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.

Development and Validation of the ScAbIeS Tool for Diagnosing Scabies by Community Healthcare Workers in Resource-Limited Settings.

Introduction Scabies can lead to community outbreaks if not diagnosed early. Developing and validating a relevant tool for diagnosing scabies at the community level is essential to bridging the early diagnosis and treatment gap. Objective The objective of this study is to develop and validate a newer tool to diagnose scabies at the community level by Community Healthcare Workers (CHWs) in resource-limited settings. Methods The developed "ScAbIeS" tool comprised five items divided into two major and three minor criteria. After its development, a longitudinal descriptive study validated the "ScAbIeS" tool. The eligible participants were included in the study through active screening in villages under the Rural Health Training Center (RHTC) Mendhasala. Those villages' Accredited Social Health Activists (ASHS) were included as CHWs for diagnosing scabies using the "ScAbIeS" tool. The participants with skin lesions and/or itching were diagnosed with scabies by CHWs using the "ScAbIeS" tool. The diagnosis of CHWs using the "ScAbIeS" tool was compared with those of physicians, including expert dermatologists, to determine the sensitivity and specificity. Results Kappa's agreement is found to be 0.896 for CHWs and trained physicians regarding the diagnosis of scabies by the "ScAbIeS" tool. Cronbach's alpha is 0.738 for major criteria and 0.565 for minor criteria. 0.778 is found to be Cronbach's alpha for the total scale. The "ScAbIeS" tool is 85% sensitive and 100% specific to diagnose scabies when used by CHWs. Conclusion The "ScAbIeS" tool can be used to diagnose scabies at the community level by CHWs with appropriate training. It will lead to the prevention of complications and community outbreaks of scabies.

Psychosocial Distress and Quality of Life Among Patients With a Chronic Skin Disorder at a Tertiary Care Hospital in Eastern India: A Hospital-Based Case-Control Study.

Background Chronic skin disorder affects the physical and psychological well-being of patients. The impact of psychological burden ranges from low self-esteem and stress to anxiety and depression. Hence, this study was conducted to compare the psychological distress and quality of life (QoL) of patients with a comparative group without any apparent skin disorders. Methods This hospital-based case-control study was done on adult patients (≥18 years) suffering from any chronic skin disorder for three or more months and attending the dermatology out patient department (OPD) of a tertiary care institution of Eastern India. Data was collected from 101 patients and 101 controls (matched for age, gender, and place of residence) after obtaining written informed consent in May and June, 2017. Depression was assessed using the Patient Health Questionnaire-9, anxiety was assessed using the Generalised anxiety disorder-7 scale, and health-related quality of life (HRQoL) was assessed using the World Health Organization Quality-of-Life Scale (WHOQoL-BREF). Prevalence and mean scores were compared using Chi-square test and t-test. Results About half (49.5%) of the cases had clinically significant impairment of their dermatological quality of life. Clinically significant depression and anxiety was found in 45.54% and 41.58% patients respectively. Depression (OR=4.13, 95% CI 2.06-8.45) and anxiety (OR=4.42, CI=2.13-9.51) were significantly higher in cases as compared to the controls. No significant difference was seen in HRQoL scores. Conclusion Screening for anxiety, depression, and QoL should be done for patients of chronic skin disorders attending dermatology OPD so that appropriate psychiatric consultation can be offered to those in need.

Strongyloides Hyperinfection Syndrome in Dermatology in-Patients: A Case Series.

Strongyloides stercoralis is a common intestinal pathogen, which often causes disseminated infection in patients on long term immunosuppressive therapy. The features of this syndrome range from subtle abdominal discomfort to fatal infection. Many of the immunologically mediated dermatological conditions need prolonged treatment with Immunosuppressants. Hence there is increased risk of this infestation. In dermatology in-patients, strongyloides stercoralis hyperinfection can be confused with a number of conditions, such as steroid-induced gastritis, corticosteroid withdrawal, electrolyte imbalance, lepra reactions, and erythrodermic enteropathy. In a country like India, where barefoot walking is still prevalent, this condition has been reported less often. We report a series of five patients who were diagnosed with strongyloides hyperinfection syndrome during their admission in the dermatology department during the last year. This case series aims at creating awareness among the dermatologists, so that, this, potentially fatal but easily preventable and treatable condition, can be managed properly.

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.

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.

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.

Cutaneous Botryomycosis in Immunocompetent Patients: A Case Series.

Botryomycosis is a rare chronic suppurative bacterial infection of skin and viscera mostly reported in immunocompromised adults. Most of published literature on botryomycosis are case reports. Though morphological presentation of cutaneous botryomycosis has been described as nodules, sinus, abscesses, and ulcers discharging seropurulent exudates, sequential evolution of lesions is not clear. We report a series of three cases of cutaneous botryomycosis in immunocompetent patients (one child and two adults). Two cases had localized lesion, while adult male had lesions in a sporotrichoid distribution. In all cases the lesions evolved in the form of appearance of subcutaneous swelling which later on developed multiple nodules and papules on surface which either developed erosion, ulceration or sinus on surface associated with seropurulent discharge. The organisms isolated from discharge and tissue culture were coagulase negative staphylococcus and methicillin sensitive staphylococcus aureus. All cases were treated with monotherapy of sensitive systemic antibiotic. Two patients fully recovered and one lost to follow-up in the middle of therapy.

Cutaneous Munchausen Syndrome by Proxy: A Diagnostic Challenge for Dermatologist.

Munchausen syndrome by proxy (MSBP) is a rare psychiatric disorder of a caregiver (commonly mother) who induces injury or symptoms on victim because of his or her psychiatry illness. The victims are usually under 6 years of age who cannot complain regarding inflicted injury. Diagnosis is challenging to the physician. We came across a 15-month-old girl child, who had consulted various specialists for episodes of blister followed by erosions on body since 6 months of age. Dermatological examination revealed blisters and healed leaf-shaped scars of different sizes which were suggestive of scalds. Smell of different varieties of oils, dribbling of hot oil from body at various intervals, and mother being the first to notice appearance of new skin lesions in all past episodes lead to suspicion of cutaneous MSBP with mother being the culprit. The family members were counselled regarding nature and course of the condition, mother was started on psychotropics, and the child was rescued from mother along with symptomatic treatment of the skin lesions.