Taru Garg

Combination of Microdermabrasion and 5‐Fluorouracil to Induce Repigmentation in Vitiligo: An Observational Study

BACKGROUND Treatment of resistant vitiligo is challenging. A few well‐researched studies have shown variable results with surgical and other therapeutic strategies. OBJECTIVE To evaluate the usefulness of a less‐painful method of repigmentation of vitiligo patches. PATIENTS AND METHODS Forty vitiligo patches in 22 consecutive patients with resistant vitiligo presenting at a vitiligo clinic of a university teaching medical school in New Delhi, India, were treated with microdermabrasion followed by topical 5% 5‐fluorouracil (5‐FU). RESULTS One‐third of the patches showed more than 50% repigmentation, and one‐fourth showed more than 75% repigmentation. Gratifying results were obtained in seven patches after a single session. CONCLUSION Microdermabrasion is adjunctive with topical 5% 5‐FU in the treatment of resistant vitiligo patches. Further well‐controlled randomized trials are required to validate the observations of the study. The authors have indicated no significant interest with commercial supporters.

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.

Amyloidosis cutis dyschromica: a rare pigmentary disorder

Amyloidosis cutis dyschromica represents a rare type of primary cutaneous amyloidosis with few reported cases worldwide. It is characterized by asymptomatic, generalized hyperpigmentation with intermingled hypopigmented macules without atrophy or telangiectasia. We report herein a 19‐year‐old female who developed this pigmentary abnormality at 4 years of age. Her aunt and great grandfather also had similar skin pigmentation. An unusual finding in our patient was the presence of papules in addition to characteristic macules. Amyloid deposits were shown histopathologically in both dyschromic macules and papules.

Specific Pregnancy Dermatoses in 1430 females from Northern India.

BACKGROUND The specific dermatoses of pregnancy represent a heterogenous group of ill-defined pruritic skin diseases, unique to pregnancy and post partum period. OBJECTIVE The aim of our study was epidemiological and clinical evaluation of various specific dermatoses of pregnancy. METHODS All patients visiting our antenatal clinic were screened for various pruritic skin conditions and those with specific pregnancy dermatoses were identified and evaluated. RESULTS Out of 1430 patients screened, nearly 5% (70 cases) patients had specific dermatoses of pregnancy. Intra hepatic cholestasis was the commonest specific pregnancy dermatoses. CONCLUSION Specific dermatoses of pregnancy can be diagnosed primarily on the basis of clinical features. All of these, except intra hepatic cholestasis, do not have any effect on normal course of pregnancy.

Segmental vitiligo with segmental morphea: An autoimmune link?

An 18-year old girl with segmental vitiligo involving the left side of the trunk and left upper limb with segmental morphea involving the right side of trunk and right upper limb without any deeper involvement is illustrated. There was no history of preceding drug intake, vaccination, trauma, radiation therapy, infection, or hormonal therapy. Family history of stable vitiligo in her brother and a history of type II diabetes mellitus in the father were elicited. Screening for autoimmune diseases and antithyroid antibody was negative. An autoimmune link explaining the co-occurrence has been proposed. Cutaneous mosiacism could explain the presence of both the pathologies in a segmental distribution.

Sexually transmitted diseases among men who have sex with men: A retrospective analysis from Suraksha clinic in a tertiary care hospital

BACKGROUND Men who have sex with men (MSMs) are a vulnerable population for spread of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). Apart from being important for HIV transmission, they tend to have a different distribution patterns of STDs. Few Indian studies have looked into this aspect. OBJECTIVE We retrospectively analyzed the available data on MSM from Suraksha clinic of a tertiary care hospital in a metropolitan city from 2004 to 2010. MATERIALS AND METHODS A total of 75 MSM constituting 11.4% of the total 660 patients visited our Suraksha clinic in these 6 years. The clinical and behavioral profile of each patient along with the pattern of STDs was evaluated. OBSERVATIONS AND RESULTS 75% of the MSMs were promiscuous; one-third of them indulging in only homosexual activities. Syphilis was the most common STD, followed by condyloma acuminata, herpes genitalis, and gonorrhea. On comparing the data on the STD profiles of the heterosexual males, predisposition toward bacterial STDs among MSMs was observed. CONCLUSION Identification of MSMs is important as most of them are bisexual and promiscuous, thereby playing a role in spread of STDs in vast number of partners. The profile of STDs also differs in MSM, which makes it all the more important to identify them.

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.

Patch testing in patients with suspected cosmetic dermatitis: A retrospective study

Growing use of cosmetics has led to an increase in the incidence of allergic contact dermatitis (ACD) to cosmetics. Patch testing helps to confirm allergy to cosmetics and pinpoint the exact offending allergens.

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.