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Background Vitiligo is an acquired disorder of pigmentation with an elusive pathogenesis, though various theories have been proposed. The presence of peri-lesional autoreactive CD8+ T cell infiltrate suggests the involvement of abnormal immune responses and autoimmunity in vitiligo. Recent studies have identified the IFN-γ-CXCL9/CXCL-10 axis as a key component of the autoimmune response that perpetuates disease activity in vitiligo. Objectives The primary objective was to estimate serum CXCL9 and CXCL10 levels in vitiligo patients compared to age- and sex-matched controls. Additionally, the study aimed to find correlations between CXCL9 and CXCL10 levels and disease severity and stability. Secondary objectives included comparing levels in segmental/nonsegmental vitiligo and stable/progressive vitiligo and assessing the impact of age and gender. Methods A hospital-based cross-sectional study included 60 vitiligo patients and 30 age- and sex-matched controls. Serum levels of CXCL9 and CXCL10 were assessed using Enzyme-linked immunosorbent assay (ELISA). Cases were clinically evaluated for the type of vitiligo (segmental or non-segmental), disease severity (VASI score), and disease stability (VIDA score). Statistical analysis included t-tests, chi-square tests, and correlation coefficients. P value less than 0.5 was taken as significant. Results Serum CXCL9 and CXCL10, both, were significantly raised in vitiligo patients as compared to controls (p-value = 0.001* & 0.001* respectively) and correlated positively with both VASI score (p-value = 0.001* & 0.001* respectively) and with VIDA score (p-value = 0.032* & 0.001* respectively). Serum CXCL10 showed significant elevation in progressive vitiligo, and CXCL9 exhibited a non-significant trend. No significant difference was observed between segmental and non-segmental vitiligo. Both chemokines positively correlated with disease severity and stability, while age and gender did not significantly impact chemokine levels. Conclusion The expression of chemokines CXCL9 and CXCL10 is markedly increased and correlated positively with disease severity & instability, underscoring their mechanistic role in vitiligo pathogenesis. The values were also higher in the progressive group than in the stable group, inferring their conceivable potential as serum biomarkers. Both serum CXCL9 and CXCL10 were significantly elevated in vitiligo patients compared to controls and they can be used as potential serum biomarkers for assessing the disease activity. Limitations Small sample size of control population. The voluntary sampling technique led to an unequal number of patients in progressive and stable vitiligo groups, as well as in segmental and non-segmental groups. The current study did not include blister fluid analysis and the effect of therapy on the chemokine levels. Conclusion The expression of chemokines CXCL9 and CXCL10 is markedly increased and correlates positively with disease severity and instability, underscoring their mechanistic role in vitiligo pathogenesis. The values were also higher in the progressive group than in the stable group, inferring their conceivable potential as serum biomarkers. *represents statistically significant results.
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Background: It is difficult to diagnose the underlying cause of erythroderma on mere clinical presentation. The role of dermoscopy in diagnosing erythroderma secondary to various etiologies is evolving. Aim and Objectives: This study aimed to observe the dermoscopic features of erythroderma secondary to different cutaneous disorders and compare them with clinical features and histopathology. Materials and Methods: Twenty-nine consecutive patients of erythroderma were enrolled in the study. Dermoscopy was performed on every case using a Heine Delta II Dermatoscope with 10x magnification in polarized mode. A histopathological examination was conducted to confirm the diagnosis. Results: Eight patients were diagnosed with psoriasis, five with endogenous eczema, four with pityriasis rubra pilaris (PRP), three with pustular psoriasis, two with drug rash secondary to antitubercular therapy, two with dermatophytic infection, one patient each of atopic dermatitis, crusted scabies, pemphigus foliaceous, drug reaction with eosinophilia and systemic symptoms, and mycosis fungoides. Characteristic dermoscopic features were observed in erythroderma due to psoriasis, PRP, pustular psoriasis, endogenous eczema, scabies, and dermatophytosis. Differentiation of other disorders based on dermoscopy alone was difficult, and clinico-histopathological correlation was crucial to reach a diagnosis. Conclusion: Dermoscopic features of classical patterns of skin disorders are preserved even in the corresponding erythrodermic or unstable stage. Dermoscopic features of erythroderma secondary to psoriasis, pustular psoriasis, PRP, endogenous eczema, scabies, and dermatophytosis are clearly differentiating, whereas the dermoscopic features in other causes of erythroderma are overlapping. Thus, dermoscopy can be a good screening tool in the clinical assessment of erythroderma.
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Background: Melasma is a common disorder of hyperpigmentation mainly affecting the face. It is difficult to treat and is a cause for great cosmetic concern for the patient. So, we did this research to compare the therapeutic efficacy of tranexamic acid (TXA) through oral route versus its transepidermal administration with a dermaroller in melasma. Materials and Methods: This was a hospital-based, interventional study carried over a span of 1 year on 40 patients with facial melasma. The enrolled patients were randomly divided into 2 groups of 20 patients each. Group A patients received oral tablet TXA in a dose of 250 mg twice daily for 12 weeks and Group B patients were given TXA solution transepidermally into the melasma lesions using a dermaroller at 2 weekly interval for 12 weeks. Thereafter, all patients were followed up for improvement in Melasma Area and Severity Index (MASI) score, adverse effects and relapse at 4 weekly intervals till 24 weeks. All the patients were evaluated for therapeutic outcome both objectively (by MASI) and photographically at 4, 8, 12, 18, and 24 weeks. Grading of improvement was done by assessing percentage reduction in MASI score. Results: Majority of the patients, 24 (60%) in our study had centrofacial pattern of melasma followed by malar pattern seen in 16 (40%) patients. The baseline MASI score was 11.98 (± 5.47) in Group A and 12.13 (± 3.16) in Group B. The mean MASI score in Group A at the end of 4, 8, 12, 18, and 24 weeks was 9.75 (±4.83), 6.09 (±3.64), 4.21 (±2.48), 2.56 (±1.95), and 3.10 (±3.38) while these values were 9.73 (±3.32), 6.06 (±2.75), 4.55 (±1.89), 2.94 (±1.36), and 3.09 (±1.32) for Group B. At the end of 24 weeks follow-up period, good (51%-75% improvement) and very good (>75% improvement) response occurred in 5 (25%) and 14 (70%) patients in Group A and 11 (55%) and 9 (45%) patients in Group B, respectively. However, the final reduction in MASI score was similar in both the groups. Relapse was uncommon and occurred at 24 weeks in 1 patient from Group A. Limitation: The major limitation was small sample size due to time limitation and long follow-up period. Conclusions: Oral and transepidermal TXA appear equally effective suggesting that the efficacy of TXA is perhaps independent of its route of administration. Oral therapy is convenient for the patient. Transepidermal therapy of TXA has the advantage of local action, hence systemic side effects are avoided, but it is slightly painful and the time period between consecutive microneedling sessions is left to the prerogative of the treating doctor, hence a proper quantification is lacking. Moreover, scheduling of maintenance sessions is necessary as melasma is prone for recurrence.
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Squamous cell carcinoma (SCC) of the nail bed is not encountered commonly although it is the most common primary malignancy at this site. In general, it has a low rate of spread, except for high risk types which carry a greater risk of spread. Screening for systemic tumours should be done in all cases especially in the elderly. We present the case of a 67 year old male who was otherwise healthy and presented with just nail discoloration associated with pain and occasional profuse bleeding with minor trauma which turned out to be SCC of nail bed on biopsy. Subsequently, he was screened for internal malignancies and was found to have clear cell Renal cell carcinoma of right kidney and a metastatic nodule in right lung. This presentation has not been previously described in literature.