International Journal of Research in Dermatology

Cutaneous leishmaniasis: an enigma of rare clinical presentations

Rohini Sharma — 2025-04-23

Leishmaniasis is a neglected tropical disease caused by leishmania parasite. It is divided into two groups: old world species like L. major, L. infantum, and L. tropica and new world species such as L. amazonensis, L. mexicana, L. panamensis, L. braziliensis, and L. guyanensis. In India, cutaneous leishmaniasis (CL) cases are mostly seen in Rajasthan, Delhi, Himachal Pradesh, Haryana, Jammu and Kashmir with few isolated reports from south India as well. J and K over the past few years has emerged as a hot spot of CL. Although majority of the cases show classical presentation, atypical presentations mimicking various dermatoses are witnessed. As a clinician, we need to have a high index of suspicion to confirm the diagnoses. Moreover, in an endemic area, it is imperative for the physician to be well acquainted that any atypical lesion, especially chronic form, should be investigated for CL.

An overview of students in integrated teaching in undergraduate medical education in Bangladesh

Ridwana Rahman — 2025-04-23

Background: Integrated teaching denotes the integration of different subjects of corresponding phases as well as successive phases of medical education. This newly launched DGME-initiated teaching-learning (T-L) methodology aims to bring evolution to traditionally practiced medical education for undergraduate medical education in Bangladesh. Furthermore, this method is supposed to modify and improve students’ perception of basic knowledge along with prudent association of clinical assessment and expertise. Aim of the study was to evaluate the impact of integrated teaching on first-year MBBS students in terms of academic outcomes and perceptions.

Methods: This cohort study was conducted at the Department of Physiology, Ad-Din Women’s Medical College Hospital, Moghbazar, Dhaka from January 2023 to September 2023. The undergraduate MBBS students (session 2022-23) were enrolled in the study. The outcome of the students was assessed after integrated teaching sessions and the data were recorded through a semi-structured questionnaire. Informed written consent from students was taken. The data from the questionnaires was statistically analyzed and results were obtained using statistical package for the social sciences (SPSS) version 26.

Results: All participants were female, aged 18–21 years, with 39% being international students. Students rated the sessions positively, with 98% agreeing that topics were well-known and 96% confirming sequential delivery by departments. Audio-visual aids (87%) and effective clinical applications (72%) were highlighted as strengths. Areas for improvement included the use of simulated patients (60%) and understanding clinical correlations (58%).

Conclusions: Integrated teaching significantly enhanced students' academic performance and interest in medical education. However, refinement in practical teaching elements, such as simulated patient use, is necessary to maximize its efficacy. These findings support the broader implementation of integrated teaching methodologies in undergraduate medical education.

Integrating Ayurvedic therapies with minoxidil: a randomized, single-blinded, parallel-controlled trial assessing the efficacy and safety of Traya's customized approach for treating male androgenetic alopecia

Sonia Tekchandani — 2025-04-02

Background: Male androgenetic alopecia (MAA) is the most common form of hair loss in men, influenced by genetics, hormonal imbalances, nutritional deficiencies, and stress. While treatments like minoxidil address symptoms, they do not target underlying causes. This study compares the effectiveness of a customized regimen versus minoxidil in treating male pattern hair loss (MPHL) in men with MAA stages 2-4.

Methods: A 6-month, single-blinded, randomized, controlled study with 135 adult males (stages 2-4 MAA) was conducted. Participants were assigned to group A (holistic hair treatment regimen), group B (minoxidil), or group C (placebo). Baseline and follow-up assessments (2, 4, and 6 months) included dermatological and Trichoscan® assessments, imaging, and self-assessment questionnaires.

Results: 6 months of TrichoScan® assessment showed a 3.16-fold increase in hair density for group A compared to group B and 5.82-fold compared to group C. Groups A and B showed significant improvements over group C.

Conclusions: The holistic hair treatment regimen proved to be more effective than minoxidil for treating MAA stages 2-4, offering a promising alternative to traditional treatments.

Efficacy of intralesional immunotherapy with measles, mumps and rubella virus vaccine for the treatment of warts

Thirth Kumar Hemmandanahalli Venkataramanappa — 2025-04-10

Background: The human papillomavirus (HPV) is the cause of warts, which are benign epithelial proliferations. Traditional therapies, such as salicylic acid and cryotherapy, frequently have poor results and a high rate of recurrence. A viable substitute is intralesional immunotherapy using the MMR vaccine, which boosts the host immune system to eradicate HPV-infected cells. The purpose of this study was to assess the intralesional MMR vaccine's effectiveness and safety in treating warts.

Methods: Fifty-two patients with warts participated in a randomized clinical trial. Five intralesional MMR vaccination sessions were given to the participants at two-week intervals. At baseline and following five sessions, wart size and resolution were measured. Throughout the course of the study, adverse effects were observed.

Results: After five sessions, 73.1% of patients had completely cleared their warts. There were no notable systemic side effects, and the most frequently reported adverse effect was mild erythema at the injection site.

Conclusions: The intralesional MMR vaccine is a safe and efficient way to treat warts. It is less expensive than traditional treatments and has a lower chance of recurrence. To verify its long-term effectiveness, more research with bigger sample sizes and longer follow-up times is required.

Thyroid related skin manifestation and their association with autoimmune dermatology

Vartika — 2025-04-23

Background: Thyroid disease is associated with changes in hair, skin and nails. which may sometimes be the first clinical clue. A variety of cutaneous findings may present in the setting of either a hyperthyroid or hypothyroid state. Of all the endocrinopathies that might have cutaneous display of dysfunction, thyroid disorders are presumably the most common. Skin conditions and thyroid autoimmunity are strongly linked, according to convincing evidences alopecia areata and vitiligo have the high incidence. The present study is aimed to study various cutaneous manifestations in thyroid disorders and to know various autoimmune and non-autoimmune dermatologic associations of thyroid disorders.

Methods: This was a Cross-sectional, observational study with sample size of 400 conducted over a period of 18 months starting from August 2022 to February 2024 in S. N. Medical college, Agra, Uttar Pradesh. All patients with thyroid abnormality and cutaneous manifestations are included in the study.

Results: Female preponderance s hypothyroidism hold the major section of thyroid disorders. The most affected age group was 31-40 years. dry skin (67.83%), TE (65.7%) were the commonest symptoms among hypothyroid patients and Warm skin (93.3%) and increased sweating were commonest among hyperthyroid patients. Urticaria (33%) was the most common autoimmune association noted followed by vitiligo (11.75%) and alopecia areata (6.25%) among both hypo and hyperthyroidism patients.

Conclusions: This study shows that various cutaneous manifestations be seen in thyroid patients and significant association with autoimmune dermatological disease.

Triple palm, florid cutaneous papillomatosis and malignant acanthosis nigricans maligna as a first sign of gastric carcinoma

Daniela Martinez Nieves — 2025-04-23

Authors report the case of a 68-year-old male with a history of well-controlled type 2 diabetes mellitus. Five months before his dermatological evaluation, he developed hyperpigmented facial lesions, alopecia, and multiple verrucous lesions on the oral mucosa, palms, and soles. These findings were consistent with acanthosis nigricans, pachydermatoglyphia, and florid cutaneous papillomatosis. The patient also had a 14 kg unintentional weight loss and altered bowel habits over the prior 10 months. Diagnostic workup revealed stage IV gastric adenocarcinoma. The combination of these three paraneoplastic dermatoses is exceedingly rare. Although some hyperpigmented dermatoses are known to be associated with malignancy, the association between pigmented lichen planus and cancer remains undocumented.

Liraglutide-induced oral hyperpigmentation: a case report and review of management strategies

Anhar K. Alzahrani — 2025-04-23

A 41-year-old female patient with no significant past medical history presented with asymptomatic hyperpigmentation of the oral mucosal surfaces, noticed over two months. The onset of hyperpigmentation coincided with the use of Liraglutide injections for weight §mg. The patient was also taking ferrous sulfate supplements for the past two months without prior adverse effects. Physical examination revealed multiple hyperpigmented macules on the bilateral buccal mucosa, lower gingiva, lower alveolar mucosa, and anterior tongue, along with mild lip hyperpigmentation. Laboratory tests, including thyroid function and serology, were normal. Histopathological examination showed chronic interface mucositis. The patient was treated with topical tacrolimus 0.03% cream, applied once daily, resulting in significant improvement within one week. This case suggests a possible link between Liraglutide and oral hyperpigmentation, highlighting the importance of considering medication-induced etiologies in such presentations. Additionally, using lip balm with SPF is recommended to prevent further pigmentation.

Acquired reactive perforating collagenosis in association with non-Hodgkin lymphoma: two case reports of a rare association

Kinjal Rajendrakumar Sankesara — 2025-04-23

Acquired reactive perforating collagenosis (ARPC) is the most common form of acquired perforating dermatoses. These are uncommon and underdiagnosed clinical entities characterised by trans epidermal elimination of degenerate collagen, elastin and other connective tissue components. It primarily affects individuals with underlying systemic conditions, most notably diabetes mellitus and chronic kidney disease, particularly those undergoing dialysis. ARPC presents clinically as pruritic, hyperkeratotic papules and nodules, often with central umbilication or crusting, predominantly appearing on the extremities, trunk and areas subject to repetitive trauma or friction, which are believed to trigger or exacerbate the disease. The pathogenesis remains unclear, but trauma, microangiopathy and metabolic disturbances are thought to contribute to its development. Diagnosis is confirmed through histopathology, revealing collagen extrusion through the epidermis. Despite various therapeutic measures, the curative effect is not satisfactory and symptoms can only be improved rather than cured. Here we report a new observation of ARPC occurring in two patients with non-Hodgkin lymphoma.

Lichen sclerosus et atrophicus and morphea occurring over different sites in a young male: an interesting association

Adapa Pallavi Sai — 2025-04-23

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory disorder primarily affecting the female genitalia, presenting as white, atrophic skin plaques; extra-genital LSA is less common, occurring in about 15% of cases. Morphea, or localized scleroderma, is a rare connective tissue disease that typically presents with sclerotic skin plaques. We report a 15-year male patient with dark coloured itchy lesions over lower back since childhood and left knee since 6 months. Various investigations, including hemogram, serum biochemistry, thyroid profile, lipid profile, viral markers, and histopathological examination, were conducted. Patient was treated with potent topical corticosteroid, antihistamines and methotrexate 10 mg weekly once for 6 weeks with moderate improvement. Common immune-pathogenic mechanisms and trigger factors such as genetic predisposition and trauma may be responsible for development of 2 different immune mediated dermatoses in the same patient.

Decoding skin deposits: a rare case of miliarial gout

Muthusubramanian Chandrasekar — 2025-04-23

Gout, metabolic disorder characterized by hyperuricemia and deposition of monosodium urate crystals in joints, soft tissue, and peri articular tissues causing recurrent arthritis. Here, we present a case of disseminated gout with distinctive cutaneous lesions and systemic comorbidities. A 50-year-old chronic alcoholic male presented with multiple white to yellowish papules with extrusion of chalky white materials all over body with soft tissue swelling over right elbow and distal joints for 3 years with joint pain. On clinical examination, multiple yellowish-white, non-tender, hard papules and nodules on an erythematous base present along the forearms, shoulders, and upper back with discharge of white chalk-like material. There were multiple soft tissue swellings over the right elbow and interphalangeal joints of hands and feet with flexion deformity and limitation of movement. Diffuse grain like aggregations of whitish gritty substance noted over the palms and soles. Musculoskeletal examination revealed swelling, tenderness, and warmth over both ankles, elbows, metatarsophalangeal (MTP), and metacarpophalangeal (MCP) joints. Other systemic and neurological examinations were unremarkable. Investigations showed increased uric acid level. With X-ray and histopathological examination, diagnosis of tophaceous gout (miliary) was made and managed accordingly. Various forms of chronic tophaceous gout have been described: classic periarticular subcutaneous tophi, disseminated intradermal tophi, ulcerative form, and gouty panniculitis. Miliarial gout is an extremely rare form of tophaceous gout that manifests as "milia-like" widely distributed papules containing white to cream-colored material on an erythematous base.

Epidermolysis bullosa acquisita in a 53-year-old female with extensive cutaneous and mucosal involvement

Reddy Siva Sai Manikanta — 2025-04-23

Epidermolysis bullosa acquisita (EBA) is a rare autoimmune blistering disorder characterized by subepidermal blisters, typically caused by an autoimmune response against type VII collagen, a key structural component of the dermal-epidermal junction. Here, we report a case of EBA in a 53-year-old female with extensive multiple bullae, erosions over extremities, trunk, genitaila. HPE revealed a sub-epidermal blister with fibrin, neutrophils, and some eosinophils, DIF showed IgG positivity (+3) in a linear pattern along the dermal-epidermal junction. enzyme immunoassay (EIA) for anti-collagen type VII antibodies was positive. Based on clinical features and investigations patient is diagnosed as Epidermolysis Bullosa Acquisita. She was treated with systemic steroids and topical steroids with gradual tapering. This case highlights the importance of early diagnosis and treatment in managing this condition effectively.

Posterior extension of beaded juxta-clavicular lines

Nikita Narayanan — 2025-04-23

Juxta-clavicular beaded lines are a dermatological condition that typically appears during puberty. It is also called as cutis punctata lineraris colli. It presents as an asymptomatic, linear papular eruption, predominantly affecting the neck and supraclavicular regions. This condition is more commonly seen in individuals of African descent compared to Caucasians, with a notable female predominance. While the exact cause remains unclear, it is thought to be associated with hormonal changes during puberty. Here we presented a case report on a 28-year-old male with juxta clavicular beaded lines over the neck, extending to the back.

Paraneoplastic pemphigus: a rare case

Thota Pravallika — 2025-04-23

Paraneoplastic pemphigus is an autoimmune disorder characterized by recalcitrant blistering, erosive mucocutaneous lesions, associated neoplasm and high titres of “pemphigus-like” anti-cell surface autoantibodies. A 55-years-old male presented to the OPD with fluid filled lesions over the chin region and few crusted lesions over the chin and chest since 10 days. There was a history of carcinoma tongue 6months back for which patient underwent 33 sessions of radiotherapy and chemotherapy. Various investigations, including hemogram, serum biochemistry, thyroid profile, lipid profile, viral markers, serum electrophoresis and histopathological examination, were conducted. Histopathology showed intraepidermal blister formation and DIF showed immune deposits in a linear deposition at DEJ and in a fishnet pattern over keratinised surface. Based on history and thorough examination, the case was diagnosed as Paraneoplastic Pemphigus. Patient was treated with oral corticosteroids, oral and topical antibiotics and complete resolution of all skin lesions and with residual pigmentary changes was seen after 4 weeks.