Binod K. Khaitan

THE FREQUENCY OF SEXUAL DYSFUNCTIONS IN PATIENTS ATTENDING A SEX THERAPY CLINIC IN NORTH INDIA

Analyzed data on 1000 consecutive patients with sexual disorders attending the psychosexual clinic at the All India Institute of Medical Sciences. The majority of patients were educated males between 21 and 30 years of age, belonging to the middle class. There was a slight preponderance of married patients. Fifty-two percent of patients had premarital or extramarital sexual contact; less than 5% had had homosexual contact; 10% had no sexual contact. Most patients had more than one complaint. Premature ejaculation (77.6%) and nocturnal emission (71.3%) were the most frequent problems followed by a feeling of guilt about masturbation (33.4%) and small size of the penis (30%). Erectile dysfunction was a complaint of 23.6%. Excessive worry about nocturnal emission, abnormal sensations in the genitals, and venereophobia was reported in 19.5, 13.6, and 13% of patients, respectively. Only 36 female patients attended the clinic with their spouses.

Imiquimod 5% cream for the prevention of recurrence after excision of presternal keloids

Imiquimod 5% cream has been found to be effective and safe in preventing recurrence of keloids on earlobes after excision. We evaluated the efficacy and safety of imiquimod 5% cream in preventing the recurrence of presternal keloids after excision (3 keloids in 2 patients). After excision with radiofrequency, imiquimod 5% cream was applied once daily at bedtime for 8 weeks, and the defect was left to heal by secondary intention. In all the treated keloids, the defect healed in 6–8 weeks, and no recurrence was seen while on imiquimod application; however, all keloids completely recurred within 4 weeks of stopping imiquimod. Side effects were mild and acceptable in the form of burning and pain. Imiquimod did exert an antifibrotic action but it was short-lived.

Phaeohyphomycosis caused by Exophiala spinifera in India.

The second case of phaeohyphomycosis due to Exophiala spinifera in India has been diagnosed 46 years after the initial case. The present case involved a 12-year-old female patient with no known immunocompromising conditions. She presented with multiple verrucous, well-defined plaques encompassing phaeohyphomycotic lesions of varying sizes on her face, chest, arms and thighs. Lymph node involvement in dissemination was confirmed by demonstrating pigmented fungal elements in histopathology of the left axillary node. The infection responded positively to prolonged administration of itraconazole. The original case involved a young boy and was similarly disseminated but was more severe, with bone involvement, and had a fatal outcome. It is likely that other such cases have occurred in the intervening time but have not been reported.

The psychosocial impact of vitiligo in Indian patients

BACKGROUND Vitiligo has a special significance in Indian patients both because depigmentation is obvious on darker skin and the enormous stigma associated with the disease in the culture. AIMS This study was carried out to determine the beliefs about causation, aspects of the disease that cause concern, medical, and psychosocial needs of the patients, expectation from treatment and from the treating physician, and effects of disease on the patients life. METHODS Semi-structured interviews were conducted in 50 patients with vitiligo. Purposive sampling was used to select subjects for the study. Each interview was recorded on an audio-cassette and transcripts were analyzed to identify significant issues and concerns. RESULTS Patients had a range of concerns regarding their disease such as physical appearance, progression of white patches onto exposed skin and the whole body, ostracism, social restriction, dietary restrictions, difficulty in getting jobs, and they considered it to be a significant barrier to getting married. The condition was perceived to be a serious illness. Stigma and suicidal ideation was reported. While there were several misconceptions about the cause of vitiligo, most patients did not think their disease was contagious, heritable or related to leprosy. Multiple medical consultations were frequent. Complete repigmentation was strongly desired, but a lesser degree of repigmentation was acceptable if progression of disease could be arrested. The problems were perceived to be more severe in women. The disease imposed a significant financial burden. CONCLUSION Addressing psychosocial factors is an important aspect of the management of vitiligo, particularly in patients from communities where the disease is greatly stigmatizing.

Measurement properties of the Vitiligo Impact Scale-22 (VIS-22), a vitiligo-specific quality-of-life instrument

Vitiligo has a significant psychological impact which needs to be evaluated separately from the extent of depigmentation. We have developed a vitiligo‐specific quality‐of‐life (QoL) instrument, Vitiligo Impact Scale‐22 (VIS‐22) for this purpose.

A two-step schedule for the treatment of actinomycotic mycetomas.

Actinomycotic mycetomas usually respond slowly to treatment with antibiotics. In an attempt to hasten clinical resolution, we used a 2-step regimen consisting of an intensive phase of therapy with penicillin, gentamycin and co-trimoxazole for 5-7 weeks, followed by maintenance therapy with amoxicillin and co-trimoxazole. Seven patients were treated, all of whom showed significant reduction in discharge and swelling after the intensive phase. Maintenance therapy was continued for 2-5 months after the lesions became completely inactive. Five patients completed maintenance therapy, which was given for 6-16 months (mean 10.7 months), and remained free of disease during a mean post-treatment follow-up period of 6.4 months. The other 2 patients also responded satisfactorily and continue to receive maintenance therapy. Side-effects necessitating a modification of the treatment schedule occurred in 2 patients but reversed on discontinuation of the drugs responsible. This treatment schedule produces a rapid clinical response during the initial, intensive phase and promotes compliance with the longer maintenance phase of treatment necessary to achieve a complete cure.

Segmental vitiligo: A randomized controlled trial to evaluate efficacy and safety of 0.1% tacrolimus ointment vs 0.05% fluticasone propionate cream

BACKGROUND Segmental vitiligo is a small subset of vitiligo which responds very well to surgical therapy, but the role of medical treatment is not very well defined. AIM To compare the efficacy and safety of 0.1% tacrolimus ointment versus 0.05% fluticasone propionate cream in patients of segmental vitiligo. METHODS A randomized control trial was conducted in a tertiary care hospital on 60 consecutive patients with segmental vitiligo. Patients with segmental vitiligo exclusively or along with focal vitiligo, untreated or had not taken any topical treatment in previous 1 month or systemic treatment in previous 2 months, from May 2005 to January 2007, were block randomized into two groups. Children <5 years, pregnant and lactating women, and patients with known hypersensitivity to either drug and with associated multiple lesions of vitiligo were excluded. Group A (n = 29) patients were treated with tacrolimus 0.1% ointment twice daily and group B (n = 31) patients were treated with 0.05% of fluticasone cream once daily for 6 months. Response and side effects were recorded clinically and by photographic comparison. RESULTS Nineteen patients treated with tacrolimus and 21 patients treated with fluticasone completed the treatment with median repigmentation of 15% and 5%, respectively, at 6 months (P = 0.38). Transient side effects limited to the application site were observed. CONCLUSIONS Both tacrolimus and fluticasone propionate produce variable but overall unsatisfactory repigmentation in segmental vitiligo.

Ichthyosiform erythroderma with rickets: report of five cases.

We describe five children with ichthyosis and rickets. The association of ichthyosis and rickets is very rare. Four children had lamellar ichthyosis and one child had nonbullous ichthyosiform erythroderma/psoriasis with atopy. All had biochemical and radiological evidence of rickets. Three had clinically evident rickets, of whom two had very severe skeletal deformities. Such a severe skeletal involvement due to rickets in association with ichthyosis is exceptionally rare. We suggest that children with severe ichthyosis, in particular those with pigmented skin, need to be evaluated for rickets, especially in developing countries where there is a background prevalence of vitamin D deficiency.

Evaluation of oral methotrexate in the treatment of systemic sclerosis.

Background  Treatment of scleroderma is difficult and currently no treatment can induce complete remission of the disease.

Osteoma cutis in pseudohypoparathyroidism.

Osteoma cutis is the formation of normal bone in the skin. Primary osteoma cutis occurs de novo, whereas the secondary type develops in association with the underlying inflammatory, tumorous or traumatic conditions. Primary osteoma cutis is also associated with Albrights hereditary osteodystrophy (AHO), which can include hypocalcaemic‐type pseudohypoparathyroidism (also known as pseudohypoparathyroidism type Ia) or normocalcaemic‐type pseudohypoparathyroidism (also known as pseudopseudohypoparathyroidism). We describe a case of osteoma cutis in a 7‐year‐old boy who had cutaneous, biochemical and phenotypic features of pseudohypoparathyroidism type Ia and AHO.