Aluminium in dermatology - Inside story of an innocuous metal.

Aluminium, the third most abundant element in the earth's crust, was long considered virtually innocuous to humans but has gained importance in the recent past. Aluminium is ubiquitous in the environment, with various sources of exposure like cosmetics, the food industry, occupational industries, the medical field, transport and electronics. Aluminium finds its utility in various aspects of dermatology as an effective haemostatic agent, anti-perspirant and astringent. Aluminium has a pivotal role to play in wound healing, calciphylaxis, photodynamic therapy and vaccine immunotherapy with diagnostic importance in Finn chamber patch testing and confocal microscopy. The metal also finds significance in cosmetic procedures like microdermabrasion and as an Nd:YAG laser component. It is important to explore the allergic properties of aluminium, as in contact dermatitis and vaccine granulomas. The controversial role of aluminium in breast cancer and breast cysts also needs to be evaluated by further studies.

Spesolimab: a comprehensive review on the anti-IL-36 receptor antibody in dermatology.

Interleukin-36 (IL-36) cytokines contribute to the pathogenesis of various inflammatory skin conditions and are potential therapeutic targets. Spesolimab is a monoclonal antibody that inhibits IL-36 signaling recently approved by the Food and Drug Administration for the management of generalized pustular psoriasis flares in adults. Clinical trials are evaluating the efficacy of this monoclonal antibody in a few other dermatological conditions. Here, this review comprehensively summarizes the safety and efficacy of spesolimab treatment in various dermatological conditions.

Dermatological adverse effects of hair dye use: A narrative review.

Hair dyeing is a popular practice dating back to ancient Egyptian times. Initially, hair dye use was restricted to concealing grey and white hairs of the elderly population. However, in recent times, its use is common among the younger generation as a fashion statement. Hair dye contact dermatitis is a common dermatological condition encountered by dermatologists. It is a delayed type of hypersensitivity reaction that commonly affects the scalp and the vicinity of hair line and neck. Para-phenylenediamine (PPD), a synthetic aromatic amine is the most common allergen specifically implicated in hair dye contact dermatitis. Para-phenylenediamine was announced as the allergen of the year in 2006 by the American Contact Dermatitis Society. Contact allergy to para-phenylenediamine can occur in 0.1-2.3% of the general population. Epicutaneous patch testing is the gold standard test for the diagnosis of hair dye contact dermatitis. However, para-phenylenediamine carries a risk of cross-sensitivity and co-sensitization to other allergens. Apart from contact dermatitis, hair dye use is also associated with various other cutaneous adverse effects such as pigmentary changes, hair loss, skin malignancies and autoimmune disorders. Due to the various adverse effects associated with hair dye use, it is prudent to look for safer alternatives to allergenic hair dyes. In this article, we review the epidemiology, cutaneous and systemic adverse effects associated with hair dye use, patch testing, preventive strategies to minimize the risk of hair dye contact dermatitis, and treatment aspects.

Dyschromatosis universalis hereditaria.

Reticulate pigmentary dyschromatoses primarily include dyschromatosis universalis hereditaria (DUH), dyschromatosis symmetrica hereditaria (DSH) (Reticulate acropigmentation of Dohi), and unilateral dermatomal pigmentary dermatosis, which differ in their patterns of distribution. The disease was initially described by Ichikawa and Hiraga in Germany in 1933. The prevalence of DUH is 0.3 per 100,000 with a female preponderance. The skin lesions usually appear in infancy or early childhood and cease to progress beyond adolescence. The subtypes DUH 1 and DUH 3 are found to have autosomal dominant inheritance, which is the most common inheritance pattern, while DUH 2 has an autosomal recessive pattern. The most common gene involved in DUH is ABCB6, while the other genes include SASH 1, PER 3, and KITLG (DUH type 2). DUH is characterized by multiple irregular hyperpigmented macules interspersed with hypopigmented macules in a mottled pattern over the trunk and extremities. The face is involved in 50% of individuals. Rarely, it can also involve hairs, nails, mucous membranes, palms, and soles. Other varied presentations include localized forms, localization of lesions to sun-exposed areas, large macules, uniform palmar hypopigmentation, diffuse hyperpigmentation with spotty depigmented macules, and unilateral involvement. DUH has been reported to be associated with various cutaneous and systemic diseases. The authors have observed cases of DUH associated with hepatocellular carcinoma, solitary keratoacanthoma, and dermoid cyst. The various diagnostic modalities include dermoscopy, histopathology, electron microscopy, and targeted gene sequencing. Though various treatment modalities like NBUVB and lasers have been tried, no treatment is promising.

Turmeric: The Yellow Allergen.

Turmeric is the dried rhizome of Curcuma longa Linn which is extensively used in Indian culture. Curcumin is its most active pharmaceutical component. Turmeric use is very closely related with the socio-religious life of the population. Topical application of turmeric is a very common practice in the daily lives and auspicious occasions in South India. However, the allergenic potential of this commonly used spice is mentioned in various case reports and studies. The dermatologists and patients should be aware of the possible allergic reactions of this widely used herb. The purpose of this review is to give a brief overview of allergenic potential of this commonly used spice.

Pitted keratolysis.

Pitted keratolysis (PK) is a common superficial bacterial skin infection confined to the stratum corneum. It is clinically characterized by multifocal, discrete, pits or crater-like punched-out lesions, commonly over the pressure-bearing aspects of the foot. It is asymptomatic and associated with malodour. The surface is often moist and macerated. The diagnosis of PK is often clinical and diagnostic procedures are usually unnecessary. Lifestyle modifications form the cornerstone of the management of PK. It responds well to topical antimicrobials.

Contact sensitizers in commercial hair dye products in the Indian market: A consumer exposure study.

BACKGROUND: Hair dye is a concoction of various ingredients that can result in allergic contact dermatitis (ACD) which is a common problem encountered by dermatologists. OBJECTIVES: To find out the presence of potent contact sensitizers in commercially available hair dyes in Puducherry, a union territory in South India, and to compare the findings with similar studies conducted in different countries. METHODS: Ingredients labels of 159 hair dye products from 30 brands that were manufactured and marketed in India screened for the presence of contact sensitizers. RESULTS: A total of 25 potent contact sensitizers were found in 159 hair dye products. p-Phenylenediamine and resorcinol were the most frequent contact sensitizer found in the study. The mean contact sensitizer concentration in a single hair dye product is 3.72 ± 1.81. The number of potent contact sensitizers in individual hair dye products ranged from 1 to 10. CONCLUSION: We observed that most of the consumer-available hair dyes contain multiple contact sensitizers. Also, an inadequacy in mentioning the p-Phenylenediamine content, and appropriate warning contents regarding hair dye use were not mentioned in the cartons.

Mind Mapping as a Novel Method in Teaching the Morphology of Skin Lesions: A Quasi-Experimental Study.

Introduction: Mind mapping is a visual mapping technique used in a few disciplines of medical education to represent ideas linked to and arranged around a central core idea or topic through different subtopics/categories. We aimed to utilize this technique to teach the undergraduate medical students the morphology of skin lesions and assess its effectiveness. Methods: This pre- and post-test quasi-experimental study was done among 144 undergraduate medical students. A total of 144 students were selected, and odd and even roll numbers were categorized into two groups using simple random sampling. Group 1 (intervention group) students were taught using mind mapping technique and Group 2 (control group) with traditional lecture-based teaching. A Computer-Assisted pre-test and post-test were carried out. A feedback questionnaire was administered to the intervention group to explore the students' perceptions regarding mind mapping as a learning tool. The data were analysed using SPSS software (version 16), and the difference in the mean pre- and post-test scores was found using independent sampled-t-test. Results: Pre and post-test score distribution was 5.04±1.27 and 11.44±2.52 (p-value=<0.001), respectively, in the intervention group. In the control group, the pre and post-test score distributions were 4.83±1.39 and 8.04±1.63, respectively. The mean rank of the mind mapping group was higher (76.43) than the lecture group (67.5). Among the students, 97.2% agreed on the fact that mind mapping enhanced their interest in learning, and 91.7% of the students were satisfied with mind mapping as the learning method. Conclusion: To kindle the interest and develop critical thinking skills in students, faculty members should continue to explore and evaluate the efficacy of various learning and teaching strategies. Mind mapping could be a novel and integral part of conventional teaching techniques in medical education as evidenced by our student's performances.

Linear focal elastosis.

Linear focal elastosis (LFE) is an uncommon, benign, acquired elastotic condition with uncertain pathogenesis. It is characterized clinically by asymptomatic, multiple, yellowish, elevated, irregularly indurated, striae-like lines or bands distributed horizontally across the lower and middle part of the posterior trunk. The histopathological hallmark of LFE is a focal increase of elastic fibres in the dermis. The differential diagnosis is varied, and striae distensae is the closest mimic of LFE. Response of LFE to treatment is often poor. The focus of this article is to provide insights into this condition for dermatologists.

Miliaria crystallina.

Miliaria crystallina (MC) is an uncommon form of a sweat retention syndrome that chiefly affects neonates. It is more common in hot and humid conditions, such as in tropical regions. It commonly presents as clusters of dewdrop-like vesicles on a nonerythematous base that heals with furfuraceous scaling. A clinical diagnosis is often sufficient. The differential diagnosis is wide and varying. One of the hallmarks of MC is its self-limiting nature. The purpose of this review is to increase awareness of this condition among physicians and dermatologists.

Dermatosis Neglecta: A Retrospective Study at a Tertiary Care Center in Southern India.

Background: Dermatosis neglecta (DN) is an acquired skin condition that occurs due to unconscious neglect of self-cleaning in individuals with some underlying risk factor. Aims and Objectives: The purpose of this study was to summarize the demographic, clinical characteristics, and treatment outcomes of patients with DN in a tertiary care center. Methods: We evaluated the medical records of 28 patients with DN who were diagnosed and treated in our center between August 2020 and July 2022. The retrospective data related to demographic details, duration of lesions, morphology, distribution of lesions, associated symptoms, history of cleanliness, a risk factor for the development of the condition, treatment provided, and the details of follow-up were taken into account and analyzed. Results: Of the 28 patients, there were 19 males and nine females. The most common site in our study was the anterior trunk (n = 7) followed by the posterior trunk (n = 6). The most common site to develop DN was a recent surgical site. Soap and water cleansing resulted in the removal of lesions in the majority of the patients. Recurrence was observed in two patients. Conclusion: Our study indicates that the frequency of this condition is often underestimated and under-reported. To the best of our knowledge, this is the largest case series of DN in the medical literature.

Acquired Fibrokeratoma: A Retrospective Study in a Tertiary Centre in South India.

Background: Acquired fibrokeratoma (AFK) is an uncommon, sporadic, benign, acquired, slow-growing dermo-epidermal tumour. Aims and Objectives: The purpose of this study was to summarize the demographic, clinical characteristics and treatment outcomes of patients with AFK in a tertiary care centre in South India. Methods: We evaluated the records of 26 patients with AFK who were diagnosed and treated in our centre between January 2017 and December 2021. The retrospective data related to age, sex, occupation, consistency, duration of lesions, history of trauma, anatomical site, morphological appearance, histopathological type, treatment provided and recurrence were taken into account and analysed. Results: Of the 26 patients, there were 21 males and 5 females. Fingers (n = 23) were the most common site involved, followed by toes (n = 2) and palm (n = 1). A total of 18 patients had finger-like projected lesions and eight patients had dome-shaped lesions. In histopathology, Type I AFK type was observed in 16 cases and Type II in 10 cases. Conclusion: We believe that our study would contribute by providing the clinical, histopathology and treatment outcomes of this uncommon dermo-epidermal tumour. The frequency of this condition is often underestimated as it is misdiagnosed for many other dermatological conditions.