Hand, foot and mouth disease (HFMD), an acute viral illness caused by coxsackieviruses or enteroviruses, is predominantly encountered in children under 10 years of age. Although it is usually self-resolving, there are a few rare cases which have an extremely aggressive clinical presentation and need to be treated on a priority. Many affected children present with florid or unusual lesions; are highly febrile, with high irritability or listlessness; and also refuse to eat. Such cases could be considered as severe ones. With no specific effective antiviral available to tackle HFMD cases, acyclovir may be used in severe cases for its antiviral effect. We describe three such cases of HFMD in children, treated with oral acyclovir, with gratifying results.

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Pruritus is an unpleasant subjective sensation evoking a desire to scratch. It is commonly encountered in dermatological diseases but could be a signaling symptom of several systemic disorders. Chronic refractory pruritus of systemic origin is often unresponsive to antihistamines and glucocorticoids due to multiple underlying mechanisms. Holistic approach is usually needed to address the stubborn symptom.This review will focus on various topical and systemic pharmacological agents used in the management of pruritus of systemic origin.

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Background: Cutaneous adverse drug reactions (CADRs) are common, comprising 10%–30% of all reported adverse drug reactions (ADRs) and its incidence in hospitalized patients is 2%–3%. Aims: The aim is to study the different clinical spectrum of CADRs in outpatient and inpatient and to find out the offending drug. Settings and Design: A prospective observational, nonrandomized hospital-based study was conducted at a tertiary care hospital over a period of 12 months. Materials and Methods: Patients presenting with suspected drug-related cutaneous lesions were included if drug identity could be ascertained. Clinical profiling was done. The severity of the reaction was assessed using modified Hartwig and Siegel ADR severity assessment scale. Statistical Analysis Used: Data were analyzed using Stata Version 13. Results: Out of the total study population, most commonly observed cutaneous ADRs were fixed drug reaction in 28.75%, followed by maculopapular drug rash in 26.3%, and urticarial rash in 20.6%. Few less frequently observed CADRs were a lichenoid eruption, acneiform eruption, and baboon syndrome, generalized pruritus, pityriasis rosea, and vasculitis. Antimicrobials accounted for 37.5% of the total followed by nonsteroidal anti-inflammatory drugs 25%, anti-epileptics 12.5%, and antifungal 6.25%. Anti-retroviral therapy contributed 3.125%, whereas 1.875% were due to Anti-Koch's therapy. About 28.1% of patients were taking monotherapy, whereas 71.9% of patients were received polytherapy. Conclusions: Wide spectrums of drug reaction were observed in this study. Sound knowledge of these drug eruptions may help the clinician to diagnose and effectively manage their cases. Polypharmacy is a well-known predictor of ADRs in children and adults.

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Lymphangioma circumscriptum is a congenital lymphatic malformation of superficial lymphatics. It may present at any age but is usually noted at birth or appears during childhood. The usual sites of presentation are head and neck; oral cavity is rarely involved. Very few cases of lymphangioma circumscriptum of the tongue are reported. The diagnosis is confirmed by histopathology. The usual treatment for such cases includes local excision or sclerotherapy. We present a case of symptomatic lymphangioma circumscriptum of the tongue in a 15-year-old boy who was treated by debulking of lesion, followed by intralesional injections of bleomycin.

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Aims: The aim is to study the efficacy of conventional and extended-release minocycline therapy in acne vulgaris and to compare the two regimens for the efficacy and side effects. Materials and Methods: An open, randomized, comparative, prospective study was conducted on forty newly diagnosed cases of acne vulgaris (Grades 2 and 3) with more than 15 lesions. Patients were randomly allotted into one of the two groups which received extended-release minocycline and conventional minocycline, respectively, for 3 weeks. Both groups were prescribed local application of benzoyl peroxide 2.5% at night. All the patients were evaluated at the end of 3 weeks using paired and unpaired t-test. Results: Improvement was noted in patients belonging to both the groups. When both the groups were compared statistically using unpaired t-test, extended-release minocycline was significantly better in the treatment of inflammatory papules. Conclusions: Both conventional minocycline and extended-release minocycline were effective in the treatment of moderate and moderately severe acne vulgaris. Statistically inflammatory lesions respond better to extended-release minocycline.

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We represent a case of 11-year-male child with multiple facial angiofibromas who showed moderate improvement after application of 0.1 and 1% sirolimus. We evaluated the results clinically and dermoscopically.

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Background: Over-the-counter (OTC), unlabeled steroids are widely available as cosmetics and have been a recent area of interest in research and clinical practice due to the side effects. However, less is known about OTC-labeled steroid misuse for various cutaneous diseases at a primary care or community level. Objective: The present study was aimed to assess the frequency of different skin diseases and patterns of topical steroid (TS) misuse in them. Materials and Methods: All new patients attending dermatology outpatient department (OPD) on 6 random OPD days in November 2016 for skin diseases were inquired about the use of any unsupervised steroid-containing medication on their skin lesions. The diagnosis and the prescription of the chief consultant/faculty for the disease were also screened in the context of steroid prescription. Data were presented in absolute number and percentage scale, and risk of misuse was analyzed using INSTAT software. Results: A total of 463 patients with a mean age of 27.01 ± 14.57 years (range 3 months to 92 years) were included. The majority (66.09%) were male. The most common disease was infectious in nature (933.19%) of which tinea infection was the most common (22.69%). A total of 119 (25.70%) patients had used unsupervised and OTC TSs; 4.20% presented with steroid dermatitis. Misuse was highest in photodermatitis and melasma (60 and 50%, respectively). TS misuse was more common in 15–40 years' age group and in diseases affecting face (relative risk 1.64 and 1.70, respectively; P < 0.01). Gender was not a risk factor. Conclusion: TS misuse is rampant (25.70%), and steroid dermatitis is a frequent complication. Patients aged 15–40 years and those with diseases affecting face are at risk of misusing it.

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Dapsone is fairly a common drug in the armamentarium of a dermatologist with varied approved and ever-increasing latitude of novel indications. Methemoglobinemia is a known hematologic adverse effect with protean clinical manifestations depending on percentage of hemoglobin involved. We report one such case of Hansen's disease on multi drug therapy (MDT) and oral steroids who reported with an episode of sudden-onset palpitation.

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