Search

Wegener's Granulomatosis with polyangiitis (GPA) is a systemic disease of unknown etiology characterized by necrotizing granulomatous inflammation, tissue necrosis, and variable degrees of vasculitis in small- and medium-sized blood vessels. The classical clinical triad consists of involvement of the upper airways, lungs, and kidneys. Saddle-nose deformity is a well-recognized complication of GPA but more commonly occurs due to leprosy, trauma, cocaine abuse, and sarcoidosis. Since this entity is not commonly encountered in our country, we present a unique case of a middle-aged woman presenting with saddle-nose deformity and the diagnostic dilemmas faced by us. This case is being reported due to its rarity in Indian literature.

Epithelioid angiosarcoma (AS) is a rare vascular tumor affecting more commonly men in their seventh decade. We are reporting a case of epithelioid AS affecting a male patient in his third decade. He presented with a well-defined ulcerated plaque with an elevated border on the scalp. Histopathology showed sheets of epithelioid cells infiltrating the dermis, formation of slit-like vascular spaces, and cellular atypia. Immunohistochemistry showed positive CD31, D2-40, and FLI-1 and negative cytokeratin and epithelial membrane antigen. With these findings, a diagnosis of epithelioid AS was made. This case highlights the rare occurrence of this condition in younger age group.

Bullous pemphigoid (BP) is an autoimmune blistering disorder affecting elderly people. It presents as tense blisters on urticarial base and is associated with intense pruritus. It commonly involves lower abdomen, inner or anterior thighs, and flexor forearms. Localized BP limited to certain parts of the body has also been described in literature. Both classical and localized BP is diagnosed based on histopathology and immunofluorescence. Corticosteroids remain the main stay of treatment. Here, we describe a case of BP presenting as malar blistering closely mimicking bullous systemic lupus erythematosus.

Title: Secukinumab efficacy and safety in Indian patients with moderate-to-severe plaque psoriasis: sub-analysis from FIXTURE (Full Year Investigative Examination of Secukinumab vs. Etanercept Using Two Dosing Regimens to Determine Efficacy in Psoriasis), a randomized, placebo-controlled, phase 3 study. Background: Evidence has suggested Interleukin (IL)-17A to be an important effector cytokine in the pathogenesis of psoriasis. Here, we report results for an Indian sub-population from a multinational study FIXTURE, designed to assess the safety, tolerability, and long-term efficacy of fully human anti–IL-17A monoclonal antibody secukinumab in patients with moderate-to-severe plaque psoriasis. Materials and Methods: In this double-dummy, placebo controlled, 52-weeks phase 3 study FIXTURE, 149 Indian patients were randomized 1:1:1:1 to receive secukinumab at a dose of 300 mg or 150 mg, etanercept, or placebo. The study objective was to show the superiority of secukinumab over placebo at week 12, vis-à-vis proportion of patients achieving a reduction of 75% or more from the baseline in the psoriasis area-and-severity index score (PASI 75) and a score of 0 (clear) or 1 (almost clear) on a 5-point modified investigator's global assessment (IGA mod 2011) (co-primary end points). Results: At week 12, 61.0% and 55.9% patients in secukinumab 300 mg and 150 mg groups, respectively, achieved PASI 75 response compared to 20.0% in the etanercept and 7.1% in the placebo groups. Similarly, IGA mod 2011 0 or 1 response was achieved by 43.9% and 20.6% in patients in the secukinumab 300 mg and 150 mg group, respectively, vs. 13.3% in the etanercept and 2.4% in the placebo groups at week 12. Likewise, higher proportions of patients in secukinumab 300 mg (41.5%) and 150 mg (20.6%) group were PASI 90 responders at week 12 than those in the etanercept (10.0%) or placebo (0.0%) groups. The incidences of adverse events (AEs), during the induction period were similar in all the treatment groups. Overall secukinumab was well-tolerated at both doses in the Indian sub-population. Conclusion: The results from the Indian sub-population suggest that secukinumab is an efficacious and safe drug for use in moderate-to-severe chronic plaque psoriasis

Context: Therapeutic wounding includes wounding the skin to induce pigmentation of the depigmented skin patches that was earlier used for repigmenting small patches of stable vitiligo. In this study, we have used the same principle to induce pigmentation in idiopathic guttate hypomelanosis (IGH) by spot peel with 88% phenol. Aims: To study the efficacy of phenol in causing repigmentation in IGH and its adverse effect profile. Settings and Design: Open prospective study. Materials and Methods: Twenty patients with 139 IGH macules were subjected to spot peel. Eighty-eight percent phenol was applied with an ear bud once a month for two sittings. Patients were assessed both subjectively and objectively after every session and at the end of 3 months of initiation of therapy. Results: Repigmentation was noted in 64% of IGH macules. More than 75% improvement was seen in 45% of the total IGH macules, while 41.5% showed 50-75% improvement at the end of three months. Persistent scabbing was the common adverse effect noted in 17.26% of lesions. Conclusion: Spot peel with 88% phenol is a safe, simple, cost-effective, outpatient procedure for IGH, which can be combined with other medical therapies.

Context: Hair loss is a common complaint among Indian women. For female pattern hair loss (FPHL), diagnosis is primarily clinical. In the early stages, it can be confused with other conditions. Histopathology is the diagnostic method of choice but requires multiple biopsies and can be disfiguring. Trichoscopy is an alternative noninvasive, rapid tool., Aim: The aim of this study is to study the hair density and hair diameter variance in relation with severity grading of FPHL., Settings and Design: Cross-sectional study., Materials and Methods: Ninety women aged 18 years and above were included in this cross-sectional study conducted at the dermatology department of Bangalore Medical College and Research Institute. Trichoscopic examination was done with a videodermoscope (Firefly DE300) at 20 and 70-fold magnification. Only those patients who met the trichoscopic diagnostic criteria for FPHL were included., Statistical Analysis Used: Descriptive statistics, ANOVA, and Spearman's correlation test for fitness of good, using Microsoft Excel data analysis tools., Results: Increase in disease severity from grade one to grade three positively correlated with a decrease in hair density over the frontal scalp ( P < 0.001) and the occipital scalp ( P < 0.001), decrease in average hair shaft diameter over both frontal and occipital scalp ( P < 0.001)., Conclusion: Trichoscopic tools, particularly hair density and hair diameter variance over both frontal and occipital scalp can be useful to help determine FPHL disease severity and its progression., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 International Journal of Trichology.)

Competing Interests: There are no conflicts of interest.

Earlobe keloids are commonly encountered in this era where ear piercing is routine in various traditions. Various medical and surgical methods have been tried for its management. Surgically, fillet flap surgery has better acceptability worldwide. Various difficulties are faced during keloid excision, and we hereby describe few innovative modifications (use of needle, hydrodissection, pressure dressing, bolster button) using cost-effective and simple materials (needles, dynaplast, buttons) to ease the excision of keloids. These have easy adaptability and also reduce the recurrence rate of earlobe keloids.

Background: Scars over the face are cosmetically and psychologically disturbing. Various techniques have been described and are being practiced in the management of these scars., Aims and Objectives: This study was undertaken to study the safety, effectiveness of using dermal grafts as fillers in the management of facial scars due to acne, chickenpox, trauma or any others., Materials and Methods: Fifteen patients with atrophic facial scars of varied aetiology and willing for surgery were considered for dermal graft technique. After pre-operative workup, subcision was done 2 weeks before planned surgery. Depending on the type of scar, grafts were inserted using pocket or road railing techniques. Scar improvement was assessed based on patient satisfaction., Results: Linear scars showed excellent improvement. Acne, varicella and traumatic scars also showed good improvement. However, two patients did not appreciate improvement due to marked surface irregularities as the scars were elevated. They were further subjected to LASER and chemical peel resurfacing., Conclusion: Dermal grafting can be used in the management of any round to oval facial scar which is soft, prominent and at least 4-5 mm across; linear scars at least 2-3 mm across and 3-4 cm in length. However, scars with prominent surface irregularities need further resurfacing techniques along with dermal grafting., Limitations: Limitations of the study include small sample size, and only subjective assessment of the scar has been taken into consideration to assess the outcome., Competing Interests: There are no conflicts of interest.

Pityriasis rosea is one of the commonly encountered papulo squamous disease in dermatology outpatient department. Its clinical presentations are varied, and it also has many atypical forms. We report a case of a male patient with classical Pityriasis rosea lesions limited to the patches of Hansen's disease. This is probably being reported for the first time in literature.

The terminology Cauliflower ear refers to the appearance of external ear, sequelae to underlying primary inflammation/infection. Trauma and secondary infection or perichondritis being the most common cause of cauliflower ear, this article describes a case of unilateral cauliflower ear due to multibacillary leprosy. This case shows the importance of skin smears and the histopathological identification and classification of leprosy patients with unusual lesions.

Background: Frictional dermal melanosis is aesthetically displeasing. Various modalities ranging from depigmenting agents to lasers have been tried but it continues to be a difficult problem to treat., Objective: To study and compare the efficacy of 15% trichloroacetic acid (TCA) and 50% glycolic acid in the treatment of frictional melanosis of the forearm., Materials and Methods: 40 patients of frictional melanosis of the forearm were included in the study. Patients were randomly divided into two equal groups A and B. Pre-peel priming was carried out with 12% glycolic acid and sunscreen for 2 weeks. Group A was treated with trichloroacetic acid (TCA-15%) peel and Group B with glycolic acid (GA-50%) peel. Four peels were done one every 15 days. Clinical photographs were taken to assess the response. Response to therapy was evaluated by both objective and subjective methods. The patients were followed up for 3 months after the last peel to note any relapse., Results: Both TCA and glycolic acid peels were effective in frictional melanosis. TCA showed better response compared to glycolic acid at the end of the treatment, both by subjective and objective methods. However, this difference was not statistically significant (P > 0.05). No permanent side effects were seen in any of the treated patients and the improvement was sustained without any relapse at 3 months., Conclusion: Chemical peeling with both tricholoroacetic acid (15%) and glycolic acid (50%) is safe and effective for the treatment of frictional dermal melanosis. Tricholoroacetic acid was found to be marginally superior to glycolic acid.

A case of necrotising fasciitis is being reported. Due to delay in diagnosis and treatment, patient developed contracture leading to flerxion deformity.