Search

Background: Tuberculosis (TB) is a major global health problem and leading cause of death. Anti-tubercular therapy (ATT) can lead to various adverse effects including cutaneous reactions. Re-challenge remains the only option to restart the safe therapy with limited number of most efficient primary ATT drugs. Objectives: To study the demographic profile, identify the spectrum of cutaneous eruptions, offending drug and the reinstitution of safe ATT. Materials and Methods: This was a retrospective study with inclusion of the indoor patients with cutaneous adverse drug reaction secondary to ATT. Hospital records were analyzed regarding demographic characteristics, type of TB, ATT regimen, pattern of drug rash, offending drugs, laboratory parameters, and reinstitution of ATT after re-challenge. Results: All the cases (40 patients) were reported in adults with male to female ratio of 1:1.2 and mean age of 50 years. Pulmonary TB was the most common type of TB observed in 24 (60%) patients followed by extra-pulmonary in 16 (40%) patients. Maculopapular rash was the most common (42.5%) type of cutaneous eruptions and ethambutol, the most common (45%) offending drug followed by other first line anti-tubercular drugs. Ten (25%) patients developed multiple drug hypersensitivity on re-challenging. Multiple drug hypersensitivity was seen in 10 (25%) patients. Conclusion: Drug reaction to ATT is like a double-edged sword as stopping ATT and starting treatment of reaction with systemic steroids can further aggravate the condition with increased risk of disseminated and multidrug resistant tuberculosis. Re-challenge with ATT not only find out the culprit drug but also helps to restart a safer alternate ATT regimen. Limitations: Small sample size, lack of proper hospital records due to which some patients were missed and the fact that re-challenge was not performred in mild lichenoid type rash.

Background: Phytodermatitis refers to inflammation of the skin caused by a plant. The clinical patterns of dermatitis due to plants can present as allergic phytodermatitis, photophytodermatitis, irritant contact dermatitis or in the form of mechanical injury. The commonest plant causing allergic contact dermatitis in India is Parthenium hysterophorus, followed by other plants. Phytodermatitis due to Toxicodendron succedaneum is not uncommon in sub Himalayan range of North India and it has variable clinical presentation.The aim of the study was to study and evaluate the patients of allergic contact dermatitis due to T. succedaneum.Methods: All patients having allergic contact dermatitis due to T. succedaneum from August 2015 to July 2016 were enrolled for the study.Results: Our study included 13 (76.4%) males and 4 (23.5%) females with a mean age of 32 years. 76.4% patients developed lesions within 24-48 hours after contact with plant, 17.6% after 48 hours and 5.8% developed in less than 24 hours. Most of the (88.2%) patients presented with disseminated lesions and 11.7% had localised lesions involving only hands and forearms. Urticaria (41.1% ) was the commonest finding followed by papuloplaque lesions (in 29.4% patients), further followed by erythema multiforme like lesions (in 11.7% patients) and maculopapular, vesiculobullous lesions and angiodema (in 5.8% of each patients). Patch test was positive in 16 (94.1%) cases. Majority of patients required systemic steroids to settle the dermatitis. Conclusions: Allergic contact dermatitis due to T. succedaneum is very common in this region. Although it presents with widespread clinical presentations but adequate literature was not found on this plant. This plant further requires more study to know the dermatitis caused by it.

Background: Leprosy is a chronic disease caused by Mycobacterium leprae, which is a non culturable, slowly multiplying bacillus. The incubation period is variable and may take as long as twenty years for the symptoms to appear. It mainly affects the skin and peripheral nerves, but has a wide range of clinical presentations. The disease is associated with deformities and social stigma. Methods: Records of Hansen’s disease patients from January 2007 to December 2016 were taken and analysed retrospectively. A total of 288 patients were registered during this period. Results: Out of 288 registered patients, 78.8% were males and 21.2% were females. Maximum number of patients (62.15%) was in the age group of 20-40 years. Multibacillary patients constituted 86.11% and only13.88% were paucibacillary patients. 66.66% patients had grade 0 deformities, 22.56% had grade 1 deformities and 10.76% had grade 2 deformities. Conclusions: The study recommends that continuous efforts should be made for early detection of cases to prevent spread of disease in the community and to avoid development of deformities.

Background: Endogenous eczemas are often complicated by exogenous factors like environment and contact allergens. Nummular eczema, a variant of endogenous eczema is no exception to this. Our study aimed at investigating the incidence of allergic contact dermatitis and finding offending agent responsible for chronicity or relapsing course of nummular eczema in patients from a hilly region with cold and dry environmental conditions.Methods: Forty patients of nummular eczema with a mean age of 39.1±19 years were patch tested with the Indian Standard Patch Test Series. Positive reactions were graded as per recommendations of International contact dermatitis research group.Results: Twenty one out of forty patch tested patients showed positive reactions. The most common allergens were found to be: fragrance mix in seven (17.5%) patients, nickel in five (12.5%) patients, PPD in three (7.5%) patients and gentamicin in two (5%) patients. Sensitivity to thiuram mix, black rubber mix, P. tert. butylphenol formaldehyde, neomycin, benzocaine and chinoform was observed in one patient each (2.5% each). Conclusions: Patients of nummular eczema of a hilly region are at a significant risk of developing allergic contact dermatitis owing to xerosis due to dry environmental conditions. This results in chronic nature of their disease. Patch testing should be considered in such patients and avoidance of offending allergens can improve their quality of life.

Background: Sexually transmitted infections (STIs) are a public health problem, which increase the HIV transmission and are a burden to the individual, his family and community. The prevalence of STIs varies widely across different regions in our country. There is immense need to study the pattern of STIs in various regions for proper planning and implementation of control strategies. The study was conducted with the objective to assess the pattern of STIs and their prevalence in a District hospital of Himachal Pradesh . Methods: A retrospective hospital based study was carried out from clinical records of the STI clinic over a period of one year (January 2016 to December, 2016). Detailed history, demographical data and clinical features were recorded, and STIs were categorized into various syndromes as depicted by National AIDS Control Organization. The data collected was analyzed statistically, and compared with other studies from across the country . Results: Cervical/vaginal discharge (80.4%) was the commonest STI followed by balanoposthitis (33.3%), lower abdominal pain syndrome (LAP) (17.1%), genital scabies (4.2%), herpes genitalis (3.7%), uretheral discharge (1.9%), genital warts (0.98%), chancroid (0.61%), molluscum contagiosum (0.6%), syphilis (0.12%) and inguinal bubo (0.12%). Balanoposthitis was the commonest STI in males, followed by genital scabies, herpes genitalis, genital warts, chancroid and genital molluscum, uretheral discharge and syphilis. In females, cervical/vaginal discharge was the most frequently reported STI followed by LAP, genital herpes, genital scabies, genital warts, chancroid, inguinal bubo and molluscum contagiosum . Conclusions: The increase prevalence of cervical/vaginal discharge was due to increased referral from Gynaecology OPDs. Balanoposthitis was quite commonly reported in males. The increase in the viral STIs has been seen, which is consistent with other studies from different regions .

Herpes zoster, caused by Varicella-zoster virus is generally considered to be a disease of the elderly. Recently, a number of studies have shown in the increased incidences in children. Herein, a case of Herpes zoster in an otherwise healthy child of 9 years of age is being reported, who did not have any evidence of immunosupression.

Sweet's syndrome or acute febrile neutrophilic dermatosis is characterized by tender polymorphous skin lesions, accompanied by fever and peripheral neutrophilia. Although it may be seen at any age, it most commonly occurs in women in the fourth and fifth decade. It is a relatively rare diagnosis in children. We report a 1-year-old boy with Sweet's syndrome following an upper respiratory tract infection.