Efficacy of 810 nm diode laser in hair reduction in Indian subpopulation using a novel Gabor filter-based detection software and hair algorithm.

BACKGROUND: Diode laser (810 nm) is frequently employed for hair reduction. There are few studies determining the efficacy in Indian population. OBJECTIVES: Assessment of efficacy and safety of 810 nm diode laser in facial/axillary hair reduction and objective assessment of the improvement with dermoscopy, photographs, and novel Gabor filter-based hair detection algorithm. METHODOLOGY: This hospital-based study included 40 adult women with 108 treatment sites over 5.4 sessions (range 4-8). Evaluation of treatment areas (hair texture, density) was done using modified Ferriman-Galwey scoring. Photography and dermoscopic images were taken before each session and 6 weeks after the last. Immediate and delayed adverse reactions were noted. Assessment of efficacy was done by patient, principal, and blinded investigator using Global Aesthetic Improvement scale (GAIS) and hair detection algorithm (evaluating characteristics of dermoscopic hair). RESULTS: The fluences ranged from 16 to 29 Joules/cm2 with pulse width of 30 ms. Upper lip (n = 29, 26.9%) and chin (n = 25, 22.1%) were commonly treated areas. Improvement in hair texture and density (reduction in uniformly distributed, terminal hair from 37.1% to 13.9%) was statistically significant (p < 0.0001). Excellent improvement of 75-100% (GAIS) was noted by principal and blinded investigator in 24.1% and 33.3% total sites, respectively. The median improvement, calculated by the algorithm, was 60% for side locks, 53.9% for axilla, 24.1% for upper lip, and 14.9% for chin. Axilla and upper lip were sites associated with maximum discomfort. Epidermolysis and paradoxical hypertrichosis were seen in five patients each. CONCLUSION: The 810 nm diode laser is safe and effective in the reduction of dark, coarse terminal hairs in Fitzpatrick skin types III-V. Inter-observer variation and investigator bias in the assessment of efficacy can be successfully overcome by using the algorithm.

A comparative study of Michel's medium versus honey as a transport medium for skin specimens prior to direct immunofluorescence microscopy and antigen mapping.

BACKGROUND: Michel's medium (MM) is currently the recommended transport medium for skin biopsy specimens prior to direct immunofluorescence (DIF) microscopy. OBJECTIVE: To compare the utility of honey with that of MM as a transport medium for skin biopsy specimens used for DIF and antigen mapping. METHODS: Group I consisted of 45 freshly-taken skin specimens earmarked for DIF testing. It was divided into three groups (A, B and C), each containing 15 specimens. Biopsy specimens were sliced into two, one each for MM and honey. Samples in group A were processed at the end of week 1 while those in group B and C were processed at the end of weeks 2 and 4, respectively. Group II consisted of five specimens of epidermolysis bullosa (EB) which was further divided into three groups; two specimens were processed for antigen mapping at the end of week 1, while others were processed at the end of week 2 (two specimens) and 4 (one specimen). RESULTS: Sensitivity of honey as a transport medium for skin biopsy specimens was 100%, 92.6% and 53.8% at weeks 1, 2 and 4, respectively. The antigen mapping was positive in all specimens. CONCLUSION: Utility of honey was comparable to MM for DIF samples tested at weeks 1 and 2 but was lower at week 4.

Detection of Anti-basement Membrane Zone Antibodies in the Blister Fluid in Subepidermal Autoimmune Bullous Diseases.

BACKGROUND: Subepidermal autoimmune bullous diseases (sAIBD) are diverse of conditions with clinicopathological overlap. Circulating autoantibodies in the serum can be demonstrated using indirect immunofluorescence (IIF) microscopy. Artificially split normal human skin is considered as an optimum substrate for the demonstration of anti-basement membrane zone (BMZ) antibodies using IIF in sAIBD; it not only helps to detect the presence of circulating antibodies in the serum but also helps to subclassify these conditions into "roof" and "floor" binding disorders. AIM: In this study, we evaluated the utility of IIF to detect anti-BMZ antibodies in the blister fluid of patients with sAIBD. MATERIALS AND METHODS: Twenty-two patients with a clinical diagnosis of sAIBD were enrolled in the study. IIF of serum and blister fluid were done simultaneously using salt-split skin as a substrate. RESULTS: Anti-BMZ antibodies could be detected in the blister fluid using IIF in all patients in the study group. LIMITATION: We could not do enzyme-linked immunosorbent assay of blister fluid. This would have given us the quantitative data of circulating antibodies in the blister fluid. CONCLUSION: Blister fluid offers an alternate source for the detection of autoantibodies in patients with sAIBD. It may be of particular help in children and in elderly with poor venous access.

Epidermolysis bullosa acquisita and anti-p200 pemphigoid as major subepidermal autoimmune bullous diseases diagnosed by floor binding on indirect immunofluorescence microscopy using human salt-split skin.

BACKGROUND: Subepidermal autoimmune bullous diseases are a diverse group of diseases with overlapping clinical and immunopathological features. Indirect immunofluorescence microscopy on artificially split skin helps to classify these conditions into those with staining on the epidermal side of the split ("roof-binding") and those with staining on the dermal side ("floor-binding"). Epidermolysis bullosa acquisita is the prototype of "floor-binding" subepidermal autoimmune bullous diseases. However, not all floor-binding sera are associated with epidermolysis bullosa acquisita. AIM: The aim of this study was to evaluate the clinical and immunological profile of patients with floor-binding subepidermal autoimmune bullous disease by indirect immunofluorescence microscopy and to identify the target antigens in them. METHODS: Ten patients who showed a floor-binding pattern were studied with regard to their clinical and immunopathological characteristics. Target antigens were identified by modified indirect immunofluorescence microscopy using recessive dystrophic epidermolysis bullosa skin, enzyme linked immunosorbent assay, and immunoblotting. RESULTS: Diagnosis of epidermolysis bullosa acquisita was confirmed in six patients. Three patients with an inflammatory subepidermal autoimmune bullous disease mimicking bullous pemphigoid reacted with a 200 kDa protein on immunoblotting with dermal extract, as is characteristic of anti-p200 pemphigoid. One serum showed both roof and floor binding, and reacted with the BP180 antigen. LIMITATION: We could not perform serration pattern analysis in our patients. CONCLUSION: In this study, we report three cases of anti-p200 pemphigoid from India. These cases, though indistinguishable clinically from bullous pemphigoid, revealed a floor-binding pattern on indirect immunofluorescence using salt-split skin.

Painful erythematous, infiltrated papulonodules in a middle aged man.

Cutaneous leiomyomas (CL) often present as painful tumors in the skin. Herein we report an adult man who presented with multiple, erythematous papulonodules in both segmental and non-segmental distribution.

Granular IgM Deposition at Basement Membrane Zone in an Infant with Diffuse Cutaneous Mastocytosis.

Diffuse Cutaneous mastocytosis (DCM) occurs due to abnormal accumulation of mast cells in the skin. We report an 8-month-old infant presented papulovesicular lesions, predominantly on the trunk. Skin biopsy revealed subepidermal bulla, interspersed with mast cells, eosinophils and neutrophils. Direct immunofluorescence microscopy of perilesional skin revealed nonspecific deposition of IgM in granular pattern along the dermoepidermal junction.

Childhood Epidermolysis Bullosa Acquisita: Confirmation of Diagnosis by Skin Deficient in Type VII Collagen, Enzyme-linked Immunosorbent Assay, and Immunoblotting.

Epidermolysis bullosa acquisita (EBA) is an acquired subepidermal bullous disorder characterized by autoantibodies against Type VII collagen. It usually affects adults; childhood EBA is rare. We describe a 10-year-old girl presenting with recurrent tense blisters predominantly on legs, dorsa of hands and feet accompanied by oral erosions since the age of 5 years. Direct immunofluorescence (IF) microscopy showed linear deposition of IgG and C3 along the basement membrane zone (BMZ); indirect IF microscopy on salt-split skin revealed staining of IgG to the dermal side of the split. The patient's serum did not show BMZ staining in recessive dystrophic epidermolysis bullosa skin deficient for Type VII collagen, thus confirming autoantibody reactivity against Type VII collagen. Circulating antibodies against the immunodominant noncollagenous 1 domain of Type VII collagen were detected by ELISA and immunoblotting studies. The patient was treated with oral corticosteroids and dapsone with good improvement.

Guidelines for bath PUVA, bathing suit PUVA and soak PUVA.

BACKGROUND: The aim of these guidelines is to encourage dermatologists to use bath psoralen plus ultraviolet A (PUVA), bathing suit PUVA and soak PUVA in the treatment of psoriasis vulgaris and other conditions. METHODS: Evidence was collected using searches of the PubMed, MEDLINE and COCHRANE databases using the keywords "bath PUVA," "soak PUVA," "bathing suit PUVA" and "turban PUVA." Only publications in English were reviewed. RESULTS: One hundred and thirty-eight studies were evaluated, 57 of which fulfilled the criteria for inclusion. CONCLUSIONS: Both bath PUVA and bathing suit PUVA are very effective and safe treatments for generalized stable plaque psoriasis (strength of recommendation, A). Soak PUVA is very effective in the treatment of both palmoplantar psoriasis and chronic palmoplantar eczema (strength of recommendation, A).