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INTRODUCTION

KEY POINTS

  • South Asia consists of Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka.

  • Dyspigmentation, infectious diseases and infectations are commonly seen among patients in this region.

  • Treatment modalities are similar to those used in other populations. However, treatment for dyspigmentation is still challenging.

Dermatologic conditions commonly seen in South Asian patients include pigmentary disorders, eczemas, and infections. Other conditions seen, such as chemical leukoderma and bindi dermatitis, are specifically due to cultural practices in India.

ATOPIC DERMATITIS

Epidemiology

Atopic dermatitis is a chronic relapsing eczematous skin disease characterized by pruritus and inflammation and accompanied by cutaneous physiologic dysfunction, with a majority of the patients having a personal or family history of atopic diathesis (see Chapter 27).1 Genetics has a great role to play and is one of the major diagnostic criteria.2 The role of environmental factors, such as temperature, humidity, and clothing, and psychological factors is also gaining prominence.3 The prevalence is greater in urban areas and among boys.4 Prevalence and incidence are greater in north and central India, compared to the east and south, because these regions experience harsh winters with low humidity.4

Clinical Features

The diagnosis of atopic dermatitis is based on well-defined clinical criteria.5 Infantile atopic dermatitis patients generally present with facial involvements, whereas patients presenting in childhood have flexural involvement [Figure 91-1].

FIGURE 91-1.

Atopic dermatitis showing generalized dryness of the face with Dennie-Morgan fold under lower eyelid.

Treatment

Management is similar to that in patients seen in other parts of the world. The liberal use of emollients and moisturizers forms the backbone of therapy. Avoidance of aggravating environmental factors is beneficial.

Topical corticosteroids form the first and, in most cases, the only pharmacologic therapy. In obviously secondarily infected limited area disease, in lesions close to anterior nares, and in flexures, corticosteroids may be combined with topical antibacterials.6 The only concern is the high incidence of contact sensitivity, especially to neomycin, which is why it is avoided by dermatologists.7 In extensive disease, a course of systemic antibiotics reduces the disease severity even if there is no obvious focus of infection in the skin or respiratory tract. Topical tacrolimus is a safer alternative to topical steroids for long-term use.8

Systemic therapy is reserved for severe and extensive cases. Systemic steroids can be used to control acute exacerbations. Oral cyclosporine is a good alternative for extensive cases for long-term use with proper monitoring.9

OCCUPATIONAL CONTACT DERMATITIS

Epidemiology

Occupational contact dermatitis (OCD) is the most significant and frequent dermatosis among all occupational skin diseases. OCD ...

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