Study of Topical Anti-Inflammatory Potency and Clinical Efficacy of Formulation of Mometasone and Betamethasone by Cutaneous Blood Flow Measurements in Psoriatic Patients using Laser Doppler Velocimetry

Laser Doppler Velocimetry (LDV) was used to measure cutaneous blood flow (CBF) in psoriatic skin lesions to assess the effect of once daily application of Mometasone furoate (MF) in a base claimed to possess a "reservoir" effect, as against Betamethasone-17-valarate (BV) in a conventional cream base, applied twice daily, for 4 weeks. Bilaterally symmetrical active lesions were studied in 10 psoriatics, at baseline and at the end of 2 and 4 weeks' treatment. The formulations were also evaluated for topical anti-inflammatory potency in terms of their ability to inhibit the Post-Ischaemic-Reactive-Hyperaemic-Response (PIRHR) induced on normal uninvolved skin treated under occlusion. The lesions were also assessed subjectively for Clinical Psoriasis Index (CPI). The psoriatic lesions showed high baseline Psoriatic Hyperaemia Index (PHI = CBF on lesions/CBF on uninvolved skin : 8.42 +1.74 & 10.13 + 1.70) correlating with high CPI (9+ 0.50 & 9.1 + 0.51). During treatment with MF or BV, the lesions resolved rapidly, with a concomitant decrease in PHI and CPI (Week 2 : PHI = 3.40 + 0.46 & 5.19+ 1.5, CPI = 4.15 + 0.86 & 5.20 + 0.87 and Week 4 : PHI = 1.99+ 0.23 & 2.81 + 0.74, CPI = 2.00 + 0.50 & 2.88 + 0.72 respectively). The two formulations inhibited PIRHR to same extent (auc/min : Control = 1871 + 399.22 MF = 536.11 + 153.34 & BV = 567.5 + 110.76), indicating equal potency. The results show that pharmaceutical factor such as vehicle can significantly influence the clinical efficacy of corticoids.

Personal and Family History of Atopy in Children with Atopic Dermatitis in North India

Personal and/or family history of atopy are evaluated in 130 children, 83 boys and 47 girls, with atopic dermatitis (AD) in the age group of 3 months to 1.5 years, with mean age 2.2 + 1.93 years at onset of AD. The data have been compared with those obtained from 130 age and sex matched controls. Personal history of atopy available in 24 (18.5%) patients : 16 (12.3%) having allergic rhinitis (AR), 6 (4.7%) bronchial asthma (BA) and 2 (1.5%) with both AR and BA. The corresponding figure in control is 7 (5.4%). Both personal and family history of atopy are present in 52 (40%) patients, 28 (53.9%) having BA, 10 (19.2%) each with AR and AD, 3 (5.8%) with both BA and AD and 1 (1.9%) with AR and AD. The corresponding figure in control is 16 (12.3%). In 52 patients, 72 of family members were affected - 7 (9.7%) in first generation, 32 (44.4%) in second generation and 33 (45.9%) in third generation. None of the patients had both parents affected.

Comparative Efficacy of 2% and 1% Clotrimazole Gel in Dermatophytosis

Fifty consecutive patients of dermatophytosis satisfying a set of inclusion/exclusion criteria randomly received treatment with either 1% or 2% clotrimazole gel in a double blind set up of 42 patients who completed the study, 20 received treatment with 1% (Gr. 1) and 22 with 2% (Gr. 2) clotrimazole gel. Trichophyton rubrum was grown in culture from lesions of all patients. No statistically significant difference was found in clinical scores and mycologic findings at the beginning of study and after first week of treatment. At the end of second week, Gr. 2 showed statistically significant reduction in the severity of clinical illness and mycologic clearance in a significantly larger number of cases compared to Gr. 1. At the end of 4 week study, however, no significant difference in the overall cure rates - 81.8% in Gr. 2 and 80% in Gr. 1 - was observed. It was concluded that compared to 1% formulation, clotrimazole as a 2% gel provides faster mycologic clearance and earlier clinical improvement in dermatophytosis.

Clinico-Pathological Correlation in Classification of Leprosy

102 cases of leprosy were studied clinically and histopathologically according to Ridley's scale of 1997; 8 odd cases where criteria were not exactly fulfilled were excluded. Clinico-histopathological correlation (CHC) was studied in 94/102 cases. CHC was seen in 75/94 (79.7%). 63/102 cases had hypopigmented macules with variable degree of anaesthesia and CHC was seen in 49/63 (77.7%).

Zosteriform Lichen Planus

Lichen planus (LP) lesions as a sequence to herpes zoster in association with other active lesions of LP are described rarely in literature. One such case is reported here.

Non-septicemic Echthyma Gangrenosum

A 35 year male suffering from acid-peptic disease since last 15 years developed multiple, progressive necrotic gangrenous ulcers with pus discharge since one month. He also had cellulitis and a big serpiginous necrotic ulcer of left ring finger resembling decubitus ulcer. Smears of pus from both types of ulcers revealed gram negative bacilli. Culture of pus from both sites showed growth of pseudomonas aeruginosa. Blood culture was negative. Diagnosis of Echthyma gangrenosum (EG) was established histopathologically as gram negative bacilli invaded the dermal vessels. Complete cure occurred after 3 months of treatment with different antibiotics; 80% of ulcers healed with cefadroxyl therapy.

Rowell's Syndrome

Two cases with discoid lupus erythematosus (DLE) and lesions resembling erythema multiforme (EM), associated with depigmentation, are reported since DLE with EM and resultant depigmentation is rare.

Squamous Cell Carcinoma arising in Lichen Planus Hypertrophicus

The case of a 58 year old man who developed a well-differentiated squamous cell carcinoma (SCC) in a pre-existing plaque of lichen planus hypertrophicus (LPH) is reported. The LPH lesions were confined to the anterior aspect of legs for 34 years before the development of SCC in one of the larger plaques. Although reported in the literature, the malignant transformation of cutaneous lichen planus is a rare occurrence. The SCC was treated with complete excision and the defect was closed with an autograft taken from the thigh.

Porokeratosis Plantaris, Palmaris et Disseminata

A 14 year old girl developed dark, keratotic lesions all over the body for the last 9 years. The lesions were mostly linear but some were oval with keratotic border and atrophied centre. The lesions were almost symmetrical in distribution. Homy and warty lesions appeared over soles for the last 2 years. An unusual presentation of porokeratosis plantaris, palmaris of disseminata is described.

Plaque Type Blue Naevus

A case of plaque type blue naevus was encountered in a Dermatology Clinic in Madras. The various clinical differential diagnoses are discussed, the histopathological features described and the benign nature of the tumour stressed. The case is reported for its rarity and to create an awareness of this entity.

Widespread Lichen Nitidus

An interesting case of widespread lichen nitidus in a child is reported.

Squamous Cell Carcinoma on a Lesion of Discoid Lupus Erythematosus

A 45 year old female, with lesions of disseminated discoid lupus erythematosus (DLE) for about 10 year duration, developed a solitary lesion of well-differentiated squamous cell carcinoma on the healed scar of a DLE on the right forearm.

Lichen Spinulosus

One 8 year girl had repeated crops of mildly pruritic, erythematous plaques studded with follicular papules showing prominent antenna sign on sides of neck, trunk (more on back), buttocks and extensors of limbs since one year. Plaques increased in size for 7-8 days, remained stationary for 20-22 days and resolved slowly after another 14-15 days. Erythematous colour changed from dark brown to orangish yellow to pale yellow to normal skin colour. Discrete follicular papules with antenna sign were also present. Her mother had bronchial asthma.

Erythema Elevatum Diutinum

A patient with a three year history is presented as a classic example of erythema elevatum diutinum which responded to dapsone therapy.

Multicentric Lupus Vulgaris

A 20 year old male patient presented with multiple plaques of lupus vulgaris over face and left thigh extending over mid leg. He also had left inguinal lymphadenitis along with discharging sinus. The multiple foci were probably due to haematogenous dissemination.