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.

Estimation of Metabolic Syndrome in Acanthosis Nigricans - A Hospital Based Cross-Sectional Study.

Background and Objectives: Acanthosis nigricans is characterized by hyperpigmentation and velvet-like thickening of the skin. It symmetrically involves the neck, axilla, groins, antecubital and popliteal fossae, umbilical, and perianal areas. Acanthosis nigricans is a marker for insulin resistance and is increasingly found to be associated with metabolic syndrome. We conducted this study to estimate the frequency of metabolic syndrome in acanthosis nigricans. Methods: In this hospital-based, cross-sectional study, we evaluated 60 patients with acanthosis nigricans with neck involvement. They were examined for other areas of involvement by acanthosis nigricans. Axillary and neck severity was graded based on the scale described by Burke et al. Insulin resistance was interpreted using homeostatic model assessment (HOMA-IR). Metabolic syndrome was diagnosed according to the SAM-NCEP criteria. Collected data were analyzed using IBM SPSS Statistics, Version 22 (Armonk, NY: IBM Corp). Results: Axilla was the most common site involved in 51 patients (85%) followed by knuckles (55%). Metabolic syndrome was found in 78.3% of our patients, and 56.66% had insulin resistance. A statistically significant association of severity grading of axillary acanthosis nigricans with both metabolic syndrome (P = 0.001) and insulin resistance (P = 0.03) was noted. However, no meaningful association was found between the severity grading of neck acanthosis nigricans with both metabolic syndrome (P = 0.4) and insulin resistance (P = 0.08). The association of neck texture grading of acanthosis nigricans with insulin resistance was statistically significant (P = 0.005). Conclusions: Metabolic syndrome was seen in 78.3% of acanthosis nigricans. Axillary severity grading was associated with metabolic syndrome.

Efficacy of fractional CO2 laser with intralesional steroid compared with intralesional steroid alone in the treatment of keloids and hypertrophic scars.

BACKGROUND AND OBJECTIVE: Keloids and hypertrophic scars (HTS) are abnormal fibrous reactions that persist for prolonged periods, rarely regress without treatment and recur after excision. Many modalities of treatment have been advocated but the success rates of these have been variable. The present study is an attempt to evaluate and compare the efficacy of combination of fractional CO2 laser (FCL) and intralesional steroid (ILS) against ILS alone in the treatment of keloids and HTS. METHODS: Patients with keloids or HTS were divided into two groups of 25 each receiving four sessions of therapy. Group 1 (FCL + ILS) received combination of FCL and intralesional triamcinolone acetonide (TAC) 10 mg/mL. Group 2 (ILS only) received intralesional TAC 10 mg/mL alone. Pretreatment measurements and photographs were taken. Two unbiased qualified dermatologists made independent evaluation of the photographs using modified Manchester quartile score (MQS). The patient's satisfaction to treatment was graded on a scale of 1-4. Statistical analysis was done using a statistical software. RESULTS: Statistically significant improvement was seen in height and length of the lesions. Overall appearance criteria of modified MQS showed an improvement of more than 50% in 43.3% of the lesions by the end of four sessions. Degree of hypertrophy showed more than 50% improvement in 40% of the lesions treated. Dyschromia showed more than 50% improvement in 33.4%. Texture showed the least improvement, with only 30% of lesions showing an improvement of more than 50%. The improvement of these parameters in ILS only group was significantly lower than the improvement seen in the FCL + ILS group. CONCLUSION: Combination therapy with FCL and ILS was superior in efficacy when compared to ILS alone, in the treatment of keloids and HTS.

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.

Clinico-microbiological study of dermatophytosis in a tertiary-care hospital in North Karnataka.

CONTEXT: The dermatophytoses constitute a group of superficial fungal infections of keratinized tissues, namely, the epidermis, hair, and nails. The distribution and frequency of dermatophytosis and their etiologic agents vary according to the geographic region studied, the socio-economic level of the population, the time of study, the climatic variations, the presence of domestic animals, and age. AIMS: The present study was undertaken to assess the clinical profile of dermatophytic infections and to identify the causative fungal species in the various clinical presentations. SETTINGS AND DESIGN: This was a hospital-based observational study. MATERIALS AND METHODS: One hundred and fifty clinically suspected cases of dermatophytosis attending the outpatient department of a tertiary care hospital were included in the study. History was taken, general physical and cutaneous examination was done and details of skin lesions noted. Direct microscopy in 10% KOH (40% KOH for nail) and fungal culture on SDA with 0.05% chloramphenicol and 0.5% cycloheximide was done in every case. STATISTICAL ANALYSIS USED: Statistical analysis was done using SPSS 17.0 software. Chi-square test and contingency coefficient test were used as significant tests for analysis. RESULTS: Out of 150 patients studied, majority belonged to the age group of 21-30 years (22.7%). Male-to-female ratio was 1.63:1. Tinea corporis (24.7%) was the most common clinical type observed. The overall positivity by culture was 40% and by direct microscopy was 59.3%. Trichophyton mentagrophytes was the predominant species isolated (48.3%). CONCLUSIONS: The present study reveals the changing trend in the prevalence of dermatophyte species in this part of Karnataka.

Necrobiotic xanthogranuloma.

Necrobiotic xanthogranuloma is a rare, chronic, progressive granulomatous disorder which manifests as yellowish plaques and nodules, most commonly in the periorbital region. The exact aetiology is not known. It is commonly associated with monoclonal gammopathy. Various treatment modalities used include chemotherapy, intralesional and systemic steroids, radiotherapy and surgical excision. We report a case of necrobiotic xanthogranuloma involving the periorbital area causing cosmetic disfigurement.

Giant congenital melanocytic nevus (bathing trunk nevus) associated with lipoma and neurofibroma: report of two cases.

Giant congenital melanocytic nevi are rare and occur in about one out of every 2,00,000 to 5,00,000 births. There is a significant association between bathing trunk nevus and neurofibromatosis and lipomatosis. Apart from this, association of bathing trunk nevus with abnormalities like spina bifida occulta, meningocele, club foot and hypertrophy or atrophy of deeper structures of a limb, have been described. We are herewith reporting two cases of bathing trunk nevi. In our first case, an eight-year-old girl presented with a bathing trunk nevus studded with multiple, large nodules. Histopathological examination of the biopsy taken from one nodule revealed features of both neurofibroma and lipoma. To the best of our knowledge, features of both these hamartomas in one nodule of a single patient are probably not reported in the literature. In our second case, a 12-year-old girl presented with bathing trunk nevus and she had spina bifida occulta. She also had lipoma in the lesion of bathing trunk nevus. Both of our patients had satellite melanocytic nevi over the face, forearm, upper back and legs. Our second patient, in addition, had small melanocytic nevi over the medial canthus and sclerocorneal junction of the right eye. By the time this girl presented to us, the melanocytic nevus started fading in color and it had become brownish. We are reporting these cases for their peculiarities and for their rare features.

Three cases of Dowling Degos disease in two families.

Dowling Degos disease is a rare condition inherited as autosomal dominant trait characterized by numerous, asymptomatic, symmetrical, progressive, small, round-pigmented macules over axillae and groins, face, neck, arms and trunk, scattered comedo-like lesions (dark dot follicles) and pitted acneiform scars. Histopathology is diagnostic. We are hereby reporting three cases of Dowling Degos disease belonging to two families. Our first and second case belonged to the same family, whereas our third case belonged to different family. In our series, all the patients had onset after puberty. All three cases had reticulate pigmentation over face and/or flexures, black comedones and follicular pits. On histopathological examination of the skin biopsy taken from the lesion over the back, all these patients showed classical histopathological features of Dowling Degos disease. We feel that one should investigate the patient presenting with reticulate pigmentation over the face and flexures with blackish comedone-like lesions, because histopathological features of this condition are unmistakable.