Profile of Nail Disorders in Patients Presenting to a Tertiary Care Hospital in Kashmir Valley

Introduction: Nail disorders comprise about 10% of alldermatological conditions. They may get involved invarious systemic diseases, infectious processes, nutritionaldeficiencies, ageing, genetic disorders, and neoplasms.Current study objective was to see the clinical pattern of nailchanges in patients presenting with various nail disorders andto determine the clinical pattern of nail involvement in variousdermatoses.Material and methods: This was a cross sectional study inwhich patients presenting to our department with any naildisorders were examined. A proper history, examination andthe relevant investigations like KOH, nail culture, and nailbiopsy were also done.Results: A total of 500 patients were screened, 282 femalesand 218 males. The most common nail change observed waslongitudinal ridging (45.6%), followed by distal subungualhyperkeratosis (35.8%) and cuticular changes (35.2%).Onychomycosis was the most common nail disorder observed,constituting 36.2% of all nails diseases. Among non infectivediseases, nail psoriasis was the most common nail disorderfollowed by nail lichen planus.Conclusion: A variety of nail changes can occur in variousdermatological and various other systemic disorders. So athorough clinical examination of nails is of prime importanceto correlate all these nail changes and to make dermatologiststo reach a conclusive diagnosis.

Comparison of dermatoses seen in community health camps and a tertiary care centre in Kashmir.

Background: Various environmental, socio-economic and geographical factors influence the pattern of dermatoses in an area. Observations made at tertiary dermatology centres may not reflect the actual pattern of dermatoses at the community level. Aims: To evaluate the pattern of dermatoses at community level and compare it with that at a tertiary centre. Methods: Cases were registered through community visits in block Hazratbal in Kashmir valley, once a week over a calendar year. The pattern of dermatoses observed was compared with that seen at the tertiary centre over the same period. Results: A total of 1065 community cases, with 1105 dermatoses, were compared with 4358 patients with 4466 dermatoses seen at the tertiary centre. Non-infectious dermatoses in each group were more common than infectious dermatoses (34.08% infectious dermatoses versus 65.97% non-infectious in community cases and 29.42% infectious dermatoses versus 70.58% non-infectious in hospital patients). Infectious cases were seen significantly more in the community (34.08%) than at the tertiary centre (29.42%). Among the infectious diseases, fungal infection was the most common and in the non-infectious group, pigmentary disorders were the most common, followed by acne and eczema. Conclusion : Infectious dermatoses were found statistically significantly more in community cases as compared to hospital patients while the opposite was the case with non-infectious dermatoses. The study emphasizes the need for providing frequent dermatology services to the community at the primary healthcare level so that the burden of dermatoses, especially infectious, may be reduced. Also, wider studies should be conducted in different regions in order to assess the actual magnitude of dermatological illnesses in the community.

Understanding itch: An update on mediators and mechanisms of pruritus.

Pruritus is the most common symptom secondary to skin diseases. Advances in the fi elds of neurobiology, immunology and physiology have made it possible for us to understand and unravel the deeper pathophysiological basis of pruritus. This review aims to update our current understanding of the mechanisms and mediators of pruritus. Special attention is paid to endogenous itch mediators particularly newly identifi ed ones like endovanilloids, opioids, neurotrophins, cannabinoids, proteases and cytokines. Various theories explaining the peripheral encoding of itch are reviewed. Multiple neural pathways including the central itch pathways as well as supraspinal processing of itch and brain areas involved in pruritus are highlighted. Apart from peripheral itch mediators, spinal neural receptors are also involved in control of itch and should form part of the development of a novel antipruritic strategy. Further studies are required to fi ll the lacunae in our current understanding of the pathophysiology of pruritus.

Psoraisis In Kashmir Valley: A Clinico-Epidemiological Study.

A cross sectional observational clinico epidemiological study on psoriasis was done on one thousand ethnic Kashmiri patients attending the Out patient Department of Dermatology,STD and Leprosy,Government Medical College Srinagar Kashmir over a period of six years (1999-2005).The patients were evaluated as regards the demographic profile,morphological or clinical type of psoriasis,involvement of joints,exacerbating factors especially infections (streptococcal sore throat),drug intake and winter exacerbation.The study revealed a male preponderance with peak age of occurrence in second or third decade of life.The predominant clinical type was seen to be Psoriasis vulgaris.Joint involvement was seen in 9.5 %of patients.Araised Anti Streptolysin titre was seen in 46.2% of acute guttate type.Drugs seen to be associated with exacerbation of disease included withdrawal of systemic corticosteroids,intake of Unani medicines and ACE inhibitors.An increased severity of the disease was seen in winter in 16.7 % of patients.The results of this study were consistent with the trend observed in other studies done in North India.

Bathing trunk naevus and neurofibromatosis type 1: a unique association of Friedrich's ataxia.

A 15-year-old male presented with history of progressive instability of gait for last 6 months. General examination revealed multiple subcutaneous nodules all over the body. There was a large pigmented naevus over the lower back area along with a subcutaneous bosselated swelling over right arm. Neurological examination revealed features of gait ataxia. Plantar reflexes were extensor on both sides. Skin biopsy from the pigmented naevus showed features of melanocytic naevus. Electrophysiological studies of both common peroneal and sural nerves revealed features of axonal neuropathy. With the above clinical and laboratory findings a diagnosis of neurofibromatosis type 1 accociated with bathing trunk naevus and Friedrich's ataxia was entertained.