Background: Psoriasis neurodermiformis (PN) and verrucous psoriasis (VP) are two distinct forms of psoriasis characterized by thickened plaques, whose proper description in most dermatologic texts is still lacking. Psoriasiform keratosis (PK) is a recently described clinical entity characterized by a solitary keratotic plaque whose microscopic findings simulate psoriasis. Aim: To compare and evaluate the clinical and histological profile of PN, VP and PK, and systematically characterize each of them. Settings and Design: This was a prospective, descriptive study done on a total of 51 patients, who were diagnosed with PN, VP and PK based on certain clinical criteria. The study was done at a teaching hospital in eastern India. Methods and Materials: The study was carried out on a total of 51 patients presenting with thickened psoriasiform plaques, who visited our outpatient department, over a period of 9 months. They were then carefully evaluated clinically (along with their demographic profile), followed by meticulous microscopic assessment. Each biopsy specimen was then categorically evaluated to enable a precise diagnostic conclusion. Statistical Analysis: As all values in our study were qualitative, they were expressed as numeric values and percentages. Results: Out of 51 patients, 18 were diagnosed as PN, 19 with VP and 14 with PK. PN demonstrated an equal gender distribution, whereas in VP and PK a male preponderance was apparent. History of past/present psoriasis was positive in only one patient diagnosed with VP. Intensity of pruritus was marked in 88.88%, 21.05% and 14.28% of patients with PN, VP and PK respectively. Dorsa of feet was the commonest site of involvement in PN and VP. In PK, the shin was the predominating site. VP presented clinically as mammillated, verrucous and crateriform phenotypes. PN and PK however, demonstrated single clinical patterns. Microscopically, none of the specimens satisfied all the 7 epidermal criteria set forth by Ackerman. In each slide Trozak’s histologic psoriasiform numeric score was >10. Conclusion: PN, VP and PK are certainly not as rare as previously considered. Mammillated VP closely mimics PN clinically. Crateriform VP is an extremely rare phenotypic expression encountered. Histological findings of papillomatosis, buttressing and anastomosing rete ridges and a dense dermal lymphocytic infiltrate point more in favor toward VP. Detecting solitary keratotic plaques with a psoriasiform histology should allow clinicians to consider the possibility of PK.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Surgery of the knee, injury to the infrapatellar branch of the saphenous nerve, traumatic eczematous dermatitis (SKINTED) is a regional dermatitis specific to total knee arthroplasty, occurring postsurgically. It is characterized by an eczematous eruption localized to the knee, mostly the anteroinferior aspect, presenting as pruritic, dry, erythematous, scaly, or at times papulovesicular lesions. Having been known over the past decade by various nomenclatures, the basic pathogenesis has now been agreed upon as a locoregional immune dysfunction because of damage to lymphatics occurring postsurgically. We have described three case reports of typical eczematous lesions occurring after total knee replacement surgery and reviewed the literature for similar cases described across the literature. A PubMed and Google Scholar search pertaining to the articles published with the keywords “SKINTED” and “autonomic denervation dermatitis” was conducted. A total of 10 results were obtained after exclusion of duplicated and irrelevant search results. This yielded one review article, one original article, seven case reports, and two correspondence articles. Based on the review, the authors agree with the concept of Rucco’s immunocompromised district, being the most logical explanation for the occurrence of SKINTED. SKINTED should be differentiated from implant eczema occurring because of hypersensitivity to metal implants, which presents as systematized contact dermatitis and has a predefined set of diagnostic criteria.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Psoriasis is a chronic inflammatory disorder and is associated with obesity, diabetes mellitus, and hypertension. There is an increased expression of inflammatory cytokines (interleukin [IL]-17, tumor necrosis factor [TNF]-α, IL-22, vascular endothelial growth factor [VEGF]) in the serum of psoriasis patients. Serum levels of IL-10, another anti-inflammatory cytokine, have been found at varying values in psoriasis in different regions of the world. Aims and Objectives: The aim of this article is to assess the serum IL-10 and serum VEGF in psoriasis patients with no co-morbidities and healthy controls. Materials and Methods: This study was conducted on 46 serum samples (23 psoriasis subjects and 23 healthy controls). After informed consent, 3 mL of serum was obtained and stored at -70°C. The samples were quantitatively assessed for VEGF-A and IL-10 by the enzyme-linked immunosorbent assay. Results: This study revealed that the mean (±SD) value of serum VEGF in cases was significantly higher than that in controls (cases = 235.21 ± 138.71; controls = 104.73 ± 36.01 pg/mL). However, levels of serum IL-10, although increased in cases (2.37 ± 1.61 pg/mL) when compared with controls (1.64 ± 0.89 pg/mL), showed no statistical significance. Conclusion: In this study, serum VEGF and IL-10 levels were increased in psoriasis when compared with controls but were not significantly related to the Psoriasis Area and Severity Index. The significant correlation between serum VEGF and IL-10 levels in cases when compared with controls suggests their role in the pathogenesis of psoriasis. Persistently increased values in psoriasis patients may lead to the development of comorbidities.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Autoimmunity has been implicated in the etiopathogenesis of vitiligo. Aim: We sought to determine whether polymorphisms in the major histocompatibility complex class I-related chain A (MICA) and macrophage migration inhibitory factor (MIF) genes may have a role in the pathogenesis of vitiligo. Materials and Methods: We conducted a study including 100 patients with vitiligo and age- and sex-matched 172 control subjects to examine the role of single-nucleotide polymorphisms of MICA gene rs1051792 and MIF genes rs755622 and rs2096525 as risk factors for vitiligo. Real-time PCR combined with the melting curve analysis using fluorescence-labeled hybridization probes was used for genotyping analyses. Mann–Whitney, Kruskal–Wallis, and chi-square (χ²) tests as well as multivariate logistic regression adjusted for age and gender were used for statistical evaluation. Linkage disequilibrium (LD) and haplotype frequencies were also performed. Results: No significant association was observed between the variant alleles of studied genes and vitiligo. Haplotype analysis demonstrated that there was a strong LD between rs755622 and rs2096525 loci of MIF gene (D′ = 0.92, r² = 0.827). However, haplotype frequencies in patients were similar to those in controls. Conclusion: These preliminary results suggest that the polymorphic variants of MIF rs755622, MIF rs2096525, and MICA rs1051792 genes do not play a critical role in the etiopathogenesis of vitiligo.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Oral isotretinoin is one of the most frequently used treatment options in moderate and severe acne. Abnormal laboratory results may occur during the treatment and there may be differences in approach to these abnormal laboratory results among dermatologists. Aim: In this study, we aimed to retrospectively evaluate the differences in approach to abnormal laboratory results and treatment modifications of dermatologists during oral isotretinoin treatment. Materials and Methods: Data of 207 patients who had oral isotretinoin treatment for acne between January 2013 and October 2020 were included in this study. Baseline and follow-up laboratory results were reviewed. All treatment modifications were noted and evaluated with relevant literature. Results: Among 207 patients, 28 (13.5%) had treatment modifications due to the abnormal laboratory results, and all of them were due to elevation of lipid and liver enzyme levels. The dose was reduced in 24 (11.6%) patients and the treatment was discontinued in 4 (1.9%) patients. Treatment modification was not compulsory in the vast majority of patients (26 of 28) according to the relevant literature. Conclusion: The results of the present study showed that unnecessary treatment modifications due to the abnormal laboratory results can be made by dermatologists during oral isotretinoin treatment for acne. Educational programs for dermatologists and more detailed guidelines may prevent these unnecessary treatment modifications.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Lentigines are hyperpigmented macules, which represent the simplest form of increased melanocytic proliferation. The term “lentiginosis” is applied for the presence of lentigines in an exceptionally large number or in a distinctive configuration. Lentigines evolve slowly, but widespread occurrence over a short period of time is typical of eruptive lentiginosis. We report an unusual case of eruptive lentiginosis in a female patient with no prior systemic disorder or familial pattern, presenting with widespread hyperpigmented macules, symmetrically distributed over the face, neck, upper trunk, shoulders, and both arms and forearms. Clinicohistopathological features were consistent with eruptive lentiginosis. Our case report seems interesting as well as a rare one as it involved an otherwise healthy young woman.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]