A Clinical and Dermatoscopic Perspective of the Efficacy and Safety of Erbium: YAG Laser Ablation Versus 50% Trichloroacetic Acid for the Management of Xanthelasma Palpebrarum.

Xanthelasma palpebrarum (XP) is a benign cosmetic condition. Although the role of CO2 laser is well described, there are only a few studies on Erbium: YAG in XP. Similarly, trichloroacetic acid (TCA) is commonly used in XP. However, there are only a few studies comparing these modalities in the treatment of XP. Aim: To evaluate the effectiveness and safety of Erbium: YAG laser and 50% TCA in the treatment of XP with the role of dermoscope in the evaluation of lesions. Materials and Methods: A total of 20 subjects were randomly allocated into two groups: group A (TCA) and group B (laser). All patients were subcategorized into three grades viz. I (mild), II (moderate), and III (severe) using a self-devised scoring system. Results: About 25% and 70% of patients achieved complete clearance in groups A and B, respectively (P = 0.017). The rate of recurrence was 40% and 15% in groups A and B. Dyspigmentation and erythema were the most common side effects. Pretreatment dermoscopic evaluation of the lesion showed a network of brown streaks on a background of a yellowish structureless area and was used to assess the area and margins of the lesion where the adipose tissue was found during the procedure and serial assessment of the lesion.

An Unusual Case of Anderson-Fabry Disease: Case Report.

Angiokeratoma is a group of capillary malformations characterized by the formation of variably sized dark red hyperkeratotic papules. Initially, it was believed that angiokeratoma corporis diffusum was a telltale sign of Anderson-Fabry disease; however, current consensus states that it is also seen in various other lysosomal enzymatic deficiencies. In this report, we present the case of a 12-year-old boy who developed angiokeratoma corporis diffusum with sensorineural deafness, acroparesthesias, and renal involvement.

Efficacy and Safety of Erbium-YAG Laser Ablation Therapy in Superficial Dermatoses: The Workhorse of Dermatology.

Background: Erbium-YAG laser has been the working horse in dermatology for years. Surprisingly, data on the efficacy and adverse effects of this novel resurfacing and ablative technique of erbium-YAG laser for superficial dermatoses in Indian skin is limited. Aim and Objective: To evaluate the efficacy and safety profile of erbium-YAG laser ablation in superficial cutaneous lesions. Materials and Methods: Two hundred and fifty patients of various superficial dermatoses, treatable by erbium-YAG laser, were recruited in the study. All the patients were subjected to erbium-YAG laser sessions. The number of laser sessions, fluence, frequency and other parameters were individualized as per the respective dermatosis. The clinical response was evaluated as grade 4 (100% lesion clearance), grade 3 (75-99%), grade 2 (50-75%) or grade 1 (<50%). Results: The overall mean age of our study group was 37.70 years. In our study, 52.38% cases of verruca plana, 36.84% cases of seborrheic keratosis, 56.4% cases of xanthelasma palpebrarum, 22% cases of acquired melanocytic nevus, 23.8% cases of plantar wart and 40% cases of sebaceous hyperplasia showed complete clearance. The most common adverse effect was post-laser erythema in 50.4% of cases, followed by pain in 36.8%. Besides this, scarring and dyspigmentation were observed in 11.6% and 12% of cases, respectively. The rate of recurrence on 3 months follow-up was 9 (23.07%) cases in xanthelasma palpebrarum, 11 (28.9%) cases in seborrheic keratosis, 10 (23.8%) cases in verruca plana and 9 (42.8%) cases in plantar warts. Conclusion: This study suggested that erbium-YAG ablation achieved good results for superficial lesions like verruca plana, seborrheic keratosis, xanthelasma palpebrarum, plantar wart, sebaceous hyperplasia and acquired melanocytic nevus. Thus, Er: YAG laser can offer a one-step procedure with better cosmetic results and a lesser rate of recurrence.

Assessing the Association between Psoriasis and Cardiovascular Ischemia: An Investigation of Vascular Endothelial Growth Factor, Cutaneous Angiogenesis, and Arterial Stiffness.

Background: Vascular endothelial growth factor (VEGF)-mediated angiogenesis's role in developing psoriasis and cardiovascular events has been established. However, the interplay between the two diseases regarding this cytokine remains an understudied area. Aim and Objectives: This case-control study aimed to investigate the relationship between VEGF-mediated angiogenesis and cardiovascular ischemia in patients with psoriasis. Materials and Methods: The study included 200 clinically diagnosed treatment-naïve cases of psoriasis and 200 controls. The VEGF level, cutaneous vascularity, and cardiovascular ischemia were measured between cases and controls. Cutaneous vascularity was assessed using non-invasive imaging technique such as laser doppler imaging (LDI) and measuring skin blood flow measurement (SBFM). Cardiovascular ischemia was evaluated using noninvasive techniques by measuring carotid intima-media thickness (CIMT) and pulse-wave velocity (PWV). The arterial vasa vasorum was evaluated using ultrasound imaging. Results: The study found a significant correlation between psoriasis severity and levels of VEGF (P < 0.001). Cases had significantly higher CIMT and PWV levels (P = 0.001 and <0.001, respectively). There was a significant positive correlation between the severity of psoriasis and the levels of cutaneous angiogenesis (r = 0.7, P < 0.001). Conclusion: According to this study, patients with psoriasis are at a higher risk of developing cardiovascular ischemia due to excessive angiogenesis associated with the condition. VEGF plays a key role in atheroma formation in psoriasis patients.

The Impact of Tofacitinib on Quality of Life in Patients with Moderate-to-Severe Psoriasis- An Observational Study.

Background: Global phase III trials have established the effectiveness and the safety profile of 5 and 10 mg twice-daily regimens of Tofacitinib for the management of psoriasis. Aims and Objectives: This study was aimed at assessing the improvement in quality of life in patients suffering from moderate-to-severe psoriasis following 12-week Tofacitinib therapy. Materials and Methods: 50 adults with moderate to severe plaque psoriasis enrolled with informed consent. Tofacitinib was given orally for 12 weeks, as 5 mg or 10 mg twice daily based on weight. Improvement in PASI and DLQI was recorded. Results: We observed a statistically significant improvement in PASI (p-value < 0.001) and DLQI (p-value < 0.001) following Tofacitinib therapy. The 3 domains of DLQI with the most significant improvement were symptoms and feelings (items 1 and 2) (p-value-0.001), daily activities (items 3 and 4) (p-value-0.0001), and treatment (item 10) (p-value-0.0001). Conclusion: Tofacitinib demonstrated a significant improvement in psoriasis disease severity and symptoms with 12 weeks' therapy.

Kounis Syndrome: A Rare Case of Allergic Angina Secondary to Loxoscelism.

Kounis syndrome or allergic angina is characterized by a sudden transient or permanent myocardial dysfunction caused by inflammatory mediators such as histamine, leukotrienes, platelet-activating factor, neutral proteases, and a number of cytokines and chemokines. Herein, we discuss a case of Kounis syndrome, which was brought on by loxoscelism.

Ocular Discoid Lupus Erythematosus: More Than what Meets The Eye.

Lupus erythematosus is a spectrum that includes auto-immune disorders such as systemic lupus erythematosus (SLE), subacute cutaneous lupus erythematosus (SCLE), and chronic cutaneous lupus erythematosus (CCLE). Discoid lupus erythematosus (DLE) is the most common type of CCLE, and ocular DLE is a rather rare presentation. We report the case of a 42-year-old male patient who had been repeatedly mis-diagnosed and upon detailed dermatological workup was found to possess clinical, dermoscopic, and histopathological features of DLE. Our report focuses on the importance of dermoscopy as a useful point-of-care investigation to avoid delay, and thus related complications. It further suggests how fundus examination could prove helpful in identifying lupus-related fundus changes, and explores how to devise a suitable plan of treatment for such patients.

Histopathological Spectrum of Cutaneous Reactions following COVID-19 Vaccine - An Observational Study.

Background: Owing to the myriad clinical presentations of COVID-19 vaccine-induced adverse events, clinicopathological correlation is the key to understanding the underlying pathophysiology of these reactions. However, there is still a dearth of such systematic studies across a wide spectrum of vaccine reactions. Aim and Objectives: This study provides a clinical and histopathological correlation of COVID-19 vaccine-induced mucocutaneous reactions. Materials and Methods: The study population included all the individuals developing any form of self-reported mucocutaneous adverse events within 4 weeks of receiving the COVID-19 vaccine. The clinical and histopathological features were recorded. Results: A total of 126 cases were identified. Seven histopathological patterns were recognized. The most common histopathological feature was spongiotic dermatitis, seen in all the patients with "vaccine-related eruption of papules and plaques" (VREPP). Other patterns included lichenoid or interface dermatitis, dermal hypersensitivity reaction, leukocytoclastic vasculitis, subepidermal blistering, psoriasiform hyperplasia, and dermal granulomatous reaction. Conclusion: Owing to such myriad clinical presentations, utilizing a histopathological classification could ease categorizing the vaccine-induced mucocutaneous eruptions.

Concurrent acute generalized exanthematous pustulosis in siblings.

Acute generalized exanthematous pustulosis (AGEP) is a rare severe cutaneous adverse reaction triggered in most cases by drugs. It is characterized by abrupt onset and rapid evolution of fields of sterile pustules on an erythematous background. The role of genetic predisposition in this reactive disorder is being explored. We report the simultaneous occurrence of AGEP in two siblings after being exposed to the same drug.

Hand Foot Mouth Disease During the SARS-CoV-2 Pandemic: A Multicentric Study.

OBJECTIVES: This prospective observational study aimed to identify the current trend of the circulating viral strains responsible for HFMD outbreak in four tertiary care centers in Rajasthan, amidst the COVID-19 pandemic (April-October 2022). METHODS: Cases with suspected HFMD, presenting to our skin outpatient department were assessed clinically and serologically (IgM antibodies against coxsackie virus (CV) A6, A16 and enterovirus 71) for evidence of the disease. RESULTS: We identified 718 new HFMD patients (161 adults) with peaks in May and August, 2022. Male:female ratio decreased with increasing age. Most children were asymptomatic. A total of 385/409 patients assessed serologically, were found positive, most commonly against CV-A6. CONCLUSION: Though HFMD typically affects young children, an unusually higher proportion of adults were affected during the current pandemic. There were some subtle differences between pediatric and adult presentation of HFMD.

Fractional Erbium YAG Laser Resurfacing Versus 20% Trichloroacetic Acid Chemical Peeling in the Treatment of Acne Scars: A Comparative Study.

Background: Acne scarring not only affects the aesthetic appearance of an individual but also has a detrimental effect on mental health and social life. Various treatment modalities are available for acne scars. Aim: In this study, fractional erbium-doped yttrium-aluminum-garnet (Er:YAG) laser resurfacing was compared with 20% trichloroacetic acid (TCA) peeling in terms of efficacy and safety. Materials and Methods: This prospective comparative study included 50 subjects of acne scar who were randomly divided into Groups A and B, 25 patients in each group. Group A was treated with 4 sessions of fractional Er:YAG laser and Group B with 4 session of 20% TCA application as chemical peeling, repeated every 21 days over a period of 3 months. The patients were evaluated for improvement at each visit using Goodman and Baron's qualitative and quantitative acne scar grading. Results: Statistically significant improvement in Goodman and Barron's qualitative acne scar grades was observed in both groups. At the end of therapy, that is, after 12 weeks of therapy, the mean percentage reduction in Goodman and Baron's quantitative acne scar scores was 21.69% ± 16% in Group A and 20.97% ± 8.70% in Group B. In regards of complications, both procedures were well tolerated. Conclusion: We concluded that fractional Er:YAG laser resurfacing and 20% TCA peel application in the treatment of atrophic acne scar are equally efficacious. Both procedures are safe and well tolerated by the patients.