Search

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-à-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 multiformè, 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.

Little information is available about the prevalence of skin conditions among children in the general population of northern India. Low socioeconomic status, malnutrition, overcrowding, and poor standards of hygiene are important factors accounting for the distribution of skin diseases in developing countries such as India. In order to estimate the burden and relative frequency of dermatologic diseases among children in the community, we measured the point prevalence of skin conditions in 12,586 Indian school children ages 6-14 years. The overall point prevalence of one or more identifiable/apparent skin conditions was 38.8%. Of those studied, 3786 children (30%) had only one skin disease, 765 (6%) had two, and 336 (2.7%) had three skin pathologies. The most common skin conditions and their respective point prevalences were skin infections (11.4%), pityriasis alba (8.4%), dermatitis/nonspecific eczemas (5.2%), infestations (5.0%), disorders of pigmentation (2.6%), keratinization disorders (mostly keratosis pilaris) (1.3%), and nevi/hamartomas (1.1%). This study shows that skin conditions are common in children and about one-third of them are affected at any given time. The finding that more than 85% of the disorders can be grouped into fewer than eight categories is important in designing training programs for medical teams involved in the delivery of primary health care services in developing countries such as India, where about one-third of the population is less than 15 years of age.

Leprosy, also known as Hansen's disease, an ancient affliction of mankind, is still endemic in some countries. The fear and stigma associated with the disease arised from the unsightly deformities due to nerve damage and anesthesia. Historically, mono- and multidrug therapies have been used in a range of combinations for various durations with variable results and degrees of compliance. WHO-recommended multidrug therapy has proved to be the most important landmark in the chemotherapy of leprosy with a tremendous success in the control of the disease, significant fall in the number of patients worldwide and acceptable relapse rates. Research for more effective and bactericidal drugs is in progress. Intensive short-course regimens and uniform schedules all along the spectrum are being evaluated in field trials. Care of patients with nerve function impairment, reactions, relapses and prevention of disabilities and rehabilitation will remain an imperative task for healthcare providers even in the post-elimination era. Integration of leprosy with general health services in all endemic countries poses a challenge for early diagnosis and proper management of disease, including reactions, prevention of disabilities, imparting quality training to primary healthcare workers and maintaining required expertise at the referral level. It is hoped that the newer and more effective patient-friendly regimens combined with the positive approach of national and international agencies could lead to leprosy becoming a historical disease. [ABSTRACT FROM AUTHOR]

Dithranol is infrequently used in psoriasis in spite of excellent efficacy due to its local adverse effects. We have synthesized a novel formulation of dithranol in which the drug is entrapped in phospholipid liposomes. This formulation has shown markedly low irritation and minimal staining of skin and clothes in preliminary studies. Twenty patients with bilaterally symmetrical stable plaque psoriasis applied 0.5% dithranol lipogel to lesions over one side of the body. On the other side, 10 patients were randomized to apply pure liposomal base and 10 applied a conventional cream containing 1.15% dithranol, 1.15% salicylic acid and 5.3% coal tar in a 30-minute, short contact regimen for 6 weeks. Patients were assessed for disease severity, perilesional erythema and skin staining, pruritus and any other adverse effects at baseline, 2, 4 and 6 weeks. Both lipogel and the cream significantly reduced the total severity score compared to the liposomal base at 4 (p = 0.004) and 6 (p = 0.01) weeks. There was no significant difference in the clinical response of dithranol cream and lipogel. Markedly low incidence and severity of perilesional erythema (p<0.001) and skin staining (p<0.05) was seen with the lipogel in comparison with the cream. [ABSTRACT FROM AUTHOR]

Objectives: To conduct a cross-sectional study to compare Dsg1 and Dsg3 antibody levels independently with severity of disease activity in pemphigus vulgaris (PV) and pemphigus foliaceus (PF).Methods: Blood samples from 44 patients with pemphigus (PV-38, PF-6) were analyzed using ELISA. The severity of skin and mucosal disease was graded using a score from 0 to 3.Results: A statistically significant correlation between increase in Dsg 3 antibody titres with severity of oral involvement and Dsg 1 titres with severity of skin involvement was found in both PV and PF patients (p < 0.01). However, we were unable to demonstrate a relationship between increased titres of Dsg1 and Dsg 3 antibodies with oral and skin involvement respectively.Conclusion: This study suggests that the severity of skin and oral disease in pemphigus is determined by the quantities of Dsg1 and Dsg3 antibodies respectively. [ABSTRACT FROM AUTHOR]

Disordered differentiation and hyperproliferation of keratinocytes with inflammation are the hallmarks of psoriasis. Ligand activation of peroxisome proliferator receptor-γ (a class of nuclear receptors) by thiazolidinediones can normalize the histologic features of psoriasis.In a 10-week, double-blind, randomized, placebo-controlled, parallel-group study, 70 patients with moderate to severe psoriasis received one of the following treatments: pioglitazone 15 mg, pioglitazone 30 mg or placebo. Efficacy was evaluated by observing the change in the psoriasis area and severity index (PASI) after 10 weeks of treatment.There was a dose-dependent improvement in psoriasis. Median PASI scores at the end of 10 weeks were significantly reduced in the pioglitazone treatment groups as compared to the placebo-treated group. The psoriasis lesions cleared in more than 40% of patients treated with pioglitazone as compared to 12.5% of those with placebo. The percentage reduction in mean PASI scores was 21.6%, 41.1% and 47.5% in the placebo, pioglitazone 15 mg, and 30 mg groups, respectively. No serious adverse events were detected.This is the first report from a controlled trial demonstrating that pioglitazone could be considered as an efficacious and safe agent for the treatment of plaque psoriasis. The optimum dose and duration of pioglitazone therapy remain to be determined. [ABSTRACT FROM AUTHOR]

We undertook this study in order to determine the pattern and prevalence of childhood psoriasis in northern India and to highlight the differences and similarities with previous studies.In this retrospective epidemiologic study, the data from 419 children (less than 14 years of age) with psoriasis registered at the Psoriasis Clinic between January 1990 and December 2002 were included.The 419 children registered at the Psoriasis Clinic constituted 0.3% of the dermatology outpatients and 12.5% of the total psoriasis patients seen over a period of 13 years in the department. There were 219 (52.2%) boys and 200 (47.7%) girls, with a male to female ratio of 1.09 : 1. The age of onset ranged from 4 days to 14 years. The mean age of onset was 8.1 ± 2.1 years in boys and 9.3 ± 2.3 years in girls. The peak age of onset in boys was in the 6–10-year age group, whereas the majority of girls showed an onset of psoriasis between the ages of 10 and 14 years. A positive family history was present in only 19 (4.5%) patients. The extensors of the legs were the most common initial site affected[105 (25%) cases], followed by the scalp[87 (20.7%)]. Classical plaque psoriasis was the most frequent clinical presentation[254 (60.6%) patients], followed by plantar psoriasis[54 (12.8%)]. Nail involvement was observed in 130 (31%) cases. All types of nail changes described in psoriasis were seen in these patients. Pitting was the most common nail change, followed by ridging and discoloration. Five children (1.1%) (three girls and two boys) had psoriatic arthropathy. Precipitating factors that brought about the onset of the disease or were associated with exacerbation could be recalled in only 28 (6.6%) patients. Koebnerization was observed in 27.9% of patients. Pruritus was the most frequent symptom, reported by 365 (87.1%) children. Twenty-seven (6.4%) children had other concurrent mucocutaneous diseases (vitiligo, pityriasis alba, alopecia areata, ichthyosis vulgaris, halo nevus, aphthous stomatitis, urticaria, pityriasis versicolor, nummular eczema, salmon patch, and verrucous epidermal nevus). Eighteen children had systemic disorders, including seizures, bronchial asthma, mitral regurgitation, scleroderma, Down's syndrome, high arched palate, cholelithiasis, anterior mongoloid slant, and prognathism; however, these conditions were possibly chance findings only and no correlation with the age of onset or severity of the disease was found.Our findings differ from those of previous studies in showing a delayed onset, equal sex distribution, less frequent facial involvement, uncommon guttate lesions, more frequent involvement of the soles, and a less frequent history of familial occurrence. [ABSTRACT FROM AUTHOR]

Although palmoplantar psoriasis can be severely disabling, there are very few large clinico-epidemiological studies on this condition. Our purpose was to study the morphology and pattern of lesions in Indian patients with palmoplantar psoriasis and to elucidate the role of occupation in the incidence/localization of these lesions. All patients attending our Psoriasis Clinic from 1993 to 2000 were screened for palmoplantar lesions and their demographic characteristics, occupation and the exact localization of the lesions were noted. Out of 3,065 patients screened, 532 had palm and/or sole involvement. Plantar lesions were seen in 91.9% and palmar lesions in 55.6% of these patients. Four distinct patterns of lesion localization were noted on the palms and 5 patterns on the soles. Almost half of the men involved in regular manual labor had palmar lesions restricted to areas exposed to pressure, whereas only a quarter of other men had this type of lesion pattern. All patients with unilateral palmar lesions had them on their dominant hand and these patients were involved in regular manual labor. In our patients, the prevalence of plantar lesions was much higher than that of palmar lesions. The possible role of occupational trauma in lesion localization in Indian patients with palmoplantar psoriasis is discussed. [ABSTRACT FROM AUTHOR]

Abstract Background Keloids are notoriously difficult to treat. A variety of treatment modalities are currently in use, indicating that none is totally satisfactory. Surface cryosurgery is effective for smaller keloids, but not for larger ones. It often results in widespread depigmentation over the surface of the keloids, which may not be desirable, especially in patients with dark skin. Objectives To determine the efficacy of intralesional (IL) cryosurgery in large, bulky keloids unresponsive to IL steroids, and to observe the extent of depigmentation and other complications produced by the technique. Methods Twelve patients with large, bulky, symptomatic keloids unresponsive to at least five injections of IL triamcinolone acetonide were included in the study. The age of the patients and the duration of the keloids were in the range 19–50 years and 1–12 years, respectively. The IL cryosurgery device was assembled using a small liquid nitrogen Dewar cylinder, a rubber and a plastic tube taken from a drip-set, adhesive tape, and hypodermic and lumbar puncture needles. The lumbar puncture or injection needle was introduced through the lesion until it appeared at the other side. Liquid nitrogen was then passed through the needle. The freezing time was between 20 and 30 s. The procedure was repeated for a second freeze–thaw cycle in the same session. Results The patients underwent a minimum of five up to a maximum of 10 sessions of IL cryosurgery. Seven out of 12 patients showed > 75% flattening. Depigmentation was observed along the tracks of the needles in all the patients, which improved during follow-up due to pigment spread from the normally pigmented areas in between. At the end of follow-up, 1–25% of the area remained hypo- or depigmented in four patients, 26–50% in six patients, and 51–75% in the remaining two patients. Conclusions IL cryosurgery should be the preferred mode of therapy for large, bulky... [ABSTRACT FROM AUTHOR]

Comments on a study conducted by N.L. Sharma et al. (1999) which gave an overview of reported cases of chromoblastomycosis in India between 1957 and 1997. Report on two additional cases in Chandigarh, India which occurred in 1991; Causative agents; Response of patients to itraconazole.

Background Palmoplantar psoriasis (PPP) is a disabling condition which is usually resistant to most of the available therapeutic modalities. Coal tar is an accepted therapy for psoriasis which has not been well studied for PPP. Methods Thirty patients with a plaque type of PPP were allocated into two groups: Group A (19 patients) were treated with 6% crude coal tar (COT) ointment and Group B (11 patients) were treated with white petrolatum and salicylic acid. In both groups, ointment was applied and left on overnight. Wearing of gloves and socks during the night and application of emollients in the day was routinely advised The lesions were assessed for erythema, scaling, and induration (ESI) every 2 weeks for a total of 8 weeks. Patients with greater than 50% improvement were considered to have good improvement. Side-effects, if any, were also monitored. Results In Group A, 76.5% of patients (13/17) showed good improvement, whereas only 45.5% of patients (5/11) in Group B showed the same magnitude of improvement (P < 0.05). No side-effects were reported by any patient in either of the groups. Conclusions Crude coal tar is a safe, effective, and inexpensive modality for the treatment of PPP. We recommend coal tar under occlusion, along with the liberal use of emollients, as the first line of therapy for all cases of PPP. [ABSTRACT FROM AUTHOR]

The article presents information on the study which examines whether the incidence of psoriasis is less in leprosy patients. Leprosy is characterized by peripheral nerve damage. Findings demonstrates rare co-existence of the two diseases, although a few cases had clinical signs for both leprosy and psoriasis. The rarity of psoriasis in leprosy patients is due to first, altered immune response and secondly differences in genetic makeup. The release of neuropeptides is possibly responsible for triggering psoriasis.

One hundred and twelve cases of childhood psoriasis, constituting 5% of all psoriasis patients registered in our clinic, were studied over a period of nine years (January 1980 to December 1988). There were 57 male and 55 female patients. Age of onset ranged from 1 month to 13 years, with a mean and median age of 7 years. A positive family history of psoriasis was elicited from 9.8% of patients. The commonest form of psoriasis found was plaque (89.6%), followed by guttate (25.9%). infection was the most common triggering factor, occurring in 15.2% of cases. Many of these findings are at variance with observations reported elsewhere for this age group. [ABSTRACT FROM AUTHOR]

A 50-year-old female developed a swelling in the epigastrium which later ruptured to from a sinus. A diagnosis of primary cutaneous cryptococcosis was made with the help of histopathology and microbiological studies. Treatment with amphotericin-B and 5-flucytosine gave a good therapeutic response and the sinus healed within 2 months. [ABSTRACT FROM AUTHOR]

The article offers information on patients with plasma cell balanitis (PCB), which is a benign inflammatory dermatosis affecting the penis and foreskin in uncircumcised men. It mentions information on plans of steroids, calcineurin inhibitors, antifungal agents, and combinations of steroids with antifungals or antibacterials. It states that circumcision removes the occlusion produced by the foreskin and the nidus of inflammation caused by smegma and friction.

Psoriasis is a chronic disease that may require lifelong intermittent treatment with systemic drugs. Because of the high cost and frequent and serious side-effects of systemic therapies, there is an overwhelming need for the evaluation of newer drugs in order to widen the therapeutic options available for the management of patients with severe, disabling disease. Due to the nonavailability of retinoids and the poor response to photochemotherapy in developing countries such as India, cyclosporine may be the most effective alternative despite its relatively high costs.

Reports on the case of an 18-year-old boy diagnosed with Purpura annularis telangiectoides with vasculitic ulcers treated with colchicine. Initial diagnosis; Medical history; Description of the disease; Symptoms of the disease; Treatment options.

This article discusses cutaneous inoculation tuberculosis among laboratory personnel. Cutaneous inoculation tuberculosis results from direct inoculation of Mycobacterium tuberculosis into skin, mucosa, or subcutaneous tissues. The infection may be transmitted during ritual circumcision, ear piercing, tattooing, brawl injury, and mouth-to-mouth resuscitation of an individual with pulmonary tuberculosis. Rarely infection is acquired by sexual intercourse with a person with genitourinary tuberculosis.