Histopathological spectrum of cutaneous reactions following COVID-19 Vaccine - An observational study

Background: Owing to the myriad clinical presentations of COVID-19 vaccine-induced adverse events, clinicopathological correlation is the key to understanding the underlying pathophysiology of these reactions. However, there is still a dearth of such systematic studies across a wide spectrum of vaccine reactions. Aim and Objectives: This study provides a clinical and histopathological correlation of COVID-19 vaccine-induced mucocutaneous reactions. Materials and Methods: The study population included all the individuals developing any form of self-reported mucocutaneous adverse events within 4 weeks of receiving the COVID-19 vaccine. The clinical and histopathological features were recorded. Results: A total of 126 cases were identified. Seven histopathological patterns were recognized. The most common histopathological feature was spongiotic dermatitis, seen in all the patients with “vaccine-related eruption of papules and plaques” (VREPP). Other patterns included lichenoid or interface dermatitis, dermal hypersensitivity reaction, leukocytoclastic vasculitis, subepidermal blistering, psoriasiform hyperplasia, and dermal granulomatous reaction. Conclusion: Owing to such myriad clinical presentations, utilizing a histopathological classification could ease categorizing the vaccine-induced mucocutaneous eruptions

Efficacy of Intralesional Bleomycin in Palmo-plantar and Periungual Warts

Background/Aim : Intralesional bleomycin gained increasing popularity in the recent past for treatment of warts particularly in palmo-plantar and periungual regions as other modalities are not very effective. Hence we evaluated the role of intralesional bleomycin in periungual and palmo-plantar warts to know its efficacy in Indian patients. Settings and Design : This was a placebo-controlled study. Materials and Methods : Fifty patients of multiple palmo-plantar and periungual warts were included in this study and categorized in groups A and B of 25 each. Alternate patients were included in groups A and B and treated respectively with intralesional bleomycin (1 mg/mL solution) and normal saline as placebo, fortnightly for maximum up to two injections. Patients were followed up weekly for 1 month, fortnightly up to 12 weeks, and then quarterly for 1 year. If warts persisted after 12 weeks of starting treatment, it was considered a failure. Statistical analysis was done by the chi-square test using M-stat software. Results : Group A and B patients were having 85 warts and 72 warts, respectively. The cure rate in group A and B patients was 96.47% (82/85 warts) and 11.11% (8/72 warts), respectively, after one or two injections within 12 weeks. The difference in the cure rate between two groups was statistically highly significant (<0.0001). In group A patients, a haemorrhagic eschar was formed which gradually healed in 8-12 weeks without atrophy or pigmentation; this phenomenon was not seen in group B. Only moderate pain was observed by most of the patients during injection in both groups. Conclusion : The intralesional injection of bleomycin is highly effective, safe, and non-toxic in periungual and palmo-plantar warts

Early neonatal dermatoses: An epidemiological study from a tertiary care center in Western Rajasthan

Background: The spectrum of cutaneous manifestations during the neonatal period varies from transient self-limiting conditions to serious life-threatening ones. Transient and pathological neonatal dermatoses should be differentiated from physiological changes to avoid unnecessary treatment and to relieve parent's stress. Purpose: The aim of this study was to determine the incidence and patterns of various dermatoses in early neonates and correlate these changes with maternal or neonatal factors; in the west region of Rajasthan, India. Methods: This hospital-based prospective study at a tertiary-level referral teaching medical center entailed recording detailed dermatological examination of 5000 early neonates having any physiological and/or pathological cutaneous changes. Results: A total of 5000 newborns were observed, there were 3248 (64.96%) male and 1752 (35.04%) female. Out of the total, 67.36% were full-term birth, whereas 30.44% were preterm and 2.2% were postterm newborns. Physiological skin changes (92.42%) were more commonly observed as compared to pathological changes (45.1%). The physiological skin changes observed in the order of frequency were sebaceous hyperplasia (65.32%), milia (51.12%), and physiological scaling (41.02%). Cutis marmorata (2.06%) and harlequin skin changes (1.06%) were seen more in preterms, weighing <2.5 kg. Miliaria was observed in 39% of neonates, due to the hot and humid environment at our place. Bullous impetigo was the most common infection observed in 199 neonates. The most common iatrogenic complication was caput succedaneum; noted in 160 neonates. Conclusion: Neonatal dermatoses are mostly transient and physiological, but these innocent dermatoses need to be differentiated from serious and aggressive pathological dermatoses to avoid unnecessary therapy

Efficacy and safety of Erbium-YAG laser ablation therapy in superficial dermatoses: The workhorse of dermatology

Background: Erbium-YAG laser has been the working horse in dermatology for years. Surprisingly, data on the efficacy and adverse effects of this novel resurfacing and ablative technique of erbium-YAG laser for superficial dermatoses in Indian skin is limited. Aim and Objective: To evaluate the efficacy and safety profile of erbium-YAG laser ablation in superficial cutaneous lesions. Materials and Methods: Two hundred and fifty patients of various superficial dermatoses, treatable by erbium-YAG laser, were recruited in the study. All the patients were subjected to erbium-YAG laser sessions. The number of laser sessions, fluence, frequency and other parameters were individualized as per the respective dermatosis. The clinical response was evaluated as grade 4 (100% lesion clearance), grade 3 (75–99%), grade 2 (50–75%) or grade 1 (<50%). Results: The overall mean age of our study group was 37.70 years. In our study, 52.38% cases of verruca plana, 36.84% cases of seborrheic keratosis, 56.4% cases of xanthelasma palpebrarum, 22% cases of acquired melanocytic nevus, 23.8% cases of plantar wart and 40% cases of sebaceous hyperplasia showed complete clearance. The most common adverse effect was post-laser erythema in 50.4% of cases, followed by pain in 36.8%. Besides this, scarring and dyspigmentation were observed in 11.6% and 12% of cases, respectively. The rate of recurrence on 3 months follow-up was 9 (23.07%) cases in xanthelasma palpebrarum, 11 (28.9%) cases in seborrheic keratosis, 10 (23.8%) cases in verruca plana and 9 (42.8%) cases in plantar warts. Conclusion: This study suggested that erbium-YAG ablation achieved good results for superficial lesions like verruca plana, seborrheic keratosis, xanthelasma palpebrarum, plantar wart, sebaceous hyperplasia and acquired melanocytic nevus. Thus, Er: YAG laser can offer a one-step procedure with better cosmetic results and a lesser rate of recurrence