Iffat Hassan

Assessment of esophageal involvement in systemic sclerosis and morphea (localized scleroderma) by clinical, endoscopic, manometric and pH metric features: A prospective comparative hospital based study

BackgroundSystemic sclerosis (SSc) is a generalized disorder of unknown etiology affecting the connective tissue of the body. It affects the skin and various internal organs. Gastrointestinal tract involvement is seen in almost 90% of the patients. Esophagus is the most frequently affected part of the gastrointestinal tract. Esophageal motility disturbance classically manifests as a reduced lower esophageal sphincter pressure (LESP) and loss of distal esophageal body peristalsis. Consequently, SSc patients may be complicated by erosive esophagitis and eventually by Barrett’s esophagus and esophageal adenocarcinoma. Morphea, also known as localized scleroderma, is characterized by predominant skin involvement, with occasional involvement of subjacent muscles and usually sparing the internal organs. The involvement of esophagus in morphea has been studied very scarcely. The proposed study will investigate the esophageal involvement in the two forms of scleroderma (systemic and localized), compare the same and address any need of upper gastrointestinal evaluation in morphea (localized scleroderma) patients.Methods56 and 31 newly and already diagnosed cases of SSc and morphea respectively were taken up for the study. All the patients were inquired about the dyspeptic symptoms (heartburn and/or acid regurgitation and/or dysphagia). Upper gastrointestinal endoscopy, esophageal manometry and 24-hour pH monitoring were done in 52, 47 and 41 patients of SSc; and 28, 25 and 20 patients of morphea respectively.ResultsEsophageal symptoms were present in 39 cases (69.6%) of SSc which were mild in 22 (39.3%), moderate in 14 (25%), severe in three (5.3%); while only four cases (7.1%) of morphea had esophageal symptoms all of which were mild in severity. Reflux esophagitis was seen in 17 cases (32.7%) of SSc and only two cases (7.14%) of morphea. Manometric abnormalities were seen in 32 cases (68.1%) of SSc and none in morphea. Ambulatory 24-hour esophageal pH monitoring documented abnormal reflux in 33 cases (80.5%) of SSc and no such abnormality in morphea.ConclusionWhile the esophageal involvement is frequent in SSc, no such motility disorder is seen in morphea. Meticulous upper gastrointestinal tract evaluation is justified only in SSc and not in morphea.

Human demodex mite: the versatile mite of dermatological importance.

Demodex mite is an obligate human ecto-parasite found in or near the pilo-sebaceous units. Demodex folliculorum and Demodex brevis are two species typically found on humans. Demodex infestation usually remains asymptomatic and may have a pathogenic role only when present in high densities and also because of immune imbalance. All cutaneous diseases caused by Demodex mites are clubbed under the term demodicosis or demodicidosis, which can be an etiological factor of or resemble a variety of dermatoses. Therefore, a high index of clinical suspicion about the etiological role of Demodex in various dermatoses can help in early diagnosis and appropriate, timely, and cost effective management.

Pentoxifylline and its applications in dermatology

Pentoxifylline is a methyl-xanthine derivative with many anti inflammatory effects. Pentoxifylline has been found to be effective for many dermatological as well as non-dermatological conditions. It has been used both as primary drug as well as adjuvant and is a safe and relatively cost-effective alternative drug. In this article, we review the literature and highlight various important aspects of pentoxifylline.

Thalidomide in dermatology: Revisited

The use of thalidomide in relation to dermatology is well- known and enough data is available in the literature about various aspects of thalidomide. Despite being an interesting and useful drug for many dermatoses, it is associated with many health hazards including the birth defects, phocomelia. We hereby present a comprehensive review about thalidomide and its application in dermatology.

A clinical study of the skin changes in pregnancy in Kashmir valley of north India: A hospital based study

Background: Pregnancy is associated with multiple skin changes, most of which are physiological in nature, being the direct result of expected modifications of the hormonal, vascular, metabolic or immunologic status in pregnant females. Pregnancy however is also associated with certain pruritic eruptions, which not only cause distress to the pregnant female, but may influence the fetal outcome as well. Objective: The objective of this study was to determine the pattern of skin changes associated with pregnancy and to identify the various clinical types of pregnancy specific dermatoses (PSDs). Materials and Methods: The study was a cross sectional study carried out at the out-patient Department of Gynecology and obstetrics of our hospital. A total of 650 pregnant females, irrespective of their parity and gestational age were screened for the presence of any dermatological complaint. Results: The age of the study population ranged from 17 to 39 years (mean age: 24 years). The study population included 272 (42%) primigravidae and 378 (58%) multigravidae. Physiological skin changes of pregnancy were seen in all patients, out of which linea nigra was the most common change, seen in 520 (80%) cases. Specific dermatoses of pregnancy were seen in 32 (4.9%) cases, which included (in the decreasing order of frequency) prurigo of pregnancy (50% cases), intrahepatic cholestasis of pregnancy (25% cases), polymorphic eruption of pregnancy (22% cases) and pemphigus gestationis (3% cases). Conclusion: Skin changes were seen in 100% of pregnant females in this study, the major proportion being formed by physiological skin changes of pregnancy though PSDs were also seen in a significant number.

Diagnostic value of Tzanck smear in various erosive, vesicular, and bullous skin lesions

Background: Cutaneous cytology has long been shown to be useful in the diagnosis of several erosive, vesicular, and bullous skin lesions. The Tzanck smear although an old tool, still remains a simple, rapid, easily applied, and inexpensive test for these skin lesions. Aims and Objectives: The aim of this study was to evaluate the diagnostic value of Tzanck smear by determining its sensitivity and specificity in various erosive, vesicular, and bullous skin lesions. Materials and Methods: One hundred and forty-two patients with erosive, vesicular, and/or bullous skin lesions were included in the study. Four groups of disorders were identified: infections, immunologic disorders, genodermatosis, and spongiotic dermatitis. All the study cases were evaluated by Tzanck smear. Definitive diagnosis was established by standard diagnostic techniques (including when appropriate, viral serology, bacterial culture, histopathology, direct immunoflourescence). Results: The sensitivity and specificity of cytologic findings was respectively 86.36% and 91.30% for viral infections; for bacterial infections, it was 85.7% and 66.6%. The sensitivity and specificity of Tzanck smear was respectively 85.0% and 83.33% for pemphigus; for bullous pemhigoid it was 11.11% and 100.0%. Tzanck smear sensitivity in genodermatoses was 100%. The sensitivity and specificity of the test in spongiotic dermatitis could not be calculated due to an insufficient number of patients. Conclusion: The Tzanck smear is a quick and reliable tool for the evaluation of various erosive and vesiculobullous skin lesions.

Histopathological analysis of the cutaneous changes due to kangri use in kashmiri population: a hospital based study.

Background: Kangri cancer is peculiar to the valley of Kashmir as people of all age groups are accustomed to warm their bodies by the use of Kangri baskets. The clinical spectrum of skin cancer in the Kashmir valley is entirely different from the rest of the country, which could be attributed to the use of Kangri in this geographical region.[12] Aims: Histopathological analysis of the cutaneous changes due to kangri use in Kashmiri population. Materials and Methods: This is a prospective hospital based study. All the patients attending the outpatient department of Dermatology, STD and Leprosy at SMHS Hospital, an associated hospital of govt. medical college in Srinagar and presented with suspicious lesions (i.e., erythema ab igne, papular or nodular skin growths) due to Kangri use were taken up for the study. A detailed history including the use of Kangri and a physical examination was done in each patient followed by a histopathological examination in case of suspicious lesions. Results: The cutaneous changes which were observed during the study period of 8 months were erythema ab igne, bowens disease and squamous cell carcinoma. Conclusion: Although this is a preliminary study we will be studying more of such changes caused due to Kangri use in the future.

Evaluation of the antioxidant status in vitiligo patients in Kashmir valley-a hospital based study.

Sir, Vitiligo is an idiopathic, acquired, circumscribed hypomelanotic skin disorder, characterized by milky white patches of different sizes and shapes. It affects about 1-2% of the world population.[1] Several theories have been proposed about the pathogenesis of vitiligo, but the precise cause behind melanocyte destruction remains unknown. Theories regarding the destruction of melanocytes include autoimmune mechanisms, cytotoxic mechanisms, an intrinsic defect of melanocytes, and neural mechanisms. One of the hypotheses that have been recently proposed is the antioxidant deficiency theory.[2]

Preliminary experience of patch testing at Srinagar, Kashmir

Sir, Leukonychia is the most common dyschromia of nails. We would like to add on the information to an interesting case reported by Arsiwala[1] in your journal. In most of such nail aberrations, it is difficult to make complete diagnosis. True hereditary leukonychia may be another diagnostic possibility here. Variable expression and incomplete penetrance in total hereditary leukonychia have been documented in past.[2] Leukonychia partialis is a subtle variant or phase of leukonychia totalis with variable expression of same genetic defect.[2] Absence of family history does not necessitate diagnosis of acquired leukonychia. There have been reports documenting onset of hereditary leukonychia in childhood, not necessarily at birth.[3] Moreover, it is highly unlikely that trauma may result in total leukonychia in all finger nails simultaneously. While hereditary leukonychia is a rare condition and usually involves the entire nail, acquired type usually presents in childhood as leukonychia partialis (either punctata or transverse striae).[3] True leukonychia may occur as an isolated trait or it may be a marker of several clinical syndromes.[3]

Epidermolysis bullosa: A series of 12 patients in Kashmir valley

Background: Epidermolysis Bullosa (EB) is a genetically determined mechano-bullous disorder of the skin encompassing a group of conditions that share skin fragility as a common feature. Materials and Methods: Twele patients with Epidermolysis Bullosa from Kashmir valley are reported. Results: Our series included 12 patients, 5 males and 7 females. Features were consistent with EB simplex in 8 patients, EB pruriginosa in 2 patients, generalized atrophic benign EB in one patient and EB acquista in one patient. Conclusion: EB is a rare, genetically determined, blistering disorder affecting both males and females with predominant involvement of hands and feet. In the absence of specific therapy, treatment mainly involves avoidance of provoking factors, prevention and treatment of complications.