Clinical assessment for psoriasis in a primary care setting

Suneeta Kochhar looks at what nurses need to know about this common dermatological condition

Paediatric dermatological conditions in an emergency department: a single-centre study in Thailand

BackgroundFew studies have evaluated paediatric dermatological conditions and their associated factors that warrant admission at the emergency department.ObjectivesThe main objective of this study was to present the demographic information of paediatric dermatological conditions encountered in the emergency department and identify possible associated factors for hospital admission.MethodsThis retrospective cross-sectional study included paediatric patients who visited the emergency department between 1 January 2016 and 31 December 2019. Data collection was performed using an authorised electronic medical records programme at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.ResultsA total of 40 683 paediatric patients visited the emergency department during the study period, with 1701 cases presenting dermatological conditions. Infections were the most frequent conditions encountered in the emergency department (647, 38.0%), followed by urticaria/anaphylaxis (478, 28.1%), eczematous diseases (463, 27.2%), cutaneous drug eruptions (64, 3.7%) and miscellaneous (49, 2.9%). Among 1701 paediatric cases with dermatological conditions, only 182 cases (10.7%) were admitted to the hospital and required further management. Cases presenting cutaneous drug eruptions had the highest proportion of hospital admissions (60.9%) and were significantly different from cases in other dermatologic categories (p<0.001). The association of admission found an OR of 0.96 for every year of increase in age (95% CI 0.93 to 0.99, p=0.003).ConclusionThe present study found that the majority of patients with cutaneous conditions visiting the emergency department were non-urgent; however, dermatological emergencies exist and should not be underestimated. Younger paediatric patients presenting with dermatological condition is a population with a high risk for hospital admission. Cutaneous drug eruptions showed the highest proportion of hospital admissions compared with other dermatological categories. Therefore, physicians in the emergency department should always look for specific cutaneous signs of drug eruptions, such as target-like lesions and mucosal involvement in Steven-Johnsons syndrome/toxic epidermal necrolysis to prevent misdiagnosis of this dermatological condition.

Potential Treatment of Psoriasis with Oral Spironolactone as TNF-Alpha Inhibitor – A Future Prospective Review

Psoriasis is a chronic dermatological condition that cause scaly red patches on the different parts of body. It always tends in cycles of months wherein winter aggravation is most common then it subsides for a while then again relapse or remission. The exact identity of the factors causing psoriasis is not established but the fact that T cell activates the release of proinflammatory cytokines such as TNF-α, interferon-γ and IL-2 has been identified. Cytokine, TNF- α plays a key role in keratinocyte proliferation and other vascular changes in psoriasis. TNF-α protein levels has been found on higher side in psoriasis lesions, intraepidermal Langerhans cells and dermal dendrocytes. The available treatment options for suppressing TNF-α are given only by IV/SC route like adalimumab, infliximab and etanercept also costlier and give only symptomatic relief for a shorter period of time. Hence, we need a pharmacologically active, therapeutically safe and cost-effective agent for long term use. Against all the available data, Spironolactone an aldosterone antagonist has been found to fulfill all the necessary conditions to be used as TNF- α antagonist, a noticeable suppressive effect on TNF- α receptor along with several pro-inflammatory cytokines. Such findings encouraged beginning of clinical studies of spironolactone as TNF- 𝛼 antagonist in patients with psoriasis.

Hair restoration

Hair restoration focuses on replacing hair where it has been lost, although there is also a demand for hair to be placed where it is desired, but lacking, for a perceived aesthetic gain. For both men and women, hair loss can be devastating and lead to loss of confidence and self-esteem. Hair restoration can be beneficial but treatment should be tailored to the individual’s needs and the correct diagnosis for the hair loss needs to be determined through a detailed history, thorough examination, and appropriate investigations. The average human has over 5 million hair follicles of which only about 100,000 are located on the scalp. While it is loss of scalp hair that is often most noticeable and distressing, eyebrow and eyelash hair loss is also very obvious in both sexes, as is loss of beard and moustache hair in men. Hair loss may be localized or generalized, part of a medical condition, a side effect of medications, the result of a dermatological condition, or genetically predetermined. Hair restoration can be achieved through medical treatment, surgery, and non-surgical alternatives.

Lipedema and lipedematous scalp: An overview

Lipedema is a chronic, progressive disease marked by abnormal fat distribution in the limbs, resulting in disproportionately sized and painful limbs. It primarily affects women and causes significant disability, functional impairment, and psychological distress. Despite its clinical significance in women’s health, lipedema is largely unknown, underdiagnosed, and misdiagnosed with other diseases with similar symptoms including obesity. It is difficult to distinguish between obesity and lipedema since these two conditions often coexist. Since the precise etiology of lipedema is yet to be determined, there is no treatment that targets the underlying cause. The most basic conservative treatment is decongestive physical therapy, which is normally needed life-long. In some cases, surgical procedures such as liposuction and excisional lipectomy are the therapeutic alternatives. Lipedematous scalp is a rare, dermatological condition with no known cause, characterized by increased subcutaneous tissue thickness and a smooth and boggy scalp. When it occurs in conjunction with alopecia, it is known as lipedematous alopecia, often mistaken as androgenetic alopecia. The goals of this article are to explain the etiology, clinical features, and treatment options for lipedema and lipedematous scalp (two relatively less known conditions), as well as to highlight their diagnostic features.

Collodion Baby in a Sudanese patient

The aim of my clinical image is to recall this rare dermatological condition and to highlight instructions to follow in treatment and proper management of the complications that can arise.

Treatment and management of acne in primary care settings

Suneeta Kochhar explains how this common dermatological condition can be treated effectively

Diagnosis of Pemphigus associated with canine Leishmaniosis: a Case Report

Pemphigus is an autoimmune dermatological condition that affects dogs and has in its clinical aspects a similarity to leishmaniasis, in which a differential diagnosis by means of histopathological examination is necessary. The present study sought to report a case of a dog, male, mixed breed, 10 years old, diagnosed with pemphigus and, later, diagnosed with leishmaniosis. Upon diagnosis, the animal presented only a lesion in the nasal plane, without apathy and without systemic changes, as evidenced by hematological and biochemical tests. After performing histopathological examination, the animal was diagnosed with pemphigus and underwent immunosuppressive treatment, obtaining significant improvement of the lesion. Under clinical suspicion of leishmaniasis, the animal was subjected to serological exams RIFI and ELISA resulting in an indeterminate result in ELISA and 1/40 reagent in the RIFI. As this is not a very relevant result, it was decided to perform another histopathological examination of the lesion where the presence of Leishmania spp. In this new exam it was not possible to obtain a diagnosis of pemphigus again, since the animal was under immunosuppressive treatment. Therefore, it is concluded that, in cases of co-infection of autoimmune diseases, such as pemphigus and canine leishmaniasis, the differential diagnosis by means of histopathological examination is extremely relevant to the patient's therapeutic success and prognosis. Thus, it is necessary to note that the diagnosis of pemphigus does not exclude the diagnosis of leishmaniosis.

A real world retrospective analysis of comparison of effectiveness and safety of mometasone furoate and fluticasone propionate in the management of eczema and dermatitis

Contact dermatitis is one the commonest dermatological condition which is managed by topical corticosteroids. Mid potent topical corticosteroids are commonly prescribed but there is no any comparative data between mometasone furoate and fluticasone propionate in the management of dermatitis.A real world retrospective study was conducted across India to compare the clinical assessment of mometasone 0.1% cream and fluticasone 0.005% cream in the management of contact dermatitis at 236 dermatology clinics.A data of 1106 patients were included in this analysis in which 598 were included in mometasone group while 508 in fluticasone group. At the end of 2 weeks, 216 patients (36.1%) in mometasone and 129 patients (25.4%) in fluticasone group achieved complete clearance of symptoms (p&#60;0.05). Additionally, in mometasone group, 354 patients (59.2%) were found to achieve improvement whereas 293 patients (57.7%) achieved the same in fluticasone group. On further sub group analysis on aggravating factors, it was found that, mometasone was statistically significant in relieving symptoms of dermatitis due to artificial jewellery, detergent and occlusive foot ware than fluticasone. Moreover, mometasone demonstrated significant results in physician and patient global assessment as well. Patients in both groups tolerated therapy well.Both, mometasone furoate and fluticasone propionate were effective and safe in treatment of eczema/dermatitis. But mometasone furoate had shown significantly better effectiveness as compared to fluticasone in all predisposing factors for the disease.