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Biomedical subjects

Rashmi Sarkar

Publications and source records attributed to Rashmi Sarkar.

At least 19 recordsLinked to original sources
PubMed2005

Neurocutaneous melanosis: an atypical presentation.

An eleven-year-old male child presented with multiple small melanocytic nevi in a generalized distribution and a giant congenital melanocytic nevus (GCMN) over the lumbosacral area since birth. He had had difficulty in walking since the age of two and a half years. Histopathological examination revealed intradermal melanocytic nevi. Serial Magnetic Resonance Imaging (MRI) scans showed brainstem atrophy with central nervous system abnormality suggestive of neuromelanosis. Clinically and histologically, the diagnosis was suggestive of neurocutaneous melanosis (NCM). The present case is reported due to its clinical presentation of quadriparesis, which has been rarely reported as a manifestation of neurocutaneous melanosis.

Brain Diseases↗
PubMed2004

Psychological disturbances in Indian children with atopic eczema.

Although the link between atopic dermatitis (AD) and emotional disturbance is well known, there have been only a few studies assessing the extent of these disturbances in affected children and the problems experienced by their parents. Furthermore, these studies are mostly from western countries, where atopic dermatitis is seen in a more severe form than in India. The purpose of this study was to determine whether there is an excess of psychological disorders in Indian children with AD as compared to healthy controls and whether their mothers showed higher levels of emotional or mental distress than a comparison group. Twenty-two children, aged 3-9 years, with atopic dermatitis, twenty age and sex matched controls, and their mothers were selected for the study. The personalities of the mothers were assessed from a standard and valid questionnaire, the Hindi adaptation of Personality Trait Inventory, which explored nine areas of the maternal personality and mental distress as well as negative traits of some of these. The two groups were compared using the Chi-square test. To assess the psychopathology of the children, the mothers were made to answer parts of a valid, well-developed questionnaire, the Childhood Psychopathology Measurement Schedule, which enabled the assessment of the following factors: low intelligence with behaviour disorders, conduct disorders, anxiety, and depression. The means of each factor in both the groups were compared using the Students' t-test. Out of all the maternal personality traits, an increased number of mothers of affected children, 13 (59%) were found to be submissive as compared to the mothers of the controls i.e. 2 (10%), which was statistically significant (p<0.01). The children with AD had a higher frequency of low intelligence with behaviour disorders (5.9+/-2.9) as compared to controls and also of conduct disorders (2.1+/-1.4), which were both statistically significant (p<0.01). The results of this pilot study, although small in number, suggest that increased psychological disorders are observed in Indian children with AD as compared to controls, despite the fact that the disease is of a milder variety in this country as compared to its western counterparts. More mothers of children with AD were submissive, which could contribute to the psychological disorders and maintenance of eczema in the children. We suggest that children with AD may benefit if such psychological dimensions are considered as a part of their treatment.

Adult↗
PubMed2004

Pigmented purpuric dermatoses: an overview.

Pigmented purpuric dermatoses are a spectrum of disorders characterized by a distinct purpuric rash, mainly localized to the lower limbs, which are morphologically dissimilar but histopathologically indistinguishable. Their etiology remains obscure. They are rather resistant to treatment. Although diagnosed quite straightforwardly, the disease entity remains an enigma and a therapeutic challenge. The current narration discusses the outline of the epidemiology, etiopathogenesis, clinical features, histopathology and management of these disorders. The current review, hopefully, may once again rekindle interest in the entity, for it has been sparingly reported or discussed for the benefit of under- and/or postgraduates and those in practice, including family physicians.

Humans↗
PubMed2004

Tretinoin peels versus glycolic acid peels in the treatment of Melasma in dark-skinned patients.

BACKGROUND: Chemical peels have become a popular method for treating melasma. Although daily topical 0.05 and 0.1% tretinoin have been used for melasma, the therapy takes at least 4 to 6 months to produce clinically significant lightening. In a recent trial, 1% tretinoin peel has shown good clinical and histologic results after biweekly applications in 2.5 weeks only in the treatment of melasma. OBJECTIVE: Because there is a paucity of studies evaluating the efficacy and safety of 1% tretinoin peel in the treatment of melasma in dark-skinned Asian population, we conducted a pilot study to evaluate the efficacy and side effects of this potentially new peeling agent versus a standard peeling agent, 70% glycolic acid, in the treatment of melasma in Indian women. METHODS: Ten female patients of melasma, after written consent, were taken up for an open left-right comparison pilot study of 12 weeks. One percent tretinoin peel was applied on one-half of the face, whereas 70% glycolic acid was applied on the other at weekly intervals. The results were evaluated by a clinical investigator by using the modified Melasma Area and Severity Index and with photographs at baseline and 6 and 12 weeks. RESULTS: A significant decrease in the modified Melasma Area and Severity Index from baseline to 6 weeks and then from 6 to 12 weeks was observed on both facial sides (p<0.001). Nevertheless, there was no statistically significant difference between the right and the left sides. Side effects were minimal and 1% tretinoin peel appeared to be well tolerated by the patients. CONCLUSIONS: It was concluded from the present trial that serial 1% tretinoin peel is a well tolerated and as effective a therapy for melasma in dark-skinned individuals as a standard and well-tried chemical peel, 70% glycolic acid, although larger trials over longer periods may be necessary to substantiate such findings.

Administration, Topical↗
PubMed2003

An open trial of calcium dobesilate in patients with venous ulcers and stasis dermatitis.

BACKGROUND: Venous leg ulcers and associated stasis dermatitis are a major cause of morbidity, economic loss, and decreased quality of life in afflicted patients. Hence, there has been a renewal of interest in the medical management of varicose veins and ulcers. Calcium dobesilate, a capillotropic agent, has been found to be beneficial in the treatment of varicose veins. METHODS: This is an open pilot study of 25 patients (15 with venous ulcers with/without stasis dermatitis, 10 with stasis dermatitis only) who were given calcium dobesilate, 500 mg twice daily, for 8 weeks. The clinical parameters were graded (0-4; 0, absent; 1, mild; 2, moderate; 3, severe; 4, very severe) both before and after therapy, and included pain, itching, tiredness, heaviness, paresthesia, cramps, and leg swelling. Evaluation also included subjective changes in tenderness, oozing, and pigmentation, and measurement of the circumference of the leg for swelling and malleolar edema (measured in millimeters). The venous ulcer sizes were also recorded both before and after therapy. Color Doppler studies were performed to confirm the diagnosis of varicose veins, determine the competence of the valves, and to rule out deep vein thrombosis. Serum biochemistry, hemogram, and urinalysis were performed both before and after treatment. The results were analyzed statistically using the Wilcoxon rank sum test and Student's t-test. RESULTS: A statistically significant improvement was observed post-therapeutically in the clinical parameters of pain, itching, tiredness, heaviness, and leg swelling. There was also a significant decrease in ulcer size. The serum biochemistry, hemogram, and urinalysis remained unaffected. Color Doppler studies before treatment revealed venous valvular incompetence in 20 patients. They were repeated in only 10 patients after treatment, four of whom showed improved valvular competence. Recurrence of venous ulcers was seen in five of 12 patients who were followed up after therapy. No significant side-effects were noted. CONCLUSIONS: Calcium dobesilate is an effective adjuvant therapy, with an absence of significant side-effects, in patients with venous ulcers and stasis dermatitis. More double-blind trials are required in the future to substantiate and evaluate the role of the drug in these two indications.

Adult↗
PubMed2003

Trichotillomania.

Trichotillomania, though uncommon, is one of the causes of unexplained hair loss, especially in children. Three girls in the age group of 4-6 years were observed in our pediatric dermatology clinic to have trichotillomania. In one child, there was co-existent alopecia areata. All were referred to the child guidance clinic and they all showed improvement with behavior therapy. A close liasion between the dermatologist, psychiatrist and parents would go a long way in preventing this alopecia

Alopecia Areata↗
PubMed2002

The combination of glycolic acid peels with a topical regimen in the treatment of melasma in dark-skinned patients: a comparative study.

BACKGROUND: Melasma continues to be a difficult condition to treat, especially in dark-skinned patients, although various topical modalities including hydroquinone, tretinoin, and/or topical steroids have been used singly or in combination with variable results. OBJECTIVE: To determine if serial glycolic acid peels provide additional improvement when combined with a time-tested topical regimen, a modification of Kligman's formula (hydroquinone 5%, tretinoin 0.05%, hydrocortisone acetate 1% in a cream base). All cases had epidermal melasma as detected by Wood's light examination. METHODS: Forty Indian melasma patients were divided into two groups of 20 each. One group received serial glycolic acid peel combined with a topical regimen, modified Kligman's formula. The other, a control group, received only modified Kligman's formula. The results were evaluated by a clinical investigator both subjectively and with photographs taken at baseline, 12 (before the fourth peel), and 21 (3 weeks after the sixth peel) weeks. For clinical evaluation, the Melasma Area and Severity Index (MASI) was used. RESULTS: A significant decrease in the MASI score from baseline to 21 weeks was observed in both groups (P <.001). The group receiving the glycolic acid peels showed a trend toward more rapid and greater improvement, with statistically significant results (P <.001). Only a few side effects were observed in the peel group. CONCLUSION: This study demonstrates that serial glycolic acid peels provide an additional effect to a topical regimen which is a modification of the time-tested Kligman's regimen for treating melasma in dark-complexioned individuals if used judiciously and under supervision. It demonstrates that superficial chemical peels are beneficial in the treatment of melasma.

Administration, Topical↗
PubMed2002

Seasonal variation in acne vulgaris--myth or reality.

A traditional opinion proposed by Western dermatologists is that acne improves in summer and worsens in winter. We studied 452 patiens with acne vulgaris and asked them about seasonal variation in their acne. A total of 229 patients (50.67%) complained of a seasonal variation; a significant proportion (56.33%) noticed an aggravation in summer, while 16.16% improved in summer and only 11.35% worsened in winter. Apparently winters did not affect the severity of acne in a majority of patients (64.20%). Significantly, a majority (80.62%) of patients noticed a summer aggravation due to sweating and increased humidity. Thus our study is at variance with the existing literature, with summer aggravation being the predominant complaint. We would like to propose that the increased temperature, marked humidity, and sweating might explain the results seen in our region.

Acne Vulgaris↗
PubMed2002

A comparative study of 20% azelaic acid cream monotherapy versus a sequential therapy in the treatment of melasma in dark-skinned patients.

BACKGROUND: Melasma is a commonly found hyperpigmentary disorder in dark-complexioned persons, which is rather difficult to treat. Azelaic acid (AZA) 20% is considered efficacious in the treatment of melasma, although the response is rather slow. It has also been combined synergistically with topical retinoic acid, where the results were satisfactory. OBJECTIVE: The study was done to evaluate the usefulness of a sequential therapy of potent topical steroids +20% AZA cream versus only 20% AZA cream in the treatment of melasma. METHODS: This was a prospective, single-blind, right-left comparison pilot study with (1). twice daily application of 20% AZA to one half of the face for 24 weeks and (2). a potent topical steroid, 0.05% clobetasol propionate cream, to be applied for 8 weeks only and then to be followed by 20% AZA cream only for the next 16 weeks on the other half. Concomitant use of a broad-spectrum sunscreen was also mandatory. Thirty Indian patients (25 females, 5 males), whose ages ranged from 21 to 45 years and who were not pregnant, nursing or on any concurrent therapy, completed the study. Clinical evaluation, photography and the overall response were assessed at 4, 8, 16 and 24 weeks. RESULTS: At 4, 8 and 16 weeks, the lightening of melasma was significantly more marked on the side receiving the sequential therapy rather than the side receiving only 20% AZA cream (p < 0.001). However, at 24 weeks, although the difference was still significant (p = 0.0052), as many as 96.7 and 90% of patients of each group (sequential therapy and AZA) had good to excellent responses to treatment. The side-effects noted were mostly mild and transient and mainly local irritant effects. CONCLUSIONS: A sequential therapy of topical potent steroids +20% AZA cream can be considered as another alternative treatment for melasma, which combines the beneficial effects of both besides perhaps increasing the compliance of the patients. 20% AZA monotherapy itself is also an effective and well-tolerated therapy for melasma in dark-skinned races.

Administration, Topical↗
PubMed2002

Genital elephantiasis.

Genital elephantiasis (esthiomene), which is the dramatic end-result of lymphatic obstruction, is rather rare. Although mainly associated with filariasis and sexually transmitted diseases, such as lymphogranuloma venereum and donovanosis, it could also be an uncommon complication of tubercular lymphadenitis, a common infection in tropical countries. We report a rare case of a 32-year-old Indian female in whom genital elephantiasis occurred as a complication of tubercular lymphadenitis.

Adult↗
PubMedDate not supplied

Anticonvulsant hypersensitivity syndrome.

Anticonvulsant hypersensitivity syndrome is an acute, life-threatening, idiosyncratic drug reaction seen with the aromatic antiepileptic drugs, phenytoin, carbamazepine, phenobarbital, and primidone, with frequent cross sensitivity. It usually occurs 2-8 weeks after initiation of therapy and the hallmark clinical features are fever, rash, and lymphadenopathy. Hematologic abnormalities such as eosinophilia, atypical lymphocytes, and internal organ involvement also occur with varying severity. A case of hypersensitivity syndrome due to carbamazepine with cross sensitivity to phenytoin is reported. It is emphasized that this serious drug reaction with diverse clinical presentations should be recognized and treated promptly.

Adolescent↗
PubMedDate not supplied

Cutis laxa in seven members of a north-Indian family.

Congenital cutis laxa, characterized by cutaneous laxity and loose skin, may be autosomal dominant or autosomal recessive. The autosomal dominant variety is usually not associated with any systemic defects and has a good prognosis. We report an unusual family in which seven members were affected by the autosomal dominant variant of this disorder. We suggest that close monitoring of the cardiorespiratory systems may be worthwhile to detect any systemic complications, although these complications are rare in the autosomal dominant variant of cutis laxa.

Child↗
PubMedDate not supplied

Extensive fixed drug eruption to nimesulide with cross-sensitivity to sulfonamides in a child.

Nimesulide, a new nonsteroidal anti-inflammatory drug with a favorable tolerability profile, is being used increasingly in pediatric practice. Its common side effects pertain to the gastrointestinal tract and central nervous system. The common cutaneous adverse effects are pruritus and skin rash. Rarely purpura and fixed drug eruptions have also been observed in adults. We present herein a case of nimesulide-induced fixed drug eruption in a 10-year-old boy. The lesions were extensive and showed cross-sensitivity to sulfonamides.

Anti-Inflammatory Agents, Non-Steroidal↗