ABSTRACT
Objective: to report our 5-year experience in the treatment of pemphigus with dexamethasonecyclophosphamide pulse therapy, with a slight modification in phase I which resulted in higher rates of remission and no relapses
Methods: all patients diagnosed as pemphigus on the basis of clinical and histopathological grounds were started on DCP therapy, but patients in the reproductive age group, both unmarried and those who had not completed their families were started on dexamethasone pulse therapy and Dexamethasone methotrexate pulse therapy was considered in patients with prolonged phase I [>9cycles]
Results: a total of 51 cases diagnosed with pemphigus were included in the study, of which 21 were males and 30 were females. 49 cases were of Pemphigus vulgaris type and 2 cases were of Pemphigus foliaceus. DCP therapy was started on 46 patients and dexamethasone pulse therapy was started in 5 females of reproductive age group who were yet to complete their families. 2 patients with prolonged phase I [>9cycles] were shifted to dexamethasone methotrexate pulse therapy, of which one patient was initially on dexamethasone pulse therapy, who was unmarried and methotrexate was started after taking informed consent. 9 patients discontinued the treatment in phase I after around 3-4cycles and 7 patients were lost for follow up during phase II. The average duration of phase I was 6 months. At present, 13 patients are in phase I and a total of 6 patients in phase II, 7 patients in phase III and 9 patients in phase IV are in complete clinical remission, with absolutely no relapses in compliant patients except for defaulters
Conclusion: phase I was continued not only until the new lesions stopped appearing, but was extended for 3 more months even after the new lesions ceased, to appear to reduce the relapse rates when the patient enters phase II
ABSTRACT
Objective: To study the various clinical presentations - age of onset, sex preponderance, course of disease and histopathological patterns of autoimmune vesiculobullous disorders and correlate clinical and histopathological findings and immunofluorescence with clinical and histopathological findings in few affordable cases
Methods: The present descriptive study was undertaken in a tertiary care hospital over a period of 2 years. It included 50 patients of autoimmune vesicobullous diseases fulfilling inclusion criteria. Diagnosis was established by clinical and histopathological findings. Direct immunofluorescence [DIF] testing was done in few affordable patients
Results: Autoimmune vesiculobullous disorders constituted 0.128% of skin disease. Pemphigus vulgaris [62%] constituted the most common vesiculobullous disorder. Females [58%] outnumbered males [42%]. The age group ranged from 11 years to 85 years and the mean age was 46.2 [15.6] years. The duration of the diseases ranged from less than a week to more than a year. Tzanck smear findings revealed acantholytic cells in 90.3% cases of pemphigus vulgaris and all cases of pemphigus foliaceus and pemphigus erythematosus. Correlation between clinical and histopathological findings was seen in 96% of cases and that between histopathological and DIF findings in 89% of cases
Conclusion: After the preliminary clinical and cytological diagnosis, histopathology and DIF are required to confirm the diagnosis. Considering the socioeconomic situations of the patients and unavailability of immunofluorescence technique widely, the study showed that clinical features and histopathology are fairly specific and cost-effective in arriving at the diagnosis
ABSTRACT
Objectives: To study the lipid levels in patients with lichen planus and controls, to find the association of lichen planus with dyslipidemia and to find the association of lichen planus with metabolic syndrome
Methods This was a case-control study involving a total of 100 patients, consecutively visiting the Outpatient Dermatology Department at Karnataka Institute of Medical Sciences Hubli, Karnataka. Men and women with age more than 18 years [50 cases with Lichen planus and 50 controls without lichen planus and had other skin diseases mainly nevi, seborrheic keratosis, verruca vulgaris]
Results We found significantly higher levels of triglycerides [153.03 vs 107.91 p value 0.008], total cholesterol [158.49 vs 143.47 p value 0.018], VLDL [30.61 vs 22.75 p value 0.021] and significantly lower levels of HDL [38.86 vs 45.78 p value 0.00l]. Both TG/HDL ratio [4.26 vs 3.19] and LDL/HDL ratio [2.45 vs 1.78] were significantly higher with a p value of 0.0001. ATP-III criteria for metabolic syndrome were met by 6% of the patients with LP versus 2% of the controls [p value=0.617], suggesting no association between metabolic syndrome and lichen planus. The prevalence of dyslipidemia in patients with LP was 38% for cases and 6% for controls [p value< 0.001]
Amultivariate logistic regression model demonstrated that LP was associated with dyslipidemia, even after controlling for confounders, including age, gender, BMI and FBS levels [OR=11.53 95%, CI-2.80-47.55, p value 0.00l]
Conclusion The results obtained in our study support the association of dyslipidemia in lichen planus which was seen even after controlling the confounding factors
The study also highlights the importance of routine screening of dyslipidemia since early intervention may reduce the risk and complications of cardiovascular disease later in life. However, there was no association seen between lichen planus and metabolic syndrome. Further studies are required to establish this finding
ABSTRACT
Objectives The study aimed [1] to compare incidence of co-morbidities among psoriatic patients [cases] and nonpsoriatic patients [controls], [2] to determine the association between psoriasis and various co-morbidities and [3] to determine the relationship between the severity of psoriasis and co-morbidities
Methods We performed a hospital-based case-control study involving 100 psoriatic patients [cases] and 100 age- and sex-matched nonpsoriatic patients [controls] from the dermatology outpatient department in a government teaching institute
Detailed history and examination was followed by relevant investigations. The severity of psoriasis was assessed according to Psoriasis Area and Severity Index [PASI], and body surface area [BSA] measurement. Cardiovascular risk factors were assessed by using the definition for metabolic syndrome, which includes the presence of three or more of the National Cholesterol Education Program's Adult Panel III [ATP III] criteria
Results The study revealed statistically significant association of psoriasis with metabolic syndrome [27% vs 8%, p = 0.0004] and psoriatic arthritis. Psoriatic patients had significantly higher levels of triglycerides [24% vs 8%, p = 0.002] and fasting blood sugar [23 % vs 8%, p = 0.003] along with significantly lower HDL levels [29 % vs 7%, p = 0.000, in males and 7% vs 2%, p = 0.043 in females]. Abdominal obesity was more prevalent in psoriatic patients [24 % vs 9%, p = 0.02 in male and 9 % vs 3%, p = 0.033 in females]. Neither metabolic syndrome nor psoriatic arthritis correlated with the severity of psoriasis
Conclusion There was higher prevalence of metabolic syndrome in patients with psoriasis. However, its presence did not correlate with either severity or duration of the psoriasis. Hence, we suggest that all patients need to be evaluated for metabolic syndrome irrespective of severity of psoriasis which is the risk factor for systemic diseases
ABSTRACT
The introduction of highly active antiretroviral treatment [HAART] has led to the emergence of a new clinical syndrome, immune reconstitution inflammatory syndrome [IRIS]. This syndrome affects human immunodeficiency virus [HIV]- positive patients at an advanced stage of the disease [CD4 lymphocyte counts 200/micro L]. In these patients, clinical signs of inflammation appear mostly in association with opportunistic infection, when HAART triggers a generalized immune activation during the transition phase of viral load suppression and CD4 lymphocyte counts increase. The infectious agent may have been treated previously or may have been present in a latent state, but is always present in the patient's body before the introduction of antiretroviral treatment. In the first situation, the opportunistic infection, which is initially improved by specific treatment, then leads to generalized or localized inflammation. In the second situation, the opportunistic infection is first detected when the CD4 lymphocyte count increases. In the first reported cases of IRIS, in 1998, the infectious agents were mycobacteria [Mycobacterium avium complex and M tuberculosis]. The syndrome has since been described in association with more than a dozen different infectious conditions, with herpes zoster [41 cases], M tuberculosis [37 cases], M avium complex [32 cases], and cytomegalovirus [22 cases] in 73% of the first 182 published cases. In some cases, IRIS appears in the absence of opportunistic pathogens and manifests itself as an autoimmune or granulomatous disease, of which sarcoidosis is the most frequent [10 cases]. The first case of leprosy diagnosed after HAART initiation was reported in 2003. We herewith report three cases of leprosy presenting as IRIS as the first manifestation