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On a sunny morning, as I sat in the outpatient department of an HIV and palliative care unit in rural India, a little six-year-old soul with big brown eyes and beautiful long eyelashes arrived and immediately captured my attention. I'll call her B. Her dishevelled, short, dull-brown hair framed her tiny face, and she wore a faded t-shirt and pants that were far too big for her 10-kg frame. Clutching the hands of her guardian tightly, she kept looking at the floor. The staff nurses and I were taken aback at her malnourished state. Over the years I've often wondered whether Mrs. A was allowed to be reunited with her children and how B was coping in school. I have been curious to know if the little girl outgrew omelettes and chocolate milk, and whether she ever learned to like eating vegetables. Above all, I've wondered whether she missed Mrs. A's motherly love.

Granuloma annulare is an inflammatory dermatosis that affects people of all ages, particularly females, with an annual incidence of 37.9 per 100,000 people. Generalized granuloma annulare accounts for 15% of cases and typically manifests as erythematous or skin-colored annular plaques with a raised, rope-like border and central clearing, predominantly affecting the trunk and extremities. Localized granuloma annulare is the most common variant. Other variants include perforating, subcutaneous, patch, papular, photo-distributed, and drug-induced granuloma annulare. Potential triggers include drug exposure and viral infections. Here, Lobo and Kaimal examine the case of a 57-year-old woman with granuloma annulare.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are some of the less common cutaneous adverse drug reactions with significant mortality. This study was undertaken with the objective of studying the demographics and clinical profile of SJS/TEN and identifying parameters associated with mortality. All patients with SJS/TEN over 10 years (2010-2020) were included in the study. Data obtained from in-patient and out-patient records were analysed. A total of 82 patients with SJS/TEN were admitted to our centre over a period of 10 years. Patients with SJS were significantly younger than those with TEN, with a male: female ratio >1 in SJS and <1 in TEN. The most commonly implicated drugs were antiepileptics ( = 29, 35.4%), antibiotics ( = 20, 24.4%). and Non-steroidal antiinflammatory drugs (NSAIDs) ( = 7, 8.5%). The mortality rate in the TEN group was 16% ( = 8). Certain factors such as cutaneous lesions preceding mucosal lesions at onset, high mean Body surface area (BSA) of denudation and a transfer to intensive care unit (ICU) more than 7 days after admission were significantly associated with higher mortality. There was no difference between survivors and deaths in terms of delay in hospitalisation, total disease duration, implicated drug, delay in initiation of therapy, the onset of re-epithelialisation, Severity-of-illness score for TEN (SCORTEN) and total duration of hospital stay. Factors significantly associated with increased mortality in TEN were cutaneous onset of lesions, mean BSA of involvement and transfer to the intensive care unit (ICU) beyond day 7 of admission.

A 34-year-old male presented with multiple asymptomatic papules over both the hands, feet, forehead and ears for 10 years. He was a known case of type 2 diabetes mellitus for 9 years and was initially prescribed 500mg of metformin. However, he had been non-compliant with the treatment and had not taken any medications for the past 7 years. On physical examination, blood pressure was 140/84mm Hg and BMI was 30.07kg/m2. Cutaneous examination revealed multiple, yellowish, firm monomorphic non-follicular-based papules on the dorsum and palmar aspect of both hands, dorsum of both feet, ears, forehead, elbows and buttocks (Figure 1). Koebnerization was noted. Tendon examination was normal. Ophthalmological evaluation revealed 6/6 visual acuity in both eyes, with normal colour vision and pupil reactions. Anterior segment examination was normal. Dilated fundus evaluation showed multiple sclerosed vessels and arteriolar whitening suggestive of lipemia retinalis, with no evidence of diabetic retinopathy.

BackgroundLeprosy being a chronic disease is often associated with malnutrition due to multiple factors such as inadequate dietary intake, socioeconomic status and disabilities. There is limited literature on the effect of nutrition and diet in leprosy. Detailed nutritional assessment and anthropometry will aid in the holistic care of patients with leprosy.Objective of the study:- Primary: To assess nutritional status of Leprosy patients.-Secondary: To assess if there is any correlation between Nutritional status and outcome of leprosy such as disability, deformity, lepra reactions.MethodsIn this study, 62 patients with a diagnosis of Leprosy were included. After consent process and clinical history, patients were then subjected to anthropometry.ResultsSteroid use and reactional states were significantly associated with overnutrition as measured by Waist Hip ratio; regardless of age, gender or socioeconomic status. The spectrum of disease, treatment and grade of disability had no impact on the level of nutrition.ConclusionThis study highlights the importance of anthropometry especially measurement of Waist Hip Ratio as part of a holistic approach towards evaluation of Leprosy patients.