Impact of COVID-19 Pandemic on Dermatologists and Dermatology Practice.

The COVID-19 pandemic has directly or indirectly affected every human being on this planet. It's impact on the healthcare system has been devastating. The medical fraternity across the world, including India, is facing unprecedented challenges in striving to cope up with this catastrophic outbreak. Like all other specialties, dermatology practice has been profoundly affected by this pandemic. Measures have been taken by dermatologists to control the transmission of the virus, whereas providing health care to patients in the constrained environment. Preventive measures such as social distancing and hand hygienic practices along with patient education is being prioritized. Dermatological conferences and events scheduled across the globe in the first half of year 2020 have been either cancelled or postponed to discourage gatherings. Rationalization of resources and practice of teledermatology are being encouraged in current scenario. Non-urgent visits of the patients are being discouraged and elective dermatology procedures are being postponed. Many national and international dermatology societies have recently proposed recommendations and advisories on usage of biologicals and immunomodulators in present context of COVID-19 pandemic. Urticarial, erythematous, varicelliform, purpuric and livedoid rash as well as aggravation of preexisting dermatological diseases like rosacea, eczema, atopic dermatitis, and neurodermatitis rash have been reported in Covid-19 patients. Self medications and poor compliance of dermatology patients in addition to lack of proper treatment protocols and monitoring are a serious concern in the present scenario. Strategies for future course of action, including the dermatology specific guidelines need to be framed. This issue includes a special symposium on dermatology and COVID-19 having recommendations from special interest groups (SIGs) of Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) Academy on leprosy, dermatosurgery, lasers and dermoscopy.

Update on etiopathogenesis and treatment of Acne.

Acne, the most common skin disease, is a disorder of pilosebaceous units that affects adolescents mainly and adults occasionally. The pathogenesis is multifactorial. Besides genetic predisposition, other major factors include the action of androgens, pro-inflammatory lipids acting as ligands of peroxisome proliferator-activated receptors in the sebocytes, toll-like receptor-2 acting on keratinocytes, recognition of pathogen-associated molecular patterns, cytokines, chemokines, inflammasomes, neuroendocrine regulatory mechanisms, diet and other pro-inflammatory targets implicated in the activation of immune detection and response. Most of these factors converge on mammalian target of rapamycin complex1 (mTORC1) activation which is further enhanced by the nutrient signaling of Western diet. This multitude of pathogenic factors has led to a new armamentarium of drugs for the treatment of acne. Topical anti-androgens, insulin-like growth factor-1 inhibitors, peroxisome proliferator-activated receptor-modulators, acetylcholine inhibitors, topical retinoic acid metabolism-blocking agents, vitamin D analogues, antimicrobial peptides, interleukin-1α and interleukin-1ß blockers and immunotherapy are some of the novel treatment options.

Cutaneous changes in internal malignancy: Study from a tertiary care center.

BACKGROUND: A wide variety of systemic diseases and internal malignancies have cutaneous manifestations. In the context of internal malignancy, many cutaneous changes are highly specific to the underlying malignancy, while other changes are nonspecific. Some changes are also due to the modalities employed in the treatment of malignancies. METHODS: Two hundred and fifty patients who were diagnosed with internal malignancy and who were attending the department of radiation oncology, were evaluated at the Department of Dermatology, Sexually Transmitted Diseases and Leprosy of Government Medical College, Srinagar. The study was conducted over a period of 5 months. Relevant investigations, wherever needed, were carried out. RESULTS: Among the 250 cases examined, nonspecific cutaneous changes were seen in 39 (15.6%) cases, whereas specific skin lesions in the form of cutaneous metastases were seen in two (0.8%) patients. Nail changes and hair changes were also seen in some patients. LIMITATIONS: As this was a cross-sectional study and most of the patients were lost to follow up, we could not assess the outcome of the dermatological changes seen in the affected patients. CONCLUSION: Many dermatological changes are noticed early in the course of malignancy, reflecting a strong association of the cutaneous change with malignancy. Few manifestations occur late in the course of the disease, indicating dissemination or immunosuppression. Some changes reflect radiation-induced or chemotherapy-induced toxicity, indicating the need for treatment modifications.

De novo histoid leprosy: a case report from a post-elimination area.

Histoid leprosy is an uncommon variant of lepromatous leprosy that usually follows treatment failure. Occasionally it occurs de novo without any history of previous inadequate or irregular treatment. We, hereby, report a case of de novo histoid leprosy in a 25-year-old man from the post-elimination area of Kashmir, where the prevalence rate of the disease was reported to be 0.17/10000 in March, 2013 (NLEP).

Serum prolactin levels in psoriasis and its association with disease activity: a case-control study.

BACKGROUND: Psoriasis is a T-cell-mediated autoimmune chronic skin disorder in which an environmental factor, perhaps a viral antigen, induces T cells to produce cytokines. These cytokines stimulate keratinocyte proliferation and production of antigenic adhesion molecules in the dermal blood vessels. Several mediators and hormones have been implicated in keratinocyte hyperproliferation and among these hormones, prolactin (PRL) has been found to have an effect on epithelial cells, lymphocytes and keratinocytes, thus an effect on the etiopathogenesis of psoriasis. AIM: The present study was designed to compare serum PRL levels in psoriatic patients with a control group. SETTINGS AND DESIGN: This study was a hospital-based case control study, conducted in the department of Dermatology, STD and Leprosy, SMHS Hospital (Associated teaching hospital of Government Medical College Srinagar) over a period of 1 year, from September 2012 to 2013. MATERIALS AND METHODS: The present study included 60 patients of psoriasis (42 males and 18 females) and 60 controls matched for age and sex. Serum PRL levels of patients and controls were measured by ECLIA and inferences were drawn. STATISTICAL ANALYSIS USED: Statistical significance of the results was carried out by the Chi-square test and the independent samples t-test. Statistical significance was determined at a level of P < 0.05. RESULTS: Serum PRL levels were significantly increased in patients as compared to the control group (P value: 0.002). There was a positive correlation between pretreatment serum PRL levels and PASI score (r value: 0.379; P value: 0.003). An insignificant association was found between the pretreatment PRL level and serum PRL level after treatment (P value: 0.22). Also, a negative correlation between the duration of psoriasis and serum PRL was seen (r value: -0.008; P value: 0.954). CONCLUSION: PRL may have a role to play in the etiopathogenesis of psoriasis. However, further studies with large sample size should be carried out so as to validate this hypothesis.

Comparison of dermatoses seen in community health camps and a tertiary care centre in Kashmir.

BACKGROUND: Various environmental, socio-economic and geographical factors influence the pattern of dermatoses in an area. Observations made at tertiary dermatology centres may not reflect the actual pattern of dermatoses at the community level. AIMS: To evaluate the pattern of dermatoses at community level and compare it with that at a tertiary centre. METHODS: Cases were registered through community visits in block Hazratbal in Kashmir valley, once a week over a calendar year. The pattern of dermatoses observed was compared with that seen at the tertiary centre over the same period. RESULTS: A total of 1065 community cases, with 1105 dermatoses, were compared with 4358 patients with 4466 dermatoses seen at the tertiary centre. Non-infectious dermatoses in each group were more common than infectious dermatoses (34.08% infectious dermatoses versus 65.97% non-infectious in community cases and 29.42% infectious dermatoses versus 70.58% non-infectious in hospital patients). Infectious cases were seen significantly more in the community (34.08%) than at the tertiary centre (29.42%). Among the infectious diseases, fungal infection was the most common and in the non-infectious group, pigmentary disorders were the most common, followed by acne and eczema. CONCLUSION: Infectious dermatoses were found statistically significantly more in community cases as compared to hospital patients while the opposite was the case with non-infectious dermatoses. The study emphasizes the need for providing frequent dermatology services to the community at the primary healthcare level so that the burden of dermatoses, especially infectious, may be reduced. Also, wider studies should be conducted in different regions in order to assess the actual magnitude of dermatological illnesses in the community.

Understanding itch: an update on mediators and mechanisms of pruritus.

Pruritus is the most common symptom secondary to skin diseases. Advances in the fields of neurobiology, immunology and physiology have made it possible for us to understand and unravel the deeper pathophysiological basis of pruritus. This review aims to update our current understanding of the mechanisms and mediators of pruritus. Special attention is paid to endogenous itch mediators particularly newly identified ones like endovanilloids, opioids, neurotrophins, cannabinoids, proteases and cytokines. Various theories explaining the peripheral encoding of itch are reviewed. Multiple neural pathways including the central itch pathways as well as supraspinal processing of itch and brain areas involved in pruritus are highlighted. Apart from peripheral itch mediators, spinal neural receptors are also involved in control of itch and should form part of the development of a novel antipruritic strategy. Further studies are required to fill the lacunae in our current understanding of the pathophysiology of pruritus.

Histopathological analysis of the cutaneous changes due to kangri use in kashmiri population: a hospital based study.

BACKGROUND: Kangri cancer is peculiar to the valley of Kashmir as people of all age groups are accustomed to warm their bodies by the use of Kangri baskets. The clinical spectrum of skin cancer in the Kashmir valley is entirely different from the rest of the country, which could be attributed to the use of Kangri in this geographical region.[12]. AIMS: Histopathological analysis of the cutaneous changes due to kangri use in Kashmiri population. MATERIALS AND METHODS: This is a prospective hospital based study. All the patients attending the outpatient department of Dermatology, STD and Leprosy at SMHS Hospital, an associated hospital of govt. medical college in Srinagar and presented with suspicious lesions (i.e., erythema ab igne, papular or nodular skin growths) due to Kangri use were taken up for the study. A detailed history including the use of Kangri and a physical examination was done in each patient followed by a histopathological examination in case of suspicious lesions. RESULTS: The cutaneous changes which were observed during the study period of 8 months were erythema ab igne, bowen's disease and squamous cell carcinoma. CONCLUSION: Although this is a preliminary study we will be studying more of such changes caused due to Kangri use in the future.