Yasmeen J Bhat

Trace element levels in alopecia areata

BACKGROUND Alopecia areata (AA) is a recurrent, nonscarring type of hair loss considered to be an autoimmune process. Though its etiopathology is not fully understood, there are claims that imbalance of trace elements may trigger the onset of AA. AIM The aim of the present study was to assess the levels of zinc, copper, and magnesium in the serum of AA patients. METHODS Fifty AA patients (34 men and 16 women), and fifty age and sex matched healthy control subjects were studied. Samples were analyzed using atomic absorption spectrometric methods. RESULTS Serum zinc levels were significantly decreased (P < 0.05) in AA patients whose disease was extensive, prolonged, and resistant to treatment, whereas serum copper and magnesium levels showed insignificant rise compared to controls. CONCLUSION We conclude that copper and magnesium levels are not altered in AA, but the decreased zinc levels found in our study may merit further investigation of the relationship.

Steroid-induced rosacea: a clinical study of 200 patients.

Background: Topical corticosteroids were first introduced for use in 1951. Since then uncontrolled use (abuse) has caused many different reactions resembling rosacea – steroid dermatitis or iatrosacea. Multiple pathways including rebound vasodilatation and proinflammatory cytokine release have been proposed as the mechanism for such reactions. Aim: The aim was to study the adverse effects of topical steroid abuse and the response to various treatment modalities. Materials and Methods: Two hundred patients with a history of topical steroid use on face for more than 1 month were studied clinically and various treatments tried. Results: The duration of topical corticosteroid use varied from 1 month to 20 years with an average of 19.76 months. Majority of patients were using potent (class II) topical steroids for trivial facial dermatoses. The common adverse effects were erythema, telangiectasia, xerosis, hyperpigmentation, photosensitivity, and rebound phenomenon. No significant change in laboratory investigations was seen. Conclusion: A combination of oral antibiotics and topical tacrolimus is the treatment of choice for steroid-induced rosacea.

Ellis-van Creveld syndrome with facial hemiatrophy

Ellis-van Creveld (EVC) syndrome is a rare autosomal recessive congenital disorder characterized by chondrodysplasia and polydactyly, ectodermal dysplasia and congenital defects of the heart. We present here a case of a 16-year-old short-limbed dwarf with skeletal deformities and bilateral postaxial polydactyly, dysplastic nails and teeth, also having left-sided facial hemiatrophy. The diagnosis of EVC syndrome was made on the basis of clinical and radiological features. To the best of our knowledge, this is the first report of EVC syndrome with facial hemiatrophy in the medical literature from India.

Gorham's disease of femur

Gorhams disease is a rare condition of bones characterized by spontaneous massive and progressive osteolysis. Less than 200 cases have been reported so far. Femur is an uncommon site of Gorham disease. We report a young female, presenting as pathological fracture of the femur, wherein rapid osteolysis of femur occurred. The clinical, pathological, and radiological picture suggested a diagnosis of Gorhams disease. The patient was subjected to radiotherapy (40 Gys) and put on bisphosphonates. At a follow-up of 2 years, the disease process had stopped and partial recalcification of the bone had occurred.

Familial reactive perforating collagenosis

Background: Reactive perforating collagenosis (RPC) is one of the rare forms of transepidermal elimination in which genetically altered collagen is extruded from the epidermis. This disease usually starts in early childhood as asymptomatic umbilicated papules on extremities, and the lesions become more conspicuous with age. Aims: The objective of our study was to determine the clinico-pathological features of RPC and the response to various treatment modalities. Methods: Ten patients of RPC, belonging to five different families, were studied clinically. Various laboratory investigations were carried out and diagnosis was made by histopathology of the lesions. Patients were given various topical and oral treatments. Results: RPC is familial in most cases without any definite inheritance pattern. It begins in childhood and the lesions are usually recurrent and become profuse and large with age. Systemic diseases have no role in the onset of lesions. Conclusion: Oral and topical retinoids in combination with emollients is the best treatment option.

Epidermolysis bullosa: A series of 12 patients in Kashmir valley

Background: Epidermolysis Bullosa (EB) is a genetically determined mechano-bullous disorder of the skin encompassing a group of conditions that share skin fragility as a common feature. Materials and Methods: Twele patients with Epidermolysis Bullosa from Kashmir valley are reported. Results: Our series included 12 patients, 5 males and 7 females. Features were consistent with EB simplex in 8 patients, EB pruriginosa in 2 patients, generalized atrophic benign EB in one patient and EB acquista in one patient. Conclusion: EB is a rare, genetically determined, blistering disorder affecting both males and females with predominant involvement of hands and feet. In the absence of specific therapy, treatment mainly involves avoidance of provoking factors, prevention and treatment of complications.

Serum Iron, Ferritin and Calcium Levels in Premature Canities

Background: Premature canities is defined as a minimum of five gray hairs present in a person less than 20 years of age. Etiologically, it is genetically mediated or may be associated with autoimmune syndromes. Few studies have found an association of decreased levels of trace elements with early canities, however the scientific evidence for the same is lacking. Aims and objectives: of this study were to evaluate the relationship of serum iron, ferritin and calcium concentrations with premature canities. Material and methods: This was a hospital based case-control cross-sectional study in which 50 patients aged less than 20 years with premature canities were studied. Age and sex matched 50 subjects with other mild skin ailments but no canities were taken as controls. A detailed history, thorough examination and lab investigations were carried out in all the patients and controls after taking informed consent. The severity of canities was graded as: mild (up to 50), moderate (50-100) and severe (more than 100 gray hairs). Results: Seventeen patients (34%) had mild disease, 30 patients (60%) had moderate disease and 3 patients (6%) had severe disease. The mean age of onset was about 2 years earlier than mean age of presentation. Femalemale ratio was 1.38:1. Positive family history was present in 31 patients (62%). The mean levels of serum iron. Ferritin and calcium were statistically significantly low in patients when compared to controls. Conclusion: The significantly low levels of these trace elements in our patients with premature canities support the fact that their supplementation might prevent the progression of canities. However, large scale studies are needed to substantiate these observations.

Etiopathogenesis of Alopecia Areata

Alopecia areata (AA) is a recurrent, non-scarring type of hair loss affecting the hair follicles and sometimes the nails. Current evidence indicates that hair follicle inflammation in alopecia areata is caused by a T-cell mediated autoimmune mechanism occurring in genetically predisposed individuals. Environmental factors like infections, diet, vaccination and stress may be responsible for triggering the disease. The association between alopecia areata and other autoimmune diseases suggests that alopecia areata is itself an autoimmune disease. Recently many cytokines have been implicated in the pathogenesis of AA and these are focused upon in this article.