Pulmonary function severity in relation to interleukin-23 levels in patients with psoriasis vulgaris.

Background Interleukin-23 (IL-23), a key inflammatory regulator in the pathogenesis of psoriasis, is suspected to play a role in the onset of pulmonary dysfunction (chronic obstructive pulmonary disease) in psoriasis. Despite that, pulmonary function tests are rarely studied in these subjects. This study aims to seek a possible relation between pulmonary function in psoriasis patients serum IL-23. Methods For this analytical cross-sectional study, male psoriasis patients in the age group of 25-45 years were recruited from dermatology out patient department (n = 40). Age and BMI matched apparently healthy individuals were recruited as control group (n = 40). After obtaining demographic and personal details, anthropometric parameters and blood pressure were recorded. The severity of psoriasis was assessed using Psoriasis Area and Severity Index score. Pulmonary function was assessed using computerized spirometry, and serum IL-23 was measured using ELISA. Results Forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow rate, and forced expiratory flow at 25%-75% of the pulmonary volume (FEF25%-75%) were significantly reduced in psoriasis. Based on the percentage of predicted values FEF25%-75% was significantly reduced in psoriasis. Serum IL-23 (pg/mL) was significantly higher in psoriasis. The increase in IL-23 in psoriasis subjects does not correlate with their pulmonary function. Conclusions Psoriasis may be associated with a reduced lung function even when the disease is in the mild stage. Increased IL-23 found in these subjects is suggestive of systemic inflammation, which indirectly lowers lung function.

Monilethrix: A Report of Three Cases in Children Confirmed with Dermoscopy.

Monilethrix is a rare hereditary disorder affecting hair resulting in hair fragility and alopecia. We report three patients of monilethrix who presented with complaints of sparse and brittle hair from early childhood. All three patients had multiple discrete hyperkeratotic papules over the scalp. Dermoscopy revealed beaded appearance of hair with the presence of elliptical nodes and intermittent constrictions on the hair shafts as well as broken hairs, which were confirmed with routine microscopic examination of hair. Dermoscopy helps in easier and faster diagnosis of monilethrix.

Xanthoma Disseminatum Presenting with Hoarseness.

INTRODUCTION: Xanthoma disseminatum (XD) is a rare, benign, non-Langerhans cell histiocytic disorder with unknown etio-pathology. It manifests with multiple, grouped, red-brown to yellow papules and nodules involving the skin, mucous membranes, and internal organs with a predilection for flexures and the face. CASE REPORT: We report a patient who presented with disseminated xanthomatous papules and nodules involving the face, neck, trunk, axilla, groin, and oral cavity, along with hoarseness of voice. Video laryngoscopy revealed multiple yellowish nodules over the base of the tongue, vallecula, laryngeal surface of the epiglottis, ary-epiglottic folds, interarytenoid region, and subglottic region. Histopathology was suggestive of xanthoma disseminatum and the patient was treated with tablet acitretin 25mg daily for three months without any response. Following this, the patient was prescribed tablet thalidomide 100 mg daily without any significant improvement at the end of two months. CONCLUSION: Xanthoma disseminatum is a very rare form of non-Langerhans cell histiocytosis that classically presents with cutaneous xanthomas, mucosal xanthomas, and diabetes insipidus. Hoarseness of voice due to lesions involving the larynx is a rare symptom. Because the disease has punctated, numerous relapses and causes morbidity to the patient, its multisystem manifestations have to be known. Therefore, xanthoma disseminatum has to be kept in mind as a differential diagnosis for hoarseness of voice.

Therapeutic Efficacy of Intralesional Steroid With Carbon Dioxide Laser Versus With Cryotherapy in Treatment of Keloids: A Randomized Controlled Trial.

BACKGROUND: Keloids are difficult to treat due to their poor response and high recurrence rate. OBJECTIVE: We conducted a randomized controlled trial to compare the therapeutic efficacy of intralesional triamcinolone acetonide (ILTA) in combination with carbon dioxide laser (Group 1) versus in combination with cryotherapy (Group 2) in the treatment of keloids. MATERIALS AND METHODS: Sixty patients with 101 keloids were randomized into 2 groups. On Day 1, keloids were ablated using either CO2 laser or cryotherapy followed by injection of ILTA at baseline and at 4 weeks interval for 3 months. Patients were followed up for 12 months to assess for therapeutic response and side effects. RESULTS: Successful therapeutic response (>50% improvement) between the 2 groups (CO2 vs cryotherapy) were assessed in terms of reduction in thickness, reduction in volume, patient's self-assessment, observer's assessment, and Vancouver Scar Scale score at the end of 6 months and 12 months (55.55% vs 70.37%; 61.1% vs 77.8%; 75% vs 77.78%; 61.12% vs 85.18%; 52.78% vs 62.96% respectively). The difference in therapeutic response between the 2 groups was not statistically significant at the end of 12 months. CONCLUSION: Both CO2 laser and cryotherapy in combination with ILTA were found to be equally effective in the treatment of keloids.

Effect of antiretroviral therapy on mucocutaneous manifestations among Human Immunodeficiency Virus-infected patients in a tertiary care centre in South India.

BACKGROUND: Human Immunodeficiency Virus (HIV) infection produces a wide range of infectious and noninfectious dermatoses which correlate with the degree of immunodeficiency. Since the introduction of highly active antiretroviral therapy (HAART), there has been a dramatic decrease in the incidence of HIV-associated dermatoses. However, HAART itself causes various cutaneous adverse drug reactions. AIMS: To assess the various mucocutaneous manifestations in HIV-infected individuals and its association with CD4 count and to assess the effect of HAART on mucocutaneous manifestations. MATERIALS AND METHODS: Of the 170 patients recruited, 110 patients were previously diagnosed with HIV and were on follow-up. The rest 60 patients were newly diagnosed cases at recruitment, and these patients were followed up every month for mucocutaneous manifestations for a period of 6 months. RESULTS: Of the 170 patients screened, 69.41% patients had at least one mucocutaneous lesion at presentation. Fungal, viral, and bacterial infections were observed present in 17.6%, 10.6%, and 9.4% patients, respectively. There was a significant difference in the occurrence of candidal infections in the HAART versus non-HAART group (P = 0.0002). Candidiasis (P ≤ 0.0001) and human papillomavirus infection (P = 0.0475) occurred more commonly with CD4 count <200 cells/mm (3) . Among the noninfectious dermatoses, inflammatory dermatoses (17.6%) were more commonly observed at recruitment followed by adverse cutaneous drug reactions (16.5%) and neoplasms (5.3%). CONCLUSION: HAART has significantly altered the patterns of mucocutaneous manifestations. The prevalence of both infectious and inflammatory dermatoses has come down. However, there is an increase in the incidence of adverse cutaneous drug reactions.

A retrospective audit of skin biopsies done in a tertiary care center in India.

BACKGROUND: Skin biopsies are an invaluable tool in the diagnostic armamentarium of a dermatologist and have several factors that determine outcome. OBJECTIVES: The aim of this study was to retrospectively assess the quality of data included in the pathology request forms and reports and to assess the level of clinicopathological correlation in the reported biopsy specimens. METHODS: We retrospectively analyzed 3006 histopathology request forms and reports of skin, mucosal, and nail biopsies to assess the quality of data included in them and assessed the level of clinicopathological correlation in these biopsies. Two hundred discordant histopathology slides were randomly reviewed by a pathologist in the presence of a dermatologist to analyze the causes for discordance. RESULTS: The pathological diagnosis was concordant with clinical diagnosis in 1798 (59.8%) biopsies, partially concordant in 228 (7.6%) biopsies, and discordant in 929 (30.9%) biopsies. In a clinicopathologically concordant category, the duration for reporting the biopsies was significantly shorter, and the definitive pathologist's diagnosis was frequently mentioned. Of the 200 discordant slides reviewed randomly by a pathologist in the presence of a dermatologist, 7.5% slides afterward turned out to be consistent and 15% partially consistent with the diseases in doubt. CONCLUSION: Several deficits were identified that need to be rectified to improve the diagnostic accuracy of skin biopsy. A portion of discordant slides showing features compatible with the disease when reviewed by a pathologist and dermatologist together emphasizes the importance of a joint review by both in doubtful cases.

Spotty skin pigmentation and multiple blue naevi as cutaneous markers for spinal melanotic schwannoma.

Spinal melanotic schwannomas are rare spinal tumours with a very poor prognosis in terms of mortality due to difficulty in complete resection and local recurrences. A 67-year-old man presented with acute onset progressive paraparesis for 2 weeks. The patient also had spotty skin pigmentations (blue naevi) in his right lateral thigh. MRI revealed an intradural extramedullary enhancing lesion in the lower thoracic cord level. With a preoperative diagnosis of simple nerve sheath tumour excision was planned. At laminotomy, an infiltrating "en plaque" like lesion reaching up to mid and upper thoracic cord level was identified and excision was carried out. Postoperative histopathology was unique with the identification of melanin and presence of epitheloid cells, with the additional detection of psammoma bodies and adipose-like cells. Melanotic schwannomas though rare and carry poor prognosis must be borne in mind in patients with spotty skin pigmentation and acute onset limb weakness.

Multiple hair whorls in a child with normal cranial and neurologic development.

Hair whorls are a normal characteristic of the human scalp and abnormally placed or absent whorls have been associated with cranial or neurologic abnormalities. We report a case of multiple whorls in a child with normal neurologic development. We also include a brief review of the literature on the development of hair whorls and their associations.

Fixed-duration therapy in leprosy: limitations and opportunities.

Leprosy has been considered a curable disease after the implementation of multidrug therapy (MDT), which has been proven to be safe and effective, by bringing about a significant change in the global and national scenario of leprosy by upgrading the control of leprosy to the next stage of eradication. Since its introduction, the MDT regimens for the treatment of leprosy have undergone several changes especially with regard to the duration of treatment. The advantages of shortened duration of treatment need to be balanced against the risk of relapse and a lot of controversies exist pertaining to this aspect. The fixed-duration (FD) therapy is not popular among academicians and private practitioners who prefer precise diagnosis and treatment with superior MDT regimens and for a longer duration. On the contrary, from a public health-care point of view, precise diagnosis and a longer treatment schedule are not cost effective and not feasible to be implemented in elimination programs. Hence, a fine balance needs to be maintained between achieving a cure for the patient and protecting the society at risk, and this review discusses the various limitations and opportunities of FD therapy with a note on the newer MDT regimens.

Spectrum of periorbital dermatoses in South Indian population.

BACKGROUND: Periorbital dermatoses are very common dermatological disorders which pose a diagnostic and therapeutic challenge for the treating dermatologist due to the similarity of symptoms in this area. AIMS: To study the spectrum of periorbital dermatoses and to assess the association of systemic diseases with periorbital dermatoses. METHODS: This was a hospital based descriptive study done on 250 consecutive patients irrespective of their age and sex who attended the Dermatology out patient department (OPD), with dermatological conditions pertaining to the periorbital area over a period of 2 years from October 2010 to September 2012. RESULTS: The most common dermatological conditions seen in the periorbital region were benign and malignant skin tumors observed in 63 (25.2%) cases, followed by the disorders of pigmentation in 51 (20.4%) and eczema in 44 cases (17.6%), infections in 33 (13.2%) cases and nevoid conditions in 26 (10.4%) cases. Certain periorbital dermatoses were significantly more in females than in males in the present study like skin tags, connective tissue diseases, and periorbital melanosis (POM). Some periorbital dermatoses were significantly more common in older age group such as seborrheic keratoses, skin tags and airborne contact dermatitis whereas infections, syringomas, allergic contact dermatitis and atopic dermatitis were more prevalent in younger age group. Syringomas and POM were more common in middle-aged women. CONCLUSIONS: The most common dermatological condition seen in the periorbital region in this study are benign skin tumors (keratosis and skin tags), followed by the disorders of pigmentation and eczema, infections and nevoid conditions.

Aging in elderly: chronological versus photoaging.

BACKGROUND: Skin is a window to aging changes, a biological reality. There is a dearth of studies regarding the various chronological (intrinsic) aging and photoaging (extrinsic) changes seen in Asians. This study was undertaken to detect the clinical pattern of aging skin changes and dermatoses seen in the elderly. MATERIALS AND METHODS: This was a descriptive study conducted on 500 consecutive elderly individuals attending the Dermatology out-patient department. The severity of photoaging was graded using Glogau scale. RESULTS: Most of the population had skin type IV and V. Majority (415, 83%) of our cases had chronological aging without photoaging and the remaining 85 (17%) individuals had photoaging along with chronological aging. The common skin changes due to chronological aging were thin skin, fine wrinkles, xerosis, and loss of elasticity. Photoaging changes such as dyspigmentation, freckles, thick skin, deep wrinkles, melasma, citrine skin, senile purpura, pseudostellate scar, acrokeratoelastoidosis marginalis, and lentigines were less frequent in our study. Smoking and prolonged sun exposure was the risk factors aggravating photoaging. The most common dermatosis was pruritus in 248 (49.6%) individuals, of which 149 (29.8%) had pruritus associated with xerosis. Contact dermatitis was more common in males. Fungal infections were frequently seen in females. Seborrhoeic keratosis (253, 50.6%) was the most common benign neoplasm more commonly seen in males. Cutaneous malignancies were less common in our study population. CONCLUSION: Photoaging changes were less common than chronological aging changes in skin type IV. Chronological changes were more frequent in females than males, while photoaging was more frequent in males.

Cutaneous angiosarcoma of the scalp masquerading as a squamous cell carcinoma: case report and literature review.

BACKGROUND: Cutaneous angiosarcoma is a rare tumor of the elderly male, most commonly affecting the head and neck region. It is difficult to differentiate this tumor from hemangiomas, hemangioblastomas, Kaposi sarcoma, squamous cell carcinoma and anaplastic melanomas. METHODS: Case report and review of pertinent English medical literature. CASE SUMMARY: We report a case of a 60-year-old male presenting with multiple nodules over the scalp where a preoperative histopathologic diagnosis of squamous cell carcinoma was made by wedge biopsy from the tumor. Postoperative histopathology and immuno histochemistry of the wide local excision specimen proved the tumor to be cutaneous angiosarcoma and the patient completed adjuvant radiotherapy. He is now on regular follow-up for 1 year without recurrence. CONCLUSIONS: Cutaneous angiosarcoma must be kept in mind in view of its rarity especially in extensive involvement of the scalp by malignancy. The primary treatment is wide local excision with adequate skin cover and adjuvant chemotherapy and radiotherapy in positive margins and lymph node metastasis.