Efficacy of oral terbinafine versus itraconazole in treatment of dermatophytic infection of skin - A prospective, randomized comparative study.

OBJECTIVES: Dermatophytic infections are the common fungal infections aggravated by hot and humid climate. Terbinafine and itraconazole are commonly used oral antifungal agents for the same. However, resistance to these drugs is being seen increasingly when used in the conventional doses and duration. Therefore, this study was designed to compare the efficacy of terbinafine and itraconazole in increased dosages and duration in the treatment of tinea corporis and tinea cruris. MATERIALS AND METHODS: In this randomized comparative study, patients of tinea cruris and tinea corporis were randomly divided into two groups of 160 each and were given oral terbinafine (Group I) and oral itraconazole (Group II) for 4 weeks. The scores and percentage change in scores of pruritus, scaling, and erythema were evaluated at 2 and 4 weeks. RESULTS: At the end of week 4, mycological cure was seen in 91.8% after 4 weeks in the itraconazole group as compared to 74.3% of patients in the terbinafine group. There was a significant improvement in percentage change in pruritus, scaling, and erythema in both the groups from 0 to 4 weeks. On comparing groups, the percentage change was significantly different in scaling from 0 to 2 weeks (5.4 vs. -4.8) and 2-4 weeks (16.7 vs. 29.6) between Group I and Group II, respectively. Clinical global improvement was better with itraconazole. Mild adverse effects such as gastrointestinal upset, headache, and taste disturbances were observed which were comparable in both the groups. CONCLUSIONS: Itraconazole and terbinafine seem to be equally effective and safe in the treatment of tinea cruris and tinea corporis.

A Study of Cutaneous Adverse Drug Reactions in a Tertiary Care Center in Punjab.

CONTEXT: Cutaneous adverse drug eruptions are the most common adverse reactions attributed to drugs in which any type of skin reaction can be mimicked, induced, or aggravated. AIMS: To study the pattern of various types of cutaneous adverse drug reactions (CADRs), to find out the causative drug(s) involved and to determine the response to treatment and outcome in patients with CADRs. PATIENTS AND METHODS: This prospective study was done in the department of dermatology. Patients with suspected drug rash, of either sex and all age groups were included in the study. STATISTICAL ANALYSIS: Frequencies and proportions were calculated using Chi-square test and t-test as the tests of significance. Data was analyzed using SPSS version 21. RESULTS: A total of 258 patients were enrolled in the study. The most common CADR observed in the study was exanthematous drug eruption in 42.63% patients followed by drug induced urticaria in 21.32% patients. Antimicrobials were the most common offending drugs in 64.73% of patients, followed by non-steroidal anti-inflammatory drugs (NSAIDs) in 15.50% patients. In the study, 12 patients (4.65%) were found to have severe cutaneous adverse drug reactions (SCADRs). Stevens-Johnson syndrome (SJS) - Toxic epidermal necrolysis (TEN) was the most common SCADR (50%) and antituberculous drugs were the most common causative group of drugs causing SCADRs. CONCLUSION: The most common CADR observed in the study was exanthematous drug eruption and antimicrobials were the most common causative drugs.

Fixed drug eruption related to sunitinib: a case report.

Sunitinib is an oral multi-targeted tyrosine kinase inhibitor. It has been approved for the treatment of gastro-intestinal stromal tumor and advanced renal cell carcinoma. Fixed drug eruption related to sunitinib is a rare cutaneous adverse drug reaction.

Pattern of Inpatient Dermatology Consultations in a Tertiary Care Centre from Northern India.

INTRODUCTION: The importance of dermatology inpatient consultation is of significant importance yet is not well documented. AIM: To retrospectively analyse the spectrum of dermatology inpatient consultations from the various departments and to document the most commonly occurring dermatological disorders from each speciality. MATERIALS AND METHODS: This study was done in an 800 bedded premier teaching hospital in Ludhiana, Punjab, North Western India. It was an audit of inpatient referrals to the dermatology department from January 2014 to August 2014. We analysed the spectrum of dermatological disorders in relation to the various specialities, demographic profile and age groups. STATISTICAL ANALYSIS: The data was entered in Microsoft Excel and analysed using SPSS Version 21. Descriptive statistics, frequency and proportions were used. RESULTS: Of the 559 in-patients, 60% were males. The majority of the patients belonged to age group 51-60 years (25.9%). The departments most commonly requesting for dermatology consultations were Medicine (27.7%), Neurology (9.7%), Cardiology (8.8%), Urology (7%), Haematology (6.4%), Nephrology (6.1%), Intensive Care Unit (ICU) (5.4%), General Surgery (5.2%), Orthopaedics (5%), Gynaecology and Neurosurgery (2.9%) and Paediatrics (2.7%). The commonest dermatological diagnoses for which consultations were sought were eczematous dermatitis (12.9%), superficial dermatophytosis (12.3%), drug reactions (8.9%) and viral skin infections (8.5%). CONCLUSION: Dermatology consultations offer a significant role in diagnosis and management of the in-patients from various clinical speciality departments. There is a significant need of inter-departmental dermatology consultations which help to decrease morbidity and improve the quality of the patient's hospital stay. Knowledge about the pattern of dermatoses in the inpatients can help the primary clinician to recognize when to seek dermatology consultation on a priority basis.

A case of secondary syphilis with HIV, resembling borderline lepromatous leprosy.

We are reporting an unusual case of secondary syphilis, in a homosexual male patient, which resembled borderline lepromatous leprosy, and in whom the diagnosis was considered on clinical grounds. The patient also had concomitant HIV infection, with asymptomatic neurosyphilis. His rapid plasma reagin test was reactive in 1:128 dilution. He improved with three standard, weekly injections of benzathine penicillin, along with 2 g of intravenous ceftriaxone daily for 15 days. This case is being reported to highlight the need for a high index of suspicion in diagnosing unusual cases of secondary syphilis, especially in those with concomitant HIV infection.

Lichenoid drug eruption due to imatinib mesylate.

Imatinib mesylate is a selective tyrosinase kinase inhibitor which has revolutionized the treatment of chronic myeloid leukemia. It is also used in gastrointestinal stromal tumors and dermatofibrosarcoma protruberans. Cutaneous adverse reactions are the most common nonhematological side effects secondary to imatinib. Nonlichenoid reactions are common, while lichenoid reactions are rare. We report a case of lichenoid drug eruption due to imatinib. As the indications and use of imatinib are increasing, the incidences of adverse effects, including cutaneous ones, are likely to increase. Some of the reactions may be severe enough to warrant discontinuation of the drug. The physicians should be aware of this morphological entity, which is usually benign and does not warrant withdrawal of the drug.

Terbinafine induced pityriasis rosea-like eruption.

Terbinafine is an allylamine antifungal agent which is widely used for the treatment of fungal infections. Cutaneous side effects have been reported in 2% of the patients on terbinafine therapy with many morphological patterns. We report a case of terbinafine induced pityriasis rosea, a very rare side effect of terbinafine. This report emphasizes the importance of counseling the patient to report immediately in the event of a cutaneous eruption.

Mucocutaneous manifestations of Dengue fever.

Dengue viral infection is a cause of considerable morbidity and mortality and may be associated with a variety of mucocutaneous manifestations that may provide important early clues to the diagnosis of this condition. Cutaneous and mucosal findings like confluent erythema, morbilliform eruptions, and hemorrhagic lesions may figure prominently in the clinical features of dengue. The differential diagnoses include a large number of bacterial and viral exanthems as well as drug rash.