Proposed global drooping and wrinkles classification and scoring system for aging face with validation and experience on 54 Indian subjects.

BACKGROUND: Aging is an inevitable biological change, but understanding the process of aging of face is important to customize the treatment options for facial rejuvenation. Evidence-based estimation of global facial aging is necessary for the validation of various treatment modalities. AIMS: Classification and implementation of a scoring system for aging face based upon volume loss and surface changes as evident by drooping of different areas of the face and appearance of fine and deep wrinkles, respectively, and to apply this drooping-wrinkles classification on 54 participants to evaluate and understand the validity of scoring. METHODS: An observational study was conducted, and scores were calculated based on 13 parameters (7 areas of drooping and 6 areas of wrinkles on the face) at Aura Skin Institute, Chandigarh, India. Accordingly, age was divided in different age groups followed by clinical estimation of facial age and calculation of scores. RESULTS: According to our classification and scoring system, 61% (33 out of 54) of the participants were correlated with their chronological age group. Out of the remaining 21 (39%) participants who were aging faster, 13 (24%) were in the age group of 25-35 years. Approximately one-fourth of the patients in the age groups 36-45 and 46-55 years were aging faster. Only 1 patient had scores showing younger age in comparison to chronological age. Overall, there was a good correlation between the calculated score and the chronological age of patients. Moreover, a gradual increase in scores was noticed with increasing age groups. CONCLUSIONS: This is a new clinical classification and scoring system for facial age which is much easier to apply in daily clinical practice for easy calculation of baseline scores and customizing their antiaging treatment options. Moreover, it will also make it easier to compare the efficacy of treatment in their future follow-ups. The limitation of this study is that it has been proposed for all skin types but validation has been done only for Indian participants.

Misnomers in dermatology: time to change and update.

Most of the misnomers encountered in dermatology have arisen from lack of understanding of the underlying etiopathogenesis, histopathology and/or concepts. Some misnomers are due to imprecise translations from word of origin, etymological bungles and/or factual errors. It is very important for the residents and practitioners of dermatology to update and change the old misnomers with relevant names to avoid confusion and misunderstanding. In this article, we have listed all the misnomers in dermatology and suggested the appropriate names as indicated.

The relation between the Lucio phenomenon and cutaneous allergic vasculitis (Ruiter)

This is a report of two imported cases, seen in the Netherlands, of rather diffuse lepromatous leprosy with cutaneous allergic vasculitis (Ruiter). Emphasis is laid upon similarities with the Lucio phenomenon. The first patient, a native of Indonesia, showed diffuse infiltration and several small nodules on the face. After a year of treatment with DDS, numerous erythematous and purpuric spots appeared abruptly on the extremities and body, accompained with fever and symptoms of arthritis. Some spots had bullous necrotic centers, which subsided in a few weeks with superficial healing. An elevated antistreptolysin later suggested the existence of a secondary infection. The second case, in a Hollander born in Indonesia, ahd diffuse lepromatous leprosy which was irregularly treated since 1947. An accidental injury caused an ulceration of the leg which became secondarily infected, with high fever and symptoms of arthritis. Shortly thereafter painful spots, capriciously typical of the Lucio phenomenon, appeared on the extremities. The histopathologic preparations from both patients obtained from the lesions described showed, in addition to the features of lepromatous leprosy, the picture of allergic vascularitis. Both cases responded well to antibiotic treatment. The relationship between cutaneous allergic vasculitis (Ruiter) and the Lucio phenomenon is discussed.