Ayurvedic Management on Vicharchika- A case study

Vicharchika is often correlated to eczema based on the clinical presentation. Eczema is a form of dermatitis. As per Ayurvedic texts Vicharchika is characterized by symptoms namely kandu (itching), srava (discharge), pidaka (vesicles) and shyava vrana (discolouration). No satisfactory treatment is available in contemporary medical practice except antihistamines and topical steroids. A 55 years old female patient approached to OPD with chief complains of discharge, edema, erythematous skin lesion and intense itching at right ankle region. Line of treatment plan was Raktamokshana as shodhana upkarma and Shaman aushadhi according to dosh dushya samurchana. Remarkable improvement was observed within span of 30 days of commencement of treatment.

The Confusion between Pustular Psoriasis and Acute Generalized Exanthematous Pustulosis as a Cause of Exfoliative Dermatitis: A Case Report

Background: Pustular psoriasis and Acute Generalized Exanthematous Pustulosis (AGEP) are grouped under pustular diseases, in which their clinical manifestations are similar. Those diseases can lead to exfoliative dermatitis. Purpose:To evaluate a specific histopathological examination in differentiating Pustular Psoriasis and AGEP. Case: A 55-year-old woman presented with sudden redness and diffused scaly skin with multiple pustules and also fever. She had taken Cefadroxil 2 days before the scales and pustules appeared. Leukocytosis and histopathological examination results from biopsy supported the diagnosis of AGEP. The patient was then hospitalized and received steroid therapy. Within the first week of tapering off, the scales disappeared but the pustules increased. After such clinical findings, the histopathological examination results were revisited and reassessed. Thus, we considered changing the diagnosis to Pustular Psoriasis, and the therapy was switched to Methotrexate. The patient had a better outcome, and the pustules slowly disappeared entirely. Discussion: It is often difficult to differentiate between the pustules in pustular psoriasis and AGEP unless by thorough history-taking and physical examinations. AGEP is characterized by a widespread of pustules with an acute febrile onset; while pustular psoriasis is an acute variant of psoriasis where pustules are spread over erythematous skin and accompanied by high fever and leukocytosis. Conclusion: Histopathological examination is the gold standard for the establishment of pustular psoriasis diagnosis. The histopathological characteristics of pustular psoriasis and AGEP are difficult to differentiate. Therefore, we need detailed history-taking and physical examination to establish the diagnosis.

P082 Appendicular syndrome revealing Kawasaki-like syndrome: a case report

Background With the wide spread of the current SARS-CoV-2, It was found that about 2% of children was affected according to several studies, However, a small number of children with Covid-19 develop a significant systemic inflammatory response similar to Kawasaki disease, a new disease entity called multisystem inflammatory syndrome. Methods A 12-year-old child, without a notable pathological history, who presented to the emergency, during the SARS-CoV-2 pandemic, for management of a pseudo-appendicular syndrome. Our patient was initially assessed by the surgical team due to his query acute abdomen. The pain had been evolving for 3 days associated with several episodes of bilious vomiting in a context of fever at 38.5°. Abdominal examination noted abdominal tenderness and defence. Extradigestive signs were not reported, The Lab Testing objectified a CRP at 235, elevated white blood cells at 18 180, an abdominal ultrasound was requested returning without particularities. Faced with the persistence of bilious vomiting, surgical exploration was indicated objectifying a catarrhal appendix. A pediatric opinion was requested, the clinical examination shows conscious child who presents infra cervical lymphadenopathy with a fever at 38 associated with an erythematous skin rash on the back and aseptic conjunctivitis. The Lab Testing objectified an important inflammatory syndrome, a acute kidney and heart failure a Covid 19 serology was requested with positive IGG, négative IGM, PCR covid test was negative, given the unavailability of In immunoglobulins, the treatment was based on corticosteroid bolus then relay by oral corticosteroid associated with an anti-inflammatory treatment, gastric protection by proton pump inhibitors, treatment of heart and acute kidney failure. The evolution was marked by clinical and biological improvement Discussion Coronavirus 2 (SARS-CoV-2) infection among children and adolescents, is mainly responsible for mild respiratory symptoms, in contrast to the severe forms reported in adults [7]. A systemic inflammatory syndrome mimicking kDa, temporally associated with infection with SARS-CoV-2 (Kawa-COVID-19) has recently been described as a serious illness sometimes requiring intensive care (44%). The median age is older (> 5 years), the frequency and severity of myocarditis are very different from classic kDa, abdominal pain and/or diarrhea were more frequently (81%) reported than in classic kDa, heart failure, pneumonia, neurological and renal impairment, associated with elevated CRP, hyperferritinemia are more common in Kawasaki-Like syndrome [10]. Some investigations must be systematically realized urgently to diagnose potentially fatal complications. These include testing for myocarditis, patients should benefit from careful monitoring and treatment with IV Ig 2 g/kg should be administered rapidly and seems to be effective in the majority of cases, associated anti-inflammatory therapy, such as steroids is necessary Conclusion Pediatricians should be aware of these atypical presentations of COVID-19 infection for early diagnosis.

Asymmetrical erythematous rash secondary to subcutaneous emphysema

Subcutaneous emphysema is a frequent post-operative complication. Although many cardiorespiratory complications associated with subcutaneous emphysema has been described, skin rashes have not been described as a complication. We present a case of asymmetrical erythematous skin rash secondary to subcutaneous emphysema. To the best of our knowledge this association has not been reported before. It is important to recognise cutaneous changes such as skin rash as a potential complication of subcutaneous emphysema and avoid inappropriate management and prolonged hospital stay. complication.

Psoriasis epidemiology screening tool (PEST) is useful for the detection of psoriatic arthritis in the Japanese population

Psoriasis is a chronic inflammatory skin disease that involves various systemic organs and tissues and is characterized by scaly erythematous skin. Among the different types of psoriasis, psoriatic arthritis (PsA) is frequently reported, and occasionally develops into severe arthritis leading to joint dysfunction. There are various tools, especially questionnaires, to identify the presence of PsA in European and American populations; however, little is known about the utility of these tools in the Asian population. In this study, we investigated the utility of a representative tool, the psoriasis epidemiology screening tool (PEST) questionnaire, to identify PsA among Japanese patients with psoriasis. A total of 143 patients with psoriasis were enrolled in this study. Among them, 29 patients were diagnosed with PsA. The frequency of PsA was significantly increased in patients with PEST scores > 3, with a sensitivity of 93.1% and a specificity of 78.9%. Among the questions in the PEST questionnaire, “Have you ever had a swollen joint?” showed the highest frequency to answer “Yes” among patients with PsA. Univariate and multivariate analyses revealed that high PEST scores (> 3) was an independent variable in PsA patients. Taken together, our study suggests that the PEST questionnaire is a useful tool to identify PsA among Japanese patients with psoriasis.

Erythrodermic Manifestation due to Hyperinfestation of Scabies

Background: Scabies is a highly contagious skin disease with various skin clinical presentations. In consideration of its clinical presentations, proper early-onset diagnosis of scabies may not be met, leading to mistreatment and more severe scabies, Norwegian (crusted) scabies. Purpose: To report a case of Norwegian scabies misdiagnosed as eczema in a previously immunocompetent patient. Case: A 32-year-old man was admitted with generalized erythematous skin rash, pruritic, and hyperkeratotic scales of the body. He was previously diagnosed with eczema two months ago and was prescribed both topical and systemic steroid. Skin scales worsened and kept expanding after the treatment. There was a family history of nocturnal itch. Dermoscopic and microscopic examination from skin lesion and scraping with potassium hydroxide revealed the signs of scabies infection. Discussion: Norwegian scabies could be prevented by the correct diagnosis at the early-onset of the disease. Misdiagnosis due to various skin clinical presentations, leading to mistreatment of the infection. In this case, family history plays a role that could elucidate the presence of scabies infection. Conclusion: A correct diagnosis and treatment for the early-phase scabies-infected patient will be beneficial for the patient to prevent hyperinfestation of scabies mites. Specific examination for scabies decreases the possibility of misdiagnosis.

COVID-19 Related Acro-Ischemic Neuropathic-like Painful Lesions in Pediatric Patients: A Case Seriese

Background: A variety of skin manifestations have been associated with COVID-19 infection. Acral lesions on hands and feet, closely resembling chilblains, have been reported in association with COVID-19, which are nonspecific. These acro-ischemic painful lesions have been described mainly in asymptomatic and mildly symptomatic pediatric COVID-19 positive patients, without a precise pathogenetic mechanism.COVID-19-induced chilblains may portend an indolent course and a good outcome. In young patients, the IFN-1 response induces microangiopathic changes and produces a chilblain lupus erythematosus-like eruption with vasculitic neuropathic pain features. Objectives: This paper presented a case series of pediatric patients with COVID-19-related skin lesions and neuropathic-like pain. Methods: Clinical outcomes were collected from 11 patients diagnosed with painful erythematous skin lesions with neuropathic-like pain and positive IgG for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: It is a mildly symptomatic condition not related to severe pain rates, and it is treated with paracetamol due to the transitory nature of the problem, which provides good results. Conclusions: A particular point of interest is skin lesion manifestation as a further indirect sign of SARS-CoV-2 infection. Due to the initial manifestation of chilblains in pauci-symptomatic pediatric patients, they need to be immediately tested and isolated. Chilblains can be considered a clinical clue to suspect SARS-CoV-2 infection and help in early diagnosis, patient triage, and infection control.

Evaluation of Erythema Severity in Dermatoscopic Images of Canine Skin: Erythema Index Assessment and Image Sampling Reliability

The regular monitoring of erythema, one of the most important skin lesions in atopic (allergic) dogs, is essential for successful anti-allergic therapy. The smartphone-based dermatoscopy enables a convenient way to acquire quality images of erythematous skin. However, the image sampling to evaluate erythema severity is still done manually, introducing result variability. In this study, we investigated the correlation between the most popular erythema indices (EIs) and dermatologists’ erythema perception, and we measured intra- and inter-rater variability of the currently-used manual image-sampling methods (ISMs). We showed that the EIBRG, based on all three RGB (red, green, and blue) channels, performed the best with an average Spearman coefficient of 0.75 and a typical absolute disagreement of less than 14% with the erythema assessed by clinicians. On the other hand, two image-sampling methods, based on either selecting specific pixels or small skin areas, performed similarly well. They achieved high intra- and inter-rater reliability with the intraclass correlation coefficient (ICC) and Krippendorff’s alpha well above 0.90. These results indicated that smartphone-based dermatoscopy could be a convenient and precise way to evaluate skin erythema severity. However, better outlined, or even automated ISMs, are likely to improve the intra- and inter-rater reliability in severe erythematous cases.

Mistaken identity: an unexpected case of spontaneous cholecystocutaneous fistula formation

We describe the case of a 78-year-old woman who presented to the emergency department with a 2-week history of a superficially developing mass in the lower right abdominal wall, fluctuant and non-tender with overlaying erythematous skin changes. Though resembling an abdominal wall abscess and initially listed for a simple incision and drainage, diagnostic uncertainty encouraged further investigation. CT and ultrasound confirmed the mass appeared to be in continuity with the gallbladder fossa, with the lumen also containing small bowel medially. While awaiting a multidisciplinary team discussion, the patient re-presented with concern over discharge appearing at the site of the mass. On inspection, we noted black flecks and small stones. This case describes the unusual and rare presentation of a cholecystocutaneous fistula. The patient was managed conservatively and remains clinically well.

Concurrent development of HIV-negative Kaposi’s sarcoma and mycosis fungoides in an elderly Inuit from Canada

An 88-year-old Inuit man from Northern Canada presented with an extensive skin rash associated with numerous violaceous skin nodules on his palms and lower extremities. Biopsy of a skin nodule revealed Kaposi’s sarcoma (KS), a human herpesvirus 8 (HHV8)-associated malignancy, whereas biopsy of the erythematous skin showed an atypical infiltrate of CD4-positive T-cells that, together with TCR gene rearrangement and presence of clonal T-cells in peripheral blood by flow cytometry, was consistent with a T-cell lymphoma, mycosis fungoides (MF) subtype. Serology was negative for HIV and HTLV-I/II and no immunodeficiency syndrome was identified. The patient was successfully treated with an oral retinoid for KS, and with topical hydrocortisone and ultraviolet B (UVB) phototherapy for MF. This case highlights the existence of HHV8-related lesions in native persons of Northern Canada, and also that MF-induced immunosuppression combined with immunosenescence may play a role in the development of non-HIV-related KS.