Indian Dermatology Online Journal最新文献

Background: Laser therapy has emerged as an innovative approach for managing various nail conditions, offering precise targeting, minimal invasiveness, and favorable safety profiles. This review analyzes the literature on laser therapy for nail indications, encompassing onychomycosis, nail psoriasis, nail warts, ingrown toenails, onychodystrophy, nail pigmentation disorders, and nail tumors.

Methods: PubMed and Google Scholar databases were searched to identify articles on laser therapy using specific key terms related to nail conditions (e.g., onychomycosis, nail psoriasis). Relevant articles were shortlisted based on laser treatment in nail disorders, its mechanisms of action, research outcomes, and clinical applications.

Results: Nd: YAG or CO₂ lasers showed efficacy in onychomycosis by targeting fungal cells. Studies suggest that laser treatments offer comparable results to traditional therapies, often enhancing outcomes when combined with topical agents such as calcipotriol/betamethasone in nail psoriasis. For nail warts, ingrown toenails, onychodystrophy, and nail pigmentation disorders, lasers provide alternative or adjunctive therapies, achieving positive outcomes lesion clearance and symptom improvement. Conclusion: This review underscores the transformative potential of laser therapy in nail disorder management, providing clinicians with innovative treatment alternatives. Nevertheless, further studies are needed to refine protocols, evaluate long-term outcomes and explore its application in specific conditions such as nail tumors.

Background: The widespread occurrence of chronic and recurrent dermatophytosis has significantly affected the quality of life for patients in India and beyond. Identifying the causative dermatophytes and understanding their antifungal susceptibility can aid clinicians in tailoring effective antifungal therapies.

Materials and methods: Patients with chronic and recurrent dermatophytosis were enrolled, and conventional fungal cultures were conducted on skin scrapings. Identified isolates underwent antifungal susceptibility testing using the Clinical and Laboratory Standards Institute broth microdilution method (CLSI M38-A2) for common systemic antifungals, determining the minimum inhibitory concentration (MIC) range and calculating MIC 50 and MIC 90.

Results: Sixty samples were tested. Tinea corporis was the most common presentation (66.6%). Trichophyton mentagrophyte species complex was the prevalent species (45, 75%), followed by Trichophyton rubrum (7, 11.7%). In Trichophyton mentagrophytes species complex, MIC range was 8-64 μg/mL for fluconazole, 0.06-0.25 μg/mL for terbinafine, and 0.125-0.5 μg/mL for griseofulvin. For Trichophyton rubrum, the MIC range was 8-64 μg/mL for fluconazole, 0.06-0.25 μg/mL for terbinafine, and 0.125-0.5 μg/mL for griseofulvin. For all species, itraconazole MIC was ≤0.125 μg/mL. Hence, itraconazole and terbinafine had the best MIC range against tested isolates in our study.

Limitations: Absence of genotyping of isolate and not compared the results with studies where sequence-based identification to species level was done.

Conclusion: In vitro, resistance to itraconazole for any of the four isolated agents was not seen. Terbinafine resistance appears to be an uncommon occurrence in South India. In vitro susceptibility tests shall be regularly done to design the epidemiological cutoff values.

Background: Inflammatory dermatological conditions, including psoriasis, lichen planus, eczema, and alopecia areata, are frequently accompanied by nail findings and can have a significant impact on quality of life. Biologic and small-molecule medications have been approved over the past several decades in treating patients with these inflammatory nail disorders. They may be used in conjunction with longstanding mainstays of treatment (topical and intralesional corticosteroids, topical vitamin D3 analogs).

Objectives: Our objectives were to review biologic and small-molecule treatment efficacies for nail psoriasis and alopecia areata-associated nail dystrophy, including Janus kinase inhibitors, apremilast, tumor necrosis factor (TNF) inhibitors, interleukin (IL)-17 inhibitors, and IL-23 inhibitors.

Materials and methods: A comprehensive PubMed literature review of clinical research studies, narrative reviews, systematic reviews, and meta-analyses was performed.

Conclusion: Many biologics and small molecules are effective in treating nail psoriasis and alopecia areata, with each requiring precautions for adverse events. Clinical trials for use of biologics and small molecules for nail lichen planus and atopic dermatitis have not been published to date.

Pemphigus is an autoimmune blistering disorder characterized by the presence of intraepidermal blisters and erosions, primarily affecting the mucosa and/or skin. There are no established Indian guidelines for the management of pemphigus, and Western guidelines cannot be directly applied due to differences in clinicodemographic profiles, comorbidities, and resource limitations. These guidelines aim to provide Indian dermatologists with evidence-based and consensus-driven recommendations for the management of pemphigus vulgaris (PV) and pemphigus foliaceous (PF), taking into account the unique challenges posed by the Indian healthcare setting. The guidelines focus on the comprehensive management of PV and PF, addressing diagnosis, treatment, monitoring, and follow-up. It is intended for dermatologists working in both outpatient and inpatient settings across India. The first draft of the guidelines was prepared by the writing group and then reviewed by 19 national experts in pemphigus management, including inputs from allied specialties. Areas with limited evidence or anticipated variation in recommendations were subjected to rounds of voting, with responses categorized as "strongly agree," "agree," "neutral," "disagree," or "strongly disagree." Suggestions were incorporated, and statements were revised until a mean agreement score of 4 or higher was reached across 16 key areas after four voting rounds. These guidelines offer a structured approach to managing pemphigus in India, addressing the need for region-specific recommendations that account for unique challenges such as resource constraints and specific comorbidities in Indian patients. They serve as a valuable resource for dermatologists treating pemphigus in a range of clinical settings.

Introduction: Ultraviolet-induced fluorescence dermoscopy (UVF dermoscopy) is a novel diagnostic technique for identifying and diagnosing numerous skin tumors, inflammatory dermatoses, and infectious diseases. The ultraviolet (UV) band has a wavelength ranging from 10 to 400 nm. When intense UV radiation with shorter wavelengths strikes a target chromophore, visible light (VL) with a longer wavelength and lower energy is produced in the skin. This VL is apparent to the naked eye and is referred to as fluorescence.

Aim: The current review compares ultraviolet fluorescence dermoscopy (UVFD) and polarized dermoscopy (PD) features in various dermatological disorders.

Materials and methods: This review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Metanalyses) guidelines. A comprehensive search of the literature was carried out through the PubMed and Google Scholar electronic databases from inception to 25^th December 2023 using the following search terms: "UV dermoscopy" OR "ultraviolet fluorescence dermoscopy" OR "ultraviolet-induced fluorescence dermoscopy" OR "Ultraviolet-induced fluorescent dermoscopy". Titles, abstracts, and full texts were screened by two independent reviewers to select papers dealing with UVF-dermoscopy.

Results: A total of 23 relevant articles were included in this systematic review, including a total of 313 patients. Pigmented skin tumors included 209 patients, Fordyce spot mimickers (13), scabies (57), biopsy site (20), psoriasis (3), corynebacterium infections (2), fungal infections (4), vitiligo (3), acne folliculitis (1) and glomus tumors (1). Levels of evidence (LoE) was 3 and 4 in only two included studies; the rest had a LoE of 5.

Discussion: UVF dermoscopy is a new diagnostic and prognostic tool for neoplastic and non-neoplastic dermatological conditions. This is the first systematic review of its sort that compares and categorizes dermoscopic findings in UVF and polarized light in dermatological practice. As UVFD does not penetrate deeper skin layers, we observed that it is a better way to distinguish features restricted to the skin's superficial layers in neoplastic diseases. As a result, tumor-free margins and improved surgical outcomes can be achieved. More favorable outcomes for evaluation and treatment were seen with non-neoplastic conditions. Limitations included a lack of studies with a high level of evidence, control groups, and larger sample sizes.

Conclusion: We concluded that UVFD will improve clinical diagnosis, disease management, and outcomes. More clinical trials with larger sample sizes are recommended to better understand this novel and intriguing new diagnostic tool.

Microcystic adnexal carcinoma (MAC) is a rare, slow-growing, locally aggressive malignant, and recurring appendageal tumor. Prolonged UV exposure, immunosuppression, and radiotherapy are a few frequently associated risk factors. MAC classically presents as an asymptomatic skin coloured plaque on the face. The key to diagnosis is a deep-sectioned biopsy. Surgical modalities are the first line of treatment.

Background: Chronic spontaneous urticaria (CSU) appears to share some pathomechanisms with metabolic syndrome (MS), such as proinflammatory state, increased oxidative stress, changes in adipokine profile, and coagulation system activation.

Aim and objectives: To evaluate clinical and laboratory parameters of MS in CSU patients and to assess relationship of MS with duration and severity of CSU, Ig-E, thyroid-stimulating hormone (TSH), C-reactive protein (CRP), and autologous serum skin test (ASST).

Materials and methods: A hospital-based cross-sectional study was conducted on 131 CSU cases and 131 controls who were age- and sex-matched. Duration of the CSU and urticaria activity score (UAS) were noted. Waist circumference (WC), blood pressure, fasting blood sugar, high-density lipoprotein (HDL), triglycerides (TG), CRP, TSH, IgE, and ASST were noted. MS was considered according to Harmonization Asian criteria.

Results: The percentage of patients with elevated clinical and laboratory parameters of MS was higher in cases compared to controls, in which WC, HDL, and TG were significantly elevated. MS was positive in 25.19% and 14.50% of cases and controls, respectively (P = 0.044). Cases with MS had a significant higher mean duration (16.60 months) than those without MS (8.81 months) (P = 0.004). MS was positive in 15.2%, 32.3%, and 36.4% of mild, moderate, and severe UAS patients, respectively (P = 0.095). Patients with increased TSH and CRP had a significantly higher percentage of MS (68.4% and 40.7%, respectively) than with normal TSH and CRP (15% and 19.4%, respectively) (P < 0.05), while it was not significant with respect to IgE and ASST.

Limitations: Small sample size and it was a hospital-based study, therefore, all controls were from the patients attending our outpatient department only and could not be compared with the general population.

Conclusion: MS is not uncommon in CSU patients. The duration of CSU, CRP levels, and TSH levels have a significant positive correlation with MS. Screening, along with regular surveillance of CSU patients, aids in the early detection of MS and minimizes the risk of cardiovascular disease.

Introduction: The incidence of sexually transmitted infections (STIs) has increased disproportionately to STI services. It is uncertain how many residents trained in STI services continue them. This study assessed the self-rated quality of training and attitudes about STI services amongst residents of Indian teaching hospitals.

Materials and methods: In this descriptive cross-sectional survey study, opinions from Indian postgraduate trainee residents were sought in three domains of STIs- institutional STI management practices, quality and satisfaction with training, and attitude towards STI services.

Results: A total of 225 responses were included. There was no separate area for STI services at centers of 51.6% of residents, and among those with separate STI posting, the duration was ≤2 months for 34.7%, with 59.6% wishing for its increase. Easily available bedside tests were used regularly when indicated by only 41.8%. Only 58.2% of respondents strictly ensured contact tracing and partner treatment. Only 65.8% of centers had provision of benzathine penicillin. Under-confidence in managing STIs independently was reported by 19.6%. Inadequate training was the second reason for wishing to discontinue STI services upon completion of training; with 71.5% wishing to continue STI practice. In univariate analysis, frequent point-of-care testing (P < 0.001), and >2 months of separate STI posting (P = 0.018) were associated with good satisfaction with STI training. Frequent point-of-care testing (P < 0.001), and male gender (P < 0.001) were associated with good confidence in independently managing STIs. Male gender (P = 0.038), having less reluctance in dealing with STI patients (P = 0.003), and good confidence in independently managing STIs (P = 0.008), was associated with willingness to continue STI practice.

Conclusions: STI care is associated with reluctance. Current STI training in Indian teaching hospitals is less than desired and can lead to unwillingness amongst residents to practice STI services in the future. Having >2 months of separate STI posting, frequent point-of-care tests, and efforts to reduce reluctance when dealing with STI patients are steps that can improve the STI training experience of residents.