An observational study of alopecia areata in Sri Lankan adult patients.

OBJECTIVES: The objectives were to assess the demographical pattern, clinical presentation and therapeutic response in a cohort of patients with alopecia areata (AA) in Sri Lanka. METHODS: Hospital-based observational study of 290 adults aged 18 years or above. RESULTS: Alopecia areata was commoner in men (M:F=1.3:1). Age of onset was between 20-35 years (median 31 years) in 61%. Those with juvenile-onset AA (≤ 17 years, n=5) showed severe disease with many relapses and resistance to therapy. Late-onset AA (<50 years, n=12) was commoner among females and had mild disease activity. Alopecia areata was the commonest clinical type (93.7%), followed by alopecia universalis (n=10), ophiasis pattern (n=3), alopecia totalis (n=3), and reverse ophiasis pattern (n=1). Mild disease (>10% scalp area) was the commonest (82%). Alopecia was total, universal or extensive (>10% scalp area) in 18%. Sites involved were scalp (71%), beard only (20.5%) and multiple sites (8.7%). Nail changes were associated with severe disease. Associated autoimmune diseases were vitiligo 6 (2%), thyroid disease 5 (1.7%) and rheumatoid arthritis 1 (0.3%). Atopy (21%) was not associated with younger age of onset or severity of disease. Patients with a family history among first degree relatives had earlier onset of disease. Most (61%) were cured after 1-2 intralesional steroid injections. Oral dexamethasone mini pulse with or without topical 5% minoxidil lotion for 12 months or more were used in 28%. CONCLUSIONS: In Sri Lanka AA is a disease of the young. Extensive disease, juvenile onset, and associated nail changes were poor prognostic factors.

The quality of life of Sri Lankan patients with cutaneous leishmaniasis.

The effect of cutaneous leishmaniasis on the quality of life (QoL) in Sri Lankan patients' had not been evaluated before. This study was done to identify the factors resulting poor QoL in cutaneous leishmaniasis. The standard one-week Dermatology Life Quality Index (DLQI) questionnaire was used on 146 patients. The children <15 years of age, illiterates, who could not understand the questionnaire were excluded. Twenty one percent had no effect; overall 86% had DLQI ≤10 indicating low/moderate effect. The least affected area was sexual function with some 92% stating they were not affected at all, while the areas of feelings, shopping, social, partner and treatment, (in descending order), being endorsed as the most affected areas. Facial lesions, lesions ≥25mm diameter, 21-40 age group were identified as being associated with poor QoL. Overall cutaneous leishmaniasis in Sri Lanka was a mild disease having low/moderate impact on 86% of patient's, in which 'feelings' being the most affected and 'sexual function' being the least affected domain.

Correlation of clinical, parasitological and histopathological diagnosis of cutaneous leishmaniasis in an endemic region in Sri Lanka.

INTRODUCTION: Diagnosis of cutaneous leishmaniasis (CL) largely depends on the clinical appearance of the lesions in endemic areas. OBJECTIVES: The aim of this study was to correlate the clinical diagnosis with positive laboratory tests used for the identification of leishmania parasite (stained smears and histopathology) and therapeutic response. METHODS: 114 clinically suspected patients (190 lesions) were studied. They were diagnosed as typical clinical cases (87.4%) and clinically suggestive cases (12.6%) on the basis of criteria for clinical diagnosis. Slit-skin-smear and histopathology were performed in all patients. RESULTS: Out of 103 who were clinically diagnosed, 62 (60.2%) were confirmed parasitologically. Out of 41 who were negative for both smear and histology, 34 (33%) had supportive histology and the diagnosis was supported by good treatment response in 37 (35.9%). Hence, the clinical diagnosis was 93.2% accurate and this increased to 96% after observing the good response to therapy. CONCLUSIONS: Considering the magnitude of the problem, limited resources, and clinical accuracy of 96%, clinical diagnosis by a dermatologist appears to be reliable enough in diagnosing CL lesions in endemic areas in Sri Lanka.

A prospective case-controlled cohort study of endothelial function in patients with moderate to severe psoriasis.

BACKGROUND: There is well-documented evidence that patients with moderate and severe psoriasis have a significantly increased risk of cardiovascular disease (CVD). While this risk can, at least in part, be attributed to the high prevalence of traditional risk factors in the population with psoriasis, some epidemiological evidence suggests it may be independent of these. OBJECTIVES: This prospective, case-controlled study investigates whether psoriasis is a risk factor for CVD using two, validated, sensitive markers of CVD, endothelial dysfunction and high-sensitivity C-reactive protein (hsCRP). METHODS: Patients were recruited from a tertiary referral psoriasis clinic and exclusion criteria included established CVD and/or conventional risks for CVD. Preclinical CVD was assessed using flow-mediated brachial artery dilatation, which measures endothelial dysfunction, and hsCRP, a serological marker of atherosclerosis. RESULTS: Sixty-four patients (22%) out of a total of 285 consecutive patients attending the severe psoriasis clinic were entered into the study. One hundred and sixty-one (56%) were excluded following identification of cardiovascular risk; 39 of the 161 (24%) had at least two cardiovascular risk factors. A further 16 (6%) patients were excluded because of established CVD. No statistically significant difference in endothelial dysfunction was observed between patients with psoriasis (n = 60) and healthy controls (n = 117) (P = 0·508). The hsCRP level was, however, significantly elevated in the psoriasis group (2·828 mg L(-1), SEM 0·219; controls 0·728 mg L(-1), SEM 0·142; P < 0·05). CONCLUSION: This large, investigative study is the first to assess endothelial function in patients with psoriasis after exclusion of traditional risk factors for CVD. These data suggest that psoriasis per se is not a risk factor for CVD and that elevated hsCRP is possibly independent of atheroma risk. There was a high prevalence of traditional risk factors in our population with severe psoriasis.

Patterns of chromonychia during chemotherapy in patients with skin type V and outcome after 1 year of follow-up.

The study was carried out on 17 patients (16 female, 1 male) who presented with nail pigmentation after chemotherapy. Ten patients who were given cyclophosphamide had diffuse black pigmentation, slate-grey to black longitudinal streaks, or diffuse dark-grey pigmentation located proximally with overlying black transverse bands. The pigmentation appearing after hydroxyurea was located more distally, was brownish-black in colour and diffuse, or appeared in single or double transverse bands. Diffuse pigmentation of the skin, patchy macular pigmentation of the gum margins, and the tip and lateral margins of the tongue were also seen. In patients on carboplatin treatment, brown pigmentation in bands 2-4 mm wide was seen, located distally on the fingernails. Black longitudinal bands on a background of diffuse brown pigmentation were noted after docetaxel treatment. Chemotherapy-induced nail pigmentation in patients skin type V is not an uncommon event, which is probably underestimated and under-reported.