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Background: Methotrexate is a widely used immunosuppressant with good efficacy and cost‑effectiveness. However, one of the drawbacks of methotrexate has been toxicity due to accidental overdose. During the COVID pandemic, there was an alarming increase in the number of patients with methotrexate toxicity which prompted us to do this study. Objective: To evaluate the clinical features and contributing factors in patients presenting with methotrexate toxicity. Materials and Methods: A detailed evaluation of the clinical features, laboratory indices, contributing factors, and outcomes of the patients presenting with methotrexate toxicity was analyzed. Results: A total of 19 cases were seen during the study period. All of the patients had oral mucositis and several developed cutaneous ulcerations. Laboratory abnormalities included cytopenia, transaminitis, and renal impairment. While sixteen patients recovered successfully, three people died as a result of delays in medical assistance. In addition to comorbidities, pandemic‑induced restrictions played a major role in patients accidentally overdosing with methotrexate. Conclusion: This study highlights the fact that even low‑dose methotrexate taken incorrectly can result in a lethal outcome, which is preventable [ABSTRACT FROM AUTHOR]

Byline: Dodmallur. Sindhu, Sumanth. Shivaram, Shilpa. Rao, Madhu. Nagappa, Doniparthi. Seshagiri, Vani. Santosh, J. Madhukara, A. Shreedhara, Maya. Bhat, Rose. Bharath, Sanjib. Sinha Sir, Köhlmeier-Degos disease or Degos disease or [...]

Introduction: Natural rubber latex (NRL) is processed from Hevea brasiliensis trees. Allergic reactions to certain proteins in the latex manifest as immediate hypersensitivity reactions and allergic reactions to chemicals added to latex during processing manifest as allergic contact dermatitis. Healthcare workers (HCWs) are at increased risk of developing latex allergies. As little data is available from India, this study was directed toward identifying the prevalence of latex glove-related dermatoses among nurses and the factors leading to it. Methodology: This cross-sectional study was undertaken among nurses in a private tertiary care hospital. Results: A total of 700 nurses were included in the study. Symptoms of latex allergy were present in 74 (10.6%) of study subjects, out of which 69 (9.9%) had features of contact dermatitis. Patch test was done in 50 subjects and was positive in 12 (24%); among them, patch test antigens were positive in 9 (18%) and a positive result to glove piece was seen in 3 subjects. Conclusions: Latex allergy in India is a significant problem; though lesser compared to western countries, its prevalence necessitates the development of pre-employment protocols to avoid workplace morbidity. [ABSTRACT FROM AUTHOR]

Byline: Sendhil. Kumaran, Ishwara. Bhat, J. Madhukara, Pritilata. Rout, J. Elizabeth Background: As the world moves toward elimination of leprosy, persistence of infective cases in endemic pockets remains a significant [...]

Byline: Ishwara. Bhat, J. Madhukara, J. Elizabeth, Usha. Kini, A. Anuradha Sir, Sebaceous carcinomas are uncommon, aggressive, malignant neoplasms derived from the adnexal epithelium of sebaceous glands. Approximately 75% of [...]

Byline: K. Shreedhar, J. Madhukara, J. Jessy, S. Manohari, K. Srinivasan Sir, Drug hypersensitivity syndrome (DHS) is one of the more severe cutaneous adverse drug reactions. It is characterized by [...]

Byline: J. Madhukara, M. Kumaran, Anil. Abraham Sir, Metal cases of mobile phone are newer sources of the growing list of conditions where nickel may cause contact dermatitis. A 32-year-old [...]

Byline: J. Madhukara, M. Kumaran Costello syndrome is a rare, distinctive, multiple congenital anomaly syndrome, characterized by soft, loose skin with deep palmar and plantar creases, loose joints, distinctive coarse [...]

Background: Pemphigus is an autoimmune blistering disease. The common cause of death in pemphigus is septicemia which is usually secondary to cutaneous bacterial infection. Aim: The aim was to study the cutaneous bacteriological profile in patients with pemphigus. Materials and Methods: Pus for culture and sensitivity was collected from clinically infected lesions of pemphigus patients in the Department of Dermatology, St. John's Medical College Hospital, Bengaluru, from June 2013 to June 2014. Results: Of the 49 patients included in the study, 44 were suffering from pemphigus vulgaris, 4 from pemphigus foliaceus and one had pemphigus vegetans. There were 31 male and 18 female patients. The mean age of the group was 35.51 year. Mean Autoimmune Bullous Disorder Intensity Score was 17.36. About 32.7% were diabetic. About 40.81% showed the growth of Staphylococcus aureus, 12.24% of Pseudomonas aeruginosa, 6.12% of Proteus mirabilis, 4.08% of β-hemolytic streptococci and nonfermenting Gram-negative bacilli, and 2.04% of Proteus vulgaris, Staphylococcus saprophyticus, Enterococcus species, and Klebsiella species. S. aureus showed 100% sensitivity to antibiotics - tetracycline, amikacin, chloramphenicol, and netilmicin; 90% resistance was found for penicillin and 55% resistance was found for ciprofloxacin and erythromycin. Methicillin-resistant S. aureus was 30%. P. aeruginosa showed 100% sensitivity to ciprofloxacin, amikacin, gentamicin, piperacillin, piperacillin + tazobactam, and netilmicin. Conclusion: S. aureus was the most common organism showing sensitivity to tetracycline, amikacin, chloramphenicol, and netilmicin and resistance to penicillin, ciprofloxacin, and erythromycin. [ABSTRACT FROM AUTHOR]

Aim: To collect data pertaining to oral drug provocation testing (DPT) in hospitalized patients with antiretroviral (ARV)/antitubercular agent-induced rashes., Methods: Patients with cutaneous adverse drug reactions (ADRs) to ARV/antitubercular drugs and who underwent oral DPT during a 5-year period were included in this study., Results: Data were collected from the records of 21 patients. Of the 21, 19 had HIV infection. The most commonly implicated drug was nevirapine (NVP), followed by cotrimoxazole and antitubercular agents. Of the 11 ADRs that occurred on rechallenge, the ADR on rechallenge was similar in clinical presentation to the initial ADR in 6 patients, while a different rash was elicited in 5 patients., Conclusion: Oral DPT is a safe and effective tool to accurately diagnose ADRs, especially in patients on multiple drugs and in situations such as HIV infection and tuberculosis where second-line agents are expensive and/or not easily available through the national AIDS control/tuberculosis programs.

Background: Androgenetic alopecia is a condition with a high prevalence worldwide and affects both males and females. Currently, only 2 approved treatments exist: finasteride (males only) and minoxidil 2 or 5% solution (males and females)., Methods: We conducted a randomized, open-label, multicenter noninferiority study to determine whether a caffeine-based 0.2% topical liquid would be no less effective than minoxidil 5% solution in males (n = 210) with androgenetic alopecia. The primary end point was the percentage change in the proportion of anagen hairs from baseline to 6 months using a frontal and occipital trichogram., Results: At 6 months, the group of the 5% minoxidil solution showed a mean improvement in anagen ratio of the trichogram of 11.68%, and the group of the 0.2% caffeine solution had an anagen improvement of 10.59%. The difference of mean values between both groups was 1.09%. The statistical analysis was performed and reported in accordance with the CONSORT Guidelines 2010 for reporting of noninferiority and equivalence randomized trials., Conclusion: A caffeine-based topical liquid should be considered as not inferior to minoxidil 5% solution in men with androgenetic alopecia., (© 2017 The Author(s) Published by S. Karger AG, Basel.)