Maitreyee Panda

Comparative study of oral isotretinoin versus oral isotretinoin + 20% salicylic acid peel in the treatment of Active Acne

Background: Acne is a self limiting condition that often results in scarring and disfigurement disproportionate to its clinical severity. Isotretinoin is considered the gold standard in the medical management of severe form of acne vulgaris. Salicyclic acid (SA) peels, a β- hydroxy acid peel has got sebosuppressive effect and helps in faster resolution of acne with minimal scarring. It also decreases the post inflammatory hyperpigmentation. Combining both the modalities is usually not advocated because of expected excessive dryness and irritation Aims: To compare the efficacy of oral isotretinoin and oral isotretinoin with 20% SA peels in patients with moderate to severe acne. Materials and Methods: 60 consecutive patients with moderate to severe facial acne attending the skin department were randomized in to 2 groups. 1st group received 20mg oral isotretinoin once daily for 16 weeks and 2nd group received 20mg oral isotretinoin once daily along with 20% SA peels every two weeks for 16 weeks. Baseline grading of acne was done with Michelsons Acne severity index (MASI).Right and left sides of the face were scored separately and total score was taken. Severity score was assessed monthly .Clinical photographs were obtained for evaluation every month. Patients were asked to follow up once every 2 weeks or earlier in case of any adverse events. Results: Patients in both the groups revealed a reduction in the number of lesions. The 1st group showed a reduction of approximately 73.4% after receiving 20mg oral isotretinoin for 16 weeks. The 2nd group showed a reduction of approximately 92.5 % after receiving 20mg oral isotretinoin along with 20% SA peel once every 2 weeks for 16 weeks. Conclusion: Both oral isotretinoin and combination of oral isotretinoin with 20% SA peels once every 2 weeks are effective in treating moderate to severe acne but the combination showed significantly better clearance of acne than monotherapy with isotretinoin.

A study on the prescribing pattern of drugs for acne in a tertiary care teaching hospital in odisha.

BACKGROUND Acne vulgaris is a common disease of the skin affecting the socially vulnerable young age group. There are multitudes of treatment options available but till now no studies have been reported to demonstrate the current prescribing pattern of drugs in acne vulgaris. AIM To study the prescribing pattern of drugs in acne in a tertiary care teaching hospital in Odisha, India. MATERIALS AND METHODS The study was an observational study conducted for a period of one year on patients more than 10 yeras age and having acne attending the Skin & VD OPD. Drug induced acne and acneiform eruptions were excluded. RESULTS A total of 1210 prescriptions of acne were analysed. The male to female ratio was 1:1.29. Most patients presented with grade 2 (60%) acne followed by grade 3 (20.99%). Out of prescribed drugs, 47.44% were oral and 52.56% were topical formulations. Oral isotretinoin (68.10%) was the most frequently prescribed drug among oral formulations. Doxycycline (54.18%) was the most preferable oral antibiotic. The average number of drugs per prescription was 3.003. Polypharmacy was preferred over monotherapy. CONCLUSION In the management of acne, judicious and early intervention with oral isotretinoin improves the overall treatment outcome, the fact which has increased its use in acne patients.

Metabolic Derangements in Lichen Planus - A Case Control Study

INTRODUCTION An association between psoriasis and metabolic syndrome has been established in previous studies. Lichen Planus (LP) is also a chronic inflammatory disease morphologically related to psoriasis and few studies have shown association of metabolic derangements in LP. AIM To study the association of metabolic derangements in LP. MATERIALS AND METHODS A prospective case control study was undertaken for a period of one year. Age and sex matched patients of LP and other non-inflammatory diseases were taken as cases and controls respectively. Data on height, weight, lipid profile and fasting blood glucose levels were collected for all the patients. Body Mass Index (BMI) was calculated. RESULTS A total of 80 patients were recruited, 40 cases and 40 controls. The mean values for all the lipid and glucose parameters were high in cases as compared to controls with significant p-values. CONCLUSION In the present study metabolic derangements were seen in patients with LP.

Dermatitis neglecta as a complication after cataract surgery.

Dermatitis neglecta, a condition of the skin secondary to a primary underlying disease, is an important diagnosis to be kept in mind as the clinical presentation may mimic a severe disease, but the treatment basically includes patient counseling and personal hygiene.

Isolated cutaneous leishmaniasis over face – A diagnostic dilemma

Abstract Cutaneous Leishmaniasis (CL) is a disease caused by an intracellular protozoa belong to the genus Leishmania, transmitted by the bite of a sandfly. It has diverse clinical presentation and may create a public health problem in endemic countries. CL is often confused with lepromatous leprosy, pimples and fungal dermatitis. This case is an isolated cutaneous variety in facial region which was mistaken and treated initially for fungal dermatitis and then for leprosy by local physicians. Smears examined from the skin lesion confirmed Leishmania amastigotes. The isolated localized CL may create confusion and its many differential diagnoses made delaying in the diagnosis.

Pityriasis rosea like drug rash - a need to identify the disease in childhood.

Pityriasis rosea is a common dermatosis named by Gibert in 1860. It is an acute self limiting papulosquamous disease, probably infective in origin affecting healthy adolescents and young adults. It is characterized by distinctive skin eruptions and minimal constitutional symptoms. Drug induced pityriasis rosea tend to occur in older generation and resolution seen only after withdrawal of the offending drug. We report a case of 12-year-old boy with erythematous papules distributed over trunk and proximal arms after nimesulide therapy consistent with a clinical diagnosis of atypical pityriasis rosea. The relation of drug and development of pityriasis rosea is confirmed by dechallenge test of the suspected drug.

Sociodemographic profile and pattern of superficial dermatophytic infections among pediatric population in a tertiary care teaching hospital in Odisha

Background: There is a recent rising trend of superficial dermatophytic fungal infections all over the globe. Apart from the causative organisms, there are many modifiable environmental factors contributing to this sudden pandemic. The prevalence of the disease in the pediatric age group needs to be studied more vigorously. Materials and Methods: All children in the age group of 2–15 years with dermatophytic infections were studied for the pattern of infection and various environmental associations. Results: Most (102 [51.51%]) of the patients belonged to 11–15 years age group with tinea cruris (99 [50%]) and tinea corporis (94 [47.47%]) type of pattern being the most common. The majority (175 [88.38%]) of the patients belonged to rural and semi-urban locality with improper sanitation system and poor quality of water source in use by the patients. Conclusion: This study highlights the prevalent pattern of dermatophytic infections in children in our locality.

Necrotic erythema nodosum leprosum healing with extensive scars

509 Indian Dermatology Online Journal | Volume 8 | Issue 6 | November‐December 2017 patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Symmetric drug-related intertriginous and flexural exanthema due to itraconazole: An uncommon side effect of a commonly used drug

501 Indian Dermatology Online Journal | Volume 8 | Issue 6 | November‐December 2017 anti‐keratin antibodies using formalin‐fixed, paraffin‐embedded sections. J CutanPathol 1989;16:133‐6. 4. Salim T, Shenoi SD, Balachandran C, Mehta VR. Lichen amyloidosus: A study of clinical, histopathologic and immunofluorescence findings in 30 cases. Indian J Dermatol Venereol Leprol 2005;71:166‐9. 5. Eto H, Hashimoto K, Kobayashi H, Fukaya T, Matsumoto M, Sun TT. Differential staining of cytoid bodies and skin‐limited amyloids with monoclonal anti‐keratin antibodies. Am J Pathol 1984;116:473‐81. 6. Kitano Y, Okada N, Kobayashi Y, Tanigaki T, Okano M, Yoshikawa K. A monoclonal anti‐keratin antibody reactive with amyloid deposit of primary cutaneous amyloidosis. J Dermatol 1987;14:427‐9. 7. Bolognia JL. Disorders of hypopigmentation and hyperpigmentation. In: Harper J, Orange H, Prose N, editors. Textbook of Pediatric Dermatology. 2nd ed. United States: Blackwell Science; 2000. p 868‐70. 8. Weedon D. Cutaneous deposits. In: Weedon D, editor. 3rd ed. Weedon’s Skin Pathology. China: Elsevier; 2010. p 370‐96. How to cite this article: Yadav A, Garg T, Mandal AK, Chander R, Yadav A. Immunofluorescence and immunohistochemistry in macular amyloidosis: An observational study. Indian Dermatol Online J 2017;8:499-501.

Isolated mucosal histoid hansen's disease of nasal cavity in post elimination era

Back ground: Histoid Hansens disease is a rare form of multibacillary leprosy whereas isolated mucosal histoid is rarer with distinct clinical and histopathological features. This type of leprosy is a variant of lepromatous leprosy with a very high bacterial reserve. Case Report: A 45 year old male was diagnosed as mucosal histoid lepromatous leprosy.It is a matter of concern as we found an isolated mucosal histoid leprotic lesion inside the nasal cavity in post-global leprosy elimination era. Our case had no history of leprosy or exposure to dapsone/ multidrug therapy, with heavy bacillary index. Discussion and Conclusion: We are reporting this case to highlight the rarity of mucosal lesion of histoid leprosy, nasal cavity involvement and to create awareness and so as to avoid misdiagnosis, which will help in prompt treatment so that we can minimize the complications and deformities of the patient and also prevent its spread in the community.