Tadalafil-Induced Generalized Bullous Fixed Drug Eruption: A Rare Side Effect of a Common Drug.

Tadalafil is a phosphodiesterase-5 (PDE-5) inhibitor, an FDA-approved treatment for erectile dysfunction (ED), pulmonary arterial hypertension (PAH), benign prostate hyperplasia, etc. It is also widely used by otherwise healthy individuals for recreational purposes. Fixed drug eruption (FDE) is a distinctive type of adverse drug reaction in which every exposure to the offending medication leads to the appearance of lesions at the same 'fixed' sites. A sharply defined erythematous patch or plaque with a violaceous hue is typically seen. A clinical variant featuring classic FDE lesions along with blistering in at least three out of six anatomical sites or involving at least 10% of body surface area is known as generalized bullous fixed drug eruption (GBFDE). Tadalafil-induced FDE is in itself an uncommon phenomenon, with only a handful of documented cases, none of which seem to have reported GBFDE-type presentation post-tadalafil intake. Here, we present a case of GBFDE following tadalafil administration.

Nailfold Capillaroscopic Changes as a Marker of Interstitial Lung Disease in Systemic Sclerosis: A Cross-Sectional Study in a Tertiary Care Hospital in Eastern India.

Background: Systemic sclerosis (SSc) is an autoimmune connective tissue disorder causing microvascular abnormality leading to Raynaud's phenomenon, skin tightening, and nailfold capillary changes. The patient may have systemic involvement, among them interstitial lung disease (ILD) and pulmonary arterial hypertension are mainly associated with disease-related mortality. Aims: To find out an association between nailfold capillaroscopic changes with ILD severity. Materials and Methods: An institution based cross-sectional study was performed among the patients of SSc above 18 years. Detailed history was taken. Clinical examinations, nailfold capillaroscopy (NFC) with a dermatoscope and high-resolution computed tomography (HRCT) scan of thorax were done. Data were analyzed in MedCalc statistical software version 20. Results: Out of total 43 patients, 74.4% (n = 32) were female. Mean age was 35.05 ± 7.24 years and mean duration 4.28 ± 2.81 years. Diffuse SSc was found in 88.37% (n = 38). On NFC, early, active, and late patterns were found in 30.2% (n = 13), 25.6% (n = 11), and 44.2% (n = 19) cases, respectively. On HRCT, early, active, and late ILD were present in 18.6% (n = 8), 37.2% (n = 16), and 30.2% (n = 13) cases, respectively. ILD changes were absent in 14% (n = 6) though NFC changes were present in them. Respiratory symptoms were absent in 20.93% (n = 9) patients though all had features of early NFC and among them 9.3% (n = 4) showed early ILD changes on HRCT. Significant associations were found between NFC changes and ILD severity (P = 0.0003), NFC changes and respiratory symptoms (P < 0.0001) and between ILD changes and respiratory symptoms (P < 0.0001). Discussion: NFC, an inexpensive procedure, can be performed in all patients of SSc to detect development of early ILD even before appearance of respiratory symptoms to prevent further progression.

Extracorporeal Therapy in Dermatology.

Extracorporeal therapy is a treatment modality where human blood undergoes favorable technical modifications and is reintroduced into the same patient. Since the last four decades this technique has been deployed in the management of difficult and refractory disorders in dermatology. Over a period of time newer techniques like immunoadsorption has emerged and opened new vistas in management of morbid dermatoses. In extracorporeal photopheresis a patient's leukocytes are separated and treated outside with Ultra Violet A in presence of 8-methoxypsoralen. Double filtration plasmapheresis and Immunoadsorption are techniques to remove offending immune complexes. They are safe and reduce the need of toxic medications that are conventionally used in recalcitrant skin diseases. In recent years immunoadsorption is emerging as first-line therapy in condition like immunobullous diseases. High cost is one of the important factors limiting their wider use in developing countries like India. Our review discusses different extracorporeal therapies, their applications, recommendations and guidelines based on various clinical trials.

Moxifloxacin-induced oral erythema multiforme: An unusual adverse effect hitherto unreported.

Moxifloxacin is a fluoroquinolone with excellent activity in community-acquired respiratory tract infections. Common adverse effects are gastrointestinal symptoms, headache, dizziness, etc., Some serious adverse effects include tendon rupture, rhabdomyolysis, peripheral neuropathy, and interstitial nephritis. Cutaneous adverse effects include allergic reactions, angioedema, Steven-Johnson syndrome, and toxic epidermal necrosis. Erythema multiforme (EM), an acute self-limiting disease, most commonly occurs due to infection and rarely due to drugs or systemic disease. EM is classified into EM major and minor, both having skin lesions. A third category of EM has also been described with only oral involvement and without any skin lesions. Oral EM itself is an uncommon entity which has been reported due to nonsteroidal anti-inflammatory drugs. Here, we are reporting a case of moxifloxacin-induced oral EM. After extensive search in PubMed-Medline database, we could not find any such co-occurrence of moxifloxacin-induced oral EM. To the best of our knowledge, this is the first reported case.

Dermatoses among Children from Celebration of "Holi," the Spring Festival, in India: A Cross-sectional Observational Study.

BACKGROUND: "Holi" is a spring festival celebrated primarily in the Indian subcontinent and also abroad by expatriate Indians. It is a festival of colors, traditionally celebrated by mutual application of colors in different forms on a particular day of the year. These colors frequently comprise a range of synthetic dyes which have harmful effects on the skin and mucosae. Children take part in this colorful festival with much enthusiasm and vigor, making them prone to develop different "Holi"-related dermatoses. Our objective was to find out the different patterns of "Holi"-related dermatoses in a group of pediatric patients. METHODOLOGY: This was a cross-sectional descriptive study carried out over a period of 6 years (2010-2015). Consecutive patients of pediatric age group who attended dermatology outpatient department (OPD) with different dermatoses following application of "Holi" color were included in this study. RESULTS: A total of 63 patients (mean age 11 years; range 1-16 years) were evaluated with a female to male ratio of 1.3:1. Itching is the predominant presenting symptom followed by burning sensation, dryness, scaling, oozing, and loss of hair. Examination revealed that eczematous lesion was the most common (69.8%) reaction pattern followed by xerosis, desquamation, excoriation, erythema, morbilliform eruption, erosion, alopecia, ulceration, acute paronychia, and hyperpigmentation. The face was the most common (76.4%) site of affection. CONCLUSION: A sizable number of patients of pediatric age group may be affected by "Holi"-related dermatoses necessitating precautionary measures.

LEOPARD Syndrome.

LEOPARD syndrome (LS) is an autosomal dominantly inherited or sporadic disorder of variable penetrance and expressivity. The acronym LEOPARD stands for its cardinal clinical features including Lentigines, Electrocardiographic conduction abnormalities, Ocular hypertelorism, Pulmonary stenosis, Abnormalities of genitalia, Retardation of growth, and Deafness. We present herein a patient with LEOPARD syndrome and distinctive features. It was noteworthy that our patient presented with the concern of generalized lentiginosis and subsequent evaluation revealed that the patient had LEOPARD syndrome. In this report we would like to highlight the importance of detailed clinical examination and appropriate imaging in patients with multiple lentigines.

A curious case of blue-green discoloration in a middle-aged indian man: Chromhidrosis.

INTRODUCTION: Chromhidrosis is a rare sweat gland disorder characterized by the excretion of colored sweat. It can be classified as apocrine, true eccrine, and pseudochromhidrosis. Amongst the different types of chromhidrosis, green chromhidrosis is extremely rare. We describe herein a case of blue green chromhidrosis induced by ingestion of homeopathic medicine. CASE REPORT: A middle aged man presented to us with blue green discoloration of hands and feet. There was a preceding history of ingestion of homeopathic medication. Histopathology from the involved skin showed greenish particles within eccrine glands. Initial blood copper level was high which returned to normal level after discontinuation of the homeopathic medicine. Spectrophotometry revealed high copper content of the green sweat. CONCLUSION: Our case emphasizes the importance of considering any type of ingested medicine, including homeopathic medicine, as a probable cause of chromhidrosis.

Porokeratotic eccrine ostial and dermal duct nevus - revisited.

We hereby report a rare case of a 14-year-old girl presenting with asymptomatic pitted papules over the flexor aspect of her right 4th and 5th digits. This was histopathologically proven to be porokeratotic eccrine ostial and dermal duct nevus (PEODDN).