Belliappa Pemmanda Raju

The concomitant occurrence of psoriasis vulgaris (PV) and bullous pemphigoid in a patient is rare. We report a 55-year-old male, with history of PV since 4 years, on irregular topical medication, who developed multiple fluid-filled lesions all over the body. A combination treatment with prednisolone, cyclosporine, and dapsone followed by methotrexate was proved suitable and effective.

Antimicrobial activity of green tea against Staphylococcus aureus both in vitro and in vivo has been reported recently. Studies on clinical efficacy and safety of green tea as antibacterial agent against S. aureus in human cases are rare. To evaluate the clinical effectiveness and safety of topical green tea on primary pyoderma caused by S. aureus. We also attempted to determine the minimum inhibitory concentration of green tea against S. aureus and methicillin-resistant S. aureus. Open label, prospective, placebo-controlled study included community-acquired primary pyoderma cases caused by S. aureus. Severity grading was done on a scale of 1-5. Green tea ointment 3% and placebo ointment were used. Cure was defined on the basis of negative culture and assessment of clinical improvement. Minimum inhibitory concentration was determined by agar dilution method. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 16. Of the 372 patients, 250 received green tea and 122 received placebo. Multidrug-resistant S. aureus was isolated in 89.1% in green tea group and 81.1% in placebo group, respectively. Methicillin-resistant S. aureus was isolated in 24 patients. Cure was seen in 86% in green tea group and 6.6% in placebo group which was statistically very significant. The number of days for comprehensive cure in green tea group was 9.2 ± 6.4 days. All patients with methicillin-resistant S. aureus infection in the green tea group were cured. Minimum inhibitory concentration of green tea against S. aureus was 0.0265 ± 0.008 μg/ml and against methicillin-resistant S. aureus was 0.0205 ± 0.003 μg/ml. Comparative trial was not conducted in the same patient with different lesions; children less than seven years were not considered as the school authorities did not permit for younger children to be included in the study and true randomization and blinding of investigators were not done. Green tea has a significant antibacterial effect against multidrug-resistant S. aureus. Minimum inhibitory concentration of green tea is established and is promising in methicillin-resistant S. aureus infections.

Rhinophyma is characterized by nodular thickening of the Nasal skin, sebaceous gland hyperplasia, dilated pores, and in its late stage, fibrosis. In severe cases, it results in loss of normal facial contours, significant disfigurement, and social isolation. Treatment options for severe rhinophyma include cryosurgery, partial-thickness decortications with subsequent secondary reepithelialisation, laser ablation, full thickness resection with graft or flap reconstruction, excision by electrocautery or radio frequency. We report a case of severe rhinophyma resulting in marked facial disfigurement treated successfully with trimodal therapy with excellent cosmetic outcome on a long term follow up.

Background: Non-healing trophic ulcers in Hansen's disease patients is one of the major causes for disability. It has been shown that autologous platelet-rich fibrin matrix (PRFM) is effective in healing chronic non-healing leg ulcers. Aim: The objective of this study is to demonstrate the efficacy of autologous platelet-rich fibrin matrix (PRFM) in non-healing trophic ulcers in patients treated for Hansen's disease. Design: A prospective study. Setting: An institution-based clinic. Participants: Seven treated patients with Hansen's disease, with a mean age of 38.33 years, with nine non-healing trophic ulcer of more than 6 weeks duration. Measurements: Photographs were taken before treatment and at every subsequent sitting. Area and volume were calculated at baseline and every subsequent sitting till the closure was achieved. Materials and Methods: The healthy ulcers were treated with PRFM at weekly intervals, repeated once a week for a maximum of five sittings as per requirement. Results: The mean percentage improvement in the area was 93.52%, and volume was 97.74% at the end of the second sitting. All ulcers closed by a maximum of five sittings. No adverse events were noted. Conclusion: PRFM for the treatment of trophic ulcers in treated patients with Hansen's disease is a feasible, safe, simple and inexpensive method.

Background: Acne is a common problem in adolescent children and has a considerable impact on their quality of life (QoL). Aims: The impact of acne on QoL in Indian adolescent patients remains undocumented. The study was undertaken to detect the impact of acne vulgaris in adolescents on the QoL using two questionnaires: the Children's Dermatology Life Quality Index (CDLQI) and the Cardiff Acne Disability Index (CADI). Materials and Methods: This was a hospital-based, prospective, cross-sectional, prestructured, questionnaire-based study done on 140 consenting individuals, who attended the Acne Clinic of our Dermatology Outpatient Department. Acne vulgaris was graded using simple grading system. QoL was measured using a combination of skin disease-specific (CDLQI) and acne-specific (CADI) questionnaires. Results: The study population included 140 cases with a female:male ratio of 1.5:1. Comedones (123, 87.9%) were the most common type of lesion. Grade I acne was the most common clinical type (76.4%). There was a statistically significant difference between acne severity and gender. The overall mean CDLQI score (7.21 of maximum 30) and the overall mean CADI score (4.8 of maximum 15) were low, indicating a mild impairment of QoL among adolescents. Statistically significant association was noted between CDLQI and CADI scores and grade of acne. There was no statistically significant association noted between CDLQI and CADI scores and gender. Conclusion: Although acne had an impact on patient's QoL, it was less severe in our study. The CDLQI and CADI questionnaires represent simple and reliable instruments for the assessment of QoL among adolescents and should be incorporated when managing acne patients to provide better and appropriate care.

Background: Emergence of methicillin-resistant Staphylococcus aureus (MRSA) infections among previously healthy persons in community settings (without exposure to healthcare facilities) has been noted recently. Limited studies have been carried out from India in an exclusive pediatric population on MRSA in community-acquired pyoderma. Aims: The objective of this study was to evaluate different types of primary pyoderma in children caused by S. aureus and to determine the incidence of MRSA in community-acquired primary pyoderma in children. Materials and Methods: Children aged ≤ 16 years with pyoderma caused by S. aureus who attended camps conducted in schools around Bengaluru were inducted. They were evaluated for a variety of skin infections which were cultured and analyzed for antimicrobial susceptibilities. Swabs from the anterior nares were also collected from each patient. Results: Of the total 372 children with pyoderma caused by S. aureus studied, 232 were boys and 140 were girls. Impetigo contagiosum (47%) was the most common form of pyoderma, followed by ecthyma (19.9%) and folliculitis (18.5%). The most common site involved was face in 48.4% patients, followed by legs in 32.5% patients. MRSA was isolated in 6.5% patients. Nasal colonization with S. aureus was observed in 59.7% patients. Conclusion: MRSA in community-acquired pyoderma in children was 6.5% and nasal colonization with S. aureus was 59.7% in our study. High resistance to commonly used antimicrobials in methicillin-sensitive S. aureus was also observed. Judicious use of antimicrobials is essential to control the emergence and spread of antimicrobial resistance.

Conventional technique of dermal grafting for acne scars where the source of filler material used is the patient's own dermis requires longer surgical time, recovery period and can result in unsightly scars at the donor area. Hence, it is not suitable for treating a larger number of scars. Furthermore, these dermal grafts are firm and cannot be contoured to fit all types of acne scars. Occurrence of epidermal cyst and secondary infection is another complication if epidermis is not completely removed. Enzymatic techniques need trypsinisation which is expensive and requires laboratory facilities.