Sarita Sanke

A Comparison of the Hormonal Profile of Early Androgenetic Alopecia in Men With the Phenotypic Equivalent of Polycystic Ovarian Syndrome in Women.

IMPORTANCE Early androgenetic alopecia (AGA) is patterned hair loss occurring before age 30 years. Early AGA in men is frequently reported as the phenotypic equivalent of polycystic ovarian syndrome (PCOS) in women, which carries the risk of developing obesity, metabolic syndrome, and cardiovascular diseases. Very few studies have been conducted to evaluate this. OBJECTIVE To study the hormonal profile of men with early AGA and to evaluate if early AGA in men can be considered as the phenotypic equivalent of PCOS, the associated risks of which are well known. DESIGN, SETTING, AND PARTICIPANTS This case-control study was conducted from January 1, 2014, to March 31, 2015, in a tertiary care government hospital. Fifty-seven men aged 19 to 30 years presenting with patterned hair loss were recruited as study participants. Thirty-two age-matched men with no evidence of hair loss were recruited as controls. Men who had any established endocrine disorder, diabetes mellitus, or cardiovascular disease and those who took any oral medication or hormonal treatment for hair loss were excluded from the study. The serum concentrations of total testosterone, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, fasting plasma glucose, and insulin levels were measured. Insulin resistance (IR) and free androgen index (FAI) were calculated and compared with age- and sex-matched controls. MAIN OUTCOMES AND MEASURES The primary outcome was to measure the clinico-endocrinological profiles (LH, FSH, SHBG, DHEAS, and testosterone levels) of men with early AGA and to compare it with the PCOS profile; the secondary outcome was to establish a relationship between this endocrinological profile and IR. RESULTS Compared with the 32 controls, the 57 participants with AGA showed significantly increased mean (SD) levels of testosterone (24.61 [7.97] vs 20.57 [4.9] nmol/L; P = .04), DHEAS (3.63 [2.19] vs 2.64 [1.49] µg/mL; P = .02), LH (7.78 [3.19] vs 4.56 [2.01] mIU/mL; P < .001), and prolactin (14.14 [9.48] vs 9.97 [3.12] ng/mL; P = .01) and decreased mean levels of FSH (4.02 [2.69] vs 5.66 [1.93] mIU/mL; P < .001) and SHBG (35.07 [11.11] vs 46.41 [14.03] nmol/L; P < .001). The mean FAI and LH/FSH ratio were was also increased in the AGA group. These hormonal parameters resemble the well-known profile of women with PCOS. The mean (SD) insulin levels did not show any significant difference between the cases and controls (6.34 [3.92] vs 5.09 [3.38] μIU/mL; P = .07). There was no statistically significant association between hormone levels and AGA or IR grade severity. CONCLUSIONS AND RELEVANCE Men with early AGA could be considered as male phenotypic equivalents of women with PCOS. They can be at risk of developing the same complications associated with PCOS, including obesity, metabolic syndrome, IR, cardiovascular diseases, and infertility.

Stevens-Johnson syndrome and toxic epidermal necrolysis-like cutaneous presentation of chikungunya fever: A case series

Chikungunya fever is a benign, self‐limiting, acute viral illness. An epidemic occurred in New Delhi, India, in August and September 2016. We observed many cases with atypical cutaneous features mimicking Stevens‐Johnson syndrome and toxic epidermal necrolysis during this epidemic, especially in infants and children. Twenty‐one children (13 [61.9%] boys, 8 [38%] girls) presenting with vesico‐bullous and necrotic lesions were reviewed. Cutaneous presentation included vesicles and bullae with purpuric macules and necrosis, seen in 16 (76%) patients. Skin lesions resolved in 5‐7 days, leaving behind hyperpigmentation in seven (33.3%) patients and hypopigmentation in three (14.2%). Minor oral erosions were observed in three (14.2%) patients, and palmoplantar erythema was seen in four (19.04%). It is essential for dermatologists to understand the Stevens‐Johnson syndrome and toxic epidermal necrolysis‐like presentation of chikungunya and not to misinterpret it as true Stevens‐Johnson syndrome and toxic epidermal necrolysis, which will lead to unnecessary intervention and management.

Free Androgen Index (FAI): Marker of Premature Androgenetic Alopecia in Men

Introduction: Premature androgenetic alopecia (AGA) in men is alopecia occurring before the age of 30 years. We conducted this study to evaluate various androgenic hormones in men with premature androgenetic alopecia and to assess if free androgen index (FAI) can be used as a marker of hyperandrogenism in these men. Materials and methods: 57 men with premature AGA (defined as grade 3 or more on Hamilton-Norwood scale) were taken as subjects. The serum concentrations of Testosterone, DHEAS, and SHBG were measured and Free androgen index (FAI) was calculated and compared with age and sex matched controls. Results: There were significant differences in the mean values of all the three indicators for androgen status (FAI, DHEAS and testosterone) in cases as compared to the controls. The statistical significance was higher for FAI and DHEAS than that for testosterone. FAI appeared to be a better predictor of hyperandrogenism than DHEAS and testosterone. Conclusion: FAI is the best marker of a person’s androgen status and can be considered as the marker of premature AGA. Taking into consideration the technical limitations of the currently available methods for measuring free testosterone, and the diagnostic importance of using FAI as indicator of androgen status, it is recommended to implement these parameters in the routine investigation and assessment of men with AGA.

Atypical cutaneous sporotrichosis in an immunocompetent adult: Response to potassium iodide

Cutaneous sporotrichosis, also known as “Rose Gardeners disease,” caused by dimorphic fungus Sporothrix schenkii, is usually characterized by indolent nodular or nodulo-ulcerative lesions arranged in a linear pattern. We report bizarre nonlinear presentation of Sporotrichosis, in an immunocompetent adult occurring after a visit to Amazon rain forest, speculating infection with more virulent species of Sporothrix. The diagnosis was reached with the help of periodic acid-Schiff positive yeast cells and cigar shaped bodies seen in skin biopsy along with the therapeutic response to potassium iodide.

Metastatic tubercular gummas and splenic tuberculoma secondary to tubercular lymphadenitis in an immunocompetent female

Tubercular gummas and splenic tuberculomas are rare forms of extrapulmonary tuberculosis, usually occurring in immunocompromised individuals. We hereby report a rare combination of multiple tubercular gummas and splenic tuberculoma secondary to TB lymphadenitis in an immunocompetent individual. The patient responded to antitubercular therapy. Thus, in a developing country like ours, tuberculosis can present in a wide clinical spectrum even in an immunocompetent individual.

Keratosis follicularis spinulosa decalvans with associated mental retardation: response to isotretinoin

138 International Journal of Trichology / Volume 9 / Issue 3 / July September 2017 Sir, Keratosis follicularis spinulosa decalvans (KFSD), a rare disorder that was originally described by Siemens, often starts at infancy or early childhood with an X‐linked mode of inheritance. Males are predominantly affected. It is characterized by photophobia, corneal dystrophy, widespread follicular hyperkeratosis, scarring alopecia of the scalp, eyebrows, and eyelashes. We report an 18‐year‐old boy, born of nonconsanguineous marriage, who presented with rough, keratotic papules over the scalp, neck, upper, and lower limbs, along with alopecia since birth. There was sparse growth of hairs over these papules which eventually shed off. There was no history of atopy, ichthyosis, photophobia, hypo or hyperhidrosis, skeletal abnormality, and eye or ear complaints. A family history was not contributory. Physical examination showed multiple follicular dark brown to black, monomorphic, keratotic papules over the scalp, neck, and other areas of the body (upper/lower limb and trunk) along with scarring alopecia over the scalp [Figure 1]. Pubic hairs were normal but hairs over axilla, eyebrows, eyelashes, and beard were sparse. The oral cavity, nails, palms, and soles were found to be normal. Rest of the systemic evaluation revealed no abnormal findings. Hair shaft microscopic examination revealed no abnormality. Neuropsychiatric evaluation revealed a borderline mental retardation (Intelligence quotient‐60). Histopathology from a keratotic papule over the scalp showed follicular plugging, basket weave orthokeratosis, mild perivascular inflammatory infiltrate along with perifollicular fibrosis and a small vertical scar [Figure 2]. Magnetic resonance imaging brain did not reveal any abnormal finding. With all the above finding, a diagnosis of KFSD in association with mental retardation was made. Our patient was started on oral isotretinoin (0.5 mg/kg). Following 1 month of therapy, there was marked flattening of the keratotic papules, and significant hair growth was seen by the 3rd month [Figure 3]. He was followed up for the next 6 months.

Inflammatory dermatoses in human immunodeficiency virus

Various inflammatory dermatoses have been described in association with human immunodeficiency virus (HIV) infection. These either present in the usual way or in varied atypical presentations. This article gives a brief review about the etiopathogenesis and clinical presentation of the common inflammatory dermatoses associated with HIV such as psoriasis, reactive arthritis, seborrheic dermatitis, eosinophilic folliculitis, pruritic papular eruption, photosensitivity disorders prurigo nodularis, atopic dermatitis, and ichthyosis.

Childhood lichen planus: A series of 42 Indian patients

Background: Lichen planus (LP) is a papulosquamous disease of unknown etiology that is relatively uncommon in children. There is a paucity of data on the clinical profile of LP in children. Available case series are few and majority being retrospective. A cross-sectional observational study to evaluate the clinical profile of childhood LP was performed. Materials and Methods: All childhood cases (<18 years) with histopathologically confirmed diagnosis of LP were evaluated. Detailed clinical history, examination, and investigations were performed according to a proforma. Observation and Results: There were 42 children and childhood LP constituted 1.4% of the pediatric dermatoses. There were 26 females (61.9%) and 16 (38.1%) males with male to female ratio of 1:1.6. The age ranged from 2 to 18 years with a mean age of 11.6 ± 5.1 years. The duration of the disease ranged from 15 days to 5 years with a mean of 8.6 ± 9.4 months. History of recent hepatitis B vaccination was found in 6 (14.3%) patients, and exposure to X-ray radiation was seen in 3 (7.1%). The most common morphological presentation of LP was papules and plaques observed in 34 (81%) patients. Classical LP was the most common variant, found in 29 (69%) patients, followed by hypertrophic variant in 7 (16.7%) patients. Koebnerization was found in 31 (73.8%) patients. Oral mucosa involvement was seen in 28.6% of patients, nail in 42.85%, and scalp in 7.1% of patients. Conclusion: Childhood LP resembles adult LP in most of the aspects. However, etiological factors in childhood LP may be different. It is an under-reported disease. Large multi-centric prospective studies should be undertaken to acquire a better understanding of the clinical profile of childhood LP.

Multiple asymptomatic hard papules on cheeks in an elderly woman

A 55‐year‐old woman, recently diagnosed with dermatomyositis, presented with multiple, tiny, firm papular lesions on cheeks for many years. These lesions were asymptomatic with no history of ulceration or discharge. Past history was notable for the presence of severe facial acne vulgaris during adolescence and early adulthood. On examination, there were multiple small round to irregular‐shaped skin‐colored, hard, monomorphic papules on both cheeks [Figure 1]. There were no similar lesions elsewhere. Patient had characteristic cutaneous manifestations of dermatomyositis ‐‐ V sign, shawl sign, heliotrope rash, Gottron’s sign and holster sign) with proximal muscle weakness.

A case of dermatomyositis with underlying unusual malignancy

473 Indian Journal of Dermatology, Venereology, and Leprology | Volume 83 | Issue 4 | July-August 2017 thumb and great toe. Pain is usually a late symptom appearing with the occurrence of bone compression and may result in fracture. Histopathologically, subungual epidermoid inclusions are characterized by bulbous proliferation of rete ridges, a unilocular cyst lined by thin epidermoid epithelium, filled with orthokeratin, and hypogranulosis in the cyst wall. The connection to nail bed epithelium may be disrupted and calcification may be seen.1,2,5