A Study on Knowledge, Attitude, and Practice Related to Sexually Transmitted Infections Among Students of Nonmedical Background in Manipal, India.

Background: Sexually transmitted infections (STIs) are one of the major public health problems in India with adolescents being a vulnerable section of the affected population. According to the World Health Organization (WHO), one in twenty adolescents contracts an STI every year, excluding the human immunodeficiency virus (HIV) and other viral infections. It is important to assess the knowledge, attitude, and practices related to STIs among adolescents and young adults of non-medical backgrounds to educate them properly about protective and preventive measures and to allay misconceptions, if any. Materials and Methods: This is a cross-sectional study involving 507 engineering students who were asked to fill out the predesigned anonymous questionnaire form. Results were statistically analyzed and tabulated. Results: Of the 507 students, 375 were males and 132 were females. The mean age of the patients was 20.5 years. HIV was the most commonly identified STI (94.2%), followed by herpes genitalis (76.5%). Around 97.4% and 85.7% identified the sexual route and blood transfusion as the modes of transmission of STIs, respectively. A total of 90.9% said that the Internet was their primary source of information regarding STIs. Infertility and cancer were identified as complications by 59.5% and 25% of them, respectively. Only 23.4% were aware of the National STI Control Program. The results with respect to attitudes and practices related to STIs were variable. Conclusion: Our study reflects that with change in time, the attitude of young adults toward sexuality is becoming very casual, but knowledge remains low. A lot of educational activities should be undertaken to educate our youth about various aspects of STIs and thus reduce the burden of the disease in the community.

Leukocytoclastic Vasculitis: A peculiar presentation of scrub typhus.

Scrub typhus is a disease endemic to the Indian subcontinent caused by the obligate intracellular pleomorphic organism, Orientia tsutsugamushi. Scrub typhus, among other acute febrile illnesses, manifests as prodromal symptoms of fever, malaise, myalgia and anorexia followed by a distinct maculopapular rash, hepatosplenomegaly and lymphadenopathy. We report the case of a patient presenting to tertiary care hospital in southern India in 2021 who developed a rare cutaneous vasculitis secondary to infection with Orientia tsutsugamushi. After performing the Weil-Felix test, a diagnostic titre of >1:640 against OXK was obtained. Furthermore, a skin biopsy was carried out which confirmed the diagnosis of leukocytoclastic vasculitis. The patient was treated with doxycycline and showed drastic improvement in his symptoms.

Risk of cutaneous carcinogenesis with phototherapy in Indian subpopulation: A 10-year analysis and a review of literature.

Phototherapy is an extremely effective and established therapeutic modality in a variety of dermatological disorders. However, there has been a constant concern with respect to its long-term usage as some of the studies have identified the risk of cutaneous malignancy associated with phototherapy. The carcinogenic potential of PUVA has been demonstrated in most US studies; however, the studies done on Asian and Arabian-African population have not corroborated similar findings, thus suggesting that the darker skin may confer protection against the development of cutaneous malignancy following phototherapy. The main aim of the present study was to assess the safety of phototherapy (bath PUVA and NBUVB) in Indian population (Fitzpatrick skin types IV and V) with respect to its carcinogenic potential and to determine the maximum cumulative dose that our patients could tolerate without developing any untoward complications such as cutaneous malignancy. All patients who received phototherapy between January 2006 and October 2016 were enrolled in the study. Details such as cumulative dose, number of phototherapy sessions received, indication for phototherapy, adverse effects such as pigmentary changes, new growths on the skin surface following the therapeutic sessions were entered in a predesigned proforma. This ambispective study had 1300 patients who had received phototherapy over a period of 10 years. A total of 929 patients had received PUVA, and the remaining 371 patients had received NBUVB for various dermatological indications. The average follow-up period for PUVA was 3 years and 6.5 years for NBUVB. The maximum cumulative dose of UVA and UVB that could be safely administered in our patients was 2085 J/cm2 and 1985 mJ/cm2, respectively. None of our patients developed any features of cutaneous malignancy during their follow-up. Both bath-PUVA and NBUVB are safe and efficacious in treating patients of darker skin types (IV and V). The risk of developing cutaneous malignancy is negligible in this subset of patients. However, more studies need to be done on the Asian population to substantiate the same.

Cutaneous ulceration as a presenting feature of type 1 lepra reaction: A case report.

Reactions in leprosy represent sudden shift in the immunological response and are seen in 11-25% of affected patients. It can be seen before, during or after the completion of multidrug therapy (MDT).1 Two types of reactions are recognized; Type 1 reaction (T1R), seen in borderline leprosy, affecting mainly skin and nerves; type 2 reaction (T2R) or erythema nodosum leprosum (ENL), seen in lepromatous leprosy, characterized by systemic features in addition to cutaneous lesions. Trophic ulcers and ulcerating ENL are well known entities while cutaneous ulceration in T1R is extremely rare; we describe an immune-competent woman with cutaneous ulceration as a presenting feature to highlight the need to recognize this entity at the earliest opportunity.

Efficacy of 810 nm diode laser in hair reduction in Indian subpopulation using a novel Gabor filter-based detection software and hair algorithm.

BACKGROUND: Diode laser (810 nm) is frequently employed for hair reduction. There are few studies determining the efficacy in Indian population. OBJECTIVES: Assessment of efficacy and safety of 810 nm diode laser in facial/axillary hair reduction and objective assessment of the improvement with dermoscopy, photographs, and novel Gabor filter-based hair detection algorithm. METHODOLOGY: This hospital-based study included 40 adult women with 108 treatment sites over 5.4 sessions (range 4-8). Evaluation of treatment areas (hair texture, density) was done using modified Ferriman-Galwey scoring. Photography and dermoscopic images were taken before each session and 6 weeks after the last. Immediate and delayed adverse reactions were noted. Assessment of efficacy was done by patient, principal, and blinded investigator using Global Aesthetic Improvement scale (GAIS) and hair detection algorithm (evaluating characteristics of dermoscopic hair). RESULTS: The fluences ranged from 16 to 29 Joules/cm2 with pulse width of 30 ms. Upper lip (n = 29, 26.9%) and chin (n = 25, 22.1%) were commonly treated areas. Improvement in hair texture and density (reduction in uniformly distributed, terminal hair from 37.1% to 13.9%) was statistically significant (p < 0.0001). Excellent improvement of 75-100% (GAIS) was noted by principal and blinded investigator in 24.1% and 33.3% total sites, respectively. The median improvement, calculated by the algorithm, was 60% for side locks, 53.9% for axilla, 24.1% for upper lip, and 14.9% for chin. Axilla and upper lip were sites associated with maximum discomfort. Epidermolysis and paradoxical hypertrichosis were seen in five patients each. CONCLUSION: The 810 nm diode laser is safe and effective in the reduction of dark, coarse terminal hairs in Fitzpatrick skin types III-V. Inter-observer variation and investigator bias in the assessment of efficacy can be successfully overcome by using the algorithm.

Hair Loss in Children: A Clinicoetiological Study from South India.

BACKGROUND: Scalp hair loss in children is one of the common complaints encountered in dermatological practice. Accurate diagnosis of hair loss in children is of major significance as it can have severe psychological implications given the cosmetic importance of hair. AIMS: This study aims to study the different causes and clinical presentations of scalp hair loss in children. MATERIALS AND METHODS: This was a hospital-based descriptive study that enrolled a total of 170 children with scalp hair loss. A detailed history, scalp, and hair examination were done. Bedside investigations such as KOH mount, hair shaft microscopy, and hair pull tests were conducted. Scalp biopsy and dermoscopy were done wherever necessary to confirm the diagnosis. RESULTS: Majority of the children with scalp hair loss were school going and adolescents accounting for 62.4% of cases; 52.4% of patients were male and 47.6% were female. Asymptomatic hair loss was the most common presenting complaint contributing to 71.2% of cases. Patchy pattern of scalp hair loss formed a majority (86.5%) compared to diffuse pattern (13.5%). Around 89.4% of scalp hair loss were of acquired type and remaining 10.6% were of congenital type. Neonatal occipital alopecia (38.9%) was the most common cause of congenital hair loss. However, in the acquired group, 90.1% had nonscarring and 9.9% had scarring alopecia. In the nonscarring group, tinea capitis, alopecia areata, and telogen effluvium accounted for 47.4%, 37.9%, and 8.8% of cases, respectively. CONCLUSION: Childhood alopecia is different from adult alopecia in terms of causes and the pattern of presentation. There is a scarcity of literature on childhood alopecia from India, hence, this study can serve as a useful guide in understanding the different causes and its presentation in our population. In addition, this study signifies the importance of simple diagnostic tests such as KOH and hair shaft microscopy in the diagnosis of common hair loss conditions in children.

Utility of Immunofluorescence Antigen Mapping in Hereditary Epidermolysis Bullosa.

BACKGROUND: Epidermolysis bullosa (EB) is characterized by blisters and erosions on the trauma-prone areas of the body. It occurs as a result of mutation in the genes encoding structural proteins. Transmission electron microscopy (TEM) is considered the gold standard test in the laboratory diagnosis of EB. However, this test requires a lot of expertise and is not widely available. Immunofluorescence antigen mapping (IFM) is considered a suitable alternative with comparable sensitivity and specificity. However, there is paucity of studies analyzing the utility of IFM in the diagnosis of EB. AIMS AND OBJECTIVES: To study the utility of IFM in the laboratory diagnosis of EB. MATERIALS AND METHODS: A cross-sectional study was conducted involving 179 biopsy specimens of patients with EB. IFM was carried out using a panel of monoclonal antibodies against K14, laminin 332, type IV collagen, and type VII collagen. RESULTS: Diagnosis of EB simplex (EBS), junctional EB (JEB), and dystrophic EB (DEB) was made in 104, 28, and 26 biopsy specimens, respectively. The overall concordance rate was 41.3% with higher concordance rates in EBS. CONCLUSION: The present study is conducted to assess the efficacy of IFM in the diagnosis of EB with large sample size. Our study serves to establish IFM as an important tool in the diagnostic armamentarium of EB as the prognosis mainly rests on diagnosing the type of EB.

Serration pattern analysis as a practical adjunct tool for categorization of subepidermal autoimmune blistering diseases.

BACKGROUND: Serration pattern analysis helps in the classification of subepidermal autoimmune blistering disorders; more precisely, it helps to differentiate epidermolysis bullosa acquisita from other subepidermal autoimmune blistering disorders. Most of the published reports of this tool have come from a single center. OBJECTIVES: The objectives of the study were to study the utility of serration pattern analysis in classifying subepidermal autoimmune blistering disorders. METHODS: Seventy five cases of subepidermal autoimmune blistering disorders were enrolled in this prospective study. A three millimeter punch biopsy was taken from the perilesional skin or mucosa for direct immunofluorescence; indirect immunofluorescence was carried out using salt-split skin. Subclassification of subepidermal autoimmune blistering disorders was done based on direct immunofluorescence, indirect immunofluorescence on salt-split skin, indirect immunofluorescence using knockout skin and serration pattern analysis findings. RESULTS: Indirect immunofluorescence was positive in 68 cases; 14 cases showed a dermal staining pattern while the rest showed either an epidermal or a combined pattern. All patients with epidermal or combined staining patterns showed "n" serrated pattern on direct immunofluorescence. Nine patients with dermal staining on indirect immunofluorescence also revealed an "n" serration pattern on direct immunofluorescence indicating the diagnosis of anti-p200 pemphigoid, and the rest showed a "u" serrated pattern. Three patients with negative indirect immunofluorescence showed "u" serration on direct immunofluorescence while the rest showed "n" serration. LIMITATIONS: ELISA and immunoblotting could not be performed due to resource constraints. CONCLUSION: Based on indirect immunofluorescence and serration pattern analysis, classification of the majority of patients with subepidermal autoimmune blistering disorders was possible in our study. Pattern recognition is a cost-effective tool and can be easily learnt. It is recommended to be practiced in all laboratories where facilities for advanced immunological diagnosis are unavailable.

Utility of immunofluorescence in dermatology.

Immunofluorescence (IF) tests have redefined our understanding of many immune-mediated skin diseases, especially autoimmune blistering diseases (AIBDs). Nomenclature of certain AIBDs (for example, linear IgA diseases and IgA pemphigus) has been done based solely on the finding of tissue-bound immunoreactants as detected by IF tests. Direct and indirect are the two major types of IF tests; they are not only useful in the diagnosis but also guide the clinician in the treatment at least in certain AIBDs, as the titer of circulating antibodies as detected by IF reflects the disease activity. In this review, we describe techniques, various types of IF, and its modification.