Evaluation of nail fold capillaroscopy changes in patients with diabetic retinopathy and healthy controls, and its correlation with disease duration, HbA1c levels and severity of diabetic retinopathy: An observational study.

Background Diabetic retinopathy (DR) is an important microvascular complication of long-term type 2 diabetes mellitus (T2DM) leading to blindness if not properly diagnosed and managed. It can develop as early as 7 years before the diagnosis of diabetes. Nail fold capillaroscopy (NFC) is a non-invasive technique for observing capillary microvasculature and there are few studies which have explored the use of NFC in diabetes mellitus patients. Objective To study the nail fold capillaroscopic alterations in patients with T2DM having diabetic retinopathy and compare them to healthy controls. The secondary objective was to correlate the NFC findings with the duration of diabetes, haemoglobin A1c (HbA1c) levels and the severity of DR. Materials and methods This cross-sectional observational study enrolled 200 patients - 100 cases with T2DM having diabetic retinopathy (as per the American Diabetes Association criteria and Diabetic Retinopathy Disease Severity Scale) and 100 healthy age and sex-matched controls. All patients were subjected to NFC and ophthalmological assessment. Results NFC revealed that patients with DR showed significantly higher frequencies of tortuous, dilated, bushy, meandering, angulated capillaries, avascular areas and micro-haemorrhages as compared to healthy controls (p < 0.05). In proliferative DR (PDR), the frequency of tortuous, bushy capillaries, and avascular areas was statistically high and the capillary density was reduced as compared to non-proliferative DR. The DR patients with longer disease duration (>20) years had a significantly higher frequency of tortuous capillaries, avascular areas, meandering, angulated and dilated capillaries. The frequency of tortuosity, avascular areas, and bushy areas was significantly higher in patients with poor glycaemic control (HbA1c >11). Limitations A larger sample size study with different demographic populations could have provided a broader picture of NFC changes in T2DM patients with DR. Discussion NFC may act as a surrogate marker of retinal involvement in patients with DM and should be performed at regular intervals. Conclusion NFC is a quick, simple, safe, and non-invasive method to assess the capillaroscopic alterations in diabetic patients which inturn can help in assessing the severity of DR.

Nail fold dermoscopy in collagen vascular disorders: A cross-sectional study.

BACKGROUND: The collagen vascular disorders, particularly systemic sclerosis, dermatomyositis, systemic lupus erythematosus and mixed connective tissue disorder, are often characterized by microangiopathic abnormalities of the nail folds. Nail fold dermoscopy is a well-established technique to assess these vascular changes. AIMS: To evaluate finger nail capillary vascular abnormalities by dermoscopy and their correlation with cutaneous and systemic involvement in the patients of collagen vascular disorders. METHODS: This was a cross-sectional study involving patients of collagen vascular disorders presenting to Government Medical College, Amritsar over a period of 2 years. Nail fold dermoscopy was done in these patients and correlated with cutaneous and systemic involvement. Statistical analysis was done using SPSS 17.0 version. RESULTS: A total of 30 patients were enrolled in the study. Sixteen (53.3%), 11 (36.7%) and 3 (10%) patients of systemic sclerosis, systemic lupus erythematosus and mixed connective tissue disorder, respectively were included for nail fold dermoscopy. The commonest change recorded in our study was dilated capillaries in 21 (70%) patients, followed by capillary dropouts in 17 (56.7%) patients and avascular areas in 16 (53.3%) patients. Of 17 patients presenting with sclerodactyly, active, early and late patterns were seen in 7 (41.2%), 2 (11.8%) and 7 (41.2%) patients, respectively. Out of 13 patients with respiratory involvement, active, early and late patterns were seen in 1, 1 and 7 (53.8%) patients, respectively (P value = 0.004). LIMITATIONS: Owing to lesser number of patients in our study, it is difficult to draw conclusive recommendations, and more studies with a larger sample size are required. CONCLUSION: Dermoscopy is a valuable tool not only to diagnose collagen vascular disorders but also for prognostication by correlating with systemic involvement.

An approach to venerophobia in males.

Venerophobia is a lesser recognized entity in clinical practice though the prevalence is on the rise. Our observations of current trends in the Sexually Transmitted Diseases (STI) clinic indicate that venerophobia is not an uncommon presentation among youngsters following an isolated or multiple episodes of sexual contact. This has a major bearing on the mental as well as sexual health. So far, there is no published data available in literature on the prevalence and extent of the problem. In this paper, we have made an attempt to cover the various modes of presentation, laboratory investigations and have outlined an approach towards the management of venerophobia in males.

Metastatic dermatofibrosarcoma protuberans: A rare case report from North India.

Dermatofibrosarcoma protuberans (DFSP) is a low-grade tumor with rare metastasis. A 26-year-old male presented with multiple cutaneous nodular lesions of DFSP since 3 months along with distant metastasis to the brain, pleura, and muscles that were detected on investigations. The case is being reported due to its rare disseminated cutaneous with systemic metastasis.

Paraneoplastic dermatomyositis with carcinoma cervix: a rare clinical association.

Dermatomyositis is an uncommon inflammatory myopathy associated with cutaneous manifestations. It may also occur as paraneoplastic syndrome associated with various malignancies, most common of which being lung, breast, stomach, rectum, kidney, or testicular cancer. A postmenopausal woman presented to us with generalized itching along with skin rash and proximal muscle weakness of 2 years' duration. Examination revealed heliotrope rash and mechanic hands and muscle power 2/5 in proximal muscle groups of both upper and lower limbs. A clinical diagnosis of dermatomyositis was made which was supported by raised lactate dehydrogenase levels and skin biopsy findings. Past history was significant for vaginal discharge and bleeding per vagina. Further work-up revealed carcinoma cervix and she was referred to oncology department for further management. Temporal relationship and improvement of muscle weakness with treatment of underlying neoplasm supported its paraneoplastic nature. So, final diagnosis of keratinizing squamous cell carcinoma of cervix with paraneoplastic dermatomyositis was made. A nationwide cohort study of 1,012 patients with dermatomyositis in Taiwan revealed only 3 patients with cervical cancer. So this case is being reported for its rare association with carcinoma cervix and to highlight the need of detailed evaluation for underlying malignancies in patients with dermatomyositis.

Herpes genitalis - Topical zinc sulfate: An alternative therapeutic and modality.

BACKGROUND: Herpes genitalis is one of the commonest sexually transmitted infections in the world caused by herpes simplex virus (HSV) 1 and 2. All herpes viruses show latency. Herpes genitalis caused by HSV-1 and HSV-2 is recurrent in 55 and 90% of case respectively. AIMS: To comparatively evaluate the therapeutic efficacy of topical zinc sulfate (ZnSO4) in varying concentrations in herpes genitalis. MATERIALS AND METHODS: Ninety patients clinically diagnosed as herpes genitalis and confirmed by Tzanck test were taken up for study and divided into 3 groups of 30 patients each which were applied topical ZnSO4 in concentrations of 1%, 2% and 4% respectively for 3 months. Ten patients of herpes genitalis were kept as control in whom only distilled water was applied. Patients were followed up for a total period of 6 months for any recurrences. RESULTS: Ten patients of group 1 (1% ZnSO4) showed recurrence, 6 patients in group 2 (2% ZnSO4) and only one patient in group 3 (4% ZnSO4) showed recurrence. In the control group, 8 out of 10 patients showed recurrence. No serious side effects were seen in all 3 groups. CONCLUSION: Topical ZnSO4 has been found to be an effective therapeutic modality not only for treatment but also for prolonging remissions in herpes genitalis. Topical 4% ZnSO4 has been found to be most efficacious out of the three concentrations, without any side effects.

Psychiatric morbidity among inmates of leprosy homes.

CONTEXT: Leprosy affected people are having high psychological distress and it in turn leads to psychiatric disorders. There is a paucity of literature from our country in this significant health problem. AIMS: The aim of this study was to find the prevalence of psychiatric morbidity and its association with sociodemographic and clinical factors among the inmates of leprosy homes. SETTINGS AND DESIGN: Study sample was obtained from individuals residing in two leprosy homes of malwa belt of Punjab. MATERIALS AND METHODS: In screening stage, the study subjects were administered sociodemographic proforma and general health questionnaire (GHQ-12). In the confirmation stage, the study subjects were interviewed in detail and disability assessment was done using World Health Organization disability scale. Final psychiatric diagnosis was made as per ICD-10 criteria's. STATISTICAL ANALYSIS: Statistical analysis was performed using the descriptive statistics, Chi-square test, analysis of variance, and correlation analysis. RESULTS: Majority of the subjects was in the age group 41-50 years, female, married, illiterate, Hindu and were from nuclear families. Nearly, 50.38% of subjects were having GHQ-12 score more than twelve. Nearly, 55.6% subjects were having psychiatric disorders out of which a large number of patients was diagnosed as having dysthymia. The other psychiatric disorders found in the study population were moderate depressive episode, generalized anxiety disorder, mixed anxiety and depressive disorder and schizophrenia unspecified. Psychiatric morbidity was found to be significantly related to age, family status, and duration of leprosy illness and presence of deformities among inmates. CONCLUSIONS: This study highlighted that psychiatric disorders were found in a large number among inmates of leprosy homes. Leprosy eradication program must place specific emphasis on psychiatric care of these patients.

Congenital melanocytic nevus studded with strawberry haemangioma on the scalp.

A six-month-old male infant presented with congenital melanocytic nevus (CMN) studded with strawberry haemangioma on the right side of scalp since birth. Both lesions were gradually increasing up to the present size. The case is being reported for its rare occurrence.

Topical 20% KOH--an effective therapeutic modality for moluscum contagiosum in children.

Topically 20% KOH aqueous solution once daily at bedtime was applied in 27 children having molluscum contagiosum by their parents, till lesions showed signs of inflammation or superficial ulceration. 24 children (88.9%) completed the trial and complete clearance was achieved after a mean period of 17 days. No recurrence was observed during follow up period. Thus in this open trial topical 20% KOH aqueous solution has proved to be convenient, easy to apply at home, safe and inexpensive alternative therapeutic modality for the treatment of molluscum contagiosum in children.

Therapeutic efficacy of intralesional triamcinolone acetonide versus intralesional triamcinolone acetonide plus lincomycin in the treatment of nodulocystic acne.

BACKGROUND: Intralesional triamcinolone is an established therapy for cysts of acne. However, intralesional antibacterials have not been used earlier. AIM: To compare the efficacy of intralesional triamcinolone with that of a combination of intralesional lincomycin and intralesional triamcinolone in nodulocystic acne. MATERIAL AND METHODS: Ten patients of nodulocystic were injected with intralesional triamcinolone acetonide (2.5 mg/ml), while nine patients were given lincomycin hydrochloride (75 mg/ml) in addition to the intralesional triamcinolone. They were followed up 48 hrs, one week and one month later. RESULTS: At one week, 7 patients (70%) treated with injection triamcinolone showed 66% improvement, whereas all 9 (100%) patients treated with lincomycin and triamcinolone showed 100% improvement which was stable at one month. CONCLUSION: A combination of intralesional triamcinolone and lincomycin is superior to intralesional triamcinolone alone in the treatment of nodulocystic lesions of acne.

Pachyonychia congenita-like nail changes treated successfully with a combination of vitamins A and E: a case report.

A 20-year-old man presented with thickening, subungual hyperkeratosis and discoloration of all the nails of both hands and both great toes since birth. No other ectodermal abnormalities were found. Treatment with vitamins A and E in high doses along with a moisturizing ointment topically for one year resulted in complete resolution of all nail abnormalities.

Skin grafting in chronic leg ulcers--a dermatologist's domain.

A case of chronic leg ulcer for the last two years in a 50-year-old male, not responding to conventional therapeutic modalities had shown faster healing and excellent cosmetic results by undertaking split skin thickness grafting in the hands of a dermatologist.

A study of behavioural changes and clinical evaluation of leprosy in school going children of leprosy parents.

Seventy-seven school going children in age group 5-15 years having one or both parents affected with leprosy and staying away from their parents in charitable ashram cum school for the last 6 months to 6 years time were examined for any behavioural changes and signs and symptoms of leprosy. None of these children showed any behavioural changes or signs and symptoms of leprosy.

Tattooing with electrocauterization: a cosmetically acceptable therapeutic modality for a single halo naevus.

Two cases of single lesion halo naevus were treated with tattooing followed by electrocauterization resulting in good cosmetic acceptability. Tattooing with electrocauterization should be tried as a new therapeutic modality in a single lesion halo naevus especially on exposed parts of the body to avoid the unavoidable psychological trauma.

Chemical peeling--evaluation of glycolic acid in varying concentrations and time intervals.

Thirty-one patients with melasma, 4 with superficial post acne scarring and one each with xeroderma pigmentosum and epidermal naevus were studied to know the efficacy of glycolic acid for chemical peeling in varying concentrations and time intervals such as 35% (4 minutes), 52.5% (3 minutes), 70% (2 minutes) at varying intervals upto 6 months. These patients were in the age group of 17-44 years. These patients were followed up regularly. Results showed significant improvement when peeling was done with 52.5% glycolic acid for 3 minutes in melasma, 70% glycolic acid for 2 minutes in superficial post acne scarring.

Intraoral giant condyloma acuminatum.

A case of intraoral giant condyloma acuminatum is reported in a 50- year- old Indian. He did not respond to topical application of podophyllin 20% but responded partially to electric cauterisation. Surgical excision was done to get rid of the warty growth completely. Since there were no skin or genital lesions and no history of marital or extramarital sexual contact the lesion was probably acquired from environmental sources. Nonsexual transmission should be considered especially when the lesions are extragenital.