Indian Dermatology Online Journal最新文献

Background: Alopecia areata (AA) is an autoimmune, T-cell-mediated disorder manifesting as non-scarring alopecia. Treatment consists of corticosteroids, calcineurin inhibitors, prostaglandin analogs, minoxidil, anthralin, vitamin D analogs, and JAK STAT inhibitors. Despite several treatment options, personal opinions regarding the safety and efficacy of a particular treatment are highly variable. This has led the management of AA to be quite challenging.

Aim: To compare the efficacy and safety between the three molecules, namely mometasone 0.1% ointment, calcipotriol 0.005% ointment, and tacrolimus 0.1% ointment, in localized AA.

Patients and methods: Patients were randomized into three groups, and topical medications were dispensed for each group in unlabeled tubes. Lesional photographs, dermoscopic images, Severity of Alopecia Tool (SALT) scoring, hair pull test, and Dermatology Life Quality Index questionnaires were done at the baseline visit and at every follow-up visit at 4 weeks and 8 weeks from the baseline visit.

Results: At the end of 8 weeks, both mometasone and calcipotriol groups had a significant decrease in their SALT scores (<0.001), but the tacrolimus group did not show any significant change in parameters at the end of the study.

Limitations: The main drawback is that there was no control group and the vehicle dispensed was ointment formulation, which may have penetration issues. The lack of long-term follow-up is also a limitation of this study.

Conclusion: Both mometasone and calcipotriol formulations were found to be effective in the treatment of localized stable AA; however, calcipotriol preparation was associated with minimal side effects.

Introduction: Hansen's disease is a chronic, infective granulomatous skin disease with a wide array of manifestations that resemble many dermatological and neurological conditions. Pure neuritic Hansen's disease is a familiar form among leprosy physicians, and it poses significant diagnostic difficulty. Various disorders can mimic leprosy neuropathy clinically and these patients may receive multidrug therapy in endemic areas due to the commonality of leprosy. Hence, it is necessary to be aware of mimickers of leprosy in its various forms.

Patients and methods: We conducted a single-center retrospective analysis from January 2022 to June 2023. We reviewed clinical, radiological, and histopathological findings of the patients referred from neurology outpatient department which mimicked leprosy neuropathy.

Results: We are presenting four such patients with symptoms related to neuropathy and disability. The slit skin smear was negative in all these patients, and ultrasonography, magnetic resonance imaging, and histopathology were done for diagnostic confirmation. Ultimately, all these patients were concluded to be non-leprosy cases, and an alternative diagnosis was made.

Conclusion: Leprosy can appear in various patterns and can be mistaken for other dermatoses. Since leprosy still carries a social stigma attached to it, a wide range of dermatological and neurological illnesses must be ruled out in the differential diagnosis. These four rare entities can also mimic pure neuritic leprosy, and a thorough neurocutaneous examination complemented with appropriate radiological investigations is key to diagnosing these conditions.

Background: Polyethylene glycol (PEG) is commonly used in dermatology due to its excellent solubility, nontoxic nature, and compatibility with various therapeutic agents. Its applications extend from moisturizing creams to chemical peels, improving skin hydration and facilitating drug delivery. Despite its broad utility, PEG is associated with hypersensitivity reactions, including rare cases of anaphylaxis, that necessitates a thorough assessment of its safety profile. This review evaluates PEG's therapeutic roles, safety, and dermatological applications, focusing on its pharmacokinetics, chemical properties, and potential adverse effects.

Methods: A comprehensive literature search was conducted in PubMed, SciVerse, and EMBASE databases to identify studies on PEG's dermatological uses, including its role in treating psoriasis, acne, ichthyosis, fungal infections, wound healing, and cosmeceuticals. Studies addressing PEG's allergenic potential were also reviewed, focusing on cutaneous reactions and rare anaphylactic events. Articles in English, published until June 2024, were included in this narrative review.

Results: PEG's emollient and humectant properties make it valuable in treating psoriasis, where it enhances corticosteroid delivery and reduces erythema and scaling. In acne, PEG-based salicylic acid peels offer controlled exfoliation with minimal irritation. PEG's hydrating properties also benefit ichthyosis and wound healing by maintaining moisture and delivering antibacterial agents. In cosmetics, PEG functions as an emulsifier, surfactant, and conditioner. However, hypersensitivity risks, including urticaria and anaphylaxis, require cautious use, especially for allergy-prone individuals.

Conclusion: PEG's properties make it a useful dermatological component, though awareness of hypersensitivity risks is essential for safe clinical use. Further studies are needed to understand PEG-induced hypersensitivity and to guide safety protocols.

Background: Filaggrin deficiency causes early-onset atopic dermatitis (AD), extrinsic AD, persistent and severe disease, palmoplantar hyper linearity, keratosis pilaris, and increased risk of hand eczema. There is a paucity of data on the prevalence and types of variation in the filaggrin gene (FLG) in the Indian population.

Aim and objectives: To study the prevalence and characteristics of filaggrin mutations in Indian children affected with AD and to attempt a genotype-phenotype correlation.

Materials and methods: A pilot study was done among Indian children with AD aged 4-16 years, attending the Pediatric Dermatology outpatient department between February and September 2022 (7 months). Long-range polymerase chain reaction target enrichment and next-generation sequencing were used to sequence the complete FLG gene from peripheral blood samples. The identified variants were analyzed and categorized.

Results: Among the 30 recruited children with AD, 28 genetic variants in exon 3 of FLG were found in 19 (63%) patients. These variants were classified as pathogenic (6, 21.4%), likely pathogenic (3, 10.7%), benign (16, 57.1%), and variant of uncertain significance (3, 10.7%). Among the 9 significant variants, 4 (45%) were novel. Although the patients with filaggrin variants had a higher prevalence of positive family history of atopy, other allergic diseases in the child, higher IgE levels, and a higher percentage of severe AD, the difference was not statistically significant.

Limitation: Small sample size.

Conclusion: Significant FLG null variants were identified in 23% (among which 45% were novel) of Indian children with AD. The spectrum of identified variants did not reflect the known FLG hotspots from other ethnicities, indicating the need for larger studies to determine the relevant hotspots in the Indian population.

Background: One of the prevalent dermatological conditions identified among Indian patients visiting dermatology clinics is pigmented contact dermatitis (PCD). The gold standard for diagnosing PCD is patch testing. The allergen that results in PCD and its clinico-demographic pattern could differ. Identifying the common allergens will help the clinician while treating cases with PCD.

Aim and objective: To determine the clinico-demographic distribution of PCD and to establish the common allergens that are responsible by patch testing.

Patients and methods: The study included 30 patients with PCD. All patient's clinico-demographic profiles were recorded. The extended Indian Standard Series kit comprising of 56 antigens was used for patch testing in the outpatient department. In addition, patch testing was done with a few brands of kumkum, sacred ash, sandalwood paste, and patients own material where it was indicated. The patch test was performed and interpreted as recommended by the International Contact Dermatitis Research Group.

Results: The male: female ratio was 1:1.7. In 21 patients (70%), face was the most common site of pigmentation. The most frequently related symptom was pruritus. Out of the 30 patients, the patch test was positive in 25 (83.3%) of the cases. Paraphenylenediamine (PPD) and fragrance mix were found to be the most common allergens in 7 (28%) and 6 (24%) patients, respectively. In 13 patients (52.2%), reaction was observed with two or more allergens.

Limitation: The above study, followed by photo-patch testing, may have detected more allergens inducing PCD. The photo-patch test was not performed due to non-availability of allergens.

Conclusion: PPD is the most common allergen implicated, followed by fragrances.

Background: Vitiligo in hair bearing areas, especially segmental vitiligo, is frequently associated with leukotrichia. Leukotrichia, in general, is considered a predictor of unsatisfactory response to conventional treatment methods like phototherapy. This review aims to systematically review various available treatment options in patients with eyebrow and eyelash leukotrichia and assess the response to these therapeutic modalities.

Materials and methods: Articles were searched using the keywords "eyelid", "eyelash", "leukotrichia", either singly or combined. The databases searched include Pubmed, Cochrane Library, Embase, and Science Direct. The strategy was to include studies in which any therapeutic modalities were undertaken for treatment of eyelash or eyebrow leukotrichia.

Results: After applying the inclusion and exclusion criteria, this review included 15 studies. There was a positive response to the surgical treatment options for eyebrow and eyelash leukotrichia. Topical tofacitinib has emerged as a promising new therapeutic option, but further studies are needed to establish its efficacy.

Conclusion: In conclusion, there are several treatment options for eyebrow and eyelash leukotrichia. However, further studies are needed to better understand their efficacy and optimal applications.

Background: Currently available pruritus assessment tools may not always fulfill the needs of the Indian population and populations who share similar sociocultural backgrounds. To overcome this limitation, a new assessment tool "Pruritus Impact Scale (PIS)" was constructed and validated.

Aims and objectives: The primary objective is to construct and validate the novel PIS. The secondary objective is to evaluate the responsiveness of PIS to changes in symptoms.

Patients and methods: This study design was cross-sectional for the primary objective and longitudinal for the secondary objective. The study recruited 435 patients of chronic pruritus of different etiologies for the construction of the PIS scale. Patients were asked to fill out four different pruritus measuring tools i.e., Numerical Rating Scale (NRS), Dermatology Life Quality Index (DLQI), 12-item Pruritus Severity Score (PSS), and newly constructed PIS. The PIS was derived from existing standard assessment tools with certain modifications to keep a balance of psychometric properties of the scale and the sociocultural needs of the population. The validity and reliability of the scale was assessed. For detecting the response of PIS to change in pruritus intensity, 276 patients were followed and were instructed to refill all four scales at 6 weeks from the baseline. The responsiveness was judged by comparing the mean score of all scales at baseline with the mean score at 6 weeks. In addition, the changes in the scores among all 4 scales were correlated and compared.

Results: PIS showed strong internal consistency (Cronbach α = 0.882) and positively correlated with other validated pruritic tools such as NRS (ρ = 0.938, P < 0.0001), DLQI (ρ = 0.914, P < 0.01) and 12- PSS (ρ = 0.913, P < 0.001) at baseline. PIS showed satisfactory reproducibility at 3-hour intervals (Cronbach α = 0.994). Responsiveness to change in pruritus as measured by PIS at 6 weeks reassessment was correlated well with the changes in NRS (ρ = 0.689, P value < 0.0001), DLQI (ρ = 0.586, P value < 0.0001) and 12-PSS (ρ = 0.928, P value <0.0001).

Limitations: A noteworthy limitation of the present study is the lack of comparison of different items (within a construct) comprised in different tools used for comparison.

Conclusions: The newly constructed PIS is a valid tool in the studied population.