Indian Dermatology Online Journal最新文献

Background: Phototherapy is the most commonly used treatment for vitiligo, with initial pigment appearing at the perifollicular site, eventually coalescing into uniform pigmentation due to melanocyte migration from hair follicles. Melanocyte activity is higher during the anagen phase of the hair cycle, which is prolonged by minoxidil.

Aim: To assess if topical minoxidil enhances the rate of pigmentation during phototherapy for the treatment of vitiligo.

Patients and methods: In this double-blinded, randomized control study, the efficacy of minoxidil in inducing repigmentation was compared with the vehicle used as a placebo. Thirty vitiligo patients with a minimum of 2 patches were included and randomized into 2 groups and treated with phototherapy. Minoxidil 5% solution was randomly applied on one patch and vehicle on the other patch. The vitiligo area severity index (VASI) score of the lesion was measured at baseline and then at 4, 8, and 12 weeks for each lesion. Physician and patient global assessment scores were recorded at week 12.

Results: In minoxidil group, the baseline VASI score of 94 ± 9.68% reduced to 47.76 ± 17.25% at 12 weeks. In the placebo group, the VASI score reduced from 94 ± 9.68% to 67.93 ± 16.88%. Reduction in VASI was found to be greater in minoxidil group as compared with the placebo group ( P value = <0.001). The difference in the physician and patient's global assessment scores in both minoxidil and placebo groups was also statistically significant.

Limitations: The study had a small sample size and a short follow-up period.

Conclusion: Concomitant use of phototherapy and minoxidil increases the rate of pigmentation with reduction in VASI score.

Abstract: Chronic spontaneous urticaria (CSU) is a burdensome dermatological condition with a complex, multifactorial pathogenesis involving intricate immune, neurological, and psychological interactions. While traditional models primarily emphasize auto-allergic mechanisms, evidence highlights the critical role of neuroimmune interaction in the chronicity and exacerbation of disease. This review examines the neuroimmune contributions to CSU pathogenesis, focusing on mast cell (MC)-sensory neuron interactions, autonomic nervous system dysregulation, neuroinflammatory pathways, and psychological comorbidities that perpetuate disease activity. A comprehensive narrative review of the literature was undertaken, evaluating mechanisms such as MC activation through immunoglobulin-E (IgE)-independent pathways, neuropeptide-mediated inflammation, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, and psychiatric associations with CSU. Findings indicate that beyond the classical IgE-mediated MC degranulation, neurogenic inflammation via Mas-Related G-Protein Coupled Receptor X2 (MRGPRX2) receptors-triggered by neuropeptides such as substance P and vasoactive intestinal peptide-plays a pivotal role. Chronic psychological stress activates the HPA axis, contributing to MC hyperactivity and reinforcing the pruritus-stress cycle. Furthermore, a high prevalence of psychiatric comorbidities, including anxiety and depression, contributes to central sensitization and worsens disease severity. The interplay of T cells, basophils, eosinophils, and endothelial cells further amplifies the neuroimmune-inflammatory network. These insights suggest that optimal CSU management requires an integrated approach encompassing dermatological, immunological, and psychological interventions. Emerging therapies targeting neuroimmune pathways, such as MRGPRX2 antagonists, beta-adrenergic blockers, and cognitive-behavioral strategies, show promise. Future research should prioritize the development of personalized neuroimmune-directed therapies to enhance disease control in CSU.

Background: Kumkum and bindi are applied on the forehead as a custom. Allergic reactions develop in some due to the allergens present in kumkum and bindi adhesive. It is unlikely to subside unless the exposure to the allergens is completely discontinued, which is difficult for women, due to social and religious obligations in certain communities.

Aim: To evaluate and compare the safety and efficacy of indigenously prepared kumkum, bindi stickers, and annatto seed powder when used as alternatives in patients with bindi and kumkum dermatitis.

Patients and methods: A comparative study was conducted on adult patients of both sexes with kumkum and bindi dermatitis. Fifteen patients in each group were allotted based on simple random sampling. Group kumkum patients were given kumkum prepared by boiled, dried turmeric powder mixed with sodium bicarbonate and fresh lime juice to obtain a scarlet red mixture. Group stick bindi patients were given bindi prepared with red-colored craft paper cut into circular discs with adhesive paste. Group annatto patients were given annatto seed powder. Follow-up was performed in the second and fourth weeks to observe for the development of the reaction.

Results: Among 45 patients, 42 did not develop any reaction to the given compounds. One patient in group annatto and two in group kumkum developed mild reactions. The development of reaction to the given compounds between the groups was statistically insignificant (P = 0.18). The difference between all three groups in terms of patient satisfaction was statistically insignificant (P = 0.31).

Limitations: The period of 4 weeks was not sufficient in all cases, as the sensitization phase may be longer. We do recommend a follow-up for a longer period, and we also need to develop a more acceptable form of our products.

Conclusion: The alternatives were cosmetically acceptable and did not cause any reaction in the majority of the patients. All the alternatives were promising, safe, and cost-effective to be given as an alternative in patients with bindi and kumkum dermatitis.

Background: Sleep disorders in psoriasis and their improvement with treatment have not been evaluated in the Indian subcontinent. The aim of the study was to assess the extent of sleep impairment and the effect of treatment on sleep impairment in patients with psoriasis.

Patients and methods: This was a prospective, observational study with 59 participants of chronic plaque psoriasis, receiving standard non-biological treatment. Psoriasis Area Severity Index (PASI) score, 5D Itch Score, Pittsburg Sleep Quality Index, and Insomnia Severity Index were calculated at baseline, 4 weeks, and 12 weeks of follow-up. The primary outcomes were changes in sleep quality and insomnia at week 4 and week 12 compared to baseline.

Results: Poor sleep quality and clinical insomnia were noted in 6 (10%) and 15 (25.4%) participants, respectively. Sleep quality was associated with body mass index (P = 0.01) and pruritus (P < 0.001), while insomnia showed an association with PASI (P < 0.001). With treatment, poor sleep quality decreased to 5% at week 12 and this decrease was significant between weeks 4 and 12 (P < 0.001). Insomnia decreased to 3.4% at week 12. This improvement was significant between baseline and week 4 (P = 0.01) and between weeks 4 and 12 (P = 0.005). The improvement in sleep quality had a positive correlation with a decrease in pruritus at 4 weeks (P < 0.001) and 12 weeks (P = 0.005).

Limitation: Follow-up of 12 weeks only and missing values are drawbacks.

Conclusion: Sleep quality and insomnia improved with standard non-biological treatment and correlated with a reduction in psoriasis-induced pruritus. This finding is important as the treatment of psoriasis in resource-poor and developing countries mainly involves non-biological options.