Potassium Hydroxide Mount Research Articles

Management of Covid Associated Mucormycosis of Mandible: A Mountain Beneath a Molehill-A Lesson Learnt.

The opportunistic infection of post-Covid associated mucormycosis has been reported globally; however, it has reached alarming proportions in India. Mucormycosis of the mandibular region is rare, and only a few cases have been reported to date. Covid associated mucormycosis has not been reported in the literature before, and we are the first to report them. We report two patients who presented with tooth loosening with pus discharge a few weeks following recovery from Covid infection. After tooth extraction adjacent necrotic bony specimen was sent for calcofluor potassium hydroxide mount, which was found positive for broad pauciseptate hyphae. Although CT scan imaging demonstrated the involvement of a mandible segment, we found a much more extensive involvement in both cases during resection. There was intramedullary spread of the mucormycosis throughout the inferior alveolar canal, with pus discharge and foul odor. The management of covid associated mandibular mucormycosis consists of surgical debridement with antifungal therapy and control of the underlying disease. It became challenging because the radiological extent of the disease was different from the definite clinical extension of the lesion found during surgery. The authors recommend surgeons adopt a flexible approach during surgery to plan resection depending on the clinical judgment and not rely entirely on CT scans. And the reconstruction of the mandible will follow as per the extent of excision.

NAIL VARIATIONS IN PAPULO-SQUAMOUS DISORDERS: A CLINICAL INVESTIGATION

Background: Nail diseases account for about 10% of all dermatological conditions. Any abnormality that affects any part of the nail unit is classified as a nail condition. The plate, matrix, bed, proximal and lateral folds, hyponychium, and underlying distal phalanx are all part of the nail unit. Heredity, skin problems, infections, systemic disease, and the ageing process, as well as internal and external drugs, physical and environmental agents, trauma, and benign and malignant tumours, can all affect these tissues. Papulo-squamous disorder is one of the main causes. Nail changes in Papulo-squamous disease have received insufficient attention, with only a few research available.
 Aims & Objectives: This study attempts to shed some information on the frequency and patterns of nail involvement in Papulo-squamous illnesses.
 Methodology: This is a descriptive research project. Over the course of two years, it was conducted at the dermatology department of a tertiary healthcare centre in central India. Examinations of the general, systemic, and dermatological systems were performed. The nails were meticulously examined. In pertinent cases, special examinations such as skin biopsy and potassium hydroxide (KOH) mount were performed.
 Results: Papulo-squamous disorder affected 100 people. Psoriasis was the most frequent Papulo-squamous condition, followed by lichen-planus and PRP. Pitting was the most prevalent nail alteration (81%) while dorsal pterygium was the least common.
 Conclusion: The nail is an important appendage that affects a variety of dermatoses and serves as a diagnostic window. Knowing the normal and abnormal variations, as well as their relationship to various Papulo-squamous illnesses, aids not only in diagnosis but also in treatment.
 Key words: Papulo-squamous disorder, nail changes, psoriasis, lichen-planus.

Asymptomatic COVID 19 infection: An innocent bystander in Mucormycosis or maybe not?

We report a case of 48 year old male with past medical history of poorly controlled Diabetes mellitus, Chronic Liver Disease-child Pugh B who came with complaints of left frontal headache and left orbital pain. A clinical diagnosis of possible Rhinorbital Mucormycosis was made and further confirmed by potassium hydroxide (KOH) mount from tissue, which showed broad sparsely septate hyphae and fungal culture grew Rhizopus oryzae. Covid 19 infection was detected as an incidental finding on admission to the hospital. The patient was successfully treated with surgical debridement and liposomal Amphotericin B followed by oral Posaconazole.

Pulmonary mucormycosis presenting as central bronchopleural fistula\u2014a case report with review of literature

BackgroundBronchopleural fistula (BFF) is a fistulous communication between the trachea or bronchus and the pleural space. Central type of bronchopleural fistula is usually post-surgical. Infective cause for central bronchopleural fistula is rare. This case report encompasses an infective cause of central bronchopleural fistula, mucormycosis. Pulmonary mucormycosis is a rapidly progressive condition with high mortality. A high index of suspicion and timely intervention is required to alleviate fatal outcome. The present case is discussed in detail about the clinical presentation and diagnostic imaging of pulmonary mucormycosis presenting with central bronchopleural fistula.Case presentationThirty-five years old diabetic male, presented with fever, productive cough, mild haemoptysis and chest pain for 10 days duration. The patient was pale on general examination and had decreased breath sound in the right suprascapular and interscapular areas with coarse crackles in the right infrascapular and infra-axillary areas. The laboratory investigations were unremarkable except for anaemia and raised blood glucose level. Sputum examination on potassium hydroxide (KOH) mount showed broad aseptate hyphae. There was a loculated right hydropneumothorax with collapsed lung in chest radiograph. Multi-detector computed tomography of the thorax revealed central type of bronchopleural fistula with the right main bronchus, consolidation of the middle lobe and superior segment of the right lower lobe with multiple internal thick-walled cavities. Right pneumonectomy was performed as the patient did not improve on medical management and showed worsening of symptoms. Histopathological examination was suggestive of mucormycosis.ConclusionCentral bronchopleural fistula due to an infective aetiology is uncommon. However, mucormycosis should be considered as a differential diagnosis in cases of central bronchopleural fistula with the destroyed lung, especially in diabetic individuals. Hence, a high index of suspicion is necessary for early diagnosis and management as mucormycosis is a rapidly progressive disease with delay in treatment leading to high mortality.

Acanthamoeba Keratitis- Camouflage Entity in Eastern Nepal: A Case Series

Acanthamoeba keratitis is a sight-threatening corneal infection and is a growing clinical problem in the world. Though Acanthamoeba keratitis is considered uncommon and rarely reported in Nepal, we encountered six cases in 2019. All patients had redness, photophobia, decreased vision, and pain with ring infiltrate. Ten percent potassium hydroxide mount revealed Acanthamoeba cyst in all cases. Non-nutrient agar overladen with Escherichia coli revealed feeding tracks and Polymerase Chain Reaction revealed T4 genotype Acanthamoeba in four cases. Amoebicidal treatment was started with chlorhexidine 0.02% eye drop half-hourly and supplementary treatment included moxifloxacin eye drop, a combination of polymyxin B sulfate, neomycin sulfate, and bacitracin eye ointment. After treatment, one patient had the best-corrected visual acuity of 6/9 while others had a visual outcome of hand movement. A high level of clinical suspicion and wet mount examination of specimen from infected corneal tissue are essential to aid in rapid diagnosis.

Expression of epidermal antimicrobial peptides is increased in tinea pedis.

Tinea pedis is often chronic or recurrent, but not all individuals are equally susceptible to this infection. Dermatophytes are able to induce the expression of antimicrobial peptides and proteins (AMPs) in human keratinocytes and certain AMPs can inhibit the growth of dermatophytes. The focus of this study was to analyse the secretion of relevant AMPs, especially RNase 7, human beta-defensin-2 (hBD-2) and the S-100 protein psoriasin (S100A7), in patients with confirmed tinea pedis. To verify the diagnosis, skin scales were obtained from all patients (n=13) and the dermatophytes were identified by potassium hydroxide mount, culture and molecular analysis. To determine the AMP concentrations, the lesional skin area of the foot was rinsed with a buffer that was subsequently analysed by ELISA. The corresponding area of the other unaffected foot as well as defined healthy skin areas of the forearm and forehead and samples from age and gender-matched healthy volunteers served as controls. In tinea pedis patients the AMP concentrations were higher in lesional skin than in non-lesional skin and in healthy skin of controls. In particular, concentrations of hBD-2 and psoriasin were significantly elevated. The induction of AMPs in tinea pedis might be triggered directly by the dermatophytes; furthermore, attendant inflammation and/or differentiation processes may play a role. Our results indicate that there is no defect in the constitutive expression and induction of the analysed AMPs by dermatophytes in the epidermis of affected patients. However, it is not known why the elevated AMP concentrations fail to efficiently combat dermatophyte growth.

A STUDY ON CHROMOBLASTOMYCOSIS IN A TERTIARY CARE HOSPITAL (DMCH), LAHERIASARAI, BIHAR

Background: Chromoblastomycosis, a chronic subcutaneous mycosis, is caused by several dematiaceous Fungi, the most common being Fonsecaea pedrosoi. A majority of cases from India have been reported from the sub-Himalayan belt and South India. Aim: The aim was to study chromoblastomycosis in around Darbhanga reason of Bihar including demographic and clinicomycological prole. Materials and Methods: This report is a retrospective hospital record-based analysis of all cases of chromoblastomycosis who presented to the dermatology outpatient department of our tertiary care hospital during the past 3 years. Results : A total of 11 cases of chromoblastomycosis were diagnosed during the above period. The disease was seen predominantly in middle-aged male. The lower extremity (72.7%) was more commonly affected. Verrucous and nodular lesions are the common clinical presentation. Sclerotic bodies are demonstrated in potassium hydroxide mount and histopathological section in 81.8% and 90.9% cases, respectively. The causative fungus was isolated in 90.9% and cass with F. pedrosoi, as the most common species

English

BACKGROUND Mycoses are assuming greater significance both in developed and developing countries particularly due to advent of immunosuppressive drugs and diseases. Dermatophytosis is most common type of cutaneous fungal infections seen in man, though in past few decades non-dermatophytes are also assuming importance. Present study is undertaken to know the pattern of dermatophytosis from our region. METHODS An observational study was conducted on 150 samples of patients with complaints of superficial mycoses. Samples were processed for microscopy on potassium hydroxide (KOH) mount and culture on Sabouraud’s dextrose agar (SDA) with and without cycloheximide and chloramphenicol. Any growth was identified by conventional technique. RESULTS One hundred and fifty samples consisting of 86 skin and 64 nails were studied. Most samples were seen in rainy season and males were predominantly affected. Adults from age of 21 - 50 years were most commonly affected. Most common clinical presentation was tinea corporis (70.93 %). In dermatophytic causes, T. mentagrophytes (36.21 %), T. tonsurans (27.59 %) followed by T. rubrum (15.52 %) were common isolates. In non-dermatophytic causes, candida spp. followed by aspergillus spp. were commonest isolates. CONCLUSIONS Tinea corporis is found to be the commonest presentation. Along with dermatophytes, non-dermatophytic fungi are also emerging as the cause of superficial mycoses. In non-dermatophytic fungi, candida is the commonest species, which is now a days showing drug resistance; hence, identification of causative agent is important for correct and prompt treatment. KEY WORDS Dermatophytosis, Non-Dermatophytic Fungi, Dermatophytic Fungi

Utility of Chicago Sky Blue Stain in Rapid Diagnosis of Mycotic Infections

Introduction: Diagnosis of fungal infection is mostly relied on clinical skills assisted by array of diagnostic methods. Culture and molecular testing are specific but lacks sensitivity and are labour intensive, time consuming, expensive and not readily available. Direct examination using Potassium Hydroxide (KOH) mount is most often practiced but lacks contrast and requires a skilled eye to interpret. Chicago Sky Blue 6B (CSB) stain has shown a promising result providing coloured contrast and better sensitivity and specificity. Aim: To evaluate the rapid diagnosis of fungal infections using CSB stain over conventional KOH mounts. Materials and Methods: This cross-sectional analytical study was done at RIMS, Raipur catering to rural and tribal population in Chhattisgarh in Central India over a period of 10 months after due approval from Institutional Ethics Committee. Clinically, suspected cases of mycosis belonging to all ages of either gender attending Outpatient Department (OPD) of Dermatology and Ophthalmology Department, who were advised mycological evaluation by physician but not on treatment were included in study. The samples were processed with KOH mount and CSB stain and were observed by two independent observers. The data was managed in Microsoft office Excel and was analysed using tests of proportion and Pearson’s Chi-square test for significance. Results: A total of 128 participants were involved in the study with a male preponderance of 96/128 (75%) as against 32/128 (25%). A total of 110 patients were diagnosed using CSB 6B stain whereas 80 patients were diagnosed using KOH mount. CSB 6B was evaluated against the conventional KOH mount using a Chi-square test and was found to be highly significant with Chi-square value of 39.74 with 1 degree of freedom and p-value of <0.001. Conclusion: This study brought out the significance of CSB 6B stain over conventional KOH mount with better sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) and ease and rapidity of diagnosis with better colour contrast helping clinicians with prompt initiation of treatment with a laboratory confirmation.

Onychoscopy: a quick and effective tool for diagnosing onychomycosis in a resource-poor setting

Onychomycosis is the most prevalent nail disease. Although clinical diagnosis of onychomycosis is easy, fungal culture as a confirmatory test requires an equipped laboratory and is time-consuming. Onychoscopy is a simple, quick, and inexpensive technique and may help clinicians increase the diagnostic accuracy of onychomycosis. The aim of this study was to identify common onychoscopic patterns of onychomycosis and correlate them with clinical subtypes of onychomycosis. This study was performed in the dermatology outpatient department of a tertiary care hospital in northern India for 6 months. Clinically diagnosed cases of onychomycosis were confirmed by potassium hydroxide (KOH) mount. After obtaining informed written consent, these patients underwent onychoscopy with DermLite II hybrid m, 3Gen, polarized mode, 10× magnification. The common onychoscopic patterns were recorded and the data analyzed. The study included 60 confirmed cases of onychomycosis. The common onychoscopic patterns observed were jagged edges with spikes of the onycholytic area in 65.5% of cases, longitudinal striae in 77.6%, distal irregular termination or a "ruin pattern" in 82.7%, and chromonychia in 62.1%. Clinical types of onychomycosis showed a statistically significant association with chromonychia (p = 0.000), jagged edges with spikes (p = 0.015), and distal irregular termination (p = 0.016). Onychoscopy can be a complementary tool in clinical diagnosis of onychomycosis to alleviate the need for direct microscopy and culture.

Dermatoscopic Features of Onychomycosis and its Correlation with Nail Plate Potassium Hydroxide Mount (KOH), Culture, and Periodic Acid Schiff Stain (PAS) in North East India.

Context:Dermatoscopy has been used recently for identifying the specific features of onychomycosis. Very few studies have used it as a diagnostic tool. Our study highlights the specific patterns in different clinical types of onychomycosis and the novel features that have never been reported previously.Aims:To study the dermatoscopic patterns in patients with onychomycosis and determine the sensitivity, specificity, positive, and negative predictive values of the different features.Study Design:A cross-sectional study.Materials and Method:Dermatoscopic picture using dinolite video dermatoscope was taken in patients diagnosed with onychomycosis either with a positive KOH, culture, and/or PAS.Result:A total of 80 patients were included. Onychomycosis was identified in 68 individuals. Clinically, 73.52% presented with distal lateral subungual onychomycosis (DLSO) and 26.47% had total dystrophic (TD). PAS was positive in 85.29% of patients, KOH in 75%, and culture in 66.17%. Trichophyton species were isolated in 53.33%, whereas Candida species in 40% of patients. Dermatoscopic features were seen in all 68 patients (100%). The most common finding in decreasing order includes spike pattern, ruin appearance, distal irregular terminations (DIT), longitudinal striations, chromonychia, focal homogeneous opacities, microsplitting, and uniform homogeneous pattern. Three novel patterns were observed: homogeneous opacity with a-z pattern border, microsplitting in a Christmas tree pattern, and focal homogeneous opacities.Conclusion:To our knowledge, this is the first study conducted in northeast India where dermatoscopy was used as a diagnostic tool and it was found to have the highest sensitivity. New features that have not been described before have been identified.

Comparative Evaluation of Potassium Hydroxide Mount, Fungal Culture, and Histopathology of Nail Clipping with Periodic Acid–Schiff Stain in the Diagnosis of Onychomycosis

Context: Onychomycosis (OM) is a commonly encountered problem in clinical practice, which needs to be differentiated from other causes of dystrophic nails as its treatment is long-term and may have potential side effects. Routinely used laboratory tests like direct microscopy with potassium hydroxide (KOH) and fungal culture (FC) show inconsistent sensitivity. Hence, newer methods of diagnosis are required. Aim: This study aims to compare the efficacy of KOH mount, fungal culture, and histopathology of nail clippings with periodic acid–Schiff stain for the diagnosis of onychomycosis. Settings and Design: This was a cross-sectional study conducted in the Dermatology Outpatient Department of a tertiary care center in Navi Mumbai from September 2013 to September 2014. Subjects and Methods: A total of 102 patients with clinically suspected OM were included in the study and evaluated for the following three methods: KOH mount, FC, and HP/PAS stain. To determine the efficacy and performance characteristics of each test, FC was chosen as the gold standard for statistical analysis. Statistical Analysis Used: Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each test. Association among the study group was assessed with the help of Chi-square test. Results: Of the 102 patients, direct microscopy with KOH mount was positive in 47, FC in 30, and HP/PAS in 71 patients. Ninety-one out of the 102 patients had at least one of the three diagnostic tests positive. Using this as the denominator, KOH mount, culture, and HP/PAS had sensitivities of 51.64%, 32.96%, and 78.02%, respectively. Diagnostic sensitivity increased to 89.38% when both KOH and HP/PAS were combined. For calculation of specificity of KOH and HP/PAS, we used FC as the gold standard because it gives precise identification of the pathogen. Specificity for KOH and HP/PAS was 59.7% and 34.7%, respectively. It increased to 73.7% if both KOH and HP/PAS were positive. Conclusion: Using PAS on nail scraping can yield higher diagnostic sensitivity with no loss of specificity and hence can be considered as the method of choice for the diagnosis of OM. Accuracy of diagnosis can be increased by combining the two tests (KOH and HP/PAS) instead of one test (HP/PAS).

Clinical patterns of sexually transmitted diseases in human immunodeficiency virus-infected individuals in a tertiary care center in South India.

Background:Human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) synergize to aggravate the associated morbidity of each other in the human body.Aims:The aim was to study the pattern of presentations of STDs in patients with HIV.Materials and Methods:This study was conducted by selecting 100 consecutive cases of HIV infection with symptoms suggestive of co-existing STD attending the outpatient department in a tertiary care center in south India.Results:Most of the patients belonged to the age group of 26–30 years, with a slight male preponderance. Genital ulcer was the predominant presenting complaint (60%), followed by dysuria (32%) and genital growth (29%). Genital ulcer was the most common lesion (56%), followed by other genital lesions (37%) and extragenital lesions (18%). Among the investigations, Tzanck smear was most commonly seen positive (62.3% of 61 patients), followed by positive potassium hydroxide mount and Venereal Disease Research Laboratory. About 35.5% of the male patients and 60.53% of the female patients had multiple diagnoses. In males, herpes genitalis (29.76%) was the most common STD, followed by condyloma accuminata (23.08%). In females, candidal vulvovaginitis (28.12%) was the most common STD, followed by herpes genitalis (23.43%).Conclusion:Our study found genital ulcer as the most common symptom and sign of STD in HIV-infected patients. Herpes genitalis was the most common STD among males and candidal vulvovaginitis was the most common STD among females.

Epidemiological Trends and Clinicomycological Profile of Chronic Dermatophytosis: A Descriptive Study From South India.

Background:Chronic dermatophytosis refers to persistent or recurrent episodes of dermatophytosis lasting for more than 1 year despite adequate treatment with topical and systemic antifungal agents. The rise in the number of these cases is alarming over the past 5 to 6 years, and a thorough knowledge about the reasons for chronicity of dermatophytosis may go a long way in the treatment and prevention of this infection.Aims and Objectives:The aim of this study was to investigate the epidemiology, various clinical types, and factors associated with chronicity in patients with chronic dermatophytosis, and to isolate the etiological agents and study the clinicomycological correlation.Materials and Methods:Detailed history and clinical details of all patients with chronic dermatophytosis who presented to our tertiary care center over a span of 1 year were recorded. Skin scrapings from these patients were subjected to potassium hydroxide mount and culture in modified Sabouraud's dextrose agar medium.Results:Sixty-four patients were enrolled in this study with a mean age of 44.5 years. The mean duration of infection was 3.14 years. Tinea corporis was the most common clinical type seen in 46 (71.9%) patients, affecting commonly the waist area in females and the back in males. Bronchial asthma was the most frequent systemic association affecting 20 (31.3%) patients followed by diabetes mellitus, which was present in 13 (20.3%) patients. About 34% patients had a history of long-term steroid use. Among the 28 isolates, Trichophyton mentagrophytes was the most frequent species isolated (46.4%), followed by Trichophyton rubrum (39.3%). Trichophyton tonsurans and Trichophyton verrucosum were isolated from two patients each.Conclusion:Extensive area of involvement, atopy, diabetes, and long-term use of systemic corticosteroids were associated with chronicity. Unlike in the yesteryears, T. mentagrophytes has emerged as the most common etiological agent of chronic dermatophytosis.

Study of respiratory viruses and their coinfection with bacterial and fungal pathogens in acute exacerbation of chronic obstructive pulmonary diseases.

Background:Patients with chronic obstructive pulmonary disease (COPD) develop acute exacerbations (AE), with varying natural history. The exacerbation is triggered by infection, leading to increased morbidity and mortality. The study on infectious aetiology of AECOPD is largely restricted to only viral or only bacterial aetiology. There are no studies from India that have investigated multiple viral, bacterial, and fungal associations from the same group of patients. This prospective study was conducted over 2 years to estimate the incidence and profile of viral infections in AECOPD patients, their coinfection with other bacterial and fungal agents, and association of the type and pattern of infective agent with the clinical severity.Materials and Methods:Seventy-four AECOPD cases were included in the study. Multiplex polymerase chain reaction was performed from nasopharyngeal swab using Fast Track Diagnostics Respiratory Pathogens 21 Plus Kit. Ziehl–Neelsen (ZN) stain, Modified ZN, and potassium hydroxide (KOH) mount were performed for Mycobacteria, Nocardia, and fungal elements. Bacterial cultures and fungal cultures were done as per the standard techniques. Serum samples were tested for Mycoplasma and Chlamydia pneumoniae immunoglobulin M enzyme-linked immunosorbent assay.Results:The number of AECOPD events involving only viral infection, only bacterial infection, bacterial–viral coinfection, and no infection were 43 (58.1%), 32 (43.2%), 20 (27%), and 19 (25.7%), respectively. Influenza A virus was the most common virus (22/43, 51%) identified. In 26 patients, monoviral infections were found, and in 17 patients, polyviral infections were identified, the most common pattern being influenza A and B virus, followed by human rhinovirus and human parainfluenza. The most common bacteria isolated were Pseudomonas aeruginosa (9/32,28%) followed by Acinetobacter baumanii and Klebsiella pneumoniae (7/32, 21%). Among the viral–bacterial coinfection, human coronavirus NL63 infection was always associated with a bacterial infection.Conclusion:This information on the various viral and bacterial etiologies of respiratory infections in AECOPD in this part of India will improve the understanding of the management of AECOPD using a timely institution of antivirals and reduce the overuse of antibiotics and the implementation of routine influenza vaccination.

A study on malassezia species causing superficial infections among patients attending a tertiary care hospital in Puducherry

Introduction: Malassezia are normal resident flora in humans and are opportunistic in nature. Superficial infections caused by Malassezia include pityriasis versicolor, pityriasis capitis (dandruff), seborrheic dermatitis and folliculitis. Though the manifestations due to Malassezia are trivial, chronicity and recurrence of lesions are associated with social embarrassment and decreased self-esteem. Aims and Objectives: The primary aim of the study was to detect the prevalence of Malassezia among superficial skin and scalp lesions. It also aims to compare Wood’s lamp examination, KOH mount examination and culture for the diagnosis of Malassezia and study the percentage of various species of Malassezia responsible for superficial infections of skin and scalp. Materials and Methods: One hundred samples collected from patients attending the Dermatology outpatient room with superficial infections of skin and scalp. Patients attending Dermatology outpatient room with complaints of hypopigmented / hyperpigmented / erythematous, scaly skin patches and patients attending Dermatology OP with complaints of itchy / non itchy scaly flakes of scalp (dandruff) were included in the study. Results: Among the 100 samples, 77% were Wood’s lamp positive, 64% were KOH positive and 59% yielded growth of Malassezia in culture. Overall prevalence of Malassezia in our study was 59%. In our study, M. globosa was the commonest species (57.62%) followed by M. furfur and M. sympodialis. Conclusion: Prevalence of Malassezia was 59% in our study. Wood’s lamp examination and KOH mount showed more positivity than culture. M. globosa was the most common species in the study. Wood’s lamp and KOH mount can be used for diagnosis of Malassezia in resource poor settings. But culture and speciation should be performed wherever possible to avoid treatment failure and recurrences. Keywords: Culture, Malassezia, Potassium hydroxide mount, Skin scrapings, Wood’s lamp.

Clinicoepidemiological profile of steroid modified dermatophytosis following abuse of irrational combination of topical corticosteroid containing preparations (ICSP)

Topical corticosteroids are the most commonly used drug and mainstay of dermatotherapeutics for many dermatoses. Topical corticosteroids are irrationally combined with other medications and widely available as the over the counter preparations (OTC) and are widely misused for various conditions. Dermatophytosis is a superficial fungal infection which is becoming resistant and difficult to treat because of inappropriate usage of irrational combination of topical corticosteroid containing preparations (ICSP).To study the prevalence and factors which promotes the abuse of Irrational combination of topical corticosteroid containing preparations(ICSP) in dermatophyte infection.A Prospective observational study conducted at department of Dermatology, Venereology & Leprosy in a tertiary care centre, South India. The sample size of this study is n=55.Out of 55 patients most common age group is 15 -30 years (n=16,29.09%).Females (n=30,54.54%) predominated over males with male:female ratio of 0.83:1.The most common complaint was intractable itching (n=46,83.64%) .The majority of study group had disease duration was 0-1 months (n=27,49.1 %) with mean duration of 4 months. The main source of referral was Over the counter (OTC) (n=32,58.18%). The most common irrational combination was FDC 3 combination(30.9%). Most commonly abused brand was betnovate GM(n=17,30.9%).Most of the patients used Clobetasol propionate 0.05% (n=25,45.5%).Patients were using ICSP mostly for less than 1 month (n=27,49.1%),with intermittent(n=19,34.5%) frequency of application. Most common side effect was tinea incognita (n=33,60%).Potassium hydroxide mount was positive in 25 patients(45.45%).Fungal culture was done in all patients and 12 patients(21.81%) showed growth. The commonest organism isolated among culture positive specimen was Trichophyton rubrum(12.72%).Inappropriate usage of irrational combination of topical corticosteroid containing preparations (ICSP) in dermatophyte infection induces short term clearance whereas the long term side effects results in variable presentation. Awarness of this problem leads to prevention of steroid modified dermatophytosis which is the rising menace.

The change of causative pathogens in toenail onychomycosis.

Toenail dystrophies are among the most common diseases in adulthood. Onychomycosis is one of the most frequently observed infectious diseases of the nail. The aim of this study was to determine the prevalence of fungal agents in the etiology of nail dystrophies such as discoloration, thickening, subungual hyperkeratosis, and onycholysis in toenails and to emphasize the importance of diagnosis by other laboratory confirmation tests since various nail diseases may mimic onychomycosis. Nail samples taken from 53 patients who were admitted to the dermatology clinic with the complaint of toenail disorders were examined by using potassium hydroxide mount, fungal culture, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry methods. Each nail was photographed, and descriptive analysis of the data was performed. Of 53 patients included in the study, 39 were female (73.6%) and 14 were male (26.4%). The ages of the patients ranged from 14 to 70years, and the mean age was 37.8years. No fungi could be isolated in 17 (32%) patients with nail dystrophy, while fungal pathogens were observed in 36 (68%) patients on potassium hydroxide mount, culture, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry examinations. Among nondermatophyte molds, Aspergillus species (52.7%) were identified as the most common fungal pathogen causing onychomycosis. Although fungal pathogenic agents are mostly detected among the diseases causing color changes and deformities in the nails, it should be kept in mind that nail findings of systemic or other skin diseases may mimic onychomycosis and the diagnosis should be confirmed by laboratory tests in addition to clinical manifestations for accurate treatment. Other systemic diseases causing nail dystrophy were not questioned in the study.

A cross sectional study to observe the diversity of fungal species in Onychomycosis isolated from a tertiary care hospital in Karachi.

To study the frequency and diversity of fungi involved in onychomycosis. The cross-sectional study was conducted from February 2018 to February 2019 at the Department of Microbiology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi, and the University of Karachi. Specimens were taken from patients suffering with onychomycosis attending the Dermatology Department of Jinnah Postgraduate Medical Centre and were processed for the isolation of fungi. Specimens were processed for the diagnosis by potassium hydroxide mount for microscopic evaluation and mycological culture to determine the type of fungus involved in onychomycosis. Fungi were isolated using Sabouraud Dextrose Agar with antibiotics cycloheximide and chloramphenicol, and without antibiotics. Plates were observed for the growth periodically until 4th week. Appearance of any colony was studied further for identification on the basis of cultural characteristics and microscopy. Precise identification of Candida species was done. Of the 230 samples, 85(36.96%) were from males and 145(63.04%) from females. Potassium hydroxide mount showed fungal element in 134(58.26%) specimens, while in 111(48.26%) patients the fungal culture was positive. Nine (3.9%) cases were culture-positive but potassium hydroxide-negative, while among the 134(58.26%) potassium hydroxide-positive cases, 32(23.9%) were culture-negative.

Senna (Cassia) alata (Linn.) Roxb. leaf decoction as a treatment for tinea imbricata in an indigenous tribe in Southern Philippines.

Tinea imbricata, a rare form of tinea corporis caused by Trichophyton concentricum, is endemic to the T'boli tribe in the Southern Philippines. Temporary remissions and limited access to antifungal medications make its treatment a pressing public health concern. Anecdotal reports about the use of Senna alata leaf decoction as treatment exist. To determine the efficacy of community-prepared S alata leaf decoction in the treatment of tinea imbricata. Tinea imbricata patients were instructed to apply S alata leaf decoction for 4weeks (28±3days). Disease severity, pruritus visual analogue scale scores (VAS) and potassium hydroxide (KOH) mounts of skin scrapings were evaluated before and after treatment. Two assessors evaluated disease severity based on photographs. Cohen's kappa statistics were used to assess diagnostic concordance. Adverse drug events were recorded. Twenty patients were enrolled. After 4weeks, 95% had decreased pruritus VAS scores, with a mean decreased of 4.05 after treatment (P<.0001). There was a significant difference in disease severity scores before and after treatment (P≤.05) with an overall agreement of 'moderate' for both assessors (κ=0.6, 95% CI [0.33, 0.87]). Forty per cent had negative KOH tests after treatment. None had adverse drug events. This is the first study that showed the potential of a community-prepared leaf decoction as a treatment option for tinea imbricata. Larger clinical trials establishing its efficacy, effectiveness and safety profile are recommended to enable its promotion among the indigenous people and health authorities as an accessible and affordable treatment for tinea imbricata.