Evaluation and Comparison of Cervical Spine Posture in Class II Division I Patients Treated with Twin Block Appliances, Forsus Appliances, and Bilateral Sagittal Split Osteotomy: A Cephalometric Study.

Background: It has been speculated that a change in cervical spine posture occurs due to forward repositioning of the mandible. Therefore, this study aimed to evaluate and compare the cervical spine posture in Class II division one patient treated with three different treatment modalities. Materials and Methods: A retrospective cohort study was conducted using pre and post-treatment lateral cephalograms of Class II Division one patients who have undergone orthodontic therapy using twin block appliance, Forsus, and bilateral sagittal split osteotomy (BSSO). This study included a total of 57 subjects comprising 19 subjects in each group. Seven cervical, three sagittal, and one vertical parameters were compared within and between each group. The data were tested using the Dependent t-test, One-way analysis of variance, and Tukey's post hoc test. Results: A significant difference existed between the pre- and post-treatment angular measurements within the three groups showing a change in the cervical spine posture with forward positioning of the mandible. A comparison of mean changes in angular measurements between the three groups showed a significant difference in SNA, SNB, ANB, and odontoid process tangent-cervical vertebral tangent (OPT-CVT), indicating a change in the cervical posture. Conclusion: OPT-CVT angle predicts a change in cervical spine posture after treatment with a significant difference in the Twin Block group (P = 0.029) compared to Forsus and BSSO groups. Thus, the twin block group results in a more upright craniocervical posture than the other two treatment groups.

Confluent and Reticulate Papillomatosis: A Retrospective Study from southern India.

BACKGROUND: Confluent and reticulate papillomatosis (CRP) is an uncommon benign, acquired keratinization disorder. Studies on this disorder are lacking except for a few case reports and there is a paucity of Indian literature on the condition. OBJECTIVES/METHODS: To study and describe the various morphological patterns and histopathological findings, as well as assess the response to treatment of 30 patients diagnosed with CRP. RESULTS: Thirtypatients with a diagnosis of confluent and reticulate papillomatosis were included in the study. The male to female ratio was 1:1.5. Mean age at onset of skin eruptions was 27.3 years and mean duration of skin eruptions was 8.2 months. Most of the patients (60%) were asymptomatic. The majority (66.7%) had lesions distributed over upper trunk. Two-thirds of patients had typical brown macules in confluent and reticulate pattern. KOH mount was done in 24 cases and was positive in three cases (12.5%) for yeast-like hyphae. Biopsy demonstrated variable degrees of hyperkeratosis, papillomatosis, and moderate acanthosis. Thirteen out of eighteenpatients on minocycline showed complete clearance within 3 weeks andthreepatients had more than 50% improvement at the end of 3 weeks. Doxycycline showed satisfactory response but results were less satisfactory with azithromycin. CONCLUSION: CRP is an uncommon condition. There is a paucity of large studies in Indian literature. The present study highlightssuch a large cohort of cases. Prevalence of CRP was more in female in contrast to western studies. Association of CRP with hyperthyroidism was described in many studies but the present study highlights the association with hypothyroidism. Morphological variants like shiny atrophic lesions, verrucous lesions, and involvement of atypical sites like forearm have been described. Role of minocycline in the management of chronic and recurrent cases has been reinforced.

Hypersensitive Reaction to Tattoos: A Growing Menace in Rural India.

BACKGROUND: Increased enthusiasm toward newer fashion trends among rural India along with the lack of government regulation has led to increased tattoo reactions. OBJECTIVE: The objective of this study is to describe various clinical manifestations of hypersensitive reactions to tattoo ink reported at a tertiary care hospital in Mandya district. MATERIALS AND METHODS: An observational study was carried out over a period of 1 year from June 2014 to May 2015 at Mandya Institute of Medical Sciences, Mandya. All the patients reporting with allergic reaction due to tattooing were included in the present study after obtaining informed consent. Transient acute inflammatory reaction, infections, and skin diseases localized on tattooed area were excluded from this study. A detailed history regarding the onset, duration and color used for tattooing were collected. Cutaneous examination and biopsy was to done to know the type of reaction. RESULTS: Fifty cutaneous allergic reactions were diagnosed among 39 patients. Mean age of subjects was 22 years and mean duration before the appearance of lesion was 7 months. Common colors associated with reactions were red (53.9%), black (33.3%), green (5.1%), and multicolor (7.7%). Itching was the predominant symptom. Skin lesions mainly consisted of lichenoid papules and plaques, eczematous lesions, and verrucous lesions. Lichenoid histopathology reaction was the most common tissue allergic reaction. CONCLUSION: Increasing popularity of tattooing among young people has predisposed to parallel increase in adverse reactions. Red pigment is most common cause of allergic reaction in the present study, and lichenoid reaction is the most common reaction.

Guidelines on the use of finasteride in androgenetic alopecia.

BACKGROUND: Finasteride is a widely used drug in dermatology for the treatment of androgenetic alopecia. There are many reports of associated sexual side effects. This article reviews the use of once-daily 1 mg finasteride in androgenetic alopecia and its associated sexual adverse effects. METHODS: A literature search was performed to collect data on the use of finasteride in male pattern baldness. Relevant literature published till March 2014 was obtained from MEDLINE, EMBASE, CINAHL, Cochrane registers and LILACS. The keywords "finasteride", "male pattern baldness" and "androgenetic alopecia" were used for literature search. Similarly, a search was done for finasteride in female pattern hair loss with keywords "female pattern baldness", "finasteride" and "female pattern alopecia". All systematic reviews, meta-analyses, national guidelines, randomized controlled trials, prospective open label studies and retrospective case series in the English literature were reviewed. RESULTS: Two hundred sixty two studies were evaluated, twelve of which fulfilled the inclusion criteria. CONCLUSIONS AND RECOMMENDATIONS: Current evidence on the safety of finasteride indicates that it is safe but there is growing concern about its sexual side effects. In view of this, proper information should be provided to patients prior to starting treatment (Level of recommendation 1+, Grade of recommendation B). The reported sexual side effects are few and reverse with stoppage of the drug (Grade of recommendation B) but further studies are required.

Targeted phototherapy.

BACKGROUND: Targeted phototherapy is a new form of phototherapy which has many advantages and disadvantages over conventional phototherapy. This article reviews the different technologies and outlines recommendations based on current evidence. METHODS: A literature search was performed on targeted phototherapy to collect data. Relevant literature published till March 2014 was obtained from PubMed, EMBASE, and the Cochrane Library. Keywords like "targeted phototherapy", "excimer laser", "excimer lamp", "Nonchromatic ultraviolet light", "vitiligo", and "psoriasis", were used for literature search. All systematic reviews, meta-analysis, national guidelines, randomized controlled trials (RCT), prospective open label studies and retrospective case series in English were reviewed. RESULTS: Three hundred and forty studies were evaluated, 24 of which fulfilled the criteria for inclusion in the guidelines. CONCLUSIONS AND RECOMMENDATIONS: All forms of targeted phototherapy are useful in vitiligo. Good responses were seen in localized involvement, resistant lesions and in children in whom their use is more accepted and convenient (Level of evidence 2+, Grade of recommendation B). Similarly it is useful in psoriasis, either alone or in combination with drugs, even in resistant forms such as palmoplantar psoriasis. In view of expense and practical application, their use is limited to resistant lesions and localized disease. (Level of evidence 2+, Grade of recommendation B). But in other conditions there is no convincing evidence for its use. (Level of evidence 3+, Grade of recommendation C).

Gingival pigmentation reduction: a novel therapeutic modality.

AIM: The objective of the present clinical study was to compare the effectiveness of radiofrequency de-epithelialization and conventional (slicing) method in reducing gingival pigmentation on long term basis by split mouth design. MATERIALS AND METHODS: A total of 28 maxillary gingival units from 4 subjects aged between 15-30 years were considered for this clincal study and the selected gingival units were made plaque free and clinically healthy before subjectiing these sites to one of the procedures. The selected sites were abraded by either the conventional (slicing) method (14 gingival units of 21, 22, 23, 24) or by radiofrequency (14 gingival units of 11, 12, 13, 14). After the procedure periodontal dressing was applied to protect the operated area. After 1 week periodontal dressing was removed and the area was irrigated with saline. Follow up examination was done on 30(th), 60(th) and 90(th) days to evaluate the recurrence of pigmentation, if any. RESULTS: It was obsereved that, sites operated with conventional (slicing) method, showed higher mean pigmentation than the sites treated with the radioablation during the follow up period of 90 days. CONCLUSION: When used judiciously, radiofrequency can be clinically valuable, safe and effective method to reduce pigmentation of gingiva.

Giant congenital melanocytic nevus (bathing trunk nevus) associated with lipoma and neurofibroma: report of two cases.

Giant congenital melanocytic nevi are rare and occur in about one out of every 2,00,000 to 5,00,000 births. There is a significant association between bathing trunk nevus and neurofibromatosis and lipomatosis. Apart from this, association of bathing trunk nevus with abnormalities like spina bifida occulta, meningocele, club foot and hypertrophy or atrophy of deeper structures of a limb, have been described. We are herewith reporting two cases of bathing trunk nevi. In our first case, an eight-year-old girl presented with a bathing trunk nevus studded with multiple, large nodules. Histopathological examination of the biopsy taken from one nodule revealed features of both neurofibroma and lipoma. To the best of our knowledge, features of both these hamartomas in one nodule of a single patient are probably not reported in the literature. In our second case, a 12-year-old girl presented with bathing trunk nevus and she had spina bifida occulta. She also had lipoma in the lesion of bathing trunk nevus. Both of our patients had satellite melanocytic nevi over the face, forearm, upper back and legs. Our second patient, in addition, had small melanocytic nevi over the medial canthus and sclerocorneal junction of the right eye. By the time this girl presented to us, the melanocytic nevus started fading in color and it had become brownish. We are reporting these cases for their peculiarities and for their rare features.

Three cases of Dowling Degos disease in two families.

Dowling Degos disease is a rare condition inherited as autosomal dominant trait characterized by numerous, asymptomatic, symmetrical, progressive, small, round-pigmented macules over axillae and groins, face, neck, arms and trunk, scattered comedo-like lesions (dark dot follicles) and pitted acneiform scars. Histopathology is diagnostic. We are hereby reporting three cases of Dowling Degos disease belonging to two families. Our first and second case belonged to the same family, whereas our third case belonged to different family. In our series, all the patients had onset after puberty. All three cases had reticulate pigmentation over face and/or flexures, black comedones and follicular pits. On histopathological examination of the skin biopsy taken from the lesion over the back, all these patients showed classical histopathological features of Dowling Degos disease. We feel that one should investigate the patient presenting with reticulate pigmentation over the face and flexures with blackish comedone-like lesions, because histopathological features of this condition are unmistakable.