Indian Dermatology Online Journal最新文献

Objectives: We aimed to compare inflammatory markers and determine their potential role in distinguishing secondary leukocytoclastic vasculitis (SLV) from idiopathic leukocytoclastic vasculitis (ILV).

Materials and methods: We included in this cross-sectional study patients with cutaneous leukocytoclastic vasculitis (CLV) diagnosed on cutaneous biopsy. We assessed clinical and laboratory data and then calculated platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP)-to-albumin ratio (CAR), and fibrinogen-to-albumin ratio (FAR). We have also defined the number of positive etiological examination (NPE) as the sum in a unique patient of the positive paraclinical examinations involved in the etiological assessment of CLV.

Results: In total 77 patients were included, with 52 SLV group patients and 25 in the ILV group, mean age was 44+/-18 vs 49+/-21, and gender ratio was 29/23 vs 11/14. Comparison of PLR, NLR, CAR, and FAR showed significant differences in mean values between SLV and ILV groups with 199.1 (117.3-309.8) vs 126.8 (79-193) (P = 0.01) for PLR, 3.6 (1.9-5.1) vs 2.3 (1.7-3.4) (P = 0.048) for NLR, 1.9 mg.g-1 (0.4-3.6) vs 0.6 mg g-1 (0.2-1.9) (P = 0.043) for CAR, and 155.8 mg.g-1 (90.7-192.3) vs 108.7 mg.g-1 (82.2-148.1) (P = 0.034) for FAR. PLR, CAR, and FAR were positively correlated to NPE (r = 0.463, P < 0.001; r = 0.434, P < 0.001; and r = 0.411, P < 0.001, respectively), and there was no significant correlation between NLR and NPE (r = 0.165, P = 0.151).

Conclusion: This is the first study to investigate PLR, NLR, CAR, and FAR in CLV, and it demonstrates that elevation of these ratios is associated with SLV, which leads us to suggest to exhaustively explore patients with elevated ratios.

Background: Pyoderma gangrenosum (PG) is a reactive neutrophilic inflammatory dermatosis with a varied clinicopathologic presentation. It commonly manifests as rapidly progressive painful ulcers, mimicking varied conditions including infections, vasculitis, and malignancies, and is a diagnosis of exclusion. There are scarce data on PG from the Indian subcontinent.

Aim and objectives: The aim of the study was to study the clinicopathologic profile of patients with PG and their underlying systemic associations.

Materials and methods: A retrospective observational study was done between 2011 and 2021, and patients diagnosed as PG based on the diagnostic tool proposed by Maverakis et al. were recruited and their demographic, clinical, and histological findings were obtained.

Results: Among 54 patients with suspected PG, 17 patients (eight males and nine females) fulfilled the diagnostic criteria, and the mean age of disease onset was 32.1 years (range: 3-60 years). Ulcerative variant was the most common type (9/17, 52.9%), and 29.4% had systemic associations including autoinflammatory syndromes. The onset at atypical sites such as face and hand were noted in one patient each. Histopathology revealed a polymorphous dermal infiltrate with neutrophilic predominance in the majority (94.1%). Systemic steroids (dose ranging from 0.5-1 mg/kg prednisolone equivalent) were used in 11/17 (64.7%) patients. The commonly used alternative drugs included clofazimine (47%), minocycline (29%), thalidomide (23.5%), adalimumab and mycophenolate mofetil in 17.6% each, dapsone and ciclosporine in 11.7% each. Remission was achieved between two weeks and three months in 10 (58.8%) patients after treatment initiation and two mortalities (11.7%) were recorded.

Conclusion: PG can affect any age group and may be localized to rarer, atypical sites. The possibility of underlying autoinflammatory conditions should be considered in addition to the evaluation of other disorders like inflammatory bowel disease, hematological disorders, and rheumatological disorders.

Background: Hair symbolizes well-being and self-expression, with graying occurring naturally among different racial groups at varying ages. Premature graying has psychological and societal impacts, influencing self-esteem and quality of life. Gray hair usually advances gradually and is permanent, with occasional reports of natural repigmentation. Premature graying of hair (PMGH) results from a complex interplay of genetic, environmental, and cellular factors.

Materials and methods: Studies exploring links between gray hair and conditions such as osteopenia, hearing loss, smoking, obesity, dyslipidemia, and cardiovascular disease have yielded mixed results. Despite continuous research into the causes of gray hair, effective, evidence-based treatments are lacking and still need to be improved.

Conclusion: Herein, we reviewed the causes, mechanisms, risk factors, psychosocial effects, and emerging therapies for PMGH.

Basidiobolomycosis is an unusual chronic subcutaneous zygomycosis reported from tropical regions which is usually misdiagnosed because of its rarity. In this retrospective review, we describe 6 children with basidiobolomycosis who were managed in the Department of Paediatric Surgery at a tertiary institute in central India over a period of four and half years (January 2018 to June 2022). All patients were less than 5 years of age and had no co-morbidities (immune-competent). All were males. All were misdiagnosed at outside hospital. All responded well to anti-fungal therapy. High index of suspicion and biopsy of the lesions lead to appropriate diagnosis and management. Management appears good with triazole antifungals with fewer side effects and safety in children.

Background: Autoimmune bullous diseases are associated with high morbidity and mortality. Traditionally, systemic corticosteroids and conventional immunosuppressive agents have been the mainstay of treatment, but their broad immunosuppressive effects and long-term complications have prompted the exploration of newer more targeted therapies.

Materials and methods: This review explores the evolving landscape of therapeutic options for immunobullous diseases, with a particular focus on pemphigus, bullous pemphigoid (BP), and mucous membrane pemphigoid, by searching PubMed, clinicaltrials.gov, and Cochrane databases for published literature from 2014 to 2023.

Results/discussion: We discuss emerging treatments for pemphigus such as B cell modulatory drugs, anti-inflammatory drugs, those inhibiting autoantibody half-life or blister-inducing activity, and stem cell therapy, while offering insights into the level of evidence, potential benefits, and limitations of each approach. The role of biologics and novel therapies like rituximab, omalizumab, and dupilumab in reshaping the management of BP is also discussed.

Conclusion: The article highlights the need for further research, clinical trials, and comparative studies to determine the most effective and safest treatment options for patients with immunobullous diseases.

Background: Autoimmune blistering diseases (AIBDs) are a type of dermatosis with antibodies produced against various structural proteins of the epidermis or dermoepidermal junction. AIBDs are broadly divided into intraepidermal and subepidermal types. Apart from the common AIBDs, there is an array of uncommon AIBDs.

Objective: To discuss uncommon variants of AIBDs so that the readers are updated about them.

Methods: In this review, we have discussed uncommon and unusual variants like pemphigus herpetiformis, IgA pemphigus, paraneoplastic pemphigus, induced pemphigus, IgG/IgA pemphigus, oral lichenoid pigmentation in pemphigus, pemphigus acanthoma, and follicular pemphigus. Rarer variants of the pemphigoid group of disorders include anti-laminin 332 pemphigoid, mixed linear IgA/IgG pemphigoid, anti-p200 pemphigoid, Brunsting-Perry pemphigoid, IgM pemphigoid, granular C3 pemphigoid, anti-p105 pemphigoid, ORF-induced anti-laminin 332 pemphigoid, and acral purpura in dermatitis herpetiformis.

Conclusion: This review will help in early diagnosis and treatment of uncommon and unusual variants of AIBDs.

Background: Despite the availability of various treatment modalities, the treatment of melasma is often incomplete, with a high recurrence rate. The present study was undertaken to assess the efficacy and safety of oral tranexamic acid (TXA), modified Kligman's formula (MKF), and a placebo cream in melasma.

Materials and methods: Ninety cases of melasma of both sexes were enrolled, and divided into three groups of 30 patients each. The baseline severity of melasma was graded by Melasma Area Severity Index (MASI) score. Group A, B, and C patients were treated with oral TXA 250 mg twice daily, daily MKF cream at night, and daily placebo cream at night, respectively, for 12 weeks. Improvement in MASI score was calculated after 4, 8, and 12 weeks. At each visit, adverse effects, if any, were noted. Statistical analysis was done using Chi-square test.

Results: Based on intention to treat analysis, at the end of 12 weeks, the reduction in MASI score in oral TXA, MKF, and placebo groups was 9.94(65.91%), 6.12(54.78%), and 2.07(17.22%), respectively (P = 0.00). The difference in reduction of mean MASI scores after 12 weeks between oral TXA group and MKF group was not significant (P = 0.29). The efficacy of oral TXA and MKB was significantly higher than that of the placebo group (P = 0.01 and P = 0.03, respectively). Adverse effects in all groups were mild and self-limiting.

Limitations: A limited sample size, non-blinded design, and absence of dermoscopic evaluation were the study limitations.

Conclusion: In view of its excellent safety profile, oral TXA may be considered as a better option for moderate to severe melasma.