Common Dermatological Manifestations Research Articles

Marked clinical improvement in a cat with a refractory non‐surgical case of dermatophytic pseudomycetoma responding to combination antifungal therapy

AbstractFeline dermatophytosis is a common dermatological manifestation that carries a good prognosis once a proper diagnosis has been achieved. In rare cases, dermatophytosis can manifest as a nodular dermatosis. This condition, known as dermatophytic pseudomycetoma, can be challenging to diagnose and treat. Surgical excision and systemic antifungal therapy are the standard treatments, which generally will carry a good prognosis for the patient. This case report describes a non‐surgical dermatophytic pseudomycetoma, which failed treatment with a singular antifungal agent, but improved when multiple antifungal medications were combined. This case highlights challenges associated with treating a cat with severe dermatophytic pseudomycetoma and concurrent feline leukaemia virus.

MANAGEMENT OF DADRU KUSHTHA THROUGH AYURVEDA – A CASE REPORT

Skin being the largest and a protective covering of all our internal organs is susceptible to many harmful environmental factors causing different kinds of bacterial, viral and fungal infections. All the skin disease in Ayurveda has been classified into Mahakushtha and Kshudra Kushtha. Dadru is one among them. As per modern perspective “Superficial fungal infection of skin” is the most common dermatological manifestation affecting up to 15% of world‟s population in all age groups. In present time, antifungal treatment is based on systemic and topical medications which may lead to many side effects and relapse too. Fungal infections are more demoralizing to the patients due to their appearance, recurrence, chronicity, and negative psychological impact. Keeping this fact in mind below mentioned study drafted to focuses on Ayurvedic Shamana and Shodhan Chikitsa in Dadru Kushtha. AIM AND OBJECTIVES –To evaluate the effect of Shodhana and Shamana Chikitsa in Dadru Kushtha. MATERIAL AND METHODS- It will be collected from classical Ayurvedic texts as well from previous research works / thesis, Internet sources, research articles and modern sciences text. DISSCUSSION AND CONCLUSIONS- On the basis of signs and symptoms we can correlated the Dadru Kushtha to Tinea Cruris. In This case report, a 67 yr old male patient came with complaints of Dadru Kushtha, which is closely similar to the presentation of Tinea Cruris infection. The present case showed significant improvement with Ayurvedic Shodhan, Shaman and Bahiparimarjan (topical) Chikitsa in Dadru.

Varicose Eczema: Current State of The Problem

Varicose eczema, being a common dermatological manifestation of chronic venous diseases, nevertheless remains an insufficiently studied problem. Without being a dangerous disease, varicose eczema significantly reduces the quality of life of patients. The term “varicose eczema,” although it has become commonly used, is ambiguous. The problem of varicose eczema is primarily organizational: effective diagnosis and treatment requires interaction between surgeons and dermatologists. To date, there are no uniform approaches to diagnosing skin lesions in chronic venous insufficiency

Dermatologic care of patients with differences of sex development.

Differences of sex development (DSD or disorders of sex development) are uncommon congenital conditions, characterized by atypical development of chromosomal, gonadal, or anatomic sex. Dermatologic care is an important component of the multidisciplinary care needed for individuals with DSD. This article discusses the most common primary dermatologic manifestations of DSD in addition to the cutaneous manifestations of hormonal and surgical therapies in individuals with DSD. Published articles including case series and case reports on PubMed. Selection was conducted by examining existing literature with a team of multidisciplinary specialists. Narrative review. This article was not conducted as a systematic review. In Klinefelter syndrome, refractory leg ulcers and incontinentia pigmenti have been described. Turner syndrome is associated with lymphatic malformations, halo nevi, dermatitis, and psoriasis. Virilization can be seen in some forms of congenital adrenal hyperplasia, where acne and hirsutism are common. Dermatologists should consider teratogenic risk for treatments of skin conditions in DSD depending on pregnancy potential. Testosterone replacement, commonly used for Klinefelter syndrome, androgen insensitivity syndrome, 5-alpha reductase deficiency, gonadal dysgenesis, or ovotesticular DSD, may cause acne.

The most common dermatological manifestations of inflammatory bowel diseases

Inflammatory bowel diseases are increasingly common problem in clinical practice. This condition is caused by both the growing morbidity and more accurate and widely available diagnostic methods, affecting the rising recognition. 
 It is worth remembering, that clinical presentation of inflammatory bowel disease is not limited to gastrointestinal tract. 
 Dermatological symptoms are an important part in the diagnosis of inflammatory bowel diseases, because they can occur as the first manifestation of the beginning of the disease process, as well as be a prognostic factor for the occurrence of exacerbations of the disease. This is an invaluable source of information on the patient's clinical condition, affecting the effectiveness of his treatment in the early stages of the disease, and allowing more efficient control of its course. 
 This has an enormous impact on the prognosis and comfort of patients' lives. In the following article, available medical studies on extraintestinal skin manifestations, clinical presentation and treatment options have been reviewed.

A prospective observational study of prescription pattern in dermatology outpatient department of associated hospitals of Rajasthan University of Health Sciences-college of medical sciences, Jaipur

Background: Skin diseases are chronic in nature and they require lifetime treatment. Prescription pattern reflects health professional attitude towards the disease and role of drugs in its treatment. The study of prescription pattern is important to make medical care rational and monitoring adverse drug reactions. Methods: An observational and prospective study was carried out in Skin and VD department along with department of pharmacology, RUHS college of medical sciences, Jaipur. Data collection was done in three months after ethical approval. Data was entered and analysed with latest Microsoft Excel version. Descriptive statistics were used to analyse the results. Results: During the study period, a total of 979 prescriptions were included and analysed, out of which the usage of dermatological drugs was maximum among males (n=520, 53.11%). Total 2848 drugs were prescribed in 6 different dosage forms. The most common dosage form prescribed was tablet (1267, 44.49%) followed by cream (685, 24.05%). Total 1632 (57.30%) drugs were prescribed through oral route and 1216 (42.70%) drugs were prescribed through topical route. the present study depicted that dermatophytosis (n=243, 24.82%) was one of the most common dermatological manifestations. antihistaminic (673, 23.63%) were the most commonly prescribed drug. Conclusions: The study of drug use is an effective tool to promote rational drug prescribing. Such type of study will help in formulation of proper antibiotics, drugs policy, prescription of cost-effective drugs, improvement in the patient compliance and reduction in undesirable effect of drugs.

Mucocutaneous Manifestations in Kidney Transplant Patients: Risk Factors.

Introduction Mucocutaneous complications in kidney transplant patients are due to drug toxicity or immunosuppression. The main objective of our study was to determine the risk factors associated with their occurrence. Methods We conducted a prospective analytical study (January 2020- June 2021) including kidney transplant patients seen at the Nephrology Department.We described the characteristics of the patients who presented mucocutaneous complications and then compared them to those who didn't to deduce the risk factors.Statistical analysis was performed using SPSS 20.0 (p<0.05). Results Of the 86 patients recruited, thirty patients had mucocutaneous complications. The mean age was 42.73, with a male predominance (73%). Ten kidney transplants were performed from a living-related donor. All the patients received corticosteroids, Mycophenolate Mofetil, and the Calcineurin Inhibitor: Tacrolimus (76.7%) or Ciclosporin (23.3%). Induction was performed with Thymoglobulin (n=20) or Basiliximab (n=10). Mucocutaneous complications were dominated by infectious manifestations (53.4%): eight cases of fungal infections; six cases of viral infections: warts (n=3), herpes labialis (n=2), intercostal herpes zoster (n=1), and two cases of bacterial infections: atypical mycobacteria and boils. Inflammatory complications (36.6%) included acne (n=4), urticaria (n=3), rosacea (n=1), simple maculopapular exanthema (n=1), aphthous lesion (n=1), and black hairy tongue (n=1). Actinic keratosis, skin xerosis, and bruises were found in one patient respectively. The evolution with a symptomatic treatment was good in all the patients.After statistical analysis, the factors significantly associated with the occurrence of mucocutaneous complications were advanced age, male gender, anemia, HLA non-identical donor, as well as the use of Tacrolimus or Thymoglobulin. Conclusion Infectious mucocutaneous complications are the most common dermatological manifestations among renal transplant recipients. Their occurrence is related to advanced age, male gender, anemia, HLA non-identical donor, and the use of Tacrolimus or Thymoglobulin.

Chronic kidney disease-associated pruritus in patients undergoing hemodialysis: Xerosis and topical therapy.

Chronic kidney disease-associated pruritus (CKD-aP) is a common and distressing symptom for patients with CKD and a difficult challenge for nephrologists and dermatologists. Recent results showed the multifactorial nature of the pathophysiology, and therapeutic trials were only successful in certain subsets of patients. The clinical manifestations are varied, with xerosis being the most common dermatological manifestation and correlated with the intensity of CKD-aP. A better understanding of the pathophysiology of xerosis in CKD-aP and appropriate topical treatment could correct xerosis to reduce the intensity of CKD-aP and improve the patient's quality of life.

Clinical Characteristics of Human Mpox (Monkeypox) in 2022: A Systematic Review and Meta-Analysis.

Since May 2022, large numbers of human mpox (previously known as monkeypox) cases have been reported in non-endemic regions. We conducted a systematic review and meta-analysis to elucidate clinical characteristics of the current mpox outbreak. Our systematic review and meta-analysis were undertaken according to PRISMA and MOOSE guidelines. We searched PubMed, EMBASE, and Web of Science for publications between 1 January and 11 November 2022. Random-effects models were used to pool results. Heterogeneity was assessed using I2. This study is registered with PROSPERO, CRD42022355590. Skin lesions (95.2%, 95% CI [93.3-96.9%]), fever (58.4%, [54.9-61.8%]) and lymphadenopathy (53.0%, [48.7-57.3%]) were the most common symptoms. The most common dermatological manifestations were anogenital lesions (65.7%, [57.8-73.0%]), and the most common lymphadenopathy was inguinal (46.8%, [40.6-53.0%]). There were no differences in symptoms including malaise, fever, headache, and genital, anal, and oropharyngeal lesions according to HIV infection status. Median age of patients varied from 15 to 57.5 years (median, 35 years). The median proportion of men who had sex with men (MSM) was 100.0% (20.6-100.0%). The median proportion of patients who reported recent sexual exposure was 99.2% (14.3-100.0%). The median proportion of PLHIV was 42.2% (0.0-100.0%). Skin lesions, fever, inguinal lymphadenopathy, and anogenital lesions were the most common symptoms of mpox reported in the current outbreak. Existing guidelines should be updated to reflect these clinical manifestations and groups at highest risk of infection, MSM in particular.

Dermatoses among snow skiers in North India

Background: Snow skiers are directly exposed to a variety of extreme environmental conditions, which may lead to numerous physiological and pathological changes in the skin, and potentially increased chances of various specific and non-specific skin diseases. Although there are studies on skin diseases caused by exposure to cold and high altitudes, yet those on snow skiers are scarce as the study population is small. Objective: This study was undertaken to observe various dermatoses existing exclusively in snow skiers. Methods: It was a descriptive, cross-sectional, community-based study conducted at the world-famous ski resort Gulmarg Kashmir in North India. The initial questionnaire-based assessment and the subsequent examination of those exhibiting skin involvement were undertaken by visiting places of accommodation for snow skiers as well as on-spot visits to skiing slopes. Result: The most common dermatological manifestations in our study were dryness (xerosis) and its related aftereffects such as pruritus and chapping of the lips, followed by UV-related skin damage such as whole-face tanning, various types of infections and infestations, and endogenous eczema, including seborrheic and xerotic eczema. Direct cold-related injuries such as perniosis and various forms of urticaria were also common presentations. Conclusion: Snow skiers are especially susceptible to a variety of dermatoses because of exposure to cold conditions and direct contact with the snow. Proper protective measures against cold and snow and awareness about preventive strategies may decrease the chances of snow skiers developing various dermatoses, thereby reducing morbidity and work and economic loss.

Prevalence of dermatological manifestations due to face mask use and its associated factors during COVID-19 among the general population of Bangladesh: A nationwide cross-sectional survey.

Following the worldwide COVID-19 pandemic, individuals have begun to take preventive measures to avoid exposure. Among the precautionary measures, facemask was mostly emphasized. This study aimed to determine the prevalence of dermatological symptoms linked with face mask usage and explore other associated factors. This cross-sectional survey was conducted throughout all eight divisions of Bangladesh. 1297 people were approached using a fixed-step procedure on a random route sample where 803 fulfilled the inclusion criteria. The overall prevalence of dermatological manifestation in this study was 40.85%. The common dermatological manifestations due to facemasks use were acne (26%), allergy symptoms (24%), traumatic symptoms (24%), and other symptoms (26%). Two important frequently reported risk factors were previous history of skin diseases and obesity. Females were more likely to have acne (CI: 1.199, 3.098; p = .007) and allergy issues (CI: 1.042, 2.359; p = .031). N95 and KN95 masks were more likely to produce allergic symptoms, while surgical mask users were more likely to develop acne. Acne was prevalent more than twice (CI: 1.42, 4.26; p = 0.001) in persons with a COVID-19 infection history. Further exploration is required to find out the reason. Surgical mask users reported more complaints than other types of masks, and prolonged use caused more skin symptoms. Modifications in the pattern of facemask usage and planning for work recesses might also be advised to provide for a pause from uninterrupted facemask use.

SARS-CoV-2 vaccine-related cutaneous manifestations: a systematic review.

To date, over 250 million people have been reportedly infected by COVID‐19 disease, which has spread across the globe and led to approximately 5.1 million fatalities. To prevent both COVID‐19 and viral transmission, DNA‐based/RNA‐based vaccines, non‐replicating viral vector vaccines, and inactivated vaccines have been recently developed. However, a precise clinical and histological characterization of SARS‐CoV‐2 vaccine‐related dermatological manifestations is still lacking. A systematic review of 229 articles was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, in order to provide an extensive overview of SARS‐CoV‐2 vaccine‐related skin manifestations. Data on demographics, number of reported cases with cutaneous involvement, vaccine, and rash type (morphology) were extracted from articles and summarized. A total of 5941 SARS‐CoV‐2 vaccine‐related dermatological manifestations were gathered. Local injection‐site reactions were the most frequently observed, followed by rash/unspecified cutaneous eruption, urticarial rashes, angioedema, herpes zoster, morbilliform/maculopapular/erythematous macular eruption, pityriasis rosea and pityriasis rosea‐like eruptions, and other less common dermatological manifestations. Flares of pre‐existing dermatological conditions were also reported. Cutaneous adverse reactions following SARS‐CoV‐2 vaccine administration seem to be heterogeneous, rather infrequent, and not life‐threatening. Vaccinated patients should be monitored for skin manifestations, and dermatological evaluation should be offered, when needed.

Prevalence and Pattern of Dermatological Manifestations Among Substance Users Across Kashmir Valley in North India.

Background:Substance use has turned out to be one of the growing social problems of the present society cutting across all sorts of boundaries of the world with Kashmir Valley being no exception to this growing pathological phenomenon.Aims and Objectives:To find the prevalence and pattern of dermatological manifestations among substance users across Kashmir Valley.Materials and Methods:Cross-sectional study where patients of all age-groups, irrespective of gender, were enrolled in the three largest districts of Kashmir Valley over a span of 18 months.Results:Sample size was 710 with a male/female ratio of 12.4:1. The mean age of the cases was 25.2 ± 7.05 years. Heroin, one of the opioids, was the most common substance used (n = 515), followed by cannabis (n = 334). Pruritus was found to be the most common dermatological manifestation overall and statistically significant among heroin users. Stigmata of injection drug use (IDU) with the presence of track marks and sooting tattoos (93.1%), atrophic scars secondary to skin popping (30.7%), active skin ulcers (18.8%), and puffy hand syndrome (8.7%) were specifically seen among injection drug users. Oral involvement was seen in 48.5%, including periodontal disease, oral thrush, and stomatitis nicotinica. Hyperhidrosis was present in 30%, and hesitation cuts over arms in 16.3% of all substance users.Conclusion:Dermatological manifestations are quite prevalent among substance users in the population of Kashmir. Pruritus with temporal relation to substance use, stigmata of injectable drug use including track marks and sooting tattoos, atrophic scars at injection sites, active skin ulcers, and skin and soft tissue infections, and hyperhidrosis are among important dermatological clues for detecting substance use. Recognition of such cutaneous signs is important in these cases for more effective diagnosis and treatment.

Apert syndrome: A dermatologist’s perspective

Apert syndrome is a Type 1 acrocephalosyndactyly syndrome presenting predominantly with craniofacial malformations and syndactyly. It can present with a multitude of clinical features involving any system of the body. A literature search of the PubMed electronic database was performed using the keywords “Apert syndrome” and “dermatology” in the title. The relevant references of the included articles were traced and included. A total of 27 articles appeared, the abstracts of which were screened and reviewed by both the authors independently for inclusion. After carefully analyzing all papers case by case, 21 such cases were retrieved. Cases presenting with other clinical features apart from dermatological features were also reviewed but were not included in the table. A total of about 30 patients of Apert syndrome have been described in dermatological literature, acne being the most common dermatological manifestation. Predominant clinical features in all the cases were brachycephaly due to craniosynostosis and syndactyly of hands and feet. Most of the patients had skeletal, dental, gastrointestinal, genitourinary, respiratory, cardiovascular, and dermatological manifestations in varying proportions. Apert syndrome is a rare entity which can present to a dermatologist. It is, therefore, pertinent to be able to diagnose and recognize the various clinical features of this syndrome to ensure timely management of such patients.

Frequency of Cutaneous Disorders in Patients With Celiac Disease.

Background and objectiveCeliac disease is an autoimmune multisystem disorder that is triggered by dietary gluten sensitivity in genetically susceptible individuals. It presents with extraintestinal cutaneous manifestations including dermatitis herpetiformis (DH), atopic dermatitis, psoriasis, urticaria, and alopecia areata. Due to the insufficient availability of data, this study aimed to estimate the frequency of cutaneous manifestation in a Pakistani population with celiac disease.MethodsThis cross-sectional study was conducted from January 2020 to July 2021, and 300 patients with a confirmed diagnosis of celiac disease were enrolled in the study from the internal medicine department of a tertiary care hospital in Pakistan. Celiac disease was confirmed by the presence of immunoglobulin A (IgA) endomysial antibody and IgA tissue transglutaminase antibody. The presence of cutaneous manifestations was assessed with the assistance of a qualified dermatologist and noted in a self-structured questionnaire.ResultsOverall, the most common cutaneous manifestation was DH (16.0%), whereas the second most common cutaneous manifestation was psoriasis (13.8%). DH was most commonly found among males (18.9%), while psoriasis was more common among females (14.12%).ConclusionAmong the various cutaneous presentations in patients with celiac disease, the most common dermatological manifestation was DH. Therefore, patients with cutaneous manifestations should undergo screening for celiac disease.

Do Pruritus and Urticaria Predict For Response to Antihistamine Therapy in COVID-19 Patients with Pulmonary Symptoms?

Dear Editor,&#x0D; Skin manifestations and respiratory symptoms are commonly seen in patients with COVID-19. While infection by SARS-CoV-2 and an accompanying cytokine storm are proposed to account for respiratory symptoms, additional inflammatory mediators including histamine may also contribute. In this regard, we report the resolution of dyspnea associated with urticaria in a 61-year-old female patient acutely infected with SARS-CoV-2. The patient’s medical history is significant for idiopathic thrombocytopenic purpura, hypertension, and gastroesophageal reflux disease, and her long-standing medications consisted of eltrombopag, hydrochlorothiazide, lisinopril, and pantoprazole. The patient had no prior history of urticaria, angioedema, or respiratory illness. Due to the severity of her symptoms which developed over the course of a few days, the patient was referred to an urgent care clinic where intravenous methylprednisolone was administered, and tapering doses of prednisone were prescribed starting at 50mg. Nevertheless, all of her symptoms, particularly the urticaria (Figure 1 a,b), continued to worsen, prompting her to visit our dermatology clinic where she was started on hydroxyzine 25mg q.d. and topical triamcinolone acetonide 0.1%. A first-generation antihistamine was selected to address both pruritus and associated insomnia. Additionally, prednisone was discontinued as there was no response to the medication. The patient experienced relief of urticaria within 4 hours after starting hydroxyzine and reported improvement of her dyspnea by the following morning. A SARS-CoV-2 test performed at the urgent care clinic was positive for the detection of viral antigen. The patient’s symptoms completely resolved within 5 days after initiating hydroxyzine. The signs and symptoms of mast cell activation including urticaria and pruritus and response to antihistamines suggest that mast cells and their chemical mediators play a significant role in the pathophysiology of some COVID-19 patients. While case reports have described improvement of urticaria and other mast cell-mediated symptoms in COVID-19 patients following the administration of antihistamines, these cases were co-founded by the concomitant addition of new medications; this issue is less relevant in our report.1&#x0D; Urticaria is a common dermatologic manifestation of COVID-19 patients, with an incidence of 19% in a prospective study of 375 patients.2 No correlation between urticaria and disease severity, or timing of onset has been described.3 Possible etiologies of urticaria in COVID-19 patients include a reaction to viral infection, medications, and stress. The SARS-CoV-2 virus itself may directly activate mast cells via toll-like receptors or signaling molecules such as interferon type 1, TNF-α, and/or chemokines.4 It is thought that mast cell degranulation may either be caused directly by the virus or indirectly through viral stimulation of complement fragments C3a and C5a activating G-protein-coupled receptors.4&#x0D; While cytokine storms, and more recently, bradykinin storms, are proposed as mediators in the pathophysiology of COVID-19, mast cells and histamine may also contribute to the development of pulmonary manifestations of COVID-19 patients.5 The clinical course of our patient indicates her respiratory symptoms appeared solely related to SARS-CoV-2 induced urticaria. Release of histamine, prostaglandin-D2, and leukotriene-C4 by mast cells cause bronchoconstriction.6 Further, the release of mast cell cytokines such as IL-1 and IL-6 contribute to the development of pulmonary and systemic inflammation, as well as urticaria in COVID-19 patients.3,4,6,7 Preliminary clinical trial reports suggest antihistamine treatment mitigates pulmonary symptoms in COVID-19 patients. Trials of dual-histamine receptor blockade with cetirizine-famotidine in hospitalized COVID-19 patients with severe pulmonary symptoms resulted in marked reductions in rates of intubation, mortality, and length of hospital stay.8 Additionally, a retrospective study of 1,620 COVID-19 patients who received the H2 receptor antagonist famotidine, showed a statistically significant reduction in the rates of intubation and death.9&#x0D; Based on the observations that urticaria and pruritus may accompany pulmonary symptoms, we postulate these patients may better respond to antihistamine therapy. Therefore, we suggest these dermatologic findings are incorporated into the analysis plans of clinical studies assessing antihistamines in COVID-19 patients with pulmonary symptoms. Further, we suggest considering antihistamines as a component of the first-line treatment for COVID-19 patients with urticaria.

Prevalence of Skin Disorders (SD) among school going children of semiurban areas in Puducherry.

Aims and Objective: The study is carried out to study the prevalence and the spectrum of Skin Disorders (SD) among school going children of Semi-Urban (SU) areas in Puducherry. Background: Skin Disorders (SD) are one of the commonest health problems faced by the school going children especially among the developing countries. The high prevalence of skin diseases among developing countries could be accounted for poor socioeconomic conditions, poor sanitation, and lack of awareness to seek medical attention. Acne, atopic dermatitis and eczematous conditions are more common in developed countries those with infectious causes are more common in developing countries. They may cause discomfort, psychological effects like embarrassment, stigmatization and loss of confidence. In spite of these consequences, awareness among the public regarding skin diseases is still lacking. This study is hence undertaken to study the current scenario of Skin Disorders (SD) among school children of Semi-Urban (SU) areas in Puducherry. Methods: This is a cross-sectional study carried out among 1000 school going children of 5-15 years of age belonging to Semi-Urban (SU) areas in Puducherry. The children were interviewed based on a prestructured questionnaire and detailed history is entered into the proforma followed by s clinical examination by a Paediatrician. The children with Skin Disorders (SD) are diagnosed based on clinical features and appropriate investigations such as KOH Examination, Gram’s stain, and Wood’s lamp wherever necessary by a Dermatologist. The information thus obtained is analyzed using SPSS Software. Chi square test is used to compare the categorical variables and p-value<0.05 is considered to show statistical significance. Results: The prevalence of skin disorders among the study population is 72%. The children were distributed into 5-10 years (53.5%) and 11-15 years (46.5%). Majority of (44.5%) children of the younger age group had manifestation of Skin Disorders (SD) compared to affected children (27.5%) among the older age group. The association of Skin Disorders (SD) seen more prevalent among Boys when compared to Girls showing statistical significance. Majority of children belonging to Middle Middle class (79.1%) and Lower Middle class (80%) were affected with Skin Disorders (SD) as compared to children of Upper Middle class (43%) and Upper class (4%) with statistically significant association. The skin disoreders were broadly categorised into Infectious dermatoses (51.7%), Non- Infectious dermatoses (38.8%) and Nutritional dermatoses (9.5%). Conclusion: The prevalence of Skin Disorders (SD) among school going children of 5-15 years of age in semi urban areas of Puducherry is found to be high. Majority of children of the younger age group had manifestation of Skin Disorders (SD) compared to children affected among the older age group. The importance of recognizing these common dermatological manifestations has to be inculcated among parents, school teachers and even School Children (SC). Educating the school children regarding the proper sanitation and hygienic practices can increase the chances of improving the health status of the future generation.

Dermatological Manifestations in Pediatric Inflammatory Bowel Disease.

Background and Objectives: Over the last years, inflammatory bowel disease (IBD) has been reported on a high incidence in pediatric populations and has been associated with numerous extraintestinal manifestations, making its management a real challenge for the pediatric gastroenterologist. Dermatological manifestations in IBD are either specific, related to the disease activity or treatment-associated, or non-specific. This literature review aims to identify and report the dermatological manifestations of IBD in children, the correlation between their appearance and the demographical characteristics, the relationship between these lesions and disease activity, and to highlight the impact of dermatological manifestations on an IBD treatment regime. Materials and Methods: A systemic literature review was performed, investigating articles and case reports on dermatological manifestations in children with IBD starting from 2005. A total of 159 potentially suitable articles were identified and after the exclusion process, 75 articles were selected. Results: The most common dermatological manifestations reported in pediatric IBD are erythema nodosum and pyoderma gangrenosum. More rare cases of metastatic Crohn’s disease, epidermolysis bullosa acquisita, small-vessel vasculitis, necrotizing vasculitis, leukocytoclastic vasculitis, cutaneous polyarteritis nodosa, and Sweet’s syndrome have been reported. Oral manifestations of IBD are divided into specific (tag-like lesions, mucogingivitis, lip swelling with vertical fissures, aphthous stomatitis, and pyostomatitis vegetans) and non-specific. IBD treatment may present with side effects involving the skin and mucosa. Anti-tumor necrosis factor agents have been linked to opportunistic skin infections, psoriasiform lesions, and a potentially increased risk for skin cancer. Cutaneous manifestations such as acrodermatitis enteropathica, purpuric lesions, and angular cheilitis may appear secondary to malnutrition and/or malabsorption. Conclusions: The correct diagnosis of dermatological manifestations in pediatric IBD is of paramount importance because of their impact on disease activity, treatment options, and a patient’s psychological status.

Atypical manifestations of recent syphilis: study of 19 cases

BackgroundSyphilis is one of the most common diseases that start with genital ulcers. Aside from the initial, classic ulcerative lesion of syphilis, called hard chancre, atypical presentations are common, with erosions, erythema, edema, balanitis, and other dermatological manifestations. Associated with initial genital lesions, the presence of inguinal adenopathies is frequent, and the presence of hardened and painless lymphangitis on the dorsum of the penis is rare. ObjectivesTo describe atypical penile manifestations in patients with early syphilis. MethodsThe present study reports patients who developed cord-like lesions on the penis. ResultsThe study included 25 patients with cord-like lesions on the penis; in 19 of those, the diagnosis of syphilis was confirmed. Study limitationsSmall number of patients included. ConclusionsIn view of the findings of the present investigation, it is important to emphasize that all patients who present with cord-like lesions on the penis must undergo a rapid test for syphilis, VDRL, serologies for HIV viral hepatitis B and C and, whenever possible, histopathological and Doppler exams.

Erythema nodosum in a 14 year old boy: a case report

Background: The most common dermatologic manifestation of IBD is EN occurring. Case report: The boy of 14 year old with complaints of his were tender erythmato patches, pain and high grade fever had negative bone marrow aspiration .He treated with anti-inflammatory such as Naproxen and his fever and pain reduced but at the last day of his stay in the hospital several ulcers appeared in his mouth and he was discharged with the diagnosis of EN due to herpes of the mouth until 2 days after his discharge that he was admitted again because of one time of rectorrhagia and a colonoscopy was performed for him in which several ulcers were seen in the mucosa of esophagus and duodenum and the pathology report was crohn's disease and the patients treatment was started right away. Conclusion: In our case EN was a prior symptom to the gastrointestinal symptoms which is not a common presentation, and due to the colonoscopy performed after the episode of rectorhagia the diagnosis was confirmed in biopsy retrospectively.