Correlation of psoriasis and serum vitamin D

Psoriasis is an immuno-mediated chronic systemic disease involving cytokines of helper Th1 pathway. Vitamin D has an effect on keratinocyte proliferation, differentiation and immune modulation of immune system especially Th1 pathway, which is altered in psoriatic skin suggesting that Vitamin D may have a role in pathogenesis of psoriasis. To study correlation between psoriasis vulgaris and serum vitamin D. To evaluate serum vitamin D level in psoriasis cases and in control group and correlating vitamin D level with severity and duration of the psoriasis. 57 cases (>15years of age) with psoriasis and 57 healthy subjects were recruited. Psoriasis was clinically diagnosed and severity evaluated by PASI scale. Vitamin D was analysed by enhanced chemilumine scence on vitrus Eci autoanalyzer of Orth clinical diagnostic. Vitamin D deficiency defined as <20ng/ml, insufficiency 20-30ng/ml and sufficient 30-100ng/ml. Vitamin D deficiency in the study was 22.8% in patients and 14% in control group. Vitamin D insufficiency was found in 42.1% of cases and 19.3% of control. According to chi-square the p-value is 0.003 showing significant association. There was a tendency towards decrease in vitamin D level with increase in disease duration. There was negative correlation between vitamin D and PASI score. The study found a significant relationship between vitamin D and psoriasis. Further metanalysis involving larger study population will be required to establish whether vitamin D levels benefits patient with psoriasis vulgaris.

Capillaroscopic nail fold changes in collagen vascular diseases: A prospective observational study from a tertiary care teaching hospital in Western India

: To examine nail changes with capillaroscopy in patients with collagen vascular diseases. In this prospective observational study, patients with collagen vascular diseases presented to dermatology outpatient department of a tertiary care center were subjected to capillaroscopy. Structural and morphological abnormalities in these patients were noted. Fifty patients (Mean age 38.2 years; 86% females) with mean disease duration of 1.96 years were included. Patients with systemic sclerosis and systemic lupus erythematosus constituted 34% and 32% patients respectively. Twenty two (44%) patients had presence of dilated nail fold capillary loops. Out of 17 patients with systemic sclerosis, 15(88.23%) and 14(87.5%) showed dilated nail fold capillary loops and capillary drop-pouts respectively. Capillary dropouts were observed in 14(82.35%) patients. Raynaud’s phenomenon, splinter hemorrhage and fingertip scarring was observed in 11(64.71%), six (35.29%) and 33(17.65%) patients respectively. Ragged cuticle was observed in four (25%) patients with systemic lupus erythematosus. In our study, systemic sclerosis and systemic lupus erythematosus were two most common disorders. Dilated nail fold capillary loops/giant capillaries were the most common observation in overall population. Dilated nail fold capillary loops, capillary dropouts, Raynaud’s phenomenon, splinter hemorrhage and fingertip scarring were common in patients with systemic sclerosis.

The clinical study of dermatophytosis in a tertiary care hospital of konkan region, Maharashtra

Dermatophytes are aerobic fungi that produce proteases that digest keratin and allows colonization, invasion and infection of the stratum corneum of the skin, the hair shaft, and the nail. This study was an attempt on the part of the author to find out the incidence and various clinico-epidemiological characteristics of Dermatophytosis in skin OPD of Tertiary care Hospital, B.K.L.W.R.M.C., Dervan. The study was carried on 2444 patients of Dermatophytosis attending the OPD, out of which 49.79% of the cases were Tinea Cruris (TC). The age group of 11-20 years showed maximum prevalence of Dermatophytosis (22.17%). 58% of the patients had diffuse lesions. Body involvement was seen in 87% of cases. Itching was the most common condition associated with Dermatophytosis. 35% of the patients reported with family history of Tinea Cruris.Circumscribed variety of TC was found to be most common variant mostly observed in 2and 4 decade, with a male preponderance. Groin was the most common site with multiple lesions. Nail changes was most commonly associated with TC.

Assessment of clinical and etiological factors in nail dyschromias

Healthy nails appear smooth and have consistent coloring. Nail dyschromias have a wide variety of presentation. There are numerous causes of discoloration of the nail affecting the nail plate, nail attachments, or the substance of the nail. Different pattern of nail dyschromias can point out certain dermatological or systemic diseases. To evaluate the causes of nail dyschromias in our clinical setting. Cross sectional observational study. 200 patients presenting with nail dyschromias were included in the study from April 2015 to July 2015. Detailed history was taken and cause for nail dyschromias was evaluated. 115 (57.5%) were males and 85 (42.05%) were females. The most seen nail dyschromia in this study was melanonychia (86.5%) followed by leukonychia (5%), blue chromonychia (5%), brown chromonychia (2%) yellow chromonychia (1.5%). The cause of nail dyschromias were:60 cases(%) were due to antiretroviral drugs, 25(12.5%) due to HIV, 30(15%) physiological melanonychia, 7(3.5% of onychomycosis, 8(4%) of lichen planus, 7(3.5%) of eczema, 15(7.5%) vitamin B12 deficiency, 10(5%) chemotherapy induced blue chromonychia, 3(1.5%) haematoma, 10(5%) leukonychia, 3(1.5%) jaundice 2(1%) Addison’s disease induced, 3(1.5%) cosmetic induced and 17(7.5%) due to other dermatological and systemic conditions. Examination of nail should always be a part of routine cutaneous examination and presentation with nail dyschromias should be worked up with the help of a good history and examination. Careful examination of the nail may help in identifying the root cause and many a times unravels some underlying systemic disorder

Evaluation of trichoscopic features in female pattern hair loss

Female pattern hair loss (FPHL) is explained by decrease in hair fiber production and their eventual miniaturization. It is considered a counterpart of male androgenetic alopecia but the role of androgens in its pathogenesis is yet to be proven. To evaluate the trichoscopic features in females with patterned hair loss. Inclusion and exclusion criteria were applied and 37 cases were enrolled in our study. Detailed history and clinical examination were done to establish the diagnosis. Trichoscopic examination was done after taking consent in diagnosed cases. On trichoscopy, hair diameter variability, peri pilar sign, white dots, scalp pigmentation and focal atrichia was observed in 62.2%, 62.2%, 40.5%, 45.9% and 40.5% respectively. Most common trichoscopy finding observed was peri pilar sign and hair diameter variability in 23/37 females. Definitive diagnosis of FPHL is difficult to be established solely on the basis of clinical examination. Thus, trichoscopy serves as a non-invasive tool to ascertain the diagnosis in these patients.

Comparative evaluation of the clinical effects of high Air-Through soft diaper and standard diaper in Indian babies with diaper rash

The incidence of diaper dermatitis (rash) in India is reported to be in the range of four to thirty-five per cent in children up to 2 years of age. To evaluate the clinical effect of using High Air-Through Soft Diaper and babies’ favourite diaper (Standard diaper) on Indian babies’ skin. This was a single-blinded, randomized, controlled, cross-over study. Eligible babies were randomized in two treatment groups. Babies in Group A used High Air-Through Soft Diaper for the first two weeks and then used standard diaper for the next 2 weeks. Babies in Group B used a standard diaper for the first two weeks and then used a High Air-Through Soft Diaper for the next 2 weeks. The study was completed with 105 babies. Theevaluation of the skin using the scoring system and photographs for representative purposes. At baseline, the mean total diaper rash scores were comparable in both Group A and Group B viz. 3.04 ± 1.00 and 3.30 ± 1.04 respectively and the difference was not statistically significant (p = 0.195). After 2 weeks, the mean total diaper rash score increased significantly from the baseline in both Group A and Group B (5.05 ± 1.97; p = 0.001 and 6.16 ± 2.22, p = 0.001 respectively); the rise in the mean total diaper rash score was significantly more in Group B than that in Group A (p = 0.045). After 4 weeks, a significant increase in the mean total diaper rash score (1.31 ± 2.69; p =0.001) was observed from what it was at 2 weeks in the Group A and there was an insignificant decrease in the mean total diaper rash score (-0.52 ± 2.54; p =0.153) in Group B from what it was at 2 weeks; the change in the mean total diaper rash score was significantly more in Group A than that in Group B (P = 0.001). Both High Air-Through Soft Diaper and standard diaper in babies caused a significant increase in mean total diaper rash score. However, the extent and the degree of rash induced with the use of High Air-Through Soft Diaper was significantly less than that during the usage of the standard diaper. Thus, High Air-Through Soft Diaper due to technologies used in it appears to be superior to the standard diaper in reducing the mean total diaper rash score.

A study using psoriasis knowledge assessment questionnaire in psoriasis affected patients

Psoriasis is a chronic disease, which is potentially controllable but cannot be cured. Treatment is long term and requires continuous effort by the patient. Patient education is important for a chronic disease like psoriasis and this involves acquiring knowledge about the disease. With knowledge gained, the patient will be able to cope better with improved decision making and comply with treatment. To assess the knowledge about psoriasis in patients diagnosed with psoriasis attending skin outpatient department (OPD) of Sree Balaji Medical College and Hospital, Chennai. This was a cross sectional study, which was conducted at dermatology OPD in Sree Balaji Medical College and Hospital, Chennai 2021 after ethical committee approval. About 80 patients with psoriasis attending OPD were included in study to whom questionnaire with sixteen questions was asked and data was collected and analysed. A total of 80 individuals were included in this study, out of which 43 were males and 37 were females .79% of study population answered that psoriasis is a long life disease. About 75% and 71% of patients answered that climatic conditions and stress aggravates psoriatic lesions respectively. Results were taken from various questions asked in survery and tabulated. The results of the present study suggest that an educational intervention may be helpful in improving the knowledge, give psychological relief to patients with psoriasis and improves quality of their life .

A study to evaluate the efficacy and safety of intradermal and intralesional Purified Protein Derivative (PPD) for treatment of common warts in children

: Viral warts are common dermatological diseases with wide range of treatment modalities. Utilization of various vaccines and skin test antigens has broadened the horizon of available immunotherapeutic agents for the treatment of warts. In this study, we compared efficacy and safety of intradermal and intralesional purified protein derivative (PPD) for treating common warts in children. Toevaluate efficacy and safety of intradermal and intralesional PPD in treatment of common warts in children.: 180 children (aged 5-15 years) with common warts were randomly divided to receive intradermal (n=90) PPD 10 TU/0.1 ml at middle third of right forearm or intralesional PPD (n=90) 0.1 ml in the largest wart once in 2-weeks till there is complete clearance or maximum of five injections whichever is earlier. Patients were followed at 4 week after last injection for assessment of response, adverse effects, and recurrence of common warts. : Complete, partial clearance and no response in 51.2%, 45.3% and 2.3% children was observed in intradermal group as compared to 54.2%, 42.5% and 1.1% response in intralesional group respectively. Recurrence of warts was observed in 1.2% and 2.2% children in intradermal and intralesional group respectively. Pain was the most common adverse effect in both groups followed by erythema lasting for 2-3 days not warranting for discontinuation of treatment in any patient.: Overall 96.5% and 96.7% patients in both intradermal and intralesional group responded to treatment respectively. We conclude that immunotherapy with PPD appears safe, effective, and acceptable treatment modality for common warts in children. Although intralesional group showed slightly higher efficacy for warts (0.2%), intradermal PPD has advantage of less pain, high patient satisfaction, less spillage of injection material onto surroundings and better compliance over intralesional group and hence can be considered as valuable first line treatment in children in resource poor developing countries.

Clinical and dermoscopic analysis of generalised linear and whorled hypermelanosis in a child: A case report

Linear and whorled nevoid hypermelanosis (LWNH) is a rare sporadic disorder of pigmentation characterised by swirls and streaks of macular pigmentation along the lines of Blaschko. It can be frequently associated with extracutaneous features. We report clinical and dermoscopic presentation of a case of generalised linear and whorled nevoid hypermelanosis in a 1-year-old child involving the trunk and extremities while sparing the face, palms, soles and mucosae without any extracutaneous features.

PRP therapy in chronic diffuse alopecia areata – A case report

Alopecia areata, an auto-immune disorder characterised by the appearance of non-scarring bald patches affecting the hair bearing areas of the body, it can be extremely difficult to treat and has a poor prognosis despite many therapeutic options. Platelet Rich Plasma (PRP) has been previously used to treat variety of alopecia including alopecia areata. A 21-year old girl presented with asymptomatic loss of hair from the scalp for the last more than two years. On examination, there was diffuse loss of hair all over the scalp with few small, thin light-coloured hair in the occipital region. Histopathological examination showed miniaturised hair follicles surrounded by variable inflammatory lymphohistiocytic infiltrate with a marked reduction in terminal-vellus hair ratio to 1:1.The response to previous treatments was poor at the end of 1 year. A trial of PRP was given with no adjuvant treatment with a total of eight sessions of PRP. Dramatic response was noted after 2 sessions in the form of improvement in hair diameter and total volume. Resistant areas also started showing hair growth. There are a few studies assessing the role of PRP therapy in AA. First report to establish the efficacy of PRP as a treatment modality in AA, showed PRP therapy to be superior to TCA and Placebo in growing pigmented hair in AA patches. A case report with ophiasis type AA resistant to intralesional steroid injections showed excellent response to PRP therapy. Previous studies have demonstrated beneficial role of PRP therapy in cases of patchy alopecia areata, in contrast ours was a case of chronic diffuse AA. Inspite of many treatment modalities tried for more than a year, the response was unsatisfactory. PRP therapy yielded amazing results in the form of hair growth over resistant areas and overall increase in pigmented hair which were sustained at one and a half year follow up. Our case was unique in the way that excellent response to PRP treatment was noted (a) In a case of diffuse alopecia areata. (b) In a case non- responsive to standard modalities. (c) In a case with no other supportive treatment.