Case report of mucha-habermann disease

Pityriasis lichenoides et varioliformis acuta (PLEVA), also known as a Mucha-Habermann disease, is an uncommon, idiopathic, and acquired dermatosis. The disease is characterized by erythematous, scaly, papules, and polymorphic lesions which often progresses to hemorrhagic necrosis and heals with varioliform scarring. A febrile ulceronecrotic variant of PLEVA, also termed pityriasis lichenoides (PL) with ulceronecrosis and hyperthermia (PLUH) or febrile ulceronecrotic Mucha-Habermann disease (FUMHD), is a severe variant of PLEVA. The disease is characterized by the acute onset of large, more destructive, coalescent papules, leading to ulceronecrotic skin lesions associated with high fever and other systemic symptoms. In spite of the presence of multiple treatment modalities with variable success rate, the disease has poor prognosis. Here, we report the case of a 17-year-old male patient who presented with typical features of FUMHD and responded well to systemic administration of corticosteroid therapy

Changing incidence of nevirapine-induced cutaneous drug reactions: After revised guideline Nov 2011

Aims and Objectives: To study the change in the incidence and pattern of nevirapine (NVP)-induced adverse cutaneous reactions (ADR) after commencement of revised National AIDS Control Organisation (NACO) guidelines for initiation of antiretroviral therapy (ART) since Nov 2011. Materials and Methods: The study was conducted on patients who developed cutaneous reactions after starting NVP based regimen. According to the revised NACO ART initiation guidelines Nov 2011, ART should be started if CD4 count is < 350 cells/mm 3 in stages 1, and 2 and irrespective of CD4 count in stages 3, and 4. Patients were divided in groups A and B. Group A consisted of patients enrolled on NVP-based regimen during Jan 2011 to Oct 2011, whereas, in Group B patients from Nov 2011 to Aug 2012 were included. Grading of rash, appropriate investigations and management was done. Observations: In Group A, out of 645 patients 30 (4.66%) patients developed cutaneous reactions, where as in Group B out of 720, 65 (9.03%) patients presented with drug reaction. In Group A (n = 30) developed reaction as Grade 1 in 1.55% (n = 10), Grade 2 in 1.86% (n = 12), grades 3 and 4 in 0.76% (n = 5) and 0.47% (n = 3), respectively. In Group B (n = 65) developed reaction, out of which Grade 1 reaction was seen in 1.39% (n = 10), Grade 2 was seen in 2.78% (n = 20), grades 3 and 4 was seen in 3.33% (n = 24) and, 1.53% (n = 11), respectively. Conclusion: There is a striking increase in the incidence of NVP-induced cutaneous reactions of all forms and considerable increase in frequency of severe kind of reactions with the revised guidelines