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Medicine and Dentistry >
Indian Journal of Clinical and Experimental Dermatology
Editor in chief:Dr. SanjitaTripathy
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Fixed Drug Eruption To Cetirizine ? Role Of Patch Testing
Author:Sonia Raghukumar, Ravikumar Bc
Volume: 2 | Issue no: 3-2016 | Pagination: 122-124
Antihistamines are prescribed for a wide variety of disorders like urticaria, eczema, allergies and infestations. Adverse reactions due to them is unusual and the incidence of fixed drug eruption is scarce. They are characterized by a sudden onset of edematous, erythematous plaques appearing at the same sites following an oral provocation with the drug and is proposed to be due to the epidermal CD8+ T cells resident at the sites of these residual post inflammatory hyper pigmented macules. Antihistamines sharing a similar chemical structure have an increased likelihood of showing cross reactions and a patch test based evaluation can be carried out to deduce the offending drugs, cross reactions and alternative medications
A Rare Case Of Systemic Sarcoidosis With Cutaneous And Sublingual Salivary Gland Involvement
Author:Shahul Hameed G, Jeevan Malaiyan, Chittambalam Pc, Selvam Md, Pradeep Raj
Volume: 2 | Issue no: 3-2016 | Pagination: 119-121
Sarcoidosis is a systemic granulomatous disorder of unidentified etiology and pathologically characterized by non-caseating granulomas. Majority of patients (~30%) have cutaneous lesions, exhibit different manifestations depending on diverse races whereas some patients develop systemic involvement. Diagnosis is based on a compatible clinical and radiological presentation and evidence of non-caseating granulomas. Here, we report a rare case of cutaneous sarcoidosis with a nodulocystic swelling on the floor of the mouth, which upon biopsy revealed a dense, non-caseating granulomatous infiltrate in the dermis. Identification of systemic involvement was based on laboratory investigations, slit skin smear, sputum smear for acid-fast bacilli (AFB), chest X-ray, pulmonary function tests, computerized tomography (CT), ultrasound of abdomen and radiological examination. The patient was treated successfully and is being reviewed once every two weeks till date.
Primary Systemic Amyloidosis ? A Great Mimicker
Author:Ps Mohana Sundari, V. Anandan, Ns Jayanthi, C.Yoganandhini
Volume: 2 | Issue no: 3-2016 | Pagination: 115-118
A 40 year old female patient presented with myalgia and both knee joint pain for 3 years and raised skin lesions over both eyelids for 1 year. General examination and systemic examination were normal and vitals were stable. Dermatological examination showed multiple well defined erythematous smooth plaques over both eyelids, waxy papules over upper lips, microstomia, macroglossia, sclerodactyly, nodules over both suprascapular region, fixed flexion contracture of index and middle finger present. Routine investigations were normal. Serum protein electrophoresis showed band in gamma globulin region. Histopathology showed homogenous eosinophilic material in papillary dermis and dense fibrocollagenous tissue in reticular dermis. Congo red stain was positive. Hence diagnosis of primary systemic amyloidosis was made.
Cutaneous Manifestations In Chronic Renal Failure Patients On Haemodialysis
Author:Swathi K, Purnachandra B, Subbarao D, Ramachandra Bv
Volume: 2 | Issue no: 3-2016 | Pagination: 111-114
Introduction: Chronic renal failure presents with wide range of cutaneous manifestations. Many newer changes have been described since the advent of haemodialysis which prolongs the life expectancy giving time for these changes to manifest. Aims & Objectives: To find the array of various dermatological conditions that can occur in patients of CRF on haemodialysis. Materials and Methods: A total 100 patients with chronic renal failure on haemodialysis and having at least single cutaneous manifestation was included in the study. Results: Of the total 82% of the patients complained of certain skin problems however on examination all patients had at least one skin problem attributable to chronic renal failure. The most prevalent finding among them was Xerosis (52%), Pruritus (32%), Diffuse cutaneous hyperpigmentation (22%), Kyrle?s disease (71%) of the total of acquired reactive perforating dermatosis(7%), Fungal infections (16%), Bacterial infections (10%) and Viral in (10%), Purpura (3%) and other Dermatosis (13%).The nail changes observed were Half and Half nails (20%), Koilonychia (18%), Onychomycosis (15%), Sub-ungual hyperkeratosis (8%), Beaus lines (2%) .Hair changes were sparse body hair (10%), dry lustreless hair (4%), and sparse scalp hair (10%). Oral changes observed were Ulcerative stomatitis (29%), Angular chelitis (12%. Other manifestations of CRF observed were like gynaecomastia, psuedokaposis sarcoma, and nephrogenic fibrosing dermopathy. Conclusion: CRF is associated with a complex array of cutaneous manifestations caused either by the disease or by the treatment. The early recognition of cutaneous signs can relieve suffering and decrease morbid
The Incidence Of Vitiligo And Its Clinical Features In Response To Psoralen Group Of Drugs And Associated Other Diseases
Author:Girish V. Nagaral, Karibasappa
Volume: 2 | Issue no: 3-2016 | Pagination: 102-105
Background: Vitiligo incidence and treatment modalities are diverse and remain unsatisfactory. There is high incidence of vitiligo among patients suffering from systemic disorders. Aim: The present study was undertaken to study the incidence of vitiligo and its response to psoralen group of drugs and association with other diseases. Methodology: 150 patients attending the outpatient department of Dermatology, Venereology and leprology at Chitageri General Hospital and Bapuji Hospital attached to J.J.M Medical College, Davengere were utilized for the current to study clinical features in response to psoralen group drugs in vitiligo and its association with other diseases. Results: The incidence of vitiligo was at around 1.49% in the present study. The localized type was 46.7% and spread type 14% and vulgaris type 2.7% was observed in the current study. Among 50 cases which were studied with psoralen groups of drugs; vitiligo repigmentation occurred in 11 patients treated with 8-Methoxy Psoralen (8MOP) and 1 patient treated with Tri-methyl Psoralen (TMP) and 2 patients treated with Psoralen alone in the present study was recorded. 5 patients out of 130 were associated with other diseases of 2 with Diabetes mellitus, 1 each of Psoriasis, alopecia areata and borderline tuberculoid leprosy observed in the present study. Conclusion: Awareness should be given to the vitiligo patients on its incidence, type and role of psoralen drugs in treatment. Psoralen group drugs could give better results in treatment of vitiligo than other drugs.
Clinical Study Of Cutaneous Manifestations In Neonates
Author:Likhita Punuru, Purnachandra Badabagni, Subbarao Dasika, Ramachandra Bendapudi V
Volume: 2 | Issue no: 3-2016 | Pagination: 98-101
The neonatal period constitute the initial 4 weeks of extra-uterine life. A host of clinical manifestations occur in neonates varying from physiological to grossly pathological, hence it is necessary to differentiate between benign and clinically significant skin lesions among the newborn. It is important to be aware of the transient skin lesions in newborn and differentiate them from other serious conditions which will avoid unnecessary therapy to the neonates and the parents can be assured of good prognosis of these skin manifestations. Aims: 1) To study the various patterns of cutaneous manifestations occurring among the newborn. 2) To estimate the prevalence of physiological and pathological skin lesions among the new born. Materials and Methods: An Institutional based, prospective study was conducted in the department of Dermatology, Venereology and Leprosy, Eluru, West Godavari district, A.P. 100 neonates born in the Department of Obstetrics and Gynecology of the same institution and having at-least one cutaneous manifestation were considered in this study. The study was conducted between the period of November 2011 to May 2013. Results: Of 100 neonates, 54 were males, 46 were females, of these, 89 were born at term, 9 were preterm, and 2 were post term. Of the cutaneous lesions in the newborn, physiological skin lesions were more common among all accounting for 57.0%, followed by eczematous eruptions 18.2%, transient non infective conditions 10.2%, birthmarks 9.1% and others 5.5% in decreasing order of frequency. Conclusion: This study of newborn skin provides information about normal variants occurring in neonatal period. It is important to be aware of the fact that most of the skin lesions in the newborn are transient and require no therapy.
Clinico-Histopathological Correlation Of Leprosy In Western Region Of Nepal-A Pioneer Pilot Study
Author:Kumar Pokhrel, Parajuli S, Shah M, Sushma Subedi
Volume: 2 | Issue no: 3-2016 | Pagination: 93-97
Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae disease affecting mainly cutaneous and peripheral nervous system. This entity expresses with a wide array of clinical manifestations and may mimic variety of disparate diseases, therefore is difficult to diagnose clinically, so for the adequate treatment and better prognosis, the diagnosis must be made early and it should be accurate, therefore clinic-pathological correlation is extremely important. Hence, the present study was conducted to correlate different types of leprosy clinically and histopathologically. Objectives: To analyze different histological types of leprosy, correlate histopathological diagnosis with clinical diagnosis and study the uniformity of clinical and histological findings in the diagnosis of leprosy. Methodology: This study was conducted on 21 biopsy samples received in Department of Dermatology, Nepalgunj Medical College and Teaching Hospital, Nepalgunj over a period of one year from December 1, 2014 to December 31, 2015. All the clinically diagnosed new skin lesions (clinical classifications noted) were subjected for biopsy; tissue specimen were fixed in 10% formalin and sent for histopathological analysis. 5 micron sections were stained with haematoxylin and eosin for morphological assessment and with modified Fite-Farcao stain for identification of the lepra bacilli. Ridley and Jopling classification was applied for histopathological taxonomy. Data was analyzed using SPSS software version 15.0 and kappa test was applied to evaluate the concordance results. Results: The present study comprised of 21 patients, 12 were males (57.1%) and 9 females (42.9%) with a male: female ratio of 1.33:1. Majority of the patients were between 31 to 40 years of age. Based on histopathology, 14 (66.7%) patients had Tuberculoid leprosy (TT); 5 patients had Borderline Lepromatous (BL) leprosy; 1 (4.8%) had Borderline Tuberculoid (BT) leprosy and Lepromatous Leprosy (LL) each. Out of the 21 patients included in the study, 16 (76.1%) presented a clinical suspicion of paucibacillary leprosy and 5 (23.8%) of multibacillary leprosy. Maximum clinico-histopathological correlation was seen in BL (100%), followed by TT (84.6%), LL (50%) and 0% in BT. Overall clinico-histopathological agreement was seen in 15 (71.4%) cases and disagreement in 6 (28.7%) cases. Conclusion: Cl
Early Androgenetic Alopecia And Insulin Resistance- A Case Control Study
Author:Leelavathy Budamakuntla, Eswari Loganathan, Shankar Kumar V, Shruthi Chikkaiah, Aishwarya Radhakrish
Volume: 2 | Issue no: 3-2016 | Pagination: 88-92
Background: In Androgenetic alopecia AGA, androgens induce miniaturization of hair follicles in those genetically predisposed to baldness. The previously known association between Androgenetic Alopecia AGA and cardiovascular risk factors raises a question of common pathogenetic mechanism of these disorders. Aim: To study the association of Insulin resistance and metabolic syndrome in early onset AGA in young males Materials and Methods: This was a case control study with 30 participants in each group. Young males between 18 and 35 years of age were included in the study. Participants in the cases group had AGA greater than stage 3. Blood pressure, anthropometry, fasting insulin and glucose levels in blood, lipid profile, total and free testosterone and TSH were investigated for all participants. Insulin resistance was calculated using HOMA-IR and metabolic syndrome criteria devised by National Cholesterol Education Program Adult Treatment Pannel III NCEP ATP III was used. Results: Cases had a higher mean diastolic blood pressure and a more frequent family history of AGA than controls. Total and free testosterone levels were significantly more in participants with AGA than controls. There was no significant difference in Insulin resistance and Metabolic syndrome criteria between the cases and controls but the prevalence of Insulin resistance IR and metabolic syndrome MS increased with the severity of AGA. Conclusion: In conclusion, more studies are required in order to objectively clarify whether early AGA can be attributed to dyslipidaemia due to androgens, IR alone, or MS due to IR. In the present study we could not establish a clear cut role of IR or MS, though the testosterones were significantly higher in the AGA participants suggesting the role of androgens.
Mucocutaneous Manifestations Of Hiv Infection
Author:Shashikant Malkud, Veeresh Dyavannanavar
Volume: 2 | Issue no: 3-2016 | Pagination: 84-87
Background: Human immunodeficiency virus (HIV) infection is associated with several mucocutaneous conditions which may be the first clinical presentation of HIV. A wide range of infectious and non-infectious skin lesions develop during the course of the disease but their frequency and associated factors vary from place to place. Aim: To evaluate cutaneous manifestations in HIV infected patients attending to Dermatology outpatient department and their relationship with CD4 cell counts. Methods: It is a hospital-based cross-sectional study. One hundred and twenty HIV seropositive patients attending the outpatient and inpatient departments were included in the study. Detailed history including age, sex, occupation, presenting complaint, highrisk behaviour, mode of transmission, marital status, partner?s HIV status and treatment history was taken. Thorough cutaneous and systemic examination was done in all patients. Cluster of differentiation (CD4) count was noted in all patients at the time of presentation. Results: Majority of the patients 85 (70.8%) were rural residents who belonged to low socio-economic and low educational strata. Housewives formed the largest group 44 (36.7%) followed by truck drivers 31 (25.8%) and laborers 25 (20.8%). The predominant mode of transmission was heterosexual contact 113 (94.2%). Most common mucocutaneous manifestations noticed were seborrheic dermatitis 78 (65%) followed by oral candidiasis 56 (46.6%), xerosis 51 (42.5%), generalized skin hyperpigmentation 42 (35%) and dermatophytosis 40 (33.3%). Conclusion: This study showed the prevalence of various dermatological manifestations in HIV positive patients and their relation with CD4 count. Most of the manifestations occur in patients with low CD4+ count (<200). Early recognition of mucocutaneous manifestations helps in the early diagnosis and better management of the disease.
A Study Of Cutaneous Adverse Drug Eruptions In Dermatologic Practice
Author:Sai Kranthi Kumar Varma Nadimpalli, Purnachandra Badabagni, Subbarao Dasika, Ramachandra Bendapudi V
Volume: 2 | Issue no: 3-2016 | Pagination: 79-83
Cutaneous adverse drug reactions (CADR) are a major problem in drug therapy and is one of the leading causes of morbidity and mortality in health care. Objectives: 1) To study the diverse clinical spectrum of CADR. 2) To assess the causality and identify the offending drug. Materials and Methods: Present study was an 18 months prospective, hospital based study conducted, recording a total of 100 patients with various cutaneous ADR. The diagnosis of cutaneous drug reactions was made mainly based on detail history and correlation between the intake of probable offending drug and the onset of rash. Results: The most common type of CADR patterns recorded among the 100 cases in the present study were Maculopapular rash (30%), Fixed drug eruption & bullous variant (19%), Acute urticaria (18%), Acneiform eruptions (6%), Erythema multiforme & Stevens ? Johnson syndrome (SJS) in (5%), Exfoliative dermatitis & Photosenstivity in (4%), Angioedema, Vasculitis & Hyperpigmentation in (2%), Toxic epidermal necrolysis (TEN), Drug hypersensitivity syndrome & Pruritus in (1%) each. The drugs most often implicated were Antimicrobials(40%), NSAIDs (30%), and Anticonvulsants (11%). Antimicrobials were implicated in (43.3%) of Maculopapular rash followed by NSAIDs (33.3%). Antimicrobials (52.6%) and NSAIDs (42.1%) in FDE. Urticarial reaction was caused mainly by NSAIDs (44.3%). Life threatening severe cutaneous adverse drug reactions (SCARs) such as SJS, TEN & Drug hypersensitivity syndrome (DHS) were seen 7% of total cases. Conclusion: Although it was a monocentric study, this study revealed a high frequency of cutaneous drug reactions with different clinical presentations, induced by frequently used antibiotics, analgesics and anticonvulsants as and when used giving an interesting data with respect to onset, severity and clinical presentation
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