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Byline: Mitali. Wagh, Jayesh. Mukhi, Smita. Sontakke, Amit. Dhok, Avinash. Turankar, Mrunalini. Kalikar BACKGROUND: Variable results about efficacy as well as safety of apremilast compared to methotrexate are reported in [...]

Congenital atrichia with papular lesions is a rare, autosomal recessive and irreversible form of total alopecia of the body hair characterized by hair loss soon after birth and the development of keratinfilled cysts or horny papules over extensive areas of the body. The condition is associated with a mutation of the human hairless gene on chromosome region 8p12. We report a 1-year-old boy presenting with the absence of scalp and body hair since birth. On examination, he had complete absence of hair on the scalp, eyebrows, and eyelashes. Multiple, discrete, pearly-to-skin-colored papules of 1-3mm in size were present over the scalp. The skin biopsy from a scalp papule revealed normal overlying epidermis with multiple keratin cysts and hypoplastic hair follicles in the upper dermis.

Byline: Bhagyashree. Supekar, Rajesh. Soni, Ravi. Bhushan, Jayesh. Mukhi, Rajesh. Singh, Dharitri. Bhat Lazarine leprosy is an unusual expression of usually borderline tuberculoid (BT) form characterized by spontaneous ulceration of [...]

This article discusses a rare case of a 13-year-old female with neurofibromatosis 1 (NF1) who presented with painful swelling in her right lower limb. NF1 is an inherited disorder characterized by tumors in the skin and central nervous system, which can potentially become malignant. In this case, the patient was diagnosed with NF1 and venous malformation in her right lower limb. The article emphasizes the importance of careful clinical examination and radiological imaging for diagnosing new onset swelling in NF1. [Extracted from the article]

Purpose: Bilastine is a novel second-generation antihistaminic. Very few studies in Indian population have compared the safety and efficacy of bilastine with other second-generation antihistaminic like cetirizine. Hence, the present study was planned. Materials and Methods: This was a randomized, open-label comparative parallel group study conducted on 70 patients of chronic spontaneous urticaria (CSU). Patients either received cetirizine 10 mg or bilastine 20 mg once daily for 6 weeks. The primary endpoint was to find out the difference in the mean total symptom score (MTSS) at baseline and 6 weeks. The secondary endpoint was to find out changes in the scale of the number of wheals, change in pruritus scale, scale for size of wheal, change for interference of wheals with sleep, change in visual analog scale (VAS) for sedation, change in scale for intensity of erythema, and change in Scale for Extent of Skin Area Involvement (SESI). Results: Bilastine and cetirizine offer a significant reduction in MTSS, mean number of wheals, and mean pruritus scale at baseline to 1, 3, and 6 weeks. The mean difference in MTSS was significantly more in bilastine. Cetirizine showed a significant increase in VAS score for sedation as compared to bilastine. Both the drugs were well tolerated and safe. Adverse events like headache, gastric irritation, dryness of mouth, and sedation were more reported in cetirizine group. Conclusion: Bilastine was more efficacious than cetirizine in patients of CSU and the efficacy was seen earlier at 1 week, which was not seen in the cetirizine group. [ABSTRACT FROM AUTHOR]

Byline: Rajesh. Soni, Bhagyashree. Supekar, Jayesh. Mukhi, Rajesh. Singh Sir, Lenalidomide is a 4-amino-glutarimide derivative of thalidomide that has an immunomodulatory and antitumoral effect. It is a useful therapeutic agent [...]

Byline: Bhagyashree. Supekar, Kinjal. Rambhia, Rajesh. Singh, Jayesh. Mukhi A 30-year-old female patient presented with progressive reticulate pigmentation of the neck, upper chest, back, cubital fossa, and axillae since the [...]

Introduction: Cutaneous adverse drug reactions (CADRs) are the most common adverse reactions attributed to drugs in which any type of skin reaction can be mimicked, induced, or aggravated. Aim and Objectives: To study the morphological patterns of various types of CADRs. Materials and Methods: It was a descriptive cross-sectional study carried out from November 2017 to September 2019, where medical records of diagnosed cases of CADRs were analyzed in a predesigned proforma with respect to demographic data, clinical features, treatment history (topical and oral), offending drug, temporal association with a skin eruption, investigations, and treatment outcome. Statistical analysis was done using mean, median, and proportion. Results: A total of 180 patients with CADRs were enrolled. There was a male preponderance with the mean age being 32.9 ± 2.9 years. The most common CADR reported was fixed drug eruption (n = 77). Steven Johnson syndrome was the most common (n = 7) severe cutaneous adverse reaction. The mean duration of latency was 6.2 (±8.61 days). Antimicrobial drugs accounted for most of the benign as well as severe CADRs (41.4%). Among all cases, 43.9% of patients had mild CADR and 16.7% had severe CADR. Causality assessment using the Naranjo adverse drug reaction probability scale, 70% had a possible association, 18.3% probable and 11.7% had a doubtful association. Conclusion: Early identification of CADR is important to reduce morbidity and mortality. Patient education is required to avoid self-administration of drugs and re-administration of the same offending drugs to prevent further morbidity. Immediate withdrawal of the culprit drug/drugs with adequate management can be lifesaving. [ABSTRACT FROM AUTHOR]

Introduction: Lipoid proteinosis is a rare autosomal recessive disease, characterized by deposition of Periodic Acid‒Schiff-positive hyaline material in the skin, mucous membrane of the upper aerodigestive tract, and different organs of the body, resulting in varied clinical manifestations. Case Report: We report a case of lipoid proteinosis in a 7-year-old boy who responded well to oral acitretin therapy. Discussion: Lipoid proteinosis is a rare disease entity, and very few reports have been mentioned in the literature based on its treatment modalities, with each treatment showing varied success rates. Oral acitretin can prove useful in cases of failure or inadequate response to other treatment, as seen in our case. [ABSTRACT FROM AUTHOR]

Background: Facial acanthosis nigricans (FAN) is an underrecognized and underdiagnosed entity. The typical presentation of acanthosis nigricans (AN) seen elsewhere on the body like axillae and groins is not seen on the face, making it mimic other pigmentary disorders. Moreover, FAN is seldom not accompanied with AN on the classical sites making the diagnosis challenging. The aims of this study were to determine clinical, dermoscopic, and histopathological features of FAN and to estimate the prevalence of obesity and insulin resistance (IR) in FAN. Methods: Forty cases of FAN and forty healthy nonobese individuals with comparable ages and gender were included in the study. Body mass index, waist circumference, hip circumference, waist to hip ratio, and serum fasting lipid levels were used to evaluate obesity, whereas serum fasting insulin and Homeostatic Model of Assessment of Insulin Resistance (HOMA-IR) were used to evaluate IR. Dermoscopy was performed in all cases. Histopathological features of the skin biopsies were reviewed. Results: Out of the 40 cases, 24 were male and 16 were female. The patterns of facial pigmentation in addition to the classic pattern were a hyperpigmented band over forehead (55%), periorbital darkening (25%), perioral (10%), and generalized darkening (10%). Dermoscopy in all cases revealed linear crista cutis, sulcus cutis, and hyperpigmented dots in crista cutis. Biopsy of 20 cases showed mild hyperkeratosis, acanthosis, papillomatosis, and increase in basal melanin. Clinico-dermoscopic-histological correlation showed that milder (light brown) variants of FAN had follicular plugging and subtle sulci pattern with irregular brown globules and perifollicular pigmentation on dermoscopy and mild hyperkeratosis and hypermelanization of the basal layer with minimal acanthosis and papillomatosis on histopathology. On the other hand, chronic variants (dark brown and black) showed prominent sulci, larger brown globules, and perifollicular hyperpigmentation on dermoscopy and moderate hyperkeratosis and hypermelanization of the basal layer with moderate to severe acanthosis and papillomatosis on histopathology. Fasting blood glucose, insulin, HOMA-IR, fasting serum triglyceride, and total cholesterol were statistically significantly high in cases in comparison with controls (P-value <0.05). Conclusions: Varied clinical presentations of FAN were observed. Dermoscopy and histopathology provide a good aid. FAN may be considered as a cutaneous marker of obesity and IR. Thus, FAN should be suspected in patients presenting with facial melanosis who are obese and have AN over other sites, although FAN can also present de novo. [ABSTRACT FROM AUTHOR]

Objective: To compare efficacy, safety, and cost-effectiveness of sertaconazole (2%) and luliconazole (1%) cream in patients with dermatophytoses. Materials and Methods: Sixty-four patients with tinea corporis and tinea cruris infections were enrolled in this single-center, randomized, open–label, parallel study. Following inclusion and exclusion criteria, patients were randomly divided into two treatment groups and received either sertaconazole 2% cream applied topically twice daily for 4 weeks and luliconazole 1% cream once daily for 2 weeks. At follow-up, efficacy was assessed clinically using 4-point physician global assessment (PGA) scale, composite score, and mycologically by KOH mount. Safety was assessed by monitoring adverse drug events at each visit. Results: The primary efficacy variables including changes in pruritus, erythema, vesicle, and desquamation (4-point PGA) were significantly (P < 0.0001) improved in both the groups, at the end of treatment. There was a significant reduction in mean total composite score (pruritus, erythema, vesicle, and desquamation) after the end of treatment in the sertaconazole group (P = 0.0002) compared to the luliconazole group. Both the groups showed equal negative mycological assessment. Both the study drugs were well tolerated. Only one patient in the sertaconazole group showed allergic contact dermatitis. Conclusion: Sertaconazole was better than luliconazole in relieving signs and symptoms during the study and follow-up period, but cost-effectiveness wise, luliconazole was better than sertaconazole. [ABSTRACT FROM AUTHOR]

Neurofibromatosis is a rare autosomal dominant disorder characterized by café-au-lait macules and cutaneous neurofibromas. Café-au-lait spots are sharply defined, light-brown colored homogenous macules observed in more than 90% of cases. Plexiform neurofibromas are benign tumors originating from nerve sheath cells, subcutaneous or visceral peripheral nerves involving multiple fascicles often described on palpation as a bag of worms. We describe a case of 25-year-old male who presented with a giant plexiform neurofibroma underlying a giant café-au-lait macule. [ABSTRACT FROM AUTHOR]

Byline: Bela. Shah, Tharayil. Sumathy, Rachita. Dhurat, Raghunandan. Torsekar, Vishalakshi. Viswanath, Jayesh. Mukhi, Ganesh. Kadhe, Pashmina. Ahirrao Background: A combination of topical retinoid and antibacterial therapy is often advocated for [...]

Byline: Sachin. Hiware, Meena. Shrivastava, Dharmendra. Mishra, Jayesh. Mukhi, Gaurav. Puppalwar Objectives: To detect cutaneous drug reactions through spontaneous reporting system in IGGMCand H, Nagpur and analyze them using standard [...]

A 40 years old female patient presented with a solitary raised lesion over upper lip since 6 months. Topical 1% 5-fluorouracil is well tolerated on lip and oral mucosa and further studies are necessary to know the tolerability, efficacy, and duration of treatment with 5-fluorouracil. [Extracted from the article]

Phacomatosis pigmentokeratotica is a rare form of cutaneous mosaicism characterized by epidermal nevus usually nevus sebaceous, papular speckled lentiginous nevus, and extracutaneous anomalies. This type of twin-spot phenomenon (didymosis) is due to postzygotic crossing-over resulting in two homozygous daughter cells, representing the stem cells of the two distinct types of nevi and leading to additional extracutaneous defects. We report a case of this rare syndrome in a 4-year-old male child associated with skeletal anomalies. [ABSTRACT FROM AUTHOR]

Objective To determine the various causes of vaginal discharge in a tertiary care setting. Methodology A total of 120 women presenting with vaginal discharge were subjected to cytological diagnosis and confirmed by culture. Results Out of total 120 women with vaginal discharge, 103 (85.83%) women were found positive for the diagnosis of interest (bacterial vaginosis, candidiasis and trichomoniasis) which were more or less equally divided in the different age groups. Most common reproductive tract infection in study population was bacterial vaginosis (45.8%) followed by candidiasis (25.8%) and trichomoniasis (14.2%). Seventeen (14.2%) women were found to have vaginal discharge without any microbiological evidence. Conclusion The pattern of infectious causes of vaginal discharge observed in our study was comparable with the other studies in India. Our study emphasizes on importance of specific type of cervical discharge in diagnosing various reproductive tract infections (RTIs). This study highlight the opportunity of simultaneous counselling and assessment of co-existing RTIs which could be present in many of the cases. [ABSTRACT FROM AUTHOR]

Background: A combination of topical retinoid and antibacterial therapy is often advocated for acne to enhance therapeutic efficacy. Aims: A preliminary study to evaluate the efficacy and tolerability of a topical fixed combination of nadifloxacin (1%) and adapalene (0.1%) in the treatment of mild to moderate acne in Indian patients. Materials and Methods: This was an open-labeled, phase 3 non-randomized, non-comparative study conducted at five centers (Ahmedabad, Nagpur, Thane, Bangalore, and Mumbai) across India. Of 119 enrolled patients with mild to moderate acne, 117 patients were evaluated at the end of the study for efficacy parameters. A fixed combination of nadifloxacin (1%) and adapalene (0.1%) topical gel was applied at the affected area once at night for a period of 8 weeks. Reduction in the total, inflammatory and non-inflammatory lesion counts from the baseline, investigator global assessment (IGA) and reduction in the severity of acne as per combined acne severity classification were the primary efficacy variables measured at 2 weeks, 4 weeks, and 8 weeks. Results: Overall, 98.3% patients showed a statistically significant progressive reduction in non-inflammatory lesion counts, inflammatory lesion counts, and total lesion counts over the study duration. By the end of 8 weeks, 75% of the patients had their global assessment scores approaching to normal healthy skin score. The adverse events were mild to moderate in severity. Conclusion: This preliminary study shows that a fixed combination of 1% nadifloxacin and 0.1% adapalene topical gel could be an effective and well-tolerated option for the treatment of mild to moderate acne vulgaris. However, further well-controlled, randomized and comparative evaluation of this combination is necessary. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 52‑year‑old male patient has presented to dermatology outpatient department with swelling over left inguinal region since 2 months, which was small to start initially and gradually increased over a period of 2 months. Topics include the later swelling has ruptured to form a raw area with discharge of clear fluid, the associated with significant weight loss, and the patient also gave history of unprotected sexual contact with commercial sex worker.

Nevus Lipomatosus Cutaneous Superficialis (NLCS) is a rare benign hamartomatous disorder in which mature collection of adipocytes are present ectopically in the dermis. NLCS usually presents as multiple, soft, pedunculated, cerebriform, yellowish or skin colored papules, nodules, or plaques, mostly involving the pelvic or gluteal region. We herewith report two cases of adult onset classical NLCS. First case had a classical presentation with lesion on lower back while second case was associated with some unusual features like occurrence on pubic area and associated comedo-like lesions. [ABSTRACT FROM AUTHOR]

Competing Interests: There are no conflicts of interest.