Combination therapy in the treatment of Stevens-Johnson syndrome/toxic epidermal necrolysis: a case series and review of literature

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening disease of skin and mucous membrane that are mostly caused by drugs. Many studies have focussed on treatment that modify immunologic responses like corticosteroid, IVIG, cyclosporine, biologics like TNF-α inhibitors etanercept, infliximab etc. But there are few studies available on using two immunomodifier drugs simultaneously. However, no standardized treatment protocol has been established for SJS/TEN patients. We present a case-series of 10 SJS-TEN patients treated with both systemic corticosteroid and cyclosporine. We provide a review of literature on individual systemic corticosteroid, cyclosporine and also simultaneous use of both agents for SJS/TEN, including various outcome measures-stabilization, mortality rate, hospital length of stay and comparison to other systemic agents

Original Article Section: Dermatology Patterns of Infant Dermatoses -A Cross Sectional Study in A Tertiary Care Centre

ABSTRACT Background: The stage of infancy lasts from birth to 12 months of age (WHO).Infant Dermatosis is quite different from adult dermatosis.The objective of our study is to find out various patterns of infant dermatosis in eastern India. Methods: The cross sectional study was done in Nilratan sircar Medical college & Hospital for a period of one year (April 2015 to March 2016). The study was carried out on 600 infants. As per different patterns of skin manifestations, the infants were divided into two groups -neonatal and post neonatal. After studying the individual infants' history, the relevant clinical examinations and investigations(clinically doutful cases) were carried out.Diseases were tabulated accordingly. Results: In neonatal group physiological conditions were predominant (65.3%) whereas infections were prevalent in post neonatal period (54.8%). Among the infectious conditions parasitic infections (25.3%) were most common followed by bacterial (12.2%), viral(10.2%),and fungal infections (7.1%). Sweat gland disorders (14.5%) were commonest after infections and prevalent in older age group. Seborrheic dermatitis was commonest among dermatitis and equally prevalent in both groups (10%). Conclusion: Infants are vulnerable to various types of infections (bacterial,viral,fungal).Infected family members may be source of chronicity of infections.Though various physiological conditions are very common in neonatal age group which needs proper explanation and counseling of parents. Infections and non infectious dermatitis are also prevalent which need proper treatment

MELASMA: A CLINICO-EPIDEMIOLOGICAL STUDY OF 312 CASES

Background: Melasma is an acquired increased pigmentation of the skin, characterized by gray-brown symmetrical patches, mostly in the sun-exposed areas of the skin. The pathogenesis is unknown, but genetic or hormonal influences with UV radiation are important. Aims: Our present research aims to study the clinico-epidemiological pattern and the precipitating or provocation factors in melasma. Materials and Methods: A total of 312 patients were enrolled for the study over a period of one year. Results: The mean age of patients with melasma was 33.45 years, ranging from 14 to 54 years. There was female preponderance with a female to male ratio of approximately 4 : 1. The mean age of onset was 29.99 years, with the youngest and oldest being 11 and 49 years, respectively. The patients sought medical treatment on an average of 3.59 years after appearance of melasma. About 55.12% of our patients reported that their disease exacerbated during sun exposure. Among 250 female patients, 56 reported pregnancy and 46 reported oral contraceptive as the precipitating factors. Only 34 patients had given history of exacerbation of melasma during pregnancy. A positive family history of melasma was observed in 104 (33.33%) patients. Centrofacial was the most common pattern (55.44%) observed in the present study. Wood light examination showed the dermal type being the most common in 54.48% and epidermal and mixed were seen in 21.47% and 24.03% of the cases, respectively. We tried to find an association with endocrinal diseases and observed that 20 of them had hypothyroidism. Conclusion: The exact cause of melasma is unknown. However, many factors have been implicated in the etiopathogenesis of this disorder. Here we try to identify the causative factors and provocation to develop melasma

Pattern Of Non-Venereal Genital Dermatoses In Adult Male- A Clinical Study In A Tertiary Care Centre.: Non-Venereal Male Genital Dermatoses

Objective : Non venereal genital dermatoses are genital dermatoses not sexually transmitted. It causes extreme anxiety in patients, because venereal disease is often patient’s primary concern. Aims were To study the clinical pattern of various non-venereal genital dermatoses of male having age 18 to 60 yrs. Methods and Material: A cross-sectiona lclinical study was done among Male patients between 18-60 years of age, having Non-venereal Genital dermatoses, attending the dermatology O.P.D of a tertiary care hospital in Eastern IndiaPatients clinically diagnosed with Non-venereal Genital Dermatoses were included in the study after signing the Informed consent Thorough examination of genital lesion was done with special relevance to the morphology, number, tenderness, regional lymph node involvement etc. Complete physical andsystemic examination was done. Associated skin lesions were noted. Investigations such as Blood sugar, Tzanck smear, KOH mount, Gram-stain and histopathological examination were done in relevant cases. VDRL, HIV test were done to rule out STD. Statistical analyses were done using necessary software. Results: Total 133 patients were included in the study. The commonest age group was 18 – 30 years. Most common [35%] disease was Candidal Balano-posthitis. Married persons were more affected Diseases predominant in rural areawere LSA.  Non-STD genital dermatoses are less commoner in Muslim. Diabetes came as common in both personal and family history Conclusions: For the differentiation of non venereal genital dermatoses, apart from history and investigations the clinical study such as age, residence, religion and morphology of the lesions are very important. Clinician should have an unbiased approach towards genital conditions

Tri-filial presentation of familial tuberous sclerosis with renal tumors

Tuberous sclerosis is a rare neuro-cutaneous syndrome with autosomal dominant penetrance. Only some organs are involved, e.g., skin (earthy skin thickenings, ash leaf patches), cerebral cortex (hamartomatous nodules) and kidneys, (angiolipoma, adenocarcinoma). These hamar-tomatous swellings resemble potatoes and hence, referred to as tubers. We herein report on three patients (all familial), father, son and granddaughter, with this rare involvement, from the eastern part of India. The father and son had involvement of only the skin (i.e. nose) and kidneys while the disease penetrated further in the subsequent filial generations with son and granddaughter having skin, brain and bilateral kidney involvement. This kind of tri-filial progression has not till date, been reported from this region, making it an interesting case presentation

Automated Tissue Classification Framework for Reproducible Chronic Wound Assessment

The aim of this paper was to develop a computer assisted tissue classification (granulation, necrotic, and slough) scheme for chronic wound (CW) evaluation using medical image processing and statistical machine learning techniques. The red-green-blue (RGB) wound images grabbed by normal digital camera were first transformed into HSI (hue, saturation, and intensity) color space and subsequently the “S” component of HSI color channels was selected as it provided higher contrast. Wound areas from 6 different types of CW were segmented from whole images using fuzzy divergence based thresholding by minimizing edge ambiguity. A set of color and textural features describing granulation, necrotic, and slough tissues in the segmented wound area were extracted using various mathematical techniques. Finally, statistical learning algorithms, namely, Bayesian classification and support vector machine (SVM), were trained and tested for wound tissue classification in different CW images. The performance of the wound area segmentation protocol was further validated by ground truth images labeled by clinical experts. It was observed that SVM with 3rd order polynomial kernel provided the highest accuracies, that is, 86.94%, 90.47%, and 75.53%, for classifying granulation, slough, and necrotic tissues, respectively. The proposed automated tissue classification technique achieved the highest overall accuracy, that is, 87.61%, with highest kappa statistic value (0.793)