Indian Dermoscopic Study of Forty Six Cases of Lichen Planus Pigmentosus - New Dermoscopy Signs Discovered

2018 ◽  
Vol 3 (02) ◽  
Author(s):  
Rahul Kumar Sharma, Rajendra Kumar Sharma
Keyword(s):  
Lichen Planus ◽  
Smart Phone ◽  
Poor Response ◽  
Response To Treatment ◽  
Dermatology Clinic ◽  
Single Marker ◽  
Brownish Black ◽  
Brown Pigmentation ◽  
Black Pigmentation ◽  
Very High

Lichen planus pigmentosus (LPP) is a atypical pigmented variety of lichen planus. Lichen planus pigmentosus is an unpredictable relapsing idiopathic dermatosis with periods of activation and remission with poor response to treatment and may leads to cosmetically disfiguring post inflammatory pigmentation. Aim - To study dermoscopic features of untreated cases of Lichen planus pigmentosus. Study subjects - All the patients who attended the dermatology clinic from November 2015 to November 2017 with the clinical diagnosis of LPP and who fulfilled the inclusion and exclusion criteria. Methodology - All the patients who attended the dermatology clinic with the diagnosis of LPP were examined by a dermatoscope. Dermoscopy was performed with DL4 dermatoscope. The images were further magnified with smart phone. Results - Our study showed various dermoscopic signs in cases of LPP like annular granular pattern (35 cases), annular globular pattern (5 cases), homogeneous brown pigmentation (12 cases), homogeneous brownish black pigmentation (8 cases), brownish ovoid nests (3 cases), bluish blackish fine dots (4 cases), Wickham’s striae(2 cases) and pigmented targetoid globules(3 cases). Discussion - Dermatoscope is an indispensible valuable tool in clinical practice which helps in making early lucid diagnosis of LPP with very high accuracy. Our study showed that annular granular pattern is the commonest pattern in Indian LPP cases followed by homogeneous brown pigmentation. In our Indian LPP dermoscopy study we discovered three novel dermoscopic signs which includes brownish globular nests, pigmented targetoid globules and bluish blackish fine dots. In our study we got few unique cases where Wickham’s striae was also present with other dermoscopic signs which supports the link of LPP to lichen planus. Dermatoscopic diagnosis of LPP is made by combination of various signs and should not be dependent on the presence of single marker.

Vulval lichen planus–lichen sclerosus overlap

2018 ◽  
Vol 29 (10) ◽  
pp. 1017-1023 ◽  
Author(s):  
Matthew Howard ◽  
Anthony Hall
Keyword(s):  
Lichen Planus ◽  
Lichen Sclerosus ◽  
Poor Response ◽  
Clinical Findings ◽  
Response To Treatment ◽  
Prolonged Treatment ◽  
Dramatic Improvement ◽  
Labia Majora ◽  
Erosive Lichen Planus ◽  
Oral Corticosteroids

Vulval lichen planus–lichen sclerosus overlap is an emerging observation. Few clinical reports exist with no reviews of literature. We present a focused update of this phenomenon and discuss a clinical case. We report a 63-year-old woman with a 20-year history of ulcerative vulvo-vaginitis, initially diagnosed as benign mucous membrane (cicatricial) pemphigoid. This led to prolonged treatment with oral corticosteroids with minimal improvement in symptoms. Subsequent complications of long-term use of systemic corticosteroid ensued. A clinico-pathological diagnosis of severe erosive lichen planus was made on clinical findings and on non-specific biopsy changes of ulceration and inflammation. Treatment with topical clobetasol propionate 0.05% ointment twice daily led to dramatic improvement of ulceration, easing of discomfort and marked improvement in quality of life. Clinical examination revealed Wickham’s striae on the labia majora supporting the diagnosis. Six years after commencement of topical clobetasol, white plaques were noticed on the labia majora, perineum and peri-anal region consistent with lichen sclerosus, confirmed by repeat vulval skin biopsy and on vulvectomy. This case highlights the challenge of diagnosis of extensive vulvo-vaginal ulceration and the necessity to re-examine a previous diagnosis if there is poor response to treatment.

scholarly journals Management Of Childhood Lichen Planus

2016 ◽  
Vol 12 (1) ◽  
pp. 1-6
Author(s):  
DM Thapa ◽  
M Malathi
Keyword(s):  
Lichen Planus ◽  
Treatment Options ◽  
Poor Response ◽  
Response To Therapy ◽  
Response To Treatment ◽  
Direct Immunofluorescence ◽  
Topical Steroids ◽  
Indian Children ◽  
Lichen Planopilaris ◽  
Oral Steroids

Childhood lichen planus (LP) is a rare entity, with less than 2–3% of all cases seen in patients under 20 years of age. LP in childhood is common in subtropical countries such as India. The most common clinical type of LP in Indian children is the classic form. Approximately 1–15% of patients with LP demonstrate nail involvement, but disease of the nails without skin involvement is rare. LP is diagnosed by historical and physical findings, biopsy results, and, in some cases, features on direct immunofluorescence (DIF). LP tends to have a chronic course. Depending on disease severity, however, LP may respond to a combination of topical or systemic therapies. The response to therapy may be similar to that seen in adults. Moderately potent or super potent steroids are the treatment of choice. Topical steroids can be combined with oral steroids in tapering doses over 2-12 weeks period. This is useful for children with widespread involvement or cutaneous LP lesions associated with significant morbidity. Intralesional steroid is effective for hypertrophic LP unresponsive to topical steroids. Topical steroids in adhesive base used several times a day for several months is a treatment of choice for symptomatic oral LP. Topical steroids in combination with systemic steroids can be given in a tapering dose over 3-6 weeks in very symptomatic cases in early stages. In severe unresponsive cases of both cutaneous and oral LP, oral retnoids are the preferred option. Treatment options for the nail LP in young children are oral steroids given as tapering dose over 4-12 weeks and oral retinoids. Intralesional steroids as nail matrix injection are the third option for older children. Most pediatric patients with LP respond to treatment with full clearance over 1-6 months. Poor response to treatment is a feature of hypertrophic LP and lichen planopilaris. DOI: http://dx.doi.org/10.3126/njdvl.v12i1.10588 Nepal Journal of Dermatology, Venereology & Leprology Vol.12(1) 2014 pp.1-6

Indian Dermoscopic Study of One Thirty Eight Cases of Alopecia Areata

2018 ◽  
Vol 3 (02) ◽  
Author(s):  
Rahul Kumar Sharma, Divya Sharma, Rajendra Kumar Sharma
Keyword(s):  
Alopecia Areata ◽  
Smart Phone ◽  
Cotton Wool ◽  
Exclusion Criteria ◽  
Dermatology Clinic ◽  
Exclamation Mark ◽  
Single Feature ◽  
Males And Females ◽  
Vellus Hairs ◽  
Difficult Cases

Alopecia areata (AA) is a type of non-scarring alopecia first described by Cornelius Celsus, characterized by hair loss without any clinical inflammatory signs and affecting both males and females equally. The activity of AA is by the presence of black dots, broken hair, and tapering, furthermore black dots and yellow dots are equated to severity of AA. Aim - To study dermoscopic features of untreated cases of alopecia areata. Study subjects-All the patients who attended the dermatology clinic from March 2015 to March 2017 with the clinical diagnosis of alopecia areata and who fulfilled the inclusion and exclusion criteria. Study period - Two year (from March 2015 to March 2017). Methodology - All the patients who attended the dermatology clinic from March 2015 to March 2017 with the diagnosis of alopecia areata and who fulfilled the inclusion and exclusion criteria were recruited for the study. Trichoscopy was performed with DL4 dermatoscope. The images were further magnified with smart phone. Results - We got various dermoscopic signs in different combinations in our study. Yellow dots were seen in 10 cases, White dots in cotton wool pattern were seen in 3 cases, Black dots were seen in 25 cases, Dermoscopic coudability sign was demonstrated in 38 cases, Pigtail hairs were present in 2 cases, five cases showed short vellus hairs, Short broken hairs were found in 18 cases, Exclamation mark hairs were very common and were detected in 131 patients out of 138. Discussion - Single feature is not leading to the diagnosis so we should use combination of features which will help in difficult cases like AA incognito. Dermatoscope is an indispensible valuable tool in trichology practice which helps in prognosticating and making early diagnosis of AA. It also helps to differentiate it from trichotillomania and other causes of alopecia. In our study the incidence of AA was almost similar in both sexes. Our study revealed that exclamation mark hair is very common and sensitive dermoscopic marker of AA.

Criteria positive and criteria negative anaphylaxis, with a focus on undifferentiated somatoform idiopathic anaphylaxis: A review and case series

2020 ◽  
Vol 41 (6) ◽  
pp. 436-441 ◽  
Author(s):  
Daniel A. Rosloff ◽  
Kunal Patel ◽  
Paul J. Feustel ◽  
Jocelyn Celestin
Keyword(s):  
Diagnostic Criteria ◽  
Statistical Significance ◽  
Case Series ◽  
Poor Response ◽  
Response To Treatment ◽  
Fisher Exact Test ◽  
Subjective Symptoms ◽  
Significant Difference ◽  
Physical Findings ◽  
Idiopathic Anaphylaxis

Background: Undifferentiated somatoform (US) idiopathic anaphylaxis (IA) is considered a psychogenic disorder characterized by a lack of observable physical findings and poor response to treatment. Although failure to diagnose true anaphylaxis can have disastrous consequences, identification of US-IA is crucial to limit unnecessary expenses and use of health care resources. Objective: To better define the presentation and understand the potential relationship between US-IA and underlying psychiatric comorbidities. Methods: We retrospectively reviewed 110 visits by 107 patients to our institution for evaluation and management of anaphylaxis over a 1-year period. The patients were classified as having either criteria positive (CP) or criteria negative (CN) anaphylaxis based on whether they met Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium criteria for the clinical diagnosis of anaphylaxis. Patient characteristics, including objective and subjective signs and symptoms, and the presence of psychiatric diagnoses were collected and analyzed. Statistical significance was assessed by using the Fisher exact test. A literature review of US-IA and other psychogenic forms of anaphylaxis was performed. Results: Patients with CP anaphylaxis were more likely to present with hypotension, wheezing, urticaria, and vomiting than were patients with CN anaphylaxis. The patients with CN anaphylaxis were more likely to present with subjective symptoms of sensory throat tightness or swelling compared with patients with CP anaphylaxis. No significant difference was detected in the prevalence of psychiatric conditions between the two groups. Conclusion: Patients who met previously established diagnostic criteria for anaphylaxis were more likely to present with objective physical findings than those who did not meet criteria for true anaphylaxis. CN patients who presented for treatment of anaphylaxis were more likely to present with subjective symptoms. Formal diagnostic criteria should be used by clinicians when evaluating patients with suspected anaphylaxis.

scholarly journals Predictive Factors of the Responses to Treatment of Mycoplasma pneumoniae Pneumonia

2021 ◽  
Vol 10 (6) ◽  
pp. 1154
Author(s):  
Eun Lee ◽  
Yun Young Lee
Keyword(s):  
Pleural Effusion ◽  
Mycoplasma Pneumoniae ◽  
Predictive Factors ◽  
Respiratory Virus ◽  
Clinical Laboratory ◽  
Poor Response ◽  
Response To Treatment ◽  
Slow Response ◽  
Response Group ◽  
Time Of Admission

The prevalence of refractory Mycoplasma pneumoniae (MP) pneumonia is increasing. The present study aimed to identify the predictive factors of responses to treatment of MP pneumonia in children. A total of 149 children were diagnosed with MP pneumonia, of whom 56 were included in the good response group, 75 children in the slow response group, and 18 children in no response or progression group. Data on the clinical, laboratory, and radiologic features were retrospectively obtained through medical chart reviews. The severity of pneumonia, based on the extent of pneumonic lesions on chest x-ray (adjusted odds ratio (aOR), 10.573; 95% confidence intervals (CIs), 2.303−48.543), and lactate dehydrogenase (LDH) levels (aOR, 1.002; 95% CIs, 1.000–1.004) at the time of admission were associated with slow response to treatment of MP pneumonia. Pleural effusion (aOR, 5.127; 95% CIs, 1.404–18.727), respiratory virus co-infection (aOR, 4.354; 95% CIs, 1.374–13.800), and higher LDH levels (aOR, 1.005; 95% CIs, 1.002–1.007) as well as MP-specific IgM titer (aOR, 1.309; 95% CIs, 1.095–1.564) were associated with no response or progression of MP pneumonia. The area under the curve for the prediction of no or poor response in MP pneumonia using pleural effusion, respiratory virus co-infection, LDH levels, and MP-specific IgM titer at the time of admission was 0.8547. This study identified the predictive factors of responses to treatment of MP pneumonia in children, which would be helpful in establishing a therapeutic plan and predicting the clinical course of MP pneumonia in children.

scholarly journals Modified Rio Score with Platform Therapy Predicts Treatment Success with Fingolimod and Natalizumab in Relapsing-Remitting Multiple Sclerosis Patients

2021 ◽  
Vol 10 (9) ◽  
pp. 1830
Author(s):  
Anna Jamroz-Wiśniewska ◽  
Radosław Zajdel ◽  
Agnieszka Słowik ◽  
Monika Marona ◽  
Marcin Wnuk ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Treatment Success ◽  
Prospective Trial ◽  
Poor Response ◽  
Response To Treatment ◽  
First Year ◽  
Second Line ◽  
Second Line Therapy ◽  
Line Therapy ◽  
Multiple Sclerosis Patients

Background: Reliable markers of disease outcomes in multiple sclerosis (MS) would help to predict the response to treatment in patients treated with high efficacy drugs. No evidence of disease activity (NEDA) has become a treatment goal whereas the modified Rio score (MRS) predicts future suboptimal responders to treatment. The aim of our study was to identify factors that would predict poor response to treatment with natalizumab and fingolimod. Methods: In the multicenter prospective trial, 336 subjects were enrolled, initiating therapy with natalizumab (n = 135) or fingolimod (n = 201). Data on relapse rate, the expanded disability status scale, and MRI results were collected, and MRS was estimated. Results: NEDA-3 after the first year of therapy was 73.9% for natalizumab and 54.8% for fingolimod (p < 0.0001). Patients with MRS = 0 in the last year on platform therapy had the best NEDA-3 (71%) and patients with MRS = 3 had the worst NEDA-3 (41%) in the first year of treatment with the second-line therapy. Conclusion: We conclude that switching to the second-line therapy should occur earlier to enable better results for patients treated with natalizumab or fingolimod. The outcome on both drugs is better with better neurological conditions and lower MRS of the patient on the platform therapy.

Phlegmonous gastritis in 2 yearling horses

2022 ◽  
pp. 104063872110650
Author(s):  
Julie B. Engiles ◽  
Francisco A. Uzal ◽  
Mauricio A. Navarro ◽  
Virginia B. Reef ◽  
Susan J. Bender
Keyword(s):  
Clinical Signs ◽  
Poor Response ◽  
Abdominal Ultrasound ◽  
Mucosal Injury ◽  
Response To Treatment ◽  
Bacterial Populations ◽  
Proliferative Enteropathy ◽  
Mucosal Involvement ◽  
Phlegmonous Gastritis ◽  
History Of

Phlegmonous gastritis was diagnosed in 2 yearling fillies that were presented with a 1-wk history of fever, lethargy, and hypoproteinemia, associated with a previous diagnosis of equine proliferative enteropathy based on clinical signs and PCR assay detection of Lawsonia intracellularis in fecal samples. Abdominal ultrasound revealed enlargement of the stomach and expansion of its submucosal layer with hypoechoic fluid, as well as thickened hypomotile small intestinal segments. Given the poor prognosis and poor response to treatment, both horses were euthanized, one on the day of presentation and the other after 3 wk of intensive medical management including a combination of antimicrobials, analgesics, and intravenous colloids. At autopsy, acute mural gastritis characterized by severe submucosal edema with suppurative inflammation (i.e., phlegmonous gastritis) and necroulcerative enteritis compatible with the necrotizing form of equine proliferative enteropathy were identified in both horses. The gastric inflammation was associated with thrombosis and mixed bacterial populations, including Clostridium perfringens, that were confined to the submucosa without evidence of mucosal involvement; toxin genes compatible with C. perfringens type C were identified in one case. Human phlegmonous gastritis is an uncommon, often-fatal pyogenic infection that is often associated with mucosal injury, bacteremia, or immunocompromise. Our finding of this unusual gastric lesion in 2 horses with similar signalment, clinical disease, and spectrum of postmortem lesions suggests a similar etiopathogenesis that possibly involves local, regional, or distant hematogenous origin, and should be considered a potential complication of gastrointestinal mucosal compromise in horses.

Clinical Profile and Prediction of Response to Treatment in Childhood Epilepsy - A Single-Centre Experience from Eastern India

2021 ◽  
Vol 8 (15) ◽  
pp. 977-981
Author(s):  
Prakash Chandra Ghosh ◽  
Mitali Bera ◽  
Punyabrata Barma ◽  
Arijit Roy ◽  
Sananda Majumder ◽  
...  
Keyword(s):  
Management Strategies ◽  
Poor Response ◽  
Cost Effective ◽  
Point Of View ◽  
Clinical Profile ◽  
Response To Treatment ◽  
Childhood Epilepsy ◽  
Primary Health Centres ◽  
Single Centre Experience ◽  
Active Epilepsy

BACKGROUND Though epilepsy remains a significant problem for children and adolescents in our country, studies delineating the clinical profile and response to treatment in childhood epilepsy are lacking. The current study was carried out for obtaining a baseline profile and to predict the response to treatment in childhood epilepsy in India that may be helpful in planning management strategies from a public health point of view. METHODS Patients with clinical suggestion of active epilepsy (N = 141) from one month to 12 years, were enrolled into the study over a period of 1 year (February 2010 to January 2011) from the out-patient department and epilepsy clinic of Bangur Institute of Neurology. Detailed history was taken along with neurological examination. Electroencephalography (EEG) and neuroimaging (MRI / CT scan) were done on all patients. Each patient included in the study was kept in followup for a period of 6 months and their response to the treatment was recorded. RESULTS About 48.9 % (N = 69) patients had localisation related epilepsy while the rest had generalised epilepsy. Of those with generalised epilepsy, generalised tonicclonic seizures (GTCS) was by far the most common type. Of those with focal EEG activity, the highest proportion (50 %), were localised to the temporal lobe. Symptomatic aetiology accounted for 59.6 % (N = 84) of the patients. 20.6 % (N = 29) had poor response to treatment at 6 months follow-up. Abnormal neuroimaging (OR = 6.708) and abnormal EEG (OR = 6.357) were effective factors in predicting poor response to treatment. CONCLUSIONS Our study highlights the need to link specialised epilepsy services with primary health centres for early detection and treatment. EEG is an essential cost-effective modality in determining seizure localisation and response to treatment. KEYWORDS Paediatric, Epilepsy, Clinical Profile, Response to Treatment

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