Castellani's paint

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A clinical study of cutaneous changes in pregnancy

AbstractBackground/objectivePregnant women experience a myriad of physiological and metabolic changes that affect different organ systems in the body. Cutaneous and appendageal alterations that manifest during pregnancy are largely modulated by hormonal, immunologic, and metabolic factors. Detailed reports encompassing physiological changes and specific dermatoses of pregnancy and effects of various dermatoses on pregnant women are scanty in literature. This study was conducted to examine in detail both physiological changes and specific dermatoses. The cutaneous changes are divided into physiological changes, skin diseases aggravated by pregnancy, and specific dermatoses of pregnancy. The objectives were to study the various cutaneous changes of pregnancy and to know the proportion of these cutaneous manifestations in pregnant women.MethodsThis study included 600 pregnant women attending the Obstetrics and Gynecology Department of a tertiary teaching hospital in Northern Kerala, India. Detailed history elicitation and complete physical and dermatological examination were performed. Skin biopsy was performed in relevant cases.ResultsCutaneous changes were seen in a majority of patients, of which physiological changes were the most common (99%). The most common cutaneous manifestation was hyperpigmentation (526; 87.6%), followed by striae gravidarum (72.8%). Other changes were vascular, including pedal edema (10%), pregnancy gingivitis (1.8%), and varicose veins (1%). Infections were the common dermatological problem in this study group. The most common infections were vulvovaginal candidiasis (21%), Tinea versicolor (6%), scabies (2.8%), dermatophytosis (1.5%), and sexually transmitted infection (0.5%). Specific dermatoses were seen in 12 cases (2%), with the most common being pruritic urticarial papules and plaques of pregnancy (1.3%).ConclusionPregnant women are prone to suffer from a wide range of dermatological problems apart from specific dermatoses of pregnancy. The study emphasizes the need for a detailed and meticulous examination of these patients to detect these various disorders

A prospective study comparing the safety and efficacy of combination of topical tacrolimus 0.1% and mometasone furoate 0.01% with topical tacrolimus 0.1% alone in vitiligo

Background: Vitiligo is a common acquired skin disorder. Corticosteroids are considered to be the first line treatment for vitiligo, but have side effects on prolonged use. Calcineurin inhibitors like Tacrolimus are found to be effective which is used either alone or in combination with steroids. The advantage of combination therapy of Tacrolimus with Mometasone is that it provides additional benefit for the disease as well as the adverse effects of steroids can be minimised. The main objective of this study is to compare the safety and efficacy of combination of topical Tacrolimus 0.1% and Mometasone furoate 0.01% with topical Tacrolimus 0.1% alone in vitiligo.Methods: In this study 90 patients were divided into two groups to receive either combination treatment of topical Tacrolimus 0.1% and Mometasone furoate 0.01% or topical Tacrolimus 0.1% alone. The efficacy was measured in terms of mean improvement in VASI (Vitiligo Area Scoring Index) scores at 2weeks, 4weeks, 6weeks, 12weeks, and 24weeks from the start of therapy. Safety of the drugs were measured in terms of adverse effects reported during therapy.Results: At the start of the study, mean VASI scores of both groups were comparable. At the endpoint, mean VASI improvement score was statistically significant among the combination group (57.82vs31.45, p <0.001). Adverse effects were found to be less in combined treatment group (p= 0.046).Conclusions: Combination treatment (Tacrolimus+ Mometasone) found to be superior to Tacrolimus alone in the treatment of vitiligo in terms of efficacy and safety

Case Report - Poland syndrome (anomaly) with congenital hemangioma: A new association

Unilateral defect of pectoral muscle and ipsilateral syndactyly constitute Poland syndrome. Absence or hypoplasia of the breast and nipple, axillary hair loss and dermatoglyphic abnormalities have also been reported in this syndrome. The primary defect could be in the development of the proximal subclavian artery with early deficit of blood flow to the distal limb and the pectoral region, resulting in partial loss of tissue in those regions. However, the association of congenital hemangioma with Poland sequence has not been observed so far. Such an association is being reported here in a 1-year-old infant, second-born of nonconsanguineous parents, who also had polydactyly instead of the documented syndactyly