Indian Journal of Dermatology最新文献

Background: Plantar wart is a common viral infection occurring in the plantar aspect of the foot, caused by human papillomavirus (HPV). Intra-lesional immunotherapy has emerged as a front-runner treatment option for plantar warts.

Objectives: This study aimed to compare the efficacy and tolerability of intra-lesional injections of acyclovir versus candida antigen in patients with plantar warts.

Methods: This randomised-controlled clinical trial was conducted on 40 patients with plantar warts. The included patients were randomly assigned into two groups: Group 1 (n = 20) was treated with intra-lesional injections of acyclovir. Group 2 (n = 20) was treated by intra-lesional injections of candida antigen. Injections were every 2 weeks for 5 sessions. All the patients were evaluated before and after treatment through clinical, photographic, and dermoscopic assessments. All side effects (local and systemic), during or after injections were recorded.

Results: In acyclovir intra-lesional injected warts, a score of 3 (complete clearance clinically, and dermoscopically) was achieved in 65% of target warts, 15% had a score of 2 (patients' dermoscopy confirmed the persistence of warts despite the fact that the warts had disappeared clinically), 20% had a score of 1 (warts were smaller and thinner but not completely gone upon clinical or dermoscopic examination). In candida intra-lesional injected warts, a score of 3 was achieved in 70% of target warts and 25% had a score of 1.

Conclusion: Both intra-lesional acyclovir and candida antigen appear to be effective and tolerated treatment modalities for plantar warts. Although there were similar reports of side effects for both treatments, the success rate of curing warts using intra-lesional candida antigen was slightly greater.

Vitiligo is an acquired cutaneous disorder that affects about 0.5%-2% of the global population. It is characterised by depigmented macules due to the loss of melanocytes. This condition may significantly affect the psychosocial and emotional well-being of patients, cause diminished self-esteem, and lead to social ostracization. Traditional therapeutic options include topical treatments like corticosteroids and calcineurin inhibitors, as well as topical or systemic phototherapy. Systemic immunomodulators target immune and inflammatory pathways to halt depigmentation and bring about repigmentation. Recent insights into the pathogenesis of vitiligo indicate an interplay of genetic, autoimmune, and environmental factors, with oxidative stress and genetic predisposition playing a part as well. Novel treatment modalities targeting multiple molecular targets, such as the JAK-STAT pathway, melanocortin-1 receptor, and different immune checkpoints, aim to combat autoimmunity and enhance melanocyte function. These emerging therapies offer encouraging results, although literature on them is limited and efficacy varies among patients. The continuous advancement in treatment strategies, along with advances in genetic and pathophysiological research, underscores a dynamic and hopeful course for vitiligo management, which in turn can improve the quality of life of affected individuals.

Atopic dermatitis (AD) is a chronic inflammatory skin condition that affects individuals of all ages. While probiotics have been widely studied as a treatment option in children with AD, evidence regarding their efficacy in adults remains limited. To address this gap, we conducted a meta-analysis to evaluate the impact of probiotic supplementation on AD in adult populations. Seven randomized controlled trials (RCTs) were included in the analysis. Compared to placebo, probiotic treatment significantly reduced SCORAD (Scoring Atopic Dermatitis) values (weighted mean difference [WMD], -4.52; 95% confidence interval [CI], -6.89 to -2.15; P < 0.001; I² = 61.6%). Subgroup analyses indicated that both single-strain and mixed-strain probiotics demonstrated similar trends in SCORAD improvement, although mixed strains did not reach statistical significance. While overall cytokine levels showed no significant change after treatment, notable reductions in interleukin-4 (IL-4) and thymus- and activation-regulated chemokine (TARC) levels were observed (interleukin [IL]-4: WMD, -2.35; 95% CI, -3.23 to -1.47; TARC: WMD, -1.10; 95% CI, -1.49 to -0.71; both P < 0.001). These findings suggest that probiotics may offer clinical benefits for adults with AD, potentially by modulating inflammatory responses through the downregulation of IL-4 and TARC.

Background: A dermatoscope is a non-invasive diagnostic imaging tool that enables to visualise superficial, deeper structures, pigmentary and vascular patterns of skin, nails, hair and mucosa. Oral mucosal lesions are abnormal alterations in colour, surface, presence of swelling, or loss of integrity of mucosal and semimucosal surface. The use of dermoscopy in the characterisation of mucosal disorder is a grey area and needs further exploration.

Aim: To describe clinical and mucoscopic features and correlate histopathologically in oral mucosal diseases.

Method: Single-centre, cross-sectional, observational study presenting to inpatient and outpatient departments of dermatology, and otorhinolaryngology. Patients fulfilling inclusion criteria were dermoscopically evaluated using DermLite DL4, 30 mm lens system and 10× magnification and documented in a prestructured proforma. Then, a mucosal biopsy was taken from the visualized site.

Results: Fordyce spots were observed as white-yellow clods with dots. Median rhomboid glossitis as atrophic filiform papillae at the centre with normal-looking peripheral papillae. Pemphigus vulgaris visualized as a red structureless area, red dots, with violaceous streaks at the periphery. Lichen planus showed a tricolor pattern, Wickham's striae, blunted tips of lingual papillae, discoid lupus erythematosus showed superficial erosions, yellow-white scale, brown pigment spots at the periphery with telangiectasia and follicular plugs at the vermilion border. Aphthous stomatitis characterised by three zones with a central yellowish-white structureless area, a surrounding white area, and a peripheral red structureless area. Actinic cheilitis showed superficial ulceration, polymorphic vessels and white scales. Warts have hyperkeratotic pointed tips with fused bases, with central thrombosed capillaries. Molluscum contagiosum showed a central pore-like structure with crown vessels. Vitiligo showed a white structureless area, a diffuse white glow with a scalloped margin. Premalignant conditions such as oral submucosal fibrosis and leukoplakia showed atrophic lingual papillae, chrysalis white structureless area, with telangiectasia and white to pink structureless area, surface corrugation, white clods and dotted vessels. Limitations in our study were a response to therapy could not be assessed and the relation with the disease activity could not be determined. Difficult-to-reach sites such as the palate, and retromolar area were not assessed. Haziness while capturing pictures due to mist formation hindered the quality of images. Not many premalignant and malignant diseases were recruited to provide the mucoscopy features in predicting the risk of conversion.

Conclusion: Mucoscopy helps in delineating various mucosal diseases with subtle features.

Background: Wound complications associated with pilonidal sinus (PS) significantly contribute to its high post-operative morbidity. Therefore, speeding up the wound healing process after surgery can help minimize potential complications. This study investigated the effectiveness of Lawsonia inermis extract (LIE) in promoting wound healing following PS surgery, given its known benefits in this area.

Methods: This randomized, double-blind, controlled clinical trial involved 60 patients with open post-operative PS wounds. Participants were randomly divided into three groups: the first group received LIE ointment treatment, the second group used phenytoin as a standard occlusive dressing method and the third group used eucerin ointment as a negative control. In all groups, the wound was cleansed with normal saline and dressed with wet gauze daily. A physician measured the length, depth and volume of the wounds on days 7, 14 and 28 post-PS surgery.

Results: After two weeks, the LIE topical ointment significantly decreased the length and depth of the wound compared to phenytoin and eucerin ointments. Additionally, the wound volume in the LIE-treated group was substantially lower than in the other groups (P < 0.05).

Conclusion: The study highlighted the wound-healing properties of henna extract. The results indicate that LIE ointment can enhance the wound healing process, thereby lowering the risk of infection and complications in post-operative wounds.