Diagnosis of a recurred lesion in dermatophytosis patients after 2 weeks of antifungal therapy: A prospective observational study.

Few researchers believe that various risk factors may complicate the course of dermatophytosis and/or develop various dermatoses unrelated to fungal infection at the previous lesion site. However, there is a paucity of studies that analyzed the diagnosis of lesions that recurred at the treated site of dermatophytosis. Materials and Methods: A prospective observational study was conducted on 157 cases of dermatophytosis with positive fungal test results. A fixed dose of 100 mg of oral itraconazole once daily was administered to all patients for 2 weeks. At the end of 2 weeks, patients were assessed for clinical cure and recurrence. Recurred cases were assessed for mycological profile using a fungal test (potassium hydroxide mount and/or fungal culture) for identifying fungal infection. Results: Only eight (5.36%) patients showed clinical cure, and 141 (94.63%) patients developed recurrence after therapy. Of the 141 cases with recurrence, only 47 (33.33%) patients were positive for fungus. Eight (5.09%) patients were lost to follow-up. Frequently encountered risk factors in the study were topical steroid use, disease in family, associated atopic dermatitis and contact with pets. Conclusion: This is the first study that described the clinical diagnosis and mycological profile of the various lesions recurring at the previous tinea infection site in patients with dermatophytosis. Such patients presented not only with recurrent lesions of fungal infection but also developed various dermatoses unrelated to fungal infection at the sites of previous tinea infection. Various factors, which could have resulted in the observed changes, are reinfection by dermatophytes at the sites of previous tinea infection, inadequate antifungal therapy or antifungal resistance; or due to the effects of various topical steroid formulations used by the patients, such as anti-inflammatory or immunosuppressive effects or shift in immunity. Hence, diagnosis of the recurrent lesion at the site of previous dermatophytosis must be individualized and should be based on 1) duration of antifungal therapy received, 2) associated risk factors, 3) response to antifungal therapy, 4) evolution of the recurrent lesion, and/or 5) fungal tests.

Adult-Onset Asthma with Periocular Xanthogranuloma (AAPOX), a Variant of Periorbital Xanthogranulomatous Disease: An Uncommon Entity.

Adult orbital xanthogranulomatous disease (AOXGD) is a rare granulomatous disorder. Adult-onset asthma with periocular xanthogranuloma (AAPOX) which is a subtype of AOXGD is very rare and a realtively unknown entity among dermatologists. Very few cases had been reported in literature. Clinically recurrent periorbital swelling and its location may mimic other dermatological conditions like sarcoidosis, necrobiotic xanthogranuloma, dermatomyositis, and rarely amyloidosis. Herein we report a female with recurrent periorbital swelling with brownish yellow papulonodular lesions on periorbital area with adult-onset asthma. Histopathology and immunohistochemistry proved the diagnosis. She was started with systemic methylprednisolone and methotrexate and improved significantly after 4 months. We report this case because of its rarity and to create awareness among dermatologists about this uncommon entity.

Progressive Osseous Heteroplasia: A Rare Case Report.

Progressive osseous heteroplasia (POH) is a rare genetic condition of progressive extraskeletal bone formation. POH is clinically suspected by cutaneous ossification, usually presenting in early life, that involves subcutaneous and then subsequently deep connective tissues, including muscle and fascia. We report a case of POH in a 3-year-old child with multiple nontender subcutaneous nodules which, on radiology and histopathology, showed intracutaneous bone formation. Although there is no specific and effective treatment, knowledge about this entity is necessary for early detection and genetic counseling of parents.

Secondary Syphilis with Polymorphous and Sweet Syndrome like Lesions: A Rare Case Report.

Secondary syphilis can present with wide range of mucocutaneous lesions. Because of its varied morphology, it is considered a great mimicker. However, syphilitic lesions presenting as Sweet syndrome is uncommon. We report a case of a 28 year adult male presenting with erythematous edematous papules and plaques with pseudovesicular appearance, lichenoid annular plaques on skin, and painless indurated ulcer over the glans. The Venereal Disease Research Laboratory test was reactive (1:32 dilutions), and treponema pallidum hemagglutination test was positive. The histopathology from erythematous edematous lesion and genital ulcer revealed neutrophilic abscess and characteristic plasmacytic picture in biopsy, respectively. He was treated successfully with single dose intramuscular injection of benzathin penicillin 2.4 million units. This case is reported for its rarity.

Annular Pattern of Pustular Vasculitis: A Case Report of Unusual Morphological Presentation.

Pustular cutaneous vasculitis is a rare entity. Only handful cases are reported from all over the world. They typically present with painful pustules mainly over dorsum of hands and rarely on lower legs. We report a 50-year female who presented with painful pustules arranged in annular pattern predominantly distributed over lower limbs. Laboratory investigation ruled out any systemic associations. Histopathology was suggestive of pustular vasculitis. Final diagnosis of idiopathic pustular vasculitis was made. The patient was successfully treated with oral prednisolone and dapsone without any recurrence on follow up. It is the first report of annular morphological presentation of pustular vasculitis.

Pyoderma Gangrenosum Over Hypertrophic Scar: Report of a Rare Presentation.

Pyoderma gangrenosum (PG) is a chronic neutrophilic dermatoses characterised by large ulcer healing with cribriform scar. PG can rarely occur over the healed scar. Its diagnosis depends on clinical morphology and exclusion of other diseases. We report a case of large pyoderma gangrenosum ulcer on a hypertrophic scar since 1 year. Biopsy from ulcer edge was suggestive of PG and hypertrophic scar. The hypertrophic scar had been formed by healing of a large ulcer 2 years back. The ulcer healed to two-third size over next three months with monthly dexamethasone pulse, daily oral steroid and dapsone. This case was unique since the PG ulcer had occurred over a hypertrophic scar. Such a presentation in PG is rare and physicians should be aware of such occurrence of PG.

Dyschromatosis Universalis Hereditaria with Hypospadias: A Rare Association.

Dyschromatosis universalis hereditaria (DUH) is a rare genodermatosis, which presents as hyper- and hypopigmented macules all over the body. Although a benign condition, rarely DUH is associated with abnormalities of dermal connective tissue, nerve, and systemic conditions. We report a case of DUH associated hypospadias and complicated with hydronephrosis that has not been described earlier.

Co-occurrence of Symmetrical Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) and Pigmented Fixed Drug Eruption (FDE) in a Single Patient Due to Doxycycline: A Case Report.

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), and fixed drug eruption (FDE) are adverse cutaneous drug reactions. SDRIFE is most commonly associated with the use of beta-lactam antibiotics. There is only one case report describing SDRIFE due to intake of doxycycline in literature. Previously reported case describes the characteristic morphology of well-defined macular erythema over the flexural and intertriginous area. We here in report a 38-year-old male presented with unusual morphology of SDRIFE, and well circumscribed erythematous patches suggestive of FDE on the thigh and back after doxycycline intake. Histopathology was consistent with SDRIFE and FDE respectively. The skin lesions improved with 5 days of 40 mg oral prednisolone. After 6 weeks, drug provocation with doxycycline was done following which patient developed itching and erythema over the older sites. Though there is a single published report of SDRIFE due to doxycycline, our case had additional findings of having pigmented FDE lesions along with flexural lesions of SDRIFE.