Medical Management of Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group.

Melasma is one of the most common hyperpigmentary disorders found mainly in women and dark-skinned patients. Sunlight, hormones, pregnancy, and genetics remain the most implicated in the causation of melasma. Although rather recalcitrant to treatment, topical agents such as hydroquinone, modified Kligman's Regime, azelaic acid, kojic acid, Vitamin C, and arbutin still remain the mainstay of therapy with sun protection being a cornerstone of therapy. There are several new botanical and non botanical agents and upcoming oral therapies for the future. There is a lack of therapeutic guidelines, more so in the Indian setup. The article discusses available evidence and brings forward a suggested treatment algorithm by experts from Pigmentary Disorders Society (PDS) in a collaborative discussion called South Asian Pigmentary Forum (SPF).

Chemical Peels in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group.

Melasma is a notorious dermatosis, often resistant to treatment. Chemical peeling constitutes an acceptable option of management of melasma (of any type and duration). In this article, as a group of experts from Pigmentary Disorders Society (PDS) in collaboration with South Asian Pigmentary Forum (SPF), we have tried to elaborate the various chemical peeling agents for the treatment of melasma. Besides, we have reviewed the indications, mechanism of action, rationality and the detailed procedure of peeling. The evidence in favor of various peeling agents have been summarized as well.

Lasers in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group.

Lasers have come up as the newest therapeutic modality in dermatological conditions including melasma. In this article, as a group of experts from Pigmentary Disorders Society in collaboration with South Asian Pigmentary Disorders Forum (SPF), we have tried to discuss the lasers which have been used in melasma and formulate simple consensus guidelines. Following thorough literature search, we have summarised the rationale of using the lasers and the supporting evidences have also been provided. It is clear that laser cannot be the first line treatment for melasma. However, it can be used as an adjuvant therapy in resistant cases, provided the selection of patient and counselling has been done properly.

Nephrogenic systemic fibrosis following hair-dye ingestion induced acute renal failure.

We report a patient who developed acute renal failure following the ingestion of a hair-dye with a suicidal intent. He was managed by hemodialysis and other symptomatic measures. He developed generalized seizures and underwent MRI scan of the brain using gadolinium containing contrast material followed by development of bilateral and symmetrical thickening and induration of the skin over the extremities and verrucous papules and plaques over the lower back. Skin biopsy and immunohistochemistry showed typical features of nephrogenic fibrosing dermopathy as well as deposits of calcium. Successful management of renal failure resulted in clearing of all skin lesions except a small bony hard plate like area overt the left leg, the biopsy of which showed features of osseous metaplasia.

A study of allergen-specific IgE antibodies in Indian patients of atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing, pruritic dermatitis frequently associated with the hyperproduction of IgE to various allergens. Identification of these allergens is possible by various laboratory investigations. AIM: The present study was designed to assess these allergen-specific antibodies in the diagnosis of AD in the Indian context. METHODS: This prospective study comprised 50 patients of AD. The diagnosis was made clinically after satisfying Hanifin and Rajka's criteria. Serum IgE levels were estimated and specific IgE antibodies were measured for 20 food allergens and aeroallergens. RESULTS: Serum IgE was elevated in 88% of the patients. The highest elevation of mean IgE levels was seen in the 10-20 years age group. Sixty five percent of the children under the age of ten years were positive to one or more food allergens. Food allergens were more often positive in the < or = 10 years age group and specific antibodies to inhalants were seen more frequently in the older age groups. Specific antibodies to apples were found in all age groups. CONCLUSION: Antibodies against apples and hazelnuts were the more commonly seen specific antibodies in children. Incidence of positivity was much higher in children when compared to earlier studies. Identification of food allergens can be an important factor in the diagnosis of AD in children in India. Positivity to inhalant allergens in the older age groups was lower in this study. The allergen profile with regard to inhalants in Indian patients was similar to that of earlier studies.

Histiocytoses.

Histiocytoses are a heterogeneous group of disorders that are not clearly understood. The unifying aspect of the entire spectrum lies in the accumulation of histiocytes in various tissues. Two cases are being presented for their rarity and the importance of histological features and marker studies in the diagnosis is emphasized.

Pigmentary demarcation lines over the face.

BACKGROUND: We have been observing that a significant proportion of our patients, especially females, have certain pigmentary demarcation lines (PDL) over the face. However, systematic studies of the subject are lacking. AIMS: We categorized the different clinical patterns of facial PDLs in the Indian subpopulation and assessed their prevalence in this study. METHODS: About 4000 consecutive patients, both males and females, attending our skin clinic were examined for the presence of any pigmentary demarcation lines on the face, from October 1998 to February 2000. RESULTS: Out of the study population of 4037 patients, 243 (6%) were found to have demarcation lines on the face. The demarcation lines were far more common in women (9%) than in men (0.75%). These lines could be classified into three patterns that we would like to label as F, G, H as PDLs A to E have already been described. CONCLUSIONS: Pigmentary demarcation lines are fairly common in the Indian population especially amongst the females. Hormonal influences could possibly explain the female preponderance. Aggregation of cases within families or among close relatives suggests a genetic background.

Witchcraft's syndrome: Munchausen's syndrome by proxy.

A 28-year-old man presented to the Dermatology Outpatient Department with a complaint of a burning sensation and soreness over his left cheek and left ear of 10 days duration. It had started suddenly one morning when he woke up from sleep. He noticed a large blister with intense redness over his left cheek, associated with a burning sensation. There was a history of similar episodes over the past year, and all were sudden in onset, involved the cheeks, and were noticed after waking up from sleep. The patient volunteered that the episodes were always associated with a drinking spree the previous night. The individual was a healthy man with a wife and two children. The patient had been dependent on alcohol for the past year, and had been consuming alcohol for many years. On examination, there was an eschar occupying almost the entire cheek, with a few scattered lesions over the left tragus and left external ear. Peripheral scarring was noted with hyperpigmentation. While the angle of the mouth was superficially involved on the left side, the oral mucosa was normal. The right cheek also showed a few areas of scarring with patches of alopecia. There were no similar lesions elsewhere on the body. The peculiar history and the morphology of the lesion, that defied any classical diagnosis description, prompted us to interrogate both the man and his wife with regard to any serious differences. After much persuasion and on assurance of secrecy, the wife admitted that her husband was an alcoholic and was neglecting his family. When her efforts to prevent his drinking failed, she resorted to this drastic measure. Each time he passed out after a drinking bout, she poured acid on his cheek, hoping that the sequelae would frighten him from drinking. The acid was readily available to her as she used it for domestic cleaning. The couple were sent for psychiatric evaluation as Munchausen's syndrome by proxy (MSBP) or witchcraft's syndrome (WS) was suspected. Detailed psychiatric evaluation, together with psychometric assessment, revealed that the patient had an alcohol dependence (Axis-I diagnosis) and had a cyclothymic personality. Severe marital discord due to alcohol dependence had been present for the past 2 years. Evaluation of the patient's wife revealed that she was under significant psychologic distress. She showed major depressive symptoms with a histrionic personality. She revealed that she had resorted to using the corrosive out of frustration and anger over the behavior of the patient while he was in an inebriated state. The couple are currently undergoing psychiatric treatment.

The efficacy of flutamide, an antiandrogen in idiopathic hirsutism.

The efficacy of flutamide, an antiandrogen in idiopathic hirsutism was studied. The long term effects of. treatment with low doses of flutamide on clinical and hormonal parameters were investigated. Nine patients with idiopathic hirsutism were studied basally and during treatment with 125mg flutamide thrice daily for a period of 9 months. Safety parameters were assessed throughout the study. Hirsutism was graded by Ferriman and Gallwey score and hormones were evaluated basally and later quarterly. After three months of therapy, flutamide had caused a significant alleviation of hirsutism and this continued during the subsequent months. No clinical significant side effects were observed during the period of the study. Biochemical and hormonal parameters remained unchanged after 9 months of flutamide.

Hereditary motor and sensory neuropathy mimicking hansen's disease.

A rare case of hereditary motor and sensory neuropathy in a 45 year old man with glove and stocking hypoaesthesia, bilateral clawing, foot drop and thickening of the peripheral nerves mimicking Hansen's disease is reported.

Congenital multiple cutaneous mastocytoma.

A rare case of multiple cutaneous mastocytoma presenting at birth with multiple skin coloured to hyperpigmented papulonodules and plaques all over the body is being reported.

Primary cutaneous phaeohyphomycosis.

A rare case of phaeohyphomycosis presenting with a solitary nodule on right lower leg of 2 years duration is being reported. The disease showed marked response to oral fluconazole.

Nylon friction dermatitis: A distinct subset of macular amyloidosis.

43 patients were taken up for the study, all of whom were asymptomatic and presented with bluish black pigmentation. 23 patients presented with pigmentation which was proximal and distal to the bony prominences, all of whom gave a history of using nylon scrubbers during bathing. 20 patients gave no history of friction and the pigmentation was present on the extensor forearms, shins and upper back. Histopathological examination confirmed amyloid deposits.