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This article discusses the integration of narrative medicine into dermatology residency training. Narrative medicine is the practice of recognizing and interpreting the stories of illness, allowing for a more holistic understanding of patients and their experiences. The article emphasizes the importance of listening, empathy, and non-judgment in building a narrative from patient interactions. It also explores how narrative medicine can complement the use of artificial intelligence in healthcare. The article highlights the significance of understanding the individual stories of those with skin diseases and calls for the implementation of a narrative medicine curriculum in dermatology training. It provides goals for such a curriculum, including enhancing observational skills, incorporating arts and humanities, and exploring social and cultural issues affecting skin health. The article suggests a pedagogic approach to developing narrative competence and addresses challenges and solutions for integrating narrative medicine into healthcare. It concludes by emphasizing the transformative power of narrative medicine in patient care and the need for a more inclusive and understanding medical practice. [Extracted from the article]

Objective: The objective of the study was to evaluate the spectrum of skin diseases among older patients in a coastal city of Southern India and its association with systemic illness. Materials and Methods: In this retrospective, cross-sectional study, medical records from the dermatology outpatient clinics were assessed. Patients over 60 years old and attending the dermatology outpatient clinic between November 2021 and June 2022 were included in the study. Results: Of 1182 records, 663 were male (56%) and 519 were female (43.9%). Most of the patients were in the age group between 60 and 70 years (71.7%). Overall, the most frequent dermatologic diseases in this cohort of patients were infections (41.37%), eczematous dermatitis (30.02%), and papulosquamous disorders (9.39%). Among the physiological changes of aging skin, xerosis was the most common manifestation observed in 66 (5.5%) cases, followed by seborrheic keratosis in 24 (2%) cases. Twelve (1.01%) individuals had premalignant and malignant lesions identified. Bowen's disease (n = 5, 0.4%), basal cell carcinoma (n = 6, 0.5%), and leukoplakia (n = 1) were the most prevalent. Conclusion: Dermatoses in the older population are among the most common causes of daily consultations. In our study, infectious causes of dermatoses are more common than eczematous diseases. We discovered a higher prevalence of premalignant diseases like Bowen's disease, emphasizing the need for screening in people of skin color. [ABSTRACT FROM AUTHOR]

Background: Melasma is a common acquired cause of facial hyperpigmentation seen predominantly among females with significant psychological and social impact. It is often recalcitrant to treatment. Several topical hypopigmenting agents have been used to combat melasma. Hydroquinone and Kojic Acid are well established monotherapeutic agents for treating melasma. Objectives: This study focuses mainly on the efficacy of once daily application of 4% Hydroquinone and 0.75% Kojic Acid cream (containing 0.75% Kojic acid and 2.5% vitamin C) so as to determine an effective modality of treatment for facial melasma. Materials and Methods: A total number of 60 patients with facial melasma attending the Out.patient department of Dermatology, Venerology and Leprosy, Fr. Muller Medical College Hospital, Mangalore from Oct 2008.April 2010 were studied. Patients were allocated alternately to group A and group B. Group A patients received 4% Hydroquinone cream and group B patient received a Kojic Acid cream (which contained 0.75% Kojic acid and 2.5% vitamin C) and were advised to apply topically once daily at night. Patients were followed up on 4th, 8th and 12th week. At each visit side effects were noted and clinical response to treatment was calculated using the MASI score. Statistical Methods: Chi square test, student 't' test. Results: At the 4th week post treatment evaluation, facial hyperpigmentation responded early to 4% Hydroquinone cream than to 0.75% Kojic Acid cream. At the end of 12 week treatment period, 4% Hydroquinone cream had an overall superiority to 0.75% Kojic Acid cream as a topical hypopigmenting agent. Conclusion: The results of the study show that 4% Hydroquinone cream is a better topical hypopigmenting agent with rapid rate of clinical improvement when compared to 0.75% Kojic Acid cream. [ABSTRACT FROM AUTHOR]

Competing Interests: There are no conflicts of interest.

Context: Keloids are defined as scars that invade the adjacent tissues and rarely regress. In recent years, antimitotic drugs have been used in the management of keloids with promising results. This study highlights the effectiveness of 5-fluorouracil (5-FU) in keloids., Aims: To study the efficacy of intralesional 5-FU in keloids as a solo agent and in combination with triamcinolone acetonide and to study the side effects of both the drugs., Methods and Materials: A total of 30 patients with keloids were randomly allocated into two groups. Group A received 50 mg/mL of 5-FU intralesionally. Group B patients received a combination of 40 mg/mL of intralesional triamcinolone acetonide and 50 mg/mL of 5-FU. The patients were observed for immediate and delayed complications and the treatment was continued for a total of 3 months., Statistical Analysis Used: ANOVA, Mann-Whitney test, Fisher's test, Chi-square test., Results: The patients in both groups showed a significant reduction in the size and thickness of the lesions. The reduction in the length of keloid was highly significant in both the groups but in comparison, there was no statistically significant difference in the reduction of lesions among both the groups. Hence, both modalities of treatment can be claimed to be equally efficacious. The therapeutic response was good to excellent in most patients with only one patient opting out of the therapy in the 5-FU group due to the inability to tolerate the pain. The common side effects noted were pain, itching, ulceration, burning sensation, and bulla formation., Conclusions: 5-FU, both as a single agent or in combination with steroids is equally efficacious in reducing the keloid size. The side effects are lesser with the combination group., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Dermatology.)

Context: Psoriasis is a common papulosquamous disorder characterized by increased epidermal turnover resulting in excessive skin shedding and a compromised barrier function of the skin. Transepidermal water loss (TEWL) is an effective and non-invasive way to measure the barrier function in this condition., Aims: To measure the physiological changes in the skin barrier function in psoriasis by measuring the extent of TEWL. To study the differences in TEWL in pathologically involved and uninvolved skin in psoriasis. To compare the TEWL in skin lesions in psoriatic patients and site matched controls., Subjects and Methods: To determine the barrier quality of the stratum corneum, we performed TEWL measurements using the closed chamber evaporation method (VapoMeter Delfin Technologies, Kuopio, Finland). The ambient temperature ranged between 21°C and 24°C, with a mean relative humidity range of 39%-50%. In total, four sites were measured for all the 50 cases, two involved plaques on the body were selected for the study of lesional psoriatic skin, and the standard sites of ankle and elbow were measured irrespective of being involved or uninvolved with psoriatic skin. TEWL measurements in controls were site matched. Statistical testing was done using SPSS ver. 17. The interval scale data were tested for normality using Shapiro-Wilk test, and between groups testing was done using Mann-Whitney test., Results: The TEWL was higher among the cases in all the four measured areas compared to the controls, thus showing overall impaired skin barrier function in psoriatic skin. In addition, among the cases, the involved sites show higher TEWL in comparison to the uninvolved skin. This is highly suggestive that plaques of psoriasis have reduced water holding capacity., Conclusions: Psoriasis is a dermatosis with overall compromise of the skin barrier function exhibiting exponential TEWL in lesional skin, with increased TEWL over non-lesional skin as well. Thus, it may be concluded that TEWL is an effective, non-invasive and objective method in assessment of skin barrier function., Competing Interests: There are no conflicts of interest.