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   2016| July-December  | Volume 36 | Issue 2  
    Online since March 21, 2017

 
 
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ORIGINAL ARTICLES
Oral zinc sulfate in the treatment of recalcitrant warts
Eisha A Moniem, Rasha M Genedy, Rehab Moussa
July-December 2016, 36(2):34-38
DOI:10.4103/1110-6530.202637  
Background Cutaneous warts are benign papillomas of the skin caused by infection with human papillomavirus. The primary treatment methods of warts are physical destruction. However, these treatments are not suitable for patients with multiple lesions or with fear of pain and scarring. Therefore, immune-modifying agents might be a useful therapeutic alternative because they can be painlessly and easily administrated. Zinc is a trace element that is essential for the functioning of the immune system. It could counteract viral infections. Zinc sulfate is a promising therapy for the management of multiple warts. Aim The aim of this study was to determine the association of low serum zinc levels with persistent viral warts and to assess whether oral zinc sulfate was effective in treating persistent viral warts. Patients and methods This randomized case–control clinical trial was conducted on 40 patients. Eligible patients had five or more warts of at least 6-month duration resistant to one or more lines of treatment. Blood samples of all patients were taken to determine basic serum zinc level using spectrophotometry. Patients were randomly divided into two groups; each group consisted of 20 patients. Group I received oral zinc supplementation 10 mg/kg up to 600 mg maximum daily dose for 1 month. Group II did not receive any treatment. All of the patients were instructed not to take any other treatment during the trial. At the end of the study, the patients were assessed and the serum zinc level was remeasured. The percent of improvement of the warts was classified as follows: excellent, greater than 75%; moderate, 75–50%; mild, less than 50%; and no change. Results At the beginning of the study, the mean serum zinc level in group I was 85.95 μg/dl and that in group II was 81.30 μg/dl. However, at the end of the study, the mean serum zinc level in group I was 115.61±19.69 μg/dl and that in group II was 81.90±36.04 μg/dl. Serum zinc level significantly increased after treatment compared with that before treatment in group I (P=0.013); moreover, it became significantly higher than that in group II (P=0.006). The significant increase in serum zinc level in group I was associated with more clinical improvement in the warts. Shorter duration of the disease was associated with better response. Patients with excellent improvement had significantly higher serum zinc level than those with no improvement. Conclusion Our findings suggest that oral zinc supplementation should be considered as a therapeutic option in the treatment of recalcitrant multiple warts. Zinc deficiency is relatively common in our population. Oral zinc supplementation was associated with elevation of serum zinc level, which was associated with clinical improvement in the warts.
  8,116 1,797 -
Serum concentration of 25-hydroxy vitamin D in psoriatic patients in a tertiary care hospital: a case–control study
Latha Srirama
July-December 2016, 36(2):29-33
DOI:10.4103/1110-6530.202642  
Background Vitamin D is a fat-soluble vitamin and synthesized in the skin from 7-dehydroxy cholesterol during exposure to ultraviolet B. Vitamin D is essential for calcium homeostasis, bone growth, and immune regulation. Vitamin D deficiency causes rickets, osteomalacia, osteoporosis, and muscle weakness. Vitamin D deficiency is associated with cancers, cardiovascular diseases, schizophrenia, wheezing illness, and autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, type 1 diabetes mellitus, multiple sclerosis, Crohn’s disease, psoriasis, vitiligo, and chronic urticaria. Objective The main objective of this study was to analyze the 25-hydroxy vitamin D status of patients with psoriasis in comparison with controls without psoriasis. Patients and methods This study included 30 patients (age-matched and sex-matched controls) from the Outpatient Department of Narayana Hospital Dermatology Department in Nellore, Andhra Pradesh. All patients and controls were studied during the 4-month period from July 2015 to October 2015. Results Serum 25-hydroxy vitamin D levels were significantly lower in psoriatic patients than in controls even after adjusting for confounding factors in a multivariate analysis. Low 25-hydroxy vitamin D levels were positively associated with psoriasis and BMI in multiple linear regression analysis. Psoriatic patients with BMI greater than or equal to 27 kg/m2 had a higher risk for 25-hydroxy vitamin D insufficiency. Limitations Further studies with larger numbers of patients are required to analyze the pathogenic mechanisms underlying the relationship between 25-hydroxy vitamin D deficiency and psoriasis. Conclusion The 25-hydroxy vitamin D values are significantly lower in psoriatic patients than in controls. Low 25-hydroxy vitamin D levels are positively associated with psoriasis and with obesity.
  1,743 3,307 -
Expression of hair follicle stem cell markers CD34 and CK15 in scarring alopecia
Inchara K Yeliur, Rajalakshmi Tirumalae, Ishwara Bhat, Anil Abraham
July-December 2016, 36(2):39-42
DOI:10.4103/1110-6530.202643  
Introduction Pathogenesis of scarring alopecia (SA) is poorly understood with recent studies implicating loss of follicle stem cells (FSC). Objectives The aim of the present study was to examine the expression patterns of FSC markers CK15 and CD34 in SA and to compare them with biopsies from normal and non-SA cases. Materials and methods Twenty-one cases of SA were assessed using CK15 and CD34 immunostains. Biopsies from normal scalp and alopecia areata (AA) cases were studied for comparison. Results CD34 was expressed in the outer root sheath of the lower segment of follicles in all normal, 33% of the AA and 33% of the SA cases. CK15 was seen in the outer root sheath of the upper segment of hair follicles in 100% of normal and AA biopsies, compared with 91% of SA. CK15 was expressed in the lower segment of the follicle in 9/10 cases of SA, which is hitherto undescribed. CK15 was also retained in the bulge in 84% of the SA cases. Conclusion CD34 FSCs are lost in most SA cases. CK15 FSC are retained in both the bulge and the rest of the follicle, signifying that stem cell destruction alone does not eventuate in hair loss. The aberrant distribution of CK15 also suggests that there may be compensatory mechanisms yet to be understood.
  1,487 237 -
Clinical profile of nail apparatus abnormalities in dermatology patients
Rubina Jassi, Ram Chander, Vibhu Mendiratta
July-December 2016, 36(2):51-56
DOI:10.4103/1110-6530.202639  
Introduction Anatomically, nail is a hard protective covering over the terminal phalynx, and this helps to avoid any injury, as well as enhances the sensory perception over the pulp of digits. The nail apparatus consists of nail plate, nail folds, nail bed, and hyponychium. Various Diseases may affect the nail, eg infections, papulosquamous disorder, habitual dosrde and tumorers. Patients and methods We included 250 patients aged more than 18 years presenting to our out patients department (OPD) primarily with nail complaints. A detailed history of the disease was taken, and all the 20 nails were examined. Relevant investigations (KOH scraping, pus culture sensitivity, or biopsy) were performed. Results The age of the patients varied between 18 and 85 years, with a mean value of 35.37±15.16 years. Male to female ratio was 1:1.06. About 24 patients belonged to the geriatric age group. In all, 50 (20%) patients had their disease directly related to their profession. The most common presenting complain was discoloration followed by deformity. Finger nails were more commonly involved. The most common diagnosis was onychomycosis (55.6%), followed by traumatic nail (6.4%), chronic paronychia (4.4%), acute paronychia (3.6%), lichen planus (3.6%), onychocryptosis (3.6%), and eczematous nail changes (1.6%). Conclusion Onychomycosis is the most common primary nail apparatus abnormality responsible for discoloration of nail presenting to dermatology OPD, followed by nail trauma, paronychia, lichen planus, and onychocryptosis.
  1,438 153 -
Usefulness of enzyme-linked immunosorbent assay in the diagnosis of pemphigus and bullous pemphigoid in upper Egypt: correlation with intensity score
Azza Mahfouz Abdel-Megaid, Hisham D Gaber, Amal T Abo-elghiet, Sohir K Sayed, Asma O Ahmed, Aya Y Badran
July-December 2016, 36(2):43-50
DOI:10.4103/1110-6530.202638  
Background The availability of complementary DNA clones for pemphigus and pemphigoid antigens has led to the production of recombinant proteins representing epitopes of native antigens Dsg1, Dsg3, BP180 and BP230, and to the development of related enzyme-linked immunosorbent assay (ELISA) systems. Objective The aim of this study was to evaluate the diagnostic value of Dsg1, Dsg3, BP180 and BP230 ELISAs in upper Egypt patients, and to assess its correlation with the severity of diseases. Patients and methods Forty-six patients with pemphigus and bullous pemphigoid were enrolled. The diagnosis was confirmed by means of histopathology and direct immunofluorescence. Autoantibodies against Dsg1, Dsg3, BP180 and BP230 were assayed using ELISA in the serum of pemphigus and bullous pemphigoid patients. In pemphigus vulgaris, anti-Dsg1 and anti-Dsg3 antibody titre were raised above the cutoff value in 88.5 and 96.1% of patients, respectively. A strong positive correlation between the titre of anti-Dsg1 and Dsg3 and the total Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) in (mucocutaneous) pemphigus patients (P<0.001) was detected. Moreover, a strong positive correlation between the titre of anti-BP180 and anti-BP230 and the total ABSIS score was found (P<0.001). Conclusion ELISA can be considered an important step in the laboratory diagnosis of pemphigus and bullous pemphigoid, especially as it is a simple, noninvasive and fast manoeuvre. Anti-Dsg1 Ab and anti-Dsg3 Ab ELISA values are correlated with the disease activity of pemphigus. Anti-BP180 and anti-BP230 Ab ELISA values are correlated with the disease activity of bullous pemphigoid.
  1,364 121 -
CASE REPORTS
A resistant case of pyoderma gangrenosum with monoclonal gammopathy of unknown significance showing excellent response to combination therapy of methyl prednisolone pulse and oral cyclosporine
Saswati Das, Najmus S Jamadar, Aloke K Roy
July-December 2016, 36(2):60-62
DOI:10.4103/1110-6530.202641  
Pyoderma gangrenosum (PG) is a rare and painful skin condition of uncertain etiology characterized by one or more areas of chronic ulceration with well-demarcated and undermined borders. PG often occurs in patients who have other diseases (arthritis, inflammatory bowel disease, hematologic dyscrasias, monoclonal gammopathy of unknown significance, etc). Immunosuppressive agents have been used for its management. Among them, although corticosteroid is known as the most effective agent, other immunosuppressants including cyclosporine have been selected for patients with PG who were refractory to systemic steroids. Here, we report a case of PG with monoclonal gammopathy of unknown significance, resistant to systemic steroids and cyclosporine, that was successfully treated with a combination of cyclosporine and methyl prednisolone pulse.
  1,157 103 -
A rare case of isolated extragenital bullous lichen sclerosus
Kajal Manchanda, Pallavi C Rohatgi, Sandip Mohanty
July-December 2016, 36(2):57-59
DOI:10.4103/1110-6530.202640  
Lichen sclerosus et atrophicus is a rare, chronic, mucocutaneous disorder of unknown etiology predominantly involving the anogenital skin and mucosa. It is rarely seen exclusively at an extragenital site. A 40-year-old man presented with multiple asymptomatic clear fluid-filled vesicles with shiny atrophic papules over bilateral thighs and the calf region for a period of 4 months. Histopathology confirmed the diagnosis of bullous lichen sclerosus. The patient showed significant improvement with topical clobetasol propionate 0.05% and tacrolimus 0.1% ointment.
  1,017 207 -
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