Qualitative analysis of nailfold capillaries in diabetes and diabetic retinopathy using dermatoscope in patients with coloured skin.

Introduction Diabetes mellitus (DM) is associated with significant morbidity and mortality due to vascular complications. Diabetic retinopathy (DR) is the most common microvascular complication of diabetes. Videocapillaroscope has been the predominant tool for nailfold capillary analysis. We aimed at using the commonly available handheld dermatoscope and observe changes in the nailfold capillaries as a part of evaluating diabetic microvascular involvement. Materials and methods A cross-sectional observational study involving 262 patients of diabetes mellitus and 150 controls was conducted for nailfold capillaroscopic changes using a hand-held dermatoscope over a period of 1 year. Results All the capillaroscopic variables like tortuosity, increased capillary density, neoangiogenesis, microhaemorrhages, avascular areas, crossing and meandering capillaries and receding capillaries were significantly more among diabetic than healthy controls. Patients with diabetic retinopathy had significant nailfold capillaroscopic features as compared to patients without DR (P value < 0.001). Neoangiogenesis, receding capillaries and avascular area were significantly higher in proliferative DR as against nonproliferative DR (P < 0.001). A positive association was found between the duration of DM and HbA1c values and NFC features. A decrease in the visualisation of NFC features was noted with increasing skin tone. The difference was significantly more between Fitzpatrick skin phototypes 4 and 5. Limitations The study was limited by its qualitative nature of accessing parameters as precise quantitative assessment of various findings cannot be done by a hand-held dermatoscope. Conclusion Nailfold capillaroscopy is a quick, cost-effective screening tool for identifying patients at high risk of DR in patients with skin of colour. NFC findings may mirror DR changes. The qualitative findings of NFC using a hand-held dermatoscope were comparable to other modes of nailfold capillaroscopy.

Fixed Tapering Dosage of Acitretin in Patients with Psoriasis: A Short-Term Analysis of Clinical Efficacy and its Effects on Biochemical Parameters.

BACKGROUND: Acitretin is a widely used systemic retinoid in the treatment of psoriasis. Dosage of acitretin in not weight adjusted due to certain interindividual variations. OBJECTIVE: To evaluate the clinical efficacy and effects on biochemical parameters of fixed tapering dosage of acitretin in patients with psoriasis administered over a period of 4 weeks. MATERIALS AND METHODS: This was an observational study. The study included patients of psoriasis vulgaris in the age group of 18 and 65 years with a psoriasis area severity index (PASI) score of >10 which was not responsive to topical therapy and phototherapy. Patients were given oral acitretin daily at a dose of 25 mg BD for 2 weeks, which was later tapered to 25 mg OD for another 2 weeks. The clinical efficacy and biochemical parameters were assessed. RESULTS: Out of the 18 patients, PASI 75 was achieved in 66% of the patients by the end of the third week. Significant elevations were noted in serum lipids during 4 weeks, which returned to normal limits or near baseline levels at the end of 4 weeks. CONCLUSION: Fixed tapering dose of acitretin is effective in psoriasis with minimal clinical and biochemical adverse events.

Novel medical strategies combating nonmelanoma skin cancer.

The incidence of nonmelanoma skin cancer (NMSC) continues to rise, partly because of aging, the frequency of early childhood sunburns, and sporadic extreme recreational sun exposure. A nonsurgical approach to selected cutaneous malignancy could possibly reduce the cost as well as morbidity of surgical treatment for NMSC. There has been growing interest in isolating compounds that could suppress or reverse the biochemical changes necessary for cutaneous malignancies to progress by pharmacologic intervention. By targeting diverse pathways recognized as important in the pathogenesis of nonmelanoma skin cancers, a combination approach with multiple agents or addition of chemopreventative agents to topical sunscreens may offer the potential for novel and synergistic therapies in treating nonmelanoma skin cancer. This preliminary information will expand to include more therapeutic options for NMSC in the future.

Subacute cutaneous lupus erythematosus presenting as erythroderma.

Subacute cutaneous lupus erythematosus (SCLE) is a type of lupus erythematosus having distinct characteristic clinical, serologic, and genetic features. Other than the commonly occurring papulosquamous and annular polycyclic lesion, rarely it may present as erythema multiformae, toxic epidermo necrolysis like lesion (Rowell syndrome), erythroderma, and generalized poikiloderma. Herein, we report a case of SCLE presenting as erythroderma.

Novel applications of Rituximab in dermatological disorders.

Rituximab is a monoclonal therapeutic anti-CD20 antibody that has been approved for use in lymphoma and rheumatoid arthritis. Over the past decade several reports based on case series and observational studies have recorded the benefits of rituximab in particular groups of dermatological patients. Off-label use of rituximab in many dermatological indications is not uncommon in many countries in the world. This article reviews the available data that may be of use to the practicing dermatologist. Because of its potential complications, paucity of clinical data, and cost considerations, rituximab is favoured only when standard systemic therapies fail or corticosteroids are absolutely contraindicated. Further research is required in this field.

Familial reactive perforating collagenosis: a report of two cases.

Reactive perforating collagenosis (RPC) is a rare form of transepithelial elimination, in which genetically altered collagen is extruded through the epidermis. Of the acquired and inherited form, inherited form is extremely rare. Here, we present two cases of inherited form of RPC in a family.

Antioxidants in dermatology.

Antioxidants neutralize free radicals produced by various environmental insults such as ultraviolet radiation, cigarette smoke and air pollutants, thereby preventing cellular damage. The role of oxidative stress and antioxidants is known in diseases like obesity, atherosclerosis, and Alzheimer's disease. Herein we discuss the effects of oxidative stress on the skin and role of antioxidants in dermatology.