A study of biophysical profile of inguinal skin: An implication for health and disease.

CONTEXT: Inguinal skin is prone to various infectious dermatological conditions such as erythrasma, intertrigo, hidradenitis suppurativa, folliculitis, dermatophytic infection, and various sexually transmitted diseases, as compared to the skin elsewhere. AIM: Our study attempts to compare the biophysical profile parameters (BPPs) of the genital skin with that of the rest of the body, while taking skin of the upper back as control. It also attempts to find out if there is a difference in BPPs of the two sites and that how the change in the BPPs, bring about change in microbiome and make inguinal skin more prone to infections. MATERIALS AND METHODS: This was a hospital-based comparative study conducted over 976 patients (600 males and 376 females) of age group 18-60 years, where BPP parameters such as hydration, skin pH, transepidermal water loss (TEWL), and sebum content were measured over the skin of the upper back and right inguinal region, and the results were summarized and presented as proportions (%). Chi-square test was used to compare abnormal findings. P ≤ 0.05 was taken as statistically significant. MedCalc 16.4 version software was used for all statistical calculations. RESULTS: Significant difference was noted in skin pH and TEWL, where P value came out to be <0.05, which was statistically significant, whereas there was minimal difference in sebum content and skin hydration in both the areas, in males and females. CONCLUSION: Raised skin pH disturbs organization of lipid bilayers (disturbed barrier), decreases lipid processing (impaired SC cohesion), and increases serine protease activity (reduced AMP). Increased TEWL (defect in physical barrier) and decreased hydration predispose the genital skin to infections. Use of pH buffered solutions (3-4), barrier repair creams containing ceramides, and barrier protective creams with dimethicone can help prevent these inguinal dermatoses.

Efficacy of Metformin in the Treatment of Acne in Women with Polycystic Ovarian Syndrome: A Newer Approach to Acne Therapy.

Introduction: Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous units and has been associated with hyperandrogenism, which, in women, is most commonly caused by polycystic ovary syndrome (PCOS). Metformin treatment can correct ovarian and functional adrenal hyperandrogenism in adolescents with PCOS. Objective: We evaluated the efficacy of metformin therapy in women with acne and PCOS in terms of acne load. Methods: This was a hospital-based, interventional, longitudinal study that included 40 female patients with acne and PCOS diagnosed using the Rotterdam criteria. Hormonal assay, including serum levels of testosterone, dehydroepiandrosterone sulphate, luteinizing hormone, follicle-stimulating hormone, prolactin, and blood sugar, was conducted on the third or fourth day of the menstrual cycle in a fasted state. An abdominal ultrasound was performed on the ninth day of menstrual cycle to diagnose PCOS. Baseline acne severity was assessed as per the Definition Severity Index. Metformin 500mg was given to all selected patients three times a day for eight weeks. Patient follow-up and acne severity reassessment was conducted at Weeks 3 and 6. At Week 8, all work-ups were repeated. Intention-to-treat analysis was done. Wilcoxin signed-rank sum test was used to identify significance in acne severity. Results: Metformin treatment significantly reduced acne severity in patients with PCOS (p<0.001). Conclusion: Metformin reduces ovarian hyperandrogenism, leading to clinical improvement of acne in women with PCOS.

Idiopathic Calcinosis Cutis Universalis Treated Successfully with Oral Diltiazem-A Case Report.

Idiopathic calcinosis cutis is very rare and difficult to treat. Various medical modalities of treatment described with inconsistent results include chelating agents, colchicine, and probenecid. Calcium channel blockers are known to work by inhibiting intracellular entry of calcium. We successfully treated a case of idiopathic calcinosis cutis using oral diltiazem.

Study of patterns of sexually transmitted diseases using a syndromic approach in the era of human immunodeficiency virus from a tertiary care hospital of the Northern India.

BACKGROUND: Sexually transmitted infections (STIs) increase the risk of transmission of Human Immunodeficiency Virus (HIV) infection causing immense need to understand the patterns of STIs prevailing in the regions of a country for proper planning and implementation of STI control strategies. Due to the lack of adequate laboratory infrastructure in the country, information regarding the profile of STIs relies essentially on syndromic diagnosis. AIMS AND OBJECTIVES: To study the pattern of common STIs and the prevalence of HIV infection in patients attending the STI clinic of a tertiary care hospital in northern part of India using a syndromic approach. MATERIALS AND METHODS: A retrospective analysis of data collected from the clinical records of 2700 patients over a period of 21 months (July 2012 to March 2014) was carried out at the Skin and VD Department of SMS Hospital, Jaipur. Detailed history, demographical data, and clinical features were recorded from all the patients. All patients were tested for HIV by ELISA and rapid plasma reagin. STIs were categorized in different syndromes as depicted by National AIDS Control Organization in the syndromic management of STIs. The data collected was analyzed statistically. The proportions were calculated for various syndromes and disease prevalence. RESULTS: The overall most common STI was balanoposthitis, followed by genital herpes, vaginal/cervical discharge, molluscum contagiosum, genital warts, nonherpetic genital ulcer disease, lower abdominal pain, and urethral discharge in decreasing order. Among the study population, 2.55% were found to be HIV-positive. CONCLUSION: Viral STIs such as molluscum contagiosum, herpes genitalis, and condylomata acuminata are on the rise among STI/RTI clinic attendees.

Kindler syndrome with palmoplantar hyperhidrosis and blonde hair.

Kindler syndrome (KS) is a very rare genodermatosis characterized by acral blistering starting in infancy along with photosensitivity, progressive poikiloderma, cutaneous atrophy, and a variable degree of mucosal involvement. A large number of other cutaneous and extracutaneous features have been described, which aid in diagnosing it. Generally KS has been found to be associated with hypohidrosis/anhidrosis. We herein present a rare case of KS with unique features.

Sporotrichoid lupus vulgaris: A rare presentation.

Lupus vulgaris is the most common presentation of cutaneous tuberculosis in India and can present as papular, nodular, plaque, ulcerative, vegetating, and tumid forms. Unusual variants include the frambesiform, gangrenous, ulcerovegetating, lichen simplex chronicus, myxomatous, and sporotrichoid types. We describe a rare sporotrichoid presentation of lupus vulgaris on the leg of a 28-year-old female of 12 years duration.

Panatrophy of Gowers is a rare disease: case reports and review of the literature.

BACKGROUND: Panatrophy of Gowers (PG) is a very rare disorder. It is characterized by a sharply defined and localized area of atrophy involving subcutaneous tissue and, on rare occasions, bone. The etiopathogenesis of this disorder is an enigma. A limited number of patients have been described in single case reports. OBJECTIVES: This article describes the clinical features and histopathological findings of PG with the aim of indicating that PG may not be as rare as it is assumed to be. METHODS: We studied patients with lesions resembling those of PG between the years 2007 and 2012. Diagnoses of PG were based on clinical and histopathological findings. RESULTS: Four female and three male patients presented with clinically and histologically identical lesions. CONCLUSIONS: This disorder is not as rare as it is assumed to be, probably because it is misdiagnosed as post-steroid atrophy; thus PG requires more attention. Seven patients with PG are reported here to counteract the supposed rarity of this disorder and to highlight findings of hypopigmentation mimicking steroid-induced atrophy.