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Introduction: Urticaria is a common debilitating dermatological disorder impairing a patient's quality of life. Such patients are increasingly using socialmedia to manage their health and interact with peers, particularly during the ongoing COVID-19 pandemic. Objectives: To explore and analyse the quality of urticaria related social-media information available to patients. Materials and Methods: An in-depth data audit of the three most commonly used social networks viz. Facebook®, LinkedIn®, and Twitter® were done on a single day, as posts may change or lose relevance over time. The word "urticaria" was searched on three social media, and the first 100 posts in each were further analysed. The post-creator was either categorised as "individual" or "group", and non-English posts were excluded. All types of posts have been analysed, including text, images, video, and website links. We also collected the comments/replies, share/re-tweet, and likes on the posts. Results: Among the total 300 social-media posts, the highest number of "individual" posts was on LinkedIn® followed by Twitter® and Facebook® (χ2 = 82.86, P < 0.0001). Regarding thematic content, most Facebook® posts discussed disease symptoms, followed by the promotion of journal or blog posts, and discussion about causative and triggering agents. LinkedIn® was primarily used for the promotion of journal articles or blog posts, followed by educational webinars and urticaria treatment stories. Twitter® users mostly interacted with peers about their urticaria symptoms and perceived etiologic and triggering factors. Regarding the type of post, images were maximally shared on Facebook®, while video/video links and web links were highest on LinkedIn® (χ2 = 21.59, P < 0.0001). Conclusion: The overall quality of urticaria related information on these 3 social media platforms is satisfactory for patients. Dermatologists may consider utilising social media to further educate such patients and improve the overall treatment outcome. The use of such networking channels will continue to grow, as communication remains crucial for urticaria management.
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Incontinentia pigmenti (IP) is a rare multi-system genetic disorder mostly affecting females. It presents primarily with cutaneous lesions but is often associated with dental, ocular, neurological, musculoskeletal, and cardiovascular abnormalities. We report a series of one male and five female infants with IP having isolated cutaneous involvement at the time of presentation. In such cases, timely diagnosis of the condition, followed by systemic evaluation and long-term periodic follow-up, is imperative to detect and treat more serious systemic manifestations at an early stage.
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Background: Oral second-generation antihistamines (sgAH) constitute the first-line treatment for chronic spontaneous urticaria (CSU), a debilitating dermatological condition. However, many patients respond incompletely, and up-dosing sgAHs up to four-fold their conventional dose is recommended for disease control. Many physicians refrain from up-dosing due to a paucity of efficacy and safety data, instead adding a second antihistamine or an immunomodulator. Objective: With the aim of addressing this knowledge gap, we conducted a literature review to highlight efficacy and safety data on up-dosed sgAHs. Methods: We conducted a comprehensive search of the literature across multiple databases (PubMed, EMBASE, MEDLINE and Google scholar) using the keywords (alone and in combination) and MeSH items as well as non-MeSH terms such as "chronic spontaneous urticaria", "chronic idiopathic urticaria", AND "updosing", "second-generation anti-histamines", "cetirizine", "fexofenadine", "levocetirizine", "desloratadine", "ebastine", "bilastine", and "rupatadine". Results: Our review suggests bilastine, fexofenadine, levocetirizine, and cetirizine are recommended for up-dosing in non-responsive patients with CSU (Grade A recommendation), while desloratadine and ebastine can be recommended (Grade B recommendation). Among those with Grade A recommendation, bilastine and levocetirizine may be up-dosed safely to four times, while fexofenadine has been studied at three times the conventional dose. None of the drugs showed any dose-dependent increase of adverse effects; however, cetirizine up-dosing may increase the risk of dose-related sedation. There were no reports of systemic complications, including cardiotoxicity, at higher than licensed doses of these drugs. Only cetirizine and rupatadine up-dosing have been documented to be effective and safe in children, while there is lack of data on geriatric patients and pregnant or lactating females.
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Background Chronic urticaria exerts a profound impact on quality of life. Recent guidelines recommend its evaluation in all chronic urticaria patients. Currently, the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) is the only validated tool to assess chronic urticaria-specific quality of life. Objective To validate and adapt the CU-Q2oL to the Bengali language for its widespread use. Methods The CU-Q2oL questionnaire was translated into Bengali. Its internal consistency and reliability were tested by asking 42 chronic urticaria patients to complete this version. They completed the validated Bengali Dermatology Life Quality Index and Urticaria Control test questionnaires, and their scores were correlated with CU-Q2oL score to assess the validity of our Bengali version. Results The mean CU-Q2oL score of our patients (mean age 38.41 ± 13.4 years, male: female 29:13) was 48.8 ± 16.5. Domain 4 (sleep problems) was worst affected, followed by domain 1 (pruritus), while domain 2 (swelling) was least affected. We detected an excellent overall internal consistency (Cronbach's alpha = 0.93) of our version and nearly complete agreement (intra-class correlation coefficient = 0.91) between the test-retest scores. We found a significant positive correlation between the overall CU-Q2oL and Dermatology Life Quality Index scores (rs = 0.53, P = 0.0002), thus implying the validity of our version. Additionally, we noted a significant negative correlation between the overall CU-Q2oL and Urticaria Control test scores (rs = -0.48, P = 0.0007), suggestive of a more severe impairment of quality of life with poorer disease control. Limitations Small sample size, observational design and bias in test-retest reliability analysis due to the use of rescue therapy in-between assessment sessions were important limitations of our study. Conclusion The Bengali version of CU-Q2oL questionnaire is a valid and reliable tool suitable for both clinical and research use in Bengali speaking chronic urticaria patients.