Background: Chronic dermatophytosis is an increasingly prevalent and therapeutically challenging condition in India. Rising cases of treatment failure and relapse have prompted concerns about antifungal resistance. Understanding the antifungal susceptibility patterns of dermatophytes is essential to guide effective therapy.

Objectives: To isolate and identify dermatophytes from patients with chronic tinea infections and determine their antifungal susceptibility profiles.

Materials and Methods: This prospective study was conducted over a one-year period (July 2023 to June 2024) at a tertiary care teaching hospital in Central India. Clinical specimens (skin, hair, and nail samples) from patients with chronic dermatophytosis (defined as tinea infection persisting for more than six months) were processed by direct microscopy and cultured on Sabouraud Dextrose Agar with and without cycloheximide. Dermatophytes were identified using standard morphological methods. Antifungal susceptibility testing (AFST) was performed using the CLSI M38-A2 broth microdilution method for terbinafine, itraconazole, griseofulvin, fluconazole, ketoconazole, and voriconazole.

Results: Out of 220 clinical samples, 158 (71.8%) were positive for dermatophytes. Trichophyton mentagrophytes complex (58.2%) was the predominant isolate, followed by T. rubrum (28.4%). High minimum inhibitory concentrations (MICs) were observed for griseofulvin and fluconazole, whereas terbinafine and itraconazole showed better in vitro activity. A concerning proportion of isolates showed reduced susceptibility to multiple antifungal agents, particularly terbinafine.

Conclusion: The study highlights a shift in the epidemiology of chronic dermatophytosis, with dominance of T. mentagrophytes complex and emerging antifungal resistance. Regular surveillance of antifungal susceptibility and judicious antifungal use are crucial for effective management of chronic tinea infections.

Introduction: Vitiligo is an acquired pigmentary disorder of unknown origin that poses not just cosmetic concerns but presents a major psychological burden due to its visible and chronic nature. It often leads to stigmatization, poor self-image, and psychiatric comorbidities like depression and anxiety. Despite the high psychological impact, there is a paucity of literature from North India assessing these mental health outcomes in vitiligo patients.

Objective: To assess the prevalence and severity of anxiety and depression in patients with vitiligo and explore its association with disease severity and quality of life (QOL).

Methods: A cross-sectional study was conducted on 40 vitiligo patients at a tertiary care hospital in North India. The Vitiligo Area Severity Index (VASI) was used to measure disease severity. The Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A) were used for psychological assessments, and WHOQOL-BREF was used for evaluating QoL. Statistical analysis included descriptive data, Pearson correlations, and group comparisons.

Results: 50% of patients had mild depression, 30% moderate, and 5% severe. 62.5% had clinically significant anxiety symptoms. VASI showed a significant positive correlation with both HAM-A and HAM-D scores (p < 0.05) and a negative correlation with WHOQOL-BREF domains, especially psychological and social health. Unmarried participants had significantly higher levels of depression and anxiety than married ones (p < 0.05). No significant gender differences were noted.

Conclusion: Vitiligo significantly compromises psychological well-being and quality of life, especially in patients with greater disease severity. Routine mental health screening and a multidisciplinary treatment approach are strongly recommended for holistic care.

Background: Cutaneous mucormycosis is a rare but aggressive fungal infection typically associated with immunocompromised states, particularly uncontrolled diabetes mellitus. The disease can rapidly progress to systemic involvement, requiring prompt diagnosis and intervention.

Case Presentation: A 33-year-old male with no prior medical history presented with right lower limb swelling, ulcerations, and blistering. He was found to have newly diagnosed diabetes mellitus. Despite fasciotomy and broad-spectrum antibiotic therapy, the condition progressed to necrotizing fasciitis requiring a guillotine amputation. Histopathology revealed broad, aseptate, right-angled branching fungal hyphae consistent with mucormycosis. Bacterial cultures grew Proteus mirabilis and Escherichia coli. The patient deteriorated due to septic shock and multi-organ dysfunction and succumbed despite intensive care.

Investigations: Elevated renal parameters and electrolyte imbalances were noted. Histopathology confirmed cutaneous mucormycosis. Culture reports showed a polymicrobial bacterial infection.

Intervention: Right above-knee guillotine amputation, supportive care, antifungal and antibiotic therapy.

Outcome: Despite surgical and medical management, the patient died due to complications of septic shock and multi-organ failure.

Conclusion: Cutaneous mucormycosis, although rare, should be considered in patients with rapidly progressive necrotizing soft tissue infections—even in the absence of classical signs such as black eschar. This case highlights the importance of early recognition, timely histopathological examination, and prompt surgical and antifungal management to improve outcomes.

Background:

Chronic Spontaneous Urticaria (CSU) is a persistent skin disorder characterized by recurrent wheals, angioedema, or both, lasting for at least six weeks without an identifiable trigger. CSU significantly affects patients’ quality of life, often causing sleep disturbances, emotional distress, and reduced work productivity. First-line treatment involves second-generation H1-antihistamines, but many patients remain refractory to standard doses, necessitating dose escalation or antihistamine switching.

Objective:

This study aims to evaluate the efficacy of three second-generation antihistamines—Fexofenadine, Levocetirizine, and Desloratadine—in CSU management, focusing on symptom relief, dose escalation, antihistamine switching, and adverse effects.

Mehods:

A prospective, observational study was conducted on 300 CSU patients at a dermatology outpatient clinic. Patients were initially treated with standard doses of Levocetirizine (5 mg), Desloratadine (5 mg), or Fexofenadine (180 mg). Non-responders underwent a stepwise dose escalation up to fourfold. Patients who remained symptomatic despite escalation were switched to a different antihistamine. Symptom severity was assessed using the Urticaria Activity Score (UAS), and adverse effects were monitored over a six-month follow-up period.

Results:

Fexofenadine demonstrated superior efficacy, with 87% of patients achieving symptom relief after fourfold dose escalation, compared to 38% with Levocetirizine and 15% with Desloratadine. Antihistamine switching yielded a 31.5% response rate among non-responders, with the highest success observed when switching from Desloratadine to Levocetirizine (18.5%). Fexofenadine showed the greatest reduction in UAS at one-week (50%) and three-week (75%) follow-ups (p<0.05). Adverse effects were minimal, with headaches more common in the Fexofenadine group, while drowsiness was prevalent in Levocetirizine and Desloratadine groups.

Conclusion:

Fexofenadine is the most effective antihistamine for CSU management, particularly at higher doses. Dose escalation significantly improves symptom control, while antihistamine switching benefits a subset of non-responders. Personalized treatment strategies considering patient-specific responses can enhance clinical outcomes in CSU. Future research should focus on biomarker-based therapy and combination treatments to optimize CSU management.

Background: Chronic granulomatous disease (CGD) is a rare, potentially life-threatening primary immunodeficiency caused by defects in the NADPH oxidase complex, leading to impaired phagocytic function and recurrent bacterial and fungal infections. Neonatal onset is extremely uncommon and may present with atypical, severe manifestations.

Case Presentation: We report a male neonate presenting at 44 days of life with persistent fever, nasal regurgitation of feeds, severe perianal excoriation, and necrotic palatal ulceration. Laboratory evaluation revealed leukocytosis, elevated C-reactive protein, and blood cultures positive for Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Galactomannan ELISA suggested concomitant Aspergillus infection despite a negative KOH mount. Dihydrorhodamine (DHR) assay demonstrated a markedly reduced neutrophil oxidative index (3.4%), confirming CGD. The patient was managed with targeted intravenous antibiotics, surgical debridement, and initiation of prophylactic cotrimoxazole.

Conclusion: This case illustrates an unusual neonatal presentation of CGD with extensive necrosis involving the hard palate, nasal septum, and perianal region, highlighting the heterogeneity and diagnostic challenges of early-onset disease. Prompt recognition via DHR assay is essential for timely prophylactic therapy and multidisciplinary management. Awareness of such atypical presentations may facilitate earlier diagnosis, guide intervention, and improve neonatal outcomes. Longitudinal studies are warranted to clarify prognostic implications and optimize management strategies in extremely early-onset CGD.

Context: - Hypertensive disorders of pregnancy constitute one of the leading causes of maternal and perinatal mortality worldwide. It has been estimated that preeclampsia complicates 2–8% of pregnancies globally. Βeta human chorionic gonadotropin (βhCG) is secreted mainly from placenta and it is elevated in mid trimester in patients who develop PIH later on.11,12 Keeping in view the present study was planned to estimate serum βhCG during 14-20 weeks of pregnancy with the aim to investigate the role of serum βhCG level as predictors of gestational hypertension and preeclampsia.

Objectives: To investigate the role of serum βhCG at 14-20 weeks of gestation as predictors for the development of gestational hypertension and preeclampsia & to access Accuracy of serum βhCG in predicting gestational hypertension and preeclampsia at different values of βhCG

Material & Methods:  A prospective cohort study was conducted in the Department of Obstetrics and Gynaecology in collaboration with Department of Clinical Biochemistry and Laboratory Medicine of VMMC and Safdarjung Hospital, New Delhi.  The study group included 150 pregnant women attending the ANC OPD; the sample size was calculated assuming alpha to be 0.05 and power of study to be 90%.  For the analysis, the study group (n=150) was divided into 2 groups on the basis of   the subsequent development of hypertension (with and without proteinuria). Cases(n=20): Women who subsequently developed gestational hypertension or preeclampsia were included in the case group and were labelled as the hypertensive group. Controls (n=130): Women who remained normotensive till delivery were included in the control group and were labelled as normotensive group. The obstetrical examination was done at every visit to note fetal growth and wellbeing.  Besides routine antenatal investigations, βhCG profile was done between 14-20 weeks of gestation from the central hospital laboratory. All the women were monitored for the development of gestational hypertension /preeclampsia and were followed up till delivery.

Results & Conclusion: Serum βhCG at 14-20 weeks of gestation is a good predictor for the subsequent development of hypertension (PE/GH) in pregnancy. At an acceptable sensitivity of 85%, the value of βhCG obtained from ROC curve is 57,226 mIU/ml. The accuracy of this value in predicting hypertension is 96.67%.

Background: Leprosy continues to be an important public health concern in India, and chronic ulcers remain one of its most disabling complications. Secondary bacterial and fungal infections are frequent in these ulcers, contributing to delayed wound healing, recurrence, and disability. Limited regional data exists from Northern Karnataka regarding the microbiological spectrum of these infections and their impact on ulcer healing.

Objectives: To study the spectrum of bacterial and fungal infections in leprosy patients with ulcers and to evaluate their influence on ulcer healing outcomes.

Methods: A prospective observational study was conducted in the Department of Microbiology, in collaboration with the Department of Dermatology, Venereology & Leprosy, M. R. Medical College and Basaveshwar Teaching and General Hospital, Kalaburagi, from January to June 2025. A total of 100 leprosy patients with ulcerative lesions were enrolled. Ulcer samples were subjected to bacterial culture, antibiotic susceptibility testing (CLSI 2024 guidelines), and fungal culture. Patients were followed up for eight weeks to assess healing. Statistical analysis was performed using SPSS v26, with p < 0.05 considered significant.

Results: Pseudomonas aeruginosa (33.8%) and Staphylococcus aureus (28.7%) were the predominant bacterial isolates, while Candida albicans (46.7%) was the most common fungal isolate. Gram-negative bacilli showed high resistance to cephalosporins and fluoroquinolones but retained sensitivity to carbapenems and piperacillin-tazobactam. S. aureus isolates were uniformly sensitive to vancomycin and linezolid, though methicillin resistance was noted. Ulcers without infection healed in a mean of 4.2 weeks, whereas those with bacterial, fungal, and mixed infections required 7.1, 6.8, and 9.3 weeks, respectively. Mixed infections had the poorest outcomes, with only 50% achieving complete healing (p < 0.05).

Conclusion: Secondary bacterial and fungal infections significantly delay ulcer healing in leprosy patients, with mixed infections having the worst prognosis. Routine microbiological evaluation, including fungal studies, along with targeted antimicrobial therapy, is essential for improving healing outcomes and preventing disability in leprosy.

Background: Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disorder, predominantly affecting the elderly. Healing usually occurs with post-inflammatory hyper- or hypopigmentation, but the development of milia is rare and more often associated with epidermolysis bullosa acquisita (EBA).

Case Presentation: We report a 60-year-old woman with chronic bullous pemphigoid, who, during the healing phase, developed widespread and numerous milia diffusely involving the trunk and extremities. Milia were present over more than 40% of body surface area, with hundreds of dome-shaped pearly white papules ranging from 1–5 mm, clustered over previously involved sites, including the arms, legs, dorsum of feet, trunk, and peri-umbilical region. Diagnosis was confirmed by skin biopsy demonstrating keratin-filled cysts.

Conclusion: Milia formation, although uncommon in BP, may occur extensively and mimic other immunobullous disorders such as EBA. Awareness of this rare sequela is essential to avoid diagnostic confusion and to guide appropriate patient counseling

Leprosy reactions are acute exacerbations of the signs and symptoms of leprosy occurring during the natural course of the disease and during or after treatment. Left untreated or improperly managed, reactions can lead to severe nerve function impairment and subsequent disabilities. Leprosy reactions continue to pose a significant and enduring challenge. Type 1 leprosy reaction and type 2 leprosy reaction are substantial contributors to nerve impairment and the subsequent development of enduring impairments. We are reporting a case of Concurrent Lepra reactions (Mixed type 1&2) in an 18-year-old male patient and its histopathological correlation.