A cross sectional study of cutaneous manifestations in 300 patients of diabetes mellitus

Background: Diabetes Mellitus (DM) is a worldwide problem and one of the most common endocrine disorder. The skin is affected by both the acute metabolic derangements and the chronic degenerative complications of diabetes.Methods: The present study was a one-year cross sectional study from January 2014 to December 2014. All confirmed cases of DM with cutaneous manifestations irrespective of age, sex, duration of illness and associated diseases, willing to participate in the study were included in the study. Routine haematological and urine investigations, FBS, RBS and HbA1c levels were carried out in all patients.Results: A total of 300 patients of diabetes mellitus with cutaneous manifestations were studied. Majority belonged to the 4th decade (33%) and 3rd decade (27.7%) respectively. Males constituted 65% of the cases and male to female ratio was 1.85:1. Type 2 DM was most commonly observed (96%). Among the 300 diabetic patients, 73 patients (24.3%) had good control of DM with HbA1c levels in the range of 6.5-7% while 132 patients (44%) had a poor control of DM with HbA1c levels >8%. Hypertension was the most commonly associated systemic illness (37.6%). Cutaneous infections (63%) were the most commonly observed manifestation of which fungal infections (35.3%) were most frequently observed. Some of the other dermatoses observed were generalized pruritus (15.3%), acrochordons (11%), acanthosis nigricans (6%), diabetic dermopathy (5.33%), diabetic foot (3%), peripheral vascular disease (2.66%), vitiligo (2.66%), xanthelasma palpebrarum (2.33%), diabetic bullae (1%). Cutaneous infections, dermatoses associated with microangiopathy were more common in the uncontrolled diabetic patients which was statistically significant.Conclusions: Infections were the most common cutaneous manifestations in diabetics followed by dermatoses most commonly associated with diabetes. Proper skin care and long-term control of blood glucose levels may reduce the risk of some of the skin diseases.

Keratinocyte-melanocyte graft technique followed by PUVA therapy for stable vitiligo.

BACKGROUND: Various surgical procedures for correcting stable vitiligo exist but these have their own limitations. Autologous, non-cultured, non-trypsinized, melanocyte plus keratinocyte grafting is a new and simple method of vitiligo surgery. OBJECTIVE: The study aimed to evaluate efficacy of a new grafting technique in vitiligo patches. METHODS: Eighteen vitiligo patches underwent this procedure. The upper layer of epidermis was removed by superficial dermabrasion using a dermabrader micromotor until the epidermis appeared wet and shiny. Then, antibiotic ointment was applied and dermabrasion was continued up to the whitish area of the upper dermis. The paste-like material (ointment with entangled epidermal particles) was collected and spread over the dermabraded recipient site. RESULTS: Pigmentation usually started at 4-6 weeks. Complete uniform pigmentation took 16-20 weeks. CONCLUSION: For smaller vitiligo patches this method gives cosmetically acceptable results. It is easy to perform and does not require specific laboratory setup.

Occupational contact dermatitis among the traditional 'tie and dye' cottage industry in Western Rajasthan.

BACKGROUND: Dyeing is an age-old process and forms an integral part of textile industries. Tying is a process by which a particular part of cloth is prevented from the process of dyeing. The skin diseases in workers engaged in the 'tie and dye' industry have not been extensively studied. AIMS: To study the prevalence of contact dermatitis among workers engaged in the 'tie and dye' industries in and around Jodhpur (Western Rajasthan). METHODS: One thousand three hundred workers engaged in 'tie and dye' work were evaluated for occupation-related dermatitis. Those with skin lesions were subjected to patch tests using 2% aqueous solution of the dyes and chemicals commonly used by them. These included direct dyes, VAT dyes, sulfur dyes and azo dyes. Fifty workers without skin lesions served as controls. RESULTS: One hundred patients (7.69%) had dermatitis involving the exposed sites, mainly the hands and forearms. Eighty-one patients showed positive reactions to one or more dyes, most commonly Red RC base (azo dye), followed by naphthol. CONCLUSION: Red RC base and naphthol were the commonest allergens in the 'tie and dye' industry.

Florid cutaneous papillomatosis with adenocarcinoma of stomach in a 35 year old male.

Various paraneoplastic dermatoses may be seen in association with underlying visceral, especially gastrointestinal, malignancy. Florid cutaneous papillomatosis describes the sudden appearance of multiple acuminate keratotic papules that morphologically resemble viral warts. It may be seen in association with acanthosis nigricans and/or the sign of Leser Triotalat. We report a 35-year-old male with extensive seborrhoeic keratoses and florid cutaneous papillomatosis. Unusually marked verrucous changes caused disfigurement of the hands and feet. The patient also reported dyspepsia, abdominal distention and weight loss 6 months prior to the development of cutaneous lesions. Gastroscopy revealed a large growth in the stomach. Histopathology of the tumor showed features of adenocarcinoma.

Juvenile hyaline fibromatosis in siblings.

Juvenile hyaline fibromatosis (JHF) is a rare, autosomal recessively inherited disorder. We report two siblings with multiple large tumors on the scalp, translucent papules on the nape of the neck, hypertrophic gingiva, and severe flexural contractures of large joints. The histopathology from the skin lesions showed features characteristic of juvenile hyaline fibromatosis. The cases are being reported on account of the extreme rarity of the condition.

Dexamethasone-cyclophosphamide pulse therapy in systemic lupus erythematosus.

BACKGROUND AND AIMS: Therapy systemic lupus erythematosus (SLE) has been generally discouraging. Methyl-prednisolone pulse therapy has been used for various connective tissue disorders. We used intravenous dexamethasone cyclophosphamide pulse therapy to treat SLE. METHODS: Fourteen patients (10 females and 4 males) between the age of 15-48 years with definite or classical clinical criteria laid by American Rheumatism Association criteria were treated by Dexamethasone-Cyclophosphamide pulse (DCP) therapy at our center. RESULTS: It was possible to induce a complete clinical remission with DCP therapy in most of the patients thereby offering them life free from disease and drugs. The side effects commonly observed with conventional daily dose regimen of corticosteroids were not present or were mild. CONCLUSIONS: Almost all patients had good response after 3-4 pulses to allow them a normal life style. Fever, malar rash and oral ulceration responded early but photosensitivity, discoid rash, alopecia and joint pains took some more time.

A retrospective study of clinico-histopathological correlation in leprosy.

Leprosy is a chronic infectious disease caused by Mycobacterium Leprae and is characterized by well-recognized pathological changes. But there are various disagreement in clinical type and histological finding of leprosy. We observed highest parity in LL and TT group followed by histoid, BT, BL, BB, & indeterminate respectively. There was 10% minor disagreement (difference of one group) and 5% major disagreement (difference of two or more group). Non-specific histological finding was present in 20% cases.