Abstract Background: Oral mucosa is typically the most frequent site of involvement in pemphigus vulgaris (PV). Currently, the mainstay in the treatment of oral erosions is topical corticosteroid. Topical pilocarpine has been tried in oral PV, based on the cholinomimetic property of pilocarpine, which is known to block the process of blister formation. Objectives: We aimed (1) to study the healing effect of pilocarpine 2% paste in oral PV and (2) to compare the efficacy of topical pilocarpine versus topical triamcinolone in oral pemphigus. Materials and Methods: A total of 30 subjects receiving treatment for PV were randomized into two groups. Group A was treated with topical triamcinolone 0.1% paste and Group B with topical pilocarpine 2% paste. The oral Pemphigus Disease Area Index score and epithelization index were calculated before and after the treatment interval. Results: Analysis of results showed a significant reduction in disease severity and lesional area with topical pilocarpine paste. A higher epithelization index was noted with topical pilocarpine as compared to topical triamcinolone. Limitations: This study is limited by its small sample size, short follow-up duration, and single-center design. The assessment of the erosion area was subjective, relying on visual clinical evaluation. Thus, further large-scale studies on diverse populations are required to validate these findings. Conclusion: In the early phase of pemphigus pathogenesis, anti-acetylcholine receptor antibodies block signaling essential for intercellular adhesion. Pilocarpine, a muscarinic acetylcholine agonist, serves as a potential alternate therapy to corticosteroid for oral PV.
Abstract Introduction: Tinea corporis is one of the most common clinical variants of dermatophytosis worldwide. Despite its typically straightforward diagnosis, therapeutic challenges and atypical presentations often complicate management. Dermoscopy has emerged as a powerful noninvasive diagnostic tool for multiple dermatological conditions, enabling visualization of sub-surface structures that are not apparent on clinical examination alone. Objective: To evaluate dermoscopic changes in tinea corporis lesions before and after antifungal therapy, establishing dermoscopy as a reliable and practical method for monitoring disease progression and treatment response. Methods: A prospective, longitudinal observational study was conducted on 100 patients with clinically and mycologically confirmed tinea corporis at a tertiary care hospital in South India. Polarized dermoscopic images were obtained at baseline and at 4, 8, 12, and 16 weeks of follow-up on treatment. We assessed scales, hemorrhagic dots, and background pigmentation using a global assessment scale (GAS). Data were analyzed with SPSS version 18.0, employing the Friedman test and the Wilcoxon signed-rank test to evaluate the statistical significance of parameter changes over time. Results: Peripheral scales showed the earliest response to treatment, followed by the resolution of hemorrhagic dots. Background pigmentation was the slowest feature to normalize. GAS scores for each dermoscopic parameter declined significantly from baseline to the final follow-up ( P < 0.05). Dermoscopic evolution closely mirrored clinical improvement, highlighting the technique’s value in guiding therapy. Conclusion: Dermoscopy is a valuable, noninvasive tool for assessing lesion severity and monitoring antifungal response in tinea corporis. Sequential observation of peripheral scales, hemorrhagic dots, and background pigmentation provides an objective measure of disease activity. Incorporating dermoscopy into routine practice can enhance the accuracy of clinical assessment and optimize patient management.
Abstract Context: Palmoplantar dermatoses are the skin disorders affecting the palms and soles – areas characterized by distinct anatomical, physiological, and environmental exposures. The clinical impact of these disorders is greater, owing to their often-visible nature, chronic course, and association with pain, functional impairment, and psychosocial distress. Aims: A comprehensive analysis of the clinical spectrum of palmoplantar dermatoses at a tertiary care setting in Central India, with particular focus on demographic distribution, etiological classification, and diagnostic challenges encountered in routine practice. Materials and Methods: A prospective cross-sectional study carried out over a period of 1 year in the department of dermatology at a tertiary center in Central India after taking approval from the institutional ethical committee. Results: Out of 500 patients enrolled, 249 were male and 251 were female. The most common age group affected was 31–40 years, comprising 217 (43.4%) subjects. Disease duration of more than 6 months was seen in 297 patients. The majority of patients, 288 (57.6%), were residing in urban areas, and 138 (27.6%) individuals were laborers by profession. Palmoplantar eczema was the most common dermatosis, followed by palmoplantar psoriasis, keratoderma, and fungal infections affecting 27.6%, 13.2%, 10%, and 8% cases, respectively. Pruritus was present in 249 patients, while pain was reported by only 112 individuals. Plantar involvement was seen in 364 (72.8%) patients and nail changes were seen in 74 (14.8%) subjects. Conclusions: Our findings support the growing consensus that palmoplantar dermatoses represent a distinct clinical group requiring dedicated diagnostic algorithms and individualized treatment strategies.
Abstract Background: In 2015, diagnostic criteria for Mycoplasma pneumoniae -induced rash and mucositis (MIRM) were recommended, and currently, reactive infectious mucocutaneous eruption (RIME) is preferred. Due to the relatively recent introduction of this disorder, clinicians are still not extensively primed regarding the morphology and diagnosis of MIRM. Materials and Methods: A retrospective study was undertaken in a referral children’s hospital in Western India over 6 months where children concomitantly affected with M. pneumoniae respiratory illness and mucositis and skin involvement were included and their characteristics were analyzed. Results: Severe mucositis affecting ≥2 mucosae classically associated with a respiratory illness was the norm in all nine patients, but the morphology and distribution of mucocutaneous lesions varied. Oral mucosa was most prevalent followed by ocular mucosa. Nasal and urogenital mucositis was also noted. Cutaneous involvement of <10% body surface area (BSA) was in eight patients, with the remainder reporting BSA involvement of >50%. All cases had confirmed immunoglobulin M antibodies for M. pneumoniae . Resolution of skin lesions took an average of 4.67 days, albeit mucosa took longer. Conjunctival synechiae were seen in one patient. All patients were treated in an inpatient care with supportive management, antimicrobials, and immunomodulatory agents. Conclusion: Children with severe mucositis and sparse cutaneous eruptions especially with concomitant respiratory illness are characteristic of MIRM under the umbrella of RIME. Since their cutaneous morphology and distribution varies, physicians must maintain a high index of suspicion for this diagnosis, as this diagnosis drastically changes the management protocol, prognosis, and resultant counseling of parents.
Abstract A middle-aged female presented with persistent, unexplained pain in her fingertips, which was unresponsive to conventional treatments. Routine examination revealed no visible pathology, prompting further evaluation using Wood’s lamp and dermoscopy, which uncovered an unexpected etiology. This case highlights the role of advanced diagnostic tools in detecting elusive dermatological conditions and underscores the importance of thorough investigative approaches in unexplained dermatoses.
Abstract Angina bullosa hemorrhagica (ABH) is a rare, benign condition characterized by the sudden appearance of blood-filled blisters in the oral cavity, typically in the absence of systemic, hematological, or mucocutaneous disorders. These lesions often arise spontaneously or following minor trauma and tend to rupture quickly, healing without scarring. We report the case of a 74-year-old female who presented with well-defined hemorrhagic blisters in the oral mucosa. The lesions developed abruptly, ruptured spontaneously, and resolved without intervention. Clinical examination and history revealed no evidence of underlying systemic disease, coagulopathy, or dermatological condition. The diagnosis of ABH was made based on characteristic clinical features and exclusion of other causes of oral bullous lesions. This case highlights the importance of recognizing ABH to avoid unnecessary diagnostic procedures and to differentiate it from other serious conditions such as autoimmune mucocutaneous disorders and bleeding diatheses. Increased awareness among clinicians can aid in prompt diagnosis and appropriate patient reassurance.
Background: Keloids are benign fibroproliferative lesions characterized by excessive collagen deposition, with unpredictable growth and high recurrence rates. Laser therapy has emerged as a promising option, but comparative data on different laser modalities remain limited, particularly in darker skin types. Aim: The aim of this study was to evaluate and compare the efficacy of the 1064 nm long-pulsed (LP) neodymium-doped: yttrium–aluminum–garnet (Nd:YAG) laser and the 585 nm solid-state semiconductor laser in the treatment of keloids. Materials and Methods: A retrospective study was conducted from January 2024 to January 2025. Treatment-naïve patients with keloids were included and divided into two groups: one treated with the 1064 nm LP-Nd:YAG laser and the other with the 585 nm solid-state laser. Clinical improvement, reduction in pigmentation, visible thickness, and relapse rates were assessed over multiple sessions. Results: A total of 36 patients were included (21 in the 1064 nm group and 15 in the 585 nm group). Over 70% of patients in both the groups showed clinical improvement. The 1064 nm laser was more effective for thick, fibrotic keloids, while the 585 nm laser showed superior results in erythematous, vascular lesions. No significant adverse effects were observed. Conclusion: Both laser modalities demonstrated effectiveness in keloid management. The 1064 nm laser is preferable for fibrotic lesions, whereas the 585 nm laser offers better outcomes for vascular keloids. Individualized, morphology-based laser selection is essential for optimizing treatment results in patients with Fitzpatrick type IV skin.
Abstract Autoimmune polyendocrine syndrome type 1 (APS-1) is a rare autosomal recessive genetic disorder. It is caused by a loss of immune tolerance due to a mutation in the autoimmune regulator gene. Its systemic features include the presence of autoimmunity against multiple endocrine organs, and its cutaneous features include the presence of chronic candidiasis of the mucosa, nails, and skin. We report a case of an 8-year-old male presenting with progressive blackening of the nails, recurrent oral candidiasis, and acute paronychia. Clinical, laboratory, and genetic evaluations confirmed APS-1. The patient was managed with itraconazole, supportive therapy, and an antifungal mouthwash. Early recognition and a multidisciplinary approach are crucial in managing APS-1.
Introduction: Auspitz is probably the most well-known dermatologic sign in psoriatic plaques. The traditional methods of elicitation using a glass slide scraping can be time-consuming and distressing for the patient. This study investigates the utility of dermoscopy as an assistive tool to visualize punctate hemorrhage at an earlier stage of the grattage test (dermoscopic Auspitz sign [DAS]), taking into account other parameters like speed and the discomfort experienced by the patient. Materials and Methods: A hospital-based cross-sectional study was conducted on two sets of identical plaques (50 each). Clinical Auspitz sign (CAS) was performed over one plaque, and DAS was performed over the other plaque, and they were analyzed with respect to speed, number of scrapings, and pain severity. Results: The average DAS is more than three times faster than CAS, requiring a reduced number of scrapings. The pain score with CAS is much higher than with DAS. The difference between the two (CAS/DAS) with respect to speed and discomfort was significant (P < 0.001). Conclusion: Our study showed that DAS is quicker, and the patient is more comfortable with a better acceptability, making it more patient-friendly compared to the clinical Auspitz sign.
Background: Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease caused by autoantibodies targeting BP180 and BP230. We evaluated the diagnostic performance of anti-BP180-NC16A and anti-BP230 enzyme-linked immunosorbent assay (ELISA) and their relationship with disease severity in an Indian population. Aim: The aim is to compare the diagnostic performance of anti-BP180-NC16A and anti-BP230 ELISA in BP and evaluate their correlation with disease severity. Materials and Methods: This case–control study included 21 BP patients confirmed by clinical features, histopathology, and direct immunofluorescence, and 21 age- and sex-matched healthy controls. Serum IgG antibodies against BP180 and BP230 were measured using EUROIMMUN ELISA kits. Disease severity was assessed using the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). Statistical analyses included the Mann–Whitney U test, the receiver operating characteristic curve analysis, McNemar’s test, and Spearman correlation. Results: Anti-BP180-NC16A levels were significantly elevated in BP patients. Anti-BP180 ELISA demonstrated 57.1% sensitivity and 95.2% specificity. Anti-BP230 levels were also elevated with 38.1% sensitivity and 100% specificity. Anti-BP180 showed significantly greater sensitivity than anti-BP230. Disease severity: 61.9% mild, 23.8% moderate, and 14.3% severe. Higher BP180 levels trended toward greater severity, though not statistically significant. A moderate positive correlation existed between BP180 and BP230 levels. Conclusion: Anti-BP180-NC16A ELISA demonstrated superior diagnostic sensitivity while maintaining high specificity. Anti-BP180 should serve as the primary serological marker, with anti-BP230 as a useful adjunct to improve diagnostic yield. In addition, BP180 antibody levels showed a positive trend toward correlation with disease severity ABSIS score, reflecting clinical disease activity and aiding disease monitoring.
Abstract Paradoxical psoriasis, by definition, includes either (i) new-onset psoriasis in patients treated for a different disease or (ii) worsening and phenotypical change of preexisting psoriasis. Originally, the term was used in tumor necrosis factor-alpha using psoriasis patients, in whom new psoriasiform lesions started to appear after prolonged use. However, similar descriptions began to gain attention as the use of other biologics increased. We describe a patient with Down syndrome and severe psoriasis who developed pustular aggravation of the lesions after two dosages of ixekizumab.
Disseminated herpes zoster is a rare presentation in immunocompetent individuals. Neurological complications such as facial palsy usually occur early or concurrently with the rash, making delayed onset uncommon. We report a case of a 48-year-old immunocompetent female who presented with painful, widespread vesicular eruptions and was diagnosed with disseminated herpes zoster. Although she responded to antiviral therapy, she subsequently developed left-sided lower motor neuron facial palsy after resolution of the cutaneous lesions. This case highlights the potential for delayed neurological complications in disseminated herpes zoster, even among immunocompetent patients, emphasizing the importance of early recognition and close follow-up.
