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  • 1
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    ISSN: 1365-4632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1365-4632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background  Pemphigus, a common immunobullous disease of skin and mucous membranes affecting both sexes of all ages, was almost fatal before the advent of corticosteroids. Better strategies to avoid their side-effects and recent introduction of adjuvant therapy has further improved its prognosis. As the treatment remains need-based and patient-specific, different regimens and strategies have evolved, each with its own merits and demerits.This retrospective hospital-based study was carried out to understand the clinico-therapeutic aspects of pemphigus in our clinic.Methods  Medical records of all new patients admitted to our hospital with the diagnosis of pemphigus from 1990 to 2002 were analyzed.The diagnosis was mainly clinical and confirmed by positive Tzanck's test and histopathology. All patients were assessed clinically on a severity score of 1+ to 4+.These patients had received treatment with dexamethasone-cyclophosphamide pulse (DCP) therapy, oral mini-pulse (OMP) with betamethasone, or intramuscular triamcinolone acetonide alone or with azathioprine, dapsone or cyclophosphamide. They were followed up for clinical remission and side-effects of therapy.Results  There were a total of 54 new patients comprising 53.7% females and 46.3% males, and 12.9% of these were 〈 18 years of age. Pemphigus vulgaris was the commonest clinical type seen in 81.48% and mucosal involvement was seen in 63.63% of cases. The severity of mucosal lesions was not proportionate to that of cutaneous lesions. Associated diseases seen were seropositive rheumatoid arthritis, hypertension, diabetes mellitus and hyperthyroidism in one case each.Dexamethasone-cyclophosphamide pulse therapy was given to 75% of the pemphigus vulgaris patients while those having less severe disease were treated with other regimens. In general, clinical remission was seen after 2–16 (mean 6.5) DCP doses. Two patients have been in complete remission for the last 5 and 7 years of completion of DCP therapy, respectively. Addition of other adjuvants to corticosteroids was also helpful. However, azathioprine 50 mg/day was not as effective as cyclophosphamide 50 mg/day. Menstrual irregularities, amenorrhoea, azoospermia, rise in blood pressure and glycosuria were the major side-effects seen during DCP pulse therapy. Drop out rate was unacceptably high with all modes of treatment, although with DCP therapy it appears to be partly owing to early disease control. There was no mortality in this series.Conclusions  Pemphigus vulgaris is the commonest clinical type. Mucosal surfaces other than the oral cavity are uncommonly involved, it may herald the onset of disease and takes longer to heal. Dexamethasone-cyclophosphamide pulse therapy seems to have a definite advantage over treatment with steroids alone, especially in terms of better control of disease activity, near absence of steroid side-effects and significantly reduced hospital stay. However, ways and means to reduce gonadal toxicity of adjuvants need to be explored as DCP therapy is likely to stay as a treatment of choice.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Oxford, UK; Malden, USA : Munksgaard International Publishers
    Contact dermatitis 51 (2004), S. 0 
    ISSN: 1600-0536
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We describe here a Parthenium hysterophorus patch-test-positive patient with widespread dermatitis of non-airborne contact dermatitis pattern, improving while staying in Shimla (a parthenium-free area) and rapidly worsening while visiting his native place, where there was exuberant parthenium growth. After recovery, inhalation of fresh plant material from a polythene bag resulted in exacerbation of dermatitis and pruritus within 8–10 hr, without any respiratory symptoms. The possible pathomechanism of such a phenomenon is discussed.
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  • 4
    Electronic Resource
    Electronic Resource
    Melbourne, Australia : Blackwell Science Pty
    ISSN: 1440-0960
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This paper describes a case of sparfloxacin-induced photodermatitis associated with photo-onycholysis in a 36-year-old man. He was being treated with sparfloxacin, streptomycin, ethambutol and pyrazinamide for pulmonary tuberculosis. He developed an exaggerated sunburn-like rash over the face and the dorsa of hands and feet, and painful onycholysis of finger- and toe-nails. Withdrawal of sparfloxacin resulted in resolution of the skin rash and nail tenderness.
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  • 5
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    ISSN: 1365-4632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Kindler syndrome is a rare genodermatosis characterized by acral bullae and photosensitivity. The photosensitivity improves with advancing age and results in progressive poikiloderma and cutaneous atrophy, and many additional features have also been described. This report describes two male Kindler syndrome patients with classical features of acral blistering and photosensitivity in childhood, and subsequent development of poikiloderma, leukokeratosis of oro-ano-genital mucosae, phimosis and meatal stenosis. The first patient had additional ophthalmic features of chronic simple conjunctivitis caused by persistent irritation, multiple stromal nebular corneal opacities and thickened corneal nerves. The second patient showed skeletal changes, namely a dome-shaped skull (turri-cephaly), bifid fourth rib, missing fifth rib, short fourth and fifth metacarpals and mandibular abnormalities. This is the first report of such ophthalmic and skeletal features of Kindler syndrome.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1365-4632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background Four patients with chromoblastomycosis are presented. An additional 30 infected Indian patients are reviewed. Results These 34 patients ranged in age from 12 to 80 years with a male to female ratio of 5.8 : 1. Onset before the age of 20 years was seen in 24% of cases which was comparatively high. Culture was positive in 72% of cases and sclerotic bodies were observed in 84% of cases. A relatively higher prevalence (15%) of Fonsecaea compacta was observed. Unusual cutaneous sites afflicted were the penile shaft, vulva, and ala of the nose, and unusual extracutaneous spread was seen in the pleural cavity, ileocecal region, laryngotracheal area, and tonsils. Extracutaneous involvement was seen in 24% of cases. Overlapping infection with another fungus, Geotrichum candidum, was seen in one case. Conclusions Combination therapy with two azoles was attempted with some success for clinical cure.
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  • 7
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    ISSN: 1365-4632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1365-4632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background Pheohyphomycosis is a rare infection caused by dematiaceous fungi, affecting the skin and subcutis, paranasal sinuses, or central nervous system.Methods A case of subcutaneous pheohyphomycosis in the lumbar region is reported. The Indian literature on subcutaneous pheohyphomycosis is also reviewed.Results In India, 23 patients with subcutaneous pheohyphomycosis have been reported, distributed throughout the country in a belt from north to south, sparing the eastern and western regions. The age of the patients ranged from 3 to 60 years, with a male to female ratio of 1.3 : 1. A relatively early age of onset was observed. A history of prior injury was recalled by five patients. The lower extremities were involved in eight cases, upper extremities in five, gluteal region in two, lumbar area and submandibular area in one, face in two and disseminated disease was seen in four cases. Three of these cased died during follow up. Osteomyelitis was observed in two cases, hepatosplenomegaly in one, and lymph node involvement in two. Carcinomatous change developed in a long-standing lesion of 33 years. Thirteen species from seven genera of dematiaceous fungi were isolated. Phialophora dermatidis was the most common isolate.Conclusions Indian patients with subcutaneous pheohyphomycosis are afflicted at an earlier age. Exophiala dermatidis seems to be associated with more fatalities. Treatment with newer azoles seems promising, and excision alone or combined with azoles is a good therapeutic modality.
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