Dermatology Department Of Hospital Research Articles

Knowledge, attitude and practice of urticaria patients towards urticaria medication treatment: a cross-sectional study at the first affiliated hospital of Kunming Medical University

ObjectivesTo explore the knowledge, attitudes and practices (KAP) of urticaria patients regarding the medication treatment.Methods designA cross-sectional study.SettingAt the Dermatology Department of the First Affiliated Hospital of Kunming Medical University...

Clinical Study on the Induction of Psoriasis Flare-Ups by PM2.5 Air Pollutants via Immune Barrier Dysfunction.

This study explores the clinical correlation between the air pollutant PM2.5 and the induction of psoriasis flare-ups through the disruption of the immune barrier. Air quality data, the average mass concentration of the primary atmospheric pollutant PM2.5, and meteorological data spanning from November 2023 to March 2024 were gathered from 9 air quality monitoring stations situated within our city, courtesy of the local Meteorological Information Center. Psoriasis cases were sourced from our hospital's dermatology department, encompassing patients diagnosed and treated from November 2023 to March 2024 and residing within the city. From January 2023 to May 2024, aberrant expression of Th1 cells and Th2 cells was observed in psoriasis flare-up patients. Spearman correlation coefficient analysis revealed a positive correlation between PM2.5, PM10, and Th1 cells, and a negative correlation with Th2 cells, exhibiting significant differences (P < .05). Supplemental Figure 1 illustrates an increase in psoriasis flare-ups on the fifth day following a unit increase in PM2.5 concentration, with an excess risk (ER) value of 0.046 [95% confidence interval (CI): 0.137-0.893]. Conversely, after an increase of 1 unit of PM10, there was a decrease on the third and fourth days, followed by increases on the fifth, sixth, and seventh days, with ER values of 0.038 (95% CI: 0.013-0.067), 0.045 (95% CI: 0.019-0.073), 0.051 (95% CI: 0.034-0.078), 0.057 (95% CI: 0.045-0.083), and 0.061 (95% CI: 0.051-0.087), respectively. Air pollutant PM2.5 could potentially exacerbate psoriasis flare-ups by compromising the immune barrier, suggesting a plausible mechanism linked to the onset of this condition.

Epidemiology, clinical features, and outcome of the hospitalized patients with Kerion in Fars Province, Iran: an eleven-year retrospective study

BackgroundKerion, a severe inflammatory type of tinea capitis, presents with purulent, boggy swelling and alopecia. Few articles in the literature provide information on this uncommon manifestation of tinea capitis (TC). This study aimed to determine the epidemiological and clinical characteristics of patients with Kerion over an 11-year period in an inpatient setting.MethodsIn this retrospective cross-sectional study, we enrolled all the admitted patients with inflammatory TC in the dermatology department of Shahid Faghihi referral hospital during 2011–2022. The data included demographic factors, animal contact, treatment, outcome, and past medical profiles. We used STATA 14.2 to analyze the data.ResultsOne hundred and thirty-two patients with Kerion were enrolled in to the study. the mean age of patients was 7.6 ± 5.8 years. Boys (82.5%, n = 109) significantly outnumbered girls (17.5%, n = 23), and 82.2% of patients were under 11 years of age. Eight patients were one to two years old, two were infants under one year old, and five were adults. More than half (52.2%) of the patients were from rural areas. Most of the cases had heavily utilized systemic antifungal therapy, antibiotics, and corticosteroids. In addition, 43 patients reported positive animal contact. Over the course of an eleven-year period, there was a downward trend in the number of hospitalized patients.ConclusionWe report one of the largest studies on Kerion patients over an eleven-year period. We have expanded the information on Kerion patients’ epidemiology, transmission mode, and clinical outcomes. To develop preventative strategies for Kerion, future studies should focus on additional risk factors and individual susceptibilities.

Investigation of Factors Associated with Gut Microbiota in Demodex-associated Skin Conditions.

This study describes the relationships of factors related to gut microbiota and skin conditions associated with Demodex, including demodicosis, rosacea, and perioral dermatitis. A total of 113 patients from Dokuz Eylül University Hospital Dermatology Department answered a cross-sectional questionnaire. They consisted of 42 cases of Demodex-related skin diseases and 71 healthy controls. Demographic data and medical history, dietary and lifestyle habits, and gastrointestinal symptoms were recorded. Statistical analysis included descriptive statistics, chi-square tests, Fisher's Exact tests, independent samples t-tests, and logistic regression methods. Our findings identified alcohol consumption [odds ratio (OR)=11.13, 95% confidence interval (CI): 4.11-17.22, p<0.01] and smoking (OR=10.32, 95% CI: 2.47-21.57, p<0.01) as strong risk factors for Demodex-related conditions. Low water intake (0-1 liter per day) (OR=3.39, 95% CI: 2.08-5.57, p=0.03) and infrequent exercise (less than 1 hour per week) (OR=4.87, 95% CI: 2.70-12.54, p=0.02) were also significant risk factors. Additional factors associated with increased Demodex risk included reduced bowel movements (OR=2.71, 95% CI: 1.45-4.06, p=0.01) and higher pet ownership (OR=2.85, 95% CI: 2.13-4.27, p=0.03). Although vegetarian and high-fat diets showed some associations, they were not independently significant. This study demonstrates key environmental and lifestyle factors, such as low water intake, infrequent exercise, reduced bowel movements, higher pet ownership, alcohol consumption, and smoking, that are significantly associated with Demodex-related skin conditions. These factors, related to gut microbiota, may provide valuable insights for managing these skin conditions and suggest promising directions for future research.

A Clinico-Histopathological Study of Nail Dermatoses in a Tertiary Care Hospital.

Introduction Nail disorders account for an important component of all dermatological conditions.Nail abnormalities can result from local pathology or systemic diseases. Pathologies can lead to pain and impaired fine touch and are aesthetically distressing. Clinical assessment of nail pathologies is seldom accurate; moreover, the limited available investigative modalities make it difficult to correctly diagnose the disorders. Nail biopsies provide crucial histological information, especially for nail-limited dermatoses, though they are infrequently used and technically challenging. Proper biopsy techniques are vital to avoid complications like nail dystrophy and to ensure accurate diagnoses and effective treatments. Materials and methods A cross-sectional and observational study was conducted in the Dermatology Department of a tertiary care hospital in Maharashtra from November 2022 to July 2024, involving 51 patients aged 8-80 years with undiagnosed nail dermatoses. Patients with bleeding disorders, anesthesia allergies, and peripheral vascular diseases were excluded. Ethical clearance and written consent were obtained. In the case of pediatrics, patients' parental consent was obtained. Observation and results The age of the patients ranged from eight to 74 years, with a mean age of 38.04 years. The most affected age groups were 20-29 and 30-39 years old. Nineteen (37%) were manual laborers, followed by 10 (20%) students and nine (18%) professional workers. Symptoms lasted from one month to eight years, with a mean duration of 16.65 months. The most common dermatoses diagnosed clinically were as follows: 18 (35.3%) were onychomycosis, 16 (31.4%) were psoriasis, and eight (15.7%) were lichen planus. However, on histopathology, 20 (37.2%) were onychomycosis, followed by 16 (31.4%) of psoriasis, and eight (15.7%) were lichen planus. Conclusion This study highlights the critical role of nail biopsies in diagnosing nail disorders, particularly among middle-aged males who were manual laborers by occupation. It underscores the importance of combining clinical and histopathological approaches to accurately diagnose and manage, advocating for continued research and collaboration to improve patient outcomes.

Computer-Aided Assessment of Repigmentation Rates in Vitiligo Patients: Implications for Treatment Efficacy - A Retrospective Study

Precise evaluation of repigmentation in vitiligo patients is crucial for monitoring treatment efficacy and enhancing patient satisfaction. This study aimed to develop a computer-aided system for assessing repigmentation rates in vitiligo patients, providing valuable insights for clinical practice. A retrospective study was conducted at the Dermatology Department of Shenzhen People's Hospital between June 2019 and November 2022. Pre- and post-treatment images of vitiligo lesions under Wood's lamp were collected, involving 833 participants stratified by sex, age, and pigmentation patterns. Our results demonstrated that the ‘marginal’ pigmentation pattern exhibited a higher repigmentation rate of 72% compared to the ‘central non-follicular’ pattern at 45%. Males had a slightly higher average repigmentation rate of 0.37 in comparison to females at 0.33. Among age groups, individuals aged 0-20 years showed the highest average repigmentation rate at 0.41, while the oldest age group (61-80 years) displayed the lowest rate at 0.25. Analysis of multiple visits identified the ‘marginal’ pattern as the most prevalent (60%), with a mean repigmentation rate of 40%. This study introduced a computational system for evaluating vitiligo repigmentation rates, enhancing our comprehension of patient responses, ultimately contributing to enhanced clinical care.

Long-term follow-up study of the efficacy of fosravuconazole in the treatment of onychomycosis in elderly patients.

Onychomycosis is a chronic and intractable disease whose prevalence increases during aging. In elderly patients, if onychomycosis is left untreated and progresses to a severe stage it may cause functional decline of the lower limbs due to foot pain. This could lead to a decline in activities of daily living and secondary impairment such as cognitive decline. Thus, the treatment of onychomycosis in elderly patients is important. We have previously shown that fosravuconazole is relatively safe and effective for onychomycosis in elderly patients. In the present study, we continued the follow-up study and investigated the efficacy of re-administration of fosravuconazole in patients with recurrent onychomycosis. One hundred and twenty-five patients aged ≥65 years who had been initially diagnosed with onychomycosis at our hospital's dermatology department, and who had responded well to fosravuconazole at 48 weeks after the initial treatment, were followed up until 144 weeks after the start of the initial treatment. Patients who experienced a recurrence within 24 weeks after the start of the follow-up were assigned to the short-term recurrence group, and those who experienced a recurrence after 24 weeks were assigned to the long-term recurrence group. All patients in both groups were re-treated with fosravuconazole to evaluate its efficacy. The short-term and long-term recurrence groups consisted of 17 (14.3%) and 10 (8.4%) patients, respectively. There were no significant differences in mean age and sex ratio between the two groups. There were no serious adverse effects in either group, and the toenail opacity ratio was significantly reduced after 12 weeks of re-treatment in both groups. The short-term and long-term recurrence groups were significantly more likely to have wedge-shaped onychomycosis and total dystrophic onychomycosis, respectively. The results suggest that re-administration of fosravuconazole is safe and as effective as the first administration for elderly patients with recurrent onychomycosis. This study was registered at UMIN-CTR (UMIN000053516).

A study of cutaneous adverse drug reactions in the dermatology department of a tertiary care teaching hospital in Gujarat

Background: Various drugs are responsible for different cutaneous adverse drug reactions (CADRs). Considering variation in drug responses and the day-to-day increasing burden of ADRs, this study was done with emphasis on the need for effective evaluation and the reporting of the ADR reporting programme. Methods: This was an observational cross-sectional study conducted for the duration of six months in the dermatology department to evaluate various clinical patterns of CADRs. Results: A total of 60 CADRs were reported. Among them, 51.67% were present in males and 48.33% were present in females. The most common CADR was FDE (35%), followed by macula-papular rash (25%). Antimicrobials were most commonly responsible for CADRs, followed by NSAIDs, antiepileptic, anti-gout, and anti-hypertensive medications. Conclusions: For better patient care, drug safety, and rational use of medicines, knowledge of various drugs responsible for CADRs can be useful for health care professionals to reduce mortality and morbidity by monitoring, reporting, and assessment of CADRs whenever detected.

The Impact of Shared Assistance between Dermatology and Internal Medicine on Patients with Psoriasis.

Background: The care of psoriatic patients requires a multidisciplinary approach that addresses not only skin involvement but also cardiovascular risk factors. Coordination between dermatology and internal medicine departments, with a specific focus on treatment and long-term follow-up, can substantially improve the course of a disease and its associated complications. Objective: to evaluate the effects of the holistic management of patients with psoriasis by a multidisciplinary team consisting of dermatology and internal medicine specialists. Methods: We conducted an observational, prospective, single-center case-control study between October 2016 and December 2019 in San Jorge University Hospital (Huesca, Spain). Cases included patients undergoing follow-up in the combined dermatology and internal medicine clinic. The control group consisted of an equivalent number of randomly selected, age- and sex-matched patients with moderate-to-severe psoriasis who were seen in the general dermatology department of the same hospital during the same time period. Main outcomes and measures: The primary outcome was the control of psoriatic disease and cardiovascular risk factors such as weight, blood pressure, waist circumference, body mass index (BMI), SCORE index (Systematic Coronary Risk Evaluation), and blood test parameters, as well as diet, physical exercise, and habits such as tobacco and alcohol consumption. To compare data collected over time, data were grouped into three time periods: baseline (t1), intermediate (t2), and final (t3). Results: The case group consisted of 27 patients, and the control group consisted of 25 patients. Multivariate analysis was used to evaluate the relationship between the 10-year risk of experiencing a cardiovascular event (SCORE) and the clinical characteristics and analytical variables of patients with psoriasis and controls (n = 52). The variables that were significantly associated with a higher 10-year risk of experiencing a cardiovascular event were age (OR, 1.33; CI95% 1.21-1.50; p < 0.001); smoking (OR, 5.05, CI95% 1.07-27.37; p = 0.047); PASI (OR, 7.98, CI95% 2.32-35.86; p = 0.003); BSA (OR, 1.22, CI95% 1.01-1.49; p = 0.044); and being a control patient (OR, 3.26; CI95% 0.84-13.56; p = 0.029). Conclusions: Pharmacological and behavioral interventions carried out as part of the procedure of the multidisciplinary clinic resulted in improvements in the following variables relative to the control group: PASI, BSA, DLQI, PSOLIFE, lipid profile, insulin and HOMA-IR GGT levels, vitamin D levels, and SCORE. These findings indicate the beneficial effect of the multidisciplinary clinic, which reduced the risk of cardiovascular events in psoriatic patients with metabolic comorbidities.

Skin cancer referrals by nonmedical practitioners: aprospective observational study.

The aim of this study was to investigate the appropriateness of suspected skin cancer referrals made by nonmedical practitioners (NMPs) and compare this with referrals made by local general practitioners (GPs). Data were collected prospectively from patients referred from primary care to a UK hospital dermatology department. The profession of the referrer was ascertained from review of referral letters and direct questioning. Patient records and subsequent histology reports were reviewed to determine the ultimate diagnoses. Eighty-nine per cent of patients (n = 668/753) were referred by GPs vs. 11.3% (n = 85/753) by NMPs. Fifty-one per cent of patients (n = 340/668) in the GP group and 55% (n = 47/85) in the NMP group were discharged without intervention (P = 0.45). An ultimate diagnosis of skin malignancy was made in 196 of 668 (29.3%) patients in the GP and 25 of 85 (29%) patients in the NMP group (P = 0.99). These early data suggest significant potential for NMPs to become more involved in skin lesion assessment.

Clinical Profile of Patients with Lichenoid Drug Eruption: A Observational Study.

Lichenoid drug eruption (LDE) is an uncommon cutaneous adverse drug reaction, where a variety of drugs used in day-to-day clinical practice have been implicated. To describe the clinico-demographic characteristics of patients with LDE and to identify the most likely drugs involved. In this prospective, observational study, consecutive patients with LDE presenting to the dermatology department of a tertiary teaching hospital were included. The clinico-demographic profile of patients with LDE and implicated drugs was noted. Treatment of drug reaction along with outcome was also documented. Naranjo adverse drug reaction probability scale was used for causality assessment of the drug reactions. A thorough literature review on LDE was also undertaken due to the paucity of existing literature. A total of 15 patients (11 males and 4 females) with LDE were evaluated. Their age ranged from 37 to 61 years, with a mean of 51.53 ± 7.59 years. Anti-hypertensive medications (40%) were the most common culprit agent, followed by antitubercular drugs (33.4%), anti-diabetic agents (13.3%), and others (13.3%). The latent period (time from drug initiation to the appearance of a cutaneous eruption) varied from 15 days to 6 months (mean 2.2 months). Cutaneous involvement was generalized in 73.4% and photo-distributed lesions in 26.6%. Drug provocation test was done to identify the culprit drug. According to the Naranjo adverse drug reaction probability scale, one-third of LDEs were "definite," whereas two-thirds were designated as "probable." LDE is more common in the elderly population. The latent period is comparatively longer in LDE than in other common drug reactions. Prompt recognition and withdrawal of suspected drug are essential to minimize disease morbidity.

Comparison of Efficacy of 5% Tranexamic Acid vs 20% Azelaic Acid in Patients of Melasma

Background: Melasma is a significant cosmetic concern globally, affecting individuals across various ethnic backgrounds, particularly in South Asian populations. The condition's etiology is complex, involving genetic, hormonal, and environmental factors such as sun exposure. Despite numerous treatment options, melasma remains challenging to manage effectively. Recent studies have explored the efficacy of tranexamic acid and azelaic acid, both of which target the melanin synthesis pathway but through different mechanisms. Objective: The aim of this study was to compare the effectiveness of topical 5% tranexamic acid versus 20% azelaic acid in the treatment of melasma, with a focus on changes in the Melasma Area and Severity Index (MASI) scores. Methods: This prospective comparative study was conducted at the Dermatology department of PIMS Hospital, Pakistan, over six months from August 2023 to January 2024. A total of 200 patients with melasma were enrolled and randomly assigned to two groups: Group A received 5% tranexamic acid cream, and Group B received 20% azelaic acid cream, both applied twice daily. Inclusion criteria included men and women aged 18 to 50 years with a diagnosis of melasma for at least six months. Pregnant women, patients with a history of Systemic Lupus Erythematosus (SLE) or Discoid Lupus Erythematosus (DLE), and those on hormonal therapy were excluded. The primary outcome measure was the change in MASI scores from baseline to the end of the study period. Data were analyzed using SPSS Version 25. Results: The study found significant differences in treatment efficacy between the two groups. Group A (tranexamic acid) showed a reduction in MASI scores from 7.94 ± 1.88 at baseline to 5.50 ± 1.61 post-treatment. Group B (azelaic acid) demonstrated a decrease from 8.21 ± 1.96 to 5.89 ± 1.49. The proportion of patients experiencing excellent response was higher in Group A (36.0%) compared to Group B (19.0%), with a statistically significant difference in overall treatment efficacy (P&lt;0.0001). Conclusion: Topical 5% tranexamic acid was more effective than 20% azelaic acid in improving MASI scores in patients with melasma. This study supports the inclusion of tranexamic acid as a preferable treatment option for melasma, offering a promising alternative for those not responding to conventional therapies.

Prescription pattern of antibiotics in dermatology: A Profile from a tertiary care teaching hospital, Kerala

Background: Antibiotics are commonly used in dermatology for infectious and inflammatory diseases. A study on the pattern of prescriptions will help in establishing fundamental data to enhance the utilization pattern of medications, elevate the standard of treatment, and enable prescribers to identify issues associated with drug usage, including adverse drug reactions, antibiotic resistance, drug interactions, and polypharmacy. Aim and Objective: The aim of the study was to describe the prescription pattern of antibiotics given to inpatients with dermatological disorders. Materials and Methods: This was a record-based descriptive study where the case records of 240 inpatients of the dermatology department of a tertiary care teaching hospital during the period from January 2019 to January 2022 were studied. The demographic profile, pattern of skin diseases reported, and pattern in antibiotic drugs usage were recorded with the help of a predesigned pro forma. Results: The mean age of the study population was 52.04 ± 16.91 years with male to female ratio 2.62:1. The most common skin disease diagnosed was Psoriasis (17.91%). Out of the 518 antibiotics prescribed to the patients in the study, the most preferred route of antibiotic administration was oral (48.84%). The most common oral antibiotic was cloxacillin (37.94%) while the most common parenteral antibiotic prescribed was cefotaxime (83%). Fusidic acid (78%) and mupirocin (16%) were commonly prescribed among the topical antibiotics. Amoxicillin-clavulanic acid combination (76%) was commonly prescribed among the fixed drug combinations. Among the topical antibiotics, 8.78% were prescribed as fixed-dose combination with steroids. Antibiotics (29%) constitute the major class of drugs among prescriptions followed by steroids (14%) and antacids (11%). Most of the prescribed antibiotics belonged to the Access group of antibiotics according to AWaRe classification of antibiotics (63.2%). Conclusion: The most common class of antibiotics prescribed was beta-lactam group of antibiotics. The study will help in formulating guidelines for rational prescription of antibiotics with special reference to dermatological cases and create awareness among physicians for effective therapeutic outcome. This will avoid the burden of antimicrobial resistance and pave pathway for the strengthening of economy.

Profile of Teleconsultation in Dermatology at a Tertiary Care Hospital in South India during the First Wave of COVID-19 Pandemic

Abstract Background: There was a rapid expansion of teledermatology around the world with the onset of COVID-19 pandemic. This helped to reduce hospital visits with better adherence to medication and overall costs, especially in chronic dermatoses. Methodology: A retrospective study of teleconsultations during the first wave of COVID-19 pandemic at the dermatology department of a tertiary care hospital in South India was done from May to October 2020. Real-time video teleconsultations were done using the hospital’s teleconsultation portal. Demography, clinical profile of patients, and outcome of teleconsultation were studied. Results: During the study period, 476 teleconsultation sessions in 265 patients were carried out. The mean age of patients was 40.65 ± 16.79 years; geriatric population constituted 38 (14.3%) patients. Urban to rural population ratio was 1:1.3. Median disease duration was 2.5 years (interquartile range 4.75 years). Papulosquamous disorders and infectious diseases were the most common disorders constituting 52 (19.6%) and 51 (19.2%) cases, respectively. Patients with chronic dermatoses on systemic therapy constituted 268 (56.42%) teleconsultation sessions in 119 (44.9%) patients; common diseases being autoimmune blistering disorders (38; 31.9%), psoriasis (23; 19.3%), and leprosy (17; 14.3%). Optimization of therapy was done in 117 (44.2%) patients, initiation of new medication in 89 (33.6%), and continuation of therapy in 75 (28.3%) patients. An in-person review was advised in 46 (9.7%) sessions in 36 (13.6%) patients. Six (2.3%) patients were advised to have an urgent review. Conclusion: Teledermatology was an effective tool during the pandemic to extend hospital services. Optimization of therapy was the outcome in nearly half the sessions. This service can benefit patients from remote areas and geriatric population, especially with chronic dermatoses.

Epidemiologic, Clinical and Mycological Profile of Onychomycosis in the Hospital Setting in Benin.

Introduction: Onychomycosis accounts for 50% of nail disorders and remains one of the most frequent reasons for consultation in dermatology. Several factors favour the development of onychomycosis, such as age, morphological abnormalities of the nails, immunodeficiency and certain underlying pathologies. The aim was to study the epidemiological and diagnostic profile of onychomycosis in patients treated in the dermatology and venerology department of the Benin referral hospital. Patients and Methods: This was a retrospective study conducted from 2003 to 2022, covering patients treated for onychomycosis in the Dermatology-Venerology University Clinic at the National University Hospital Center Hubert Koutoukou Maga (NUHC-HKM) in Cotonou. Results: During the study period, 389 new patients were seen for onychopathy, 301 of whom had a clinical suspicion of onychomycosis. Of these, 128 were confirmed by mycological examination, giving a hospital frequency of onychomycosis of 32.90% compared with onychopathy. The mean age was 44.93 ± 12.50 years; the patients were predominantly female, with a sex ratio (M/F) of 0.41. Aesthetic complaints (76.47%) were the most frequent reason for consultation, and the nail of the hand was the most common lesion location. Melanonychia was the most frequent morphological anomaly, and distolateral subungual onychomycosis was the most frequent clinical form. Yeasts (86.92%) were the most isolated group of fungi, followed, respectively, by moulds (08.44%) and dermatophytes (04.64%). Candida albicans (21.52%) was the most common species. Conclusion: Onychomycosis is relatively uncommon in hospitals in Benin. This is underestimated because most patients with a clinical suspicion of onychomycosis do not undergo a mycological examination before being put on antifungal treatment.

Drug utilization pattern evaluation and cost variation analysis of anti-fungal agents in tinea infected patients in dermatology department of a tertiary care teaching hospital

Background: Tinea infections are chronic superficial fungal infections, highly prevalent in tropical countries like India. Therefore, long-term therapy is needed and this can inflict a financial burden on the patients. Aim of the study was to assess drug utilization patterns in patients diagnosed with tinea infection and to evaluate the cost variability of anti-fungal agents. Methods: A cross-sectional observational study was conducted in patients for 3 months after taking permission from IEC. All adult patients already diagnosed with tinea infection were enrolled. Evaluation of drug utilization pattern was carried out using WHO core drug prescribing indicators and percentage of cost variability was calculated between different brands of anti-fungal agents. Results: A total of 252 patients were enrolled. Tinea corporis and cruris were the most commonly diagnosed tinea infection. Pruritus was the most common presenting symptom. Past history of similar illness was seen in 74 (29.4%) patients mean of 3.83±0.87 drugs were prescribed per patient. Drugs prescribed from NLEM was only 42.1%. Most commonly prescribed drugs were oral itraconazole and topical miconazole. Percentage of cost variability was seen maximum with capsule itraconazole 200 mg (237.5%) by oral route and luliconazole 30 gm (175.6%) by topical route. Conclusions: Prescribing practices of drugs can be improved by promoting generic drug and prescribing drugs from NLEM. Wide range of cost variation can lead to high economic burden in tinea infected patients.

Risk Factors of Onset Time and Persistence of Atopic Dermatitis in Children Under Age 5 Years: A Cross-Sectional Study.

Background: The prevalence of atopic dermatitis (AD) is high among children, with development of AD occurring during early childhood in most affected children and some having a chronic disease course. Risk factors for AD in this group remain undefined. Objectives: We analyzed the medical records of children with AD under 5 years of age. We summarized characteristics of the natural course of AD in these children and explored relevant risk factors of AD in infancy and early childhood. Methods: Using a self-developed questionnaire, we investigated 716 children under 5 years of age who were treated for AD at the Dermatology Department of the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China. We conducted the study from October 2021 to September 2022 using telephone and on-site interviews with the children's parents. In parental interviews, data were gathered on neonatal diseases, comorbidities, parental allergy history, maternal history of tobacco and alcohol use, and basic infant information at birth. Some children were tested for serum total immunoglobulin E (IgE) before this study. Results: Neonatal hyperbilirubinemia, neonatal respiratory distress syndrome (NRDS), neonatal infection, and infection during childhood had a significant impact on persistent symptoms and the onset of first symptoms in children with AD (P < 0.05). Allergic diseases as common comorbidities with AD, which had earlier onset of AD related to more obvious disease activity (P < 0.05). Parental history of allergy was also significant in AD (P < 0.05). Serum total iIgE levels in children with AD showed an impact on the clinical course of AD; neonatal hyperbilirubinemia and NRDS may affect IgE levels (P < 0.05). Persistent AD had a significant effect on the physical growth of children with height/length for age Z score ≤3 and weight for height/length Z score ≤3 (P < 0.05). Conclusions: Early adverse events in infants, infection before onset, and susceptibility to infection may affect the onset and clinical course of childhood AD. Serum total IgE levels affect the progression of AD. Persistent AD in childhood may have a slight impact on children's physical growth.

Efficient triaging of advice and guidance referrals using teledermatology via the UK National Health Service e-Referral service platform: reporting positive outcomes from the COVID era.

Substantial increases in the implementation and use of dermatology advice and guidance (A&G) services has been a legacy of the COVID pandemic. To evaluate the impact that a 45-month period of A&G use had on the health service outcomes in a university teaching hospital dermatology department. A&G data for June in 2019, 2020, 2021 and 2022 were retrospectively analysed. Areas analysed included: total number of A&G requests; number of requests converted to referrals; percentage of discharges at first attendance; and referral-to-treatment (RTT) performance (defined as percentage of referrals seen by 18 weeks). A&G requests increased over the study period, from 45 requests in June 2019 to 1384 in June 2021. Increased request numbers were because of the COVID-19 pandemic, and then a subsequent change to the referral pathway. In January 2021, A&G became the obligatory referral route for all routine referrals to our department. The percentage of A&G requests converted to referral were 22.4%, 46.4%, 43.4% and 52.2% in June 2019, 2020, 2021 and 2022, respectively. Between 2019 and 2022 our discharges at first attendance decreased from 36.7% to 29.0%. RTT performance remained consistently above the national average; local RTT performances were 95.2% (2543/2671), 59.8% (782/1308), 90.1% (1697/1884) and 87.9% (1660/1888), in June 2019, 2020, 2021 and 2022, respectively, which compared favourably against RTT figures for England (90.2%, 56.5%, 78.2% and 65.1%). We highlight to other NHS dermatology departments the positive impact A&G triaging can have on outcomes, as observed for our service, reducing our discharges at first attendance and maintaining an RTT performance above the national average.

Pattern of pediatric dermatoses in a tertiary hospital in South India

Background: Several cross-sectional studies in the form of school surveys and studies on paediatric patients visiting dermatology OPD in tertiary care hospital has been conducted in the last three decades. This study was conducted to note the pattern of paediatric dermatoses and also to compare the difference in disease pattern with other studies conducted in southern India in last decade. Methods: A retrospective cross-sectional study was conducted at the Dermatology department of MVJ teaching hospital to determine the pattern of pediatric dermatoses from May 2021 to October 2021 after obtaining institutional ethics committee clearance. Cases under the age of 18 years were included in the study. Cases with age above 18 years, incomplete data, dermatoses where diagnosis was uncertain were excluded from the study. A total of 150 children were included in the study. The results were entered and tabulated in MS-excel sheet and descriptive analysis was done. Results: 150 children were included in the study.36 types of dermatoses were noted overall. Eczematous diseases (32.7%) contributed to the maximum followed by infections and infestations (25.3%). The most frequent dermatoses found were Atopic dermatoses (10%), pityriasis alba (8.6%), scabies (8.6%), Acne vulgaris (8.6%). Eczematous diseases and hypersensitivity disorders were noted to have increased frequency when compared to other studies in last one decade Conclusions: Rising trend in atopic dermatitis has been noted which might be due to changing environmental factors and also due to better recognition of condition by physicians in last one decade. With respect to spectrum of skin infections and infestations not much of difference is appreciated when compared to previous studies

Successful treatment of disseminated granuloma annulare with adalimumab

Granuloma annulare (GA) is a chronic inflammatory necrobiotic granulomatous skin disease, which is based on a delayed hypersensitivity reaction caused by the production of interferon- (IFN-) by tissue macrophages and th1-limocytes, tumor necrosis factor- (TNF-) and matrix metalloproteinases (MMP), which leads to the degradation of connective tissue.&#x0D; The most frequent form of GA if localized which is characterized clinically by grouped papules and plaques of red or pink color on the extremities. although disseminated variants of disease occur in 15% of all cases of ag. in contrast to the practically asymptomatic course of the localized form, typical signs of disseminated form are intensive sense of itching, the presence of at least ten foci of skin lesions, recurrent and resistance to treatment course.&#x0D; A 53-year-old female patient with a long-term recurrent course of annular granuloma after a weak clinical response to therapy with pentoxifilin, methotrexate and azathioprine turned to the dermatology department of the university hospital. In light of the lack of satisfactory treatment options anti-cytokine therapy with adalimumab was recommended at a daily dosage of 80 mg, once a week, for 2 weeks, then 1 time every two weeks for 1.5 months. Already on the 5th day after receiving the first injection, the patient reported that the feeling of itching disappeared. By the end of the second week of the induction phase of biotherapy, it became obvious that new rashes did not appear, and the old elements of the skin rash had significantly flattened, turned pale and decreased in volume. After the second week of consolidated therapy, the dermatologist confirmed the convalescence.