Ashok Kumar Khare

Randomized comparison of topical betamethasone valerate foam, intralesional triamcinolone acetonide and tacrolimus ointment in management of localized alopecia areata.

Background: Alopecia areata (AA) is a common, non-scarring, patchy loss of hair at scalp and elsewhere. Its pathogenesis is uncertain; however, auto-immunity has been exemplified in various studies. Familial incidence of AA is 10-42%, but in monozygotic twins is 50%. Local steroids (topical / intra-lesional) are very effective in treatment of localized AA. Aim: To compare hair regrowth and side effects of topical betamethasone valerate foam, intralesional triamcinolone acetonide and tacrolimus ointment in management of localized AA. Materials and Methods: 105 patients of localized AA were initially registered but 27 were drop out. So, 78 patients allocated at random in group A (28), B (25) and C (25) were prescribed topical betamethasone valerate foam (0.1%) twice daily, intralesional triamcinolone acetonide (10mg/ml) every 3 weeks and tacrolimus ointment (0.1%) twice daily, respectively, for 12 weeks. They were followed for next12 weeks. Hair re-growth was calculated using “HRG Scale”; scale I- (0-25%), S II-(26-50%), S III - (51-75%) and S IV- (75-100%). Results: Hair re-growth started by 3 weeks in group B (Scale I: P<0.03), turned satisfactory at 6 weeks in group A and B (Scale I: P<0.005, Scale IV: P<0.001)), good at 9 weeks (Scale I: P<0.0005, Scale IV: P<0.00015), and better by 12 weeks of treatment (Scale I: P<0.000021, Scale IV: P<0.000009) in both A and B groups. At the end of 12 weeks follow-up hair re-growth (>75%, HRG IV) was the best in group B (15 of 25, 60%), followed by A (15 of 28, 53.6%) and lastly group-C (Nil of 25, 0%) patients. Few patients reported mild pain and atrophy at injection sites, pruritus and burning with betamethasone valerate foam and tacrolimus. Conclusion: Intralesional triamcinolone acetonide is the best, betamethasone valerate foam is better than tacrolimus in management of localized AA.

Pattern of pediatric dermatoses in a tertiary care centre of South West Rajasthan.

Background: The evaluation for skin disorders forms an important component of primary health care practice for all including children. The prevalence of certain skin diseases in children can reflect status of health, hygiene, and personal cleanliness of a community. Aims: This study was planned to evaluate the magnitude of skin diseases, pattern of various dermatoses, factors contributing to these dermatoses and concurrent systemic disease among children up to five years of age. Materials and Methods: Consecutive 1000 children, aged up to five years, attending the Dermatology OPD of RNT Medical College and MB Government Hospital, Udaipur were the subjects of this study. A detailed general, systemic and cutaneous examination followed by relevant investigations were carried out. The findings were recorded in a proforma for analysis and interpretation of data. Results: One thousand twenty seven (1027) diagnoses were made in 1000 children. Etiological analysis revealed that majority (417; 40.60%) of dermatoses belonged to infection and infestation group followed by eczematous (358; 34.86%) and hypersensitivity (105; 10.22%) groups. Of the infection and infestation group, bacterial infection (141; 13.72%) was the most common entity followed by scabies (107; 10.42%), fungal (67; 6.52%), and viral infection (35; 3.40%). Conclusion: This study provides a preliminary baseline data for future clinical research. It might also help to assess the changing trends of pediatric dermatoses.

Therapeutic response of 70% trichloroacetic acid CROSS in atrophic acne scars.

BACKGROUND Acne scarring is a common sequela of acne for which no single treatment method is uniformly effective. The chemical reconstruction of skin scars (CROSS) therapy using high-concentration trichloroacetic acid (TCA) has shown promise as a cheap, safe, and effective modality of treatment in acne scars. OBJECTIVE To assess the therapeutic response of 70% TCA CROSS on atrophic acne scars and to evaluate the adverse effects of this therapy. MATERIALS AND METHODS Fifty-three patients with postacne atrophic scars were treated with 70% of TCA focal application every 2 weeks by the CROSS technique and results evaluated on 3 parameters: physician assessment, patient assessment, and satisfaction level of patients, after a follow-up of 3 months. RESULTS Good or excellent improvement (>50%) was seen in 66% of patients on physician and patient assessments. The patients were either very satisfied or satisfied in 81.1% of cases. Patients with predominantly boxcar scars and higher pretreatment scar severity were associated with better treatment outcomes. Age, sex, duration of scars, or type of skin did not significantly influence the treatment outcome and adverse effects. CONCLUSION The study showed that 70% of TCA is a safe and effective treatment option in all types of atrophic acne scars, especially in severe boxcar scars.

Chemical reconstruction of skin scars therapy using 100% trichloroacetic acid in the treatment of atrophic facial post varicella scars: A pilot study

Context: Chickenpox (varicella) is a common viral disease caused by Varicella zoster virus. Facial atrophic scars after varicella infection are not uncommon and pose a cosmetic problem. Like atrophic scars of other aetiologies, they are a difficult condition to treat. There are not enough references in the literature regarding efficient treatment of post varicella scars. High strength Trichloroacetic acid (TCA), which is known to cause dermal collagen remodelling, was used to treat varicella scars in the present study. Aims: The study was undertaken to assess the efficiency of Chemical Reconstruction of Skin Scars (CROSS) technique using 100% TCA in the treatment of atrophic facial post varicella scars. Settings and Design: Open label, pilot study. Materials and Methods: A total of 16 patients with atrophic facial post varicella scars were treated by focal application of 100% TCA solution by pressing down upon the scar surface by a toothpick (CROSS technique). Total 4 sittings were given at 2 weekly intervals and the results evaluated after 3 months of follow-up. Statistical analysis was carried out using Fischers exact t-test. Results: All of the 13 patients who completed the study showed good clinical improvement, with 69% patients grading the response as excellent (>75%) improvement, whereas the rest 31% patients reporting good (51-75%) improvement. No significant complications were seen in any patient. Conclusions: CROSS technique using 100% TCA is a safe, cheap and effective therapy for the treatment of post varicella scars.

A case of zosteriform Darier's disease with seasonal recurrence

Dariers disease is an uncommon genodermatosis characterized by keratotic papules in seborrheic distribution. The disease can rarely present in unilateral zosteriform pattern, as a mosaic form following the Blaschkos line. We present a 35-year-old woman with zosteriform pattern of Dariers disease over right infra mammary region. The lesions occurred strictly during summers. Histologically, suprabasal acantholysis with abundant dyskeratotic cells were seen.

Congenital hypertrichosis lanuginosa

A 3-month-old male infant of non-consanguineous parents, born full term by normal vaginal delivery, was seen with excessive hair growth over entire body since birth. None of the family members had abnormal hair growth. Mother denied intake of alcohol or any other medication during pregnancy. There was no history of seizures in infant. The developmental milestones were normal for his age. He weighed 5 kg. The head circumference and crown-heel length were 41 and 57 cm, respectively. Dermatological examination revealed dense growth of gray to light brown, silky hair over most of the body [Figure 1]. Hair was relatively profuse and long over face [Figure 2], axillae, extremities and genitalia [Figure 3]. The hair over scalp was dark and coarse [Figure 2]. The palms, soles [Figure 3] and lips were spared. Nails and mucosae were normal. Systemic examination did not reveal any abnormality. The diagnosis of congenital hypertrichosis lanuginosa (CHL) was made on the basis of above findings.

Cutaneous leishmaniasis in a nonendemic area of South Rajasthan: A prospective study

Background: Cutaneous leishmaniasis (CL) usually occurs in areas with hot and dry climate. In India, the desert areas of Rajasthan, Gujarat, and the plains of Northwestern frontier are endemic for this disorder. Aims and Objectives: The present study was aimed to describe clinicoepidemiological profile of the cases of CL from South Rajasthan, which is a nonendemic area of Rajasthan. Materials and Methods: During a period of 4 years (2010–2014), a total of 23 patients with CL were diagnosed. All the suspected cases of CL were interrogated in detail regarding visit to areas where CL is known to occur. This was followed by clinical examination, relevant investigations, and treatment. All except one patient were treated with azole antifungals. In one patient, CO2 laser ablation was done. Results: There were 12 (52.17%) males and 11 (47.83%) females with age ranging from 3 to 72 years. Duration of disease ranged from 7 days to 10 months. Face (15; 65.22%) and extremities (12; 52.17%) were involved in majority of the patients. Common morphologies were noduloulcerative lesions and crusted plaques. Tissue smear for Leishmania donovani bodies was positive in all except one patient. Conclusion: The present report highlights occurrence of CL in nonendemic area. Further epidemiological studies are required for identification of vector and strain of Leishmania involved.

A study of postherpetic pruritus

Sir, Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ), affecting approximately 50% of patients older than 60 years and 15% of all HZ patients.[1] Most of these patients complain of pain; which has been studied extensively. Itch is relatively under-reported and therefore, often, a neglected component of PHN. We, therefore, conducted a study on 100 consecutive patients of PHN to determine the burden of postherpetic pruritus (PHP) among them. We defined PHN as pain and/or pruritus persisting 1 month after the onset of zoster rash. Severity of pruritus was assessed on the visual analog scale and rated as mild (1-3), moderate (4-7), and severe (8-10).

The H syndrome

The H syndrome is a rare autosomal recessive genodermatosis caused by mutations in the nucleoside transporter hENT3. It is characterized by progressive skin sclerosis, hyperpigmentation, and hypertrichosis, along with multiple systemic manifestations including insulin-dependent diabetes mellitus. We report this case for its rarity.

Chromoblastomycosis from a Non-endemic Area and Response to Itraconazole.

Chromoblastomycosis belongs to the heterogeneous group of subcutaneous mycoses. It is caused by various pigmented (dematiaceous) fungi, which gain entry into the skin via traumatic implantation. We would like to share a case report of chromoblastomycosis in a 32-year-old male, who presented to us with 3 years history of slowly progressive, itchy, verrucous, crusted lesions over right forearm and arm. He is being treated with itraconazole 100 mg twice daily. The case is of interest because it has so far not been reported from our region- the northwest arid zone of India. The patient showed favorable response to itraconazole.