Aditya Kumar Bubna

Metformin - For the dermatologist

Metformin though primarily an antidiabetic drug, has found to play an important role in a number of cutaneous disorders. Because of its role in improving hyperinsulinemia, it has proven beneficial in hormonal acne, hidradenitis suppurativa (HS) and acanthosis nigricans. Its antiandrogenic properties further serve as an add-on to the conventional management of hirsutism associated with polycystic ovarian syndrome. Very recently, systemic usage of metformin for psoriasis and cutaneous malignancies has shown promising results. Interestingly, metformin has also been topically used in hyperpigmentary disorders with pertinent levels of improvement and happens to be the most recent addition to the list of dermatologic indications. Though an oral hypoglycemic agent to begin with, metformin today has proven to be a boon for dermatologists.

Imiquimod - Its role in the treatment of cutaneous malignancies.

Imiquimod is a synthetic imidazoquinolone amine, which has potent immune response modifier activity, when topically used. This characteristic property of imiquimod has led to its use in a number of applications in dermatology, particularly in cutaneous malignancies, where it has been found to be effective and safe. Currently, additional mechanisms for its activity in actinic keratosis, basal cell carcinoma, and invasive squamous cell carcinoma have been elucidated. Its usage for cutaneous metastasis in breast cancer has been a further addition to its therapeutic armamentarium recently.

Vorinostat-An Overview.

Vorinostat is a new drug used in the management of cutaneous T cell lymphoma when the disease persists, gets worse or comes back during or after treatment with other medicines. It is an efficacious and well tolerated drug and has been considered a novel drug in the treatment of this condition. Currently apart from cutaneous T cell lymphoma the role of Vorinostat for other types of cancers is being investigated both as mono-therapy and combination therapy.

Alitretinoin in dermatology-An update

Alitretinoin is a pan retinoic acid agonist. It was initially used as 0.1% gel in the management of localized Kaposis sarcoma. At present, the use of systemic alitretinoin has proved extremely efficacious in the management of recalcitrant chronic hand eczema. Furthermore, there have been other retinoid responsive dermatosis that have demonstrated remission post usage of systemic alitretinoin. With a better toxicity profile, compared to the other systemic retinoids, alitretinoin could be considered a valuable treatment option in the near future for the treatment of these dermatologic disorders.

A case of lamellar ichthyosis with rickets and carcinoma of the hypopharynx.

Lamellar ichthyosis (LI) is an autosomal recessive disorder rarely associated with systemic organ involvement and development of carcinoma. Rickets has occasionally been described with LI owing to impaired vitamin D synthesis following altered keratinization. There has also been a high association of cutaneous cancers in patients of LI. We as Dermatologists should therefore be very meticulous while doing a full work up of these patients. We report here a case of LI associated with rickets and carcinoma of the hypopharynx.

Successful management of recalcitrant perianal warts with two sessions of intralesional 5-fluorouracil

Sir, Genital warts (GWs) have been associated with high recurrence rates even following treatment. Managing these patients, therefore, still remains a challenge. Nonablative methods for managing GWs include podophyllin, podophyllotoxin, imiquimod, trichloroacetic acid, bleomycin, interferons, synecatechins, cidofovir, and 5‐fluorouracil (5‐FU).[1] Intralesional instillation of 5‐FU has recently demonstrated promising results for managing GW.

Prevalence of metabolic syndrome in patients with psoriasis: A prospective, observational, descriptive study from a tertiary health-care center in South India

Background: Psoriasis is a chronic inflammatory disorder which of late has been significantly linked with metabolic syndrome (MS). Objective: To assess the association between psoriasis and MS and evaluate specific disease characteristics predisposing for the development of MS. Materials and Methods: We performed a prospective, observational, descriptive study with 207 adult patients with various types of psoriasis. Results: MS was found in 49.8% of psoriatic patients. It was more prevalent after 40 years of age with a female preponderance (P = 0.000). Smoking (P = 0.0320) and alcohol consumption (P = 0.025) were significant contributing factors for the development of MS in our study population. No association for the same was reflected with parameters such as psoriasis type, lifestyle behavior, family history, and other associated systemic disease. Conclusion: A definite association does exist between psoriasis and MS. Patients with psoriasis should be periodically screened for MS and managed appropriately utilizing an interdisciplinary approach.

A clinical study of cutaneous lesions in neonates at a tertiary health care center in Chennai

Background: Neonatal dermatoses constitute an important category of cutaneous disorders. They range from physiological transient conditions at one end to serious pathological entities at the other. Any of these could be a source of immense anxiety to the parents, and therefore the significance of their adequate awareness amongst dermatologists. Aim and Objective: To study the clinical pattern of various dermatoses in neonates at a tertiary health care center in Chennai. Materials and Methods: This was a descriptive, cross-sectional, and observational study conducted at our institute which included a detailed dermatologic examination of each neonate followed by recording each finding and their statistical analysis. Results: In the 220 neonates analyzed, 97 were females (44.1%) and 123 males (55.9%), with 126 being term babies (57.3%), 86 preterm (39.1%), and 8 postterm (3.6%). Physiological skin changes (52.7%) were the most common cutaneous change identified, followed by transient non-infective dermatoses (20%), developmental defects (7.3%), birth marks (7.3%), eczema (6.8%) and infections (5.9%). Conclusion: Studying neonatal dermatoses holds significance to all dermatologists so that they are able to differentiate physiological and pathological conditions, thereby relieving unnecessary therapy for neonates in circumstances not requiring any and also facilitating to allay undue anxiety among parents.

Saw palmetto extract: A dermatologist's perspective

Saw palmetto extract is believed to have antiandrogenic properties and has been used widely for the treatment of androgenic alopecia. It is claimed to have much less side effects as compared to finasteride. Along with its use for androgenic alopecia, it has also been tried for other conditions associated with increased androgen levels in dermatology. This article will review a dermatologists perspective of this traditional herb.

Iontophoresis with topical 0.05% tretinoin for the management of recalcitrant palmar psoriasis: A report of two cases.

Sir, Psoriasis is a chronic inflammatory disorder of the skin with variable presentation, and requires long-term treatment. The drugs utilized to clear psoriasis differ in their chemistry, route of administration, mode of action and adverse effect profile. In localized forms of psoriasis such as palmoplantar psoriasis, the treating clinician has to weigh the risks and benefits before initiating systemic therapy. The skin is semi-permeable and passive diffusion of topical drugs is poor on the palms and soles due to the stratum lucidum. Due to this, there could be a substantial deficit in therapeutic outcome. Combining topical therapy with physical modalities such as iontophoresis facilitates percutaneous absorption of drugs thereby enhancing drug penetration and causing quicker disease remission.