A comparison study of the clinical efficacy and safety of topical adapalene gel (0.1%) and tretinoin cream (0.025%) in the treatment of acne vulgaris

Background: Adapalene a synthetic retinoid analogue, is an addition to the arsenal of topical retinoids developed for the topical treatment of acne vulgaris. The study was designed to compare the clinical efficacy and safety of topical adapalene gel 0.1% and tretinoin cream 0.025% in the treatment of acne vulgaris.Methods: A total of 80 patients with grade I-III acne vulgaris seen in the out-patient department of a tertiary care center were randomized to 8 weeks of daily treatment with either adapalene gel 0.1% or tretinoin gel 0.025%. Counts of total lesions, inflammatory lesions and non-inflammatory lesions were made at baseline and again at treatment weeks 2, 4, 6 and 8. Global assessment ratings, based on percent lesion reduction from baseline were also made. Side-effects like erythema, burning, pruritus, scaling and dryness were rated on a 0-3 severity scale.Results: Out of 80 patients there were 8 dropouts in the study; the 72 patients who completed the study were evaluated for efficacy and safety. Both adapalene and tretinoin produce dramatic reductions in total, inflammatory and non-inflammatory lesion counts, on an average. Cutaneous side-effects were limited to a mild retinoid dermatitis occurring in both treatment groups however patients treated with adapalene gel tolerated this therapy significantly better than those treated with tretinoin cream.Conclusions: Adapalene gel 0.1% offers comparable efficacy to tretinoin cream 0.025 % cream, but is less irritating. Adapalene gel 0.1% is a safe and effective topical agent in the treatment of mild to moderate acne vulgaris in Indian patients

A Study of Depression and Quality of Life in Patients of Lichen Planus

The precise cause of lichen planus is unknown, but the disease seems to be immunologically mediated. It is a psychocutaneous disorder. Due to scarcity of Indian studies in this field, we decided to study in patients of lichen planus the prevalence of depression and quality of life with comparison of the same in both the genders. Patients diagnosed as having lichen planus by consultant dermatologist were enrolled after informed consent and ethics approval. 45 patients were screened, of which 35 who satisfied the criteria were taken up for the study. A semistructured proforma was designed to collect the necessary information with administration of dermatology life quality index and Beck’s depression inventory. While 25% were depressed with females being more affected than males, quality of life was impaired in more than 90% patients. Impairment was maximum due to symptoms and illness feelings, disturbed daily activities, or work and time consumption in treatment. There was a strong association between depression and impairment in quality of life in both the genders. This study helps in early identification of psychological problems in lichen planus patients and in planning their future course of management, hence reducing the lack of productivity and improving the prognosis and quality of life

Association of the cornoid lamella with the follicular infundibulum and the acrosyringium: A histological analysis

Background: The classical histological feature of porokeratosis (PK) is the cornoid lamella. The occurrence of the cornoid lamella within the follicular infundibulum and the acrosyringium is believed to be primarily associated with specific types of PK, for example, follicular PK, porokeratotic eccrine and hair follicle nevus. We looked for such occurrence in all cases of PK. Objective: We attempted to evaluate the incidence of follicular and acrosyringeal involvement in the various clinical types of PK in our population and describe the histological features of the same. Materials and Methods: Case records in 2011 were reviewed for patients diagnosed with PK based on clinicopathological correlation. The histology was reevaluated and follicular or acrosyringeal involvement was noted. Results: In total, biopsies from 28 lesions from 16 patients were reviewed. Nine (32%) lesions were found to have follicular involvement and 12 (42%) were found to have acrosyringeal involvement on histopathology. Of these, 61% of these patients were clinically diagnosed as PK of Mibelli (PM), 14% as disseminated superficial actinic PK (DSAP), 13% as linear PK (LP), 7% cases of follicular PK (FP), and 7% as genital PK. Conclusions: Follicular and acrosyringeal involvement in PK is more frequent than expected. Though follicular PK has been described as a distinct entity, there is no correlation between the clinical subtype and the involvement of the follicular infundibulum and acrosyringium. This involvement may occur as an incidental finding and hence, histological delineation of follicular or acrosyringeal PK as distinct entities without appropriate clinical correlation appears unjustified

Dermoscopy to detect signs of subclinical nail involvement in chronic plaque psoriasis: A study of 68 patients

Background: Onychopathies constitute one of the major challenges faced by a dermatologist in terms of its early detection and diagnosis. Utility of dermoscope as a tool for detection is increasing by the day and its use in onychopathies needs to be explored. Aims: To study the dermoscopic features of nails in patients of chronic plaque psoriasis. Materials and Methods: In a cross-sectional study, a total of 68 patients with chronic plaque psoriasis were recruited. Dermoscopy of nail plate was conducted and were compared with equal number of age and sex matched healthy volunteers. Results: Forty-six patients showed dermoscopic findings. Twenty-two patients did not show any dermoscopic findings. Coarse pits (18/46, P < 0.0001), onycholysis (10/46, P < 0.001), oil drop sign (2/46, P = 0.12) and splinter hemorrhages (5/46, P = 0.05) were seen. In addition certain findings of interest were stout, globose, dilated, pink- to red-colored nail bed vessels arranged longitudinally at the onychodermal band surrounded by a prominent halo (9/46, P = 0.01). In contrast, splinter hemorrhages appeared as streaks and were purple in color. Conclusion: In a psoriasis patient, dermoscope can be a useful tool to detect early nail involvement in psoriasis and aid in differentiating it from other disorders of nails

Gender Differences in Depression, Coping, Stigma, and Quality of Life in Patients of Vitiligo

Though vitiligo is one of the psychodermatological disorders which do not cause direct physical impairment, it is cosmetically disfiguring leading to serious psychological problems in daily life. We undertook this research to study patients of vitiligo the prevalence of depression, coping, stigma, and quality of life and comparison of the same in both genders. Patients diagnosed clinically as having vitiligo by consultant dermatologist were enrolled after informed consent and ethics approval. 156 patients were screened, of which 100 satisfying criteria were taken up for the study. A semistructured proforma was designed to collect the necessary information with administration of Beck’s depression inventory, participation scale, dermatology life quality index, and adjustment to chronic skin diseases questionnaire. Depression prevalence was 63.64% in females and 42.86% in males (p<0.0457); the total mean BDI scores were significant with females having higher scores than males (p<0.0083). No significant differences were seen on participation scale though 52% females felt stigmatized as compared to 45% males (p <0.5779). While almost 97% of our patients had impaired quality of life there was no significant difference in both genders on the total score (p<0.3547). Females had significantly higher faulty coping style than males with significant differences on all domains and total scores (p< 0.0094). There was a strong association of depression with faulty coping and stigma (p< 0.0001) in both genders. Also association of stigma with quality of life showed highly significant findings in both genders (p< 0.0001) on all the domains of DLQI. This study helps in early identification of psychological problems in vitiligo patients and planning their future course of management, hence improving the prognosis and quality of life

Ichthyosis associated with rickets in two Indian children

We wish to report two cases of rickets due to vitamin D deficiency secondary to underlying ichthyotic skin disorder. The first case is of an 8-year-old male with history of multiple fluid-filled lesions over the body that would rupture to heal with thickening and scaling of skin, suggestive of epidermolytic hyperkeratosis, and the second is of a 14-year-old female with thick, large, quadrilateral scales over the extremities and back clinically consistent with lamellar ichthyosis. Both showed improvement with parenteral vitamin D3 and oral calcium supplements in addition to topical emollients