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Notes: Background. Widespread alopecia areata (AA) is difficult to treat and modalities such as topical and systemic steroids, topical sensitizers (e.g., squaric acid dibutylester and diphencyprone), psoralen-ultraviolet A (PUVA) therapy, minoxidil, and immunomodulators have been tried. Methods. Patients with widespread alopecia (〉 40% scalp involvement), including alopecia totalis (AT) and universalis (AU), were treated with 300 mg oral prednisolone pulses at 4-week intervals, for a minimum of 4 doses or until cosmetically acceptable hair growth was obtained. Response to therapy was monitored by serial photographs and patients were examined monthly for side effects of steroids. A 1000 mg oral prednisolone pulse was administered to five patients with alopecia totalis/universalis and to three failures of the 300 mg-pulse treatment. Results. Thirty-two patients (24 men, 8 women) with a mean age of 29 years were recruited. They had alopecia for a mean period of 2.8 years. Twenty-seven patients (21 alopecia areata, 5 alopecia universalis, 1 alopecia totalis) received 300 mg pulse therapy and eight patients received 1000 mg prednisolone pulses. Fourteen (58.3%) patients (13 AA, 1 AT) out of 24 evaluated treated with 300 mg pulse therapy showed complete or cosmetically acceptable hair growth. Response was evident on average after 2.4 months and was cosmetically acceptable at 4 months. Three (AA, AT, AU-one each) out of seven patients assessed for the 1000-mg pulse had cosmetically acceptable hair growth at 6–9 month. Conclusions. An oral monthly pulse of prednisolone 300 mg is effective, safe, and can be administered on an outpatient basis. It is recommended as one of the modalities for the treatment of widespread alopecia areata.

Notes: Background. Epidemiologic studies of alopecia areata (AA) are available from USA, Japan, and European countries, but there is a paucity of literature on AA from Asian countries, especially from the Indian subcontinent. Methods. In a prospective, hospital-based study lasting for a decade (1983–1992), the epidemiology of AA was studied, including associated diseases and risk factors for development of severe AA. Simultaneously a similar study was carried out in age- and sex-matched controls. Results. Eight hundred and eight patients (532 men, 276 women) and 572 age- and sex-matched controls (370 men, 202 men) were studied. The incidence of AA was 0.7% of new dermatology outpatients. The majority of patients (712, 88%) were below 40 years of age, including 196 children 〈 16 years of age (24%). Almost half (46%) of the women patients had onset of AA in childhood, compared to only 19% in men (P 〈 0.001).Alopecia was total, universal, or extensive in 154 patients (19%). An onset in the first two decades was more often associated with severe alopecia (P 〈 0.001), especially in men (P 〈 0.01). Alopecia areata was recorded in family members of 70 patients (9%), being more frequent in the severe forms of AA (16%). Evidence of atopy was recorded in a total of 146 instances (18%). The frequency of atopy was the same in circumscribed alopecia (18.1%) and severe alopecia (18.2%). Nail changes were found in 162 patients (20%) and were more frequent in 76 (47%) with the severe form of AA (P 〈 0.001). On 39 occasions (5%), autoimmune-related diseases were detected: vitiligo in 15 (1.8%), thyroid disorders in 8 (1%), lichen planus in 6 (0.7%), collagen vascular diseases in 5 (0.6%), diabetes mellitus in 4 patients (0.4%), and pemphigus foliaceus in 1 (0.1%) patient. Patients with family members having vitiligo (recorded in 5.9% of patients), were more frequently affected with severe alopecia (P 〈 0.001). Conclusions. Alopecia areata in North Indians showed a preponderance in men (M:F = 2:1) and the majority of persons with disease (88%) were below 40 years of age. Onset in childhood was more frequent in girls or women, but the incidence of severe alopecia was higher in boys or men with onset at an earlier age. Diseases associated with autoimmunity were seen in only 5% of patients. Atopy was found to be associated in 18% of patients, but its reported association with younger age of onset and severe alopecia was not confirmed. Presence of vitiligo in family members and onset before 20 years of age, especially in boys or men, were found to be risk factors for severe alopecia.Int J Dermatol 1996; 35:22–27

Notes: Background. Involvement of the oral cavity in lepromatous leprosy is well-documented. The tongue may demonstrate multiple nodules, thickening, and scarring. Methods. Ten consecutive untreated patients with lepromatous leprosy with a bacteriologic index of 4+ or more were clinically and histopathologically studied for evidence of tongue involvement. Results. Three patients showed clinical tongue involvement, as a noduloplaque lesion in one patient and fissured tongue (lingua plicata) in two patients. Tongue was clinically normal or showed nonspecific changes in the remaining seven patients. Histologic evidence of tongue involvement by lepromatous process was seen in six patients, including three without clinical involvement. Conclusions. We conclude from this study that the tongue is as prone to involvement by lepromatous process as buccal and palatal mucosa.

Notes: Background. Alopecia areata is suspected to be an autoimmune disease. We studied 104 consecutive patients with alopecia areata for the presence of autoantibodies and associated autoimmune diseases. Methods. A detailed history and examination was carried out in all patients to look for associated atopy, diabetes mellitus, hypertension, rheumatoid arthritis, vitiligo, lupus erythematosus, and thyroid disorders, etc. in the patients or their family members. Venous blood for estimation of fasting and postprandial blood glucose was collected in 30 patients, especially in those with family history of diabetes mellitus. Antimitochondrial (AMA), antismooth muscle (SMA), antinuclear antibodies (ANA), antiparietal cell antibody (PCA), and antibody against thyroid microsome (TMA) were detected employing indirect immunofluorescence on a composite section of rat liver, stomach, kidney, and human thyroid. Skin biopsy was processed for direct immunofluorescence by a conventional technique. Results. Disseminated discoid lupus erythematosus, lichen planus, urticaria, psoriasis, and seronegative spondylarthritis were associated with alopecia areata in one case each. Anti-smooth-muscle-antibodies and PCA were found in 36 (34.6%) and 44 (42.3%) patients respectively, followed by TMA in 8 (7.7%), AMA in 6 (5.7%), antithyroglobulin antibodies in 3 (2.8%), and ANA in 2 (1.9%) patients. The incidence of SMA was higher in men with alopecia areata (P〈 0.001). Direct immunofluorescence carried out in 24 patients did not reveal significant findings, except for occasional immunoglobulin deposits around hair follicles and blood vessels. Conclusion. Alopecia areata in India is associated more often with antismooth muscle and antiparietal cell antibodies.

Notes: Background  Pentazocine was introduced in 1967 as a “non-narcotic, nonaddicting” analgesic. However, the abuse potential of this medication was soon recognized, and cutaneous and muscular complications of pentazocine abuse have been reported.Methods  Demographic and clinical data on 10 patients with pentazocine-induced ulcers attending the Dermatology Outpatient Department of the All India Institute of Medical Sciences (AIIMS), New Delhi, India between November 2000 and October 2002 have been compiled.Results  Ten patients with pentazocine-induced ulcers were seen at AIIMS between November 2000 and October 2002, six of whom were female. The average age of these patients was 32 years. The duration of the complaints ranged from 10 days to 7 years (average 17.5 months). Nine of the 10 patients had past history of painful medical conditions for which they had received pentazocine injections. All the patients presented with deep ulcers and sinuses over the accessible sites. The margins of these ulcers were hyperpigmented and indurated. Six patients had scars along the superficial vein access sites. Three patients had puffy-hand syndrome, while two had muscle contractures. No underlying psychiatric disorders were found in any of these patients. Urine screening for pentazocine was positive in two patients. Antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA) and antibody against DNA (antidsDNA) tests and screening for infections such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) were negative in all patients.Conclusions  Pentazocine abuse can be suspected from cutaneous findings, even when the patient does not volunteer a history of self-medication. Recognition of the condition will prevent misdirected investigations and treatment. The patient should be encouraged to seek treatment for drug dependence.

Notes: Parthenium hysterophorus is the commonest cause of airborne contact dermatitis in northern India. Treatment is mostly palliative and consists of repeated courses of antihistamines and topical and/or systemic corticosteroids. We have evaluated the effect of oral hyposensitization as an alternative therapeutic modality. In 70% of those patients who completed the study, there was a gradual improvement in their clinical status, as evident from a fall in their clinical severity score for eczema. 30% of patients had an exacerbation during the course of the study and hence hyposensitization in them was stopped. Patients tolerated therapy well and no significant side-effects were seen, except for abdominal pain, ‘heartburn’ and cheilitis.