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Showing papers in "Indian Journal of Dermatology, Venereology and Leprology in 2010"



Journal ArticleDOI
TL;DR: Improved understanding of the dermal delivery aspects and that of designing and developing diverse carrier systems have brought in further novelty in this approach, but majority of the work is related to the preclinical studies and demands further clinical assessment in psoriasis patients.
Abstract: Psoriasis is a chronic inflammatory skin disorder that may drastically impair the quality of life of a patient. Among the various modes of treatments for psoriasis, topical therapy is most commonly used in majority of patients. The topical formulations based on conventional excipients could serve the purpose only to a limited extent. With the advent of newer biocompatible and biodegradable materials like phospholipids, and cutting-edge drug delivery technologies like liposomes, solid lipid nanoparticles (SLNs), microemulsions, and nanoemulsions, the possibility to improve the efficacy and safety of the topical products has increased manifold. Improved understanding of the dermal delivery aspects and that of designing and developing diverse carrier systems have brought in further novelty in this approach. Substantial efforts and the consequent publications, patents and product development studies on the subject are the matter of interest and review of this article. However, majority of the work is related to the preclinical studies and demands further clinical assessment in psoriasis patients.

105 citations


Journal ArticleDOI
TL;DR: There is a significantly higher prevalence of metabolic syndrome in psoriasis patients as compared to general population and so is the risk of having atherosclerotic adversity and while managing the psoriatic plaques of these patients, concerns should extend to the atheOSclerotic plaques.
Abstract: Background: Psoriasis is a chronic inflammatory disease of the skin and is associated with an increased risk of cardiovascular atherosclerosis. Metabolic syndrome, a conglomerate of various clinical and biochemical parameters is a significant predictor of atherosclerotic disease and the associated risk for cardiovascular events in such patients. Aim: To investigate the prevalence of metabolic syndrome in patients with psoriasis. Methods: The study was a prospective, hospital based case-control study involving 150 adult patients with chronic plaque psoriasis and 150 healthy controls. Venous samples were taken at the enrolment visit after the subjects had fasted overnight (at least 8 h). Serum cholesterol and triglycerides were measured with enzymatic procedures. Plasma glucose was measured using a glucose oxidase method. Metabolic syndrome was diagnosed by the presence of three or more criteria of the National Cholesterol Education Programme's Adult Panel III (ATP III). Statistical analysis of the data was done using statistical processing software (SPSS-17) and epi-info software. Results: Metabolic syndrome was significantly more common in psoriatic patients than in controls 42(28%) vs 9(6%), odds ratio (OR) = 6.09, P<0.05. Psoriatic patients also had a significantly higher prevalence of hypertriglyceridaemia (73/150 among cases vs 24/150 among controls; P<0.05), arterial hypertension (74/150 among cases vs 24/150 among controls; P<0.05) and impaired fasting plasma glucose levels (27/150 among cases vs 04/150 among controls; P<0.05). Psoriatic patients with metabolic syndrome had mean disease duration of 13.67±11.87 years against 6.46±5.80 years in those without metabolic syndrome. Conclusion: There is a significantly higher prevalence of metabolic syndrome in psoriasis patients as compared to general population and so is the risk of having atherosclerotic adversity. While managing the psoriatic plaques of these patients, concerns should extend to the atherosclerotic plaques as well.

97 citations


Journal ArticleDOI
TL;DR: Different types of pigmentation were observed with a striking nose pigmentation in a large number of patients, by looking at which even a retrospective diagnosis of CKG could be made, which is suggested to be called "chik sign".
Abstract: Background: There was a recent epidemic of chikungunya (CKG) in Calicut and other northern districts of Kerala, South India, affecting thousands of people. Aims: To study the cutaneous manifestations of CKG and to have a serological and histopathological correlation. Methods: A total of 162 patients (63 males and 99 females) with cutaneous manifestations of CKG were enrolled in the study and serological confirmation was done with capture IgM ELISA for CKG. Skin biopsy was done in all representative cases. Results: Cutaneous manifestations were found more in females. There were 23 children, the youngest being 39 days old. Generalized erythematous macular rash was the most common finding. Vesicles and bullae were also common especially in infants. Localized erythema of the nose and pinnae, erythema and swelling of the pre existing scars and striae and toxic epidermal necrolysis-like lesions sparing mucosae were the other interesting findings. Different types of pigmentation were observed with a striking nose pigmentation in a large number of patients, by looking at which even a retrospective diagnosis of CKG could be made. Hence we suggest this peculiar pigmentation may be called chik sign. There was flare up of existing dermatoses like psoriasis, lichen planus and unmasking of Hansen's disease with type 1 reaction. Serological tests were positive in 97%. Some hitherto unreported histopathologic findings like melanophages in the erythematous rashes were observed. Conclusion: A spectrum of cutaneous manifestations of CKG with a wide variety of unusual presentations with confirmed serological and histopathological evidence was encountered.

70 citations


Journal ArticleDOI
TL;DR: A prepeel program of daily application of 12% GA cream at night for 2 weeks, followed by graded increase in GA and TCA concentrations proved to be an equally effective treatment modality for epidermal and mixed melasma.
Abstract: Background: Melasma is a common cause of facial hyperpigmentation with significant cosmetic deformity. Many modalities of treatment are available, but none is satisfactory. Aim: This study was designed to compare the therapeutic response of melasma in Indian women to glycolic acid (GA 20-35%) versus trichloroacetic acid (TCA 10-20%) for chemical peeling. Methods: Forty nonpregnant female patients with a minimum melasma area and severity index (MASI) of 10 were recruited in the study. After a detailed history and clinical examination under natural light, MASI was calculated and color photographs were taken of all the patients. The patients were advised to carry out a prepeel program of daily application of 12% GA cream or 0.1% tretinoin at night for 2 weeks. They were then treated with graded concentrations of 20-35% GA facial peel every 15 days in GA group and 10-20% TCA in the second group. Results: Objective response to treatment evaluated by reduction in MASI scoring after 12 weeks was by 79% reduction (from 26.6 to 5.6) in GA group and by 73% reduction in TCA group (from 29.1 to 8.2) but this difference was not significant. Patients with epidermal-type melasma showed a better response to treatment than those with mixed-type melasma (P < 0.05). Subjective response, as graded by the patient, showed good or very good response in 75% in GA group and 65% in TCA group. No relation of treatment response to age and duration of melasma could be established in this study. Conclusions: A prepeel program of daily application of 12% GA cream at night for 2 weeks, followed by graded increase in GA and TCA concentrations proved to be an equally effective treatment modality for epidermal and mixed melasma. There are hardly any major side effects, and regular use of sunscreens prevents chances of postpeel hyperpigmentation. GA peel is associated with fewer side effects than TCA and has the added advantage of facial rejuvenation.

59 citations


Journal ArticleDOI
TL;DR: Cutaneous tuberculosis in children is treated as per the recommendations of therapy for extrapulmonary TB and the diagnosis relies mainly on histopathology, culture on LJ medium or radiometric BACTEC 460 TB culture system and PCR.
Abstract: Cutaneous tuberculosis continues to be a significant medical problem even with the advent of highly effective antituberculous drugs. It constitutes about 1.5% of all extra pulmonary tuberculosis. The prevalence in children varies from 18 to 54% in India. There is no gender predilection and the infection occurs with increased frequency in 10-14 year age group. Intrafamilial source of TB has been observed very frequently. A concomitant TB lymphadenitis is most common while involvement of other systemic organs like lung, bone and abdomen has also been observed. Protective efficacy of BCG is debatable and not yet fully defined. Of all the clinical types, scrofuloderma (SFD) is the most commonly encountered variant followed by lupus vulgaris (LV) and tuberculosis verrucosa cutis (TBVC). Lichen scrofulosorum (LS) is generally found to be associated with systemic TB focus in about 72% of cases. The impact of HIV on childhood cutaneous TB seems to be minimal. Similar to adults, the diagnosis of cutaneous tuberculosis relies mainly on histopathology, culture on LJ medium or radiometric BACTEC 460 TB culture system and PCR. In addition Mantoux positivity and a positive therapeutic trial with anti-tubercular drugs may be a good pointer to tubercular infection. A thorough clinical evaluation and exhaustive investigations to pin-point associated systemic focus is advocated as the latter has an impact on the duration of treatment. Cutaneous TB in children is treated as per the recommendations of therapy for extrapulmonary TB.

59 citations


Journal ArticleDOI
TL;DR: The DIF of skin in conjunction with histopathology gives the best diagnostic yield and can be used as an additional tool to pinpoint the diagnosis of systemic and localized autoimmune diseases involving the skin.
Abstract: Background: By direct immunofluorescence (DIF), presence of immune complexes in the skin biopsy at various locations such as the dermo-epidermal junction, dermal blood vessels, etc. help to arrive at a diagnosis. Aims: (1) To study the role of DIF in confirmation or exclusion of diseases involving skin vis-a-vis histopathology and clinical diagnosis, (2) to describe the annual spectrum of dermatologic conditions that present to a tertiary referral center and require DIF examination of skin biopsy for confirmation of diagnosis. Methods: A total of 267 biopsies received over a period of 16 months in the Department of Immunopathology were analyzed along with clinical and histopathological details and the correlation between them was studied. Results: DIF was positive in 204 skin biopsies. Of these, 127 biopsies showed good clinico-immuno-histopathological correlation. In 10 cases, only DIF could clinch the diagnosis. In another nine cases, immune deposits were noted, which were unexpected in light of clinical and histopathological diagnosis. The most common skin involvement was seen in vasculitides. DIF was, however, non-contributory in lesions like erythema multiforme, post Kala-azar dermal leishmaniasis, sarcoidosis, lupus vulgaris, pyoderma gangrenosum and prurigo nodularis. Conclusion: The DIF of skin in conjunction with histopathology gives the best diagnostic yield. It is invaluable in confirming the diagnosis of small vessel vasculitides and bullous lesions of skin and can be used as an additional tool to pinpoint the diagnosis of systemic and localized autoimmune diseases involving the skin.

47 citations


Journal ArticleDOI
TL;DR: Coexistent onychomycosis in psoriatic nails does occur and the duration of skin lesions of psoriasis and Psoriasis Area Severity Index scores were significantly higher in patients with nail changes.
Abstract: Background: Psoriatic nail changes predispose to onychomycosis because it becomes easier for fungi to penetrate an already compromised nail plate. Moreover, some of the psoriatic nail changes closely resemble onychomycosis. Aim: To investigate cases of nail psoriasis for any evidence of onychomycosis. Methods: Seventy-two patients with psoriasis were included in the study. The patients were selected from the psoriasis clinic and dermatology in-patient ward. Direct microscopic examination with 20% KOH and culture were carried out in all patients showing psoriatic nail changes. Histopathological examination with Periodic Acid-Schiff (PAS) stain was done in cases negative by KOH examination and culture. Results: Nail changes were seen in 66.66% (48/72) of psoriasis patients. The most common fingernail changes observed were pitting, onycholysis and subungual hyperkeratosis, and the most common toenail changes were onycholysis and subungual hyperkeratosis. Nail changes were significantly more common in males. The duration of skin lesions of psoriasis and Psoriasis Area Severity Index scores were significantly higher in patients with nail changes. Out of 48 patients with psoriatic nail change, 23 (47.91%) had investigative evidence of onychomycosis. The fungal isolates on culture were non-dermatophytic molds in nine patients (18.75%) and yeast like fungi also in nine patients (18.75%). Conclusion: Coexistent onychomycosis in psoriatic nails does occur.

47 citations


Journal ArticleDOI
TL;DR: From a practical point of view, it will be useful for the dermatologist to keep some dietary information handy to deal with the occasional patient who does not seem to respond in spite of the best, scientific and evidence-based therapy.
Abstract: Diet has an important role to play in many skin disorders, and dermatologists are frequently faced with the difficulty of separating myth from fact when it comes to dietary advice for their patients. Patients in India are often anxious about what foods to consume, and what to avoid, in the hope that, no matter how impractical or difficult this may be, following this dictum will cure their disease. There are certain disorders where one or more components in food are central to the pathogenesis, e.g. dermatitis herpetiformis, wherein dietary restrictions constitute the cornerstone of treatment. A brief list, although not comprehensive, of other disorders where diet may have a role to play includes atopic dermatitis, acne vulgaris, psoriasis vulgaris, pemphigus, urticaria, pruritus, allergic contact dermatitis, fish odor syndrome, toxic oil syndrome, fixed drug eruption, genetic and metabolic disorders (phenylketonuria, tyrosinemia, homocystinuria, galactosemia, Refsum's disease, G6PD deficiency, xanthomas, gout and porphyria), nutritional deficiency disorders (kwashiorkar, marasmus, phrynoderma, pellagra, scurvy, acrodermatitis enteropathica, carotenemia and lycopenemia) and miscellaneous disorders such as vitiligo, aphthous ulcers, cutaneous vasculitis and telogen effluvium. From a practical point of view, it will be useful for the dermatologist to keep some dietary information handy to deal with the occasional patient who does not seem to respond in spite of the best, scientific and evidence-based therapy.

45 citations


Journal ArticleDOI
TL;DR: The current review emphasizes the potential of various phospholipid based carriers viz. liposomes, transferosome, ethosomes, lipid emulsions, solid lipid nanoparticles and organogels in optimizing and enhancing the topical delivery of anti-vitiligo agents, whilst reducing the side effects of drugs commonly used in its topical treatment.
Abstract: Vitiligo is a psychologically devastating condition. Topical therapy is employed as first-line treatment in localized vitiligo. Currently, several topical agents are available in many forms viz. methoxsalen (solution and cream), trioxsalen (solution), corticosteroids (gel, cream, ointment and solution) and calcineurin inhibitors (ointment and cream). Although topical therapy has an important position in vitiligo treatment, side-effects or poor efficacy affect their utility and patient compliance. Novel drug delivery strategies can play a pivotal role in improving the topical delivery of various drugs by enhancing their epidermal localization with a concomitant reduction in their side-effects and improving their effectiveness. The current review emphasizes the potential of various phospholipid based carriers viz. liposomes, transferosomes, ethosomes, lipid emulsions, solid lipid nanoparticles and organogels in optimizing and enhancing the topical delivery of anti-vitiligo agents, whilst reducing the side effects of drugs commonly used in its topical treatment.

45 citations


Journal ArticleDOI
TL;DR: Malassezia species identified by culture in Sabouraud's dextrose agar containing cycloheximide with olive oil overlay and modified Dixon agar and by doing biochemical tests (catalase reaction, assimilation of glycine, and Tween utilisation tests) were revealed.
Abstract: Background: In the last 10 years, different studies have shown interesting geographical variations in the prevalence of different Malassezia species in pityriasis versicolor. Aim: Identification of Malassezia species isolated from patients with pityriasis versicolor. Methods: In 100 patients with pityriasis versicolor, Malassezia species were identified by culture in Sabouraud's dextrose agar containing cycloheximide with olive oil overlay and modified Dixon agar and by doing biochemical tests (catalase reaction, assimilation of glycine, and Tween utilisation tests). Results: In 10 patients, 10% KOH smear was negative, while in 90 patients the smear showed characteristic spaghetti and meatball appearance. Of these 90 cases, growth was obtained on modified Dixon's agar in 87 cases. Fifty of the isolates (57.5%) were M. globosa, 15 (17.2%) were M. sympodialis, seven (8.0%) were suspected M. sympodialis, 6 (6.9%) each of the isolates were M. furfur and M. obtusa, and three (3.4%) isolates were M. restricta. Conclusion: M. globosa was the most common species, followed by M. sympodialis, M. furfur, M. obtusa, and M. restricta.

Journal ArticleDOI
TL;DR: Clinical morphology or KOH findings were not found to be clearly or exclusively predictive of the species involved in TC, but there was a fair degree of overlap in the clinical or microscopic patterns produced by the fungal species.
Abstract: Background: Tinea capitis (TC) is a common superficial fungal infection seen predominantly in children The etiological factors vary from one region to the other The clinical and microbiological characteristics of the same were studied in patients up to the age of 12 years seen at a pediatric superspeciality hospital in New Delhi, India Aims: To delineate the various patterns of TC observed in North India and to assess for any correlation between the clinical, microscopic and microbiologic findings in the patients seen Also, to identify the common fungal species responsible for producing TC in North India Methods: Clinical morphology and KOH findings were studied in 214 patients with the suspected diagnosis of TC Fungal culture were also performed for all the cases An attempt was made to evaluate any correlation among the clinical, microscopic and etiological findings The epidemiological factors associated with the disease were also assessed Results: TC was found to be most common in the 8-10-year age group, with noninflmmatory TC being the more common type (565%) A mixed morphological pattern was recorded in 10% of the cases Microscopic examination revealed an endothrix pattern of hair invasion to be more common (415% cases) Again, 88% of the cases showed foci of both endothrix and ectothrix pattern of invasion simultaneously Trichophyton violaceum was the most common fungal species isolated Conclusions: In the present study, clinical morphology or KOH findings were not found to be clearly or exclusively predictive of the species involved There was a fair degree of overlap in the clinical or microscopic patterns produced by the fungal species Mixed patterns were observed both on clinical examination as well as on KOH examination However, none of the specimens grew more than one fungal species

Journal ArticleDOI
TL;DR: The epidemiology, pathogenesis, clinical features, diagnosis, management and prognosis pertaining to lichen planus in children with emphasis on studies published from India are reviewed.
Abstract: Lichen planus in children is considered to be rare overall, though it does not appear to be so in Indian subcontinent. Most of the large studies on lichen planus in children have been undertaken in India. We review here the epidemiology, pathogenesis, clinical features, diagnosis, management and prognosis pertaining to lichen planus in children with emphasis on studies published from India.

Journal ArticleDOI
TL;DR: A 20-year-old male presenting with multiple subcutaneous nodules on bilateral feet and toes, left palm, right elbow, helix of left ear since last one and half year prior to any other manifestation of gout is reported, the first case report from India, demonstrating tophi as the initial clinical presentation of gouts.
Abstract: Chronic tophaceous gout classically occurs after 10 years or more of recurrent polyarticular gout. However, tophi can also occur as first sign of the disorder. Here we report a 20-year-old male presenting with multiple subcutaneous nodules on bilateral feet and toes, left palm, right elbow, helix of left ear since last one and half year prior to any other manifestation of gout. He was having mild intermittent arthritis since last six months. Fine Needle Aspiration Cytology of one tophus showed monosodium urate crystals, which are pathognomonic for gout. His serum uric acid was normal and ultrasound revealed bilateral nephrocalcinosis. So far as we know, this is the first case report from India, demonstrating tophi as the initial clinical presentation of gout.

Journal ArticleDOI
TL;DR: Current advances in the understanding of the pathogenesis, diagnostic tools, medical and surgical modalities of treatment for infantile hemangiomas are reviewed.
Abstract: Infantile hemangiomas (IH) are neoplastic proliferations of endothelial cells, characterized by a period of growth after birth, and eventual spontaneous involution. The course can be uneventful, culminating in spontaneous resolution; or it may be marked by complications such as bleeding; ulceration; infection; visual, feeding and breathing compromise; cosmetic and life-threatening complications such as congestive heart failure. Recognition of associated syndromes and impending complications of hemangiomas is of utmost importance. Great advances have taken place in the nomenclature, pathogenesis, immunohistochemistry, diagnostic workup and management of hemangiomas in the recent years. This article reviews current advances in the understanding of the pathogenesis, diagnostic tools, medical and surgical modalities of treatment for infantile hemangiomas.

Journal ArticleDOI
TL;DR: The analysis of the data revealed that the efficacy and relapse rates of low-dose isotretinoin in mild to moderate grades of acne is comparable with the standard regimen (1 mg/kg/day), which is given in the severe grade of acne vulgaris.
Abstract: Low-dose isotretinoin (0.5 mg/kg/day) is a mode of therapy for mild to moderate grades of acne.We analyzed the various trials of this mode of therapy with or without combination with topical agents.We also statistically analyzed the results, efficacy and relapse rates of standard therapy in comparison with the low-dose therapy. Our analysis of the data revealed that the efficacy and relapse rates of low-dose isotretinoin in mild to moderate grades of acne is comparable with the standard regimen (1 mg/kg/day), which is given in the severe grade of acne vulgaris. Thus, the grade of acne vulgaris should dictate the dose of administration of isotretinoin and the standard dose of 1 mg/kg/day is an unnecessary overtreatment for mild to moderate grades of acne.


Journal ArticleDOI
TL;DR: Lupoid CL is not strictly a chronic form of disease, which presents on the face from the very onset and shows no scarring or recurrence, and is redefined/described in view of clinical features.
Abstract: Background: Lupoid cutaneous leishmaniasis (CL) is known as the chronic form of CL. However, keeping its clinical presentation in view, there is a need to revisit this form of disease. Aims: To redefine/describe lupoid CL in view of clinical features. Methods: It was a case series seen in Muzaffarabad (Pakistan) from Jan 2006 to May 2008. All patients clinically suggestive and consistent with laboratory diagnosis of CL were registered. Patients of all age groups and either sex having cutaneous lesions resembling lupus vulgaris or lupus erythematosus on the face or elsewhere were included in the study. Those having chronic fluctuating/relapsing course or scarring within the lesions were also included. Various demographic features of the patients and clinical patterns were recorded. Descriptive statistics were used for analysis. Results: Of 254 registered patients of CL, 16 (6.3%) were diagnosed as lupoid CL. None of the patients had scarred lesions. Age ranged from 38 to 75 (55 + 15.11) years and duration of lesions varied from 4 to 32 (14.25 + 07.59) weeks. All patients had lesions over the face. Thirteen (81.25%) had a large solitary plaque extending over the nose and a large part of the cheeks and three (18.75%) had multiple lesions. Lesions were central/nasal in two (12.5%), unilateral/asymmetrical in four (25%) and bilateral/symmetrical in 10 (62.5%). Morphological patterns included erythematous/infiltrated (7), psoriasiform (6), ulcerated/crusted (2) and Discoid lupus erythematosus (DLE)[G1] like (1). Conclusion: Lupoid CL is not strictly a chronic form of disease, which presents on the face from the very onset and shows no scarring or recurrence.

Journal ArticleDOI
TL;DR: It is suggested that anti-nuc detection can be useful as an additional disease activity marker to other laboratory tests and could be a better tool for the diagnosis of SLE.
Abstract: Background: Detection of anti-nucleosome antibodies (anti-nuc) in patients with systemic lupus erythematosus (SLE) has been well established and it is claimed that their presence is associated with disease activity. Aims: The aim of this study is to evaluate the incidence of anti-nuc antibodies and to correlate them with disease activity and its association with other autoantibodies like anti-nuclear antibodies (ANA), anti-double stranded DNA (anti-dsDNA), anti-histone antibodies (AHA), as well as autoantibodies to histone subfractions like H1, (H2A-H4) complex, H2B, and H3. Methods: This cross-sectional study included 100 SLE patients referred from the Rheumatology, Dermatology, and Nephrology Departments. SLE disease activity was evaluated by using SLE-Disease Activity Index (SLEDAI) score. A patient was defined as having active SLE when the SLEDAI score was more than 5.0. Fifty normal controls were also tested as a healthy control group. Anti-nuc antibodies, anti-dsDNA, and AHA were tested by Enzyme-Linked Immunosorbent Assay (ELISA) and ANA was detected by an indirect immunofluorescence test. Results: All patients studied were in an active stage of disease and were untreated, of which 44 patients had renal biopsy-proven kidney involvement, which was categorized as lupus nephritis (LN) and 56 patients did not show any renal manifestations (SLE without LN). Anti-nuc antibodies were positive in 88%, anti-dsDNA in 80%, and AHA in 38% of the cases. ANA was positive in all SLE patients studied. None of the normal controls was found to be positive for these antibodies. Although a slightly higher incidence of autoantibodies were noted in LN, there was no statistical difference noted between LN and SLE without LN groups for anti-nuc and anti-dsDNA antibodies (p > 0.05). A higher incidence of autoantibodies to ANA specificities were noted in anti-nuc positive cases, but there was no statistical difference between anti-nuc positive and anti-nuc negative cases for ANA specificities among LN and SLE without nephritis groups (p > 0.05). Conclusions: Anti-nuc antibody detection could be a better tool for the diagnosis of SLE. Although there was no significant difference in LN and SLE without LN groups, this study suggests that anti-nuc detection can be useful as an additional disease activity marker to other laboratory tests.

Journal ArticleDOI
TL;DR: The management of childhood erythroderma is mainly supportive with correction of the hematologic, biochemical and metabolic imbalance if required.
Abstract: Although erythroderma is a well-recognized entity in the adult age groups and has been studied by various authors, there is a paucity of studies on erythroderma in the pediatric age group. It poses a greater challenge to the dermatologist and pediatrician because of its potential life threatening nature. In a study conducted by us in a large Indian hospital to delineate the causes of neonatal and infantile erythroderma, the causes identified were infections (40%), ichthyosiform erythroderma (25%), atopic dermatitis (15%), infantile seborrheic dermatitis (10%) and unidentified (10%). In another study of childhood erythroderma, etiologically, drugs (29%) showed the highest incidence, followed equally (18%) by genodermatoses, psoriasis and staphylococcal scalded skin syndrome (SSSS). The management of childhood erythroderma is mainly supportive with correction of the hematologic, biochemical and metabolic imbalance if required. In this review, the causes of childhood erythroderma, the clinical features useful to the diagnosis and management are discussed.

Journal ArticleDOI
TL;DR: Patch testing should be considered not only in children with lesions of a morphology suggestive of ACD, but in any child with dermatitis that is difficult to control, including 1-week-old neonates.
Abstract: Allergic contact dermatitis (ACD) in children, until recently, was considered rare. ACD was considered as a disorder of the adult population and children were thought to be spared due to a lack of exposure to potential allergens and an immature immune system. Prevalence of ACD to even the most common allergens in children, like poison ivy and parthenium, is relatively rare as compared to adults. However, there is now growing evidence of contact sensitization of the pediatric population, and it begins right from early childhood, including 1-week-old neonates. Vaccinations, piercing, topical medicaments and cosmetics in younger patients are potential exposures for sensitization. Nickel is the most common sensitizer in almost all studies pertaining to pediatric contact dermatitis. Other common allergens reported are cobalt, fragrance mix, rubber, lanolin, thiomersol, neomycin, gold, mercapto mix, balsum of Peru and colophony. Different factors like age, sex, atopy, social and cultural practices, habit of parents and caregivers and geographic changes affect the patterns of ACD and their variable clinical presentation. Patch testing should be considered not only in children with lesions of a morphology suggestive of ACD, but in any child with dermatitis that is difficult to control.

Journal ArticleDOI
TL;DR: Sir, Vitiligo is disfiguring in all races, particularly in patients with darker skin, because of stronger contrasts, and in Iran, there is a strong negative public attitude toward this disease.
Abstract: Sir, Vitiligo is disfiguring in all races, particularly in patients with darker skin, because of stronger contrasts. Patients suffer from poor body image and low self-esteem and also experience a considerable level of psychological burden.[1] Moreover, in Iran, there is a strong negative public attitude toward this disease. Since ancient times, patients with vitiligo suffered the same mental abuses as patients with leprae and, maybe, the two diseases have been confused clinically.[2]

Journal ArticleDOI
TL;DR: Skin biopsy findings were significant in all cases and the morphological patterns of cutaneous metastases corresponded with the primary tumors and their evaluation helped localize unknown primary malignancies.
Abstract: Background: Secondary tumor deposits in the skin represent advanced malignancy and are of uncommon occurrence. The clinical presentation of these lesions is variable, and the clinical impression is rarely correct, except in cases of known primary malignancies. Aim: To summarize the clinical and histopathological findings in biopsy-proven cutaneous metastases. Methods: The present study has analyzed 14 cases of cutaneous metastases from internal malignant neoplasms, excluding hematolymphoid neoplasms. The clinical parameters analyzed include presentation of deposits and their relation to the primary tumor. The histological features of cutaneous metastases were compared with the primary tumors and the frequency of common features in them were evaluated. Results: Cutaneous metastases from internal organ malignancies showed a prevalence rate of approximately 2%. Eight cases (56%) presented as primary manifestations of the tumor; biopsy evaluation in these cases suggested the possible primary tumor site and triggered further evaluation and imaging studies. Four patients, undergoing treatment for a known malignant tumor, had recurrence of the tumor in the form of cutaneous metastatic deposits. In the remaining two patients, cutaneous metastases of the tumor appeared simultaneously with the primary neoplasm and represented a higher stage of malignancy. Conclusions: Skin biopsy findings were significant in all cases. The morphological patterns of cutaneous metastases corresponded with the primary tumors and their evaluation helped localize unknown primary malignancies. In cases with known primaries, cutaneous metastases upstaged the malignancy and affected the prognosis.

Journal ArticleDOI
TL;DR: A comparison of the use of steroids and low-dose enalapril in the treatment of surgical cutaneous hypertrophic scar and keloid in a black African population and the results indicate that the former is more beneficial than the latter.
Abstract: 1. Alabi GO, George AO. Cutaneous sarcoidosis and tribal scarifications in West Africa. Int J Dermatol 1989;28:29-31. 2. Mammen L, Norton SA. Facial scarification and tattooing on Santa Catalina Island (Solomon Islands). Cutis 1997;60:197-8. 3. Jalali M, Bayat A. Current use of steroids in management of abnormal raised skin scars. Surgeon 2007;5:175-80. 4. Iannello S, Milazzo P, Bordonaro F, Belfiore BF. Low-dose enalapril in the treatment of surgical cutaneous hypertrophic scar and keloid—two case reports and literature review. Med Gen Med 2006;8:60. 5. Olaitan PB. Keloids: Assessment of effects and psychosocial impacts on subjects in a black African population. Indian J Dermatol Venereol Leprol 2009;76:32-6.

Journal ArticleDOI
TL;DR: Two cases of hemangioma, successfully treated with propranolol, showed dramatic response, with more than 80% regression, without any relapse after stopping the treatment.
Abstract: Hemangiomas are indolent birthmarks of vascular origin, which are known to appear soon after birth, proliferate for 8-18 months, and then slowly regress over the next 5-8 years, leaving behind normal or slightly blemished skin. In rare instances, hemangiomas may encroach upon and endanger vital structures with a mortality of up to 60%. Multiple therapeutic modalities are available for hemangiomas with variable results and associated with side effects. We report two cases of hemangioma, successfully treated with propranolol. Case 1 was a 5-month-old female child who presented with a giant segmental hemangioma since birth. She was unable to open her left eye over the past 7 days. Within 48 hours of administering full dose of oral propranolol (2 mg/kg/day), the lesion decreased considerably, and the patient was able to open her eye. Case 2 was a 1-year-old female child who presented with hemangioma over the danger area of face. Oral propranolol was given for a period of 6 months with monthly follow up. Both the cases showed dramatic response, with more than 80% regression, without any relapse after stopping the treatment.

Journal ArticleDOI
TL;DR: The management of psoriasis limited to certain areas of the body like scalp, nails, palms and soles remains difficult to treat.
Abstract: Psoriasis is a common, chronic, inflammatory disease with a wide range of clinical presentations. The disease severity ranges from mild to severe. Plaque type of psoriasis is the most common. A number of factors like previous treatment history and comorbid conditions influence the treatment of psoriasis in an individual patient. Location of the lesions is also an important consideration. Psoriasis localized to certain areas of the body like scalp, nails, palms and soles remains difficult to treat. These sites have been referred to as the difficult locations in literature. This article covers the management of psoriasis limited to these special areas.

Journal ArticleDOI
TL;DR: The evolution of narrowband ultraviolet B, its mechanism of action pertaining to psoriasis, indications and contraindications, dosimetry, complications of NBUVB while being used in patients with psOriasis, its merits and demerits in comparison with broadband UVB and psoralen+UVA (PUVA), and recent developments in the delivery system are discussed.
Abstract: Ever since artificial TL-01 lamps were developed, narrowband ultraviolet B (NBUVB) has gained giant strides in dermatology. Psoriasis is one of the common indications for the use of NBUVB in present day dermatology. We discuss here the evolution of NBUVB, its mechanism of action pertaining to psoriasis, indications and contraindications, dosimetry, complications of NBUVB while being used in patients with psoriasis, its merits and demerits in comparison with broadband UVB and psoralen+UVA (PUVA), and recent developments in the delivery system of NBUVB.

Journal ArticleDOI
TL;DR: Histopathology of both cases of acroangiodermatitis showed dilated capillaries in the dermis with extravasated red blood corpuscles (RBCs), hemosiderin deposits, and hyperplastic granulation tissue.
Abstract: Acroangiodermatitis (synonym pseudo-Kaposi sarcoma) is an unusual, benign condition which clinically presents as purple-colored patches, plaques or nodules, mostly on the extensor surfaces of lower extremities in patients with chronic venous insufficiency and arteriovenous malformations. It resembles aggressive conditions like Kaposi's sarcoma and requires histopathological examination for its diagnosis. We report two such cases of acroangiodermatitis. Histopathology of both the cases showed dilated capillaries in the dermis with extravasated red blood corpuscles (RBCs), hemosiderin deposits, and hyperplastic granulation tissue. Both were treated with oral antibiotics and topical steroids. The ulcers showed a good response within 2 months of treatment.

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TL;DR: Three unusual clinical forms of sporotrichosis described in this paper will be a primer for the clinicians for an early diagnosis and treatment, especially in its unusual presentations, to prevent chronicity and morbidity in these patients.
Abstract: Three unusual clinical forms of sporotrichosis described in this paper will be a primer for the clinicians for an early diagnosis and treatment, especially in its unusual presentations. Case 1, a 52-year-old man, developed sporotrichosis over pre-existing facial nodulo-ulcerative basal cell carcinoma of seven-year duration, due to its contamination perhaps from topical herbal pastes and lymphocutaneous sporotrichosis over right hand/forearm from facial lesion/herbal paste. Case 2, a 25-year-old woman, presented with disseminated systemic-cutaneous, osteoarticular and possibly pleural (effusion) sporotrichosis. There was no laboratory evidence of tuberculosis and treatment with anti-tuberculosis drugs (ATT) did not benefit. Both these cases were diagnosed by histopathology/culture of S. schenckii from tissue specimens. Case 3, a 20-year-old girl, had multiple intensely pruritic, nodular lesions over/around left knee of two-year duration. She was diagnosed clinically as a case of prurigo nodularis and histologically as cutaneous tuberculosis, albeit, other laboratory investigations and treatment with ATT did not support the diagnosis. All the three patients responded well to saturated solution of potassium iodide (SSKI) therapy. A high clinical suspicion is important in early diagnosis and treatment to prevent chronicity and morbidity in these patients. SSKI is fairly safe and effective when itraconazole is not affordable/ available.

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TL;DR: Daily use of a facial lotion containing niacinamide, panthenol, and tocopheryl acetate improved skin tone and texture and was well tolerated in Indian women with facial signs of aging.
Abstract: Background The B vitamins niacinamide and panthenol have been shown to reduce many signs of skin aging, including hyperpigmentation and redness. Aims To measure the facial skin effects in Indian women of the daily use of a lotion containing niacinamide, panthenol, and tocopherol acetate using quantitative image analysis. Methods Adult women 30-60 years of age with epidermal hyperpigmentation were recruited in Mumbai and randomly assigned to apply a test or control lotion to the face daily for 10 weeks. Effects on skin tone were measured using an image capturing system and associated software. Skin texture was assessed by expert graders. Barrier function was evaluated by transepithelial water loss measurements. Subjects and evaluators were blinded to the product assignment. Results Of 246 women randomized to treatment, 207 (84%) completed the study. Women who used the test lotion experienced significantly reduced appearance of hyperpigmentation, improved skin tone evenness, appearance of lightening of skin, and positive effects on skin texture. Improvements versus control were seen as early as 6 weeks. The test lotion was well tolerated. The most common adverse event was a transient, mild burning sensation. Conclusions Daily use of a facial lotion containing niacinamide, panthenol, and tocopheryl acetate improved skin tone and texture and was well tolerated in Indian women with facial signs of aging.