Obesity-Related Skin Conditions: Exploring the Link.

Background Obesity is a medical condition characterized by the accumulation of excess fat that can negatively impact health, resulting in a decreased life expectancy and heightened health issues. Obese patients experience skin changes caused by skin infections, mechanical friction, and various skin hypertrophic conditions like fibromas and acanthosis nigricans. Approximately 60-70% of patients suffering from obesity exhibit a range of skin changes.  Objective The main objective of the present study is to identify the various types of skin conditions linked to obesity and investigate their relationship with body mass index (BMI).  Methodology This is a cross-sectional observational study. This study included obese patients with a BMI greater than 30 kg/m2 who visited the dermatology outpatient department at Saveetha Medical College and Hospital in Chennai, India. We enrolled 100 patients in this study. After obtaining consent, demographic information, height, weight, and cutaneous examination were conducted, and the results were documented. Statistical analysis was conducted using the chi-squared test, where P<0.05 was considered significant. The t-test for independent samples was done to analyze quantitative variables. Results The mean age at presentation was 39.3, and the standard deviation was 9.9. The average BMI was 34.3, and the standard deviation was 2.6. Of the total patients, 34% belonged to the 31-40-year age group, which was followed by 30% in the 41-50-year age group, 23% belonged to the 19-30-year age group, 11% belonged to the 51-60-year age group, and 2% belonged to the >60-year age group. Most patients (63%) had Class I obesity (BMI 30.00-34.99), 34% had Class II obesity (BMI 35.00-39.99), and 3% had Class III obesity (BMI >40.00). The most common cutaneous manifestation overall was acrochordons, followed by acanthosis nigricans, striae distensae, infections, and psoriasis.  Conclusion Obesity is identified as a significant public health issue, and its association with skin problems is of practical importance for many clinicians.

Pseudoglucagonoma Syndrome Following Frey's Surgery: A Case Report of a Rare Presentation.

Pseudoglucagonoma syndrome is defined as the presence of necrolytic migratory erythema in the absence of a glucagon-secreting tumor. Necrolytic migratory erythema is the hallmark of glucagonoma syndrome but can also occur due to pancreatitis, pancreatic insufficiency, gastrointestinal dysfunction, inflammatory bowel disease, celiac disease, malabsorption disorders, nutritional deficiencies, hepatocellular dysfunction, and hypoalbuminemia. Pseudoglucagonoma syndrome is extremely rare, and the diagnosis is often delayed, resulting in delayed treatment. We report a rare case of pseudoglucagonoma syndrome in a malnourished male patient following Frey's surgery. The patient presented with a skin rash which gradually progressed over 20 days with diffuse hair loss. On cutaneous examination, multiple irregular erythematous and eroded plaques surrounded by a hyperpigmented scaly border were present over the dorsal aspect of the lower limbs, upper limbs, gluteal region, and genitals. Routine investigations showed normocytic normochromic anemia, neutropenia, lymphocytosis, dyslipidemia, and hypoalbuminemia. Rapid resolution of the skin lesions was observed with improved nutrition.

Unusual Genital Wart Lesions: A Case Series on Angiokeratoma of Fordyce.

Angiokeratoma is a vascular cutaneous disorder that is generally asymptomatic and presents with multiple dark red to blue or black papules over the skin. The prevalence of angiokeratoma increases as the age increases and it is more common after third and fourth decades of life. There are different types of angiokeratoma which may be localized forms (angiokeratoma of Mibelli, angiokeratoma circumscriptum, solitary angiokeratoma, and angiokeratoma of the scrotum or vulva) or diffuse variant (angiokeratoma corporis diffusum). Here, we report a series of five rare cases of angiokeratoma of Fordyce, of which two cases had vulval involvement and one case showed lesions on unilateral scrotal wall which was unusual.

Uncombable Hair in a Case of Zellweger Syndrome - A New Association.

Zellweger syndrome (ZS) is a rare autosomal recessive, peroxisomal biogenesis disorder (PBD) that occurs due to a mutation in any of the thirteen peroxin (PEX) genes. It is reported to manifest with varying degrees of severity, ranging from non-specific gastrointestinal abnormalities, nail and enamel defects to multisystem involvement (cerebro-hepato-renal syndrome, eye, ear, and neurological abnormalities). Uncombable hair syndrome (UHS) is a rare hair shaft disorder characterized by dry, frizzy, unmanageable hair. Diagnosis of UHS can be confirmed by scanning electron microscopy (SEM), which reveals a triangular cross-section of the hair. We report a case of UHS with a hitherto unreported association of ZS (due to a homozygous mutation of PEX 12).

Correlating CD4 count with mucocutaneous manifestations in HIV-positive patients: A prospective study.

BACKGROUND: Mucocutaneous findings may be the presenting symptoms in HIV-afflicted individuals. A multitude of mucocutaneous diseases also occurs during the course of the ailment, with some conditions being classed as disease defining. They include infectious diseases and noninfective inflammatory and neoplastic dermatoses. With progressive fall in CD4 count, there is a change in the types of mucocutaneous lesions encountered. AIM: This study aims to statistically correlate the CD4 counts with the mucocutaneous manifestations in 100 HIV-positive patients. MATERIALS AND METHODS: A total of 100 cases of HIV-positive patients with skin and mucous membrane manifestations were selected serially. A complete history was taken, clinical examination was done, and the CD4 count was noted. Patients were divided into four groups (Groups I, II, III, IV) with different ranges of CD4 values, namely, <50, 50-200, 201-500, >500, respectively. RESULTS: The distribution of study population in CD4 ranges showed that majority (47%) of the study population had CD4 count between 201 and 500, and 29% of the study group had CD4 count between 50 and 200 cells. Almost 21% of the patients had the count > 500 cells and 3% had cell count < 50. Majority of the infectious and non-infectious dermatoses were common in the CD4 count between 201-500 (Group III) and 50-200 (Group II). In the study groups, 52 cases (52%) were on antiretroviral therapy (ART), and the remaining 48 cases (48%) were not on ART at the time of diagnosis of mucocutaneous manifestations. Out of 48 ART-naïve cases, 23 patients were screened and newly diagnosed at the outpatient department (OPD) based on the mucocutaneous manifestations. Most of the patients with multiple mucocutaneous conditions were in the CD4 count <200, whereas single manifestation was seen predominantly in CD4 count >200. CONCLUSION: Statistically significant association with the CD4 count was seen in herpes zoster ophthalmicus, genital wart, genital herpes, vaginal discharge syndrome, scabies, pyoderma, dermatophytosis, Hansen's disease, herpetic gingivostomatitis, seborrhoeic dermatitis, lichen planus, and drug reactions. These dermatoses may indicate the worsening of immune status and the need for regular monitoring with periodical CD4 counting. Occurrence of dermatoses such as photosensitive eczema, drug reaction, lichen planus, Type I lepra reaction, and herpes zoster ophthalmicus in patients on ART may be due to IRIS. To avoid the more frequent occurrence of infectious dermatoses and to reduce the development of IRIS with ART, all HIV-positive cases may be started on ART at higher CD4 count. Screening for HIV infection is suggested whenever the following conditions are seen: persistent oral candidiasis, atypical manifestations of zoster, herpes zoster ophthalmicus, herpetic gingivostomatitis and MC in adults, exaggerated IBA, and extensive seborrhoeic dermatitis.

Effectiveness of CO2 laser with subcision in patients with acne scars.

BACKGROUND: Post-acne facial scarring has always been a challenge to treat. It requires multiple therapeutic modalities as single modality is not hundred percent effective. Therefore, we have combined CO2 laser resurfacing with subcision in patients with acne scars for better results. OBJECTIVES: The aim is to study the effectiveness and side effects of CO2 laser with subcision in patients with atrophic acne scars. METHODS: Fifty patients were selected for the study. Baseline grading was done with Goodman and Baron grading system. Twenty-five patients were randomly selected for subcision followed by CO2 laser and the remaining patients were selected for CO2 laser alone. The treatment was done for four sessions at 4-week interval. Clinical photographs were obtained for evaluation. RESULTS: CO2 laser with subcision showed excellent response in grade-2 and -3 acne scars. Statistically there is a significant difference between CO2 laser following subcision and CO2 laser alone at 5% level (p < 0.05). Both procedures were well tolerated with minimal side effects. CONCLUSION: The highly versatile CO2 laser is useful for treating acne scars. Subcision prior to the CO2 laser procedure showed better improvement when compared to CO2 laser alone. Thus, in acne scars, multiple therapeutic modalities achieve better results.

Hypereosinophilic syndrome: cutaneous involvement as the sole manifestation.

Hypereosinophilic syndrome (HES) encompasses a group of leukoproliferative disorders with variable involvement of the internal organs. More than half of all patients have cutaneous involvement. In a minority of the reported cases, skin involvement has been the only manifestation of HES . We report one such rare case of HES, with cutaneous involvement as the sole manifestation.