Acitretin-Induced Necrotizing Sweet’s Syndrome in a Patient Having Psoriasis

A 52-year-old male presented with multiple tender, plum-coloured facial plaques following the treatment with acitretin 50 mg/day for his psoriasis. The lesions subsided over 3 months. Acitretin was restarted at 20 mg/day as psoriasis flared.  A week later, the patient presented with fever and a symmetrically distributed, tender, livid, hemorrhagic papulopustular eruption and large violaceous ulcerated plaques on both soles. Within a week, the patient developed abdominal pain and distension. CT scans of the abdomen showed segments of small bowel wall thickening. Chest X-ray showed consolidation and nodularity of the lung bases. Histopathology demonstrated findings consistent with a diagnosis of Sweet’s syndrome. The diagnosis of drug-induced Sweet’s Syndrome was established. The patient was treated with a combination of intravenous methylprednisolone and cyclophosphamide. Drug-induced SS has been reported to be associated with many drugs, especially granulocyte-monocyte-colony-stimulating-factor and all-trans-retinoic acid. Although very rare, acitretin-induced SS should be considered in a patient who develops pustulonecrotic skin lesions and systemic upset after intake of acitretin

A Delphi consensus on the nomenclature and diagnosis of lichen planus pigmentosus and related entities

Background: Although well known in clinical practice, research in lichen planus pigmentosus and related dermal pigmentary diseases is restricted due to lack of consensus on nomenclature and disease definition. Aims and Objectives: Delphi exercise to define and categorise acquired dermal pigmentary diseases. Methods: Core areas were identified including disease definition, etiopathogenesis, risk factors, clinical features, diagnostic methods, treatment modalities and outcome measures. The Delphi exercise was conducted in three rounds. Results: Sixteen researchers representing 12 different universities across India and Australia agreed to be part of this Delphi exercise. At the end of three rounds, a consensus of >80% was reached on usage of the umbrella term ‘acquired dermal macular hyperpigmentation’. It was agreed that there were minimal differences, if any, among the disorders previously defined as ashy dermatosis, erythema dyschromicum perstans, Riehl’s melanosis and pigmented contact dermatitis. It was also agreed that lichen planus pigmentosus, erythema dyschromicum perstans and ashy dermatosis did not differ significantly apart from the sites of involvement, as historically described in the literature. Exposure to hair colours, sunlight and cosmetics was associated with these disorders in a significant proportion of patients. Participants agreed that both histopathology and dermatoscopy could diagnose dermal pigmentation characteristic of acquired dermal macular hyperpigmentation but could not differentiate the individual entities of ashy dermatosis, erythema dyschromicum perstans, Riehl’s melanosis, lichen planus pigmentosus and pigmented contact dermatitis. Limitations: A wider consensus involving representatives from East Asian, European and Latin American countries is required. Conclusion: Acquired dermal macular hyperpigmentation could be an appropriate conglomerate terminology for acquired dermatoses characterised by idiopathic or multifactorial non-inflammatory macular dermal hyperpigmentation

Childhood psoriasis: What is new and what is news

Psoriasis is a chronic inflammatory disorder that affects around 2%–4% of the general population, and the prevalence can be higher in selected populations. About one-third of the people affected with psoriasis have the onset of their disease in the first and second decades of life. Of the pediatric population, about 0.5%–2% is affected. Infants are affected rarely. The incidence increases with age and is reported to be ~0.55% in the age group of 0–9 years and 1.37% in the age group of 10–19 years. Flexures, face, periauricular area and medial aspect of the upper eyelid are commonly involved in children. In infants, there is predilection for diaper area. Overall, plaque psoriasis is the most common type, followed by guttate and pustular psoriasis. Lesions are more pruritic, but thinner, less erythematous, and less scaly. Follicular lesions are common. Treating psoriatic erythroderma can pose difficulties, especially in pediatric population. Some cases achieve rapid control of disease activity, while others develop chronic erythroderma with frequent disease flares. The impact of disease on psychosocial parameters is significant in this subgroup of psoriasis and affects patients and parents alike with significantly high rates of absenteeism from school. Pediatric psoriasis therefore needs to be managed effectively. However, effective treatment also poses the risk of producing adverse effects, more so in pediatric age group. A delicate balance therefore should be maintained and overzealous treatment should be avoided

Clinical and Molecular Aspects of Vitiligo Treatments

Vitiligo is an asymptomatic but cosmetically disfiguring disorder that results in the formation of depigmented patches on skin and/or mucosae. Vitiligo can be segmental or non-segmental depending upon the morphology of the clinical involvement. It can also be classified as progressing or stable based on the activity of the disease. Further, the extent of involvement can be limited (localized disease) or extensive (generalized disease). The treatment of vitiligo therefore depends on the clinical classification/characteristics of the disease and usually comprises of 2 strategies. The first involves arresting the progression of active disease (to provide stability) in order to limit the area involved by depigmentation. The second strategy aims at repigmentation of the depigmented area. It is also important to maintain the disease in a stable phase and to prevent relapse. Accordingly, a holistic treatment approach for vitiligo should be individualistic and should take care of all these considerations. In this review, we shall discuss the vitiligo treatments and their important clinical and molecular aspects