Diagnostic ability of Peptidase S8 gene in the Arthrodermataceae causing dermatophytoses: A metadata analysis.

An unambiguous identification of dermatophytes causing dermatophytoses is necessary for accurate clinical diagnosis and epidemiological implications. In the current taxonomy of the Arthrodermataceae, the etiological agents of dermatophytoses consist of seven genera and members of the genera Trichophyton are the most prevalent etiological agents at present. The genera Trichophyton consists of 16 species that are grouped as clades, but the species borderlines are not clearly delimited. The aim of the present study was to determine the discriminative power of subtilisin gene variants (SUB1-SUB12) in family Arthrodermataceae, particularly in Trichophyton. Partial and complete reads from 288 subtilisin gene sequences of 12 species were retrieved and a stringent filtering following two different approaches for analysis (probability of correct identification (PCI) and gene gap analysis) conducted to determine the uniqueness of the subtilisin gene subtypes. SUB1 with mean PCI value of 60% was the most suitable subtilisin subtype for specific detection of T.rubrum complex, however this subtype is not reported in members of T. mentagrophytes complex which is one of the most prevalent etiological agent at present. Hence, SUB7 with 40% PCI value was selected for testing its discriminative power in Trichophyton species. SUB7 specific PCR based detection of dermatophytes was tested for sensitivity and specificity. Sequences of SUB7 from 42 isolates and comparison with the ITS region showed that differences within the subtilisin gene can further be used to differentiate members of the T. mentagrophytes complex. Further, subtilisin cannot be used for the differentiation of T. benhamiae complex since all SUB subtypes show low PCI scores. Studies on the efficiency and limitations of the subtilisin gene as a diagnostic tool are currently limited. Our study provides information that will guide researchers in considering this gene for identifying dermatophytes causing dermatophytoses in human and animals.

A Study of miRNA 223 Expression and its Correlation with Disease Severity in Chronic Plaque Psoriasis.

Background: Psoriasis is a chronic immune-mediated inflammatory disease affecting the skin and/or joints. MicroRNAs (miRNA) are single-stranded non-coding RNA molecules that bind to messenger RNA (mRNA) and regulate gene expression. Studies on peripheral blood mononuclear cells (PBMCs) in psoriatic patients showed an upregulation of miRNA 223. Aims and Objectives: a) To estimate and compare the expression of miRNA 223 in cases of chronic plaque psoriasis and controls. b) To correlate the expression of miRNA 223 with the severity of chronic plaque psoriasis. Materials and Methods: This study included 80 subjects (40 with psoriasis and 40 with age- and sex-matched healthy controls) attending the dermatology OPD of a tertiary care hospital from January 2018 to June 2019. A detailed history, determination of Psoriasis Area Severity Index (PASI) score and estimation of miRNA 223 by quantitative real-time polymerase chain reaction (qRT-PCR), was done in all subjects. Results: The expression of miRNA 223 (ΔCt) was higher in cases than in controls. The observed mean ΔCt was higher in severe (12.90 ± 0.46) than in mild (9.81 ± 1.70) and moderate (10.58 ± 1.26) psoriasis. The difference in expression of miRNA with varying severity of psoriasis was significant. The mean difference of ΔCt between mild to severe was (3.09) (P ≤ 0.001) and moderate to severe was (2.31) (P = 0.013). Among cases, the expression of miRNA 223 was higher in those exhibiting Koebner's phenomenon compared to those without Koebner's phenomenon (P = 0.0424). Conclusion: Expression of miRNA 223 was higher in psoriatic patients than in controls and the expression increased with the severity and activity of the disease suggesting the upregulation of miRNA 223 with the progression and activity of the disease.

Carotid intima-media thickness and epicardial fat thickness predict precoronary artery disease status in psoriasis.

BACKGROUND: Carotid intima-media thickness test is a surrogate marker of subclinical atherosclerosis. Epicardial fat thickness is an early marker of coronary artery disease. Several studies have noted that psoriasis patients have an increased risk of coronary artery disease. In the present study, we attempted to see any variation in carotid intima-media thickness and epicardial fat thickness in psoriasis patients when compared to controls. AIMS: 1) To determine the carotid intima-media thickness and epicardial fat thickness in psoriatic patients and healthy controls. 2) To evaluate the association between carotid intima-media thickness and epicardial fat thickness in psoriasis patients. METHODS: A hospital-based study with 100 subjects (50 with psoriasis and 50 healthy controls) was conducted in the Dermatology Outpatient Department of Justice KS Hegde Charitable Hospital, a unit of KS Hegde Medical Academy affiliated to NITTE (Deemed to be University) Mangaluru. A detailed history and examination including body mass index, psoriasis area and severity index were done. Carotid ultrasound was done to measure carotid intima-media thickness and transthoracic echocardiography was done to assess epicardial fat thickness in both cases and controls. Independent sample t-test, Pearson rank correlation (r) coefficient were used for statistical analysis. P-value <0.05 was considered statistically significant. IBM Statistical Package for the Social Sciences version 22 Armonk, NY: IBM Corp was used for statistical analysis. RESULTS: Mean carotid intima-media thickness in the right carotid ([0.51 ± 0.1mm vs 0.47 ± 0.1 mm] [P = 0.038]) and left carotid ([0.53 ± 0.12 mm vs 0.48 ± 0.1 mm] [P = 0.041]) were significantly increased in psoriasis patients than in controls. Mean epicardial fat thickness was significantly increased ([1.76 ± 0.66 mm vs. 1.49 ± 0.47 mm] ([P = 0.020]) in patients with psoriasis when compared with the controls. Epicardial fat thickness was positively correlated with carotid intima-media thickness in patients with psoriasis. LIMITATIONS: The cross-sectional design of the study, smoking among study subjects, inter and intraobserver variability of measurement of epicardial fat thickness and carotid intima-media thickness. CONCLUSION: Carotid intima-media thickness and epicardial fat thickness were increased in psoriasis patients when compared with healthy controls. Epicardial fat thickness was positively correlated with carotid intima-media thickness in cases.

Clinico-Dermoscopic Pattern of Beard Alopecia Areata: A Cross-Sectional Study.

BACKGROUND: Alopecia areata (AA) is an autoimmune condition affecting hair-bearing regions of the body. Few studies worldwide have focused exclusively on beard alopecia areata (BAA). AIMS: To describe the clinical associations, comorbidities, and dermoscopy of BAA. MATERIALS AND METHODS: Forty-six patients with BAA were recruited for this hospital-based cross-sectional study. Patients with disease onset of less than 1 month, patches showing extension, and appearance of new patches within the past 1 month were grouped under active disease. Dermoscopy was performed using handheld polarized dermoscope. Chi-square test was applied to know the various associations. P value <0.05 was considered statistically significant. STATA 11.2 was used for analysis of data. RESULTS: The mean age was 31.07 ± 8.72 years. The majority (50%) belonged to 20-29 age group. Twenty-two (48%) patients had active disease. Fourteen (30.43%) patients had extra-beard manifestation of AA. Statistically significant association was noted between active disease and extra-beard manifestation (P = 0.034). Diabetes mellitus and hypertension were noted in one and three patients, respectively. Alcohol abuse was noted in six patients and smoking in five patients. Dermoscopic findings such as black dots, short vellus hair, tapering hair, nonfollicular white dots, regrowing hair, yellow dots, and black dots were similar to findings noted in AA. Uncommon findings such as peripilar sign, i-hair, perifollicular hemorrhage, and tulip hair were observed in BAA. LIMITATIONS: Small sample size, lack of follow-up. CONCLUSION: Trichoscopy of BAA may reveal newer nonfollicular findings, in addition to the follicular findings already described in literature for AA.

A perspective study of cutaneous manifestations in primary psychiatric disorders in a tertiary care hospital.

BACKGROUND: Cutaneous disorders are frequently seen in psychiatric patients. This may be attributed to the common ectodermal origin of skin and neurons. There is a paucity of data on cutaneous comorbidity in primary psychiatric disorders. AIMS: The aim of this study is to determine the pattern of cutaneous manifestations in patients with primary psychiatric disorders. SETTINGS AND DESIGN: This was a hospital-based observational study. SUBJECTS AND METHODS: A total of 210 patients suffering from various psychiatric disorders along with associated skin disease were recruited. Patients with an age <18 years and with history of substance abuse were excluded from this study. STATISTICAL ANALYSIS: IBM SPSS Statistics, version 22 (IBM Corp, Armonk, NY, USA) was used for the statistical analysis. RESULTS: A total of 314 cutaneous manifestations were observed in the psychiatric patients recruited in this study. Among the patients surveyed, 88 patients were male (41.9%) and the remaining 122 patients (58.1%) were female. Primary psychiatric conditions observed were schizophrenia (25.7%), major depressive disorder (23.8%), bipolar mood disorder (23.3%), and psychosis not otherwise specified (11.9%). A majority (63.06%) of the cutaneous manifestations were noninfective dermatoses, and the rest (36.94%) were infective dermatoses. Fungal skin infections and eczema were seen in 33.8% and 24.8% of the cases, respectively. Seborrheic dermatitis (16.2%) was the most common eczema encountered. Nearly 75.2% of cases were found to have an insight into their skin problems. The common medical comorbidities seen in our patients were diabetes mellitus and hypertension. CONCLUSIONS: In our study, cutaneous manifestations were quite common in primary psychiatric disorders. A collaborative approach, between psychiatry and dermatology, should be an integral part of management in such cases.

A Case of an Indolent CD8-Positive Lymphoid Proliferation of the Ear.

A lady presented with indolent slowly spreading erythematous nodule on the left external ear which on histopathology showed dense monomorphic lymphoid cells in the dermis. No epidermotropism or angioinvasion was seen. Immunohistochemistry showed that the infiltrating lymphoid cells were CD8+ but CD4-. Majority of the cases of cutaneous T-cell lymphomas have a CD4+, CD8- T-cell expression. Few cases have been reported with similar CD8-positive lymphoid proliferation with a curious ear tropism.

Low Vitamin D in Psoriasis: Reality or Myth?

CONTEXT: Psoriasis is a chronic, systemic disease with the beneficial effect of topical vitamin D3 analogs, known for a long time. Low levels of vitamin D are increasingly found to be associated with the initial development of some autoimmune diseases. There are contradictory reports of low serum levels of vitamin D3 in the pathogenesis of psoriasis. AIMS: (1) To determine the serum levels of vitamin D, calcium and C-reactive protein (CRP) in patients with psoriasis vulgaris, (2) To compare these levels with the serum levels of controls, and (3) To correlate them with the severity of the disease. SUBJECTS AND METHODS: A hospital-based case-control study with 61 patients of psoriasis and 61 age- and sex-matched controls was undertaken. A detailed history was taken and examination including body mass index, Psoriasis Area and Severity Index (PASI) was done. Estimations of serum vitamin D, serum calcium, and CRP levels were done. RESULTS: Mean 25(OH) vitamin D level was not significantly different between persons with and without psoriasis. Mean vitamin D level in cases was 18.41±9.41 and that in controls was 17.24±13.03 (P =0.63). However, vitamin D level were significantly lower in females than in males in both cases (P =0.02) and controls (P =0.006). There was no significant correlation between the severity of psoriasis and serum levels of vitamin D, serum calcium, and CRP. CONCLUSIONS: Serum level of vitamin D did not correlate with the severity of psoriasis in our study.

Correlation between Disease Severity, Family Income, and Quality of Life in Psoriasis: A Study from South India.

BACKGROUND: Psoriasis is a common, chronic inflammatory disorder of skin characterized by a long clinical course with exacerbations, remissions, and relapses. The cost of therapy and psychological burden of the disease depends on disease severity. The objective of this study was to assess the quality of life and financial status and to correlate the financial burden of the disease with the severity of psoriasis and quality of life. MATERIALS AND METHODS: A total of 102 psoriasis patients attending the dermatology outpatient department in our hospital were enrolled in this study. A detailed history and complete physical examination, including, Psoriasis Area and Severity Index (PASI), was done. Their family income was calculated. Quality of life was measured using the dermatology life quality index (DLQI) proposed by Finlay et al. Multiple linear regression was done to identify the predictor variables of quality of life (DLQI). P < 0.05 was considered statistically significant. RESULTS: Among the 102 psoriasis patients 78 were men(76.5%) and 24 were women(23.5%). The mean PASI score was 8.20 ± 6.18 the mean DLQI was 13.01 ± 6.95, and mean family income was INR 15570.10 ± INR 10081.82 per month. There was a significant positive correlation between disease severity and DLQI, and a significant negative correlation between family income and PASI as well as DLQI. CONCLUSION: The quality of life in psoriasis is affected by both the disease severity and financial status of the patient. The chronic course of psoriasis along with disease severity, in a background of low financial status, impairs the quality of life.

A Case Report of Krukenbergs Tumor with Cutaneous Seeding.

A 47-year-old female patient presented with painless skin colored and erythematous papules coalesced to form plaques over lower abdomen for 10 days. She had undergone exploratory laparotomy with hysterectomy and bilateral oophorectomy 1 month ago, and histopathology was reported as Krukenbergs tumor. She was getting evaluated for primary, when she was referred to dermatology. A clinical diagnosis of cutaneous infiltration of tumor was made, and biopsy was done from a representative lesion which showed features suggestive of metastatic poorly differentiated adenocarcinoma. In the majority of cases in the past, cutaneous metastasis is seen much later in the course of the disease. High degree of suspicion and histopathology was helpful in the diagnosis of underlying malignancy in our patient.