Publications by authors named "Kabir Sardana"

194 Publications

An uncommon variant of erythema nodosum leprosum responding well to methotrexate: Report of two cases.

Trop Doct 2021 Jun 9:494755211016652. Epub 2021 Jun 9.

Professor, Department of Pathology, DR RMLH ABVIMS, New Delhi, India.

Reactions in leprosy are acute inflammatory episodes that can be classified as type I or type II. Recognition and timely management of these patients is critical to avoid permanent disability. We present two cases of erythema nodosum leprosum, presenting with recurrent atypical features, responding well to a low dose of methotrexate.
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http://dx.doi.org/10.1177/00494755211016652DOI Listing
June 2021

Checkerboard analysis to evaluate synergistic combinations of existing antifungal drug and PGMC in isolates from recalcitrant tinea corporis and cruris harboring SQLE gene mutation.

Antimicrob Agents Chemother 2021 Jun 7:AAC0032121. Epub 2021 Jun 7.

Vyome Therapeutics Limited, New Delhi, India.

Recalcitrant dermatophytic infections of the glabrous skin (tinea corporis/cruris/faciei) pose a huge challenge to healthcare systems. Combinations of oral and topical drugs may potentially improve cure rates but the same has never been objectively assessed for this condition in laboratory or clinical studies.The presentstudy was undertaken with an aim of identifying synergistic combinations of oral and topical antifungals by testing clinical isolates obtained from patients with recalcitrant tinea corporis/cruris. Forty two patients with tinea corporis/cruris who had failed oral antifungals or had relapsed within 4 weeks of apparent clinical cure were recruited. Twenty one isolates were identified on sequencing (all ) andwere subjected to antifungal susceptibility testing (AFST) andsqualene epoxidase (SQLE) gene mutation analysis. Finally, five isolates - four with underlying SQLE gene mutations, and one wild type strain, were chosen for checkerboard studies using various combinations of antifungal agents. Most isolates (n=16) showed high MICs to TRB (0.5->16μg/ml), with SQLE gene mutations present in all isolates with MICs ≥0.5μg/ml. Synergistic interactions were seen with combinations of itraconazole with luliconazole, TRB and ketoconazole, PGMC with luliconazole and with the triple combination of Propylene glycol Monocaprylate (PGMC) with luliconazole and ketoconazole. synergistic interactions provide a sound scientific basis for possible clinical use of antifungal combinations. Hence, these synergistic combinations may be tested for clinical utility in the wake of rising resistance among dermatophytic infections of the glabrous skin.
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http://dx.doi.org/10.1128/AAC.00321-21DOI Listing
June 2021

Herpes zoster after inactivated COVID-19 vaccine: A cutaneous adverse effect of the vaccine.

J Cosmet Dermatol 2021 Jun 2. Epub 2021 Jun 2.

Dr Ram Manohar Lohia Hospital & Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS), New Delhi, India.

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http://dx.doi.org/10.1111/jocd.14268DOI Listing
June 2021

A case of orofacial granulomatosis evolving into Melkersson Rosenthal syndrome in a child treated with a steroid free regimen of Clofazimine and Minocycline.

Dermatol Ther 2021 May 27:e15009. Epub 2021 May 27.

Department of Pathology, Dr Ram Manohar Lohia Hospital and ABVIMS, New Delhi, India.

Orofacial granulomatosis (OFG) is a rare disorder with varied etiological, immunological and infectious mechanisms implicated and is believed to be a umbrella term which includes Melkersson Rosethal syndrome (MRS). We describe a 17 year old female who was diagnosed with OFG and was successfully treated with a combination of minocycline and clofazimine without oral steroids with significant improvement within 1 month of therapy.
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http://dx.doi.org/10.1111/dth.15009DOI Listing
May 2021

Hematohidrosis of the mid-face and hands treated with oral oxybutynin.

Pediatr Dermatol 2021 May 26. Epub 2021 May 26.

Department of Dermatology, Venereology and Leprosy, Dermaway Skin and Laser Clinic, Kutch, India.

Hematohidrosis is a rare condition characterized by blood in the sweat. We report a case of hematohidrosis of the mid-face and hands in a 13-year-old girl who was treated successfully with oral oxybutynin and discuss the therapeutic rationale.
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http://dx.doi.org/10.1111/pde.14621DOI Listing
May 2021

Does oxidative stress correlate with disease activity and severity in alopecia areata? An analytical study.

J Cosmet Dermatol 2021 May 26. Epub 2021 May 26.

Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Atal Bihari Vaypayee Institute of Medical Sciences, New Delhi, India.

Background: Oxidative stress (OS) has been implicated as a contributory factor in the multifactorial etiopathogenesis of alopecia areata (AA). But with the existing data, it is unclear whether OS is a cause or effect of the disease state in Alopecia areata.

Aims: To compare the OS parameters viz.malon-di-aldehyde (MDA), superoxide dismutase (SOD), total antioxidant status (TAS) in serum of patients with alopecia areata versus age and sex matched controls, and assess their correlation with the severity of the disease.

Patients/methods: Forty clinically diagnosed patients of alopecia areata and forty (n = 40) age and sex-matched healthy controls were recruited. ELISA was used for the evaluation of MDA, and spectrophotometric method was used to evaluate serum TAS and whole blood SOD.

Results: Mean serum TAS and whole blood SOD levels of cases were significantly lower than controls (p = 0.005 and p = 0.002, respectively). Mean serum MDA level of patients was significantly higher compared to controls (p = 0.001). While levels of serum TAS and whole blood SOD were found to decrease from mild to severe grades of disease (p = 0.003, p < 0.001 respectively), levels of MDA increased with increasing disease severity (p < 0.001).

Conclusion: The OS parameters were deranged in all subsets of AA, with the greatest derangement seen with whole blood SOD levels.
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http://dx.doi.org/10.1111/jocd.14253DOI Listing
May 2021

Unilateral deep vein thrombosis with gangrene involving the ascending aorta with sepsis and pulmonary thromboembolism-a pertinent cutaneous marker of severity of COVID-19.

J Cosmet Dermatol 2021 May 12. Epub 2021 May 12.

Department of Critical Care Medicine, Atal Bihari Vajpayee Institute of Medical sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India.

While myriad skin manifestations have been reported with COVID, they are insignificant as compared to the number of cases and do not indicate specificity as the studies that report them have either been based on telephonic consultation or have not been compared with case-control analysis from a normal skin OPD or IPD referral population. The most feared complication of COVID-19 is the combination of coagulopathy and thromboembolism, which is consequent to thrombo-inflammation and a heightened prothrombotic state. It is exaggerated in severe COVID associated with sepsis and skin manifestations that correlate with severity are more useful to clinicians. We had a case of COVID-positive 65-year-old man with features of thromboembolism followed by general symptoms of cough and fever. D-dimer test was positive, and the Ultrasound Doppler showed thrombosis in the right lower limb arteries and deep vein thrombosis in right lower limb veins.
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http://dx.doi.org/10.1111/jocd.14213DOI Listing
May 2021

Beefy red asymptomatic penile lesion: unusual presentation of squamous cell carcinoma.

An Bras Dermatol 2021 May-Jun;96(3):383-384. Epub 2021 Mar 15.

Dr Ram Manohar Lohia Hospital, New Delhi, India.

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http://dx.doi.org/10.1016/j.abd.2020.06.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178544PMC
March 2021

Hyperpigmented Papules with Palmar Pits.

Indian Dermatol Online J 2021 Jan-Feb;12(1):195-197. Epub 2020 Sep 28.

Department of Dermatology, Venereology and Leprosy, Maulana Azad Medical College, New Delhi, India.

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http://dx.doi.org/10.4103/idoj.IDOJ_590_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982041PMC
September 2020

Multiple Asymptomatic Hypopigmented Macules in a Child.

Indian Dermatol Online J 2021 Jan-Feb;12(1):193-194. Epub 2020 Sep 28.

Consultant Dermatopathologist, Delhi Dermpath Laboratory, 10, Aradhana Enclave, Ring Road, R K Puram, New Delhi, India.

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http://dx.doi.org/10.4103/idoj.IDOJ_575_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982037PMC
September 2020

Super Bioavailable Itraconazole and Its Place and Relevance in Recalcitrant Dermatophytosis: Revisiting Skin Levels of Itraconazole and Minimum Inhibitory Concentration Data.

Indian Dermatol Online J 2021 Jan-Feb;12(1):1-5. Epub 2021 Jan 16.

Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India.

Itraconazole, is the most commonly prescribed oral antifungal agent in India, and has a low minimum inhibitory concentration as compared to other oral antifungals, and in conjunction with the markedly high skin levels, the drug should have a predictably good clinical response which is not the consistent experience of clinicians. Probably the variation in pelletization parameters might affect the bioavailability of the drug and consequently affect the serum levels. The maximum bioavailability of conventional itraconazole is 55 percent, which is neither consistent nor predictable. However, the novel itraconazole (Super bioavailable Itraconazole) with targeted drug release in the small intestine has predictable serum levels with minimum interindividual variability, which could make it a potentially useful drug in recalcitrant dermatophytosis.
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http://dx.doi.org/10.4103/idoj.IDOJ_618_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982045PMC
January 2021

"Mask vitiligo" secondary to frictional dermatitis from surgical masks.

Contact Dermatitis 2021 07 12;85(1):121-123. Epub 2021 Mar 12.

Department of Dermatology & STD, Dr. Ram Manohar Lohia Hospital & ABVIMS, New Delhi, India.

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http://dx.doi.org/10.1111/cod.13813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014792PMC
July 2021

Severe type 2 leprosy reaction with COVID-19 with a favourable outcome despite continued use of corticosteroids and methotrexate and a hypothesis on the possible immunological consequences.

Int J Infect Dis 2021 Feb 14;103:549-551. Epub 2020 Dec 14.

Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India.

Type 2 leprosy reaction (T2LR), or Erythema Nodosum Leprosum (ENL), often poses a therapeutic challenge to clinicians and commonly requires long courses of steroids for control. While immunosuppressants are known to achieve control and lower steroid dependence in T2LR, the prospect of managing a severe T2LR in conjunction with COVID-19, with the concern of worsening COVID-19 with long-term immunosuppression has not previously been encountered. We report a case of severe T2LR treated with oral steroids and methotrexate, with COVID-19 infection acquired during hospital stay, and a favourable outcome achieved despite the continued use of immunosuppressants. We discuss the possible reasons for this both in terms of the drug pharmacodynamics and the immunological profile of T2LR.
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http://dx.doi.org/10.1016/j.ijid.2020.12.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831392PMC
February 2021

A Real-World Analysis of Relapse Rate and Efficacy of a Restricted Monthly Dose of Omalizumab in Recalcitrant Chronic Spontaneous Urticaria in India.

Indian Dermatol Online J 2020 Sep-Oct;11(5):835-837. Epub 2020 Sep 19.

Department of Dermatology, Venereology and Leprosy, Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, Baba Kharak Singh Marg, New Delhi, India.

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http://dx.doi.org/10.4103/idoj.IDOJ_499_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678515PMC
September 2020

Colchicine in Dermatology: Rediscovering an Old Drug with Novel Uses.

Indian Dermatol Online J 2020 Sep-Oct;11(5):693-700. Epub 2020 Sep 19.

Department of Dermatology, STD and Leprosy, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India.

Colchicine is an anti-inflammatory agent which has been used for decades in the treatment of gout. The drug has a number of dermatological indications like Psoriasis, Sweet's syndrome, aphthosis, Behcet's disease, erythema nodosum, leukocytoclastic vasculitis and is consistently effective in neutrophilic disorders. Thought it is an affordable with minimal side effects, It has remained underutilized. However, it has novel uses and is being considered in COVID-19 due to its action on IL-1β and IL-6. This article presents a concise and up-to-date review focusing on its mechanisms of action and indications.
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http://dx.doi.org/10.4103/idoj.IDOJ_475_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678539PMC
September 2020

Contact leukoderma following irritant contact dermatitis to an isopropanol-based hand rub: A consequence of rigorous hand hygiene.

Contact Dermatitis 2021 May 1;84(5):346-348. Epub 2020 Dec 1.

Department of Dermatology & STD, Dr. Ram Manohar Lohia Hospital & ABVIMS, New Delhi, India.

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http://dx.doi.org/10.1111/cod.13743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754559PMC
May 2021

A prospective study of anti-mullerian hormone and other ovarian and adrenal hormones in adult female acne.

Dermatol Ther 2020 11 27;33(6):e13974. Epub 2020 Jul 27.

Department of Biochemistry, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India.

Polycystic ovarian syndrome (PCOS) diagnosis in adult female acne (AFA) is tough owing to unreliable ultrasonography in virgins or obese females and inconsistent hyperandrogenemia. We analyzed hormones in AFA and established a diagnostic cut-off value of anti-mullerian hormone (AMH) for PCOS. Female acne patients aged ≥25 years were assessed with total testosterone (TT), sex hormone binding globulin (SHBG), free androgen index (FAI), AMH, 17-hydroxyprogesterone (17-OHP), dehydroepiandrosterone sulfate (DHEAS), follicle stimulating hormone (FSH), and luteinizing hormone (LH). Rotterdam's criteria defined PCOS. AMH was measured (Access AMH assay) to calculate the diagnostic cut off value using receiver operating characteristic (ROC) curve. Of 120 cases, 25.83% had PCOS. This group had significant clinical hyperandrogenism, truncal and adolescent acne, polycystic ovarian morphology (PCOM), and raised hormones (AMH, TT, FAI, LH, and LH/FSH). AMH levels were significantly higher in the PCOS group (6.91 ± 3.85 ng/mL) and positively correlated with TT, FAI, 17OHP, LH, and LH/FSH ratio. AMH at >5.1 ng/mL (sensitivity-70.97% and specificity-82.02%) predicted PCOS and correlated with PCOM. AMH (>5.1 ng/mL) is useful for diagnosing PCOS and surrogate for hyperandrogenemia and PCOM. Its correlation with hormones in non PCOS AFA highlights its sensitivity to diagnose endocrinological derangements.
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http://dx.doi.org/10.1111/dth.13974DOI Listing
November 2020

Mechanistic Insight Into the Antifungal Effects of a Fatty Acid Derivative Against Drug-Resistant Fungal Infections.

Front Microbiol 2020 8;11:2116. Epub 2020 Sep 8.

Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.

The prevalence of drug-resistant pathogenic fungi is a major global health challenge. There is an urgent need for novel drugs that can exert a potent antifungal activity and overcome resistance. Newly discovered anti-fungal properties of existing compounds can potentially offer a rapid solution to address this persistent threat. We rationalized that structures which disrupt the fungal cell membrane could address the above unmet need. As fatty acids underpin the formation and stability of cell membranes, we used computational simulations to evaluate the interactions between selected short chain fatty acids and a model cell membrane. Here, we report that caprylic acid could penetrate and perturb the membrane . Based on the findings, we identified a derivative of this fatty acid that disrupts fungal membranes as detected using steady-state fluorescence anisotropy. We show that this fatty acid derivative is potent against a variety of fungal pathogens like and . We further demonstrated the ability of this fatty acid derivative to potentiate some azoles and enhance the efficacy of antifungal formulations Our data suggests the emergence of a novel therapy for effective disease management and overcoming anti-fungal drug resistance.
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http://dx.doi.org/10.3389/fmicb.2020.02116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505954PMC
September 2020

Real-world assessment, relevance, and problems in use of personal protective equipment in clinical dermatology practice in a COVID referral tertiary hospital.

J Cosmet Dermatol 2020 Dec 17;19(12):3189-3198. Epub 2020 Oct 17.

Department of Dermatology, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India.

Background: Doctors and healthcare workers (HCW) are at frontline in control of the pandemic caused by the novel coronavirus infection (COVID-19). The virus is transmitted by contact, droplet, and airborne transmission; hence, hand hygiene, social distancing, environmental disinfection, and use of appropriate personal protective equipment (PPE) form important components to protect HCWs from cross-infection. Appropriate use of PPE is of paramount importance not only to reduce the risk of transmission but also to maintain adequate stock for those who are dealing directly with COVID-19 patients.

Aims: In this article, we aim to provide the rationale for appropriate use of PPE in the dermatology setting in the current scenario. We have also discussed the scientific evidence for use of each component of protection and the practical problems faced in our COVID referral tertiary hospital.

Methods: Our review was based on articles that have studied or analyzed the efficacy of various protective measures being utilized by health workers against spread of COVID-19. This was done by carrying out a PUBMED search with terms "coronavirus, COVID-19, personal protective equipment (PPE), transmission, mask, face shields, goggles, gloves." We also scrutinized the various pragmatic issues being faced by doctors in our setup while using PPE.

Results: In order to maximize the appropriate use of PPE, the rationale for use needs to be understood and problems encountered in daily practice need to be addressed.

Conclusion: Adherence to protective measures and use of PPE is of utmost importance for HCWs to prevent cross-infection in this pandemic. The use of PPE can limit transmission to a great extent, but appropriate use and avoiding misuse is equally important in the dermatology setting in order to avoid depletion of stock. It is also essential to consider various practical issues with use of PPE and device measures to avoid them so that breach in protocols can be prevented and spread of infection minimized.
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http://dx.doi.org/10.1111/jocd.13736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537031PMC
December 2020

A hypopigmented plaque on the face in a leprosy endemic area and the consequent histological confirmation of follicular mucinosis: an uncommon differential of leprosy in children.

Int J Dermatol 2020 Dec 31;59(12):e471-e473. Epub 2020 Aug 31.

Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India.

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http://dx.doi.org/10.1111/ijd.15170DOI Listing
December 2020

Cutaneous Histoplasmosis: An Unusual Presentation with Nasal Obstruction.

Indian Dermatol Online J 2020 Jul-Aug;11(4):612-615. Epub 2020 Jan 24.

Department of Pathology, Dr. RML Hospital and PGIMER, New Delhi, India.

Histoplasmosis is a systemic fungal disease that may be presented with a variety of clinical manifestations, usually as an opportunistic infection in immunocompromised individuals. We present an HIV seropositive patient with a large fleshy growth causing left-sided nasal obstruction, as an unusual presentation. The lesions shrunk dramatically and almost completely on intravenous amphotericin-B lipid complex (ABLC) given for 2 weeks followed by long-term oral itraconazole.
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http://dx.doi.org/10.4103/idoj.IDOJ_422_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413458PMC
January 2020

Complete Remission in a Patient with Treatment Refractory Bullous Pemphigoid after a Single Dose of Omalizumab.

Indian Dermatol Online J 2020 Jul-Aug;11(4):607-611. Epub 2020 Jul 13.

Department of Pathology, Dr. RML Hospital and PGIMER, New Delhi, India.

Bullous pemphigoid (BP) is an autoimmune disorder known to be mediated by immunoglobulin G (IgG) autoantibodies. The role of immunoglobulin E (IgE) antibodies is being investigated as their presence has been described in severe cases. Herein, we report a patient of BP who was refractory to most conventional agents and developed hypotension after rituximab but achieved lasting remission after a single dose of the anti-IgE monoclonal antibody omalizumab.
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http://dx.doi.org/10.4103/idoj.IDOJ_438_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413437PMC
July 2020

A Prospective Study Examining Trigger Factors and Hormonal Abnormalities in Adult Female Acne.

Indian Dermatol Online J 2020 Jul-Aug;11(4):544-550. Epub 2020 Jul 13.

Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India.

Background: Numerous triggers have been implicated in adult female acne including endogenous (hormonal dysfunction and genetic predisposition) and exogenous causes (drugs, cosmetics, sunscreens, stress, and smoking).

Aims: To evaluate the role of various trigger factors in adult female acne and to analyze the androgenic hormone pattern including anti-Mullerian hormone (AMH) in these patients.

Materials And Methods: Patients having acne of age ≥25 years were analyzed using a pre devised proforma to elicit trigger factors while the severity was graded using the Global Acne Grading System (GAGS). A detailed hormonal assessment was undertaken that assessed total testosterone (TT), sex hormone-binding globulin (SHBG), free androgen index (FAI), AMH, 17-hydroxyprogesterone (17-OHP), dehydroepiandrosterone sulfate (DHEAS), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), and prolactin.

Results: Out of the 165 cases seen and sub-analyzed for triggers, premenstrual flare, diet, cosmetics, and stress were the most commonly implicated causes. Among cosmetics, fairness creams and foundations were implicated. The hormonal analysis revealed deranged values of all hormones with the most common being 17-OHP and AMH. Almost 42.8% patients with DHEAS derangement and 58.75% females with raised 17-OHP suffered from moderate to severe stress.

Limitations: A prospective cohort correlation study of the implicated triggers is needed to confirm the association with adult female acne.

Conclusions: Adult female acne may be triggered by diet, stress, and cosmetics and there is a distinct hormonal milieu that accounts for hyperandrogenemia. We noted high levels of adrenal androgens which have been known to be associated with stress and sleep deprivation. Our study shows the value of counseling adult female acne patients about various acne triggers.
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http://dx.doi.org/10.4103/idoj.IDOJ_500_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413461PMC
July 2020

Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) Task Force against Recalcitrant Tinea (ITART) Consensus on the Management of Glabrous Tinea (INTACT).

Indian Dermatol Online J 2020 Jul-Aug;11(4):502-519. Epub 2020 Jul 13.

Consultant Dermatologist, Dr. Kaushal's Skin Clinic, Agra, Uttar Pradesh, India.

Background And Aims: Dermatophytosis has always been a common superficial mycosis in India. However, the past 6-7 years have seen an unprecedented increase in the number of patients affected by recurrent, chronic, recalcitrant and steroid modified dermatophytosis involving the glabrous skin (tinea corporis, tinea cruris and tinea faciei). Importantly, there has been a notable decrease in clinical responsiveness to commonly used antifungals given in conventional doses and durations resulting in difficult-to-treat infections. Considering that scientific data on the management of the current epidemic of dermatophytosis in India are inadequate, the Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) Task force Against Recalcitrant Tinea (ITART) has formulated a consensus statement on the management of dermatophytosis in India.

Methods: Seventeen dermatologists with a focussed interest in dermatophytosis participated in a Delphi consensus method, conducted in three rounds. They responded as either "agree" or "disagree" to 132 statements prepared by the lead experts and gave their comments. Consensus was defined as an agreement of 80% or higher concurrence. Statements on which there was no consensus were modified based on the comments and were then recirculated. The results were finally analysed in a face-to-face meeting and the responses were further evaluated. A draft of the consensus was circulated among the participants and modified based on their inputs.

Results: Consensus was achieved on 90 of the 132 statements. Direct microscopy using potassium hydroxide mount was recommended in case of diagnostic difficulty on clinical examination. Counselling of patients about strict adherence to general measures and compliance to treatment was strongly recommended as the key to successful management of dermatophytosis. A combination of systemic and topical antifungal drugs was recommended for the treatment of glabrous tinea in the current scenario. Topical corticosteroid use, whether used alone or in combination with other components, was strongly discouraged by all the experts. It was suggested that topical antifungals may be continued for 2 weeks beyond clinical resolution. Itraconazole and terbinafine were recommended to be used as the first line options in systemic therapy, whereas griseofulvin and fluconazole are alternatives. Terbinafine was agreed to be used as a first line systemic agent in treatment naïve and terbinafine naïve patients with glabrous tinea. Regular follow-up of patients to ensure compliance and monitoring of clinical response was recommended by the experts, both during treatment and for at least 4 weeks after apparent clinical cure. Longer duration of treatment was recommended for patients with chronic, recurrent and steroid modified dermatophytosis.

Conclusion: Consensus in the management of dermatophytosis is necessary in the face of conventional regimens proving ineffective and dearth of clinical trials re-evaluating the role of available antifungals in the wake of evolving epidemiology of the infection in the country. It needs to be backed by more research to provide the required level of evidence. It is hoped that this consensus statement improves the quality of care for patients with dermatophytosis, which has emerged as a huge public health problem, imposing considerable financial burden on the country.
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http://dx.doi.org/10.4103/idoj.IDOJ_233_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413465PMC
July 2020

Hydroxychloroquine in Dermatology and Beyond: Recent Update.

Indian Dermatol Online J 2020 May-Jun;11(3):453-464. Epub 2020 May 10.

Department of Dermatology, STD and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) (PGIMER), Dr. Ram Manohar Lohia Hospital, New Delhi, India.

Hydroxychloroquine is one of the most frequently used drugs in dermatology with a wide variety of uses due to its immunomodulatory, anti-inflammatory, photoprotective, and metabolic actions and low side effect profile. Demonstration of its antiviral action has led to renewed interest by physicians worldwide during the ongoing coronavirus disease of 2019 (COVID-19) pandemic. Like its immunomodulatory action, its antiviral activity is also due to its ability to alkalinize the intracytoplasmic milieu, leading to disordered viral entry/fusion and deranged viral protein synthesis. However, randomized controlled trials are the need of the hour to conclusively determine its clinical efficacy in such infections. A review of the multitude of mechanisms of action, updated screening and monitoring guidelines, drug interactions, side effects, and its use in special populations is described.
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http://dx.doi.org/10.4103/idoj.IDOJ_280_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367590PMC
May 2020

Zosteriform multidermatomal nodules and plaques in a case of lepromatous leprosy: an uncommon presentation.

Trop Doct 2020 Oct 29;50(4):378-380. Epub 2020 Jun 29.

Postgraduate Student, Department of Dermatology, Venereology and Leprosy, Dr. Ram Manohar Lohia and Post Graduate Institute of Medical Education and Research, New Delhi, India.

Leprosy is caused by the obligate intracellular organism which mainly affects the skin and nervous system. The course of the disease is determined by host immunity, it is thus believed that in lepromatous leprosy (LL), all manifestations are bilaterally symmetrical. This is because of the inability of the host to mount an adequate cell-mediated immune response, resulting in widespread haematogenous dissemination of bacilli. Varied manifestations of LL have been reported; however, a multidermatomal pattern of nodules is hitherto unreported and we suggest a hypothesis for its presentation.
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http://dx.doi.org/10.1177/0049475520932473DOI Listing
October 2020

Cutaneous side effects of hydroxychloroquine in health care workers in a COVID referral hospital - implications for clinical practice.

J Dermatolog Treat 2020 Jun 22:1-3. Epub 2020 Jun 22.

Department of Dermatology and STDs, Dr RML Hospital and PGIMER, New Delhi, India.

The utility of hydroxychloroquine for the prophylaxis and treatment of alarmingly rising COVID-19 infection has been widely explored in several studies. However, its cutaneous adverse effects among health care workers and COVID patients taking prophylactic doses has not been reported. We report cases of palmoplantar among health care workers who were on prophylactic doses of hydroxychloroquine and their management with cetirizine and methylprednisolone.
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http://dx.doi.org/10.1080/09546634.2020.1781041DOI Listing
June 2020

A Case of Familial Trichomegaly with Synophrys in Association with Loose Anagen Syndrome.

Indian Dermatol Online J 2020 Mar-Apr;11(2):263-265. Epub 2020 Mar 9.

Department of Pathology, Dr. Ram Manohar Lohia and Post Graduate Institute of Medical Education and Research, New Delhi, India.

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http://dx.doi.org/10.4103/idoj.IDOJ_16_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247634PMC
March 2020

Late leprosy reaction presenting as erythema multiforme-like erythema nodosum leprosum with underlying rifampicin resistance and its potential implications.

Int J Mycobacteriol 2020 Apr-Jun;9(2):226-228

Research Scientist, Stanley Browne Laboratory, The Leprosy Mission Community Hospital, New Delhi, India.

Erythema multiforme (EM)-like erythema nodosum leprosum (ENL) is a rare atypical presentation, and its late appearance after the completion of multidrug therapy (MDT) is unusual. We describe the case of a lepromatous leprosy patient who after the completion of MDT presented to us with late EM-like ENL and was found to be resistant to rifampicin. We discuss the implications of this finding and the potential role of resistant bacilli in causing reactions with atypical presentations.
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http://dx.doi.org/10.4103/ijmy.ijmy_26_20DOI Listing
June 2020