Sandhya Chauhan

Clinical efficacy of psoralen + sunlight vs. combination of isotretinoin and psoralen + sunlight for the treatment of chronic plaque-type psoriasis vulgaris: a randomized hospital-based study.

Isotretinoin has been used in combination with oral psoralen + UVA (PUVA) and narrowband UVB (NBUVB) for treating psoriasis, especially in women of child‐bearing age. The efficacy of oral psoralen + sun exposure (PUVAsol) is comparable to that of PUVA. This study was planned to compare the efficacy of oral PUVAsol with that of the combination of oral isotretinoin and PUVAsol in patients with chronic plaque psoriasis.

Vitamin k deficiency bleeding presenting as nodular purpura in infancy: a rare and life-threatening entity.

Vitamin K deficiency bleeding (VKDB) disorder is an uncommon entity, which occurs due to inadequate activity of vitamin K-dependant coagulation factors. An 8-months-old exclusively breast-fed male infant presented with multiple, purpuric and nodular non-collapsible swellings on trunk of 4 days duration. Investigations revealed raised activated partial thromboplastin time and prothrombintime. Fibrinogen level and platelet counts were normal. Late VKDB usually presents as intra-cranial or mucosal hemorrhages.[1] Though skin and mucosal bleeding may occur in 1/3rd of infants with VKDB, ‘nodular purpura’ is not the common presenting feature. Earlier recognition of VKDB and immediate investigation/treatment helps prevent the potentially fatal outcome of the disease. Very little is mentioned about this entity in dermatology literature.

Herpes zoster duplex bilateralis in an immunocompetent host

Varicella zoster virus causes both chicken pox and herpes zoster. The phenomenon of herpes zoster occurring concurrently in two non-contiguous dermatomes involving different halves of the body is termed herpes zoster duplex bilateralis (HZDB). Few cases, reported in the literature, were seen in either an immunosuppressed host or in the older age group. Here we present a case of HZDB in an immunocompetent host, probably the first in India.

Comparison of Topical Anesthetics for Radiofrequency Ablation of Achrocordons: Eutectic Mixture of Lignocaine/Prilocaine versus Lidocaine/Tetracaine

Introduction. Topical application of local anesthetics is currently considered to be the easiest, most effective, and convenient way for treatment of patients who may be undergoing superficial dermatosurgical procedures. Materials and Methods. This study compares the anesthetic potential of 2.5% lidocaine and 2.5% prilocaine topical cream with 7% lignocaine and 7% tetracaine combination cream for radio ablative dermatosurgery when applied, under occlusion, for 30 minutes. 40 subjects of achrocordons were enrolled in this split-side randomized trial. Result. The pain severity experienced by subjects in terms of visual analogue scale score was significantly lesser for lignocaine/tetracaine combination cream as compared to lidocaine/prilocaine combination. Conclusion. This small study proves the efficacy of lidocaine/tetracaine combination as a topical anesthetic cream when applied for a short time interval of 30 minutes. This will help a dermatosurgeon to perform various dermatological procedures in a better and efficient manner with a shorter waiting period for analgesia to set in.

Drug advertisements in two dermatology journals: a critical comparison of IJDVL and JAAD.

BACKGROUND Though drug promotion regulations exist worldwide, low quality of journal drug advertising is a global issue. Medical journals are regarded as a leading source of information for new drugs. They may also modulate prescribing behavior of physicians without their knowledge. A comparative analysis of advertisements from different countries may provide insights regarding strengths and weaknesses of different regulating systems. AIMS Prescription drug advertisements from the Indian Journal of Dermatology, Venereology, and Leprology (IJDVL) and Journal of American Academy of Dermatology (JAAD) were compared to check their compliance with criteria of World Health Organization (WHO) and International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). METHODS All the prescription drug advertisements of at least one page length appearing in all the issues of IJDVL and JAAD from January 2012 till December 2012 were included in this study. The contents of both advertisements were compared for compliance regarding different criteria of ethical codes for drug advertising of WHO and IFPMA. Statistical analysis was done using Fishers exact test. RESULTS Compared to IJDVL, more advertisements in JAAD complied with WHO and IFPMA codes. On the whole, advertisements in IJDVL had significantly less information regarding the approved usage, dosage, abbreviated prescribing information (API), summary of scientific information, safety information regarding the drug, and references to the scientific literature to support various claims. However, JAAD had more advertisements with multiple claims than IJDVL, and many advertisements interspersed between scientific articles while IJDVL had none. CONCLUSION The complex issue of ethical drug advertising in dermatology journals requires constant review and discussion. Dermatologists should be cautious in assessing any advertisement or claim even if it seems evidence-based. The results from our study highlight the need for a global, proactive and effective regulatory system to ensure ethical medicinal drug advertising in medical journals.

Bullous mastocytosis in an infant treated with the help of narrowband ultraviolet B

Mastocytosis represents a group of disorders characterized by abnormal accumulation of mast cells in the bone marrow, liver, spleen, lymph nodes, gastrointestinal tract, and skin. Skin involvement is seen in almost all the cases. A 1-year-old male child presented with complaints of multiple fluid-filled lesions all over the body since 2 months. Examination revealed multiple vesicles and tense bullae present on the face, neck and trunk along with surrounding erythema and multiple excoriation marks. Dariers sign was positive. Histopathology showed dense infiltrates of mast cells in the papillary dermis. Bone marrow aspiration showed no mast cells infiltrate. The patient was started on oral antihistamines, prednisolone, and narrowband ultraviolet B (NBUVB). The skin lesions showed dramatic improvement within a week and patient is on follow-up with NBUVB. Bullous mastocytosis (BM) is a rare variant of cutaneous mastocytosis manifested by diffuse infiltration of skin by mast cells, where cutaneous bullae are the predominant feature. This case is being presented for its rarity and highlights the effectivity of NBUVB for treating BM.

Ichthyosis follicularis alopecia and photophobia syndrome:Transient improvement with oral isotretinoin

Ichthyosis follicularis alopecia photophobia (IFAP) syndrome (OMIM 308205) is a rare genetic disorder characterized by a triad of follicular ichthyosis, congenital atrichia of scalp and photophobia. Until date, only 40 patients have been mentioned in the worldwide literature. The management of this syndrome remains a daunting task because very few case reports have described interventions for treating various clinical features of this entity. We describe IFAP syndrome in an 18-month-old male child, who showed transient improvement in his cutaneous features with oral isotretinoin therapy.

Anolunula in Fingernails among Patients Infected with HIV

Lunula is the white, half-moon shaped area seen in proximal ends of some nails. Though a few studies have described the nail changes that can occur in association with HIV infection, none of these paid much attention to lunula. Aims and Objectives. To study the lunula in fingernails among HIV infected patients. Materials and Methods. An observational, cross-sectional study to record presence of lunula in 168 HIV-positive patients and compare it with age and sex matched 168 healthy HIV-negative control. Anolunula (absence of lunula) in HIV-positive patients was correlated with CD4 counts, stages of HIV infection, time since patient was diagnosed as HIV-positive, and status of antiretroviral therapy. Results. Anolunula was present in significantly more fingernails in HIV-positive patients compared to HIV-negative controls. There was a highly significant difference for total anolunula (anolunula in all fingernails) in study and control group. Incidence of total anolunula was directly proportional to the stage of HIV infection, increasing progressively as the HIV infection advances from stage 1 to stage 4. Conclusion. Absence of lunula is related to not only HIV infection per se but also the stages of HIV infection.

Correlation of pulse oximetry and Apgar scoring in the normal newborns

Context: Apgar score (AS) is routinely used for assessment of newborns immediately after birth. Within acceptable limits, low saturations at birth are normal in vigorous newborn babies. Various studies have questioned the reliability of AS. Aims: To detect whether AS is an accurate indicator of hypoxemia and to study the correlation of different components of AS with the arterial oxygenation saturation (SpO2) levels of normal newborns in the delivery room. Settings and Design: A prospective cross-sectional observational study on normal healthy neonates delivered vaginally in a tertiary level referral medical college. Materials and Methods: SpO2 levels were monitored continuously in the newborns with a pulse oximeter and serial recording of SpO2 levels was done at 5 min intervals starting at 1 min of life until 30 min after birth. Simultaneously, AS was recorded in these newborns at 1 and 5 min of life. Statistical Analysis: Data was analyzed using the Mann-Whitney–U test. Results: AS at 1 and 5 min of life didn’t correlate with the changes in SpO2 of newborns. In AS; though respiratory efforts and muscle tone were significantly correlated with SpO2 of the newborns, body color did not have significant correlation with simultaneously recorded SpO2. Conclusions: A revised AS in which evaluation of color is replaced by pulse oximetry monitoring would prove to be a better tool for neonatal evaluation in the immediate postnatal period.

Menstrual Disorders in Adolescents: Few Observations

Sir, Menstruation is the hallmark of female pubertal development. It has an important bearing on fertility, bone and cardiovascular status of the girls’ future life. Hence, adolescents and their parents should be made aware about the variability of a normal menstrual cycle and menstrual disorders per se. In this regard the study done by Nair et al. [1] is really appreciable. However there are certain observations which are intriguing. This study defines oligomenorrhoea as infrequent, irregularly timed episodes of bleeding occurring at intervals of >35 d. However, available literature generally defines it as infrequent, irregular bleeding of ≥45 d [2]. The length of normal menstrual cycle in adolescence can vary from 21 to 45 d [2]. Further Diaz et al. [3] stated that cycle length of 21–35 d is established only around the 6th gynecologic year, at a chronological age of 19–20 y. By the 4th gynecologic year, the 95th percentile for cycle length is around 50 d [3]. In the present study 97.5 % girls are in the age group 15–17 y with majority in the 4th or 5th gynecologic year [1]. Thus the percentage of girls with oligomenorrhea may be overestimated thereby increasing the risk for the future development of Polycystic ovarian disease. This may result in unwarranted negative counseling on the part of the consulting pediatrician. In an earlier study, Van Hooff et al. (2004) found a subset of girls whose cycle length (35–41 d) was within normal limits but the cycles were highly irregular [4]. This subgroup was separately specified as Mild Oligomenorrhea. These were also found to be at a high risk for remaining oligomenorrheic at the age of 18 y and hence may have long term consequences [4]. It would be interesting to know if the present study also identified any subset of mild oligomennorhea. Further, the present study does not clearly state the criteria used for defining irregular menstrual cycle. Considering the high variability of menstrual cycle patterns in adolescence, standard guidelines are required for defining the various terminologies regarding cycle length, regularity etc. This will enable the pediatricians to diagnose the conditions accurately and counsel the adolescents and their parents appropriately.