Clinical Patterns and Clinicopathologic Correlation of 100 Patients with Erythroderma in a Tertiary Care Institute in India.

Erythroderma is a severe dermatologic manifestation of a variety of diseases. We analyzed the clinical parameters and the clinicopathologic correlation in patients with erythroderma. Consecutive patients diagnosed with erythroderma at a tertiary care institute were evaluated for 5 years. Detailed history and clinical examination were noted along with extensive hematologic and biochemical investigations, radiologic studies, and skin biopsy for histopathologic examination, and if required, for immunoflourescence and immunohistochemistry; 83 men and 17 women were included in the study. Based on microscopic findings, 34 patients were given a diagnosis of psoriasis, 28 of spongiotic dermatitis with predominant eosinophilic infiltrate, five of chronic actinic dermatitis, 18 of drug-induced erythroderma, three of pemphigus foliaceous, and two each of pityriasis rubra pilaris and erythrodermic mycosis fungoides. Histology was inconclusive in five cases, one each of psoriasis, dermatitis, pityriasis rubra pilaris, bullous pemphigoid, and drug eruption. Clinical-pathologic correlation occurred in 78.3% cases. The most common etiologies found in our study were psoriasis, airborne contact dermatitis, and drugs.

Adult-onset Atopic Dermatitis.

Adult-onset atopic dermatitis is still an under recognized condition as there are only few studies regarding this entity. As compared to childhood onset atopic dermatitis, clinical features of adult onset atopic dermatitis are still not categorized. Adult atopic dermatitis can present for the first time in adult age with atypical morphology or may progress from childhood onset. This article reviews the characteristic clinical features of adult atopic dermatitis, associated risk factors and management.

Low-dose oral isotretinoin therapy in lichen planus pigmentosus: an open-label non-randomized prospective pilot study.

BACKGROUND: Lichen planus pigmentosus (LPP) is a cosmetically distressing pigmentary disorder often posing a therapeutic challenge. Isotretinoin has been shown to be effective in oral and cutaneous LP, but its role in LPP is yet unknown. OBJECTIVE: To evaluate the efficacy and safety of isotretinoin in the management of LPP. METHODS: In this prospective study, 32 clinically and histologically proven patients with LPP were recruited. Subjects were treated with fixed low-dose (20 mg/day) oral isotretinoin once daily for 6 months along with topical sunscreens. Response was graded as mild (<25%), moderate (26-50%), and good (>50%) improvement based on decrease in intensity and progression of hyperpigmentation. RESULTS: Twenty-seven patients (17 females and 10 males), aged 20-62 years, completed the study. Twenty-three (85.2%) patients had active disease and pruritus at presentation. Treatment outcome was moderate improvement in 15 patients (55.7%) followed by good in seven (21.8%) and mild in two (6.2%). Pruritus subsided at the earliest at 9-14 days, and disease stabilized by 4-6 weeks in treatment-responsive patients. Patients with a shorter duration (≤5 years) of disease and limited body area involvement had a better outcome. CONCLUSIONS: Low-dose isotretinoin seems to be a promising treatment modality in stabilizing and decreasing the pigmentation in LPP particularly in early and limited disease.

Glycolic Acid peels/azelaic Acid 20% cream combination and low potency triple combination lead to similar reduction in melasma severity in ethnic skin: results of a randomized controlled study.

BACKGROUND: Numerous therapeutic options have been tried in the management of melasma. AIMS AND OBJECTIVES: This prospective randomized study was planned to assess the efficacy of low potency triple combination (TC) cream (TC-hydroquinone 2%/tretinoin 0.05%/fluocinolone 0.01%) versus glycolic acid (GA) peels/azelaic acid (AA) 20% cream (GA/AA) combination in melasma. MATERIALS AND METHODS: Forty patients with melasma were recruited into this study and randomized into two groups. Group A consisting 20 patients received TC cream once a day for night time application for 3 months. Group B comprising of 20 patients received GA/AA 20% cream combination for 3 months. The disease severity was monitored with digital photography, melasma area and severity index (MASI) score, which was calculated at baseline, 6 weeks and 12 weeks, and visual analog scale (VAS) score, which was calculated at baseline and 12 weeks. RESULTS: Of 40 patients, 38 were completed the study. A significant reduction in MASI and VAS was recorded after 6 weeks and 12 weeks of treatment in both groups A and B (P = 0.001). However, there was no significant difference in the mean MASI scores between the two groups at baseline, 6 weeks and 12 weeks. Similarly, there was no difference in the mean VAS scores between the two groups at baseline and 12 weeks. Four patients in group A and 3 in group B experienced adverse effects such as irritation, dryness, and photosensitivity. CONCLUSION: Both low potency TC cream and GA/AA 20% cream combination are effective in treating melasma among Indian patients.

Diagnostic agreement between a primary care physician and a teledermatologist for common dermatological conditions in North India.

BACKGROUND: Primary care physicians (PCPs) encounter a large number of patients with dermatological diseases. However, delivering appropriate management is a challenge considering the inadequate dermatology training offered during the undergraduate medical curriculum. Teledermatology is the clinical evaluation of skin lesions by dermatologists and allows patients to be diagnosed and treated from a distant site. It is seen as a potential solution to the shortage of specialists and providing equitable service in remote areas. AIM: The study was aimed at estimating the diagnostic agreement of common dermatological conditions between a PCP and a teledermatologist. MATERIALS AND METHODS: Consecutive patients with dermatological ailments who attended a primary health care clinic were recruited into the study, examined by the PCP and offered a diagnosis. The clinical images and patients' history were collected and transferred to a dermatologist at a tertiary center who also made a diagnosis. Agreement between diagnosis made by the PCPs and the teledermatologist was measured using kappa (κ) statistics. RESULTS: Overall agreement between the diagnoses made by a PCP and the dermatologist was found to be 56%. Poor κ agreement (<0.4) was seen in the diagnosis of psoriasis and eczema. CONCLUSION: Teledermatology can supplement specialist dermatology service in remote areas. There was poor agreement in the diagnosis of psoriasis, classifying various types of eczematous conditions and fungal infections. Scarce manpower in dermatology at the primary health care level compounded by the burden of skin ailments necessitates training of PCPs in common dermatological conditions.

Randomized controlled study to evaluate the effectiveness of dexamethasone oral minipulse therapy versus oral minocycline in patients with active vitiligo vulgaris.

BACKGROUND: Oral minocycline has been recently shown to halt disease progression in active vitiligo. AIMS: The present study was planned to compare the efficacy and tolerability of oral minocycline with oral mini pulse (OMP) corticosteroids in active vitiligo. METHODS: A total of 50 patients with actively spreading vitiligo were randomized to receive either minocycline 100 mg/day (Group I-25 patients) or OMP 2.5 mg dexamethasone on 2 consecutive days in a week (Group II-25 patients) for 6 months. These were followed-up at every 2 weeks interval. Mean vitiligo disease activity score (VIDA) and mean Vitiligo Area Scoring Index (VASI) were assessed in all patients in addition to the photographic comparison before and after treatment. RESULTS: Both groups showed a significant decrease in VIDA from 4.0 to 1.64±0.86 (P<0.001) in Group I and from 4.0 to 1.68±0.69 (P<0.001) in Group II. However, the difference between the mean VIDA scores in the two groups was not statistically significant (P=0.60) at the end of treatment period. The mean VASI declined from 1.71±1.45 to 1.52±1.43 Group I (P=0.06) and from 1.39±1.31 to 1.17±1.34 in Group II (P=0.05). The difference between VASI in Group I and II was not significant at the end of 24 weeks of treatment (P=0.11). CONCLUSION: Both dexamethasone OMP and oral minocycline are effective drugs for managing the arrest of disease activity in vitiligo.

Condyloma lata in a preschooler: The dilemma of sexual abuse versus non-abuse.

It is well-known that syphilis is a sexually-transmitted or an inherited infection. Syphilis in preschoolers is rarely described in modern medical literature. Our case represents the difficulty or dilemma faced by dermatologists after diagnosing syphilis in a girl child due to inability of the young children to provide a history of sexual abuse and more over the parents/guardians also try to hide the history of sexual-abuse. Although rare, we can consider non-sexual transmission after we have thoroughly investigated and ruled out even the remote possibility of sexual abuse, because misdiagnosis of both abuse and non-abuse can be devastating to the patient and family.

Childhood vitiligo: treatment paradigms.

Childhood vitiligo differs from the adults by showing a higher incidence in females, segmental vitiligo being more common and less frequent association with other systemic autoimmune and endocrine disorders. Childhood vitiligo is often associated with a marked psychosocial and long lasting effect on the self-esteem of the affected children and their parents, hence an adequate treatment is very essential. Treatment of vitiligo is indeed a tough challenge for the dermatologists' more so in the background of childhood vitiligo. Although multiple therapeutic modalities are available in the therapeutic armamentarium, not all can be used in children. This brief report updates regarding various therapies available in the treatment of childhood vitiligo.

Mucous membrane pemphigoid with antibodies against ß3 subunit of laminin-332: first report from India.

Mucous membrane pemphigoid (MMP) is a chronic, recurrent, progressive, subepidermal blistering disorder, mainly affecting the mucous membranes. Anti-laminin 332 MMP is a distinct subset of MMP with antibodies, mainly targeted against α3 or γ2 subunit. Antibodies exclusively against ß3 subunit are rarely seen. An internal malignancy is frequently associated with anti-laminin 332 MMP. This disorder usually responds poorly to treatment, requiring multidisciplinary approach. Herein, we describe the first case of anti-laminin-332 MMP from India, which showed antibodies exclusively to ß3 subunit.

Extensive cerebriform nevus sebaceus: an unusual presentation.

Nevus sebaceus is an epidermal nevi composed of sebaceous glands, which usually presents as single yellowish plaque over the head and neck. A rare morphological variant, namely cerebriform nevus sebaceus was first reported in 1998. As with other nevi, the occurrence of nevus sebaceous is related to genetic mosaicism and the shape and distribution of the nevus is determined by the stage at which mosaicism has arisen. We report a patient with cerebriform nevus sebaceus having an unusually widespread distribution over the head, face, and trunk, but without any other organ system involvement.

Pityriasis lichenoides with ulceronecrosis and hyperthermia: a rare variant of pityriasis lichenoides et varioliformis acuta.

Pityriasis lichenoides with ulceronecrosis and hyperthermia (PLUH) is a severe variant of pityriasis lichenoides et varioliformis acuta that is characterized by high fever and papulo-necrotic skin lesions. We report the case of a 49-year-old male with typical features of PLUH along with an unusual manifestation of extensive skin necrosis including involvement of the intertriginous regions. Systemic administration of corticosteroids and antibiotics did not help to control the disease and the patient succumbed to death due to its fulminant nature.

Generalized morphea, lichen sclerosis et atrophicus associated with oral submucosal fibrosis in an adult male.

Generalized morphea is a disease characterized by wide-spread sclerosis of the skin. A 39-year-old man presented with history of multiple pigmented and bound-down plaques on the body along with mucosal involvement. Dermatological examination showed multiple indurated and sclerosed plaques with follicular plugging in few of them and gross thickened eroded and glazed tongue. The constellation of these findings with histopathological correlation led us to diagnosis of this spectrum of cutaneous involvement. The coexistence of localized morphea with lichen sclerosis et atrophicus has been reported earlier but existence of these entities with submucosal fibrosis in a same patient is documented here and is the first of its kind.