Aradhana Sood

Containing leprosy: Current epidemiological status, detection and management strategies, and experiences at a tertiary level center

Leprosy, an infectious disease, described since ancient times and endemic in India since then, has been eliminated (elimination defined as a prevalence of less than 1 case per 10,000 population) as a public health problem in December 2005. World Health Organization and National Leprosy Eradication Program (NLEP) have now focused on reducing the disease burden in the population. Data indicates that annual fresh case detection rate remains high with a high incidence of multibacillary cases. A review of present NLEP figures and those reported in a number of studies reflect a discordance and caution by dermatologists. A review of present policy, epidemiological status in the population, and our experience is presented. Data from Base Hospital, Delhi Cantonment, over the past 3 years, including patients treated as well as those on surveillance is presented. A higher incidence of paucibacillary cases was seen, with a high incidence of pure neuritic involvement (15%), reactions (24.7%), and deformities (28.37%). Tenosynovitis was observed with increasing frequency. Future challenges in containing the epidemic to reduce the disease burden in population will require regular assessment of treatment measures, especially the use of fixed drug therapy as well as rehabilitation of the affected. Dermatologists shall play a central role in any such endeavor in the management of this disease.

Dermatological Manifestations in Patients Undergoing In Vitro Fertilisation: A Prospective Study

Background: Changing sociodemographic patterns with an increase in the age of childbirth have affected fertility rates worldwide. With advancing reproductive medicine, assisted reproductive techniques (ARTs) are becoming common. While dermatological manifestations in normal pregnancies have been well documented, there is a paucity of data regarding cutaneous manifestations in patients undergoing ART. Objectives: The objectives of our study were to estimate the incidence and types of dermatological manifestations in patients undergoing in vitro fertilisation (IVF) and to study their associations with age, type of infertility, and outcome of the procedure. Methods: A prospective cohort of 200 patients undergoing IVF in a tertiary care centre was observed for occurrence of any dermatological manifestations from initiation of the IVF protocol to the outcome of the procedure at 3 weeks after embryo transfer. Results: Dermatological manifestations were seen in 27% of the study group, with urticaria being the most common cutaneous finding seen in 13.5%, followed by acneform eruptions (3%). Twenty-six (96.3%) of patients who manifested with urticaria were on progesterone. No statistically significant association was found between the occurrence of dermatological manifestations and the outcome of IVF, type of infertility, history of ART, and ovum donation in our study. Association between the age of the patient and the outcome of IVF cycle was statistically significant. Conclusion: Dermatological manifestations are seen in almost one-quarter of patients undergoing IVF, with progesterone-induced urticaria being the most common. Occurrence of cutaneous manifestations has no significant association with the outcome of IVF.

Blaschkoid angioma serpiginosum: A dermoscopic diagnosis

The patient we presented had no known risk factors for nasal mucosal dysplasia. However, he had used nasal steroid (mometasone furoate, beclomethasone dipropionate) sprays with benzalkonium chloride for the last 2 years. Therefore, we suggest that long‐term use of intranasal corticosteroids with benzalkonium chloride can lead to high‐grade dysplasia in the nasal mucosa. We present an unusual case of nasal mucosal dysplasia in an otherwise healthy young man to emphasize the possible side effects of benzalkonium chloride in the upper respiratory tract.

Tenosynovitis: An unusual presentation of leprosy

Tenosynovitis is an uncommon presentation of Type 1 reaction in leprosy. Herein, we report a case of bilateral tenosynovitis of wrist joints who after being unsuccessfully treated by a rheumatologist for several months, was finally diagnosed as a case of Hansens disease (borderline lepromatous) with Type 1 reaction.

Tungiasis: Outbreak investigation of a zoonosis during overseas deployment

BackgroundnTungiasis is an ectoparasitosis caused by the sand flea Tunga penetrans. It is endemic in the under privileged communities of Latin America, the Caribbean and Sub Saharan Africa with geographic and seasonal variations even within endemic areas. We describe investigation of an outbreak of Tungiasis in troops deployed as part of UN peacekeeping force in Central Africa.nnnMethodsnTungiasis was diagnosed in an unusually large number of cases of severely pruritic boils over feet in soldiers of a UN peacekeeping battalion. An outbreak investigation was carried out and the outbreak was described in time, place and person distribution. A retrospective cohort study was done to ascertain the associated risk factors.nnnResultsnA total of 36 cases were identified of which 33 had laboratory confirmation. Of the 36 cases, 10(27.77%) had only Fortaleza Stage II lesions, 22 (61.11%) a combination of Fortaleza Stage II and III lesions and four (11.11%) cases had a combination of Stage, II, III and IV lesions. Secondary bacterial infection was seen in 25 (69.44%) cases. Epidemiological analysis revealed that it was a common source single exposure outbreak traced to a temporary campsite along one of the patrolling routes.nnnConclusionnIn a Military setting an integrated approach combining health education and environmental control is required to prevent such outbreaks.

Linear and whorled nevoid hypermelanosis with depigmentation

Linear and whorled nevoid hypermelanosis (LWNH) is a rare disorder of pigmentation characterized by hyperpigmented macules in a linear or whorled streaky configuration. Lesions are distributed mainly on the trunk and extremities, sparing the palms, soles, and mucosae. Depigmentation occurring in the pre-existing whorls has not been reported till date. Herein, we report one such rare case of familial LWNH with depigmentation.

Cutaneous leishmaniasis in nonendemic geographic areas: Unraveling the itinerant cases

Background: Cutaneous leishmaniasis endemic in 70 countries worldwide and in certain regions of India is otherwise an uncommon presentation in non-endemic zones, leading to their missed diagnosis. Movement of people between these regions further exposes them to the risk of this infection. The aim of this study was to analyze the presentation of these missed cases, basis of their final diagnosis, management and follow up with the objective of highlighting cutaneous leishmaniasis as an important differential diagnosis in these cases. Methods: A prospective 4-year cohort of patients who were diagnosed as cutaneous leishmaniasis (CL) and post kala azar dermal leishmaniasis (PKDL) between 2012 and 2016 were studied. Their presentation, basis of diagnosis, treatment response to different agents and follow up was studied. Results: Of a total of 380547 patients seen in the four-year period, 15 CL and 2 PKDL symptomatic from 6 months to 7 years were diagnosed at our centre. Leishmania amastigotes were seen in smears in 10 and 4 in skin biopsy. Four were diagnosed based on polymerase chain reaction for Leishmania. Ten were managed with iv Sodium Stibogluconate (SSG), five with intralesional SSG and one with liposomal amphotericin B. All responded to treatment and were followed up for one year thereafter. Conclusion: Although CL and PKDL are rare outside their endemic zones, travelers and population exposed to newer endemic zones may result in atypical presentations which clinicians are not experienced with. This study highlights this possibility and our experience in diagnosing and treating such cases.

A common but underreported entity of papulonecrotic tuberculid

Papulonecrotic tuberculid is characterized by symmetric eruption of necrotizing papules on extensor aspect of extremities, sometimes healing with a varioliform scar formation. It is infrequently reported but is not uncommon in areas where tuberculosis is endemic. Tuberculin test is generally positive while pulmonary and extrapulmonary tuberculosis is often associated. Rapid response to antitubercular therapy leaves no doubt of tuberculous etiology even when no active focus of tuberculosis is present.

Secondary cutaneous plasmacytoma: A bad prognostic marker

Plasmacytomas are malignancies of plasma cells that may affect skin or other organs. Plasmacytoma of skin is a rare presentation, which may occur either secondary to multiple myeloma or very rarely may originate in the skin. Histopathology with immunohistochemistry is diagnostic. We present a rare case of secondary cutaneous plasmacytoma.

Atypical post kala azar dermal leishmaniasis with "muzzle area" swelling.

A 50-year-old male presented with recurrent swelling of the muzzle area of the face with history of low-grade intermittent fever of 3 year duration managed variously with antibiotics, systemic steroids, and antituberculous therapy. Skin biopsy revealed a granulomatous infiltration negative for acid-fast bacilli and leishmania donovan bodies. Immunochromatography test for rK 39 antigen and polymerase chain reaction for leishmania was positive. He was diagnosed as a case of post kala azar dermal leishmaniasis, managed with injection sodium stibogluconate and followed-up thereafter.