Sowmya Kaimal

Diet in dermatology: revisited.

Diet has an important role to play in many skin disorders, and dermatologists are frequently faced with the difficulty of separating myth from fact when it comes to dietary advice for their patients. Patients in India are often anxious about what foods to consume, and what to avoid, in the hope that, no matter how impractical or difficult this may be, following this dictum will cure their disease. There are certain disorders where one or more components in food are central to the pathogenesis, e.g. dermatitis herpetiformis, wherein dietary restrictions constitute the cornerstone of treatment. A brief list, although not comprehensive, of other disorders where diet may have a role to play includes atopic dermatitis, acne vulgaris, psoriasis vulgaris, pemphigus, urticaria, pruritus, allergic contact dermatitis, fish odor syndrome, toxic oil syndrome, fixed drug eruption, genetic and metabolic disorders (phenylketonuria, tyrosinemia, homocystinuria, galactosemia, Refsums disease, G6PD deficiency, xanthomas, gout and porphyria), nutritional deficiency disorders (kwashiorkar, marasmus, phrynoderma, pellagra, scurvy, acrodermatitis enteropathica, carotenemia and lycopenemia) and miscellaneous disorders such as vitiligo, aphthous ulcers, cutaneous vasculitis and telogen effluvium. From a practical point of view, it will be useful for the dermatologist to keep some dietary information handy to deal with the occasional patient who does not seem to respond in spite of the best, scientific and evidence-based therapy.

Sexually transmitted infections in India: Current status (except human immunodeficiency virus/acquired immunodeficiency syndrome)

Sexually transmitted infections (STIs) are more dynamic than other infections prevailing in the community. It is important that such dynamic epidemiological changes in STIs are acknowledged and kept track of in a vast and populous developing country like India, particularly in this HIV era. It is with this aim that the authors have reviewed the relevant literature in STI epidemiology in India during the past 25 years. Admittedly, there has been heterogeneity of data to account for the subcontinental dimension of this country. But a basic pattern in the changing epidemiology is discernible. Like the developed countries, in India too the bacterial STIs like chancroid and gonorrhea are declining, while viral STIs like HPV and herpes genitalis are on an upswing. The overall decline in the prevalence of STIs has to be interpreted with caution, however. This may partially reflect the improved facilities of treatment in the peripheral centres that obviates the need of many patients in attending the STD clinics in the tertiary centres. Also, the improved pharmacotherapy of many of the bacterial STIs may result in partial clearance and non-reporting of many of these infections.

Dermatitis cruris pustulosa et atrophicans revisited: our experience with 37 patients in south India.

Background  Dermatitis cruris pustulosa et atrophicans (DCPA) is a distinctive type of chronic superficial folliculitis, with a number of unique features such as its peculiar symmetric localization to legs, extreme chronicity, resistance to therapy, and inevitable alopecia and atrophy.

Methods of specimen collection for the diagnosis of STIs.

Many of the landmark discoveries with regard to the etiology pathogenesis and epidemiology of sexually transmitted infections (STIs) occurred with the use of various diagnostic techniques many years ago. However the concept of providing comprehensive laboratory services for the diagnosis of STIs has surfaced relatively recently. The correct method of specimen collection helps in achieving desirable goals in the laboratory diagnosis of STIs. If simple precautions are taken it will avoid spurious results. The collection of specimens and use of the appropriate swab and transport media are vital in the success of tissue culture. (excerpt)

Sexual behavior of clinic attendees in a tertiary care hospital in Pondicherry

The recent years have witnessed a renewed interest in human sexual behavior, partly because of the growing AIDS pandemic. We undertook a study of the pattern of sexual behavior among outpatients attending our dermatology clinic. Sexually active patients attending the dermatology clinic for non-STD complaints from March 2007 to June 2007 were randomly selected and interviewed about their sexual behavior using a questionnaire. The study included 500 respondents (240 women, 260 men). The mean ages of the women and men were 37.9 years and 38.9 years, respectively. Forty-two of the unmarried men (54.5%) were sexually active, while 55 of the married men (30%) admitted to having had premarital sex. A total of 81 men (38.8%) admitted to premarital sex, compared to only 2.9% of women. With regard to extramarital contact, 62 of the married men (33.8%) were affirmative in their response, while the corresponding figure for married women was 12 (5.5%). Nine men had a history of bisexual contact and, of these, one man admitted to having had exclusively homosexual contact. Fifteen men had indulged in anal sex; 48.3% men with pre/extramarital contact had more than one partner, and 43 (30.1%) had visited commercial sex workers (CSWs). Most of the respondents (141; 87%) with pre/extramarital contact had had unsafe sex. Among the women with pre/extramarital sexual contact, most (17; 89.5%) had only one partner; all were heterosexual and the majority had had sexual contact with relatives (73.7%). To summarize, men had overwhelmingly more pre/extramarital sexual contact as compared to women.

Phage typing in dermatitis cruris pustulosa et atrophicans: does staphylococcal carrier status have a role?

Background  Dermatitis cruris pustulosa et atrophicans (DCPA) is a form of chronic folliculitis of the legs with a multifactorial etiopathogenesis, seen primarily in tropical countries. Staphylococcus aureus has been isolated from the pustules in earlier studies, although the organisms isolated have not been further characterized.

Current best evidence from dermatology literature

Infraorbital dark circles are a cosmetic concern for a large number of individuals. However, the exact definition and precise cause has not been elucidated clearly. In their experience infraorbital dark circles due to thin and translucent lower eyelid skin overlying the orbicularis oculi muscle can be treated successfully with autologous fat transplantation. They conducted this study to clarify the nature of dark circles under the eyes and determine the efficacy of autologous fat transplantation. Ten patients with dark circles due to increased vascularity and translucency of the skin were included. They received at least one autologous fat transplantation and follow-up evaluations were conducted at least 3 months after the last treatment. An average of 1·6 autologous fat transplantations were done in both infraorbital areas. Patients showed an average of 78% improvement (average grading scale: 2·6 out of 4). Most of the patients showed improvement in the infraorbital darkening and contour of the lower eyelids. Authors conclude that autologous fat transplantation is an effective method for the treatment of infraorbital dark circles due to thin and translucent lower eyelid skin overlying the orbicularis oculi muscle.