Maculopapular rash mainly distributed over the trunk, is reported as the most common cutaneous manifestation in COVID-19 patients. The palms, soles, and face are usually spared. The rash is associated with itching in 56% of patients and is observed along with COVID-19 symptoms. Maculopapular rash is considered as a feature of severe COVID-19 and the lesions usually resolve in 10 days. We report a COVID-19 patient whose initial manifestation was an atypical maculopapular rash with urticarial wheals and erythema multiforme-like lesions. The patient denied drug intake before the onset of skin lesions. The rash was distributed over the face, palms, and soles in addition to the trunk and limbs. The patient had only mild symptoms of COVID-19. The rash lasted for 3 weeks and resolved with post-inflammatory hyperpigmentation and peeling of the skin of the fingertips. We report this case to highlight the possibility of skin rash being the initial sign of COVID-19.

Objectives: The aims of the study were (1) to document the demography and clinical profile of patients with leprosy at a tertiary referral center from 2009 to 2018. (2) To compare the disease manifestation in children aged 12 years/below and the same in patients above 12 years. Materials and Methods: Case records of all patients diagnosed to have leprosy as per the World Health Organization cardinal criteria at our tertiary referral center from 2009 to 2018 were included in this study. The findings recorded in those aged 12 years/below were compared with those above 12 years using Pearson’s Chi- square test. Results: A total of 705 patients who attended our institution during the 10 year period were diagnosed to have leprosy. Six hundred and sixty-four (94.2%) were above 12 years of age and 41 patients (5.8%) were aged 12 years or below. Lepromatous spectrum cases, pure neuritic cases, Grade 2 disability, and lepra reactions were not documented in any of the patients aged 12 years or below which were contrary to the observations in those above 12 years. The differences were found to be statistically significant. Limitations: Retrospective design and small number of childhood cases were the main limitations of the study. Conclusion: Clinical presentation of leprosy in children differs from that in adults. Detection of disease in childhood offers an opportunity to cure the disease with less risk of developing some of the important disease and therapy-related complications.

Objectives: The objectives of the study were: (1) To document the nailfold capillary changes (using a dermoscope) in patients with systemic sclerosis attending a tertiary care center, (2) to study the relation between nailfold capillaroscopic pattern and skin sclerosis assessed by modified Rodnan skin score (mRSS), and (3) to study the relation between nailfold capillaroscopic pattern and organ involvement in systemic sclerosis. Materials and Methods: A cross-sectional study was conducted among 40 patients with systemic sclerosis who attended the dermatology outpatient department of a tertiary care center from January 1, 2018, to December 31, 2018. Nailfold capillaries were examined with the help of dinolite dermoscope AM4113ZT at 50× and 200× magnification, under polarized light. Results: Study participants included 34 (85%) females and 6 males (15%). The nailfold capillaroscopy showed “early scleroderma pattern” in 3 (7.5%) “active pattern” in 28 (70%) and “late pattern” in 9 (22.5%) patients. “Late scleroderma pattern” showed a significant association with disease duration, mRSS, and mean number of organs affected. Limitations: The study participants may be over-representing advanced cases since the study was conducted among patients attending a tertiary referral center. Conclusion: We found dermoscope to be a useful tool to study the nailfold capillary changes in patients with systemic sclerosis as reported by others. Late scleroderma pattern may serve as an indicator of high mRSS and involvement of more number of organs in systemic sclerosis.

A 41-year-old HIV positive woman was started on highly active antiretroviral therapy when her CD4 count was 54/cu mm. Three weeks later, she developed erythematous to skin-colored plaques over the face. Investigations revealed a moderate eosinophilia, raised ESR, elevated 24-hour urinary calcium and hyperglobulinemia. Skin biopsy of the facial plaque revealed prominent epithelioid cell granulomas in the dermis. Reticulin stain showed reticulin fibers within the granulomas. Five months later, all the facial lesions regressed with continuation of HAART, with no specific treatment for facial plaques. Repeat CD4 count was 104/cu mm. A diagnosis of cutaneous sarcoidosis occurring as a part of immune reconstitution inflammatory syndrome was made. Although systemic sarcoidosis has been reported, the occurrence of cutaneous sarcoidosis as part of immune reconstitution inflammatory syndrome has not been elucidated conclusively.