OXIDANT/ANTIOXIDANT STATUS IN OBESE ADOLESCENT FEMALES WITH ACNE VULGARIS

Background and Objectives:

Acne vulgaris is a distressing skin condition, which can carry with it significant psychological disability. Oxidant/antioxidant imbalance leads to increased production of free radicals, that cause many diseases. Some nutrients, along with systemic oxidative stress, have been implicated in acne vulgaris. The goal of the present study was to assess oxidant and antioxidant status in correlation with the incidence of acne vulgaris in adolescent obese females.

Materials and Methods:

A total of 60 adolescent females (age 16-22 years) were divided into four groups (15 each) as follows: The first included obese females with acne; the second included obese females without acne; the third included non obese with acne and the fourth included non obese without acne. Fasting serum Malondialdehyde (MDA), β-carotene, and Vitamins A, E, and C were measured. In addition, platelet monoamineoxidase (MAO), and erythrocyte catechol-o-methyltransferase (COMT) activities were determined.

Results:

It was found that serum MDA was statistically significantly decreased in obese and non obese subjects with acne, as compared to those without acne (P<0.05, P<0.001) respectively. In contrast, the levels of β-carotene, vitamins A, E and C and the activity of MAO were significantly decreased in the obese and non obese with acne, as against the obese and non obese without acne.

Interpretation:

In obese subjects, increased fat content facilitates free radical production and lipid peroxidation, as indicated by increased MDA level, which is scavenged by the antioxidant vitamins. The decreased activity of MAO may be inhibited by free radicals and this causes psychological depression in adolescents. However there were non significant changes in the activity of COMT among the studied groups.

Conclusion:

The nutritional factors and a weakened antioxidant defense system may interplay, to increase the risk of psychological sequelae in acne vulgaris.     

HYPERTROPHIC LUPUS VULGARIS: AN UNUSUAL PRESENTATION

Lupus vulgaris is the most common form of cutaneous tuberculosis occurring in previously sensitized individuals with a high degree of tuberculin sensitivity. Various forms including plaque, ulcerative, hypertrophic, vegetative, papular, and nodular forms have been described. A 30-year-old male patient presented with a very large hypertrophic lupus vulgaris lesion over left side of chest since 22 years. Histopathological examination showed granulomatous infiltration without caseation necrosis. The Mantoux reaction was strongly positive. Hypertrophic lupus vulgaris of such a giant size and that too at an unusual site is extremely rare and hence is being reported.     

HIRSUTISM IN KASHMIR: AN ETIOLOGICAL STUDY

Background:

Hirsutism refers to the presence of terminal hairs at the body sites under androgenic control. Various factors, including genetic makeup and hormonal status, influence the rate and pattern of hair growth at these sites.

Purpose:

To study the pattern of hirsutism in Kashmir.

Materials and Methods:

Thirty five consecutive patients of hirsutism were included in the study. After detailed history taking, physical examination and relevant investigations, scoring of hirsutism was done using the Ferriman Gallwey (FG) scoring system.

Findings:

The FG score ranged from 10-34. Twenty patients had associated menstrual abnormalities. Polycystic ovarian syndrome (PCOS) was diagnosed in four patients, hypothyroidism in two and congenital adrenal hyperplasia (CAH) in one. The rest of the patients had idiopathic hirsutism.

Conclusion:

Idiopathic hirsutism was the most common category, whilst PCOS, hypothyroidism and CAH were also seen.     

COMPARISON OF THE ACTIVITIES OF FOUR ANTIFUNGAL AGENTS IN AN IN VITRO MODEL OF DERMATOPHYTE NAIL INFECTION

Background:

Onychomycosis is a difficult condition to treat and cure rates are disappointing. Moreover fungicidal action of antifungal agents in NCCLS assays and their rapid accumulation in nails in vivo are not compatible with the duration of treatment.

Aims:

This study aimed to find the effectiveness of 4 different antifungal agents in an in vitro model with some similarities to in vivo conditions.

Materials and Methods:

Strains of Trichophyton rubrum I-III, Trichophyton mentagrophytes (usual form), Trichophyton mentagrophytes 73, Epidermophyton Flucosom, Microsporum Canis, and Trichophyton Schoenleini which were isolated from the nails of patients, were hired. Inocula suspensions were prepared from 7 to 14 day-old cultures of dermatophytes. Antifungal agents including fluconazole, ketoconazole, terbinafine, and griseofulvin were obtained as standard powders. For each antifungal agent, initial MIC was calculated by registering the optical density for 10 two-fold serially diluted forms which was incubated with diluted fungal suspensions with RPMI 1640. Human nail powder inoculated with different strains and incubated in RPMI 1640 and different concentrations of antifungal drugs for 4 weeks. Final MIC at different steps of 1, 2, 3 and 4 weeks were investigated.

Results:

The final MIC that resulted from the incubation of dermatophytes with nail powder was much more than the initial which was concluded from conventional MIC assay. Terbinafine had the lowest rate of initial and final MICs.

Conclusion:

The model described here may present more similar conditions to clinical fungal infections; therefore the results such as MIC may be more helpful for hiring the most effective antifungal agent.     

CUTANEOUS ZYGOMYCOSIS DUE TO SAKSENAEA VASIFORMIS IN AN IMMUNOCOMPETENT HOST

Saksenaea vasiformis is an emerging zygomycete species, most often associated with cutaneous, subcutaneous and rhino- orbito-cerebral infections. Herein, we report a case of cutaneous zygomycosis of face caused by Saksenaea vasiformis in a 54-year-old immunocompetent female. The diagnosis was carried out by microscopy using KOH mount, Gram staining, Gomori''s methenamine silver staining, hemotoxylin and eosin staining and culture on Sabouraud''s Dextrose agar without actidione. Slide cultures were put up on Czapek Dox agar, which showed typical flask-shaped sporangium with rhizoids. The patient was treated successfully with intravenous amphotericin B.     

BLISTER FLUID IMMUNOFLUORESCENCE IN A CASE OF PEMPHIGUS VULGARIS

Indirect immunofluorescence with serum is used in the diagnosis of pemphigus. We report a case in whom blister fluid was used as the specimen for indirect immunofluorecscence.     

AN UNCONTROLLED OPEN PILOT STUDY TO ASSESS THE ROLE OF DIETARY ELIMINATIONS IN REDUCING THE SEVERITY OF ATOPIC DERMATITIS IN INFANTS AND CHILDREN

Background:

The severity of atopic dermatitis (AD) has been reported to be reduced by dietary eliminations in a subset of patients with AD.

Aims:

To assess the reduction of the severity of atopic dermatitis in infants and children after eliminations of certain dietary items.

Materials and Methods:

The study group comprised of 100 children with atopic dermatitis. Their severity of itching, surface area of involvement, and SCORAD index were measured. Patients who did not have any systemic disease or were not on systemic corticosteroids were included in the study. Selected patients were advised to strictly adhere to a diet excluding milk and milk products, all kinds of nuts and nut-containing foods, egg and egg-containing foods, seafish and prawns, brinjal and soyabean for a period of 3 weeks. Instead of these avoided items, the food items to be included freely to maintain proper nutrition were dal and dal products, rohu fish, chicken, and fruits. All the preintervention parameters were measured again after 3 weeks.

Results:

There was a statistically significant reduction in severity scores after dietary elimination alone.

Conclusion:

Dietary elimination helped to alleviate symptoms and signs in a subset of infants and children with AD.     

MALIGNANT TRANSFORMATION OF ACTINIC KERATOSES TO SQUAMOUS CELL CARCINOMA IN AN ALBINO

A 25-year-old male, who was a known case of oculocutaneous albinism presented to us with right inguinal swellings of six months'' duration. He gave a preceding history of a similar lump in the right thigh, which was excised at the Chennai Government Hospital. He was diagnosed to have oculocutaneous albinism with actinic keratoses, with multiple squamous cell carcinomas (with metastatic deposits in the right inguinal region) and cutaneous horns. The case is reported to highlight preventive aspects in the management of albinos.     

Cultural Adaptation of the Cardiff Acne Disability Index to a Hindi Speaking Population: A Pilot Study

Background:

Acne vulgaris is known to impair many aspects of the quality of life (QoL) of its patients.

Aim:

To translate the Cardiff Acne Disability Index (CADI) from English into Hindi and to assess its validity and reliability in Hindi speaking patients with acne from India.

Methods:

Hindi version of CADI, translated and linguistically validated as per published international guidelines, along with a previously translated Hindi version of dermatology life quality index (DLQI) and a demographic questionnaire were administered to acne patients. The internal consistency reliability of the Hindi version of CADI and its concurrent validity were assessed by Cronbach''s alpha co-efficient and Spearman''s correlation co-efficient respectively. Construct validity was examined by factor analysis. Statistical analysis was carried out using the Statistical Package for the Social Sciences (SPSS) version 20 (SPSS Inc., Chicago, IL, USA) for Windows.

Results:

One hundred Hindi speaking patients with various grades of acne participated in the study. Hindi version of CADI showed high internal consistency reliability (Cronbach''s alpha co-efficient = 0.722). Mean item-to-total correlation co-efficient ranged from 0.502 to 0.760. Concurrent validity of the scale was supported by a significant correlation with the Hindi DLQI. Factor analysis revealed the presence of two dimensions underlying the factor structure of the scale.

Conclusion:

Hindi CADI is equivalent to the original English version and constitutes a reliable and valid tool for clinical assessment of the impact of acne on QoL.     

Rediscovering Perifollicular Elastolysis: A Hitherto Undocumented Entity in India

Perifollicular elastolysis, also known as papular acne scars is a common but taken for granted entity. It appears as asymptomatic whitish yellow papules on the trunk and proximal arms. Histologically there is loss of elastin around the pilosebaceous follicles. The lesions are the result of a scarring process that appear as papules and are often mistaken for papules of acne and are treated. A knowledge of this entity which has never been described before in India is being reiterated.     

NONDERMATOPHYTIC MOULDS AS A CAUSATIVE AGENT OF ONYCHOMYCOSIS IN TEHRAN

Background:

In the last few years the number of cases of nondermatophytic onychomycosis has greatly increased.

Aim:

To evaluate the incidence, the clinic characteristics, and predisposing factors of nondermatophytic onychomycosis.

Materials and Methods:

All collected specimens were analyzed by direct microscopy and culture. Microscopic examination of these specimens was carried out in potassium hydroxide solution (20%) with dimethyl sulfoxide (4%). These specimens were cultured on sabouraud''s glucose agar with chloramphenicol and sabouraud''s glucose agar with chloramphenicol and cycloheximide. Cultures were incubated at 25°C for up to 28 days and checked twice weekly for growth.

Results:

Nondermatophytic onychomycosis were 11.5% of all onychomycosis. We found that Aspergillus spp. were the more responsible etiologic agents of nondermatophytic onychomycosis, resulting in a total of 28 patients (59.6%). In our study other causative agents were Acremonium spp. (17%), Fusarium spp. (12.7%), Geotrichum spp. (4.2%), Trichosporun spp., (4.2%) and Scopulariopsis spp (2.1%). In our patients moulds onychomycosis developed mainly in toenails (74.5%).

Conclusion:

Knowing the exact pathogen is important and has implications in therapy and prognosis.     

ELEPHANTIASIS OF THE EXTERNAL GENITALIA: A SEQUEL TO CUTANEOUS TUBERCULOSIS

Tuberculosis continues to be an important public health problem and cutaneous tuberculosis constitutes a minor proportion of extra pulmonary manifestations of tuberculosis. Elephantiasis of the external genitalia, as a sequel to cutaneous tuberculosis, in a 40-year-old diabetic lady is being reported for its rarity. The patient also had lesions of healed scrofuloderma of 27 years’ duration, in both axillae, with residual pedunculated nodules.     

ISOLATION OF BACTERIA CAUSING SECONDARY BACTERIAL INFECTION IN THE LESIONS OF CUTANEOUS LEISHMANIASIS

Background:

Cutaneous Leishmaniasis (CL) is a parasitic disease characterized by single or multiple ulcerations. Secondary bacterial infection is one of the complications of the disease that can increase the tissue destruction and the resulting scar.

Objective:

To effectively determine the incidence of real secondary bacteria infection in cutaneous leishmaniasis, we designed the current study.

Methods and Materials:

This was a cross-sectional study performed in Skin Diseases and Leishmaniasis Research Centre, Isfahan, Iran. In this study, 854 patients with confirmed CL were enrolled. Samples were taken from all the patients. Sterile swaps were achieved for the ulcer exudates and scraping was used for nonulcerated lesions. All the samples were transferred to tryptic soy broth medium. After 24 h of incubation in 37°C, they were transferred to eosin methylene blue agar (EBM) and blood agar. Laboratory tests were used to determine the species of bacteria. All of the collected data were analyzed by SPSS software and chi-square.

Results:

Among 854 patients with confirmed cutaneous leishmaniasis, 177 patients (20.7%) had positive cultures for secondary bacterial infection. Bacteria isolated from the lesions were as follows: Staphylococcus aureus - 123 cases (69.4%), coagulase negative Staphylococcus - 41 cases (23.1%), E. coil - 7 cases (3.9%), Proteus - 3 cases (1.7%) and Klebsiella - 3 cases (1.7%).

Conclusions:

The incidence of secondary bacterial infection in lesions of CL was 20.7%. The most common isolated pathogen was Staphylococcus aureus. The incidence of secondary bacterial infection was significantly more in the ulcerated lesions as compared with nonulcerated lesions (P = 0.00001).     

OUTBREAK OF TINEA GLADIATORUM IN WRESTLERS IN TEHRAN (IRAN)

Background:

In recent years, skin diseases in wrestling have finally received the attention they deserve. Outbreaks of tinea corporis are often associated with sports involving extensive bodily contact; such sports include wrestling. Tinea corporis gladiatorum is primarily caused by Trichophyton tonsurans, infecting wrestlers at alarming rates. The management of skin infections in wrestlers and other athletes in sports involving skin-to-skin contact entails numerous challenges, from making an accurate diagnosis to determining eligibility for playing the sports. To control outbreaks, we conducted an epidemiologic investigation. The purpose of this article is to determine the prevalence of tinea corporis gladiatorum in wrestlers in Tehran, Iran.

Materials and Methods:

A study of dermatophytosis was carried out during the period of March 2004 to December 2005 on 612 mycological proven cases of dermatophytosis found in male wrestlers in Tehran. Mycological examination consisted of culturing of pathologic material followed by direct microscopic observation. Diagnosis was based on macroscopic and microscopic characteristics of the colonies.

Results:

T. tonsurans was the predominant dermatophyte, accounting for >90% of all tinea corporis gladiatorum isolates during the 2 year analysis. Tinea corporis gladiatorum was found to be more frequent in individuals between the ages of 10 and 20 years of age (72.7%). Wrestlers with tinea corporis gladiatorum were predominantly from wrestling clubs in southern and southeastern Tehran. Transmission of tinea corporis is primarily through skin-to-skin contact.

Conclusion:

Rapid identification and treatment of tinea corporis gladiatorum is required to minimize the disruption of team practices and competitions. Infection with dermatophytes can disqualify a wrestler from competing in matches, and thus, vigilant surveillance and rapid initiation of treatment is important to prevent the suspension of team practices and competitions.     

Comparison of Red and Infrared Low-level Laser Therapy in the Treatment of Acne Vulgaris

Background/Purpose:

Acne vulgaris is a very prevalent skin disorder and remains a main problem in practice. Recently, phototherapy with various light spectrums for acne has been used. There are some evidences that low-level laser therapy (LLLT) has beneficial effect in the treatment of acne lesions. In this study, two different wavelengths of LLLT (630 and 890 nm) were evaluated in treatment of acne vulgaris.

Materials and Methods:

This study was a single-blind randomized clinical trial. Patients with mild to moderate acne vulgaris and age above 18 years and included were treated with red LLLT (630 nm) and infrared LLLT (890 nm) on the right and left sides of the face respectively, twice in a week for 12 sessions, and clinically assessed at baseline and weeks 2, 4, 6, and 8.

Results:

Twenty-eight patients were participated in this study. Ten weeks after treatment acne lesion were significantly decreased in the side treated by 630 nm LLLT (27.7±12.7 to 6.3±1.9) (P<0.001), but this decrease was not significant in the site treated by 890 nm LLLT (26.9±12.4 to 22.2±8.5) (P>0.05).

Conclusion:

Red wavelength is safe and effective to be used to treat acne vulgaris by LLLT compared to infrared wavelength.     

Efficacy of 2% metronidazole gel in moderate acne vulgaris

Background:

Acne vulgaris is an inflammatory disease of the pilosebaceous units. Various systemic and topical options are available for its treatment.

Aims:

This study aimed to evaluate the efficacy of 2% metronidazole gel in acne vulgaris.

Materials and Methods:

Double-blind, randomized, placebo-controlled, split-face clinical trial. Seventy young adults with moderate acne vulgaris received 2% metronidazole gel on the right side of their face and placebo on the left side of their face twice daily for 8 weeks. The number of inflamed and noninflamed facial lesions and side effects of treatment were documented on weeks 1, 2, 4, and 8. The patients’ overall satisfaction was recorded at the end of the study. For statistical analysis we used the repeated-measures analysis, the chi-square test, Fisher''s exact test, and the independent-samples t-test as appropriate.

Results:

Counts of inflamed and noninflamed facial lesions were comparable between the two sides at baseline. The number of the lesions was significantly lower on the metronidazole-treated side at all follow-up visits. Erythema and oily face decreased by 85.7% and 87.1%, respectively, on the metronidazole-treated side. Mild burning sensation and dryness on the metronidazole-treated side was reported by 3.4% and 22.9% of the patients, respectively. Eighty-eight percent of the patients were satisfied with the results of treatment on the metronidazole-treated side.

Conclusions:

Metronidazole gel (2%) is an effective, safe, and well-tolerated topical medication for moderate acne vulgaris.     

AN OPEN STUDY OF TRIPHASIL AND DIANE 50 IN THE TREATMENT OF ACNE

Levonorgestrel, as used in oral contraceptives, has antiovulatory activity at doses far lower than those producing androgenic effects. Triphasil, containing levonorgestrel was compared with Diane, containing cyproterone acetate in a trial of acne treatment. Twenty closely matched patients were alternatively allocated to 6 months of Triphasil or Diane treatment. Both groups had a 72% reduction in acne counts. Assays of total testosterone, androgen index, free testosterone, dehydroepiandrosterone sulphate and androstenedione showed significant reduction on treatment and sex hormone binding globulin was raised. All hormonal changes were more marked in the Diane group. Side effects caused only one withdrawal from the trial.     

Generation and characterization of chicken egg yolk antibodies against propionibacterium acnes for the prevention of acne vulgaris

Introduction:

Antigen-specific antibody has been widely used for immunological analysis in the field of diagnosis as well as in pure scientific research, where the IgY antibodies can be raised against P acnes antigen.

Material and Methods:

To produce IgY against Propionibacterium acnes, laying hens were immunized with P acnes (MTCC No: 1951) and subsequent booster injections were given. The antibodies produced were purified from the egg yolk of immunized chicken using the polyethylene glycol and ammonium sulfate precipitation method and, further, by Diethylaminoethyl (DEAE) cellulose ion-exchange column chromatography. The protein fraction of IgY was isolated from the egg yolk. The separation was rapid, and the success of each step was viewed on Sodium Dodecyl Sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). The reactivity of anti–P acnes was evaluated by the Enzyme-linked immunosorbent assay (ELISA) test and the dot-immunoassay.

Results:

With ELISA, the highest titter of 1:10000 was observed on the 150^th day after vaccination. The results of dot-immunoassay suggested that anti–P acnes IgY developed a brown color as positive reaction, which showed the antigen-antibody binding even after a maximum dilution of 1/500. These results suggest that anti-acne IgY was produced and had strong specific antibody reactivity.

Conclusion:

The findings indicate that anti-acne IgY is worth utilizing as a preventive agent for acne vulgaris.     

Discordant HIV Couple: Analysis of the Possible Contributing Factors

Several intricacies still abound with respect to HIV infection. Discordance is one such intriguing aspect of HIV infection. Out of 35 discordant couples included in the study. husbands were positive in 29 couples and wives in 6. Pre/extramarital affairs was the probable reason for HIV infection in 23 out of 29 discordant males, and 2 out of 6 discordant females. Even though, decreased frequency of sexual acts between the couple was the reason for discordance in a few, but in majority of the couples who had regular sexual contact for many years, the exact cause for discordance could not be ascertained. inherent resistance to HIV in some individuals may be the reasons for the discordance.     

Evaluation of pH of Bathing Soaps and Shampoos for Skin and Hair Care

Background:

Normal healthy skin has potential of hydrogen (pH) range of 5.4-5.9 and a normal bacterial flora. Use of soap with high pH causes an increase in skin pH, which in turn causes an increase in dehydrative effect, irritability and alteration in bacterial flora. The majority of soaps and shampoos available in the market do not disclose their pH.

Aims and Objectives:

The aim of this study was to assess the pH of different brands of bathing soaps and shampoos available in the market.

Materials and Methods:

The samples of soaps and shampoos were collected from shops in the locality. The samples of different brands are coded before the analysis of the pH. Solution of each sample was made and pH was measured using pH meter.

Results:

Majority of the soaps have a pH within the range of 9-10. Majority of the shampoos have a pH within the range of 6-7.

Conclusions:

The soaps and shampoos commonly used by the population at large have a pH outside the range of normal skin and hair pH values. Therefore, it is hoped that before recommending soap to patient especially those who have sensitive and acne prone skin, due consideration is given to the pH factor and also that manufacturers will give a thought to pH of soaps and shampoos manufactured by them, so that their products will be more skin and hair friendly.