Comparative evaluation of therapeutic efficacy and safety of black peel versus 25% trichloroacetic acid peel in mild to moderate acne vulgaris: a split face study.

Introduction: Peeling has withstood the test of time as a simple, minimally invasive method to renew the skin, despite the introduction of more advanced procedures like lasers. Materials and Methods: Thirty patients (or 60 sites) with age ranging from 15 to 45 years with mild-to-moderate acne vulgaris were included in the study. Assessment at baseline was done by the global acne grading system score for including mild and moderate acne patients. Results: On grading the improvement according to the 5-point Global Assessment Scale (GAS), it was found that in area A (black peel), 6.7% of patients showed excellent improvement, 86.7% of patients showed good improvement, and 6.7% of patients showed fair improvement. In area B (25%TCA peel), 6.7% of patients showed excellent improvement, 80% of patients showed good improvement, and 13.3% of patients showed fair improvement. Discussion: None of the patients showed poor or worse outcomes in any of the areas. The difference between the groups was not significant (P = 0.688). Conclusion: There is a paucity of data in the literature regarding the comparison of black peel with other conventional peels in the treatment of acne vulgaris. To the best of our knowledge, this is the first study comparing black peel with TCA peel in the treatment of acne vulgaris.

Pharmacovigilance Study of Anticancer Drugs in a Tertiary Care Teaching Hospital in North India: A Retrospective Study.

INTRODUCTION: Anticancer agents are responsible for a majority of adverse drug reactions (ADRs) in cancer patients. ADR reporting with anticancer drugs is very rare in India due to the lack of awareness and knowledge about the Pharmacovigilance Programme of India. Hence, this study was done to assess the pattern of ADRs with anticancer agents in cancer patients and to increase awareness about ADR monitoring among healthcare professionals. MATERIALS AND METHODS: This is an observational, retrospective and non-interventional study conducted in an ADR monitoring centre (AMC) in Govt. Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, North India. Voluntarily reported ADR forms with anticancer drugs as suspected drugs over a period of seven years from January 2016 to December 2022 were analyzed. Various parameters were analyzed, which include demographic details of the patients, type of ADR, department reporting ADR and suspected drug. Causality assessment, severity assessment and preventability assessment were done according to the World Health Organization Uppsala Monitoring Centre (WHO-UMC) scale, modified Hartwig and Siegel scale and modified Schumock and Thornton scale, respectively. RESULTS: The maximum numbers of ADRs were reported in the age group of 41-60 years (68.29%) and in females (59.75%). The maximum number of ADRs was reported with the use of taxanes (docetaxel and paclitaxel) (24.39%), targeted drugs (geftinib, imatinib, bortezomib, bevacizumab, rituximab and pazopanib) (24.39%) and platinum co-ordination complexes (cisplatin, oxaliplatin and carboplatin) (17.07%). Majority of the ADRs reported were shivering and ADRs on the skin. Majority of the ADRs were probable (64.70%), mild in nature (85.29%), definitely preventable (45.58%) and probably preventable (45.58%). CONCLUSION: ADR monitoring is needed to increase the outcome of anticancer drug treatment in cancer patients. The quality of treatment in cancer patients can be improved through the timely management of these ADRs. It is a need of the present era to inform healthcare professionals about the Pharmacovigilance Programme to increase the reporting of ADRs due to anticancer drugs.

Comparative Evaluation of Therapeutic Efficacy and Safety of Microneedling Alone Versus Microneedling with Hyaluronic Acid in Post-Acne Scarring.

Background: Facial acne scars are perceived negatively by society; in an era where everyone wants to look their best, acne and its sequelae are a great source of stress driving down self-worth and elevating the risk of depression and anxiety. It affects over 95% of acne patients, particularly in nodulocystic, conglobate, and fulminans varieties. Various treatment modalities are available, but no single modality is 100% curative. Microneedling produces controlled skin injury, releasing various growth factors and setting up a healing cascade, and laying down collagen as a result. Hyaluronic acid plays an important role in wound healing by creating physiological conditions in the extracellular matrix for the proliferation, migration, and organization of dermal cells. Aims and Objectives: To compare the therapeutic efficacy and safety of microneedling alone and microneedling with hyaluronic acid in acne scars. Materials and Methods: Sixty patients of age 18-40 years with clinically diagnosed acne scars were recruited and randomly divided into two groups of 30 each. Three sittings were done at an interval of 3 weeks of microneedling alone to Group A and microneedling with hyaluronic acid to Group B and followed up with two visits 4 weeks apart. Scoring was done with Goodman Quantitative Global Scarring Grade System. Side effects, patient satisfaction score, and pre and postprocedure Dermatological Life Quality Index (DLQI) were also recorded. Results: The female:male ratio was 3:2, mean age was 26.90 ± 4.90 years in Group A and 24.43 ± 5.39 years in Group B. Overall, 60% patients had a duration of 2-5 years, and unmarried patients outnumbered married ones in both groups. The combination morphology of the scars was the most common finding. In Group A mean Goodman Quantitative Global Scarring Grade System score reduced from baseline 24.13 ± 7.96 to 16.3 ± 7.2, and in Group B, from 27.73 ± 7.86 to 18.20 ± 7.12 at 17 weeks, this decrease was gradual and statistically significant. The patient satisfaction score for Group B (6.20 ± 1.45) was only slightly higher than that of Group A (5.73 ± 1.31). DLQI for Group A decreased from 7.77 to 4.10 and in Group B from 7.63 to 5.00. Both procedures were safe, with over 80% patients experiencing no side effects. Conclusion: The majority of patients showed "moderate" improvement in both groups; however, more patients in microneedling with hyaluronic acid group showed "good" and "very good" results at the end of the treatment completion. These are easy, office-based procedures not requiring training or any high-end machine, especially useful in resource-limited setups; the use of hyaluronic acid can enhance the efficacy of microneedling alone.

Tranexamic Acid in Melasma: Comparative Evaluation of Therapeutic Efficacy of Oral Tranexamic Acid versus Its Transepidermal Administration.

Background: Melasma is a common disorder of hyperpigmentation mainly affecting the face. It is difficult to treat and is a cause for great cosmetic concern for the patient. So, we did this research to compare the therapeutic efficacy of tranexamic acid (TXA) through oral route versus its transepidermal administration with a dermaroller in melasma. Materials and Methods: This was a hospital-based, interventional study carried over a span of 1 year on 40 patients with facial melasma. The enrolled patients were randomly divided into 2 groups of 20 patients each. Group A patients received oral tablet TXA in a dose of 250 mg twice daily for 12 weeks and Group B patients were given TXA solution transepidermally into the melasma lesions using a dermaroller at 2 weekly interval for 12 weeks. Thereafter, all patients were followed up for improvement in Melasma Area and Severity Index (MASI) score, adverse effects and relapse at 4 weekly intervals till 24 weeks. All the patients were evaluated for therapeutic outcome both objectively (by MASI) and photographically at 4, 8, 12, 18, and 24 weeks. Grading of improvement was done by assessing percentage reduction in MASI score. Results: Majority of the patients, 24 (60%) in our study had centrofacial pattern of melasma followed by malar pattern seen in 16 (40%) patients. The baseline MASI score was 11.98 (± 5.47) in Group A and 12.13 (± 3.16) in Group B. The mean MASI score in Group A at the end of 4, 8, 12, 18, and 24 weeks was 9.75 (±4.83), 6.09 (±3.64), 4.21 (±2.48), 2.56 (±1.95), and 3.10 (±3.38) while these values were 9.73 (±3.32), 6.06 (±2.75), 4.55 (±1.89), 2.94 (±1.36), and 3.09 (±1.32) for Group B. At the end of 24 weeks follow-up period, good (51%-75% improvement) and very good (>75% improvement) response occurred in 5 (25%) and 14 (70%) patients in Group A and 11 (55%) and 9 (45%) patients in Group B, respectively. However, the final reduction in MASI score was similar in both the groups. Relapse was uncommon and occurred at 24 weeks in 1 patient from Group A. Limitation: The major limitation was small sample size due to time limitation and long follow-up period. Conclusions: Oral and transepidermal TXA appear equally effective suggesting that the efficacy of TXA is perhaps independent of its route of administration. Oral therapy is convenient for the patient. Transepidermal therapy of TXA has the advantage of local action, hence systemic side effects are avoided, but it is slightly painful and the time period between consecutive microneedling sessions is left to the prerogative of the treating doctor, hence a proper quantification is lacking. Moreover, scheduling of maintenance sessions is necessary as melasma is prone for recurrence.

Extramammary Paget's disease of the penis: A rare case report.

Extramammary Paget's disease (EMPD) of the penis is a rare, intraepidermal adenocarcinoma. We describe the case of a 60-year-old male who presented with an erythematous plaque on his penis, previously treated with various topical and oral drugs. Punch biopsy from the lesion revealed the diagnosis of EMPD. Early diagnosis and treatment is necessary for this rare neoplastic condition.

Brauer Nevus of Eyebrow: A Rare Entity.

Brauer nevus presents as a local circumscribed area of noncicatricial alopecia. It usually involves the frontotemporal scalp. We report an unusual case of Brauer nevus involving the right eyebrow. Trichoscopy helps to confirm the diagnosis and differentiate this condition from other types of nonscarring alopecias. It also helps to avoid unnecessary diagnostic and therapeutic interventions.

Comparative Evaluation of Therapeutic Efficacy of Intralesional Injection of Triamcinolone Acetonide versus Intralesional Autologous Platelet-rich Plasma Injection in Alopecia Areata.

CONTEXT: Alopecia areata is a chronic non-scarring alopecia that involves scalp and/or body. Corticosteroids are the most popular drugs for its treatment. AIM: The aim of the study was to evaluate the therapeutic efficacy of intralesional injection of triamcinolone acetonide and platelet-rich plasma (PRP) in alopecia areata and to compare the efficacy of these modalities in alopecia areata. SETTINGS AND DESIGN: This was a randomized controlled comparative study. SUBJECTS AND METHODS: Forty patients were enrolled from the outpatient department and divided into two groups of 20 patients each. Group A and B randomly received intradermal triamcinolone acetonide suspension (10 mg/mL) and PRP, respectively, into the lesion using an insulin syringe in multiple 0.1 mL injections 1cm apart. The injections were repeated every 3 weeks till 12 weeks. The patients were evaluated by Severity of Alopecia Tool (SALT) score and photographically every 3 weeks till the end of 12 weeks and then at the end of 6 months. Statistical analysis used descriptive analysis along with Pearson chi-square test or Fisher exact test, paired samples, and independent samples t test or their nonparametric analogs for continuous variables. RESULTS: The reduction in SALT score at each visit with respect to baseline was greater in the triamcinolone group as compared to PRP group. This signifies greater effect of triamcinolone in alopecia areata. Around 50% patients in triamcinolone group and 5% patients in PRP group showed grade V improvement. Pain during intralesional injection was higher in the PRP group. CONCLUSION: Both intralesional triamcinolone and PRP were found to be efficacious in alopecia areata but the latter produced lesser improvement.

Drug-associated Plica Polonica: An Unusual Presentation.

Plica polonica is an uncommon condition characterized by irreversible matting of hair on the scalp. It is usually associated with psychiatric disturbance, neglect of hair, scalp infestation, and use of ionic surfactants for shampooing. Rarely, plica polonica has been associated with drugs. We report this condition in a patient of metastatic carcinoma breast on docetaxel chemotherapy.

Imatinib mesylate induced erythroderma: A rare case series.

Imatinib is a tyrosine kinase inhibitor approved as a first line treatment for chronic myeloid leukemia and gastrointestinal stromal tumors. Usually the drug is well-tolerated with hematological adverse effects being most commonly seen. Dermatological side effects are seen in 9.5-69% of patients on imatinib; majority of which are minor and self-limiting. We, hereby, report a case series of erythroderma occurring secondary to imatinib in two patients with chronic myeloid leukemia. Both the patients improved upon the discontinuation of the drug. The literature review revealed only six probable cases of erythroderma due to imatinib. So, this case series is being reported for the rarity of this adverse effect of imatinib.

A study of Basal cell carcinoma in South asians for risk factor and clinicopathological characterization: a hospital based study.

Objectives. Although the incidence of skin cancers in India (part of South Asia) is low, the absolute number of cases may be significant due to large population. The existing literature on BCC in India is scant. So, this study was done focusing on its epidemiology, risk factors, and clinicopathological aspects. Methods. A hospital based cross-sectional study was conducted in Punjab, North India, from 2011 to 2013. History, examination and histopathological confirmation were done in all the patients visiting skin department with suspected lesions. Results. Out of 36 confirmed cases, 63.9% were females with mean ± SD age being 60.9 ± 14.2 years. Mean duration of disease was 4.7 years. Though there was statistically significant higher sun exposure in males compared to females (P value being 0.000), BCC was commoner in females, explainable by intermittent sun exposure (during household work in the open kitchens) in women. Majority of patients (88.9%) had a single lesion. Head and neck region was involved in 97.2% of cases, with nose being the commonest site (50%) with nodular/noduloulcerative morphology in 77.8% of cases. Pigmentation was evident in 22.2% of cases clinically. Nodular variety was the commonest histopathological variant (77.8%). Conclusions. This study highlights a paradoxically increasing trend of BCC with female preponderance, preferential involvement of nose, and higher percentage of pigmentation in Indians.

Future perspective of probiotics in dermatology: an old wine in new bottle.

Probiotics are live microbial food supplements that are beneficial to the host health when administered in adequate amounts. Probiotics do have an exciting concept in digestive functions, but these live microbes have wider applicability as evidenced by gut-brain-skin axis theory given 80years back. However, the details regarding use of probiotics for dermatological indications ranging from atopic dermatitis to acne and sexually transmitted infections is dispersed in the literature, herein we have tried to focus all under one heading. Overall, probiotics seem to be promising and safe therapeutic modality, but the evidence as of now, from the available published data is low. This review will stimulate readers to carry out well designed, larger population based trials, so as to validate its use in dermatology practice.

A clinicopathological and immunohistochemical correlation in cutaneous metastases from internal malignancies: a five-year study.

Cutaneous metastases from internal malignancies are uncommon and occur in 0.6%-10.4% of all patients with cancer. In most cases, cutaneous metastases develop after the initial diagnosis of the primary internal malignancy and late in the course of the disease. Skin tumors are infrequent in Asian population and cutaneous metastases are quite rare. Cutaneous metastases carry a poor prognosis with average survival of few months. In the present five-year study 1924 malignant tumors were screened which included only nine cases of cutaneous metastatic deposits. A wide range of site and clinical presentations including nodules, plaques, and ulcers was noted. Histopathological findings were significant and corresponded with the primary internal malignancy. Cutaneous metastases from breast carcinoma (44.4%) were the most common finding followed by non-Hodgkin lymphoma and renal cell carcinoma (22.2% each) and carcinoma cervix (11.1%). The aim of our study is to classify the cutaneous metastases and to evaluate their clinicopathologic and immunohistochemical correlation with the primary tumor.

Autologous therapies in dermatology.

Autologous therapy is a therapeutic intervention that uses an individual's cells or tissues, which are processed outside the body, and reintroduced into the donor. This emerging field presently represents a mere tip of the iceberg with much knowledge and applications yet to be discovered. It, being free from risks of hypersensitivity reactions and transmission of infectious agents, has been explored in various fields, such as plastic surgery, orthopedics, and dermatology. This review article focuses on various forms of autologous therapies used in dermatology along with their applications and mechanisms of action.

Paraneoplastic dermatomyositis with carcinoma cervix: a rare clinical association.

Dermatomyositis is an uncommon inflammatory myopathy associated with cutaneous manifestations. It may also occur as paraneoplastic syndrome associated with various malignancies, most common of which being lung, breast, stomach, rectum, kidney, or testicular cancer. A postmenopausal woman presented to us with generalized itching along with skin rash and proximal muscle weakness of 2 years' duration. Examination revealed heliotrope rash and mechanic hands and muscle power 2/5 in proximal muscle groups of both upper and lower limbs. A clinical diagnosis of dermatomyositis was made which was supported by raised lactate dehydrogenase levels and skin biopsy findings. Past history was significant for vaginal discharge and bleeding per vagina. Further work-up revealed carcinoma cervix and she was referred to oncology department for further management. Temporal relationship and improvement of muscle weakness with treatment of underlying neoplasm supported its paraneoplastic nature. So, final diagnosis of keratinizing squamous cell carcinoma of cervix with paraneoplastic dermatomyositis was made. A nationwide cohort study of 1,012 patients with dermatomyositis in Taiwan revealed only 3 patients with cervical cancer. So this case is being reported for its rare association with carcinoma cervix and to highlight the need of detailed evaluation for underlying malignancies in patients with dermatomyositis.

Isolated facial cutaneous sarcoidosis.

Isolated cutaneous sarcoidosis is a rare multisystemic granulomatous disorder of unknown etiology. Cutaneous lesions have been classified into specific and nonspecific depending on the presence of noncaseating granulomas on histopathologic studies. Macrophages most likely initiate the response of sarcoidosis by presenting unidentified antigens to CD4+ lymphocytes. A persistent poorly degradable antigen-driven CMI response leads to cytokine cascade, granulomaformation, and fibrosis. In the present study, we report a case of isolated cutaneous sarcoidosis, localized to the face, in an adolescent girl without systemic manifestations which is a rare entity.