Hemorrhagic dot score as a follow up marker in psoriasis on treatment: A prospective observational study.

CONTEXT: Psoriasis assessment tools in use presently lack reproducibility and are cumbersome to use. An easily reproducible, objective tool with ability to maintain visual records for follow up is hence desirable. We conducted a study with the aim to assess dermoscopic changes in psoriasis while on treatment by recording the number of hemorrhagic dots (Hemorrhagic Dot Score-HDS) in a representative plaque and comparing it to the PASI score. SETTINGS AND DESIGN: A longitudinal prospective study was conducted between October 2018 to March 2020 in a dermatology centre of a tertiary hospital on cases of chronic plaque psoriasis on treatment over 6 months, assessed at baseline and thereafter monthly for 6 months. METHODS: Hundred consenting patients of chronic plaque psoriasis were assessed, clinically, PASI and dermoscopically. HDS and other dermoscopic features were noted at every visit. STATISTICAL ANALYSIS USED: ANOVA and F test of testing of equality of Variance; effect size in terms of Cohen were used to report the strength of an apparent relationship. RESULTS AND INTERPRETATION: Percentage improvement in the mean PASI scores and HDS and percentage improvement of mean was found significant in each month on follow up. Systemic therapy as compared to topical therapy showed higher effect size of 6.1 and 1.7, respectively. CONCLUSION: Hemorrhagic dot score can be used as an objective, definite assessment tool correlating with clinical severity of psoriasis with more accuracy which shows changes early following institution of therapy.

An observational study on the efficacy of single injection of omalizumab in the treatment of chronic spontaneous urticaria.

Chronic Spontaneous Urticaria (CSU) is one of the most challenging therapeutic problems faced by dermatologists. Omalizumab is a third line drug for CSU which is currently recommended as monthly injections for 6 months. To study the efficacy of single injection of Omalizumab in the treatment of CSU. This was a prospective single center observational study. Single dose of injection Omalizumab 300 mg was administered to 30 patients of CSU on double the dose of tablet Fexofenadine 180 mg with Urticaria Activity Score (UAS-7) more than 15 and their response was assessed using UAS-7 up to 6 months. The mean duration of response of early and late responders were analyzed. Of the 30 patients who completed the study, 29 patients (96.7%) were responders and one (3.3%) was nonresponder. Of the 29 responders, 21 (70%) were early responders and eight (26.7%) late responders. The mean total symptom free durations amongst early and late responders were analyzed and were found significant. The prolonged symptom free intervals in early responders after single injection of Omalizumab followed by antihistamines not only prevented over treatment with Omalizumab but was also cost saving in the long-term management of these cases. With careful monitoring of UAS7 scores an individualized, cost-effective approach can be adopted in the treatment of CSU. This study provides a basis for larger studies and may eventually determine a new standard of care with respect to limiting the doses of a biologic.

Single-Session Fractional CO2 Laser following Urea Occlusion in Management of Onychomycosis: A Pilot Study.

Introduction: Onychomycosis is a common nail disorders. Antifungal resistance, interactions, and side effects limit treatment options. Fractional CO2 (FCO2) laser along with topical antifungal is effective in multiple monthly sessions. A modification reducing repeated visits and hence better compliance is preferable. Single-session FCO2 laser following urea occlusion is reported to be effective. Thus, we conducted a study to determine the efficacy of single-session FCO2 laser with 1% terbinafine cream with and without "urea cream occlusion" in managing onychomycosis. Methods: A prospective, randomized, parallel-group study was conducted at a tertiary centre. Onychomycosis was confirmed by positive fungal mount and culture. Patients were randomized into 2 groups and administered single-session FCO2 laser. Group A was treated after overnight urea cream occlusion and group B without occlusion. Both groups applied 1% terbinafine cream twice daily for 3 months. Response was assessed by improvement in Onychomycosis Severity Index (OSI) at 6 months. Results: Group A had 10 patients, 14 nails. Clinical improvement was seen in 12/14 (85.7%) nails. Average reduction in OSI was 10.78. Group B had 10 patients, 11 nails. Clinical improvement was seen in 5/11 (45.5%) nails. Average reduction in OSI was 1.73. "Reduction in OSI" was statistically significant (p < 0.05) only in group A. Conclusion: Single-session FCO2 laser following overnight urea cream occlusion, followed by 1% terbinafine cream, is effective for management of onychomycosis.

A Comparative Study of Topical 5% 5-Fluorouracil with Needling versus 30% Trichloroacetic Acid with Needling in the Treatment of Plantar Warts.

BACKGROUND: Warts are benign proliferations of keratinocytes caused by Human Papilloma Virus (HPV). Plantar warts are caused by HPV types 1, 2, 4, 27 and 57. It is challenging to treat them due to frequent recurrences. AIM: To compare the efficacy and safety of topical 5% 5-Fluorouracil (5-FU) with needling versus 30% Trichloroacetic acid (TCA) with needling in the treatment of plantar warts. MATERIALS AND METHODS: Sixty consecutive patients of plantar warts were randomly allocated into two groups of 30 each and treated with either 30% TCA with needling or 5% 5-FU with needling once in four weeks, until complete clearance of warts or for a maximum of three sessions. Baseline clinical photographs were taken and subjective response at the end of treatment was recorded. Objective assessment at 4, 8, and 12 weeks was carried out and outcome was evaluated by reduction in number and size of warts. Adverse effects of each group were noted and compared. Follow-up of patients was done at 6 months for clinical assessment of results and to study recurrence. RESULTS: Out of 30 patients in 30% TCA group, 28 patients (93.33%) had complete response and 02 patients (6.66%) had partial response at the end of 12 weeks. In 5-FU group, 26 patients (86.66%) showed complete response, 02 patients (6.66%) had partial response, and 02 patients (6.66%) had no response to treatment. The mean reduction in size and number of warts was better in the TCA group and was significant at 4th week of follow up while at the end of 8th week and 12th week, the response was identical. There was no recurrence of warts in the complete responders at the end of 6 months. The main adverse effect seen in both groups was pain at the needling site. CONCLUSION: Needling with both topical 5% 5-FU and 30% TCA are highly effective in clearing plantar warts. However, 30% TCA has the advantage of early action and complete clearance of plantar warts with fewer adverse effects.

A Comparative Study on the Efficacy of Fractional CO2 Laser and Fractional CO2 Laser with Autologous Platelet-Rich Plasma in Scars.

CONTEXT: Surgical correction of scars may not be an ideal solution in all cases and hence it is desirable to have a nonsurgical option available. Autologous platelet-rich plasma (PRP) and fractional carbon dioxide laser (FCL) offer an alternative treatment modality. AIMS: To compare the efficacy and safety of FCL and intradermal PRP with FCL in the management of postburn and posttraumatic scars. SETTINGS AND DESIGN: A prospective, randomized, observer-blinded, comparative study was conducted at a hospital skin centre from Oct 2016 to Sep 2018. SUBJECTS AND METHODS: A total of 67 patients with scars were randomly divided into two groups; Group I was treated with four sessions of monthly FCL and Group II was treated with four sessions of PRP and FCL. The patients were assessed using the Patient and Observer Scar Assessment Scale (POSAS) at baseline and 4 weeks after each session. STATISTICAL ANALYSIS USED: For continuous variables, the summary statistics of mean ± standard deviation was used; for categorical data, number and percentage were used. Chi-square (χ2) test was used for association between two categorical variables. P value <0.05 was considered to be statistically significant. RESULTS: Thirty cases in each group completed the study. There was a significant improvement in the total score of POSAS (p < 0.001) in both groups, but the final difference between the two groups was not statistically significant (p = 0.793 and P = 0.278, respectively). CONCLUSIONS: Fractional CO2 laser causes significant improvement in scar appearance. PRP in combination with FCL offers no additional advantage.

A Randomized Controlled Study Comparing the Efficacy of Topical 5% Tranexamic Acid Solution versus 3% Hydroquinone Cream in Melasma.

BACKGROUND AND AIMS: Melasma is a common, relapsing, acquired, symmetrical facial hypermelanosis with no universally effective therapy. Hydroquinone (HQ) is considered the gold standard in the treatment of melasma till date. Tranexamic acid (TA) is an upcoming molecule being explored in melasma therapy and has shown optimistic results in preliminary trials. This study aimed to compare the efficacy of topical 5% TA solution with 3% HQ cream in the treatment of melasma in Indian skin. MATERIAL AND METHODS: This was a prospective, randomized, single-blind study of 12 weeks' duration. Hundred eligible patients randomly divided into two intervention groups were analyzed after screening 346 patients with melasma. Serial photographs, Melasma Area Severity Index (MASI), and adverse effects were documented at monthly intervals. Patient satisfaction score was noted at the end of 12 weeks. A repeated measurement analysis of variance, independent t-test, and χ2 tests were used for statistical analysis. A P-value of <0.05 was considered to be statistically significant. RESULTS: Our study population consisted of 84 females and 16 males. Mixed melasma had the highest prevalence (63%) followed by epidermal (22%) and dermal types (15%). Percentage reduction of MASI was 27% and 26.7% in the TA and HQ group, respectively, at the end of 12 weeks, and the difference between the two groups was not significant (P > 0.05). However, patient satisfaction score was significantly higher in TA group (P value = 0.03) in view of lesser adverse effects. CONCLUSIONS: Topical 5% TA solution is as effective as 3% HQ cream in melasma with enhanced patient satisfaction.