A prospective randomized open label comparative study of efficacy and safety of intralesional measles, mumps, rubella vaccine versus 100% trichloroacetic acid application in the treatment of common warts

Background:Treatment of warts represents a continuing challenge for dermatologists as many of the available therapeutic modalities are associated with unsatisfactory results and high recurrence rates. Several clinical trials have proved the efficacy of intralesional immunotherapy by different antigens including MMR vaccine in the treatment of different types of warts.Methods:Total 150 patients having common warts over hands and feet including palmar and plantar warts were included in the study and were randomly divided into two groups. Group 1 consisted of 87 patients in whom MMR vaccine was given intralesionally in the largest wart whereas in Group 2, 63 patients were applied 100% trichloroacetic acid locally to the warts. These treatments were repeated 2 weekly for total three treatments. Patients were assessed for treatment response monthly for 3 months.Results: A highly significant difference was found in the response rates between the two groups (p75% improvement and 26.44% patients had complete resolution whereas in TCA group, 11.11 % had >75% improvement and 7.94% patients had complete resolution. In the MMR group, side effects included pain at the injection site 100%, flu like symptoms 1.15 %, post-inflammatory hyperpigmentation 1.15% and tenderness 1.15% whereas in the TCA group all patients experienced burning sensation and 2 (3.17%) patients had post-inflammatory hyperpigmentation.Conclusion: Intralesional MMR vaccine is an effective treatment for warts without any significant side effects.

A hospital based study to assess the prevalence of cardiovascular risk factors among patients of chronic plaque psoriasis

Background: Psoriasis is a chronic systemic inflammatory disease associated with several cardiometabolic co morbidities such as obesity, insulin resistance, dyslipidemia and hypertension, and with clinically significant increased risk of cardiovascular disease and cardiovascular mortality.Methods: The study group included 110 patients with chronic plaque psoriasis and an equally sized age and sex matched control group. Cardiovascular disease (CVD) risk factors studied included hypertension, diabetes mellitus, obesity, dyslipidemia, smoking, heavy alcohol use and family history of CVD.Results: Psoriatic patients had a significantly higher prevalence of alcohol use (p=0.014), current smokers (p= 0.023), impaired fasting glucose (p=0.032), central obesity based on waist circumference (p=0.008), central obesity based on waist hip ratio (p=0.020) and dyslipidemia (p=0.000).Conclusions: Psoriasis patients have a unfavourable cardiovascular risk profile. Therefore these patients should undergo screening and treatment of various modifiable risk factors to reduce morbidity and mortality

Congenital genralized cutis laxa in two sisters

Two sisters, aged 2 and 3 years, having generalized cutis laxa, presenting with progressive loose pendulous skin since birth are reported

Severe androgenetic alopecia as a maker of metabolic syndrome in male patients of androgenetic alopecia: a hospital based case control study

Background: Several previous studies have investigated the association between androgenetic alopecia (AGA) and metabolic syndrome (MS), with inconsistent results. Objectives of the study were to study the prevalence of metabolic syndrome in male patients of androgenetic alopecia and compare with control population and study the relationship of metabolic syndrome with different grades of AGA.Methods: This prospective hospital based case control study included 100 new clinically diagnosed males of androgenetic alopecia, and age and sex matched control group. Assessment for presence of various components of metabolic syndrome was done following a uniform protocol in cases and controls. AGA was classified as per Hamilton –Narwood classification, grade I to III was classified as mild –moderate and grade IV and higher as severe AGA.Results: Of the 100 male AGA patients (age range 21-50, mean 34.49), 36 had grade II AGA, 24 had grade III AGA, 20 had grade IV AGA, 15 had grade V AGA and 5 had grade VI AGA. Among AGA patients, 60 of patients had mild-moderate AGA and 40 patients had severe AGA. Metabolic syndrome was statistically significantly more common in patients with AGA compared to controls. Among patients of AGA, metabolic syndrome was statistically significantly present in severe AGA compared to mild-moderate AGA. Among the evaluated parameters, like blood pressure, fasting blood sugar, dyslipedemia, abdominal obesity, all were significantly more common in AGA patients compared to controls except abdominal obesity.Conclusions: In the present study, metabolic syndrome was found to be 4.6 times more common in patients of androgenetic alopecia as compared to controls, being statistically significant, and more common in those with severe grades. This suggests that androgenetic alopecia patients especially with severe grades are at risk of metabolic syndrome and other cardiovascular diseases

LICHEN SCROFULOSORUM: AN IMPORTANT MARKER OF OCCULT TUBERCULOSIS

Lichen scrofulosorum is a tuberculid that is usually seen in children or young adults. Although a rare occurrence, this tuberculid is an important marker of occult tuberculosis, which may not be detected otherwise. We report here a case of lichen scrofulosorum in a ten year-old boy with typical grouped lichenoid papules on the trunk associated with axillary tuberculous lymphadenitis

A hospital based study to assess the prevalence of cardiovascular risk factors among patients of chronic plaque psoriasis

Background: Psoriasis is a chronic systemic inflammatory disease associated with several cardiometabolic co morbidities such as obesity, insulin resistance, dyslipidemia and hypertension, and with clinically significant increased risk of cardiovascular disease and cardiovascular mortality.Methods: The study group included 110 patients with chronic plaque psoriasis and an equally sized age and sex matched control group. Cardiovascular disease (CVD) risk factors studied included hypertension, diabetes mellitus, obesity, dyslipidemia, smoking, heavy alcohol use and family history of CVD.Results: Psoriatic patients had a significantly higher prevalence of alcohol use (p=0.014), current smokers (p= 0.023), impaired fasting glucose (p=0.032), central obesity based on waist circumference (p=0.008), central obesity based on waist hip ratio (p=0.020) and dyslipidemia (p=0.000).Conclusions: Psoriasis patients have a unfavourable cardiovascular risk profile. Therefore these patients should undergo screening and treatment of various modifiable risk factors to reduce morbidity and mortality

Congenital genralized cutis laxa in two sisters

Two sisters, aged 2 and 3 years, having generalized cutis laxa, presenting with progressive loose pendulous skin since birth are reported

A clinical study of severe cutaneous adverse drug reactions and role of corticosteroids in their management

Background: Various medications are used for the treatment of various diseases. Ironically, adverse drug reactions (ADRs) also accompany the use of these medications and are as old as the medicine itself. These drug reactions can range from mild transient erythema at one end of the spectrum to severe cutaneous ADRs (SCADRS) that include Steven–Johnson syndrome (SJS), toxic epidermal necrolysis, acute generalized exanthematous pustulosis, and drug reaction with eosinophilia and systemic symptoms complex (DRESS). Aim: This study aims to study the clinical and epidemiological aspects of severe cutaneous adverse drug reactions (SCADRS) at a referral center of Jammu region, with special reference to the role of corticosteroids in the management. Materials and Methods: The study was carried out between July 2015 and December 2015, at a tertiary hospital after permission from Ethical Committee of the institution. A total of 44 patients were included in the study which included outpatients as well as inpatients admitted after written informed consent. The Naranjo ADR probability scale was applied to indicate the causality of the drug with the SCADRS. Results: In the study, a total of 44 patients were included in the study. Males outnumbered the females, and maximum patients were in the age group of 21–40 years. SJS was the most common SCARD found followed by DRESS. Antiepileptic class of drug was found to be most commonly implicated. Immediate withdrawal of the culprit drug and administration of systemic steroids reverted the SCARD in maximum patients. Conclusion: Severe cutaneous adverse drug reactions can be associated with serious morbidity as well as mortality. Their knowledge and prompt recognition are essential for clinicians as early recognition, and immediate withdrawal of the culprit drug/drugs with adequate management can be lifesaving

Lichen scrofulosorum: An important marker of occult tuberculosis

Lichen scrofulosorum is a tuberculid that is usually seen in children or young adults. Although a rare occurrence, this tuberculid is an important marker of occult tuberculosis, which may not be detected otherwise. We report here a case of lichen scrofulosorum in a ten year-old boy with typical grouped lichenoid papules on the trunk associated with axillary tuberculous lymphadenitis

Serum Iron profile in Female patients of Melasma: A case control study

Background: Melasma is a common acquired pigmentary dermatosis characterized by presence of symmetric, hyperpigmented patches, most commonly seen on the face. It is most commonly seen in young to middle aged females. The exact cause of melasma is not known, however a number of factors have been implicated in its etiopathogenesis. The effect of body iron stores on melasma is not exactly known. Although iron overload has been seen to affect skin pigmentation, effect of low body iron stores on skin pigmentation is unknown. In this study, we evaluated total body iron stores by assessing serum iron , ferritin and total iron binding capacity (TIBC) level among nonpregnant females with and without melasma. Materials and Methods: A cross-sectional case control study was conducted in 2016 at Department of Dermatology, Government Medical College, Jammu for a period of one year. The study comprised of 70 non pregnant females with and without melasma . Serum iron level, TIBC and ferritin in the two groups were measured and compared. The severity of melasma was assessed on the basis of MASI score. The correlation between severity of melasma and derangements in iron profile were also assessed in the study.Results: Comparison of serum Iron levels in cases and controls showed lower levels in patients of melasma(58.84± 29.17) as compared to control population (82.26± 45.83) ;p<0.001. Serum ferritin levels were found to be lower in patients of melasma (20.06±18.64) as compared tp control population(42.29±30.08);p<0.001.Comparison of serum TIBC between cases and controls showed higher values in cases(424±58 98.33) compared to control population (384.45± 74.55) p<0.007.Also a positive correlation was found between severity of melasma as per MASI score and derangement in Iron profile. Conclusion: Serum Iron, ferritin levels were found to be significantly lower in patients of melasma compared to the control population whereas Total iron binding capacity(TIBC) was found to be higher in patients of melasma compared to the control population indicating low body iron storesin patients of melasma. The severity of maelasma as per MASI score correlated well with the derangements in iron profile. Hence patients with melasma had low body Iron stores compared to control population indicating a possible role of iron deficiencyin the etiopathogenesis of melasma