Clinicopathological study of discoid lupus erythematosus.

INTRODUCTION : Discoid lupus erythematosus is a benign disorder of the skin characterised by well defined, erythematous atrophic plaques covered by a prominent, adherent scale that extends into the orifices of dilated hair follicles. The disease affects twice as many females as males. The salient histopathological features of classic DLE lesion are hyperkeratosis with follicular plugging, liquefaction degeneration of basal cell layer of epidermis, degenerative changes in the connective tissue and patchy dermal lymphocytic infiltrate around the appendages. Immunohistology shows presence of immunoglobulins IgG, IgA, IgM and complement at the dermoepidermal junction in the skin lesions. The majority of researchers consider DLE to be part of a spectrum of the lupus erythematosus diseases (LE). Accordingly, the clinical expression of LE varies from DLE, a benign and strictly cutaneous form, to a systemic form with an unfavorable prognosis, known as Systemic Lupus Erythematosus (SLE). The risk of developing overt SLE is only approximately 6.5%. The risk is higher in patients with Disseminated DLE (22%) than in DLE confined to the head and neck (1.2%) . AIM OF THE STUDY : 1. To study the incidence of Discoid Lupus Erythematosus in Government General Hospital, Chennai during the period between July 2006 to September 2008. 2. To study the incidence of various clinical types of Discoid Lupus Erythematosus. 3. To study the age and sex distribution. 4. To study the commonest site of lesions. 5. To study the main presenting complaints and precipitating factors. 6. To study the relevant serological abnormalities. 7. To study the associated disorders. 8. To study Histopathological features in all cases and immunofluorescence pattern in selective cases. CONCLUSION : * The incidence of Discoid lupus erythematosus during the period from July 2006 to September 2008 was 1.7 per 1000. * The incidence of Localised and Disseminated discoid lupus erythematosus were as follows Localised DLE - 76% Disseminated DLE – 24% * The most common clinical presentation of localized DLE was localised circumscribed lesions (59%). * The maximum number of patients were in the age group of 31 – 50 years. * The female to male sex ratio was 2.3 : 1 * No familial cases were seen. * Peak incidence of localised DLE was between 31 to 40 years. Peak incidence of disseminated DLE was between 41 to 50 years. * Localised DLE was more common in females (77%) than males (23%) * Disseminated DLE was more common in males (58%) than females (42%). * Mucosal lesions were found in 27% of the patients. Patients with disseminated DLE had higher incidence of mucosal lesions (42%) than those with localised DLE (18%). * Mucosal involvement was more common in female patients (28%) than in males (25%). * Involvement of the lower lip was the commonest of the mucosal lesions. * The most common presenting complaint was burning sensation (39%) on exposure to sunlight. The most common exacerbating factor was sunlight (57%). * Scalp (38%) was the most common site involved in localized DLE. Trunk was involved in 92% of disseminated DLE patients. * Raynaud’s phenomenon was present in 6% of the patients. 12% of patients had complaints of joint pain. * Laboratory investigations showed anaemia in 25% and raised ESR in 57% of the patients. * ANA was found in 29% of the patients. ANA positivity was more common in disseminated DLE(42%) than in localized DLE (26%). * Anti-double stranded DNA was negative in all the patients. * Rheumatoid factor was positive in 33% of the patients. C reactive proteins was positive in 33% of the patients. * Histopathological study showed compatibility with the features of DLE in all cases, except one. One case showed features of lichen planus. Another case showed features of Verrucous DLE. * Direct immunofluorescence study showed moderately strong homogenous IgG, IgM, IgA and C3 at the basement membrane zone band in the lesional skin and negative findings in the uninvolved skin, features suggestive of Discoid Lupus Erythematosus in most of the cases. One case showed discontinuous ragged fibrinogen band in the basement membrane zone and IgG, IgM and C3 colloid bodies in the lesional skin. These features were suggestive of Lichen planus. * Neoplastic change was noted in 2% of the cases

Clinical studies to broaden the application and improve the safety of Psoralen and ultraviolet A (PUVA) phototherapies

This medical doctorate thesis contains clinical studies to broaden the application and to improve the safety and efficacy of ultraviolet (UV) A phototherapies, the main focus being to enhance the current clinical practice of topical psoralen photochemotherapy (PUVA. The thesis includes three studies: 1. The validation of a semi-automated Minimal Phototoxic Dose (MPD) Tester for topical photochemotherapy Thirty seven psoriasis patients referred to the phototherapy unit at St. Woolos, Newport were recruited. Patients had two sets of minimal phototoxic dose (MPD) tests performed on symmetrical, contralateral sites on the lower back. MPD test results from a panel of PUVA-lamps with a UV-opaque template and windows were compared to those from the modified hand-held MPD tester. The hand-held MPD results were linearly related to the PUVA-panel MPD results and this was therefore shown to be a convenient and reliable method of assessing MPD. However, the difference in MPD between the PUVA lamp and the modified handheld MPD tester (CFL TL-10 lamp) was much less than predicted from the PUVA action spectrum of previously published studies suggesting that formal re-evaluation of the erythema action spectrum for PUVA was now appropriate

Skin Diseases and Sexually Transmitted Infections

ПОСОБИЯКОЖНЫЕ БОЛЕЗНИДЕРМАТОЛОГИЯВЕНЕРОЛОГИЯИНОСТРАННЫЕ СТУДЕНТЫВЕНЕРИЧЕСКИЕ БОЛЕЗНИПособие охватывает как общие, так и редкие вопросы дерматологии и венерологии. Содержатся главы о кожных и венерических заболеваниях, которые являются общими для Азии, Африки и Латинской Америки

Endocrinology

ВГМУ; учебные пособия; эндокринологияПособие состоит из 12 глав, включающих материал по эндокринологии. Содержит материал о структуре, функции, методах диагностики и лечения наиболее распространенных заболеваний эндокринных желез. Книга учитывает базовые материалы и программные требования квалификационных экзаменов, требующихся для верификации медицинского диплома за рубежом

Skills in Rheumatology

This Open Access book presents practical approaches to managing patients affected by various rheumatological diseases, allowing readers to gain a better understanding of the various clinical expressions and problems experienced by these patients. Discussing rheumatology from an organ systems perspective, it highlights the importance ofdetailed musculoskeletal examinations when treating patients affected by rheumatological diseases. The book first explores the latest diagnostic approaches and offers key tips for accurate musculoskeletal examinations before addressing the various treatment modalities, with a particular focus on the most common joints involved in rheumatoid arthritis: the wrists and the metacarpophalangeal joints (2nd and 3rd). Featuring easy-to-understand flow diagrams and explaining the common medical problems associated with rheumatic disease, such as shortness of breath and anemia, it is not only a valuable resource to rheumatologists, but will also appeal to medical students, junior residents, and primary healthcare physicians

Skills in Rheumatology

This Open Access book presents practical approaches to managing patients affected by various rheumatological diseases, allowing readers to gain a better understanding of the various clinical expressions and problems experienced by these patients. Discussing rheumatology from an organ systems perspective, it highlights the importance ofdetailed musculoskeletal examinations when treating patients affected by rheumatological diseases. The book first explores the latest diagnostic approaches and offers key tips for accurate musculoskeletal examinations before addressing the various treatment modalities, with a particular focus on the most common joints involved in rheumatoid arthritis: the wrists and the metacarpophalangeal joints (2nd and 3rd). Featuring easy-to-understand flow diagrams and explaining the common medical problems associated with rheumatic disease, such as shortness of breath and anemia, it is not only a valuable resource to rheumatologists, but will also appeal to medical students, junior residents, and primary healthcare physicians