RFP Journal of Dermatology

Scar revision forms a major part of plastic surgery practice. Various methods of scar revision have been described including revision by Z Plasty, W Plasty, serial excision, dermabrasion of the scar etc. the final outcome of scar revision depends on various factors like type of scar, skin type of the patient, orientation of the scar, technique used for revision and instrument used for revision. In this article we describe the use of the radiofrequency probe for revision of a trapdoor scar in a 32 year old patient and its benefits.

 Keywords: Scar; Radiofrequency.

The first case report of natural rubber-associated allergic reaction was described in Germany in the year 1927: a case of latex associated allergy by type I or immediate hypersensitivity [1]. Despite the increase of latex associated allergy in general population, severe anaphylactic reactions during some surgical procedures are still rare; however, they are associated with increased morbidity and mortality. Up to now, natural latex rubber is still the second most common cause for anaphylactic reactions during anesthesia [2]. Prevention, diagnosis, treatment, and follow-up of patients affected by this event represent a big challenge for anesthesiologists. The objective of this report was to describe the anesthetic management of a patient with known latex allergy and associated allergy to multiple drugs, food and fibres and to take measures to prevent life threatening allergic emergencies.

Keywords: Anaphylaxis; Contact Dermatitis; Latex Rubber

 Introduction: Contact sensitizers remain the mainstay of treatment of alopecia areata totalis (AT). Systemic steroids in different regimes have been tried in AT with variable success. Many authors consider that addition of systemic steroids to the contact sensitizing protocol may mitigate the effect of the latter. However, there is scarcity of studies evaluating the response to combination therapy of systemic steroids with contact sensitizers. Case Summary: We report the case of a 19-year-old boy with AT of 5 years duration. Diphenylcyclopropenone (DPCP) was applied to right half of the scalp as per the standard protocol. With no response even after six months of this treatment, DPCP application was stopped and oral betamethasone pulse at the dose of 0.1 mg /kg weekly was started. Within 4 weeks of Betamethasone pulse, new hair growth was visible only on the right half of the scalp. DPCP was re-instituted on the same side of the scalp along with continuation of systemic steroids. Left half of the scalp served as control. At 8 weeks, DPCP treated side showed excellent growth while the left side responded poorly. Conclusion: This singular split scalp treatment outcome suggests that the response of contact sensitizers like DPCP is not suppressed by systemic corticosteroids; rather seems to have a synergistic effect in the treatment of AT.

Keywords: Alopecia Totalis; Areata; Diphenylcyclopropenone; Oral Minipulse; Steroid.

 Management of biofilm in chronic wounds is rapidly becoming a primary objective of wound care. However management of biofilm is an undeniably complex task. Beyond the basic steps of initial prevention (use of anti-biofilm agents), removal (debridement, desloughing) and prevention of reformation (use of antimicrobial agents), there are myriad patient, environmental and clinical parameters that must be considered when identifying a tailored solution. Systemic treatment strategies are required for infected chronic wounds, whereas in noninfected wounds where the presence of biofilm is impeding healing, strategies can be adopted to break up the biofilm. The antimicrobial effects of various lasers have been studied in vitro, and most reports have indicated that laser irradiation is useful for bacterial suppression. In the present case report we discuss the use of low level laser therapy in chronic leg wound.

Keywords: Biofilm; Chronic Wound; Low Level Laser Therapy.

 Background: Vitiligo is a common skin problem affecting people globally. Though usually symptomless, it is associated with many taboos and social stigma in India. In this study, we analyzed the clinicoepidemiological profile of vitiligo patients visiting dermatology opd of a tertiary care centre of east India. Aim: A clinical study of vitiligo to know profile of patients suffering from vitiligo with associated cofactors. Methods: All patients of vitiligo visiting dermatology opd of All India Institute of Medical Sciences, Patna from March 2013 to February 2015, were included in the study. Result: Of 256 vitiligo patients included in the study, 51.5% (132) were males and 48.4% (124) were females. Most common morphological patterns noted were vitiligo vulgaris in 49.6% (127) patients. Most common site of onset was lower limbs in 26.56% (68) patients. Koebner phenomenon was present in 23.8% (61 cases). Leucotrichia was noted in 17.8% (46 patients). Most common associated condition noted was thyroid disorders in 6.6% (17) cases.

Keywords: Vitiligo; Bihar; Clinical Pattern

Intraoperative bleeding can be cumbersome while operating on scars using a scalpel. Though skin incisions by a scalpel is of common practice, incisions done by electromagnetic radiation of high frequency in the form of radiofrequency are more precise, accurate, associated withless bleedingand in turn less time consuming giving more defined result. Intra-lesional Keloid scar excisions required good haemostasis and precision leaving behind only a thin rim of tissue.

Keywords: Keloid; Radiofrequency; Intra-Lesional Excision.

Skin diseases and their complications are a significant burden on health system of many nations.Information on prevalence would be useful in planning an effective healthcare system. Objective: To identify the spectrum of dermatological disorders in the tribal area of Valsad(India). Methods: In this retrospective follow up, 4283 patients with skin disorders were randomly selected from dermatology outpatient department of a government centre between 1/11/2016 to 1/2/17. Results: A total of 4283 patient data collected which included males: 2718 ( 63.56 %) and females: 1565 (36.54%). The patients were divided into different age groups as 1-15(n = 259), 16-60 (n = 3685), 61and above(n = 339). Among infective dermatological disorder, Tinea was the most frequent diagnosis, comprising 40% (1718/4283), while scabies 6.5% (279/4283), and Hansens disease 1.9% (82/4283). The non infectious dermatological conditions largely included Urticaria 6.7%(291/4283), Eczema 6%(261/4283) and Acne Vulgaris 3.19%(137/4283). Under Infectious dermatological disorders, the male exhibited significantly higher cases of Tinea infection than females [male: (26.2%)1126/4283 vs. female:(13.8%) 592/4283]. Under non infectious disorders, Eczema was more commonly seen in males than females [male:161/4283 vs. female 100/4283]. Conclusion: Tinea happens to be the most prominent infection among the Indian population owing to the work, working condition and Climate.This is followed by scabies and Hansens. This study helps in creating awareness about the means of prevention and adopting certain life style. This study also helps in highlighting certain factors which can make a decisive role in planing of core health care system,prevent morbidity, mortality and also provide proper understanding of the nature and the course of disease

Keywords: Epidemiological Study; Valsad; Tribal Area

Introduction: Mast cells are responsible for secreting cytokines and other chemical mediators, involved in immuno-inflammatory responses. However, their role has not been clearly defined in the immunopathogenesis of leprosy. Aims and Objectives: To count the number of mast cells in leprosy granulomas and to correlate their numbers with the serum levels of IL-4 in borderline spectrum of leprosy. Materials and Methods: Thirty cases of newly diagnosed, untreated patients of borderline tuberculoid (BT), borderline borderline (BB) and borderline lepromatous (BL) leprosy were included in the study. Skin biopsies were taken from the margins of the skin lesion of leprosy and stained with toluidine blue for quantification of mast cells. An average number of mast cells per granuloma was calculated after examining the granulomas in each skin biopsy. Concentration of serum IL-4 was measured quantitatively in the collected venous blood samples by ELISA method. Results: The mean of average number of mast cells increased from BT towards BL leprosy. Statistically significant difference was seen between BL and BT/BB leprosy. However, no significant difference was found between BB and BT Hansen’s. A positive correlation was found between mast cell numbers and serum levels of IL-4 since both showed an increasing trend from BT through BL leprosy. Conclusion: We found a progressive rise in mast cell count and serum levels of IL-4 across the borderline spectrum of leprosy. This indicates that mast cells play a role in progression and dissemination of leprosy by proliferating at the site of inflammation and secreting an array of chemical mediators especially IL-4.

Keywords: Borderline Leprosy; Mast Cells; Granuloma; Interleukin 4; Tuberculoid; Lepromatous.