Mucocutaneous Condition Research Articles

Correlating CD4 count with mucocutaneous manifestations in HIV-positive patients: A prospective study.

Background:Mucocutaneous findings may be the presenting symptoms in HIV-afflicted individuals. A multitude of mucocutaneous diseases also occurs during the course of the ailment, with some conditions being classed as disease defining. They include infectious diseases and noninfective inflammatory and neoplastic dermatoses. With progressive fall in CD4 count, there is a change in the types of mucocutaneous lesions encountered.Aim:This study aims to statistically correlate the CD4 counts with the mucocutaneous manifestations in 100 HIV-positive patients.Materials and Methods:A total of 100 cases of HIV-positive patients with skin and mucous membrane manifestations were selected serially. A complete history was taken, clinical examination was done, and the CD4 count was noted. Patients were divided into four groups (Groups I, II, III, IV) with different ranges of CD4 values, namely, <50, 50–200, 201–500, >500, respectively.Results:The distribution of study population in CD4 ranges showed that majority (47%) of the study population had CD4 count between 201 and 500, and 29% of the study group had CD4 count between 50 and 200 cells. Almost 21% of the patients had the count > 500 cells and 3% had cell count < 50. Majority of the infectious and non-infectious dermatoses were common in the CD4 count between 201–500 (Group III) and 50–200 (Group II). In the study groups, 52 cases (52%) were on antiretroviral therapy (ART), and the remaining 48 cases (48%) were not on ART at the time of diagnosis of mucocutaneous manifestations. Out of 48 ART-naïve cases, 23 patients were screened and newly diagnosed at the outpatient department (OPD) based on the mucocutaneous manifestations. Most of the patients with multiple mucocutaneous conditions were in the CD4 count <200, whereas single manifestation was seen predominantly in CD4 count >200.Conclusion:Statistically significant association with the CD4 count was seen in herpes zoster ophthalmicus, genital wart, genital herpes, vaginal discharge syndrome, scabies, pyoderma, dermatophytosis, Hansen's disease, herpetic gingivostomatitis, seborrhoeic dermatitis, lichen planus, and drug reactions. These dermatoses may indicate the worsening of immune status and the need for regular monitoring with periodical CD4 counting. Occurrence of dermatoses such as photosensitive eczema, drug reaction, lichen planus, Type I lepra reaction, and herpes zoster ophthalmicus in patients on ART may be due to IRIS. To avoid the more frequent occurrence of infectious dermatoses and to reduce the development of IRIS with ART, all HIV-positive cases may be started on ART at higher CD4 count. Screening for HIV infection is suggested whenever the following conditions are seen: persistent oral candidiasis, atypical manifestations of zoster, herpes zoster ophthalmicus, herpetic gingivostomatitis and MC in adults, exaggerated IBA, and extensive seborrhoeic dermatitis.

Skin conditions in a South African tuberculosis hospital: Prevalence, description, and possible associations.

The current pandemic of tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection, the modern era of antiretroviral therapy, and the rising incidence of multidrug-resistant TB have led to a broader spectrum of skin conditions in patients hospitalized with TB. These factors also influence investigations into possible causal relationships with TB. The aim of this study was to describe mucocutaneous conditions found in patients hospitalized with TB and to report associated factors. A cross-sectional observational study examining the spectrum of skin manifestations found in 105 patients hospitalized with TB was conducted. All relevant demographic and clinical data were collected. Possible associations were evaluated by making use of statistical analysis. Seventy-four (70%) of the investigated population were HIV-positive, and 46 (44%) patients were being treated for drug-resistant TB. The most prevalent dermatosis was xerosis (n = 83, 79%), followed by oral candidiasis (n = 33, 31%) and scars (n = 33, 31%), finger clubbing (n = 31, 29%), leukonychia (n = 29, 28%), striae (n = 25, 24%), and facial hyperpigmentation (n = 22, 21%). Anemia was detected in 90 (86%) patients, and 75 (71%) were classified as being underweight. Three patients were diagnosed with cutaneous TB. Patients hospitalized with TB have on average four different dermatoses, but xerosis remains the leading dermatological finding, irrespective of HIV status or TB drug sensitivity. Anemia and malnutrition are associated with numerous skin conditions found in this population. The prevalence of cutaneous TB among patients hospitalized with TB remains low, despite the high rate of TB and HIV co-infection.

Myeloid cell leukemia-1 is a molecular indicator for malignant transformation of oral lichen planus

Oral lichen planus (OLP), characterized by a chronic mucocutaneous inflammatory condition, is a common disease of the oral cavity. Retrospective and prospective epidemiological data suggest that OLP is considered to have malignant potential. However, it is unclear as to which types of molecules may cause malignant transformation of OLP. In the present study, the presence of myeloid cell leukemia-1 (Mcl-1) and B-cell lymphoma-2 (Bcl-2) was studied by western blot analysis in 11 OLP and three normal oral mucosa (NOM) samples and in two human oral cancer cell lines. The functional role of Mcl-1 in oral cancer cells was analyzed using a trypan blue exclusion assay and soft agar assay. Mcl-1 was strongly expressed in the OLP and the two oral cancer cell lines compared with NOM, whereas Bcl-2 was not. Sorafenib and mithramycin A decreased cell viability in MC-3 and HSC-3 oral cancer cells and at same concentration they reduced the expression level of Mcl-1 in the two cell lines. The two chemicals affected Mcl-1 protein and significantly inhibited neoplastic cell transformation in the two cell lines. We suggest that the malignant potential of OLP may be associated with the expression of Mcl-1, and that downregulation of Mcl-1 may prevent malignant transformation of OLP to oral cancer.

Mucocutaneous manifestations of HIV infection

Background: Human immunodeficiency virus (HIV) infection is associated with several mucocutaneous conditions which may be the first clinical presentation of HIV. A wide range of infectious and non-infectious skin lesions develop dur­ing the course of the disease but their frequency and associated factors vary from place to place. Aim: To evaluate cutaneous manifestations in HIV infected patients attending to Dermatology outpatient department and their relationship with CD4 cell counts. Methods: It is a hospital-based cross-sectional study. One hundred and twenty HIV seropositive patients attending the outpatient and inpatient departments were included in the study. Detailed history including age, sex, occupation, presenting complaint, high-risk behaviour, mode of transmission, marital status, partner’s HIV status and treatment history was taken. Thorough cutaneous and systemic examination was done in all patients. Cluster of differentiation (CD4) count was noted in all patients at the time of presentation. Results: Majority of the patients 85 (70.8%) were rural residents who belonged to low socio-economic and low educational strata. Housewives formed the largest group 44 (36.7%) followed by truck drivers 31 (25.8%) and laborers 25 (20.8%). The predominant mode of transmission was heterosexual contact 113 (94.2%). Most common mucocutaneous manifestations noticed were seborrheic dermatitis 78 (65%) followed by oral candidiasis 56 (46.6%), xerosis 51 (42.5%), generalized skin hyperpigmentation 42 (35%) and dermatophytosis 40 (33.3%). Conclusion: This study showed the prevalence of various dermatological manifestations in HIV positive patients and their relation with CD4 count. Most of the manifestations occur in patients with low CD4+ count (

Case Series of Three Infants with Erythema Multiforme Following Hepatitis B Vaccination

Erythema multiforme (EM) is an acute, self-limited, sometimes recurring mucocutaneous condition characterized by distinctive target lesions, and it has been associated with infections, accounting for up to 90% of cases, as well as with drugs, and other triggers. Most cases of EM occur in children, adolescents, and young adults, but rarely occur in neonates and infants. Here, we report three infants in whom EM developed following hepatitis B vaccination.

Mycophenolate mofetil in erosive genital lichen planus: A case and review of the literature

Erosive genital lichen planus is a disabling, inflammatory mucocutaneous condition that can cause significant patient morbidity and loss of function. Treatment initially involves topical corticosteroids but some patients can have severe treatment-resistant courses requiring systemic immunosuppression. With potentially unfavorable adverse effect profiles and subsequent intolerance of these agents by patients, erosive lichen planus can ultimately be a challenging condition to treat effectively. We present a case of a 66-year-old woman with treatment-resistant erosive genital lichen planus who was successfully managed with mycophenolate mofetil. Although there is only weak evidence for this agent in this condition, its role in dermatology is growing due to its efficacy and advantageous adverse effect profile and should therefore be considered in patients with treatment-resistant erosive genital lichen planus.

An Oral Clinician's Perspective towards Peutz Jegher's Syndrome A Case Report

Peutz Jegher’s syndrome is a mucocutaneous autosomal dominant condition associated with extensive melanin pigmentation and intestinal hamartomatous polyp formation. It is characterised by round, oval patches of blackish brown pigmentation, irregularly distributed over the oral mucosa, lips, tongue and the hard palate. This condition is associated with an increased risk towards carcinoma and several other complications like small intestine intussusception and anemia. The current case report highlights the oral manifestations of Peutz Jeghers syndrome; also it enumerates the important role played by an oral clinician in the early diagnosis of this inherited syndrome, thereby reducing the morbidity.

Herpes Labialis-Induced Erythema Multiforme along Blaschko's Lines.

Dear Editor: Erythema multiforme (EM), first described by Von Hebra in 1862, is an acute, self-limiting mucocutaneous condition induced by some immune reaction to infections or pharmacologic antigens1. The distribution of EM along Blaschko's lines (BL) is extremely unusual. A 28-year-old, non-consanguineous Hindu male patient presented with an asymptomatic linear lesion of 3 days' duration along with multiple vesicular eruptions over the right side of his upper lip for 5 days. The lesion consisted of multiple erythematous annular eruptions. He had a history of recurrent vesicular eruptions on the lip during the last 5 years. There was no other systemic illness or history of similar skin rash. Physical examination revealed the presence of multiple, discrete, small target-like lesions, most having a central dark spot, on the right forearm along BL. Some lesions were confluent, forming a bigger and irregularly shaped lesion. A group of tiny vesicular eruptions were present on the upper lip (Fig. 1A, B). Fig. 1 Erythema multiforme on the right forearm along Blaschko's line. Insets: (A) grouped vesicles with crusting due to herpes labialis on the upper lip, (B) close-up of the target lesions. (C) Low-power view (H&E, ×100) showing an intact epidermis ... It was diagnosed clinically as EM along BL with recurrent herpes labialis. Routine tests of blood, urine, and stool samples showed no abnormality. Biopsy and histopathological examination from a lesion on forearm revealed exocytosis, extensive interface dermatitis, necrotic keratinocytes, dermal edema, and mononuclear cell infiltration in the upper dermis (Fig. 1C). Proposed mechanisms of EM include type IV hypersensitivity immune response mediated by T lymphocytes2, genetics and infections. The most possible etiologic factor is herpes simplex virus. Infection due to Mycoplasma pneumoniae, vulvovaginal candidiasis, hepatitis C virus; drugs like acetaminophen, penicillin, and sulfonamides; and diseases like systemic lupus erythematosus (SLE), small vessel vasculitis, urticaria, and granuloma annulare are also implicated. The lesions of EM usually start in a symmetric fashion over the acral areas and extensor surfaces of the limbs, and progress centripetally. Koebnerization may influence the distribution. BL are known to represent mosaicism3. Besides nevi, autosomal and X-linked dominant diseases; polygenic diseases such as lichen planus, psoriasis, eczema, SLE, pemphigus vulgaris, granuloma annulare, linear drug eruption, and graft-versus-host disease may also be distributed along BL. In polygenic diseases, distribution along BL as an isolated manifestation or as a superimposed manifestation on classic generalized disease may occur owing to postzygotic mutation involving one of the predisposing genes. This is also known as loss of heterozygosity (LOH), which gives rise to a patch of homozygous or hemizygous tissue. The possible mechanisms for the development of LOH are mitotic recombination, gene conversion, point mutation, deletion, or mitotic nondisjunction. Blaschko-linear EM is extremely rare and has been described in only two cases (Table 1)4,5. None of these previous cases involved active herpes labialis at the time of presentation. One of them, however, involved a history of recurrent herpes labialis5. The case reported by Micalizzi and Farris5 was linear; however, morphological assessment of the lesions was difficult with the clinical photograph provided. Our case possibly is the first case of EM associated with active herpes labialis and with a distribution along BL. This case provides strong evidence in support of a genetic mechanism in the pathogenesis of EM. Table 1 Comparing all published cases of linear erythema multiforme4,5

Erythema Multiforme- Case Report with Review

AbstractErythema Multiforme is a rare, acute, inflammatory mucocutaneous condition caused by a hypersensitivity reaction with the appearance of cytotoxic T lymphocytes in the epithelium that induce apoptosis in keratinocytes, which leads to satellite cell necrosis. Reactions to drugs are quite common and are generally mild, hence not reported. However, occasionally life threatening reactions including Erythema multiforme major (Steven Johnson’s syndrome) and Toxic Epidermal Necrolysis may occur. A wide spectrum of drugs can sometimes give rise to Erythema Multiforme. We report a case of Erythema Multiforme following administration of Non Steroidal Anti-Inflammatory Drugs.

CR0299 Herpes zoster virus–associated erythema multiforme in a child

Erythema multiforme (EM) is a mucocutaneous condition, rarely associated with varicella zoster virus (VZV) infection in children, despite the virus's high incidence as a childhood pathogen. In the literature, only 2 cases of VZV associated with EM have been recorded, one in a 5-year-old and the other in a 13-year-old. One case of VZV associated with Stevens-Johnson syndrome in a 12-month-old has also been reported to date.

An atypical presentation of pulmonary air‐leak syndrome and multisystem toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN) is a rare and potentially fatal mucocutaneous condition that may affect both children and adults. TEN mortality rates vary greatly between both patient populations, but multisystem involvement is common. Management presents many challenges as there is no specific therapy for TEN, and patients often require the expertise of burn units. We report a child who survived TEN with multisystem involvement including the rare but life threatening occurrence of a pulmonary air-leak syndrome while also reviewing controversies surrounding TEN's pathophysiology, sequelae, and multidisciplinary approach to management.

Utility of serological assays in the diagnosis of paraneoplastic pemphigus

Background Paraneoplastic pemphigus (PNP) is a rare autoimmune mucocutaneous blistering condition which has a universal association with malignancy and a poor prognosis. PNP, which is characterised by the presence of autoantibodies against plakins in the skin epithelial layer, can be a challenging diagnosis to make, particularly in those without an existing history of malignancy, as tissue biopsy findings may resemble other disorders that have similar clinical features. Thus, serology may be helpful in the diagnosis. Historically, indirect immunoflourescence (IIF) has been the most widely used assay in diagnostic laboratories with reasonable, but not ideal, specificity. Western blotting for various anti-plakin antibodies is more specific but not routinely available. Recently many antiplakin antibody specific assays have been developed commercially. Aim The aim of our study was to compare the utility of three traditional assays, (IIF on rat bladder, monkey bladder and rat cardiac tissue) versus two newer plakin-based assays (envoplakin ELISA and HEK-transfected cell IIP) in patients presenting initially with oral ulceration alone. Method Fifty-nine samples [PNP n = 5, healthy controls n — 10, and disease controls n = 44, including pemphigus vulgaris (PV), mucous membrane pemphigoid (MMP), lichen planus (LP) and miscellaneous oral ulcers] were analysed on the five different assays and results were compared. Results The current assay employed by our laboratory, rat bladder IIF, is the most sensitive assay for our three confirmed PNP cases (3/3, 100%), and has high specificity among all controls (53/54, 98.1%). The Envoplakin ELISA was even more specific (54/54, 100%), although less sensitive (1/3, 33.3%). Monkey bladder IIF had equal sensitivity to rat bladder IIF, although poorer specificity (51/54, 94.4%). Rat cardiac and HEK-transfected cell IIF performed the most poorly with 78-88% specificity, with the latter also having 0% sensitivity. Conclusion Our findings show that the newer envoplakin ELISA compares favourably with more traditional IIF in its high negative predictive value for PNP in both disease and healthy controls. However, traditional IIF seems to have superior sensitivity in our limited cohort of PNP patients. Paraneoplastic pemphigus (PNP) is a rare autoimmune mucocutaneous blistering condition which has a universal association with malignancy and a poor prognosis. PNP, which is characterised by the presence of autoantibodies against plakins in the skin epithelial layer, can be a challenging diagnosis to make, particularly in those without an existing history of malignancy, as tissue biopsy findings may resemble other disorders that have similar clinical features. Thus, serology may be helpful in the diagnosis. Historically, indirect immunoflourescence (IIF) has been the most widely used assay in diagnostic laboratories with reasonable, but not ideal, specificity. Western blotting for various anti-plakin antibodies is more specific but not routinely available. Recently many antiplakin antibody specific assays have been developed commercially. The aim of our study was to compare the utility of three traditional assays, (IIF on rat bladder, monkey bladder and rat cardiac tissue) versus two newer plakin-based assays (envoplakin ELISA and HEK-transfected cell IIP) in patients presenting initially with oral ulceration alone. Fifty-nine samples [PNP n = 5, healthy controls n — 10, and disease controls n = 44, including pemphigus vulgaris (PV), mucous membrane pemphigoid (MMP), lichen planus (LP) and miscellaneous oral ulcers] were analysed on the five different assays and results were compared. The current assay employed by our laboratory, rat bladder IIF, is the most sensitive assay for our three confirmed PNP cases (3/3, 100%), and has high specificity among all controls (53/54, 98.1%). The Envoplakin ELISA was even more specific (54/54, 100%), although less sensitive (1/3, 33.3%). Monkey bladder IIF had equal sensitivity to rat bladder IIF, although poorer specificity (51/54, 94.4%). Rat cardiac and HEK-transfected cell IIF performed the most poorly with 78-88% specificity, with the latter also having 0% sensitivity. Our findings show that the newer envoplakin ELISA compares favourably with more traditional IIF in its high negative predictive value for PNP in both disease and healthy controls. However, traditional IIF seems to have superior sensitivity in our limited cohort of PNP patients.

Crohn’s Disease and Mucocutaneous Conditions

Crohn’s disease is an immune-mediated disorder. Tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) produced by Th1 lymphocytes have traditionally been shown to be important in the pathogenesis of Crohn’s disease. In addition, recent studies demonstrate more complex cytokine networks, in which Th17 cells play a central role. The expansion and maintenance of Th17 cell responses require the activity of interleukin-23 (IL-23), and thus IL-23/IL-17 axis has been suggested to play a major role in the pathogenesis of Crohn’s disease. Crohn’s disease presents with various mucocutaneous signs, some of which show similar histological features of non-caseating granulomas with multinucleated histiocytes. Specific mucocutaneous manifestations include metastatic (cutaneous) Crohn’s disease, perianal fistula, and oral Crohn’s disease. Although not specific, other various manifestations which histologically show granulomatous conditions are sometimes associated with Crohn’s disease. Also, Crohn’s disease exhibits other organ manifestations such as joints, eyes, kidneys, liver and biliary tracts, and vasculature. Those disorders may share pathognomonic significance attributed to common or similar mechanisms. The efficacy of TNF-targeting therapies strongly suggests the pivotal role of TNF-α in Crohn’s disease. Anti-TNF therapies bring beneficial effects for not only intestinal, but also mucocutaneous, joint, and ocular involvements. In this review, recent insights of the pathogenesis of Crohn’s disease, as well as mucocutaneous manifestations associated with Crohn’s disease, are introduced.

A study on oral mucosal lesions in 3500 patients with dermatological diseases in South India.

Background:Oral mucosal lesions that are observed in the dermatological diseases are categorized under mucocutaneous conditions. The oral lesions in dermatological diseases may be the early aspects of the disease manifestation or the most significant clinical appearance or the only sign/and or symptom of such dermatological diseases and occasionally lesions occur simultaneously in the skin as well as mucous membrane.Aim:This present study attempts to find out the prevalence of oral mucosal lesions in patients with dermatological diseases.Subjects and Methods:The study includes 3500 patients who attended out-patient Department of Dermatology. Patients with oral manifestation were subjected for clinical examination in the Department of Oral Pathology. Diagnostic procedures were performed to confirm the clinical oral diagnosis. The results of the study were analyzed by SPSS software version 19.0 (Armonk, NY) and presented as descriptive statistics. Correlation of oral manifestions with their respective dermatological disease was statistically analysed by Pearson's correlation test.(P < 0.05 were considered as statistically significant)Results:The prevalence rate of oral mucosal lesions in the present study was 1.8% (65/3500). The most frequent lesions observed were psoriasis 32.3% (21/65), lichen planus 18.4% (12/65), Stevens Johnson Syndrome 18.4% (12/65), pemphigus 10.7% (7/65), toxic epidermal necrolysis 4.6% (3/65), systemic lupus erythematosus 3% (2/65), discoid lupus erythematosus 1.5% (1/65), pemphigoid 1.5% (1/65). Gender distribution in the study population was statistically significant (P < 0.001). Employed and unemployed individuals in the study population were statistically significant (P < 0.001). Pearson's correlation analysis of oral manifestations with their respective dermatological disease showed r = 0.466 and signifies a positive correlation and is statistically significant at the 0.01 level (two-tailed).Conclusion:The prevalence rate of oral mucosal lesions in patients with dermatological diseases was relatively low. However, predominant oral mucosal lesions observed in the study were autoimmune in origin with a high morbidity and mortality index. Hence, multidisciplinary approach will definitely help in the prognosis of patients.

Evaluation of efficacy of a bioresorbable membrane in the treatment of oral lichen planus.

Background:Gingival involvement is commonly seen in lichen planus, a chronic mucocutaneous inflammatory condition of the stratified squamous epithelia. It is often painful and may undergo malignant transformation and thus warrants early diagnosis and prompt treatment. The aim of this study is to evaluate the use of a bioresorbable membrane (Polyglactin 910) in the management of erosive lichen planus of gingiva.Materials and Methods:A split-mouth randomized controlled trial was carried out. Fifteen patients with identical bilateral lesions of lichen planus on gingiva were included in the study. Three parameters were selected for the clinical assessment of gingival lesions: Surface texture, color, and burning sensation. After complete oral prophylaxis, an excisional biopsy procedure was carried out for lesions on both sides, but on the experimental side, the biopsy procedure was combined with placement of the bioresorbable membrane. The statistical significance of intergroup differences in measurements was tested by using an independent sample t-test. A two-tailed P-value less than 0.05 was considered as statistically significant.Results:Intragroup comparisons revealed a statistically significant difference between mean value of grades at 6, 12, and 24 weeks in both groups for the surface texture, color, and burning sensation of gingiva, respectively. For intergroup comparison of change in surface texture, color, and burning sensation of gingiva between group A and group B, differences were statistically nonsignificant.Conclusion:Surgical management of the lesion accomplished significant improvement of lesion with no significant additional clinical benefits with the application of bioresorbable membrane. Worsening of baseline scores was not observed in any case at the end of the study.

Early Bilateral Amniotic Membrane Transplantation in the Management of Severe Ocular Involvement from Acute Toxic Epidermal Necrolysis in a Chinese Pediatric Patient

Introduction: Toxic Epidermal Necrolysis (TEN) is a rare but potentially life-threatening muco-cutaneous condition associated with idiosyncratic hypersensitivity to certain drugs. Ophthalmic involvement is common, typically affecting the ocular surface and eyelids. Survivors often suffer from resulting bilateral blindness and ocular dryness or pain. Objective: To report the successful management of severe ocular surface disease during the acute stage of toxic epidermal necrolysis using early amniotic membrane transplantation on both eyes in a Chinese paediatric patient. Design: Interventional case report Case report: A 15 year-old Chinese girl was transferred to the intensive care unit of Queen Mary Hospital, Hong Kong with TEN after taking oral cefuroxime and diclofenac. She developed bilateral keratoconjunctivitis, diffuse corneal epithelial defects (80-90% of cornea surface) and later bilateral symblephara. After initial treatment with daily rodding, topical lubricants, steroids and antibiotics, there was no improvement in her condition. Bilateral amniotic membrane transplantation (AMT) was performed over the cornea, fornix, tarsal and bulbar conjunctiva on day 10 of illness. On discharge from the hospital (post-operative week 7), the patient had pinhole visual acuity of 6/7.5 in the right eye and 6/6 the left eye. She was eventually weaned off all topical medication Visual acuity eventually recovered to 6/6 in both eyes by week 20 after surgery. There was mild residual forniceal symblepharon and eyelid margin keratinization. She continues to require regular lubricants for her chronic ocular surface condition. Conclusion: Early use of AMT minimized ocular damage and prevented severe vision loss in a Chinese pediatric patient with severe bilateral ocular surface inflammation secondary to TEN. Effective management is dependent on early and active communication between the patient’s family, pediatricians, intensive care physicians and ophthalmologists.

Mucocutaneous Manifestations of HIV and the Correlation with WHO Clinical Staging in a Tertiary Hospital in Nigeria.

Skin diseases are indicators of HIV/AIDS which correlates with WHO clinical stages. In resource limited environment where CD4 count is not readily available, they can be used in assessing HIV patients. The study aims to determine the mucocutaneous manifestations in HIV positive patients and their correlation with WHO clinical stages. A prospective cross-sectional study of mucocutaneous conditions was done among 215 newly diagnosed HIV patients from June 2008 to May 2012 at adult ART clinic, Wesley Guild Hospital Unit, OAU Teaching Hospitals Complex, Ilesha, Osun State, Nigeria. There were 156 dermatoses with oral/oesophageal/vaginal candidiasis (41.1%), PPE (24.4%), dermatophytic infections (8.9%), and herpes zoster (3.8%) as the most common dermatoses. The proportions of dermatoses were 4.5%, 21.8%, 53.2%, and 20.5% in stages 1–4, respectively. A significant relationship (using Pearson's Chi square with P value <0.05) was obtained between dermatoses and WHO clinical stages. Pearson's correlation coefficient showed a positive correlation between the number of dermatoses and the WHO clinical stages. Dermatoses can therefore serve as diagnostic and prognostic markers in resource limited settings to initiate HAART in clinical stages 3 and 4.

Oral lichen planus in a 13 year old boy: A rare case report

Oral lichen planus (OLP) is a fairly distinctive mucocutaneous premalignant condition. The aetiology of the condition appears to be complex and multifactorial. It is thought to occur in approximately 1–2% of the population. Malignant transformation of OLP has been reported in 0.5% of cases. OLP is very rare in children. This report shows a rare case of a 13 years old child diagnosed with lichen planus.

Association of Cytokine Gene Polymorphisms with Oral Lichen Planus in Malayalam-Speaking Ethnicity from South India (Kerala)

Oral lichen planus (OLP) is a chronic mucocutaneous condition that affects the oral mucous membrane as well as skin. It is a chronic cell-mediated autoimmune condition where the T-cell-mediated immune response plays an important part in the pathogenesis by causing damage to basal keratinocytes in oral mucosa. Cytokine gene polymorphisms have an unquestionable role in the orchestration of the immune response, leading to different functional scenarios, which in turn influence the outcome of the disease establishment and evolution. The purpose of this study was to understand the role of these cytokine gene polymorphisms in the tumor necrosis factor-alpha (TNF-α), interleukin-1β (IL-1β), and IL-6 genes with OLP in 101 individuals of Malayalam-speaking ethnicity from South India (Kerala). We further investigated the role of these polymorphisms in patients suffering from OLP with other comorbid factors. Genotyping was carried out by polymerase chain reaction-restriction fragment length polymorphism. The results demonstrate that the A allele in the TNF-α -308 polymorphism could play an important role in the susceptibility to OLP. IL-1β +3954 in OLP was associated with other comorbid factors in both allelic and genotypic combinations. However, when patients suffering from OLP were stratified to understand the involvement of other comorbid factors, we observed that the T and C alleles were independent risk factors for chronic periodontitits and diabetes mellitus. On the other hand, IL-6 -597 did not show any disease association with OLP in the study population. This study indicates that proinflammatory cytokines are an important factor in understanding the disease burden of OLP and their comorbid factors.

Ulcerative Lichen Planus in Childhood

Lichen planus (LP) is a chronic inflammatory mucocutaneous condition which is relatively common in adults but rarely affects children. The present study is a report on an unusual case of ulcerative oral LP involving the dorsum of tongue in a 12-year-old boy. Patient complained of painful oral lesion on the tongue which was burning in nature and obstructing talking and eating spicy foods. On intraoral examination, a white ulcerative lesion on the dorsum of tongue was observed. Diagnosis was made based on clinical examination and histopathological features. We instituted local treatment and patient responded well to the treatment. Although rarely reported in childhood, lichen planus should be considered in a differential diagnosis of hyperkeratotic, reticular, and ulcerative lesions of the oral mucosa in children.