STUDY OF THE ROLE OF SERUM FOLIC ACID IN ATOPIC DERMATITIS: A CORRELATION WITH SERUM IgE AND DISEASE SEVERITY

Background:

Most atopic dermatitis (AD) patients have elevated serum immunoglobulin E (IgE). Impaired folic acid (FA) metabolism was found to reduce the intracellular methyl donor pool, associated with a higher prevalence of atopy.

Aim:

To assess serum IgE and FA in AD patients and to correlate their levels with the disease severity, and with each other.

Materials and Methods:

Twenty patients with AD were assessed for serum FA and IgE, compared with 20 age- and sex-matched controls. Patients were classified into three groups (mild, moderate, and severe AD) based on clinical severity according to Nottingham index. In both patients and controls, serum IgE was measured using Enzyme-linked immunosorbent assay technique and serum FA was measured using Microparticle Enzyme Immunoassay technique.

Results:

Serum FA levels were lower in AD patients compared with controls, but the difference was not statistically significant. FA levels did not show statistically significant difference among disease severity groups and did not correlate with serum IgE levels. On the other hand, serum IgE levels were significantly elevated in AD patients compared with controls, and among AD patients, its levels were significantly elevated in severe AD compared with mild and moderate disease.

Conclusion:

Serum IgE is useful in assessment of AD severity and activity. FA contribution to AD needs further investigations.     

RANDOMIZED COMPARATIVE CLINICAL TRIAL OF ARTEMISIA SIEBERI 5% LOTION AND CLOTRIMAZOLE 1% LOTION FOR THE TREATMENT OF PITYRIASIS VERSICOLOR

Aims:

To compare the therapeutic effects of topical Artremisia sieberi 5% lotion with topical clotrimazole 1% lotion in the treatment of pityriasis versicolor.

Materials and Methods:

100 patients with pityriasis versicolor and microscopic identification of Malassezia furfur were randomly assigned to treatment with either topical Artemisia sieberi 5% lotion (group 1) or topical clotrimazole 1% lotion (group 2) for 2 weeks. Group 1 and group 2 consisted of 51 and 49 patients respectively. The patients were evaluated both clinically and mycologically at baseline and every 2 weeks for a period of 4 weeks.

Results:

At the end of the second week, clinical cure rates were 86.3% and 65.3% for group 1 and group 2 respectively (P<0.01), but at the same time mycological cure rate was 92.2% for group 1 and 73.5% for group 2 (P<0.05). At the end of the fourth week, clinical cure rates were 86.3% and 59.2% for group 1 and group 2 respectively (P<0.01), and at the same time mycologic cure rate was 96.1% for group 1 and 65.3% for group 2 (P<0.01).

Conclusions:

The results of this study demonstrated that Artemisia sieberi 5% lotion was more effective than clotrimazole 1% lotion in the treatment of pityriasis versicolor.     

A STUDY ON THE ETIOLOGICAL AGENT AND CLINICO-MYCOLOGICAL CORRELATION OF FINGERNAIL ONYCHOMYCOSIS IN EASTERN INDIA

Background:

Onychomycosis manifests itself in various forms, notably onychodystrophy, onycholysis, subungual hyperkeratosis, or nail-plate discoloration. Not necessarily nail changes mentioned here should always be of fungal origin.

Objective:

The present study is planned to get an idea about etiological agent and clinical correlation in fingernail onychomycosis.

Materials and Methods:

Nail-clipping and subungual debris of patients with above mentioned nail changes were subjected to KOH preparation. Culture was done on SDA and SDCCA media. Species identification was done by colony character, pigment production, LCB staining, and some special tests like germ tube test, etc.

Results:

Out of 85 cases, 44 cases showed the growth of fungus, amounting to 51.76% positivity. Among those 44 cases, the infective fungal agents were predominantly dermatophytes (50%), and the rest were due to yeasts (27.27%) and moulds (22.72%). Among the different species, Trichophyton rubrum (29.54%) accounted for the majority of dermatophytes; Candida albicans (11.78%) was the predominant yeast; and Aspergillus niger (18.18%) the commonest mold. No significant association could be established between the different fungal species and various clinical manifestations. Positive results were found more with fungal culture (95.45%) than KOH preparation (63.64%).

Conclusion:

The results show that nail changes are not always a reliable marker for predicting the causative organism, and relying only on the clinical manifestation (i.e., pattern of nail changes) in the diagnosis of onychomycosis is often misleading. The present study highlights the need for microbiological confirmation in case of onychomycosis.     

GALENICALS IN THE TREATMENT OF CRUSTED SCABIES

Crusted scabies is rare. It is a therapeutic challenge, as the common drugs used against scabies are unsatisfactory. The successful use of galenicals in a 10-year-old girl with crusted scabies is reported.     

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.     

STUDY OF TOTAL ANTIOXIDANT STATUS AND GLUTATHIONE PEROXIDASE ACTIVITY IN TUNISIAN VITILIGO PATIENTS

Background:

Vitiligo affects one to two percent of the word population. Its pathogenesis has not been clarified yet. Multiple mechanisms such as autoimmune, neuronal, endocrine and oxidative stress resulting from unbalanced antioxidant defense system have been proposed.

Aims:

Our purpose was to study the total antioxidant status and glutathione peroxidase activity in Tunisian vitiligo patients with or without diabetes or dysthyroidism.

Materials and Methods:

We studied 60 vitiligo patients and 62 healthy controls. The sex ratio male/female in vitiligo patients was (27/33 = 0.81). Patients with vitiligo were divided into three groups, according to the association with diabetes or dysthyroidism. The total antioxidant status (TAS), glutathione peroxidase activity (GPX activity) was evaluated by adaptable methods using Kits.

Results and Conclusion:

The generalized vitiligo was the most frequent type (35 patients versus 25 of focal ones). All patients having vitiligo showed low levels of TAS: 0.85 ± 0.7 and low GPX activity: 45 ± 0.6, as compared to the control group: 1.40 ± 0.12 mmol/L; 49 ± 1.8 U/L, (p < 0.01), for TAS and GPX, respectively. The association of low TAS and GPX activities was more pronounced in diabetic vitiligo patients than in dysthyroid vitiligo patients. This study demonstrated that antioxidant processes depletion (low TAS and low GPX activity) is clearly involved with vitiligo in Tunisian patients, regardless of the association of the disease with diabetes or dysthyroidism.     

RARE PRESENTATION OF KYRLE'S DISEASE IN SIBLINGS

Background:

Kyrle''s disease is a rare variant of primary perforating dermatosis. Its occurrence in a familial setting, especially in children, is extremely uncommon. Similar appearing skin lesions have been described in adults, secondary to metabolic disorders, infective agents as well as exposure to chemicals. We present a rare case of this genodermatosis in two siblings.

Materials and Methods:

Two siblings of a non-consanguineous marriage came with generalized discrete papular lesions with a central keratotic plug. All biochemical and serological investigations were within normal limits. Serial sections of the biopsy revealed typical epidermal invaginations filled with parakeratotic debris and perforation into the dermis with accompanying granulomatous reaction.

Results and Conclusions:

A careful history, detailed routine investigations and serial sections of the skin biopsy are required to demonstrate the typical morphology and stages of evolution of Kyrle''s disease. This helps to differentiate the rare primary Kyrle''s disease from other primary and secondary keratotic lesions. Due to the familial occurrence, screening of relatives of an index case is recommended.     

EPIDEMIC OF HAND, FOOT AND MOUTH DISEASE IN WEST BENGAL, INDIA IN AUGUST, 2007: A MULTICENTRIC STUDY

Background:

Hand, foot, and mouth disease (HFMD) is caused mostly by Coxsackievirus A16 (CA16) and enterovirus 71 (EV71). Epidemic of HFMD has occurred in India only once in Kerala in 2003. We report here a recent outbreak of HFMD in three districts of West Bengal, India.

Materials and Methods:

A case detection system developed with 1) three private clinics in three districts; two at Howrah and one at Hooghly, 2) Pediatrics Department of two medical colleges in Kolkata, 3) 12 practioners of these three districts with 4) a central referral center at Department of Dermatology, NRS Medical College, Kolkata where all cases from this system were confirmed by a single observer. Pediatric Dermatology unit of the Institute of Child Health, Kolkata was another independent unit.

Results:

A total of 38 cases of HFMD were reported till 08.10.07. Age group ranged from 12 months to 12 years (mean 40.76 months, SD 29.49). Males were slightly higher than females (M:F - 21:17). Disease was distributed mostly over buttocks, knees, hands, feet - both dorsum and palmar or the plantar surface and the oral mucosa. Highest severity noted over the buttocks and the knee. Healing time for skin lesions was 6-13 days (mean 9.13 days, SD 1.93). Oral lesions were found in 33 (86.8%) cases.

Conclusion:

This outbreak far away from the initial one confirmed regular outsourcing of the virus with possibilities of future epidemics. Also the fact that EV71 induced epidemic is on rise in this part of globe is alarming for India. We hope this early report will be of help for strategic planning for a better management of the disease and prevention of dreaded neurological complications in India.     

COMPARATIVE ASSESSMENT OF TOPICAL STEROIDS, TOPICAL TRETENOIN (0.05%) AND DITHRANOL PASTE IN ALOPECIA AREATA

Background:

There have been various controversial reports regarding the efficacy of topical agents in topical therapy of alopecia areata.

Aim:

The study aims to find out the effective ones among the readily available ones for a dermatologist.

Materials and Methods:

Eighty patients were chosen from the skin OPD of Bankura Sammilani Medical College, Bankura, West Bengal, after evaluating the exclusion criterions. Treatments were continued for 3 month period and a follow up after further 3 months. After dividing them into four groups–group-I (topical steroids), group-II (topical tretinoin 0.05%) group-III (dithranol paste 0.25%), and group-IV (white soft petrolatum jelly)–patients were evaluated.

Results:

Seventy percent of group-I, 55% of group-II, 35% of group-III, and 20% of the control group (white soft petrolatum jelly) responded favorably. Side effects in the form of dermatitis and hyperpigmentation were seen in group-III. However, no patient discontinued from the study.

Conclusion:

We conclude that both topical steroids and tretinoin were fairly effective in limited variant of alopecia areata.     

RECURRENCE PATTERN IN SQUAMOUS CELL CARCINOMA OF SKIN OF LOWER EXTREMITIES AND ABDOMINAL WALL (KANGRI CANCER) IN KASHMIR VALLEY OF INDIAN SUBCONTINENT: IMPACT OF VARIOUS TREATMENT MODALITIES

Background:

The spectrum of skin cancer in Kashmir valley is drastically different from the rest of the country. Maxwell was the first to report skin cancer of lower extremities in Kashmiri population, developing on/over erythema ab igne, and attributed it to the use/or exposure of Kangri. These tumors have an aggressive biological behavior with a substantial risk of loco-regional metastasis in 30-50% cases. Because of unique geographical distribution of Kangri cancer, there is dearth of literature regarding the natural history, loco-regional and distant metastatic pattern and treatment recommendations in these tumors.

Aims:

To study the metastatic pattern of these skin tumors and to assess the impact of various treatment modalities and use of prophylactic nodal treatment in this clinical entity.

Methods:

The retrospective study (study period 1993-2005) included 266 patients of squamous cell carcinoma of skin of lower extremities and abdominal wall. Two hundred and forty-four cases with a follow-up of 2-7 years were included for final analysis with stress on loco-regional relapse pattern and methods of treatment evolved and used at our institute from time to time. Statistical analysis was done using yates corrected Chi-square test and odds ratio analysis.

Results:

Our results favor the use of post operative radiotherapy to primary and prophylactic treatment of regional nodes on the lines of head and neck tumors in these cases.

Conclusion:

Post operative radiotherapy significantly decreases the loco-regional recurrences and a trial of prophylactic nodal irradiation is justified in a selected group of such patients.     

METASTATIC CROHN'S DISEASE OF EXTERNAL GENITALIA

Metastatic Crohn''s disease is an uncommon extraintestinal manifestation of Crohn''s disease. Its hallmark features include the presence of cutaneous noncaseating granulomas that are noncontiguous with the gastrointestinal tract or fistula. We report a rare case of metastatic Crohn''s disease involving the external genitalia in a 14-year-old girl. Diagnosis was based on skin biopsy. Patient had complete recovery on treatment with oral and topical steroids along with azathioprine.     

Epitheloid Hemangioma: A Report of Two Cases

We report two cases of epitheloid hemangioma presented with multiple nodular lesions over head and neck region. One of them gave history of bleeding on minor trauma. Pyogenic granuloma was considered as a differential diagnosis from the morphological appearance and history of bleeding. Nodular leprosy, sarcoidosis, and secondary syphilis were also considered. Histopathological examination of both was typical of epitheloid hemangioma, an entity commonly overlooked clinically due to its rarity.     

Risk of Parkinson's Disease Among Patients with Psoriasis: A Systematic Review and Meta-analysis

Background:Patients with psoriasis might be at a higher risk of developing Parkinson''s disease (PD) as a result of the detrimental effect of chronic inflammation on the neuronal tissue. This meta-analysis aimed to investigate this risk by comprehensively reviewing all available data.Methods:We conducted a systematic review and meta-analysis of cohort and case–control studies that reported relative risk, hazard ratio, odds ratio, or standardized incidence ratio comparing the risk of PD in patients with psoriasis versus subjects without psoriasis. Pooled risk ratio and 95% confidence interval (CI) were calculated using random-effect, generic inverse variance methods of DerSimonian and Laird.Results:Three retrospective studies and one case–control study met our eligibility criteria and were included in this meta-analysis. The pooled risk ratio of PD in patients with psoriasis versus participants without psoriasis was 1.38 (95% CI, 1.15–1.66). The statistical heterogeneity was low with an I² of 35%.Conclusions:Our meta-analysis demonstrated a statistically significant increased risk of PD among patients with psoriasis.     

Recurrent Bilaterally Symmetrical Bullous Sweet's Syndrome: A Rare and Confusing Entity

A rare presentation of Sweet''s syndrome (SS) (acute febrile neutrophilic dermatosis) is being reported in a 28-year-old man from India. I report a rare presentation of SS that consisted of bilaterally symmetrical, bullous lesions on both forearms with a seasonal recurrence. A thorough work-up for the usual conditions predisposing to or leading to SS did not throw any light on the etiology. After failing treatment with prednisolone alone we added indomethacin, and he responded to the combination in a matter of days with complete clearance of lesions.     

A case series of kaposi's varicelliform eruption in dermatology in-patients in a tertiary care centre

Background:

Recently, we noted increasing number of cases of Kaposi''s varicelliform eruption (KVE) among dermatology in-patients who were being treated for various dermatoses, some of which have not been reported earlier to be associated with KVE, and hence, this report.

Aims:

This study was designed to identify various dermatoses in which KVE occurred, to study the clinical features, course and response to specific antiviral treatment, to establish the risk factors, and course of the primary dermatoses during the episode of KVE.

Materials and Methods:

We analyzed our data of dermatology in-patients in a tertiary care centre in South India from April 2008 to November 2009 (20 months). The data were tabulated and analyzed.

Results:

Twenty cases (12 female and 8 male patients) of KVE were seen. The mean age of the patients was 46.4 years. There were seven cases of erythroderma, four of pemphigus vulgaris, three of toxic epidermal necrolysis, two of airborne contact dermatitis (ABCD), one each of lichenoid drug rash, and drug rash with eosinophilia and systemic symptoms (DRESS). Underlying dermatoses for erythroderma were: ABCD (3), psoriasis (3), and cutaneous T-cell lymphoma (1). Possible source of infection could be identified in five cases: exogenous sources in four cases and endogenous source in one case. The mean incubation period for cases with known source was 5 days (range, 2–9 days). Eighteen patients responded favorably to acyclovir. None of our patients had recurrent KVE during the study period.

Conclusion:

KVE may complicate any dermatosis where the integrity of the skin is compromised. Diagnosis and early treatment are important and possible in most cases if suspected.     

Psychosocial impact of cicatricial alopecias

Background:

Cicatricial alopecias have a significant impact on the psychological status, quality of life, and social interaction of those suffering from it. Till date, limited or no data have been available regarding the psychosocial and quality of life aspects of cicatricial alopecias.

Aims:

To assess the psychosocial impact of cicatricial alopecias.

Materials and Methods:

Thirty patients fulfilling the criteria for cicatricial alopecia irrespective of their age and sex were included in the study. Psychosocial assessment was carried out in 23 patients who were capable of responding to the questionnaire, using an adopted and suitably modified version of Women''s Androgenetic Alopecia Quality of Life Questionnaire.

Results:

We observed that 73.9% of our patients with cicatricial alopecias had moderate to severe psychosocial impact due to their hair loss. Patients of younger age group and with inactive disease, suffered from greater psychosocial impact of the disease. Patients with slight hair loss also had considerable psychological distress. The chronicity of disease duration did not seem to reduce the psychosocial impact of the disease. Both married and unmarried patients suffered equally from the psychosocial impact of the disease.

Conclusion:

The management of cicatricial alopecias needs a holistic approach. In addition to laying an emphasis on early diagnosis aided by clinco-pathological correlation, to prevent irreversible hair loss, the psychosocial impact of the disease should also be taken into consideration and addressed by the treating dermatologist.     

A Case of Reticulate Acropigmentation of Kitamura: Dowling Degos Disease Overlap with Unusual Clinical Manifestations

Reticulate hyperpigmentary disorders are a group of rare genetic pigmentary abnormalities which includes reticulate acropigmentation of Kitamura (RAPK), Dowling-Degos disease (DD), reticulate acropigmentation of Dohi (RAPD), Haber''s syndrome, and Galli-Galli disease. A 25-year-old male presented with asymptomatic dark-colored lesions on his hands and feet with light-colored skin lesions involving the trunk since three years. Dermatological examination revealed hyperpigmented macules in a reticulate pattern involving the dorsa of the hands and feet, front and sides of the neck, axillae, periorbital region, and groin. Multiple pits were present over both palms, with breaks in dermatoglyphics. He also had multiple nonacne facial scars predominantly on the nose and malar areas. The patient had overlapping features of RAPK and DDD. In addition, he also had hypopigmented macules and acneiform facial scars. Such an overlap of features of reticulate pigmentation has not been previously reported in the literature.     

Serum Lipid, Lipoprotein and Oxidatively Modified Low Density Lipoprotein Levels in Active or Inactive Patients with Behçet's Disease

Aim:

To determine serum lipid, lipoproteins and oxidized low density lipoprotein (oxLDL) levels in Behçet''s disease (BD) and to evaluate the relationship of these parameters with the clinical activity of the disease.

Materials and Methods:

Sixty-two patients (25 active, 37 inactive) and —26 healthy controls were included in the study. We measured serum oxLDL levels using the enzyme-linked immunosorbent assay method, and serum total cholesterol (TC), triglyceride (TG) and high density lipoprotein-cholesterol (HDL-C) levels by spectrophotometric method.

Results:

Serum TG (108±70 mg/dL and 79±40 mg/dL, respectively; P<0.05), LDL-C (124±35 mg/dL and 108±26 mg/dL, respectively; P<0.05) and oxLDL (65±19 U/L and 53±10 U/L, respectively; P<0.01) levels were significantly higher in patients than in controls, but HDL-C levels were significantly lower in patients than in controls (39±11 mg/dL and 50±13 mg/dL, respectively; P<0.05). The levels of oxLDL in patients were found to correlate with those of TC and LDL-C. Neither the lipid parameters nor the oxLDL levels in the patients with active disease (n=25) were different than those in the patients who were in inactive stage (n=37). Serum levels of oxLDL in the patients with active and inactive disease were significantly higher than those in controls (66±19 U/L, 65±19 U/L, and 53±10 U/L, respectively; P<0.05).

Conclusions:

We conclude that the increase of TG, LDL-C and oxLDL levels and the decrease of HDL-levels may indicate that there is a tendency to atherothrombotic process in patients with BD. Inflammation and immunologic reactions in BD may be caused by a response to elevated oxLDL. TG, LDL-C and oxLDL are not useful markers for the severity of the disease activity.