Role of clobetasol propionate 0.025% topical therapy in various dermatoses

The anti-inflammatory and vasoconstrictive properties of topical corticosteroids (TCs) contribute in providing therapeutic benefits in several skin conditions, including atopic eczema, localized vitiligo, psoriasis, and chronic hand eczema. Clobetasol propionate (CP) is the most common topical agent used for psoriasis management and demonstrates an efficacy superior to other TCs. A new CP 0.025% cream formulation has demonstrated hypoallergenic effects due to the absence of known contact allergens, such as propylene glycol, short-chain alcohols, and sorbitol-based emulsifiers. Lower CP serum levels and less hypothalamic–pituitary–adrenal axis suppression with CP 0.025% cream formulation than with CP 0.05% ensure better safety. The present case series discusses the clinical experience of using CP 0.025% cream in various dermatological conditions

Genetic Variants Associated with Arsenic Susceptibility: Study of Purine Nucleoside Phosphorylase, Arsenic (+3) Methyltransferase, and Glutathione S-Transferase Omega Genes

BACKGROUND: Individual variability in arsenic metabolism may underlie individual susceptibility toward arsenic-induced skin lesions and skin cancer. Metabolism of arsenic proceeds through sequential reduction and oxidative methylation being mediated by the following genes: purine nucleoside phosphorylase (PNP), arsenic (+3) methyltransferase (As3MT), glutathione S-transferase omega 1 (GSTO1), and omega 2 (GSTO2). PNP functions as arsenate reductase; As3MT methylates inorganic arsenic and its metabolites; and both GSTO1 and GSTO2 reduce the metabolites. Alteration in functions of these gene products may lead to arsenic-specific disease manifestations. OBJECTIVES: To find any probable association between arsenicism and the exonic single nucleotide polymorphisms (SNPs) of the above-mentioned arsenic-metabolizing genes, we screened all the exons in those genes in an arsenic-exposed population. METHODS: Using polymerase chain reaction restriction fragment length polymorphism analysis, we screened the exons in 25 cases (individuals with arsenic-induced skin lesions) and 25 controls (individuals without arsenic-induced skin lesions), both groups drinking similar arsenic-contaminated water. The exonic SNPs identified were further genotyped in a total of 428 genetically unrelated individuals (229 cases and 199 controls) for association study. RESULTS: Among four candidate genes, PNP, As3MT, GSTO1, and GSTO2, we found that distribution of three exonic polymorphisms, His20His, Gly51Ser, and Pro57Pro of PNP, was associated with arsenicism. Genotypes having the minor alleles were significantly overrepresented in the case group: odds ratio (OR) = 1.69 [95% confidence interval (CI), 1.08–2.66] for His20His; OR = 1.66 [95% CI, 1.04–2.64] for Gly51Ser; and OR = 1.67 [95% CI, 1.05–2.66] for Pro57Pro. CONCLUSIONS: The results indicate that the three PNP variants render individuals susceptible toward developing arsenic-induced skin lesions. KEY WORDS: arsenic, As3MT, GSTO1, GSTO2, PNP, skin lesion, susceptibility. Environ Health Perspect 116:501–505 (2008). doi:10.1289/ehp.10581 available via http://dx.doi.org/ [Online 14 January 2008

Evidence and suggested therapeutic approach in psoriasis of difficult-to-treat areas: Palmoplantar psoriasis, nail psoriasis, scalp psoriasis, and intertriginous psoriasis

Psoriasis is resistant to treatment and it shows frequent relapse; systemic treatment is often associated with toxicities, and long-term safety data are lacking for most of the newer drugs like biologics. Moreover, some body areas such as hands, feet, intertriginous areas, scalp, and nails are even more resistant. Frequently, systemic treatments are necessary considering the higher psychological impact on the patient. There is a lack of agreement on the best therapeutic modalities in the management of psoriasis involving difficult-to-treat locations. At present, there are no Indian guidelines for these conditions. Available literature has been reviewed extensively on the treatment of psoriasis involving difficult-to-treat locations; level of evidence has been evaluated as per the Oxford Centre for Evidence-Based Medicine 2011 guideline, and therapeutic suggestions have been developed. Best care has been employed to consider socioeconomic, cultural, genetic, and ethnic factors to prepare a therapeutic suggestion that is appropriate and logical to be used among Indian population and people of similar ethnic and socioeconomic background

LATE REACTION, PERSISTENT REACTION AND DOUBTFUL ALLERGIC REACTION: THE PROBLEMS OF INTERPRETATION

The standard method of patch test reading is to read the test site for any positive allergy at 48 hr and then again at 72/96 hr. A late reading on the seventh day is also advised to exclude the irritant reaction (IR) and to notice some delayed development of allergic reaction. However, multiple visits are often difficult for the patient; therefore, this late reading is sometimes omitted. Here a case of plantar hyperkeratosis, due to allergic contact dermatitis, is reported with some insight into interpretation of the patch test. The patient showed delayed patch test reaction to formaldehyde and colophony, which has never been reported before

OCCUPATIONAL ALLERGIC CONTACT DERMATITIS AMONG CONSTRUCTION WORKERS IN INDIA

<b>Background:</b> Allergic contact dermatitis is one of the important occupational hazards in construction workers and it often leads to poor quality of life of the workers with substantial financial loss. However, this is often a neglected entity. There are no past studies on the construction workers in Indian subcontinent. <b> Objective:</b> This pilot study has been done to assess the allergological profile among the workers engaged in construction of roads and bridges. <b> Materials and Methods:</b> The study was conducted among the workers working on construction of a bridge, flyover, and roads in West Bengal, India. Sixteen workers were selected on clinical suspicion. Ten were selected randomly and patch tested with Indian standard battery of patch test allergens. Analysis of reactions and relevance of positive test was assessed as per standard guidelines. <b> Results:</b> All the workers were men. Average age of workers was 24.8 years (range, 19-34 years). Dermatitis affected exposed parts in 93.75&#x0025; and covered areas in 62.5&#x0025;. Total positive test was 24 and relevant 11. Most common allergens were chromate (relevant allergy/RA: in 60&#x0025; of patch tested workers), epoxy resin (RA: 30&#x0025;), cobalt (RA: 20&#x0025;), nickel (RA: 20&#x0025;), thiuram mixture (RA: 10&#x0025;) and black rubber mix (RA: 10&#x0025;). Two cases (20&#x0025;) had irritant contact dermatitis. <b> Conclusion:</b> The result indicated that chromate is the most frequent allergen among construction workers in this part of India. High frequency of involvement of the covered areas as well as the exposed areas highlighted the fact that the allergens had access to most body parts of the workers