Pratik Gahalaut

Pattern of skin diseases among migrant construction workers in Mangalore

BACKGROUND With increasing industrialization, the construction industry provides employment to a large number of skilled and nonskilled workers, many of them migrant workers. AIM This study was undertaken to provide epidemiological data regarding various dermatoses among migrant construction workers in India as currently there is a paucity of the same. METHODS One thousand construction workers, including 467 migrant laborers, were examined for various dermatoses. RESULTS Most (88%) workers were males and 51.17% were in their third decade. Infective and noninfective dermatoses were seen in 89.72% and 53.74% of laborers respectively. Among infective dermatoses, fungal infections were the most common (46.25%) ones, followed by bacterial infections (24.83%), scabies (8.56%) and viral infections (6.42%). Contact dermatitis to cement was seen in 12.48% of the laborers. Masons had a significantly higher incidence of contact dermatitis to cement, viral infections and scabies than helpers. CONCLUSIONS The pattern of dermatoses is an expression of poverty, overcrowding and the occupational hazards of the construction industry.

Dermatology Specific Quality of Life in Vitiligo Patients and Its Relation with Various Variables: A Hospital Based Cross-sectional Study.

INTRODUCTION Vitiligo is an acquired, idiopathic skin disease characterized by progressive loss of the inherited skin color. Vitiligo has a special significance to patients in our country because depigmentation is obvious on dark skin and due to the enormous stigma that the disease carries. MATERIALS AND METHODS One hundred vitiligo patients aged more than 18 years were included in our hospital based study depending on inclusion and exclusion criteria. All the patients were asked to fill a validated Hindi version of DLQI questionnaire. DLQI scores and its interpretation were recorded separately. correlation of DLQI Scores with different variables like age, body surface area, duration of disease and socioeconomic status were studied using Pearsons correlations. Mean DLQI scores were also compared between different groups. RESULTS Male and female patient were statistically similar in all variables, like their age, BSA of the involvement and DLQI score. DLQI interpretation showed that out of 100 patients of vitiligo, 16 felt no effect of vitiligo on their quality of life while 84 patients reported small to very large effect on their quality of life. Out of this 84, 37 felt small effects, 21 felt moderate effect and rest 26 felt very large effect on their quality of life. There was no significant difference among the different groups mentioned except very large effect on quality of life seen significantly more in unmarried patients compared to married one. CONCLUSION Vitiligo although a cosmetic disease without any symptoms, it carry a significant social stigma especially in Indian society. Data interpretation in this study indicates that vitiligo affects QOL in majority of vitiligo patients and such patients require more aggressive and empathic attitude from a dermatologist to cure/improve this so called chronic cosmetic disease.

Clinical efficacy of psoralen + sunlight vs. combination of isotretinoin and psoralen + sunlight for the treatment of chronic plaque-type psoriasis vulgaris: a randomized hospital-based study.

Isotretinoin has been used in combination with oral psoralen + UVA (PUVA) and narrowband UVB (NBUVB) for treating psoriasis, especially in women of child‐bearing age. The efficacy of oral psoralen + sun exposure (PUVAsol) is comparable to that of PUVA. This study was planned to compare the efficacy of oral PUVAsol with that of the combination of oral isotretinoin and PUVAsol in patients with chronic plaque psoriasis.

Vitamin k deficiency bleeding presenting as nodular purpura in infancy: a rare and life-threatening entity.

Vitamin K deficiency bleeding (VKDB) disorder is an uncommon entity, which occurs due to inadequate activity of vitamin K-dependant coagulation factors. An 8-months-old exclusively breast-fed male infant presented with multiple, purpuric and nodular non-collapsible swellings on trunk of 4 days duration. Investigations revealed raised activated partial thromboplastin time and prothrombintime. Fibrinogen level and platelet counts were normal. Late VKDB usually presents as intra-cranial or mucosal hemorrhages.[1] Though skin and mucosal bleeding may occur in 1/3rd of infants with VKDB, ‘nodular purpura’ is not the common presenting feature. Earlier recognition of VKDB and immediate investigation/treatment helps prevent the potentially fatal outcome of the disease. Very little is mentioned about this entity in dermatology literature.

Herpes zoster duplex bilateralis in an immunocompetent host

Varicella zoster virus causes both chicken pox and herpes zoster. The phenomenon of herpes zoster occurring concurrently in two non-contiguous dermatomes involving different halves of the body is termed herpes zoster duplex bilateralis (HZDB). Few cases, reported in the literature, were seen in either an immunosuppressed host or in the older age group. Here we present a case of HZDB in an immunocompetent host, probably the first in India.

Comparison of Topical Anesthetics for Radiofrequency Ablation of Achrocordons: Eutectic Mixture of Lignocaine/Prilocaine versus Lidocaine/Tetracaine

Introduction. Topical application of local anesthetics is currently considered to be the easiest, most effective, and convenient way for treatment of patients who may be undergoing superficial dermatosurgical procedures. Materials and Methods. This study compares the anesthetic potential of 2.5% lidocaine and 2.5% prilocaine topical cream with 7% lignocaine and 7% tetracaine combination cream for radio ablative dermatosurgery when applied, under occlusion, for 30 minutes. 40 subjects of achrocordons were enrolled in this split-side randomized trial. Result. The pain severity experienced by subjects in terms of visual analogue scale score was significantly lesser for lignocaine/tetracaine combination cream as compared to lidocaine/prilocaine combination. Conclusion. This small study proves the efficacy of lidocaine/tetracaine combination as a topical anesthetic cream when applied for a short time interval of 30 minutes. This will help a dermatosurgeon to perform various dermatological procedures in a better and efficient manner with a shorter waiting period for analgesia to set in.

Drug advertisements in two dermatology journals: a critical comparison of IJDVL and JAAD.

BACKGROUND Though drug promotion regulations exist worldwide, low quality of journal drug advertising is a global issue. Medical journals are regarded as a leading source of information for new drugs. They may also modulate prescribing behavior of physicians without their knowledge. A comparative analysis of advertisements from different countries may provide insights regarding strengths and weaknesses of different regulating systems. AIMS Prescription drug advertisements from the Indian Journal of Dermatology, Venereology, and Leprology (IJDVL) and Journal of American Academy of Dermatology (JAAD) were compared to check their compliance with criteria of World Health Organization (WHO) and International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). METHODS All the prescription drug advertisements of at least one page length appearing in all the issues of IJDVL and JAAD from January 2012 till December 2012 were included in this study. The contents of both advertisements were compared for compliance regarding different criteria of ethical codes for drug advertising of WHO and IFPMA. Statistical analysis was done using Fishers exact test. RESULTS Compared to IJDVL, more advertisements in JAAD complied with WHO and IFPMA codes. On the whole, advertisements in IJDVL had significantly less information regarding the approved usage, dosage, abbreviated prescribing information (API), summary of scientific information, safety information regarding the drug, and references to the scientific literature to support various claims. However, JAAD had more advertisements with multiple claims than IJDVL, and many advertisements interspersed between scientific articles while IJDVL had none. CONCLUSION The complex issue of ethical drug advertising in dermatology journals requires constant review and discussion. Dermatologists should be cautious in assessing any advertisement or claim even if it seems evidence-based. The results from our study highlight the need for a global, proactive and effective regulatory system to ensure ethical medicinal drug advertising in medical journals.

Effect of Oral PUVAsol on the Quality of Life in Indian Patients Having Chronic Plaque Psoriasis.

Background. Psoriasis is associated with a high impact on health-related QoL (quality of life). PUVAsol has been successfully used for treating psoriasis instead of standard PUVA therapy in developing countries. However, data for PUVAsol therapy and its effect on QoL in psoriatic patients is meagre. Objective. To investigate the effect of PUVAsol on the quality of life in patients having chronic plaque psoriasis. Materials and Methods. An observational prospective study done in patients having chronic plaque psoriasis. PASI and DLQI were calculated before initiating treatment with oral PUVAsol. These were compared with the respective scores after 12 weeks of regular treatment with PUVAsol. Statistical analysis was done using SPSS version 20.0. Results. Both PASI and DLQI showed statistically significant reduction after 12 weeks of regular treatment. 90% of patients responded favourably to PUVAsol therapy in the study and all the domains of DLQI showed significant reduction except domain of “work and school.” Conclusion. Our results show that regular PUVAsol treatment improves the physical appearance of disease as evident by decrease in PASI scores. It also improves the QoL of the patients. This study will add upon the growing evidence of efficacy of PUVAsol.

Azithromycin in ACNE: A protagonist for fixed drug reaction?

Azithromycin is a semi-synthetic macrolide derivative approved for treating mild to moderate infections of the skin, soft tissues, lower and upper respiratory tracts.1 Pulse azithromycin therapy2,3 is being increasingly used nowadays as a safe and effective treatment of acne vulgaris with excellent patient compliance. A hitherto unreported probable fixed drug eruption to azithromycin is being reported here. A 26-year-old married female presented to the Dermatology outpatient Department with history and clinical features suggestive of acne vulgaris of 3-year duration. The patient denied taking any medication, either systemic or topical, for acne or any other disease in the preceding 2 months. She was started on azithromycin 500 mg, thrice weekly along with topical benzoyl peroxide application. Fifteen days afterwards, the patient came for follow-up with the complaint of a hyperpigmented lesion on the upper lip of 1-week duration. According to the patient, the lesion appeared spontaneously 6 days after starting azithromycin therapy and it worsened, i.e. became darker in colour on taking the next weekly azithromycin dose. However, she continued with the treatment and took the second pulse also. Although the lesion was asymptomatic at onset, she complained of itching in the lesion after taking a second pulse of azithromycin. She denied taking any other oral medication concurrently. On clinical examination, a well-circumscribed hyperpigmented macule, of size 1 × 1 cm2, was seen at the mucocutaneous junction of the upper lip on the left side. A provisional diagnosis of a probable fixed drug reaction (FDE) to azithromycin was made. The offending drug was stopped and the lesion improved with a short course of topical mild corticosteroid application. The obviously disturbed patient refused to undergo an oral provocation test again or to get the lesion biopsied. Fixed drug eruptions, first described by Brocq in 1894, is one of the commonest types of adverse cutaneous drug reactions.4 They are responsible for 10% of all adverse drug reactions and occur in all ages, more so in young adults.5 FDE consists of recurrent eruptions characterized by sharply marginated, round, erythematous to violaceous macules that subsequently evolve into a plaque. Vesicles and haemorrhagic bullae with crusting may develop later on. Generalized bullous fixed drug eruption is rare, but severe. The lesions vary in size and can occur on any part of the skin and mucous membranes.5 Classically, the transitional epithelium of mucocutaneous junctions is involved, as in this case. In a study done by Gupta et al., the lips were the most commonly involved site followed by genitals, arms, abdomen, hands and face.6 The diagnostic hallmark is its recurrence at previously affected sites with repeated ingestion of the suspected drug.5 Oral rechallenge test is still the only reliable method to confirm the causative agent, but unlike our patient, patients co-operation is essential.6 When the acute phase subsides, there is usually residual hyperpigmentation that becomes more pronounced after each recrudescence. Although most commonly, non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics, namely sulphonamides, are implicated in FDE, over a 100 drugs are known to induce FDE.5 With the advent of new drugs, the list of offending drug is growing everyday. An extensive search of the literature on Medline and internet failed to report FDE to azithromycin. Although FDE to azithromycin could not be confirmed in this case, probability of the same cannot be ruled out. Inducing awareness among physicians about this hitherto unreported side effect of azithromycin warrants intense observation and caution, since more such cases may be reported with extensive usage of this molecule in future.

LEPROSY WITH PSORIASIS A RARE ISOTOPIC PHENOMENON

Introduction: Isotopic phenomenon refers to the occurrence of a new dermatosis at the site of previously healed dermatosis. A number of factors including viral, neural, vascular, and immunologic factors have been implicated in the causation of this peculiar phenomenon but none has been proven conclusively. We report a case where leprosy developed at the site of psoriatic lesion previously treated with medical therapy. Case Report: A 50 years old male presented with chief complaints of erythematous, mildly itchy scaly lesions all over the body with a history of relapses and remissions for last 20 years. After confirming the diagnosis of psoriasis with leprosy, patient was managed as an inpatient with oral hypoglycemic drugs along with multibacillary multi drug therapy. For psoriasis, patient was prescribed topical corticosteroids along with emollients over thick scaly lesions. Conclusion: This case has been reported due to the rarity of Wolf’s isotopic phenomenon and the coexistence of psoriasis with leprosy. The existing sporadic cases in literature which question the mutually exclusive relationship of leprosy and psoriasis needs further evaluation.