Pravesh Yadav

Clinico-mycological study of dermatophyte toenail onychomycosis in new delhi, India.

Introduction: There is a constant need to define the epidemiological and mycological characteristics of onychomycosis (OM) for optimal management strategies. Objectives: To define the epidemiological and mycological characteristics of patients with dermatophyte toenail OM in a tertiary care hospital. Materials and Methods: Hundred consecutive patients of KOH and culture-positive dermatophyte toenail OM were subjected to detailed history, clinical examination and investigations. Results: Maximum number of patients (40%) belonged to 31-45 years age group and there was a male preponderance (M:F = 6.7:1). The mean duration of disease was 54 months. Thirty-three patients had fingernail involvement in addition to the toenail OM and 37% had co-existent cutaneous dermatophyte infection. Discoloration was the most common symptom (98%). Ninety-four (94%) patients had distal lateral subungual onychomycosis (DSLO) while two had superficial onychomycosis (SO) and only one had proximal superficial onychomycosis (PSO). Trichophyton interdigitale was the most common etiological agent (61%) followed by Trichophyton rubrum and Trichophyton verrucosum. Conclusions: Toenail OM is more common in males. DSLO was the most common clinical variant and T. interdigitale the most common etiological fungus responsible for toenail OM in our region. The importance of early diagnosis and treatment is highlighted as long-standing toenail OM predisposes to fingernail onychomycosis and recurrent tinea pedis.

Comparative efficacy of continuous and pulse dose terbinafine regimes in toenail dermatophytosis: A randomized double-blind trial

INTRODUCTION Dermatophytes are the most frequently implicated agents in toenail onychomycosis and oral terbinafine has shown the best cure rates in this condition. The pharmacokinetics of terbinafine favors its efficacy in pulse dosing. OBJECTIVES To compare the efficacy of terbinafine in continuous and pulse dosing schedules in the treatment of toenail dermatophytosis. METHODS Seventy-six patients of potassium hydroxide (KOH) and culture positive dermatophyte toenail onychomycosis were randomly allocated to two treatment groups receiving either continuous terbinafine 250 mg daily for 12 weeks or 3 pulses of terbinafine (each of 500 mg daily for a week) repeated every 4 weeks. Patients were followed up at 4, 8 and 12 weeks during treatment and post-treatment at 24 weeks. At each visit, a KOH mount and culture were performed. In each patient, improvement in a target nail was assessed using a clinical score; total scores for all nails and global assessments by physician and patient were also recorded. Mycological, clinical and complete cure rates, clinical effectivity and treatment failure rates were then compared. RESULTS The declines in target nail and total scores from baseline were significant at each follow-up visit in both the treatment groups. However, the inter-group difference was statistically insignificant. The same was true for global assessment indices, clinical effectivity as well as clinical, mycological, and complete cure rates. LIMITATIONS The short follow-up in our study may have led to lower cure rates being recorded. CONCLUSION Terbinafine in pulse dosing is as effective as continuous dosing in the treatment of dermatophyte toenail onychomycosis.

Paraphenylenediamine dye allergic contact dermatitis of mustache region manifesting as prurigo nodularis-like lesions.

Paraphenylenediamine is a potent skin sensitizer, which is uniformly present in hair dyes and henna tattoos. Paraphenylenediamine in hair dyes is well known to cause severe immediate reactions over the face; however, a long-term dermatologic reaction to paraphenylenediamine is hitherto unknown. In the present report, a case of prurigo nodularisYlike lesions of the lower face resulting from application of hair dye to the moustache is described.

Tumid lupus erythematosus: An intriguing dermatopathological connotation treated successfully with topical tacrolimus and hydroxyxhloroquine combination

Tumid lupus erythematosus (LE) is a rare variant of lupus erythematosus, which often follows a favorable course. A case of a young woman is illustrated, who presented with an asymptomatic erythematous, solitary plaque over her face. Histopathological and direct immunofluorescence examination established a diagnosis of tumid lupus erythematosus. She responded slowly and near-completely to hydroxychloroquine sulfate; however, a flare up occurred a month later. Addition of topical tacrolimus 0.1% resulted in complete regression without leaving any residual changes. No recurrence was seen subsequently.

Neonatal Purpura Fulminans Due to Methicillin Resistant Staphylococcus aureus

Abstract:  Neonatal purpura fulminans is rare and may be inherited or acquired. It may ultimately lead to multiorgan failure and death. Purpura fulminans in a premature neonate resulting from Staphylococcus aureus septicemia is illustrated. Unfortunately, the baby succumbed to septicemia.

Proliferating trichilemmal tumor of scalp: Benign or malignant, A dilemma

PXE is a genetic disorder primarily affecting the skin, eyes and cardiovascular system, resulting from the accumulation of morphologically abnormal and mineralized elastic fibers in these tissues. The skin changes are often detected during childhood or adolescence and progress slowly and unpredictably during adulthood. The accumulation of abnormal calcified elastic fibers in the mid-dermis produces typical skin lesions, which consist of yellowish papules and plaques, and laxity with loss of elasticity. These lesions are primarily seen on the neck, axilla, antecubital fossa, groin, and periumbilical areas.[2,3]

Concurrence of lichen striatus and localised pityriasis rosea: Cutaneous mosaicism

Cutaneous mosaicism has always been an intriguing subject. A 15‐year‐old boy presented to us with a unilateral band of lesions of pityriasis rosea and lichen striatus. The case is discussed in the light of the concept of genetic mosaicism.

Dermatitis artefacta manifesting as genital scars: a result of an unusual behaviour pattern

A 25-year-old man, diagnosed previously with borderline personality disorder, presented with curvilinear genital scars. A meticulous history and examination led to a diagnosis of dermatitis artefacta with an atypical behaviour pattern.