Background:
Dermatology is primarily an outpatient specialty. However, dermatology consultations play an important role in care of inpatients. Data on inpatient dermatological consultations in tertiary care settings is limited.
Objectives:
To evaluate clinical characteristics of inpatient dermatological consultations and effect on clinical outcomes in a tertiary care setting.
Methods:
This was a single-center retrospective study where the records of all dermatological consultations for patients admitted under various specialties, emergency services, and intensive care units (ICU) at our tertiary care institute over 2 years period were reviewed. The details of patients, primary care unit, dermatological complaints, diagnosis, investigations performed, treatment given, and follow-up were recorded and analyzed.
Results:
Total of 1717 dermatologic consultations (1000 males) were recorded, with mean age of study population being 33.6 ± 21.6 years (median - 32 years). Out of total 1717 patients, 136 (7.9%), 321 (18.7%), 1135 (66.1%), and 125 (7.3%) patients were infants, children, adolescents, adults, and elderly, respectively. The most frequent diagnostic group was infective diseases (586; 34.1%) followed by inflammatory diseases (442; 25.7%), mucocutaneous adverse drug reactions (160; 9.3%), and autoimmune diseases (65; 3.8%). Primary team's diagnosis was concordant with the dermatology consultation in 1112 (64.8%) patients and discordant observations were recorded in 605 patients (35.2%). Most discordant dermatological diagnoses included inflammatory disorders such as lichen planus, atopic dermatitis, bullous pemphigoid; mechanical disorders; nutritional deficiency disorders, and benign neoplasms.
Conclusion:
Common skin conditions account for a large majority of dermatologic consultations in a hospital setting. Inpatient dermatology consultations improve the diagnostic accuracy.
There is lack of literature on serial dermatoscopic assessment in patients undergoing non‐cultured epidermal cell suspension (NCES) for treatment of stable vitiligo. This prospective study was conducted to evaluate the role of serial dermatoscopy in assessing disease stability and predicting repigmentation rates in vitiligo patients undergoing NCES. Dermatoscopic assessment of target lesions were done at baseline and post‐NCES at week 4, 8, 12, 16, and 24. Patches obtaining >90% repigmentation at 24 weeks were categorized to have obtained excellent repigmentation. The dermatoscopic features of target lesions that showed clinical signs of disease activity anytime during the follow‐up period were compared to those maintaining clinical stability throughout. Twenty‐six vitiligo patients with 52 patches, clinically stable for atleast 1 year were recruited. At follow‐up, six patches showed clinical signs of instability. Five patches in the unstable group developed satellite lesions by week 16, compared to none in the stable group (p < 0.05). Excellent repigmentation was achieved in 29 out of 52 patches. Appearance of normal reticular pigment network at 8 weeks was a positive predictor of excellent response (OR = 10.5, CI 1.2–89.7), whereas, altered pigment network at 12, 16, and 24 weeks and telangiectasias at 12 and 16 weeks significantly reduced the odds of excellent repigmentation.
Background: Recipient site preparation is a crucial step in non-cultured epidermal cell suspension (NCES) as it facilitates proper uptake of the grafted melanocytes.
Objectives:To compare the repigmentation rate of recipient sites prepared with manual dermabrasion (MD) versus electrofulguration-assisted dermabrasion (EF) in patients undergoing NCES for treatment of stable vitiligo.
Methods:This was a prospective randomized study including 26 patients of stable vitiligo (VIDA 0 or −1), each having two patches of size greater than 3 × 3 cm located symmetrically or at the same site or a single patch of 6 × 6 cm or larger. After randomization of patches in the given patient, MD and EF were performed on recipient areas followed by NCES. The patients were followed up at 4 weekly intervals up to 24 weeks and assessed for extent of repigmentation and adverse effects if any.Results: Greater than 75% repigmentation was observed in 69.3% of the patches prepared by MD as compared to 73.1% patches prepared by EF at the end of 24 weeks (p = 0.791). The mean improvement in target VASI was 64.0% in the MD group as compared to 68.8% in the EF group (p = 0.21). Patches prepared by EF achieved successful repigmentation earlier as compared to patches prepared by MD (9.4 weeks vs 11.4 weeks, p = 0.12).
Conclusion:Both MD and EF have comparable outcomes with respect to all parameters.
Background
Lymphocyte enhancer-binding factor-1 (LEF1) is responsible for melanocyte proliferation, migration and differentiation and its downregulation may result in depigmentation in vitiligo. Narrowband UVB (NB-UVB) phototherapy is known to enhance melanocyte migration from hair follicles to lesional epidermis; hence, it may have a role in the upregulation of LEF1.
Objectives
We intended to assess the expression of LEF1 both before and after NB-UVB therapy and correlate it with the extent of re-pigmentation.
Materials and methods
In this prospective cohort study, 30 patients of unstable non-segmental vitiligo were administered NB-UVB phototherapy for 24 weeks. Skin biopsies were obtained from acral and non-acral sites in all patients, both prior to initiation and after completion of phototherapy and LEF1 expression was measured.
Results
Amongst the 16 patients who completed the study, at 24 weeks, all patients achieved > 50% re-pigmentation. However, > 75% re-pigmentation was achieved in only 11.1% of acral patches, whereas it was achieved in a significantly higher number of non-acral patches (66.6%) (
p
= 0.05). A significant increase was observed in the mean fluorescent intensity of the LEF1 gene in both acral as well as non-acral areas at 24 weeks as compared to baseline (
p
= 0.0078), However, no difference was observed between acral and non-acral lesions in the LEF1 expression at 24 weeks or the change in LEF1 expression from baseline.
Conclusion
LEF1 expression modulates the re-pigmentation of vitiligo lesions after treatment with NBUVB phototherapy.
To the Editor, Dermatoscopy is increasingly being used as an ancillary tool in the diagnosis and monitoring of various dermatoses, including vitiligo.Progressive vitiligo is indicated on dermatoscopy by polka dot or confetti-like lesions, comet tail appearance, micro-Koebner phenomenon and starburst pattern. 1 However, there is limited data on serial dermatoscopic monitoring of treatment response in unstable non-segmental vitiligo (NSV). In this study, we have serially assessed the dermatoscopic features of disease stabilisation and markers of repigmentation in NSV patients undergoing narrow band ultraviolet B (NBUVB) phototherapy.This was a prospective study, in which nine patients of unstable NSV were administered NBUVB phototherapy as per the standard protocol for a period of 24 weeks. 2 Disease activity was clinically assessed by vitiligo disease activity score (VIDA) and an inclusion criteria of VIDA 4+ was applied to all patients. Lack of progression in size of lesions and absence of new lesions in the periphery for atleast 6 weeks (VIDA 3+) was defined as stabilisation.At baseline, two lesions of size of at-least 3*3 cm were chosen as target lesions in each patient for dermatoscopic assessment (n = 18). The patients were subsequently followed up every 4 weeks for a period of 24 weeks during which phototherapy was administered.At follow-up visits, target lesions were assessed for disease activity, extent of repigmentation and dermatoscopic features. Based on disease activity the target lesions were categorised as stable patch (VIDA 3+ and lower) or unstable patch (VIDA 4+). Extent of repigmentation was assessed as proportions and lesional repigmentation of >75% was considered as treatment success. Fischer exact test was used to determine the significance of difference in the dermatoscopic features between the stable and unstable groups.Overall, eighteen study patches were assessed over seven follow-up visits to obtain 126 unique observations. Seventyeight patches were categorised as stable and 48 patches as unstable (Table 1). Interfollicular loss of pigment network, micro-Koebnerisation, satellite lesions, leukotrichia and ill-defined borders were common in unstable group. Whereas, perifollicular
The impact of vitiligo on quality of life (QOL) of children is not well studied. In this cross-sectional study, QOL in the form of Children's Dermatology Life Quality Index (CDLQI) was assessed in 114 children with vitiligo over a year. The mean CDLQI was 2.72 ± 3.35. There was a significant correlation of body surface area involved with the DLQI and the impairment was higher in older children. The psychosocial burden of vitiligo in children cannot be ignored and must be tackled early on in order to prevent an ever lasting impact on young minds.
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