Aarti Sarda

Coexistence of frontal fibrosing alopecia with lichen planus pigmentosus

A 47-year-old, postmenopausal woman presented with asymptomatic, excessive hair loss on the frontal region of the scalp of one year’s duration. Over the same period, she had noticed progressive, diffuse pigmentation of the face. She reported no history of hair manipulation or cosmetic practices involving the hair prior to the beginning of hair loss and no regular use of facial cosmetics. She had been using antihypertensive medication (amlodipine and atenolol) for the previous four years and had been applying hair dye for five years with no untoward side effects. She had no history of gynecological or endocrine problems. Clinical examination revealed a 2-cm band of recession along the frontotemporal hairline; the underlying skin was smooth, shiny, and atrophic (Figs. 1 and 2). Follicular orifices were absent from the patches. Follicular keratotic papules were seen around the alopecia patches, but there was no perifollicular erythema. Interestingly, hairs in the eyebrows were preserved. There was diffuse hyperpigmentation of the forehead, ear lobule, preauricular region, and sides of the neck. Examination of mucosae and nails did not reveal any abnormality. The subject’s

Lupus band test.

Systemic lupus erythematosus is a heterogenous chronic autoimmune disease affecting one or more organ systems and is characterized by the production of various autoantibodies, complement consumption and the presence of circulating immune complexes. In the diseased tissue of SLE and DLE, liquefactive degeneration of the basal cells with edematous changes and thickened subepidermal basement membrane are characteristic features.

“Turban PUVAsol:” A simple, novel, effective, and safe treatment option for advanced and refractory cases of alopecia areata

Background: Alopecia areata (AA) is an autoimmune characterized by nonscarring loss of scalp and/or body hairs. Topical PUVA has been reported to have good effect in AA. The modification of topical PUVA which we call, “Turban PUVA-sol,” is a method of localized immunotherapy using psoralen solution followed by sun exposure. Aims: We aim to study the therapeutic role and side effect profile of turban PUVA in the treatment of advanced and refractory AA. Methodology: Fifteen consecutive patients of alopecia subtotalis (at least 70% of scalp hair loss), totalis, and universalis, attending the dermatology outpatient department of a tertiary care hospital in eastern India were subjected to “Turban PUVA-sol” after duly signed consent. Alternate day therapy was given. Results: At the end of 10 months of study, 2 (13%) out of fifteen patients were lost to follow-up for some unknown reasons. The severity of alopecia tool scores showed a significant (P = 0.0002) decrease posttreatment. Correlation between the severity of alopecia and grade of improvement showed a rho value of −0.453. In the remaining thirteen patients, using physician global assessment (PGA), 4 (26%) showed good response, 4 (26%) showed moderate response, 3 showed mild (20%) response, and 2 patients (13%) showed negligible response. Three out of four patients who showed good improvement in PGA showed more than 80% of new hair growth. Side effects are minimal with some patients complaining of mild irritation and scaling. Conclusion: We found topical Turban PUVAsol to be a very cost-effective and safe treatment option for AA.

Controversies in the management of cutaneous adverse drug reactions

Some cutaneous adverse drug reactions (CADRs) are severe life-threatening conditions due to multisystem involvements with a high morbidity and mortality rates ranging from 25 - 70% and require immediate medical care. But there are huge controversies regarding the management because large clinical trials are lacking. Most frequent discussion and division occur regarding the use of systemic corticosteroid as early intervention with corticosteroids controls inflammation. Corticosteroids are potent agents that target several intracellular processes to modify almost all components of inflammatory and immune responses but their impact on the long term disease course is not known. Controlled relapses of rash and hepatitis may occur as corticosteroids are tapered. A chronic HHV6 activation promoted by systemic steroids could explain these relapses. Second important issue is the use of antitubercular drugs (ATD) in case of CADR due to multidrug therapy of ATD. As both the tuberculosis and CADR are life threatening conditions and we can not spare treatment of tuberculosis for CADR, we should come to a conclusion which is not yet decided. In the same way the use of antileprotic MDT in CADR due to MDT raises a similar controversy. So, here we focus on those controversies and discuss the issues.

An Asymptomatic Whitish Nodule on the Cheek of An Adult Male: What is Your Diagnosis?

A 28-year-old previously healthy male presented with a slowly progressive, mildly tender nodule over the right cheek since 6 months. There was no history of trauma prior to the onset of the lesion [Figure 1]. There was no history suggestive of connective tissue disorder. He was not on any medication and had not undergone any surgery. A dermatologist at his native place had diagnosed it as acne pustulosa. Our differential diagnoses were verruca, xanthoma, epidermoid cyst and giant molluscum contagiosum. The laboratory investigations revealed low-normal serum calcium and normal phosphorus levels. All other hematological and biochemical parameters were normal. The histopathology with the hematoxylin and eosin staining showed basophilic deposits in the dermis Figures 2-4.