"Turban PUVAsol:" A Simple, Novel, Effective, and Safe Treatment Option for Advanced and Refractory Cases of Alopecia Areata.

BACKGROUND: Alopecia areata (AA) is an autoimmune characterized by nonscarring loss of scalp and/or body hairs. Topical PUVA has been reported to have good effect in AA. The modification of topical PUVA which we call, "Turban PUVA-sol," is a method of localized immunotherapy using psoralen solution followed by sun exposure. AIMS: We aim to study the therapeutic role and side effect profile of turban PUVA in the treatment of advanced and refractory AA. METHODOLOGY: Fifteen consecutive patients of alopecia subtotalis (at least 70% of scalp hair loss), totalis, and universalis, attending the dermatology outpatient department of a tertiary care hospital in eastern India were subjected to "Turban PUVA-sol" after duly signed consent. Alternate day therapy was given. RESULTS: At the end of 10 months of study, 2 (13%) out of fifteen patients were lost to follow-up for some unknown reasons. The severity of alopecia tool scores showed a significant (P = 0.0002) decrease posttreatment. Correlation between the severity of alopecia and grade of improvement showed a rho value of -0.453. In the remaining thirteen patients, using physician global assessment (PGA), 4 (26%) showed good response, 4 (26%) showed moderate response, 3 showed mild (20%) response, and 2 patients (13%) showed negligible response. Three out of four patients who showed good improvement in PGA showed more than 80% of new hair growth. Side effects are minimal with some patients complaining of mild irritation and scaling. CONCLUSION: We found topical Turban PUVAsol to be a very cost-effective and safe treatment option for AA.

Skin Surface pH in Acne Vulgaris: Insights from an Observational Study and Review of the Literature.

OBJECTIVE: Recurrent and chronic course of acne vulgaris, despite effect-proven therapies, point to an underfocused aspect in its pathogenesis and management. This study aims to assess in subjects with and without acne, the skin surface pH, a parameter that cumulatively represents functioning of various units of skin, including the barrier. METHODS: A total of 200 patients with acne and 200 age- and sex-matched controls were included. Under basal conditions, facial skin pH was derived from five sites using a skin pH-meter. The relation between skin pH and acne was evaluated according to sex. RESULTS: There were more subjects with normal skin pH in the control group compared to the case group, and the majority of acne occurrences in the case group were related to high skin pH (p=0.000). Mean pH among cases was higher than normal reference value (pH 4.5-5.5 for women, 4-5.5 for men) and that of controls p (<0.001). No significant association was observed between sex and skin pH in either cases or controls (p>0.05). CONCLUSION: Increased facial skin pH in patients with acne at basal conditions mirrors a chronic state of stratum corneum instability, which could be predisposing individuals to acne occurrence and/or recurrences. It could possibly be a common domain via which the classical pathomechanisms might be acting in acne. Integrating measures that maintain stratum corneum pH during therapy might prove worthwhile.

Macrodystrophia lipomatosa: Review of clinico-radio-histopathological features.

We report clinical, radiological, and pathological features of three cases of macrodystrophia lipomatosa, which is characterized by progressive proliferation of all mesenchymal elements, with a disproportionate increase in fibroadipose tissue. The peculiarity in our report is the involvement of contralateral hand and feet in our 1(st) case in contrast to usual presentations of this rare condition, which is often unilateral. In our 2(nd) case, the lateral aspect of foot was involved as against the usual finding of involvement of medial aspect in lower limbs, also another surprising finding in this case is increase in the size of lesion after puberty. Coming to our 3(rd) case, enlargement of almost whole of an upper extremity with profound involvement of middle, ring and little finger along with total sparing of the thumb is in itself an extremely rare occurrence as in upper limb, mainly the lateral aspect of hand and related digits bear the burnt and more over involvement of whole limb is itself an unique phenomenon.

Asymptomatic papules over central and pericentral areas of the face.

We report the case of a 24-year-old college girl, presenting with numerous acneiform papular eruptions over the central part of the face.

A Clinico-Mycological Study on Suspected Cases of Chromoblastomycosis: Challenges in Diagnosis and Management.

INTRODUCTION: Verrucous plaques mimicking chromoblastomycosis are frequently seen in dermatology outpatient departments (OPD). However, no scientific evaluation has been carried out till date from eastern India. So this present endeavour is aimed at a thorough study of those cases to readdress the challenges in diagnosis and management in chromoblastomycosis from this part of the country. AIM: The study is to observe the incidence of proved chromoblastomycosis cases from clinically mimicking conditions and to note therapeutic prospects by use of different antifungal agents. MATERIALS AND METHODS: Twenty clinically suspected cases attending dermatology OPD were included in this study. Relevant histories were taken. Apart from routine hematological and biochemical investigations, scrapings from lesions were examined by direct microscopy with KOH wet mount, calcoflour white mount and fungal culture. Histopatholgical examination was also done. Any fungal growth was identified by growth characteristics and morphological features. RESULTS: Sclerotic bodies were detected in five samples. Of them three were found to be culture positive. Two growths were identified as Fonsecaea pedrosoi and one as Cladosporium carrionii. Rest 12 cases were diagnosed as either lupus vulgaris (3 cases; 15%), atypical mycobacterial infections (3 cases, 15%), Hypertrophic lichen planus (2, 10%), Hypertrophic DLE plaque (2; 10%), Wart (1, 5%) or fixed cutaneous sporothricosis (1, 5%), zygomycosis (1, 5%). Three cases (15%) were lost in follow up. Cases of chromoblastomycosis were managed with prolonged use of antifungal alone or in combination with saturated solution of potassium iodide and/or debridement. They were followed up for at least six months post treatment. CONCLUSION: A database comprising diagnostic clues and effective therapeutic intervention have been proposed for these rare subcutaneous mycoses.

Recurrent Pyogenic Granulomas with Underlying Arteriovenous Malformation: An Exclusively Rare Entity.

We report a case of recurrent localized pyogenic granulomas with underlying arteriovenous malformation in an 11-year-old male child on upper back with onset in early infancy.