Tarun Narang

Comparative efficacy of thalidomide and prednisolone in the treatment of moderate to severe erythema nodosum leprosum: A randomized study

The present study was undertaken to compare the efficacy and safety of thalidomide to that of oral prednisolone in the treatment of moderate to severe type 2 lepra reaction. Sixty patients with a histologically confirmed diagnosis of erythema nodosum leprosum with a clinical score of 4 or more (i.e. moderate to severe type 2 reaction) were randomly allocated to two groups comprising 30 patients each. Group 1 patients were given thalidomide at a dose of 300 mg/day for 1 week and the dose was gradually reduced, and Group 2 received prednisolone 40 mg daily for 2 weeks, which was tapered by 10 mg every 2 weeks. Thalidomide induced a faster clinical response (cutaneous as well as systemic) compared with prednisolone. Patients taking thalidomide had fewer relapses and a longer period of remission than those receiving prednisolone.

Psychodermatology: A comprehensive review

Psychodermatology is an interesting domain of dermatology that overlaps with psychiatry. This arena in dermatology has received limited diligence, partly due to lack of training in this realm. We present here a comprehensive review of salient features and treatment updates in primary psychiatric dermatoses and have also discussed the role of psyche in psychophysiological cutaneous disorders. Secondary psychiatric morbidity is relatively common among patients visiting the dermatologists but often overlooked and uncared for. Dermatologist should be able to initiate basic pharmacotherapy, should be knowledgeable about various non-pharmacological treatments and know the right time to refer the patient to the psychiatrist. Awareness and pertinent treatment of psychodermatological disorders among dermatologists will lead to a more holistic treatment approach and better prognosis in this unique group of patients.

Plasma cell balanitis: clinicopathologic study of 112 cases and treatment modalities.

Background: Plasma cell balanitis or Zoons balanitis is an idiopathic benign condition of the genitalia that mostly presents as a solitary, persistent plaque on the glans primarily in uncircumcised, middle-aged to older men. Methods: One hundred twelve patients with a clinical diagnosis of plasma cell balanitis were studied between January 1985 and April 2003. Results: The age of the patients ranged from 24 to 70 years. The majority of patients had symptoms for more than 12 months. Lesions involved the prepuce and glans in the majority of patients (66; 58.92%), the prepuce only in 26 patients (23.21%), and the glans only in 20 patients (17.85%). Tissue for histopathology was available in 96 patients. Histologically, epidermal edema, a dense upper dermal band of chronic inflammatory cells, including many plasma cells, dilated capillaries, extravasated red blood cells, and hemosiderin deposition, was seen. In most, cases, plasma cell balanitis was successfully treated by circumcision. Conclusions: This report describes our experience with plasma cell balanitis and reviews its clinical and histopathologic aspects. The treatment modalities are also reviewed, and the importance of circumcision as the treatment of choice is emphasized.

Adams–Oliver Syndrome: A Sporadic Occurrence With Minimal Disease Expression

Abstract:  Adams–Oliver syndrome is a congenital condition comprising congenital scalp defects and distal limb abnormalities. We report a child with the sporadic form of the disease who had minimal disease expression, illustrating the wide clinical spectrum of the syndrome.

Low-dose oral isotretinoin therapy in lichen planus pigmentosus: an open-label non-randomized prospective pilot study

Lichen planus pigmentosus (LPP) is a cosmetically distressing pigmentary disorder often posing a therapeutic challenge. Isotretinoin has been shown to be effective in oral and cutaneous LP, but its role in LPP is yet unknown.

Confetti-like hypopigmentation: a rare complication of common phototherapeutic modality

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Malassezia and psoriasis: Koebner's phenomenon or direct causation?

Editor Malassezia is a lipophilic yeast belonging to the normal human cutaneous flora in adults. It is not only a saprophyte but also an opportunistic pathogen associated with Pityriasis versicolor, Pityrosporum folliculitis, seborrhoeic dermatitis and some forms of atopic dermatitis. Malassezia furfur has been implicated as a trigger for the initiation of scalp lesions in psoriasis. We present a case in which P. versicolor lesions triggered guttate exacerbation of psoriasis. A 42-year-old man presented with multiple, scattered, erythematous and scaly papular lesions of 1-week’s duration on his trunk. These were preceded by asymptomatic, minimally scaly, hypopigmented macules for 1 month. He was a known case of psoriasis vulgaris for the past 2 years. Examination revealed erythematous scaly plaques of psoriasis on his trunk and extremities and hypopigmented scaly macules on the chest and upper back. Superimposed on these hypopigmented lesions on the chest and upper back were multiple, scattered erythematous and scaly papular lesions of guttate psoriasis (fig. 1). A KOH preparation from the hypopigmented lesions showed short, wide, fungal hyphae along with yeast cells (spaghetti and meatball appearance) on microscopy. Skin biopsy from the lesions revealed evidence of both fungal elements and psoriasis (fig. 2). The patient was started on fluconazole tablets 150 mg/day for 7 days. Within a period of 4 weeks almost all hypopigmented macules and guttate psoriasis lesions had cleared. Psoriasis is considered a genetic, controlled disease; however, its expression is in part dependent on external factors. Microorganisms such as β-Haemolytic streptococci, Staphylococcus aureus and Candida albicans have been suggested as external triggers that release factors which serve as superantigens, and stimulate T cells to initiate the pathogenic events of psoriasis. The following findings indicate that Malassezia may also be involved in the pathogenesis of psoriasis. Cell fragments of Malassezia topically applied to the skin of psoriatic patients induced new psoriatic plaques. Furthermore, it has been observed that Malassezia folliculitis can transform into psoriatic lesions. The possible mechanisms by which these organisms may trigger psoriatic lesions have, however, yet fig. 1 Multiple, scattered erythematous, scaly papular lesions with hypopigmented patches on the upper trunk.

A clinico-aetiological and ultrasonographic study of Peyronie’s disease

BACKGROUND Peyronies disease is a localised connective tissue disorder that involves the tunica albuginea of the penis. Although long recognised as an important clinical entity of the male genitalia, the aetiology of this disease has remained poorly understood. METHODS The epidemiology and clinical presentation of Peyronies disease during a 10-year period was evaluated. RESULTS Forty-two men with Peyronies disease from Chandigarh, India were reviewed retrospectively. The prevalence of Peyronies patients was 1.97/1000 patients. Their ages ranged from 23 to 70 years. Most of them presented during the early phase of the disease. The most common presenting complaint was penile curvature in 34 (80.95%) followed by pain on erection in 28 (66.66%). History of penile trauma was revealed by four (9.52%) patients. Among the risk factors, hypercholesterolemia (60%), hypertension (33.3%) and asymptomatic hyperuricemia (28.34%) were the most common. Twenty-two patients with Peyronies disease were studied by ultrasonography. Ultrasonogram was more accurate than clinical assessment in delineating the extent of lesions. In one-third of the patients, sonography demonstrated the plaques to be more extensive than had been detected by clinical examination. CONCLUSIONS The clinical symptoms and signs in our study were, in general, similar to those found in the previous studies. Higher incidence of hypertension and diabetes in patients with Peyronies disease may also be to an extent due to patients being in an older age group.

Red scrotum syndrome: idiopathic neurovascular phenomenon or steroid addiction?

BACKGROUND Red scrotum syndrome (RSS) is not infrequent but is often misdiagnosed or underdiagnosed, and seldom reported. The exact etiopathogeneis is still unknown but it almost always follows the prolonged application of topical corticosteroids and is characterised by persistent erythema of the scrotum, associated with severe itching, hyperalgesia and a burning sensation. OBJECTIVE To evaluate the clinicoepidemiological profile and assess the efficacy of various treatment modalities in addition to corticosteroid abstinence in the treatment of RSS. METHODS Twelve patients with RSS, who presented to us during 2010 and 2011, were identified, and various aspects of their illness and treatment were studied. Patch testing was performed in all patients. A skin biopsy was done in seven patients. RESULTS The average age of the patients was 45.83 years (26-62 years). The average duration of illness or the duration of topical steroid use was 27.41 months (6-56 months). Psychiatric comorbidities were seen in 9 (75%) out of 12 patients. Histopathology revealed features resembling erythematotelengiectatic rosacea in four of the biopsied patients. Patch test results were negative. All patients reported improvement of their symptoms within 4 weeks of starting doxycycline with amitriptyline or pregabalin; the treatment had to be continued for 3-4 months. CONCLUSIONS RSS appears to be a manifestation of corticosteroid misuse rather than a primary disease. We suggest that RSS is a rosacea-like dermatosis or steroid-induced rebound vasodilation based on clinical and histopathological features. Our patients responded to cessation of steroids and doxycycline in combination with amitryptaline or pregabalin.

Riga‐Fede disease: trauma due to teeth or tongue tie?

© 2007 The Authors 395 JEADV 2008, 22, 363–404 Journal compilation