Indian Dermatology Online Journal最新文献

Background: Scoring systems play a crucial role in dermatology by providing objective measurements of disease severity, treatment efficacy, and outcome comparisons. In autoimmune blistering diseases (AIBDs), standardized scoring systems are essential for accurate evaluations; however, there is currently a lack of consensus on scoring methods.

Objective: This literature review explores scoring systems in AIBDs by tracing their development, addressing challenges, and highlighting their role in defining endpoints, regulatory considerations, and clinical trials.

Materials and methods: Existing scoring systems for AIBDs, such as the Pemphigus Disease Area Index, Autoimmune Bullous Skin Disorder Intensity Score, Pemphigus Oral Lesions Intensity Score, Oral Disease Severity Score, and Pemphigus Vulgaris Activity Score, are examined for their validity, reliability, and responsiveness. The Bullous Pemphigoid Disease Area Index for bullous pemphigoid is also discussed. The concept of minimal clinically important differences is explored to determine clinically significant improvements in disease severity.

Conclusion: This review provides a comprehensive understanding of the central role of scoring systems in dermatology and their implications for research and clinical practice in AIBDs.

Background: Warts are benign epidermal proliferations, caused by infection of keratinocytes with human papillomavirus (HPV). Auto implantation and intralesional mumps, measles, and rubella (MMR) vaccine are novel methods of immunotherapy for treating periungual and palmoplantar warts. They act by stimulating the patient's immune system; this clears not only the local warts but also distant warts with lesser side effects.

Objective: We conducted this study to compare the efficacy and safety of both methods in treating periungual and palmoplantar warts.

Materials and methods: A total of 160 patients were randomly allocated into two groups of 80 patients. Group A was treated with 0.3 mL of intralesional MMR vaccine at an interval of 3 weeks or for a maximum of three sittings, and Group B was treated with auto implantation.

Results: At the end of therapy, the result was better in group A (MMR vaccine) as 86% of cases yielded an excellent response as compared to 71% in group B (auto implantation). The recurrence rate was 5% in group A and 4% in group B. There were no serious side effects in both groups with pain during injection (70%) in group A and swelling at the recipient site (8%) in group B being the most common side effect.

Conclusion: Both MMR and auto implantation had significant response rates. But MMR was faster and better.

Background: There are no recent studies with a focus on the histopathology of erythema nodosum leprosum (ENL).

Objectives: To describe the histopathological spectrum of ENL.

Materials and methods: Digital records from the pathology department were searched, and 125 slides were included. The histopathologic findings were recorded using a pre-designed proforma.

Results: Several patterns were noted with the most common being a superficial and deep, perivascular and peri-appendageal, well-circumscribed dermal infiltrate that was seen in 70 (56.0%) biopsies. Other dermal patterns included a similar but loose infiltrate in 19 (15.2%) biopsies, diffuse dermal involvement in 9 (7.2%), top-heavy in 9 (7.2%), and bottom-heavy infiltrates in 12 (9.6%). Subcutaneous tissue was included in 107 biopsies. Extension of dermal infiltrates to the subcutis was noted in 71 (66.4%) biopsies and predominant involvement of the subcutis was noted in 6 (4.8%) biopsies, with lobular involvement in 60 (56.1%), septal involvement in 3 (2.8%), and septo-lobular involvement in 14 (13.1%). In 30 (28.0%) biopsies, the subcutaneous fat was uninvolved. The infiltrates contained neutrophils and foamy histiocytes in variable proportions, along with lymphocytes and plasma cells. Eosinophils were noted occasionally. Medium and/or small vessel vasculitis was noted in 11 (8.8%) biopsies. Fite-Faraco staining was available for 112 biopsies and revealed mainly fragmented and granular acid-fast bacilli (AFB) in 29 (25%) biopsies.

Limitations: Our study had a retrospective design; we could not compare the lesional age and clinical characteristics of patients with the histological features.

Conclusion: ENL is characterized by dermal infiltrates composed of foamy histiocytes and neutrophils in varying proportions arrayed in different dermal patterns. Extension of dermal infiltrates into the subcutis was frequent but absent in some. Predominant or exclusive involvement of the subcutis was rare. Vasculitis was noted in a small minority, while AFB were demonstrated in about a quarter of cases.

Background: Dermatitis cruris pustulosa et atrophicans (DCPA) is a chronic superficial folliculitis that can cause scarring alopecia if left untreated. Hardly any studies are there describing the dermoscopic features of DCPA. Dermoscopy can be a useful tool for diagnosing DCPA in addition to clinical and histopathological features and for differentiating other conditions like superficial folliculitis, folliculitis decalvans, and pseudofolliculitis.

Aims/objectives: The aim of this retrospective study was to describe the dermoscopic features of 30 patients with DCPA at a tertiary care center in South India.

Materials and methods: A retrospective study of clinical and biopsy-proven cases of DCPA at a tertiary care center in South India.

Results: Thirty patients of DCPA of skin phototype IV or V were studied. Male preponderance of DCPA was noted in our study. Lower extremities 28 (93.3%) and upper extremities 2 (6.7%) were the common sites of involvement. The most common findings noted in dermoscopy were follicular-based pustules in 30 (100%) patients, follicular white structureless area in 16 (53.3%), perifollicular collarette of scales in 12 (40%), diffuse background dotted blood vessels in 12 (40%), and the absence of follicular orifices in 12 (40%). Other findings were yellow or hemorrhagic scales, perifollicular linear white lines, broken hair, and perifollicular dotted blood vessels. Pigmentary patterns observed were dark brown pigmentation, blue-grey globules, blue-grey dots, and accentuation of the pigmentary network.

Limitations: The limitations of the study were the retrospective nature of the study, the small sample size, and the lack of a comparison group.

Conclusion: The predominant dermoscopic features observed in our patients were follicular-based pustules, follicular white structureless areas, perifollicular collarette of scales, diffuse background dotted blood vessels, and the absence of follicular orifices. Vascular and pigmentary patterns were less commonly noted.

Background: There is only limited data on the association between psoriasis and metabolic comorbidities in South-Asian children.

Objective: To examine metabolic comorbidities among South-Asian children with and without psoriasis.

Materials and methods: A hospital-based, comparative, cross-sectional study was conducted in children with and without psoriasis over 19 months. Anthropometric, clinical, and metabolic comorbidity details (including disease extent and severity scores, obesity, systemic hypertension, diabetes mellitus, lipid abnormalities, and metabolic syndrome) were obtained in both groups according to standard criteria.

Results: Fifty-eight children with psoriasis (25 males/33 females, age 11.3 ± 3.0 years, range 4 to 17 years) and 62 children without psoriasis (37 males/25 females, age 11.0 ± 3.6 years, range 4 to 18 years) were recruited. The prevalence of obesity (31.0% versus 14.5%, P = 0.031, odds ratio 2.65) and metabolic syndrome (18.6% versus 4.6%, P = 0.044, odds ratio 4.68) were higher in children with psoriasis than without. The prevalence of other metabolic comorbidities (systemic hypertension, pre-diabetes, lipid abnormalities, elevated serum alanine aminotransferase, and non-alcoholic fatty liver disease) was not different between children with and without psoriasis and between obese and non-obese children with psoriasis. Among children with psoriasis, those with abdominal obesity had significantly lower disease severity and extent scores than those without.

Conclusion: Psoriasis is associated with a significantly higher prevalence of obesity and close to significantly higher prevalence of metabolic syndrome in South-Asian children. Screening for metabolic comorbidities is essential even in non-obese children with psoriasis. Disease extent and severity are less in obese compared to non-obese South-Asian children with psoriasis.