The Efficacy and Safety of Eberconazole Nitrate 1% and Mometasone Furoate 0.1% w/w Cream in Subjects with Inflamed Cutaneous Mycoses.

BACKGROUND: Topical antifungal agents along with the steroids may provide not only rapid symptomatic relief but also clearance of disease causing fungi in inflamed cutaneous mycoses (ICM). AIM: To assess the efficacy and safety of fixed dose combination (FDC) of Eberconazole nitrate 1% and Mometasone furoate 0.1% w/w cream, in subjects with ICM. METHODS: This was a multi-centric, non-comparative study conducted in 155 eligible adult Indian subjects with ICM. They were treated with study medication for 21 days (D21) and followed up on day 35 (D35). Efficacy (by Investigator's Static Global Assessment-ISGA, symptom severity scores) and safety were assessed to evaluate the therapeutic response. RESULTS: Of 155 subjects, 129 completed the study. Lesions healed completely in 77.52% and improved markedly in 22.48% patients by D21. There was a statistically significant reduction (p<0.001) in total symptom score (TSS) and mean severity scores of erythema, scaling and pruritus on days 7 and 21 compared to baseline. There was no treatment failure. Only 11 patients remained culture positive on D21 compared to 68 at baseline. Physicians evaluated the drug as 'Good' in 72% and 'Excellent' in 28% of subjects; adverse events were reported in 27.74% subjects and none was severe. There was a decrease in serum cortisol level in 4.52% (7/155) subjects and was considered clinically significant in three subjects. On D35, 18.55% and 24.20% subjects had greater ISGA score and TSS respectively, compared to D21. CONCLUSION: Tested FDC demonstrated efficacy and was well tolerated by study population. It offers an effective and safe therapeutic option for the management of ICM.

Evaluation of Efficacy, Safety, and Tolerability of Fixed Dose Combination (FDC) of Halometasone 0.05% and Fusidic Acid 2% W/W Topical Cream Versus FDC of Betamethasone Valerate 0.12% and Neomycin Sulphate 0.5% W/W Topical Cream in the Treatment of Infected Eczematous Dermatosis in Indian Subjects: A Randomized Open-Label Comparative Phase III Multi-Centric Trial.

AIM: To evaluate the efficacy and safety of fixed drug combination (FDC) halometasone 0.05% and fusidic acid 2% (group A) vs FDC betamethasone 0.12% and neomycin sulfate 0.5% cream (group B) in acute or chronic infected eczematous dermatosis, through a randomized open-label, comparative, multicentric study. MATERIALS AND METHODS: A total of 152 patients were randomized to either Group A or Group B. EASI (Eczema Area and Severity Index), IGA (Investigator's global assessment), scale for severity of eczema, pruritus, and safety parameters were assessed at baseline, Day 5/Day 10, Day 10/20, and Day 20/Day 30 for acute/chronic cases. Skin swabs were tested at screening, Day 10, and end of the study. RESULTS: Staphylococcus aureus was the frequently encountered causative agent. There was a significant reduction within the study groups in EASI, IGA scales for severity of eczema, pruritus at various visits, compared to baseline. At the end of study, 83.87% in group A and 65.71% in group B were culture negative. Cure rate was 54.28% and 50% in group A and B, respectively. Five adverse events were reported in five patients, of which three patients withdrew from the study. CONCLUSION: Halometasone 0.05% and Fusidic acid 2% cream is effective, safe, well tolerated with comparable efficacy to the comparator in the treatment of acute and chronic infected eczematous dermatosis.

Response to narrow-band UVB--vitiligo-melasma versus vitiligo: a comparative study.

BACKGROUND: Vitiligo is the most common depigmentary disorder of the skin and hair, resulting from selective destruction of melanocytes. Melasma, a hyperpigmentary disorder, presents as irregular, brown, macular hypermelanosis. A small subset of vitiligo patients paradoxically also have melasma. OBJECTIVE: To evaluate and compare the response to narrow-band UVB in a group of patients with vitiligo, and another group of patients with vitiligo and coexisting melasma (vitiligo-melasma). METHODS: Patients in both groups were treated with narrow-band UVB and a comparison of the zonal repigmentation was made at 4, 8, and 12 weeks after the initiation of therapy. RESULTS: At the end of 12 weeks, 86% of patients in the vitiligo-melasma group attained ≥75% pigmentation on the face, whereas this was achieved in only 12.5% of patients in the vitiligo group. Over the limbs, 73% of patients in the vitiligo-melasma group attained 75% or more pigmentation at the end of 12 weeks compared with only 9% in the vitiligo group. On the trunk, only 20% of vitiligo-melasma patients showed ≥75% pigmentation at 12 weeks compared with 63% of patients in the vitiligo group. CONCLUSION: Patients having both vitiligo and melasma have a significantly better prognosis for repigmentation on the face and limbs with narrow-band UVB compared with patients with vitiligo alone; the vitiligo-melasma patients achieve repigmentation much earlier and also attain a greater level of repigmentation. Unexpectedly, for truncal lesions, patients with vitiligo alone responded better than those with both conditions. Although the vitiligo-melasma group with truncal lesions started repigmenting earlier, the final pigmentation was more extensive in the vitiligo group.

Efficacy and safety of topical halometasone in eczematous dermatoses in Indian population: an open label, noncomparative study.

BACKGROUND: Topical steroids remain the mainstay of treatment in eczema, an inflammatory skin reaction characterized by pruritus, redness, scaling, and clustered oozing papulovesicles. Halometasone is a new potent corticosteroid approved in the Indian market for topical application in the treatment of dermatitis. AIMS: To evaluate the efficacy and safety of halometasone in the treatment of acute or chronic noninfected eczematous dermatosis in Indian population. MATERIALS AND METHODS: A prospective, open, multicentric, phase 3, noncomparative clinical trial conducted at outpatient departments of seven centres. Two hundred endogenous eczema patients meeting study criteria were enrolled. Halometasone 0.05% cream was applied twice daily for 30 days in chronic and 20 days in acute eczema patients. Calculation of eczema area and severity index, and assessment of investigator's global assessment of severity of eczema and severity of pruritus score were done at each visit and compared with baseline. All adverse events (AE) were captured and documented. Laboratory investigations including haematological tests, urinalysis, renal and liver function tests were performed at baseline and at end of treatment. RESULTS: Of the 200 patients enrolled, 180 were chronic and 20 were acute eczema patients. It was found that there was a significant (P<0.001) improvement in all efficacy parameters compared with baseline. The treatment was shown to be successful in 91% patients. AE were reported in 30 patients and there was no serious AE reported. There was no clinically significant difference in laboratory investigations with treatment. CONCLUSIONS: Halometasone was shown to be safe and very effective in Indian patients with acute and chronic eczema and the drug was well tolerated.

Disseminated histoplasmosis with conjunctival involvement in an immunocompromised patient.

We report a case of disseminated histoplasmosis in a 37-year-old male acquired immunodeficiency syndrome patient from south India. The patient presented with high-grade fever, cough, conjunctival nodule and papulonodular hyperpigmented skin lesions. Histology of skin lesions and conjunctival nodule showed numerous intracellular Periodic Acid Schiff-positive rounded yeast cells within macrophages. Bone marrow aspirate confirmed disseminated histoplasmosis. The patient showed dramatic response after starting treatment with Amphotercin B.

Nevus of Ota: a series of 15 cases.

BACKGROUND: The nevus of Ota is a dermal nevus characterized by bluish pigmentation in the distribution of the first and the second division of the trigeminal nerve. AIM: Our aim was to study the cutaneous and extracutaneous manifestations of the nevus of Ota. METHODS: A total of 15 cases were included in our study. A detailed history, clinical examination along with direct ophthalmoscopy and otoscopy were done for all the cases. RESULTS: Most of the patients (60%) had lesions at birth and the majority (86.7 %) were females. Five (33.3%) patients belonged to Tanino class II. Combined dermal and ocular involvement was observed in 60% of the cases. CONCLUSION: Tanino class II was the most common type observed in our studies. A few rarer associations such as nevus of Ito and hemangioma were also noted in our patients.

Angiogenesis in cutaneous lesions of leprosy: implications for treatment.

OBJECTIVE: To examine the potential role of angiogenesis in leprosy. DESIGN: Immunohistochemical analysis of leprosy lesions. SETTING: Department of Dermatology, Venereology, and Leprology, Kasturba Medical College; Division of Dermatology, University of California at Los Angeles; and Departments of Dermatology and Pathology, Emory University. PATIENTS: Thirty-two cutaneous lesions that represented the spectrum of leprosy were obtained from 32 patients. MAIN OUTCOME MEASURE: CD31 microvessel counts. RESULTS: The mean CD31 microvessel count in borderline tuberculoid, midborderline, and lepromatous leprosy lesions was significantly higher than in indeterminate leprosy lesions. CONCLUSIONS: Increased bacterial load is associated with increased angiogenesis. Angiogenesis inhibitors may be of benefit in the treatment of leprosy.

Pattern of skin diseases among migrant construction workers in Mangalore.

BACKGROUND: With increasing industrialization, the construction industry provides employment to a large number of skilled and nonskilled workers, many of them migrant workers. AIM: This study was undertaken to provide epidemiological data regarding various dermatoses among migrant construction workers in India as currently there is a paucity of the same. METHODS: One thousand construction workers, including 467 migrant laborers, were examined for various dermatoses. RESULTS: Most (88%) workers were males and 51.17% were in their third decade. Infective and noninfective dermatoses were seen in 89.72% and 53.74% of laborers respectively. Among infective dermatoses, fungal infections were the most common (46.25%) ones, followed by bacterial infections (24.83%), scabies (8.56%) and viral infections (6.42%). Contact dermatitis to cement was seen in 12.48% of the laborers. Masons had a significantly higher incidence of contact dermatitis to cement, viral infections and scabies than helpers. CONCLUSIONS: The pattern of dermatoses is an expression of poverty, overcrowding and the occupational hazards of the construction industry.

Methicillin-resistant Staphylococcus aureus in community-acquired pyoderma.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen. It can also cause community-acquired infections. Indian reports about MRSA in community-acquired infections are rare. AIM: To evaluate the rate of MRSA in community-acquired pyoderma and the nasal colonisation with S. aureus in such patients. METHODS: Two hundred and fifty patients with community-acquired pyoderma, who attended outreach camps around Mangalore, south India between January 2000 and July 2001, were studied. Swabs collected from the skin lesions and anterior nares were inoculated onto blood agar and MacConkey's agar. Antimicrobial sensitivity testing was performed using Kirby-Bauer disk diffusion, agar dilution, and agar screen. RESULTS: Of 250 pyoderma cases, S. aureus was isolated from 202 (80.8%) patients. Twenty-two (10.9%) S. aureus isolates were methicillin resistant, 179 (88.6%) were resistant to penicillin, and 114 (56.4%) were resistant to erythromycin. S. aureus colonization in the anterior nares was observed in 136 (54.4%) cases, 11.8% of which were MRSA. Antibiograms of clinical isolates of S. aureus matched with nasal isolates in 99 (49%) cases. CONCLUSION: The emergence of MRSA in the community is a warning. A high nasal carriage rate may contribute to recurrent pyoderma. A correct antimicrobial policy and the avoidance of inappropriate antimicrobial usage are mandatory to reduce the spread of MRSA in the community.

A study of skin disorders in patients with primary psychiatric conditions.

BACKGROUND: The skin occupies a powerful position as an organ of communication and plays an important role in socialization throughout life. The interface between dermatology and psychiatry is complex and of clinical importance. AIMS: To document the incidence of cutaneous disorders in patients with primary psychiatric conditions. METHODS: Three hundred patients with a primary psychiatric condition who had cutaneous disease were entered into the study group. The patients were classified appropriately based on the classification of psychocutaneous disorders. The control group included 300 patients presenting with a skin disorder and without any known psychiatric complaint. RESULTS: The majority of the cases in the study group were in the 3rd-5th decade. In this study, the most common primary psychiatric conditions were manic depressive psychosis (53.33%), depression (36.33%), schizophrenia (8.33%) and anxiety (2%). Of the study group, 68.66% patients had infective dermatoses and the rest had non-infective dermatoses. A high incidence of pityriasis versicolor and dermatophyte infections was noted in males from the study group. Among non-infective dermatoses, 8% had eczema, and psychogenic skin disorders were seen in 4.67% of the study group. Of these, delusions of parasitosis were the commonest (2%) followed by venereophobia (1%). CONCLUSIONS: A statistically significant higher incidence of tinea versicolor and dermatophyte infections was seen in the study group. Delusion of parasitosis was the most common psychogenic skin disorder seen in the study group, followed by venereophobia.

Occupational dermatoses in beedi rollers.

A total of 91 beedi workers were analyzed for the pattern of cutaneous lesions. Period of rolling beedi ranged from 2 months to 40 years. Dermatological findings included; callosities seen in 51 (56.04%) of workers on fingers and feet, nail changes in 22 (24.18%) like pigmentation, paronychia, dystrophy which were more prominent on the right index finger, fungal infections in 15 and eczemas in 29. Callosities and localised nail changes can be considered to be occupational marks in beedi rollers correlated to use of scissors for cutting leaves and use of gum and artificial metallic nails for rolling beedis.

Generalised cutis laxa.

A 44-year-old man presented with generalised progressive lax skin of 14 years duration associated with dysphagia, joint pains and hoarseness of voice. Examination revealed "blood hound" like facies, lox skin with loss of elasticity, dilated tortuous superficial vessels over extremities and back. Systemic involvement noted were oesophageal and pharyngeal diverticuli, inguinal hernia and dermatochalasis. Skin biopsy using Verhoeff Van Gieson's stain was suggestive of cutis laxa.

Rare sequelae of herpes zoster in HIV positive patient.

A 34 year -old woman, who was diagnosed to be HIV positive 4 years back, presented with zoster along T-6 dermatome followed by development of keloid.