Rajib Malakar

Epidemic of hand, foot and mouth disease in West Bengal, India in August, 2007: A multicentric study

Background: Hand, foot, and mouth disease (HFMD) is caused mostly by Coxsackievirus A16 (CA16) and enterovirus 71 (EV71). Epidemic of HFMD has occurred in India only once in Kerala in 2003. We report here a recent outbreak of HFMD in three districts of West Bengal, India. Materials and Methods: A case detection system developed with 1) three private clinics in three districts; two at Howrah and one at Hooghly, 2) Pediatrics Department of two medical colleges in Kolkata, 3) 12 practioners of these three districts with 4) a central referral center at Department of Dermatology, NRS Medical College, Kolkata where all cases from this system were confirmed by a single observer. Pediatric Dermatology unit of the Institute of Child Health, Kolkata was another independent unit. Results: A total of 38 cases of HFMD were reported till 08.10.07. Age group ranged from 12 months to 12 years (mean 40.76 months, SD 29.49). Males were slightly higher than females (M:F - 21:17). Disease was distributed mostly over buttocks, knees, hands, feet - both dorsum and palmar or the plantar surface and the oral mucosa. Highest severity noted over the buttocks and the knee. Healing time for skin lesions was 6-13 days (mean 9.13 days, SD 1.93). Oral lesions were found in 33 (86.8%) cases. Conclusion: This outbreak far away from the initial one confirmed regular outsourcing of the virus with possibilities of future epidemics. Also the fact that EV71 induced epidemic is on rise in this part of globe is alarming for India. We hope this early report will be of help for strategic planning for a better management of the disease and prevention of dreaded neurological complications in India.

Hypomelanosis of ito-whorled hyperpigmentation combination: a mirror image presentation.

Abstract:  We hereby report a 2‐year‐old boy who presented with a peculiar combination of hyperpigmented and hypopigmented skin lesions along the lines of Blaschko, sharply demarcated at the midline, both on the anterior and posterior trunk. Although combinations of hyperpigmented and hypopigmented skin lesions distributed along the lines of Blaschko have been described, the combination of skin lesion comprised hypomelanosis of Ito and whorled hypermelanosis distributed in the extremely unusual manner described in this patient has not been reported previously.

Oil massage in babies: Indian perspectives

Oil massaging of the newborn has been a custom in India for ages. A variety of oils have been used for this purpose. Recently, it has gained popularity in the western countries as well.

Neonatal erythroderma: diagnostic and therapeutic challenges.

Erythroderma a life-threatening entity during the first one month, and many a time, a manifestation of genodermatosis, immune deficiency, psoriasis, metabolic diseases, and infections. Atopic dermatitis presenting as erythroderma is usually observed later, after this one-month period, and hence not a common differential for neonatal exfoliative dermatitis. Although a rare entity, there is a paucity of studies on this and in contrast to adults, some may manifest as cardinal signs of primary disease conditions.

An uncontrolled open pilot study to assess the role of dietary eliminations in reducing the severity of atopic dermatitis in infants and children.

Background: The severity of atopic dermatitis (AD) has been reported to be reduced by dietary eliminations in a subset of patients with AD. Aims: To assess the reduction of the severity of atopic dermatitis in infants and children after eliminations of certain dietary items. Materials and Methods: The study group comprised of 100 children with atopic dermatitis. Their severity of itching, surface area of involvement, and SCORAD index were measured. Patients who did not have any systemic disease or were not on systemic corticosteroids were included in the study. Selected patients were advised to strictly adhere to a diet excluding milk and milk products, all kinds of nuts and nut-containing foods, egg and egg-containing foods, seafish and prawns, brinjal and soyabean for a period of 3 weeks. Instead of these avoided items, the food items to be included freely to maintain proper nutrition were dal and dal products, rohu fish, chicken, and fruits. All the preintervention parameters were measured again after 3 weeks. Results: There was a statistically significant reduction in severity scores after dietary elimination alone. Conclusion: Dietary elimination helped to alleviate symptoms and signs in a subset of infants and children with AD.

Cutaneous drug reactions in children

Cutaneous drug reactions (CDR) are common in pediatric age group and can be important not only for further therapeutic strategy but also for future of the child. CDR can be classified based on the pathogenesis, morphology, dose relation and predictability. About 3% of patients admitted in hospital have adverse drug reaction. CDR can be due to both immunological and nonimmunological reactions, with nonimmunological reactions being more common. Morphologically CDR in children is divided into five subtypes with exanthematous type being most common. Meticulous history and examination are the basis of diagnosis of CDR. Management is primarily withdrawal of the offending agent and supportive and symptomatic care. Such patients should be advised to carry a drug diary so as to maintain a record of the offending drug/drugs and also to guard against future adverse events.