Indian Journal of Dermatology最新文献

Background: Vulvovaginal candidiasis (VVC) is a prevalent form of vaginitis, and most patients show improvement when treated with antifungal medications. However, recurrence may affect a minority. It has been found through previous research that the concomitant utilisation of probiotics during acute VVC leads to early relief of symptoms and signs and offers a preventive measure against recurrences.

Objectives: This study aimed to assess the efficacy of the combination of oral probiotics with conventional antifungal treatment as compared to conventional antifungal treatment alone.

Methods: Sixty patients who were newly diagnosed with VVC were enrolled in a randomised controlled trial. They were divided into two groups. Group A included 30 cases treated with conventional antifungal medication (oral fluconazole 150 mg single dose), while Group B included 30 cases treated with conventional antifungal medication (oral fluconazole 150 mg single dose) alongside oral probiotic capsules (Lactobacillus rhamnosus, L. crispatus, L. gasseri, L. jensenii) for 2 months. The clinical and mycological findings were recorded before and after treatment. The relapse rate and side effects were recorded during the period of our study.

Results: No significant difference between the clinical cure rate, mycological cure, and relapse rate was seen between the two groups. (P < 0.05). However, a larger proportion of patients in Group B (97%) achieved complete remission compared to Group A (90%). No side effects were noted in either of the groups.

Conclusion: Based on the findings, it can be concluded that the addition of probiotics to conventional antifungal treatment led to better rates of clinical and mycological cure and a lower likelihood of relapse compared to conventional antifungal treatment alone.

Skin colour usually depends upon melanin, haemoglobin, and carotenoids. Pigmentary disorders indicate an increased amount of melanin, leading to a darker colour of the skin, called hypermelanosis. Addison's disease is a rare endocrinal disorder with severe oral and systemic manifestations. Any form of diffuse skin hyper-pigmentation which is more pronounced on sun-exposed areas mimics Addison's disease and is called Addisonian pigmentation. Pigmentation often precedes other manifestations by months to years and hence can lead to early diagnosis and can prevent life-threatening adrenal crisis. The most common cause of adrenal insufficiency in developing countries is tuberculosis. A similar pattern of pigmentation has been reported in Cushing's syndrome, ectopic ACTH-producing tumours, vitamin B12 deficiency, and thyrotoxicosis. Addisonian pigmentation can be a manifestation of multiple systemic diseases; hence, an inter-disciplinary approach is needed with extensive clinical and laboratory evaluation. It is not merely a cosmetic concern. Not much data are available in the literature regarding this entity. This brief review serves as an important source for clinicians to stay up-to-date regarding the history, clinical presentation, differential diagnosis, and management of this entity.

Background: Female genital dermatoses (FGD) or vulvar dermatoses are a group of disorders that affect the vulva and contiguous parts. Most of the FGDs can be chronic or recurrent. Effects on Quality of life (QoL) in patients having dermatological conditions are well studied but this is not the case in vulvar dermatoses.

Aims: We aimed to study the etiology of genital dermatoses in females attending the Dermatology Out Patient Department (OPD) and to assess QoL in females with chronic FGD (>6 weeks duration).

Settings and design: This was an observational study on female patients with vulvar complaints presenting to dermatology OPD. Both venereal and nonvenereal dermatoses were enrolled. QoL was assessed in females with chronic FGD using a self-administered Dermatological Life Quality Index (DLQI) questionnaire.

Statistical analysis: Sample size was calculated using the formula Categorical variables were presented as numbers and percentages (%) and continuous variables were presented as mean ± standard deviation (SD) and median. The normality of the data was tested by the Kolmogorov-Smirnov test or non-parametric test. A t-test was used for the estimation of the mean.

Results: Ninety-seven patients were included in our study; Vulvovaginal candidiasis was the most common dermatoses (22.6%); Lichen simplex chronicus (11.3%) the commonest non-venereal dermatoses. 57 (58.7%) had chronic FGD, among whom 43 (75.4%) had significant QoL impairment.

Conclusions: Infectious etiologies predominated. There was significant impairment in QoL in females with chronic FGD.

Dengue fever, a viral disease transmitted by Aedes mosquitoes, is a global health problem affecting millions of people each year. It is prevalent in tropical and subtropical areas, with epidemic potential due to climate change and increased travel. The disease commonly presents with cutaneous symptoms such as erythema, maculopapular rash and minor haemorrhagic lesions. This case is notable for the unusual presentation of haemorrhagic bullae, resembling drug eruption or autoimmune bullous disease. In the field of dermatology, tropical diseases like dengue have rarely been discussed. However, the recent increase in cases in Southeast Asia highlights the need for dermatologists to become familiar with dengue, as it often presents with diverse skin rashes. Herein, we report an unusual case of dengue fever presenting with haemorrhagic bullae.

Background: Ingrown toenail is a nail disorder that commonly affects great toenails. Surgical modalities are commonly used as first-line treatment. A conservative approach is preferable as surgical procedures lead to pain and affect routine activities. Our aim is to study the efficacy of a new conservative technique using steri-strip^TM for the treatment of mild to moderate ingrown toenails as an outpatient procedure.

Methods: Fifty patients presenting with stage 1-2 ingrown toenails were treated with the 'steri-strip sling technique'. Steri-strip^TM is inserted between the disto-lateral edge of the nail plate and nail fold and secured with an elastic bandage. The dressing is kept till the nail edge grows over the nail fold and stops penetrating the skin. Patients were reviewed every week for a month after the treatment and monthly thereafter. The final result was assessed at 6 months. The success of treatment was assessed clinically and by patient satisfaction levels.

Results: Fifty patients were treated and followed up. Immediately after the procedure, all patients reported significant relief in pain. After 6 months, 46 out of 50 patients were satisfied with the treatment and showed no recurrence. No complications were reported.

Conclusion: The 'Steri-strip^TM sling technique' is a simple and effective outpatient procedure for the management of mild to moderate ingrown toenails.

Background: Androgenetic Alopecia (AGA) refers to the appearance of common non-scarring progressive loss of terminal hair. Trichoscopy shows a magnified view of the hair shafts and hair follicle openings and helps us to diagnose, prognosticate and determine the disease severity.

Aims: The aim of the study was to identify the trichoscopic findings in patients with androgenetic alopecia and associate these findings with disease severity.

Methods: This was a cross-sectional analytical study of both male and female patients with AGA. The Hamilton Norwood staging was used in males and Ludwig's staging was used in females. The NC 2 Heine Dermoscope was used to assess the scalp and a 64 MP rear camera was used for the photographic assessment. A Chi-square test was performed to find out the association between the stage of alopecia and trichoscopic findings.

Results: A total of 63 patients were assessed in this study. Trichoscopic examination showed Hair Shaft Heterogeneity (HSTH) in all patients of AGA. Scalp honeycomb pigmentation and brown peripilar signs were seen in more than half of the patients. The white peripilar sign was associated with advanced stages in both male and female patients, (P = 0.015) and (P = 0.038) respectively. Focal atrichia was also associated with advanced stages in both male and female patients, (P = 0.001) and (P = 0.05) respectively.

Conclusion: HSTH was the characteristic trichoscopic feature of AGA. White peripilar sign and focal atrichia correlated with the severity of the disease. Trichoscopy-based assessment can be used to individualise the treatment options and counsel the patients regarding prognosis.

Background: Vitiligo, affecting 0.25% in India (>1% in Jharkhand), stigmatises and devastates self-esteem/relationships causing depression. Apart from medical treatment, surgical procedures like applying 5-fluorouracil after microneedling are to be confirmed in unstudied populations and across time periods. An interventional study was conducted among out-patients of a tertiary hospital in a high-prevalence population wherein earlier attempts were not conducted.

Aims/objectives: To assess the effect of microneedling and applying 5% 5-fluorouracil on stable vitiligo patches.

Methods and materials: Microneedling and topical application of 5-fluorouracil was planned on 30 subjects of 10-50 age-groups with stable vitiligo, from September 2019 to September 2021 every 15 days for 12 visits. Age, gender, site, size/stability of vitiligo patches, leukotrichia and vitiligo family history were studied. Repigmentation (overall and variable-wise) was measured at each visit using 76-100% (excellent), 51-75% (very good), 25 to 50% (good) and <25% (poor). Data was analysed with the Chi-square test or Standard Error of Difference between two proportions.

Results: Under COVID restrictions (2020-2021), sample coverage was 77% (23/30) comprising 13 females and 10 males. Visits varied for each subject totalling 185 visits out of an expected 276 (67%). Significantly, 3 (13%) achieved excellent repigmentation, 10 (43%) very good, 8 (35%) good and only 2 (9%) poor repigmentation. Cumulatively, 13 (56%) attained excellent/very good repigmentation and 21 (91%) had excellent/very good/good repigmentation. Repigmentation ranged from 10% to 100% among 23 subjects, averaging 54% in average 8 visits (4 months). Repigmentation was equally achieved irrespective of age, gender, site, size and stability of the vitiliginous patch, presence/absence of leukotrichia and family history of vitiligo. Manageable pain (100%), itching (4%) and hyperpigmentation 43%, were side effects.

Conclusion: Cumulative 91% (excellent/very good/good) repigmentation despite COVID-19 in the study period, and its comparability with other studies, strengthens evidence that microneedling and 5% 5-fluorouracil is effective in treating stable vitiligo in a high prevalence population.