Journal of Skin and Sexually Transmitted Diseases

Published by Scientific Scholar
Online ISSN: 2582-3175
Publications
Pinhead-sized pustules and erythematous papules on the forehead of a patient following Moderna COVID-19 (mRNA-1273) vaccine.
Pustules on the upper chest of a patient following Moderna COVID-19 (mRNA-1273) vaccine.
Article
Coronavirus disease-2019 (COVID-19) has affected countries around the world. The introduction of COVID-19 vaccines has proved the most effective arsenal in the fight against the disease. However, with the vaccination of billions of people, data on vaccine-induced adverse reactions are also emerging. We report a 32-year-old woman who manifested papulopustular rash 7 days after receiving Moderna COVID-19 (mRNA-1273) vaccine. The patient responded to a short course of systemic steroids and antihistamines. Awareness regarding the possible adverse events that can be anticipated after the COVID-19 vaccination may help the healthcare professionals to offer prompt and effective care to the affected.
 
Article
Paraneoplastic pemphigus is an autoimmune blistering disease associated with an underlying malignancy. This is a case of a 13-year-old boy initially presenting with isolated oral erosions – managed as a case of pemphigus, who one and a half years later developed toxic epidermal necrolysis like rash, both refractory to treatment. Evaluation for an underlying malignancy revealed a retroperitoneal Castleman’s tumor, following the excision of which there was clinical remission of the oral and skin lesions.
 
Article
Paul Gerson Unna, one of the leading dermatologists of Central Europe, was way ahead of his time. The originality of this meticulous researcher always reflected in his works on anatomy and histology of the skin. Field of dermatology was made very attractive and appealing to many at that time by his first book on histopathology. His revolutionary Unna boot was only a minor invention when compared to his extensive contribution to the educational research and therapeutic dermatology.
 
Article
Paul Gerson Unna, one of the leading dermatologists of Central Europe, was way ahead of his time. The originality of this meticulous researcher always reflected in his works on anatomy and histology of the skin. Field of dermatology was made very attractive and appealing to many at that time by his first book on histopathology. His revolutionary Unna boot was only a minor invention when compared to his extensive contribution to the educational research and therapeutic dermatology.
 
Article
COVID-19 is not a lung disease alone. It produces several collateral damages in all the specialities of medicine, including dermatology. Neither a major breakthrough in the treatment nor a vaccine has been introduced to deal with this virus. We developed a three-pronged strategy to ensure that our patients are not denied treatment for their chronic dermatoses; at the same time, minimizing their risk of contracting the COVID-19 infection through frequent hospital visits. First, we reduced the need of the patients for repeated hospital visits by providing them medical help through phone calls. Second, we ensured safety of the patients who comes for dermatological procedures, photo therapy, and laser therapies. Third, we ensured the protection of our lab persons by following strict guidelines while performing blood tests of COVID-19 patients.
 
Article
Maculopapular rash mainly distributed over the trunk, is reported as the most common cutaneous manifestation in COVID-19 patients. The palms, soles, and face are usually spared. The rash is associated with itching in 56% of patients and is observed along with COVID-19 symptoms. Maculopapular rash is considered as a feature of severe COVID-19 and the lesions usually resolve in 10 days. We report a COVID-19 patient whose initial manifestation was an atypical maculopapular rash with urticarial wheals and erythema multiforme-like lesions. The patient denied drug intake before the onset of skin lesions. The rash was distributed over the face, palms, and soles in addition to the trunk and limbs. The patient had only mild symptoms of COVID-19. The rash lasted for 3 weeks and resolved with post-inflammatory hyperpigmentation and peeling of the skin of the fingertips. We report this case to highlight the possibility of skin rash being the initial sign of COVID-19.
 
Article
Leukocytoclastic vasculitis (LCV) refers to the histopathological changes observed in a common form of small vessel vasculitis that can affect skin and/or internal organs. LCV can be precipitated by several causes (including infections, drugs, and collagen vascular diseases) or can be idiopathic. We report a 50-year-old man who presented with fever, parotid enlargement and skin rash (discrete and confluent erythematous macules, papules, and plaques and a few purpuric lesions on the back of trunk and upper limbs), 3 weeks after being diagnosed with coronavirus disease 2019 (COVID-19). The patient showed four out of the five features required to satisfy the working case definition of multisystem inflammatory syndrome in adults (MIS-A). Histopathology of rash was consistent with LCV. Whether, COVID-19 was the cause for LCV in our patient remains unclear. The fever, parotid enlargement and rash showed complete resolution following treatment with systemic corticosteroids and enoxaparin.
 
Article
Cutaneous manifestations of Coronavirus disease 2019 (COVID-19) are variable. We report a 57-year-old woman who developed toxic epidermal necrolysis (TEN) in association with COVID-19. The patient had not received any drugs prior to the onset of TEN. She responded to treatment with cylosporine. Previous authors have suggested a better prognosis for TEN associated with COVID-19 in comparison to drug-induced TEN.
 
Eruption of multiple seborrheic keratoses in a patient with adenocarcinoma of stomach.
Basal cell carcinoma. Figure 1: Xerosis of skin in an elderly.
Nail and oral mucosal manifestations in patients aged 60 years and above attending the dermatology department of a tertiary referral center.
Article
Objectives With the rise in life expectancy at birth, geriatric population contributes to a significant proportion of those seeking medical aid. Skin problems in the elderly are very common and vary according to region and ethnicity. It is essential for dermatologists to have a better understanding of the pathophysiology of geriatric skin disorders to formulate quality management guidelines. This study was undertaken to document the frequency and the clinical pattern of various physiological and pathological changes in the elderly skin. Materials and Methods A cross-sectional study was carried out in 200 consecutive patients aged 60 years and above and who attended the Dermatology outpatient clinic of a tertiary referral center in North Kerala. A pre-set pro forma was used to document the patient characteristics, the comorbidities, the medications used, and the clinical findings. Results All the study participants (100%) had one or more dermatoses. The age of the study population ranged from 60 to 89 years (mean 67.7 ± 6.2 years). This was a female preponderant study with a female to male ratio of 1.4:1. Hypertension (36%), hyperlipidemia (27%) and diabetes mellitus (26%) were the common comorbidities observed. Graying of hair was the most common physiological change, followed by wrinkling. Pruritus was the most common presenting complaint (136, 68%). Statistically significant association was noted between xerosis and generalized pruritus. Fungal infections (30.5%) outnumbered other infections and infestations. Changes of severe photoaging were less frequent. One patient had skin malignancy (basal cell carcinoma). Significant association was noted between photoaging and male sex, smoking, and sun exposure. Limitations Study conducted in a tertiary referral center not reflecting the status in the community was the major limitation. Conclusion Photoaging and skin cancers are less frequent in darker skin type. Healthy lifestyle, nutritious diet, frequent application of emollient, better skin care, and judicious use of sunscreen can delay the process of cutaneous aging. More prospective studies in different population groups may go a long way in improving the current knowledge about the less known aspects of geriatric dermatoses.
 
Article
Disseminated Nocardia infection is uncommon in clinical practice, with most cases occurring as opportunistic infections in immunocompromised patients. Cutaneous nocardiosis is often misdiagnosed because of its rarity and nonspecific clinical picture. Here, we report a case of disseminated nocardiosis in an immunocompetent patient presenting with multiple cutaneous abscesses.
 
Article
Acantholytic dyskeratotic acanthoma (ADA) is a rare benign condition characterized by circumscribed epidermal proliferation displaying both acantholysis and dyskeratosis. It is of unknown etiology and pathogenesis. We report a case of ADA of long duration in a 75-year-old female along with a review of literature with special reference to cases reported during the past 10 years.
 
Article
Objectives The objectives of this study are as follows: (1) To study the levels of testosterone and dehydroepiandrosterone sulfate (DHEAS) in females with acne and/or female pattern hair loss (FPHL) and (2) to study the correlation of the severity of acne and/or FPHL with serum levels of testosterone and DHEAS. Materials and Methods A cross-sectional study was carried out in the department of dermatology and venereology, of a tertiary care institution over a period of 1 year among patients who presented with acne and/or FPHL. Acne was graded using Leeds revised acne grading system and FPHL with Ludwig scale. Competitive immunoenzymatic colorimetric method for quantitative determination of testosterone and DHEAS concentrations in serum (“DiaMetra” kits) was performed. Correlation between quantitative variables was assessed by Pearson correlation and Spearman rank correlation. Results A total of 84 patients with acne and/FPHL were studied over a period of 1 year. Fifty-one (60.7%) patients had acne, 21 (25%) had FPHL, and 12 (14.3%) patients had both. The mean levels of testosterone in acne, FPHL, and in patients with both were 1.14 ± 4.65 ng/ml, 0.51 ± 0.17 ng/ml, and 0.53 ± 0.24 ng/ml, respectively. The mean DHEAS in patients with acne, FPHL, and with both was 4.64 ± 4.96 μg/ml, 4.96 ± 5.34 μg/ml, and 6.34 ± 5.37 μg/ml, respectively. The Spearman rank correlation between the level of testosterone and the grades of inflammatory acne in face and FPHL was 0.193 and -0.16, respectively. The Spearman rank correlation of DHEAS with the grades of inflammatory acne in face and FPHL was 0.092 and 0.01, respectively. Limitations The study carried out in a tertiary referral center, not reflecting the status of the condition in general population was the major limitation. Conclusion This study in a localized population could not elicit a significant statistical correlation between serum levels of total testosterone and DHEAS with severity of acne or FPHL. However, a majority of patients with acne, FPHL, or both had low levels of total testosterone which were discordant with most of the previous studies. Half of the study population with coexisting acne and FPHL had high levels of DHEAS which suggests the need to study the role of DHES in patients with coexistence of acne and FPHL.
 
Article
Objectives To determine the association of acrochordons with metabolic syndrome and its components. Materials and Methods A cross-sectional study was conducted in 100 patients with acrochordon and 100 age- and gender-matched controls who attended the dermatology outpatient department of a tertiary care center in South India from January 2017 to December 2017. A detailed dermatological examination was carried out in cases with respect to distribution, number, color, and morphology of acrochordons. Blood pressure (BP), pulse rate, waist circumference, height, weight, and body mass index were recorded in all cases and controls. Fasting lipid profile, fasting blood sugar, liver function test, and renal function test were done in all study participants. A diagnosis of metabolic syndrome was made based on the International Diabetes Federation metabolic syndrome worldwide definition specified for the Asian population. Statistical analysis was done using Pearson’s Chi-square test. Results There were 52 females and 48 males in each group. About 80% of patients belonged to the age group of 20–50 years. A significantly higher number of cases had metabolic syndrome ( P < 0.001). Acrochordons showed a significant association with the components of metabolic syndrome such as high BP ( P < 0.001), high fasting plasma glucose levels ( P < 0.001), and low levels of high-density lipoprotein cholesterol ( P = 0.04). Comparison of cases showed that patients with acrochordons limited to axilla were less likely to have metabolic syndrome in comparison to those who had acrochordons on other body sites with or without involvement of axilla ( P = 0.008). Patients who manifested only sessile lesions were less likely to have metabolic syndrome when compared to those who manifested pedunculated/filiform/pedunculated and filiform lesions ( P < 0.001). Limitations A cross-sectional study design and study carried out in a tertiary referral center were the limitations. Conclusion A significant association was noted between acrochordons and metabolic syndrome.
 
Article
Atopic dermatitis (AD) is a chronic skin disorder resulting from complex interactions between skin barrier defects and a dysregulated immune system, marked by activation of multiple T cell subsets at different stages of the disease. Until recently, the management of AD rested mainly on the judicious use of emollients, topical steroids, and topical calcineurin inhibitors in the majority of patients and systemic immunosuppressants were advocated in severely diseased. However, in the last few years, new therapeutic strategies were designed and developed to target the various steps in the chain of molecular events that lead to the AD phenotype. This review article will focus on the recent advances in the management of AD.
 
Article
There has been a paradigm shift in the management of lymphedema with a better understanding of the functioning of lymphatics with the introduction of “lymphosome concept” and with the recent advances in super-microsurgical techniques. The most frequently used intraoperative imaging modality now is indo cyanine green lymphangiography. In endemic countries, any patient with lymphedema without prior history of trauma or, oncosurgical or radiotherapy interventions must undergo Alere filariasis test strip. Patients in early stages of disease can benefit from complex decongestive therapy and physiologic surgical procedures such as lymphovenous anastomosis or vascularized lymph node transfers. However, in advanced disease, excisions or debulking through radical reduction with preservation of perforators will be required. The localized adipose tissue deposits in lymphedema can be removed by liposuction. At present, there is still no cure for lymphedema, but emerging research in tissue engineering, lymphangiogenic growth factors, and immunomodulatory therapy may provide better management options for lymphedema in future.
 
Article
Biologicals are a rapidly evolving group of drugs derived from biological agents which target specific immune mediators. The use of biologicals in dermatology is on the rise, especially for inflammatory and immunological conditions. As pregnancy and lactation are associated with exacerbation of various inflammatory conditions necessitating administration of biologicals in certain cases, their use in these physiologically altered states has to be evaluated. This article aims at reviewing the common biologicals used in dermatology and their feasibility in pregnancy and lactation. Tumor necrosis factor-alpha inhibitors are the most experienced group of biologicals in pregnancy and lactation, the newer biologicals have only animal studies and isolated case reports to back up their use. The commonly used biologicals are tabulated and discussed herewith. The guidelines and recommendations are derived from the data of use in other conditions such as inflammatory bowel disease and rheumatoid arthritis as there is no sufficient literature evidence for the use of biologicals in pregnancy for dermatological conditions. It was extrapolated that biologicals, being large molecular weight immunoglobulins or recombinant proteins, may be used with judicious care in the first two trimesters of pregnancy and after the 1 st week of lactation, if benefits to the mother outweigh the theoretical risk to the infant.
 
Article
Immunosuppressive drugs are the main stay of treatment for autoimmune dermatoses. The main disadvantage of these drugs is the increased susceptibility to life-threatening infections. Hence, in recent years, there has been an enthusiastic search for newer groups of drugs that can reduce this risk. Immune enhancing agents are considered as the key players of future. Immune enhancers function by activating various elements of the immune system and thereby amplifying the immune responses. They can be specific or non-specific in action. The main autoimmune dermatoses where the benefits of these drugs have so far been utilized include alopecia areata, vitiligo, psoriasis, lichen planus, and discoid lupus erythematosus. Immunostimulants are available in both topical and systemic forms. Topical immune- enhancing agents include contact sensitizers (diphenylcyclopropenone, dinitrochlorobenzene, and squaric acid dibutyl ester), anthralin, topical zinc, and interferons. Systemic agents include levamisole, zinc, probiotics, and so on. The exact mechanism of action of some of these drugs and other autoimmune conditions where they can be benefited is not completely understood. Another therapeutic agent that may come up in the future is individualized vaccines. Let us look forward to the days when individualized vaccines work wonders in the management of autoimmune diseases.
 
Article
In India and rest of the world, there has been a tremendous decline in the number of leprosy patients over the last four decades. However, one of the major challenges faced by India is the continued occurrence of new leprosy cases, evidenced by almost a static new case detection rate (NCDR) over the last decade. The article discusses the challenges faced by the country and the solutions available for achieving the target of ‘Zero Leprosy’.
 
Article
Objectives The objective of the study was to identify the allergens showing positive patch test reaction (using Indian standard battery of allergens) in cement workers with clinically diagnosed allergic contact dermatitis (CD) to cement attending a tertiary referral center. Materials and Methods We included cement workers with clinically diagnosed allergic CD to cement who attended the dermatology outpatient clinic of our tertiary referral center from January 2013 to December 2013. We did patch testing in all the cases ( after subsidence of active dermatitis) with Indian standard battery of patch test allergens and documented the allergens that showed a positive reaction. Results Forty-seven (94%) of the 50 study participants showed a positive reaction to one or more of the allergens. The most common allergen that showed a positive reaction was potassium dichromate (43/50, 86%). Twenty-five patients (50%) showed positive reactions to more than 1 allergen. Four patients (8%) showed positive reactions only to allergens that were not seen in cement. Limitations Small sample size and lack of information on clinical response of dermatitis to avoidance of identified allergen were the major limitations. Conclusion Twenty-five (50%) patients showing positive reactions to more than 1 allergen tested and 4 (8%) showing positive patch test reaction to none of the allergens in cement (but to other allergens) highlight the role of patch testing in identifying the probable allergens in patients with clinically diagnosed allergic CD to cement.
 
Article
Customs and traditional practices may predispose to the development of dermatitis in unusual sites and patterns. The mangalsutra (thali) or holy thread is tied by the Hindu groom around the bride’s neck and is a mark of her marital status, comparable to the wedding ring in the west. The thread is smeared with turmeric before the ceremony. Turmeric is considered auspicious and plays an important role in Hindu ceremonies. Although dermatitis to turmeric in kumkum is reported, its presentation as a mangalsutra dermatitis does not find mention. The patient who developed dermatitis with pigmentation over the contact sites of mangalsutra and over the forehead (corresponding to the bindi) is presented.
 
Article
Alopecia mucinosa, also called follicular mucinosis, is a rare inflammatory disease affecting the pilosebaceous units in the skin. It presents clinically as follicular papules with or without erythematous scaly plaques and evident hair loss in the absence of other conditions causing alopecia. Histologically, it presents as a deposition of mucopolysaccharides (mucin) within the outer root sheath and sebaceous glands. We present here a case of alopecia mucinosa in a 26-year-old male.
 
Article
Frontal fibrosing alopecia (FFA) is a primary progressive cicatricial alopecia of the frontal, temporal, or frontotemporal scalp. In FFA, hairline recession, scalp pruritus, perifollicular erythema, and eyebrow loss are common at presentation. At present, there are no evidence-based treatment guidelines for FFA; hence, adopted modalities of treatment vary among clinicians. This review is an overview of the disease characteristics and the available therapeutic options in FFA.
 
Article
Objectives To determine the relation between serum vitamin D levels and alopecia areata. Materials and Methods This cross-sectional study included patients with AA who were above 12 years of age and age- and sex-matched controls who attended the dermatology department of a tertiary care center during a period of 1 year. Serum Vitamin D level was determined in each participant. Serum Vitamin D levels documented in both groups were compared. Results Thirty patients and 30 age- and sex-matched controls constituted the study population. The male-to-female ratio was 1.7:1. Most of the patients (9/30, 30%) were in the age group of 31–40 years. We observed patchy AA in 17 patients (56.7%). Nail involvement was seen in 9 patients (30%). Serum vitamin D levels were insufficient/deficient in 16 patients (53.3%), while in the age- and sex-matched comparison group, vitamin D was insufficient / deficient in 7 cases (23.3%). The difference was statistically significant ( P = 0.03). No significant relation was noted either between serum vitamin D levels and number of alopecia lesions or between serum vitamin D levels and the clinical pattern of AA. No significant difference was noted in the vitamin D levels between patients who had involvement of only scalp and those who showed involvement of other body sites. Limitations Small sample size was the major limitation of the study. Conclusion Low serum vitamin D levels were more frequent in patients with AA in comparison to healthy controls.
 
Article
A 45-year-old male presented with multiple discrete and confluent erythematous plaques, distributed on the malar area and bridge of nose of 1-year duration those were blanching on diascopy. There was no history of photosensitivity. There were no skin lesions elsewhere. Blood examination was normal and antinuclear antibody profile was negative. Skin biopsy showed the upper dermis, mid dermis, and subcutaneous tissue packed with vascular spaces lined by epithelioid endothelial cells with eosinophilic infiltrate, diagnostic of angiolymphoid hyperplasia with eosinophilia. The patient was treated with Nd-Yag laser resection.
 
Article
Annular atrophic lichen planus is the rarest variant of lichen planus which shares features of annular and atrophic lichen planus. It presents as atrophic plaques with raised borders which expand centrifugally. Reported cases are few till date. The characteristic feature is the reduction of elastin fibres in superficial dermis on histopathology. Annular atrophic lichen planus is resistant to topical steroids. In this article, we report a case of annular atrophic lichen planus with Koebner phenomenon which responded to topical tacrolimus.
 
Article
Anti-p200 pemphigoid, initially described in 1996, is a subepidermal autoimmune blistering disease. It is manifested as tense blisters, mostly in an acral distribution, and is accompanied by mucosal involvement in more than half the cases. The disease is produced by circulating autoantibodies directed against the dermal antigen of 200-kDa, the exact identity of which remains unknown. This review focuses on the clinical features, immunopathogenesis, and diagnosis of anti-p200 pemphigoid.
 
Article
Objectives The objectives of the study were to determine the in vitro susceptibility of dermatophyte species, isolated from the clinically diagnosed lesions of cutaneous dermatophytosis to fluconazole, and terbinafine. Materials and Methods The skin scrapings from clinically diagnosed lesions of cutaneous dermatophytoses were cultured in Sabouraud dextrose agar to identify the causative dermatophyte. Antifungal susceptibility testing was performed using microbroth dilution assay. Results During the study period, 94 specimens from clinically diagnosed lesions of cutaneous dermatophytoses were received for fungal culture. Dermatophytes were identified as the causative agent in 44 specimens ( Trichophyton rubrum was identified in 18/44 (40.9%), Trichophyton mentagrophytes in 17/44 (38.6%), Trichophyton interdigitale in 5/44 (11.4%), and Nannizia gypsea in 4/44 (9.1%) isolates). Minimum inhibitory concentration (MIC) of fluconazole was ≥64 µg/ml in 22.7% (10/44) and MIC of terbinafine was ≥0.5 µg/ml in 36.4% (16/44) of specimens. When compared to fluconazole, terbinafine showed a lower MIC 50 of 0.0019 µg/ml for Nannizia gypsea . Limitations Small sample size and lack of clinical correlation were the major limitations of the study. Antifungal susceptibility testing limited to fluconazole and terbinafine was another limitation of the study. Conclusion Trichophyton rubrum was the most common isolate identified in culture of scrapings from clinically diagnosed lesions of cutaneous dermatophytosis. A rising trend in MIC values of isolates to terbinafine and fluconazole was observed.
 
Article
Drug interactions can occur when two or more medications are simultaneously given, and one drug increases or decreases the effectiveness of the other. Azole antifungal agents show a wide range of interactions with other drugs. Failure to recognize a drug–drug interaction may produce harm to the patient, including enhanced toxicity of the concomitantly administered medication. Most of the interactions of azole antifungals are of pharmacokinetic type. This article reviews the clinically relevant drug interactions of commonly used antifungals - fluconazole and itraconazole.
 
Demographic profile of patients referred for Antiretroviral Therapy Plus Centre during the study period.
Univariate analysis of factors affecting death, loss to follow-up, and death after starting second-line antiretroviral therapy.
Article
Background Assessment of the functioning of Kerala’s second-line component of antiretroviral therapy (ART) program by National AIDS Control Organization (NACO) is attempted. Aims This study aims to evaluate the factors related to mortality and loss to follow-up (LFU) during the second-line ART rollout in Kerala. Materials and Methods Prospective observational cohort study. All patients referred for the second-line ART from September 2011 to June 2013 were included, followed up till December 2013 or till death. Those who were not eligible to attend the State AIDS Clinical Expert Panel (SACEP) were excluded from the study. Descriptive variables were compared using proportions and percentages. Univariate analysis and multivariate logistic regression were done to find out the association. The study was approved by ethical committee and consent was taken from all the interviewed patients. Results Of 238 patients enrolled, 62 died and 25 became LFU. Age >40 years (odds ratio [OR] 2.08; 95% confidence interval [CI]: 1.05, 4.1), HIV concordance between partners (OR 1.53; 95% CI: 0.7, 3.34), and duration of >90 days from last CD4 ⁺ to SACEP (OR 2.32; 95% CI: 1.17, 4.5) were significantly associated with death. Only factor affecting LFU was distance >150 km from patient’s home to ART Plus Centre (OR: 2.7; 95% CI: 0.11, 1.85). Limitations We could not consider all factors affecting mortality while initiating second-line ART. Moreover, experience from a low-level epidemic state, with good health-care infrastructure may not reflect rest of India. Conclusions Accessibility to program in terms of distance to the point of care and delayed linkage of patients for the second-line ART is presently the main weaknesses in Kerala. Special attention should be given to concordant couples and older individuals who are more vulnerable. Recent steps by NACO, such as initiation of two ART Plus Centre and provision viral load testing at the point of care, are big leaps toward solution.
 
Article
Gerhard Henrik Armauer Hansen radicalized the views on leprosy when he discovered the leprosy bacilli in 1873. He was a man born in a humble background but with perseverance finished medicine at the University of Christiania and later joined as assistant physician under another stalwart Danielssen at St. Jogren’s Hospital, Bergen. It was here that he made the greatest discovery of his time, but it would be years before, he was truly acknowledged for his work. His theory of contagion helped in the measures to control leprosy in the form of leprosy acts. Hansen passed away in 1912, and his name remains engraved in the pages of the history of leprosy.
 
Article
The treatment of psoriatic arthritis (PsA) makes use of many agents. Most of them are used for the treatment of other forms of inflammatory arthritis or the management of cutaneous manifestations of psoriasis. Although a number of medications are effective in the treatment of both rheumatoid arthritis (RA) and PsA, trials involving some classes of biologic agents indicate that patients with RA and PsA may show different responses to certain drug classes. Treatment of the different elements of PsA includes coordinated interventions to address the major domains of the disease, including peripheral and axial arthritis, enthesitis, dactylitis, and skin and nail involvement.
 
Article
Artificial intelligence (AI) refers to the ability of a machine to communicate, reason, and operate independently. There is a need to understand this technology’s progress for future medical care. AI has many applications in the field of medicine, but its use in dermatology is comparatively new. Applications that commonly analyse and classify images and tools like risk assessment calculators are available. Even though many applications exist, the important implementation barriers inclue difficulty in standardization, interpretability, and acceptance by patient and doctor.
 
Article
Objectives The objectives of the study were (1) to study the fine-needle aspiration cytology (FNAC) features of skin lesions of leprosy, (2) to determine the agreement between FNAC and histopathology to classify leprosy into different groups of the spectrum, and (3) to determine the sensitivity and specificity of FNAC to classify leprosy into different groups of the spectrum against the gold standard of histopathology. Material and Methods All newly diagnosed cases of leprosy who attended the outpatient department of dermatology and venereology of a tertiary referral center during the 16 months study period were included in this cross-sectional study. Based on FNAC and histopathology, patients were classified into different groups of the spectrum. Agreement between FNAC and histopathology to classify leprosy was determined by Kappa statistics. Sensitivity and specificity of FNAC to classify leprosy were determined against the gold standard of histopathology. Results All the 47 study participants had histopathology features of leprosy. FNAC could obtain adequate aspirate in 30 patients (63.8%), who were considered for further analysis. There was moderate agreement (76.6%) between classification of leprosy by FNAC and histopathology on Kappa statistics (Kappa value 0.766). FNAC showed 80–100% sensitivity and 84–100% specificity to classify leprosy against the gold standard of histopathology. Limitation Small sample size. Conclusion When adequate aspirate is obtained, FNAC could serve as a useful tool in classification of leprosy.
 
Article
The term pemphigus is collectively used to describe a group of immunobullous disorders characterized by intraepidermal cleft and circulating antibodies against intercellular adhesion molecules. Pemphigus vegetans was first described as a variant of pemphigus vulgaris by Neumann in 1876. We report a case of 36-year-old female who presented with swelling of scalp, which was diagnosed as pemphigus by fine-needle aspiration cytology.
 
Article
Objectives To study the clinical profile of idiopathic guttate hypomelanosis (IGH) and its association with diabetes mellitus (DM). Materials and Methods A 1-year descriptive study was carried out in clinically diagnosed cases of IGH. A detailed history was taken and a thorough dermatological examination was carried out in each case. Serum fasting blood sugar [FBS] and postprandial blood sugar (PPBS) levels were determined in all cases. FBS and PPBS were assessed in age- and sex-matched individuals without IGH who were included as the comparative group. Results There were a total of 102 patients ( n = 102) with IGH in the designated study period. The male/female ratio was 1:3.08. The mean age was 36.7 years. The most common age group was 61–70 years (29, 28.4%). History of chronic sun exposure was present in 19 (18.6%). Thirty-one patients (30.4%) showed lesions affecting upper limb, lower limb, and trunk. In the present study, 23 patients with IGH had DM. In the age- and sex-matched comparative group, 19 patients had DM (18.6%). The difference was not statistically significant ( P = 0.498). In the present study, 17 patients (17/23, 73.9%) with IGH and DM had 20 lesions or more, while 6 patients (6/23, 26.1%) with IGH and DM had < 20 lesions. Among the 79 non-diabetic patients with IGH, 57 (72.2%) had 20 lesions or more and 22 (27.8%) had less than 20 lesions. This was not statistically significant ( P = 0.868). Limitations Small sample size was the major limitation. Conclusion There was no association between IGH and DM in this study and there was no association between number of lesions of IGH and DM.
 
Top-cited authors
Sarita Sasidharanpillai
  • Government Medical College, Kozhikode
Olasseri Kalathingal Reena Mariyath
Jishna Pulpadathil
  • Calicut Medical College
Kidangazhiathman Ajithkumar
  • Governmental Medical College, Kottayam
Abel Francis
  • Amala Institute of Medical Sciences, Amala nagar, Thrissur