Soni Nanda

Combination of surgical avulsion and topical therapy for single nail onychomycosis: a randomized controlled trial

Summary Background Conventional therapy of onychomycosis is prolonged and often frustrating, which is why combination therapy involving topical, oral and surgical measures has been advocated as the treatment of choice. There are no controlled studies evaluating the efficacy of nail avulsion followed by topical antifungal therapy.

Efficacy of Triamcinolone Acetonide in Various Acquired Nail Dystrophies

The treatment of nail disorders is currently an unsatisfying exercise. Isolated nail involvement generally does not warrant any systemic therapy. At the same time, treatment is requested because of significant cosmetic and functional handicap. Intralesional triamcinolone acetonide (TA) in the proximal nail fold was evaluated as a treatment modality in 30 patients with twenty‐nail dystrophy, 14 with nail lichen planus, and 6 with nail psoriasis. The number of involved nails varied from 1–20, and 1–10 nails were treated with TA. Fourteen patients discontinued treatment after 1–2 sittings. Out of the 28 patients completing the treatment protocol, 16 showed 75–100% improvement. Predominant side effects included pain, subungual hematoma formation, proximal nail fold hypopigmentation, and atrophy. TA given as a single injection in the proximal nail fold produced good improvement in a significant number of patients completing the treatment protocol. Lower concentrations of TA (5 mg/ml) were quite effective in treating various dermatoses affecting the nail unit. Our technique had fewer side effects than needle‐less injection or multiple injection techniques. Careful attention to injection technique further minimized the side effects associated with the procedure. Sixteen patients completed the six‐month follow‐up and a relapse of nail changes was seen in 10. The relapses were equally responsive to retreatment. TA injected into the proximal nail fold area is a useful, cheap and efficacious treatment for dermatoses affecting the nail unit.

An epidemiologic study of childhood leprosy from Delhi.

1. Chang A, Tung RC, Schlesinger T, et al. Familial cutaneous mastocytosis. Pediatr Dermatol 2001;18:271–272. 2. Gibbs NF, Friedlander SF, Harpster EF. Telangiectasia macularis eruptive perstans. Pediatr Dermatol 2000;17:194–197. 3. Ellis DL. Treatment of telangiectasia macularis eruptiva perstans with the 585 nm flash lamp pumped dye laser. Dermatol Surg 1996;22:33–37. 4. Ball FI. Telangiectasia macularis eruptiva perstans: report of an early stage in a child. Arch Dermatol Syphilol 1937;36:65–69.

Pigmentation: a potential cutaneous marker for AIDS?

Pigmentation of skin, nails and mucosae has frequently been described in HIV positive patients. Various causes for this phenomenon have been ascribed, which include intake of various drugs like zidovudine, opportunistic infections like toxoplasmosis and adrenocortical suppression. However, there has been no uniform explanation. We describe three AIDS patients with different personal and disease profiles but essentially the same pattern of pigmentation. This pattern of pigmentation is thereby discussed. We also propose that this pigmentation could be a result of late stage HIV disease per se and thus could serve as a useful cutaneous marker for the same.

Congenital Becker Nevus with Lichen Planus

Abstract:  We report an interesting and rare association of congenital Becker nevus with lichen planus occurring in an 11‐year‐old boy. Both conditions were confirmed histopathologically.

Cardio‐facio‐cutaneous syndrome: report of a case with a review of the literature

A sporadic case of cardio‐facio‐cutaneous syndrome occurring in an 18‐year‐old girl is reported, with a brief review of pertinent literature, for its rarity and clinical interest. She had a characteristic cranio‐facial appearance, a wide range of ectodermal defects, dystrophic nails and teeth, palmo‐plantar keratoderma, typical short, coarse, unruly hair, pulmonic stenosis and mild mental retardation. She had no history of consanguinity and genetic studies did not reveal any abnormality.

A Case of Extensive Linear Porokeratosis with Evaluation of Topical Tretinoin versus 5‐Flourouracil as Treatment Modalities

A 19‐year‐old male presented with linear raised lesions over extensive areas of his body that followed Blaschkos lines. The lesions were asymptomatic with ridged borders. Histopathology confirmed a diagnosis of porokeratosis. He was given topical tretinoin and topical flourouracil for local application on specified areas. The cosmetic acceptability and the safety profile of tretinoin were found to be better than those of flourouracil. However, both the agents were equally efficacious. A rare case of extensive porokeratosis with comparative evaluation of two treatment modalities is hereby presented.

PUVA‐Induced Lichen Planus

A 28‐year‐old male with histologically proven psoriasis vulgaris was administered oral 8‐methoxypsoralen UVA therapy (PUVA). The plaques of psoriasis gradually responded to treatment, however numerous pruritic, violaceous papules over the right forearm and left thigh developed 5 months after starting PUVA (45 sittings with a cumulative dose of 156 J/cm2). Histopathologic examination of these lesions was compatible with the diagnosis of lichen planus (LP). On stopping PUVA therapy, the lesions subsided in one month. This case emphasizes the hypothesis that cell injury caused by PUVA therapy could expose some sequestered antigens to autoreactive lymphocytes and induce lichen planus.

Long pulsed Nd:YAG laser with inbuilt cool sapphire tip for long term hair reduction on type- IV and V skin: a prospective analysis of 200 patients.

BACKGROUND Laser hair reduction has become a very popular means to get rid of unwanted hair. AIMS We conducted the current study to evaluate the safety and efficacy of Nd: YAG laser on dark skin. We also evaluated the effect of increasing the gap between sessions on the long term efficacy of hair reduction achieved with long pulsed Nd: YAG laser. METHODS A prospective study was conducted on 200 consecutive female patients who underwent laser hair reduction for unwanted hair over the face, at Kaya skin clinic Delhi, with long pulsed Nd: YAG laser, from May 2006 to May 2009. The gap between sessions was increased from 2 nd session itself. RESULTS were evaluated 6 months after 6 sessions. Also a note was made of worsening of hair growth or any side effects experienced the patient during any of the sessions. RESULTS A total of 200 female patients (160 skin type IV and 40 skin type V) were followed up. Of these, 64 enrolled for lower face, 88 for chin or upper neck and 48 for upper lip. 6 months after 6 sessions, more than 50% improvement was seen in 68.7% of lower face, 89.69% cases of chin and 59% of upper lip cases. None of the patients had any worsening. CONCLUSIONS The current study shows that long pulsed Nd: YAG is a very safe and effective means of hair reduction in skin types IV and V. Adequate fluences and increasing the gap between sessions from the 2 nd session could be the key to achieving long term hair reduction with Nd: YAG laser. Adequate cooling and proper shaving are the key factors determining the safety.

Leprosy with Guillain Barre Syndrome: A New Neurologic Manifestation?

A 19‐year‐old female patient of lepromatous leprosy with Type II reaction, on multidrug therapy and prednisolone, presented with acute onset flaccid quadriparesis. The cerebrospinal fluid examination revealed albumino‐cytologic dissociation. Nerve biopsy showed infiltration with lepra bacilli, features of vasculitis, and demyelination. There were no other identifiable precipitating factors for Guillain Barre Syndrome in this patient. Her condition improved without any steroid therapy. This case emphasizes the hypothesis that cell injury caused by Type II reaction can expose neural antigens and incite an autoimmune reaction in the form of Guillain Barre Syndrome.