Clinical Evaluation of the Safety and Tolerability of Film-Forming Sprays in Patients With Psoriasis and Eczema.

Background Treating dermatological pathologies under occlusion therapy is a popular adjunct, especially in thickened, lichenified areas of psoriasis where sustained contact with topical corticosteroids plays a pivotal role. Film-forming spray (FFS) can be a novel, alternate approach along with topical treatment in this area for carefully selected cases. This study aimed to evaluate the safety profile and physical characteristics of a novel formulation of an FFS in patients with psoriasis and eczema.  Methods This open-label, multicentre, comparative study included subjects diagnosed with chronic plaque psoriasis requiring topical corticosteroid therapy or those with eczema necessitating its application and occlusion therapy. The study product was applied to two groups of subjects. For patients in group 1, the FFS was applied to the skin area affected by the dermatological condition, which was covered with ointment only. In the second group, the FFS was applied to the corresponding unaffected skin area. The FFS was applied for 60-90 seconds and was observed for two hours after the application. The subjects were evaluated for primary outcomes, including safety assessment, overall physical characteristics, and appearance of FFS from local skin effects. The secondary outcomes included physical appearance characteristics and overall patient satisfaction following the application of FFS at the target sites. Further statistical assessments were conducted using the SAS software version 9.4 (2023; SAS Institute Inc., Cary, North Carolina, United States). Result A total of 100 subjects were included in the study across 10 outpatient centers, of which 79% had psoriatic plaques and 21% had eczematous lesions. Primary outcomes showed a lack of appearance of clinical symptoms such as dryness, flakiness, or irritation. A total of 10% of subjects in group 1 had erythema, and 6% had a tingling sensation, which was transient and mild. The secondary outcomes showed that only 12% of subjects in Group 1 and 6% of subjects in Group 2 showed a feeling of stickiness at the application site. In group 1, 8% reported a cooling sensation, which disappeared in one and two minutes, and none experienced a cooling sensation in Group 2. The average drying time for FFS in subjects with dermatological conditions was 5.19 minutes compared to 1.51 minutes on unaffected skin. The film washability results indicated that 96% of subjects in group 1 reported complete removal in less than two minutes. At the end of the study period, the mean satisfaction score was 8.99. No significant adverse events were reported in the patients. Conclusion This study highlights the potential application of a novel formulation of FFS as a safe and well-tolerated option for enhancing uniform skin coverage with the topical corticosteroid in patients affected with psoriasis and eczema.

Efficacy of Ozone, UV Radiation, Herbal and Glutaraldehyde Method for Sterilisation of Elastomeric Impression Materials for Orthodontic and Prosthodontic procedures.

Objectives: The objectives of the current study was to evaluate the disinfection efficacy of ozone, ultraviolet (UV) radiation, herbal and glutaraldehyde method for sterilization of elastomeric impression materials. Materials and Methods: Disinfection of elastomeric impression material was performed with each of the disinfection methods: ozone, UV radiation, herbal, and glutaraldehyde. Later microbiological analysis was performed and the colony-forming units were evaluated and compared. Results: The highest disinfection efficacy was found with glutaraldehyde, followed by ozone and UV radiation, and the least with neem herbal rinse. Intergroup comparison was highly significant. Conclusion: Dry gaseous ozone and UV radiation can be used effectively for the disinfection of impressions.

A CBCT Assessment of Orthodontic Mini-Implant Placement.

Objectives: This study compares the precision of cone beam computed tomography (CBCT) and two-dimensional radiography for mini-implant implantation. Materials and Method: For 30 sites (in 15 patients between the ages of 13 and 26 years), the buccal interradicular region among the 2nd premolar and 1st molar was found to be the best location for mini-implants. Next, two groups of the mini-implant implantation process were created. Mini-implants were positioned at the CBCT data-identified sites in the CBCT group. Mini-implants were inserted in the RVG group by using two-dimensional digital radiography and a specially constructed guide. To assess the precision of the mini-implant implantation, post-placement CBCT images were acquired. The obtained data were statistically analyzed. Result: The two groups showed a statistically considerable variation in the mini-implant placement's departure from the optimal height. Due to the smaller interradicular space and decreased convenience in the posterior mandibular area, two out of 15 mini-implants in the RVG group demonstrated root contact in the mandibular jaw. Conclusion: The two-dimensional intraoral radiograph of the interradicular area provides sufficient information for mini-implant placement even though CBCT accurately visualizes the interradicular space in three dimensions.

A Comparative Study on Effectiveness of Parental Presence versus Sedative Premedication for Reducing Anxiety in Children Undergoing General Anesthesia.

Background: Preoperative anxiety is an important, yet often unattended problem in children. Minimizing anxiety and distress at the time of anesthetic induction may reduce adverse psychological and physiological outcomes. Sedative premedication and parental presence during anesthesia induction are among the most commonly employed strategies for reducing child anxiety. Aims and Objective: The study aimed to compare the effectiveness of a pharmacological intervention (premedication with midazolam) versus behavioral intervention (parental presence) in reducing preoperative anxiety in children undergoing general anesthesia. Methodology: Sixty patients of age group of 4-12 years, of ASA Grade 1 and 2 and either sex posted for elective surgery under general anesthesia were divided into two groups of 30 each Group M (midazolam group) and Group P (parental presence). Group M received intravenous midazolam 0.03-0.05 mg/kg preoperatively and anxiety was measured in preoperative room, during separation from parents and during introduction of anesthesia mask, whereas in Group P, parents accompanied the child inside the operation theater and anxiety was measured at preoperative room and during introduction of mask. Parental anxiety was measured in both groups at preoperative room and waiting room. Modified Yale Preoperative Anxiety Scale (mYPAS) and State Trait Anxiety Inventory (STAI) tool was used to measure anxiety in children and parents, respectively. Results: The mean mYPAS score while the introduction of anesthesia mask in Group M was 31.30 ± 12.04 and in Group P was 63.19 ± 25.31, and the difference was found to be statistically significant (P = 0.001). In preoperative room, there was no significant difference in anxiety in the two study groups. The mean STAI score in Group P was 45.63 ± 1.45 and in Group M was 41.10 ± 1.69, and the difference was found to be statistically significant (P = 0.001). In preoperative room, parental anxiety was found to be comparable among the two groups. The mean duration of induction of anesthesia in Group M was 5.53 ± 1.01 min, and in Group P, it was 8.77 ± 2.03 min. The difference was found to be statistically significant (P = 0.001). Conclusion: Both interventions were effective in reducing anxiety in children, but midazolam was more effective compared to parental presence. Parents in Group M were less anxious in the waiting room than Group P. Children in Group M were more compliant during the induction of anesthesia, hence a lesser duration of induction than Group P.

The Safety and Effectiveness of Decapeptide in Patients With Vitiligo: A Real-World Study.

Background Vitiligo, a chronic autoimmune depigmenting skin disease, affects a significant portion of the global population. One of the topical treatment options for vitiligo is basic fibroblast growth factor (bFGF)-related decapeptide (bFGFrP) 0.1% solution. This study aimed to assess the real-world effectiveness and safety of decapeptide in treating vitiligo. Methods This retrospective analysis utilized data collected from routine clinical practice in the management of vitiligo, focusing on patients treated with topical decapeptide lotion (Melgain™, manufactured by Zydus Healthcare Ltd., Ahmedabad, India). The primary outcome measures included the extent of re-pigmentation (EOR) and the grade of re-pigmentation (GOR) assessed at each follow-up visit. Results The analysis included data from 65 patients (24 males and 41 females) with an average age of 30.83 years. Segmental vitiligo was present in 52.31% of cases, with the face being the most commonly affected site. Among the patients, 33 received decapeptide as monotherapy, while 32 received decapeptide alongside adjuvant drug/phototherapy. The mean duration of treatment was five months. The first, second, and final follow-ups were observed to be at a mean of 45 days, two months, and five months, respectively. During the second and final follow-up, a significant response (>75% re-pigmentation) was observed in 12% (eight) and 71% (46) of the patients. A mild response (<50% re-pigmentation) was noted in 45% (29) of the patients during the first follow-up visit, 15% (10) during the second follow-up visit, and 6% (four) during the final follow-up visit. Grade 6 and 7 re-pigmentation occurred in a higher number of patients at the final visit, indicating treatment effectiveness. Overall, nearly all patients (96.92%) reported excellent tolerability of the decapeptide lotion based on the global assessment of tolerability. Conclusion This real-world study demonstrates that decapeptide promotes re-pigmentation and improves patient outcomes in vitiligo. Both decapeptide regimens, as monotherapy or in combination with other therapies, were effective and well tolerated by most patients. Thus, decapeptide represents a safe and effective therapeutic option for vitiligo treatment.

Prospective Efficacy and Safety Study of an Innovative Kerascalp Hair Growth Serum in Mild-to-Moderate Alopecia in India: Regrowth Study.

BACKGROUND AND AIM: Male and female pattern baldness, commonly known as androgenetic alopecia is the most common type of alopecia, often predetermined genetically, which generally affects the scalp and is characterized by progressive terminal hair loss, known as miniaturization. This study aimed to assess the safety and efficacy of Kerascalp hair serum, a unique combination of esculin, ximenynic acid, and lauric acid, extracted from natural sources in subjects with mild to moderate androgenetic alopecia. METHODS: An open-label, single-arm clinical study was conducted on healthy males and females aged 18-60 years. Each subject applied the hair serum once daily for 90 days. The efficacy of hair serum was evaluated in terms of the following outcome variables: anagen and telogen ratio (A:T ratio), hair thickness, hair density, hair fall, and hair strength assessment. Subjects were assessed on day 0, day 30, day 60, day 90, and on follow-up day 120. RESULTS: Thirty subjects completed all assessment visits. After using the hair serum for 90 days, statistically significant (p<0.0001) improvement was observed in A:T ratio, hair density, hair thickness, and hair strength; a statistically significant reduction (p<0.0001) in hair fall was also observed. Moreover, improvement in general appearance of hair (in terms of hair volume and density) and scalp (in terms of itchiness, redness, roughness, and dryness) was recorded through dermatological assessment at each treatment visit and at follow-up visit compared to baseline. No adverse event was recorded during the study period, and on follow-up. CONCLUSIONS: The results of this clinical study suggest that a 90 days treatment with a phyto-ingredient-based Kerascalp hair serum is safe and effective in significantly improving A:T ratio, hair density, hair thickness, and hair strength, while reducing hair shedding. The improvement in the test parameters persists, even 30 days after stopping the usage of the serum.

Lumbar osteoporotic fractures develop in segments with less degenerated discs which then become more degenerated.

PURPOSE: Our aim was to study the influence of segmental variations in intervertebral disc degeneration on the location of acute osteoporotic compression fractures and to investigate chronic effect of such fractures on adjacent discs. METHODS: This retrospective study included 83 patients (69 females; mean ± SD age: 72.3 ± 14.0 years) with osteoporotic vertebral fractures. Using lumbar MRI, two neuroradiologists evaluated 498 lumbar vertebral segments for the presence and acuity of fractures and graded adjacent intervertebral disc degeneration on Pfirrmann's scale. Absolute and relative (to average patient-specific degeneration grade) segmental degeneration grades were compared against the presence and chronicity of vertebral fractures for all segments and for upper (T12-L2) and lower (L3-L5) subgroups. Intergroup analysis was conducted using Mann-Whitney U tests, with p value of < .05 considered significant. RESULTS: Fractures involved 149/498 (29.9%; 15.1% acute) vertebral segments, majority (61.1%) involving T12-L2 segments. Segments with acute fractures had significantly lower degeneration grades (mean ± SD: absolute: 2.72 ± 0.62; relative: 0.91 ± 0.17) than those with no (absolute: 3.03 ± 0.79, p = 0.003; relative: 0.99 ± 0.16, p < 0.001) or chronic fractures (absolute: 3.03 ± 0.62, p = 0.003; relative: 1.02 ± 0.16, p < 0.001). Degeneration grades were higher in the lower lumbar spine (p < 0.001) in the absence of fractures, but comparable to upper spine for segments with acute or chronic fractures (p = 0.28 and 0.56, respectively). CONCLUSIONS: Osteoporotic vertebral fractures favour segments with lower burden of disc degeneration, but likely contribute to subsequent worsening of adjacent disc degeneration.

Evaluating the combined efficacy of oral isotretinoin and topical tacrolimus versus oral finasteride and topical tacrolimus in frontal fibrosing alopecia-A randomized controlled trial.

OBJECTIVE: Treatment of frontal fibrosing alopecia (FFA) is complicated and challenging. In this study, we evaluated the efficacy of combining topical tacrolimus with isotretinoin versus finasteride in patients with FFA. METHODOLOGY: Thirty-one patients with FFA were divided randomly into two groups. Therapeutic regimen of the first group (group A, n = 16) was isotretinoin and tacrolimus (Capsule isotretinoin 20 mg daily and topical tacrolimus 0.1% BD). The second group (group B, n = 15) was given finasteride and tacrolimus (Tablet finasteride 2.5 mg daily and topical tacrolimus 0.1% BD). Patients were treated and followed up periodically for 12 weeks. Evaluation of the treatment efficacy was based on Patient Global Assessment and Physician Global Assessment scales. Objective evaluation was based on improving the severity of skin lesions by viewing serial images taken from the affected areas. RESULTS: Physician Global Assessment (PGA) was significantly better in the group A as compared with the group B at 4 weeks (p = 0.038). Physician satisfaction in the group A was better than the group B at 12 weeks, but this was not statistically significant (p > 0.05). Patient Global Assessment and patient satisfaction in the group A was better than the group B at 8 and 12 weeks, but it was not statistically significant (p > 0.05). CONCLUSION: Although both therapeutic regimens were effective in the treatment of FFA, treatment with tacrolimus and isotretinoin is significantly more effective than tacrolimus and finasteride.

"Storage, Backup and Archiving of Images"- E-Dermatology Task Force (IADVL Academy).

Dermatology is a specialty that relies a lot on the visual aspect of clinical diagnosis. Taking photographs of skin lesions is a routine part of clinical practice. They are used to document skin changes during the course of treatment. It is useful for publishing articles in academic journals and textbooks, and serves as a teaching aid. Images are an important form of patient data. Like all patient data, the need for ensuring confidentiality and security is of paramount importance. Keeping all this in mind, it is important to know how to store, backup and archive your images in a safe and efficient manner.

Sweet Syndrome in the Garb of Cellulitis: The Continuing Diagnostic Conundrum of Neutrophilic Dermatoses.

A 58-year-old woman presented to the emergency department with a 3-day history of painful, reddish skin lesions over her legs and high-grade fever. Her prior medical and surgical history was unremarkable. She denied a history of similar lesions, and she was not taking any medication prior to the onset of these lesions.