Efficacy of Metformin in the Treatment of Acne in Women with Polycystic Ovarian Syndrome: A Newer Approach to Acne Therapy.

Introduction: Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous units and has been associated with hyperandrogenism, which, in women, is most commonly caused by polycystic ovary syndrome (PCOS). Metformin treatment can correct ovarian and functional adrenal hyperandrogenism in adolescents with PCOS. Objective: We evaluated the efficacy of metformin therapy in women with acne and PCOS in terms of acne load. Methods: This was a hospital-based, interventional, longitudinal study that included 40 female patients with acne and PCOS diagnosed using the Rotterdam criteria. Hormonal assay, including serum levels of testosterone, dehydroepiandrosterone sulphate, luteinizing hormone, follicle-stimulating hormone, prolactin, and blood sugar, was conducted on the third or fourth day of the menstrual cycle in a fasted state. An abdominal ultrasound was performed on the ninth day of menstrual cycle to diagnose PCOS. Baseline acne severity was assessed as per the Definition Severity Index. Metformin 500mg was given to all selected patients three times a day for eight weeks. Patient follow-up and acne severity reassessment was conducted at Weeks 3 and 6. At Week 8, all work-ups were repeated. Intention-to-treat analysis was done. Wilcoxin signed-rank sum test was used to identify significance in acne severity. Results: Metformin treatment significantly reduced acne severity in patients with PCOS (p<0.001). Conclusion: Metformin reduces ovarian hyperandrogenism, leading to clinical improvement of acne in women with PCOS.

Hereditary Sensory and Autonomic Neuropathy Presenting With Mutilating Trophic Ulcers.

Two siblings, a 19-year-old woman and an 18-year-old man, born to apparently normal parents of second-degree consanguineous marriage, presented to the Department of Dermatology, Sawai Man Singh Medical College Hospital, Jaipur, India, with recurrent skin ulcers of the hands and feet since early childhood. The ulcers were spontaneous, slow to heal, and caused deformities. On initial examination, they were found to have distal sensory loss, predominantly to pain and temperature. The patients were diagnosed with hereditary sensory and autonomic neuropathy of ulceromutilating type (Type 2) based on clinical evidences, nerve studies, and neuropathology. Although clinical features were distinct, due to slow progression of the disease and lack of clinical suspicion, diagnosis was delayed until adulthood when complications developed leading to deformities. Through this report, the authors intend to familiarize readers with this rare disease that can present with trophic ulcers.

Idiopathic Calcinosis Cutis Universalis Treated Successfully with Oral Diltiazem-A Case Report.

Idiopathic calcinosis cutis is very rare and difficult to treat. Various medical modalities of treatment described with inconsistent results include chelating agents, colchicine, and probenecid. Calcium channel blockers are known to work by inhibiting intracellular entry of calcium. We successfully treated a case of idiopathic calcinosis cutis using oral diltiazem.

Study of patterns of sexually transmitted diseases using a syndromic approach in the era of human immunodeficiency virus from a tertiary care hospital of the Northern India.

BACKGROUND: Sexually transmitted infections (STIs) increase the risk of transmission of Human Immunodeficiency Virus (HIV) infection causing immense need to understand the patterns of STIs prevailing in the regions of a country for proper planning and implementation of STI control strategies. Due to the lack of adequate laboratory infrastructure in the country, information regarding the profile of STIs relies essentially on syndromic diagnosis. AIMS AND OBJECTIVES: To study the pattern of common STIs and the prevalence of HIV infection in patients attending the STI clinic of a tertiary care hospital in northern part of India using a syndromic approach. MATERIALS AND METHODS: A retrospective analysis of data collected from the clinical records of 2700 patients over a period of 21 months (July 2012 to March 2014) was carried out at the Skin and VD Department of SMS Hospital, Jaipur. Detailed history, demographical data, and clinical features were recorded from all the patients. All patients were tested for HIV by ELISA and rapid plasma reagin. STIs were categorized in different syndromes as depicted by National AIDS Control Organization in the syndromic management of STIs. The data collected was analyzed statistically. The proportions were calculated for various syndromes and disease prevalence. RESULTS: The overall most common STI was balanoposthitis, followed by genital herpes, vaginal/cervical discharge, molluscum contagiosum, genital warts, nonherpetic genital ulcer disease, lower abdominal pain, and urethral discharge in decreasing order. Among the study population, 2.55% were found to be HIV-positive. CONCLUSION: Viral STIs such as molluscum contagiosum, herpes genitalis, and condylomata acuminata are on the rise among STI/RTI clinic attendees.

Panatrophy of Gowers is a rare disease: case reports and review of the literature.

BACKGROUND: Panatrophy of Gowers (PG) is a very rare disorder. It is characterized by a sharply defined and localized area of atrophy involving subcutaneous tissue and, on rare occasions, bone. The etiopathogenesis of this disorder is an enigma. A limited number of patients have been described in single case reports. OBJECTIVES: This article describes the clinical features and histopathological findings of PG with the aim of indicating that PG may not be as rare as it is assumed to be. METHODS: We studied patients with lesions resembling those of PG between the years 2007 and 2012. Diagnoses of PG were based on clinical and histopathological findings. RESULTS: Four female and three male patients presented with clinically and histologically identical lesions. CONCLUSIONS: This disorder is not as rare as it is assumed to be, probably because it is misdiagnosed as post-steroid atrophy; thus PG requires more attention. Seven patients with PG are reported here to counteract the supposed rarity of this disorder and to highlight findings of hypopigmentation mimicking steroid-induced atrophy.