Amiya Kumar Nath

Metabolic syndrome in patients with psoriasis: A comparative study

Background: Psoriasis patients are at increased risk of developing the metabolic syndrome (MS). Proinflammatory cytokines such as tumor necrosis factor-α, interleukin-6 that are increased in the psoriatic plaques are known to contribute to features of MS such as hypertension, dyslipidemia and insulin resistance. Aims: (1) To establish the frequency of MS in patients with psoriasis. (2) To study the risk factors associated with MS in psoriasis. Materials and Methods: A hospital based comparative study was conducted involving 40 adult patients with psoriasis and 40 age- and sex-matched controls. All participants were evaluated for components of MS. Results: Both groups included 31 males and 9 females. The mean age of the cases and controls were 49.95 years and 49.35 years, respectively. Psoriasis patients with MS had a statistically significant higher mean age (56.31 ± 11.36 years) compared with those without MS (46.89 ± 11.51 years). MS was present in 13 out of 40 (32.5%) patients with psoriasis and 12 out of 40 (30%) controls; this difference was not statistically significant. Higher age and female gender correlated with the presence of MS in psoriasis patients. The presence of MS in psoriasis patients was statistically independent of psoriasis area severity index score, body surface area involvement or psoriatic arthropathy. Conclusion: Our results suggest that there is no close correlation between psoriasis and MS in South Indian patients.

Mal de meleda with lip involvement: a report of two cases.

Mal de Meleda is a rare autosomal recessive transgradient palmoplantar keratoderma characterized by transgradient keratoderma with associated scleroatrophy, nail changes, pseudoainhum around digits and perioral erythema, without a tendency for spontaneous resolution. Involvement of the lip by keratoderma has not been reported in the English literature. Here we present two cases of Mal de Meleda with unusual lip involvement. The first case was a 15-year-old girl, born of second-degree consanguineous marriage, who presented with transgradient palmoplantar keratoderma from 6 months of age, with lichenoid papules and plaques on the elbows and knees, conical tapering of the distal digits, flexion deformity of several fingers, digital constriction, knuckle pads and lip involvement. The second case was a 24-year-old male with transgradient palmoplantar keratoderma since birth. He also had scaly plaques on the extensors of bilateral knees and elbows, knuckle pads, pseudosclerodermatous fingers with conical tapering, digital constrictions at various places with mild flexion deformity and lip involvement. Both patients were otherwise normal without any family history.

Congenital insensitivity to pain and anhidrosis: A case report from South India

Congenital insensitivity to pain with anhidrosis, also known as hereditary sensory and autonomic neuropathy type IV, is an autosomal recessive disorder characterized by the congenital lack of pain sensation, inability to sweat, episodes of recurrent hyperpyrexia, mental retardation, and self-mutilating behavior. It is an extremely rare disorder with only a handful of reports from India. A five- year- old boy, born to second-degree consanguineous parents after uneventful antenatal period, presented to us with history of recurrent unexplained fever, recurrent ulcers in the lower limbs, insensitivity to painful stimuli (like injections, vaccination) and self-mutilating behavior from early childhood. Cutaneous examination showed multiple ulcers, loss of teeth, loss of tip of the tongue (due to biting), scarring of finger tips, xerosis and lichenification. Sensory examination showed complete loss of pain and temperature sensations, but fine touch and vibration were preserved. Deep tendon reflexes were normal. Evaluation for Hansens disease was non-contributory. An intradermal injection of histamine did not show any flare response. Based on clinical as well as compatible histological features a diagnosis of congenital insensitivity to pain with anhidrosis was made. The ulcers were treated with appropriate antibiotics and daily dressings. The parents were counseled about appropriate care of the child.

Intralesional immunotherapy with tuberculin purified protein derivative for verruca: A study from a teaching hospital in South India

Sir, Cutaneous wart is a common skin disease and although multiple treatment options are available, none is completely effective.[1,2] Recurrences after destructive treatment are common and can be frustrating. Immunotherapy with diphenylcyclopropenone and squaric acid dibutyl ester can cause allergic reactions. Risk of oncogenic potential of the virus is associated with autologous vaccine therapy.[3] Good therapeutic results were reported with immunotherapy using Candida, Trychophyton measles, mumps, rubella and tuberculin purified protein derivative antigens which are safe and inexpensive.[4]

Diltiazem worsens Darier's disease

Diltiazem worsens Darier’s disease While reading an article published by Sehgal and Srivastava, we noticed it suggests diltiazem as a treatment option for recalcitrant Darier’s disease (DD): the sentence pertaining to this discussion reads ... ‘‘In recalcitrant cases, oral cyclosporine, oral contraceptives, and diltiazem have also been tried.’’ We found it interesting as we had a patient with recalcitrant Darier’s disease in whom we thought of using diltiazem. Hence, we read the original article by Lorentzen and Svejgaard cited by Sehgal and Srivastava. We were surprised to note that the case reported by Lorentzen and Svejgaard was that of a case of Darier’s disease, that worsened upon starting diltiazem (120 mg b.i.d.) for ischemic heart disease, and the skin condition improved after cessation of diltiazem. Lorentzen and Svejgaard stated ‘‘The concurrence between the introduction of diltiazem and the gradual worsening of our patient’s condition and between the substantial clinical improvements after cessation of this drug indicates a causal relation.’’ They concluded saying ‘‘Although the exact mechanism remains obscure, diltiazem acts on the same axis as the gene defect of DD [Darier’s disease] suggesting that alternative treatment modalities for ischemic heart disease in DD patients should be considered in recalcitrant cases.’’ Therefore, the bottom line is that Darier’s disease is worsened when diltiazem is given and should be avoided in patients with this disease.