Effectiveness of conventional drug therapy of plaque psoriasis in the context of consensus guidelines: a prospective observational study in 150 patients.

BACKGROUND: Evidence for superior outcome by adhering to therapy guidelines is imperative to their acceptance and adaptation for the optimal management of disease variants. OBJECTIVE: Comparative study of prospective outcomes in simultaneous consideration of independent variables in groups of 150 patients of plaque psoriasis either treated adhering to or in digression of standard guidelines. METHODS: The psoriasis area severity index (PASI) and the dermatology life quality index (DLQI), prior to and after three months of uninterrupted therapy were examined in treatment groups among 150 patients. Recovery rates of 75% or more in PASI were compared. Independent variables were also examined for their bearing on the outcome. RESULTS: The vast majority was early onset disease phenotype. All three treatment regimens when administered in adherence to the guidelines yielded significantly superior rates of defined recovery both in PASI and DLQI. Compromise of the therapeutic outcome appeared in high stress profiles, obesity, female sex and alcohol, tobacco or smoking habit. CONCLUSION: Conventional drug therapy of plaque psoriasis yields superior outcome by adhering to the consensus guidelines. Psychiatric address to stress must be integral and special considerations for phenotypic/syndromic variants is emphasized for effective therapy of psoriasis.

Hypohidrotic ectodermal dysplasia.

Ectodermal dysplasias (ED) are a group of inherited disorders characterized by dysplasia of structures of ectodermal origin, clinically classified into hypohidrotic and hidrotic forms. A 21-year-old female presented with history of hypohidrosis, thinning of scalp and eyebrow hair, xerotic skin, and periorbital and perioral wrinkling. There was hypodontia and peg-shaped teeth on intraoral examination. Routine investigations were normal, orthopantomogram revealed absence of multiple teeth with peg-shaped teeth. Histopathological examination showed thinned epidermis and reduction in the number of eccrine units. Thus, the diagnosis was confirmed as Hypohidrotic ED.

Lymphocutaneous sporotrichosis in an adolescent girl presenting as mycetoma.

A 13-year-old girl presented with multiple painless purulent ulcers with raised borders on the medial aspect of the sole of her right foot associated with inguinal lymphadenopathy for the past 4 years. There was history of local trauma at the site prior to the formation of ulcers. There were no other significant associated signs or symptoms. The patient was initially treated with multiple antibiotics with minimal improvement. Fungal cultures of biopsy specimens demonstrated the presence of colonies of Sporothrix schenckii thus confirming the diagnosis of sporotrichosis. Oral itraconazole at the dose of 100 mg twice daily was initiated with marked response at 4 weeks. This case demonstrated a rare morphological presentation of the lymphocutaneous sporotrichosis as mycetoma. The possible diagnosis of sporotrichosis should be kept in mind in such a clinical presentation not responding to antibiotics. Cutaneous sporotrichosis should be diagnosed and treated as early as possible because untreated cases may disseminate to cause visceral involvement with fatal outcome in immunocompromised patients.

Verrucous cell carcinoma arising from an underlying giant keratoacanthoma.

Keratoacanthoma is a well-known, fast-growing, benign squamous epithelial neoplasm that usually presents as a solitary, dome-shaped, pink or flesh-colored nodule developing a central keratin-filled crater. Few authors consider it to be a benign cutaneous tumor whereas others suggest that it should be regarded as a low-grade variant of cutaneous squamous cell carcinoma (SCC). A 21-year-old female presented with a firm, nontender, well-defined plaque with irregular margins measuring about 8 × 4 cm over the dorsal aspect of the right foot along with an exuberant growth from the plaque measuring 4 × 5cm. There was no lymphadenopathy. Systemic examination was within normal limits. Routine investigations, including complete blood counts, liver and renal function tests, urinalysis, chest radiographs, and abdominal ultrasonography, were normal. Histopathological examination of a skin biopsy from the plaque showed features suggestive of keratoacanthoma, whereas exuberant growth overlying the plaque showed features of verrucous carcinoma (a variant of SCC). Thus, it represents a case of SCC arising from a giant keratoacanthoma.

Increased level of serum Homocysteine in vitiligo.

BACKGROUND: Vitiligo is an acquired depigmenting disorder caused by the destruction of melanocytes. The exact etiopathogenesis and mechanisms of vitiligo are not fully understood. Vitamin B12 and folic acid levels are decreased in vitiligo, which are the important cofactors required in the metabolism of Homocysteine (Hcy). Consequently, Hcy level increases in the circulation. Therefore, it is possible that increased Hcy plays a role in melanocytes destruction. The aim was to study for any association of vitiligo with serum Hcy level. METHOD: A total of 30 vitiligo patients of both sexes and 30 control subjects were enrolled in this study. Sera from patients and controls were assayed for Hcy by Enzyme immunoassay. The collected data were analyzed by SPSS version-16. RESULTS: The mean serum level of Hcy was significantly higher in patients with vitiligo as compared with healthy controls and its level was high in male patients as compared with female patients. The Hcy level in vegetarian patients was significantly higher as compared with nonvegetarian patients. The Hcy level was also significantly higher in active vitiligo patients as compared with stable vitiligo patients. CONCLUSION: An increased serum Hcy may be a precipitating factor for vitiligo in the predisposed individuals. Serum Hcy is related to the gender of patients, activity of disease, and dietary habits of vitiligo patients.

Pattern of skin and nail changes in chronic renal failure in Nepal: a hospital-based study.

Chronic renal failure, regardless of its cause, often produces specific dermatological abnormalities, which can develop long before failure manifests clinically. Our aim was to study the clinical pattern of skin and nail changes in chronic renal failure and also study the associations of these changes with age, sex, etiology and duration of the chronic renal failure. A total of 104 diagnosed cases of chronic renal failure were included in the study over a period of 1 year. Equal numbers of age- and sex-matched individuals were taken as controls. The male : female ratio was 1.4:1. The mean duration of chronic renal failure was 19 +/- 20 months. Among cases and controls, 72% and 16% had skin changes, respectively. Xerosis was the most common of the skin changes (28%), followed by hyperpigmentation (20%), pruritus (15%), infectious diseases (5%) and other skin changes (33%) in chronic renal failure patients. Abnormal nail changes were seen in 82% of the cases compared to only 8% of the controls. In the cases, white nail was most common followed by brown and half-and-half nail. Pruritus was significantly higher in the dialysis group whereas the nail changes were significantly higher in the non-dialysis group. The skin and nail changes were common in chronic renal failure and manifested in various forms. Thus, thorough inspection of the integument might reveal markers of occult renal disease.

Pattern of Dermatophytoses in and Around Varanasi.

Four hundered cases of dermatophytoses confirmed microscopically, were analysed. it was more common in 11 to 20 years age group mid males. Females acquired tinea corporis more commonly. Tinea cruris was more frequent in males. Ma3dmum cases were of tinea cruris followed by tinea cruris et corpmis and tinea corporis in that order. the isolation rate on culture was 70.75%. The relative incidence of Trichophyton rubrum was maximum and it was found in all clinical entities.