P K Kaviarasan

Aim of the study: To evaluate the repigmentation with non-cultured epidermal cell suspension followed by PUVA in patients with stable vitiligo. Materials and Methods: A prospective study conducted at the department of Dermatology, Venerology, Leprosy of Rajah Muthiah Medical College and Hospital. 26 cases of stable vitiligo were treated with non-cultured epidermal cell suspension followed by PUVA and were reviewed for a period of 20 weeks.  Results: The results were assessed subjectively. 9 (34.6%) patients showed excellent response to our therapy, 7 (26.9%) patients had good response, 5 (19.3%) patients showed fair response and 3 (11.5%) showed very poor response. 17 (65%) patients showed a very good colour match when compared with the surrounding skin and 1 (3.8%) patients showed donor site scarring. Conclusion: Epidermal non cultured cell suspension followed by PUVA is a relatively safe method with superior quality of repigmentation. Keywords: Noncultured epidermal cell suspension, Vitiligo, Phototherapy, Hyperpigmentation.

Introduction: Lymphoedema is a chronic, progressive debilitating disorder of lymphoreticular system, characterized by abnormal collection of excessive proteins, oedema, chronic inflammation and fibrosis. Classification: Primary lymphoedema, associated with underlying, but inherent malfunction of lymphatic channels, unilateral or bilateral. It can be further subdivided in to congenital lymphoedema, lymphoedema praecox and lymphoedema tarda. Depends on the age of onset or manifestation. Another genetic disorder of lymphatic dysfunction is Milroy disease. It is an autosomal dominant condition due to VEGFR3 mutation characterised by lymphatic hypoplasia. Secondary lymphoedemas are more frequent than primary to dysfunction of lymphatics. Mostly localised, follwing recurrent infections, trauma, surgery, obesity and malignancy. Pathophysiology: Inadequate drainage of lymphatics, leads to accumulation of lymph, interstitial fluid and proteins in skin and subcutaneous tissue. Elastic tissue disruption, fibroblast stimulation occurs and the resulting hypoxia causes chronic inflammation and fibrosis. Later adipocyte remodelling occurs and proinflammatory cytokines secreted. Clinical Features: Starts as pitting non tender pedal oedema, later skin thickening and fibrosis which results in non-pitting oedema. Squared off appearance and Kaposi Stemmer sign are characteristic features. May develop lymphorrhoea and secondary infections may supervene. Confusions: Chronic venous insufficiency, lipoedema, myxedema. Complications: Vicious cycle of infections and lymphedema. Diagnosis: Lymphoscintigraphy, lymphoflouroscopy- gold standard. Treatment: Depends on severity. Pneumatic compression garments, Low level light therapy (LLLT), Extracorporeal shock wave therapy (ESWT). Advanced stages may require surgical debulking, lymphatic reconstruction. But the results are mostly unsatisfactory, recurrences are inevitable. Combined multidisciplinary approaches will be helpful and that should be continued throughout their life. Keywords: Primary congenital, Lymphoedema, Lymphoscintigraphy, Lipoedema.

Introduction: Ageing process is a complex phenomenon which affects all organs in the body as well as skin. Geriatric dermatoses can be regarded as a cutaneous marker of underlying systemic disorders and internal malignancies. This was study aimed to analyse various clinical ageing patterns among elderly aged above 60 years. Objectives: To determine the prevalence of clinical patterns of ageing and non-ageing dermatoses among elderly compare with non-dermatology patients. Materials and Methods: An observational study, conducted on 300 patients aged 60 years and above were analysed for geriatric dermatoses. Of them 211 patients were subjects attended dermatology OPD (group A) and 89 patients were controls (Group B) from other were selected from specialties.. Detailed history, through examination and appropriate investigations were done after obtaining informed consent. Results: Out of 300 patients, males were (192, 64%) and females (108, 36%), the male female ratio of 1.77:1. Majority werein 60 -70 years age group (245, 81.67%). Primary ageing dermatoses were more prevalent than non-ageing dermatoses (95.3% vs 39%). Pruritus was the commonest complaint in(164, 54.7%). Common patterns of geriatric dermatoses were wrinkling (286, 95.3%), xerosis (164,54.7%), seborrheic keratosis(94, 31.3%), Leucoplakia(48,16%), actinic keratosis(6,2.3%), infections (66, 22%), eczema (48, 16%), pigmentary disorders (38,12.7%), papulo-squamous disorders (31, 10.3%), autoimmune blistering disorders (6,2%) and exfoliative dermatitis in 5 (1.7%) cases Conclusion: Geriatric dermatoses become more prevalent following environmental and occupational hazards as their skin is nutritionally, immunologicallyand psychologically compromised. Primary ageing and pathological disorderswere higher among pre-existing dermatoses group than other systemic disorders group. Early recognition of patterns and appropriate management improve the quality of life in elderly. Keywords: Ageing, Dermatoses, Geriatric, Pruritus Ageing, Pruritus.

Systemic lupus erythematosus (SLE) is an auto immune connective tissue disease which affects all organs in the body including eye. Ocular manifestations vary with underlying severity of the SLE had beed observed in 30% of cases. Ocular complications of SLE are commonly seen in advanced but uncontrolled and patients on irregular treatment. Keratoconjunctivitis sicca is the most common form of ocular complication of SLE, clinically manifests as dry eyes, lack of tear production which can be managed with artificial tear preparations. Clinical severity varies from mild asymptomatic red eyes and acute painful conjunctivitis, retrobulbar pain, orbital cellulitis, retinal artery occlusion and very severe cases leads to blindness which is often irreversible. Scleritis is an inflammatory complication of sclera which is as common as episcleritis in SLE. It can be classified in to anterior scleritis and posterior scleritis. Retinal involvement is a rare devastating complication of SLE. The prevalence of retinal disease in SLE accounts for 10% of cases. Mild forms of retinopathy are usually asymptomatic. In acute cases of SLE, the retinal changes manifests as defects in the visual field, distortion or floaters and sudden loss of vision. Anti-inflammatory agents, corticosteroids, anti-malarials play a major role in the management of long-standing complications of SLE. Immune complex deposition of antibodies against various structures of eye manifest differently. Early suspicion, prompt treatment, periodic monitoring of disease activity, early ophthalmic assessment of fundus, retina will bring down the incidence of SLE associated blindness. Early intervention of immune complex mediated Vasculitis involving eyes will prevent brain stem and central Nervous system (CNS) complications will bring down the mortality. Keywords: Autoimmune, Blindness, Lupus, Ophthalmic, Red eyes.

Generalized pustular psoriasis (GPP) is a rare, but severe form of psoriasis characterized by febrile illness, sudden eruption of erthema, sterile pustules, sever psoriatic arthritis. We report a case of 21 year old female patient having recalcitrant GPP, resistant to usual line of treatment who has been successfully treated with secukinumab. Treatment of GPP include steroids, acitretin or methotrexate, which still comprise the first-line treatment. Secukinumab is a first in class, recombinant, fully human monoclonal antibody that targets and blocks the actions of Interleukin 17-A (IL-17A). It is approved for the treatment of moderate to severe plaque psoriasis, psoriatic arthritis and rheumatoid arthritis from 2015. The recalcitrant pustular psoriasis responded well to secukinumab with disappearance of steroid induce complications, after 3 doses and no recurrence during follow-up period. Keywords: Impetigo herpetiformis, Pustular psoriasis, Secukinumab, IL17, Biologics.

Pemphigoid gestationis (PG), also known as herpes gestationis, is a rare autoimmune blistering disease that presents in the second or third trimesters and during the immediate postpartum period. PG is presumably caused by circulating autoantibodies against bullous pemphigoid antigen 180 (BP180) within the basement membrane zone (BMZ). Clinical diagnosis is confirmed with a biopsy and positive direct immunofluorescence. PG tends to recur in subsequent pregnancies with an earlier and more severe presentation. Mild forms can be treated with topical antihistamines and corticosteroids and successful remission occurs with oral corticosteroids. Patients with PG are at greater risk of miscarriages, preterm delivery, still birth, small for gestational age (SGA), transient erythema and blistering. We report a rare case of early onset PG. Keywords: Pemphigoid gestationis, Autoimmune, Sub epidermal blister, BP180.