Indian Journal of Dermatology Venereology & Leprology最新文献

Background In the pathophysiology of bullous pemphigoid, besides IgG, there has been evidence that supports the role of IgE antibodies. However, there have been no studies to evaluate total serum IgE levels or detect IgE deposits in the skin of Vietnamese patients. Aim To analyse the association between IgE levels in the serum and disease severity as well as eosinophils and IgE basement membrane zone (BMZ) deposition in Vietnamese bullous pemphigoid patients. Methods A single-centre observational research on 35 newly diagnosed and untreated bullous pemphigoid patients. Total serum IgE levels were analysed using enzyme-linked immunosorbent assay (ELISA). For controls, we collected sera of 30 pemphigus patients and 30 elderly patients with pruritus. Perilesional skin biopsies underwent direct immunofluorescence (DIF) staining, with biopsies of pemphigus patients as controls. Results Elevated total serum IgE was observed in 60% of bullous pemphigoid patients, the percentage in the pemphigus group and pruritus group was 20% and 40%, respectively. The mean total serum IgE level among the bullous pemphigoid group was higher than that of the pemphigus group (123.3 ± 102.4 IU/mL vs. 64.3 ± 45.1 IU/mL, p = 0.010). Total serum IgE levels of bullous pemphigoid patients correlated with higher eosinophil counts (r = 0.61; p = 0.018) and urticaria/erythema (U/E) Bullous Pemphigoid Disease Area Index (BPDAI) score (r = 0.50; p = 0.035). Among 35 bullous pemphigoid patients, 5 patients showed positive IgE DIF staining, accounting for 14.3%. Higher serum IgE levels correlated with the deposition of IgE in patients' perilesional skin (p = 0.037). Limitations Due to the rarity of bullous pemphigoid, the effect of the COVID-19 pandemic, and self-treatment issues in Vietnam, we could not recruit a larger number of participants. Conclusions Total serum IgE values correlated with urticarial lesions and IgE deposition in perilesional skin of Vietnamese bullous pemphigoid patients. IgE autoantibodies present in the skin of bullous pemphigoid patients support the role of IgE in bullous pemphigoid pathogenesis.

Cutaneous T-cell lymphoma is a heterogeneous group of T-cell neoplasms, of which mycosis fungoides and Sezary syndrome are the most common. The prognosis depends on the stage of the disease. The early stage follows a protracted course with a five-year disease-specific survival of greater than 95% and is treated with skin-directed topical therapies, phototherapy, and oral drugs like methotrexate. Advanced disease has a five-year overall survival of less than 25% and requires management by systemic chemotherapeutic agents. This review article is the second part out of the two covering the staging, prognosis, and treatment from a dermatologist's perspective.

Introduction With a vision of a 90% reduction of grade 2 disability (G2D) in the Global Leprosy Strategy by 2030, the management of trophic ulcer, a common G2D, has become a priority. Autologous injectable perilesional platelet rich plasma (PRP) is first generation, whereas autologous platelet rich fibrin membrane (PRFM) is second generation platelet concentrate helping in trophic ulcer healing by providing growth factors and cytokines. PRFM requires less amount of blood (8 mL) against 20 mL in PRP. Objectives Evaluate the effectiveness and safety of PRFM with total contact cast versus PRP with total contact cast in leprosy trophic ulcer. Methods Observer-blind, non-inferiority randomised controlled trial recruited clinically diagnosed leprosy trophic ulcer with wound area measurement <40 cm2 after obtaining informed consent. Calculated sample size was 26 per group considering the percentage success in the control group (PRP) 39.29% and the experimental group (PRFM) 55.55%, 5% significance-level, 80% power, non-inferiority limit 10%, and 10% drop-out rate. Randomisation was done by computer generated random number table and allocation concealment by sequentially numbered opaque sealed envelope (SNOSE) technique. PRP was prepared with first spin 1,600 rpm for 10 minutes and second spin 4,000 rpm for 10 minutes. PRFM was prepared by centrifugation at 2,600 rpm for 3 minutes. Four treatment sessions followed by two follow-ups at 2 weekly intervals were conducted. Results Baseline clinico-demographic profile was similar in both groups. The surface area was significantly reduced (Friedman's ANOVA P<0.001) in both PRP (from 422.48+657.30 sq cm to 247.84+635.96 sq cm) and PRFM (290.04+281.42 sq cm to 152.77+336.09 sq cm) with significant reduction from first FU onwards in both groups (Post-Hoc Dunn's test P<0.001). Complete improvement was noted in 12% of PRP and 23% of PRFM (Fischer's test P=0.465). Both groups showed improvement in DLQI. Limitations Short duration of treatment and follow-up (10 weeks). Conclusion PRFM with total contact cast is not inferior to PRP. Because of operational ease (less blood, less time), PRFM is a better alternative to PRP.

Background Seborrheic dermatitis (SD) is a long-lasting inflammatory skin condition that predominantly impacts regions abundant in sebaceous glands, including the scalp. Objectives To assess the efficacy and anti-inflammatory effect of atorvastatin as an additive treatment among SD patients. Methods In a prospective, randomised, double-blind trial, 46 patients over 18 years old with mild to moderate scalp SD were randomly assigned to receive either 2% ketoconazole shampoo or 2% ketoconazole shampoo plus 5% atorvastatin. The severity of dermatitis was assessed based on the symptom scale of seborrheic dermatitis (SSSD), and the variables of erythema, scaling, and itching, at baseline and 4 weeks after the intervention. Results Based on our analyses, both treatment methods significantly reduced the SSSD scores. However, the average SSSD score in patients using ketoconazole shampoo plus atorvastatin decreased by an average of five points after 1 month. This reduction was comparable to the average decline of 3.5 points observed in the group using ketoconazole shampoo alone. Specifically, the severity of dermatitis, as assessed by the SSSD score, significantly decreased by 1.92 points more, in individuals using the atorvastatin-containing shampoo compared to the comparison group (P = 0.02). Limitation This research was conducted at a single centre which limits the validity of the findings. Conclusion The results of this study suggest that shampoo containing atorvastatin provides a statistically significant effect compared to ketoconazole shampoo alone, indicating its potential as an alternative treatment for SD. The treatment notably alleviates symptoms associated with scaling and itching which are the common manifestations of the condition.

Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterised by recurrent painful nodules, abscesses, and sinus tract formation in intertriginous areas. Accurate staging of this disorder is crucial for appropriate management and prognosis. The role of imaging in the staging of HS is still evolving. Objectives To assess the correlation between clinical disease severity staging and high-resolution ultrasonography and colour doppler (HRUS-CD) staging in HS patients. Methods This was a cross-sectional, single-centre study in patients above 18 years of age with the clinical diagnosis of HS. All patients underwent clinical examination and high-resolution ultrasonography and colour doppler study with high-frequency linear probe (L+ 8-24 MHz). Correlations between clinical Hurley staging and the various ultrasonographic parameters i.e. SOS-HS (sonographic staging of severity of HS), degree of vascularisation, fibrotic scarring and oedema were explored and analysed. Spearman's correlation coefficient was applied to study the correlations and p<0.05 was considered significant. Results A total of 46 patients with HS who met the inclusion criteria were included. The majority of patients were clinically in Hurley stages 1 (32.6%; n=15) and 2 (56.5%; n=26) (41 in all). However, on the basis of ultrasonographic findings, significant numbers of patients had greater severity of staging on SOS-HS (58.5%; n=24/41), higher vascularity on colour doppler (26.8%; n=11), more severe grading of fibrous scarring (43.9%; n=18) and oedema (68.2%; n=28) in comparison to the clinical Hurley staging. Limitations Limitations of our study include a small sample size and cross-sectional design. Conclusion The results of the study indicate that the majority of the patients were under-staged and under-treated clinically, hence emphasising the role of high-resolution ultrasonography and colour doppler study in the accurate determination of HS severity. Future research should focus on standardised protocols and larger, prospective studies to establish the role of these imaging modalities in routine clinical practice.