Publications by authors named "Iffat Hassan"

88 Publications

Interleukin 4 and Interleukin 4 receptor alpha gene variants and risk of atopy - A case control study based assessment.

Clin Immunol 2021 Aug 12;229:108783. Epub 2021 Jun 12.

Department of Clinical Biochemistry, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Soura, 190011, J&K, India. Electronic address:

Introduction: IL4 pathway is known to upregulate IgE mediated immune responses and responsible for the manifestation of Atopic disorders. The current study was aimed to elucidate the genetic variations of Interleukin 4 (IL4) and Interleukin 4 receptor alpha (IL4R) genes and their possible association with atopic subjects.

Methods: The well-designed questionnaire was used to collect the subject demographic and clinical details. Biochemical parameters were analysed using Chemiluminescent Immunoassay (CLIA) technique. The genotyping was performed using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP).

Results: We observed a statistically significant difference of serum Immunoglobulin-E (IgE) levels among cases and controls (P<0.05). Subjects harbouring the variant genotypes of I50V and Q576R single nucleotide polymorphisms (SNPs) in IL4R gene showed statistically differential risk towards atopic disorders. However, the variants genotype of 70 bp VNTR polymorphism in IL4 gene showed a protective role towards in predisposition to Atopy. On stratification, the above genetic variants had a significant impact on modifiable and non-modifiable factors associated with the disease.

Conclusion: Our study demonstrates that increased IgE levels and IL4 gene variants (I50V and Q576R) are significantly associated towards predisposition to allergic disorders in this study population.
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http://dx.doi.org/10.1016/j.clim.2021.108783DOI Listing
August 2021

Prevalence of Cold Dermatoses in Kashmir Valley: A Cross-Sectional Study from North India.

Indian Dermatol Online J 2020 Sep-Oct;11(5):731-737. Epub 2020 Sep 19.

Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India.

Background: Often quoted as "heaven on earth," Kashmir forms one of the two divisions of the Union territory of Jammu and Kashmir. A high-altitude region with abundant precipitation and snowfall, the people of Kashmir experience peculiar dermatoses not commonly seen in the majorly tropical subcontinent of India. In this study, we focussed on cold dermatoses as a comprehensive cluster and attempted to study them as a group.

Aims: To determine the prevalence of cold dermatoses in Kashmir valley and study their epidemiological characteristics.

Methods: This observational, cross-sectional community-based study was conducted on native Kashmiri population in three districts of the valley, exclusively during the winter season of the year 2016-17 and 2017-18. The data were tabulated and analyzed with Chi-square test for discrete variables and -test for continuous variables, using OpenEpi. A value of less than 0.05 was taken as significant.

Results: The study included a total of 1200 cases with 602 males and 598 females. Perniosis was most commonly encountered dermatoses in our study with a prevalence of 12.2%. Frostbite had a prevalence of 0.83%. Raynaud's phenomenon and asteatotic eczema were seen in 1.5% and 1.67% of the population, respectively. Cold panniculitis, cold urticaria, and livedo reticularis were each seen in 0.08% of the population.

Conclusions: Cold dermatoses form an important source of morbidity among the native population of Kashmir. These can be easily prevented by ensuring adequate protection against cold. Creating awareness regarding these disorders and probable association with connective tissue disorders is also imperative.
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http://dx.doi.org/10.4103/idoj.IDOJ_543_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678543PMC
September 2020

Clinical and epidemiological study of cutaneous leishmaniasis in two tertiary care hospitals of Jammu and Kashmir: An emerging disease in North India.

Int J Infect Dis 2021 Feb 9;103:138-145. Epub 2020 Nov 9.

Postgraduate Institute of Pathology, Government Medical College Srinagar, University of Kashmir, Srinagar, Jammu and Kashmir, India.

Background: An increasing number of patients with cutaneous leishmaniasis (CL) are reporting to tertiary care centers in Jammu and Kashmir, an area that has previously been non-endemic for this disease. This merits consideration of CL as a major health problem of considerable epidemiological importance. The aims of this study were firstly to describe the clinico-epidemiological profile, therapeutic characteristics, and outcomes of patients with CL and secondly to highlight this union territory as a new focus of endemicity for CL.

Methods: A two-center hospital-based prospective cohort study was conducted at two tertiary care hospitals in Jammu and Kashmir over a period of 10 years (July 2009 to June 19). All patients presenting to the outpatient departments with lesions suggestive of CL were enrolled for the purpose of this study. Demographic data were recorded on a proforma questionnaire, along with a detailed history and the results of a meticulous examination. Patients diagnosed with CL based on clinical criteria were subjected to slit skin smear (SSS) and histopathological examination for confirmation of the diagnosis. An intralesional pentavalent antimonial, sodium stibogluconate (SSG), was administered at a dose of 0.5 mL/cm (100 mg/mL solution) three times weekly to those patients with smaller lesions, and intravenously or intramuscularly at a dose of 20 mg/kg/day to those with larger lesions. The response to treatment was assessed by total re-epithelialization of the lesion and an absence of infiltration and erythema, with or without scarring. Treatment was given until complete resolution of the lesions or for a maximum duration of 10 weeks when given intralesionally and 3 weeks when given systemically. Clinical follow-up was performed twice weekly for the first 2 months and monthly thereafter. The final response to treatment was assessed at 6 months.

Results: The study included a total of 1300 patients with a mean age of 26.7 ± 18.5 years. The mean duration of the disease was 28.52 ± 13.5 weeks, ranging from 8 to 64 weeks. Lesions were noted mainly on exposed parts of the body, with the face being the most commonly affected site (89.00%). Nodulo-ulcerative plaques were the predominant lesion type observed (73.92%). The presence of Leishman-Donovan bodies could be demonstrated on SSS and histopathology in 60.69% and 39.54% of patients, respectively. The presence of a recognizable histological pattern conforming to CL and a response to a therapeutic trial of SSG was considered to be confirmatory in the remaining patients. Complete cure was achieved in 84.23% of cases during the study period. Single lesions were more likely to respond to treatment as compared to multiple lesions. The route of administration did not have any significant impact on the final outcome.

Conclusions: With the disease showing an escalating trend in Jammu and Kashmir, the possibility of a new focus of endemicity and its impact on public health need to be contemplated, and appropriate measures should be initiated to contain its spread.
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http://dx.doi.org/10.1016/j.ijid.2020.11.002DOI Listing
February 2021

Dermoscopy of Paget's Disease.

Indian Dermatol Online J 2020 Jul-Aug;11(4):674-675. Epub 2020 Jan 24.

Department of Dermatology, Government Medical College, Srinagar, Jammu and Kashmir, India.

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http://dx.doi.org/10.4103/idoj.IDOJ_64_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413442PMC
January 2020

Female Pattern Hair Loss-An Update.

Indian Dermatol Online J 2020 Jul-Aug;11(4):493-501. Epub 2020 Jul 13.

Postgraduate Department of Dermatology, Government Medical College, Srinagar, Jammu and Kashmir, India.

Female pattern hair loss (FPHL) is nonscarring progressive thinning of hair with gradual decrease in the number of hair, especially in the frontal, central, and parietal scalp, due to a process known as follicular miniaturization. The etiopathogenesis of FPHL is complex with multiple factors such as genetics, inflammation, hormones, and environment playing role in it. It usually manifests as slowly progressive hair thinning, mainly over the vertex and upper parietal scalp, the frontal hairline is often spared and the miniaturization is also not as severe as in men. A thorough history, clinical examination, hair loss evaluation tests, dermoscopy, and scalp biopsy can help in establishing the diagnosis. Various biochemical tests may be needed in patients with hyperandrogenism. The treatment includes medical and surgical modalities. Topical minoxidil is still considered the first line of treatment. Along with medical therapy, cosmetic camouflage may also be needed in some cases.
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http://dx.doi.org/10.4103/idoj.IDOJ_334_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413422PMC
July 2020

Etiopathological and Clinical Study of Acute Generalized Exanthematous Pustulosis: Experience from a Tertiary Care Hospital in North India.

Indian Dermatol Online J 2020 May-Jun;11(3):391-397. Epub 2020 May 10.

Department of Pathology, Sexually Transmitted Diseases and Leprosy, Government Medical College, Srinagar, University of Kashmir, Jammu and Kashmir, India.

Background: Acute generalized exanthematous pustulosis (AGEP) is a type of severe cutaneous adverse reaction that is characterized by the rapid development of nonfollicular, sterile pustules on an erythematous base.

Objectives: The aim of our study was to enroll all cases of AGEP reporting to our department over a period of one year and to find out the clinical and etiological profile of the patients.

Materials And Methods: All the patients reporting to our department with clinical features suggestive of AGEP were enrolled for the study. Careful history and examination were done to rule out other causes of pustular eruptions, which can resemble AGEP. AGEP validation score of the EuroSCAR study group was used to establish the diagnosis.

Results: A total of 16 patients were enrolled during the study period of one year. The majority of the patients were females with a mean age of 28.41 ± 12.2 years. Twelve (75%) of the patients had a history of drug intake while 4 (25%) had developed AGEP following an insect bite. Penicillins were the causative factor in five patients followed by cephalosporins in three patients, nonsteroidal anti-inflammatory drugs (NSAIDs) in 2 patients, and terbinafine in 1 patient. Tetanus toxoid was responsible for the development of AGEP in one patient. The insect bites were all spider bites.

Conclusion: AGEP is a rare type of severe cutaneous adverse drug reaction.We encountered 16 patients of AGEP over a period of one year. An important cause of AGEP was spider bite in our study group.
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http://dx.doi.org/10.4103/idoj.IDOJ_232_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367567PMC
May 2020

Impact of COVID-19 Pandemic on Dermatologists and Dermatology Practice.

Indian Dermatol Online J 2020 May-Jun;11(3):328-332. Epub 2020 May 10.

Department of Dermatology, Venereology and Leprosy, PGIMER, Chandigarh, India.

The COVID-19 pandemic has directly or indirectly affected every human being on this planet. It's impact on the healthcare system has been devastating. The medical fraternity across the world, including India, is facing unprecedented challenges in striving to cope up with this catastrophic outbreak. Like all other specialties, dermatology practice has been profoundly affected by this pandemic. Measures have been taken by dermatologists to control the transmission of the virus, whereas providing health care to patients in the constrained environment. Preventive measures such as social distancing and hand hygienic practices along with patient education is being prioritized. Dermatological conferences and events scheduled across the globe in the first half of year 2020 have been either cancelled or postponed to discourage gatherings. Rationalization of resources and practice of teledermatology are being encouraged in current scenario. Non-urgent visits of the patients are being discouraged and elective dermatology procedures are being postponed. Many national and international dermatology societies have recently proposed recommendations and advisories on usage of biologicals and immunomodulators in present context of COVID-19 pandemic. Urticarial, erythematous, varicelliform, purpuric and livedoid rash as well as aggravation of preexisting dermatological diseases like rosacea, eczema, atopic dermatitis, and neurodermatitis rash have been reported in Covid-19 patients. Self medications and poor compliance of dermatology patients in addition to lack of proper treatment protocols and monitoring are a serious concern in the present scenario. Strategies for future course of action, including the dermatology specific guidelines need to be framed. This issue includes a special symposium on dermatology and COVID-19 having recommendations from special interest groups (SIGs) of Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) Academy on leprosy, dermatosurgery, lasers and dermoscopy.
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http://dx.doi.org/10.4103/idoj.IDOJ_180_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367587PMC
May 2020

Dermoscopy of Two Cases of Cutaneous Leishmaniasis.

Indian J Dermatol 2020 May-Jun;65(3):232-234

Department of Dermatology, Government Medical College, Srinagar, Jammu and Kashmir, India. E-mail:

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http://dx.doi.org/10.4103/ijd.IJD_284_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292443PMC
June 2020

Laser Treatment in Hirsutism: An Update.

Dermatol Pract Concept 2020 20;10(2):e2020048. Epub 2020 Apr 20.

Department of Dermatology, STD & Leprosy, Government Medical College, Srinagar, India.

Unwanted hair growth, which is a common aesthetic problem, has traditionally been treated using various techniques such as shaving, waxing, and epilation, but most of these provide only a temporary solution. Laser and light-based technology for hair removal has become one of the fastest growing procedures in modern cosmetic dermatology in the last decade. Clinical experience suggests that in the ideal subject with fair skin and dark hair, laser treatment can reduce hair growth significantly. This article reviews the various laser and light-based devices used for hair removal along with the various laser and patient parameters that affect the outcome of laser treatment for hair removal. Photoepilation, when properly used, offers clear advantages when compared with older, traditional techniques.
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http://dx.doi.org/10.5826/dpc.1002a48DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190465PMC
April 2020

Clinicoepidemiological and Patch Test Profile of Patients Attending the Contact Dermatitis Clinic of a Tertiary Care Hospital in North India: A 7-Year Retrospective Study.

Indian Dermatol Online J 2019 Nov-Dec;10(6):669-675. Epub 2019 Nov 1.

Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India.

Introduction: Allergic contact dermatitis (ACD) is a growing concern due to increased use of cosmetics and topical medications routinely and exposure to a large number of allergens on day-to-day basis. Patch testing is a reliable method for detecting the causative antigens in suspected cases.

Aims And Objectives: To assess the demographic profile, pattern of ACD, and patch test profile of suspected cases of ACD attending contact dermatitis clinic of our department.

Materials And Methods: It was a retrospective study in which all the data enrolled in the contact dermatitis clinic of our department over a 7-year period were analyzed. Patch testing was done using the Indian Standard Series of 20 antigens primarily, and other batteries were used depending on patient requirement and availability.

Results: A total of 582 patients were enrolled in the contact dermatitis clinic over a period of 7 years. Hand eczema was the most common pattern seen in 268 cases followed by feet eczema, hand and foot eczema, facial eczema, forearm and leg eczema and photoallergic contact eczema. A total of 177 patients (30.4%) gave positive patch test results, with nickel sulfate being the most common allergen identified followed by potassium dichromate, cobalt sulfate, paraphenylenediamine, neomycin sulfate, and fragrance mix.

Conclusion: Common allergens identified in our study were more or less similar to studies from other parts of India. However, due to the unique climate of the valley, the profile of parthenium sensitivity was low in our study when compared to the rest of the country.
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http://dx.doi.org/10.4103/idoj.IDOJ_26_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859765PMC
November 2019

Can Dermoscopy Serve as a Diagnostic Tool in Dermatophytosis? A Pilot Study.

Indian Dermatol Online J 2019 Sep-Oct;10(5):530-535. Epub 2019 Aug 28.

Department of Dermatology, STD and Leprosy, Government Medical College, Srinagar, University of Kashmir, Jammu and Kashmir, India.

Background: Dermoscopy has been shown to be a useful tool in assisting the noninvasive diagnosis of various general dermatological disorders.

Aim: The purpose of the study was to describe the dermoscopic findings in various dermatophytosis.

Materials And Methods: This cross-sectional study included 100 clinically diagnosed tinea infections of skin, hair, and nails, which were evaluated using a dermoscope (Dermlite 3 gen DL3N, California USA, 10x).

Results: Among 100 patients of dermatophytosis, 69 were males and 31 females. The maximum number of patients had tinea corporis, followed by tinea cruris and tinea capitis. Dermoscopic findings noted in cases of tinea corporis included diffuse erythema, follicular micropustules, and brown spots surrounded by a white-yellowish halo, broken hair, wavy hair, and rare, morse code hair. Dermoscopy of tinea capitis depicted comma hairs, corkscrew hairs, zigzag hairs, and morse code hairs. Proximal jagged edge, spikes, and longitudinal striations were present in the cases of onychomycosis. Dermoscopy of tinea incognito yielded morse code hairs, follicular micropustules, and easily deformable hairs that look weakened and transparent and show unusual bends.

Limitations: Dermoscopic findings were not correlated to fungal culture.

Conclusion: Dermoscopy can be used as a fast, inexpensive, and noninvasive diagnostic tool to enhance diagnosis of cutaneous fungal infections.
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http://dx.doi.org/10.4103/idoj.IDOJ_423_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6743399PMC
August 2019

Clinical and epidemiologic features of melasma: a multicentric cross-sectional study from India.

Int J Dermatol 2019 Nov 11;58(11):1305-1310. Epub 2019 Jun 11.

Department of Dermatology, Maulana Azad Medical College, New Delhi, Delhi, India.

Background: Though melasma is a common skin condition in India, epidemiological studies are few and geographically confined. The present study was designed to gain insights into factors involved in causation and aggravation of melasma, demographic distribution, clinical presentations, and treatment patterns.

Methods: A cross-sectional multicentric study was conducted in 10 centers distributed across the four regions of India. Data including demographics, personal and family medical history, triggering and aggravating factors, clinical patterns, and details of past treatment regimens were recorded, and severity was estimated using the modified Melasma Area and Severity Index (MASI) score. Data collected by site dermatologists were collated and analyzed.

Results: The study evaluated 1,001 patients with melasma from 10 centers. Mean age was 38.02 years. Females dominated (85%). Proportion of males was highest in the east (22.2%) and lowest in the south (10.8%). Majority of patients belonged to intermediate skin phototypes. There was a significant difference (P = 0.000) between duration of sun exposure and duration of cooking fire/occupational heat exposure across the four regions. There was a significant association (P = 0.003, Mann-Whitney U test) and a positive correlation between duration of cooking heat/occupational heat exposure and severity of melasma. Sunscreens were used by only one-fifth of the study population (19.6%) whereas use of steroids and triple combinations was more common (28%).

Conclusion: One of the largest studies on melasma from the subcontinent, this study describes the epidemiological determinants of melasma. Data suggests that the duration of cooking fire/occupational heat exposure may be linked to severity of melasma. Sunscreen use seems inadequate in Indian patients; use of steroid-containing medications is more common.
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http://dx.doi.org/10.1111/ijd.14541DOI Listing
November 2019

Role of Adjuvant Narrow Band Ultraviolet B Phototherapy in the Treatment of Chronic Urticaria.

Indian J Dermatol 2019 May-Jun;64(3):250

Department of Dermatology, STD and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India.

Background: Chronic urticaria is a common dermatological disorder that causes a great deal of distress in patients and affects daily life. Narrow band ultraviolet B (NBUVB) has been shown to be an effective treatment in chronic urticaria in few studies. However, the data regarding its role in chronic urticaria are limited.

Aims And Objectives: The aim of this study was to determine the role of NBUVB in the treatment of chronic urticaria in combination with antihistamine.

Materials And Methods: A total of 80 patients of chronic urticaria were recruited, out of which 40 were allocated to NBUVB-loratadine group and 40 to loratadine group. Patients were assessed using urticaria activity score (UAS) at same point of time, i.e. after 4 weeks (8 sessions), 8 weeks (16 sessions) and at follow up of 4 weeks after stopping the treatment.

Results: On comparing the two groups, the mean UAS was significantly lower after 8 and 16 sessions in NBUVB-loratadine group (12.03 v/s 21.43 and 3.54 v/s 17.16, respectively). The difference in reduction of UAS7 in two groups was seen to be statistically significant ( value < 0.01).

Conclusion: Thus we conclude that NBUVB may be useful in the treatment of chronic urticaria.
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http://dx.doi.org/10.4103/ijd.IJD_475_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537687PMC
June 2019

Chronic Relapsing Cutaneous Leishmaniasis in an Elderly Female: A Rare Clinical Presentation from a Nonendemic Area.

Indian Dermatol Online J 2019 Mar-Apr;10(2):165-167

Department of Dermatology and STDs, Government Medical College, Srinagar, J and K, India.

The presentation of cutaneous leishmaniasis (CL) varies from asymptomatic erythematous papules to nodulo-ulcerative forms over the exposed parts of body, generally healing slowly in 3-12 months. Besides, rare and atypical presentations of disease are being reported that pose both a diagnostic and therapeutic challenge especially in nonendemic areas. There has been an increase in the incidence of CL in our region over the past decade, and most of our patients belong to district Kupwara which is the north-most district of Kashmir valley, situated at an altitude of 5300 feet above sea level sharing borders with Pakistan-administered Kashmir. Herein, we report a case of an elderly female from a nonendemic area who had a relapse of cutaneous disease at a previously treated site and came to us with an atypical presentation of more than 2 years duration.
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http://dx.doi.org/10.4103/idoj.IDOJ_264_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434751PMC
April 2019

Association of Vitamin D Receptor Gene Polymorphisms and Serum 25-Hydroxy Vitamin D Levels in Vitiligo - A Case-control Study.

Indian Dermatol Online J 2019 Mar-Apr;10(2):131-138

Department of Preventive and Social Medicine, Government Medical College, Srinagar, Karan Nagar Srinagar, J and K, India.

Background: Vitamin D has stimulatory and protective effects on melanocytes and acts through its nuclear vitamin D receptor (VDR) on target cells. Various single-nucleotide polymorphisms (SNPs) in VDR genes have been described.

Aims: The aim was to study and compare the association of SNP of in VDR gene as well as the plasma vitamin D levels in vitiligo patients and healthy controls.

Methods: This was a case-control study, in which 100 patients of vitiligo and an equal number of healthy individuals were studied. The VDR polymorphisms of , , , , and were investigated, after extraction of genomic DNA by rapid capillary polymerase chain reaction with melting curve analysis, and 25 hydroxy vitamin D levels were measured in cases and controls.

Results: The frequency of genotypes (SNP and ) was higher in the patient group versus controls ( = 0.002). The genotype frequency ( and ) was higher in the patients than the controls for the genotype, but not significantly higher (48% vs. 39%, = 0.1431). The difference between the groups in frequency of the genotype ( and ) was statistically significant ( = 0.0001 and = 0.033). Statistically significant difference was also observed in -evaluated alleles in cases when compared to controls ( = 0.0001). There was no significant difference in serum vitamin D levels between various genotypes among cases and controls. Out of 100 cases, 10 were found to have vitamin D levels of >30 ng/ml, 15 had levels between 20 and 30 ng/ml, 52 had ≤20 ng/ml, and 23 ≤ 10 ng/ml, respectively.

Limitations: Since the skin biopsies were not taken from the lesions of vitiligo, the correlation of serum levels with tissue levels of VDR gene was not possible and the role of vitamin D supplementation was not evaluated.

Conclusion: The single nucleotide gene polymorphisms of various VDR genes as found in the cases might lead to vitamin D deficiency, due to VDR dysfunction, which in turn could increase the susceptibility to develop vitiligo.
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http://dx.doi.org/10.4103/idoj.IDOJ_97_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434755PMC
April 2019

Dermoscopy of Morphea.

Indian Dermatol Online J 2019 Jan-Feb;10(1):92-93

Department of Dermatology, Government Medical College Srinagar, Karan Nagar Srinagar, Jammu and Kashmir, India.

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http://dx.doi.org/10.4103/idoj.IDOJ_350_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362751PMC
February 2019

Assessment of modified Rodnan skin score and esophageal manometry in systemic sclerosis: a study correlating severity of skin and esophageal involvement by objective measures.

Acta Dermatovenerol Alp Pannonica Adriat 2018 12;27(4):169-173

Postgraduate Department of Dermatology, STD's, and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India.

Introduction: Systemic sclerosis (SSc) is a multisystem connective tissue disease characterized by immune-mediated activation of tissue fibroblasts and consequent fibrosis, vascular abnormalities, and inflammation. The skin and esophagus are the two most frequently involved organs in this disease. Data regarding the correlation between the severity of skin and esophageal involvement in SSc by objective measures are negligible so far.

Methods: Thirty-one patients with SSc were subjected to esophageal manometry. A correlation between modified Rodnan skin score (MRSS) and esophageal manometric parameters of lower esophageal sphincter pressure (LESP), percentage relaxation of the lower sphincter, amplitude, and duration of the peristaltic waves was established.

Results: The mean MRSS was found to be 16.9 ± 8.7. There was no statistical correlation between MRSS and LESP (p = 0.496), percentage relaxation (p = 0.070), amplitude (p = 0.531), and duration (p = 0.459) of the contractions. No difference between these manometric parameters was found if the patients were divided into limited and diffuse subsets.

Conclusion: There exists no correlation between the severity of skin involvement measured by MRSS and manometric abnormalities in SSc. All patients with SSc should undergo esophageal manometry irrespective of the extent of skin involvement.
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December 2018

Onychoscopy: an observational study in 237 patients from the Kashmir Valley of North India.

Dermatol Pract Concept 2018 Oct 31;8(4):283-291. Epub 2018 Oct 31.

Postgraduate Department of Dermatology, STD & Leprosy, Government Medical College, Srinagar, University of Kashmir, Jammu & Kashmir, India.

Background: Nail disorders comprise approximately 10% of all dermatological conditions. Because diagnosis is not always possible by clinical means alone, additional diagnostic procedures may be required at times. Dermoscopy of nails (onychoscopy) has shown promising results in diagnosing various nail disorders and also avoids time-consuming investigations such as culture and biopsy.

Objective: To study the dermoscopic features of various nail disorders to determine the correlation between KOH examination and onychoscopic patterns in patients with the clinical suspicion of onychomycosis, and to differentiate benign pigmented lesions from malignant ones.

Methods: An open, observational and cross-sectional study of 237 patients was conducted. All patients underwent clinical examination and the affected nails were examined with a dermatoscope. The onychoscopic patterns were identified and recorded.

Results: The study included 237 patients with the following diagnoses: 81 onychomycosis, 63 psoriasis, 27 lichen planus, 30 longitudinal melanonychia, 24 connective tissue disorders, 5 onychophagia and nail tics, 3 subungual verrucae, 2 glomus tumor, 1 Darier disease, and 1 enchondroma. The most common onychoscopic findings were spiked pattern in cases of onychomycosis, dilated and tortuous capillaries in cases of psoriasis, longitudinal streaks and nail fragmentation in cases of lichen planus, and enlarged capillaries in cases of connective tissue diseases.

Limitations: The study was only observational and did not compare the results to biopsy and culture.

Conclusions: Onychoscopy may be used as an important diagnostic tool when evaluating nail disorders. It should be used to aid in the diagnosis of various nail disorders and to avoid unnecessary and time-consuming investigations.
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http://dx.doi.org/10.5826/dpc.0804a06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6246064PMC
October 2018

Variation at Interleukin-10 Locus Represents Susceptibility to Psoriasis in North Indian Population.

Endocr Metab Immune Disord Drug Targets 2019 ;19(1):53-58

Department of Human Genetics, Punjabi University, Patiala, Punjab, India.

Background: IL-10 is an important pleiotropic, immunoregulatory and anti-inflammatory cytokine which plays a significant role in the pathogenesis of psoriasis.

Objective: The aim of the present study was to determine whether the three polymorphic sites of the IL-10 gene, haplotype and serum level confer susceptibility to psoriasis.

Method: 200 psoriatic patients and 200 controls were genotyped for three IL-10 polymorphic sites by ARMS polymerase chain reaction. Serum levels of IL -10 were measured by ELISA.

Results: Our results demonstrated that polymorphism of IL-10 -592 C/A (adjusted* OR = 9.25; 95% CI =3.16- 27.06) and IL-10 1082 A/G (adjusted* OR = 4.28; (95% CI =1.46- 12.56) was found to be in association with increased risk of psoriasis while as IL- 10 819 C/T (adjusted* OR= 1.60; (95% CI = 0.65-3.95) polymorphism does not show any significant association with the risk of psoriasis. HT7 GTC haplotype is associated with increased risk of psoriasis. Serum levels of IL-10 were found to be significantly low in patients, as compared to controls with a non-significant correlation between serum IL-10 level and psoriasis severity.

Conclusion: IL-10 polymorphism imparted significant risk towards the development of psoriasis in North Indian population. Highlighting the role of IL-10 cytokine in the pathogenesis of psoriasis will help in the development of psoriasis management.
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http://dx.doi.org/10.2174/1871530318666180821161629DOI Listing
May 2019

ANCA-associated Vasculitis in a Case of Congenital Leptin Deficiency.

Indian J Dermatol 2018 May-Jun;63(3):268-270

Department of Dermatology, Venereology and Leprosy, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India. E-mail:

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http://dx.doi.org/10.4103/ijd.IJD_52_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5996624PMC
June 2018

Footwear Contact Dermatitis: A Prospective Cross-Sectional Study of 108 Outpatients from Delhi, India.

Skinmed 2018;16(2):90-97. Epub 2018 Apr 1.

Department of Dermatology, Government Medical College, Srinagar, India.

Footwear contact dermatitis is a common problem with multifactorial exogenous, as well as endogenous, etiologies. Patch testing is the gold standard for detection of the possible contactants. A cross-sectional study was conducted in 108 outpatients over a period of 18 months. Demographic data comprising age, sex, and occupation were collected. Details of clinical and laboratory investigations were used to define the incriminating ingredient(s), subsequently confirmed by patch test using Indian standard and footwear series approved by the Contact and Occupational Dermatitis Forum of India. Reading and interpretation were carried out according to the International Contact Dermatitis Research Group (ICDRG) guidelines. Of the 108 patients, 64 were girls or women and 44 boys or men. Although footwear contact dermatitis affected all age groups, most individuals were 21 to 40 years old. The morphology and distribution of the lesions were very specific. Patch testing was helpful, the primary sensitizing agent being mercapto mix, followed by mercaptobenzothiazole, potassium dichromate, and paraphenylenediamine. Footwear contact dermatitis is an extraordinary entity, requiring a high level of expertise (or knowledge) to determine its etiology through history, clinical examination, and patch testing.
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October 2019

Common Contact Allergens in Patients with Palmoplantar and Scalp Psoriasis and Impact of their Avoidance on Dermatology Life Quality Index: A Hospital-Based Study.

Indian J Dermatol 2018 Mar-Apr;63(2):160-164

Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, University of Kashmir, Jammu and Kashmir, India.

Background: Scalp psoriasis and psoriasis limited to palms and/or soles have been referred to as difficult to control psoriasis. Contact allergy has long been suspected to aggravate existing lesions and cause resistance to therapy in these psoriasis variants.

Objectives: The objective of the study was to assess common contact allergens in patients with palmoplantar and scalp psoriasis and the impact of their avoidance on dermatology life quality index (DLQI).

Materials And Methods: A total of 54 patients with palmoplantar and scalp psoriasis were patch tested with Indian Standard Series. The patch test results were read on day 2 and day 4. DLQI was calculated before patch testing and at 1 month and 3 month in patch test positive patients after instructing allergen avoidance.

Results: Sixteen out of fifty-four patients (29.62%) showed positive patch test reactions. Metal antigens like nickel and cobalt were the most common sensitizers identified. Statistically significant improvement in DLQI was observed at 1 month and at 3 month of allergen avoidance.

Conclusion: Patch testing is a useful test to determine the triggering or aggravating antigens in patients with palmoplantar and scalp psoriasis and subsequent allergen avoidance should be stressed on.
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http://dx.doi.org/10.4103/ijd.IJD_760_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903047PMC
April 2018

Authors' Reply to Critical Comment on "Vitamin D Level in Alopecia Areata".

Indian J Dermatol 2018 Jan-Feb;63(1):82-83

Department of Dermatology, STD and Leprosy, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India. E-mail:

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http://dx.doi.org/10.4103/ijd.IJD_15_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838764PMC
March 2018

Treatment of post-burn and post-traumatic atrophic scars with fractional CO laser: experience at a tertiary care centre.

Lasers Med Sci 2018 Jul 23;33(5):1039-1046. Epub 2018 Feb 23.

Postgraduate Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, Srinagar, India.

Scars are abnormal wound responses in predisposed individuals. They occur after any kind of wound and skin inflammation in predisposed individuals. Despite their benign nature, they can be aesthetically disabling. Although several approaches have been tried in their management, most of them have produced poor results. This study aims to assess the efficacy and safety of fractional CO laser treatment in the management of post-burn and post-traumatic scars. One hundred consecutive patients (77 females and 23 males) affected by post-burn scars as well as post-traumatic atrophic scars were treated with monthly sessions of fractional CO laser treatment. Patient's response to treatment was assessed clinically as well as improvement of scars by comparing the photographs taken before treatment with those taken 6 months after the last treatment session. Changes in skin texture, surface irregularity and pigmentation were assessed on a quartile grading scale and scored individually from 0 to 4. A mean of the three individual scores was calculated and the response was labelled as 'excellent' if the mean score achieved was > 3. A score of 2-3 was labelled as good response while a score below 1 was labelled as 'poor' response. A mean of six treatments per scar were required and all patients, followed up for 1 year after the last treatment, had optimum results and no recurrence. Response to treatment was excellent in 53.75%, good in 16.25% patients, and poor in 30% patients. Fractional CO laser gives a very good result in the management of patients with post-burn scars as well as post-traumatic scars with minimal adverse effects.
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http://dx.doi.org/10.1007/s10103-018-2469-xDOI Listing
July 2018

Pattern of dermatoses in two groups of admitted psychiatric patients: a cross-sectional study from a tertiary care hospital in Kashmir.

Acta Dermatovenerol Alp Pannonica Adriat 2017 Dec;26(4):89-95

Postgraduate department of Psychiatry, Institute of Mental Health and Neurosciences (IMHANS), Government Medical College Srinagar, University of Kashmir, Srinagar, India.

Background: Various specific and non-specific dermatological manifestations can be found in patients with psychiatric ailments. Most studies in this regard have been conducted on an outpatient basis and not much work has been done on patients admitted with psychiatric diseases.

Methods: This cross-sectional hospital-based study involved two groups of admitted psychiatric patients over a period of 1 year, involving 100 patients in each group. In the family ward group patients were admitted with accompanying family members, whereas in the closed ward group patients were kept under custodial care.

Results: In the family ward setting, eczema was the most common finding, observed in 29 patients, followed by atrophic scarring in 28 patients, erythema ab igne in 25 patients, and bacterial infections in five patients. Various forms of nail changes were seen in 18 patients. In the closed ward group, most common dermatological involvement was parasitic infestation, seen in 56 patients, followed by generalized pruritus in 53 patients and atrophic scarring in 52 patients. Thirty-eight patients had nail changes.

Conclusion: Skin manifestations are more common in chronic neglected psychiatric patients under custodial care. The authors stress upon the importance of familial care provided to psychiatric patients living in custodial settings.
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http://dx.doi.org/10.15570/actaapa.2017.27DOI Listing
December 2017

Pattern of Skin Diseases and Occupational Dermatoses in Veterinarians and Veterinary Workers of Kashmir.

Indian Dermatol Online J 2017 Nov-Dec;8(6):449-453

Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, University of Kashmir, Jammu and Kashmir, India.

Background: Across the globe, skin disorders represent a frequent occupational concern for many health professionals including veterinarians and there is a serious impact of skin diseases on their lives and careers. But little is known about the prevalence and distribution of skin diseases (especially occupational) within this important professional group across Asia, especially India.

Materials And Methods: The study was a cross-sectional study carried out over a period of one year in which veterinarians and veterinary workers of Kashmir valley were screened for various skin diseases and occupational dermatoses.

Results: The study group comprised 910 veterinarians and associated workers working across the valley with the majority being males; 846 workers (93%). The mean age of the group was 38.53 years. Out of these, 267 veterinarians and associated workers (29.3%) were found to have skin lesions. Of the 267 cases, 165 (61.80%) had non-infectious lesions, while the rest had 102 (38.20%) had infectious skin diseases. The main non-infectious lesions included friction-related disorders, eczemas, pigmentary disorders, papulosquamous disorders, and many others; while the infectious lesions were of fungal, bacterial, viral, and parasitic etiology. Fungal infections, eczemas, and melasma were more common in them, indicating an occupational etiology.

Conclusion: A huge group of skin diseases was seen in veterinarians and veterinary workers, with some diseases showing an occupational nature. To reduce the burden of skin diseases in this particular group, proper prevention measures need to be instituted at work places by veterinary governing bodies of the state.
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http://dx.doi.org/10.4103/idoj.IDOJ_31_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707836PMC
December 2017

Contact dermatitis caused by tulips: identification of contact sensitizers in tulip workers of Kashmir Valley in North India.

Contact Dermatitis 2018 Jan 21;78(1):64-69. Epub 2017 Sep 21.

Department of Dermatology, Sexually Transmitted Diseases & Leprosy, Government Medical College and Associated Hospitals, 190010, Srinagar, India.

Background: Tulip, belonging to the genus Tulipa and family Liliaceae, is a spring-blooming perennial that grows from bulbs. Owing to manual handling, contact dermatitis can occur in professionals at any stage of the growth cycle of the tulip plant.

Objectives: To determine the clinical pattern of contact dermatitis resulting from tulip plant cultivation, and to assess contact allergy in workers coming into contact with this plant.

Methods: One hundred and sixty-four tulip workers were screened, and 48 patients with suspected contact dermatitis were patch tested with 39 allergens, including haptens from the Indian baseline series, a plant series, and extracts from different parts of the tulip plant.

Results: Thirty-nine positive patch test reactions were observed in 21 patients. Seventeen patients showed positive reactions to either α-methylene-γ-butyrolactone or to tulip plant extract. Clinical relevance was observed for 13 of 17 positive patch test reactions.

Conclusions: Contact dermatitis is an important health hazard in workers dealing with tulip bulbs. Further studies to identify and isolate other possible tulip allergens, and to quantify the amounts of allergens in different parts of the tulip plant, are recommended.
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http://dx.doi.org/10.1111/cod.12870DOI Listing
January 2018

Vitamin D Level in Alopecia Areata.

Indian J Dermatol 2017 Jul-Aug;62(4):407-410

Department of Dermatology, STD and Leprosy, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India.

Background: Alopecia areata (AA) is an immune-mediated disease in which autoantigens play an important part in activating T-lymphocytes. Vitamin D has been associated with various autoimmune diseases, and Vitamin D receptors are strongly expressed in hair follicles and their expression in keratinocytes is necessary for the maintenance of the normal hair cycle.

Aim: The aim of this study was to find the association between Vitamin D level and AA.

Materials And Methods: This was a hospital-based cross-sectional study in which 50 patients with clinically and trichoscopically diagnosed AA cases, and 35 healthy age- and sex-matched controls were studied in summer months. Blood samples were taken from both cases as well as controls and samples were immediately processed by centrifugation (4000 rpm) at room temperature. Plasma 25-hydroxyvitamin D (25(OH)D) was analyzed by chemiluminescence method. A deficiency in Vitamin D was defined as serum 25(OH)D concentrations <30 ng/ml.

Results: The mean body mass index in cases was 20.96 ± 1.91, whereas in controls, it was 21.37 ± 1.70 ( = 0.31). The mean serum 25(OH)D levels of AA patients was 16.6 ± 5.9 ng/ml, whereas in control group, the mean level was 40.5 ± 5.7, the difference being statistically significant ( < 0.001). A significant negative correlation was found between severity of alopecia tool score and Vitamin D level ( < 0.001; = -0.730) and also between the number of patches and Vitamin D level ( < 0.001, = -0.670).

Conclusion: In our study, we found that the levels of 25(OH)D were low in AA patients when compared to healthy controls. Furthermore, there was a significant negative correlation between the levels of serum Vitamin D and severity of AA. Thus, the study suggests the role of Vitamin D in pathogenesis of AA and hence a possible role of Vitamin D supplementation in treatment of same.

Limitations: Our study was limited by the lesser number of patients and lack of therapeutic trial of Vitamin D for these patients.
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http://dx.doi.org/10.4103/ijd.IJD_677_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527723PMC
August 2017

Occupational Dermatoses among Cottage Industry Workers of Kashmir Valley in North India.

Indian Dermatol Online J 2017 May-Jun;8(3):181-185

Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India.

Introduction: Cottage industry is usually a small-scale industry operated from home by family members using their own equipment. Kashmir has a unique cottage industry of its own which deals with production of many handicrafts, which may lead to a peculiar pattern of skin diseases in these artisans. Aim: The aim of this study was to find out the pattern of skin disorders in the cottage industry workers of Kashmir valley, with primary focus on the occupation-related dermatoses and to identify the most common cutaneous manifestation in these workers.

Materials And Methods: This was a cross-sectional descriptive study in which 1062 cottage industry workers engaged in different crafts were screened. A detailed history taking and examination was carried out in each worker and the diagnosis was made on clinical grounds. Wherever deemed necessary, relevant investigations were done to establish the nature of the disease.

Results: A total of 1062 workers were evaluated for the presence of skin disorders. The male-to-female ratio was 1:1.5. The mean age of the study group was 30.3 years ± 10.79 years, with maximum number of workers (164) belonging to the crewel embroidery industry. The mean duration of work was 6.4 ± 2.08 hours/day. A total of 953 workers (89.7%) had cutaneous manifestations, with callosities being the most common finding seen in 371 workers (35%), followed by cumulative insult dermatitis seen in 201 workers (19%).

Conclusion: Cottage industry of Kashmir valley is a unique occupational group where a high percentage of workers had cutaneous manifestations related to their occupation, with callosities being the most common finding. Information and better knowledge regarding these dermatoses are important in devising strategies to improve the health scenario of these workers. Simple measures such as proper use of instruments, use of protective gloves, guarded use of chemicals, and hand washing may be very beneficial in reducing the burden of health problems in these workers.
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http://dx.doi.org/10.4103/2229-5178.206122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447337PMC
June 2017

Contact Allergens in Food Handlers of Kashmir Valley in North India.

Dermatitis 2017 May/Jun;28(3):226-227

Department of Dermatology, Sexually Transmitted Diseases & Leprosy, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India.

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http://dx.doi.org/10.1097/DER.0000000000000267DOI Listing
October 2018
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