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: 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.

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: 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.