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ABSTRACT: Background : Vitiligo is a disease that significantly impairs quality of life. Previous studies have shown that vitiligo has an impact that may not correlate with the size and extent of depigmentation, indicating a need for an independent measure of the psychosocial burden. Aims : To develop a rating scale to assess the psychosocial impact of vitiligo. Methods : The study was undertaken in three broad phases: item generation, pre- and pilot testing, and test administration. Items were generated largely from a qualitative study using semi-structured interviews of patients. Face and content validity were assessed through pre- and pilot testing in 80 patients and the final version was administered to 100 patients who also received the Dermatology Life Quality Index (DLQI) and the Skindex-16. Each patient also underwent a physician global assessment (PGA) of the impact of vitiligo. Test-retest reliability was assessed in 20 patients. Results: Of 72 items initially generated for the scale, 27 were retained in the final version. Subjects were able to comprehend the items and took about 5-7 min to complete the instrument. The scale was internally consistent (Cronbach's α = 0.85). Scores on the scale correlated moderately well with the DLQI and the Skindex (Spearman rank correlation: 0.51 and 0.65, respectively). The scale was able to discriminate between patients having mild and those having moderate and severe impact as assessed by PGA. The test-retest reliability coefficient (Spearman rank correlation) was 0.80. Conclusion: The Vitiligo Impact Scale appears to be a valid measure of the psychosocial impact of vitiligo and this instrument may be useful both in the clinic and in clinical trials.
Indian journal of dermatology, venereology and leprology 03/2013; 79(2):205-10. · 0.98 Impact Factor
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ABSTRACT: Psoralen + ultraviolet A (PUVA) therapy is an established modality for psoriasis. As India is a tropical country that has good availability of natural sunlight psoralen + sunlight (PUVAsol) may be a more convenient option. To compare the efficacy and cost-effectiveness of PUVA versus PUVAsol in chronic plaque psoriasis. Cases of chronic plaque psoriasis with body surface area ≥10% or Psoriasis Area and Severity Index (PASI) ≥10, excluding erythrodermic or pustular psoriasis, were randomized to receive either PUVA or PUVAsol, with endpoint being the achievement of PASI 90 or completion of 12 weeks treatment, whichever is earlier. Cost analysis was also undertaken. Thirty-six cases (16 in PUVA and 20 in PUVAsol group) completed treatment. In the PUVA group, 15 cases (93.75%) responded to therapy while in the PUVAsol group, 15 (75%) responded (P = 0.29). Mean baseline PASI in the PUVA and PUVAsol groups was 16 and 14.4, respectively, and at endpoint was 1.62 and 3.77. There was a significantly greater reduction in PASI in the PUVA group at 2 and 4 weeks but at 8 and 12 weeks and endpoint, it was comparable. Treatment failure occurred in 6.25% and 25% of cases respectively (P = 0.29). Side effects were higher with PUVA. Total cost of therapy was significantly higher in the PUVA group (P = 0.002). Cost-effectiveness ratio was US$0.72 with PUVA and US$0.37 with PUVAsol. Both PUVA and PUVAsol were equally efficacious, with PUVAsol being twice as cost effective. Hence, PUVAsol may be recommended as treatment for psoriasis in a developing economy such as India.
International journal of dermatology 02/2013; · 1.18 Impact Factor
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Journal of Cutaneous and Aesthetic Surgery 07/2012; 5(3):159-62.
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ABSTRACT: Child abuse is a major public health crisis and is on the rise. Dermatologists are frequently involved in its evaluation in differentiating abusive injuries from accidental injuries and in excluding pathological conditions that may mimic abuse. Battered child syndrome or physical abuse is not only a common form of child abuse but can also result from a rarer form of child abuse known as Munchausen syndrome by proxy. In this form of abuse, mother, who is the usual perpetrator, induces an illness or abuses the child for her own self-serving psychological needs.
We report two cases of battered child syndrome. In both the cases, Psychiatric evaluation was performed on both parents. Observation through one-way mirror was done with the mother and the child alone. Routine hematological and biochemical investigations were done.
Diagnosis of Munchausen syndrome by proxy was firmly established in one case and was considered as a possibility in the other.
A multidisciplinary team effort is essential in evaluating such cases, and dermatologists should be aware and be well informed about this condition that can be potentially lethal but easily overlooked.
International journal of dermatology 06/2010; 49(6):679-83. · 1.18 Impact Factor
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International journal of dermatology 05/2010; 49(5):565-9. · 1.18 Impact Factor
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ABSTRACT: Vascular malformations have devastating cosmetic effects in addition to being associated with pain and bleeding. Sclerotherapy has been successfully used in treating complicated hemangiomas and vascular malformations.
To assess the efficacy of sclerotherapy with 3% sodium tetradecyl sulphate (STS) in venous and lymphatic malformations.
We performed sclerotherapy with 3% STS in 13 patients with venous malformations and microcystic lymphatic malformation, all low-flow malformations and with extent predominantly to the subcutis, confirmed using Doppler ultrasound. Lesions were located on the face, lower lip, flanks, buttocks, and extremities. Patients presented for cosmetic reasons, pain, or bleeding. Sclerotherapy was undertaken as an office procedure without any radiological guidance and therapy repeated every 3 weeks. Therapeutic efficacy was assessed subjectively clinically and photographically.
The lesions regressed by 90% to 100% in 11 cases after a mean of four injections, with no improvement in two cases (one each of venous malformation and lymphatic malformation). Complications included cutaneous blister formation, erosions, and crusting at injection site in seven cases and atrophic scarring in four patients.
Sclerotherapy with 3% STS is a simple, safe, and effective modality for venous malformations and can be undertaken as an office procedure in lesions limited to the subcutis.
Dermatologic Surgery 03/2010; 36(3):340-6. · 1.80 Impact Factor
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ABSTRACT: Lichen planus (LP) and lichen nitidus (LN) present with varied morphology on the palms and soles. We present four unusual cases of palmoplantar LP and LN manifesting as hyperkeratotic plaques with pits. The diagnosis was confirmed histologically. Subtle features like presence of violaceous border suggests LP and plugs within the pits suggest LN.
Indian Journal of Dermatology, Venereology and Leprology. 01/2010;
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Indian Journal of Dermatology, Venereology and Leprology. 01/2010;
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Indian Journal of Dermatology, Venereology and Leprology. 01/2009;
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Indian Journal of Dermatology, Venereology and Leprology. 01/2009;
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ABSTRACT: Secondary mucin deposition in the skin is a common feature of lupus erythematosus and dermatomyositis. In scleroderma, it occurs uncommonly or in small amount. We describe a 7-year-old boy with progressive, linear, bound-down plaques involving the thighs, lower abdomen and back with no systemic involvement. Histopathology showed features of scleroderma with abundant mucin deposition in the reticular dermis. This report highlights excessive mucin deposition in lesions of morphea.
Indian Journal of Dermatology, Venereology and Leprology. 01/2009;
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ABSTRACT: Pemphigus vulgaris (PV) is classical example of antigen-driven severe autoimmune bullous skin disorder. Auto reactive T cells are critical for the induction and regulation of antibody production. With regard to cytokine production profiles, it has been reported that qualitative as well as quantitative alterations in cytokine production can result in activation of inefficacious effector mechanisms and therefore, complex and severe impairment in immune functions. The purpose of this study was to observe the alterations in the levels of T(H)1 [Interleukin-2 (IL-2), Interferon-gamma (IFN-gamma)] and T(H)2 (IL-4 and IL-10) cytokines in the sera from patients affected with PV and compared with Pemphigus foliaceus and healthy subjects. This work is aimed to comprehend the involvement of T(H)1 and T(H)2 cells as inflammatory infiltrate in the modulation of acantholysis and production of pemphigus lesions. Seventy PV, 13 PF and 50 healthy, age-matched individuals without any generalized skin diseases were included in this study. The diagnosis of PV and PF patients was confirmed by histopathology (hematoxylin and eosin) and / direct immunofluorescence. The levels of T(H)1 cytokines (IL-2 and IFN-gamma) and T(H)2 cytokine markers (IL-4 and IL-10) were estimated by high sensitivity ELISA kits. All patients with PV and PF showed significantly (p < 0.000) elevated levels of T(H)2 cytokines (IL-10 and IL-4) as compared with healthy controls. However, the mean concentration of T(H)1 cytokines (IL-2 and IFN-gamma) was significantly decreased in patients as compared to healthy individuals. Both T(H)1 and T(H)2 cytokines did not show any significant difference between PV and PF cases. Current concepts support the idea that PV, induced by autoantibodies against Dsg3, is the consequence of an imbalance between Dsg3-reactive T(H)2 and T(H)1 cells that may be critical for the maintenance of tolerance against Dsg3. Cytokine profile for confirmed PV cases showed direct evidences for involvement of T cell responses. Increase in IL-4 and IL-10 shows induction of T(H)2 cells in the pathogenesis of autoimmune disorders Pemphigus vulgaris. The decreased levels of IL-2 and IFN-gamma might demonstrate the inhibitory effects by IL-4 and IL-10, which suppress the expansion of T(H)1 population.
Immunological Investigations 01/2009; 38(6):498-509. · 1.47 Impact Factor
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ABSTRACT: Background: In various case series, pulse therapy has shown good results in pemphigus vulgaris (PV), with long-term remissions. Aims: To compare the efficacy and side-effects of dexamethasone-cyclophosphamide pulse and daily oral cyclophosphamide (DCP+C) versus cyclophosphamide pulse and daily oral prednisolone (CP+P) in PV. Methods: Twenty-eight active PV patients were randomized to receive either DCP with daily oral cyclophosphamide (Group A, n = 15) or CP with tapering doses of daily oral prednisolone (Group B, n = 13) for 12 months and followed-up for at least 3 months after stopping therapy. They were compared for time taken to achieve mucocutaneous disease control, achieve remission, relapse during treatment period, relapse after stopping therapy and side-effects. Results: Of 28 cases, 25 (Group A - 15, Group B - 10) completed the study period and were analyzed. The time for initiation of cutaneous response and time to achieve complete disease remission were significantly lesser in group B. However, other efficacy parameters were comparable. In Group A, significant adverse events were dysgusea, hiccups, palpitation, nail discoloration, bone pain and urinary tract infection while in Group B, they included nausea, moon facies, flushing, secondary amenorrhea, steroid withdrawal symptoms and dyspnea due to weight gain. Conclusions: Early remission was achieved in group B but the relapse rates during the treatment phase or after stopping therapy were comparable. Both therapies had comparable side-effect profiles, although Group B showed greater steroid-induced adverse events.
Indian Journal of Dermatology, Venereology and Leprology. 01/2009;
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ABSTRACT: Introduction: Cryotherapy is a controlled and targeted destruction of diseased tissue by the application of low temperatures. It is a simple, cost-effective, efficacious and esthetically acceptable modality for the treatment of various dermatoses. Indications: It is indicated in the treatment of a wide variety of skin conditions, including benign tumors, acne, pigmented lesions, viral infections, inflammatory dermatoses, infectious disorders and various pre-malignant and malignant tumors. Facility: Cryosurgery is an out patient department procedure and can be undertaken in a clinic or minor procedure room. Instrumentation and Equipment: Several cryogens such as liquid nitrogen, nitrous oxide and carbon dioxide are available, but liquid nitrogen is the most commonly used. Techniques: Different techniques of application of the cryogen include the timed spot freeze technique (open spray and confined spray method), use of cryoprobe or the dipstick method. The choice of the method is based on the type of lesion. The procedure is undertaken under aseptic conditions, usually without any anesthesia. The number of freeze thaw cycles needed may vary from lesion to lesion. It is important to know the freeze time for each condition, number of sessions required and the interval between the sessions to achieve good cosmetic results with minimal complications. Contraindications: The treating physician should be aware of the absolute and relative contraindications of the procedure, such as cold urticaria, cryoglobulinemia, Raynaud′s disease, collagen vascular diseases, etc. Complications: While cryosurgery is usually a safe procedure, complications may occur due to inappropriate patient selection, improper duration of freezing and freeze thaw cycles. The complications may be acute, delayed or protracted. In Indian skin, post-inflammatory pigmentary changes are important but are usually transient. Physician qualification: Cryotherapy may be administered by a dermatologist who has acquired adequate training during post-graduation or through recognized fellowships and workshops dedicated to cryotherapy. He should have adequate knowledge of the equipment and pre- and post-operative care. Understanding the underlying pathology of the lesion to be treated, particularly in malignant and pre-malignant lesions, is important.
Indian Journal of Dermatology, Venereology and Leprology. 01/2009;
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ABSTRACT: Ayurvedic medicines are known to contain arsenic and concentrations up to toxic levels have been reported in certain formulations. However, clinical disease due to arsenic containing ayurvedic medicines has rarely been reported. We seek to highlight the existence of toxic levels of arsenic in certain ayurvedic preparations that can produce serious systemic manifestations.
An 11-year-old girl developed manifestations of arsenical keratosis (punctuate palmoplantar keratoderma and leucomelanoderma) and non-cirrhotic portal hypertension, 6 months and 18 months respectively after intake of ayurvedic medications, prescribed for epilepsy. The eight ayurvedic preparations consumed by the patient and her serum levels were analyzed for arsenic content.
Arsenic content of ayurvedic medicines ranged from 5 mg/L to 248 mg/L. The serum arsenic level was 202.20 microg/L (normal < 60 microg/L). Skin manifestations improved after the discontinuation of ayurvedic medications.
Ayurvedic medications should be consumed under strict guidance and supervision of qualified practitioners to prevent such catastrophies.
International journal of dermatology 06/2008; 47(6):618-21. · 1.18 Impact Factor
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ABSTRACT: Cutaneous tuberculosis shows wide clinical variation depending upon the virulence of the organism and host immunity. Tuberculids are difficult to diagnose since the organism often cannot be identified or isolated by microscopy, culture or polymerase chain reaction. The diagnosis rests primarily on the identification of a tuberculous focus elsewhere in the body and response to antitubercular therapy. We present the clinicopathological features of an unusual tuberculid in a 30-year-old man, remarkably mimicking Kyrle's disease. He presented with multiple, symmetrically distributed follicular and perifollicular verrucous papules, nodules and plaques on the face, earlobes and extremities since 4 years. Histopathology revealed parakeratotic follicular plug invaginating into the dermis with multiple caseating epithelioid cell granulomas. PCR for M. tuberculosis was negative. The identification of associated axillary tubercular lymphadenitis, strongly positive Mantoux reaction, tuberculoid granulomas on histopathology and complete resolution of the lesions with antitubercular therapy helped in making the diagnosis. We propose the term "verrucous tuberculid" for this entity.
International Journal of Dermatology 01/2008; 46(12):1298-301. · 1.14 Impact Factor
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ABSTRACT: Background: Pulsed dye laser (PDL) has revolutionized treatment of vascular dermatoses. It has been successfully employed to treat several non-vascular conditions in fair skinned individuals without producing significant pigmentary and textural complications. Aim: A preliminary study was undertaken to assess its efficacy in cosmetically distressing facial, vascular and non-vascular dermatoses in Indian patients with skin types IV and V. Materials and Methods: Nine patients of ages 7 to 55 years, with facial verruca plana (VP- 4 cases), angiofibromas (AF- 4 cases) and multiple pyogenic granulomas (PG- one case) were recruited. They had no systemic complaints. Laser parameters used were (spot size/fluence/wavelength/pulse duration):VP- 5mm/5.5-7.5J/585nm/0.45ms; AF-5mm/6-8.5J/585nm/0.45ms;PG- 5mm/7J/585 and 595nm alternately/1.5ms. Response was assessed clinically and photographically. Results and Conclusions: All VP lesions completely resolved after 2-4 sessions (mean 3.25 sessions), AF showed 50% regression in all cases after 2-3 sessions (mean 2.5 sessions) and ≥75% subsidence after 3-7 sessions (mean 5.5 sessions) and in PG, after 3 sessions, there was complete subsidence of small satellite lesions with moderate shrinkage of larger papules and complete resolution after 5 sessions. Complications included transient hyperpigmentation/hypopigmentation only. There was no recurrence during next 6 months. PDL offers significant cosmetic improvement in facial dermatoses in Indian patients.
Indian Journal of Dermatology. 01/2008;
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Indian Journal of Dermatology, Venereology and Leprology. 01/2008;
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Indian Journal of Dermatology, Venereology and Leprology. 01/2008;
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ABSTRACT: Pulsed dye laser (PDL) has revolutionized treatment of vascular dermatoses. It has been successfully employed to treat several non-vascular conditions in fair skinned individuals without producing significant pigmentary and textural complications.
A preliminary study was undertaken to assess its efficacy in cosmetically distressing facial, vascular and non-vascular dermatoses in Indian patients with skin types IV and V.
Nine patients of ages 7 to 55 years, with facial verruca plana (VP- 4 cases), angiofibromas (AF- 4 cases) and multiple pyogenic granulomas (PG- one case) were recruited. They had no systemic complaints. Laser parameters used were (spot size/fluence/wavelength/pulse duration):VP- 5mm/5.5-7.5J/585nm/0.45ms; AF-5mm/6-8.5J/585nm/0.45ms;PG- 5mm/7J/585 and 595nm alternately/1.5ms. Response was assessed clinically and photographically.
All VP lesions completely resolved after 2-4 sessions (mean 3.25 sessions), AF showed 50% regression in all cases after 2-3 sessions (mean 2.5 sessions) and > or =75% subsidence after 3-7 sessions (mean 5.5 sessions) and in PG, after 3 sessions, there was complete subsidence of small satellite lesions with moderate shrinkage of larger papules and complete resolution after 5 sessions. Complications included transient hyperpigmentation/hypopigmentation only. There was no recurrence during next 6 months. PDL offers significant cosmetic improvement in facial dermatoses in Indian patients.
Indian Journal of Dermatology 01/2008; 53(4):186-9.
