Indian Journal of Dermatology最新文献

Behçet's disease is a chronic inflammatory condition that affects multiple organs and systems. It is characterized by recurrent oral and genital ulcers. A previous study reported that the IL-17A inhibitor secukinumab can improve the skin and mucosal manifestations in patients with refractory Behçet's disease. Additionally, secukinumab has been shown to effectively improve neurological symptoms when administered for Behçet's disease. However, we report a case where Behçet's disease occurred after the treatment of psoriasis with the IL-17A inhibitor ixekizumab. To summarize its clinical characteristics and treatment experience, we consulted relevant domestic and international literature and conducted a literature review. We concluded that anti-IL-17A treatment may lead to the development of Behçet's disease. The reported cases are more likely to occur in middle-aged men with varying onset times. The main manifestations include oral and vulvar mucosal ulcers. Furthermore, the gut microbiota may be involved in paradoxical Behçet's disease.

Psycho-dermatology is an evolving speciality of psychosomatic medicine where psychological factors play a role in initiating and/or exacerbating the dermatological conditions. Dermatologists should be well versed with the basic pharmacotherapy of psycho-cutaneous disorders and work in close liaison with the psychiatrists when it comes to the holistic management of the same. The review has been divided into two parts, with part 1 consisting of anti-depressants and mood stabilisers and part 2 consisting of anti-psychotics, anxiolytics, and sedative-hypnotic agents used in psycho-dermatology. This comprehensive review focusses on the various psychotropic drugs which are of paramount significance to the dermatologists. The knowledge of these drugs will lead to the pertinent treatment of the psychiatric dermatoses, which has been a less explored territory in the arena of dermatology. Within the realm of psycho-dermatology, a diverse array of anti-depressants is utilised to address psychiatric dermatoses. These include selective serotonin reuptake inhibitors like citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline, alongside selective serotonin norepinephrine reuptake inhibitors such as venlafaxine, desvenlafaxine, and duloxetine. Additionally, norepinephrine dopamine reuptake inhibitors like bupropion; tricyclic antidepressants including doxepin, amitriptyline, imipramine, and clomipramine; and tetracyclic antidepressants like mirtazapine are commonly employed. Supplementary medications like anti-convulsants (e.g., gabapentin and pregabalin) further enrich the therapeutic landscape in psycho-dermatology. The approach to treatment in psycho-dermatology is meticulous, starting with a precise psychiatric diagnosis and followed by tailored drug interventions. Factors such as individual response, side-effect profiles, potential drug interactions, and concurrent medical conditions guide the selection and titration of medications. Typically, treatment initiates at conservative doses, with adjustments made based on patient progress and tolerability. This comprehensive review not only illuminates the psycho-cutaneous indications of these medications including in patients with co-morbidties but also underscores the imperative of vigilant monitoring for adverse effects and its management. This systematic review aimed to evaluate the use of psychotropic medications, including antidepressants and mood stabilizers, in dermatology. A comprehensive search of PubMed Central was conducted for studies published between 1986 and 2023, focusing on meta-analyses, reviews, and systematic reviews. After screening 2287 records, 26 studies met the inclusion criteria. The findings underscore the potential role of psychotropic drugs in managing dermatological conditions, highlighting the need for further research to strengthen the evidence base in psycho-dermatology.

Background: India is a country with diverse religious and cultural practices instigating skin diseases which may be missed due to lack of awareness. Contact dermatitis (CD) to lac is not uncommon yet an underreported entity.

Objectives: To study clinical patterns of allergic CD due to lac bangles and to assess common contact allergens.

Methodology: A retrospective study was conducted after approval by an ethical committee. Out of 850 patients attending the CD clinic from January 2021 to December 2022, the prevalence of CD lac bangles was 40 (4.7%). After obtaining consent, the history of sites, duration, morphology, and DLQI were recorded from patients' medical records. Patch testing with Indian standard series (ISS) and raw lac powder mixed with control was done.

Results: A total of 40 females were evaluated. The mean duration between contact and first symptom was 14.8 ± 10.43 months. Morphology was dry eczematous in 18 (45%), lichenoid in 10 (25%), oozy eczematous in 5 (12.5%), urticarial in 5 (12.5%) and vesiculobullous in 2 (5%) patients. In 14 (35%) females, lesions were disseminated. In 12 (30%) females, CD to bindi (4), lipstick (1), Sindhoor (5), rings (1), and plastic slippers (1) were associated. The mean DLQI was 19.37 ± 3.4. Patch test results were positive with ISS allergen epoxy in 9 (22.5%) patients, nickel in 6 (15%), cobalt in 6 (15%), paraphenylenediamine in 5 (12.5%), and lac in only 2 (5%) patients.

Conclusion: Data observed in the present study suggests that CD to lac is a distinct clinical entity. Low positivity with lac in patch test proposes the need for standardized testing material.

Background: Benign skin, soft tissue and appendageal tumours of skin are one of the most frequently encountered skin disorders. An organised systematic approach along with dermoscopic and histopathological examination can aid in the diagnosis of these diverse disorders.

Objective: To evaluate clinico-dermoscopic and histopathological findings of benign skin, soft tissue and appendageal tumours of skin in patients attending a tertiary care hospital.

Methods: Cross-sectional hospital-based study where patients of all age groups irrespective of gender suspected of having benign skin, soft tissue and appendageal tumours were enrolled. Clinical, dermoscopic and histopathological findings were recorded and the agreements between them were evaluated using the Cohen's Kappa coefficient.

Results: The study included a total of 415 patients with a mean age of 37.9 ± 15.59 years and a male to female ratio of 1:1.3. The mean duration of the disease was 4.3 ± 2.14 years. Soft tissue tumours were the commonest (60%), followed by benign skin tumours (24.3%) and benign appendageal tumours (17.1%). A good agreement between dermoscopic and clinical diagnosis was found (Cohen's Kappa = 0.879) and between dermoscopic and histopathological diagnosis was also found (Cohen's Kappa = 0.789).

Conclusion: This study infers that benign tumours of the skin include a heterogeneous group of skin disorders affecting a heterogeneous population. Dermoscopy improved the diagnostic accuracy of this large group of skin disorders and reduced the number of unnecessary excisions; however, histopathology remains the benchmark diagnostic tool to differentiate these tumours from other benign tumours and their malignant counterparts.

Aim: This article aims to examine the demographic and clinical traits of neurofibromatosis type 1 (NF1) patients, particularly focusing on the potential links between vitamin D levels, BMI, and dermatological features.

Methods: A retrospective review of medical records involving 128 patients diagnosed with neurofibromatosis type 1 (NF1) over a 3-year-period was conducted. The analysis emphasized investigating the demographic and clinical characteristics of the patients while evaluating key parameters.

Result: Nevus anemicus was present in 32.8% of NF1 patients, and a significant association was found between nevus anemicus and low vitamin D levels (P = 0.001). We also observed a notable correlation between low vitamin D levels and an increased likelihood of neurofibromas (P < 0.001). Additionally, there appears to be an inverse relationship between serum vitamin D levels and the number of neurofibromas.

Conclusion: Our study suggests a correlation between lower vitamin D levels and key dermatological characteristics in neurofibromatosis type 1 (NF1) individuals. Specifically, we observed associations with nevus anemicus prevalence and increased neurofibromas. This observation enriches NF1's understanding, offering practical implications for patient management by emphasizing the importance of monitoring and addressing vitamin D levels.

Background: Morphoea is a sclerosing disorder of skin and subcutaneous tissue. Paediatric morphoea shows increased prevalence of various auto-immune diseases, bone deformities, and systemic abnormalities. There is paucity of studies on various immunological, skeletal, and thyroid function abnormalities in paediatric morphoea.

Aims and objectives: To describe immunological, skeletal, and thyroid function abnormalities present in paediatric morphoea patients.

Materials and methods: This cross-sectional study was conducted from January 2021 to March 2023 in the Dermatology outpatient department in a tertiary care hospital. All paediatric morphoea patients were included in this study. All were subjected to detailed history, clinical examination, and investigations including complete blood count, serum IgE, anti-nuclear antibody, thyroid function tests, anti-thyroid peroxidase antibodies, and radiological investigations.

Results: A total of 42 children were recruited, out of which 61.90% were females and 38.09% were males. The majority were in the age group of 4-8 years. The most common type of morphoea was encoup de sabre. Anaemia was present in 14.28% patients. Serum IgE levels were raised in 33.33% patients. Thyroid stimulating hormone was raised in 11.9% patients. 33.33% had raised anti-thyroid peroxidase levels. Anti-nuclear antibody titres and rheumatoid factor were raised in 7.14% and 4.76% patients, respectively. Magnetic resonance imaging brain revealed abnormalities in three patients as hyper-intensities in subcortical white matter.

Conclusion: Morphoea in children can be associated with varied immunological, osteoarticular, and neurological abnormalities. This study highlights the multi-system involvement in morphoea and the need for larger data and well-designed therapeutic trials for generating evidence-based treatment of this potentially disfiguring disease.