Misuse of topical over-the-counter medication: A case report.

Overuse of topical medication is a national issue. Over-the-counter (OTC) medications are dispensed to patients directly without a physician's prescription and when used improperly without proper knowledge can lead to their misuse and toxicity.

Granulosis rubra nasi: A rare dermatosis not limited to nose.

Granulosis rubra nasi (GRN) is a rare genodermatosis involving the eccrine glands with an unknown aetiology. It is clinically characterized by localized hyperhidrosis, erythema, papules, pustules, and vesicles over central region of face and usually manifests during early childhood. GRN is asymptomatic, spontaneously resolves during puberty, and treatment options have inconsistent results. We hereby present a case of GRN in 38 years female with sites and dermoscopy findings not defined so far.

Metabolic syndrome in patients with lichen planus: A case-control study.

Background: Lichen Planus (LP) is a chronic dermatosis affecting the skin and mucous membranes. Chronic inflammation and oxidative stress in patients with LP is a trigger predisposing to Metabolic Syndrome. Objectives: To study the association of Metabolic Syndrome in patients with LP. Materials and Methods: A hospital-based prospective case-control study was conducted from April 2021 to January 2023 including 75 histopathologically confirmed patients with LP and 82 age and sex-matched controls according to the inclusion and exclusion criteria. Metabolic Syndrome was diagnosed using Modified National Cholesterol Education Programme Adult Treatment Panel III criteria. Statistical analysis of the data was performed using Statistical Package for the Social Sciences software, version 26. The chi-square test was used for data analysis. Results: The majority (30.6%) of the patients belonged to the age group 31-40 years. The mean age of patients with LP was 46.13 ± 14.9 years. Female predominance (69.3%) was observed in our study. Patients with classic LP (54.6%) were predominantly observed. Metabolic Syndrome was significantly prevalent in LP patients than in controls (32% vs. 13.4%, p = 0.005, OR 3.037) and was significantly associated with morphology (only oral mucosal involvement, 61.5%, p 0.027, OR 3.9), severity (severe LP, 58.6%, p < 0.001, OR 7.79), and duration of the disease (≥6 months, 55.5%, p 0.001, OR 5.42). 71% of Metabolic Syndrome was observed in females (p 0.847). Among patients with metabolic syndrome, the majority belonged to the age group between 31 and 40 years (37.5%, p 0.378). Systolic and Diastolic Blood Pressure values (≥130/85 mm of Hg), Serum Triglycerides (≥150 mg/dl), and Low-Density Lipoprotein (>130 mg/dl) were significantly elevated, and High-Density Lipoprotein (<40 mg/dl) was significantly low in LP than in controls (p < 0.05). Conclusion: The study showed a significant association of Metabolic Syndrome in patients with LP. Thus, patients with LP need to be screened to avoid complications associated with Metabolic Syndrome that is, Diabetes Mellitus, Cardiovascular Disease, colorectal cancer, and stroke.

Herpes zoster occurring over the site of tinea cruris-A case report based on the model of T-cell exhaustion in the Ruocco's immunocompromised cutaneous district.

Immunocompromised district refers to the area of the skin with altered immune response predisposing secondary diseases to develop in an immunocompetent individual. This might be explained by the theory of T-cell exhaustion which is characterized by the impairment of the effector function of antigen-specific T cells due to chronic persistence of the primary antigen. T-cell exhaustion model is not well known; however, it serves as a newer concept in the pathogenesis of diseases occurring simultaneously over the same site. Thus, it is not surprising to have two different infectious or non-infectious dermatoses over the same site one preceding the other as observed in our patient. The concept of immunocompromised district and T-cell exhaustion is a rare phenomenon; however, it should be identified by the treating physicians/dermatologists for the optimum management of the atypical presentation of the diseases.

Recurrent toxic epidermal necrolysis with two different drugs in a patient with chronic kidney disease-A case report with an atypical presentation.

Toxic epidermal necrolysis (TEN) is a dermatologic emergency usually attributed to drugs. Recurrent episodes of TEN are more common in the pediatric population than in adults. Patients carrying susceptible specific haplotypes, cross-reactivity between the drugs, and drug metabolites generated by the Cytochrome P450 are the key factors for the recurrent episodes. Chronic kidney disease (CKD) increases the risk of toxic epidermal necrolysis by altering the pharmacokinetics and pharmacodynamics of the drug with comparatively higher mortality in this group of patients. We hereby present an elderly female with 2 episodes of TEN following intake of furosemide at present and Nimesulide 3 years back. Cross-reactivity between these drugs because of the similar stereochemical structure might have triggered the second episode. The second episode of TEN was milder in presentation with a short latency period without any constitutional symptoms as compared to the first episode. Thus, treating physicians should always consider cross-reactivity between the chosen drugs in order to prevent subsequent life-threatening episodes, especially in patients with CKD.

Scalp marking tool (SMarT): A simple, novel method to mark the scalp for follow-up examination.

This study describes a novel and noninvasive method to mark the scalp for a follow-up examination. This method can be utilized for trichoscopic examination or assess treatment response at a particular scalp site during follow-up examinations. It can be easily implemented within a dermatology clinic with minimal use of resources.

Prostate cancer risk in patients with melanoma: A systematic review and meta-analysis.

BACKGROUND: The risk of prostate cancer in melanoma patients has been frequently assessed. However, a comprehensive meta-analysis specifically examining this association is lacking. Our aim was to quantify the risk of prostate cancer in melanoma patients based on the available evidence. METHODS: A systematic review of the existing literature was performed in PubMed, Scopus, and Cochrane databases by two authors independently. Studies reporting the effect size in the form of standardized incidence ratio (SIR) were used for quantitative analyses. RESULTS: Of 17 studies included in the review, a total of 15 studies with 282 592 male melanoma patients were used for the analysis. Random-effects meta-analysis found a 24% increased risk (SIR = 1.24, 95% confidence interval 1.18 to 1.30) of prostate cancer in melanoma patients compared to the general population, with a prediction interval of 1.05 to 1.45. The risk was consistently significant for various geographical regions and latitude. Heterogeneity was significant (I2  = 75%). CONCLUSION: These results suggest that the incidence of prostate cancer is significantly higher in patients with melanoma compared to the general population.

Interleukin-17 level in patients with vitiligo: A systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: The role of the pro-inflammatory cytokine, interleukin (IL)-17 is being continuously explored in various autoimmune disorders. Studies have assessed the levels of IL-17 in vitiligo patients. This study aims to evaluate the IL-17 levels in vitiligo patients in comparison with the healthy controls by performing a meta-analysis. METHODS: A systematic review of the existing literature was performed in PubMed, Scopus and Cochrane databases by two authors independently. The data required to calculate the pooled effect size in the form of standardised mean difference (SMD) with the corresponding 95% confidence interval (CI) were extracted from the eligible studies. Separate analyses for active and stable vitiligo were also performed. RESULTS: A total of 11 case-control studies with 626 vitiligo patients and 475 healthy controls were included. Random-effects meta-analysis found significantly higher serum IL-17 levels in vitiligo patients compared with the healthy controls (SMD = 1.67, 95% CI 1.11 to 2.22, P < 0.001). The IL-17 levels were higher in both active (SMD = 1.31, 95% CI 0.76 to 1.86) and stable (SMD = 1.47, 95% CI 0.59 to 2.35) vitiligo patients compared with the healthy controls. The skin IL-17 levels were also significantly higher in vitiligo patients (SMD = 1.28, 95% CI 0.82 to 1.74). Heterogeneity in the baseline characteristics of the included studies was the major limitation of this study. CONCLUSIONS: These results suggest that vitiligo patients have significantly elevated IL-17 levels. Further examination of this association could have implications for the treatment of vitiligo.

Association between psoriasis and celiac disease: A systematic review and meta-analysis.

BACKGROUND: Multiple studies have examined the association between psoriasis and celiac disease (CD). However, these studies have shown conflicting results. OBJECTIVE: To analyze the association between psoriasis and CD. METHODS: We conducted a systematic review of the case-control, cross-sectional, and cohort studies examining the association between psoriasis and CD in the PubMed, Scopus, and Cochrane databases. The adjusted effect sizes or crude data were extracted for quantitative analysis. RESULTS: Of 754 citations initially identified, 18 studies were included. Random effects meta-analysis found significant odds ratios of 2.16 (95% confidence interval, 1.74-2.69; 9 studies) for CD in patients with psoriasis and 1.8 (95% confidence interval, 1.36-2.38; 8 studies) for psoriasis in patients with CD. We also found a significantly increased risk of new-onset psoriasis in CD (hazard ratio, 1.75; 95% confidence interval, 1.58-1.93). Subgroup analyses according to disease severity and geographic region could not be performed due to limited data. CONCLUSION: This 2-way meta-analysis found a significant association between psoriasis and CD. Clinicians should be aware of this association. Patients with psoriasis with bowel complaints might benefit from screening for CD through questionnaires or interviews with subsequent gastroenterology consultation.

Clinicodermoscopic study of histoid leprosy: a case series.

BACKGROUND: Histoid leprosy (HL) is a highly bacilliferous form of leprosy which requires early diagnosis and management. Dermoscopy is a noninvasive diagnostic method for various malignant and nonmalignant disorders. The aim of this study was to describe the dermoscopic patterns of various types of HL lesions over different body parts. METHODS: This was a hospital-based observational study which evaluated the clinical and dermoscopic features of a series of patients with the diagnosis of HL. The diagnosis was confirmed clinically, histologically, and through the demonstration of bacilli. A handheld dermatoscope at 10x magnification in polarized mode was employed to examine multiple lesions over various body sites. RESULTS: A total of four patients (three female, one male) were included. Papules were the most common type of lesion, and limbs were most frequently involved. Linear branching vessels and shiny white structures were present in all cases and in all lesion types. The linear branching vessels frequently presented in the form of crown vessels. Ulcerated lesions and umbilicated lesions also showed prominent vascularity. Follicular plugging was observed in the lesions over limbs. CONCLUSION: Dermoscopy may aid in the diagnosis of HL by showing prominent dermoscopic features such as linear branching vessels and shiny white structures.

Association of atopic dermatitis with vitiligo: A systematic review and meta-analysis.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with multiple immune-mediated disorders. A comprehensive meta-analysis assessing the prevalence or risk of vitiligo in AD patients is lacking. OBJECTIVE: To compare the prevalence and assess the risk of vitiligo in patients with AD by performing a meta-analysis of observational studies. METHODS: PubMed, Scopus, and Cochrane databases were systematically searched until August 25, 2019, following the PRISMA guidelines. Published English-language articles including case-control, cross-sectional, or cohort studies that reported either odds or risk of vitiligo in AD patients were included. Full-text review and study assessment were performed by the two authors independently. Random-effects meta-analysis model was used to calculate the odds ratio (OR) and risk ratio (RR) with the corresponding 95% confidence interval (CI). The risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS: Seven studies with a total of 1 540 688 unique AD patients were included. The random-effects meta-analysis of case-control and cross-sectional studies showed a significant association of AD with vitiligo (OR, 3.21; 95% CI, 1.90-5.43). Subgroup analyses also showed a significant association for both adult AD (OR, 4.46; 95% CI, 1.65-12.07) and childhood AD (OR, 2.83; 95% CI, 1.53-5.25). Pooling of the results of 2 cohort studies showed an increased risk of vitiligo in patients with AD (RR, 1.64; 95% CI, 1.27-2.13). CONCLUSIONS: Results from this study support an association of AD with vitiligo. Exploration of possible mechanisms responsible for this association could be important to develop proper treatment approaches for the affected patients.

Oxidative stress in alopecia areata: a systematic review and meta-analysis.

BACKGROUND: Several studies have investigated the oxidative stress parameters in alopecia areata (AA) patients with variable results. This study aims to analyze the association between oxidative stress and AA based on current literature. METHODS: A systematic review of the existing literature was performed in PubMed, Scopus, and Cochrane databases by two authors independently. Mean and standard deviation values of oxidative stress parameters of AA patients and healthy controls were extracted for quantitative analysis. RESULTS: A total of 18 studies were included in the analysis. Patients with AA had impaired oxidative balance with elevated levels of serum malondialdehyde, nitric oxide, and total oxidant capacity and lower levels of serum superoxide dismutase, paraoxonase, glutathione peroxidase, and total antioxidant capacity. Levels of oxidative parameters were significantly higher in severe AA compared to mild/moderate AA. Heterogeneity in the baseline characteristics of the included studies and limited available data for most parameters were the limitations of this study. CONCLUSIONS: Current evidence suggests that AA is associated with oxidative stress. More studies are needed to strengthen this association. Moreover, studies evaluating the role of antioxidant use in AA may be rewarding.