Childhood atopic dermatitis-An Indian perspective.

Developing countries such as India can offer unique perspectives on and contributions to knowledge of and the literature on atopic dermatitis, including information on epidemiology, the role of environmental factors, clinical features, and treatment strategies in resource-poor settings using indigenous methodologies. This report will help in understanding atopic dermatitis in the Indian diaspora as well.

Mentorship in Dermatology-A Beginner's Guide.

Mentoring albeit is a recently described and popular phenomenon in medicine, is not a new one. All medical specialties have a complex, intertwined relationship between their physicians and trainees who are in different stages of their careers. How a specialty evolves depends on the thread woven by these relationships. This article outlines the concept of mentorship and introduces its various aspects in dermatology. This article attempts to answer what, why, how, when, and where related to mentoring in dermatology, including e-mentorship. The article also includes personal reflections of the authors who are involved in this process.

An array of unusual clinical features in a woman with amlodipine-induced linear immunoglobulin A disease.

Linear immunoglobulin A disease (LAD) is a rare, autoimmune, vesicular-bullous disease that is either idiopathic or drug-induced, most commonly by vancomycin and in rare instances by amlodipine. In drug-induced LAD, certain uncommon and atypical clinical features can occur. In our patient, a 49-year-old woman with amlodipine-induced LAD, atypical features such as koebnerization and palmo-plantar involvement occurred. She presented with tense, clear fluid-filled vesicles, bullae, and erosions all over her body, especially on the palms and soles, with some lesions showing a string-of-pearls appearance. The lesions were preceded by pruritus, and the patient had changed her anti-hypertensive medication from telmisartan to telmisartan-amlodipine for previous 10 days. Skin biopsy and direct immunofluorescence testing confirmed LAD. During the hospital stay, along with new crops of lesions, a few vesicles were present along the lines where she had scratched and the band of tight elastic sleeves of the sterile gown she wore, which is suggestive of koebnerization. Knowing the atypical manifestations of drug-induced LAD may aid clinicians in determining an early diagnosis, and LAD should be an important consideration in the differential diagnosis of vesiculobullous disease with palmar-plantar involvement. Amlodipine is a commonly used anti-hypertensive drug, so knowledge of its potential to cause this disease is important. Furthermore, knowing the potential for koebnerization, avoidance of trauma and the gentle handling of these patients can lead to early recovery from this self-limiting disease.

Seasonal aggravation of acne in summers and the effect of temperature and humidity in a study in a tropical setting.

BACKGROUND: Effect of seasonality on acne and acne flare has varied interpretations depending on the geographical area of study. In tropical areas, factors like high temperature and humidity may cause acne flares. AIMS: To assess the seasonal variation of acne in patients and to correlate it with the monthly temperature and humidity over a period of 1 year. METHODS: A cross-sectional study of acne patients was conducted for one year. The patient's acne was graded. Patients were specifically questioned about aggravation, improvement, or no change in their acne with respect to the seasons. The mean temperature and humidity of each month in Delhi were compared with grade of acne. This variation in acne was correlated with the temperature and humidity. A P-value < 0.05 was considered as statistically significant. RESULTS: Out of 171 patients, 82 (47.95%) patients reported seasonal variation in their acne. Among them, 69 patients (40.4%) reported aggravation in summer. Eleven (6.42%) and 2 (1.16%) patients reported aggravation in winter and rainy season, respectively. The aggravation in summer as compared to rainy and winter season was statistically significant. The mean temperature and mean humidity significantly varied with seasonal aggravation of acne. CONCLUSIONS: Both temperature and humidity have a contributing role in pathogenesis of acne and are causes of acne flare. In our study, aggravation of acne was more in summer and rainy season.

Role of broad-spectrum sunscreen alone in the improvement of melasma area severity index (MASI) and Melasma Quality of Life Index in melasma.

BACKGROUND: Sunscreens have long been an indispensable part in treating melasma as ancillary agents. None of previous studies have evaluated the role of sunscreens alone in the improvement of melasma. AIMS: Our objective was to study the role of broad-spectrum sunscreen with sun protection factor 19 and PA+++ as the sole agent for improvement of melasma. METHODS: A total of 100 patients with melasma were included in the study. Following proper method of application of 3 mL sunscreen, thrice daily, Melasma Area Severity Score (MASI) and Hindi language version of the MELASQOL scale (Hi-MELAQOL) was done at baseline and 12 weeks. RESULTS: The mean MASI in the study group at the beginning and at the end of the study was 12.38 ± 14.7 and 9.15 ± 4.7, respectively, whereas the mean value of Hi-MELASQOL at the beginning and at the end of the study was 47.2 ± 14 and 38.1 ± 14.2, respectively. The differences of both were statistically significant. Spearman's correlation between MASI and Hi-MELASQOL before and after the study was positive but insignificant. CONCLUSION: There was both an objective and subjective improvement in melasma after 12 weeks of sunscreen use in terms of both MASI, showing an objective improvement of melasma after using sunscreens alone and also in Hi-MELASQOL showing that use of sunscreens significantly improved quality of life of melasma patients. In our study, we have attempted to re-instate the importance of sunscreens to patients and dermatologists who are inclining more toward various skin lightening agents for treatment of melasma, which have many side effects.

Atopic dermatitis in Indian children: The influence of lower socioeconomic status.

Atopic dermatitis (AD) is a chronic inflammatory condition afflicting children and adults. In developing countries like India, the scenario is slightly different from its western counterparts, where the disease has been commonly described. Despite running a milder course, AD still has a significant negative impact on the quality of life. Environmental factors have a great influence on pathogenesis. While the diagnosis has remained clinical, variations in minor clinical features have been observed worldwide. Many indigenous and herbal agents are used for its treatment in India, in addition to conventional therapies. Treatment modalities in India emphasize less costly therapies and family education. This contribution reviews the epidemiologic issues and therapeutic differences in the Indian population with AD, highlighting important nuances in the care of the Indian patient.

The role of antimullerian hormone in the hormonal workup of women with persistent acne.

BACKGROUND: In persistent female acne, PCOS (polycystic ovarian syndrome) is a common finding. To diagnose PCOM (polycystic ovarian morphology), transvaginal - USG is required, which is not possible in virginal women. Also, hyperandrogenemia is not consistently reported. OBJECTIVES: The aim of the study was to compare the hormonal profile of persistent acne patients with or without PCOS and to assess the role of AMH (antimullerian hormone) in persistent acne patients. METHODS: A cross-sectional retrospective study of persistent acne patients was undertaken and detailed hormonal assessment and USG was undertaken and patients were divided into two group, those with and without PCOS. The various clinical parameters, AMH and other hormonal levels were compared between the two groups of patients. The predictive value of serum AMH level was evaluated using the receiver operating characteristic (ROC) curve analysis. RESULTS: Of the 112 patients of persistent acne, 40 (34.7%) were described as PCOS. Mean menstrual cycle length, hirsutism, and PCOM (polycystic ovarian morphology) were significantly more in the PCOS group (P < .0001). AMH was significantly higher in the PCOS group of acne patients as compared to the group without PCOS (6.79 ± 2.79 vs. 2.69 ± 1.23, P < 0.001), and an AMH value of 3.6 ng/mL was predictive of PCOM. Apart from the SHBG levels which were low in both groups (normal range 34.3-147 nmol/L), no other hormonal level was deranged. The total testosterone levels were in the high-normal range. CONCLUSIONS: AMH is a good tool to diagnose PCOM in persistent acne patients and can be used as a replacement for TV-USG, although it does not correlate with hyperandrogenemia. Low SHBG levels were the most common finding in persistent acne patients and could explain the hyperandrogenism seen in patients.

A comparative evaluation of the blood clot, platelet-rich plasma, and platelet-rich fibrin in regeneration of necrotic immature permanent teeth: A clinical study.

INTRODUCTION: This study was designed as a clinical trial to evaluate and compare the regenerative potential of platelet-rich fibrin (PRF), platelet-rich plasma (PRP), and blood clot in immature necrotic permanent teeth with or without associated apical periodontitis. METHODS: Access preparation was done under rubber dam isolation. Copious irrigation was done with 2.5% NaOCl and triple antibiotic paste was placed as an intracanal medicament. After 4 weeks, the cases were divided into four groups with five patients in each group. The study design had three test arms and one control arm. Group I in which mineral trioxide aggregate apexification was carried out and it was kept as control group to evaluate the regenerative potential of blood clot and platelet concentrates, Group II in which blood clot was used as scaffold in the canal, Group III in PRF was used as scaffold, and Group IV in which PRP carried on collagen was used as a scaffold. RESULTS: The clinical and radiographic evaluation after 6 and 18 months was done by two independent observers who were blinded from the groups. The scoring was done as: None score was denoted by, Fair by 1, Good by 2, and Excellent by 3. The data were then analyzed statistically by Fisher's exact test using Statistics and Data 11.1(PRP Using harvest Smart PReP2) which showed statistically significant values in Group III as compared to other Groups. CONCLUSION: PRF has huge potential to accelerate the growth characteristics in immature necrotic permanent teeth as compared to PRP and blood clot.

Platelet-rich fibrin-mediated revitalization of immature necrotic tooth.

Contemporary studies have shown that the regeneration of tissues and root elongation is possible in necrotic immature permanent teeth. The purpose of this case report is to add a new vista in regenerative endodontic therapy by using platelet rich fibrin for revitalization of immature non vital tooth. An 11year old boy with the history of trauma was diagnosed with the pulpal necrosis and symptomatic apical periodontitis in tooth #21. Intra oral periapical radiograph showed open apex and associated immature supernumerary tooth with respect to tooth #21. Access preparation and minimal instrumentation was done to remove necrotic debris under copious irrigation with 2.5% sodium hypochlorite. Triple antibiotic paste was packed in the canal for four weeks. During second visit, 5 mL of whole blood was drawn from the medial cubital vein of the patient and blood was then subjected to centrifugation at 2400 rpm for 12 minutes for the preparation of Platelet rich fibrin (PRF) utilizing Choukroun's method. Triple antibiotic paste was removed and canal was dried. PRF clot was pushed to the apical region of tooth #21 using hand pluggers. Three milimetres of Mineral trioxide (MTA) was placed in cervical part of the root canal and permanent restoration was done three days later. Clinical examination at 6 and 12 months revealed no sensitivity to percussion and palpation in tooth #21and it responded positively to both electric pulp and cold tests. Radiographic examination showed resolution of periapical rarefaction, further root development and apical closure of the tooth #21 and its associated supernumerary tooth. On the basis of successful outcome of the present case it can be stated that PRF clot may serve as a scaffold for regeneration of necrotic immature teeth.

3-D diagnosis-assisted management of anomalous mandibular molar.

This case report describes the successful non-surgical endodontic management of carious exposed three-rooted mandibular molar with four root canals detected on the pre-operative radiograph taken with 20 degrees mesial angulation and confirmed with a 64-slice helical computed tomography scan-assisted 3-D-reconstructed images. Access cavity shape was modified to locate the extra canal with respect to the distolingual root in the left mandibular first molar. Copious irrigation was accomplished with 5.25% sodium hypochlorite and 17% EDTA. Biomechanical preparation was done using protapers. Calcium hydroxide dressing was done for 1 week. The tooth was obturated using gutta percha and AH 26 root canal sealer, and it was permanently restored with composite. Clinical examination on follow-up visits revealed no sensitivity to percussion and palpation in the left mandibular first molar. Thorough knowledge of root canal variations and use of advanced diagnostic modalities lead to successful non-surgical management of the complex cases.