Periorbital Acquired Dermal Macular Hyperpigmentation: A Distinctive Clinical Entity in Young Adults-Observational Case-Control Study.

INTRODUCTION: Acquired dermal hyperpigmentation (ADMH) presenting on periorbital region has been described as individual case reports. We tried to characterize the features of periorbital ADMH. MATERIALS AND METHODS: This was a retrospective case-control study among our patients who attended the pigmentary clinic during January 2016-December 2017. Clinical, dermoscopic, and histopathological features of subjects who were recruited during the study period were prospectively evaluated. RESULTS: Total 19 subjects (11%) were identified among 177 ADMH patients. Periorbital ADMH patients had a relatively younger age of onset (23.26 ± 11.06 vs. 36.16 ± 13.41, P < 0.001). Dermoscopy of early periorbital ADMH showed only imperceptible speckled blue-gray dots that accentuated at outer-corner creases of eyes (the "outer-corner crease sign"). Clinicopathological features and prognosis of periorbital ADMH were similar to that of ADMH per se. CONCLUSION: Periorbital ADMH should be considered as a differential diagnosis of periorbital hyperpigmentation in children and young adults. Outer-corner crease sign on dermoscopy may help to rule out other differentials in its early presentation.

Metabolic syndrome and female gender, but not methotrexate, are the important associations of significant liver fibrosis in patients with moderate-to-severe psoriasis as detected by transient elastography.

BACKGROUND: Many international guidelines on psoriasis management have emphasized upon the need to identify risk factors for liver fibrosis and that the risk may be increased after a certain total cumulative dose of methotrexate. METHODS: Consecutive patients with moderate-to-severe psoriasis were assessed for liver fibrosis using transient elastography and noninvasive scores. Based on the presence of significant liver fibrosis, the Odds ratio associated with various factors was calculated using logistic regression analysis. Receiver operating characteristic curves were calculated to find maximal cutoff values of noninvasive tests to detect fibrosis. RESULTS: In this cross-sectional study, 134 patients completed the study. Significant fibrosis (liver stiffness measurement ≥7, corresponding to F2 fibrosis or higher) was seen in 33 (24.6%) patients. Neither methotrexate exposure nor total cumulative dose of ≥1.5 was associated with significant fibrosis. Female sex (P = 0.024) and the presence of metabolic syndrome (P = 0.034) were the two variables associated with significant liver fibrosis. On logistic regression analysis, the odds ratio for the female gender and metabolic syndrome was estimated to be 2.51 (95% confidence interval - 1.09-5.81) and 2.33 (95% confidence interval - 1.03-5.27), respectively. Aspartate transaminase to platelet ratio index, nonalcoholic fatty liver disease score and the fibrosis-4 index had low sensitivity in comparison to transient elastography. LIMITATIONS: These included small sample size, small number of patients with a total cumulative methotrexate dose of >3-4.5 g, and lack of control group consisting of healthy persons. Another is the absence of liver biopsies considered as the gold standard in the diagnosis of liver fibrosis. CONCLUSIONS: Metabolic syndrome and female sex are associated with the development of significant liver fibrosis in patients with psoriasis. Methotrexate exposure does not seem to be significantly associated with significant liver fibrosis.

Awareness of psychodermatology in Indian dermatologists: A South Indian perspective.

This study was aimed to survey the awareness, knowledge, practicing patterns, and attitudes of dermatologists toward psychocutaneous disorders in a South Indian State. The questionnaire-based study was performed from August 1 to October 31, 2019. Study participants included 123 dermatologists. The questionnaire consisted of nine multiple-choice questions and two open-ended questions regarding knowledge, practicing patterns, and attitude to psychodermatology. Forty five (36.6%) dermatologists completed this online survey. Out of them 73% were women and 40% were trainees. Nine respondents (20%) had frequent experience with psychodermatology, but only 6 (13.3%) were very comfortable in diagnosing and treating psychodermatology patients. Vitiligo was the disease with maximum respondents reported encountering >10 patients monthly with psychologic co morbidities (30, 66.7%). The most common diagnoses which required psychiatric referral were delusion of parasitosis (22.2%), trichotillomania (20%) and neurodermatitis (8.9%). Thirty six respondents (80%) were unaware of any patient or family resources on psychodermatology. Thirty-nine respondents (86.7%) expressed interest in attending educational events on psychodermatology. Survey results showed high need of liaison clinics of dermatology and psychiatry. Many dermatologists lack proper training in treating psychodermatology cases while they may be the sole service provider to the patients. We propose incorporation of psychodermatology curriculum in residency training programs.

Comorbid psoriasis-bipolar disorder successfully treated with apremilast: much more than a mere coincidence?

Psoriasis is a chronic, immune mediated, systemic inflammatory skin disease with a reported prevalence of 0.6%-4.8% in the general population. Bipolar disorder (BP) is a severe episodic psychiatric disorder that ranks as the fourth leading cause of disability. Recent evidence suggests that genetic and immunological factors play a significant role in the development of both disorders. Studies have also shown a higher association of psychiatric disorders among patients with psoriasis. Moreover, several autoimmune comorbidities have been reported in association with BP. Here, we describe a young woman with BP who developed psoriasis after 1 year of developing BP and showed exacerbations in psoriasis lesions with each manic episode. We also highlight the safe and efficacious use of apremilast for psoriatic lesions in the woman.

A comparative study on the turnaround time of article processing in dermatology journals: A need for improvement of this aspect in Indian journals.

INTRODUCTION: Submission and publishing of research articles in scientific journals is a multistep process that should be efficient and swift. OBJECTIVE: To compare the editorial, peer review and publication time between Indian dermatology journals and international dermatology journals. METHODS: Three Indian (Indian Journal of Dermatology, Venereology and Leprology; Indian Journal of Dermatology and Indian Dermatology Online Journal) and three international (International Journal of Dermatology; the Australasian Journal of Dermatology and Dermatology [Karger]) dermatology journals were identified for this study. Information pertaining to time to acceptance, time to publication and the total time to publication were extracted for original articles, case reports and letters to the editor published in issues from January 2017 to December 2017. RESULTS: The mean total time to publication in the order for Indian Journal of Dermatology, Venereology and Leprology, Indian Dermatology Online Journal, Indian Journal of Dermatology, International Journal of Dermatology, Dermatology and Australasian Journal of Dermatology were 12.61, 12.50, 9.14, 7.92, 7.13 and 6.52 months respectively. While time to acceptance and time to publication were the longest in Indian Journal of Dermatology (7.01 months) and Indian Dermatology Online Journal (8.99 months), respectively, Indian Journal of Dermatology, Venereology and Leprology was found to have the maximum overall total time for publication i.e. 12.61 months. The differences among the journals were found to be significant for all three time measures (P < 0.0001, ANOVA). On comparison of Indian and international journals, all three time measures were found to be higher in Indian journals (5.81 vs 4.96 months, 6.75 vs 3.59 months and 11.53 vs 7.51 months, respectively) with the differences being significant (P < 0.0001, independent samples t-test). LIMITATION: This data does not represent the performance status of rejected manuscripts, the information of which was not available in the public domain. CONCLUSION: An effective editorial screening, fast-tracked editorial and peer review process and regulation on turnover time of submissions by Indian dermatology journals are imperative in improving the impact of research publication.

Novel dermoscopic features of pityriasis versicolor-like macules in epidermodysplasia verruciformis.

Epidermodysplasia verruciformis (EV) manifests early in childhood as pityriasis versicolor (PV)-like macules on sun-exposed sites such as the face. These hypopigmented lesions closely resemble commoner pediatric dermatoses such as PV or pityriasis alba. In this report of two cases, we describe the distinguishing dermoscopic features of PV-like macules in EV. Unfocused dotted vessels in a hypopigmented or erythematous background with whitish scales and pigment diluted vellus hairs on dermoscopy should raise the suspicion of EV in children presenting with PV-like lesions.

Plug the needle hub during subcision for a bloodless field.

BACKGROUND: Subcision is a simple such procedure with considerable efficacy especially in the management of the rolling type of atrophic post-acne scars. Since its introduction in 1995, the technique has undergone several modifications to enhance its results as well as to improve the ergonomics. However, 'gushing' of blood through the hub of the needle smears the surgeon's gloves and the treatment field, which is not desirable both aesthetically and hygienically. AIM: To describe a simple technique to avoid blood spillage to the treatment field while doing subcision. METHOD: While doing subcision, the open hub of the needle used was plugged with a button of sterile cotton and cyanoacrylate glue. The new technique was demonstrated on a patient with atrophic post-acne scars. RESULTS: There was no blood spillage through the hub of the needle. CONCLUSION: This simple modification of subcision helps to attain a bloodless treatment area which also has an added advantage of better assessment of the targeted endpoints at the treatment site.