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Vinitha V. Panicker, Soumya Jagadeesan, Gopikrishnan Anjaneyan, Lekshmi S., Malini Eapen, Sreedevan V., Jacob Thomas
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20174649

Abstract:
Background: Amyloidosis is defined as extracellular deposits of heterogenic, misfolded proteins, amyloid fibrils, in various tissues. The term primary cutaneous amyloidosis (PLCA) usually includes macular amyloidosis (MA), lichen amyloidosis (LA) and nodular amyloidosis. Primary cutaneous amyloidosis is very common in Kerala probably due to socio-cultural practices. There has been no published data on PLCA from Kerala thus we undertook this study. The objectives of the study were to correlate clinical features of primary localized cutaneous amyloidosis with histopathologic findings; to evaluate the sensitivity of Congo red staining with polarized light in histopathologically proven primary localized cutaneous amyloidosis)Methods: We undertook an observational analysis for a period of 2 years from May 2012 to April 2014 in the Department of Dermatology, Amrita Institute, Cochin. All cases clinically diagnosed as cutaneous amylodosis were included in the study. After informed consent, skin biopsy was taken. The histopathologic sections were stained with Congo red and seen under polarized microscopy for apple green birefrengance.Results: A total of 70 patients were included in the study. Of the 70 cases, there were 20 males and 50 females. The most common clinical type was lichen amylodosis observed in 32 patients followed by macular amylodosis (28) and biphasic amyloidosis (10) cases. Histopathological compatibility was seen in 71% of MA and 89% cases of LA. Congored positivity was seen in 53.8%. Congored stain under immunofluorescence microscopy was done for 30 patients which gave a positivity of 85% which indicates that it is more sensitive that polarizing microscopy.Conclusions: Our study showed that the most common type is lichen amylodosis. Histopathology and congo red staining with polarized light is a valuable aid in diagnosis. Congo red stain under immunofluorescence microscopy has greater sensitivity and improves the diagnostic yield.
Bhuvnesh Girish Shah, Keya Jayesh Sheth
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20174169

Abstract:
Background: Sexually transmitted diseases have been considered as a major health problem, in developing countries. With up springing of HIV and AIDS, the attention and importance of STDs have again come into limelight. Epidemiological study is needed to understand the pattern of various STDs prevalent in tribal place of Valsad.Methods: The epidemiological pattern of around 1012 patients have been studied. Patients were followed up at regular interval.Results: 33.3% were males and 66.6% were females. Out of these major percentage of patients had reported vaginal discharge (27.7%), followed by genital warts (23.6%). Females were reluctant to consult the doctor for their problem. (72%) were married and (27.7%) were unmarried. No contraceptive measures were taken in 50% cases. 20 cases of pregnancy with STDs were studied. Conclusions: A epidemiology study was taken up to understand the nature, type and extend of sexually transmitted diseases in the tribal population. Also to know the understanding amongst the masses about the STDs especially in teenagers and young people.
Ravindranath Brahmadeo Chavan, Vasudha Abhijit Belgaumkar, Aarti Sudam Salunke, Sharada Shivaji Chirame
International Journal of Research in Dermatology, Volume 3, pp 453-455; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173929

Abstract:
Syphilis is often thought to be a disease of the past, largely eradicated in modern health care; however, the rates are still extremely high in certain populations. The diagnosis of syphilis may be overlooked by primary-care clinicians due to the presence of nonspecific signs and symptoms that may be indistinguishable from other diseases. Left undiagnosed and untreated, life-threatening complications, including hepatitis, stroke, and nervous system damage, may occur particularly in immuno-compromised individuals. We present a case of lues maligna an extremely rare presentation of syphilis.
Dadapeer H. J., Anupama Y. G., Sushma D. M.
International Journal of Research in Dermatology, Volume 3, pp 456-458; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173930

Abstract:
Discoid lupus erythematosus (DLE) is the most common chronic form of cutaneous lupus. It is characterised by persistent scaly, disk-like plaques on scalp, face and ears that may cause pigmentary changes, scarring and hair loss. Squamous cell carcinoma can rarely arise within a longstanding DLE plaque in the skin. It presents as an enlarging warty growth or ulcer. We report a case of squamous cell carcinoma which developed on lesion of discoid lupus erythematosus within a short period of time.
Nagendra S. Manthale, Dayanand R. Raikar, Shrinivas R. Raikar
International Journal of Research in Dermatology, Volume 3, pp 439-443; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173927

Abstract:
Background:Alopecia areata (AA) is one of the common causes of localized hair loss among the patients attending the outpatient department. The objective of this study was to know the clinical and epidemiological profile of AA and to compare the efficacy of different topical treatment modalities in AA.Methods:100 patients of any age group and of both sexes presenting with AA to the dermatology outpatient department were included in this study. It was conducted as a randomized prospective study for a period of 12 weeks after taking an informed consent from the patient. After studying the clinical profile, patients were randomly distributed, excluding the age and sex bias into four treatment groups. Alopecia grading scale (AGS) was calculated at first visit and 12 weeks. Regrowth score (RGS) was calculated at 12 weeks. Treatment outcome in different groups were compared using mean AGS at 12 weeks and RGS.Results:Group A patients showed statistically significant clinical improvement when compared to all the other groups. Poorest response was seen in Group D. Intermediate response was seen in Group B and C patients.Conclusions:The study concluded that topical 0.05% betamethasone dipropionate is the most effective treatment modality in patients with patchy AA (having <25% hair loss).
Krishna Santosh, Chandan Ashokan, Avisa Vijay Mohan Rao
International Journal of Research in Dermatology, Volume 3, pp 448-452; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173928

Abstract:
Background:Mucocutaneous infections have played an important role in initial diagnosis of HIV infection and in clinical staging of the disease. Mucocutaneous manifestations in HIV infected individuals are myriad and can serve as a main indicator of other problems. Health care personnel involved in HIV health care must therefore have a clear idea of type, pattern, and prevalence of skin diseases in their locality. The objective of the study was to determine the various mucocutaneous manifestations in newly diagnosed cases of HIV and to correlate them with CD4 cell counts. The manifestations and CD4 cell counts are correlated with WHO staging of the disease.Methods:Data was collected from all the newly diagnosed cases of HIV presenting to the Department of Dermatology. Thorough clinical examination was done and findings were noted. CD4 cell counts were performed by FACS counter and supportive laboratory tests were done for diagnosis of other skin manifestations.Results:250 cases were enrolled with males 148 and 102 females. Most common age group was middle age group and hetero sexual route was the most common route of transmission. Bacterial skin infections were more common and candidiasis was most common among fungal infections. Herpes zoster was most common in viral infections. Significant correlation was observed between CD4 cell counts and WHO clinical staging of disease. Majority of infections were more common at advanced stage of HIV.Conclusions:To conclude, HIV-related mucocutaneous manifestations are a good clinical clue in diagnosis of advanced stages of HIV. Most of these manifestations can serve as diagnostic and prognostic markers in HIV infection. Management of HIV related mucocutaneous manifestations should always be precluded with a screening of CD4 cell counts. A lowered CD4 cell counts will prolong the duration of treatment and may significantly alter the outcome of the disease.
Sukhjot Kaur, Amit Kumar Dhiman, Sandeep Kaur, Vikram Narang, Sunil Kumar Gupta, Neena Sood
International Journal of Research in Dermatology, Volume 3, pp 411-417; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173923

Abstract:
Background: Sweet's syndrome is characterized by sudden onset of tender, erythematous papules, nodules, and plaques with a characteristic histopathology. It arises in three clinical settings- idiopathic, drug induced and malignancy induced. It has several clinical and histopathologic variants. Newer entities have been recently described in literature, thereby, emphasizing the need for continuous research. So, this study was conducted to add to scant data published in Indian literature with respect to this uncommon disease. The aims of the study were to bring insights into this rarely seen condition with special emphasis on histopathology; to highlight association of Sweet's syndrome with other systemic diseases, and its extra-cutaneous manifestations.Methods: A retrospective analysis of medical records from January 2013 to February 2017 of patients with Sweet’s syndrome was done in our dermatology department in a tertiary care hospital.Results: Out of total 13 patients, 6 (46%) were males and 7 (54%) were females. The age of patients ranged from 33 to 82 years. Five (39%) had idiopathic Sweet's syndrome, while 8 (61%) had non-idiopathic Sweet's syndrome, out of which three were associated with autoimmune diseases (ulcerative colitis, interstitial lung disease and crohn’s disease in 1 patient each), 3 cases were associated with malignancy (chronic neutrophilic leukemia, chronic myeloid leukemia and acute myelogenous leukemia in 1 patient each) and 2 cases were linked with infection. Bullous Sweet's syndrome was seen in 2 (15%) while neutrophilic dermatosis of dorsal hands was diagnosed in 5 (39%) cases. Four patients developed uncommon extracutaneous manifestations of Sweet's syndrome. In addition to classical histopathological findings of Sweet's syndrome, one case showed presence of immature neutrophils (histiocytoid Sweet's syndrome), fibrinoid necrosis was evident in 2 (15.4%), leucocytoclasia in 6 (46.2%), RBC extravasation in 3 (23.1%) and neutrophilic infiltration into vessel wall in 3 (23.1%) patients.Conclusions: Several unique variants were observed in the current study.
Snigdha O., Mamatha George, Binitha M. P., Sunitha Balakrishnan
International Journal of Research in Dermatology, Volume 3, pp 384-388; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173919

Abstract:
Background: Erythroderma is a generalised inflammatory disorder of skin manifesting with erythema and scaling affecting more than 90% of the skin surface. Several studies have highlighted the importance of biopsy in the diagnosis and management of erythroderma, while some others have found it to be of limited use.Methods: Thirty-six patients with erythroderma were enrolled in the study and a detailed history, clinical examination and relevant investigations including skin biopsy was done to find out the etiology.Results: Pre-existing dermatoses were the predominant cause (84%) contributed equally by psoriasis (42%) and eczemas (42%) and clinicopathologic correlation could be obtained in 30.55% of cases.Conclusions: Our study showed that skin biopsy remains a valuable tool in the diagnosis of erythroderma.
Girlly Kurian, Krishnan S., Shakthi P.
International Journal of Research in Dermatology, Volume 3, pp 427-432; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173925

Abstract:
Background: Lichen planus is an autoimmune, inflammatory papulosquamous disease affecting skin and mucous membrane with a possible association with the parameters of metabolic syndrome.Methods: We carried out a hospital based case control study among patients attending DVL OPD during a period of 1.5 years (January 2015 - May 2016). Study population included 40 cases of LP and 80 age and sex matched controls. Relevant history, clinical examination and blood investigations were done. Diagnosis of MS was made based on IDF criteria.Results: There was no significant association between metabolic syndrome and lichen planus (p=0.292). Although there was higher prevalence of hypertension (47.5% vs. 27.5%, p=0.029), triglyceride level (25% vs. 10%, p=0.030) and low HDLC levels (65% vs. 45%, p=0.039). We could not establish significant association between FBS and waist circumference with LP.Conclusions: Though metabolic syndrome was not significantly associated with LP, its components such as hypertension, triglycerides and low HDLC levels were significantly associated with LP as per the study. Therefore patients with LP need to be screened to rule out each of these parameters to avoid later complications.
, Krishnan S., Manobalan K.
International Journal of Research in Dermatology, Volume 3, pp 418-426; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173924

Abstract:
Background: Urticaria persisting daily for more than six weeks is termed as chronic urticaria. A significant number of them have an autoimmune basis, where ASST is used for detection of chronic autoimmune urticaria (CAU). The aim and objective of the study was to determine the frequency of autoimmunity with ASST in chronic urticaria patients.Methods:This was a hospital based cross sectional study, 100 patients with chronic urticaria fulfilling the inclusion and exclusion criteria were enrolled in the study. Detailed history, physical examination and routine investigations were recorded and ASST was done for all patients.Results:Thirty seven (37%) out of 100 CU patients were ASST positive. Statistical analysis of the clinical variables did not show significant difference between ASST positive and negative patients except for dermographism and mean duration of the disease.Conclusions:ASST is a simple invivo clinical test for detection of basophil histamine releasing activity. Diagnosing CAU is important as these patients may need high doses of anti-histamines, systemic corticosteroids and/or immunomodulatory drugs. Autologous serum therapy itself has a therapeutic role in treatment of CAU patients.
Asha Nyati, Anil Kumar Singhal, Devendra Yadav,
International Journal of Research in Dermatology, Volume 3, pp 433-438; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173926

Abstract:
Background: Topical corticosteroids (TCS) are widely misused on face which is associated with significant adverse effects and poor awareness of these effects. The aim of this study was to assess the frequency of misuse of topical corticosteroids, the causes behind it and the most common adverse events resulting from it and to make aware the people about itMethods: This study was conducted at Dermatology Department of Govt. Medical College, Kota during period of one year from July 2015 to June 2016. A total of 670 patients using topical steroids over face were enrolled in the study. Details about the usage of topical corticosteroids and their side effects were recorded.Results: Majority of the patients were females (72.68%). The most common reason for misuse was melasma (57. 91%) followed by use as a fairness cream (22.38%). Most of the patient used topical steroid cream for duration of 3-6 months (33.13%). Most common age group was 21-30 years (48.20%). Acne form eruption (38.05%) and rebound erythema (28.20%) were the most common adverse effects noted. Patients were ignorant of the ingredients and their side effects.Conclusions: Steroids have been misused by patients on their own or by pharmacist and non-dermatologist physicians for various reasons. Topical steroid should not be used on the face unless it is under strict dermatological supervision.
Ashok S. Hogade,
International Journal of Research in Dermatology, Volume 3, pp 407-410; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173922

Abstract:
Background: Dermatoses involving genital areas are not always sexually transmitted. The diseases, which are not sexually transmitted, are referred as nonvenereal dermatoses. These disorders are the cause of considerable concern to patients causing mental distress and guilt feeling in them. Nonvenereal dermatoses are quiet often a diagnostic dilemma to the treating physician also. The aim was to determine clinical and epidemiological pattern of nonvenereal dermatoses of male external genitalia.Methods: This was a descriptive study of 50 consecutive male patients over age of 18 years, with genital lesions of nonvenereal origin, attending the skin outpatient department of BTGH, Kalaburagi. Study was done for a period of 6 months.Results: The study included 50 male patients with nonvenereal genital lesions. A total of 14 nonvenereal genital dermatoses were noted. The most common nonvenereal genital dermatoses were vitiligo (20%), fixed drug eruptions (16%), scabies (14%), pearly penile papule (10%), and dermatophytoses (10%). Other dermatoses included psoriasis, plasma cell balanitis or Zoon's balanitis, lichen simplex chronicus, lymphangioma circumscriptum, squamous cell carcinoma, scrotal dermatitis, lichen planus, steatocystoma multiplex and candidiasis.Conclusions:This study helps in understanding the etiological causes of nonvenereal genital dermatoses and their pattern in this region.
Balakrishnan Thenmozhi Priya, Chellam Janaki
International Journal of Research in Dermatology, Volume 3, pp 323-331; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173917

Abstract:
Background: To study the varied clinical presentations, the predominant etiological agent and incidence of tinea pedis in relation to sex, age group, occupation and aggravating factors among the patients. Also an attempt was made to know if any significant association is there with blood group and the occurrence of tinea pedis.Methods: A study was conducted among 75 patients who attended Mycology clinic in tertiary care hospital. Detailed history was taken along with complete physical examination and local examination. All cases of tinea pedis were first confirmed by KOH examination. Isolation of the agent was done in Modified SDA medium with cycloheximide. Differentiation of the species was done by culturing on corn meal agar.Results: Prevalence of tinea pedis infection was more common among males with male: female ratio of 2.26:1. The 21- 30 years age group was commonly affected by tinea pedis. The distribution of blood groups reflected the general distribution pattern of the population. Culture positivity was recorded in 81.3%.Conclusions: More incidences of bilateral involvement and recurrent episodes were noted among the shoe wearing population than in the non-shoe wearing population. Any patients diagnosed with tinea pedis should be screened for diabetes as implied by the outcome of the study. Infected toe nails may be the site of primary infection and fungal disease can spread to other body areas from these primary sites. Trichophyton rubrum happened to be the chief isolate.
Anu Garg, Shyam Sundar Chaudhary
International Journal of Research in Dermatology, Volume 3, pp 399-402; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173921

Abstract:
Background: Atrophic acne scars cause psychological devastation and are difficult to treat. The demand for less invasive but highly effective treatment for scars is growing. Objective is to assess the efficacy of microneedling in the management of atrophic acne scars on the basis of morphology.Methods: Fifty one patients with atrophic acne scars were selected. Each patient was evaluated for types of acne scars. Dermaroller was performed at 4 weeks interval for a total of 3 sessions. Evaluation of type of acne scar and photography were done pre-treatment and 6 months after the end of treatment. Patients own evaluation of improvement was assessed by patient perception scale.Results: At the end of treatment, boxcar scars reduced by 47.06%, rolling scars reduced by 37.25% and 05.88% reduction was seen in ice pick scars. No treatment failure was seen. There was high level of patient satisfaction with patient perception scale of 8.15.Conclusions: Dermaroller has shown good results in treating boxcar and rolling scars with little effect on ice pick scars.
Chandan Ashokan, Krishna Santosh, Avisa Vijay Mohan Rao
International Journal of Research in Dermatology, Volume 3, pp 374-379; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173918

Abstract:
Background: Most of the studies in India state that pyodermas constitute 17% of cases in regular practice. Pyodermas are classified as primary and secondary. Primary pyodermas account for infection on normal skin whereas secondary on preexisting skin disease. The spectrum of pathogens, are however changing constantly as such their resistance to antibiotics. Indiscriminate usage of antibiotics, topical or systemic has lead to the development of resistance among the pathogens, which is a big problem to the physicians. The present study was conducted to assess the magnitude of different types of pyodermas, clinical types, the causative agents and their antibiotic susceptibility pattern. The study also determines the prevalence of MRSA among pyodermas.Methods: 375 newly diagnosed cases of pyodermas attending the OPD of department of Dermatology were enrolled in the study. A thorough clinical examination, demographic data, and relevant laboratory investigations were performed including culture and sensitivity.Results: The incidence of pyoderma in our study was 1.55% with male preponderance and common in 21-30 years age group. Primary pyodermas (225 cases) outnumbered secondary pyodermas (150 cases). Lower limbs were the most common site of pyodermas. Furuncle followed by folliculitis was most common primary pyodermas. Infectious eczematoid dermatitis was the most common entity in secondary pyodermas. Staphylococcus was the most common isolate in the study followed by Coagulase negative staphylococcus. Escherichia coli were most common gram negative isolate. Among diabetics, furuncle was commonest with history of 100% recurrence. Incidence of MRSA in the study was 47%. Gram negative isolates were susceptible to Carbapenems, fluroquinolones and higher generation cephalosporins.Conclusions: To conclude, our study highlighted the clinico epidemiological features of pyodermas attending our hospital. The common clinical types of primary and secondary pyodermas and associated risk factors were stated in the study. Etiological agents were identified in the study with antibiotic susceptibility, which especially assist the clinicians in selection of antibiotics in absence of culture and sensitivity.
Olanrewaju I. Ajetunmobi, Donatus O. Dzuachii
International Journal of Research in Dermatology, Volume 3, pp 395-398; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173920

Abstract:
Background: Skin cancers are the commonest malignancies in Caucasians but are relatively less common in dark skinned persons. They are strongly linked to ultraviolet exposure, skin melanin content, and immune status.Methods: This study reviewed all histologically diagnosed skin neoplasms at the Federal Medical Centre, Makurdi from January 2012 to December 2016.Results: A total of 84 neoplasms were seen, with 42 (50%) being malignant. Of the malignant lesions, Squamous cell carcinomas were the most frequent (45.2%), followed by melanomas (23.8%). The lower limb was the most frequent site of both benign and malignant neoplasms, while a male to female ratio of 0.88:1 was observed.Conclusions: A relatively high UV radiation intensity, combined with a predominance of outdoor agricultural based activities, alongside chronic ulcerative/inflammatory lesions and a high HIV burden all indicate a need for widespread enlightenment and screening campaigns to prevent occurrence of skin cancers and aid early diagnosis.
, Souhaiel Chatti, Olfa El Maalel, Wided Boughattas, Faten Debbabi, Néjib Mrizak
International Journal of Research in Dermatology, Volume 3, pp 315-322; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173916

Abstract:
Background: Several factors can influence the results of patch-tests (PT) such as individual and external factors especially climate ones. The aim of the study was to study the impact of meteorological parameters on patch-tests results.Methods: This is a retrospective epidemiological study which concerned all patients of the Tunisian center, who consulted in the Dermato-Allergology Unit of Occupational Medicine Department of Farhat Hached University Hospital-Sousse (Tunisia) over a period of 5 years. All patients were tested by the European Standard Battery allergens (BSE). The eight allergens, most frequently encountered during the study period, were analyzed.Correlation and regression tests were used to calculate the relation of the patch-tests results with temperature and absolute humidity.Results: During the study period, 5560 patch-tests were analyzed. The results of these patch- tests for most allergens were not significantly influenced by external weather conditions. However, the irritant reactions for cobalt and colophony increased with the cold and dry climate. Some positive reactions to thiuram mix, cobalt and nickel were more frequent with humidity.Conclusions: The results of this current study support those of the literature. The majority of reactions to patch- tests didn’t seem to be influenced by weather conditions.
Ummer Yaseen, Shazia Shah, Aquisa Bashir
International Journal of Research in Dermatology, Volume 3, pp 346-350; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173691

Abstract:
Background: Acne scars have a lot of psychosocial implications, they are difficult to treat and can cause depression in the affected patient. The objective of the study was to assess the efficacy of combination of platelet rich plasma (PRP) injections and microneedling in the management of acne scars.Methods: Thirty-five patients with atrophic acne scars were enrolled and graded using Goodman and Baron qualitative grading. Platelet rich plasma injection and microneedling were done at 2-week interval alternatively for a total of 6 sessions of each. Acne scars were graded before and 6 months after starting the treatment. Patients own evaluation of improvement was also recorded.Results: A total of 12 patients had grade 4 acne scars, 8 (66.6%) improved to grade 2 and 4 (33.3%) improved to grade 3 scars. Out of 15 grade 3 scars, 8(53.3%) improved to grade 1, 7 (46.6%) improved to grade 2. 8 (100%) grade 2 patients improved to grade 1. All patients were highly satisfied with the results.Conclusions: This combination has shown good results in all grades of acne scars.
Lekshmi Sajini, Gopikrishnan Anjaneyan, Soumya Jagadeesan, Vinitha Varghese Panicker, Sreedevan V., Jacob Thomas
International Journal of Research in Dermatology, Volume 3, pp 351-354; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173690

Abstract:
Background: Lichen planus (LP) is a common chronic mucocutaneous inflammatory disorder of unknown etiology. Several editorials, chapters, studies have suggested an association between hepatitis C virus and hepatitis B virus (to a lesser extent) in LP. This association was not seen in various parts of the world including India.Methods: Patients attending the dermatology outpatient department with lichen planus confirmed by histopathologic examination were included in the study and along with clinic-epidemiological data, all the patients were tested for hepatitis B and hepatitis C infection.Results: A total of 84 patients of clinico-pathologically proven lichen planus were included in the study out of which 31 were males and 53 were females. The most common age group of lichen planus in our study group was 40-50 years. Major histopathological findings were basal cell degeneration (92.7%), hyperkeratosis (89%), pigment incontinence (73%) and lymphohistiocytic infiltration (70%). All patients in this study group tested negative for HBsAg and anti-HCV antibodies.Conclusions: Although numerous studies around the world have suggested an association between HCV and HBV infections with lichen planus- multiple subsequent studies including the present study shows contrasting results especially in this part of the world. The authors believe routine screening of lichen planus patients for presence of hepatitis B and hepatitis C infection is not warranted, particularly in Indian population.
Anu Cherian Manimala, George Kurien
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173608

Abstract:
Background: Pyodermas are one of the commonest clinical conditions encountered in dermatological practice especially in pediatric practice. Various factors like poverty, malnutrition, overcrowding and poor hygiene have been stated to be responsible for its high incidence. Recurrent pyoderma is another problem encountered by the dermatologist. Nasal carriage of S. aureus has been reported to be an independent risk factor for recurrent pyoderma. The anterior nares are the principal habitat and it has been estimated that some 20% of individuals are persistent nasal carriers; 60-70% are intermittent carriers, about 20% are resistant to nasal colonization.Methods: A study was undertaken to know the common types of pyoderma among patients attending the dermatology OPD in a tertiary care centre in central Kerala. It was also aimed to study the correlation between recurrent pyoderma and nasal carrier state.180patients attending the OPD were studied. They were categorized depending on type of pyoderma. Swabs were taken from the lesions and anterior nares. The results were analyzed using SPSS software.Results: Of the 180 patients studied, 115 had primary pyoderma and 65 had secondary pyoderma. Most common primary pyoderma was impetigo and age group affected was <10 years. 59 patients had recurrent episodes of pyoderma. 43 patients had nasal swab positivity. Of these 43 patients, 30 patients had recurrent pyoderma which is statistically significant. Conclusions: Primary pyodermas are more common than secondary pyodermas and impetigo is still the leading cause of pyoderma. High nasal carriage rates of S. aureus is an independent risk factor for recurrence of pyoderma. Treating the nasal carriage is equally important in the management recurrent pyoderma of the skin.
Heena Mittal, Sukhjot Kaur, Bhavna Garg, Neena Sood, , Sandeep Kaur
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173203

Abstract:
Background: Blistering diseases are alarming skin conditions. Autoimmune blistering diseases are a group of bullous disorders characterized by pathogenic antibodies directed at the target antigens in the epidermis or dermoepidermal junction.The objectives were to study the spectrum of histopathological changes by light microscopy, to evaluate the pattern of direct immunofluorescence (DIF) and to correlate clinical, histopathological features and DIF findings of vesiculobullous lesions of the skin or/and mucosa.Methods: The present study was carried out on 110 skin and/or mucosal biopsies with vesicobullous disorders from July 2013 to June 2016. Detailed clinical history, morphology of lesions, site of involvement and other findings were recorded as per proforma. These cases were analysed clinically, histopathologically and on immunofluorescence.Results: Majority of the patients presented in the age group of 41-50 years (30.9%). The male: female ratio was 1:1.15. Pemphigus vulgaris was the most common vesiculobullous disorder constituting 48.2%, followed by Bullous Pemphigoid constituting 27.3%. Dermatitis herpetiformis constituted 8.3%; Pemphigus foliaceous 3.6%, varicella and Stevens Johnson Syndrome both were observed in 2.7% each. DIF was performed in 81 cases out of which only 72 cases (92.6%) showed positivity. Conclusions: DIF is a sensitive tool for distinguishing immune mediated bullous diseases from other vesiculobullous disorders especially in cases which pose a diagnostic dilemma both clinically and histologically. The final diagnosis depends on correlation of clinical, histopathological and immunoflourescence findings.
A. Sarin, V. G. Binesh, , S. Suprakasan
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20173138

Abstract:
Background: Condylomata acuminata (CA) or genital wart is a sexually transmitted infection (STI) caused by human papilloma virus (HPV). As there was little information about the HPV types commonly causing CA in our state, we decided to study the clinico-epidemiological profile of CA with special emphasis on HPV typing.Methods: We did HPV typing in 25 clinically diagnosed cases of CA. The biopsied specimens were sent for HPV typing using Polymerase chain reaction (PCR) and those with high risk HPV types were histologically analyzed for any dysplastic change. We also evaluated for other STIs which can coexist with CA.Results: Out of the 25 cases, 18 (72%) were males and 7 (28%) females. Majority of our patients belonged to 21-40 year age group (64%). Clinical types of CA were the classical fleshy exuberant type in 22 patients (88%), flat type in 2 (8%) and keratotic type in 1 (4%). HPV positivity was obtained in 21 (84%). The most common type was HPV 6 in 10 cases (40%) and HPV 11 in 8 (32%) patients. HPV 16 alone was isolated in 1 (4%) case. HPV types 6 and 16 and 11 & 18 were isolated in one case each. Dysplastic changes were observed in two cases with HPV 16 and 18. VDRL and TPHA positivity was found in 2 (8%) males and HBsAg positivity was seen in 1 (4%) male patient. Conclusions: This study highlights the importance of HPV typing for identifying the high risk types and to assess the efficacy of HPV vaccines.
Sivakumar S., BanuPriya K.
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20173122

Abstract:
Background: Syphilis is difficult to diagnose challenging the clinicians. Combined use of both non treponemal and treponemal serological tests will give correct diagnosis of syphilis.The aim of the study was to evaluate the role of VDRL and TPHA in the serodiagnosis of syphilis.Methods: Open label retrospective study done in the department of dermatology of a tertiary care centre after getting IEC approval. One hundred and seventy patients’ serological reports done for syphilis during the month January 2017 to May 2017 were taken for the study and were analysed retrospectively after categorizing into three groups. Frequency and percentage of patients who were reactive to VDRL, weakly reactive to VDRL, positive for prozone phenomenon and reactive to TPHA were noted in each group and analysed statistically.Results: In our study two cases showed biological false positive results in group 1 and three cases in group 3 were biological false reactors. In our study five patients in group 1 and three patients in group 3 were non-reactive to VDRL but were reactive to TPHA due to the presence of Ig G antibodies and all these patients gave a past history of treatment of syphilis. Conclusions: Our study was successful in evaluating the role of TPHA and VDRL in the sero-diagnosis of syphilis. The VDRL and TPHA being simple and economical tests can be combined in the assessment of syphilis and ensures that no cases are missed.
Geetha K., Nithya Priyadharshini S.
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20173075

Abstract:
Background: Tinea capitis is a superficial fungal infection of the scalp and scalp hair that is caused by dermatophytes most commonly in children. It is caused by genera Trichophyton and Microsporum.The aims and objectives of the study were to study the epidemiological aspects, various etiological agents, clinical types, clinic etiological correlation and to note the changing trends.Methods: All new patients with tinea capitis were included for the study after KOH positivity. For total 98 patients in all age groups, fungal culture was performed from scalp scrapings. The epidemiological factors and the clinic etiological correlation were also assessed.Results: Tinea capitis was found most commonly in the 5-10 years age group with a male preponderance (69%). Non inflammatory types were more commonly observed in 66.3% of cases, with grey patch being the most common type. Kerion was most common in inflammatory group. T. tonsurans (31.1%) was the most frequently isolated fungus followed by T. violaceum and T. mentagrophytes in 25.7% each. In previous studies T. violaceum was the most common agent isolated in South India, whereas T. tonsurans is the most common agent in this study, showing a changing scenario. The clinic mycological correlation revealed that a single pathogen may give rise to various clinical types. Conclusions: In any location, the pathogenic species may change with time. A single pathogen may give rise to various clinical types.
Bhuvnesh Girish Shah, Keya Jayesh Sheth
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20173076

Abstract:
Background: Skin is one of the major organs of our body. With time people have started taking due care of their skin. Also with changing civilization, there are new problems up springing every now and then. Even prevalence of skin diseases is different from place to place. No precise data is available to know the exact occurrence of dermatological conditions in Timbi. Hence a study was undertaken to know the burden of the disease in that area.Methods: A study of 9500 cases, was undertaking in tribal area of Timbi. Males and females were included in the study.Results: It was observed that occupation and the literacy level has somewhat co-relation with the nature, occurrence, and pattern of disease that was seen. Also it was noted that skin diseases were directly or indirectly related to systemic diseases. It was observed that once the systemic diseases were treated, the skin condition improved drastically. Also it brought into the limelight, the nuisance of irrational and improper usage of steroid. As per our observation, half of the complications seen were due to steroids. Majority cases were of Tinea, along with eczema and psoriasis. Cases like pellagroid dermatitis were also seen along with zinc dermatitis. Conclusions: This study was helpful in understanding the nature of diseases which prevailed, helped in planning of an effective healthcare system and also brought into the notice how commonly the steroids are being used for irrational case. Also it helped in emphasizing the need of educating people and creating awareness amongst them.
Sivakumar S., BanuPriya K.
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20173077

Abstract:
Background: Obesity is major health hazard in the western world, however studies on skin manifestations in obese patients are limited. Most common co-morbid conditions associated with obesity are hypertension, Type 2 Diabetes Mellitus, dyslipidaemia, degenerative joint diseases etc. Skin conditions such as acrochordons, acanthosis Nigricans can be easily made out on inspection and seen most commonly with obesity. It is important for the clinicians to routinely screen patients for obesity and co-morbid conditions.The aims were to study the prevalence of various skin disorders in obese patients and the frequency of skin changes in various obesity classes and to study the presence of metabolic syndrome and its association with leptin and insulin levels in those patients with acanthosis Nigricans and skin tags.Methods: Cross-sectional descriptive study done on 100 patients with a BMI >30 and waist circumference >90 cm (in males) and >80 cm (in females).Results: Acanthosis Nigricans was the most prevalent skin condition (65%) and the association statistically was significant (p=0.012). Association of Skin tags (second commonest, in 42%) with p=0.012. Acanthosis Nigricans and skin tags among the various skin conditions studied like psoriasis, striae-distensae, fissure-feet, pyoderma, intertrigo, varicose veins, seborrheic dermatitis, Hand-feet eczema, osteoarthritis, candiasis was significantly associated with obesity. Conclusions: Acanthosis Nigricans and skin tags among the various skin conditions studied had a strong correlation with obesity and metabolic syndrome which may be a marker for atherosclerosis and cardiovascular risk. It was also noted that in patients with Acanthosis Nigricans and skin tags, who had metabolic syndrome, there was an elevation of the plasma leptin levels and fasting plasma insulin levels but not significant with a p=0.25.
Sivakumar S., BanuPriya K.
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20173078

Abstract:
Background: Dermatologists are using antineoplastic agent methotrexate for more than six decades for various skin diseases. Methotrexate is a dihydrofolate reductase inhibitor and has cytotoxic, anti-inflammatory and steroid sparing effect. However, long term use of methotrexate raises a concern about its safety. Careful monitoring of patients on methotrexate therapy can either minimize or prevent the adverse effects.The aim of the study was to evaluate the adverse drug reactions caused by methotrexate therapy in the treatment of dermotological diseases.Methods: Observational clinical study done in 56 patients with skin diseases, who were on methotrexate therapy. LFT, RFT, blood counts done at baseline and every 2 weeks till the end of six months. Adverse reactions were monitored and assessed using WHO-UMC scale.Results: Among sixteen Psoriasis patients on methotrexate (max 15 mg/wk) therapy, 62.5% experienced adverse effects and the most common ADR being GI upset in 6 patients. Other common adverse effects observed were elevated liver enzymes, leucopenia, thrombocytopenia, candidiasis and elevated serum creatinine. None of the patients in our study had pulmonary toxicity, life threatening adverse effects requiring hospitalisation or secondary lymphoma. Adverse effects caused by methotrexate were dose dependent. So low dose weekly methotrexate regimen with folate supplementation in the form of folic acid or folinic acid can minimize the adverse effects. Conclusions: Our study was successful in identifying the adverse effects caused by methotrexate when used for various skin diseases in the department of dermatology.
V. G. Binesh, , , S. Suprakasan, T. P. Rakesh
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20172551

Abstract:
Background: The prevalence of men who have sex with men (MSM) is showing an increasing trend in general population. MSM being a high risk population are more prone to develop sexually transmitted infections (STIs).Methods: With the help of Sevana, a nongovernmental organization (NGO), we were able to mobilize 81 MSM for detailed evaluation. All MSM, after an informed consent were given a behavioural questionnaire, followed by detailed history taking, clinical examination, pre-test counselling and specimen collection.Results: All of them were clinically asymptomatic. Of the total 81 MSM in our study, 27(33.3%) had STIs as evidenced by laboratory investigations. Out of these, 3 (3.7%) had multiple STIs. The most common STI in our study group was asymptomatic herpes gentalis (12.4%), followed by latent syphilis (9.9%) and non gonococcal urethritis (8.6%). Conclusions: The high incidence of asymptomatic STIs among MSMs in our study points to the need for strengthening targeted intervention including condom usage and a compulsory medical check-up and serological screening at least once in six months for early detection and treatment of STIs. This in turn would help us in preventing the transmission of STIs including HIV.
Prathima Munichandrappa, Manjunath K. G., Kiran C., Anirudh Variyar
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20172545

Abstract:
Background: Acne is common skin problem among adolescents and young adults. Recently the role of insulin resistance in acne is being widely researched.The objectives of the study were to evaluate insulin resistance in acne, to compare the insulin resistance among cases and controls using homeostasis model assessment of insulin resistanceMethods: 45 cases and 45 controls were recruited. Acne severity was graded using the global acne grading system(GAGS). Fasting glucose, fasting insulin levels were done and insulin resistance was assessed using homeostasis model assessment of insulin resistance (HOMA-IR).Results: We did not find any statistically significant difference in fasting insulin levels between cases and controls. However, a weak positive correlation between acne severity and fasting insulin levels (r =0.3, p=0.04) were observed. Fasting glucose levels and HOMA-IR values observed between cases and controls were not statistically significant (p=0.05, p=0.59 respectively). Conclusions: Our study did not suggest a major role of insulin resistance in acne.
, Aravella Stergiopoulou, Alexander Stratigos
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20172505

Abstract:
Background: Skin cancer is the most common type of cancer presenting with a dramatic increase in its incidence among Caucasian populations worldwide. Primary prevention in childhood and early detection is important in reducing the risk of skin cancer later in life.The objectives of the study were to investigate the effect of a focused educational intervention in school children aiming to increase their knowledge about the harmful effects of sun exposure and promote prevention behaviors regarding skin cancerMethods: The study consisted of a before/after 6-month assessment of a school intervention program applied in two hundred children from four primary Schools (Grades 3-6) at a rural area in Western Greece. The program included the presentation and distribution of educational material (activity guide, manual for pupils, posters). A detailed questionnaire with close-ended questions was distributed before and after the intervention. Both between and in groups analysis was conducted.Results: Of the participating pupils, 48% were boys, whereas 78.5% reported a fair skin complexion and 79% reported freckles and 1-20 nevi. After the intervention, an increased number of pupils were taught to enjoy sun exposure while avoiding its harmful effects. A significantly greater number of children stated proper use of sunscreen (74% vs. 31%, p=0.001) and sun protection (that avoided going outside especially at the intense hours of daily UV exposure (65% vs. 25.5% prior to the intervention). Melanoma awareness was also significantly raised. Conclusions: Students’ knowledge about the effects of sun exposure as well as the need for sun protection increased following a targeted and well-designed educational intervention. The development of preventive educational programs on skin cancer for school children is important to increase awareness in this sensitive age group.
A. S. Salunke, V. A. Belgaumkar, R. B. Chavan, S. S. Tharewal
International Journal of Research in Dermatology, Volume 3, pp 303-305; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20172218

Abstract:
Varicella is usually a mild self-limiting disease, commonly occurring in paediatric population. However, in adults and in specific groups of patients, such as those who are immunosuppressed, varicella virus infections can be fulminant and life threatening. We are hereby reporting two cases of Pemphigus vulgaris on cyclophosphamide therapy, who succumbed due to disseminated intravascular coagulopathy (DIC) after varicella zoster virus infection.
Aarti S. Salunke, Ravindranath B. Chavan, Vasudha A. Belgaumkar, Pallavi P. Patil
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20172216

Abstract:
Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder of blood and lymphatic vessels that is characterised by a combined vascular malformation of the capillaries, veins and lymphatics, congenital abnormalities, and associated limb hypertrophy. It may also involve gastrointestinal tract which can lead to life threatening bleeding. This syndrome presents since birth to early infancy or childhood with equal distribution in both genders. An adolescent female presented with right lower limb hypertrophy with port wine stain and overlying hemorrhagic vesiclessince birth. Histopathology of these hemorrhagic vesicles angiokeratoma. On the basis of history and classical clinical triad patient was diagnosed as KTS with angiokeratoma, an association rarely reported in literature.
, Ravika K. Budhiraja, Roopam Bassi
International Journal of Research in Dermatology, Volume 3, pp 300-302; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20172217

Abstract:
Anagen effluvium occurs due to an agent or event that drastically reduces the metabolic activity of the matrix cells of the hair follicle. At any given time more than 80% of scalp hair is in the anagen phase of the hair cycle. Hence the resulting hair loss is abrupt and extensive. In majority of the cases, it occurs in association with cancer chemotherapy and radiation, other causes being rare. Here we report a case of a middle aged female suffering from Atopic dermatitis that was put on treatment with Azathioprine for the same. Treatment with Azathioprine was followed by a diffuse and extensive hair loss from the scalp associated with painful oral ulcers and marked leucocytopenia within a month of administration. The hair grew back within four months of stopping Azathioprine. This case report is an attempt to highlight a rare but extremely distressing side effect of Azathioprine which is a commonly used drug in dermatology.
Ashok S. Hogade,
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20172203

Abstract:
Background: Topical Steroids (TS) are one of the most widely used therapeutic formulations in practice. Treatment was revolutionized with the advent of these anti-inflammatory corticosteroids .They provide rapid symptomatic relief in almost all inflammatory dermatoses , in short term. In India topical steroids are marketed by many pharmaceutical companies and few of these formulations are available at every medical store even without a prescription.Methods: Patients with relevant facial dermatoses (clinical features suggestive of TS abuse) with history of current TS inappropriate use were included. Diagnosis was established on clinical basis and consent was sought. Proper skin examination was performed to detect the condition related to abuse of TS.Results: Out of 100 patients studied 54 were females and 46 males. Majority were of 15-35 years age group and unmarried. 72% patients belonged to lower and 25% to middle socioeconomic class. Majority of the patients were students (42%) followed by household workers (38%). Conclusions: Unnecessary cosmetic use of TCs with or without fairness creams is quite common in facial dermatoses resulting in steroidal dermatitis resembling rosacea. Topical steroid misuse is increasing because of easy availability, Lack of awareness, Obsession for fair skin.
, Neha Pethani, Rima Bharatbhai Shah
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20172202

Abstract:
Background: To evaluate and compare the profile of adverse drug reaction, its causality, severity and preventability in patients of acne prescribed with either topical benzyl peroxide or topical retinoic acid in a tertiary care teaching hospital.Methods: Two hundred patients attending to dermatology department with acne and prescribed with either topical benzyl peroxide or topical retinoic acid were observed for occurrence of adverse drug events (ADEs). ADEs were either spontaneously reported or elucidated from personal interviews and analyzed.Results: Out of total 200 patients, 110 (55%) were given benzoyl peroxide gel (2.5%) and remaining 90 (45%) were given retinoic acid cream (0.025%). Total 54 adverse events were reported in 47 (23.5%) patients. Highest number of patients having ADR was from 16-20 years (35, 74.46%) with male predominance (59.57%). Number of adverse events reported was significantly higher (p <0.05) in retinoic acid group (34, 62.96%) as compare to benzyl peroxide group (20, 37.03%). Most common ADRs were exfoliation (14, 25.92%) and burning sensation (13, 24.07%). Most of the ADRs fell in category of ‘probable’ and ‘possible’ in causality assessment by both WHO-UMC method and Narenjo’s scale. All the ADRs were of mild (44, 81.48%) and moderate (10, 18.52%) severity. Majority of ADRs were not preventable (24, 44.44%) followed by definitely preventable 22(40.74%) and 8 (14.81%) probably preventable.Conclusions: ADRs is a common problem associated with topically used medications for acne and its occurrence is significantly higher with retinoic acid as compare to benzyl peroxide. Early diagnosis and proper education about use of topical drugs can prevent some of the ADRs.
Brinda G. David, Roshni Menon R., R. Shankar
International Journal of Research in Dermatology, Volume 3, pp 245-250; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20172205

Abstract:
Background: Besides the common alterations related to the intrinsic and extrinsic aging processes, there is one that affects individuals of any age, both sexes, and all races the so called dark circles, periorbital darkening or periorbital melanosis. There is scarcity of data regarding the incidence and prevalence of periorbital melanosis due to its transitory nature and lack of reasonable etiological explanation. Aim: To assess the prevalence of periorbital melanosis and to study the epidemiological factors responsible for the occurrence of periorbital melanosis.Methods: A single centred, cross-sectional, descriptive study was conducted in patients attending the skin OPD of our teaching hospital from Jan 2016 – Dec 2016. A total of 250 patients were included in our study. Patients with hyperpigmentation around the orbital area of all ages and both genders were included in the study. A careful physical examination to detect involvement of upper or lower or both eyelids and extension beyond the periorbital region, colour of hyperpigmented areas (light brown/dark brown/red/blue), presence of any dermatological disease or scar in periorbital region were assessed. A detailed history was taken including duration of the condition, family history, history of atopy or drug intake, associated faulty habit or lifestyle.Results: Based on the type of POM, vascular POM (44%) was found to be the most common type among our patients followed by constitutional (33.2%), post-inflammatory (13.6%) and shadow type (9.2%). Among the various factors for POM watching TV for more than 8 hours/day, usage of spectacles, sleeping habit of less than 6 hours/day, habit of regularly rubbing the eye, family history of POM, associated systemic disease like anaemia and irregular menstruation and associated skin lesion like atopic dermatitis had shown a strong association (odds ratio >0.8) in the development of POM.Conclusions: It is very much essential to classify and grade the peri-orbital melanosis and to determine the causative factors which would help us to intervene earlier and that would result in a better prognosis.
, Vinma H. Shetty, Narendra J. Shetty
International Journal of Research in Dermatology, Volume 3, pp 239-244; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20172204

Abstract:
Background: A thorough knowledge of the skin changes, physiological as well as acquired, in neonates is of prime importance for the dermatologist as well as paediatrician.Methods: A total of 430 randomly selected live-born neonates delivered and admitted to the postpartum ward or to the Neonatal Intensive Care Unit and neonates attending the Dermatology Outpatient Department of a tertiary care institute were included in this study after taking written informed consent. A detailed assessment of history was performed and a detailed dermatological examination of each neonate was carried out. Laboratory procedures were performed to confirm diagnosis if required. Data was analyzed using SPSS ver. 20.Results: Most common physiological skin change observed was Mongolian spot (65.35%) followed by Erythema Toxicum Neonatorum (51.63%), Epstein’s pearls (46.97%) and Sebaceous gland hyperplasia (45.81%). Lanugo hair was seen in 16.74% neonates. Among congenital skin lesions, Salmon patch was seen in 15.58% of the neonates whereas congenital melanocytic nevi are seen in 4.19% of the neonates. Diaper dermatitis was the most common acquired skin manifestation seen in 5.81% of cases. Conclusions: Neonates are prone to suffer from a wide range of dermatological problems, physiological as well as pathological. These manifestations are unique to the neonates. A detailed history and awareness of the clinical presentation facilitates the confirmation of the diagnosis.
Mahalakshmi R., Apoorva R., Jefferson Joshua
International Journal of Research in Dermatology, Volume 3, pp 282-285; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20172212

Abstract:
Background: Dermatophytes are fungi that break down keratin of the stratum corneum and grow. They cause superficial infections of the skin, hair, and nail that are referred to as tinea infections. This study aims to assess the socio-demographic factors and clinical profile of subjects with dermatophytic infections and their impact on the duration of the illness.Methods: 200 random subjects with dermatophytic infections were enrolled and assessed clinically.Results: There was significant association between duration of infection with age, diabetes, living condition and personal factors.Conclusions: The impact of age, diabetes, living condition and personal factors on susceptibility to and duration of dermatophytic infections was elucidated.
, Vasudha A. Belgaumkar, Nitika S. Deshmukh, Sunil N. Tolat
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20172215

Abstract:
Skin can provide a vital clue to diagnosis of internal disease. Exfoliative dermatitis (erythroderma) is an uncommon potentially serious inflammatory skin disorder characterized by an intense, widespread erythema and variable scaling. It results from aggravation of pre-existing skin disease, or may be caused by drugs or neoplasms. Although various paraneoplastic dermatoses may occur in association with carcinoma lung, erythroderma as the sole presenting feature is infrequently reported in literature. Herein we describe an elderly male in whom recalcitrant erythroderma led to the diagnosis of squamous cell carcinoma lung with fatal outcome.
R. B. Chavan, V. A. Belgaumkar, A. S. Salunke, , N. M. Bansal
International Journal of Research in Dermatology, Volume 3, pp 286-288; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20172213

Abstract:
Monoclonal gammopathy is clonal proliferation and accumulation of immunoglobulin producing B-cells. A variety of skin disorders are associated with an increased level of monoclonal immunoglobulin proteins. Synonyms such as monoclonal gammopathies, paraproteinemias, plasma cell dyscrasias and dysproteinemias are used to designate gammaglobinopathies. Here in we report a case of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes) syndrome presenting with sclerodermoid features.
Ravindranath B. Chavan, Aarti S. Salunke, Vasudha A. Belgaumkar, , Sweta S. Tharewal
International Journal of Research in Dermatology, Volume 3, pp 289-292; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20172214

Abstract:
Chikungunya fever (CF) has recently re­emerged as a major public health problem of global scale. It is characterized by an acute onset of high fever associated with severe disabling arthritis, vomiting, sore throat and often with prominent cutaneous manifestations. The disease is usually self-limiting, but the joint symptoms and some cutaneous features may persist after defervescence. Various cutaneous changes have been described in association with CF. We report a case series of ten patients presenting with pigmentation (over face, palm, sole, knuckles, fingers) and vesiculobullous lesions which were diagnosed as chikungunya rash based on of clinical and serological investigation.
, Vanathi Thirunavukkarasu
International Journal of Research in Dermatology, Volume 3, pp 277-281; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20172211

Abstract:
Background: Acne scars are a cause of major psychological morbidity in the young population. Microneedling using dermarollers which uses the principle of percutaneous collagen induction and Chemical reconstruction of skin scars (CROSS) using Trichloroacetic acid (TCA) are both widely used methods for the treatment of acne scars and are cheaper alternatives to LASER resurfacing. The aim of our study is to objectively compare the efficacy of microneedling using dermaroller with CROSS using 100% TCA in the management of acne scars.Methods: 30 patients with acne scars were divided into 2 groups A and B with 15 patients each. Group ‘A’ underwent microneedling using 1.5 mm dermaroller and Group ‘B’ underwent CROSS technique with 100% TCA. A total of 4 sessions at monthly intervals were performed on both groups. The percentage improvement in the acne scar grade between the two groups was compared using the student ‘t’ test.Results: Among the 30 patients, 13 (86%) patients in Group A (Microneedling) and 11 (78%) patients in group B (CROSS) noted significant reduction in their acne scar grade. The difference between the 2 groups was statistically insignificant. 3 patients had significant post inflammatory hyperpigmentation in group ‘B’.Conclusions: The techniques of microneedling and CROSS are both effective in acne scars But microneedling scores in other aspects such as faster wound healing, better skin rejuvenation and safety in dark skinned individuals.
Dayanand R. Raikar, Nagendra S. Manthale
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20172206

Abstract:
Background: It is not surprising that patients hospitalized on nondermatology inpatient services are frequently found to have skin problems and present as a source of confusion for their admitting physicians. Aims and Objective: To analyse the reasons for dermatology referrals and its frequency, departments sending the referral and the impact on health care management.Methods: We conducted a study on 464 patient referrals over a 4‑year period. The demographic details, specialties requesting consultation, cause of referral, and dermatological advice have been recorded and analyzed.Results: Unspecified “skin rash” was the most common dermatologic condition for which skin referral was sought. The final diagnoses made by dermatologists revealed infections as most common skin disorder. Almost 48% of the patients referred as “skin rash” were diagnosed to be suffering from infectious disorders. The referring doctors could provide an accurate dermatological diagnosis only in 32% of cases.Conclusions: Most of the nondermatologists fail to diagnose common skin disorders. This reveals need for more trained dermatologists to combat this problem and more extensive dermatological training for the medical students.
T. Sangeetha, Raghu M. T., Nataraj G. R., V. Sharath Kumar, Y. Satya Krishna, Fibin Johnson J., V. Sravan Manikanta
International Journal of Research in Dermatology, Volume 3, pp 272-276; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20172210

Abstract:
Background: The goal of the study was to assess the prescribing pattern, pattern of skin diseases among the patients and to assess the impact of quality of life in various Skin diseases of dermatological patients by using dermatological quality life index (DLQI). The present study aims at improving the patient’s knowledge towards their disease and medication and also to measure the improvement of Quality of life of patients.Methods: A prospective observational study was carried out for a period of six months at Department of Dermatology Basaveshwara Medical College and Hospital, Chitradurga.Results: Total 150 patients are included. 58 was males and 92 were females. The most skin disease is seen in the age group of 21-40 (40.7%). Majorly skin disease are seen in the illiterate people is (62%), (70.7%) married and 15.3% of socio-economic status of the patients. The major skin disease are seen in the study are psoriasis (12.66%), scabies (16.66%), dermatitis (9.33) and followed by urticaria (6.66%), eczema (4.66%), acne (5.33%). Anti-histamines (16.6%), emollients (9.33%), corticosteroids (9.33%), anti puritics (6.66%), kerotolyte (6.66%) are majorly prescribed drugs. The study showed that there was an extremely significant improvement in DLQI of patients in comparison with first visit result and follow up visit. Whose P value is (<0.001) extremely significant. Conclusions: Therefore the pharmacist patient education found to have significant influence on improves the patient knowledge towards their disease and medication which shows the positive impact on quality of life among the patients of skin diseases.
Vaishnavi Gopal, Manjunath Mala Shenoy, Malcolm Pinto
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20172208

Abstract:
Background: Common warts are cutaneous viral infections caused by various strains of human papilloma virus (HPV). Their variants include filiform, periungual and pigmented warts. At present more than 200 different HPV genotypes have been detected and a periodic clinical analysis will reveal whether any new morphological variations have occurred.Methods: Hundred and ten patients with common warts were taken up for this study.Results: The clinical characteristics of 637 common warts in 110 patients were studied over a span of 1 and a half years. The age group ranged from 18 years to 72 years. Seventy six were males and 34 were females. Majority belonged to the age group of 18-30 years. The most common occupational group involved were students followed by housewives. The initial site of onset in 44.5% of patients was on the fingers. Eleven patients had atopic diathesis. Similar complaints in friends and family were seen in 30%. The most common sites of involvement for classical common warts were on the fingers and for filiform warts were on the head. 30% had association with other warts out of which 28.1% had palmoplantar warts.Conclusions: Common warts usually present as a cosmetic concern in most patients. Our study concluded that young male students are susceptible to acquiring them. Characteristics of warts in atopics did not differ significantly from non atopics. Regions most prone to contact and susceptible to trauma are the most common sites of inoculation i.e. fingers, scalp and face.
Thansiha Nargis, Vishal Bejai, Malcolm Pinto, Manjunath Mala Shenoy
International Journal of Research in Dermatology, Volume 3, pp 267-271; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20172209

Abstract:
Background: Androgenetic alopecia (AGA) is the most common form of hair loss affecting up to 80% of the men. It manifests mostly after puberty and is evident by the age of 30. Nowadays the onset of AGA is much earlier and most of them develop AGA in early twenties. Risk factors such as smoking, alcohol consumption and prevalence of AGA in the family are considered to contribute to the early onset. Aims: To estimate the prevalence of and to determine risk factors for AGA in adult males.Methods: A total of 103 patients above 18 years of age attending the dermatology OPD were included in the study. Epidemiological data was collected using a standard questionnaire.Results: In the study population, 68% patients were in the age group 21-30 years. No association was noted between smoking and the age of onset of AGA. An early age of onset was associated in patients with history of alcohol consumption (73.3%). Prevalence of familial AGA was seen in 68% and had a paternal inheritance (62.8%) more than maternal (8.6%). Associated systemic diseases were seen in 12.6% of the patients and hypertension was the most common.Conclusions: AGA is a very common presenting complaint in the younger population. The early onset of AGA itself causes anxiety and apprehension in the patients that further contribute to the hair loss. The presence of a family history in the patients’ needs for an early management of the disorder. Environmental factors like smoking and alcohol consumption thought to play a role in the aetiology of the disease.
Balakrishnan Thenmozhi Priya, Vijayaanand Muthupandian, Krishnaveni Alagar, Rajkumar Kannan
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20172207

Abstract:
Background: To study the clinical and epidemiological pattern of occurrence of non-venereal genital dermatoses among the patients attending STI clinic. Also an attempt was made to know the level of awareness among the patients studied and the level of psychological impact on the affected persons before they were diagnosed as anon venerealdermatoses.Methods: A study was conducted among 125 patients who attended the STI Clinic in a tertiary care center in a period of 6 months. Detailed history was taken along with complete physical examination and local examination.Results: 125 patients attended the STI Clinic. Among them 75 patients [40 males and 35 females] were diagnosed to have Non venereal genital dermatoses. A total of 14 different non venereal dermatoses were observed in our study The commonest age group affected were in the age group of 30-40 year. The most common non-venereal dermatoses in females in our study were Lichen sclerosuset atrophicus and in males were fixed drug eruptions Pearly penile papules. Mild anxiety and concern about the genital lesions were found in almost all the males and females.Conclusions: A prompt and correct diagnosis of non-venereal genital dermatoses needs a greater clinical acumen along with various investigative methods Patient must be treated as a whole rather than treating the disease alone. The complete successful outcome lies not only in treating the disease but also treating the patient as a whole allying his undue fears, stress and misconceptions.
Anju S. Nair, George Kurien, V. G. Binesh
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20172104

Abstract:
Background: Pregnancy being a complex state, the interactions of multiple factors result in a number of cutaneous findings that can be separated into physiologic changes, pre-existing dermatoses that can be aggravated or improved during pregnancy and dermatoses that are specific to pregnancy. Dermatoses specific to pregnancy are important to recognise because they may be pruritic or painful to the mother and may pose significant risk to mother, her fetus or both. Early identification of the condition may go a long way in preventing morbidity and mortality.Methods: Antenatal women attending dermatology outpatient for dermatologic problems or referred from Obstetrics and Gynaecology, department for skin conditions in a tertiary care hospital in Kottayam, Kerala state were taken up for the study. Pregnancy related dermatoses or physiologic changes due to pregnancy if present were noted. The patients were followed up till delivery and the pregnancy outcome recorded. The results were analyzed using SPSS.Results: 94.3% of the patients had physiological changes, hyperpigmentation being the commonest. Specific pregnancy dermatoses were present in 38.3%. 94% of pregnancy dermatoses occurred during third trimester. The most common specific dermatoses observed was pruritic urticarial papules and plaques of pregnancy (PUPPP)-63.6%. It is more common in primi gravida (30/42), in twin pregnancies, in mothers of babies with more birth weight, male babies and those with gestational diabetes mellitus. None of the specific dermatoses produced adverse fetal outcome. Conclusions: Pregnancy dermatoses usually manifest in the third trimester. PUPPP is the commonest pregnancy dermatosis. PUPPP is more common among mothers with increased body weight, gestational diabetes, in twin pregnancy and in mothers with male babies. Most of the common pregnancy dermatoses have no adverse effect on the fetus.
Shyni Perumbil, , Sarita Sasidharan Pillai
International Journal of Research in Dermatology, Volume 3, pp 223-227; https://doi.org/10.18203/issn.2455-4529.intjresdermatol20171569

Abstract:
Background: Juvenile plantar dermatosis (JPD) is characterized by shiny dry fissured dermatitis of the plantar surface of the foot, affecting children aged 3-14years. The most accepted theory is that JPD is a frictional contact dermatitis of the forefoot in which atopics are more prone to develop. Allergic contact dermatitis remains a close differential diagnosis; it can aggravate the predisposing JPD. In this background we carried out a study among children aged fourteen years and below with clinically diagnosed JPD to know the age and sex profile, aggravating factors and clinical features in this part of the country.Methods: All children aged 14 years and below with JPD attending our outpatient department from November 2006 to November 2007 were included in this study. Using a preset proforma, data regarding age and sex, information on any relation to footwear, past history of allergic disorders in person or family members was collected. All the 40 patients were patch tested using the footwear allergen series in petrolatum base. Patch test unit was removed after 48hours and the results were interpreted using criteria laid down by International Contact Dermatitis Group (ICDRG). The data was analyzed and made an attempt to understand the role of footwear allergy in JPD.Results: 22 girls and 18 boys attended our OPD with JPD between the age group of 4-14 years. 52.5% were using footwear made of plastic; 25%used leather; 12.5% rubber footwear. Patients presented with erythema and glazed appearance of foot along with fissuring. The areas of involvement were distal soles and toes in 70%, distal sole alone in 7.5% and distal sole and dorsum of toes in 22.5% of patients. Personal history of atopy was documented in 15% of patients and family history of atopy was present in 20% of cases. 20% of patients complained of exacerbation with footwear. Of the 40 patients who underwent patch testing, 10% only showed positive patch test reaction mainly to potassium dichromate (5%). Conclusions: JPD is not an uncommon disease and it predominantly affects school going children. Seasonal variation was associated with aggravation of disease. Specific footwear was identified to cause flare ups in a significant percentage of study population (20%) and this was proven by patch test results in half of them. Though nearly one fifth of the affected had an atopic diathesis in person or family, the present data suggests that JPD is not exclusive to atopics. A large sized study is required to evaluate the role of footwear in JPD.
Ahmed Nadeem, Bindu V., Najeeba Riyaz
International Journal of Research in Dermatology, Volume 3; https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20171551

Abstract:
Background: Atopic dermatitis is chronic or chronically relapsing inflammatory dermatoses. Immune sensitization to food derived allergens play an important role in its pathogenesis. Aim of this study was to assess the clinical and epidemiological aspects of atopic dermatitis in children below 12 years of age, the role played by dietary modifications in the severity of disease and to correlate serum IgE levels with clinical severity and dietary modifications.Methods: Seventy five patients, diagnosed as atopic dermatitis in age group of 1-12 years who attended Dermatology department in a tertiary care hospital during a 1 year period were selected. The clinico epidemiological features were noted. Patients were asked to avoid milk, egg and food containing milk and egg and other precipitating food for 3 weeks. SCORAD index and serum IgE levels was assessed initially and after 3 weeks..Results: Of the 75 children with atopic dermatitis majority had pruritus and typical morphology of lesions .It was seen that 44% had food as their main precipitant; 26.7% inhalants, 22.7% seasonal variations and 6.7% had other precipitants including alternative medication. Mean SCORAD index of the cases and mean serum IgE values were decreased after 3 weeks of dietary restrictions. Conclusions: Food was found to be the major precipitant, followed by inhalants, seasonal variations and other medications. Egg, fish and milk were found to be the major precipitants amongst food. There was a decline in SCORAD index and mean serum IgE after 3 weeks of dietary restriction.
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