Atopic Dermatitis: Clinical Connotations, Especially a Focus on Concomitant Atopic Undertones in Immunocompromised/Susceptible Genetic and Metabolic Disorders.

Atopic dermatitis (AD) is an intriguing clinical entity. Its clinical connotations are varied, the updates of which are required to be done periodically. An attempt to bring its various facets have been made highlighting its clinical features keeping in view the major and the minor criteria to facilitate the diagnosis, differential diagnosis, complications, and associated dermatoses. The benefit of the current dissertation may percolate to the trainees in dermatology, in addition to revelations that atopic undertones in genetic susceptibility and metabolic disorder may provide substantive insight for the future in the understanding of thus far enigmatic etiopathogenesis of AD.

Atopic Dermatitis: A Cross-Sectional (Descriptive) Study of 100 Cases.

BACKGROUND: Atopic dermatitis is a distinct age-related clinical entity. Its etiopathogenesis is largely insubstantial. Nevertheless, it seems to be an outcome of interplay of maternal and inheritance, pregnancy/intrauterine and environmental factors. Besides, immune dysregulation, and nutritional supplements also play essential roles. Its diagnosis has been perpetuated by three or more major/minor criteria. OBJECTIVES: An endeavor to study its demographic and clinical pattern in contemporary prospective. MATERIALS AND METHODS: 100 fresh patients of atopic dermatitis, diagnosed on the basis of an established three or more major and minor criteria, salient presentations of which were recorded in a preset proforma, which also recorded age, duration, age of onset, and sex. Serum immunoglobulin E (IgE) levels were determined by conventional technique. The data thus obtained was analysed to study its clinical pattern and to correlate its severity to IgE levels. RESULTS: Its overall (new and old) prevalence was 0.98%, while that of new patients was 0.24%. 83 (83%) were in the age group of 2-12 years, of which 54 (83.1%) were males and 29 (82.9%) were female, of which 70 (70%) had urban, while 30 (30%) had rural background. Its duration varied from 8 to 192 weeks, with a mean of 76 weeks, and a standard deviation of 21.42 weeks [76 ± 21.42]. CONCLUSION: Atopic dermatitis is a discrete, overt, age and IgE-related entity frequently displaying varying demographic and clinical connotation.

Atopic Dermatitis; Etio-Pathogenesis, An Overview.

Atopic dermatitis is a well-recognized clinical entity, several facets of which continue to be mystified. Accordingly, its etio-pathogenesis is largely elusive. It appears to be an outcome of interplay of several undertones, namely: genetics, maternal factor and inheritance, pregnancy/intrauterine, environmental factors, immune dysregulation, immuno-globulins, role of diet, and infection. Besides, recent innovative breakthroughs consisting of nutritional supplementation, the highlights of which were considered worthwhile to take stock of to define its current status. An endeavor to enlighten the audience has been made for their benefit.

Hair biology and its comprehensive sequence in female pattern baldness: clinical connotation diagnosis and differential diagnosis--Part II.

Hair can become a source of concern when there is a change in its texture, number, and thinning. Although female pattern baldness is common, it has received little attention compared with male pattern baldness. Thinning that affects the vertex is insidious and progressive. Hair loss in women has accordingly been interpreted and classified differently than that in men. The Ludwig scale is the most accepted classification. The gross anatomy and the general microanatomy of the hair follicle, including that of the anagen, catagen, and telogen phase, are presented. The hair growth cycle, encompassing anagen, catagen, telogen, exogen, and kenogen, is also discussed to address pattern hair loss in women and provide therapeutic options that are currently available.

Hair biology and its comprehensive sequence in female pattern baldness: diagnosis and treatment modalities--Part I.

Hair may be a source of concern for patients when there is a change in its texture, amount, or thickness. It can present in women as androgenic alopecia also called female pattern baldness, and in men as adrogenic alopecia, also called male pattern baldness. Thinning/rarefaction affecting the vertex is a progressive condition, and hair loss in women has been interpreted and classified differently from that in men. The Ludwig classification for women's hair loss seems to be the most accepted assessment, which will be outlined in this review, along with the hair growth cycle that encompasses anagen, catagen, telogen, exogen, and kenogen.

Androgenic alopecia in women: an Indian perspective.

The authors sought to investigate androgenic alopecia (AA) utilizing clinical and investigative procedures to establish the pattern of AA in the Indian subcontinent. A total of 35 consecutive women presenting with AA were included. After obtaining informed consent, a detailed history/examination, hair pull test, trichogram, and a scalp biopsy were performed in patients. AA classification was attempted across Ludwig and Norwood guidelines. Of 35 women, 16 had grade I, 10 had grade II, and 1 had grade III Ludwig classification. In addition, 6 other women had Christmas tree baldness: 1 each of fronto-parietal and male pattern baldness. Several investigations including hormonal profile were inconclusive; however, hair pull test and trichogram may be helpful in understanding the sequence in AA in women. AA has infrequently been reported, particularly India and in Asia in general.

Noninsulin-dependent, type II diabetes mellitus-related dermatoses: part II.

Cutaneous complications of noninsulin-dependent, type II diabetes mellitus are reviewed, including diabetic dermopathy, necrobiosis lipoidica diabeticorum, diabetic bullae (bullosis diabeticorum), certain acquired perforating dermatoses, diabetic thick skin, scleredema adultorum, Dupuytren's contractures, certain xanthomas, carotenoderma, rubeosis faciei, and acanthosis nigricans.

Noninsulin-dependent, type II diabetes mellitus-related dermatoses: part I.

Diabetes mellitus is a worldwide public health problem. It manifests as either insulin-dependent or noninsulin-dependent diabetes mellitus. It is associated with several dermatoses, which need to be addressed individually. Dermatoses often provide clues to the status of diabetes. The presence of dermatoses may compound the challenges confronted by the treating physician to modify the management of each patient. Several noninfective and infective dermatoses can act as a forewarning that a particular individual is likely to develop diabetes. This association is highlighted by specific entities, such as necrobiosis lipoidica and granuloma annulare and will be discussed below.

Melasma: treatment strategy.

Melasma, a hypermelanosis of the face, is a common skin problem of middle-aged women of all racial groups, especially with dark complexion. Its precise etio-pathogenesis is evasive, genetic influences, exposure to sunlight, pregnancy, oral contraceptives, estrogen-progesterone therapies, thyroid dysfunction, cosmetics, and drugs have been proposed. Centro-facial, malar, and mandibular are well-recognized. Epidermal pigmentation appears brown/black, while dermal is blue in color, and can be distinguished by Wood's lamp illumination. The difference may be inapparent with mixed type of melasma in skin types V and VI. An increase in melanin in epidermis: basal and suprabasal layers and/or dermis is the prime defect. There is an increased expression of tyrosinase related protein-1 involved in eumelanin synthesis. The use of broad-spectrum sunscreen is important, lightening agents like retinoic acid (tretinoin), azelaic acid, and combination therapies containing hydroquinone, tretinoin, and corticosteroids, have been used in the treatment of melasma, and are thought to have increased efficacy as compared with monotherapy. Quasi-drugs, placental extracts, ellagic acid, chamomilla extract, butylresorcinol, tranexamic acid, methoxy potassium salicylate, adenosine monophosphate disodium salt, dipropyl-biphenyl-2,2'-diol, (4-hydroxyphenyl)-2-butanol, and tranexamic acid cetyl ester hydrochloride, in addition to kojic and ascorbic acid have been used. Chemical peeling is a good adjunct. Laser treatment is worthwhile.

Acrodermatitis continua of Hallopeau: evolution of treatment options.

Ever since its inception, acrodermatitis continua of Hallopeau, has been recognized as an uncommon clinical entity which has been sparingly reported from across the globe. The attempt to have cumulative information on prevalent nomenclature, definition, reminiscences, and clinical overtures has brought differential diagnosis and diagnosis in sharp focus, the highlights of which are outlined. Hence, it was considered important to review the evolution of treatment options available thus far including use of biologics.

Nail biology, morphologic changes, and clinical ramifications: part II.

Nail changes in children have been reviewed in the backdrop of nail biology. The authors review nail changes caused by a variety of cosmetics and ingestion of drugs. Nail biopsy and its significance in the diagnosis is emphasized.

Nail biology, morphologic changes, and clinical ramifications: part I.

The nail, a well-recognized and fascinating appendage of the skin, represents an invaluable clinical means to facilitate the diagnosis of a number of dermatoses; hence, the authors considered it worthwhile to examine the physiopathologic alterations affecting the nail morphology, including shape, attachment, surface, and color. The accurate definitions of nail abnormalities in various cutaneous disorders have been delineated and their clinical ramifications have been recounted.

Hand dermatitis/eczema: current management strategy.

Ever since its inception a couple of centuries ago, hand dermatitis/eczema has been in the reckoning. Idiosyncrasies continued to loom large thereafter, till it acquired its appropriate position. Dermatitis/eczema are synonymous, often used to indicate a polymorphic pattern of the inflammation of the skin, characterized by pruritus, erythema and vesiculation. A spectrum delineated into acute sub-acute and chronic dermatitis of the hands. Pompholyx, recurrent focal palmer peeling, ring, wear and tear and fingertip eczema, apron, discoid eczema, chronic acral dermatitis, gut and patchy papulosquamous eczema are its clinical variants. Occupational dermatitis/eczema may be contributory. Etiological definitions are clinched by detailed history of exogenous and endogenous factors. However, scientific confirmation of the entity is through patch testing by using available antigens.

Plexiform neurofibromas in neurofibromatosis type 1.

Plexiform neurofibroma developing in neurofibromatosis type 1 is a fascinating overture whereby diagnosis is primarily based on clinical characteristics, the details of which are outlined. Nonetheless, it is imperative to establish a clear-cut clinical status vis-á-vis the adjoining tissues. Magnetic resonance imaging (MRI) may provide an additional supplement to the diagnosis and an aid to further management of the condition.

Psoriasiform dermatoses.

Psoriasiform reaction pattern is a commonly encountered denominator in a wide variety of unrelated disorders. It may be a reaction to either the internal or the external environmental, allergic, infective, parasitic, bacterial, fungal, viral and/or malignant stimuli. The degree of evolution of such a pattern and its significance vary according to the dermatosis. The age of the skin lesions may also influence the histopathological presentation and its clinico-histopathological disparity can often bewilder an expert. However, such a situation warrants more astute and sustained observations to unveil the exact underlying condition(s). Thus, psoriasiform dermatoses should only be an initial caption until an exact dermatological disorder is defined. There has been greater number of instances of psoriasiform drug eruptions where a confirmation of the diagnosis can be achieved after their remission by doing a provocation test. Similarly, such instances have also been on the rise in HIV/AIDS-affected individuals all over the world. Besides mycosis fungoides and Hodgkin's disease, several unrelated malignancies have been preceded or accompanied by psoriasiform skin eruptions.

Parapsoriasis: a complex issue.

Parapsoriasis is a peculiar reaction pattern of the skin that appears to have a spectrum with small plaque parapsoriasis at one end and large plaque at the other. The spectrum between is bridged by pityriasis lichenoides, pityriasis lichenoides chronica, pityriasis lichenoides et varioliformis acuta, and lymphomatoid papulosis. The highlights of the clinical pattern of these diseases has been succinctly elucidated here to facilitate their recognition in day-to-day dermatologic practice. Their possible etiopathogenesis has been brought to focus in the light of changing concepts reported in the literature. Further, possible future implications demand a meticulous follow-up because, in a few cases, true neoplasms may ultimately develop. Treatment modalities are briefly discussed.