Footwear Contact Dermatitis: A Prospective Cross-Sectional Study of 108 Outpatients from Delhi, India.

Footwear contact dermatitis is a common problem with multifactorial exogenous, as well as endogenous, etiologies. Patch testing is the gold standard for detection of the possible contactants. A cross-sectional study was conducted in 108 outpatients over a period of 18 months. Demographic data comprising age, sex, and occupation were collected. Details of clinical and laboratory investigations were used to define the incriminating ingredient(s), subsequently confirmed by patch test using Indian standard and footwear series approved by the Contact and Occupational Dermatitis Forum of India. Reading and interpretation were carried out according to the International Contact Dermatitis Research Group (ICDRG) guidelines. Of the 108 patients, 64 were girls or women and 44 boys or men. Although footwear contact dermatitis affected all age groups, most individuals were 21 to 40 years old. The morphology and distribution of the lesions were very specific. Patch testing was helpful, the primary sensitizing agent being mercapto mix, followed by mercaptobenzothiazole, potassium dichromate, and paraphenylenediamine. Footwear contact dermatitis is an extraordinary entity, requiring a high level of expertise (or knowledge) to determine its etiology through history, clinical examination, and patch testing.

Oral Mucosal Lesions in a Cross-Sectional Study of 200 Dermatologic Outpatients.

Oral mucosal lesions (OMLs) present with a variety of manifestations, emanating largely from tobacco chewing, smoking, and consumption of alcohol. Evolution of the lesions may be facilitated by poor oral hygiene and restorative dental materials, as well as by trauma, infections, and immune-mediated diseases. Two hundred consecutive patients seen at a pre-eminent dermatologic clinic formed the study group. They were interviewed about clinical manifestations, duration of the lesion, patient's age and sex, and incriminating factors. After informed consent had been gained, a thorough clinical examination was performed to define the precise morphology, site, and distribution of lesions. Confirmation of the clinical diagnosis by histopathology and other relevant techniques was confirmed.

Oral Lichen Planus: A Cross-Sectional/Descriptive Study of 33 Patients.

Oral lichen planus (OLP), a well-known entity, is often neglected; however, its assessment is considered essential for evolving future strategies for treatment. Thirty-three patients with OLP from 200 consecutive patients with oral mucosal lesions were studied according to demography. Tobacco chewing, smoking, and alcohol intake were recorded. Examination of the oral cavity, using a head light and tongue depressor, was undertaken to define the morphology of the lesion(s). Colored photographs were an essential part of the process. OLP, a frequently encountered manifestation of oral mucosal lesions, was responsible for 16.50% of the total number of lesions. There was a preponderance of lesions in women aged 40 to 59 years, in contrast to men in the same age group. The duration of the lesions was variable, and tobacco chewing/smoking and amalgam fillings might have exacerbated them. Morphology ranged from a reticular, erythematous pattern to an erosive one. The diagnosis is largely clinical, but it can be confirmed by histopathology.

Footwear Dermatitis: Diagnosis and Management-Part III.

Footwear dermatitis is an entity with clear clinical features, and the confirmation of its diagnosis is vital. The authors review several tools used for its diagnosis to facilitate appropriate and timely management.

Oral Mucosal Lesions: Miscellaneous-Part III.

Oral mucosal lesions are a common occurrence in dermatology. In part III of this series, the authors discuss the epidemiology and etiopathology of these lesions, including clinical classifications, modifying factors, and incriminating agents.

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.

Palmoplantar Keratoderma as a Variant of Lichen Planus.

A 52-year-old air conditioner mechanic presented with progressively itchy grayish white eruptions affecting the skin and mucous membranes, including his palms and soles for the past 2 months. The inner aspects of the palms and weight-bearing areas of the soles were the initial sites of presentation, resulting in a diffuse thickness of the palms and soles, which inhibited his everyday activity. The eruptions were asymptomatic but conspicuous. There was marked presence of multiple erythematous to grayish white (violaceous) flat-topped polygonal papules of varying sizes, with a few coalescing to form plaques. The papules varied in size from 5 mm to 4 cm and had prominent adherent scales on top when examined after smearing with mineral oil. Koebnerization was seen over the shin. The lesions were found on the wrists, forearms, ankles, legs, and thighs. There was a yellow to brown thick symmetric hyperkeratosis of the palms and soles, including the medial and lateral aspect of the fingers and toes, sparing the dorsal surfaces of the hands and feet (Figure 1). In addition, the medial arch and weight-bearing region of both soles were involved. The nails showed subungual hyperkeratosis, nail plate discoloration, and paronychia of the toes and fingers. Hyperkeratosis and scaly plaques were also identified in the web spaces (Figure 2). The buccal mucosa showed symmetrical white plaques with a lacy white pattern.

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.

Oral Mucosal Lesions: Oral Cavity Biology-Part I.

It is important to evaluate the background of oral cavity biology to define morphologic abrasions in oral mucosa following a host of local and/ or systemic disorders. The oral cavity is not only the beginning of the digestive system, but it also plays a significant role in communication; the voice (although the voice is produced in the throat), tongue, lips, and jaw are its essential components to produce the range of sounds. The vestibule and the oral cavity are its major parts, and are usually moist. The lips and the teeth are in approximation, marking its start up. The anatomy of the oral cavity in brief has been reviewed in right prospective for disease related changed morphology, thus facilitating interpretation.

Oral Mucosal Lesions: Oral Lichen Planus and Lichenoid Tissue Reaction/Interface Dermatitis-Part II.

In order to succinctly interpret the clinical undertones of oral lichen planus and lichenoid tissue reaction/interface dermatitis, the well-recognized oral mucosal lesions, it is mandatory to comprehend oral cavity biology in the right perspective, the clinical connotations of which have been highlighted in perspective to facilitate diagnosis. In addition, a focus is formed on systemic association. Additionally, the imperative of salient histopathology in the diagnosis is emphasized for instant reference.

Footwear dermatitis: historical background, epidemiology, clinical connotation-Part II.

Footwear dermatitis is a disabling condition that is identified by blistering and/or weeping feet that may become secondarily infected and painful. Fissuring is a common feature, resulting in an inability to walk, and it may prevent the wearing of footwear, especially when shoes are the cause of the dermatosis. In the absence of adequate care and therapy, footwear dermatitis may turn into a chronic distressing disease that largely effects the daily quality of life of patients.

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.

Evaluation of genetic fidelity among micropropagated plants of Gloriosa superba L. using DNA-based markers--a potential medicinal plant.

Malabar glory lily (Gloriosa superba L.) is a medicinally potent plant species used for the production of alkaloid colchicine. With ever increasing demand, there is a pressing need to conserve it through biotechnological approaches. A large number of complete plantlets were obtained by direct regeneration from the non-dormant tuber explants on Murashige and Skoog (MS) medium supplemented with 2.0 mg/l 6-benzylaminopurine (BAP)+0.5 mg/l α-naphthalene acetic acid (NAA). Large number of plants can be produced in vitro under aseptic conditions, but there is always a danger of producing somaclonal variants by tissue culture technology. Thus, the genetic stability of micropropagated clones was evaluated using random amplified polymorphic DNA (RAPD) and inter simple sequence repeat (ISSR) analysis. During the study a total of 80 (50 RAPD and 30 ISSR) primers were screened, out of which 10 RAPD and 7 ISSR primers produced a total of 98 (49 RAPD and 49 ISSR) clear, distinct and reproducible amplicons. The amplification products of the regenerated plants showed similar banding patterns to that of the mother plant thus demonstrating the homogeneity of the micropropagated plants. This is the first report that evaluates the use of genetic markers to establish genetic fidelity of micropropagated G. superba using RAPD and ISSR, which can be successfully applied for the mass multiplication, germplasm conservation and further genetic transformation assays for colchicine production to meet the ever increasing demand of this medicinally potent plant for industrial and pharmaceutical uses.

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.