A shift in the understanding of acne from a skin disease to a systemic, chronic inflammatory, lifestyle disease has fueled our curiosity about holistic ways to manage it. As with other noncommunicable diseases, long-term management needs a comprehensive approach. Apart from topical and systemic medications, changes in diet and lifestyle can help us achieve superior and long-lasting results. Moreover, as the biochemical pathways linking risk factors to acne are getting clearer, the potential prospect of early holistic management of acne preventing or delaying other lifestyle disorders such as obesity, diabetes, or cardiovascular disease is encouraging.
{"title":"Holistic approach to management of acne: Exploring the evidence","authors":"Sujata R Mehta Ambalal","doi":"10.4103/cdr.cdr_56_21","DOIUrl":"https://doi.org/10.4103/cdr.cdr_56_21","url":null,"abstract":"A shift in the understanding of acne from a skin disease to a systemic, chronic inflammatory, lifestyle disease has fueled our curiosity about holistic ways to manage it. As with other noncommunicable diseases, long-term management needs a comprehensive approach. Apart from topical and systemic medications, changes in diet and lifestyle can help us achieve superior and long-lasting results. Moreover, as the biochemical pathways linking risk factors to acne are getting clearer, the potential prospect of early holistic management of acne preventing or delaying other lifestyle disorders such as obesity, diabetes, or cardiovascular disease is encouraging.","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45273803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Patil, A. Bubna, Maharaja Krishnamoorthy, L. Joseph
Background: Polymorphous light eruption (PLE) is the most common idiopathic photodermatoses, with a wide range of clinical presentations that tends to mimic a number of dermatoses. Objective: The aim was to study the clinicopathological profile in patients diagnosed with PLE. Materials and Methods: This was a cross-sectional, descriptive study of seventy clinically diagnosed cases of PLE over a period of 1 year, wherein following patient enrolment, they underwent a thorough clinical evaluation, followed by a skin biopsy that was studied categorically. Results: A male preponderance (62.8%) was observed. Majority of patients were in the 21-30 years' age group (28.6%). Pruritus was witnessed in 98.5% of patients. The most common morphological type encountered was plaque PLE (35.7%), followed by lichen nitidus type (11.4%). Commonest site of involvement was sides and back of neck (75.7%), followed by dorsolateral aspect of both arms (31.4%). Hyperkeratosis was identified in 82.8%, spongiosis in 87.1%, liquefactive degeneration of basal cell layer in 82.8%, atrophy in 24.2%, and moderate-to-severe lymphocytic dermal infiltrates in 90% of our cohorts. Conclusion: PLE is a disorder with diverse clinical presentations, manifesting usually in the third decade of life that closely mimics a variety of other cutaneous disorders. Histological examination with certain specific criteria enables the clinician to arrive at a concrete conclusion in those cases where clinical findings alone pose diagnostic difficulties.
{"title":"A clinicopathological study of polymorphous light eruption","authors":"N. Patil, A. Bubna, Maharaja Krishnamoorthy, L. Joseph","doi":"10.4103/cdr.cdr_110_21","DOIUrl":"https://doi.org/10.4103/cdr.cdr_110_21","url":null,"abstract":"Background: Polymorphous light eruption (PLE) is the most common idiopathic photodermatoses, with a wide range of clinical presentations that tends to mimic a number of dermatoses. Objective: The aim was to study the clinicopathological profile in patients diagnosed with PLE. Materials and Methods: This was a cross-sectional, descriptive study of seventy clinically diagnosed cases of PLE over a period of 1 year, wherein following patient enrolment, they underwent a thorough clinical evaluation, followed by a skin biopsy that was studied categorically. Results: A male preponderance (62.8%) was observed. Majority of patients were in the 21-30 years' age group (28.6%). Pruritus was witnessed in 98.5% of patients. The most common morphological type encountered was plaque PLE (35.7%), followed by lichen nitidus type (11.4%). Commonest site of involvement was sides and back of neck (75.7%), followed by dorsolateral aspect of both arms (31.4%). Hyperkeratosis was identified in 82.8%, spongiosis in 87.1%, liquefactive degeneration of basal cell layer in 82.8%, atrophy in 24.2%, and moderate-to-severe lymphocytic dermal infiltrates in 90% of our cohorts. Conclusion: PLE is a disorder with diverse clinical presentations, manifesting usually in the third decade of life that closely mimics a variety of other cutaneous disorders. Histological examination with certain specific criteria enables the clinician to arrive at a concrete conclusion in those cases where clinical findings alone pose diagnostic difficulties.","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47507864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ramachandran Gnanasuriyan, Satyadarshi Patnaik, S. Patro, I. Mohanty
Background: Recurrent dermatophytosis is a pressing problem worldwide due to inadequate treatment, drug resistance, and indiscriminate use of topical steroids. This scenario increases the need for the study of risk factors and antifungal susceptibility testing. There is a paucity of information on this subject. Objective: We aimed to find the clinico-mycological pattern of recurrent dermatophytic infections, the factors responsible for recurrence and determine the sensitivity pattern of isolates against four antifungals (fluconazole, itraconazole, terbinafine, and amphotericin B). Materials and Methods: Patients with recurrent dermatophytosis attending the outpatient Department of Our Tertiary Care Institute were enrolled in this study. A detailed history was taken; clinical examination was done; samples were collected for mycological examinations, and in-vitro antifungal sensitivity testing was done by broth microdilution method as per Clinical and Laboratory Standard Institute M38-A guidelines. Results: One hundred and twenty-eight patients were included in the study with a male:female ratio of 1.38:1. The most commonly affected age group was 31–40 years. Tinea corporis with tinea cruris was the most common type of clinical presentation. Potassium hydroxide mount was positive in 53 samples and culture was positive in 59 samples. Trichophyton rubrum was the predominant species isolated, followed by Trichophyton mentagrophytes. On in-vitro antifungal susceptibility testing, itraconazole and amphotericin B had the lowest minimum inhibitory concentrations (MIC), followed by terbinafine. Fluconazole had the highest MIC among the drugs tested. Conclusion: Topical corticosteroid abuse, lack of personal hygiene, and habit of sharing clothes were seen in many patients with recalcitrant dermatophytosis. T. rubrum was the most common isolated species. Antifungal susceptibility testing revealed itraconazole and amphotericin B to have the lowest MIC value and fluconazole to have the highest MIC value.
{"title":"Clinico-mycological profile of recurrent dermatophytosis with drug sensitivity in a tertiary care center in Southern Odisha","authors":"Ramachandran Gnanasuriyan, Satyadarshi Patnaik, S. Patro, I. Mohanty","doi":"10.4103/cdr.cdr_58_22","DOIUrl":"https://doi.org/10.4103/cdr.cdr_58_22","url":null,"abstract":"Background: Recurrent dermatophytosis is a pressing problem worldwide due to inadequate treatment, drug resistance, and indiscriminate use of topical steroids. This scenario increases the need for the study of risk factors and antifungal susceptibility testing. There is a paucity of information on this subject. Objective: We aimed to find the clinico-mycological pattern of recurrent dermatophytic infections, the factors responsible for recurrence and determine the sensitivity pattern of isolates against four antifungals (fluconazole, itraconazole, terbinafine, and amphotericin B). Materials and Methods: Patients with recurrent dermatophytosis attending the outpatient Department of Our Tertiary Care Institute were enrolled in this study. A detailed history was taken; clinical examination was done; samples were collected for mycological examinations, and in-vitro antifungal sensitivity testing was done by broth microdilution method as per Clinical and Laboratory Standard Institute M38-A guidelines. Results: One hundred and twenty-eight patients were included in the study with a male:female ratio of 1.38:1. The most commonly affected age group was 31–40 years. Tinea corporis with tinea cruris was the most common type of clinical presentation. Potassium hydroxide mount was positive in 53 samples and culture was positive in 59 samples. Trichophyton rubrum was the predominant species isolated, followed by Trichophyton mentagrophytes. On in-vitro antifungal susceptibility testing, itraconazole and amphotericin B had the lowest minimum inhibitory concentrations (MIC), followed by terbinafine. Fluconazole had the highest MIC among the drugs tested. Conclusion: Topical corticosteroid abuse, lack of personal hygiene, and habit of sharing clothes were seen in many patients with recalcitrant dermatophytosis. T. rubrum was the most common isolated species. Antifungal susceptibility testing revealed itraconazole and amphotericin B to have the lowest MIC value and fluconazole to have the highest MIC value.","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42999160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Patil, Vishalakshi Viswanath, P. R. Joshi, M. Dhakne
Background: The COVID-19 pandemic and subsequent nationwide lockdowns have contributed to complex problems in the management of chronic dermatological diseases. Objectives: The objective of this study is to evaluate the impact of the COVID-19 pandemic on the management of chronic dermatological diseases treated with/without systemic immunomodulators and phototherapy. Materials and Methods: A single-center, cross-sectional, questionnaire-based survey via telephone calls/Google Forms was conducted from May 2020 to July 2020. Multivariate correlation analysis with adherence to treatment as dependent variable was performed to study the influence of various demographic variables, treatment-related factors, and pandemic issues. Results: Data of 138 patients (55% with psoriasis, 21% with vesiculobullous diseases, 18.2% with connective tissue diseases, and 5.8% with conditions such as alopecia areata, vitiligo, lichen planus, and reactive arthritis) were analyzed. The study population consisted of 81.1% of patients on systemic immunomodulators. Autonomous treatment modification was reported by 77% leading to poor disease control in 53.7%. There was a statistically significant negative correlation between income loss during the pandemic and treatment adherence. Duration of illness also showed a significant negative correlation, thereby indicating that treatment adherence reduced with disease chronicity. The highest nonadherence was noted with apremilast. None of the patients reported confirmed COVID infection. Conclusions: The study findings emphasize the direct and indirect effects of the COVID-19 pandemic on treatment adherence in chronic dermatological diseases. It underlines the need for better pandemic response by the development of patient education programs, standard protocols, and functional teledermatology units in Indian public health-care settings.
{"title":"A cross-sectional survey to evaluate the influence of the COVID-19 pandemic on treatment adherence in chronic dermatological diseases","authors":"P. Patil, Vishalakshi Viswanath, P. R. Joshi, M. Dhakne","doi":"10.4103/cdr.cdr_32_21","DOIUrl":"https://doi.org/10.4103/cdr.cdr_32_21","url":null,"abstract":"Background: The COVID-19 pandemic and subsequent nationwide lockdowns have contributed to complex problems in the management of chronic dermatological diseases. Objectives: The objective of this study is to evaluate the impact of the COVID-19 pandemic on the management of chronic dermatological diseases treated with/without systemic immunomodulators and phototherapy. Materials and Methods: A single-center, cross-sectional, questionnaire-based survey via telephone calls/Google Forms was conducted from May 2020 to July 2020. Multivariate correlation analysis with adherence to treatment as dependent variable was performed to study the influence of various demographic variables, treatment-related factors, and pandemic issues. Results: Data of 138 patients (55% with psoriasis, 21% with vesiculobullous diseases, 18.2% with connective tissue diseases, and 5.8% with conditions such as alopecia areata, vitiligo, lichen planus, and reactive arthritis) were analyzed. The study population consisted of 81.1% of patients on systemic immunomodulators. Autonomous treatment modification was reported by 77% leading to poor disease control in 53.7%. There was a statistically significant negative correlation between income loss during the pandemic and treatment adherence. Duration of illness also showed a significant negative correlation, thereby indicating that treatment adherence reduced with disease chronicity. The highest nonadherence was noted with apremilast. None of the patients reported confirmed COVID infection. Conclusions: The study findings emphasize the direct and indirect effects of the COVID-19 pandemic on treatment adherence in chronic dermatological diseases. It underlines the need for better pandemic response by the development of patient education programs, standard protocols, and functional teledermatology units in Indian public health-care settings.","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47872140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Budamakuntla, E. Loganathan, Heera Ramesh, Priyanka Karagaiah, S. Somashekhar, Shankar Kumar Venkatarayaraju
Background: Psychological stress can exacerbate many inflammatory diseases like psoriasis by dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis. One method of establishing this correlation is by measuring cortisol levels. Deposition of cortisol in the hair during its growth allows for retrospective quantification and to analyze the relationship between hair cortisol levels, stress, and psoriasis. Objective: The objective of this study is to evaluate hair cortisol levels as a biomarker of chronic stress in psoriasis patients. Materials and Methods: Detailed clinical and personal history and stress-related events before the onset of the disease or any exacerbations during the disease were taken. Clinical severity was assessed using psoriasis area and severity index (PASI) scoring. Stress levels in individuals, during the previous 6 months were assessed, using Holmes–Rahe Life Stress Inventory. Following this, hair samples were collected from the vertex of the scalp and sent to the laboratory in an envelope. After extraction of the cortisol, their levels were estimated using an enzyme-linked immunosorbent assay. Statistical analyses were done. Results: Mean hair cortisol level per mg of hair sample was 0.92 ± 0.84 ng/mg compared to 0.50 ± 0.60 ng/mg in controls (P = 0.002). There was a significant positive correlation of hair cortisol levels with the duration of disease, PASI score, and stress level. Conclusion: Measurement of cortisol in hair is a novel, noninvasive method that may assess systemic cortisol levels over several weeks to months. It may potentially be used as a biomarker in psychocutaneous disorders like psoriasis.
{"title":"Estimation of hair cortisol levels as a biomarker of chronic stress in psoriasis: A pilot study","authors":"L. Budamakuntla, E. Loganathan, Heera Ramesh, Priyanka Karagaiah, S. Somashekhar, Shankar Kumar Venkatarayaraju","doi":"10.4103/cdr.cdr_27_22","DOIUrl":"https://doi.org/10.4103/cdr.cdr_27_22","url":null,"abstract":"Background: Psychological stress can exacerbate many inflammatory diseases like psoriasis by dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis. One method of establishing this correlation is by measuring cortisol levels. Deposition of cortisol in the hair during its growth allows for retrospective quantification and to analyze the relationship between hair cortisol levels, stress, and psoriasis. Objective: The objective of this study is to evaluate hair cortisol levels as a biomarker of chronic stress in psoriasis patients. Materials and Methods: Detailed clinical and personal history and stress-related events before the onset of the disease or any exacerbations during the disease were taken. Clinical severity was assessed using psoriasis area and severity index (PASI) scoring. Stress levels in individuals, during the previous 6 months were assessed, using Holmes–Rahe Life Stress Inventory. Following this, hair samples were collected from the vertex of the scalp and sent to the laboratory in an envelope. After extraction of the cortisol, their levels were estimated using an enzyme-linked immunosorbent assay. Statistical analyses were done. Results: Mean hair cortisol level per mg of hair sample was 0.92 ± 0.84 ng/mg compared to 0.50 ± 0.60 ng/mg in controls (P = 0.002). There was a significant positive correlation of hair cortisol levels with the duration of disease, PASI score, and stress level. Conclusion: Measurement of cortisol in hair is a novel, noninvasive method that may assess systemic cortisol levels over several weeks to months. It may potentially be used as a biomarker in psychocutaneous disorders like psoriasis.","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47517913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Chronic renal failure patients undergoing dialysis suffer from various side effects and complications where skin ailments are one of them. Skin is the largest and one of the most dynamic organs of the body and can be used as a window since it is easily accessible for observation and reflects changes seen in multiple organs including kidneys. Objective: The objective of this study is to describe various cutaneous manifestations in chronic kidney disease patients undergoing hemodialysis. Materials and Methods: A hospital-based, cross-sectional, observational study was conducted in the department of dermatology, venereology, and leprosy at a tertiary care center from November 2019 to May 2021. The demographic details and clinical manifestations were recorded. Data were recorded as numbers and percentages. For categorical data, the number and percentage were used in the data summaries, and data were analyzed by the Mann‒Whitney U test for the comparison of two data. Results: A total of 94 patients were included in the study. The most common manifestation observed was pruritus (85.1%), followed by xerosis (84%). Other findings seen in the study were mainly nonspecific changes such as pallor (59.57%), diffuse hyperpigmentation (3.2%), and ecchymosis (16%). Nail changes (56.38%) observed were half-and-half nails (22.6%), onycholysis (11%), and Beau's lines (9%). Mucosal changes (36.17%) included depapillated tongue (12.8%) and macroglossia (8.5%). Other findings such as skin infections and keloid were also noted. New finding such as angina bullosa hemorrhagica was seen in one patient. Specific change like Kyrle's disease was seen in 6.4% of the study group and 50% of these patients had concomitant diabetes mellitus. Conclusion: Patients on hemodialysis present with an array of cutaneous manifestations. The most common include pruritus and xerosis. Prompt diagnosis and early treatment help alleviate many of the cutaneous manifestations posed due to hemodialysis.
{"title":"A cross-sectional study of dermatologic manifestations in patients with chronic renal failure on hemodialysis","authors":"Indira Potthuri, Inamadar C. Arun","doi":"10.4103/cdr.cdr_37_22","DOIUrl":"https://doi.org/10.4103/cdr.cdr_37_22","url":null,"abstract":"Background: Chronic renal failure patients undergoing dialysis suffer from various side effects and complications where skin ailments are one of them. Skin is the largest and one of the most dynamic organs of the body and can be used as a window since it is easily accessible for observation and reflects changes seen in multiple organs including kidneys. Objective: The objective of this study is to describe various cutaneous manifestations in chronic kidney disease patients undergoing hemodialysis. Materials and Methods: A hospital-based, cross-sectional, observational study was conducted in the department of dermatology, venereology, and leprosy at a tertiary care center from November 2019 to May 2021. The demographic details and clinical manifestations were recorded. Data were recorded as numbers and percentages. For categorical data, the number and percentage were used in the data summaries, and data were analyzed by the Mann‒Whitney U test for the comparison of two data. Results: A total of 94 patients were included in the study. The most common manifestation observed was pruritus (85.1%), followed by xerosis (84%). Other findings seen in the study were mainly nonspecific changes such as pallor (59.57%), diffuse hyperpigmentation (3.2%), and ecchymosis (16%). Nail changes (56.38%) observed were half-and-half nails (22.6%), onycholysis (11%), and Beau's lines (9%). Mucosal changes (36.17%) included depapillated tongue (12.8%) and macroglossia (8.5%). Other findings such as skin infections and keloid were also noted. New finding such as angina bullosa hemorrhagica was seen in one patient. Specific change like Kyrle's disease was seen in 6.4% of the study group and 50% of these patients had concomitant diabetes mellitus. Conclusion: Patients on hemodialysis present with an array of cutaneous manifestations. The most common include pruritus and xerosis. Prompt diagnosis and early treatment help alleviate many of the cutaneous manifestations posed due to hemodialysis.","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44131380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Alopecia areata (AA) is an autoimmune disease affecting the scalp and body, resulting in hair loss. The fundamental goal of management is to keep the pathology under control. Intralesional corticosteroids suppress T-cell-mediated attacks on hair follicles. Platelet-rich plasma (PRP) contains growth factors that stimulate hair follicle stem cells and have anti-inflammatory properties with fewer side effects. Trichoscopy shows exclamation hair and black dots in the acute stage, yellow dots in long-standing cases, and short vellus hair in regrowing patches. Objective: The aim of this study was to evaluate and compare the efficacy of intralesional triamcinolone acetonide with autologous PRP in the treatment of two different scalp AA patches in the same individual. Materials and Methods: This was a hospital-based prospective follow-up study. Patients with two different patches of alopecia were selected. One was treated with intralesional triamcinolone acetonide (10 mg/ml) and the other with PRP given at 3-week intervals for four treatment sessions. Comparison of results was based on MacDonald Hull and Norris grading system and trichoscopy. Results: Out of 32 patients, 8 (25%) in triamcinolone-treated patches and 3 (9.4%) in PRP-treated patches showed complete hair regrowth at 12 weeks. Furthermore, a faster response was seen with triamcinolone. On trichoscopy, both patches showed an increase in short vellus and terminal hair and a reduction in yellow dots and exclamation hair. No changes in black dots were seen. Conclusion: Intralesional triamcinolone acetonide is more effective than PRP in the treatment of AA of the scalp and is safe. Trichoscopic findings indicate response to treatment and reduction of disease activity.
{"title":"Comparison of clinical efficacy and trichoscopic changes in alopecia areata of the scalp following treatment with intralesional triamcinolone acetonide and autologous platelet-rich plasma","authors":"Warood Albadri, A. Inamadar","doi":"10.4103/cdr.cdr_14_22","DOIUrl":"https://doi.org/10.4103/cdr.cdr_14_22","url":null,"abstract":"Background: Alopecia areata (AA) is an autoimmune disease affecting the scalp and body, resulting in hair loss. The fundamental goal of management is to keep the pathology under control. Intralesional corticosteroids suppress T-cell-mediated attacks on hair follicles. Platelet-rich plasma (PRP) contains growth factors that stimulate hair follicle stem cells and have anti-inflammatory properties with fewer side effects. Trichoscopy shows exclamation hair and black dots in the acute stage, yellow dots in long-standing cases, and short vellus hair in regrowing patches. Objective: The aim of this study was to evaluate and compare the efficacy of intralesional triamcinolone acetonide with autologous PRP in the treatment of two different scalp AA patches in the same individual. Materials and Methods: This was a hospital-based prospective follow-up study. Patients with two different patches of alopecia were selected. One was treated with intralesional triamcinolone acetonide (10 mg/ml) and the other with PRP given at 3-week intervals for four treatment sessions. Comparison of results was based on MacDonald Hull and Norris grading system and trichoscopy. Results: Out of 32 patients, 8 (25%) in triamcinolone-treated patches and 3 (9.4%) in PRP-treated patches showed complete hair regrowth at 12 weeks. Furthermore, a faster response was seen with triamcinolone. On trichoscopy, both patches showed an increase in short vellus and terminal hair and a reduction in yellow dots and exclamation hair. No changes in black dots were seen. Conclusion: Intralesional triamcinolone acetonide is more effective than PRP in the treatment of AA of the scalp and is safe. Trichoscopic findings indicate response to treatment and reduction of disease activity.","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49561335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nemmar Chandra shekarabhatta Sahana, Shilpa Kanathur, A. Shanmukhappa, T. Revathi
Immunoglobulin (Ig) G4-related disease is a recently described fibro-inflammatory disease with diverse clinical manifestations but consistent and characteristic histopathological features across multiple organ systems and skin, leading to tissue sclerosis and ultimately organ failure if not treated adequately. Here, we report a case of 56-year-old male patient presenting with urticarial lesions and generalized itching for 4 months. Routine investigations showed elevated 24-h urine protein, absolute eosinophil count, serum IgE, reversed albumin: globulin ratio, and “M” spike on serum electrophoresis. Renal biopsy showed storiform fibrosis, diffuse dense inflammatory cells (plasma cells and eosinophils), and IgG4-positive cells on immunohistochemistry which was histologically highly suggestive of IgG4-related chronic tubulointerstitial nephritis. Quick response was seen with oral corticosteroids.
{"title":"Urticaria with immunoglobulin G4-related disease: An association or coincidence?","authors":"Nemmar Chandra shekarabhatta Sahana, Shilpa Kanathur, A. Shanmukhappa, T. Revathi","doi":"10.4103/cdr.cdr_90_21","DOIUrl":"https://doi.org/10.4103/cdr.cdr_90_21","url":null,"abstract":"Immunoglobulin (Ig) G4-related disease is a recently described fibro-inflammatory disease with diverse clinical manifestations but consistent and characteristic histopathological features across multiple organ systems and skin, leading to tissue sclerosis and ultimately organ failure if not treated adequately. Here, we report a case of 56-year-old male patient presenting with urticarial lesions and generalized itching for 4 months. Routine investigations showed elevated 24-h urine protein, absolute eosinophil count, serum IgE, reversed albumin: globulin ratio, and “M” spike on serum electrophoresis. Renal biopsy showed storiform fibrosis, diffuse dense inflammatory cells (plasma cells and eosinophils), and IgG4-positive cells on immunohistochemistry which was histologically highly suggestive of IgG4-related chronic tubulointerstitial nephritis. Quick response was seen with oral corticosteroids.","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41594237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The main of this article is to study the interactions of certain commonly used drugs with pomelo juice which is commonly consumed as easily available fruit or fruit juice in certain parts of India. Relevant literature was identified by searching PubMed and other articles on the web. Various search words which were used are “Grapefruit,” “pomelo,” “drug interactions,” and “juice-drug interactions.” Inclusion criteria included grapefruit juice–drug interaction studies and pomelo juice–drug interactions. Exclusion criteria were articles actually irrelevant to the juice–drug interaction topics. After reviewing the summary of each article, few articles were directly excluded because of actually irrelevant topics. Finally, eight articles were selected as reference articles and certain data were obtained and our opinion about the same is mentioned in the present article. The full text of each included article was critically reviewed, and valuable information was summarized by data interpretation. Pomelo “(Citrus maxima/Citrus grandis)” is the largest citrus fruit from the family Rutaceae and the principal ancestor of the grapefruit. It is a natural, nonhybrid citrus fruit native to Southeast Asia. Pomelo is commonly consumed and used for festive occasions throughout Southeast Asia. It has also been found to have drug interactions similar to grapefruit. The fruit is large, 15–25 cm in diameter, and weighing 1–2 kg. It has a thicker rind than the grapefruit and is divided into 11–18 segments. Pomelo is closely related to grapefruit and extensively studied and contains furanocoumarins which have been identified as inhibitors of cytochrome P450 3A4 in grapefruit juice in vitro. The fruit was first described in 1750 by Griffith Hughes, and in 1789, Patrick Browne referred to it as “forbidden fruit” or “smaller shaddock.” Its taste also varies from sour or bitter to sweet. The fruit is nearly round or slightly pear shaped in clusters similar to grapes, 10–15 cm wide with smooth, finely dotted peel, up to 1 cm thick. The pulp is yellow or pink to red, which has 11–14 segments with thin membrane. The fruit is very juicy. The fruit presents with pointed seeds about 1.25 cm in length. In Karnataka, a type of pomelo named Devanahalli pomelo (Gi registered) is exclusively grown in the region around Devanahalli taluk, Bangalore, as an exotic crop variety. It is locally known as chakkota. Besides, pomelo has many names such as batabi lebu or jambura in Bengali and chakotra in Hindi-speaking states. In the present pandemic outbreak, in-home consumption of packaged fruit juices has increased among people in the cities, whereas in-home consumption of easily grown and easily available fruits such as pomelo, grapes, apples, and their juices has increased among people in the villages. Hence, caution is required while consuming pomelo juice (similar to grapefruit juice) with certain drugs.
{"title":"Pomelo juice–Drug interactions: A word of caution","authors":"Greeshma K. Shetty, P. Girish, K. Rao, A. Menon","doi":"10.4103/cdr.cdr_62_21","DOIUrl":"https://doi.org/10.4103/cdr.cdr_62_21","url":null,"abstract":"The main of this article is to study the interactions of certain commonly used drugs with pomelo juice which is commonly consumed as easily available fruit or fruit juice in certain parts of India. Relevant literature was identified by searching PubMed and other articles on the web. Various search words which were used are “Grapefruit,” “pomelo,” “drug interactions,” and “juice-drug interactions.” Inclusion criteria included grapefruit juice–drug interaction studies and pomelo juice–drug interactions. Exclusion criteria were articles actually irrelevant to the juice–drug interaction topics. After reviewing the summary of each article, few articles were directly excluded because of actually irrelevant topics. Finally, eight articles were selected as reference articles and certain data were obtained and our opinion about the same is mentioned in the present article. The full text of each included article was critically reviewed, and valuable information was summarized by data interpretation. Pomelo “(Citrus maxima/Citrus grandis)” is the largest citrus fruit from the family Rutaceae and the principal ancestor of the grapefruit. It is a natural, nonhybrid citrus fruit native to Southeast Asia. Pomelo is commonly consumed and used for festive occasions throughout Southeast Asia. It has also been found to have drug interactions similar to grapefruit. The fruit is large, 15–25 cm in diameter, and weighing 1–2 kg. It has a thicker rind than the grapefruit and is divided into 11–18 segments. Pomelo is closely related to grapefruit and extensively studied and contains furanocoumarins which have been identified as inhibitors of cytochrome P450 3A4 in grapefruit juice in vitro. The fruit was first described in 1750 by Griffith Hughes, and in 1789, Patrick Browne referred to it as “forbidden fruit” or “smaller shaddock.” Its taste also varies from sour or bitter to sweet. The fruit is nearly round or slightly pear shaped in clusters similar to grapes, 10–15 cm wide with smooth, finely dotted peel, up to 1 cm thick. The pulp is yellow or pink to red, which has 11–14 segments with thin membrane. The fruit is very juicy. The fruit presents with pointed seeds about 1.25 cm in length. In Karnataka, a type of pomelo named Devanahalli pomelo (Gi registered) is exclusively grown in the region around Devanahalli taluk, Bangalore, as an exotic crop variety. It is locally known as chakkota. Besides, pomelo has many names such as batabi lebu or jambura in Bengali and chakotra in Hindi-speaking states. In the present pandemic outbreak, in-home consumption of packaged fruit juices has increased among people in the cities, whereas in-home consumption of easily grown and easily available fruits such as pomelo, grapes, apples, and their juices has increased among people in the villages. Hence, caution is required while consuming pomelo juice (similar to grapefruit juice) with certain drugs.","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43908819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trichostasis spinulosa is a hair follicular disorder hyperkeratotic dilated hair follicles with retention of multiple vellus hairs. It is a common disorder often unrecognized by patients. Dermatoscopy helps in diagnosis and deciding the treatment of this disorder avoiding unnecessary skin biopsy. Here, we report a case of a pruritic variant of trichostasis spinulosa with characteristic signs of hair retention in dermatoscopy.
{"title":"Dermatoscopy of the pruritic variant of trichostasis spinulosa: A noninvasive diagnostic method","authors":"Mithin Balasundaram, Logamoorthy Ramamoorthy","doi":"10.4103/cdr.cdr_107_21","DOIUrl":"https://doi.org/10.4103/cdr.cdr_107_21","url":null,"abstract":"Trichostasis spinulosa is a hair follicular disorder hyperkeratotic dilated hair follicles with retention of multiple vellus hairs. It is a common disorder often unrecognized by patients. Dermatoscopy helps in diagnosis and deciding the treatment of this disorder avoiding unnecessary skin biopsy. Here, we report a case of a pruritic variant of trichostasis spinulosa with characteristic signs of hair retention in dermatoscopy.","PeriodicalId":34880,"journal":{"name":"Clinical Dermatology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46131919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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