Open Access Case Report

Isolated Skin Involvement as Manifestation of Immunoglobulin G4-related Disease (IgG4-RD) Relapse

Salem Bouomrani, Ines Masmoudi

Asian Journal of Research in Dermatological Science, Page 15-20

Immunoglobulin G4-related disease (IgG4-RD) is a very rare and little known sclerosing inflammatory disease of recent individualization.

Cutaneous manifestations during IgG4-RD are very rare. They are described as “infrequent” and “uncommon” by the majority of authors, and are often reported as sporadic clinical cases.

We report the original observation of isolated and polymorphic skin involvement of the head and neck as manifestation of IgG4-related disease relapse in 68-year-old man.

Our observation is distinguished by the polymorphism of skin lesions, the isolated nature of skin involvement (without associated involvement of other organs), and the association of lesions with different ethiopathogenic mechanisms.

Open Access Case Study

Cutaneous Tuberculosis Revealed by Erythema Nodosum

Rabie Ayari, Raja Amri, Ramy Triki, Walid Saidane, Mohamed Ali Sbai

Asian Journal of Research in Dermatological Science, Page 1-4

Tuberculosis is a major public health problem in developing countries. Cutaneous tuberculosis is a rare form of extra pulmonary tuberculosis and represents a real diagnostic challenge because of its pauci-bacillary nature. Erythema nodosum is an exceptional skin manifestation of cutaneous tuberculosis.

We report the case of a 62-year-old female with a 10-year-old history of an atypical recurrent erythema nodosum. The Tuberculin intradermal reaction was strongly positive, with a biopsy of the subcutaneous lumps showing granulomatous tuberculoid lesions with caseous necrosis suggesting a cutaneous tuberculosis.

Treatment with anti-tuberculosis drugs provided recovery without recurrence of the skin lesions.

Erythema nodosum is an exceptional manifestation of cutaneous tuberculosis. Atypical recurrent lesions, resistant to treatment in an endemic country should be suggestive to cutaneous tuberculosis and the confirmation is established with biopsy. Medical treatment based on anti-tuberculosis chemotherapy allows healing.

Open Access Case Study

A Case of Linear IgA Dermatosis in a Young Child

V. Thadchanamoorthy, V. Vijayakanth, N. Thamilvannan

Asian Journal of Research in Dermatological Science, Page 5-8

Diagnosis of Linear immunoglobulin A (IgA) bullous disease (LABD) is difficult as they present to relevant clinician late. This is the case of a 4-year-old Sri Lankan boy with a 2 months history of non-itching, blistering lesions on his extremities. Medical history was unremarkable. Medical treatments included a visit to a general practitioner, where he was treated with antibiotics unsuccessfully. We performed a skin biopsy and Direct immunofluorescent studies revealed a linear deposition of IgA antibody at the basement membrane. The clinical diagnosis of linear IgA dermatosis was established, with no eliciting cause. Resolution of blisters was achieved with oral prednisolone, dapsone and antibiotic treatment. This is the first case to our knowledge occurring in this age group with involvement of only extremities, sparing genital area.

Open Access Case Study

Cutaneous Manifestations of Rheumatoid Vasculitis Revealing a Severe Rheumatoid Arthritis

Raja Amri, Rabie Ayari, Zaineb Alaya, Manel Loukil, Monia Bousen, Imen Chaabene, Abir Chaabene, Mohamed Ali Sbai

Asian Journal of Research in Dermatological Science, Page 9-14

Rheumatoid Arthritis (RA) is a systemic inflammatory disorder with articular and extraarticular manifestations. Rheumatoid Vasculitis (RV), an extraarticular systemic manifestation of RA, is the most serious and unusual complication of long-standing RA, associated with a poor prognosis. We report an exceptional case of rheumatoid arthritis revealed by a cutaneous manifestation of RV.

We report the case of a non-smoking 51-year-old patient with no known history, who presented with a 15-day history of a rash spreading on the legs and the palms of the hands with bilateral and symmetrical polyarthritis affecting both large and small joints, in association with an inflammatory neck pain. Physical examination revealed painful unilateral subcutaneous nodules located on the left leg and on the palms of the hands. Laboratory tests revealed an inflammatory syndrome. The diagnosis of RA revealed by cutaneous manifestations of RV was established using the ACR-EULAR 2010 classification criteria with a total score of 9. Histological examination of a subcutaneous nodule of the leg showed leukocytoclastic vasculitis associated with a polymorphic inflammatory infiltrate made mostly of neutrophils. A corticosteroid therapy of 1 mg/kg/day was initiated. The evolution was good under treatment.

The prevalence of RV has been reported to be declining, with the decrease possibly attributable to the advances in the treatment of RA. Nevertheless, this serious complication should always be considered when establishing the diagnosis of RA even in the early stages.

Open Access Review Article

Synergistic Prophylaxis on COVID-19 by Nature Golden Heart (Piper betle) & Swarna Bhasma

Himesh Soni, Sarvesh Sharma, Jitender K. Malik

Asian Journal of Research in Dermatological Science, Page 21-27

Corona virus (COVID-19) is an enveloped RNA virus that is diversely initiated in humans and wildlife. An entirety of six species has been identified to cause disease in humans. Viral infections participate a vital role in human diseases and recent outbreaks is the influx globally in form of novel corona .The SS-RNA virus from the enveloped corona virus family caused SARS (Severe acute respiratory syndrome) which is life threatening viral infection. The spreading of infection is rapid in many countries of the world. As of March 26, 2020, there have been 462,684 confirmed cases globally, and 20,834 deaths have been registered. The World Health Organization (WHO) called COVID-19 a pandemic on March 11, 2020. In Ayurveda pandemics are called as  Janapadodhvansa roga. Coronavirus is an example of the latter. Janapadodhvansa literally means “annihilation of society”. Swarna Bhasma is an proficient dosage form in the Ayurvedic treatment. In the conventional system of medicine some molecules of Gold are skillful for executive of various disorders. Various Sanskrit texts describe the medicinal uses of the heart shaped betel leaves. Leaves of Piper betel rich sources of numerous phytoceuticals and are used in traditional medicinal systems. Many investigation studies on Piper betle has reported its therapeutic properties like anti-malaria, antibacterial, antifungal, anti-diabetic, anti-platelet anti-allergic, oral hygiene and anti-asthmatic effect and wound healing. The present review based on previous outcome of various pharmacological activity of both herbal (Piper betle) and herbo-mineral (Swarna Bhasma) to illustrated the proposed mechanism of the combination of both may be used can be used as prophylaxis and therapeutic treatment for corona patient. Here we review the natural and traditional two drugs and the mechanisms whereby the virus infects cells. Based on this analysis we make conclusions about whether these drugs should be used while we wait for the results of clinical trials.