The clinicoaetiological, hormonal and histopathological characteristics of melasma in men.

BACKGROUND: Melasma is relatively uncommon in males, and there is a paucity of data on male melasma, including its clinical pattern, triggering factors, endocrine profile and histopathological findings. AIM: To characterize the clinical findings and aetiological factors, including hormonal and histopathological features, of male melasma. METHODS: Male patients with melasma and age- and sex-matched healthy controls (HCs) were recruited. Demographic profile, risk factors, clinical pattern and Wood lamp findings of patients were recorded. Sera were obtained from patients and HCs to determine hormone levels. Biopsy specimens were obtained from lesional and adjacent nonlesional skin. RESULTS: In total, 50 male patients with melasma and 20 HCs were recruited into the study. Mean age of patients was 27.58 ± 4.51 years. The most common clinical pattern of melasma was malar, which occurred in 52% of cases. Positive family history was present in 16% of patients, while 34% had disease aggravation with sun exposure and 62% used mustard oil for hair growth and/or as an emollient. Wood lamp examination revealed epidermal-type melasma in 54% of patients. There were no significant differences in hormone levels between patients and HCs. Histologically, epidermal melanin, elastotic degeneration, vascular proliferation and mast cells were more pronounced in lesional compared with nonlesional skin. Absent to weak expression of oestrogen receptors, progesterone receptors and stem cell factor was observed in lesional skin. CONCLUSION: Ultraviolet light and mustard oil are important causative factors in male melasma. Although stress and family history may contribute, hormonal factors possibly have no role. Quantitative analysis of immunohistochemical markers would provide insight in understanding the pathogenesis of melasma.

Correlation between salivary and serum anti-desmoglein 1 and 3 antibody titres using ELISA and between anti-desmoglein levels and disease severity in pemphigus vulgaris.

ELISA for anti-desmoglein antibodies (Dsg) is commonly used for diagnosis and assessment of treatment response in pemphigus vulgaris (PV). The present study was conducted to assess the relationship between salivary and serum Dsg1 and Dsg3 levels, and whether salivary Dsg1 and Dsg3 levels correlate with clinical disease severity of oral mucosal lesions in PV. In total 43, patients with PV with predominantly mucosal involvement were recruited. Both serum and salivary samples were collected from the cases, and salivary samples were also collected from five controls. There was a statistically significant correlation between serum and salivary Dsg1 levels and between serum and salivary Dsg3 levels. There was no correlation between serum or salivary Dsg1 and Dsg3 levels with the objective component of the oral mucosal Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). Serum Dsg1 levels significantly correlated with cutaneous ABSIS, but there was no correlation between cutaneous ABSIS and either salivary Dsg1, salivary Dsg3 or serum Dsg3. As salivary Dsg titres correlate with serum levels, saliva can serve as a simple and noninvasive alternative to serum for Dsg ELISA.

Lipomatous neurofibromas with giant pigmented lesion.

Neurofibroma is the most common benign neural tumour. Among the large number of histopathological variants reported, lipomatous neurofibroma is exceedingly infrequent, and shows the presence of intratumoral adipocytes admixed with spindle cells in the dermis. We present a case of a 37-year-old man with lipomatous neurofibromas associated with a giant garment-like pigmented lesion involving his lower trunk and right thigh.

Comparison of efficacy and safety profile of topical calcipotriol ointment in combination with NB-UVB vs. NB-UVB alone in the treatment of vitiligo: a 24-week prospective right-left comparative clinical trial.

BACKGROUND: Narrow-band ultraviolet B (NB-UVB) is an effective and safe treatment for vitiligo. Calcipotriol, a synthetic analogue of 1,25 dihydroxyvitamin D3 may regulate melanin synthesis. Several clinical studies have been conducted but the synergistic effect of addition of calcipotriol to NB-UVB in the treatment of vitiligo is still debatable. OBJECTIVES: To compare the efficacy and safety of topical calcipotriol (0.005%) in combination with NB-UVB vs. NB-UVB alone in generalized vitiligo. METHODS: A prospective right-left comparative study including 27 patients of vitiligo was conducted for 24 weeks. On one side, calcipotriol was applied twice a day. NB-UVB was administered thrice a week. Response to treatment was assessed using change in Lund and Browder (L&B) score for percentage reduction in body surface area, investigator's global assessment (IGA) and patient's global assessment (PGA) scores. Treatment related side effects were noted. RESULTS: Mean percentage reduction in L&B score at 24 weeks was 51.4% on NB-UVB and 49% on NB-UVB plus calcipotriol side (P = 0.557), mean IGA score on NB-UVB was 2.7 ± 0.5 and on NB-UVB plus calcipotriol was 2.6 ± 0.4 (P = 0.821) and mean PGA score on NB-UVB side was 5.6 ± 3.4 and on NB-UVB plus calcipotriol side was 5.8 ± 3.2 (P = 0.706). Perifollicular repigmentation that matched with the surrounding normal skin colour was seen in majority of patients on both treatment sides. Calcipotriol produced mild local adverse effects. CONCLUSIONS: Addition of calcipotriol to NB-UVB probably does not enhance the efficacy of treatment including extent of repigmentation and time to initial repigmentation. Larger, randomized placebo-controlled trials are required to determine whether addition of calcipotriol has any utility when administered with NB-UVB in the treatment of vitiligo.

Kinetics of two different iron formulations and their effect on diurnal variation of serum iron levels.

Iron polymaltose complex (IPC) is a recently marketed preparation with questionable bioavailability. We compared the absorption kinetics of IPC with ferrous sulfate. We also studied the effect of oral iron on diurnal variation. The study was conducted in eight healthy, non-smoking, non-alcoholic volunteers after obtaining their written informed consent and after Institutional Ethical Committee approval. The study was conducted in three phases: during the first phase no drugs were given, whereas in the second and third phases, ferrous sulfate (66 mg elemental iron) and IPC (100 mg elemental iron) were given in a randomized, two-way, cross-over design, with a wash-out period of 1 week. The blood samples were collected, iron levels estimated and the pharmacokinetic parameters calculated. Circadian rhythm in iron levels was demonstrated by cosinor analysis with a mesor of 93.6 microg/dl, acrophase 10.40 h and amplitude of 26.4 microg/dl. Evening levels were higher as compared with morning levels. Drug treatment increased the mesor (115.7 microg/dl; p < 0.05), delayed the acrophase (11.30 h; p < 0.05) and increased the amplitude (38.5 microg/dl; p < 0.05). The bioavailability of ferrous sulfate was significantly greater as compared with IPC with greater Cmax and AUC (p < 0.05). A clear cut circadian rhythm in iron concentrations was demonstrated. Ferrous sulfate was shown to have significantly higher bioavailability as compared with IPC. Further studies having hemoglobin levels as an endpoint may be planned.