Observational cross-sectional study to evaluate the effects of self-medication with topical agents used by patients for superficial fungal skin infection at tertiary care hospital in Mumbai

Background: Superficial fungal infections of the hair, skin, and nails are a major cause of morbidity in the world and their incidence continues to increase. While self-medication is also one of the major health concerns for health authorities worldwide. The aim of the study was to evaluate the effects of topical agents used by patients for self-medication, to enlisting the topical agents used by patients for self-medication, to ensure by whose suggestion’s patients engaged in self-medication.Methods: It was an observational cross-sectional study which was conducted at the outpatient department (OPD) of dermatology in tertiary care hospital. A detailed history of the participant was recorded regarding topical agents used for self-medication and their effects were documented in a predesigned case record form.Results: The population consisted of 128 males and 87 females. All these 215 participants had used 61 topical agents of different brand names and the majority of were irritant, corticosteroids and antifungal much high in use. Among 215 participants, 111 had temporary relief from the infection and reoccurred after stopping its use. 98 showed aggravation in their infection among which 90 showed effects like irritation, burning and itching at the application site, while 8 participants showed dryness or flaking of skin.Conclusions: Self-medication is widely practiced among patients with a superficial fungal skin infection in Mumbai. A pharmacist was the major source for obtaining these topical agents. We can conclude, there is a need to counsel and discourage patients from self-medication and regulations for dispensing the prescribed drugs should be made stringent

Case Report-Cutaneous vasculitis as a presenting feature of multiple myeloma: A report of 2 cases

We report two male patients who presented with symmetrical, painful purpura that evolved into bullae and necrotic ulcers, predominantly on the extremities, over two months in spite of conventional therapy including oral steroids. Examination showed livedoid and purpuric patches with necrotic centers in starburst pattern over the extremities and buttocks. The first case also had similar lesions over the ears. The clinical presentation and the histopathological examination suggested a diagnosis of necrotizing leukocytoclastic vasculitis (LCV). Blood testing ruled out connective tissue disease, hepatitis B or C infection or streptococcal infection as underlying cause of vasculitis. Serum antinuclear factor, antineutrophilic cytoplasmic antibody and anticardiolipin anticoagulant were negative in both cases. Cryoglobulins were positive in case 2. An incidental finding was raised serum proteins and globulins in case 2. Further investigations revealed M band on electrophoresis and features of multiple myeloma on bone marrow biopsy in both cases. These cases emphasize the importance of simple investigations like serum proteins in the evaluation of LCV

Clinical and dermoscopic evaluation of periorbital hyperpigmentation

Introduction: Periorbital hyperpigmentation (POH) is a routinely encountered condition in dermatology practice. Studying the clinical features and its correlation with dermoscopy will help in better understanding of patterns of periorbital pigmentation and its evolution. Methodology: Fifty patients attending dermatology outpatient department with POH as presenting complaint were included in the study. A detailed history and proper clinical examination were done. Laboratory tests were advised whenever necessary. Dermoscopy of pigmentation over both lower eyelids was done with ×200 magnification of Oitez e-scope (DP-M17 filter e-scope pro [optical ×200]). Clinical photographs of all patients were taken. Results: POH was multifactorial. The most common clinical type is postinflammatory type. Other associated clinical findings included pigmentation at other anatomical sites (20%), visible bulging (10%), tear trough (8%), and visible superficial vessels in the periorbital region (6%). On dermoscopy, majority of the patients had multicomponent pattern (64%) which included more than one pattern of pigmentation, vasculature, and skin changes. The different patterns of pigmentation were blotches (30%), exaggerated pigment network (28%), coarse speckled (24%), fine speckled (20%), and globules (16%). Pattern of vasculature included telangiectases (18%) and superficial dilated vessels (20%). Patterns of skin changes included atrophy (18%) and exaggerated skin markings (22%). Dermoscopic features can correlate with its etiology. Conclusion: POH is a multifactorial entity. Dermoscopic features can correlate with its etiology

Safety of dermatologic agents in lactation

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Early onset hereditary sensory autonomic neuropathy type I and not leprosy

Hereditary sensory autonomic neuropathies (HSAN) are rare forms of chronic neuropathies in children, which lead to severe complications like foot ulcers, mutilations, fractures and deformities. We report an eight years old female who presented with nonhealing perforating ulcer over anterior sole, resorption of terminal portion of right middle finger and hyperhidrosis over back since two years of age. Deep tendon reflexes were absent in lower legs but were preserved in upper limbs. Nerve conduction studies and nerve biopsy confirmed the diagnosis of HSAN, Type I. Early diagnosis of hereditary sensory neuropathy led to significant reduction in morbidity and hence improvement in the quality of life in our patient