Indian Journal of Dermatology, Venereology and Leprology
Background: Indian data on potential hepatorenal toxic effects of highly active antiretroviral th... more Background: Indian data on potential hepatorenal toxic effects of highly active antiretroviral therapy (HAART) in HIV/AIDS-affected persons is lacking. Objectives: To assess hepatorenal abnormalities in HIV-infected persons on HAART in a hospital-based mixed cohort study using concurrent and nonconcurrent data analysis. Methods: Hepatorenal function tests, urinalysis and ultrasonogaphy for liver/kidneys (when applicable) were assessed in 400 (men 185; women 215) persons aged 2–84 (mean 47.8) years on HAART. Acute liver toxicity, acute kidney injury and chronic kidney disease were defined depending upon abnormal serum alanine aminotransferase, urea and creatinine levels/clearance as per standard guidelines. Results: The duration of HAART was 1 month to 9 years (mean 3.7 years) with 284 (71%) individuals being on treatment for ≤5years. The major HAART regimens included zidovudine + lamivudine + nevirapine in 175 (43.8%), tenofovir + lamivudine + efavirenz in 174 (43.5%) and zidovudine + lamivudine + efavirenz in 20 (5%) individuals and were associated with grade-1 hepatic dysfunction in 57 (14.3%) individuals, with men aged between 31 and 45 years on antiretroviral therapy for >5 years being mainly affected. Forty two (17.1%) of 246 individuals with anemia and 15 (9.7%) of 154 individuals without anemia showed hepatic dysfunction. None had acute kidney injury, chronic kidney disease or abnormal urinalysis or ultrasonography. In contrast, the pretreatment elevated serum alanine amiotranerase in 99 (22.3%) and blood urea and/or creatinine levels in 16 (4%) individuals decreased significantly post highly active antiretroviral therapy. Conclusions: The study reflects the low frequency of regimen based highly active antiretroviral therapy-associated hepatic or nephrotoxicity despite prolonged use, especially in the absence of other risk factors. Preexisting anemia appears an important risk factor for highly active antiretroviral therapy-induced hepatotoxicity (OR 1.90, Cl 95% CI 1.02–3.57, P = 0.04). Highly active antiretroviral therapy-associated nephrotoxicity was not a significant problem. Study of viral load or other risk factors and potential of each drug for hepatorenal toxicity/dysfunction in HIV affected were not part of the study. A small number of subjects and retrospective analysis of biochemical parameters were other important limitations.
IP Indian Journal of Clinical and Experimental Dermatology
Introduction: Commonly used destructive treatment modalities for treatment of warts though effect... more Introduction: Commonly used destructive treatment modalities for treatment of warts though effective, are associated with pain, pigmentary changes, scarring and recurrences. Utilization of various vaccines and skin test antigens has broaden the horizon of available immunotherapeutic armamentarium for the treatment of warts. Aim: Evaluation of efficacy and safety of intradermal PPD for treating facial warts - a prospective study.. Materials and Methods: Fifty-four patients with facial warts were treated with intradermal injections of PPD 10 TU/0.1 ml at two weekly intervals. They were followed up at 2, 4, 6, 8, and 12 weeks for assessment of response, adverse effects and recurrence of facial warts. Results: Out of 54 (M: F 25:29) patients, only 49 patients with facial warts completed the study. Overall, complete clearance in 22(45%) patients and partial clearance in 18(37%) patients were observed. The patients with complete/partial clearance were highly satisfied from the treatment. Recurrence was not seen in our patients. Few patients had injection site pain for 2-3 days not warranting discontinuation of treatment. Other adverse effects included temporary erythema and swelling in 3 patients which subsided on its own in 2-3 days. Conclusion: 82% patients responded (complete and partial response) to therapy. Intradermal PPD appears effective, safe, and acceptable treatment modality for facial warts. It carries the advantage of patient compliance, insignificant adverse effects and high patient satisfaction. Keywords: Warts, Purified protein derivative, Intradermal, Immunotherapy.
International Journal of Basic and Clinical Pharmacology, 2016
Background: The main motive of PvPI (Pharmacovigilance Programme of India) is to collect valuable... more Background: The main motive of PvPI (Pharmacovigilance Programme of India) is to collect valuable data so that signals can be generated from reported adverse drug events (ADEs). It also tries to establish their causality so that ADEs can be labelled as adverse drug reactions (ADRs) beyond any doubt. Methods: This retrospective observational study done in rural set up tertiary care teaching hospital collected data through voluntary reporting in ADR form of PvPI for period of 6 month. Causality assessment was done using WHO causality assessment scale. Results: In 150 reported cases, majority ADRs were due to tuberculosis, cancer and HIV treatments. Gastrointestinal tract and central nervous system were the major organs involved. Most ADRs occurred within first day of drug intake. Around 15% required hospitalization. 55% ADRs were probable and 41% were possible in nature. Vertigo and depression was most frequent ADR in MDR therapy. Rashes, pruritis, fever and joint pain was frequent in antiretroviral therapy. Dysguesia, dizziness, nausea, vomiting and constipation was frequent in patients taking anticancer drugs. Platins and antibiotics used for cancer therapy cause most cancer treatment ADRs. Conclusions: ADRs add to hospitalization expenses, insurance costs and increase in work loss days besides addition to patient suffering. Prior knowledge can help in better prescriptions and prevent valuable resource loss. Reasons for under-reporting of ADRs can be complacency, ignorance, lack of financial incentives for reporting, fear of litigation, claims of compensation and lack of time in busy hospital schedules.
Pheohyphomycosis is a rare infection caused by dematiaceous fungi, affecting the skin and subcuti... more Pheohyphomycosis is a rare infection caused by dematiaceous fungi, affecting the skin and subcutis, paranasal sinuses, or central nervous system. A case of subcutaneous pheohyphomycosis in the lumbar region is reported. The Indian literature on subcutaneous pheohyphomycosis is also reviewed. In India, 23 patients with subcutaneous pheohyphomycosis have been reported, distributed throughout the country in a belt from north to south, sparing the eastern and western regions. The age of the patients ranged from 3 to 60 years, with a male to female ratio of 1.3 : 1. A relatively early age of onset was observed. A history of prior injury was recalled by five patients. The lower extremities were involved in eight cases, upper extremities in five, gluteal region in two, lumbar area and submandibular area in one, face in two and disseminated disease was seen in four cases. Three of these cased died during follow up. Osteomyelitis was observed in two cases, hepatosplenomegaly in one, and lymp...
Localized cutaneous leishmaniasis (LCL) in India is due mostly to Leishmania tropica. It is mainl... more Localized cutaneous leishmaniasis (LCL) in India is due mostly to Leishmania tropica. It is mainly endemic in the deserts of Rajasthan. Recently, Himachal Pradesh has been identified as a new endemic focus for the disease. In the last few years, the number of new cases has been increasing almost to epidemic proportions. This report presents the preliminary findings of clinico-epidemiologic and investigative results of 161 new localized cases of LCL seen between May 2001 and December 2003. The study populaton was composed of 80 males and 81 females between 10 months and 75 years of age. All were indigenous to the sub-alpine valley along the Satluj River in the mountainous region of the Kinnaur District (altitude ס 700−2,900 meters). Most patients were seen from April to September and had 1−8 lesions (duration ס 1−6 months) that involved mainly the face. Tissue smears were positive for amastigotes in 37% and histopathology showed non-caseating epitheloid cell granuloma in 77% of the cases. Analysis by polymerase chain reaction−restriction fragment length polymorphism (PCR-RFLP) of the ribosomal gene region of 10 biopsy specimens showed amplicons indistinguishable from L. donovani in eight cases and L. tropica in two cases. Leishmania was cultured on modified Nicole-Novy-McNeal (NNN) medium containing RPMI 1640 medium and heat-inactivated fetal bovine serum from 13 of 38 biopsy samples. Three of these isolated strains were identified as L. donovani while a fourth was L. tropica by PCR-RFLP of the ribosomal internal transcribed spacer region. One strain had a gp63 sequence identical to that of east African strains. Another strain had a unique gp63 sequence that has not been found in L. donovani complex strains. Sand flies trapped in the cattle sheds of a few patients were identified as Phlebotomus longiductus (Parrot 1928). Treatment with intralesional sodium stibogluconate was effective in all patients without any major side effects. One patient developed lupoid leishmaniasis that responded to higher dose of sodium stibogluconate. Though rarely reported as a cause of LCL, L. donovani seems to be the predominant pathogen in this new focus of cutaneous leishmaniasis. Phlebotomus longiductus is a possible vector, albeit based on circumstantial evidence.
This report presents a number of unusual clinico-histopathologic and therapeutic features in a cu... more This report presents a number of unusual clinico-histopathologic and therapeutic features in a culture proven case of cutaneous sporotrichosis. These include lymphocutaneous sporotrichosis involving face; its dissemination in an otherwise healthy patient; its histology mimicking cutaneous cryptococcosis; two episodes of severe purulent inflammatory reaction bordering the lesion during therapy with saturated solution of potassium iodide; no therapeutic response to potassium iodide therapy and rapid healing of lesion with high-dose of fluconazole.Es wird der Fall einer Hautsporotrichose mit ungewöhnlicher klinisch-histopathologischer und therapeutischer Charakteristik vorgestellt: Lymphokutane Sporotrichose im Gesicht; Disseminierung, obwohl der Patient immunkompetent war; ein histologisches Bild wie bei kutaner Cryptococcose. Die Therapie mit Kaliumjodid blieb ohne Wirkung, doch heilte das Geschehen unter hoher Fluconazol-Dosierung ab.
Background: Associations among thyroid dysfunction, thyroid autoimmunity, and clinical features i... more Background: Associations among thyroid dysfunction, thyroid autoimmunity, and clinical features including age, gender, disease duration, and severity of psoriasis is less studied. Objectives: To study frequency of thyroid dysfunction and thyroid autoimmunity and examine association among thyroid dysfunction, thyroid autoimmunity, and clinical features including gender, age, duration, and severity of psoriasis. Material and Methods: The medical records of 290 (m:f 2.15:1) patients aged 13–75 years with plaque psoriasis were analyzed for thyroid dysfunction and thyroid autoimmunity. Thyroid dysfunction was defined as 10% variation in any thyroid hormone levels. Thyroid autoimmunity was diagnosed from presence of antithyroid peroxide (anti-TPO) antibodies. Results: The majority, 57.9% patients, was aged ≥41 years (Type-2 psoriasis) and duration of disease was <5 years in 58.6% patients. Mild and moderate to severe psoriasis was present in 58.3% and 41.7% patients, respectively. Dera...
Acrodermatitis enteropathica (AE) is a rare, autosomal-recessive disorder of neonatal zinc defici... more Acrodermatitis enteropathica (AE) is a rare, autosomal-recessive disorder of neonatal zinc deficiency due to SLC39A4 (intestinal zinc transporter, Zip4) gene mutation with onset after weaning while breastfeeding during this period will be protective. Transient symptomatic zinc deficiency is also acquired rarely in breastfed infants with increased zinc requirements and/or inadequate concentration of zinc in breast milk. The nursing mothers of transient symptomatic zinc deficiency infants show SLC30A2 (mammary epithelial zinc transporter, ZnT-2) gene mutation and abnormally low zinc levels in the breast milk despite normal serum zinc levels, which do not improve after zinc supplementation. A 2-month-old breastfed male infant had AE-like clinical features of zinc deficiency for two weeks. His symptoms and low serum zinc levels improved rapidly after zinc supplementation. The mother also had low serum and breast milk zinc concentration and both improved after oral zinc therapy indicatin...
The extent and disease severity, duration and other associated prognostic cofactors in vitiligo i... more The extent and disease severity, duration and other associated prognostic cofactors in vitiligo in adults may vary with the age of onset (before or after 10 years of age).
Psoriasis is now recognized as an immune-mediated inflammatory dermatosis with increased risk for... more Psoriasis is now recognized as an immune-mediated inflammatory dermatosis with increased risk for metabolic syndrome, its individual components, and cardiovascular disease. We quantitatively estimated malondialdehyde (MDA), lipoprotein-a (LP-a), lipoprotein ratios, comprehensive lipid tetrad index (CLTI), and atherogenic index (AI), and evaluated cardiovascular risk in 132 (M:F 94:38) patients with psoriasis aged 20–79 years with chronic plaque psoriasis and equal number of age and gender-matched controls. Lipoprotein ratios, CLTI and AI were calculated using standard formulae. Cardiovascular 10-year risk was graded by Framingham risk score (FRS) as low, intermediate and severe. Mild-to-moderate and severe psoriasis was present in 125 (94.7%), and 7 (5.3%) patients, respectively, and 19 (14.39%) patients had psoriatic arthritis. Statistically significant differences were noted for LDL, LDL/HDL, non-HDL/HDL, MDA, LP-a, AI and CLTI. There was a significantly positive correlation between PASI with LP-a (p = 0.003, r = 0.25) and AI (p = 0.012, r = 0.22). Serum levels of MDA correlated positively with LP-a (p < 0.001, r = 0.55), AI (p < 0.001, r = 0.51) and CLTI (p = 0.006, r = 0.24). FRS was low, intermediate and severe in 78%, 18.9%, and 3% patients compared to 85.6%, 13.6%, and 0.8% controls, respectively, and the difference was not statistically significant. Psoriasis appears to be an independent risk factor for elevated serum MDA, LP-a, CLTI and AI. However, whether they can be used as surrogate markers for enhanced cardiovascular risk in patients with psoriasis, remains conjectural.
Facial hypermelanosis is a significant cause of cosmetic disfigurement, social embarrassment and ... more Facial hypermelanosis is a significant cause of cosmetic disfigurement, social embarrassment and psychological morbidity affecting quality of life. To study clinicoepidemlogic patterns of facial hypermelanoses among men. Medical records of all adult males presenting with facial hypermelanoses were analyzed for this retrospective cross sectional study for demographic details, duration, cosmetic usage, sun exposure, drug intake, infections, systemic or cutaneous diseases, and family history of hypermelanotic dermatosis. Laboratory investigations and skin biopsy were performed when deemed necessary. These were 300 Indian men aged 18 to 74 (mean 37.35) years with 121 (40.3%) individuals aged 31-50 years. Various patterns of melasma in 230 (76.7%) patients were the major cause of facial hypermelanosis. Periorbital hypermelanosis was observed in 32 (10.7%), freckles and lentigens in 26 (8.7%), acanthosis nigricans in 12 (4%) and lichen planus pigmentosus in 10 (3.3%), pigmented cosmetic c...
The anti-inflammatory, immunomodulatory, and anti-proliferative effects of vitamin D in pathogene... more The anti-inflammatory, immunomodulatory, and anti-proliferative effects of vitamin D in pathogenesis of autoimmune diseases have been highlighted in recent years but implications of vitamin D deficiency in systemic sclerosis (SSc) remain understudied. To evaluate serum vitamin D levels in SSc patients and matched controls. Serum vitamin D levels were estimated in 38 (M:F 5:33) patients aged 23-70 years of untreated SSc and age and gender matched healthy controls. Clinical and investigative evaluation for skin sclerosis by modified Rodnan skin score (mRSS), presence of digital ulcers, Raynaud's phenomenon, type of auto-antibodies, systemic involvement, and serum vitamin D levels were performed. Serum vitamin D levels were defined as normal (30-100 ng/ml), insufficient (10-30 ng/ml), and deficient (<10 ng/ml). Serum vitamin D levels (median ± IQR) were 19.5 ± 77.8 ng/ml in 38 patients and 100 ± 31.3 ng/ml in controls each. Vitamin D deficiency in 13 (34.2%) and insufficiency in...
The American Journal of Tropical Medicine and Hygiene
We describe four cases of histoplasmosis indigenous to Himachal Pradesh (India) that will be of c... more We describe four cases of histoplasmosis indigenous to Himachal Pradesh (India) that will be of considerable public health interest. A 48-year-old human immunodeficiency virus (HIV)-negative man with cervical and mediastinal lymphadenopathy, hepatosplenomegaly, adrenal mass, and bone marrow involvement was treated as disseminated tuberculosis without benefit. Progressive disseminated histoplasmosis was diagnosed from the fungus in smears from adrenal mass. Another 37-year-old HIV-positive man was on treatment of suspected pulmonary tuberculosis. He developed numerous erythema nodosum leprosum-like mucocutanous lesions accompanied by fever, generalized lymphadenopathy, and weight loss. Pulmonary histoplasmosis with cutaneous dissemination was diagnosed when skin lesions showed the fungus in smears, histopathology, and mycologic culture. Both were successfully treated with amphotericin B/itraconazole. Third patient, a 46-year-old HIV-negative man, had oropharyngeal lesions, cervical lymphadenopathy, intermittent fever, hepatosplenomegaly, and deteriorating general health. Progressive disseminated oropharyngeal histoplasmosis was diagnosed from the fungus in smears and mycologic cultures from oropharyngeal lesions and cervical lymph node aspirates. He died despite initiating treatment with oral itraconazole. Another 32-year-old man 3 months after roadside trauma developed a large ulcer with exuberant granulation tissue over left thigh without evidence of immunosuppression/systemic involvement. He was treated successfully with surgical excision of ulcer under amphotericin B/itraconazole coverage as primary cutaneous histoplasmosis confirmed pathologically and mycologically. A clinical suspicion remains paramount for early diagnosis of histoplasmosis particularly in a nonendemic area. Most importantly, with such diverse clinical presentation and therapeutic outcome selection of an appropriate and customized treatment schedule is a discretion the treating clinicians need to make.
International journal of dermatology, Oct 19, 2017
References 1 Kluger N. Epidemiology of tattoos in industrialized countries. Curr Probl Dermatol 2... more References 1 Kluger N. Epidemiology of tattoos in industrialized countries. Curr Probl Dermatol 2015; 48: 6–20. 2 Shannon-Missal L. Tattoo takeover: three in ten Americans have tattoos, and most don’t stop at just one. Available at http://www. theharrispoll.com/health-and-life/Tattoo_Takeover.html 10 Feb 2016 (accessed 3 December 2016). 3 Ungarelli LF, Hetem CM, Farina Junior JA. Is it safe to operate on patients taking isotretinoin? Aesthetic Plast Surg 2016; 40: 139–148.
Prolactin possibly plays a pathogenetic role in psoriasis by stimulating keratinocyte proliferati... more Prolactin possibly plays a pathogenetic role in psoriasis by stimulating keratinocyte proliferation, T-lymphocyte interferon gamma production and promoting angiogenesis1. The inhibition of the T-suppressor cell functions by prolactin may serve to promote psoriatic plaque development2. It has been postulated that retinoids decrease the prolactin secretion from pituitary gland and add to their antipsoriatic effect3. Bromocriptine, an antiprolactin drug has been found useful in the treatment of psoriasis and psoriatic arthritis4,5. There are studies demonstrating serum prolactin levels varying with severity, duration and treatment of psoriasis5-8. However, not many studies are available from India.
Indian Journal of Dermatology, Venereology and Leprology
Background: Indian data on potential hepatorenal toxic effects of highly active antiretroviral th... more Background: Indian data on potential hepatorenal toxic effects of highly active antiretroviral therapy (HAART) in HIV/AIDS-affected persons is lacking. Objectives: To assess hepatorenal abnormalities in HIV-infected persons on HAART in a hospital-based mixed cohort study using concurrent and nonconcurrent data analysis. Methods: Hepatorenal function tests, urinalysis and ultrasonogaphy for liver/kidneys (when applicable) were assessed in 400 (men 185; women 215) persons aged 2–84 (mean 47.8) years on HAART. Acute liver toxicity, acute kidney injury and chronic kidney disease were defined depending upon abnormal serum alanine aminotransferase, urea and creatinine levels/clearance as per standard guidelines. Results: The duration of HAART was 1 month to 9 years (mean 3.7 years) with 284 (71%) individuals being on treatment for ≤5years. The major HAART regimens included zidovudine + lamivudine + nevirapine in 175 (43.8%), tenofovir + lamivudine + efavirenz in 174 (43.5%) and zidovudine + lamivudine + efavirenz in 20 (5%) individuals and were associated with grade-1 hepatic dysfunction in 57 (14.3%) individuals, with men aged between 31 and 45 years on antiretroviral therapy for >5 years being mainly affected. Forty two (17.1%) of 246 individuals with anemia and 15 (9.7%) of 154 individuals without anemia showed hepatic dysfunction. None had acute kidney injury, chronic kidney disease or abnormal urinalysis or ultrasonography. In contrast, the pretreatment elevated serum alanine amiotranerase in 99 (22.3%) and blood urea and/or creatinine levels in 16 (4%) individuals decreased significantly post highly active antiretroviral therapy. Conclusions: The study reflects the low frequency of regimen based highly active antiretroviral therapy-associated hepatic or nephrotoxicity despite prolonged use, especially in the absence of other risk factors. Preexisting anemia appears an important risk factor for highly active antiretroviral therapy-induced hepatotoxicity (OR 1.90, Cl 95% CI 1.02–3.57, P = 0.04). Highly active antiretroviral therapy-associated nephrotoxicity was not a significant problem. Study of viral load or other risk factors and potential of each drug for hepatorenal toxicity/dysfunction in HIV affected were not part of the study. A small number of subjects and retrospective analysis of biochemical parameters were other important limitations.
IP Indian Journal of Clinical and Experimental Dermatology
Introduction: Commonly used destructive treatment modalities for treatment of warts though effect... more Introduction: Commonly used destructive treatment modalities for treatment of warts though effective, are associated with pain, pigmentary changes, scarring and recurrences. Utilization of various vaccines and skin test antigens has broaden the horizon of available immunotherapeutic armamentarium for the treatment of warts. Aim: Evaluation of efficacy and safety of intradermal PPD for treating facial warts - a prospective study.. Materials and Methods: Fifty-four patients with facial warts were treated with intradermal injections of PPD 10 TU/0.1 ml at two weekly intervals. They were followed up at 2, 4, 6, 8, and 12 weeks for assessment of response, adverse effects and recurrence of facial warts. Results: Out of 54 (M: F 25:29) patients, only 49 patients with facial warts completed the study. Overall, complete clearance in 22(45%) patients and partial clearance in 18(37%) patients were observed. The patients with complete/partial clearance were highly satisfied from the treatment. Recurrence was not seen in our patients. Few patients had injection site pain for 2-3 days not warranting discontinuation of treatment. Other adverse effects included temporary erythema and swelling in 3 patients which subsided on its own in 2-3 days. Conclusion: 82% patients responded (complete and partial response) to therapy. Intradermal PPD appears effective, safe, and acceptable treatment modality for facial warts. It carries the advantage of patient compliance, insignificant adverse effects and high patient satisfaction. Keywords: Warts, Purified protein derivative, Intradermal, Immunotherapy.
International Journal of Basic and Clinical Pharmacology, 2016
Background: The main motive of PvPI (Pharmacovigilance Programme of India) is to collect valuable... more Background: The main motive of PvPI (Pharmacovigilance Programme of India) is to collect valuable data so that signals can be generated from reported adverse drug events (ADEs). It also tries to establish their causality so that ADEs can be labelled as adverse drug reactions (ADRs) beyond any doubt. Methods: This retrospective observational study done in rural set up tertiary care teaching hospital collected data through voluntary reporting in ADR form of PvPI for period of 6 month. Causality assessment was done using WHO causality assessment scale. Results: In 150 reported cases, majority ADRs were due to tuberculosis, cancer and HIV treatments. Gastrointestinal tract and central nervous system were the major organs involved. Most ADRs occurred within first day of drug intake. Around 15% required hospitalization. 55% ADRs were probable and 41% were possible in nature. Vertigo and depression was most frequent ADR in MDR therapy. Rashes, pruritis, fever and joint pain was frequent in antiretroviral therapy. Dysguesia, dizziness, nausea, vomiting and constipation was frequent in patients taking anticancer drugs. Platins and antibiotics used for cancer therapy cause most cancer treatment ADRs. Conclusions: ADRs add to hospitalization expenses, insurance costs and increase in work loss days besides addition to patient suffering. Prior knowledge can help in better prescriptions and prevent valuable resource loss. Reasons for under-reporting of ADRs can be complacency, ignorance, lack of financial incentives for reporting, fear of litigation, claims of compensation and lack of time in busy hospital schedules.
Pheohyphomycosis is a rare infection caused by dematiaceous fungi, affecting the skin and subcuti... more Pheohyphomycosis is a rare infection caused by dematiaceous fungi, affecting the skin and subcutis, paranasal sinuses, or central nervous system. A case of subcutaneous pheohyphomycosis in the lumbar region is reported. The Indian literature on subcutaneous pheohyphomycosis is also reviewed. In India, 23 patients with subcutaneous pheohyphomycosis have been reported, distributed throughout the country in a belt from north to south, sparing the eastern and western regions. The age of the patients ranged from 3 to 60 years, with a male to female ratio of 1.3 : 1. A relatively early age of onset was observed. A history of prior injury was recalled by five patients. The lower extremities were involved in eight cases, upper extremities in five, gluteal region in two, lumbar area and submandibular area in one, face in two and disseminated disease was seen in four cases. Three of these cased died during follow up. Osteomyelitis was observed in two cases, hepatosplenomegaly in one, and lymp...
Localized cutaneous leishmaniasis (LCL) in India is due mostly to Leishmania tropica. It is mainl... more Localized cutaneous leishmaniasis (LCL) in India is due mostly to Leishmania tropica. It is mainly endemic in the deserts of Rajasthan. Recently, Himachal Pradesh has been identified as a new endemic focus for the disease. In the last few years, the number of new cases has been increasing almost to epidemic proportions. This report presents the preliminary findings of clinico-epidemiologic and investigative results of 161 new localized cases of LCL seen between May 2001 and December 2003. The study populaton was composed of 80 males and 81 females between 10 months and 75 years of age. All were indigenous to the sub-alpine valley along the Satluj River in the mountainous region of the Kinnaur District (altitude ס 700−2,900 meters). Most patients were seen from April to September and had 1−8 lesions (duration ס 1−6 months) that involved mainly the face. Tissue smears were positive for amastigotes in 37% and histopathology showed non-caseating epitheloid cell granuloma in 77% of the cases. Analysis by polymerase chain reaction−restriction fragment length polymorphism (PCR-RFLP) of the ribosomal gene region of 10 biopsy specimens showed amplicons indistinguishable from L. donovani in eight cases and L. tropica in two cases. Leishmania was cultured on modified Nicole-Novy-McNeal (NNN) medium containing RPMI 1640 medium and heat-inactivated fetal bovine serum from 13 of 38 biopsy samples. Three of these isolated strains were identified as L. donovani while a fourth was L. tropica by PCR-RFLP of the ribosomal internal transcribed spacer region. One strain had a gp63 sequence identical to that of east African strains. Another strain had a unique gp63 sequence that has not been found in L. donovani complex strains. Sand flies trapped in the cattle sheds of a few patients were identified as Phlebotomus longiductus (Parrot 1928). Treatment with intralesional sodium stibogluconate was effective in all patients without any major side effects. One patient developed lupoid leishmaniasis that responded to higher dose of sodium stibogluconate. Though rarely reported as a cause of LCL, L. donovani seems to be the predominant pathogen in this new focus of cutaneous leishmaniasis. Phlebotomus longiductus is a possible vector, albeit based on circumstantial evidence.
This report presents a number of unusual clinico-histopathologic and therapeutic features in a cu... more This report presents a number of unusual clinico-histopathologic and therapeutic features in a culture proven case of cutaneous sporotrichosis. These include lymphocutaneous sporotrichosis involving face; its dissemination in an otherwise healthy patient; its histology mimicking cutaneous cryptococcosis; two episodes of severe purulent inflammatory reaction bordering the lesion during therapy with saturated solution of potassium iodide; no therapeutic response to potassium iodide therapy and rapid healing of lesion with high-dose of fluconazole.Es wird der Fall einer Hautsporotrichose mit ungewöhnlicher klinisch-histopathologischer und therapeutischer Charakteristik vorgestellt: Lymphokutane Sporotrichose im Gesicht; Disseminierung, obwohl der Patient immunkompetent war; ein histologisches Bild wie bei kutaner Cryptococcose. Die Therapie mit Kaliumjodid blieb ohne Wirkung, doch heilte das Geschehen unter hoher Fluconazol-Dosierung ab.
Background: Associations among thyroid dysfunction, thyroid autoimmunity, and clinical features i... more Background: Associations among thyroid dysfunction, thyroid autoimmunity, and clinical features including age, gender, disease duration, and severity of psoriasis is less studied. Objectives: To study frequency of thyroid dysfunction and thyroid autoimmunity and examine association among thyroid dysfunction, thyroid autoimmunity, and clinical features including gender, age, duration, and severity of psoriasis. Material and Methods: The medical records of 290 (m:f 2.15:1) patients aged 13–75 years with plaque psoriasis were analyzed for thyroid dysfunction and thyroid autoimmunity. Thyroid dysfunction was defined as 10% variation in any thyroid hormone levels. Thyroid autoimmunity was diagnosed from presence of antithyroid peroxide (anti-TPO) antibodies. Results: The majority, 57.9% patients, was aged ≥41 years (Type-2 psoriasis) and duration of disease was <5 years in 58.6% patients. Mild and moderate to severe psoriasis was present in 58.3% and 41.7% patients, respectively. Dera...
Acrodermatitis enteropathica (AE) is a rare, autosomal-recessive disorder of neonatal zinc defici... more Acrodermatitis enteropathica (AE) is a rare, autosomal-recessive disorder of neonatal zinc deficiency due to SLC39A4 (intestinal zinc transporter, Zip4) gene mutation with onset after weaning while breastfeeding during this period will be protective. Transient symptomatic zinc deficiency is also acquired rarely in breastfed infants with increased zinc requirements and/or inadequate concentration of zinc in breast milk. The nursing mothers of transient symptomatic zinc deficiency infants show SLC30A2 (mammary epithelial zinc transporter, ZnT-2) gene mutation and abnormally low zinc levels in the breast milk despite normal serum zinc levels, which do not improve after zinc supplementation. A 2-month-old breastfed male infant had AE-like clinical features of zinc deficiency for two weeks. His symptoms and low serum zinc levels improved rapidly after zinc supplementation. The mother also had low serum and breast milk zinc concentration and both improved after oral zinc therapy indicatin...
The extent and disease severity, duration and other associated prognostic cofactors in vitiligo i... more The extent and disease severity, duration and other associated prognostic cofactors in vitiligo in adults may vary with the age of onset (before or after 10 years of age).
Psoriasis is now recognized as an immune-mediated inflammatory dermatosis with increased risk for... more Psoriasis is now recognized as an immune-mediated inflammatory dermatosis with increased risk for metabolic syndrome, its individual components, and cardiovascular disease. We quantitatively estimated malondialdehyde (MDA), lipoprotein-a (LP-a), lipoprotein ratios, comprehensive lipid tetrad index (CLTI), and atherogenic index (AI), and evaluated cardiovascular risk in 132 (M:F 94:38) patients with psoriasis aged 20–79 years with chronic plaque psoriasis and equal number of age and gender-matched controls. Lipoprotein ratios, CLTI and AI were calculated using standard formulae. Cardiovascular 10-year risk was graded by Framingham risk score (FRS) as low, intermediate and severe. Mild-to-moderate and severe psoriasis was present in 125 (94.7%), and 7 (5.3%) patients, respectively, and 19 (14.39%) patients had psoriatic arthritis. Statistically significant differences were noted for LDL, LDL/HDL, non-HDL/HDL, MDA, LP-a, AI and CLTI. There was a significantly positive correlation between PASI with LP-a (p = 0.003, r = 0.25) and AI (p = 0.012, r = 0.22). Serum levels of MDA correlated positively with LP-a (p < 0.001, r = 0.55), AI (p < 0.001, r = 0.51) and CLTI (p = 0.006, r = 0.24). FRS was low, intermediate and severe in 78%, 18.9%, and 3% patients compared to 85.6%, 13.6%, and 0.8% controls, respectively, and the difference was not statistically significant. Psoriasis appears to be an independent risk factor for elevated serum MDA, LP-a, CLTI and AI. However, whether they can be used as surrogate markers for enhanced cardiovascular risk in patients with psoriasis, remains conjectural.
Facial hypermelanosis is a significant cause of cosmetic disfigurement, social embarrassment and ... more Facial hypermelanosis is a significant cause of cosmetic disfigurement, social embarrassment and psychological morbidity affecting quality of life. To study clinicoepidemlogic patterns of facial hypermelanoses among men. Medical records of all adult males presenting with facial hypermelanoses were analyzed for this retrospective cross sectional study for demographic details, duration, cosmetic usage, sun exposure, drug intake, infections, systemic or cutaneous diseases, and family history of hypermelanotic dermatosis. Laboratory investigations and skin biopsy were performed when deemed necessary. These were 300 Indian men aged 18 to 74 (mean 37.35) years with 121 (40.3%) individuals aged 31-50 years. Various patterns of melasma in 230 (76.7%) patients were the major cause of facial hypermelanosis. Periorbital hypermelanosis was observed in 32 (10.7%), freckles and lentigens in 26 (8.7%), acanthosis nigricans in 12 (4%) and lichen planus pigmentosus in 10 (3.3%), pigmented cosmetic c...
The anti-inflammatory, immunomodulatory, and anti-proliferative effects of vitamin D in pathogene... more The anti-inflammatory, immunomodulatory, and anti-proliferative effects of vitamin D in pathogenesis of autoimmune diseases have been highlighted in recent years but implications of vitamin D deficiency in systemic sclerosis (SSc) remain understudied. To evaluate serum vitamin D levels in SSc patients and matched controls. Serum vitamin D levels were estimated in 38 (M:F 5:33) patients aged 23-70 years of untreated SSc and age and gender matched healthy controls. Clinical and investigative evaluation for skin sclerosis by modified Rodnan skin score (mRSS), presence of digital ulcers, Raynaud's phenomenon, type of auto-antibodies, systemic involvement, and serum vitamin D levels were performed. Serum vitamin D levels were defined as normal (30-100 ng/ml), insufficient (10-30 ng/ml), and deficient (<10 ng/ml). Serum vitamin D levels (median ± IQR) were 19.5 ± 77.8 ng/ml in 38 patients and 100 ± 31.3 ng/ml in controls each. Vitamin D deficiency in 13 (34.2%) and insufficiency in...
The American Journal of Tropical Medicine and Hygiene
We describe four cases of histoplasmosis indigenous to Himachal Pradesh (India) that will be of c... more We describe four cases of histoplasmosis indigenous to Himachal Pradesh (India) that will be of considerable public health interest. A 48-year-old human immunodeficiency virus (HIV)-negative man with cervical and mediastinal lymphadenopathy, hepatosplenomegaly, adrenal mass, and bone marrow involvement was treated as disseminated tuberculosis without benefit. Progressive disseminated histoplasmosis was diagnosed from the fungus in smears from adrenal mass. Another 37-year-old HIV-positive man was on treatment of suspected pulmonary tuberculosis. He developed numerous erythema nodosum leprosum-like mucocutanous lesions accompanied by fever, generalized lymphadenopathy, and weight loss. Pulmonary histoplasmosis with cutaneous dissemination was diagnosed when skin lesions showed the fungus in smears, histopathology, and mycologic culture. Both were successfully treated with amphotericin B/itraconazole. Third patient, a 46-year-old HIV-negative man, had oropharyngeal lesions, cervical lymphadenopathy, intermittent fever, hepatosplenomegaly, and deteriorating general health. Progressive disseminated oropharyngeal histoplasmosis was diagnosed from the fungus in smears and mycologic cultures from oropharyngeal lesions and cervical lymph node aspirates. He died despite initiating treatment with oral itraconazole. Another 32-year-old man 3 months after roadside trauma developed a large ulcer with exuberant granulation tissue over left thigh without evidence of immunosuppression/systemic involvement. He was treated successfully with surgical excision of ulcer under amphotericin B/itraconazole coverage as primary cutaneous histoplasmosis confirmed pathologically and mycologically. A clinical suspicion remains paramount for early diagnosis of histoplasmosis particularly in a nonendemic area. Most importantly, with such diverse clinical presentation and therapeutic outcome selection of an appropriate and customized treatment schedule is a discretion the treating clinicians need to make.
International journal of dermatology, Oct 19, 2017
References 1 Kluger N. Epidemiology of tattoos in industrialized countries. Curr Probl Dermatol 2... more References 1 Kluger N. Epidemiology of tattoos in industrialized countries. Curr Probl Dermatol 2015; 48: 6–20. 2 Shannon-Missal L. Tattoo takeover: three in ten Americans have tattoos, and most don’t stop at just one. Available at http://www. theharrispoll.com/health-and-life/Tattoo_Takeover.html 10 Feb 2016 (accessed 3 December 2016). 3 Ungarelli LF, Hetem CM, Farina Junior JA. Is it safe to operate on patients taking isotretinoin? Aesthetic Plast Surg 2016; 40: 139–148.
Prolactin possibly plays a pathogenetic role in psoriasis by stimulating keratinocyte proliferati... more Prolactin possibly plays a pathogenetic role in psoriasis by stimulating keratinocyte proliferation, T-lymphocyte interferon gamma production and promoting angiogenesis1. The inhibition of the T-suppressor cell functions by prolactin may serve to promote psoriatic plaque development2. It has been postulated that retinoids decrease the prolactin secretion from pituitary gland and add to their antipsoriatic effect3. Bromocriptine, an antiprolactin drug has been found useful in the treatment of psoriasis and psoriatic arthritis4,5. There are studies demonstrating serum prolactin levels varying with severity, duration and treatment of psoriasis5-8. However, not many studies are available from India.
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Papers by Vikram Mahajan