Thinking outside the skin: Look at the thyroid for true diagnosis

Keratoderma is a group of disorders characterized by abnormal thickening of skin. Acquired palmar keratoderma has many underlying causes. The association of thyroid disease and palmar keratoderma rarely reported. Hypothyroidism, although very rare association, must be suspected in patients with acquired PPK, particularly when it occurs in setting of systemic symptoms or predisposing conditions.We report first case of acquired plantar keratoderma associated with undiagnosed hypothyroidism in Down syndrome

Promising Option for Treatment of Striae Alba: Fractionated Microneedle Radiofrequency in Combination with Fractional Carbon Dioxide Laser

Background. A consistent treatment has not been proposed for treatment of Striae Alba (SA). The present study was designed to compare the fractionated microneedle radiofrequency (FMR) alone and in combination with fractional carbon dioxide laser (FMR + CO2) in the treatment of SA. Methods. Forty-eight pairs of SA from six patients were selected. Right or left SAs were randomly assigned to one of the treatment groups. The surface area of the SA before and after treatment and clinical improvement using a four-point scale were measured at the baseline, after one and three months. Results. The mean age of the patients was 30.17±5.19 years. The mean difference of the surface area between pre- and posttreatment in the FMR + CO2 group was significantly higher than that in the FMR group (p=0.003). Clinical improvement scales showed significantly higher improvement in the FMR + CO2 group than in the FMR group in the first and second follow-up (p=0.002 and 0.004, resp.). There were no major persistence side-effects in both groups. Conclusions. The results showed that FMR + CO2 laser was more effective than FMR alone in the treatment of SA

COVID-19 Associated Mucormycosis::A Review of an Emergent Epidemic Fungal Infection in 3 Era of COVID-19 Pandemic

At a time when the COVID-19's second wave is still picking up in countries like India, a number of reports describe the potential association with a rise in the number of cases of mucormycosis, commonly known as the black fungus. This fungal infection has been around for centuries and affects those people whose immunity has been compromised due to severe health conditions. In this article, we provide a detailed overview of mucormycosis and discuss how COVID-19 could have caused a sudden spike in an otherwise rare disease in countries like India. The article discusses the various symptoms of the disease, class of people most vulnerable to this infection, preventive measures to avoid the disease, and various treatments that exist in clinical practice and research to manage the disease

Interventions for hyperhidrosis in secondary care : a systematic review and value-of-information analysis

Background: Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. Objective: To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. Methods: A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. Results and conclusions: Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. Limitations: The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. Future work: Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses

Sun protection behaviors among children aged 6−18 years old, the role of socioeconomic factors: A cross‐sectional study

Abstract Background and Aims Evaluation of sun protection behavior and related factors in children aged between 6 and 18 years in Isfahan, Iran. Methods This cross‐sectional study was conducted at outpatient pediatric clinics affiliated with Isfahan University of Medical Sciences, Isfahan, Iran during the summer of 2021. A checklist was designed, and the interviewer used that to gather the required information including children's demographic characteristics, families' socioeconomic data, and sun‐protective behaviors in children. Results The mean ± standard deviation (SD) age of children was 10.54 ± 3.61. Among the study population, 63.7% of children were male. The most common skin phototypes were II and III (33.5% each). 83.8% of children used at least one method of sun protection (94.5% of girls, 77.6% of boys, p < 0.001). Wearing long‐sleeved clothes was the most frequent UV‐protection method (48%), while sunscreen application was the least prevalent method (28.1%). Sun protection behaviors were more frequent among urban children (86.7%, p = 0.009) and children with wealthy families (94%, p = 0.035). Sun protection methods were used by most of the children whose mothers applied sunscreen on a daily basis (90.2%, p = 0.002) and all of the children whose mothers held a master's degree or above (100%, p = 0.004). Conclusion Children's sun protection behavior is directly associated with demographic characteristics, families' socioeconomic level and maternal usage of sun protection measures. It is necessary to provide information and education about sun protection methods and the risks of excessive sun exposure to families and children, as well as facilitate their access to these

Erosive pustular dermatosis of the scalp following hair transplantation

Erosive pustular dermatosis of the scalp (EPDS) is a rare inflammatory disease with unknown etiology that usually occurs in the elderly. It is characterized by multiple sterile pustules, chronic crusted erosions, cicatricial alopecia, and skin atrophy. It typically develops in aged or sun-damaged skin and is most often accompanied by a history of local trauma. Histopathologically, non-specialized change manifests as atrophic epidermis and chronic inflammation. Although this disease mainly occurs in elderly white women, we here report a case of EPDS in a 35-year-old man, following hair transplantation as a local trauma, that was successfully treated with topical steroid

Looking beyond the cosmetic tattoo lesion near the eyebrow: Screening the lungs

Cosmetic tattooing has become a risk factor for several adverse reactions related to inks, procedures, and associated clinical conditions. Development of a sarcoid reaction to the inserted tattoo pigment in the skin is not common. We report a 45 year-old patient with history of dyspnea and mild cough since two years who had subsequently developed reddish, scaly lesions in her 15-year old tattoo done near her right eyebrow. Skin biopsy of the tattoo lesion revealed cutaneous sarcoidosis which led to further investigations and a diagnosis of pulmonary sarcoidosis. The present case highlights the fact that cutaneous sarcoidosis can develop in a long-standing tattoo. Also such a patient should be screened for systemic sarcoidosis disease