Autoinflammatory disorders are characterized by a dysregulated and disproportionately heightened response by the innate immune system to PAMPs and DAMPs (pathogen- and damage-associated molecular patterns, respectively), with a crucial role played by neutrophils and macrophages in disease pathogenesis. Autoinflammatory disorders closely resemble connective tissue diseases (CTDs); however, tests for antinuclear antibodies, typically considered a marker of CTDs, are negative in autoinflammatory disorders. Many autoinflammatory disorders are monogenic and arise from inherited genetic mutations, resulting in autoinflammation. This is especially true for disorders presenting in childhood or early adulthood. However, with the relatively recent identification of VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome, the recognized genetic spectrum of these disorders has expanded, especially in the adult population, emphasizing that these mutations could either be inherited or acquired later in life. Additionally, many of the acquired autoinflammatory disorders, for example, adult-onset Still disease and Schnitzler syndrome, have a multifactorial pathogenesis and are typically polygenic. Many novel disorders are being described in this category, and the majority of them have prominent cutaneous manifestations - either at onset or during the course of disease - that are particularly important from a diagnostic point of view. In this review, we discuss the cutaneous findings of a few acquired autoinflammatory disorders, with a specific focus on adult-onset Still disease, VEXAS syndrome, Schnitzler syndrome, Kikuchi-Fujimoto disease and haemophagocytic lymphohistiocytosis.
Background: Syphilis has shown a recent resurgence globally, including in India. However, inconsistency in the data and diagnostic criteria used, especially in India and developing countries, hinders ideal understanding. Factors responsible for this surge need to be explored. Objectives: This study aimed to assess the trends and describe the clinicodemographic characteristics of syphilis cases seen in a tertiary care health centre from Northern India. Methods: This is a retrospective chart review of syphilis patients registered in our sexually transmitted infection (STI) clinic spanning 13 years from January 2011 to December 2023. Complete demographic details, sexual history, clinical examination and laboratory investigations of all syphilis cases, including associated STIs, were retrieved. Results: The retrospective analysis included 2000 records, of which 324 were confirmed syphilis cases (16.2% of total STI cases). Patients' mean age was 30.9 +/- 9.9 years, of which 80.9% were male and 64.2% were married. Education level varied, with professionals comprising 22.2% of the total cohort. Premarital and extramarital exposure were present in 35.8% and 32.7% patients, respectively; over half (56.8%) reported multiple partners and 13% were homosexual. There was an initial plateau in the number of confirmed syphilis attending the clinic (2011-2019), a decrease during 2020-2021 due to COVID and significant increase from 2022 onwards. Latent syphilis was the most common (66.7%), followed by secondary (18.8%) and primary (8.9%). In all, 36.1% of syphilis patients had associated STIs, with human immunodeficiency virus (HIV) infection being the most prevalent (25.0%). Limitation: Retrospective nature of the study is major limitation. Rising trend needs validation with population-based studies to establish if the rise is true or a shadow phenomenon. Conclusion: A resurgence of syphilis cases has appeared in the past two years, with latent syphilis contributing to the majority of cases. Possible factors for the surge include changing sexual behaviour, including male having sex with male (MSM), early adolescent sexual exposure, increased screening for latent syphilis, increased healthcare accessibility postCOVID-19 pandemic, and HIV co-infection.
Background:Hidradenitis suppurativa (HS) is a chronic inflammatory disorder affecting pilosebaceous units causing painful nodules, abscesses, and scarring. Despite global studies linking HS to metabolic syndrome, insights specific to Indian patients are limited. Materials and Methods:This study aimed to describe the clinicodemographic characteristics and study frequency of metabolic syndrome in Indian HS patients. In this cross-sectional study, 100 HS patients were evaluated for clinical characteristics, comorbidities, pain and suppuration scores, quality of life, and ophthalmological and dental abnormalities. Metabolic parameters, including anthropometry and blood markers, were performed in all cases and 100 age- and gender-matched controls. Results:The mean age was 29.47 years, with a male predominance of 57%. HS predominantly affected a combination of two or more sites (60%), with nodules as primary lesions (95%). Quality of life was significantly impaired, with 49% experiencing moderate impact as per Dermatology Life Quality Index. Metabolic derangements, represented by an increased body mass index, waist circumference, blood pressure, fasting blood sugar, and fasting insulin, were significantly more frequent in HS cases compared to controls (P < 0.001). The frequency of metabolic syndrome in HS patients was 42%, significantly higher than controls (8%, P < 0.001) with a relative risk of 5.25 (95% CI 2.68-10.58). Dental and ophthalmological abnormalities were observed in 35% and 21.7% of screened patients, respectively. Limitations:Cross-sectional nature, no prospective assessment to determine evolution with time, and limited patient number are the limitations of the study. Conclusion:A substantial association with metabolic syndrome and considerable impact on quality of life is seen in Indian HS patients, emphasizing the need for metabolic screening and holistic management strategies.
Data are available upon request from the corresponding author.
International Journal of DermatologyEarly View Letter to the Editor Creating the Indian Association of Dermatologists, Venereologists, and Leprologists (IADVL) Cutaneous Rare Disease Registry (I-CuReD): a 1-year experience Rahul Mahajan, Corresponding Author Rahul Mahajan [email protected] orcid.org/0000-0003-4320-3193 Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorNarayanan Baskaran, Narayanan Baskaran Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorSahil Kumar, Sahil Kumar Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorBiswanath Behera, Biswanath Behera orcid.org/0000-0002-5115-5622 Department of Dermatology, All India Institute of Medical Sciences, Bhubaneshwar, IndiaSearch for more papers by this authorDipankar De, Dipankar De Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorRashmi Sarkar, Rashmi Sarkar orcid.org/0000-0001-8768-4879 Department of Dermatology, Lady Hardinge Medical College and Hospitals, New Delhi, IndiaSearch for more papers by this authorSanjeev Handa, Sanjeev Handa Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this author Rahul Mahajan, Corresponding Author Rahul Mahajan [email protected] orcid.org/0000-0003-4320-3193 Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorNarayanan Baskaran, Narayanan Baskaran Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorSahil Kumar, Sahil Kumar Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorBiswanath Behera, Biswanath Behera orcid.org/0000-0002-5115-5622 Department of Dermatology, All India Institute of Medical Sciences, Bhubaneshwar, IndiaSearch for more papers by this authorDipankar De, Dipankar De Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorRashmi Sarkar, Rashmi Sarkar orcid.org/0000-0001-8768-4879 Department of Dermatology, Lady Hardinge Medical College and Hospitals, New Delhi, IndiaSearch for more papers by this authorSanjeev Handa, Sanjeev Handa Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this author First published: 14 June 2024 https://doi.org/10.1111/ijd.17315 Conflict of interest: None. Funding source: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Feramisco JD, Sadreyev RI, Murray ML, Grishin NV, Tsao H. Phenotypic and genotypic analyses of genetic skin disease through the Online Mendelian Inheritance in Man (OMIM) database. J Invest Dermatol. 2009; 129: 2628–2636. 10.1038/jid.2009.108 CASPubMedWeb of Science®Google Scholar 2Richter T, Nestler-Parr S, Babela R, Khan ZM, Tesoro T, Molsen E, et al. 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JAMA Dermatol. 2016; 152: 1231–1238. 10.1001/jamadermatol.2016.2473 PubMedWeb of Science®Google Scholar 6Has C, Hess M, Anemüller W, Blume-Peytavi U, Emmert S, Fölster-Holst R, et al. Epidemiology of inherited epidermolysis bullosa in Germany. J Eur Acad Dermatol Venereol. 2023; 37: 402–410. 10.1111/jdv.18637 PubMedWeb of Science®Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation
findings diagnosis of hyperkeratotic dermatophytosis was made. After histopathological diagnosis, fungal culture was also performed which yielded Trichophyton species. There was no family history of dermatophytosis or contact with pets. She was also investigated for stunting and primary immunodeficiency (PID). Investigations revealed primary hypothyroidism, normal serum immunoglobulin E levels, and a normal proportion of B, T, CD4, CD8, and NK lymphocytes. Nitroblue tetrazolium test was negative. She also had a significantly low proportion of Th17 cells. She was started on levothyroxine and syrup itraconazole 5 mg/kg/day in two divided doses, which showed almost complete clearance in the next 6 weeks [Figure 3]. On discontinuation of itraconazole patient again developed similar lesions all over the body along with oral candidiasis, so itraconazole was maintained for prophylaxis of dermatophytosis and candidiasis.
International Journal of DermatologyEarly View Case report Cutaneous manifestations of VEXAS syndrome: multiple changing faces in the same patient Dipankar De MD, Corresponding Author Dipankar De MD [email protected] orcid.org/0000-0001-8682-2598 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India Correspondence Dipankar De, MD Department of Dermatology, Venereology, and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India E-mail: [email protected]Search for more papers by this authorNarayanan Baskaran MD, Narayanan Baskaran MD orcid.org/0000-0002-4807-6018 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorShikha Shah MD, Shikha Shah MD orcid.org/0000-0003-3796-6426 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorAnuradha Bishnoi MD, Anuradha Bishnoi MD Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorPrateek Bhatia MD, DNB, PGDHM, MIPHA C.Cy, Prateek Bhatia MD, DNB, PGDHM, MIPHA C.Cy Department of Pediatrics, Pediatric Haematology Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorPraveen Sharma MD, DNB, DM, ISCYM, Praveen Sharma MD, DNB, DM, ISCYM Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorPankaj Malhotra MD, FRCP, Pankaj Malhotra MD, FRCP Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorAman Sharma MD, FAMS, FIACM, FICP, FACR, FRCP, Aman Sharma MD, FAMS, FIACM, FICP, FACR, FRCP Department of Rheumatology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorSreejesh Sreedharanunni MD, DNB, DM, Sreejesh Sreedharanunni MD, DNB, DM Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorDebajyoti Chatterjee MD, DM, Debajyoti Chatterjee MD, DM Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this author Dipankar De MD, Corresponding Author Dipankar De MD [email protected] orcid.org/0000-0001-8682-2598 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India Correspondence Dipankar De, MD Department of Dermatology, Venereology, and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India E-mail: [email protected]Search for more papers by this authorNarayanan Baskaran MD, Narayanan Baskaran MD orcid.org/0000-0002-4807-6018 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorShikha Shah MD, Shikha Shah MD orcid.org/0000-0003-3796-6426 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorAnuradha Bishnoi MD, Anuradha Bishnoi MD Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorPrateek Bhatia MD, DNB, PGDHM, MIPHA C.Cy, Prateek Bhatia MD, DNB, PGDHM, MIPHA C.Cy Department of Pediatrics, Pediatric Haematology Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorPraveen Sharma MD, DNB, DM, ISCYM, Praveen Sharma MD, DNB, DM, ISCYM Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorPankaj Malhotra MD, FRCP, Pankaj Malhotra MD, FRCP Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorAman Sharma MD, FAMS, FIACM, FICP, FACR, FRCP, Aman Sharma MD, FAMS, FIACM, FICP, FACR, FRCP Department of Rheumatology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorSreejesh Sreedharanunni MD, DNB, DM, Sreejesh Sreedharanunni MD, DNB, DM Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorDebajyoti Chatterjee MD, DM, Debajyoti Chatterjee MD, DM Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this author First published: 18 December 2023 https://doi.org/10.1111/ijd.16991 Conflict of interest: None. Funding source: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1Beck DB, Ferrada MA, Sikora KA, Ombrello AK, Collins JC, Pei W, et al. Somatic mutations in UBA1 and severe adult-onset autoinflammatory disease. N Engl J Med. 2020; 383: 2628–2638. 10.1056/NEJMoa2026834 CASPubMedWeb of Science®Google Scholar 2van der Made CI, Potjewijd J, Hoogstins A, Willems HP, Kwakernaak AJ, de Sevaux RG, et al. Adult-onset autoinflammation caused by somatic mutations in UBA1: a Dutch case series of VEXAS patients. J Allergy Clin Immunol. 2022; 149: 432–439.e4. 10.1016/j.jaci.2021.05.014 PubMedWeb of Science®Google Scholar 3Zakine E, Schell B, Battistella M, Vignon-Pennamen MD, Chasset F, Mahévas T, et al. UBA1 variations in neutrophilic dermatosis skin lesions of patients with VEXAS syndrome. JAMA Dermatol. 2021; 157: 1349–1354. 10.1001/jamadermatol.2021.3344 PubMedWeb of Science®Google Scholar 4Nguyen JK, Routledge D, van Der Weyden C, Blombery P, Angel CM, Johnson D, et al. VEXAS syndrome: a dermatological perspective. Australas J Dermatol. 2022; 63(4): 488–492. 10.1111/ajd.13932 PubMedWeb of Science®Google Scholar 5Khosravi-Hafshejani T, O'Connor M, To F, Sreenivasan G, Shojania K, Au S. The spectrum of skin disease in VEXAS syndrome: a report of a novel clinico-histopathologic presentation. 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Linear and annular lupus panniculitis of the scalp is a rare form of lupus panniculitis recently reported in literature. It presents as linear or annular or arciform areas of nonscarring alopecia of the scalp with minimal surface changes. We report a 4-year-old Indian female child with arciform erythematous plaque over the forehead extending on the scalp with nonscarring alopecia with annular erythematous plaque over the cheek. Histology showed lobular lymphocytic panniculitis with abundant mucin deposition. Antinuclear antibody and systemic screen for lupus were negative. After treatment with oral corticosteroids, complete remission was achieved with good regrowth of scalp hair with no relapse during the follow-up period of 6 months. This is the youngest reported case of linear and annular lupus panniculitis of the scalp.
Acquired dermal macular hyperpigmentation (ADMH), previously known as macular pigmentation of uncertain etiology (MPUE), is an umbrella concept that unifies the distinct but overlapping acquired dermal pigmentary disorders like lichen planus pigmentosus, ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis and pigmented contact dermatitis. All of these disorders usually lack a clinically apparent inflammatory phase, are characterised by dermal pigmentation clinically and histologically, and have a variable protracted disease course. Recently, a proposal has been made to classify these disorders into those with and without contact sensitisation. Dermoscopy is essentially similar across the spectrum of these disorders, and is useful for diagnosis and therapeutic response monitoring. Scoring system has been validated for the same. The treatment of ADMH remains challenging, with multiple topicals, oral therapies including mycophenolate mofetil, and lasers tried. Need of the hour is randomised controlled trials to enhance the therapeutic armamentarium.
International Journal of DermatologyVolume 63, Issue 3 p. 345-347 Tropical Medicine Rounds – Case Report Varicella gangrenosum—a gruesome complication of a benign infection Sejal Jain MBBS, Sejal Jain MBBS orcid.org/0000-0001-9175-6134 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, IndiaSearch for more papers by this authorShikha Shah MD, DNB, Shikha Shah MD, DNB orcid.org/0000-0003-3796-6426 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, IndiaSearch for more papers by this authorBaskaran Narayanan MD, Baskaran Narayanan MD Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, IndiaSearch for more papers by this authorYash Agarwal MBBS, Yash Agarwal MBBS Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, IndiaSearch for more papers by this authorPriyanka Goyal MD, Priyanka Goyal MD Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, IndiaSearch for more papers by this authorAnkur Jindal MD, DM, Ankur Jindal MD, DM Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, IndiaSearch for more papers by this authorKeshavamurthy Vinay MD, DNB, MNAMS, MRCP, FRCP (London), Keshavamurthy Vinay MD, DNB, MNAMS, MRCP, FRCP (London) orcid.org/0000-0001-6323-4988 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, IndiaSearch for more papers by this authorTarun Narang MD, MNAMS, Corresponding Author Tarun Narang MD, MNAMS [email protected] orcid.org/0000-0002-0464-2989 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India Correspondence Tarun Narang, MD, MNAMS Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh 160012 India E-mail: [email protected]Search for more papers by this author Sejal Jain MBBS, Sejal Jain MBBS orcid.org/0000-0001-9175-6134 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, IndiaSearch for more papers by this authorShikha Shah MD, DNB, Shikha Shah MD, DNB orcid.org/0000-0003-3796-6426 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, IndiaSearch for more papers by this authorBaskaran Narayanan MD, Baskaran Narayanan MD Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, IndiaSearch for more papers by this authorYash Agarwal MBBS, Yash Agarwal MBBS Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, IndiaSearch for more papers by this authorPriyanka Goyal MD, Priyanka Goyal MD Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, IndiaSearch for more papers by this authorAnkur Jindal MD, DM, Ankur Jindal MD, DM Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, IndiaSearch for more papers by this authorKeshavamurthy Vinay MD, DNB, MNAMS, MRCP, FRCP (London), Keshavamurthy Vinay MD, DNB, MNAMS, MRCP, FRCP (London) orcid.org/0000-0001-6323-4988 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, IndiaSearch for more papers by this authorTarun Narang MD, MNAMS, Corresponding Author Tarun Narang MD, MNAMS [email protected] orcid.org/0000-0002-0464-2989 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India Correspondence Tarun Narang, MD, MNAMS Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh 160012 India E-mail: [email protected]Search for more papers by this author First published: 14 December 2023 https://doi.org/10.1111/ijd.16955 Conflict of interest: None. Funding source: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Ceyhan M, Tezer H, Yildirim I. Secondary attack rate of hepatitis A, varicella and mumps in household settings and reliability of family history to detect seronegative children for necessity of vaccination. Scand J Infect Dis. 2009; 41: 501–506. 10.1080/00365540902968027 PubMedWeb of Science®Google Scholar 2Lokeshwar MR, Agrawal A, Subbarao SD, Chakraborty MS, Prasad AR, Weil J, et al. 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*Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.dermatologicsurgery.org). The authors have indicated no significant interest with commercial supporters.