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Biomedical subjects

Sunil Dogra

Publications and source records attributed to Sunil Dogra.

At least 19 recordsLinked to original sources
PubMed2005

Repigmentation in vitiligo universalis: role of melanocyte density, disease duration, and melanocytic reservoir.

Recent reports suggest that vitiligo lesions are not totally devoid of melanocytes. We report an interesting observation made in the vitiliginous skin of an Indian patient being treated for pemphigus vulgaris with dexamethasone cyclophosphamide pulse therapy. Our observations indicate that melanocytes are never completely absent in the depigmented epidermis and that these melanocytes can recover their functionality in vivo and in vitro under an appropriate stimulus.

Cyclophosphamide↗
PubMed2005

Placebo-controlled oral pulse prednisolone therapy in alopecia areata.

BACKGROUND: Systemic corticosteroids administered as pulse therapy have been found helpful in a wide array of diseases including alopecia areata (AA). None of the studies published so far regarding their use in AA have been randomized or placebo-controlled. OBJECTIVE: We sought to compare the efficacy of weekly oral prednisolone pulse therapy in a placebo-controlled trial for patients with extensive AA. METHODS: A total of 43 patients were randomly divided into two groups. Patients in group A (23 patients) were treated with oral prednisolone (200 mg once weekly, 5 40-mg tablets) and patients in group B (20 patients) were given placebo tablets on an identical schedule. The total study period was 6 months, consisting of 3 months of active therapy followed by another 3 months of observation. RESULTS: Significant hair regrowth was obtained in 8 patients in the prednisolone-treated group. Two of the responders experienced a relapse during the observation period of 3 months. In the placebo group, none of the patients had significant hair regrowth at the end of the study. CONCLUSION: Oral prednisolone pulse therapy is useful in AA. Placebo-controlled studies with varying dosage schedules are required to standardize the dose of prednisolone used in pulse therapy, optimize the therapeutic efficacy, and minimize side effects.

Administration, Oral↗
PubMed2005

Late onset vitiligo: a study of 182 patients.

The elderly constitute a large and rapidly growing segment of the population; however, there is complete lack of information about the epidemiology of vitiligo in this age group. To study the clinical and epidemiological profile of vitiligo in the elderly, we retrospectively analyzed the data of patients with vitiligo having onset of disease after 50 years of age attending the pigmentary clinic of our center. Of the 182 patients, 87 (47.8%) were males and 95 (52.2%) were females. The mean age of onset of disease was 55 +/- 2.3 years. Vitiligo vulgaris was the most common (83.5%) followed by focal (5.5%), segmental (4.4%), acrofacial (3.8%), mucosal (2.2%), and universal (0.5%). The most common site of onset was the head and neck (24.2%) followed by the upper limbs (23%), trunk (22%), lower limbs (17.6%), oral/genital mucosae (7.1%), and flexures (6%). Koebner's phenomenon was observed in 14.8% while leukotrichia was present in 47.3% of the patients. Halo nevi were observed in 3.8% of patients, and vitiligo was stable in 64.8%. Twenty-nine (15.9%) patients had family history of vitiligo. Associated autoimmune autoimmune/endocrine disorders were present in 39 (21.4%) of the patients. Differences in disease characteristics compared with vitiligo in children and young adults are discussed.

Adult↗
PubMed2005

Narrow-band UVB for the treatment of vitiligo: an emerging effective and well-tolerated therapy.

BACKGROUND: Vitiligo is an acquired depigmentation disorder of great cosmetic importance, affecting 1% of the general population. Photochemotherapy is the most commonly used treatment modality in extensive vitiligo, but is associated with many short- and long-term side-effects. Recently, narrow-band ultraviolet B (NBUVB) therapy has been reported to be an effective and safe therapeutic option in patients with vitiligo. We studied the efficacy and safety of NBUVB (311 nm) therapy in Indian patients with generalized vitiligo. METHODS: Fourteen patients (six males and eight females), aged 12-56 years, with generalized vitiligo, were treated thrice weekly with NBUVB radiation therapy for a maximum period of 1 year. RESULTS: At the end of 1 year, 10 patients (71.4%) had marked to complete repigmentation and two each (14.3%) had moderate or mild repigmentation. Repigmentation sites showed an excellent color match. The response to therapy was correlated with the sites of involvement, duration of disease, and compliance to therapy. Adverse events were limited and transient. CONCLUSION: NBUVB therapy is effective and safe in Indian patients with vitiligo. Long-term follow up is required, however, to establish the stability of repigmentation.

Adolescent↗
PubMed2005

Eczema herpeticum complicating Parthenium dermatitis.

Parthenium dermatitis is one of the most common causes of airborne contact dermatitis in India. Eczema herpeticum has been reported in association with various eczematous conditions, including Parthenium dermatitis. We report a case of eczema herpeticum in association with Parthenium dermatitis. Because Parthenium dermatitis is a common condition in this region, one should be aware of this complication so that appropriate treatment is not delayed.

Acyclovir↗
PubMed2005

Lichen scrofulosorum in a patient with lepromatous leprosy after BCG immunotherapy.

Lichen scrofulosorum is a rare form of tuberculid seen in children and young adults. The cutaneous lesions are typically symptomless papular eruptions, associated with a strong Mantoux reaction, tuberculosis of lymph nodes and/or other organs or rarely following BCG vaccination. We describe an unusual case of occurrence of lichen scrofulosorum following BCG immunotherapy in a patient with lepromatous leprosy.

Adult↗
PubMed2005

Study of apoptosis in skin lesions of leprosy in relation to treatment and lepra reactions.

In leprosy on treatment, one factor contributing to the healing of skin lesions with minimal fibrosis may be apoptosis of inflammatory cells, even though apoptosis is sparse in leprosy as compared to tuberculosis. The degree of apoptosis in skin lesions of leprosy was studied by histopathologic examination (HPE) and by DNA fragmentation and electrophoresis. The effect of various parameters on apoptosis was noted in untreated disease, during treatment at 3 and 6 months, and in lepra reactions in different parts of the spectrum of leprosy. Of the 31 patients, 13 had paucibacillary (PB) and 18 multibacillary (MB) disease. Twenty one patients were in reaction: 16 had type 1 reaction and 5 had type 2 reaction. The controls included patients with non-granulomatous skin diseases; there were no normal controls, and no separate controls for cases with reaction. Apoptosis occurred more frequently in patients with leprosy as compared to the controls. In both PB & MB lesions, apoptosis was observed to increase progressively with treatment at 3 and 6 months, and was more prominent in the MB cases at 6 months of treatment. When lesions in either type 1 or type 2 reaction were compared to lesions not in reaction, a significant increase in apoptosis (p = 0.014) was found only in lesions with type 2 reaction and those which were at 6 months of treatment. The type of treatment regimen, or oral steroids given for reactions, did not significantly alter the degree of apoptosis. Our observations indicate that increased apoptosis is present in leprosy lesions and that in leprosy it progressively increases with anti-leprosy treatment up to 6 months. If the process of apoptosis in skin lesions is followed up for a longer period of time, the degree of apoptosis may be expected to decline. The study of apoptosis may help to understand the mechanism of clearance of bacilli and resolution of granulomas in leprosy patients.

Adolescent↗
PubMed2005

Comparative evaluation of immunotherapeutic efficacy of BCG and mw vaccines in patients of borderline lepromatous and lepromatous leprosy.

BACKGROUND: Even after 12 months of multi-drug therapy (M.D.T.) multibacillary (MB) therapy patients with high bacterial index (B.I.) continue to harbor dead bacilli and viable persisters, which lead to immunological complications such as recurrent reactions and late relapses, respectively. To achieve faster killing of viable bacilli and clearance of dead bacilli, various immunotherapeutic agents (vaccines and cytokines) are being evaluated as an adjunct to M.D.T. Aims and objectives. To evaluate the role of BCG and Mw vaccines in the immunotherapy of leprosy. MATERIALS AND METHODS: Sixty untreated leprosy patients with a BI = 2 were randomly allocated to three treatment groups of twenty patients each. Group A patients received World Health Organization (W.H.O.) (12 months M.D.T.-MBR) and BCG intradermally (105 live bacilli/per dose). Group B patients were administered 12 months M.D.T.-MBR and Mycobacterium w (1 x 108) killed bacilli as first dose and 0.5 x 108 /dose in subsequent doses. Group C received 12 months M.D.T. MBR with 0.1 ml of normal saline as placebo. All the groups received 4 doses of vaccine or normal saline repeated at three monthly intervals. The patients were periodically monitored by clinical (Ramu's score), bacteriological (slit skin smear), and histopathological (skin biopsy) parameters, six monthly during and one year after completion of M.D.T. RESULTS: The mean reduction in clinical scores in BCG and Mw groups was significantly more when compared to controls. At 12 and 24 months, the patients in BCG group had significantly greater reduction in Ramu's score as compared to those in the Mw group. BI declined by 2.40 units/year in patients receiving BCG, 2.05 units/year in the Mw group and 0.85 units/year in the control group. Although the incidence of type 1 reactions was apparently more in the BCG and Mw vaccinated groups, the incidence of type 2 reactions, neuritis and development of new deformities was less as compared to the controls. CONCLUSIONS: In our study, BCG exhibited slightly better and faster effect on bacteriological clearance and clinical improvement as compared to Mw vaccine in borderline lepromatous (BL)/ polar lepromatous (LL) patients with a high initial B.I., however, their effect on histopathological (decrease in GF) improvement was comparable. Both the vaccines were well tolerated. Immunotherapy can be a useful adjunct to the shortened (12 months) M.D.T. MB regimen to decrease the risk of reactions and relapses in highly bacilliferous BL/LL patients.

Adolescent↗
PubMed2004

Oxcarbazepine in painful diabetic neuropathy: a randomized, placebo-controlled study.

In this multicentre, placebo-controlled, 16-week trial, the efficacy and safety of oxcarbazepine monotherapy in patients with neuropathic pain of diabetic origin was evaluated. Eligible patients had a 6-month to 5-year history of neuropathic pain symptoms of diabetic origin and a pain rating of > or =50 units on the visual analogue scale (VAS). Oxcarbazepine was initiated at a dose of 300 mg/day and titrated to a maximum dose of 1800 mg/day. In total, 146 patients (oxcarbazepine, n=69; placebo, n=77) were randomized. After 16 weeks, oxcarbazepine-treated patients experienced a significantly larger decrease in the average change in VAS score from baseline compared with placebo (-24.3 vs. -14.7 units, respectively; p=0.01). The reduction from baseline in mean VAS score for oxcarbazepine-treated patients was of a greater magnitude than placebo as early as week 2 (-8.0 vs. -4.7; p<0.05). A significantly greater proportion of oxcarbazepine-treated patients experienced a >50% reduction from baseline in VAS score at the end of treatment compared with placebo (35.2% vs. 18.4%, respectively; p=0.0156; number needed to treat=6.0). Global assessment of therapeutic effect rating was improved in more oxcarbazepine patients than placebo patients (48% vs. 22%, respectively; p=0.0025). Patients on oxcarbazepine were awakened less frequently due to pain than patients on placebo. Most adverse events were mild to moderate in severity, transient, and in line with the known tolerability profile of oxcarbazepine. These observations suggest that oxcarbazepine monotherapy, pending additional trials, may be efficacious and may provide clinically meaningful pain relief in patients with neuropathic pain of diabetic origin.

Adolescent↗
PubMed2004

Clinical study of repigmentation patterns with different treatment modalities and their correlation with speed and stability of repigmentation in 352 vitiliginous patches.

Because the etiopathogenesis of depigmentation in vitiligo is still obscure, the source of pigmentation in the repigmentating lesion and its stability is also not fully known. Several authors have shown on histopathology and electron microscopy predominantly a perifollicular spread of pigment. The aim of this study was to clinically assess the types of repigmentation patterns obtained with different treatment modalities and their correlation with speed and stability of repigmentation. A total of 125 patients with vitiligo on treatment with psoralens (topical and systemic psoralen-UVA [PUVA]), steroids (both topical and systemic), and topical calcipotriol, alone or in combination were enrolled. Representative lesions of vitiligo excluding mucosal sites were selected in each patient and photographed at baseline. Repigmentation was assessed and labeled as marginal, perifollicular, diffuse, or combined. The preselected patches were evaluated at 3 months to assess the speed of repigmentation. Retention of pigment (stability) was noted at 6 months, after the stoppage of active treatment. Of the 352 vitiligo patches selected, 194 (55%) showed predominant perifollicular repigmentation, of which a majority (127; 65.5%) were on systemic PUVA and 35 (18%) were on topical PUVA. Diffuse pigmentation was observed in 98 patches (27.8%) of which 66 (67.3%) were on topical steroids. Marginal repigmentation was seen in 15, of which the majority (80%) were on systemic PUVA and topical calcipotriol. Of the 28 total lesions showing marked repigmentation at 3 months, 22 lesions pigmented in a diffuse manner, 2 in a perifollicular pattern, and 4 showed a combined type of repigmentation. On follow-up, marginal repigmentation was the most stable (93.3%), followed by perifollicular (91.7%) and combined type (84.4%). Diffuse repigmentation was the least stable (78.5%). Psoralens predominantly exhibit a perifollicular pattern of repigmentation and steroids (topical/systemic), a diffuse type. The speed of repigmentation is much faster when initial repigmentation is of the diffuse type as compared with follicular repigmentation. The marginal and perifollicular repigmentation is more stable than the diffuse type of repigmentation.

Adolescent↗