Indian Journal of Dermatology最新文献

Melasma is a challenging pigmentation disorder for both the patient and the physician, particularly due to its frequent recurrences and resistance to standard therapies. Light and laser-based treatments are generally preferred when the condition is resistant to topical treatments. Intense pulsed light (IPL) is a light therapy that is both effective for epidermal and dermal melasma as well as vascular components, due to its broad range of energy. Compared to lasers and other energy-based devices, IPL offers broader wavelength coverage, deeper penetration, and the capacity to treat larger surface areas with reduced risk of collateral tissue damage. In this review, we will discuss about IPL mechanism in melasma and studies in the literature about IPL efficacy in melasma including its use as monotherapy and in combination with other modalities. While IPL monotherapy shows moderate improvement, the literature predominantly consists of combination therapy studies, limiting the ability to isolate IPL's direct effectiveness. Future prospective studies with standardized protocols and extended follow-up are needed to define IPL's optimal role in the management of melasma.

Background: Psoriasis is a multifactorial immune-mediated inflammatory disorder in which the involvement of the skin is merely the tip of the iceberg. It poses a significant global problem affecting both children and adults, with childhood onset occurring in almost one-third of the cases. Early diagnosis of pediatric psoriasis is crucial to address, identify, and manage the growing list of established extracutaneous manifestations and comorbidities.

Aims and objectives: To study the clinico-epidemiological profile of pediatric psoriasis and determine the prevalence of various comorbidities associated with it.

Materials and methods: This was a cross sectional observational study conducted at the Department of Dermatology of a tertiary care hospital of North India over a period of 36 months and included all patients aged 9 months to 18 years with a clinical diagnosis of psoriasis. A predesigned structured proforma was used to collect the required information from the study subjects.

Results: Eighty-six patients were recruited in this study, of which 47 (54.65%) were males and 39 (45.34%) were females. The most common type of psoriasis seen in this study was chronic plaque psoriasis (63%). Eight (9.30%) patients had evidence of psoriatic arthritis at presentation. Abnormal waist circumference was observed in 26 (30.23%) of the 86 patients recruited in the study. Abnormal BMI was recorded in 49 (56.97%) patients, of which 27 (31.39%) were overweight and 22 (25.58%) were obese. Ten (11.62%) patients had evidence of impaired fasting glucose, while 1 (1.16%) patient had type 2 diabetes mellitus. Increased levels of total cholesterol were observed in 13 (15.11%) patients involved in the study. Fifty-nine (68.60%) patients had at least 1 lipid profile abnormality. Eight (9.30%) participants fulfilled the criteria for metabolic syndrome. Concomitant autoimmune diseases were seen in 42 (48.83%) patients, of which hypothyroidism was the most common, followed by vitiligo, alopecia areata, type 1 diabetes mellitus, systemic lupus erythematosus, and juvenile rheumatoid arthritis.

Conclusion: Although the association between psoriasis and various comorbidities is well documented in adults, studies demonstrating the same relationship in children are still lacking. However, psoriasis begins in childhood or adolescence in approximately 40% of patients, suggesting that the risk of comorbidities may also begin early in life. This presents an opportunity for prevention, early detection, and intervention for children who may suffer from or be at a risk of comorbidities, especially metabolic ones.

Hypergranulotic dyscornification (HGD) represents a unique histopathologic reaction pattern with disorder in the maturation of corneocytes. Hypergranulotic dyscornification do not have specific clinical description so final diagnosis is entirely based on histological findings. A 69 yrs old man presented with multiple asymptomatic discrete depigmented papules and nodules with verrucous surface over the legs and hands of 3 months duration. Verruca vulgaris and seborrheic keratosis were provisional diagnosis based on surface verrucosity but could not explain the depigmentation. Histopathology revealed features of HGD. Special stain with Fontana Masson and immunohistochemistry with HMB-45 showed loss of melanocytes in lesional skin compared to normal skin which explained depigmentation. This case of HGD is reported for its rarity and additional finding of depigmentation which has not been reported so far in the literature. The diagnosis of HGD Albicans or with co-occurrence of vitiligo remains to be seen with further reports.

Background: Psoriasis is a chronic inflammatory skin disease linked to immune system. Despite its prevalence, the precise aetiology and pathogenesis of psoriasis remain elusive. This study aimed to assess the efficacy and safety of Secukinumab while exploring its impact on the intestinal microbiota in patients with moderate-to-severe plaque psoriasis.

Materials and methods: We recruited 60 healthy controls and 110 patients with moderate-to-severe plaque psoriasis who attended outpatient clinics between June 2022 and June 2023. Clinical data (gender, age, BMI, PASI score, PGA, DLQI, Itch NRS, and STAI score) and faecal samples were collected from all groups. Faecal samples underwent PacBio Full-Length Diversity Sequencing and subsequent informatics analysis.

Results: Patients were randomly assigned to two groups: Before Secukinumab treatment group (BT, n = 55), After 24 weeks of Secukinumab treatment group (AT, n = 55). Control group (Con) consisting of healthy individuals matched for age, sex, and body mass index (n = 60). Following 24 weeks of Secukinumab treatment, significant reductions in PASI score, PGA, DLQI, Itch NRS, and STAI score were observed in psoriatic patients (P < 0.05). The microbial diversity and composition in the AT group exhibited substantial alterations compared to the BT and Con groups, typified by an elevated abundance of Agathobacter and Anaerobutyricum and a diminished presence of Bacteroides and Phocaeicola.

Conclusion: The changes in gut microbiota occur at a slower pace than cutaneous manifestations, necessitating prolonged follow-up and microbiome-based investigations in Secukinumab-treated psoriasis patients to substantiate its therapeutic efficacy.

Introduction: Chronic urticaria (CU) is a distressing skin condition characterised by pruritic wheals, with or without angioedema, lasting for more than 6 weeks. The disease significantly compromises patients' quality of life, affecting various aspects of daily living. Assessing disease control and quality of life in CU patients is essential for evaluating disease burden and improving therapeutic outcomes. However, there is a lack of tools to assess these parameters in the Hindi-speaking population in India. This study aims to translate, adapt, and validate the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) and Urticaria Control Test (UCT) in Hindi, providing culturally relevant and accurate assessments.

Methods: The translation process followed standard procedures, including forward and backward translations, expert committee review, and preliminary pilot testing. The reliability and validity of the translated questionnaires were evaluated. Internal consistency, test-retest reliability, and inter-rater reliability were assessed for both CU-Q2oL and UCT. Construct validity was determined by comparing CU-Q2oL and UCT with an established English Dermatology Life Quality Index (DLQI) score. A cross-sectional study recruited 30 adult patients with CU from an Indian tertiary care hospital. Demographic details and disease parameters were collected, and participants filled the questionnaires at baseline and after 14 days.

Results: The mean age of the participants was 37.86 ± 11.69 years, and most were female (63.3%). The Hindi version of CU-Q2oL demonstrated respectable internal consistency (Cronbach's alpha = 0.75) and strong test-retest reliability (intraclass correlation coefficient or Pearson's r = 0.75). Domain 1 (pruritus) and domain 5 (sleep disturbances) were the most affected, while domain 2 (swelling) was the least affected. UCT also showed excellent internal consistency (Cronbach's alpha = 0.82) and acceptable test-retest reliability (Pearson's r = 0.46). Construct validity was established through positive correlation coefficients with DLQI.

Conclusion: The translated and validated CU-Q2oL and UCT questionnaires in Hindi provide valuable tools for assessing disease activity and quality of life in CU patients. These questionnaires can aid in research, enhance patient care, and improve disease management in the Hindi-speaking population. Their positive correlation with an established quality of life measure further validates their utility and reliability. Overall, this study should contribute to better healthcare outcomes for patients with CU in India.

Background: The measurement of health-related quality of life (HRQoL) is essential in dermatology, with the DLQI and Skindex-29 being popular tools for assessment. However, the literature comparing the measuring features of these two questionnaires is lacking.

Aims: This study aims to provide a comparison of the measurement properties of DLQI and Skindex-29 in patients with common dermatology conditions such as psoriasis vulgaris (PV), vitiligo vulgaris (VV), leprosy, and acne vulgaris (AV).

Methods: In this cross-sectional study, the HRQoL of 301 patients with the four dermatological conditions was measured using the DLQI and Skindex-29 questionnaires at a tertiary care centre located in Dehradun, Uttarakhand, India. Statistical analysis included determining ceiling and floor effects, informativity, and criterion validity.

Results: The mean DLQI total scores were: PV (11.03 ± 0.89), VV (4.73 ± 0.78), leprosy (8.97 ± 1.09), and AV (7.79 ± 0.63), and the mean Skindex-29 scores were: PV (37.98 ± 2.82), VV (27.92 ± 2.93), leprosy (45.12 ± 3.63), and AV (27.6 ± 1.08), with a 95% confidence interval. Of the patients with a DLQI score of 0 (n = 66), 64 (96%) had a total score greater than 0 on the Skindex-29. The most troubled areas of HRQoL among patients with a DLQI score of 0 according to the Skindex-29 were item 17 (showing affection; 12.1%), item 9 (worry about scars; 9.1%), item 12, item 13, and item 14 (being ashamed, worrying about worsening, and tending to do things oneself; 7.6%). The ceiling effect was observed in 4.7% of patients for DLQI and 0% for Skindex-29. The floor effect was high for the DLQI total score (22%), whereas Skindex-29 observed only 0.7%. The absolute informativity value of Skindex-29 was 1.66, and that of the DLQI was 1.92. The typical relative informativity value for both was 0.83.

Conclusion: Skindex-29 showed better sensitivity to clinical severity, less floor effect, higher absolute informativity, and better coverage of the 'emotion' domain. Skindex-29 was found to be more effective in detecting minor HRQoL impairment than DLQI.

Background: Diverse biological therapies have become increasingly prevalent in recent years in the treatment of psoriasis. However, current guidelines continue to recommend non-biological systemic treatments. Real-life data on the survival of acitretin and methotrexate are limited. It is important to determine the appropriate patient candidates before treatment and to determine the factors affecting survival to increase treatment compliance.

Aims and objectives: This study aimed to calculate the estimated survival and 1-, 2-, 3-, 5-year survival rates of acitretin and methotrexate and to determine the factors affecting survival. Other purposes include evaluating reasons for treatment cessation, and adverse effects.

Materials and methods: Our retrospective study, conducted at a single centre, included 364 adult patients diagnosed with psoriasis who had received at least one of the acitretin or methotrexate and had at least two visit records. The data were obtained from patient records. Response to treatment in the third month, adverse effects, and reasons for treatment discontinuation were recorded. Survival analysis was performed using the Kaplan-Meier method. Log-rank tests and Cox regression analyses were used to assess the predictive factors for survival. P <0.05 was considered significant.

Results: A total of 437 treatment courses of 364 patients were evaluated. The median follow-up was 39.5 (21.00-64.75) months. The median survival was calculated as 14 months for acitretin and 20 months for methotrexate. One-year drug survival rates for acitretin and methotrexate were 49.5% and 62.7%, respectively. Treatment response was the most important determinant of drug survival for both medications, whereas advancing age and arthritis had a positive effect on methotrexate survival.

Conclusion: Survival rates of acitretin and methotrexate were generally low in practice compared with published data on biological treatments, but as a response to treatment increased, the survival of both drugs improved. Better strategies need to be developed to increase treatment response and survival.