IntroductionProbiotics exhibit widespread effects on homeostasis and immunomodulation of both mucosal and systemic immunity. Probiotics counter weight aggressive commensals in the body and reinforce the barrier function of the epithelium while also contributing to the regulation of innate and adaptive immune responses of the host under healthy or pathogenic conditions. Probiotics could be used for prevention or treatment of chronic allergic and inflammatory diseases, such as inflammatory bowel disease (IBD) and atopic dermatitis. We describe a case of pustular psoriasis where probiotics were used for the treatment successfully.
Case ReportA 47yr old female, presented with crops of pustules all over her body since 20 days. The rashes started over the leg and rapidly progressed to the whole body. The rashes were associated with pain. Patient had fever and arthritis of both knees. There was no photosensitivity. Patient was a known case of psoriasis since 15 years. She was on treatment with different medications both topical and systemic. She was given Methotrexate 2yrs back for 6 months and since then she was on irregular treatment. The patient was anxious, looked very ill and was febrile. General physical examination showed bilateral pedal edema. On cutaneous examination there was diffuse erythema with areas of pustules over extensor aspect of upper and lower limbs, abdomen and chest ( Fig. 1, 2). Multiple scaly plaques were present over the scalp. Axilla and groins had no lesions. Nails showed pitting with subungual hyperkeratosis. Palms and soles were normal. Systemic examination was within normal limits.Her random blood sugar was 220mg/dl, triglycerides were 344mg/dl, C-Reactive Protein was positive, total protein was 5.6g/dl and albumin was 3g/dl. Ultrasonography of the abdomen did not show any significant abnormality. On the basis of history, clinical examination a diagnosis of pustular psoriasis was made. The patient was admitted and put on steroids, dapsone and as she was already on methotrexate, it was continued with supplementation of analgesics and antipyretics. But even after two weeks she did not respond and her lesions kept increasing and her blood sugar increased. She started developing signs of steroid toxicity. We were forced to withdraw steroids. As she could not afford biologics we had to look for alternative medicines.With anecdotal reference [4] of probiotics helping palmoplantar pustular psoriasis and their usefulness in atopic dermatitis, we thought of trying the regimen after obtaining consent from the patient. The patient was put on Lactobacillus, one sachet thrice daily with biotin 10mg once daily. All the other drugs were stopped forthwith. In fifteen days the fever subsided, lesions started involuting and no new lesions appeared (Fig. 3, 4). The patient's general condition also showed improvement. Blood sugar level dropped. She was continued with the same treatment and after six months follow up she is free of lesions and she is being followed up for possible recurrence. Her plaque psori...
Introduction: Topical corticosteroids (TCS) are widely misused. Uncontrolled use of steroids can cause undesirable adverse effects especially on face. Aim: The aim of this study was to assess the skin manifestations of TCS misuse over the face in the patients attending dermatology outpatient and to analyze various factors contributing to such misuse. Methods and Methods: A total of 200 patients with facial dermatoses using topical steroids over face for minimum period of 1 month, reported between June 2010 and May 2011 were enrolled in the study. Details about the usage of topical corticosteroids and their side effects were recorded. The patients were educated about the misuse. Results: Majority of the patients were females (71%). The most common reason for misuse was acne (61%) followed by use as a fairness cream (23%). The average duration of usage was 6 months to 1 year, longest being 8 years. The drug most commonly misused was Betamethaone Valerate (71%). The commonest side effect noted was acne form eruptions (52%) followed by steroid dependent face (SDF) (36%). There were no cases of allergic contact dermatitis or perioral dermatitis. The exacerbation of the lesions on stoppage of steroid cream (90%) fairness effect (10%) were the reasons for continued use. (100%) were unaware of side effects of topical steroids. Conclusions: Steroids have been misused by patients on their own or by doctors for various reasons. Hence the awareness about their correct usage is essential.
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