Publications by authors named "Tarun Narang"

166 Publications

Single-nucleotide polymorphism and haplotype analysis of macrophage migration inhibitory factor gene and its correlation with serum macrophage migration inhibitory factor levels in North Indian psoriatic patients with moderate disease severity: A cross-sectional study.

Indian J Dermatol Venereol Leprol 2021 May 8:1-7. Epub 2021 May 8.

Department of Dermatology, Venereology and Leprosy, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: Psoriasis is associated with significant morbidity and impaired quality of life. Identification of the host genes that influence disease susceptibility and can potentially guide future, targeted therapy is the need of the hour.

Aims: The aim of the study was to investigate the associations of macrophage migration inhibitory factor (MIF) gene polymorphisms, that is, a 5-8-CATT tetra nucleotide repeats at -794 (-794*CATT5-8) and a single-nucleotide polymorphism at -173 (-173*G/C) with the risk of chronic plaque psoriasis and to observe the correlation, if any, of disease determinants with genetic functional variants and circulating MIF levels.

Methods: Five hundred and seventeen individuals (265 psoriasis patients and 252 controls) were genotyped for MIF gene polymorphisms. Data were analyzed with respect to disease susceptibility, serum MIF levels, disease severity, age at onset, disease duration and presence of comorbidities.

Results: The presence of co-morbidities was more frequently noted in patients with late onset disease (P = 0.01). No statistically significant differences were observed either in genotype (P = 0.680) or allele frequency (P = 0.69) with respect to distribution of MIF-173*G/C polymorphism between patients and controls. The frequencies of genotypes -794*CATT 5/7 and 7/7 were significantly lower in patients (P = 0.027* and 0.038*, respectively). CATT*5/MIF-173*C haplotype occurred at a higher frequency in patients (odds ratio 3.03, 95% confidence intervals 1.09-8.47, P = 0.02). The mean serum MIF levels were significantly higher in patients as compared to controls (P < 0.001). The presence of either extended MIF -794*CATT repeats or C allele did not reveal any significant association with serum MIF levels or age at onset. Analysis of effect of various disease determinants revealed no significant association with genetic variants and serum MIF levels.

Limitations: The lesional expression of MIF could not be studied.

Conclusion: Our results showed that CATT*5/MIF-173*C haplotype is associated with increased susceptibility to psoriasis vulgaris.
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http://dx.doi.org/10.25259/IJDVL_988_19DOI Listing
May 2021

Teledermatology during the COVID-19 pandemic: Experience at a tertiary care centre in North India.

Dermatol Ther 2021 Jun 5:e15022. Epub 2021 Jun 5.

Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: Teledermatology has evolved as a valuable option to outpatient visits during the current pandemic. We set up a smartphone-based hybrid model of teledermatology services providing direct care to patients at our center. To analyse patient and physician-experience and acceptability for teledermatology over a 6-month-period, along with clinicodemographic profile of patients.

Methodology: Single-center, retrospective study conducted from May 20, 2020 to October 31, 2020. Patient satisfaction level for teledermatology was assessed on a 4-point scale and compared with the satisfaction level during their previous physical visits prior to COVID-19 pandemic. A physician assessment form was utilised to record the experience of dermatologists while providing teledermatology services.

Results: Of 7530 patients registered, a successful consult was provided to 6125 patients (81.34%). Average number of teleconsultations/day rose from 23.60 in May 2020 to 77.96 in October 2020. Mean age of patients availing teledermatology services was 33.60 ± 16.99 years. Average distance to care and travel time were 100.90 ± 171.77 km and 135 ± 222.32 min, respectively. A definitive diagnosis could be ascertained in 5724 patients (93.45%) and in-person visit was recommended to 133 patients (2.2%). Out of 6125 patients, 5229 could be contacted for feedback, 935 (18.18%), 2230 (42.65%), 1749 (33.45%), and 300 patients (5.70%) reported being very satisfied, satisfied, partially satisfied, and unsatisfied, respectively. Of 1914 patients, who had availed in-person OPD facilities prior to the pandemic, 914 patients (49.62%) preferred in-person visits. Of 34 dermatologists surveyed, 88.2% felt comfortable providing teleconsultations and 82.4% felt the need to continue teledermatology services in the upcoming months.

Conclusions: Overall, teledermatology is a valid alternative for in-person dermatology visits during the current crisis; helping with initial triage and further patient management. Further refinement of the process could lead to even more acceptability.
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http://dx.doi.org/10.1111/dth.15022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8209945PMC
June 2021

Immunological response and clinical profile in patients with recurrent dermatophytosis.

Mycoses 2021 May 19. Epub 2021 May 19.

Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: An alarming increase in the number of patients with chronic and recurrent dermatophytosis has invoked the need to study the immunological parameters of the host.

Objectives: To evaluate delayed type of hypersensitivity (DTH) response and immediate hypersensitivity (IH) response by flow cytometry evaluation of immune cells from peripheral blood and intradermal trichophyton skin test in patients with recurrent dermatophytosis.

Methods: A hundred patients with recurrent dermatophytosis and 50 controls (healthy controls and acute dermatophytosis controls) were included. Relevant risk factors for recurrence were analysed, and serum IgE levels were estimated. Flow cytometry evaluation of immune cells in peripheral blood and intradermal trichophyton skin test was done. Dermatophyte pathogens were isolated, and antifungal susceptibility was performed.

Results: Trichophyton mentagrophytes complex (95.84%) and T. rubrum (4.16%) were isolated in culture. Serum IgE was elevated in 83.15% cases (p = .01). IFN-γ cells (p = .0501, p = .0001, p = .0014), Th1 cells (p = .1197, p = .0024, p = .0169), IL-17 cells (p = .0127, p = .0006, p = .0007) and Th17 cells (p = .0634, p = .0001, p = .0054) were reduced, and IL-4 cells (p = .0108, p = .0175, p = .0018) were increased in cases. Intradermal test demonstrated negative DTH response in all cases (p < .001, p < .001, p < .001), strongly positive IH response in 6%, and borderline positive IH response in 85% cases (p = .018, p < .001, p < .001). Topical corticosteroids application, undergarment types (tight fit), poor frequency of washing clothes, family history of tinea, sharing of towels were significant risk factors for recurrent dermatophytosis.

Conclusions: Reduced IFN-γ , Th1, IL-17 and Th17 cells population along with impaired DTH response by the intradermal test was observed in patients with recurrent dermatophytosis.
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http://dx.doi.org/10.1111/myc.13322DOI Listing
May 2021

Role of shear wave elastography in treatment follow-up of leprosy neuropathy.

J Ultrasound 2021 May 6. Epub 2021 May 6.

Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.

Purpose: Grayscale ultrasonography when complemented with shear wave elastography helps in better evaluation of treatment response of leprosy neuropathy and in guiding appropriate management of the patient. There is limited literature regarding the use of shear wave elastography in ulnar nerve neuropathy. Our purpose was to evaluate the role of shear wave elastography in assessing stiffness changes within the ulnar nerve during treatment of leprosy.

Methods: This was a prospective study which included 30 patients diagnosed with leprosy neuropathy. Recruited patients were followed up, during the course of treatment, i.e. for 1 year. Serial ultrasonography of these patients was done at 0, 3, 6 and 12 months interval.

Results: Significant (P < 0.05) decrease in elastography parameters was seen in transverse imaging plane between first and third, as well as first and fourth visits (mean stiffness and velocity pretreatment ~ 25.78 ± 18 kPa and 2.74 ± 0.98 m/s, mean stiffness and velocity post-treatment 15.67 ± 5.89 kPa and 2.24 ± 0.428 m/s). Although elastography parameters decreased during these visits in the long-axis imaging plane, they were not found to be statistically significant. However, gross morphology and cross-sectional area of the nerve did not change significantly across visits. Interestingly, elastography values were higher in patients with neuritis, though not statistically significant.

Conclusion: Shear wave elastography is a novel, upcoming modality in musculoskeletal imaging especially in the evaluation of peripheral neuropathy. It can act as an adjunct to grey-scale imaging, which can help in early diagnosis and in guiding treatment of leprosy neuropathy.
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http://dx.doi.org/10.1007/s40477-021-00583-xDOI Listing
May 2021

Chemotherapy-induced reticulate pigmentation in three Indian patients including a case in the pediatric age group.

Indian J Dermatol Venereol Leprol 2021 May-Jun;87(3):386-388

Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.25259/IJDVL_216_20DOI Listing
March 2020

Task shifting in dermatology: Nurses' role.

Indian J Dermatol Venereol Leprol 2021 May-Jun;87(3):323-325

Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.25259/IJDVL_580_20DOI Listing
December 2020

Sudden Cardiac Death in a Young Patient With Psoriasis.

Cutis 2021 Feb;107(2):E21-E23

Postgraduate Institute of Medical Education and Research, Chandigarh, India. Drs. Sawatkar, Narang, Dogra, and Handa are from Department of Dermatology, Venereology and Leprology, and Dr. Muthu is from Department of Pulmonary Medicine.

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http://dx.doi.org/10.12788/cutis.0188DOI Listing
February 2021

Matrix-assisted laser desorption/ionisation-time of flight mass spectrometry: Protocol standardisation, comparison and database expansion for faster and reliable identification of dermatophytes.

Mycoses 2021 Aug 25;64(8):926-935. Epub 2021 Apr 25.

Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: Accurate and early identification of dermatophytes enables prompt antifungal therapy. However, phenotypic and molecular identification methods are time-consuming. MALDI-TOF MS-based identification is rapid, but an optimum protocol is not available.

Objectives: To develop and validate an optimum protein extraction protocol for the efficient and accurate identification of dermatophytes by MALDI-TOF MS.

Materials/methods: Trichophyton mentagrophytes complex (n = 4), T. rubrum (n = 4) and Microsporum gypseum (n = 4) were used for the optimisation of protein extraction protocols. Thirteen different methods were evaluated. A total of 125 DNA sequence confirmed clinical isolates of dermatophytes were used to create and expand the existing database. The accuracy of the created database was checked by visual inspection of MALDI spectra, MSP dendrogram and composite correlation index matrix analysis. The protocol was validated further using 234 isolates.

Result: Among 13 protein extraction methods, six correctly identified dermatophytes but with a low log score (≤1.0). The modified extraction protocol developed provided an elevated log score of 1.6. Significant log score difference was observed between the modified protocol and other existing protocols (T. mentagrophytes complex: 1.6 vs. 0.2-1.0, p < .001; T. rubrum: 1.6 vs. 0.4-1.0, p < .001; M. gypseum:1.6 vs. 0.2-1.0, p < .001). Expansion of the database enabled the identification of all 234 isolates (73.5% with log score ≥2.0 and 26.4% with log scores range: 1.75-1.99). The results were comparable to DNA sequence-based identification.

Conclusion: MALDI-TOF MS with an updated database and efficient protein extraction protocol developed in this study can identify dermatophytes accurately and also reduce the time for identifying them.
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http://dx.doi.org/10.1111/myc.13285DOI Listing
August 2021

Revisiting blood agar for the isolation of .

Indian J Sex Transm Dis AIDS 2020 Jul-Dec;41(2):221-222. Epub 2020 Nov 11.

Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.4103/ijstd.IJSTD_51_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000674PMC
November 2020

Stigma Experienced by the Caregivers of Patients with Chronic Plaque Psoriasis.

Indian Dermatol Online J 2021 Jan-Feb;12(1):110-115. Epub 2021 Jan 16.

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Background: Psoriasis is a chronic inflammatory dermatosis associated with psychological morbidity. Very few studies have evaluated stigma among caregivers of patients with psoriasis.

Objective: This study aimed to evaluate the prevalence of stigma and its correlates among the caregivers of patients with psoriasis.

Methodology: Forty-nine caregivers of patients with psoriasis were evaluated on psoriasis adapted version of caregiver of people with mental illness (CPMI) to assess internalized stigma, Explanatory Model Interview Catalogue Stigma Scale, Family Burden Inventory (FBI), Multidimensional aspect of perceived social support scale (PSS), Cognitive behavioral avoidance scale (CBAS), and Coping checklist.

Results: Majority of the caregivers were either spouse (42.8%) or parents (36.7%) of the patients. The caregivers were involved in the care of the patients for a mean duration of 6.5(SD; 4.8) years. On CPMI, the mean score was highest for the affective domain (3.1), this was followed by affective (2.9), and behavioral (2.9) domain. Very few (12.2%) caregivers reported significantly high caregiver burden. A higher level of stigma was associated with more often use of avoidance coping. Presence of higher social support was associated with higher level of stigma as assessed by using CPMI. A higher level of caregiver burden in all the domains of FBI was associated with higher level of stigma.

Conclusion: Stigma is highly prevalent among the caregivers of patients with psoriasis. These findings suggest that there is an urgent need to identify the stigma and address the same.
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http://dx.doi.org/10.4103/idoj.IDOJ_358_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982052PMC
January 2021

Internalized Stigma and Psychiatric Morbidity among Patients with Psoriasis: A Study from North India.

Indian Dermatol Online J 2021 Jan-Feb;12(1):97-104. Epub 2020 Sep 28.

Department of Psychiatry, PGIMER, Chandigarh, India.

Background: Psoriasis is a chronic inflammatory dermatosis associated with psychological morbidity. Like mental illness, it is also associated with stigma. Very few studies from India have evaluated stigma experienced by patients with psoriasis.

Aim Of The Study: To study stigma in patients with psoriasis (in the form of internalized stigma, perceived stigma, and social-participation-restriction stigma) and its relationship with demographic and clinical variables.

Methodology: 104 patients with psoriasis assessed on the internalized stigma of mental illness scale (ISMIS), explanatory model interview catalogue stigma scale, participation scale (P-scale), perceived social support, total score of Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) scale, Dermatology Life Quality Index, and Psoriasis disability index.

Results: On ISMIS, overall, 27.9% had experienced stigma. On domains, majority of the participants experienced discrimination (52.9%) followed by stigma resistance (51.9%), stereotype (26.0%), social withdrawal (24.1%), and alienation (23.1%). Majority of them reported mild restriction. As per the evaluation by a qualified psychiatrist, about 30% of the participants had at least one psychiatric diagnosis. On comparison, those with the presence of co-morbid psychiatric illness experienced a higher level of stigma on each domain of ISMIS except discrimination and stigma resistance. Lower social support was associated with higher stigma in all the domains. All the domains of ISMIS except discrimination and stigma resistance were associated with a higher level of anxiety and depression, poor quality of life, and higher disability.

Conclusion: The patients with psoriasis experience a significant amount of stigma and stigma is associated with the presence of psychiatric morbidity, lower social support, higher restriction, and more disability.
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http://dx.doi.org/10.4103/idoj.IDOJ_345_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982046PMC
September 2020

Comparison of the Efficacy and Safety of Apremilast and Methotrexate in Patients with Palmoplantar Psoriasis: A Randomized Controlled Trial.

Am J Clin Dermatol 2021 May 12;22(3):415-423. Epub 2021 Mar 12.

Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.

Background: Placebo-controlled studies have reported the efficacy of apremilast in the management of palmoplantar psoriasis but studies comparing efficacy with a conventional agent are lacking.

Objective: The objective of this article was to  compare the efficacy and safety of apremilast and methotrexate in patients with palmoplantar psoriasis.

Methods: In this prospective, randomized, active-controlled, observer-blinded clinical trial, conducted at a psoriasis clinic of a tertiary care institute in India from 1 July, 2019 to 1 June, 2020, 84 patients with palmoplantar psoriasis were randomized (1:1) to receive either methotrexate (0.4 mg/kg/week orally) or apremilast (30 mg twice daily). The treatment protocol was continued for 16 weeks or until achieving a ≥ 75% improvement in the Modified Palmoplantar Psoriasis Area and Severity Index (m-PPPASI 75), whichever was earlier. Changes in m-PPPASI and Dermatology Life Quality Index scores from baseline, the proportion of patients achieving m-PPPASI 75, and adverse events were assessed.

Results: Eighty-four patients were included (76 palmoplantar psoriasis and 8 palmoplantar pustulosis). The mean age (standard deviation) was 44.5 (12.9) years and 53 (63%) were women. The m-PPPASI score [median (interquartile range)] after 16 weeks of treatment showed a significant improvement from baseline in both apremilast [- 6.3 (10.9), p < 0.001] and methotrexate groups [- 8.5 (9.9), p < 0.001]. The estimated median difference between the groups was - 1.2 (p = 0.39, 95% confidence interval - 4.2 to 2.1). At 16 weeks, m-PPPASI 75 was achieved by 14/42 (33%) and 17/42 (41%) patients in the apremilast and methotrexate groups, respectively (p = 0.49). A significant reduction in the Dermatology Life Quality Index score [median (interquartile range)] was observed in both groups [apremilast: - 3.0 (6.0), p < 0.001; methotrexate: - 3.0 (6.3), p < 0.001] with an estimated median difference of 0.0 (p = 0.99, 95% confidence interval - 1.0 to 2.0). The proportion of patients experiencing adverse events was comparable (p = 0.49).

Conclusions: Apremilast showed a comparable efficacy and safety profile to methotrexate in the management of palmoplantar psoriasis.

Clinical Trial Registration: CTRI/2019/06/019830, date of registration: 24 June, 2019; trial registered prospectively.
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http://dx.doi.org/10.1007/s40257-021-00596-6DOI Listing
May 2021

Palmoplantar Involvement in Leprosy: A Clinicopathological Study.

Am J Trop Med Hyg 2021 Feb 16. Epub 2021 Feb 16.

2Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Palmoplantar involvement has been infrequently reported in leprosy and is an easily misdiagnosed entity. The institutional database of leprosy clinic from 2015 to 2018 was accessed. Details pertaining to demography, clinical presentation, comorbidities (if any), treatment received, and outcome were analyzed in leprosy patients with palmoplantar involvement. Among the 520 patients studied, the involvement of palms and/or soles was reported in 49 (9.4%) patients. Isolated palm involvement was the most frequent (26/49, 53.1%), followed by both palm and sole involvement (12/49, 24.5%) and sole involvement alone (11/49, 22.4%). A higher incidence of lepra reactions and disabilities was noted in patients with palmoplantar involvement than in those without (P < 0.0001). Palmoplantar involvement in leprosy, although uncommon, is associated with a higher risk of reactions and disabilities. A knowledge of this end of the spectrum can help in maintaining a high index of suspicion and reduce misdiagnosis.
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http://dx.doi.org/10.4269/ajtmh.19-0598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045638PMC
February 2021

Apremilast in treatment of palmoplantar pustulosis - a case series.

Int J Dermatol 2021 Jun 21;60(6):e247-e248. Epub 2021 Jan 21.

Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1111/ijd.15398DOI Listing
June 2021

Central obesity and dyslipidemia in pediatric patients with psoriasis: An observational study from India.

J Am Acad Dermatol 2021 Jan 9. Epub 2021 Jan 9.

Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.12.072DOI Listing
January 2021

Verrucous lesions in leprosy.

Int J Mycobacteriol 2020 Oct-Dec;9(4):445-447

Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Leprosy is a chronic infectious disease with varied presentation. Hypopigmented or erythematous patches and plaques, skin-colored nodules, and diffuse cutaneous infiltration are the different types of cutaneous lesions seen among patients of leprosy. Verrucous lesions are an uncommon finding of the disease and may be misdiagnosed in the present times due to its rarity. We have herein described two such patients, one of whom had verrucous lesions as the only evident manifestation of leprosy, while the other developed verrucous plaque as the part of leprosy relapse.
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http://dx.doi.org/10.4103/ijmy.ijmy_168_20DOI Listing
December 2020

Lepromatous Leprosy with Crusted Scabies.

Am J Trop Med Hyg 2020 12;103(6):2158-2159

Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.4269/ajtmh.20-0763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695097PMC
December 2020

Reversible Melanonychia Revealing Nutritional Vitamin-B12 Deficiency.

Indian Dermatol Online J 2020 Sep-Oct;11(5):847-848. Epub 2020 Sep 19.

Department of Dermatology, Venereology, and Leprology; Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.

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http://dx.doi.org/10.4103/idoj.IDOJ_13_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678521PMC
September 2020

Comments in response to report on 'Late reversal reaction with resistant : an emerging paradigm'.

Trop Doct 2020 10 17;50(4):395-396. Epub 2020 Jun 17.

Senior Consultant, Department of Dermatology, Shalby Hospital, SAS Nagar, Punjab, India.

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http://dx.doi.org/10.1177/0049475520932206DOI Listing
October 2020

Giant pyogenic granuloma on the glans penis.

Asian J Urol 2020 Oct 24;7(4):382-383. Epub 2019 Oct 24.

Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1016/j.ajur.2019.10.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498940PMC
October 2020

Correlation of serum vitamin D levels with severity of pediatric atopic dermatitis and the impact of vitamin D supplementation on treatment outcomes.

J Dermatolog Treat 2020 Oct 12:1-4. Epub 2020 Oct 12.

Department of Dermatology, Venereology & Leprology, PGIMER, Chandigarh, India.

Introduction: There is scarcity of prospective studies assessing the correlation between vitamin D deficiency and atopic dermatitis (AD).

Materials And Methods: We conducted a prospective study where in serum 25-hydroxy-vitamin D levels were measured in 35 AD patients and 35 age and sex-matched controls. AD patients deficient in vitamin D were supplemented with 1000 IU of vitamin D per day for three months. Serum vitamin D levels and SCORAD were again measured at the end of three months in all AD patients.

Results: The baseline vitamin D levels in patients and controls did not have any statistically significant difference ( = .97). There was a statistically significant ( = .02) inverse relationship between the AD severity and serum vitamin D levels at baseline ( = -0.52). Maximum reduction in SCORAD (41.4 ± 12.7) after 3 months of vitamin D supplementation was seen in severe AD and the minimum (2.4 ± 13.2) in mild AD ( = .0003).

Conclusions: We found no difference in the mean serum vitamin D levels between AD patients and controls. An inverse correlation was seen between serum vitamin D levels at baseline and severity of AD. Beneficial effect of vitamin D supplementation was observed maximally in severe AD as observed by a reduction in SCORAD.
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http://dx.doi.org/10.1080/09546634.2020.1818677DOI Listing
October 2020

Persistent plaques after release from treatment in slit-skin smear negative leprosy patients: Wait and watch or adopt a proactive approach?

Dermatol Ther 2020 11 17;33(6):e14226. Epub 2020 Sep 17.

Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

A subset of leprosy patients has clinical and histopathological activity in the form of persistent plaques and granulomas after completion of multidrug therapy (MDT) which can have significant impact on their quality of life. In the absence of clear guidelines regarding management of such patients, majority of the times they are treated either as late reversal reaction with corticosteroids or no active treatment is offered. We observed 11 patients of leprosy with persistent plaques after completing the 6/12-months MDT who were treated favorably with minocycline 100 mg once daily for 16 weeks. Complete clinical resolution was observed in 9/11 patients while two patients had partial improvement. Histopathological improvement in the form of disappearance of granulomas corroborated with the clinical improvement. All the patients tolerated the treatment well and hyperpigmentation was the only adverse effect noted. Minocycline may be considered as a useful and well tolerated therapeutic option for this subset of leprosy patients due to its immune modulatory and anti-inflammatory effects.
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http://dx.doi.org/10.1111/dth.14226DOI Listing
November 2020

Looking at the lobule-importance of ears and years in rheumatology.

Rheumatology (Oxford) 2021 01;60(1):477-478

Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1093/rheumatology/keaa426DOI Listing
January 2021

Response to: Management of leprosy patients in the era of COVID-19.

Dermatol Ther 2020 11 14;33(6):e14052. Epub 2020 Aug 14.

Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1111/dth.14052DOI Listing
November 2020

Odontogenic Cutaneous Sinus Tracts: A Clinician's Dilemma.

Indian Dermatol Online J 2020 May-Jun;11(3):440-443. Epub 2020 May 10.

Department of Prosthodontics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: Odontogenic cutaneous sinus tract (OCST) is one of the rare manifestations of chronic dental infections. Although well reported in literature, it is often misdiagnosed or under diagnosed. Apart from isolated case reports especially in dental literature there is a paucity of comprehensive case series on OCST.

Aims And Objectives: We undertook this study to observe the prevalence, clinico epidemiological features and management issues in these patients from a dermatological perspective.

Methods: A retrospective study was undertaken analyzing the clinical records of patients registered at our outpatient department (OPD) from 2011 to 2018. Cases with a clinical and radiological diagnosis of odontogenic cutaneous sinus were included in the study. We studied the following variables: frequency, gender, age, localization, morphology, mean time of evolution and treatment response.

Results: 21 patients with OCST were identified from our records. Females outnumbered males; patients in the age group between 31-40 years were more commonly affected. Three morphological presentations were noted in the form of flesh-colored dry nodules with sinus, adherent plaques with mucopurulent discharge and ulcer. Posterior set of teeth were commonly affected and mandible was the commonest site for location of sinus. The time taken for appropriate diagnosis in these cases ranged from 7-16 months. Almost all the patients responded to endodontal or root canal treatment and there were no recurrences.

Conclusion: A CST of dental origin is often a diagnostic challenge, especially in cases with minimal or no dental symptoms. A thorough skin and dental examination is required for sinuses on the head and neck area with a high index of suspicion for OCST. Most cases respond to conservative, root canal therapy. An early diagnosis can save the patient from unnecessary and ineffective therapies and sometimes surgeries.
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http://dx.doi.org/10.4103/idoj.IDOJ_261_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367566PMC
May 2020

Photosensitivity during apremilast treatment in patients with palmoplantar psoriasis.

Int J Dermatol 2020 Dec 19;59(12):e442-e444. Epub 2020 Jul 19.

Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1111/ijd.15051DOI Listing
December 2020

Lichenoid Skin Nodules as Presenting Feature of Necrotic Erythema Nodosum Leprosum in Leprosy.

Am J Trop Med Hyg 2020 07;103(1)

Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.4269/ajtmh.20-0177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356426PMC
July 2020

Metabolic syndrome and female gender, but not methotrexate, are the important associations of significant liver fibrosis in patients with moderate-to-severe psoriasis as detected by transient elastography.

Indian J Dermatol Venereol Leprol 2020 Nov-Dec;86(6):649-655

Department of Immunopathology, PGIMER, Chandigarh, India.

Background: Many international guidelines on psoriasis management have emphasized upon the need to identify risk factors for liver fibrosis and that the risk may be increased after a certain total cumulative dose of methotrexate.

Methods: Consecutive patients with moderate-to-severe psoriasis were assessed for liver fibrosis using transient elastography and noninvasive scores. Based on the presence of significant liver fibrosis, the Odds ratio associated with various factors was calculated using logistic regression analysis. Receiver operating characteristic curves were calculated to find maximal cutoff values of noninvasive tests to detect fibrosis.

Results: In this cross-sectional study, 134 patients completed the study. Significant fibrosis (liver stiffness measurement ≥7, corresponding to F2 fibrosis or higher) was seen in 33 (24.6%) patients. Neither methotrexate exposure nor total cumulative dose of ≥1.5 was associated with significant fibrosis. Female sex (P = 0.024) and the presence of metabolic syndrome (P = 0.034) were the two variables associated with significant liver fibrosis. On logistic regression analysis, the odds ratio for the female gender and metabolic syndrome was estimated to be 2.51 (95% confidence interval - 1.09-5.81) and 2.33 (95% confidence interval - 1.03-5.27), respectively. Aspartate transaminase to platelet ratio index, nonalcoholic fatty liver disease score and the fibrosis-4 index had low sensitivity in comparison to transient elastography.

Limitations: These included small sample size, small number of patients with a total cumulative methotrexate dose of >3-4.5 g, and lack of control group consisting of healthy persons. Another is the absence of liver biopsies considered as the gold standard in the diagnosis of liver fibrosis.

Conclusions: Metabolic syndrome and female sex are associated with the development of significant liver fibrosis in patients with psoriasis. Methotrexate exposure does not seem to be significantly associated with significant liver fibrosis.
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http://dx.doi.org/10.4103/ijdvl.IJDVL_152_19DOI Listing
July 2020

Cytology in the diagnosis of concomitant tuberculosis and leprosy by polymerase chain reaction using cytology scrapings.

Cytopathology 2021 03 4;32(2):290-292. Epub 2020 Aug 4.

Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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http://dx.doi.org/10.1111/cyt.12882DOI Listing
March 2021
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