Anil Abraham

Topical corticosteroid abuse on the face: A prospective, multicenter study of dermatology outpatients

BACKGROUND Abuse of topical corticosteroids (TC), especially over the face, is prevalent worldwide, including in India. Data about the magnitude of this problem in our country is lacking. AIMS The aims of this study were to ascertain the demographics, magnitude and clinical features of TC misuse on the face in the dermatology outpatient department (OPD) attendees in order to raise awareness about this problem and to analyze its causes. METHODS This was a prospective multicenter questionnaire-based clinical study conducted at 12 dermatology centers nationwide. Patients with relevant facial dermatoses reporting to the investigator were asked about their current use of over-the-counter topical formulations and a structured questionnaire applied in case the same was confirmed to be TC. RESULTS A total of 2926 patients with facial dermatoses were screened, of which 433 (14.8%) were using TC. TC was used as a fairness/general purpose cream or aftershave in 126 (29%) and in 104 (24%) for acne. Steroid combinations were used by 258 (59.6%). Potent and super-potent TC were significantly (P = 0.05) more frequently used by the rural/suburban population. The younger age groups used more potent formulations. A non-physician recommendation for TC use was obtainable in 257 (59.3%) patients. Of these, 232 (90.3%) were for potent/super-potent steroids. Among 176 physician prescriptions, 78 (44.3%) were from non-dermatologists. All non-physician prescriptions and 146 (83%) physician prescriptions for TC were inappropriately refilled. Adverse effects were seen in 392 (90.5%) TC users. Acne/exacerbation of acne was the most common adverse effect. CONCLUSIONS TC misuse in patients with facial dermatoses is quite common, and most of this use is unwarranted. Use as a fairness cream is the most common indication in this cohort. LIMITATIONS This was an OPD-based study and, therefore, it may or may not accurately reflect the community data.

Topical steroid-damaged skin.

Topical steroids, commonly used for a wide range of skin disorders, are associated with side effects both systemic and cutaneous. This article aims at bringing awareness among practitioners, about the cutaneous side effects of easily available, over the counter, topical steroids. This makes it important for us as dermatologists to weigh the usefulness of topical steroids versus their side effects, and to make an informed decision regarding their use in each individual based on other factors such as age, site involved and type of skin disorder.

A survey in India of doctors' knowledge, attitudes and practice regarding telemedicine and e-health

The potential of telemedicine and computing for health care in India has been well documented. However, there are concerns that the uptake of these techniques is patchy in different parts of the country. The attitudes, knowledge and awareness of Indian doctors about telemedicine and computing in health care have not been documented. We have therefore attempted to obtain a broad picture of current practice, perceptions, awareness and attitudes of Indian doctors towards computing and e-health initiatives, including telemedicine and continued medical education online. A short questionnaire was used to collect data from delegates at a well-attended national conference of physicians in Bangalore, South India (Dermacon) attended mainly by dermatologists, internal physicians and primary care physicians. The ten-point, single page questionnaire was designed with ‘Yes/No’ questions. In addition, respondents could choose ‘Don’t Know/Can’t Say’ (DK/CS) if their response was neither ‘yes’ nor ‘no’. The survey was carried out as pilot work for a larger multisite, multisample survey.

Disseminated cutaneous Ochroconis gallopava infection in an immunocompetent host: an unusual concurrence – a case report and review of cases reported

Introduction The incidence of deep fungal infections has increased significantly, especially in the background of human immunodeficiency virus (HIV) and immunosuppression. During this period, there has been a parallel emergence in infections due to newer pathogenic fungi that were earlier considered to be non‐pathogenic or saprophytic. Ochroconis gallopava (O. gallopava) is a neurotropic, dematiaceous fungus seldom isolated as a cause of phaeohyphomycosis in humans. Ever since its initial identification as a human pathogen, only 33 reports are available so far, affecting post transplant or immunocompromised patients. It causes severe systemic infections but rarely presents with cutaneous lesions. To the best of our knowledge, there are no reports of O. gallopava presenting primarily as cutaneous lesions in immunocompetent individuals. Herein we report one such case of primary cutaneous phaeohyphomycosis due to O. gallopava in an apparently normal male and briefly review the cases published.

Cutaneous tuberculosis of the pinna: a report of two cases

Cutaneous tuberculosis (TB) is less common than other forms of TB but accounts for 1.5% of all cases of extrapulmonary TB. The source of mycobacterial infection and the immune status of the host determine the presentation of any of a wide spectrum of clinical manifestations. Lupus vulgaris (LV) is a post‐primary, paucibacillary form of TB caused by hematogeneous, lymphatic, or contiguous spread from elsewhere in the body.

Approach to Infantile Hemangiomas.

Infantile hemangiomas are a group of vascular tumors and are considered to be one of the most common tumors in infancy. Ambiguity still prevails over its origin, etiopathogenesis, and optimal management.

A Pilot Study: Nailing Indian Elections with the Indelible Ink Mark.

Context: The indelible ink thats used in our elections was developed by National Physical Laboratories (NPL), Delhi in 1962, and has been used ever since. Though formulated by NPL, it is manufactured by Mysore Paints and Varnish Ltd. owned by the Karnataka Government. Earlier, the ink mark was applied on the cuticle but with effect from February 01, 2006 the ink is applied on the voters left index fingernail from the distal end proximally until the cuticle using an applicator. This idea of the ink mark applied during elections was used as a simple tool to measure the rate of nail growth in a busy outpatient department of a Tertiary Hospital in South India. Aims: To assess the feasibility of using the ink mark during elections as a method of obtaining data of nail growth across the spectrum of the entire country. Subjects and Methods: In 74 patients presenting to a hospital, the rate of nail growth was measured. The voters mark on the left index fingernail of patients during the recent elections was used as a marker for measuring the length of the nail. Results: The average rate of nail growth was 0.113 mm/day. The rate of nail growth was found to be more in females, younger individuals, pregnancy, patients on nutritional supplementation, psoriasis. Conclusion: This study which was conducted on 74 patients using the election ink mark successfully confirmed the possibility of using it as an efficient tool in measuring the rate of nail growth. The findings revealed the slightly higher rate of nail growth as compared to a study done by Rani et al. However, the limited sample size in this study was the major limitation.

Use and Misuse of Topical Corticosteroids in Hair and Scalp Disorders

Topical steroids have been used in the treatment of scalp and hair disorders for several years. The risk and benefit of this use is similar to the use of topical steroids elsewhere. Indications, contra-indications, use in poorly defined conditions with questionable benefit and in formulations which are inappropriate are worth considering in this set of disorders. Rational use of the drug in the correct indication, formulation, strength and duration could avoid the drug acquiring notoriety and unwarranted phobia.

Perforating folliculitis secondary to bendamustine-rituximab chemotherapy: A case report

DOI: 10.4103/2229-5178.209617 and Analysis of 38 Cases. Dermatol Surg 2015;41:1411‐8. 3. Tong LX, Weinstock M, Drews R, Sheikine Y, Kim CC. Widely metastatic squamous cell carcinoma originating from malignant transformation of hypertrophic lichen planus in a 24‐year‐old woman: Case report and review of the literature. Pediatr Dermatol 2015;32:e98‐101. 4. Wörheide J, Bonsmann G, Kolde G, Hamm H. Squamous epithelial carcinoma at the site of lichen ruber hypertrophicus of the glans penis. Hautarzt 1991;42:112‐5. 5. Joshi R, Durve U. Squamous cell carcinoma in hypertrophic lichen planus. Indian J Dermatol Venereol Leprol 2007;73:54‐5. 6. Krasowska D, Bogaczewicz J, Chodorowska G. Development of squamous cell carcinoma within lesions of cutaneous lichen planus. Eur J Dermatol 2007;17:447‐8. 7. Speziali L, Pusiol T, Zorzi MG, Morichetti D, Zumiani G. Pseudoepitheliomatous hyperplasia arising from hypertrophic lichen planus mimicking squamous cell carcinoma. G Ital Dermatol Venereol 2011;146:310‐1. 8. Pusiol T, Zorzi MG, Morichetti D, Speziali L. Pseudoepitheliomatous hyperplasia arising from hypertrophic lichen planus mimicking squamous cell carcinoma: Limited value of immunohistochemistry. Acta Dermatovenerol Croat 2012;20:112‐4.

Pulse therapy in pemphigus: Ready reckoner

Pulse therapy for the treatment of pemphigus has been in vogue for several years and is administered by many dermatologists across the world. However, even though there is enough evidence about its efficacy and methodology, there continue to be doubts and questions regarding the rationale of use of high dose intravenous steroids and steroid-sparing immunosuppressants. This article has aimed to provide clarity to young dermatology residents on the administration of pulse therapy, and the various controversies and modifications that have been mentioned in literature over the past couple of years.