Advancements in Laser Therapies for Dermal Hyperpigmentation in Skin of Color: A Comprehensive Literature Review and Experience of Sequential Laser Treatments in a Cohort of 122 Indian Patients.

The heightened awareness of ethnic dermatology aligns with the growing prevalence of skin of color communities globally, where hyperpigmentation disorders pose a common dermatological challenge. Effectively addressing dermal pigmentation is challenging due to its resistance to conventional therapies and its association with impaired quality of life. This underscores the need for effective treatments and a thorough grasp of laser advancements. A relevant literature search spanning the last 7 years across the PubMed database reveals core studies, challenges, and the evolution of laser technologies tailored for various forms of congenital and acquired dermal hyperpigmentation in skin of color. This comprehensive review explores the mechanisms, applications, and recommendations for pigmentary laser technologies, highlighting the key role of Q-switched lasers in their established millisecond/ nanosecond forms and emerging picosecond lasers, fractional non-ablative and ablative lasers, Intense Pulsed Light, etc. The summary of evidence includes studies on dermal melanocytosis (nevus of Ota and Hori's nevus), tattoos, acquired dermal macular hyperpigmentation, etc., and also entities with mixed epidermal-dermal components, such as melasma and post-inflammatory hyperpigmentation. The review offers valuable insights for clinicians to make informed decisions based on diagnosis, skin type, and the latest technologies to optimize results and minimize complications, especially in darker Fitzpatrick skin types. In their five-year study with 122 Indian patients, the authors applied specific laser combinations for diverse dermal melanoses, including tattoos, dermal/mixed melasma, acquired dermal macular hyperpigmentation, and dermal nevi. Substantial pigmentation reduction, subjectively assessed by both physicians and patients, was observed across all groups. A one-way ANOVA indicated a significant difference in mean improvement scores across various pigmentary conditions (F = 3.39, p = 0.02), with melasma patients exhibiting a significantly higher improvement score than tattoos (p = 0.03). The results affirmed the safety and efficacy of sequential laser therapy for dermal pigmentation in skin of color, advocating for flexibility in approach while maintaining the rationale behind the laser sequences. Despite advancements, challenges persist, and gaps in the current literature are identified. In conclusion, this summary highlights the ongoing pursuit of optimal protocols in dermatological laser treatments for dermal melanoses, offering valuable insights for future research and clinical practice.

Correlation of skin-related quality of life with anxiety and depression in chronic dermatoses: A cross-sectional study.

Background: Dermatology and psychiatry are two specialties which often have a bearing on each other. Multiple indices have been used to study the quality of life in skin diseases; however, very few studies have correlated these indices with questionnaires of common psychiatric comorbidities like anxiety and depression. Methods: The study was conducted in a dermatology out patient department (OPD) of a tertiary care hospital. All patients with chronic dermatological conditions (meeting the inclusion criteria) were included, and each patient was made to fill two questionnaires that are Skindex-29 for skin-related quality of life and Beck Depression Inventory (BDI-II) for depression. They were also assessed for anxiety using the Hamilton Anxiety Scale (HAM-A), which was filled under the supervision of a psychiatrist. Results: The scores for the common diagnoses were collated and analyzed using SPSS 20.0 software, and the results were tabulated. It was found that both the HAM-A and BDI-II had a moderate positive correlation with the Skindex which was statistically significant. Also, on correlating the individual domains of the Skindex with the HAM-A and BDI, the domain of emotions depicted the best correlation. Conclusion: The study brings to light that a relatively easy to administer quality of life questionnaire can be used as a screening tool to identify psychiatric morbidity and in a busy skin OPD, questions from the emotion domain can only be asked for early referral to a psychiatrist.

Trichoscopy in Alopecia Areata and Trichotillomania in Skin of Colour: A Comparative Study.

Alopecia areata (AA) and trichotillomania (TTM) are the two common causes of localised non scarring alopecia. While AA is an autoimmune disorder, TTM is an impulse control disorder which makes the treatment of the two entities completely different. Trichoscopy is a non-invasive tool used to diagnose hair disorders, which not only is extremely helpful in diagnosing AA and TTM but also differentiates them from other hair disorders as well. The aim of our study is to describe the various trichoscopic features of AA and TTM and to compare the frequency of each trichoscopic feature in order to establish diagnostic clues for differentiating AA and TTM. Trichoscopy was performed on clinically diagnosed cases of AA and TTM with DL4 dermoscope and the images were analysed by 2 dermatologists independently. The frequency of trichoscopic features in AA and TTM was compared using chi square test. Twenty-four patients of TTM and 50 patients of AA were included in the study with mean age of AA being 30 years and mean age of TTM being 23.4 years. Exclamation mark hair, tapered hair, coudability hair, pigtail hair, clustered vellous hair, clustered regrowing hair and white hair were significantly more in alopecia areata. Conversely broken hair of different length, trichoptilosis, flame hair, mace hair, coiled hair, hair powder, fractured hair, v sign and burnt matchstick sign were the common features in TTM. To conclude, even though there is an overlap of trichoscopic features in AA and TTM, it is possible to distinguish the two if an assemblage of specific features are present.

Comparative study of the efficacy and safety of two grafting procedures (an automated epidermal harvesting system and non-cultured epidermal cell suspension) in the treatment of stable vitiligo.

Background The non-cultured epidermal cell suspension method is a well-established but tedious grafting modality in the management of stable vitiligo. Recently a more user-friendly automated epidermal harvesting system has been introduced. Aim This was a pilot study to compare the efficacy and safety outcomes of the above two grafting procedures. Study design The study was a single-blinded split-body randomised controlled trial. After scientific and ethical clearance, the trial was registered with CTRI (CTRI/2018/05/014225). Thirty consenting patients of stable vitiligo with 60 near-symmetrical patches were recruited. Block randomisation was done using computer-generated randomisation software and each patch was allocated either of the two grafting modalities. Efficacy was assessed by the Physician Global Assessment Scale on serial images and pain by the Numerical Rating Pain Scale. Results and conclusion The non-cultured epidermal cell suspension was found to be an overall statistically superior technique to the automated epidermal harvesting system in terms of efficacy (re-pigmentation). Both donor and recipient site complications were significantly less with the automated epidermal harvesting system grafting and this method had the distinct advantage of being a painless and easy technique with minimal recovery time. A novel observation was that a good colour match and near-complete re-pigmentation occurred in patients with a darker skin colour with both techniques. Limitations The main limitation of our study was the small sample size. Also, the size of the treated patches was limited such that they could be covered by the 5 × 5 cm size of the automated epidermal harvesting system blade. However, a larger area can be covered with multiple sessions.

Copper-impregnated socks: A novel therapeutic option for combating occupational dermatophytosis.

BACKGROUND: Operational and training requirements of soldiers necessitate prolonged use of occlusive footwear which makes them susceptible to Tinea pedis and affects their performance. This study assesses copper oxide-impregnated socks as a treatment modality in soldiers with Tinea pedis. METHODS: Three hundred serving soldiers with Tinea pedis were randomly divided in two groups of 150 cases each. One group was supplied with 02 pairs of polyester copper oxide-impregnated socks and the second group was treated with oral terbinafine 250mg /day for two weeks and topical terbinafine twice a day for three weeks. Five end points viz. scaling, erythema, fissuring, vesicular eruptions and itching were monitored using the visual analogue score (VAS) weekly for 03 weeks. RESULTS: Copper oxide socks helped in reducing all the end points as assessed by VAS. The group treated with terbinafine showed better response; however test socks were as efficacious as oral and topical terbinafine in controlling fissuring and vesiculation. Safety profile of the copper impregnated socks was comparable with the conventional treatment. CONCLUSION: Copper-impregnated socks are effective and safe in treating Tinea pedis. They may also have prophylactic role in tinea pedis in susceptible serving soldiers deployed at remote locations in different terrain and weather conditions.

A Case Report of Early Disseminated Lyme Disease.

Lyme disease is a multi-organ infectious disease caused by the spirochete "Borrelia burgdorferi," and transmitted by the "Ixodes" tick. Early disseminated Lyme disease can have varied central nervous system manifestations ranging from meningitis to radiculopathy and cranial neuropathy. If not suspected, misdiagnosis or delayed diagnosis can prove to be fatal. Erythema migrans is the most common clinical presentation, thereby, making dermatological examination extremely crucial in early diagnosis and treatment.

Use of Transient Elastography in Detection of Liver Fibrosis in Psoriasis Patients - A Cross- Sectional Study.

BACKGROUND AND AIMS: The risk of liver damage in psoriasis increases with increase in cumulative dose of methotrexate and guidelines suggest use of liver biopsy for risk mitigation. Recently, transient elastography (TE) has been used for detection of liver fibrosis. Most studies for TE are in hepatitis B and C patients. However, psoriasis patients have risk factors like metabolic syndrome which predisposes them to increased risk of liver damage due to methotrexate. This underlying liver disease may change the TE values in patients with psoriasis. The aim of this study is to determine utility of transient elastography in detection of liver fibrosis in patients with psoriasis. METHODS: 82 patients with chronic plaque psoriasis requiring systemic therapy or already on methotrexate were included in the study. Clinical examinationand biochemical investigations were conducted. Data were analysed using STATA 12.1 (Texas, USA). Univariate analysis using Chi-square and independent't-test' was carried out to evaluate the association between categorical variables and outcomes. RESULTS: Patients consists of 62 males and 20 females. TE value >7 kPa (kilopascal) were seen in 23 patients and <7 kPa were seen in 59 patients. Value of >7 kPa was significantly associated with age, waist circumference, diastolic blood pressure, fasting and post prandial blood sugar, AST, PASI and presence of metabolic syndrome. Cumulative methotrexate dose was not significantly associated with high TE value. Mean TE value in patients with metabolic syndrome was significantly higher. LIMITATIONS: Small sample size and inability to confirm TE findings on liver biopsy. CONCLUSION: TE is a non-invasive tool for detection of liver fibrosis. Value of >7 kPa correlates with liver fibrosis in most chronic liver diseases. However, high prevalence of metabolic syndrome in psoriasis patientsmayconfound utility of TE for monitoring of methotrexate toxicity.

A dissimulate presentation of histoid Hansen's disease in the form of erythema nodosum leprosum.

Hansen's disease is a chronic infectious granulomatous disease with varied clinical presentation. Histoid Hansen's disease is an important emerging lepromatous subset of Hansen's disease known to mimic varied dermatoses. Occurrence of reactions, especially erythema nodosum leprosum (ENL), is rare in this form of leprosy. We report a case of Histoid Hansen's disease with initial presentation of ENL while undergoing management for infertility.

A Case of Rhupus-reporting of a Rare Entity.

Rhupus syndrome, a rare entity, is the co-existence of systemic lupus erythematosus (SLE) with rheumatoid arthritis (RA). It manifests as more RA and less SLE related damages. The duration of the disease is longer than typical RA or SLE. Controversies exist regarding the definition of Rhupus. The incidence of Rhupus in patients with arthritis is 0.01%-0.2% and <2% in patients with connective tissue diseases. However, we report a rare case of rhupus in a 55-year-old lady with polyarthritis and joint deformities of 6 year duration, presenting with features of lupus erythematosus.

Acute scrotum: Hansen's disease versus filariasis.

Hansen's disease is caused by Mycobacterium leprae. The disease is known to involve the visceral organs including the testis apart from the skin and nerves in the lepromatous pole of leprosy due to widespread hematogenous dissemination of lepra bacilli. Furthermore, there can be testicular pain during the type 2 reaction in Hansen's disease. Filariasis is a disease caused by the parasitic nematode, Wuchereria bancrofti. This infection most commonly results in lymphedema and secondary vaginal hydrocele with an associated epididymo-orchitis. Acute epididymo-orchitis is either seen in the acute phase or as a part of secondary bacterial infections. The particular interest of this paper is to report the case of Hansen's disease who presented with testicular pain and posed a diagnostic dilemma when his pain did not respond to the standard mode of treatment and an alternate rare diagnosis was sought. This case report also emphasizes the need of reconsideration of diagnosis when the patient is not responding to standard therapy.

Study of human sperm motility post cryopreservation.

BACKGROUND: Cryopreservation of spermatozoa is a widely used technique to preserve the fertility of males. It can also benefit the armed forces personnel who are to be sent for long recruitments, while leaving their families behind. This study, apart from studying the effects of freezing and thawing, reveals the effect of the post thaw interval on the motility of the human spermatozoa and thus widens the insemination window period. METHODS: A detailed semen analysis was carried out as per the WHO guidelines for 25 samples. The samples were then washed, analysed and frozen in liquid nitrogen. The semen samples were subsequently thawed and similarly analysed after 20 min and 40 min of thawing. This was then followed by statistical analysis of the comparative motilities. RESULTS: Motility of sperms is found to decrease after cryopreservation. However, the study revealed that after thawing a significant increase in the motility of the sperms was noted with the progression of time (p < 0.05). CONCLUSION: By simulating conditions similar to the in vivo conditions for the post thaw semen samples, we can safely wait, confirm the parameters like motility and count, and then inseminate the samples instead of blindly inseminating them immediately after thawing.