RESUMEN
BACKGROUND: Although well known in clinical practice, research in lichen planus pigmentosus and related dermal pigmentary diseases is restricted due to lack of consensus on nomenclature and disease definition. AIMS AND OBJECTIVES: Delphi exercise to define and categorise acquired dermal pigmentary diseases. METHODS: Core areas were identified including disease definition, etiopathogenesis, risk factors, clinical features, diagnostic methods, treatment modalities and outcome measures. The Delphi exercise was conducted in three rounds. RESULTS: Sixteen researchers representing 12 different universities across India and Australia agreed to be part of this Delphi exercise. At the end of three rounds, a consensus of >80% was reached on usage of the umbrella term 'acquired dermal macular hyperpigmentation'. It was agreed that there were minimal differences, if any, among the disorders previously defined as ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis and pigmented contact dermatitis. It was also agreed that lichen planus pigmentosus, erythema dyschromicum perstans and ashy dermatosis did not differ significantly apart from the sites of involvement, as historically described in the literature. Exposure to hair colours, sunlight and cosmetics was associated with these disorders in a significant proportion of patients. Participants agreed that both histopathology and dermatoscopy could diagnose dermal pigmentation characteristic of acquired dermal macular hyperpigmentation but could not differentiate the individual entities of ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis, lichen planus pigmentosus and pigmented contact dermatitis. LIMITATIONS: A wider consensus involving representatives from East Asian, European and Latin American countries is required. CONCLUSION: Acquired dermal macular hyperpigmentation could be an appropriate conglomerate terminology for acquired dermatoses characterised by idiopathic or multifactorial non-inflammatory macular dermal hyperpigmentation.
Asunto(s)
Dermatitis por Contacto , Hiperpigmentación , Liquen Plano , Melanosis , Humanos , Consenso , Técnica Delphi , Hiperpigmentación/etiología , Liquen Plano/diagnóstico , Liquen Plano/terapia , Liquen Plano/complicaciones , Eritema/etiología , Melanosis/complicaciones , Dermatitis por Contacto/complicacionesAsunto(s)
Dermatosis Facial/diagnóstico , Leprostáticos/uso terapéutico , Lepra Lepromatosa/diagnóstico , Mycobacterium leprae/aislamiento & purificación , Piel/microbiología , Adulto , Biopsia , Quimioterapia Combinada/métodos , Dermatosis Facial/microbiología , Dermatosis Facial/patología , Humanos , Lepra Lepromatosa/microbiología , Lepra Lepromatosa/patología , Masculino , Piel/patología , Resultado del TratamientoAsunto(s)
Lepra Dimorfa/diagnóstico , Mycobacterium leprae/aislamiento & purificación , Enfermedades Indiferenciadas del Tejido Conectivo/diagnóstico , Anticuerpos Antibacterianos/análisis , Diagnóstico Diferencial , Humanos , Lepra Dimorfa/microbiología , Masculino , Persona de Mediana Edad , Mycobacterium leprae/inmunología , Enfermedades DesatendidasAsunto(s)
Angioedema/diagnóstico , Países en Desarrollo , Dermatosis Facial/diagnóstico , Lepra Multibacilar/diagnóstico , Sinusitis/diagnóstico , Adolescente , Angioedema/tratamiento farmacológico , Angioedema/patología , Biopsia , Enfermedad Crónica , Clofazimina/uso terapéutico , Dapsona/uso terapéutico , Diagnóstico Diferencial , Quimioterapia Combinada , Dermatosis Facial/tratamiento farmacológico , Dermatosis Facial/patología , Estudios de Seguimiento , Humanos , India , Lepra Multibacilar/tratamiento farmacológico , Lepra Multibacilar/patología , Masculino , Rifampin/uso terapéutico , Sinusitis/tratamiento farmacológico , Sinusitis/patología , Piel/patologíaRESUMEN
Leprosy is a chronic granulomatous infectious multisystem disease that may present with protean manifestations. It mimics many systemic and dermatological disorders. Here we report a case in which an elderly female presented with malar rash, intermittent fever, and arthralgia. Her diagnosis was significantly delayed due to a close clinical resemblance to systemic lupus erythematosus. It is important to be aware of such manifestations of leprosy and improve awareness of it in clinicians to avoid misdiagnosis and delay in treatment.
Asunto(s)
Lepra Tuberculoide/diagnóstico , Lepra Tuberculoide/tratamiento farmacológico , Antibióticos Antituberculosos/uso terapéutico , Diagnóstico Diferencial , Femenino , Humanos , Leprostáticos/uso terapéutico , Lupus Eritematoso Sistémico/diagnóstico , Persona de Mediana Edad , Enfermedades de la Piel/diagnóstico , Resultado del TratamientoAsunto(s)
Antiinfecciosos Urinarios/efectos adversos , Eritema Nudoso/inducido químicamente , Lepra Lepromatosa/complicaciones , Ofloxacino/efectos adversos , Enfermedades Cutáneas Vesiculoampollosas/inducido químicamente , Adolescente , Erupciones por Medicamentos/etiología , Humanos , Lepra Lepromatosa/tratamiento farmacológico , Masculino , Infecciones Urinarias/tratamiento farmacológicoRESUMEN
Patchy alopecias of the scalp are frequently seen in clinical practice. We report a young man who presented with progressive patchy alopecia of the scalp, which was finally diagnosed to be due to tuberculoid leprosy. Progression of alopecia was stopped after anti-leprosy treatment was instituted. Despite high prevalence of leprosy in our country, scalp affection due to leprosy is extremely rare but important to recognize.
RESUMEN
A young man employed in a construction company, presented with cutaneous lesions clinically simulating pityriasis rosea. Satisfactory and complete response to corticosteroids and antihistamines was followed by recurrence. Multiple recurrences within a short span of time arose a suspicion of alternative diagnosis. Site visit helped us to rule out occupational contact dermatitis. Further history taking revealed that he was recently using mustard oil for body massage. Subsequent patch testing confirmed contact hypersensitivity to mustard oil. Avoidance of the contact with mustard oil arrested appearance of further skin lesions. We stress the importance of taking a good history in clinical practice in disclosing a possible contactant.
Asunto(s)
Dermatitis Alérgica por Contacto/diagnóstico , Pitiriasis Rosada/diagnóstico , Aceites de Plantas/efectos adversos , Adulto , Dermatitis Alérgica por Contacto/tratamiento farmacológico , Dermatitis Alérgica por Contacto/etiología , Diagnóstico Diferencial , Quimioterapia Combinada , Estudios de Seguimiento , Humanos , Hidroxizina/uso terapéutico , Masculino , Masaje , Planta de la Mostaza , Pruebas del Parche , Prednisolona/uso terapéutico , Medición de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
Recent controversies on the etiology, diagnosis and treatment have led to increased interest in pityriasis rosea (PR). We review these aspects of the disease. PR is universal. The incidence is around 0.68 per 100 dermatological patients, or 172.2 per 100,000 person-years. The prevalence in people aged between 10 and 29 years is 0.6%. The male to female ratio is around 1:1.43. Evidence on seasonal variation is conflicting, but there is no evidence that the incidence is dependent on mean air temperature, mean total rainfall, or mean relative humidity. Spatial-temporal and temporal clustering of cases of PR has been reported. The association of PR with human herpesvirus-7 infection is still controversial. Owing to the extreme high sensitivities of sequence-based detection methods such as polymerase chain reaction, novel criteria should be applied to evaluate the evidence. There is no evidence that PR is associated with other viral or bacterial infections. The role of autoimmunity in PR warrants further investigations. Many patients with PR have one or more atypical features. Application of validated diagnostic criteria may be helpful for atypical cases. The efficacy of macrolides, including erythromycin, in PR is still under evaluation. There is no evidence that antiviral agents are effective. The efficacies of ultraviolet radiotherapy and systemic corticosteroids are not well established. In managing a patient with PR, we should concentrate more on how the eruption is affecting the quality of life, i.e. the illness, rather than the extent and severity of the eruption, i.e. the disease.
Asunto(s)
Pitiriasis Rosada/terapia , Antibacterianos/uso terapéutico , Humanos , Pitiriasis Rosada/diagnóstico , Pitiriasis Rosada/epidemiología , Pitiriasis Rosada/etiologíaRESUMEN
We report an alcoholic Indian man, a known case of contact dermatitis to nickel, who presented with recurrence at the same site, without having recent contact with nickel, following disulfiram therapy for his alcohol addiction.