Vineet Relhan

IL-10 promoter single nucleotide polymorphisms are significantly associated with resistance to leprosy

The minor haplotype −3575A/-2849G/-2763C in IL-10 promoter has been defined as a marker of disease resistance to leprosy and its severity in Brazilian population. Our investigation of six single-nucleotide polymorphisms (SNPs) in IL-10 promoter in 282 Indian leprosy patients and 266 healthy controls by direct PCR sequencing, however, showed that the extended haplotype: −3575T/-2849G/-2763C/-1082A/-819C/-592C was associated with resistance to leprosy per se and to the development of severe form of leprosy, using either a binomial (controls vs cases, P=0.01, OR=0.58, CI=0.37–0.89) or ordinal (controls vs paucibacillary vs multibacillary, P=0.004) model. Whereas, IL-10 haplotype −3575T/-2849G/-2763C/-1082A/-819T/-592A was associated with the risk of development of severe form of leprosy (P=0.0002) in contrast to the minor risk haplotype −3575T/-2849A/-2763C in the Brazilian population. The role of IL-10 promoter SNPs in Brazilian and Indian population strongly suggests the involvement of IL-10 locus in the outcome of leprosy.

Vitamin D and skin diseases: A review.

Vitamin D, originally associated with rickets and osteomalacia, has recently been shown to have a role in a number of medical and dermatological diseases. It has been found that vitamin D receptors and the enzymatic machinery capable of converting circulating 25-hydroxyvitamin D [25(OH)D] to the active 1,25-hydroxyvitamin D [1,25(OH)D] is present in most cells in the body including the skin. It is well known that vitamin D analogs are effective in the treatment of psoriasis vulgaris because of their anti-proliferative and pro-differentiating effects on keratinocytes. However, new roles have been found for vitamin D in skin, such as immunomodulatory and anti-apoptotic effects thus raising a possibility of its use in conditions such as atopic dermatitis and infections. Increasing evidence now indicates that cutaneous vitamin D synthesis may help in prevention of skin malignancies and further, that cancer mortality may be reduced by oral supplementation of vitamin D. Various epidemiological studies have linked low levels of vitamin D to autoimmune diseases including vitiligo, and topical vitamin D has been used to treat vitiligo. This review focuses on a wide array of roles of vitamin D in various skin disorders with emphasis on both its well-established role as in psoriasis and the less characterized role in other disorders such as ichthyosis, tuberculosis or acne.

Complete resolution of recalcitrant periungual/subungual wart with recovery of normal nail following "prick" method of administration of bleomycin 1%.

We report a case of 14 year old girl with recalcitrant subungual wart which responded dramatically to bleomycin with normal nail regrowth.

Immunomodulators in warts: Unexplored or ineffective?

Cutaneous warts are known to be recurrent and often resistant to therapy. Resistant warts may reflect a localized or systemic cell mediated immune (CMI) deficiency to HPV. Many modalities of treatment are in use; most of the provider-administered therapies are destructive and cause scarring, such as cryotherapy, chemical cauterisation, curettage, electrodessication and laser removal. Most patient-applied agents like podophyllotoxin have the risk of application-site reactions and recurrence. Thus immunotherapy is a promising modality which could lead to resolution of warts without any physical changes or scarring and in addition would augment the host response against the causative agent, thereby leading to complete resolution and decreased recurrences. Immunomodulators can be administered systemically, intralesionally or intradermally, and topically. A few agents have been tried and studied extensively such as cimetidine and interferons; others are new on the horizon, such as Echinacea, green tea catechins and quadrivalent HPV vaccine, and their efficacy is yet to be completely established. Though some like levamisole have shown no efficacy as monotherapy and are now used only in combination, other more recent agents require large and long term randomized placebo-controlled trials to clearly establish their efficacy or lack of it. In this review, we focus on the immunomodulators that have been used for the treatment of warts and the studies that have been conducted on them.

Comparative Study of Flip-top Transplantation and Punch Grafting in Stable Vitiligo

Background Because of limitations of medical treatment in vitiligo, various surgical techniques have been devised. There is a scarcity of comparative studies of surgical techniques in vitiligo. Objective To compare the effectiveness and side‐effect profile of flip‐top transplantation (FTT) and punch grafting (PG) in patients with stable vitiligo. Materials and Methods Twenty patients with stable vitiligo were treated using PG and FTT on 26 lesions; 156 grafts were taken (78 PG, 78 flip‐top grafts). They were graded for response in the form of repigmentation as excellent (91–100%), very good (76–90%), good (51–75%), fair (31–50%), poor (<30%). Onset and maximum pigment spread were observed. Results Sixty‐five percent of our patients showed excellent repigmentation with FTT, versus 50% with PG (p = .44). Thirty percent of patients with FTT and 40% with PG had side effects. The differences in onset of repigmentation, completion, and pigment spread between the two techniques were statistically significant (p < .001). Conclusions Flip‐top transplantation was equally effective as PG for treating vitiligo, although graft uptake rate was higher with FTT, with more pigment spread, and cost less.

Pityriasis rosea with erythema multiforme - like lesions: An observational analysis

Pityriasis rosea (PR) is an acute or subacute inflammatory skin disease characterized by erythematous papulosquamous eruptions localized on the trunk and arms. The eruptions are self-limiting and usually disappear gradually in 2-10 weeks, without any treatment. Typical PR is much easier to diagnose than the rare atypical forms. There is a passing mention of PR with erythema multiforme-like lesions in the literature, but no extensive case series have been published till date. We present a series of five patients for whom we believe atypical PR is the likely diagnosis.

Mycetoma: An update

Mycetoma is a localized chronic, suppurative, and deforming granulomatous infection seen in tropical and subtropical areas. It is a disorder of subcutaneous tissue, skin and bones, mainly of feet, characterized by a triad of localized swelling, underlying sinus tracts, and production of grains or granules. Etiological classification divides it into eumycetoma caused by fungus, and actinomycetoma caused by bacteria. Since the treatment of these two etiologies is entirely different, a definite diagnosis after histopathological and microbiological examination is mandatory, though difficult. Serological test exists but is not so reliable; however, molecular techniques to identify relevant antigens have shown promise. The disease is notoriously difficult to treat. Eumycetoma may be unresponsive to standard antifungal therapy. Actinomycetoma responds to antibiotic therapy, but prolonged treatment is necessary.This review focuses on the etiopathogenesis, clinical features, laboratory diagnosis, and treatment of mycetoma.

Goldenhar syndrome with rare clinical features

Goldenhar syndrome is an uncommon syndrome with malformations of first and second branchial arches. Accessory tragus is a constant feature of this syndrome but may be associated with other syndromes as well. We report a case with a combination of rare findings, i.e., multiple bilateral preauricular skin tags with short stature and mental retardation with maintained facial symmetry.

Erythromelanosis follicularis faciei et colli

A 10-year-old boy presented with 3-year history of erythema and brown-coloured pigmentation over bilateral preauricular and malar areas, studded with tiny whitish papules giving a rough texture (figure 1). Follicular keratotic papules with perifollicular erythema of keratosis pilaris (KP) were also present on the arms. KP lesions were observed over the arms of his brother and parents. A facial lesion biopsy revealed hyperkeratosis, follicular plugs, increased basal pigmentation and …

Multiple keratoacanthomas developing in healing plaques of Psoriasis.

A 22 year old male psoriatic patient presented with multiple reddish scaly plaques all over body. After hematological and biochemical investigations the patient was started on oral methotrexate 15 mg weekly. PASI score at the start of treatment was 26.2. After 3 months PASI dropped to 11.5, the dose of methotrexate was tapered to 7.5mg weekly and the patient was maintained on this dose and kept under monthly follow up. Four months later, the patient presented with reddish to hyperpigmented raised firm nodules having a central crater over the healing plaques of psoriasis. Few lesions showed self resolution over a period of 6-12 weeks. Histopathology of the lesion confirmed it to be Keratoacanthoma. We believe the most likely etiologic factors for the multiple KAs in our patient could be a genetic susceptibility stimulated by multiple causes.