Vijay Aithal | Rajiv Gandhi University of Health Sciences (original) (raw)
Papers by Vijay Aithal
Intralesional Vitamin D3 Versus Bleomycin for Difficult-to-Heal Palmoplantar Warts: A Comparative Study, 2023
Introduction: Difficult-to-heal or recalcitrant palmoplantar warts are notoriously resistant to t... more Introduction: Difficult-to-heal or recalcitrant palmoplantar warts are notoriously resistant to treatment, making treatment difficult
and challenging. To improve the outcome and overcome the difficulties, various treatment options have been tried, but none is
gold standard. Many comparative studies have been undertaken to assess the efficacy of various drugs; however, none of them are
standardized, and no single treatment is effective. Various comparative efficacy studies have been conducted but, to the best of our
knowledge, no study has been conducted comparing intralesional (IL) injection (inj) vitamin D3 (Vit D3) with the chemotherapy
drug IL inj Bleomycin for difficult-to-heal palmoplantar warts. We conducted a trial to evaluate the efficacy of IL inj Vit D3 versus
IL inj Bleomycin in the treatment of difficult-to-heal palmoplantar warts. The purpose of this study was to compare the efficacy of
IL inj vitamin D3 versus IL inj Bleomycin as biological response modifier therapy in difficult-to-heal palmoplantar warts. Materials
and Methods: A cohort of 48 patients with difficult-to-heal warts were consecutively assigned to one of two groups: Group 1 IL inj
Vit D3 (0.2–0.5 mL inj vitamin D3 600,000 IU solution 15 mg/mL) or Group 2 IL inj Bleomycin (0.2–0.4 mL of 1 U/mL solution) for
a maximum of four treatments spaced 2 weeks apart, with a maximum of five warts treated at each visit for both groups. Warts were
measured at baseline and at each subsequent visit. Wart’s resolution was measured as 1–25%, 2–50%, 3–75%, and 4–100% reduction.
Patients were followed-up for 3 months after treatment. Results: All the 48 patients completed the study, with 26 receiving IL inj Vit
D3 with complete resolution in 88.5%, partial resolution in 11.5%, and side effects in 6.2%. In 22 patients receiving IL inj Bleomycin,
95.5% had complete resolution, 4.5% had partial resolution, and 8.2% had side effects. Maximum resolution was observed in the third
session. We found no recurrence after 3 months. Conclusion: IL inj Vit D3 and IL inj Bleomycin are both safe and effective in treating
difficult-to-heal palmoplantar warts with better outcomes and patient satisfaction. IL Bleomycin was significantly more effective than
IL Vit D3, although the difference was not statistically significant
Journal of Cutaneous and Aesthetic Surgery
Clinical Dermatology Review
Background: Aging is mainly due to chronic interaction between extrinsic and intrinsic factors. T... more Background: Aging is mainly due to chronic interaction between extrinsic and intrinsic factors. The elderly population is highly vulnerable to skin diseases due to immunosenescence, polypharmacy, chronic exposure to ultraviolet radiation, and inadequate nutrition. Objectives: (1) To estimate the prevalence of dermatological manifestation in the elderly population. (2) Clinico-pathological correlation of the cutaneous tumors seen in the study population. Materials and Methods: A total of 300 elderly patients (above 60 years) who attended the outpatient department and inpatients of a tertiary care hospital, were recruited for the study, during a 1 year period (2019-2020). Patient demographics, brief history, and clinical examination were done. Relevant laboratory investigations, including side laboratory procedures and skin biopsy were done when necessary. Results: Most of the patients were between 65 and 70 years, 175 were male and 125 were female. Type-2 diabetes mellitus and hypertension had equal incidence. Dermatophyte infection was the most common presentation, followed by eczema, papulosquamous, and auto-immune bullous disorders. Nail changes were observed in 50% of the patients. Among those who had drug reactions, 50% had drug hypersensitivity syndrome to anti-tubercular drugs. Malignancies, including basal cell carcinoma, were not uncommon. Alcohol, sunlight, and the male gender were associated with an increased risk of wrinkling. Conclusion: Health education programs regarding skin disorders and preventive measures in the geriatric population will help improve their quality of life.
DOAJ (DOAJ: Directory of Open Access Journals), 2022
Academia Letters, 2022
Rapidly growing mycobacteria are defined as non tubercular species of mycobacteria that show visi... more Rapidly growing mycobacteria are defined as non tubercular species of mycobacteria that show visible growth on solid laboratory media within 7 days. We report one such case in a 65 year old immuno-competent male, a rare entity in this part of south India.
Indian Journal of Dermatology, Venereology and Leprology
Lithium is known to cause a variety of dermatological problems, common ones being acneiform erupt... more Lithium is known to cause a variety of dermatological problems, common ones being acneiform eruptions, folliculitis and psoriasis including its pustular form. Hidradenitis suppurativa and acne conglobata are lesser known side effects, with only three reports so far. We report a patient, who had bipolar affective disorder, was on lithium for a long duration and developed hidradenitis suppurativa and acne conglobata during therapy, which subsequently decreased once lithium was stopped. We describe this case for its rarity and analyze its pathogenesis.
Academia Letters, 2022
Rapidly growing mycobacteria are defined as non tubercular species of mycobacteria that show visi... more Rapidly growing mycobacteria are defined as non tubercular species of mycobacteria that show visible growth on solid laboratory media within 7 days. We report one such case in a 65 year old immuno-competent male, a rare entity in this part of south India.
Mycobacterial Diseases, 2013
The relationship between M. tuberculosis and M. leprae remains enigmatic with evidence to support... more The relationship between M. tuberculosis and M. leprae remains enigmatic with evidence to support relative protection to predisposition cited in the literature. With the near eradication of M. leprae, recognition of new cases may be delayed with poor outcomes. We describe a case of drug-resistant extra-pulmonary tuberculosis co-infection with tuberculoid leprosy. We also discuss the findings of our comprehensive literature review on clinical features, treatment and outcomes of dual infections. We hope that this manuscript serves as a timely reminder and ready reckoner of findings of this rare situation.
Indian Journal of Paediatric Dermatology
Clinical Dermatology Review
International Journal of Oral Health Sciences
Indian Journal of Dermatology, 2016
A 34-year-old male came with complaints of multiple firms to hard nontender, nonitchy nodules, me... more A 34-year-old male came with complaints of multiple firms to hard nontender, nonitchy nodules, measuring 2 cm × 2 cm to 1 cm × 1.5 cm, present predominantly over the lower limbs. This condition started 5 years back as a single nodule over the thigh but gradually increased in number and size with time to involve both lower limbs. A differential diagnosis of cutaneous lymphoma and dermatofibroma was considered. He underwent a biopsy and immunohistochemistry for the same which were consistent with hemosiderotic histiocytoma and positive for vimentin. The patient was advised surgical excision for the same. The occurrence of multiple dermatofibromas although rare has been reported in a few case reports; however, the occurrence of multiple dermatofibromas of the hemosiderotic variant has not been documented yet.
Indian journal of dermatology, venereology and leprology
Lithium is known to cause a variety of dermatological problems, common ones being acneiform erupt... more Lithium is known to cause a variety of dermatological problems, common ones being acneiform eruptions, folliculitis and psoriasis including its pustular form. Hidradenitis suppurativa and acne conglobata are lesser known side effects, with only three reports so far. We report a patient, who had bipolar affective disorder, was on lithium for a long duration and developed hidradenitis suppurativa and acne conglobata during therapy, which subsequently decreased once lithium was stopped. We describe this case for its rarity and analyze its pathogenesis.
International Journal of Dermatology, 2013
Cutaneous tuberculosis (TB) is less common than other forms of TB but accounts for 1.5% of all ca... more Cutaneous tuberculosis (TB) is less common than other forms of TB but accounts for 1.5% of all cases of extrapulmonary TB. The source of mycobacterial infection and the immune status of the host determine the presentation of any of a wide spectrum of clinical manifestations. Lupus vulgaris (LV) is a post-primary, paucibacillary form of TB caused by hematogeneous, lymphatic, or contiguous spread from elsewhere in the body. We report two recent cases of LV in women presenting with the exclusive involvement of the ear lobe. In Patient 1, clinical presentation appeared as an apparently benign chronic eczematous process. In Patient 2, it appeared as a fulminant ulceronecrotic process. Both women were immunocompetent, and neither had a personal or family history of TB. Both patients were diagnosed with LV and treated with standard antitubercular therapy (ATT). In both patients, mycobacterial culture showed growth of Mycobacterium tuberculosis sensitive to streptomycin, rifampicin, and ethambutol. Lupus vulgaris is the most common form of cutaneous TB. It is important to diagnose LV because it can result in chronic disfigurement and because 10-20% of LV patients have active pulmonary TB or TB of the bones and joints. In addition, longstanding LV is known to lead to the development of squamous cell carcinoma, which can be avoided by early diagnosis and treatment with ATT.
International Journal of Leprosy and Other Mycobacterial Diseases, 2004
Treatment of leprous ulcers has remained inadequate, owing to the fact that most of these ulcers ... more Treatment of leprous ulcers has remained inadequate, owing to the fact that most of these ulcers are still being managed conservatively especially in developing nations, probably due to financial constraints. Pinch skin grafting, though obsolete now (2), tries to bridge this gap between cost and effectiveness. It is a simple office-based technique, not requiring much expertise or investment, and can be done in a simple set-up such as a side room (3). Also, pinch skin grafting has an added advantage over single grafts, in that even if one graft is rejected, there are other grafts, which successfully heal, and epidermize to the surrounding. Moreover, if the ulcer is draining, the discharge flows out in between the grafts, thus preventing the whole graft from being rejected. The only disadvantage to pinch skin grafting is the final cosmetic appearance, which might not be most pleasing. We had very good results with all four patients who underwent this procedure in our institution. The procedure and the final result are described in detail in this report.
Indian Journal of Plastic Surgery, 2005
The potential of nevus sebaceous to undergo malignant change has prompted many physicians to unde... more The potential of nevus sebaceous to undergo malignant change has prompted many physicians to undertake surgical excision of these lesions. Debulking surgery would leave an ugly scar, cosmetically not acceptable. Our aim was to find the therapeutic outcome and the final cosmetic appearance with Erbium YAG Laser ablation. A 19 year old boy with histologically proven Nevus Sebaceous over the forehead was taken up for ablation using Erbium YAG Laser. We also analyzed the post-operative results in another 6 patients who underwent Laser ablation of Nevus Sebaceous. All 7 patients did well, with no signs of recurrence. Also, all of them had a scar over the ablated area, which was cosmetically acceptable to them. Surgical excision with or without flap rotation, electro fulguration and Cryotherapy are other modalities to treat these lesions. However, they are either too expensive or leave a telltale scar. Erbium YAG Laser ablation is safe, effective and cosmetically acceptable in the treatment of Nevus Sebaceous.
Diagnostic Cytopathology, 2007
The Tzanck smear is a simple, sensitive, and rapid test to diagnose pemphigus vulgaris (PV), a li... more The Tzanck smear is a simple, sensitive, and rapid test to diagnose pemphigus vulgaris (PV), a life threatening autoimmune blistering disorder. The presence of acantholytic cells in cytology is indicative of but not specific for PV. Hence, a direct Immunofluorescence (DIF) test to demonstrate immunoglobulin deposits on the acantholytic cells would make the Tzanck test more specific, in addition to being a rapid test. Twenty untreated patients with PV confirmed histopathologically were enrolled to evaluate the efficacy of using DIF technique using IgG on Tzanck smear samples. The DIF smears were compared with DIF on skin biopsies in the same patient. This prospective pilot study approved by the institutional ethics committee was carried out in a tertiary health care hospital in a developing country. Of the 15 patients presenting within 3 mo of onset of the illness, 40% (n = 6) showed DIF positivity on Tzanck smear, when compared with 46.67% (n = 7) on skin biopsy. On the other hand, of the five patients presenting beyond 3 mo of their illness, only 20% (n = 2) showed positivity on Tzanck, when compared with all 100% (n = 5) on skin biopsy. The study, thus, suggests that DIF on skin biopsy is comparable to biopsy in diagnosing early PV. This preliminary study proposes that the use of DIF on Tzanck smear is a simple, rapid, painless, and user-friendly out-patient procedure for the diagnosis of early PV, even for relatively inaccessible lesions in the oral cavity and flexural regions. This methodology would be of great help in outlying and rural facilities lacking proper histological equipment, thus avoiding the need for a surgical or punch biopsy or heavy investment in laboratory equipment and expertise. Probable reasons for DIF negativity on Tzanck smears are also discussed.
Intralesional Vitamin D3 Versus Bleomycin for Difficult-to-Heal Palmoplantar Warts: A Comparative Study, 2023
Introduction: Difficult-to-heal or recalcitrant palmoplantar warts are notoriously resistant to t... more Introduction: Difficult-to-heal or recalcitrant palmoplantar warts are notoriously resistant to treatment, making treatment difficult
and challenging. To improve the outcome and overcome the difficulties, various treatment options have been tried, but none is
gold standard. Many comparative studies have been undertaken to assess the efficacy of various drugs; however, none of them are
standardized, and no single treatment is effective. Various comparative efficacy studies have been conducted but, to the best of our
knowledge, no study has been conducted comparing intralesional (IL) injection (inj) vitamin D3 (Vit D3) with the chemotherapy
drug IL inj Bleomycin for difficult-to-heal palmoplantar warts. We conducted a trial to evaluate the efficacy of IL inj Vit D3 versus
IL inj Bleomycin in the treatment of difficult-to-heal palmoplantar warts. The purpose of this study was to compare the efficacy of
IL inj vitamin D3 versus IL inj Bleomycin as biological response modifier therapy in difficult-to-heal palmoplantar warts. Materials
and Methods: A cohort of 48 patients with difficult-to-heal warts were consecutively assigned to one of two groups: Group 1 IL inj
Vit D3 (0.2–0.5 mL inj vitamin D3 600,000 IU solution 15 mg/mL) or Group 2 IL inj Bleomycin (0.2–0.4 mL of 1 U/mL solution) for
a maximum of four treatments spaced 2 weeks apart, with a maximum of five warts treated at each visit for both groups. Warts were
measured at baseline and at each subsequent visit. Wart’s resolution was measured as 1–25%, 2–50%, 3–75%, and 4–100% reduction.
Patients were followed-up for 3 months after treatment. Results: All the 48 patients completed the study, with 26 receiving IL inj Vit
D3 with complete resolution in 88.5%, partial resolution in 11.5%, and side effects in 6.2%. In 22 patients receiving IL inj Bleomycin,
95.5% had complete resolution, 4.5% had partial resolution, and 8.2% had side effects. Maximum resolution was observed in the third
session. We found no recurrence after 3 months. Conclusion: IL inj Vit D3 and IL inj Bleomycin are both safe and effective in treating
difficult-to-heal palmoplantar warts with better outcomes and patient satisfaction. IL Bleomycin was significantly more effective than
IL Vit D3, although the difference was not statistically significant
Journal of Cutaneous and Aesthetic Surgery
Clinical Dermatology Review
Background: Aging is mainly due to chronic interaction between extrinsic and intrinsic factors. T... more Background: Aging is mainly due to chronic interaction between extrinsic and intrinsic factors. The elderly population is highly vulnerable to skin diseases due to immunosenescence, polypharmacy, chronic exposure to ultraviolet radiation, and inadequate nutrition. Objectives: (1) To estimate the prevalence of dermatological manifestation in the elderly population. (2) Clinico-pathological correlation of the cutaneous tumors seen in the study population. Materials and Methods: A total of 300 elderly patients (above 60 years) who attended the outpatient department and inpatients of a tertiary care hospital, were recruited for the study, during a 1 year period (2019-2020). Patient demographics, brief history, and clinical examination were done. Relevant laboratory investigations, including side laboratory procedures and skin biopsy were done when necessary. Results: Most of the patients were between 65 and 70 years, 175 were male and 125 were female. Type-2 diabetes mellitus and hypertension had equal incidence. Dermatophyte infection was the most common presentation, followed by eczema, papulosquamous, and auto-immune bullous disorders. Nail changes were observed in 50% of the patients. Among those who had drug reactions, 50% had drug hypersensitivity syndrome to anti-tubercular drugs. Malignancies, including basal cell carcinoma, were not uncommon. Alcohol, sunlight, and the male gender were associated with an increased risk of wrinkling. Conclusion: Health education programs regarding skin disorders and preventive measures in the geriatric population will help improve their quality of life.
DOAJ (DOAJ: Directory of Open Access Journals), 2022
Academia Letters, 2022
Rapidly growing mycobacteria are defined as non tubercular species of mycobacteria that show visi... more Rapidly growing mycobacteria are defined as non tubercular species of mycobacteria that show visible growth on solid laboratory media within 7 days. We report one such case in a 65 year old immuno-competent male, a rare entity in this part of south India.
Indian Journal of Dermatology, Venereology and Leprology
Lithium is known to cause a variety of dermatological problems, common ones being acneiform erupt... more Lithium is known to cause a variety of dermatological problems, common ones being acneiform eruptions, folliculitis and psoriasis including its pustular form. Hidradenitis suppurativa and acne conglobata are lesser known side effects, with only three reports so far. We report a patient, who had bipolar affective disorder, was on lithium for a long duration and developed hidradenitis suppurativa and acne conglobata during therapy, which subsequently decreased once lithium was stopped. We describe this case for its rarity and analyze its pathogenesis.
Academia Letters, 2022
Rapidly growing mycobacteria are defined as non tubercular species of mycobacteria that show visi... more Rapidly growing mycobacteria are defined as non tubercular species of mycobacteria that show visible growth on solid laboratory media within 7 days. We report one such case in a 65 year old immuno-competent male, a rare entity in this part of south India.
Mycobacterial Diseases, 2013
The relationship between M. tuberculosis and M. leprae remains enigmatic with evidence to support... more The relationship between M. tuberculosis and M. leprae remains enigmatic with evidence to support relative protection to predisposition cited in the literature. With the near eradication of M. leprae, recognition of new cases may be delayed with poor outcomes. We describe a case of drug-resistant extra-pulmonary tuberculosis co-infection with tuberculoid leprosy. We also discuss the findings of our comprehensive literature review on clinical features, treatment and outcomes of dual infections. We hope that this manuscript serves as a timely reminder and ready reckoner of findings of this rare situation.
Indian Journal of Paediatric Dermatology
Clinical Dermatology Review
International Journal of Oral Health Sciences
Indian Journal of Dermatology, 2016
A 34-year-old male came with complaints of multiple firms to hard nontender, nonitchy nodules, me... more A 34-year-old male came with complaints of multiple firms to hard nontender, nonitchy nodules, measuring 2 cm × 2 cm to 1 cm × 1.5 cm, present predominantly over the lower limbs. This condition started 5 years back as a single nodule over the thigh but gradually increased in number and size with time to involve both lower limbs. A differential diagnosis of cutaneous lymphoma and dermatofibroma was considered. He underwent a biopsy and immunohistochemistry for the same which were consistent with hemosiderotic histiocytoma and positive for vimentin. The patient was advised surgical excision for the same. The occurrence of multiple dermatofibromas although rare has been reported in a few case reports; however, the occurrence of multiple dermatofibromas of the hemosiderotic variant has not been documented yet.
Indian journal of dermatology, venereology and leprology
Lithium is known to cause a variety of dermatological problems, common ones being acneiform erupt... more Lithium is known to cause a variety of dermatological problems, common ones being acneiform eruptions, folliculitis and psoriasis including its pustular form. Hidradenitis suppurativa and acne conglobata are lesser known side effects, with only three reports so far. We report a patient, who had bipolar affective disorder, was on lithium for a long duration and developed hidradenitis suppurativa and acne conglobata during therapy, which subsequently decreased once lithium was stopped. We describe this case for its rarity and analyze its pathogenesis.
International Journal of Dermatology, 2013
Cutaneous tuberculosis (TB) is less common than other forms of TB but accounts for 1.5% of all ca... more Cutaneous tuberculosis (TB) is less common than other forms of TB but accounts for 1.5% of all cases of extrapulmonary TB. The source of mycobacterial infection and the immune status of the host determine the presentation of any of a wide spectrum of clinical manifestations. Lupus vulgaris (LV) is a post-primary, paucibacillary form of TB caused by hematogeneous, lymphatic, or contiguous spread from elsewhere in the body. We report two recent cases of LV in women presenting with the exclusive involvement of the ear lobe. In Patient 1, clinical presentation appeared as an apparently benign chronic eczematous process. In Patient 2, it appeared as a fulminant ulceronecrotic process. Both women were immunocompetent, and neither had a personal or family history of TB. Both patients were diagnosed with LV and treated with standard antitubercular therapy (ATT). In both patients, mycobacterial culture showed growth of Mycobacterium tuberculosis sensitive to streptomycin, rifampicin, and ethambutol. Lupus vulgaris is the most common form of cutaneous TB. It is important to diagnose LV because it can result in chronic disfigurement and because 10-20% of LV patients have active pulmonary TB or TB of the bones and joints. In addition, longstanding LV is known to lead to the development of squamous cell carcinoma, which can be avoided by early diagnosis and treatment with ATT.
International Journal of Leprosy and Other Mycobacterial Diseases, 2004
Treatment of leprous ulcers has remained inadequate, owing to the fact that most of these ulcers ... more Treatment of leprous ulcers has remained inadequate, owing to the fact that most of these ulcers are still being managed conservatively especially in developing nations, probably due to financial constraints. Pinch skin grafting, though obsolete now (2), tries to bridge this gap between cost and effectiveness. It is a simple office-based technique, not requiring much expertise or investment, and can be done in a simple set-up such as a side room (3). Also, pinch skin grafting has an added advantage over single grafts, in that even if one graft is rejected, there are other grafts, which successfully heal, and epidermize to the surrounding. Moreover, if the ulcer is draining, the discharge flows out in between the grafts, thus preventing the whole graft from being rejected. The only disadvantage to pinch skin grafting is the final cosmetic appearance, which might not be most pleasing. We had very good results with all four patients who underwent this procedure in our institution. The procedure and the final result are described in detail in this report.
Indian Journal of Plastic Surgery, 2005
The potential of nevus sebaceous to undergo malignant change has prompted many physicians to unde... more The potential of nevus sebaceous to undergo malignant change has prompted many physicians to undertake surgical excision of these lesions. Debulking surgery would leave an ugly scar, cosmetically not acceptable. Our aim was to find the therapeutic outcome and the final cosmetic appearance with Erbium YAG Laser ablation. A 19 year old boy with histologically proven Nevus Sebaceous over the forehead was taken up for ablation using Erbium YAG Laser. We also analyzed the post-operative results in another 6 patients who underwent Laser ablation of Nevus Sebaceous. All 7 patients did well, with no signs of recurrence. Also, all of them had a scar over the ablated area, which was cosmetically acceptable to them. Surgical excision with or without flap rotation, electro fulguration and Cryotherapy are other modalities to treat these lesions. However, they are either too expensive or leave a telltale scar. Erbium YAG Laser ablation is safe, effective and cosmetically acceptable in the treatment of Nevus Sebaceous.
Diagnostic Cytopathology, 2007
The Tzanck smear is a simple, sensitive, and rapid test to diagnose pemphigus vulgaris (PV), a li... more The Tzanck smear is a simple, sensitive, and rapid test to diagnose pemphigus vulgaris (PV), a life threatening autoimmune blistering disorder. The presence of acantholytic cells in cytology is indicative of but not specific for PV. Hence, a direct Immunofluorescence (DIF) test to demonstrate immunoglobulin deposits on the acantholytic cells would make the Tzanck test more specific, in addition to being a rapid test. Twenty untreated patients with PV confirmed histopathologically were enrolled to evaluate the efficacy of using DIF technique using IgG on Tzanck smear samples. The DIF smears were compared with DIF on skin biopsies in the same patient. This prospective pilot study approved by the institutional ethics committee was carried out in a tertiary health care hospital in a developing country. Of the 15 patients presenting within 3 mo of onset of the illness, 40% (n = 6) showed DIF positivity on Tzanck smear, when compared with 46.67% (n = 7) on skin biopsy. On the other hand, of the five patients presenting beyond 3 mo of their illness, only 20% (n = 2) showed positivity on Tzanck, when compared with all 100% (n = 5) on skin biopsy. The study, thus, suggests that DIF on skin biopsy is comparable to biopsy in diagnosing early PV. This preliminary study proposes that the use of DIF on Tzanck smear is a simple, rapid, painless, and user-friendly out-patient procedure for the diagnosis of early PV, even for relatively inaccessible lesions in the oral cavity and flexural regions. This methodology would be of great help in outlying and rural facilities lacking proper histological equipment, thus avoiding the need for a surgical or punch biopsy or heavy investment in laboratory equipment and expertise. Probable reasons for DIF negativity on Tzanck smears are also discussed.