Refractory alopecia in lupus treated with tofacitinib - a case-based review.

One of the common cutaneous symptoms of systemic lupus erythematosus (SLE) that may have major psychosocial effects in a female is diffuse alopecia. Although Janus kinase inhibitors have shown encouraging results in the treatment of SLE and of alopecia areata in recent studies, tofacitinib in treating refractory alopecia caused by SLE has been rarely documented. The Janus kinases (JAKs) are intracellular tyrosine kinases that play a significant role in the pathophysiology of SLE by participating in a wide range of inflammatory cascades. Here, we reported a 33-year-old SLE patient with long standing (3 years) refractory alopecia who took tofacitinib and observed a substantial increase in hair growth. This was sustained at 2-years follow-up even after tapering off glucocorticoids completely. In addition, we reviewed the literature to look for further evidence to support the use of JAK inhibitors for alopecia in SLE.

Occupational Dermatoses.

Occupational skin diseases (OSDs) are one of the major problems in working life. Among occupational diseases, 30-45% are skin diseases. Contact dermatitis accounts for the greatest part (95%) of OSDs. It adversely affects the quality of life of workers. Classification of OSD is too difficult as there are geographical variations in the occupational groups affected. However, commonly affected occupational groups are agricultural workers, healthcare workers, construction workers, metal workers, cleaners, housekeepers, food handlers, hairdressers, beauticians, and mechanics. Because of the unorganized workplace, lack of a proper notification system for occupational dermatoses, and under-reporting of cases, there is a paucity of information regarding the magnitude of the problem of OSD in India. Although in India many studies have been conducted on individual small occupational groups, data on the complete epidemiology of OSD is limited. In this article, we have tried to compile the common OSDs in various occupations.

Mal De Meleda with Flexural Involvement.

Mal de Meleda is a rare variety of palmoplantar keratoderma with an autosomal recessive mode of inheritance and an estimated prevalence of 1 in 100,000 in general population. The disease is associated with consanguinity, starts in infancy, and characterized by progressive palmoplantar keratoderma spreading to dorsum of hands and feet. Involvement of extensors of knee and elbow were well described in literature. We report a rare case of Mal de Meleda with flexural involvement, which has not been reported in literature.

Clinico-Epidemiological Profile of Allergic Contact Dermatitis and Its Correlation With Patch Testing in a Tertiary Care Center in Eastern India.

BACKGROUND: Allergic contact dermatitis (ACD) is one of the most common skin disorders seen among patients attending dermatology clinics in India. Patch testing is the gold standard for diagnosing ACD. The clinical-epidemiological pattern of ACD and the allergen-causing it may be different in different geographic locations. Finding the profile of allergens commonly causing ACD in a particular region will help to formulate prevention strategies for the development of ACD. AIM AND OBJECTIVE: The primary aim of the study was to find out the clinical-epidemiological distribution of allergic contact dermatitis and to identify the common allergens causing it by patch testing in this region of India. MATERIALS AND METHODS: A total of 111 cases of ACD were included in the study. Clinico epidemiological profiles of all patients were documented. The patch testing was performed in the outpatient department using the antigens of the Indian Standard Series kit (Systopic Laboratories Pvt. Ltd., New Delhi, India). Patches were removed after 48 hours (two days) of application. The first reading was taken 15 to 20 minutes after the removal of patches on day two. A second reading was taken on day four (96 hours of application) to confirm the presence of an allergic reaction.  Results: The patch test was found to be positive in 69% of cases. It was observed that male persons from lower socioeconomic status were getting ACD on most accounts. Potassium dichromate (PDC) was found to be the most common allergen (30.43%) followed by parthenium (26.08%), para-phenylenediamine (PPD) (21.73%), nickel sulfate (18.84%), chlorocresol (15.94%), black rubber (14.49%), cobalt sulfate (13.04%), and wool alcohols (7.24%) respectively. CONCLUSION: Our study showed potassium dichromate is the commonest allergen causing ACD in this part of the country. The importance of patch testing lies mainly in educating the patient regarding the avoidance of exposure to particular allergens to avoid the development of new ACD as well as an exaggeration of pre-existing ACD.

Basidiobolomycosis: Case Report and Literature Overview.

Basidiobolomycosis or subcutaneous zygomycosis or subcutaneous phycomycosis is a chronic granulomatous infection of skin and subcutaneous tissue, caused by a saprophytic filamentous fungus, Basidiobolus ranarum, clinically characterized by firm, painless subcutaneous swelling with smooth and rounded edges. Histopathological features include the peculiar Splendore-Hoeppli phenomenon. Culture on Sabouraud dextrose agar shows creamy white, heaped up, and furrowed colonies. This entity has been reported from tropical and subtropical regions of the world and the southern part of India. We report a case of Basidiobolomycosis in a seven-year-old girl from Eastern India, which was excised twice before presenting to us. We diagnosed the case as Basidiobolomycosis based on clinical features, histopathology, and culture findings, and treated it with itraconazole.