International Journal of Research in Dermatology

Vitamin C in dermatology and cosmetology: a review

Shobhit Mohan, Neelu Singh, Lalit Mohan — Tue, 16 Jan 2024 00:00:00 +0530

Vitamin C is a very powerful water-soluble antioxidant with various potential benefits for patients with skin diseases. The chemically active form of vitamin C is L-ascorbic acid (LAA) and thus is used extensively in medical practices. Due to an active transport mechanism, the absorption of vitamin C in the gut is limited, thereby reducing the amount of drug absorbed orally despite a high dosage, which in turn reduces the bioavailability of vitamin C in the skin. Therefore, topical use of vitamin C is usually preferred in dermatology practice. The function of vitamin C is mostly linked to its electron-donating property. Several processes such as reduction of iron in the gastrointestinal tract, synthesis of carnitine, gene transcription, protection against reactive oxygen species (ROS), demethylation of DNA, Hydroxylation of transcription factors, tRNA, and ribosomal proteins, collagen, and hormonal synthesis are carried out due to the active participation of vitamin C in the body. Scurvy usually occurs due to inadequate consumption of vitamin C through a regular diet or inability to absorb the vitamin C in the body. 90% of ascorbic acid comes from fresh fruits and vegetable consumption, failure of which can lead to scurvy.

Perianal warty dyskeratoma

Thu, 01 Feb 2024 00:00:00 +0530

Warty dyskeratoma is a rare keratinization disorder marked by acantholytic dyskeratosis and belongs to the spectrum of acantholytic dyskeratosis in dermatology. It was first documented in 1954 and typically manifests in the head, neck, oral mucosa, and trunk, with several cases reported since its discovery. A 35-year-old unmarried gentleman presented in April 2022 with a 5-year history of perineal itching and discomfort. His physical examination revealed a 7-8 centimeter perianal grouped papular plaque. His medical history was unremarkable, and he has no family history of similar conditions or other dermatological disorders. Lab results showed non-reactive rapid plasma reagin and human immunodeficiency antigen/antibody combo. Liver and renal function tests were within normal range as well. The microscopic findings revealed features including prominent hyperkeratosis, invagination filled with keratin, and the surrounding area exhibiting acantholysis and intercellular edema. In conjunction with the patient’s clinical presentation, this histological profile led to the diagnosis of warty dyskeratoma. After treatment with calcipotriene and other topical agents, the last presentation showed very good improvement; the physical examination indicated remarkable thin, flat, soft, grayish plaque in the perianal area. This case report presents a unique instance of warty dyskeratoma affecting the perianal area, shedding light on differential diagnosis and clinical management in this atypical context, which significantly broadens the understanding and emphasizing that the Warty dyskeratoma can manifest in diverse body regions, urging its consideration in the differential diagnosis of perianal papular lesions.

Toxic epidermal necrolysis in a 37-year-old man with pneumonia: a case report

Wiryanti Ambarita, Sri Lestari, Anwar Fuadi, Ali Raza — Fri, 23 Feb 2024 00:00:00 +0530

Apart from allergy, TEN can be caused by infection, such as M. pneumoniae infection. Aim of this case report is to present clinical manifestations of TEN with pneumonia. A 37-year-old man, came to the emergency room with cough and fever since 5 days before hospitalized. The patient received intravenous ceftriaxone (with negative skin test), paracetamol, and n-acetylcysteine. Three days earlier, the patient had gone to primary health center and got paracetamol and n-acetylcysteine. On the first day of treatment, erythematous macules were seen on the anterior and posterior thoracic region, also the patient had sore throat and dysphagia, treated with intravenous dipenhydramine, mefenamic acid, and cetirizine. On the following day, the lesions expanded with multiple bullae on the anterior and posterior thoracic region, and erosion on the labia (BSA 28%). Intravenous methylprednisolone was administered, also Kloderma® and Ikagen® cream, and Kenalog®. Mefenamic acid and paracetamol were discontinued. On the third day of treatment, the lesions expanded (BSA 38%) and the next day, BSA reached 91.5%. The SCORTEN was 1. The patient was referred for treatment at the burn center and IVIg therapy. After the eleventh day of treatment at the referral hospital, the patient was fully recovered. The managements of TEN are stop suspected drugs, wound care, fluid therapy, systemic corticosteroids, and IVIg therapy. Appropriate management of TEN gives complete recovery to patient.

Kaposi sarcoma in an immunocompetent patient: a case report

Anjana B., Ranjeeta Sapam, Gurumayum Chitralekha Devi — Fri, 23 Feb 2024 00:00:00 +0530

Kaposi sarcoma (KS) is an uncommon vascular neoplasm associated with human herpes virus 8 (HHV8) infection. Lesions predominantly present at mucocutaneous sites, but may involve other organs. Epidemiological-clinical forms of KS include classic, endemic, AIDS associated and iatrogenic KS. KS is one of the most common AIDS defining malignancy. Lesions evolve from early (patch stage) macule into plaque stage and nodule stage. Diagnosis is made through clinical, histopathological findings and specific immunohistochemical markers for HHV8. Treatment is either by means of destructive procedures and systemic therapy in case of multiorgan involvement. This report is a case of classic KS in a 74-year nondiabetic, non hypertensive female, with no significant surgical, sexual or history of immunosuppression for the occurrence of KS. This case throws light on addressing KS in an immunocompetent patient or a newer variant of KS yet to be researched upon, which can go clinically misdiagnosed due to lack of significant history.

Bowens disease: clinico pathological correlation with review of literature

Rohini A., Leena Dennis Joseph, Anuradha Priyadarshini — Fri, 23 Feb 2024 00:00:00 +0530

Bowen’s disease is a type of squamous cell carcinoma in situ. It is most frequently diagnosed in the sixth to eighth decade of life. However, there have also been a few reports of pigmented Bowen’s disease. A single or multiple erythematous, round to irregular, scaly, keratotic, nodular, pigmented patches/plaques are first signs of the lesion. All cases of Bowen’s disease presented at a tertiary care centre over a period of seven years were included in this study. The patient details and clinical history were obtained from medical records. Histopathological slides of these cases were reviewed and analyzed. There were fourteen cases of Bowen’s disease with most patients belonging to 5-6^th decade of life (80%). Males were more commonly affected (60%). Duration of the lesion ranged between 3-5 years in 60% of the patients. Most common site involved was lower back (80%). Most common presenting feature was hyperpigmented, erythematous plaques with scaling seen in 90% of the patients. Epidermal changes such as marked acanthosis with full thickness atypia were noted in 90 % and hyperkeratosis, parakeratosis was noted in 70% of the patients. Lichenoid infiltrates at dermo-epidermal junction was noted in 70% cases. The correct identification helps in appropriate diagnosis and treatment after biopsy confirmation. Adequate resection helps in preventing risk of invasive malignancy in these conditions.

The prevalence of thyroid function test abnormalities and serum thyroid autoantibodies in vitiligo and alopecia areata patients in Saudi Arabian population

Renad Alnemari, Awadh Alamri — Wed, 14 Feb 2024 00:00:00 +0530

Background: Alopecia areata (AA) and vitiligo are immune-mediated inflammatory diseases characterized by hair loss and depigmented macules, respectively. It is often associated with other autoimmune conditions especially with autoimmune thyroid disorders indicating a potential role of autoimmunity in its development.

Methods: A 222 patients, 113 AA and 109 vitiligo diagnosed, were retrospectively reviewed. We analyzed TG-Ab, TPO-Ab, Thyroid function tests (free T3, free T4, and TSH) in all patients.

Results: In vitiligo patients, 11% (n=12) had elevated levels of anti-TG levels and 26.6% (n=29) had elevated levels of anti-TPO, Thyroid hormonal abnormalities were found in 15.6% (n=17) of vitiligo patients, and fT4 was elevated in 1.83% (n=2) patients. Within AA patients, 15.9% (n=18) had anti-TG elevation and 23.9% (n=27) had anti-TPO elevation, thyroid hormonal abnormalities were found in 16.8% (n=19), and fT4 was high in 0.88% (n=1) patient. No significant difference was found between the two groups for all measured parameters. No statistically significant correlation between the gender of the patients and the diagnosis, thyroid hormonal test, and thyroid autoantibody levels could be detected (p>0.05)

Conclusions: In our study, impaired thyroid functions and thyroid autoantibodies in vitiligo and AA patients were identified at similar rates of the previous studies. Moreover, we could not find differences in comparison to other ethnicities.

Evaluation of the effectiveness of the combination of doxycycline and trifarotene for managing acne vulgaris of moderate to severe severity: a study in a tertiary care hospital

M. Kutub Uddin, Sanjida Yesmin — Fri, 23 Feb 2024 00:00:00 +0530

Background: Acne vulgaris (AV), affecting diverse skin types, prompts a uniform therapeutic approach, with options ranging from topical to systemic treatments. Trifarotene, a fourth-generation topical retinoid, offers precise skin-specific effects, especially in facial and truncal acne treatment. The study aimed to evaluate the effectiveness of the combination of doxycycline and trifarotene for managing AV of moderate to severe severity.

Methods: At Mymensingh medical college hospital, the study enrolled 100 individuals to evaluate a new treatment for moderate AV from Jan-Jun 2023. Treatment comprised oral doxycycline (100 mg) and topical trifarotene (0.005% w/w) over 2 months, following a stratified randomization process. Evaluation criteria included clinical scores, lesion counts, and safety parameters, analyzed using SPSS v20.

Results: Study on doxycycline and trifarotene for moderate to severe acne shows promising results. Participants, mainly aged 15-25 exhibit diverse demographics and balanced gender ratio. Significant improvement on investigator's global assessment (IGA) scale is noted, with 35% experiencing notable progress at 9-10 weeks, alongside reduction in Propionibacterium acnes growth and positive patient feedback with 36% reporting 'good' response.

Conclusions: The study on doxycycline and trifarotene for moderate acne exhibits robust methodology with adherence to established practices and stratified randomization. Results, assessed via IGA, demonstrate promising efficacy and safety, providing insights for diverse skin types' acne management enhancement.

Beyond the surface: confronting the impact of topical steroids on facial skin

Krut J. Patel, Som J. Lakhani, Shreya D. Patel — Mon, 08 Jan 2024 00:00:00 +0530

Background: Topical steroids have become the primary therapeutic approach among dermatologists. The clinical outcomes are attributed to their anti-inflammatory, antiproliferative, and immunosuppressive effects. However, this miraculous remedy can lead to significant trouble when used improperly, especially on the face where it can lead to topical steroid damaged faces (TSDF).

Methods: study was conducted for 9 months among 30 patients presenting with chief complaints due to topical steroid abuse over face and data was collected and analysed after using self-designed open ended questionnaire.

Results: Out of 30 patients, preponderance were seen in females (M:F=1:2.3) The most common age group was 18-28 years (50%). Majority of them (36.6%) used class-3 of highly potent steroid which is betamethasone valerate 0.1%. Most common indication for application was as fairness cream (46.7%). In majority of the patients (70%), suggestion for application was given by pharmacist. 73.3% of patients, purchase medication over the counter (OTC) without prescription. Duration of usage was more than 6 months in 10% patients. Dyspigmentation (32.1%) followed by erythema (28.6%) were the most common adverse effects.

Conclusions: Using too many topical corticosteroids may benefit manufacturers and sellers, but it harms unsuspecting people. It's crucial to evaluate and advise patients, as well as inform doctors about avoiding excessive use of these products on the face. This is an important step that needs attention now.

Study on clinical, histopathological and dermoscopic features of palmoplantar pustulosis and palmoplantar psoriasis with pustules

Neethu M. George, Prabhakar M. Sangolli, Rosamma Thomas, Jerry R. John — Fri, 23 Feb 2024 00:00:00 +0530

Background: Palmo-plantar pustulosis (PPP) and palmoplantar psoriasis with pustules (PPso)/Palmoplantar pustular psoriasis are entities that present with chronic cyclical eruptions of vesicles and pustules of palms and soles, which were initially considered to be similar but was defined as separate entities by the international psoriasis council in 2007. Individuals with PPP are at increased risk of psoriasis vulgaris, psoriatic arthritis, autoimmune thyroid disease and 90% of pustulosis patients can have psoriasis-like rash at some stage of the disease. Aim was to assess the clinical, histopathological and dermoscopic features of PPP and palmoplantar psoriasis with pustules.

Methods: A cross sectional analysis of all patients who presented to us over 1 year with vesicles and/or pustules of hands and/or feet and were diagnosed with PPP and palmoplantar psoriasis with pustules/palmoplantar pustular psoriasis, both clinically and histologically, were done. The severity was analysed using palmoplantar pustulosis area severity index (PPPASI) and the clinical, histological and dermoscopic features were noted.

Results: Twenty-four patients were categorized into 2 groups of 12 each, with a male predominance in both the groups. Majority (66.6%) of PPP belonged to the age group of 20-40 years whereas 83% of PPso belonged to >40 years of age. Dermoscopic findings noted in both groups were translucent yellow areas, yellow/red-brown globules, dotted regularly arranged vessels, yellow crust and globules following dermatoglyphics.

Conclusions: The study, though with limited sample size, highlights few clinical, histopathological and dermoscopic features which helps in differentiating the two groups.

Effectiveness and safety of alcohol-free minoxidil in the management of treatment-naive patients with androgenetic alopecia

Narendra G. Patwardhan, Dhanashree Bhide, Sonal Shendkar — Fri, 23 Feb 2024 00:00:00 +0530

Background: Androgenetic alopecia (AGA) is a common dermatological condition in India, with potentially adverse psychosocial consequences. Here, we assess the effectiveness and safety of an alcohol-free, procapil-based formulation of minoxidil 5% in patients with AGA.

Methods: Treatment-naïve, male patients (aged 18 to ≤45 years) with AGA were enrolled in this open-label, single-arm, non-comparative, investigator-initiated study. The change in anagen/telogen ratio (ATR), hair density, and hair shaft thickness from baseline to days 45, 90, 135 and 180, investigator and patients’ global assessment for effectiveness and tolerability, and safety were assessed. A total of 53 men were enrolled.

Results: The mean (standard deviation [SD]) age of the study population was 28.3 (6.0) years. The mean (SD) ATR improvement post-treatment with minoxidil 5% was seen from day 90 (mean change: 0.4; p=0.009; 95% confidence interval [CI]: 0.1-0.7) till Day 180 (mean change: 0.4; p=0.011; 95% CI: 0.1-0.6). Improvement in hair density (p<0.01) and hair shaft thickness (p<0.01) across frontal, temporal, and occipital regions was also evident. The investigator assessment for effectiveness was ‘excellent’/’good’/’satisfactory’ for 90% of patients, which corroborated with patients’ assessment (90%) at day 180. All the investigators and patients indicated that minoxidil had ‘good’ tolerability for all patients. No adverse events were reported during the study.

Conclusions: Alcohol-free minoxidil 5% was found to have a good safety profile and was efficacious in Indian male patients with AGA, with a high level of patient acceptance.

Metabolic parameters in acne vulgaris: a case control study investigating fasting blood glucose and insulin levels in acne vulgaris

Saranya Palaniswami, Bhanu Prakash, Praveen Vasanthi Saminathan — Fri, 23 Feb 2024 00:00:00 +0530

Background: Influence of diet and lifestyle on acne among Indian population. Objectives were to identify the clinico-epidemiological profile of patients with Acne vulgaris and to assess the fasting plasma glucose and serum insulin levels in Acne vulgaris patients and the controls and correlate them.

Methods: This was a hospital-based case-control study conducted in the Department of Dermatology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore. Study included 60 cases of acne and 60 controls (age and sex matched), attending the outpatient department. After complete history, general physical, systemic and cutaneous examination, all cases were subjected to following investigation: fasting blood sugar and serum insulin levels.

Results: Acne was common in the age group 18-24 yrs (70%). In almost half the patients the age of onset was between 12-18 yrs. Commonly observed site for acne was cheeks (83.3%), forehead (66.7%), nose (55%) and chin (41.7%). The risk of developing acne was 3.5 times more among smokers than non-smokers. The mean fasting blood sugar values of cases and controls when compared showed a statistically significant difference (p<0.05). Our study did not find any statistically significant difference in fasting insulin levels between cases and controls.

Conclusions: There was only significant difference in the Mean fasting blood glucose in cases as compared to controls. Mean fasting serum insulin level though found to be raised in cases compared to controls, does not prove statistical significance. Fasting plasma glucose was significantly raised in grade III acne as compared to other grades.

Clinicomorphological patterns in an outbreak of paederus dermatitis in patients attending rural tertiary care hospital

Fri, 23 Feb 2024 00:00:00 +0530

Background: Paederus dermatitis (PD) is an acute irritant contact dermatitis caused by beetles belonging to the genus ‘Paederus’. The study aims to describe the clinical and morphological patterns and epidemiology of PD.

Methods: A descriptive study was done on 80 patients with PD attending DVL OPD in a tertiary care hospital for 6 months i.e.; from March to August 2023. A detailed clinical history was taken and local and systemic examinations were done.

Results: The mean age of the patients was 24.8 years. The percentage of females affected was 61.25% and males was 38.75%. Peak cases were noted during May (32.5%) followed by August (17.5%). Out of 80 patients, 61 had erythematous plaques (76.25%) along with other types of lesions (mixed lesions), 8 had post-inflammatory hyperpigmentation (10%), 5 had bullae (6.25%), 6 had erosions alone (7.5%). Out of 61 patients with erythematous plaques, 16 had vesicles and 15 had pustules. Common sites involved were face and neck (42.5%), trunk (35%), and upper extremity (30%), 51.2% of patients were sleeping with windows open, 73.7 % of patients complained of itching, 80% of patients were residing in areas with nearby vegetations. 60% of the patients affected were students residing at college hostels in rural areas with surrounding vegetation.

Conclusions: PD can present in various forms and should be promptly differentiated from other conditions. Proper education of the general population and awareness about the paederus beetles should be given.