Swetalina Pradhan

Oral tranexamic acid with fluocinolone-based triple combination cream versus fluocinolone-based triple combination cream alone in melasma: An open labeled randomized comparative trial

Background: Melasma is a common acquired cause of facial hyperpigmentation with no definitive therapy. Tranexamic acid, a plasmin inhibitor, has demonstrated depigmenting properties and combining this oral drug with other modalities of treatment has shown promising results. Objectives: To compare the efficacy of a combination of oral tranexamic acid and fluocinolone-based triple combination cream with that of fluocinolone-based triple combination cream alone in melasma among Indian patients. Materials and Methods: 40 patients of melasma of either sex attending to dermatology OPD were enrolled in this study. Participants were randomly divided into two groups with 20 patients in each group. Group A patients were asked to apply the cream only and Group B patients received oral tranexamic acid 250 mg twice daily and applied a triple combination cream containing fluocinolone acetonide 0.01%, tretinoin 0.05%, and hydroquinone 2% once daily for 8 weeks. Response was evaluated using melasma area severity index (MASI) at baseline, 4 weeks, and 8 weeks. Results: 40 patients completed the study. The MASI scores at baseline, 4 weeks and 8 weeks in group A were 15.425 + 1.09, 11.075 + 9.167 and 6.995 + 6.056 respectively and in group B 18.243 + 1.05, 6.135 + 4.94 and 2.19 + 3.38. Intergroup comparison showed a faster reduction in pigmentation in Group B as compared to Group A and the results were statistically significant at 4 weeks (P value 0.014) and 8 weeks (P value 0.000). The efficacy was maintained throughout the 6-month follow-up period. Conclusion: Addition of oral tranexamic acid to fluocinolone-based triple combination cream results in a faster and sustained improvement in the treatment of melasma.

Leprosy and women

Leprosy has an impact on the physical, social, and psychological health of affected people. Women in developing countries seek health care late for any health-related issues. Leprosy, a disease known for its stigma, adds further to these facts. Also, close contact between women and family members, especially children, increases the chance of transmission to others and thereby increases the disease burden in the society. Hence, leprosy in women is an important issue for the affected patient, their family members, and society as a whole.

Anti-inflammatory and immunomodulatory effects of antibiotics and their use in dermatology

Antibiotics (antibacterial, antiviral, and antiparasitic) are class of drugs which result in either killing or inhibiting growth and multiplication of infectious organisms. Antibiotics are commonly prescribed by all specialties for treatment of infections. However, antibiotics have hitherto immunomodulatory and anti-inflammatory properties and can be exploited for various noninfectious dermatoses. Dermatologists routinely prescribe antibiotics in treatment of various noninfectious disorders. This study will review anti-inflammatory and immunomodulatory effects of antibiotics and their use in dermatology.

Vitiligo Management: Procedural Options

Although medical therapies are considered the primary mode of treatment for the management of vitiligo, some refractory cases may be dealt with by either surgical intervention alone or in conjunction with medical management. Before administration of any surgical treatment, stability of the vitiligo lesions must be established. Surgical procedures must aim to achieve complete and permanent cosmetically acceptable repigmentation in the shortest time possible with minimal or no side effects, however with currently available means, this goal is not achievable in the majority of the patients. Tissue and cellular grafting are the major surgical therapeutic options; knowledge of the procedure, instrumentation, pre- and postoperative instructions, possible complications, advantages, and disadvantages will best allow what procedure to carry out for each individual patient. Other modalities as tattooing and therapeutic wounding are presented as possible options.

The study of clinical outcome of systemic methotrexate uses in moderate to severe childhood psoriasis

Background: Currently, very few studies exist regarding the use of systemic methotrexate (MTX) in childhood psoriasis. Aim: The aim is to study the effect of systemic MTX with respect to overall efficacy and safety in varied spectrum of severe childhood psoriasis patients and to assess the degree of improvement objectively by measuring psoriasis area severity index (PASI) at each visit. Materials and Methods: All patients <18 years of age having PASI >10, not responding to topical therapy and without having any contraindication to systemic MTX use were included in the study done during a period of two years. MTX was prescribed orally at a dose of 0.2–0.4 mg/kg/week and folic acid on daily basis except on the day of MTX to all the patients. Both clinical and laboratory follow-ups were done weekly for the first 2 weeks and then at 15 days interval for 1 month and monthly after that for measuring PASI and to rule out any side effects of MTX. After 75% improvement in PASI score the dose was decreased at rate of 2.5 mg/week and stopped after complete resolution of the lesions. Results: Out of nine cases (M/F - 6/3), quickest response to MTX was seen in pustular psoriasis (4.5 weeks) and one case of plaque psoriasis (5 weeks) and slowest response was seen in rupoid variant (13 weeks). Mean duration to achieve 50% and 75% improvement in PASI overall were 4.6 ± 2.46 weeks and 7.6 ± 3.36 weeks, respectively. The mean cumulative dose of MTX in all cases was 231.1 ± 176.1 mg without any major side effects. Conclusion: MTX is a safe therapeutic option in severe refractory cases of childhood psoriasis if used with proper monitoring and follow-up.

Disseminated discoid lupus erythematosus with a linear lesion on the forearm and hand: A rare presentation and review of literature

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Necrotic erythema nodosum leprosum healing with extensive scars

509 Indian Dermatology Online Journal | Volume 8 | Issue 6 | November‐December 2017 patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Polyneuritische Variante einer rein neuritischen Lepra mit massiver Beteiligung der peripheren Nerven und Verschonung der von Polio betroffenen Extremität: Ein seltenes Fallbeispiel.

die rein neuritische Lepra (pure neuritic leprosy, PNL) ist eine eigenständige klinische Entität. Sie ist gekennzeichnet durch eine Verdickung einzelner oder mehrerer peripherer Nerven mit Verlust der Sensibilität in den jeweiligen Versorgungsgebieten. Sie kann mit oder ohne motorische Defi zite auftreten. Clinical Letter Hautläsionen kommen bei dieser rein neuritischen Form der Lepra nicht vor [ 1 ] . Ein 34-jähriger Mann wurde mit einem Sensibilitätsverlust in beiden Händen, der Dorsalfl äche des rechten Fußes und anterolateral am rechten Bein vorstellig. Der Patient berichtete von einem beiderseitig, seit 15 Monaten bestehenden kribbelnden Gefühl in beiden Händen und dem rechten Bein sowie von seit über neun Monate bestehenden bilateralen handgelenksund ellenbogennahen Schwellungen und einer Schwellung der rechten Wadenmitte. Außerdem wurde eine Deformität des rechten Fußes festgestellt, die seit sechs Monaten bestand, sowie eine Deformität des linken Fußes, die in Folge einer Poliomyelitis seit der Kindheit bestand. Die Anamnese des Patienten und die Familienanamnese waren ansonsten unauffällig. In der klinischen Untersuchung zeigte sich klar ein beidseitiger Sensibilitätsverlust in den Händen, Unterarmen und dem rechten Fuß, ohne anästhetische, hypopigmentierte Maculae. Auf beiden Seiten wurden mehrere Nervenabszesse entlang des Nervus (N.) cutaneus radialis (NCR), des N. ulnaris sowie des rechten N. peroneus superfi cialis und rechten N. suralis beobachtet. Genannte Nerven waren alle vergrößert, ebenso wie beidseits der N. auricularis magnus (Abb. 1 a—c, 2 a, b). Der rechte N. suralis und die Nn. peronei superfi ciales waren bei der Tastuntersuchung weich. Anzeichen einer motorischen Lähmung wurden in Form einer Atrophie der kleinen Muskeln in beiden

Polyneuritic variant of pure neuritic leprosy with extensive involvement of peripheral nerves and sparing of the polio affected limb: a rare case report.

Pure neuritic leprosy (PNL) is a well-recognized clinical entity. It presents with thickened peripheral nerve(s) with sensory loss in the region of its/their distribution with or without motor defi cit, in the absence of present or past skin lesions [ 1 ] . A 34-year-old man presented with sensory loss in both hands, the dorsal aspect of the right foot and the anterolateral aspect of the right leg. He reported a bilateral tingling sensation in the hands as well as in the right leg for the past 15 months along with a history of bilateral swelling near the wrists, elbows and the middle of the right calf for nine months. He also showed a deformity of the right foot that had been present for six months as well as a deformity of the left foot present since childhood due to poliomyelitis. Otherwise, his medical and family history was unremarkable. Clinical examination clearly revealed bilateral sensory loss in the hands, forearms and the right foot without any anesthetic hypopigmented patches. Multiple nerve abscesses were present bilaterally along the course of the radial cutaneous nerve (RCN) and ulnar nerve as well as the right superfi cial peroneal and the right sural nerve. The aforementioned nerves were all enlarged, as was the great auricular nerve bilaterally (Figures 1a–c, 2a, b). The right sural and superfi cial peroneal nerves were tender to palpation. Signs of motor paralysis were present in the form of atrophy of the small muscles in both hands, loss of eversion of the right foot, and muscular atrophy in the polio-affected limb (Figure 1 a). Other systemic and routine laboratory examinations as well as fasting glucose levels were within normal limits. A slit skin smear for acid-fast bacilli (AFB) was negative. Histology of a biopsy of the right sural nerve revealed necrosis of nerve fi bers as well as infi ltration of neutrophils, macrophages, and lymphohistiocytes (Figure 2 c–d). High-resolution ultrasound (HRUS) with an 8 MHz probe showed increased thickness of affected peripheral nerves in the form of an increased cross-sectional area (CSA) compared to unaffected nerves. The CSAs of the left and right ulnar, RCN, lateral popliteal nerve, sural nerve, superfi cial peroneal nerve

Annular erythema in pediatric population

The term Annular Erythema encompases a great number of entity which commonly present as annular lesions. Differention of one from another is sometimes difficult. Consideration of different aspects such as age, sex, onset, duration etc of these so called less discussed entities as well as clinic-pathological correlation is required to solve the puzzle. We brought about a concise yet lucid review of annular erythema compraising salient features of each entity. We also went through extensive literature search to highlight latest updates and scientific information of the same.