ABSTRACT
BACKGROUND: Dermatophytosis has recently emerged as a major public health problem in the Indian subcontinent, most cases becoming chronic and recurrent. AIMS: Assessing the clinico-epidemiologic and mycologic profile of treatment naïve, chronic, recurrent and steroid-modified dermatophytosis. MATERIALS AND METHODS: We conducted across-sectional study involving 111 cases of dermatophytosis. Detailed epidemiology, clinical parameters, treatment history and other host factors were assessed along with scraping for potassium hydroxide (KOH) and fungal culture. RESULTS: Among 111 patients,(F: M 1.7:1; mean age 44.4 ± 18.2 years), 51.4% were treatment naïve, while 34.2% and 14.4% presented with chronic and recurrent tinea respectively. Family history and sharing of fomites among infected family members was commoner in the latter groups (P = 0.001). Topical steroid application was reported in 49.5%, however only 7.2% presented with steroid modified tinea. Tinea corporis et cruris (41.4%) was the predominant clinical type followed by tinea corporis (34.2%) and tinea cruris (27.9%). KOH mount and culture were positive in 62.2% and 39.6% cases respectively; commonest isolates being Trichophyton rubrum, and Trichophyton mentagrophytes complex in 15.3% cases each. Trichophyton rubrum was the commonest etiology for treatment naïve and recurrent cases, while Trichophyton mentagrophytes was the commonest isolate from chronic and steroid-modified cases (P = 0.0003). Interestingly, T.mentagrophytes complex and T. rubrum were the commonest causes of tinea corporis and tinea cruris respectively (P = 0.07). CONCLUSION: Trichophyton rubrum was the commonest organism in treatment naïve and recurrent cases, while Trichophyton mentagrophytes complex accounted for most cases of chronic and steroid modified tinea. The difference in predominant species seems to be a major contributory factor for chronicity and recurrence. However, several host factors like topical steroid use and sharing of fomites also play additional roles.
ABSTRACT
BACKGROUND: Linear lesions are fairly common in our daily practice. However, the appearance of these lesions can vary, thus complicating the diagnosis. AIMS: To study the various clinical presentations, the demographic profile of patients and the clinicopathological correlations of dermatoses presenting with a linear distribution. METHODS: We conducted an institution-based, cross-sectional, descriptive study of 281 consecutive patients with linear lesions attending dermatology clinics. MedCalc software (V11.6) was used for statistical analysis. RESULTS: Patients were divided into eight groups: lesions along the lines of Blaschko (n = 136), lesions along blood vessels (n = 3), lesions along lymphatics (n = 3), Koebner phenomenon (n = 24), autoinoculation (n = 24), external factors (n = 45), infestations (n = 2) and 'other' (n = 44). The mean age at presentation was 24.50 ± 18.82 years and the male/female ratio was 1.32 : 1. The commonest symptom was itching/burning (56.94% of patients), while the commonest site was the arm (44.48%); followed by the leg (30.60%), trunk and abdomen (22.42%), head and neck (19.20%), and genitalia (0.35%). Apart from the common cases, there was a wide gamut of rare conditions (e.g. angiokeratoma circumscriptum naeviforme, porokeratotic eccrine ostial and dermal duct naevus, Blaschko-linear syringocystadenoma papilliferum, progressive cribriform and zosteriform hyperpigmentation, unilateral naevoid acanthosis nigricans, fixed drug eruption, discoid lupus erythematosus). CONCLUSION: Linear lesions act as diagnostic clues to many dermatological conditions, therefore, the importance of meticulous examination in clinical dermatology cannot be overemphasized.
Subject(s)
Skin Diseases/pathology , Adolescent , Adult , Child , Cross-Sectional Studies , Diagnosis, Differential , Female , Humans , Male , Pain/etiology , Pruritus/etiology , Skin Diseases/complications , Skin Diseases/etiology , Young AdultABSTRACT
BACKGROUND: Foot dermatitis is a common debilitating dermatological disorder where the eczematous process predominantly involves the feet. AIMS AND OBJECTIVES: To analyze the clinico-demographic profile, type, clinical pattern, and evaluate the role of patch testing to determine the causative factors of foot dermatitis. MATERIALS AND METHODS: Fifty-eight new patients clinically diagnosed with foot dermatitis were subjected to detailed history taking and physical examination. The patients were subjected to patch testing using the Indian standard battery and Indian footwear series (Contact and Occupational Dermatoses Forum of India [CODFI]). RESULTS: Among the 58 patients (mean age 31.48 ± 16.4 years, M:F 1:1.2), the majority (39.7%) presented with allergic contact dermatitis (ACD) followed by irritant contact dermatitis (ICD) (19%), while atopic dermatitis was the least (3.45%). However, 48% of our patients reported a history of atopy. About 43.5% of ACD patients showed a positive patch test reactions to at least one allergen of Indian standard battery and footwear series. Mercaptobenzothiazole (MBT) was the commonest allergen (50%), followed by potassium dichromate (40%), thiuram mix (20%) while paraphenylenediamine was the least common (10%). Dorsum of the foot was affected most commonly (55.17%), followed by toe (46.55%) and sole (41.38%). Scaling was observed in almost 80% of patients followed by crusting. Housewives were affected most commonly followed by students and cement workers. CONCLUSION: Rubber and rubber chemicals were found to be the commonest allergen inciting foot dermatitis. Atopy might be a predisposing factor in these patients. Thus, patch testing is recommended to determine the cause of foot dermatitis and provide suitable treatment.
ABSTRACT
Ketamine, most often used as an anaesthetic agent can provide adequate post operative analgesia when delivered in the form of infusion, replacing narcotics, which can cause bronchospasm in susceptible individuals. This cohort study was undertaken to assess the feasibility of providing complete post operative analgesia in asthmatics with ketamine delivered in sub-anaesthetic doses (6.10-6.41 ugm./kg.-1/min-1). Diazepam (0.97-1.02 ugm./kg.-1/min-1) was delivered from the same infusion to eliminate the unwanted effects of ketamine. Ketamine induced little alteration in blood pressure while tachycardia was significant (P < 0.05). Respiratory functions observed, were favourable for asthmatics. Diazepam helped in reducing ketamine induced side effects, but after infusion over long periods tendency of cumulation was observed. Complications encountered were minimum with more than 93% patient acceptability for this method of analgesia.
