Hemorrhagic and Ecthymatous Varicella in Immunosuppressed Adults: Report of Two Cases.

Varicella infection in immunosuppressed adults can be severe with atypical presentation of skin lesions. Hemorrhagic and ecthymatous varicella is a rare entity and can be misdiagnosed due to its atypical presentation. In its severe form, individuals with underlying cell-mediated immunodeficiency disorders have a high risk of developing multiple organ involvement associated with varicella-zoster virus infection. Here, we report two cases of primary varicella with hemorrhagic and ecthymatous skin lesions in adults receiving systemic immunosuppressive drugs for autoimmune disorders. There are only a few case reports on hemorrhagic and ecthymatous varicella. Hence, this case report highlights the atypical presentation of varicella in immunosuppressed adults, which necessitates an early diagnosis and prompt treatment as a lifesaving step.

Lipid Accumulation Product Index as Visceral Obesity Indicator in Psoriasis: A Case-control Study.

BACKGROUND: Psoriasis has well-known associations with individual components of metabolic syndrome such as hypertension, dyslipidemia, insulin resistance, and obesity. Traditional anthropometric measurements of obesity such as waist circumference (WC) and body mass index (BMI) do not differentiate between subcutaneous fat and visceral fat, the latter being associated with cardiovascular risk factors. Lipid accumulation product (LAP) index is a measure of visceral fat and has been found to be a better predictor of cardiovascular risk. However, LAP index has not been well-studied in psoriasis patients. AIMS AND OBJECTIVES: Our objective was to find out if LAP index differs significantly between psoriasis patients and controls and whether LAP index shows a correlation with duration and severity of psoriasis. MATERIALS AND METHODS: A case-control study was undertaken with 40 chronic plaque psoriasis patients and 42 controls. BMI and LAP index were calculated for all the patients and controls. Psoriasis area severity index (PASI) was calculated for all the psoriasis patients. Mann-Whitney U-test was done for comparing the age, BMI, WC, serum triglyceride, and LAP index between the cases and controls and to compare the LAP index between mild psoriasis and moderate-to-severe psoriasis groups. Spearman's correlation coefficient was used to assess the correlation of LAP index with duration of psoriasis and with PASI. Logistic regression models were done to assess the risk factors in psoriasis. RESULTS: A statistically significant difference was observed between the LAP index of controls (23.79 ± 13.02) and that of psoriasis patients (46.42 ± 27.2). LAP index was significantly higher in the moderate-to-severe psoriasis group as compared to the mild psoriasis group. LAP index was a significant risk factor associated with psoriasis (OR = 1.07; 95% CI: 1.03 - 1.11). CONCLUSION: Calculation of LAP index in psoriasis patients helps in identification of more individuals at high risk of cardiovascular morbidity than traditional anthropometric measurements of obesity.

A study of community-associated methicillin-resistant Staphylococcus aureus in patients with pyoderma.

BACKGROUND: Health care-associated methicillin-resistant Staphylococcus aureus(HA-MRSA) are resistant to multiple antibiotics, therefore infections caused by them are difficult to treat resulting in high morbidity and mortality. While most of the research activities and public health initiatives are focused on HA-MRSA, the newly emerging pathogen, community-associated methicillin-resistant Staphylococcus aureus(CA-MRSA) is gaining in significance in respect to patient morbidity. There is a significant paucity of data regarding CA-MRSA in the developing parts of the world. AIM: To study the proportions of HA-MRSA and CA-MRSA infections among patients with culture-proven S. aureus infection and to find out how many of these patients showed presence of MRSA in nasal cultures of healthy contacts. MATERIALS AND METHODS: Clinical details of 227 patients were recorded in the study, such as the duration and recurrence of the infection, history of antibiotic intake, and the presence of other medical illnesses. A pus swab was taken from each lesion and sent for culture and sensitivity. If the culture grew S. aureus, they were screened for methicillin resistance. A swab from the anterior nares of the healthy contact of each patient, whenever available, was collected and it was screened for MRSA. RESULTS: Furunculosis was most common among the primary pyodermas (53/134; 39. 5%). Out of 239 pus culture samples obtained from 227 patients, 192 (84.58%) grew S. aureus; of these 150 (78.12%) were methicillin-sensitive S. aureus (MSSA), whereas 42 (21.98%) were MRSA. Out of the 42 MRSA isolated, 33 turned out to be CA-MRSA (78%) and 9 (22%) were HA-MRSA. Nasal swabs of healthy contacts of 34 MRSA patients were cultured. Out of them, two grew MRSA in the culture. CONCLUSION: The isolation rate of S. aureus was high in our study. Furthermore, our study, although hospital based, clearly indicated the substantial magnitude of the CA-MRSA problem in the local population.

Prevalence of Metabolic Syndrome in Psoriasis Patients and its Relation to Disease Duration: A Hospital Based Case-Control Study.

INTRODUCTION: Previous studies indicate a higher prevalence of metabolic syndrome in psoriatic patients. This study aimed to investigate the association of metabolic syndrome and its components with psoriasis. It also studied the relation between presence of metabolic syndrome and disease duration in psoriasis patients. MATERIALS AND METHODS: This was a hospital-based, case-control study conducted with 30 clinically diagnosed patients of chronic plaque psoriasis and 30 age- and sex-matched control subjects. Height, weight, BMI, blood pressure and waist circumference were assessed in all the subjects. Fasting levels of serum glucose, serum triglycerides and serum HDL were estimated by automated clinical chemistry analyser. Metabolic syndrome was diagnosed by the presence of at least 3 criteria of NCEP ATP III with Asian modification for waist circumference. RESULTS: Metabolic syndrome was more common in psoriatic patients than in controls but the difference was statistically insignificant (60% vs. 40%, p-value=0.12). The psoriasis group had a higher prevalence of elevated blood glucose levels and higher waist circumference compared to controls. Psoriasis patients had a higher prevalence of high triglyceride levels than controls, the difference being statistically insignificant (40% vs. 30%, p-value = 0.41). The prevalence of low HDL levels was significantly higher in cases compared to controls (86.7% vs. 60%, p-value = 0.02). There was no relation between presence of metabolic syndrome and duration of psoriasis. CONCLUSION: Our findings suggest that metabolic syndrome as well as dyslipidaemia is commoner in psoriasis patients. This underlines the need for screening of all psoriasis patients for early diagnosis and treatment of associated metabolic syndrome to reduce the high burden of morbidity and mortality.

Patch Test as a Diagnostic Tool in Hand Eczema.

INTRODUCTION: Allergic contact dermatitis is an important cause of hand eczema. Patch testing is the only investigation available to prove the diagnosis of allergic contact dermatitis. Exposures to allergens differ according to geographical, occupational, economic and social factors. Accordingly, patterns of allergic contact dermatitis differ in different parts of the world and different regions of the same country. AIM: To study the causes of allergic contact dermatitis in adult patients with hand eczema with the help of patch testing. MATERIALS AND METHODS: This was a cross-sectional study involving 54 hand eczema patients conducted between October 2013 and June 2015, at a tertiary care centre in Southern India. After a detailed history including history of occupational exposure and detailed examination, patch test was done on these patients with Indian standard series. The patches were removed after 48 hours. Another reading was taken after 72 hours. The readings were interpreted according to International Contact Dermatitis Research Group criteria and noted down. The data were summarized using mean and standard deviation for continuous variables and percentages for categorical and dichotomous variables. The test of association was done with Fisher's-exact test. RESULTS: Hyperkeratotic hand eczema was the commonest morphological type (29%), followed by discoid eczema. Pompholyx was significantly more common among patients with history of atopy. A total of 20 patients (37%) showed patch test positivity to a total of 25 allergens. Nickel was the most common allergen (11.11%) followed by para-phenylenediamine (PPD) (7.4%). Nickel (6 patients) and cobalt (3 patients) were the common allergens among women, while potassium dichromate (3 patients) and parthenium (2 patients) were the common allergens among men. Potassium dichromate allergy was significantly more common among masons and PPD allergy was significantly more common among hair dye users. Discoid pattern of hand eczema was common among patients with allergy to potassium dichromate. CONCLUSION: Majority of the cases of hand eczema are not due to allergic contact dermatitis. History of atopy is common among patients with pompholyx. Allergic contact dermatitis due to nickel remains a common cause of hand eczema.

Coexistence of mucous membrane pemphigoid and vitiligo.

Mucous membrane pemphigoid describes a rare heterogeneous group of chronic, inflammatory, mucous membrane-dominated, subepithelial blistering diseases that manifest a varying constellation of oral, ocular, skin, genital, nasopharyngeal, esophageal, and laryngeal lesions. Life-threatening airway obstruction and sight-threatening ocular scarring can occur in this condition, which is rarely reported in Indian literature. Vitiligo is another acquired autoimmune disorder characterized by loss of melanocytes. Vitiligo is associated with a number of disorders also considered to be autoimmune. Here we report a very rare coexistence of MMP and vitiligo, the first such report from India.

Autologous serum skin test as an indicator of chronic autoimmune urticaria in a tertiary care hospital in South India.

BACKGROUND: Autologous serum skin test (ASST) is a simple in-vivo clinical test for the detection of basophil histamine releasing activity and to diagnose chronic autoimmune urticaria (CAU) among chronic spontaneous urticaria (CSU) patients. Diagnosing these patients is also important as they may need high doses of antihistamines and systemic corticosteroids during acute exacerbations. AIMS AND OBJECTIVES: The aim of this study is to study the prevalence of CAU among cases of CSU by using ASST. MATERIALS AND METHODS: This was a cross-sectional study done among 48 patients presenting with CSU. Detailed history, physical examination and routine investigations were recorded for all patients. ASST was done on all the 48 patients. RESULTS: Of the 48 patients included in the study, 20 patients (41.6%) were ASST positive, while the remaining 28 (58%) were ASST negative. The median duration of disease in both ASST positive and negative patients was 1 year. ASST positivity was higher (66.6%) among patients with a history of round shaped weals, though not statistically significant. ASST positivity was seen in 5 (71.4%) out of seven patients with systemic involvement, which was again not statistically significant. CONCLUSION: Our study did not show any significant difference between patients with and without antibodies regarding mean age and sex distribution, clinical morphology of individual weals, duration, severity, systemic symptoms, angioedema, atopy, and association with other autoimmune conditions.