Knuckle lesions in inherited and acquired disorders

Skin lesions occurring over the knuckles can be a primary or characteristic manifestation of a disorder. Characteristic knuckle lesions may also be important cutaneous features of various internal disorders when they serve as useful clinical pointers, as well as may speak of the disease severity in certain instances. Furthermore, knuckle lesions also speak of various external factors as the underlying cause of the disease/lesions, such as trauma - occupational or otherwise, and contact dermatitis. Although knuckles essentially imply dorsal aspect of the metacarpophalangeal joints, many of the lesions described as those 'involving the knuckles' are seen over the proximal and/or less frequently, the distal interphalangel joints as well. This review presents a compilation of various inherited and acquired dermatoses and dermatological manifestations of various internal disorders associated with different forms of knuckle lesions.

Necrolytic Acral Erythema: Current Insights

Necrolytic acral erythema (NAE) is now considered as a distinct clinical entity. It clinically presents as well demarcated hyperpigmented papules and plaques with thick adherent scales distributed symmetrically over dorsum of feet. It usually develops in patients with Hepatitis C virus (HCV) infection. Cases of NAE have been reported in patients without HCV infection. Hepatic dysfunction resulting in metabolic alterations like hypoalbuminemia, hypoaminoacidemia, hyperglucagonemia and transient zinc deficiency has been proposed as underlying pathogenic mechanism of NAE. Clinically, NAE resembles other necrolytic erythemas like necrolytic migratory erythema (NME), acrodermatitis enteropathica (AE) and pellagra. Better understanding of etiopathogenesis and histopathological features is important to distinguish NAE from other necrolytic erythemas. The disease runs a natural course of exacerbations and remissions. Non-invasive diagnostic tools like dermoscopy can be used in differential diagnosis of NAE. Oral zinc therapy is the most effective treatment of NAE reported in most of the cases irrespective of HCV status or serum zinc levels.

Effect of yoga on blood glucose levels in patients with type 2 diabetes mellitus

INTRODUCTION

In view of people embracing sedentary life style, and the effectiveness of treatment becoming less, the role of regular exercise especially 'yoga' seems to be a beneficial and economical adjuvant in the management of the Type 2 diabetes mellitus (T2DM).

OBJECTIVES

To assess the beneficial effects of yoga on blood glucose levels in normal and T2DM volunteers.

MATERIALS AND METHODS

A prospective case-control study was conducted in the Department of Physiology and Diabetic clinic of a tertiary care teaching hospital over period of two years. The study subjects consisted of 30 male diabetic patients attending diabetic clinic and 30 non-diabetic male volunteers constituted control group. The patients in the age group of 36 to 55 years with T2DM of at least one year duration and those on diabetic diet and oral hypoglycemic agents were included in the study group. The age matched healthy male volunteers who had come to join yoga training at yoga centre were included in the control group. All the participants were trained by yoga experts and subjected to regular practice under supervision for six months. In all the participants fasting (FBS) and post-prandial blood sugar (PPBS) was estimated before, during (at three months) and after (six months) yoga training. Paired Student t-test was used to estimate difference in means calculated before and after yoga training in a same group. A p-value of <0.05 was considered as statistically significant.

RESULTS

The distribution of age, mean height and mean weight among both the groups were comparable. The reduction in mean values of FBS and PPBS at the end of six months was highly significant (p <0.001) in both the groups when compared with the mean values before and during (three months) yoga practice. The reduction in these values at three months during yoga was highly significant in T2DM group when compared with mean values before yoga (p <0.001), but it was insignificant (p<0.05) in control group.

CONCLUSION

The results of the present study demonstrated that the yoga is effective in reducing the blood glucose levels in patients with T2DM.

Light microscopy of the hair: a simple tool to "untangle" hair disorders

Light microscopy of the hair forms an important bedside clinical tool for the diagnosis of various disorders affecting the hair. Hair abnormalities can be seen in the primary diseases affecting the hair or as a secondary involvement of hair in diseases affecting the scalp. Hair abnormalities also form a part of various genodermatoses and syndromes. In this review, we have briefly highlighted the light microscopic appearance of various infectious and non-infectious conditions affecting the hair.