Glutathione as a skin-lightening agent and in melasma: a systematic review.

Hyperpigmentary disorders, including melasma, are challenging to treat. Glutathione has anti-melanogenic and antioxidant properties, which led to its use as a skin-lightening agent. Our objective was to review the published evidence and literature on the efficacy and safety of glutathione as a skin-lightening agent and in the treatment of melasma. A literature search was done in the PubMed, Embase, and Cochrane library databases using the search terms "glutathione as a skin-lightening agent" and "glutathione in melasma" for the past 10 years. The level of evidence, strength of recommendation, and risk of bias assessment were evaluated. Among various forms of topical glutathione, glutathione 0.5% was significantly more effective compared to glutathione 0.1% and placebo. For glutathione alone versus glutathione plus microneedling, more improvement was seen. Five randomized controlled trials and a single open-arm clinical study on oral glutathione at doses of 250 mg once a day, 250 mg twice a day, and 500 mg once a day showed a significant reduction in the melanin index compared to placebo. The combination of topical 2% glutathione plus oral glutathione was superior to monotherapy alone. There was only one placebo-controlled study on intravenous (IV) glutathione [6/16 (37.5%) vs. 3 (18.7%), (p0.054)]. The risk of bias assessment showed that almost an equal number of studies have low and high risk of bias. Topical versus oral glutathione both provide moderately efficacious skin-lightening outcomes that are localized versus generalized and have minimal versus substantial adverse effects, but they are unsustainable, with variable costs. IV glutathione is contraindicated due to lack of efficacy and side effects. It may work more as an antioxidant in melasma.

Interleukin Levels and Non-Alcoholic Fatty Liver Disease in Chronic Plaque Psoriasis: An Analytical Case Control Study.

Background: Psoriasis is a chronic, immune mediated inflammatory condition of the skin and imbalance in inflammatory mediators could result in insulin resistance, metabolic syndrome and facilitate the occurrence and progression of Non-alcoholic fatty liver disease (NAFLD). Objectives: Primary objectives: To study the frequency of NAFLD in cases of chronic plaque psoriasis and controlsTo study the interleukin levels in cases of chronic plaque psoriasis and controls. Secondary objectives: To study the BMI, lipid profile, waist circumference, FBS (fasting blood sugar), PPBS (post prandial blood sugar) and serum insulin in cases and controlsTo study the association of age, duration of psoriasis, PASI (psoriasis area severity index), BSA (body surface area) involved, BMI (body mass index), lipid profile, obesity, waist circumference, FBS (fasting blood sugar), PPBS (post prandial blood sugar) and serum insulin levels with NAFLD in patients of chronic plaque psoriasisTo correlate serum levels of IL1-ß, IL6 and TNF-α with NAFLD in patients of chronic plaque psoriasis. Methods: 50 clinically diagnosed cases of chronic plaque psoriasis with age ≥ 18years, diseases duration ≥ 6 months and 30 age and sex matched controls were recruited. PASI, BSA of cases was calculated and BMI, BP, WC of all subjects was measured. Serum lipid profile, FBS, PPBS, insulin level, IL1- ß , IL6, TNF- α , high frequency B-mode ultrasound, LFT and fibroscan were done in all subjects. Results: 28(56.0%) cases and 2(6.6%) controls had NAFLD with statistically significant difference. Significantly elevated WC, serum insulin, deranged lipid profile, fatty liver, transaminitis, fibroscan score, liver fibrosis, NAFLD and interleukins were found in cases vs controls. There was a significant association of NAFLD in psoriatic patients with increasing duration of psoriasis, BMI ≥23 Kg/m2, high WC, increasing BSA involved, deranged lipid profile, raised total cholesterol levels and increasing number of risk factors. Nonsignificant but positive association of NAFLD in cases was found with high levels of IL1 - ß, IL - 6, TNF-α, FBS and increasing PASI. Conclusion: Significantly increased interleukin levels and their weak positive correlation with the severity of psoriasis (PASI, BSA) in patients of chronic plaque psoriasis explains the possible role of inflammation in the causation of psoriasis. Screening may be considered in psoriatic patients with increasing duration of psoriasis, high WC, high BSA involved, high BMI, obesity, dyslipidemia and insulin resistance. Limitations: Small sample size. Conflict of Intrest: NONE.

Granulomatous Vulvitis: A Rare Case of Chronic Inflammatory Hypertrophy of Vulvar Labia Related to Ulcerative Colitis.

Granulomatous vulvitis (GV) is an idiopathic entity typically presenting with chronic, painless swelling of the genitals with histologic evidence of granulomatous inflammation. Granulomatous vulvitis can typically start as an acute inflammatory condition, which gradually transforms into a chronic disease with a relapsing and remitting course leading to swollen, indurated, and distorted external genitalia. Association of GV with Crohn's disease is being increasingly recognized. However, the association of GV with ulcerative colitis is unreported. Here, we report a rare case of GV in a middle-aged Indian female with characteristic gastrointestinal involvement suggestive of ulcerative colitis. We hope to contribute to an earlier recognition and a better management of the vulvar and gastrointestinal lesions of ulcerative colitis.

Clinical and Metabolic Characteristics in Hidradenitis Suppurativa - An Indian Perspective.

Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent follicular disorder affecting apocrine gland bearing areas such as axillae, inframammary area and groin. Significant association of HS with metabolic derangements such as hypertension, obesity, hyperlipidemia and hyperinsulinemia has been found. There is dearth of literature on epidemiological and metabolic profile of HS in Indian subjects. Aim: The aim of this study is to assess abnormalities in the levels of fasting blood glucose, serum insulin, and lipid profile in patients with HS. Primary Objective: To assess the frequency of abnormal levels of fasting blood sugar, serum insulin and lipid profile in patients with HS. Secondary objectives: To assess the frequency of hypertension, raised basal metabolic index, polycystic ovarian syndrome, follicular disorder, erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) in patients with HS and to assess the severity of of clinical presentation HS using Hurley staging system. Methodology: This is a retrospective record based study. Records of clinically diagnosed patients of HS, aged > 18 years fulfilling the inclusion and exclusion criteria were analysed. Results: Total 30 patients were recruited with 1:1 male to female ratio. Five (16.67%) cases fulfilled NCEP ATP III criteria for the diagnosis of metabolic syndrome. Statistically significant association was observed between severity of HS, in younger age group (<20 years), moderate to severe BMI, fasting serum insulin, fasting total cholesterol and raised ESR. Limitations: This is retrospective, hospital record based study with small sample size. Conclusion: Holistic management of HS should be individualized according to need of patient and it should be combined approach including dermatologist, plastic surgeon, psychiatrist and dietician. We recommend an initial screening for derangements in metabolic profile in these patients for more effective management and preventing long term cardiovascular complications.

Biochemical and hormonal abnormalities in adult female acne.

BACKGROUND: Prevalence of adult patients with acne is increasing and women comprise majority of the cases. There is lack of data on biochemical and hormonal abnormalities in adult female acne (AFA). AIMS: To evaluate biochemical and hormonal parameters in 60 patients of AFA. METHODS: A cross-sectional observational study conducted from November 2018 to March 2020 in Dermatology outpatient department of a tertiary care hospital in North India. Adult females (age > 25 years) with a clinical diagnosis of acne were included in the study. RESULTS: 60 cases of AFA were included. The age ranged between 26-41 years with mean age at presentation being 29.45 years. 53.3% patients had persistent acne while 46.7% had late-onset acne. 50% patients had history of premenstrual flare-up of their acne. Raised FBG was found in 25% patients. 10% had raised serum insulin levels. HOMA-IR index was deranged in 55% patients. At least one lipid alteration was reported in 91.6% of patients. In hormonal parameters, raised TT was present in 6.7%, LH in 3.3%, FSH in 18.3%, prolactin in 3.3%, and TSH in 15%. No association was found between acne severity and biochemical and hormonal parameters. CONCLUSIONS: Our study highlighted the importance of measuring lipid profile in AFA and calculating HOMA-IR index for measuring insulin resistance rather than simply measuring serum insulin levels. In our study, additional parameter deranged in significant number of patients was FBG. Hence, we recommend routine screening of lipid profile, FBG and calculation of HOMA-IR index in AFA.

What causes loneliness among household heads: a study based in primary setting in Mumbai, India.

BACKGROUND: With the pace of urbanization, symptoms of loneliness emerge as one of the most devastating mental illnesses among city dwellers in the modern age. The present study has tried to identify the potential factors and correlates which affect loneliness vulnerability. METHODS: The data for this study were collected from three different areas of Mumbai (i.e., Dadar, Bandra, and Chembur).This study was conducted through a cross-sectional household survey of household heads in the five different housing typologies/ localities between January and June 2016.A total of 450 household data were collected using the quota sampling method. Loneliness was the main dependent variable. The bivariate analysis was used to see the percentage of loneliness among respondents. Bivariate analysis for categorical data was carried out using the chi-square (χ2) test. Logistic regression analysis was performed to explore the correlates of loneliness among household heads. The probability of significance was set at 5%. RESULTS: It was found that around 7 percent of respondents often feel lonely, and 21 percent of respondents sometimes feel lonely in the last seven days preceding the survey date. Household heads with two or more chronic diseases had higher odds (OR = 4.87, CI = 1.52-15.57) of loneliness than household heads without any chronic disease. The odds of loneliness were almost 3 times higher (OR = 3.05; CI = 1.11-8.38) among females as compared to males. Household heads living alone (single) had higher odds (OR = 19.99; CI = 4.14-96.59) to suffer from loneliness than those living in a joint family. CONCLUSION: Finding reveals that level of loneliness symptomatology in urban dwellers may be attributed significantly by individual (i.e., morbidity status and sex of respondent), social (i.e., personal relation) and residing locality characteristics. Community psychological intervention along with enhanced civic engagement can reduce level of loneliness in existing slum rehabilitees.