Background: Topical corticosteroids are the most commonly used drug and mainstay of dermatotherapeutics for many dermatoses. Topical corticosteroids are irrationally combined with other medications and widely available as the over the counter preparations (OTC) and are widely misused for various conditions. Dermatophytosis is a superficial fungal infection which is becoming resistant and difficult to treat because of inappropriate usage of irrational combination of topical corticosteroid containing preparations (ICSP). Aims and Objective: To study the prevalence and factors which promotes the abuse of Irrational combination of topical corticosteroid containing preparations(ICSP) in dermatophyte infection. Materials and Methods: A Prospective observational study conducted at department of Dermatology, Venereology & Leprosy in a tertiary care centre, South India. The sample size of this study is n=55. Results: Out of 55 patients most common age group is 15 -30 years (n=16,29.09%).Females (n=30,54.54%) predominated over males with male:female ratio of 0.83:1.The most common complaint was intractable itching (n=46,83.64%) .The majority of study group had disease duration was 0-1 months (n=27,49.1 %) with mean duration of 4 months. The main source of referral was Over the counter (OTC) (n=32,58.18%). The most common irrational combination was FDC 3 combination(30.9%). Most commonly abused brand was betnovate GM(n=17,30.9%).Most of the patients used Clobetasol propionate 0.05% (n=25,45.5%).Patients were using ICSP mostly for less than 1 month (n=27,49.1%),with intermittent(n=19,34.5%) frequency of application. Most common side effect was tinea incognita (n=33,60%).Potassium hydroxide mount was positive in 25 patients(45.45%).Fungal culture was done in all patients and 12 patients(21.81%) showed growth. The commonest organism isolated among culture positive specimen was Trichophyton rubrum(12.72%). Conclusion: Inappropriate usage of irrational combination of topical corticosteroid containing preparations (ICSP) in dermatophyte infection induces short term clearance whereas the long term side effects results in variable presentation. Awarness of this problem leads to prevention of steroid modified dermatophytosis which is the rising menace.
To evaluate the repigmentation with non-cultured epidermal cell suspension followed by PUVA in patients with stable vitiligo. Materials and Methods: A prospective study conducted at the department of Dermatology, Venerology, Leprosy of Rajah Muthiah Medical College and Hospital. 26 cases of stable vitiligo were treated with non-cultured epidermal cell suspension followed by PUVA and were reviewed for a period of 20 weeks. Results: The results were assessed subjectively. 9 (34.6%) patients showed excellent response to our therapy, 7 (26.9%) patients had good response, 5 (19.3%) patients showed fair response and 3 (11.5%) showed very poor response. 17 (65%) patients showed a very good colour match when compared with the surrounding skin and 1 (3.8%) patients showed donor site scarring. Conclusion: Epidermal non cultured cell suspension followed by PUVA is a relatively safe method with superior quality of repigmentation.
Introduction:With the advent of pulse therapy and adjuvant immunosuppressive drugs, the outcome and prognosis of vesicobullous disorders have been improved to a greater extent. Different regimen protocol has been tried and this descriptive study was carried out to assess the outcome of various pulse therapy regimens in vesicobullous disorder at our centre. Methods: A total of 26 vesicobullous patients were enrolled for the study. Diagnosis was made clinically and confirmed by histopathology. They received treatment with Dexamethasone-Cyclophosphamide pulse (DCP) or Dexamethasone -Azathioprine pulse (DAP) or Dexamethasone pulse (DP) therapy and were followed up for clinical remission and side effects of therapy. Results: There was a total of 26 patients comprising 69.23% females and 30.77% males and 50% were between the age group of 40-50 years. Pemphigus vulgaris was the commonest clinical type seen in 69.23%.DCP was given for 22(84.62%) patients, dexamethasone pulse in 3(11.54%) and DAP in one (3.85%). In DCP group 77.27% of patients were in Phase I and 22.73% achieved clinical remission. One patient was refractory to DCP and required rituximab infusion. Weakness, headache, vomiting and weight gain were the commonest side effects encountered in our study. Avascular necrosis of femur and reactivation of pulmonary tuberculosis were the major side effects noticed in one patient each. Conclusion: DCP therapy prove to be an excellent therapeutic regimen in case of vesicobullous disorders to attain faster recovery sparing the adverse effect of corticosteroids. DAP can be an useful therapeutic option in patients who were unmarried or in reproductive age group.
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