Fractional Laser Resurfacing for Acne Scars: Our Experience at Tertiary Care Hospital of North India.

Background: Acne is very common among adolescents, which may sometimes persist into adulthood, and acne scars continue to have a profoundly negative impact on quality of life. Of all the various modalities available, fractional lasers have shown effective results. Aims and Objectives: The aim of this study was to assess the efficacy and safety of fractional carbon dioxide (CO2) laser resurfacing in atrophic facial acne scars. Materials and Methods: The study included 104 subjects aged ≥18 years with atrophic acne scars on face of more than 6 months of duration recruited over a period of 1 year. All the patients were treated with fractional CO2 laser (600 W power and wavelength 10,600 nm). Four sessions of fractional CO2 laser resurfacing were done at 6-week intervals in each patient. We compared the improvement rate of scars after every session at 6-week interval, 2 weeks after the last session, and finally 6 months after the last laser session. Results: The difference between the mean baseline score (3.43) and mean final score (1.83) using Goodman and Baron's qualitative scar scale was found to be statistically significant (P = 0.001). Mean improvement increased from first treatment session to the end of the treatment course from 0.56 to 1.62 indicating the role of the number of sessions in the overall improvement of acne scars. With regard to overall satisfaction, maximum number of patients were either very satisfied (55.8%) or satisfied (25%) as compared to those who were only slightly satisfied (11.5%) or completely unsatisfied (7.7%). Conclusion: Fractional ablative laser gives excellent results in the management of acne scars and has emerged as an appealing non-invasive option for this indication. Being a safe and effective option for atrophic acne scar treatment, it can be recommended wherever available.

Diagnostic Utility of Nailfold Capillaroscopy using Hand-held Dermoscope in Systemic Sclerosis.

Introduction: The pathogenesis in systemic sclerosis (SSc) mainly involves vascular injury, fibrosis, and immune activation. Visualization of these microvascular changes by nailfold capillaroscopy (NFC) can help in the early diagnosis of the disease. Even though the gold standard for NFC is a videodermoscope, the ease, practicality, and accessibility make the hand-held dermoscope a more versatile and suitable device in the hands of the dermatologists in the busy outpatient department. Aim: To study the pattern of nail fold capillaries using hand-held dermoscope in the patients of SSc and correlate the findings with disease severity. Materials and Methods: An observational, cross-sectional hospital-based study was carried out over a span of 2 years, from January 2020 till December 2021, in 50 patients of SSc. NFC using DermLite DL4 was performed in all the patients and distribution, morphology, density of capillaries, and nail fold capillary pattern were observed. Results: Out of 50 patients, 38 patients had diffuse type of disease, and 12 had limited type of disease. The mean capillary density in our patients was 4.7 ± 0.81/mm. Dilated capillaries was the most common NFC finding (80%), whereas active scleroderma pattern was the most common pattern (56%). A significant association was found between the type of capillary pattern and duration of disease, type of disease, and cutaneous manifestations. Conclusion: Hand-held dermoscope is reliable, practical, and assessable tool that aids in early diagnosis of the disease and also helps in assessing the severity and prognosis of SSc.

Profile of Dermatological Disorders Among Workers Involved in Fruit Growing Industry of Kashmir Valley in North India.

Introduction: Skin disorders represent a major proportion of occupational disorders. Dermatoses are becoming a source of concern in various population groups. In Kashmir valley, a large number of people are associated directly or indirectly with horticulture. Fruit cultivation is the main occupation of around 33 lakh people in the Union Territory. Aim: To study the profile of dermatological disorders in workers involved in fruit growing industry of Kashmir valley. Materials and Methods: This study was a cross-sectional observational study, carried out over a period of 2 years, in which 701 workers of fruit growing industry of Kashmir valley were screened. Results: 276 (39.37%) of these workers were found to have skin lesions while the rest, that is, 425 (60.63%) were not found to have any dermatoses. Out of the total dermatological lesions observed, occupational dermatoses contributed to 94 cases (34.05%), while non-occupational dermatoses accounted for 182 cases (65.94%). Among the occupational dermatoses, friction-related disorders (callosities and cuts) were predominant (15.9%) followed by allergic (12%) and irritant contact dermatitis (6.2%). Out of the non-occupational dermatoses group, the major portion was comprised by polymorphic light eruption (6.2%) in non-infectious type while in infectious type, onychomycoses predominated (3.3%). Conclusion: Dermatological conditions form a major group of occupational dermatoses among workers involved in fruit cultivation.

Clinical Pattern and Patch Test Profile of Hand Eczema in Hospital Employees in a Tertiary Care Hospital of North India.

INTRODUCTION: Health care workers form an important occupational group with a high risk of hand eczema. All health care professionals are exposed to a variety of allergens and irritants which can cause hand dermatitis, resulting in significant morbidity. AIMS AND OBJECTIVES: To assess the clinical profile of hand eczema in hospital employees, to perform patch test in relevant cases and to find out the most common sensitizers in them. MATERIALS AND METHODS: This was a cross-sectional, hospital-based study in which the staff was screened for features of hand eczema and patch testing was done in the suspected cases of allergic contact dermatitis. RESULTS: Out of 340 employees screened, 46 employees (13.5%) suffered from hand eczema. The most common type was wear and tear dermatitis accounting for 17 (36.9%) cases, followed by discoid eczema, pompholyx, focal palmar peeling, finger-tip eczema, hyperkeratotic eczema, ring eczema, and unspecified types. Patch testing was positive in 15 (32.6%) cases. The most common allergen was paraphenylene diamine, followed by fragrance mix, nitrofurazone, mercaptobenzothiazole, potassium bichromate, black rubber mix, and thiuram mix. A statistically significant association (0.001) was found with an underlying history of atopy. CONCLUSION: Hand eczema is a commonly encountered dermatological complaint in many hospital employees. Proper counseling, work, up, patch testing, and treatment can mitigate the symptoms in such employees.

Prevalence of Cold Dermatoses in Kashmir Valley: A Cross-Sectional Study from North India.

BACKGROUND: Often quoted as "heaven on earth," Kashmir forms one of the two divisions of the Union territory of Jammu and Kashmir. A high-altitude region with abundant precipitation and snowfall, the people of Kashmir experience peculiar dermatoses not commonly seen in the majorly tropical subcontinent of India. In this study, we focussed on cold dermatoses as a comprehensive cluster and attempted to study them as a group. AIMS: To determine the prevalence of cold dermatoses in Kashmir valley and study their epidemiological characteristics. METHODS: This observational, cross-sectional community-based study was conducted on native Kashmiri population in three districts of the valley, exclusively during the winter season of the year 2016-17 and 2017-18. The data were tabulated and analyzed with Chi-square test for discrete variables and t-test for continuous variables, using OpenEpi. A P value of less than 0.05 was taken as significant. RESULTS: The study included a total of 1200 cases with 602 males and 598 females. Perniosis was most commonly encountered dermatoses in our study with a prevalence of 12.2%. Frostbite had a prevalence of 0.83%. Raynaud's phenomenon and asteatotic eczema were seen in 1.5% and 1.67% of the population, respectively. Cold panniculitis, cold urticaria, and livedo reticularis were each seen in 0.08% of the population. CONCLUSIONS: Cold dermatoses form an important source of morbidity among the native population of Kashmir. These can be easily prevented by ensuring adequate protection against cold. Creating awareness regarding these disorders and probable association with connective tissue disorders is also imperative.

Clinicoepidemiological and Patch Test Profile of Patients Attending the Contact Dermatitis Clinic of a Tertiary Care Hospital in North India: A 7-Year Retrospective Study.

INTRODUCTION: Allergic contact dermatitis (ACD) is a growing concern due to increased use of cosmetics and topical medications routinely and exposure to a large number of allergens on day-to-day basis. Patch testing is a reliable method for detecting the causative antigens in suspected cases. AIMS AND OBJECTIVES: To assess the demographic profile, pattern of ACD, and patch test profile of suspected cases of ACD attending contact dermatitis clinic of our department. MATERIALS AND METHODS: It was a retrospective study in which all the data enrolled in the contact dermatitis clinic of our department over a 7-year period were analyzed. Patch testing was done using the Indian Standard Series of 20 antigens primarily, and other batteries were used depending on patient requirement and availability. RESULTS: A total of 582 patients were enrolled in the contact dermatitis clinic over a period of 7 years. Hand eczema was the most common pattern seen in 268 cases followed by feet eczema, hand and foot eczema, facial eczema, forearm and leg eczema and photoallergic contact eczema. A total of 177 patients (30.4%) gave positive patch test results, with nickel sulfate being the most common allergen identified followed by potassium dichromate, cobalt sulfate, paraphenylenediamine, neomycin sulfate, and fragrance mix. CONCLUSION: Common allergens identified in our study were more or less similar to studies from other parts of India. However, due to the unique climate of the valley, the profile of parthenium sensitivity was low in our study when compared to the rest of the country.

Fractional Carbon Dioxide Laser in Combination with Topical Corticosteroid Application in Resistant Alopecia Areata: A Case Series.

INTRODUCTION: Intradermal steroid injections are used as treatment option in resistant alopecia areata. However, it is difficult and quite painful to treat large areas of alopecia with this modality. OBJECTIVE: To assess the efficacy and safety profile of a combination of fractional carbon dioxide (CO2) treatment followed by topical corticosteroid application in resistant alopecia areata. MATERIALS AND METHODS: Ten cases of resistant alopecia areata who had not responded to multiple treatment modalities were treated with fractional CO2 laser followed by topical application of triamcinolone spray (10mg/mL) on the resistant lesions. Patients received 4-8 sessions that were repeated at an interval of 3-4 weeks. Response to treatment was assessed on a quartile physician assessment scale and labeled as excellent (>75% regrowth), good (50%-75% regrowth), fair (26%-50% response), and poor (<25% regrowth). RESULTS: Eight of these ten cases completed the treatment process. Seven of these eight patients had complete recovery of the area treated. One patient however did not show good response even after four sessions. No significant adverse effects were noted in any of the patients. CONCLUSION: Fractional CO2 laser in combination with topical triamcinolone can prove to be an effective treatment option in resistant alopecia areata.

Histopathological examination of nail clippings using PAS staining (HPE-PAS): gold standard in diagnosis of Onychomycosis.

Onychomycosis is fungal infection of one or more of the nail units. However, because fungi cause only about half of all nail dystrophies, the use of appropriate diagnostic techniques is important to ensure correct diagnosis and treatment. Aim of the present study was to compare direct microscopy, culture and HPE-PAS for diagnosis of onychomycosis by evaluating their sensitivity and various other relevant statistical parameters. A prospective, hospital-based, cross-sectional study was conducted on 216 patients with a high degree of clinical suspicion of onychomycosis. Nail specimens were evaluated using three diagnostic methods, i.e. direct microscopy using 20% Potassium hydroxide (KOH) & 40% Di-methyl-suphoxide (DMSO), culture and histopathological examination using PAS stain (HPE-PAS). Of 216 patients direct microscopy was positive in 138 (63.9%), culture in 147 (68%) and HPE-PAS in 164 patients (76%). One hundred and seventy-nine patients fitted into the criteria set for confirmed diagnosis of onychomycosis. Using this as a denominator; direct microscopy, culture and HPE-PAS had sensitivities of 77.1%, 70% and 91.6% respectively. Also, HPE-PAS showed the highest sensitivity of 94.7% in 19 cases with prediagnostic antimycotic treatment compared to direct microscopy (42.1%) or culture (57.9%). HPE-PAS shows high sensitivity for diagnosis of onychomycosis and can be considered as a gold standard in the diagnosis of onychomycosis.