Laser Carbon Peel: New Armamentarium for Inflammatory Acne.

There is an increasing interest in procedures to improve skin quality in acne patients with a short downtime. Off late, carbon peel laser technique which uses topical carbon suspension combined with Q-switched Nd:YAG laser treatment has gained popularity. The main advantages of this procedure are easy to perform and it requires less than 30 minutes.

A case of primary and secondary syphilis presenting together as immune reconstitution inflammatory syndrome.

Immune reconstitution inflammatory syndrome (IRIS) is a condition during the clinical course of HIV infection in which there is paradoxical worsening and/or new onset of opportunistic infections in a HIV-positive patient who has recently been started on anti-retroviral therapy (ART). We present a case of AIDS with CD4 count of 20 cells/µl who presented within 6 weeks of starting ART with a CD4 count of 160 cells/µl and a painless solitary genital ulcer along with annular dark-colored plaques over soles. His screening test for syphilis was negative both during baseline evaluation, prior to initiation of ART, and during his clinical presentation. His disease was confirmed based on a positive treponema pallidum hemagglutination test report and a suggestive skin biopsy. He responded well to three doses of Benzathine Penicillin and continuation of ART. There are very few case reports of syphilis presenting as IRIS and this case is all the more unique as he had features of both primary and secondary syphilis occurring together within 6 weeks of starting ART. This report would reiterate the fact that syphilis and HIV co-infection can alter the natural course of both the diseases and a high index of suspicion is required for treating them.

Unusual Spurts of Rosacea Like Dermatoses, Posing a Diagnostic Dilemma During Covid-19 Pandemic: A Cross-Sectional, Observational Study From a Tertiary Care Centre.

BACKGROUND: The gradual opening of healthcare system since second week of May 2020 following lockdown imposed due to corona virus pandemic saw spurts of cases of unexplained central facial dermatoses in subset of previously healthy people. The aim of the study was to find out the cause and establish the definitive diagnosis of unusual occurrence of facial dermatoses on previously healthy people so that an appropriate management can be offered to the patients. MATERIALS AND METHODS: It was a cross-sectional, observational study carried during May 15 to July 15, 2020 at a tertiary dermatology center. All cases presented with erythema on face and papular or pustular lesions on central facial area of not more than 2 months of duration were included in the study. RESULTS: Total 81 patients visited skin OPD with facial dermatoses of various types during this period, out of which 21 patients fulfilled the inclusion criteria. This was 0.72% (21/2900) of total skin OPD of the 2 months. All the patients had been using face masks during this period of symptoms due to the ongoing coronavirus situation. Dermatological examination revealed only erythema on the central area of face (n = 10), erythema and few papules (n = 3), erythmatous papules and pustules (n = 5), and erythematous papules, pustules, and telengiectasia (n = 3). All the skin biopsies showed predominantly epithelioid cells, noncaseating granuloma with a variable degree of infiltrate. CONCLUSION: There has been a definite change in the lifestyle due to the current Covid-19 pandemic. People are compulsorily using face masks to avoid the spread of Covid-19 infection. This change in behavior has brought out a surge of rosacea like lesions on the covered area of face. Partly, it can be explained by change in innate immunity due to excessive sweating and change in microenvironment of skin.

Biologics in Dermatology: Off-Label Indications.

Skin and subcutaneous diseases affect millions of people worldwide, causing significant morbidity. Biologics are becoming increasingly useful for the treatment of many skin diseases, particularly as alternatives for patients who have failed to tolerate or respond to conventional systemic therapies. Biological therapies provide a targeted approach to treatment through interaction with specific components of the underlying immune and inflammatory disease processes. Advances in the understanding of disease pathophysiology for inflammatory skin diseases and in drug development have ushered in biologic therapies in dermatology. Biologic therapies are molecules that target specific proteins implicated in immune-mediated disease. This review article highlights the increasing evidence base for biologics in dermatology for off-label use.

Correlation of Dermoscopic and Histopathologic Patterns in Leprosy - A Pilot Study.

BACKGROUND: Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. It is diagnosed based on clinical features and confirmed on the histological findings and peripheral slit-skin smear staining. Dermoscopy is a handy, easily accessible tool to diagnose this granulomatous disease and classify patients based on the immunological and clinical response. METHODS: A single spot observational analysis was conducted in a tertiary hospital in North India. Patients attending the leprosy clinic and admitted patients for institutional therapy on the day of the study were enrolled in the cohort. The clinical and histological findings were correlated with the characteristic dermoscopy findings. A total of 50 patients were included in the study. All patents included in the study were on multidrug therapy and anti-lepra reaction drugs for a duration of less than 6 months. RESULTS: The dermoscopy findings correlated with the clinical and histological findings. Tuberculoid poles of leprosy classically showed loss of hair and skin pigment along with absence of white dots as sweat glands in dermoscopy. Lack of blood vessel changes ruled out any lepra reaction. Lepromatous pole of leprosy on the other hand showed characteristic xerosis and white scaling on dermoscopy in the background of hypotrichosis and hypopigmentation. Leprosy reactions were characterized by blood vessel changes and arborizing blood vessels were characteristic in erythema nodosum leprosum, and a diffuse erythema was a clue toward diagnosing type I lepra reaction. Interestingly, clofazimine-induced pigmentation was picked up characteristically on dermoscopy as a "honey comb pattern". CONCLUSION: Dermoscopy is certainly a handy tool in aiding the diagnosis of leprosy, lepra reactions, and course of therapy. Characteristic patterns during the course of leprosy would certainly facilitate a quick and definitive diagnosis of patients suffering from leprosy. Also, patient drug compliance particularly to clofazimine can also be picked up objectively on dermoscopy.

Disease Pattern among Sexually Transmitted Infection Clinic Attendees: A Hospital-Based Study.

BACKGROUND: Sexually transmitted infections (STIs) have a definite role in the facilitation of HIV infection, which, in turn, also increases susceptibility to other STIs. Further, the social stigma and secrecy surrounding STIs create difficulty in estimating its true incidence and prevalence. OBJECTIVE: The objective of this study was to know the pattern of diseases including different clinical presentations and final diagnosis among the STI clinic attendees. MATERIALS AND METHODS: This study was a hospital-based study; a predesigned and pretested schedule was used to collect data from 140 patients after obtaining their consent. The study was carried out between January 1, 2016, and December 31, 2016. STATISTICAL ANALYSIS: Analysis was done using tabulation and proportion. RESULTS AND OBSERVATION: Genital ulcer (31.43%) was the most common clinical presentation among the attendees. Primary syphilis was the most common (17.14%) STI detected among the participants followed by herpes genitalis (16.43%). The most common mixed infection was primary syphilis with chancroid (36.36%) followed by herpes genitalis with primary syphilis (18.18%). CONCLUSION: Ulcerative STIs singly or in combination are more frequent than the non-ulcerative STIs. Further studies with large sample sizes are needed to obtain a more vivid picture.

A Clinico-epidemiological Study of Childhood Herpes Zoster.

Herpes zoster (HZ) is a viral infection believed to be caused by the re activation of varicella zoster virus (VZV) or human herpes virus type 3 (HHV 3) that persists in the posterior nerve root ganglion. HZ is rarely reported in the pediatric age group with an intact immunity. Past infection with VZV and immunization with chickenpox vaccine are key markers in the onset of varicella zoster in children. Our aim was to study the clinicoepidemiological pattern of HZ infection in children aged less than 12 years and to start an early management to prevent long term complications. A prospective observational study over a total duration of 2 years was conducted in a tertiary hospital, and all children less than 12 years of age with diagnosed HZ were included in the study. A total of 39 children were diagnosed to have pediatric HZ infection during the study period. The children were followed up over 4 weeks post diagnosis and were treated with oral acyclovir therapy along with symptomatic management. All children had an uneventful benign course, and their siblings and close pediatric contacts were also screened for the development of HZ or chickenpox during the incubation period. All children were screened for an underlying immunodeficiency and two cases of HIV co infection were detected. HZ is a rare disease in childhood. Varicella in early childhood is a risk factor for HZ in both immunocompromised and immunocompetent children. The appearance of HZ in a young child does not always imply an underlying immunodeficiency or malignancy, but the children should be screened for immunodeficiency. In general, the prognosis is good in healthy children.

Nilotinib-induced Perforating Folliculitis: Two Cases.

Cutaneous adverse effects of chemotherapy are widely known but underreported. A significant advancement is made in the field of oncology with the advent of new classes of drug being added to the existing classes at a fast pace. Most of these cutaneous adverse effects are self-limiting and subsides on suspending the drug either temporarily or permanently. Some of these effects are merely overlooked by the patients and the treating physician hence goes un-noticed. Nilotinib is a newer second-generation tyrosine-kinase inhibitor approved for the management of chronic myeloid leukemia. This drug is rapidly establishing itself as afirst-line therapy for chronic myeloid leukemia. Like other chemotherapeutic agents, a wide array of cutaneous adverse effects is noted with this drug. We report two cases of perforating folliculitis induced by nilotinib.