Shivam Goyal; Sathish Ballambat Pai; Kanthilatha Pai
Abstract
Actinomycotic mycetoma or actinomycetoma is a type of mycetoma caused by Nocardia and Actinomyces. It usually affects the trauma-prone areas or extremities of the body. It is associated with characteristic discharging granules and sinuses. Gram staining of discharged granules shows thin Gram-positive ...
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Actinomycotic mycetoma or actinomycetoma is a type of mycetoma caused by Nocardia and Actinomyces. It usually affects the trauma-prone areas or extremities of the body. It is associated with characteristic discharging granules and sinuses. Gram staining of discharged granules shows thin Gram-positive filaments. Histopathology of granules shows suppurative granulomas composed of neutrophils surrounding characteristic grains. Several antibiotics are effective, including co-trimoxazole, dapsone, streptomycin, trimethoprim (TMP), rifampicin, and amoxicillin-clavulanic acid. However, co-trimoxazole remains the gold-standard therapy. Actinomycetoma of the scalp has been rarely reported. Here, we report the case of an Asian male in his 50s presenting with swelling over the scalp. It had developed seven years ago after a road traffic accident and remained elusive to treatment. There were no discharging sinuses or granules characteristic of actinomycetoma. The Gram stain and Modified Ziehl-Neelsen stain from superficial swabs were negative for pathogens. Bacterial and fungal cultures of the biopsy sample were inconclusive. However, histopathology showed epidermis having focal acanthosis overlying granulation tissue with proliferating capillaries, edema, and infiltration by lymphocytes, plasma cells, neutrophils, and eosinophils along with scattered foreign body giant cells. Filamentous bacterial colonies with surrounding neutrophils were present. These features were suggestive of actinomycetoma. The patient was treated with oral doxycycline and co-trimoxazole and had a complete regression of swelling after three months of follow-up. This case highlights an unusual morphology and location of actinomycetoma, which should be considered when encountering subcutaneous swelling.
Smitha S Prabhu; Sathish Ballambat Pai; Manasa Narayan Kayarkatte
Abstract
Phototherapy is an essential and useful therapeutic procedure wherein the properties of ultraviolet light are used to cure certain dermatological conditions like psoriasis, vitiligo, and atopic dermatitis. This is usually an office-based procedure dependent on the accurate use of sophisticated phototherapy ...
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Phototherapy is an essential and useful therapeutic procedure wherein the properties of ultraviolet light are used to cure certain dermatological conditions like psoriasis, vitiligo, and atopic dermatitis. This is usually an office-based procedure dependent on the accurate use of sophisticated phototherapy units. Since the advent of the COVID-19 pandemic, phototherapy practices were shut down as they were considered as non-essential services. Here, we attempt to analyze how COVID-19 has affected phototherapy and seek to formulate a working guideline for safe phototherapy operations in these taxing circumstances. We used search engines like PubMed, Google Scholar, and Embase to retrieve articles and guidelines regarding phototherapy in dermatology, using the pertinent search terms. There was a paucity of data with only a couple of research letters and guidelines by the British Association of Dermatology and the American Academy of Dermatology, as well as general guidelines issued by the Indian Association of Dermatologists, Venereologists and Leprologists. After a careful study of various modalities of phototherapy and viral inactivation, we collated a set of guiding instructions toward the appropriate utilization of phototherapy amidst the COVID-19 pandemic. Phototherapy is a viable option for selected patients even amidst the COVID-19 pandemic. However, local and national guidelines have to be followed while selecting the patient and operating the phototherapy machine with adequate protective measures for both the patient and the healthcare worker. Home phototherapy units and PUVASOL are good options for those patients who are unable to attend the phototherapy center due to various reasons.