Sudha Rangarajan

A case of lamellar ichthyosis with rickets and carcinoma of the hypopharynx.

Lamellar ichthyosis (LI) is an autosomal recessive disorder rarely associated with systemic organ involvement and development of carcinoma. Rickets has occasionally been described with LI owing to impaired vitamin D synthesis following altered keratinization. There has also been a high association of cutaneous cancers in patients of LI. We as Dermatologists should therefore be very meticulous while doing a full work up of these patients. We report here a case of LI associated with rickets and carcinoma of the hypopharynx.

Molecular strain typing of Trichophyton mentagrophytes (T. mentagrophytes var. interdigitale) using non-transcribed spacer region as a molecular marker

Background & objectives: Dermatophytes are keratinophilic fungi that infect keratinized tissues of human and animal origin. Trichophyton mentagrophytes is considered to be a species complex composed of several strains, which include both anthropophiles and zoophiles. Accurate discrimination is critical for comprehensive understanding of the clinical and epidemiological implications of the genetic heterogeneity of this complex. Molecular strain typing renders an effective way to discriminate each strain. The objective of the study was to characterize T. mentagrophytes clinical isolates to sub-species level using molecular techniques and non-transcribed spacer (NTS) region as marker. Methods: Sixty four T. mentagrophytes clinical isolates were identified by phenotypic methods. These were subjected to polymerase chain reaction targeting three sub-repeat elements (SREs), TmiS0, TmiS1 and TmiS2 of the NTS region. Sequence analysis of internal transcribed spacer (ITS) region of different types was also done. Results: Strain-specific polymorphism was observed in all three loci. Totally, 13 different PCR types were obtained on combining all the three SREs loci. No variation was observed in the ITS region. Interpretation & conclusions: The study described the usefulness of molecular strain typing technique for the discrimination of the T. mentagrophytes isolates. This will help for the future explorations into the epidemiology of T. mentagrophytes and its complex.

Prevalence of metabolic syndrome in patients with psoriasis: A prospective, observational, descriptive study from a tertiary health-care center in South India

Background: Psoriasis is a chronic inflammatory disorder which of late has been significantly linked with metabolic syndrome (MS). Objective: To assess the association between psoriasis and MS and evaluate specific disease characteristics predisposing for the development of MS. Materials and Methods: We performed a prospective, observational, descriptive study with 207 adult patients with various types of psoriasis. Results: MS was found in 49.8% of psoriatic patients. It was more prevalent after 40 years of age with a female preponderance (P = 0.000). Smoking (P = 0.0320) and alcohol consumption (P = 0.025) were significant contributing factors for the development of MS in our study population. No association for the same was reflected with parameters such as psoriasis type, lifestyle behavior, family history, and other associated systemic disease. Conclusion: A definite association does exist between psoriasis and MS. Patients with psoriasis should be periodically screened for MS and managed appropriately utilizing an interdisciplinary approach.

A clinical study of cutaneous lesions in neonates at a tertiary health care center in Chennai

Background: Neonatal dermatoses constitute an important category of cutaneous disorders. They range from physiological transient conditions at one end to serious pathological entities at the other. Any of these could be a source of immense anxiety to the parents, and therefore the significance of their adequate awareness amongst dermatologists. Aim and Objective: To study the clinical pattern of various dermatoses in neonates at a tertiary health care center in Chennai. Materials and Methods: This was a descriptive, cross-sectional, and observational study conducted at our institute which included a detailed dermatologic examination of each neonate followed by recording each finding and their statistical analysis. Results: In the 220 neonates analyzed, 97 were females (44.1%) and 123 males (55.9%), with 126 being term babies (57.3%), 86 preterm (39.1%), and 8 postterm (3.6%). Physiological skin changes (52.7%) were the most common cutaneous change identified, followed by transient non-infective dermatoses (20%), developmental defects (7.3%), birth marks (7.3%), eczema (6.8%) and infections (5.9%). Conclusion: Studying neonatal dermatoses holds significance to all dermatologists so that they are able to differentiate physiological and pathological conditions, thereby relieving unnecessary therapy for neonates in circumstances not requiring any and also facilitating to allay undue anxiety among parents.

Saw palmetto extract: A dermatologist's perspective

Saw palmetto extract is believed to have antiandrogenic properties and has been used widely for the treatment of androgenic alopecia. It is claimed to have much less side effects as compared to finasteride. Along with its use for androgenic alopecia, it has also been tried for other conditions associated with increased androgen levels in dermatology. This article will review a dermatologists perspective of this traditional herb.

A clinicopathologic study of cutaneous amyloidosis at a tertiary health care center in South India

Background: Primary cutaneous amyloidosis (PCA) is quite a common disorder seen in Southeast Asia. It is characterized by amorphous eosinophilic deposits of a fibrillar protein in the dermis without any systemic involvement. However, the etiology for this disease still remains elusive without much satisfying outcomes with the currently available treatments. Aim: To study the clinical and demographic patterns of PCA and correlate it with histopathological findings along with polarized microscopy examination. Methods: A cross-sectional study done over a 1½ years period wherein after patient enrollment, they underwent a thorough clinical evaluation followed by a skin biopsy and complemented by polarized microscopy. Results: A prevalence of 0.04% and a female preponderance (61.76%) was observed. Lichen amyloidosis (LA) was more common than macular amyloidosis (MA). Majority of patients presented between 41 and 50 years. There was a significant association of pruritus and friction with PCA. The most common sites involved were shins for LA and interscapular area for MA. On histology, epidermal changes were not so significant for MA. However, hyperkeratosis and acanthosis were major epidermal findings for LA. Lymphohistiocytic infiltrates were common dermal changes for both variants of amyloidosis. Amyloid deposits appeared as eosinophilic fissured masses under light microscopy on hematoxylin and eosin staining. Conclusion: PCA is a disorder of middle age seen more commonly in females. Pruritus and friction demonstrate significant contribution in the development of PCA. Whether there is an association of PCA with diabetes mellitus, hypertension, bronchial asthma, and hypothyroidism needs further consideration.

A clinical study of neurofibromatosis-1 at a tertiary health care centre in south India

Background: Neurofibromatosis (NF)-1 is an autosomal dominant genodermatoses affecting numerous body systems. Though many associations are known, new findings encountered continue to intrigue the medical fraternity. Aim: A clinical study of various manifestations of NF-1. Methods: An observational study that was conducted on 30 patients with NF-1 over a period of 1 year. Results: Café-au-lait macules were identified in 28 (93.3%) patients. A family history of NF-1 was demonstrated in 10 (33.3%) patients. In 4 (13.3%) patients, plexiform neurofibromas were identified. Axillary freckling was seen in 27 (90%) patients and inguinal freckling in 17 (56.1%) patients. Lisch nodules were detected in 28 (93.3%) patients, conjunctival neurofibromas in 2 (6.7%) and conjunctival freckles in 3 (10%) patients. Bone changes were demonstrable in 8 (26.7%) patients. Blood pressure was normal in all our study subjects. Conclusion: In our setting, no gender preponderance of NF-1 was noted. Conjunctival freckling, an ocular pigmentary observation, was a new observation detected in 10% of our study subjects. An association of conjunctival neurofibroma along with cutaneous neurofibromas was seen in 2 (6.7%) patients. Rare radiographic findings like lytic lesions over skull bones and ribboning of metatarsal bones and ribs were detected in 2 (6.7%), 1 (3.3%) and 3 (10%) patients, respectively.

A clinical study of melasma and assessment of Dermatology Life Quality Index at a tertiary health care center in South India

Background: Melasma is a common acquired hypermelanosis, notorious for its recalcitrant nature. Though benign in nature, it could significantly affect the quality of life in some patients. Therefore, apart from pharmacologic management in cases of resistant melasma, the need for psychologic counseling would be imperative to improve the quality of life in such patients. Aim: To analyze the clinical patterns of melasma along with all other demographic parameters followed by Wood’s lamp (WL) examination, Melasma Area and Severity Index (MASI) scoring and assessment of Dermatology Life Quality Index (DLQI) in all the participants of our study. Methods: A prospective, observational and descriptive study done over a period of 7 months in 175 freshly diagnosed females with melasma above 18 years of age. Results: Majority of the patients with melasma were in the 31–40 year age group (44%), followed by 21–30 (26.9%) and 41–50 (16.6%) years. The duration of melasma in most of our patients was below 1 year. Sunlight (48.5%) appeared to be the major precipitating factor followed by cosmetics (22.2%). A significant association with hypothyroidism was demonstrated amongst our participants. A positive family history was noted in 54.85% of the study subjects. The dermal variant was the most common type of melasma that was observed. The mean MASI score observed was 5.3 and the mean DLQI seen in our study was 1.46. Conclusion: Melasma is common in middle-aged females. Solar radiation constitutes a major risk factor for melasma. Hypothyroidism appears to have a significant association with melasma. It is important to evaluate the DLQI in all patients with melasma to holistically manage these patients.

A clinicopathologic study of lichen planus at a tertiary health care centre in south India

Background: Lichen planus (LP) is a unique inflammatory papulosquamous disorder that affects the skin, hair, nail and mucous membranes, and is associated with a relapsing and remitting course. Aim: To study the clinicopathological profile in patients diagnosed with LP. Methods: A cross-sectional prospective study of 100 freshly diagnosed cases of LP over a period of 1 year, wherein following patient enrolment, they underwent a thorough clinical evaluation followed by a biopsy, that was carefully studied and evaluated. Results: A male preponderance (60%) was observed. Majority of the patients were in the 21–40 years age group (60%). Pruritus was witnessed in 84% of the patients. The morphological types of cutaneous LP encountered were classical (58.9%), hypertrophic (28.4%), linear (4.2%), lichen planopilaris (LPP) (4.2%), bullous (2.1%) and LP pigmentosus (2.1%). Out of the 42 patients with oral LP, reticulate type was present in 85.7% patients and erosive variant in the remaining 14.3%. Spotted hypergranulosis was a finding seen in 100% of the cutaneous biopsies taken. Hyperkeratosis was identified in 92.6%, pigmentary incontinence in 93.7% and subepidermal band like lymphocytic infiltrate in 92.6%. In none of the patients of LPP were the characteristic microscopic findings identifiable. In oral mucosal biopsies, dysplastic changes were evident in 50% of the participants. Conclusion: LP is a disorder more common in males usually manifesting in the 3rd to 4th decade of life, with the classical type of cutaneous LP and reticular variant of oral LP being most commonly encountered. Dysplastic changes in oral LP demonstrated a value of 50% in our study, a value much higher when compared to previous reports, thus mandating vigilant identification of the same for appropriate patient management.

Stubborn facial hypermelanosis in females: A clinicopathologic evaluation

Background: Disorders of increased facial pigmentation constitute a major group of disorders in all dermatology clinics. Apart from cosmetic disfigurement, these disorders could significantly affect patient psychology. Therefore, it becomes imperative on the part of clinician to arrive at a conclusive diagnosis so that appropriate therapy could be administered. Aim: To correlate the clinical and histology findings in 70 females 30–50 years of age with persistent facial hypermelanosis. Methods: Following a written, informed consent, a 2 mm punch biopsy was performed from the lesional skin, succeeded by microscopic evaluation and clinical correlation. Results: Out of the 70 patients studied, 31 had melasma, 14 with seborrhoeic melanosis (SM) and lichenoid dermatitis each, four with acanthosis nigricans (AN) and ashy dermatoses, and the remaining three with Riehl’s melanosis. Out of these patients studied, all patients with melasma and AN demonstrated 100% clinicopathologic concordance. Koilocytes were identified in two patients with persistent facial hypermelanosis, and in 17 patients, the histology findings were undecided. Conclusion: Melasma appears to be the most common cause of facial hypermelanosis in females and has demonstrated a 100% clinicopathologic correlation. Subclinical infection with human papilloma virus (HPV) could be a cause of increased facial pigmentation which, if not carefully evaluated, could go undetected. SM still remains a disputable entity. Majority of these disorders are chronic and highly recalcitrant to all conventional therapeutic modalities.