Efficacy of Fractional CO2 Laser for Improvement of Limited Mouth Opening in Systemic Sclerosis

Background

Systemic sclerosis is a multisystem auto-inflammatory disease-causing fibrosis in the skin and internal organs. A frequent complication of systemic sclerosis is the limited mouth opening (LMO), a difficult-to-treat condition with only a few treatment options available.

Aims and Objectives

The aim of this study was to evaluate the response of fractional carbon dioxide (CO2) laser resurfacing in LMO associated with systemic sclerosis.

Materials and Methods

This was a hospital-based prospective study in which diagnosed cases of systemic sclerosis were taken. Patients who had significant LMO and who gave informed consent were included in the study. Fractional CO2 laser treatment was performed in the perioral area. Patients were assessed at baseline, after three and six sessions, and 3 months after the last session. Assessment was done by measurement of the interincisor distance (IID) using a ruler and calculation of the mouth handicap in systemic sclerosis (MHISS) scale.

Results

Improvement in IID occurred 3 months after the first session with a mean gain of +5 mm (range 2-7). At 6 months, a mean gain of +8.5 mm (range 7-10) in IID was observed (P < 0.001). The MHISS score decreased by a mean of 14 (range 11-17) (P < 0.001). All patients showed improvement of mouth opening, which allowed the patients to have better phonation and the patients were able to have proper dental care posttreatment in the form of brushing of teeth and other dental procedures. The adverse effects noted in these patients included erythema that resolved spontaneously or after icing posttreatment. Other adverse effects noted were stinging and burning sensations that were mild and transient.

Conclusion

Fractional CO2 laser forms a safe, effective, and well-tolerated treatment modality for improvement of LMO in systemic sclerosis.

Limitations

The limitations of this study were less number of patients and no long-term follow-up.

Intra-individual Right-Left Comparative Study of Combined Therapy of Intramatricial Triamcinolone and Platelet-Rich Plasma vs. Intramatricial Triamcinolone Only in Lichen Planus-Associated Nail Dystrophy

Background

While intramatricial triamcinolone is the most commonly used treatment option for onychodystrophy due to lichen planus, the role of platelet-rich plasma (PRP) in the treatment of onychodystrophy is not established. So we combined the two treatment modalities to assess the synergistic action on nail dystrophy.

Aims and Objectives

The aim of this article is to compare the effect of combination of intramatricial triamcinolone and PRP vs. intramatricial triamcinolone alone in the treatment of onychodystrophy.

Materials and Methods

This study was done in 26 and 25 pairs of symmetrical dystrophic nails in hands and feet, respectively. The patients received intramatricial injection of triamcinolone and PRP on one side of finger and toe nails and triamcinolone on the contralateral side.

Results

Statistically significant improvements in grades of dystrophy according to the Nail Dystrophy Grading System (NDGS) in the finger and toe nails treated with combined therapy were obtained (P < 0.001 and = 0.002, respectively). According to the physician global assessment, response to combination therapy was statistically significant between the two comparison groups of finger and toe nails (P = 0.001 and = 0.004, respectively). Similarly, according to the patient satisfaction score, statistically significant difference was found between the comparison groups of combination therapy and single therapy (P < 0.001).

Conclusion

Addition of PRP significantly improved the nail quality. Intramatricial PRP is a safe and effective therapeutic modality in refractory nail dystrophies.

Role of intralesional vitamin D3 in the treatment of cutaneous warts

Background:

Cutaneous warts are common benign skin lesions caused by human papillomavirus. Various treatment options are available for these but immunotherapy is becoming more and more popular over the past few years. It stimulates cell-mediated immunity causing clearance of warts.

Aims and Objectives:

The aim is to determine the role of intralesional vitamin D3 in the treatment of warts.

Materials and Methods:

Consecutive patients with verruca vulgaris attending OPD were included. Around two to three warts were injected first with 0.2 mL of lignocaine (20 mg/mL). After a few minutes, the same warts were injected with 0.2 mL (4 U) of vitamin D3 (15 mg/mL). The injections were given2 weeks apart for a maximum of six sessions, and the patient was followed up 3 months after the last injection.

Results:

A total of 41 patients of cutaneous warts completed the study. Complete clearance was seen in 27 (65.85%) patients, partial response was seen in 11 (26.83%) patients, and three patients (7.32%) showed no response at all. The mean number of injections required for complete response was four. Recurrence was seen in two patients (4.88%) and one patient had keloid formation at the sight of injection.

Limitation:

This is a small sample sized study and lacks a control group.

Conclusion:

Intralesional vitamin D3 is an effective treatment option for common warts.

Female Pattern Hair Loss-An Update

Female pattern hair loss (FPHL) is nonscarring progressive thinning of hair with gradual decrease in the number of hair, especially in the frontal, central, and parietal scalp, due to a process known as follicular miniaturization. The etiopathogenesis of FPHL is complex with multiple factors such as genetics, inflammation, hormones, and environment playing role in it. It usually manifests as slowly progressive hair thinning, mainly over the vertex and upper parietal scalp, the frontal hairline is often spared and the miniaturization is also not as severe as in men. A thorough history, clinical examination, hair loss evaluation tests, dermoscopy, and scalp biopsy can help in establishing the diagnosis. Various biochemical tests may be needed in patients with hyperandrogenism. The treatment includes medical and surgical modalities. Topical minoxidil is still considered the first line of treatment. Along with medical therapy, cosmetic camouflage may also be needed in some cases.

Clinicoepidemiological and Patch Test Profile of Patients Attending the Contact Dermatitis Clinic of a Tertiary Care Hospital in North India: A 7-Year Retrospective Study

Introduction:

Allergic contact dermatitis (ACD) is a growing concern due to increased use of cosmetics and topical medications routinely and exposure to a large number of allergens on day-to-day basis. Patch testing is a reliable method for detecting the causative antigens in suspected cases.

Aims and Objectives:

To assess the demographic profile, pattern of ACD, and patch test profile of suspected cases of ACD attending contact dermatitis clinic of our department.

Materials and Methods:

It was a retrospective study in which all the data enrolled in the contact dermatitis clinic of our department over a 7-year period were analyzed. Patch testing was done using the Indian Standard Series of 20 antigens primarily, and other batteries were used depending on patient requirement and availability.

Results:

A total of 582 patients were enrolled in the contact dermatitis clinic over a period of 7 years. Hand eczema was the most common pattern seen in 268 cases followed by feet eczema, hand and foot eczema, facial eczema, forearm and leg eczema and photoallergic contact eczema. A total of 177 patients (30.4%) gave positive patch test results, with nickel sulfate being the most common allergen identified followed by potassium dichromate, cobalt sulfate, paraphenylenediamine, neomycin sulfate, and fragrance mix.

Conclusion:

Common allergens identified in our study were more or less similar to studies from other parts of India. However, due to the unique climate of the valley, the profile of parthenium sensitivity was low in our study when compared to the rest of the country.

Can Dermoscopy Serve as a Diagnostic Tool in Dermatophytosis? A Pilot Study

Background

Dermoscopy has been shown to be a useful tool in assisting the noninvasive diagnosis of various general dermatological disorders.

Aim

The purpose of the study was to describe the dermoscopic findings in various dermatophytosis.

Materials and Methods

This cross-sectional study included 100 clinically diagnosed tinea infections of skin, hair, and nails, which were evaluated using a dermoscope (Dermlite 3 gen DL3N, California USA, 10x).

Results

Among 100 patients of dermatophytosis, 69 were males and 31 females. The maximum number of patients had tinea corporis, followed by tinea cruris and tinea capitis. Dermoscopic findings noted in cases of tinea corporis included diffuse erythema, follicular micropustules, and brown spots surrounded by a white-yellowish halo, broken hair, wavy hair, and rare, morse code hair. Dermoscopy of tinea capitis depicted comma hairs, corkscrew hairs, zigzag hairs, and morse code hairs. Proximal jagged edge, spikes, and longitudinal striations were present in the cases of onychomycosis. Dermoscopy of tinea incognito yielded morse code hairs, follicular micropustules, and easily deformable hairs that look weakened and transparent and show unusual bends.

Limitations

Dermoscopic findings were not correlated to fungal culture.

Conclusion

Dermoscopy can be used as a fast, inexpensive, and noninvasive diagnostic tool to enhance diagnosis of cutaneous fungal infections.

Role of Adjuvant Narrow Band Ultraviolet B Phototherapy in the Treatment of Chronic Urticaria

Background:

Chronic urticaria is a common dermatological disorder that causes a great deal of distress in patients and affects daily life. Narrow band ultraviolet B (NBUVB) has been shown to be an effective treatment in chronic urticaria in few studies. However, the data regarding its role in chronic urticaria are limited.

Aims and Objectives:

The aim of this study was to determine the role of NBUVB in the treatment of chronic urticaria in combination with antihistamine.

Materials and Methods:

A total of 80 patients of chronic urticaria were recruited, out of which 40 were allocated to NBUVB-loratadine group and 40 to loratadine group. Patients were assessed using urticaria activity score (UAS) at same point of time, i.e. after 4 weeks (8 sessions), 8 weeks (16 sessions) and at follow up of 4 weeks after stopping the treatment.

Results:

On comparing the two groups, the mean UAS was significantly lower after 8 and 16 sessions in NBUVB-loratadine group (12.03 v/s 21.43 and 3.54 v/s 17.16, respectively). The difference in reduction of UAS7 in two groups was seen to be statistically significant (P value < 0.01).

Conclusion:

Thus we conclude that NBUVB may be useful in the treatment of chronic urticaria.

Treatment of post-burn and post-traumatic atrophic scars with fractional CO2 laser: experience at a tertiary care centre

Scars are abnormal wound responses in predisposed individuals. They occur after any kind of wound and skin inflammation in predisposed individuals. Despite their benign nature, they can be aesthetically disabling. Although several approaches have been tried in their management, most of them have produced poor results. This study aims to assess the efficacy and safety of fractional CO₂ laser treatment in the management of post-burn and post-traumatic scars. One hundred consecutive patients (77 females and 23 males) affected by post-burn scars as well as post-traumatic atrophic scars were treated with monthly sessions of fractional CO₂ laser treatment. Patient's response to treatment was assessed clinically as well as improvement of scars by comparing the photographs taken before treatment with those taken 6 months after the last treatment session. Changes in skin texture, surface irregularity and pigmentation were assessed on a quartile grading scale and scored individually from 0 to 4. A mean of the three individual scores was calculated and the response was labelled as 'excellent' if the mean score achieved was > 3. A score of 2-3 was labelled as good response while a score below 1 was labelled as 'poor' response. A mean of six treatments per scar were required and all patients, followed up for 1 year after the last treatment, had optimum results and no recurrence. Response to treatment was excellent in 53.75%, good in 16.25% patients, and poor in 30% patients. Fractional CO₂ laser gives a very good result in the management of patients with post-burn scars as well as post-traumatic scars with minimal adverse effects.

Vitamin D Level in Alopecia Areata

Background:

Alopecia areata (AA) is an immune-mediated disease in which autoantigens play an important part in activating T-lymphocytes. Vitamin D has been associated with various autoimmune diseases, and Vitamin D receptors are strongly expressed in hair follicles and their expression in keratinocytes is necessary for the maintenance of the normal hair cycle.

Aim:

The aim of this study was to find the association between Vitamin D level and AA.

Materials and Methods:

This was a hospital-based cross-sectional study in which 50 patients with clinically and trichoscopically diagnosed AA cases, and 35 healthy age- and sex-matched controls were studied in summer months. Blood samples were taken from both cases as well as controls and samples were immediately processed by centrifugation (4000 rpm) at room temperature. Plasma 25-hydroxyvitamin D (25(OH)D) was analyzed by chemiluminescence method. A deficiency in Vitamin D was defined as serum 25(OH)D concentrations <30 ng/ml.

Results:

The mean body mass index in cases was 20.96 ± 1.91, whereas in controls, it was 21.37 ± 1.70 (P = 0.31). The mean serum 25(OH)D levels of AA patients was 16.6 ± 5.9 ng/ml, whereas in control group, the mean level was 40.5 ± 5.7, the difference being statistically significant (P < 0.001). A significant negative correlation was found between severity of alopecia tool score and Vitamin D level (P < 0.001; r = −0.730) and also between the number of patches and Vitamin D level (P < 0.001, r = −0.670).

Conclusion:

In our study, we found that the levels of 25(OH)D were low in AA patients when compared to healthy controls. Furthermore, there was a significant negative correlation between the levels of serum Vitamin D and severity of AA. Thus, the study suggests the role of Vitamin D in pathogenesis of AA and hence a possible role of Vitamin D supplementation in treatment of same.

Limitations:

Our study was limited by the lesser number of patients and lack of therapeutic trial of Vitamin D for these patients.

Evaluation of oral poliovirus vaccine delivery during the 1994 national immunization days in Pakistan

Pakistan conducted national immunization days (NIDs) for the first time in 1994. To estimate coverage, to evaluate risk factors for failure to be immunized, and to determine the effectiveness of mass media, parents of 1288 children in 714 households in four districts were surveyed after the first NID round. In each district, a high proportion of children (93%-96%) received oral poliovirus vaccine (OPV) during the NID. In three districts, unimmunized or partially immunized children were less likely to receive NID OPV than were fully immunized children (Kohistan, P < .001; Quetta, P < .001; and Sibi, P = .05). Although a high proportion of children in each age cohort received NID OPV, in three districts children 0-11 months of age were less likely to receive NID OPV than were older children. Television and radio reached a high proportion of survey households, but other mass media were less effectively utilized. Risk factor and media effectiveness surveys provide important information that is useful for planning future NIDs.