía, solo hubo una mejoría parcial en la eritrodermia. Actualmente usa doxorrubicina. Conclusión: La paciente presentó un cuadro clínico inicial consistente con lo que se espera de la eritrodermia, que puede estar asociada con la aparición de neoplasma maligno de mama. El presente informe es importante porque puede ayudar en los diagnósticos diferenciales de eritrodermia, incluso en presencia de un cuadro clínico atípico.

Clinicopathological evaluation of the lesions of oral cavity, oropharynx, larynx and hypopharynx

Background: Early detection of malignancy substantially improves the survival in most head and neck cancers. A simpler and reliable screening method is something that is sought after by every clinician. Hence a clinicopathological study was carried out in the local population to study the pattern of various factors associated with the clinically suspicious lesions of the oral cavity, oropharynx, larynx and the hypopharynx. The role of exfoliative cytology was also evaluated.Methods: Our study, comprised of a total of 50 cases clinically suspicious of being either premalignant or malignant lesions of the oral cavity, oropharynx, larynx and the hypopharynx. All the patients were examined thoroughly and diagnosed clinically. Thereafter they were subjected to both exfoliative cytology and histopathology.Results: A malignant laryngeal lesion was the commonest. clinical diagnosis seen in 68% of the cases. On exfoliative cytology, the commonest finding was squamous cell carcinoma, seen in 34 (68%) cases. On histopathological examination, squamous cell carcinoma was found to be the commonest with 39 (78%) cases. The sensitivity and specificity of exfoliative cytology were observed as 84.6% and 90.90% respectively. The methods of diagnosis applied and their results were found to be significantly associated with a p value of 0.0119 which was <0.05.Conclusions: The commonest cause for the suspicious lesions of the oral cavity, oropharynx, larynx and hypopharynx was squamous cell carcinoma seen in 78% of the cases. Rapid assessment tools like exfoliative cytology can aid in early detection of malignant lesions.

COVID-19associated exfoliative shock syndrome / Síndrome de shock exfoliativo por covid-19

RESUMEN El síndrome de shock exfoliativo(SSE) asociado a COVID- 19 es una enfermedad recientemente descrita con características superpuestas de síndrome de shock tóxico (SST) y síndrome de la piel escaldada estafilocócica (SSSS, por sus siglas en inglés). Clínicamente se presenta con fiebre, hipotensión y erupción cutánea exfoliativa.Se expone un caso en donde las lesiones cutáneas por COVID-19 precedieron a las manifestaciones respiratorias.

ABSTRACT The exfoliative shock syndrome (ESS) associated with COVID-19 is a recently described disease with overlapping features of toxic shock syndrome (TSS) and staphylococcal scalded skin syndrome(SSSS). Clinically it presents with fever, hypotension, and exfoliative skin rash. A case is presented in which the skin lesions by COVID-19 preceded the respiratory manifestations.

Erythroderma as first manifestation of squamous cell lung cancer: rare case report

Abstract Erythroderma as the first manifestation of a solid organ malignancy is rare. The underlying cancer is a challenging condition to diagnose. There are a few cases of erythroderma in cancer patients reported in the literature. We here describe the case of a 70-year-old man who presented with asthenia, weight loss, dry cough and total body erythema with desquamation over the past month. A chest computed tomography scan showed a nodular lesion, which was finally diagnosed as a squamous cell lung carcinoma. To our knowledge, as an erythroderma presentation, only 13 cases have been reported in the literature. This case report demonstrates the need to search for a neoplasm in patients presenting with erythroderma, particularly in the presence of accompanying debilitating symptoms.

Familial "benign" pemphigus? Erythroderma and fatal outcome

Abstract Hailey-Hailey disease, or familial benign pemphigus, is a rare bullous genodermatosis that usually presents with flaccid blisters, erosions, and maceration limited to flexural areas, resulting in increased morbidity and reduced quality of life for affected patients. The authors report an unusual case of generalized Hailey-Hailey disease with erythroderma and fatal outcome.

Application of laparoscopic exploration combined with abdominal exfoliative cytology in the diagnosis and treatment of locally advanced gastric cancer / 中华胃肠外科杂志

Objective@#To explore the clinical significance of laparoscopic exploration combined with abdominal exfoliative cytology in the diagnosis and treatment of patients with locally advanced gastric cancer.@*Methods@#Inclusion criteria: (1) cancer confirmed by gastroscopy and pathology without preoperative anti-tumor treatment; (2) no distant metastases found in preoperative imaging examinations; (3) patients without surgical contraindications and being tolerant to surgery; (4) patients were willing to undergo laparoscopic exploration and abdominal exfoliative cytology examination, and signed informed consent. A retrospective cohort study method was used to collect and analyze the clinicopathological data of 225 patients with advanced gastric cancer based on the above inclusion criteria from a prospective, multicenter, open, randomized controlled phase III clinical trial (registration No. NCT01516944) conducted between February 2012 and December 2018 in The Fourth Hospital of Hebei Medical University, including 162 males and 63 females with age ranged from 23 to 78 years old. Forty-five patients (20.0%) were classified as Borrmann type I to II, and 180 (80.0%) were classified as type III to IV. All the patients underwent laparoscopy and peritoneal lavage cytology under general anesthesia. Laparoscopic exploration sequence: left and right diaphragm→liver and spleen→parietal peritoneum→pelvic cavity→greater omentum, small intestine, mesentery→transverse colon mesentery →stomach. Contents of exploration: (1) with or without ascites; (2) whether metastatic lesions existed in the peritoneum, mesentery, omentum and Douglas pouch; (3) whether metastasis existed on the liver surface; (4) whether the gastric lymph nodes were swollen; (5) whether infiltration occurred on the gastric serosa surface; (6) whether gastric wall was stiff. The left and right subphrenic, the abdominal and pelvic peritoneum, and the mesentery were rinsed with 500 ml of sterilized normal saline. Position of the reverse Trendelenburg was used in the Douglas pouch. The peritoneal lavage fluid under the liver and spleen fossa was collected. Cytological examination was carried out for exfoliative tumor cells. Evaluation criteria: (1) peritoneal metastasis (P): P0 meant no peritoneal metastasis, P1 meant peritoneal metastasis; (2) free peritoneal cancer cells (CY): CY0 meant no cancer cells in peritoneal lavage fluid cytology, CY1 meant cancer cells in peritoneal lavage fluid cytology. The results of patients undergoing laparoscopic exploration combined with abdominal exfoliative cytology, treatment options and prognosis were analyzed. Kaplan-Meier method was used to calculate the survival rate and a survival curve was drawn. Log-rank test was used for survival analysis.@*Results@#After laparoscopic exploration in 225 patients, clinical staging was corrected in 68 (30.2%) patients, of whom 7 (3.1%) downstaged and 61 (27.1%) increased in staging. Of 164 patients evaluated as P0CY0 after the first laparoscopy and peritoneal cytology examination, 126 underwent radical D2 surgery, and the other 38 patients were found to have later local lesions or extensive fusion of local lymph nodes, so then received neoadjuvant chemotherapy. Twenty-nine patients evaluated as P1CY0 or P1CY1 and 32 patients as P0CY1 underwent intraperitoneal hyperthermic chemotherapy+conversion therapy, and then a second laparoscopic exploration was performed to determine the treatment plan. In total, the original treatment regimens were changed after laparoscopic exploration in 99(44.0%) cases. The follow-up period ended in January 2019. The overall 2-year survival rate of 225 patients was 64.0%. As for those who were evaluated as P0CY0, P0CY1 and P1CY0-1 after the first laparoscopic exploration, the 2-year overall survival rate was 70.7%, 65.6% and 24.1%, respectively (P=0.002). The stratified analysis showed that among 180 patients with stage III tumor, after laparoscopic exploration combined with abdominal exfoliative cytology, 125 patients were found to be P0CY0, 28 were P0CY1, and 27 were P1CY0-1, whose 2-year overall survival rates were 70.4%, 64.3%, and 29.6% respectively, and the difference among these 3 groups was statistically significant (P=0.009).@*Conclusion@#Laparoscopic exploration combined with abdominal exfoliative cytology in patients with locally advanced gastric cancer has important clinical guiding significance in improving accurate staging, treatment options and prognosis evaluation, and can avoid non-therapeutic open-close abdominal surgery.

Cytomorphologic Analysis of Wet and Spray Fixation Methods in Oral Exfoliative Cytology

@#For a long time, oral exfoliative cytology (OEC) has been implemented as an effective preliminary diagnostic tool for pathological lesions and various methods for fixation of the cytology specimens have been studied. The present study was undertaken to compare the efficacy between the wet and spray type of fixation methods for Papanicolaou (PAP) stained oral cytosmears. The study comprised of 45 healthy subjects in the age group of 20-25 yrs. For each subject, two smears were collected from the buccal mucosa and subjected to wet and spray fixation methods respectively. Both the smears were stained using a commercial Rapid Pap Kit. Smears were observed microscopically and evaluated for cytomorphological features involving uniformity of staining, cellular morphology, nuclear morphology, cellular staining, nuclear staining and presence of impurities. Comparisons were made between the two methods of fixation and statistically analysed using McNemar non-parametric test. Cells were evenly distributed in wet-fixed smears (n=38, 95%) compared to spray fixed smears (n=19, 47.5%). Wet-fixed smears showed lesser impurities (n=13, 32.5%) than spray fixed smears (n=27, 67.5%). However, other parameters such as cytological and nuclear morphology, staining of cytoplasm and nucleus were found to be not significant when compared between the two methods of fixation (p<0.05). The study shows that wet-fixed smears have better cellular distribution and relatively fewer impurities when compared to the spray fixed smears. The method of wet-fixed smears may be used as an alternative to spray fixed smears. A larger sample size may be required for further validation.

Herbert screw internal fixation for treating adult osteochondritis dissecans of the knees / 中国组织工程研究

BACKGROUND: Osteochondritis dissecans of the knee in adults may lead to local instability of articular cartilage and subchondral bone. If it is not treated in time, it will have a secondary impact on articular cartilage, and the probability of osteoarthritis of knee joint is significantly increased. At present, there is no clear treatment plan. OBJECTIVE: To investigate the clinical effect of knee arthroscopy combined with Herbert bidirectional compression screw internal fixation for osteochondritis dissecans of the knee. METHODS: Adult patients who met the diagnostic criteria of osteochondritis dissecans of the knee from June 2014 to September 2018 were retrospectively analyzed, and those with other knee joint diseases were excluded. There were 43 patients treated, including 25 males and 18 females. All patients were treated with knee arthroscopy combined with Herbert two-way compression screw internal fixation. All patients were adults, aged 18-53 years, with an average age of (29.00±4.62) years. All patients had unilateral knee joint disease, including 19 cases of the left limb and 24 cases of the right limb. Before treatment and at final follow-up, knee motion range was compared. Visual analogue scale score was used to evaluate knee pain. Knee Lysholm score was used to evaluate knee function. RESULTS AND CONCLUSION: (1) Of the 43 patients, 35 completed the follow-up time of more than 1 year, and the follow-up time was 12-20 months, with an average of (14.0±2.5) months. None of the patients had related complications. (2) Knee joint pain and function improved significantly in all patients after surgery. The mean knee motion range before operation was (109.57±12.45)°, and (126.39±13.73)° at the final follow-up (t=-56.72, P <0.001). Visual analogue scale score was (5.53±1.47) before surgery and (0.79±1.35) (t=-137.51, P < 0.001) after surgery. Mean Lysholm score was (58.27±10.51) before surgery, and (89.36±5.43) postoperatively (t=-163.65, P < 0.001). (3) Knee arthroscopy combined with Herbert’s two-way compression screw internal fixation for adult osteochondritis dissecans of knee has reliable fixation and small surgical trauma, which can significantly improve knee function, and the clinical effect is satisfactory.

Epidemiology of exfoliative dermatitis at the University of Santo Tomas Hospital (Department of Dermatology) from 2008-2012: A five-year review

@#INTRODUCTION: Exfoliative dermatitis is a potentially life- threatening inflammatory reaction that poses a significant risk for morbidity and mortality. Several underlying etiologies of this dermatologic condition include pre-existing dermatoses, drugs and malignancy. Although it is a common disease entity, local studies on exfoliative dermatitis published in literature are very limited. OBJECTIVE: The primary objective of this study is to determine the epidemiological profile of patients with exfoliative dermatitis diagnosed at University of Santo Tomas Hospital Dermatology department from January 2008 to December 2012. METHODS: Inpatient and outpatient clinical records of patients diagnosed and treated as exfoliative dermatitis were retrieved. The prevalence, clinical presentation, history of previous dermatoses or use of any drugs/topical medications, family history and accompanying systemic symptoms were reviewed and analyzed. RESULTS: A total of 67 patients were included in this retrospective study. The prevalence among patients with exfoliative dermatitis in this study was computed at 1 per 1000 dermatologic patients. The highest number of cases belonged to the group aged seventy-one to seventy-nine (25.4%) with a mean age of 56.62 years. There was a male predilection (65.7%). Clinical presentation of patients included pruritus, generalized scaling and erythema, accompanied by bipedal edema (41.8%), chills (22.4%), fever (T ≥ 38 °C), lymphadenopathies (6%) and joint pains (4.5%). Several etiologic factors of exfoliative dermatitis recorded were: pre-existing dermatosis (67.2%), idiopathic or undetermined causes (19.4%), drug-induced (10.4%) and malignancy (3%). CONCLUSION: Exfoliative dermatitis is a condition more commonly found in the older age group. Pre-existing dermatoses, drugs and malignancy are etiologic factors. The most common pre-existing dermatosis causing exfoliative dermatitis in this study is psoriasis while the most implicated drug is allopurinol.

An exfoliative cytological study of qualitative changes in buccal mucosa cells of type 2 diabetes patients in south gujarat region

Background: Diabetes mellitus is a metabolic disease and affects many organs of the body including oralmucosa. Exfoliative cytology can be used to detect the effects of diabetes on buccal mucosa cells.Aim: The present study will evaluate the qualitative changes (cytomorphology) of buccal mucosal cells in type 2diabetic patients and compare that with the non-diabetic individuals of South Gujarat region.Materials and Method: Present study was done on 50 type 2 diabetic patients (case) and 50 healthy individuals(control) selected as per exclusion and inclusion criteria. Procedure was explained to the participants andinformed written consent was taken. Buccal mucosa smears were taken and stained with Pap’s stain. 100 cellsof each Pap stained smear was examined under a research microscope for various cytomorphological changes.Smears were examined for cell morphology like binucleation, pyknosis, perinuclear halo, cytoplasmic granules,karyolysis, karyorrhexis, cytoplsmic vacuoles and micronuclei. All data were noted and subjected to statisticalanalysis.Results: Mean values of binucleated cells, pyknotic cells, perinuclear halo, cytoplasmic granules, karyolyticcells, karyorrhectic cells, cytoplasmic vacuoles and micronuclei were noted in controls and cases. Significantdifferences in between non-diabetic control and diabetic cases for mean values of binucleation (p<0.001),pyknosis (p<0.001), perinuclear halo (p<0.001), cytoplasmic granules (p<0.001), karyolysis (p=0.026) andkaryorrhexis (p<0.001) was observed. But no significant differences in the mean cells for cytoplasmic vacuoles(p=0.109) and micronuclei (p=0.176) were found between diabetics cases and non-diabetics control.Conclusion: The results of present study showed that buccal mucosa of diabetic case group is associated withsignificant differences in the mean values of qualitative changes like binucleation, pyknosis, perinuclear halo,cytoplasmic granules, karyolysis and karyorrhexis when compare to non-diabetic control group. Diabetesproduces significant qualitative (cytomorphologic) changes in the buccal mucosa cells that can be documentedby exfoliative cytology.

Erythroderma as a manifestation of leprosy

Abstract: Erythroderma consists of erythema and scaling involving most or all of the body surface. This generalized eruption may be idiopathic, drug-induced or secondary to cutaneous or systemic disease. A 71-year-old man is reported presenting generalized erythema and desquamation with deck-chair sign, nail dystrophy, and plantar ulcers associated with loss of local tactile sensitivity. Biopsies from three different sites demonstrated diffuse lymphocytic infiltrate with incipient granulomas. Fite-Faraco staining showed numerous isolated bacilli and globi. The skin smear was positive. Clinical and pathological diagnosis of borderline lepromatous leprosy was confirmed. This report demonstrates that chronic multibacillary leprosy can manifest as erythroderma and thus should be included in the differential diagnosis.

Cytological Grading Of Oral Submucous Fibrosis

Oral submucous fibrosis (OSMF) is a condition that was first described in the 1950s. It is caused as a result of addiction to harmful areca nut products with or without tobacco. The rationale of using exfoliative cytology in our study lies in the epithelial physiology where continuous exfoliation of epithelial cells is a part of physiological turnover. Deeper cells, which are strongly adhered in normal conditions, become loose in the case of malignancy and exfoliate along with superficial cells. Our aim in this study was to compare the cellular changes such as formation of micronuclei within the cell and cytomorphometric analysis of the buccal mucosal cells of OSMF patients with that of normal controls. We identified thirty three such cases of OSMF on the basis of oral inspection and examination. We used exfoliative cytology and liquid based cytogy to obtain buccal cells. The smear thus prepared was stained with feulgan fast green, acridine orange and papanicolou. Micronuclei were identified and cytomorphometric analysis was done using Adelta software. There was a change in the hue of Papanicolou from pink to purplish indicating the degree of keratinization from normal cells to cells affected by OSMF. Acridine orange gave a green emission at wavelength 480-490 to normal cells, while it gave a bright red fluorescence in cells undergoing apoptosis. Mean cellular diameter decreased from normalcells affected oral lesions. Mean nuclear cytoplasmic ratio increased from normal-cells to those affected by oral lesions. Frequency of micronuclei increased from normal to the cells affected by oral lesions. Buccal cell mutations in premalignant and malignant lesions can serve as a useful tool for the bio-monitoring of oral lesions. Exfoliative Cytology being minimally invasive and cost effective can help in mass screening programmes

Pattern of Smokeless Tobacco Use in Various Age Groups and Its Association withthe Frequency of Micronuclei in Exfoliated Buccal Cells

Introduction: Exfoliated buccal epithelial cells serve as an ideal site for an assessment of genotoxic events. Exfoliative cytology is economical and minimally invasive, its specificity and sensitivity of over 95% makes it an ideal diagnostic tool for mass screening purposes. An assessment of micronuclei in buccal epithelial cells gives a fair idea about the genotoxic events occurring in the oral cavity. Subjects and Methods: A case controlled study was performed on 300 participants. The participants were divided into four broad categories according to their pattern of consumption of smokeless tobacco. Thereafter they were subdivided in to various age groups. The distribution was done equally with 60 participants in each broad category. Results: The results in our study show that young adults consume the packaged form of smokeless tobacco while adults above 50 consumed tobacco leaves. Oral lesions were more common in young adults. Cellular alterations in the form of micronuclei were observed to have progressively increased from the control group to tobacco to gutkha users and the frequency of micronuclei was found to be highest in the oral lesions group. Conclusion: Certain lifestyle factors, such as consumption of smokeless tobacco are one of the major factors causing oral lesions. Frequency of micronuclei was assessed in exfoliated buccal epithelial cells. Maximum number of micronuclei was found in the oral lesion group. The age group with maximum cellular alterations was between 30-40 years. Hence we conclude that an assessment of micronuclei can be used as a biomarker for mass screening purposes since it is economical and a non- invasive procedure.