Nail abnormalities in patients with vitiligo

Abstract: Background: Vitiligo is an acquired pigmentary skin disorder affecting 0.1-4% of the general population. The nails may be affected in patients with an autoimmune disease such as psoriasis, and in those with alopecia areata. It has been suggested that nail abnormalities should be apparent in vitiligo patients. Objective: We sought to document the frequency and clinical presentation of nail abnormalities in vitiligo patients compared to healthy volunteers. We also examined the correlations between nail abnormalities and various clinical parameters. Methods: This study included 100 vitiligo patients and 100 healthy subjects. Full medical histories were collected from the subjects, who underwent thorough general and nail examinations. All nail changes were noted. In the event of clinical suspicion of a fungal infection, additional mycological investigations were performed. Results: Nail abnormalities were more prevalent in the patients (78%) than in the controls (55%) (p=0.001). Longitudinal ridging was the most common finding (42%), followed by (in descending order): leukonychia, an absent lunula, onycholysis, nail bed pallor, onychomycosis, splinter hemorrhage and nail plate thinning. The frequency of longitudinal ridging was significantly higher in patients than in controls (p<0.001). Conclusions: Nail abnormalities were more prevalent in vitiligo patients than in controls. Systematic examination of the nails in such patients is useful because nail abnormalities are frequent. However, the causes of such abnormalities require further study. Longitudinal ridging and leukonychia were the most common abnormalities observed in this study.

Spectrum of periorbital dermatoses in South Indian population.

Background: Periorbital dermatoses are very common dermatological disorders which pose a diagnostic and therapeutic challenge for the treating dermatologist due to the similarity of symptoms in this area. Aims: To study the spectrum of periorbital dermatoses and to assess the association of systemic diseases with periorbital dermatoses. Methods: This was a hospital based descriptive study done on 250 consecutive patients irrespective of their age and sex who attended the Dermatology out patient department (OPD), with dermatological conditions pertaining to the periorbital area over a period of 2 years from October 2010 to September 2012. Results: The most common dermatological conditions seen in the periorbital region were benign and malignant skin tumors observed in 63 (25.2%) cases, followed by the disorders of pigmentation in 51 (20.4%) and eczema in 44 cases (17.6%), infections in 33 (13.2%) cases and nevoid conditions in 26 (10.4%) cases. Certain periorbital dermatoses were significantly more in females than in males in the present study like skin tags, connective tissue diseases, and periorbital melanosis (POM). Some periorbital dermatoses were significantly more common in older age group such as seborrheic keratoses, skin tags and airborne contact dermatitis whereas infections, syringomas, allergic contact dermatitis and atopic dermatitis were more prevalent in younger age group. Syringomas and POM were more common in middle-aged women. Conclusions: The most common dermatological condition seen in the periorbital region in this study are benign skin tumors (keratosis and skin tags), followed by the disorders of pigmentation and eczema, infections and nevoid conditions.

Afecciones dermatológicas con hipopigmentación en un área de salud,mayo-diciembre, 2010 / Dermatologic afections with hypopigmentation in a health area, may-december’ 2010

Las afecciones cutáneas con hipopigmentación constituyen una causa frecuente de consulta en el mundo y en Cuba, ya que es un síntoma común a numerosas enfermedades dermatológicas, pero hasta el momento, a pesar de la revisión bibliográfica realizada, se ha constatado que no se conoce su incidencia en edad pediátrica y adultos. Por esta razón, se realizó un estudio prospectivo-descriptivo de los pacientes portadores de hipocromía, con el objetivo de evaluar el comportamiento de las afecciones dermatológicas con hipopigmentación en el área de salud. Se encontró que el género femenino fue el más representado en este estudio, que las afecciones se manifiestan más en niños, y predominó la pitiriasis versicolor. Se recomendó incorporar el tema del cuidado de la piel mediante la fotoprotección en cada consulta.

The cutaneous affections with hypopigmentation are one of the most common cases in our offices in Cuba and in the world. It is a common symptom in many of the dermatologic illnesses. After consulting many sources, it can be stated that there is a lack of studies of the incidence of this illness in children and adults. For these reason perspective and descriptive studies have been done to patients with hypocromy. The objective was to evaluate the behavior of the dermatologic affections with hypopigmentation in the health area. This study showed that the female gender was the most represented. The affections were more frequent in children, the pityriasis versicolor was predominant. The introduction of the photoprotection topic as a skin care in each appointment was remmended.

Hipomelanose macular progressiva: estudo epidemiológico e resposta terapêutica à fototerapia / Progressive macular hypomelanosis: an epidemiological study and therapeutic response to phototherapy

FUNDAMENTOS: A hipomelanose macular progressiva é uma dermatose comum em diferentes continentes. Sua causa é desconhecida e os tratamentos propostos são pouco eficazes. OBJETIVOS: Determinar aspectos epidemiológicos da hipomelanose macular progressiva em pacientes atendidos num setor de fototerapia, no período de 1997 a 2008, e avaliar a resposta terapêutica com PUVA ou UVBNB. MÉTODOS: Foram avaliados 84 pacientes com Hipomelanose Macular Progressiva. Após 16 sessões de fototerapia, a resposta terapêutica foi definida: I=inalterado, MD=melhora discreta(< 50 por cento de repigmentação), MM=melhora moderada(50-79 por cento), MI=melhora intensa(80-99 por cento) e C=cura(100 por cento). Após um tempo mínimo de três meses, pacientes com cura ou MI foram contatados por telefone para avaliar a manutenção do resultado terapêutico. RESULTADOS: Predominaram mulheres (79 por cento) e a cor branca. A idade mínima de aparecimento da Hipomelanose Macular Progressiva foi de 13 anos e a máxima de 36 anos. Fototerapia com PUVA foi indicada em 27 pacientes e UVBNB em 57. Estatisticamente, não houve diferença significante entre o tratamento com PUVA e UVBNB (teste de Fisher P>0.05). A maioria (81 por cento) dos pacientes obteve 50 por cento ou mais de repigmentação e 65 por cento tiveram cura ou MI. Entretanto, 72 por cento apresentaram recorrência das lesões. CONCLUSÃO: A ausência de pacientes, com mais de 40 anos, sugere que a Hipomelanose Macular Progressiva seja uma doença autolimitada. Tanto PUVA como UVB NB são opções terapêuticas, porém não impedem a recidiva da doença.

BACKGROUND: Progressive macular hypomelanosis is a common dermatosis in various continents. Its cause is unknown and proposed treatments have had little effect. OBJECTIVES: To determine epidemiological aspects of progressive macular hypomelanosis in patients referred to a phototherapy clinic between 1997 and 2008 and to evaluate therapeutic response to PUVA (psoralen + UVA) photochemotherapy or narrowband UVB phototherapy. METHODS: Eighty-four patients with progressive macular hypomelanosis were evaluated. After 16 phototherapy sessions, therapeutic response was classified as: unchanged, slightly improved (<50 percent of repigmentation), moderately improved (50-79 percent of repigmentation), much improved (80-99 percent) or cured (100 percent). After a minimum of three months, patients whose response was classified as cured or much improved were contacted by telephone to evaluate the persistence of the therapeutic response. RESULTS: Most of the patients were women (79 percent) and white (85 percent). Age at onset of progressive macular hypomelanosis ranged from 13 to 36 years. PUVA was prescribed for 27 patients and narrowband UVB phototherapy for 57. No significant difference was found between the outcomes obtained with PUVA and those obtained with narrowband UVB phototherapy (Fisher's exact test; p<0.05). The majority of patients (81 percent) had 50 percent or more repigmentation, with 65 percent being classified as cured or much improved. Nevertheless, there was a recurrence of the lesions in 72 percent of patients. CONCLUSIONS: The fact that no patients were over 40 years of age suggests that progressive macular hypomelanosis is a self-limiting disease. Both PUVA and narrowband UVB are effective therapeutic options; however, they do not prevent recurrence of the disease.

Lesiones hipopigmentadas de la piel en la infancia / Hypopigmented skin disorders in children

Introducción: Las lesiones hipopigmentadas de la piel son un motivo frecuente de consulta en la infancia y pueden ser producidas por diversas causas. Objetivo: Conocer cuáles son las patologías más frecuentes que motivan la consulta al dermatólogo por lesiones hipopigmentadas. Método: Se registraron en forma prospectiva los 106 pacientes nuevos que fueron derivados por lesiones hipopigmentadas al policlínico de dermatología del Hospital Félix Bulnes Cerda de Santiago de Chile. Se describen sus características principales. Resultados: Los diagnósticos dermatológicos fueron: 38 por ciento vitíligo, 18 por ciento pitiriasis alba, 18 por ciento nevo acrómico, 7 por ciento mosaicismo hipopigmentado, 6 por ciento hipopigmentación postinflamatoria, 5 por ciento liquen estriado, 5 por ciento pitiriasis versicolor, 3 por ciento pitiriasis liquenoide crónica y 1 por ciento albinismo. Se describen las principales características y las enfermedades asociadas, se destaca la alta frecuencia de mosaicismo hipopigmentado, de los cuales la mayoría no presentó anomalías extracutáneas.