Common Dermatological Diseases Research Articles

Epidemiology of Chronic Dermatologic Conditions in Skin of Color.

Across the board, common dermatologic conditions disproportionately affect patients of color. While the causes of these disparities have been tied to the environment, societal structure, access to care, health literacy, and biological factors, there is limited understanding of the extent and impact of dermatologic healthcare inequity. This study provides a resource on the epidemiology of common dermatologic diseases across racial lines and points out current lapses in scientific understanding of the disparate impact of certain conditions. This study will review epidemiological data on atopic dermatitis (AD), adult acne, pseudofolliculitis, dermatophytosis, psoriasis, vitiligo, melasma, hyperpigmentation, keloids, hidradenitis suppurativa (HS), basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. J Drugs Dermatol. 2023;22(11):e21-e23    doi:10.36849/JDD.7131e.

A successful Ayurveda treatment of recurrence severe plaque psoriasis – A case report

Abstract Psoriasis is one of the most common dermatologic diseases characterized by erythematous, sharply demarcated papules and rounded plaques, covered by silvery micaceous scale. It is a lifelong disease with a chronic relapsing course and most patients require a long-term management. About 80%–90% of people living with psoriasis experience plaque psoriasis, the most common variant of the disease. In spite of its prevalence, recurrence is making a serious global problem. In Ayurveda, most of the chronic skin disorders are studied under a common heading Kushtha. In the present case, a 54-year-old male was diagnosed with typical symptoms of plaque psoriasis all over the body for a duration of 5 years. The patient was advised for Samshodhana (therapeutic purgation), followed by Sanshamana (disease specific internal medicine) using drugs Shuddha Gandhaka, Pancha-Nimba Churna, Panchtikta Ghrita, and Aragvadha Phala-Majja Kwatha. Psoriasis area and severity index score reduced from 65.7 to 0.9 which is a marked significant difference. There is no recurrence even after discontinuing the treatment for the last 2 years which makes it worth reporting.

Assessment of Serum Apelin Levels and Its Relation to Insulin Resistance in Acne Vulgaris Patients

Abstract Introduction Apelin is one of the adipokines. Acne vulgaris is a very common dermatological disease with a multifactorial background and hyperinsulinemia and insulin resistance are considered to play a pivotal role in its development and severity. Aim To evaluate serum apelin levels in acne vulgaris patients and to reveal the possible relation between its serum levels and the insulin resistance state in acne vulgaris patients. Material and methods Thirty-two acne vulgaris patients and thirty-two healthy controls were enrolled into the study. The blood levels of apelin, insulin and glucose were measured in patients and controls. Homeostasis model assessment index (HOMA-IR) was calculated to evaluate the insulin resistance state. Results Acne vulgaris patients experienced significant higher levels of fasting insulin, serum apelin, and HOMA-IR compared to controls. Conclusions These results suggest that serum apelin and insulin resistance may have a role in the pathogenesis of acne.

Pemphigus and pemphigoids: Clinical presentation, diagnosis and therapy.

Pemphigus and pemphigoid are two potentially life-threatening groups of autoimmune diseases, characterized by autoantibodies targeting structural components of desmosomes or hemidesmosomes, respectively. Affected patients typically show itchy/painful plaques or blistering skin lesions and/or impairing mucosal blistering and erosions, which may strongly impact their quality of life. Since the milestone work of Walter Lever in 1953, who differentiated these two groups of diseases by histopathological analysis of the level of antibody-mediated skin cleavage, enormous progresses occurred. Achievements made in laboratory diagnostics now allow to identify antigen specific structural proteins of the skin that are targeted by pathogenic autoantibodies. These progresses were accompanied by an increased understanding of the pathogenesis of these diseases thanks to the establishment of animal models reproducing disease and on studies on skin and blood of affected individuals, which have been leading to novel and disease-specific treatments. Yet, given their phenotypical overlap with more common dermatological diseases, correct diagnosis and appropriate treatment are often delayed, in some cases leading to irreversible sequelae, including organ dysfunction (i.e., loss of vision in mucous membrane pemphigoid). Here, we provide a concise overview of the clinical appearance, diagnosis and therapeutic management of pemphigus and pemphigoid diseases.

OBTAINING THE EXTRACT OF CHELIDONII MAJORIS L. AS A COMPONENT OF TOPICAL PREPARATIONS IN THE THERAPY OF PSORIASIS

Psoriasis is one of the most common dermatological diseases that significantly reduces the quality of life of patients. At the same time, about 70% of them need the use of external therapy. The aim of the study was to increase the degree of extraction of active substances from plant materials in order to improve the therapeutic properties of topical preparations for the treatment of psoriasis. For the treatment of psoriasis, it is necessary to use highly concentrated alkaloid extracts of celandine; for this, an 80% solution of acetic acid was used as an extractant.

INDICATORS OF PHAGOCYTOSIS IN WOMEN WITH ACNE DURING COMPREHENSIVE TREATMENT THAT INCLUDED PRP- AND IPL-THERAPY

Introduction. Acne is one of the most common dermatological diseases. It may have a chronic course, leaving permanent marks, and in last years has been tending to have more and more severe clinical course with widespread skin lesions. According to recent studies, the development of acne is due to the combined effect of endogenous and exogenous factors, among which endocrine diseases, disorders of metabolic processes, reduced systemic immunity and phagocytic ability of mononuclear phagocytes and granulocytes at various stages of phagocytosis of pyogenic cocci, which contributes to more severe clinical course, and frequent relapse of this diseases. It was also proved that the intestinal microbiota plays an important role in the formation of homeostasis and immune response.
 The Objective of the study is to determine the evolution of phagocytosis indices in patients with acne under different comprehensive treatments, using oral antibiotics, immunotherapy (PRPtherapy), probiotics, low-dose birth control pills and IPL- therapy.
 Materials and methods. We observed 93 women with acne aged from 18 to 25 years old. In 19 (20.43%) patient mild acne was diagnosed, in 41 (44.09%) – moderate acne, in 33 (35.48%) persons – severe acne, 54 (58.06%) persons suffered from acne up to 1 year, 39 (41.93%) – from 1 to 3 years. To assess the state of phagocytosis in patients with acne vulgaris, we determined phagocytic activity (PA) and phagocytic index (PI) of polymorphonuclear leukocytes, nitro blue tetrazolium recovery test (NBT test spontaneous) and NBT-test pyrogenal stimulated by recognized methods.
 Results. Analysis of the studied parameters of phagocytosis at the end of treatment showed a significant increase in patients of the core group who were administered a comprehensive treatment which included oral antibiotic, probiotic, and low-dose birth control pills, PRP-therapy and IPLtherapy, as compared with the patients of other groups under study.
 Conclusions. Using combined therapy for women with acne occurring against the backdrop of a sluggish process of phagocytosis and concomittant intestinal dysbiosis leads to normalization of the leading indices of phagocytosis (PI, PA, NBT tests both spontaneous and stimulated), and enhances their phagocytic activity both during capture and formation of bactericidal activity and in the final stages of phagocytosis justifying the feasibility of a combined use of antibiotics, probiotic, low-dose birth control pills PRP-therapy and IPL-therapy in the treatment of acne.

Effect of Shodhana and Gandhaka Rasayana in Psoriasis - A Case Study

Psoriasis is one of the most common inflammatory autoimmune dermatologic diseases. The major concerns of psoriasis are social stigma which leaves a significant emotional impact for the patient. However, systematic management strategies, diet modification and timely monitoring shows an improvement in health-related quality of life and thus an improvement in social and psychological wellbeing. Severity of psoriasis tends to fluctuate with exogenous factors like diet, environmental factors etc. Spontaneous exacerbations and remissions are usual. There IS no specific treatment protocol in the management of psoriasis. In Ayurveda the symptoms are more similar to Vata kapha predominant Kushta, more specifically Sidhma kushta. The present study is aimed to treat a 22-year-old male patient, a known case of plaque psoriasis admitted in the IPD of Kayachikitsa department, Govt. Ayurveda College, Thiruvananthapuram. Deepana, Pachana Sodhana, Samana and Rasayana were the treatment protocol included. Ayurvedic approach in a single case of psoriasis is found beneficial in correcting the inherent Agnimandya at Koshta and Dhatu level and thus arrest the progression of the autoimmune inflammatory pathology. PASI (Psoriasis Assessment Severity Scale) score was used to assess the severity of lesions. Before treatment PASI score was 5.7 which reduced to 4.2 after 2 weeks. At the time of discharge PASI score was 0. The case report shows no recurrence of symptoms on review after 4 weeks.

Dermatologic Diseases of Four-Toed Hedgehogs.

Dermatologic diseases are frequently diagnosed in the four-toed hedgehog. Common clinical signs include spine loss, scales and crusts, pruritus, alopecia, and masses. Caparinia tripilis, family Psoroptidae, is the most common mite affecting hedgehogs, and is diagnosed via light microscopy. Dermatophytosis from Trichophyton erinacei infection is a common zoonotic dermatologic disease in pet hedgehogs. Diagnosis is through fungal culture. Neoplasia is another major cause of dermatologic diseases in four-toed hedgehogs. The diagnostic approach typically begins with a fine-needle aspirate but often requires a biopsy for a definitive diagnosis.

The frequency of warts among patients attending at department of dermatology and venereology, in Al-Sadar Hospital in Baghdad, IRAQ

Background: Human papilloma virus [HPV] infection is a very common dermatological disease, as most people will experience infection during their lifetime. Objective: To find the frequency of warts among patients attending at Department of Dermatology and Venereology, in Al-Sadar Hospital in Baghdad. IRAQ. Patients and Methods: A descriptive cross sectional study was conducted during the period from the first of January to 31 of March 2021. This study included 7453 patients. Results: the percentage of patients with warts was 1171[15.71%] with the higher number and percentage in females 622 [53.12 %] than in males 549[46.88 %]. The differences among age groups were significant (P=0.03). Also the differences due to month were significant. Conclusions: There was high frequency of viral warts among patients attending at Department of Dermatology and Venereology at Al-Sadar Hospital especially at the children and young adult age groups.

Management of Oral Lichen Planus: Recent updates

Oral lichen planus is one of the most common dermatological disease affecting the oral mucosa. It is characterized by periods of remission and exacerbation. Regular follow up is needed for some severe forms of oral lichen planus. Various treatment modalities are reported in the literature and this article discusses about some of the recent medications used in patients with oral lichen planus.

Analysis of Prescribing Practices in the Dermatology Outpatient Department of a Tertiary Care Teaching Hospital.

Introduction The practice of appropriately prescribing and delivering pharmaceuticals to the right patient for the diagnosis, prevention, and treatment of diseases is referred to as "rational drug usage". Patients should receive pharmaceuticals that are appropriate for their clinical needs, given in doses that meet their needs, for long enough periods of time, and for the least amount of money possible. Minimizing drug therapy costs without sacrificing therapeutic effectiveness, avoiding unnecessary adverse medication reactions and drug-drug interactions, and improving therapeutic care while encouraging patient adherence are the main objectives of rational drug usage. The present study was planned to assess the current prescribing practices in the dermatology outpatient department of a tertiary care hospital. Materials and methods A prospective descriptive study was conducted in the department of dermatology at a tertiary care teaching hospital after receiving permission from the institutional ethics committee. The study was conducted from November 2022 to February 2023 and followed the WHO recommendation for sample size. A total of 617 prescriptions were analyzed thoroughly. Results Regarding the demographic profile of the 617 prescriptions, 299 were male and 318 were female. The patients had diverse diseases, with the most common being tinea infection (57 cases, 9%) and acne vulgaris (53 cases, 8.5%), followed by scabies (38 cases, 6%), urticaria, and eczema (30 cases, 5%). Twenty-six (4%) prescriptions were not written in capital letters, 86 (13%) prescriptions did not mention the route of drug administration, and the consultant's or physician's name and signature were missing in 13 (2%), and six (1%) prescriptions, respectively. None of the prescriptions were written using the generic names of the drugs. Polypharmacy was observed in 51 (8%) prescriptions. Moreover, potential drug-drug interactions were identified in 12 (1.9%) instances. The most prescribed drugs were antihistaminics, with 393 (23%) prescriptions. Antifungal drugs were the second most prescribed, with 291 (17%) prescriptions. Corticosteroids were also commonly prescribed, with 271 (16%) prescriptions. Antibiotics were prescribed in 168 (10%) cases; other drugs were prescribed in 597 (35%) cases, including retinoids, anti-scabies drugs, antileprotic drugs, moisturizers, sunscreens, etc. Conclusion The study highlighted the prescription errors in writing the drugs in capital letters, mentioning the dose, route, and frequency of drugs, etc. It provided insight into the common diseases in dermatology and routine prescribing patterns and addressed the frequency of polypharmacy and drug-drug interactions.

A STUDY OF THE PATTERN OF DERMATOLOGICALAND SEXUALLY TRANSMITTED DISEASES IN ADOLESCENTS AND YOUNG ADULTS IN EASTERN UTTAR PRADESH

Introduction: Adolescents and young adults are high-risk groups for skin and sexually transmitted diseases, especially in developing or lowincome countries. The present study was conducted to give an insight on the various dermatological and sexually transmitted diseases in adolescents and young adults in the age group of 10-24 years. Materials and Methods: This is a retrospective study where all the records of the patients who presented at a speciality clinic for adolescents and young adults were assessed. Those patients who consulted the treating dermatologist were included in the study. The records of 422 patients between the ages of 10 and 24 years, attending the tertiary care centre in Eastern Uttar Pradesh during 2020 and 2021 were included in this retrospective study. Results: Out of 422 patients, there were 164 males and 258 females. The mean age of all patients was found 19.433.57 years. The most common dermatological disease was Dermatophytic fungal infections seen in 67(15.8%) patients followed by chronic Idiopathic Urticaria in 57(13.5 %) patients followed by acne Vulgaris in 46(10.9%) patients. Among infestations, Scabies was seen in 41 (9.7%) patients. The next common dermatoses were Post Inammatory Hyperpigmentation seen in 40 patients. In hair disorders, telogen efuvium was the most common manifestation seen in 39(9.2%) patients. Among sexually transmitted infections (STI), Vulvovaginal Candidiasis was diagnosed in 19 patients and genital warts in one male patient. Conclusion: Fungal infections are common in adolescents and young adults. Acne Vulgaris is also common in this age group

Lichen sclerosus: The 2023 update.

Lichen sclerosus (LS) is an underdiagnosed inflammatory mucocutaneous condition affecting the anogenital areas. Postmenopausal women are predominantly affected and, to a lesser extent, men, prepubertal children, and adolescents. The etiology of LS is still unknown. Hormonal status, frequent trauma and autoimmune diseases are well-known associations for LS, yet infections do not seem to be clear risk factors. LS pathogenesis involves factors such as a genetic predisposition and an immune-mediated Th1-specific IFNγ-induced phenotype. Furthermore, there is a distinct expression of tissue remodeling associated genes as well as microRNAs. Oxidative stress with lipid and DNA peroxidation provides an enabling microenvironment to autoimmunity and carcinogenesis. Circulating IgG autoantibodies against the extracellular matrix protein 1 and hemidesmosome may contribute to the progression of LS or simply represent an epiphenomenon. The typical clinical picture includes chronic whitish atrophic patches along with itching and soreness in the vulvar, perianal and penile regions. In addition to genital scarring, and sexual and urinary dysfunction, LS may also lead to squamous cell carcinoma. Disseminated extragenital LS and oral LS are also reported. The diagnosis is usually clinical; however, a skin biopsy should be performed in case of an unclear clinical picture, treatment failure or suspicion of a neoplasm. The gold-standard therapy is the long-term application of ultrapotent or potent topical corticosteroids and, alternatively, topical calcineurin inhibitors such as pimecrolimus or tacrolimus. Collectively, LS is a common dermatological disease with a so far incompletely understood pathogenesis and only limited treatment options. To foster translational research in LS, we provide here an update on its clinical features, pathogenesis, diagnosis and (emerging) treatment options.

Inhibition of Mast Cell Degranulation in Atopic Dermatitis by Celastrol through Suppressing MRGPRX2.

Atopic dermatitis is a common dermatological disease, and mast cell degranulation is believed to be related with the progression of atopic dermatitis. Mas-related G protein-coupled receptor-X2 (MRGPRX2), and calcium release-activated calcium channel protein 1-2 (ORAI-1, ORAI-2) are involved in mast cell degranulation. Celastrol is an active monomer of Tripterygium wilfordii, and it presents an antiatopic role. 2,4-Dinitrofluorobenzene (DNFB) and compound 48/80 (C 48/80) were used to establish a slow and acute scratching animal model, respectively. Hematoxylin-eosin and toluidine blue staining was used to investigate tissue injury. Inflammatory factor concentration was measured with ELISA. The expression of MRGPRX2, ORAI-1, and ORAI-2 was detected with immunohistochemistry (IHC) staining. Gene expression profiling and microRNA array were performed to investigate gene differential expression. Celastrol greatly inhibited atopic dermatitis-related tissues injury, mast cell production, histamine release, scratching level, inflammatory factor expression, and activation of MRGPRX2/ORAI axis in the DNFB-induced atopic dermatitis model. The influence of Celastrol on atopic dermatitis was remarkably reversed by overexpression of MRGPRX2. We found that the improvements of atopic dermatitis caused by Celastrol were reversed by treatment with MRGPRX2OE, indicating that Celastrol might affect atopic dermatitis through MRGPRX2. This study might provide a novel thought for the prevention and treatment of atopic dermatitis by regulating MRGPRX2.

Ayurvedic management of Eka Kushta w.s.r to Psoriasis: A Case study

ABSTRACT:
 Eka Kushta is a type of Kshudra Kushta occurring mainly due to imbalance of Vata and Kapha Doshas, resembling Psoriasis in its clinical manifestations. Psoriasis is one of the most common dermatologic diseases, affecting up to 2% of world population. Childhood psoriasis is relatively common with prevalence of 1-3% of general population. Psoriasis is an immune mediated disease clinically characterized by erythematous, sharply demarcated papules and rounded plaques covered by silvery scales. The most commonly involved areas are the elbows, gluteal cleft, knees and scalp. In Ayurveda various treatment modalities have been described in the management of Eka kushta which includes Shodana and Shamana. Hence, in the present case report a 8 year male child who came to Kaumarabhritya Out Patient Department presenting with symptoms of Eka kushta on elbows, knees, hands and feet, was treated with Shodana chikitsai.e, Virechana followed by Vasti and Shamana chikitsa i.e internal medication. The symptoms were assessed with the help PASI score at pre and post therapy, and the results were noted. After treatment satisfactory results were observed.
 Key words :Eka kushta, Psoriasis, PASI Score, Shodana chikitsa, Shamana chikitsa
 Corresponding Author:
 M.Avinash Reddy,
 PG Scholar,
 Department of Kaumarabhritya,
 S.V. Ayurvedic College, Tirupati,
 Andhra Pradesh. India.
 Email Id: reddyavinash771@gmail.com

Entzündliche Dermatosen auf pigmentierter Haut

Acne, rosacea, atopic dermatitis, and psoriasis vulgaris are common inflammatory dermatoses. Of note, the epidemiology and clinical presentation of these common dermatologic diseases varies considerably between people with different colors of skin. Yet, most dermatology textbooks present and describe the clinical pictures of White people. To provide excellent dermatological care for all patients, it is of central importance to know the epidemiology and recognize key clinical characteristics of these diseases in patients with skin of color (SOC). In acne, cultural habits of Blacks (use of steroid-based lighteners, comedogenic hair care products) may lead to manifestation of specific forms of acne. In addition, postinflammatory hyperpigmentation and keloids pose particular therapeutic challenges in this patient group. Atopic dermatitis in Asians shows aclinical and histological picture that is similar to psoriasis in Whites. By contrast, atopic dermatitis manifests on the extensor side in Black people. Due to the difficulty of recognizing erythema in SOC, the severity of the respective inflammatory diseases in these individuals is often underestimated. The treatment of acne, rosacea, atopic dermatitis, and psoriasis does not differ between people of different skin colors. The exception is the necessary therapy for postinflammatory hyperpigmentation in all the inflammatory dermatoses mentioned, and for keloids in acne.

Randomized Open-Label Trial Comparing Teledermatology vs. Face-to-Face Consultation in the Follow-Up of Patients with Mild-to-Moderate Acne.

Acne vulgaris is one of the most common dermatological diseases, especially in adolescents and young adults. The current study aimed to compare teledermatology versus face-to-face consultation in the follow-up of patients with mild-to-moderate acne. In this investigator-initiated, parallel arms, open-label, randomized clinical trial, after screening, participants were randomly assigned in a 1:1 ratio to be followed up through teledermatology or standard face-to-face consultations for a period of 6 months. The primary endpoint was the cumulative time spent by physician for consultations or online assessments. Out of 24 patients (21 females and 3 males; mean age 23.0 ± 3.3 years) underwent randomization in the two study groups. In intention-to-treat analysis, the cumulative time spent by physician was higher in the teledermatology group compared to face-to-face consultations with an average difference of 8:24 mm:ss (95% CI: 1:17-15:31). However, the cumulative time spent by the patient was significantly lower in the teledermatology group (mean difference 1:21:39 hh:mm:ss; 95% CI: 41:51-2:01:27). An optimal reduction of acne-severity was observed in both groups, without significant differences between them. The patient's satisfaction did not change significantly over time and between groups, and was generally quite high. AEs were reported by one patient in the teledermatology group and four patients in the consultation group. Acne might be an optimal disease to be followed up using a teledermatology platform, to relieve the burden on patients and medical staff. However, it is necessary to implement more user-friendly platforms in order to achieve the best possible results in the treatment and follow-up of acne patients.

Using ChatGPT for Writing Articles for Patients' Education for Dermatological Diseases: A Pilot Study.

Patients' education is a vital strategy for understanding a disease by patients and proper management of the condition. Physicians and academicians frequently make customized education materials for their patients. An artificial intelligence (AI)-based writer can help them write an article. Chat Generative Pre-Trained Transformer (ChatGPT) is a conversational language model developed by OpenAI (openai.com). The model can generate human-like responses. We aimed to evaluate the generated text from ChatGPT for its suitability in patients' education. We asked the ChatGPT to list common dermatological diseases. It provided a list of 14 diseases. We used the disease names to converse with the application with disease-specific input (e.g., write a patient education guide on acne). The text was copied for checking the number of words, readability, and text similarity by software. The text's accuracy was checked by a dermatologist following the structure of observed learning outcomes (SOLO) taxonomy. For the readability ease score, we compared the observed value with a score of 30. For the similarity index, we compared the observed value with 15% and tested it with a one-sample t-test. The ChatGPT generated a paragraph of text of 377.43 ± 60.85 words for a patient education guide on skin diseases. The average text reading ease score was 46.94 ± 8.23 (P < 0.0001), and it indicates that this level of text can easily be understood by a high-school student to a newly joined college student. The text similarity index was higher (27.07 ± 11.46%, P = 0.002) than the expected limit of 15%. The text had a "relational" level of accuracy according to the SOLO taxonomy. In its current form, ChatGPT can generate a paragraph of text for patients' educational purposes that can be easily understood. However, the similarity index is high. Hence, doctors should be cautious when using the text generated by ChatGPT and must check for text similarity before using it.

Evaluating the Effect of Atache Despigman Cream for the Treatment of Melasma

Introduction: Melasma is one of the common dermatologic diseases that has an effect on the patient's quality of life, therefore its treatment is important. Various medicinal and herbal compounds have been used, including creams containing hydroquinone, vitamin C, alfa hydroxy acids, arbutin, tretinoins, and sometimes combination creams are prescribed, and there is still no definite and guaranteed treatment for it. In the present experimental study, the effect of topical medicine Atache Despigman (Atache laboratorios, Spain), which contains 2% hydroquinone, vitamin C and fruit acids) in the treatment of melasma has been investigated. After two months of treatment with this medicine, from the patients' point of view, the results of spot reduction were very good 17%, good 53%, average 25%, and poor 5%, and these percentages from the doctor's point of view were 20%, 52%, 25%, and 3%, respectively. Therefore, the majority observed the effectiveness. With the examination by Dermacatch device, a decrease in pigmentation was also observed.

156 The development of plant-based pharmaceutical substance for treatment of seborrheic dermatitis

Dermatological diseases of the scalp significantly affect the life quality of people. According to statistical data, seborrheic dermatitis (SD) is the most common dermatological disease in more than 50% of the population all over the world. The medicines for treatment of SD are synthetic antimicrobial substances with high efficiency, but their regular use changes a biodiversity of scalp microflora and determines subsequent antimicrobial resistance. Therefore, the aim of study was the development of plant-based pharmaceutical substance for treatment of SD.