Patients manifesting rheumatodermatology diseases may seek the services of dermatologist or rheumatologist, based on the predominant symptom. Awareness regarding the varied clinical presentations is ...essential for proper diagnosis and management, often necessitating interdisciplinary care. Here, we comprehensively discuss the individual autoimmune and inflammatory conditions that are classified under the category of rheumatodermatology diseases.
Background: Microcirculation in the skin of psoriasis patients significantly differs from unaffected individuals. Vascular changes precede skin lesions and occur even in nonlesional skin. Aims: The ...primary aim of this work was to study the nailfold capillary changes in psoriasis patients, and to compare it with that of controls. The secondary aim of this work was to compare the nailfold capillary changes in psoriasis patients with and without nail changes. Methods: A comparative cross-sectional study of 40 psoriasis patients and 40 age and sex-matched controls analyzed the capillaries of the proximal nailfold of all fingers using a dermoscope. The mean capillary loop density/mm, tortuous capillaries, capillary hemorrhages, and avascular areas were assessed. Results: The mean nailfold capillary loop density in psoriasis (6.98 ± 0.54 per mm) was significantly less than that in controls (8.01 ± 0.61 per mm) (P < 0.001). Avascular areas in the nailfold of psoriasis patients (55%) were significantly more than the same in controls (22.5%) (P = 0.003). Of 40 psoriasis patients, 26 had nail psoriasis. Of this, 19 (73%) had avascular areas (P = 0.002). No significant association of nailfold capillary density or avascular areas with disease duration or severity was noted. An increase in tortuous capillaries and nailfold hemorrhages noted in psoriasis was not significant. Limitations: Small sample size, not having participants with psoriatic arthropathy, and lack of information on capillary diameter and capillary changes in hyponychium were the limitations. Conclusion: The reduced mean capillary loop density, and higher frequency of avascular areas noted in cases compared to controls, points to a pathogenic role for microvascular damage in psoriasis. Whether the lack of association of these changes with disease duration and severity suggests the possibility of these being early disease markers for psoriasis, needs further analysis in larger prospective studies.
Context: Drug reaction with eosinphilia and systemic symptoms (DRESS) and drug-induced hypersensitivity syndrome (DiHS) represent the same spectrum of a drug reaction. Aims: To compare the clinical ...profile of patients diagnosed as definite/probable DRESS by the Registry of Severe Cutaneous Adverse Reaction (RegiSCAR) scoring system and as atypical DiHS by Japanese consensus group criteria. Settings and Design: We did a retrospective study in a tertiary referral center. Materials and Methods: We included patients who satisfied the criteria for definite/probable DRESS and/or atypical DiHS and who received inpatient care in our department from January 2011 to December 2018. We compared the clinical and laboratory findings in patients diagnosed by the two criteria. Statistical Analysis: Pearson Chi-square test was used to compare the proportion of patients with severe reactions diagnosed by the RegiSCAR DRESS validation scoring system and the Japanese consensus group criteria. Results: Among the 390 case records reviewed, 138 patients could be classified as definite/probable DRESS and/or atypical DiHS. Japanese criteria did not diagnose atypical DiHS in 88/137 (64.2%) patients with definite/probable DRESS. RegiSCAR scoring system made a diagnosis of definite/probable DRESS in 49/50 (98%) patients with atypical DiHS. A total of 58/138 (42%) patients had a severe reaction. RegiSCAR scoring system diagnosed 57/58 (98.3%) patients with severe reaction as definite/probable DRESS. A total of 32/58 (55.2%) patients with severe reactions were diagnosed as atypical DiHS. The difference was statistically significant (<0.001). Conclusion: Japanese criteria for atypical DiHS showed reduced sensitivity to diagnose definite/probable DRESS, and this included more than 40% of patients with severe DRESS.
Introduction: In India, a large majority of patients with craniofacial microsomia are unable to undergo complex reconstructions owing to unaffordability, lack of access to good craniofacial centers, ...or reluctance of parents to accept the surgical risk. There is also considerable social stigma attached to the resultant facial scars of surgery, especially in a girl child. Hence, we have explored autologous fat graft transfer as a "stand-alone" reconstructive option for soft tissue camouflage and aesthetic correction of facial deformity in unilateral craniofacial microsomia of Pruzansky-Kaban Grades I and II. Materials and Methods: Twelve patients who were seeking aesthetic correction of facial deformity in unilateral craniofacial microsomia of Pruzansky-Kaban Grades I and II, and who had adequate fat in the preferred donor sites of lower abdomen and antero-medial thighs, were selected. Patients with Grade III deformity, facial palsy, and previous skeletal surgeries were excluded. Autologous fat harvesting was done with the standardized Coleman's technique and injected after decantation. Volumetric augmentation was assessed by clinical comparison with normal side for facial symmetry, skin pinch thickness at four reference points, and by two-dimensional analysis of pre- and postoperative standardized photographs at periodic intervals. Results and Analysis: Eleven of our patients were female and one was a male (N = 12). In each session, 20-40mL (mean 28.75 ± standard deviation SD 5.69) fat was aspirated and 12-35mL (mean 23.67 ± SD 6.07) fat was injected. The average operating time was 35min (mean 32.91 ± SD 4.05). Majority of our patients needed three sessions (mean 2.8 ± SD 1.03) of serial fat injections to achieve bilateral facial symmetry. Increase in skin pinch thickness was 6.4167 ± 1.31 mm. The mean patient satisfaction score was 8.83 ± SD .717. Conclusion: Based on our results, we conclude that autologous fat transfer, when used for soft tissue camouflage, is a versatile, easy, effective, and inexpensive method for obtaining consistent long-term aesthetic goals in mild to moderate cases of craniofacial microsomia.
Context: Pure neuritic leprosy is a risk factor for grade 2 disability owing to the early nerve damage. Aims: To study the clinical patterns of neuritic leprosy, to determine the percentage of ...patients manifesting grade 2 disability at the time of diagnosis and to identify any risk factors for the same. Settings and Design: Retrospective descriptive study from previous case records of pure neuritic leprosy patients who attended a tertiary centre from 1st July 2007 to 30th June 2017. Subjects and Methods: Data on patients who satisfied the World Health Organization (WHO) cardinal criteria for diagnosis of leprosy, who had no skin lesion of leprosy and had acid-fast bacilli negative status on skin smears were collected using a pre-set proforma. Statistical Analysis Used: The Chi-square test was used to assess statistical significance and logistic regression model was applied to avoid the effects of confounding factors. Results: A diagnostic delay of >1 year was observed in 44% patients. At the time of diagnosis, grade 2 disability was documented in 60 (80%) of patients. No statistically significant risk factor was identified for grade 2 disability. Limitations: Retrospective nature and the study conducted in a tertiary care centre not reflecting the status in the community were the limitations. Conclusions: Grade 2 disability noted in 80% of patients points to the inherent nature of disease to cause early nerve damage. Diagnostic delay of >1 year documented in 44% of patients underscores the diagnostic challenges in the absence of skin lesions.
Nail changes in leprosy: Onychoscopy evaluation Theunuo, Ruovinuo; Sasidharanpillai, Sarita; Ajithkumar, Kidangazhiathmana ...
Indian Dermatology Online Journal,
11/2020, Letnik:
11, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Context: Repeated trauma involving extremities (in the setting of peripheral neuropathy) and poor vascularity that impairs wound healing are important causes of disability and deformity in leprosy ...patients. Nail changes can serve as indicators of trophic changes due to leprosy. Aims: To describe the onychoscopy findings in leprosy cases and to identify any specific findings in leprosy patients in comparison to controls. Settings and Design: The first 30 leprosy patients and 30 age and sex-matched controls who attended our tertiary care center from 1 August 2018 were included in this cross-sectional study. Materials and Methods: Onychoscopy examination of all fingernails was performed at 50× magnification using dinolite dermoscope AM4113ZT under non-polarizing light to document surface changes and under polarizing light to document pigmentation and vascular changes. Statistical Analysis: The observed nail changes in cases and controls were compared using Pearson's Chi-square test. Results: Statistically significant association with leprosy was found for pitting, onycholysis, melanonychia, transverse lines, nail pallor, and onychauxis. Nail pallor was unique to leprosy patients. Limitations: Small sample size and not evaluating toenails were the major limitations of the study. Conclusions: Studies with large sample size are needed to assess the significance of nail pallor as a specific onychoscopy finding in leprosy.
Background: With the declared elimination of leprosy as a public health problem, the World Health Organization has shifted the focus on the disabilities and deformities associated with leprosy. Aims: ...The aim was to study the Grade 1 and Grade 2 disability among newly diagnosed leprosy patients. Materials and Methods: All newly diagnosed leprosy patients attending the Outpatient Department of Government Medical College, Kozhikode, from January 1, 2013 to December 31, 2013 were included in the study and the Grade 1 and Grade 2 disabilities observed were analyzed. Results: During the 1-year period, 76 patients were diagnosed to have leprosy. Grade 1 and Grade 2 disabilities were noted in 31.6% and 17.1%, respectively. Major factors identified as risk for leprosy disability at the time of diagnosis were age >45 years, >5 skin lesions, ≥2 thickened peripheral nerve trunks, pure neuritic and borderline tuberculoid spectra of leprosy. Limitation: As the study was conducted in a tertiary care center, it does not perfectly indicate the status in the community. Conclusion: Disability noted in nearly 50% of leprosy cases at the time of diagnosis highlights the need to improve the effectivity of existing health-care system in early case detection and timely referral. In addition, it underscores the need to educate the affected regarding protective eye, foot, and hand care, so that progression to Grade 2 disability can be prevented.
Context: Lepra reactions if not managed promptly are an important cause of sudden onset nerve palsy and disability due to leprosy. Aim: To evaluate the usefulness of histology in predicting type 1 ...lepra reaction. Setting and Design: After obtaining clearance from institutional research and ethics committees, all histologically proven borderline tuberculoid patients diagnosed at our center from 1.8.2016 to 31.7.2018 were included in this retrospective cross-sectional study. Method: Clinical details were collected from patient records. The pathologist who was blinded to clinical evidence of type 1 lepra reaction at the time of biopsy re-evaluated the histopathology slides for evidence of type 1 reaction. The data of individual patient was analyzed to identify those who had a type 1 reaction at the time of the biopsy or who developed a lepra reaction during follow up. Statistical Analysis Used: Association between histological evidence of type 1 reaction and clinical manifestation of the same subsequently, was assessed using Pearson's Chi square test. Results: Study group comprised of 22 females and 18 males. Clinicohistological concordance was noted in 27 patients (67.5%). Subclinical type 1 reaction was documented in 11 patients (27.5%) based on histopathology evaluation. Five (45.5%) of these 11 patients subsequently developed clinical features of type 1 reaction. This was found to be statistically significant (P value 0.02). Limitations: Main limitation was the small sample size. Conclusions: Histology could serve as a useful tool in predicting future type 1 lepra reaction.
Context: An umbrella term, acquired dermal macular hyperpigmentation (ADMH), has been proposed to denote conditions including ashy dermatosis, erythema dyschromicum perstans, lichen planus ...pigmentosus, and idiopathic macular eruptive pigmentation. Aims: To classify the patients manifesting ADMH on the basis of histology. Settings and Design: In this retrospective, cross-sectional study, histology specimens of patients of ADMH, who underwent skin biopsy in our institution from 1.1 2015 to 31.12.2017, were included after obtaining ethical clearance. Materials and Methods: The histology specimens of patients of ADMH were reviewed by the pathologist and classified. Clinical features of individual patient were collected from previous records and the data analyzed. Statistical Analysis Used: Pearson's Chi-square test was used to determine significance of association between age of onset and duration of pigmentation with histology type. Results: Three patterns of histology were identified in the study group (17 males and 13 females). Type 1: Basal cell degeneration and moderate to dense inflammation (12 patients, 40%), type 2: Significant pigment incontinence and sparse inflammation without basal cell degeneration, (12 patients, 40%), and type 3: sparse inflammation without basal cell degeneration or significant pigment incontinence (six patients, 20%). Statistically significant association was noted between age of onset of pigmentation and histology type (P value, 0.02). Limitations: Main limitation was the small sample size. Conclusions: Prospective studies evaluating the clinical progression and dermoscopy features and analyzing serial biopsies of ADMH patients may confirm whether the histology patterns observed represent different stages of same disease process or are different entities.
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