Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 203175

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : January | Volume : 16 | Issue : 1 | Page : WC01 - WC04 Full Version

Clinicoepidemiological Study on Patients with Dermatosis Papulosa Nigras and Acrochordons- A Longitudinal Study


Published: January 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/51667.15821
Rajkumar Kannan, Samuel Jeyaraj Daniel, A Ramesh, P Deepavarshini

1. Associate Professor, Department of Dermatology, Venereology and Leprosy (DVL), Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India. 2. Associate Professor, Department of Dermatology, Venereology and Leprosy (DVL), Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India. 3. Professor, Department of Dermatology, Venereology and Leprosy (DVL), Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India. 4. Postgraduate Student, Department of Dermatology, Venereology and Leprosy (DVL), Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. P Deepavarshini,
Madras Medical College, Chenna-600003, Tamil Nadu, India.
E-mail: deepavarshini18@gmail.com

Abstract

Introduction: Dermatosis Papulosa Nigras (DPNs) and Acrochordons are benign epidermal outgrowths that frequently occur together over face, neck, axilla and other flexures. These are common dermatoses with high cosmetic concerns. Knowledge about the clinicoepidemiological patterns of these dermatoses will help in better management and prevention of recurrence.

Aim: To study the clinicoepidemiological patterns of DPNs and acrochordons, and to evaluate the outcome of treatment with Radiofrequency (RF).

Materials and Methods: The present study was a longitudinal study done on 121 patients in the Out-Patient Department (OPD) of Dermatology from January 2017 to June 2021 with DPNs. and acrochordons who were followed-up for three years. The lesions were treated with RF removal (the number of sessions varied depending on the number of lesions). Data regarding relevant history, complete dermatological examination, and recurrences (if any) were recorded.

Results: Male versus female ratio was 1:1.8. The mean age of the study group was 34.28 years. The most common lesions were papular type DPNs, seen more commonly over face and neck (40%), 35 patients (28.9%) were obese (≥30 kg/m2), 19 patients (15.7%) had diabetes, and 13 patients (10.7%) had Polycystic Ovarian Syndrome (PCOS). There was a positive association between co-morbidities such as obesity, diabetes and PCOS and occurrence of the lesions. Overall, 70 patients had recurrence, out of which 26 (37.1%) were obese. Fifty-three patients used sunscreen regularly and usage of sunscreen showed significant association with prevention of recurrence, p-value-0.001.

Conclusion: In this study, it was found that females presented with complaints of DPNs and acrochordons more than males. The most common lesions were papular DPNs over face and neck. The most common co-morbidity in patients was obesity followed by Diabetes Mellitus (DM). Majority of patients (71%) who did not use sunscreen after treatment experienced recurrence of lesions.

Keywords

Obese, Radiofrequency, Recurrence, Sunscreen, Treatment

The DPNs are benign epidermal growths. These are common dermatoses found in people with skin of colour: Fitzpatrick skin types III to VI. They most commonly affect people of African and Asian descent (1). The DPNs are considered to be a variant of seborrheic keratosis. These were first described by Dr. Aldo Castellani in 1925 (1). The incidence of such lesions range from 10-75% in study populations of individuals of skin type III to VI (2). These are characterised by small, pigmented, firm papules which can be sessile, pedunculated or filiform, in various sizes and configurations. Females are more commonly affected than males (3),(4). The lesions are more common over the sun-exposed sites (2),(5). The DPNs are considered to be a variant of seborrheic keratosis (6). Although the exact aetiopathogenesis is unknown, various factors are said to play an aetiological role in the causation of DPNs, viz., genetic factors like mutation in Fibroblast Growth Factor Receptor 3 (FGFR 3) and the PIK3CA (encoding for the catalytic p110 subunit of class 1 phosphatidylinositol 3-kinase) genes (7), family history (3),(5), hormonal influence from androgens (8),(9),(10), and exposure to Ultraviolet (UV) rays (11),(12), etc.

Skin tags or acrochordons or soft fibromas are also benign epidermal growths that present as soft heaped up excrescences. These appear as skin coloured or pigmented lesions, and are seen most common over areas of skin folds like axilla and neck (13). The prevalence of acrochordons is 46% among the general population (13). Clinically, there is often an overlap between DPNs and acrochordons. These lesions occur together in same sites, admixed with one another.

The RF removal of DPNs and skin tags is an easy and safe day-care procedure. RF delivers rapidly alternating currents from the probe tip to tissue, which produces a thermal effect on the target by resistive heating i.e., impedance to current flow (14). The RF (under topical usage of Eutectic mixture of 2.5% Lidocaine and 2.5% Prilocaine in a gel base) is used for removal of smaller version of these dermatoses, while the larger and deep variants and soft fibromas are removed under 2% plain lignocaine injection (14).

The RF removal of these benign lesions is an effective and safe method with minimal adverse effects (15),(16). It is considered as the standard therapy by many dermatologists for removal of benign lesions (17). However, they often recur irrespective of the treatment modality (1). Genetic factors, dyslipidaemia, obesity and type 2 diabetes are the associated metabolic conditions that probably play the role in recurrence (18). More studies are required to understand the complete aetiopathogenesis of the lesions so as to elucidate the cause for recurrence. This study was done to identify the clinicoepidemiological patterns of DPNs and acrochordons over a course of four and half years which included post-treatment follow-up period of three years.

Material and Methods

This longitudinal study was done in the Out-Patient Department (OPD) of Dermatology from January 2017 to June 2021. Institutional Ethics Committee approval was obtained (No. 1902202, dated 02.02.2021). The study group comprised of patients who came to the OPD with complaints of DPNs and skin tags. Informed consent was obtained from all the patients. The diagnosis of the lesions was done clinically.

Inclusion criteria: Those patients who were aged more than 18 years, who came to OPD with complaints of DPNs and skin tags warranting their removal and those who consented to participate in the study and were available for follow-up (3 years).

Exclusion criteria: Those who had active infections at site of lesions, those who were on cardiac pacemakers or blood thinners.

Study Procedure

Disease duration, family history and personal history of the patients were recorded. Data regarding history, co-morbidities, morphology of lesion in the first episode and recurrence (if any), time lapse for recurrence (if any) and sunscreen usage was noted. Data regarding sun exposure was collected based on occupation of patient and duration of exposure per day. Data regarding co-morbidity was accounted based on patient’s medical records. Dermatological examination regarding morphology, number and sites of the lesions was done and associated dermatological conditions were recorded. Systemic examination was done, height and weight were measured and Body Mass Index (BMI) was calculated using Quetelet index. Patient was considered as obese if BMI was more than or equal to 30 kg/m2 (19).

The RF machine model was Megasurg Gold (high frequency radiosurgery unit) Dermaindia. Surface anaesthesia containing lidocaine and prilocaine was applied 45 min before the procedure. The procedure was done using a monopolar, monoterminal RF unit, with a markedly damp (lateral heat spread–medium) and partially rectified waveform (electrodessication). The lesions were touched with a straight needle electrode held at 45 to 60° angle and with an optimum low power of 1 to 2. In a single session, all the DPN lesions were just finely touched with the electrode tip for a second until they whitened due to dehydration. The desiccation caused superficial necrosis and the lesions desquamated in a week’s time. The patients were given advice regarding sun protection and regular usage of sunscreen. Patients were given 32% zinc oxide cream and were advised to re-apply it every four hours. Compliance was checked based on history.

Criteria for Adequate Follow-up

Those patients who underwent RF removal of the lesions and who came to the Dermatology OPD at least once a year, for the next three years were selected. The patient was considered to have recurrence if the subject had at least one DPN or acrochordon in the follow-up period. If recurrence occurred, probable triggers for recurrence based on the history given by the patients were noted. The lesions were again treated with RF removal, if the patient warranted it. Total 400 patients were enrolled into the study, 279 were lost to follow-up and 121 patients completed the study.

Statistical Analysis

The statistical analysis was carried out through Statistical Package for the Social Sciences (SPSS) 23.0 version. Descriptive statistics was calculated for all univariable. Inferential statistics was carried out by bivariate and multivariate analysis. Bivariate analysis like Chi-square test and Fisher’s-exact test was used to find the association between lesions and co-morbidities. Those variables which are associated in the bivariate analysis were included in the multivariate model. A p-value <0.05 was considered to be statistically significant.

Results

Out of the 121 patients, 43 were males and 78 were females. The mean age was 34.28±10.79 years. The mean duration of lesions was 2.65±0.69 years. (Table/Fig 1) shows demographic details of study group. Majority of the patients were homemakers (24.8%) followed by students (19%). Overall, 52.1% of the patients had positive family history of DPNs or skin tags either in parents, grandparents, siblings or first degree relatives (irrespective of gender). (Table/Fig 2) shows details about site, number and morphology of lesions. The majority of the patients (37.2%) had less than five lesions. The most common morphology of lesions was papular type (21.5%) followed by mixed type of lesions (20.6%).

(Table/Fig 3) shows a patient with mixture of papular, sessile and pedunculated lesions of DPNs and acrochordons. The most common dermatological lesions associated with DPNs and acrochordons were acanthosis nigricans followed by acne vulgaris. (Table/Fig 4) shows lesions of flat and sessile DPNs associated with acanthosis nigricans of neck. (Table/Fig 5) shows lesions of DPNs admixed with acne vulgaris.

Patients with co-morbidities: A 28.9% of the patients were obese followed by 15.7% who had DM. Among the hormonal variation associated conditions predisposing to DPNs and acrochordons, the following were noted in the decreasing order of significance: Out of 78 female patients, 13 patients had PCOS, six were pregnant, two patients were on Oral Contraceptive Pills (OCPs) and two patients had hypothyroidism. (Table/Fig 6) shows the Fisher’s-exact test clearly connoting that the co-morbidities such as PCOS, obesity and DM were significantly associated with occurrence of lesions.

Association between recurrence and triggers: In the follow-up period, recurrence was observed in 70 patients (57.8%)- 44 females and 26 males. Recurrence was observed in first year in 19 patients, second year in 29 patients and third year in 22 patients. The mean time-lapse for recurrence was 1.65±0.69 years. There were a statistically significant association between recurrence and the following triggers for relapse: Obesity (37.1%), OCPs usage (22.7%), pregnancy (20.5%), UV exposure (14.3%), PCOS (13.6%), and DM (10%) (p-value for all <0.05).

Discussion

In this study, it was found that females presented with complaints of DPNs and acrochordons warranting removal more than males, which was probably due to cosmetic concern. The mean age of the patients was 34.28 years. The mean duration of lesions at the time of first presentation was 2.65±0.69 years. Positive family history was present in 52.1% patients. The most common lesions were DPNs and the most common sites were face and neck. The most common morphology of lesions was papular lesions followed by mixed lesions. Majority of patients had less than five lesions at the time of first presentation. The most common co-morbidity in patients was obesity followed by DM. The patients were treated with RF removal of lesions and were followed-up for the subsequent three years. 57.8% of patients presented with recurrence of lesions in the follow-up period. Majority of patients who did not use sunscreen after treatment experienced recurrence of lesions. The triggers for relapse noted were UV exposure, pregnancy, obesity, PCOS, OCPs usage and DM.

The observations from this study were in concordance with previous studies on DPNs and skin tags by Rajesh G et al., and Bhat RM et al., (4),(11) with respect to positive family history, female preponderance and role of sun exposure. The DPN is considered as an epidermal nevus or nevoid developmental defect of the pilosebaceous follicles (20),(21),(22). Acrochordons also have been considered as remnants of melanocytic nevus (18). Also, the mutations in the genes: FGFR3 and PIK3CA genes in patients with DPNs also play a role in occurrence and recurrence of lesions (23).

Chronic UV exposure play role in pathogenesis of these lesions, as a part of photoaging. Age is a well acknowledged risk factor for DPNs and acrochordons. Amyloid Precursor Protein (APP), which plays an important role in the pathogenesis of age-related Alzheimer’s disease, was recently shown to be elevated in these tissues and expression levels were particularly high in UV-exposed skin sites (1),(2),(5),(11),(12),(24).

In obese and diabetic individuals, increased expression of epidermal growth factors and insulin-like growth factors has been implicated in the occurrence of the lesions (2),(8),(24). Likewise, the influence from hormones (9) has been noticed in female patients. During the antenatal period, the pre-existing DPNs and skin tags grew faster in size and also the patients became prone for new ones to come up in sites where they were not present prior to conception (10),(25). Apart from hormonal influence, friction from clothing and jewellery has also been noted to influence the growth of the DPNs and skin tags.

By virtue of the association between obesity, diabetes, hormonal factors and these benign lesions, many other dermatological conditions have also been observed to occur in these patients: acanthosis nigricans, pigmentation of racial or ethnic origin, acne vulgaris and striae etc., (18),(24). In this study, treatment with RF showed good results. There were no major complications. Minor complications observed were transient burning sensation after the procedure and postinflammatory pigmentary changes RF removal causes minimal collateral thermal damage and results in rapid healing and aesthetically pleasant scars. It is an office-based procedure with minimal complications. It has the advantage of having both cutting and coagulation modes of operation and hence making the surgery easy and fast [14[,(26).

Limitation(s)

Since, this was a hospital-based study, the results cannot be amplified to the general population. The probable triggers for recurrence of lesions were considered based on history given by patients and could not be proved. Role of sunscreen was the only factor that was evaluated although others like diabetes, PCOS and obesity, genetic factors, hormonal influences, viral infections also are proven contributors in the pathogenesis of DPNs and acrochordons. A further long term study with still meticulous follow-up may throw light on the existing gap in the knowledge of pathogenesis.

Conclusion

In this study, it can be observed that there is a strong role of genetic and hormonal predilection and influence of co-morbidities in the occurrence of lesions. As far as recurrence is considered, regular usage of sunscreen does play a role in prevention of relapse. Although these lesions are not completely preventable, they can be effectively managed. Appropriate lifestyle modifications, treatment of predisposing co-morbidities and usage of sunscreen may prevent further recurrences.

References

1.
Xiao A, Muse ME, Ettefagh L. Dermatosis Papulosa Nigra. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2020 Dec 22]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK534205/.
2.
Metin SA, Lee BW, Lambert WC, Parish LC. Dermatosis papulosa nigra: A clinically and histopathologically distinct entity. Clin Dermatol. 2017;35(5):491-96. [crossref] [PubMed]
3.
Hairston MA Jr, Reed RJ, Derbes VJ. Dermatosis papulosa nigra. Arch Dermatol. 1964;89(5):655-58. [crossref] [PubMed]
4.
Rajesh G, Thappa DM, Jaisankar TJ, Chandrashekar L. Spectrum of seborrheic keratoses in south Indians: A clinical and dermoscopic study. Indian J Dermatol Venereol Leprol. 2011;77(4):483. [crossref] [PubMed]
5.
Calcaterra R, Franco G, Valenzano M, Fazio R, Morrone A. Clinical features and treatment of dermatosis papulosa nigra in migrants to Italy. Skinmed. 2010;8(4):207-09.
6.
Noiles K, Vender R. Are all seborrheic keratoses benign? Review of the typical lesion and its variants. J Cutan Med Surg. 2008;12(5):203-10. [crossref] [PubMed]
7.
Hafner C, Landthaler M, Mentzel T, Vogt T. FGFR3 and PIK3CA mutations in stucco keratosis and dermatosis papulosa nigra. Br J Dermatol. 2010;162(3):508-12. [crossref] [PubMed]
8.
Ellis DL, Nanney LB, King LE. Increased epidermal growth factor receptors in seborrheic keratoses and acrochordons of patients with the dysplastic nevus syndrome. J Am Acad Dermatol. 1990;23(6, Part 1):1070-77. [crossref]
9.
Higgins HW, Jenkins J, Horn TD, Kroumpouzos G. Pregnancy-associated hyperkeratosis of the nipple: A report of 25 cases. JAMA Dermatol. 2013;149(6):722-26. [crossref] [PubMed]
10.
Tunzi M, Gray GR. Common skin conditions during pregnancy Am Fam Physician. 2007;75(2):211-18.
11.
Bhat RM, Patrao N, Monteiro R, Sukumar D. A clinical, dermoscopic, and histopathological study of Dermatosis Papulosa Nigra (DPN)- An Indian perspective. Int J Dermatol. 2017;56(9):957-60. [crossref] [PubMed]
12.
Hafner C, Hartmann A, van Oers JMM, Stoehr R, Zwarthoff EC, Hofstaedter F, et al. FGFR3 mutations in seborrheic keratoses are already present in flat lesions and associated with age and localization. Mod Pathol Off J U S Can Acad Pathol Inc. 2007;20(8):895-903. [crossref] [PubMed]
13.
Belgam Syed SY, Lipoff JB, Chatterjee K. Acrochordon. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2021 Jan 1]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK448169/.
14.
Sachdeva S, Dogra A. Radiofrequency ablation in dermatology. Indian J Dermatol. 2007;52(3):134. [crossref]
15.
Kim DH, Hyun DJ, Piquette R, Beaumont C, Germain L, Larouche D. 27.12 MHz radiofrequency ablation for benign cutaneous lesions. Bio Med Res Int. 2016;2016:6016943. [crossref] [PubMed]
16.
Wollina U. Recent advances in managing and understanding seborrheic keratosis. F1000Research. 2019;8:F1000 Faculty Rev-1520. [crossref] [PubMed]
17.
Maghfour J, Ogunleye T. A systematic review on the treatment of dermatosis papulosa nigra. J Drugs Dermatol JDD. 2021;20(4):467-72. [crossref] [PubMed]
18.
Pandey A, Sonthalia S. Skin Tags. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2021 Jan 1]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK547724/.
19.
Weir CB, Jan A. BMI Classification percentile and cut off points. In: StatPearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2021 [cited 2021 Oct 4]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK541070/.
20.
Diasio FA. Dermatosis papulosa Nigra (castellani) of unusual distribution: (acanthosis papulosa nigra). Arch Dermatol Syphilol. 1933;27(5):751-55. [crossref]
21.
Alexander K, Barankin B. Dermatosis papulosa nigra. Enliven Clin Dermatol. 2015;01. [crossref]
22.
Babapour R, Leach J, Levy H. Dermatosis papulosa nigra in a young child. Pediatr Dermatol. 1993;10(4):356-58. [crossref] [PubMed]
23.
Sun MD, Halpern AC. Advances in the etiology, detection, and clinical management of seborrheic keratoses. Dermatology. 2021;01-13.
24.
Akpinar F, Dervis E. Association between acrochordons and the components of metabolic syndrome. Eur J Dermatol EJD. 2011;22:106-10. [crossref] [PubMed]
25.
Vora RV, Gupta R, Mehta MJ, Chaudhari AH, Pilani AP, Patel N. Pregnancy and skin. J Fam Med Prim Care. 2014;3(4):318-24. [crossref] [PubMed]
26.
Bridenstine JB. Use of ultra-high frequency electrosurgery (radiosurgery) for cosmetic surgical procedures. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 1998;24(3):397-400. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/51667.15821

Date of Submission: Jul 30, 2021
Date of Peer Review: Sep 27, 2021
Date of Acceptance: Nov 18, 2021
Date of Publishing: Jan 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 01, 2021
• Manual Googling: Nov 10, 2021
• iThenticate Software: Dec 20, 2021 (5%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com