Nail Society of India (NSI) Recommendations for Pharmacologic Therapy of Onychomycosis.

Onychomycosis (OM) is the commonest cause of dystrophic nails, responsible for upto 50% of cases. Apart from significantly damaging the nails, quality of life, and self-image of the sufferer, it also acts as a reservoir of fungal infections carrying important implications for emerging recalcitrant dermatophytoses. Treatment of OM is based on guidelines released almost a decade back, in addition to published literature and personal preferences. Hence, an expert group of nail society of India (NSI) worked towards drafting these guidelines aimed at compiling recommendations for pharmacologic treatment of OM, based on scientific evidence, along with practical experience. The group did an extensive analysis of available English language literature on OM published during the period 2014-2022. The evidence compiled was graded and discussed to derive consensus recommendations for practice. Special focus was placed on combination therapies and adjunct therapies, including experience of members, to improve treatment outcomes.

Ni/Ni(OH)2-rGO nanocomposites sensor for the detection of long forgotten mycotoxin, xanthomegnin.

Xanthomegnin, a known fungal toxin, secondary metabolite, and pigment diffuses from the dermatophytes has gained attention as local virulence factor because of the mutagenicity, toxicity, cytocidal, and immunosuppressive properties. Not only as a dermatophyte in skin related disorders, the production of xanthomegnin is implicated as a powerful diagnostic marker in patients suffering from ocular mycoses. Incidentally also attributed to death in livestock's majorly by exposing themselves to food-borne fungi like Aspergillus and Penicillium. The production of xanthomegnin in dermetophytic species Trichophyton rubrum, found commonly in infected skin and nails. In this study nickel/nickel hydroxide nanoparticles decorated reduced graphene oxide (Ni/Ni(OH)2-rGO) modified glassy carbon electrode has been successfully used for non-enzymatic detection of xanthomegnin. The Ni/Ni(OH)2-rGO composites were synthesized through a simple microwave assisted technique with less harmful reducing agent. The UV-visible spectroscopy (UV-vis), X-ray photoelectron spectroscopy (XPS), Scanning electron microscopy - energy dispersive X-ray spectroscopy (SEM-EDS), and electrochemical investigations demonstrated the robust formation of the sensor. The sensor exhibited improved electrochemical properties with enhanced electrochemical active area and excellent electrochemical behavior towards xanthomegnin detection with a limit of detection of 0.12 µM. The selectivity, stability, and analytical recovery studies proved the potential use of the sensor for the detection of xanthomegnin in real samples. Further, the sensor successfully detected xanthomegnin produced by the Trichophyton rubrum, the most common superficial fungus, accounting for at least 60% of all superficial fungal infections in humans. Validation studies showed satisfiable and quantifiable amount of xanthomegnin in comparison with common bench mark UV-Vis studies meant for fungal mycotoxin detection.

Linear verrucous hemangioma of the upper limb: a rare case.

Verrucous hemangioma is a rare, congenital vascular malformation of the cutaneous and subcutaneous tissue. It is usually present at birth and gradually increases in size and number with age; occasionally it presents in later adulthood. It has a predilection for the lower extremity and usually presents as warty or hyperkeratotic, bluish and partly confluent papules and plaques. Verrucous hemangioma occurring in a linear pattern is an even more uncommon presentation and very few cases have been reported. We report a boy with verrucous hemangioma localized to the left upper extremity in a linear pattern. We also discuss management.

Diffuse leprosy with "deck-chair" sign.

A 55-year-old male presented with asymptomatic extensive skin lesions since one year. He was found to have diffuse lesions involving the face, trunk, arms, and thighs along with symmetric peripheral nerve thickening. Bacteriological and histopathological examination confirmed lepromatous leprosy. There was a conspicuous sparing of the abdominal creases and axillae from the infiltrative lesions suggesting a positive "deck-chair" sign. This sign has been described in the past with papulo-erythroderma of Ofuji and certain other disorders. Leprosy may be now included among the causes of "deck-chair" sign.

Comparison of potassium hydroxide mount and mycological culture with histopathologic examination using periodic acid-Schiff staining of the nail clippings in the diagnosis of onychomycosis.

BACKGROUND: Onychomycosis is a common problem noticed in clinical practice. Currently available standard laboratory methods show inconsistent sensitivity; hence there is a need for newer methods of detection. AIMS: This study involves comparison of standard laboratory tests in the diagnosis of onychomycosis, namely, potassium hydroxide mount (KOH mount) and mycological culture, with histopathologic examination using periodic acid-Schiff (PAS) staining of the nail clippings. METHODS: A total of 101 patients with clinically suspected onychomycosis were selected. Nail scrapings and clippings were subjected to KOH mount for direct microscopic examination, culture using Sabouraud's dextrose agar (with and without antibiotics) and histopathologic examination with PAS staining (HP/PAS). Statistical analysis was done by McNemar's test. RESULTS: Direct microscopy with KOH mount, mycological culture, and HP/PAS showed positive results in 54 (53%), 35 (35%), and 76 (75%) patients respectively. Laboratory evidence of fungal infection was obtained in 84 samples by at least one of these three methods. Using this as the denominator, HP/PAS had a sensitivity of 90%, which was significantly higher compared to that of KOH mount (64%) or mycological culture (42%). CONCLUSIONS: Histopathologic diagnosis with PAS staining of nail clippings was the most sensitive among the tests. It was easy to perform, rapid, and gave significantly higher rates of detection of onychomycosis compared to the standard methods, namely KOH mount and mycological culture.