Selective therapy (cryo or scalpel) combined with multimodal therapy for treating keloids.

Background: Keloids are less responsive to any single treatment modality; hence, there is a need for combination therapy that can yield satisfactory outcomes. Objective: The present study assessed efficacy and safety of combination therapy-surgical excision or cryotherapy and intralesional corticosteroids along with 5-fluorouracil [IL (S + 5-FU)] injection, followed by silicone gel sheet (SGS) under compression therapy in the treatment of keloids. Materials and Methods: This was a retrospective, observational study comprising 21 clinically diagnosed keloid patients. All patients were treated with the stated combination therapy. Data about demographic, lesions, procedural characteristics, and treatment outcomes were reported. Results: Of 21, 11 (52.4%) patients were treated with liquid nitrogen (LN2) cryotherapy, and 10 (47.6%) patients were treated with surgical excision. Mean age was 30.8 ± 7.6 (range: 14-44) years with slight male (52.4%) predominance. A mean surface area of keloid lesion was 96.8 ± 170.5 cm3. The most frequently involved site was auricle (8 [38.1%] patients). Patients received the following types of treatments: intralesional LN2 cryotherapy (6 [28.6%]), intralesional excisional surgery (6 [28.6%]), surface LN2 cryotherapy (5 [23.8%]), and extralesional excisional surgery (4 [19.0%]). Complications of recurrence (2 [9.5%]), secondary infections (2 [9.5%]), persistent postinflammatory hypopigmentation (1 [4.8%]), and atrophic scarring with postinflammatory hyperpigmentation (1 [4.8%]) were reported. After a study period of 2.5 years, 100% cure rate was achieved. Conclusion: Combination therapy of surgical excision or cryotherapy and IL (S + 5-FU), followed by SGS under compression, was safe and effective in treating keloids.

A Rare Case of Rectal Carcinoma With Pulmonary Artery Thrombosis.

Cancer is a well-recognized risk factor for thromboembolic events and thromboembolism. This case report presents the rare coexistence of rectal carcinoma and pulmonary artery thrombosis in a female patient. A 44-year-old female presented with complaints of abdominal pain, vomiting, and obstipation. She had recently been diagnosed with rectal carcinoma. She had not undergone any invasive procedures in the past. Given the possibility of intestinal obstruction, an exploratory laparotomy was performed, followed by retrocolic gastrojejunostomy with Roux-en-Y anastomosis with a feeding JT tube insertion. On postoperative day six, she experienced symptoms of shortness of breath, tachypnoea, and hypoxia. At that time, a two-dimensional echocardiography showed normal findings but a CT pulmonary angiogram (CTPA) revealed a thrombus in the right upper lobe pulmonary artery. There was no evidence of lung metastasis on CTPA. This report highlights the challenging scenario associated with rectal carcinoma and concomitant pulmonary artery thrombosis.

Meningitis-Retention Syndrome as an Unrecognized Clinical Condition in Indian Scenario: Fall Through the Cracks.

Meningitis-retention syndrome (MRS) is a recently recognized condition marked by the concurrent occurrence of aseptic meningitis with acute urinary retention. We present the case of a 22-year-old man who presented with an undiagnosed fever with headache and urinary retention. Subsequent urodynamic testing revealed an underactive detrusor, resulting in insufficient contraction of the bladder during voiding despite normal sensation during bladder filling. Normal urinary voiding was successfully restored without the need for treatment within a 30-day timeframe. It is crucial to include MRS in the differential diagnosis of acute urinary retention. It is crucial to include MRS in the differential diagnosis of acute urinary retention. Despite the generally benign and self-remitting nature of MRS, the management of acute urinary retention is necessary.

Can Serum Magnesium Level and Visual Evoked Potentials (P100) be a Predictive in Migraineurs?: Evidence Based Study.

Background and Objective: Few dating back, the role of visual evoked potentials changes and reduced level of intracellular magnesium have appeared in migraine patients both throughout the attacks and in the interictal periods. Moreover, there is a lack of evidence regarding the correlation between magnesium levels and visual evoked potentials. To assess the changes in the levels of magnesium in migraineurs compared to a healthy control group is our prime intention. Also, to correlate serum magnesium levels with visual evoked potentials changes within the migraineurs is a secondary part of the study. Materials and Methods: After applying inclusion and exclusion criteria as per the study protocol, in total, 80 subjects were enrolled in the study. Of which 40 were migraineurs diagnosed as per the International Headache Society criteria for severe migraine headache. Rest of 40 was nonmigraineurs served as a control group of the study. All included patient was submitted to demographic profile, previous history of the disease and drug intake, thorough clinical investigation and baseline laboratory parameters. Apart from this, the measurement of visual evoked potentials changes (4th block) and magnesium levels were done as per our standard operating procedures. Results: In migraineurs, serum total Mg level was considerably lower compared to the control group (1.79 ± 0.14 mg/dl versus 2.10 ± 0.17 mg/dl, P < 0.0001) and amplitude of P100 (P < 0.0001) was negatively correlated to reduced serum Mg level (P < 0.0001). Conclusions: As expected, both elevated visual evoked potential amplitude and reduced level of brain magnesium can be a demonstration of neuronal hyperexcitability of the optic pathways associated with a dropped threshold for migraine attacks.

Intralesional Agents in Dermatology: Pros and Cons.

Since introduced in 1961, intralesional (IL) agent has become an essential part of the dermatological practice. The term IL referred to the direct delivery of agent percutaneously into skin lesions. This therapeutic approach is relatively safe, easy to perform and applicable for a broad range of dermatological conditions. On the other hand, immediate side effects, including pain during administration, bleeding, high risk of infection and allergic reaction, and subsequent side effects involving skin changes such as atrophy, telangiectasia, pigmentary changes, and striae are usually associated with this modality. This review paper highlights the pros and cons of IL agents in modern dermatology practice.

A Retrospective Study of 3,000 Indian Patients with Vitiligo Treated with Phototherapy or Topical Monotherapy.

BACKGROUND: Vitiligo-affected individuals, especially patients with darker skin tones, can suffer from negative psychosocial impacts due to unpredictable development of the condition and perceived cosmetic concerns. However, given that spontaneous repigmentation can be gained in vitiligo, many patients ask for treatment due to these cosmetic concerns. In the literature, only a few studies have been documented focusing on the outcome of various treatment modalities for vitiligo. OBJECTIVE: This article highlights the retrospective response of various treatment modalities in Indian patients with vitiligo. METHODS: A retrospective chart review was performed from July 2017 to August 2018 at our private dermatology clinic. A total of 3,000 patients were enrolled in this observational study. Patient characteristics and details of phototherapy (psoralen and ultraviolet A, narrow-band ultraviolet B, excimer laser) were noted as per a predefined format. The clinical response was evaluated as a marked response, defined as repigmentation in more than 75% of the initial lesional area. RESULTS: Of those included in this retrospective analysis, 1,996 patients received phototherapy and 1,004 patients were treated with topical monotherapy. Patients treated with phototherapy only and those treated with a combination of phototherapy and topical agents showed significantly higher clinical response rates relative to patients treated with topical monotherapy only (marked response rate: 47.8% vs. 8.7%; P<0.001 and 23.4% vs. 8.7%; P<0.001). Disease subtype predominately affected the treatment response. CONCLUSION: In Indian patients with vitiligo, phototherapy appears to be an effective treatment option for both focal and vitiligo vulgaris. Due to its reliability and minimal side effects, it can be considered a preferable treatment modality for vitiligo.

The Closure of Nose Piercing Site Successfully Managed with Skin Grafting: A Case Series of Three Patients.

Historically, nose piercing was considered as the symbol of elegance and sometimes also associated with regional ritual. In modern civilization, there has been a decreasing trend to wear nose rings and some people demand for its closure. Herein, we report a case series of three patients who were successfully managed with full-thickness skin grafting for the closure of nose piercing site.

A Rare Case Report of Spontaneous Disassembly of Bipolar Hip Prosthesis in Elderly Patient.

INTRODUCTION: Hip fracture is an established health problem, especially in the elderly population and, its incidence is dramatically rising in the globe. The standard protocol of management in the elderly population for end-stage hip diseases and unstable femur fracture is bipolar hemiarthroplasty. Common complications of hip replacement include infection, fracture, dislocation, venous thrombosis, nerve palsy, chronic pain, and implant failure. In the literature, there are very few reported cases of disassembly of the implant in hemi replacement arthroplasty. CASE REPORT: We, hereby, present a case of the spontaneous disassembly of the bipolar hip prosthesis, which was timely recognized and treated adequately in an elderly patient. CONCLUSION: The use of the cemented bipolar prosthesis can also lead to disassembly of the implant components and thereby the need for open reduction. Identification of the distinction between dislocation of head and disassembly of the prosthetic components is vital for favorable patient prognosis.

Case Report on Rare Clinical Variant of Porokeratosis: Disseminated Superficial Porokeratosis.

Porokeratosis is a genodermatosis, resulting from a disorder in keratinization due to an abnormal clone of epidermal precursor, presenting with various clinical manifestations but characterized histologically by the presence of cornoid lamella. Diverse clinical variants of porokeratosis exist, which are unified by this general histological feature, but differ in morphology, distribution, and clinical course. The typical lesions of porokeratosis are described by an atrophic center surrounded by an elevated keratotic rim formed by the cornoid lamella. The lesions can be found almost anywhere on the body. We report an unusual presentation of a rare clinical variant, disseminated superficial porokeratosis.

Rhinophyma Successfully Treated with Ultra Plus CO2 Laser: Report of a Case and Literature Review.

Rhinophyma (Greek "nose growth") benign skin deformity characterized by tumorous growth leading to a large, bulbous, and erythematous appearing nose. It is a rare subtype of phymatous rosacea. The exact pathogenesis is still not known. It can lead to considerable cosmetic impairment with psychosocial implications and poses a risk of developing an occult malignancy. Early diagnosis and treatment is imperative to avoid these complications. Herein, we report a case of a 47-year-old man presenting with rhinophyma who was treated with ultra plus CO2 laser.

Modified Rheumatoid Arthritis Protocol for Rituximab in Pemphigus: A Retrospective Case Series.

Background: Rituximab, an anticluster of differentation 20 antibody, has been shown in open series studies to be effective in treating pemphigus. In the literature, lymphoma (dose of 375mg/m2, four-week infusion) and rheumatoid arthritis (two infusions of 1,000mg each, 15 days apart) are two protocols extensively used for rituximab treatment in pemphigus. Objective: We investigated whether a modified rheumatoid arthritis protocol, in which the patient received a single treatment course ranging from 2 to 5 infusions of 1,000mg of rituximab during an interval of four weeks is safe and effective in pemphigus management. Methods: Patients with pemphigus were treated with a single treatment course ranging from 2 to 5 infusions of 1,000mg of rituximab during an interval of four weeks. Clinical consensus late endpoints and desmoglein 1 and desmoglein 3 indices were monitored. Results: We enrolled 32 patients in the study: four with pemphigus foliaceus (PF) and 28 with pemphigus vulgaris (PV). The follow-up period was 98.22±20.65 weeks (range: 40-140 weeks). All 32 patients responded to therapy. Nineteen patients achieved complete remission during a median period of 46 weeks (8 on minimal therapy, 11 off therapy). Thirteen patients achieved partial remission during a median period of 46 weeks (8 on minimal therapy, 5 off therapy). Relapses were seen in five (15.63%) patients between 72 and 96 weeks (median: 96 weeks) after the start of therapy. The antidesmoglein index correlated well with clinical improvement in PV or PF. Conclusion: Modified rheumatic arthritis protocol for rituximab was shown to be effective and safe in treating patients with pemphigus.

Giant Congenital Melanocytic Nevi Successfully Treated with Combined Laser Therapy.

Congenital melanocytic nevi are benign proliferations of cutaneous melanocytes that arise as a result of abnormal growth, development, or migration of melanoblasts. Clinically, the giant congenital nevus is greater than 20 cm in size, pigmented and often hairy. The risk of malignant melanoma for the giant nevi is almost 6%. Fifty percent of the melanomas develop by the age of 2 years and, 80% of the melanomas develop by the age of 7 years. Hence, early management is of paramount importance. Herein, we present a case of giant nevi along with a review of the literature in order to bring awareness among clinicians towards this rare albeit significant entity.

Recurrent Plaque Morphea Successfully Treated with PDO Mono Threads and Topical Tacrolimus Ointment.

The term plaque morphea describes a variant of morphea (localized scleroderma) in which oval or round circumscribed areas of induration, pigmentary changes, and violaceous or erythematous halo (i.e., lilac ring) are found in the dermis and occasionally to the superficial panniculus. We report a case of 28-year-old male patient with recurrent plaque morphea who was treated with polydioxanone (PDO) mono threads and topical tacrolimus ointment. After the introduction of PDO mono threads, the patient was prescribed topical tacrolimus ointment for six months. After that six-month period, the lesions were softer to palpation and lighter in color. This was observed as a positive therapeutic response. Notably, no future recurrence was seen at one-year follow up.

Case report on premature hair graying treated with Melitane 5% and oral hair supplements.

With chronological aging, hair turns gray. Untimely premature hair graying (PHG) may tremendously influence on cosmesis, self-credibility, and social life of the affected individuals. Consequently, early treatment is required to improve cosmetic appearance. To the best of our knowledge, until today, only one case of PHG is reported in the literature, and it occurred due to iron deficiency and successfully treated with ferrous sulfate. Herein, we delineate a case of PHG in a 14-year-old female treated with the topical formulation of Melitane 5% and oral hair supplements which resulted in boosting improvement in hair color.

Retrospective Analysis of the Efficacy of 10,600nm Carbon Dioxide Laser Ablation for Small Congenital Melanocytic Nevi in Adults.

Carbon dioxide (CO2) laser ablation treatment generating 10,600nm of infrared radiation has shown promising results in patients with small-sized congenital melanocytic nevi (CMN). In this retrospective study, we evaluated the efficacy (Investigator's Global Assessment [IGA] score) and patient satisfaction for CO2 laser ablation for the treatment of small CMN in 17 adults. Of those treated with CO2 laser ablation, our findings indicate the average IGA and patient satisfaction scores were 6.41 and 3.76, respectively. Apart from these, 47.1 percent of cases obtained an IGA score of 7 and 76.5 percent of cases achieved a patient satisfaction score of 4. These results support the efficacy of CO2 laser ablation treatment and might help the clinician to guide treatment selection in patients who wish to avoid more invasive surgical options.