Open Access Original Research Article

Retinoids in the Management of Acne with Depressive Symptoms: A Treatment Conundrum

S. J. Swetha, M. Preethi, J. Sharanya, Saai Ram Thejas, M. Karthik

Asian Journal of Research in Dermatological Science, Page 15-22

Introduction: Isotretinoin (ITT) a first‑generation synthetic retinoid derived from Vitamin A for the treatment of Acne Vulgaris (AV). It effectively treats acne by acting on the pathogenetic mechanisms like comedolytic effect, anti‑inflammatory effect, sebostatic effect and the inhibitory effect on proliferation of Propionibacterium acnes. The first occurrence of depressive symptoms associated with isotretinoin was seen in 1983 and since then a lot of controversies have emerged regarding the causal relationship between isotretinoin and depression.

Materials and Methods: All patients presenting to the Dermatology Out Patient Department in a Rural Private Hospital in South India with diagnosed Grade III-IV acne non-responsive to Oral Tetracyclines and Topical Clindamycin were taken to be part of the study after obtaining adequate consent. Each patient filled a Hamilton Depression Rating Scale (HDRS) and Dermatology Life Quality Index (DLQI) before the commencement of treatment. Patients with mild depression secondary to acne were considered. They were started on Oral Isotretinoin 10 mg and Topical Adapalene 0.1% for 16 weeks. The same scale was given at the end of 16 weeks for data completion.

Results: The mean DLQI score before the commencement of treatment was 13.34 and it came down to 6.94 at the end of 16 weeks, an improvement of 47.87%. The mean HDRS score before the commencement of treatment was 18.10 and it went up to 19.32 at the end of 16 weeks, a deterioration of 6.74%.

Conclusion: Based on the collected data, it can be said that although Retinoids significantly help in the management of severe Acne, they can possibly have a negative effect on the mood of the individual and worsen the symptoms of Depression slightly. A sort of double-edged sword, it can be left to the Dermatologist to alter the dosage of the Retinoids used and also have proper Psychiatric consultations including Psychotherapy for the patient to achieve success in treatment.

Open Access Original Research Article

The Profile of Patients with Dermatomyositis in Dakar: A Series of 56 Cases

M. Ndiaye, N. Ndour, S. Diadie, I. Berrada, M. T. Ndiaye, M. Sarr, C. Ndiaye, B. A. Diatta, A. Deh, K. Diop, N. Ndour, A. Diop, M. Diallo, F. Ly, S. O. Niang

Asian Journal of Research in Dermatological Science, Page 23-29

Introduction: The purpose of this study was to describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of patients with dermatomyositis in the dermatology department of the Aristide Le Dantec hospital.

Methods: It was a prospective and descriptive study analyzing all the files of patients with dermatomyositis followed at Le Dantec’s dermatology department between January 2009 and December 2019.

Results: We collected 56 cases of dermatomyositis, i.e. a hospital frequency of 1.64%. The average age of the patients was 44 years with 2 cases of juvenile dermatomyositis (9 and 15 years). Pruritus was reported in 13 patients. Cancer was associated with dermatomyositis in 11 cases, including 7 cases of gynecological cancer and 4 cases of ENT cancer. Dermatological manifestations were found in 100% of cases with a predominance of periorbital erythroedema in 66.07%. Muscular manifestations were noted in 96.42%, articular manifestations in 32.14%, pleuropulmonary manifestations in 23.21% and cardiac involvment in 3.57%. All patients received treatment with oral corticosteroids, combined in 5.35% with methotrexate. The outcome was successful in 33.9% and death was noted in 11 patients.

Conclusion: Dermatomyositis (DM) tends to affect young adults more, with a high frequency of forms associated with cancer, and deaths.

Open Access Original Research Article

Fibrosing Folliculitis of the Neck (FFN) and Associated Factors: A Prospective Study of 37 Cases

M. Ndiaye, S. Diadie, P. Dioussé, H. Gouriah, M. Sarr, C. Ndiaye, B. A. Diatta, A. Deh, K. Diop, N. Ndour, M. Diallo, S. O. Niang

Asian Journal of Research in Dermatological Science, Page 30-35

Introduction: The objective of this study was to describe FFN and associated factors.

Methodology: Prospective study conducted in the dermatology department of Aristide Le Dantec Hospital, identifying all cases of FFN and associated factors. The diagnosis of FFN was clinical.

Results: We collected 37 patients with FFN, all phototype VI and male. The average age of our patients was 34.45 years (19 to 55 years).  Pruritus was noted in 17 cases and pain in 6 cases. The average duration of evolution was 6 years with extremes from 1 year to 10 years. Family history of FFN was noted in 3 cases. The type of shaving was clippers in 35 cases (94.6%) and razor blades in 2 cases. Patients shaved one to five times per month (48.65%), with an average of three shaves. The clinical lesional aspects were dominated by papules in 37 cases and nodules in 32 cases. A high frequency of diabetes and obesity were found to be associated with FFN. Diabetes was noted in 10 cases and three patients had a lipid imbalance. A statistically significant association between the use of comb and the presence of nodule (P < 0.001) was found.

Conclusion: FFN is not rare in dark skin male. A high frequency of diabetes and obesity was noted. A high frequency of diabetes and obesity were found to be associated with FFN.

Open Access Review Article

Association between Piscine Mycobacteriosis and Morgellons Disease: Literature Review

B. Dolapihilla, M. Elapatha, J. Grimm

Asian Journal of Research in Dermatological Science, Page 1-8

Piscine Mycobacteriosis (PM) or sometimes called fish tuberculosis, is a deadly zoonotic disease found in both fresh and marine fish throughout the world. More than 20 strains of Mycobacterium spp. are known to cause PM, but their pathogenesis is currently unclear. This is a chronic progressive disease with a variety of clinical symptoms including skin ulcerations, loss of color, scoliosis, and weight loss. Advanced technical molecular methods have now allowed us to different Mycobacterium to the individual species level. Out of the 20 known strains, M. marinum is the commonest and the most pathogenic organism and it is found in marine and freshwater fish. Morgellons Disease (MD) is a multi-system disorder where patients commonly present with multiple, non-healing, cutaneous wounds. Patients report seeing multi-colored filaments/fibers under the skin and often provide samples to the clinician. However, most clinicians thought this is a delusional disorder and treated the patients with antidepressant drugs. However, recent studies have linked MD with systemic manifestations of Lyme Disease (LD). Other studies have found correlation between MD and tick-borne co-infections. Despite these studies, the definite causative agent of MD has not yet been confirmed. Since the clinical symptoms of PM and MD are somewhat similar, it could be hypothesized that PM and MD could be related to each other. Therefore, the objective of this literature review is to find any link between PM and MD based on the current literature available. However, it should be noted that there is no study done specifically looking into this hypothesis. The primary search engine used to find information for this review is PubMed and ScienceDirect. More than 30 research articles and case reports were reviewed and only 19 were shortlisted and used as references. None of the studies were limited to study design, number of participants or the study year. However, only articles written in English language were considered for this review.

Open Access Review Article

Morgellons as a Somatopsychic Disorder with Organic Etiology

Jase Grimm, Buddhini Dolapihilla, G. E. D. M. Elapatha, Udula Vidanage

Asian Journal of Research in Dermatological Science, Page 9-14

Morgellons Disease (MD) is a multi-system disorder with a primary symptom characterized by the emergence of tiny, multicolored fibers from the skin. A study conducted in Northern California led the Centers for Disease Control and Prevention to not recognize MD as a separate diagnosis. The study involved 115 patients with MD-like symptoms. The researchers conducted interviews, analyzed patients’ blood and urine, and studied skin biopsies, but they failed to find a correlation between MD and any infectious or environmental cause. The study concluded that MD was more like a delusional disorder.

The purpose of this review is to evaluate the said study and describe the limitations and biases therein. This includes lack of a comparison group, sampling bias and problems in analyzing the results. The review will also highlight why MD should be considered a separate multisystem condition with an underlying pathology based on evidence from more recent studies.