RESUMEN
Surgery of the knee, injury to the infrapatellar branch of the saphenous nerve, traumatic eczematous dermatitis (SKINTED) involving the skin lateral to the surgical incision/scar area is a site- and procedure-specific diagnosis associated with total knee replacement surgery. It results from autonomic denervation following surgical trauma to the nerve and occurs months to years after surgical trauma. It needs to be differentiated from post traumatic eczema/dermatitis, neuropathic dermatitis and contact dermatitis/sensitization due to topical therapies or implant material. Herein, we report a case of 70-year-old woman having no preexisting medical or dermatological disorder of significance presenting with eczematous lesions around both knees lateral to the incision site developing few months after bilateral total knee replacement surgery. Treatment with twice daily application of betamethasone dipropionate 0.05% cream, gabapentine 100 mg/d PO and liberal use of bland emollient cream given over 2 months was remittive without recurrence during more than one year of follow up. Since its exact prevalence, pathophysiology and clinical course remain uncertain its awareness remains relevant to both dermatologists and orthopedic surgeons to address unnecessary anxiety and dissatisfaction of the patient.
RESUMEN
BACKGROUND: The reliability of patch testing with expired Indian standard patch test kits has been not evaluated before. METHODS: Thirty adults (men:women 25:5) with allergic contact dermatitis were divided into three groups of ten patients each for patch testing by Finn chamber® method using Indian standard patch test kits having expiry in 2016, 2015 and 2014. The results were compared with those from a new kit with 2018 expiry. RESULTS: Ten patients in group-1, eight patients in group-2 and seven patients in group-3 developed positive reactions of identical intensities and mostly from identical allergens from all four kits. The major contact allergens eliciting positive reactions of identical intensities were parthenium in nine, five and three patients, colophony in four, one and zero patients, fragrance mix in three, three and one patients, thiuram mix in three, one and one patients, and paraphenylene diamine in two, one and three patients from group-1,-2, and -3, respectively. LIMITATIONS: Small number of patients in each group remains the major limitation of the study. Whether or not these results can be extrapolated with patch test results from other similar patch test kits available across countries also needs confirmation. CONCLUSION: The patch test allergens can be used beyond labeled expiry dates but needs confirmation by a few large studies and using other available patch test kits. This is important as the relevance of patch test results for individual allergen in this scenario may remain debatable requiring careful interpretation.
Asunto(s)
Dermatitis Alérgica por Contacto/diagnóstico , Pruebas del Parche , Adulto , Anciano , Alérgenos/análisis , Femenino , Humanos , India , Masculino , Persona de Mediana Edad , Proyectos Piloto , Factores de TiempoRESUMEN
OBJECTIVES: To evaluate clinical and occupational profile and common allergens in patients with occupational contact dermatitis (OCD). MATERIALS AND METHODS: The records of 455 (M:F 2:1) patients aged 18-85 years with allergic contact dermatitis were analyzed retrospectively. The diagnosis of OCD and patterns of dermatitis were defined by standard criteria. Indian standard series comprising 20 allergens and when suspected patient's own products were patch tested by Finn chamber method as per European Society of Contact Dermatitis guidelines and relevance of positive results was defined clinically. RESULTS: Airborne contact dermatitis (27.7%), acral dermatitis (14.1%), hand dermatitis (12.9%), acrofacial dermatitis (12.7%), and facial dermatitis (10.5%) were the common patterns. Agriculturists (51.2%), homemakers (27.9%), office workers (24.6%), and construction workers (4.6%) comprised the majority. Positive patch test results in 58% cases were from parthenium (31.7%), p-paraphenylenediamine (PPD) (22.9%), nickel (16%), fragrance mix (11%), potassium dichromate (10.7%), cobalt (7.6%), and mercaptobenzothiazole (4.9%). Hair colorants, shoe chips, and shaving cream also produced relevant positive reactions. Parthenium, PPD, fragrance mix, and potassium dichromate in agriculturists; nickel, parthenium, PPD, fragrance mix, and potassium dichromate in women, and potassium dichromate and parthenium in construction workers elicited the most positive reactions. PPD and hair colorants elicited positive reaction mainly in office workers. CONCLUSIONS: The agriculturists, homemakers, and construction workers have OCD most frequently. Parthenium in farmers, potassium dichromate in construction workers, nickel in women, and PPD in office workers were the major contact allergens. The study is limited by its retrospective design, small number of patients, and limited number of patch test allergens.
RESUMEN
BACKGROUND: Hirsutism is common across ethnicities and a significant cause of negative self-esteem from presumptive loss of femininity. It remains understudied in Indian patients. OBJECTIVE: We studied the clinical and investigative attributes of patients with hirsutism. METHODS: The medical records of 233 patients with hirsutism diagnosed between 2014 and 2019 were analyzed retrospectively. RESULTS: The complete records of 122 patients age 14 to 45â¯years were available. Approximately 32% were adolescents, and 50% patients were age 21 to 30â¯years. The mean⯱â¯standard deviation modified Ferriman-Gallway (mF-G) score was 17.95⯱â¯10.58, and hirsutism was graded zero/mild in 57.4% patients. Polycystic ovaries were present in 29.5% of patients. Serum-free testosterone levels were elevated in 16.4% of patients. Associated signs of clinical hyperandrogenism, such as acne, obesity, acanthosis nigricans, and menstrual irregularities, were present in 12 patients (9.8%). Familial hirsutism occurred in 13% of patients and was idiopathic in 10.7% of patients. Significantly more patients (47.7% vs. 27.9%) with severe hirsutism did not complete investigations compared with those with mild hirsutism (45.9% vs. 21.6%), which may be due to the high cost of investigative work-up (as often stated by many patients) compared with periodic depilation. LIMITATIONS: The mF-G score is a visual and subjective scale, and its validity remains limited by interobserver variations. The score's cut-off values may vary among races/ethnicities. A small number of patients and the retrospective study design are other limitations. CONCLUSION: Hirsutism of polycystic ovary syndrome or idiopathic origin is not uncommon in Indian women. Hirsutism of adrenal or thyroid origin remains uncommon. Self-referral and high cosmetic concerns for facial hair were common in adolescents and young unmarried patients, and the majority had an mF-G score ofâ¯<â¯8 to 16. Cut-off values for the mF-G score specific to our population assigning higher than current mF-G value to facial hair are highly desirable.
RESUMEN
Vitiligo in children and adolescents displays some distinct features, which may affect its clinical course, therapeutic outcome, and prognosis. We studied 579 children and adolescents with vitiligo, comprising 275 (47.5%) boys and 304 (52.5%) girls (male:female ratio [m:f], 1:1.1) aged between 2 and 19 years (mean ± SD 11.13 ± 4.23 years). The majority of children (301, 52%) were aged >5-12 years, and 221 (38.2%) were adolescents; onset of vitiligo in the above groups occurred between the ages of 2 and 19 years (mean ± SD 9.18 ± 4.08 years). The majority of patients (337, 58.2%) had developed vitiligo between 5 and 12 years of age, and 332 (57.4%) patients had a medical consultation within 1 year of the onset of the disease. The involvement of up to 10% of body surface area in 569 (98.3%) patients, generalized vitiligo in 328 (56.7%) patients, and focal vitiligo in 158 (27.3%) patients were the major presentations. Only 150 (15.9%) patients had family members affected by vitiligo, and associated systemic disorders, predominately thyroid abnormalities, occurred in three (0.5%) patients. Vitiligo was more frequent in children aged 5-12 years, and it affected girls with a slight preponderance, commonly presenting as generalized vitiligo and focal/localized vitiligo. Patients with a family history of vitiligo had an earlier onset but without a statistically significant difference. Local trauma is an important trigger, and screening for thyroid disorders appears important.