Efficacy & safety of intense pulsed light therapy for unwanted facial hair: a retrospective analysis in skin of color.

Unwanted facial hair growth is a common esthetic problem. Laser hair removal has emerged as a leading treatment option for long-term depilation. The theory of selective photothermolysis has revolutionized laser hair removal in that it is effective and safe, when operated by sufficiently trained and experienced professionals. Long-pulsed ruby (694 nm), long-pulsed alexandrite (755 nm), diode (800-980 nm), and long-pulsed Nd: YAG (1064) are commercially available laser devices for hair removal most widely studied. The authors wish to share the efficacy and safety of intense pulse light therapy for permanent facial hair reduction in Indian population.

308nm excimer lamp monotherapy for lip vitiligo-a short case series.

Vitiligo is a common depigmenting condition that carries a high psychosocial morbidity, especially when it occurs over exposed areas like lips. Many of the current topical and systemic therapies are less effective in lip vitiligo, and surgical modality remains the mainstay of treatment of lip vitiligo. The 308-nm excimer laser in combination with topical calcineurin inhibitors and calcipotriene is effective in the treatment of lip vitiligo. This case series provide further evidence to support effectiveness of 308-nm excimer lamp even as monotherapy in darker individuals with lip vitiligo.

Cutis mormorata telangiectatica congenital successfully treated with intense pulsed light therapy: A case report.

Cutis marmorata telangiectatica congenita is a rare disorder characterized by cutis marmorata, telangiectasia with or without recurrent ulcerations. It is a benign vascular anomaly with dilatation of capillaries and veins in the dermis. There is no satisfactory treatment for the ulcerative variety of cutis marmorata telangiectatica congenita. In this case, intense pulse light therapy was used with almost near total cure. Intense pulse light with its vascular filter of wavelength 550-1200 nm was used every fortnight till complete resolution of lesions.

The Efficacy and Safety of High Dose (10 mg) of Desloratadine (Dazit® 10) in the Treatment of Chronic Spontaneous Urticaria in India: A Phase III, Multicentric, Open-Label, Single-Arm Study.

BACKGROUND: Chronic spontaneous urticaria (CSU) is a debilitating affliction that affects diverse quality of life (QoL) parameters such as sleep, self-esteem, and daily activities. Second-generation antihistamines, such as desloratadine, are more effective and safer in managing CSU. Desloratadine is a nonsedating, potent, and highly selective H1 receptor antagonist. At its daily dose of 5 mg, almost half of CSU patients do not show symptomatic improvement. European Academy of Allergy and Clinical Immunology (EAACI)/Global Allergy and Asthma European Network (GA2LEN)/European Dermatology Forum (EDF) (EuroGuiDerm)/Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI) guidelines recommend increasing the dosage to up to four times in such nonresponsive patients. However, there is insufficient clinical evidence in Indian settings. METHOD: We evaluated the efficacy and safety of 10 mg desloratadine (OD) in 256 nonresponsive patients with moderate to severe CSU. The primary outcome was the change in Urticaria Activity Score (UAS7) from baseline to four weeks. Additionally, change in Chronic Urticaria Quality of Life (CU-Q2oL) scores during the course of treatment was also evaluated. RESULT: The mean UAS7 scores showed a significant reduction from 31.9 ± 4.8 at baseline to 18.2 ± 8.1 at the end of the study (p < 0.0001). The use of a higher dose of desloratadine also decreased the CU-Q2oL scores significantly from 59.8 ± 14.7 at baseline to 35.4 ± 10 at four weeks (p < 0.0001). The incidence of adverse events (AEs) possibly linked to the drug was low (1.6%), and no serious adverse events were reported. CONCLUSION: Results indicated improvements in the disease severity as well as its positive impact on participants' QoL. This study confirms the efficacy and safety of daily use of a twofold dose of desloratadine in nonresponsive moderate to severe CSU patients.

Efficacy and Safety Comparison of Basic Fibroblast Growth Factor-Related Decapeptide 0.1% Solution (bFGFrP) Plus Oral PUVA Combination Therapy with Oral PUVA Monotherapy in the Treatment of Vitiligo.

Background: Phototherapy in its different forms, is mainstay of vitiligo management. Combining treatment modalities like topical calcipotriol (for quicker, more intense repigmentation), Low dose azathioprine with PUVA have proven to be beneficial in management of vitiligo due to different mechanisms of repigmentation and their synergistic effects. Topical bFGF-related decapeptide (bFGFrP) application followed by sun exposure/ UVA phototherapy yields effective repigmentation. bFGFrP has shown to aid the targeted phototherapy in smaller lesions and its combinations with other treatment modalities have been very promising. However, there is paucity of studies on combination treatments; especially oral PUVA along with bFGFrP. This study was aimed at evaluating safety and efficacy of combination of bFGFrP with Oral PUVA in vitiligo (larger body surface area 20% or more). Materials and Methods: Phase IV, randomized, multicentre study (N = 120) in adult patients with stable vitiligo of 6 months treatment period with monthly follow up visits. Psoralen (Tab. Melanocyl) dosage 0.6 mg/kg orally 2 h before exposure to UVA phototherapy. Oral PUVA therapy, initially, at an irradiation dose 4 J/cm2 (PUVA group), followed by increments 0.5 J/cm2 every four sittings if tolerated for twice weekly. Primary end point was improvement in extent of repigmentation (EOR) in target lesion (at least 2 cm × 2 cm in greatest dimension, without leukotrichia), while secondary endpoints were improvement in patient global assessment (PGA) and safety at end of 6 months of treatment period in bFGFrP + oral PUVA combination group and Oral PUVA monotherapy group. Results: End of 6 months, significantly greater EOR >50%) was achieved in 61.8% (34 patients, n = 55) from combination group while 30.2% (16 patients, n = 53) from the oral PUVA monotherapy group (n = 53). Regarding Grade of repigmentation (GOR), complete repigmentation was observed 5.5% (3 patients, n = 55) in combination group whereas no patient showed complete repigmentation in monotherapy group (p ≤ 0.05), PGA showed significant overall improvement in combination group (p ≤ 0.05); 6 patients (10.9%) from combination group Vs one (1.9%) showed complete improvement. During treatment period, there were no reported adverse events. Conclusions: Addition of bFGFrP to oral PUVA therapy resulted in intense and faster induction of repigmentation than oral PUVA monotherapy with favorable safety profile.

3% Polidocanol Sclerotherapy for Pyogenic Granuloma: Efficacy and Safety Analysis.

Introduction: Pyogenic granuloma is a commonly occurring inflammatory hyperplasia involving skin and mucous membranes. Various modalities of treatment have been used to treat pyogenic granuloma. However, there is an increased risk of intraoperative bleeding and recurrence of pyogenic granuloma following surgical treatment of pyogenic granuloma. Therefore, sclerotherapy has evolved as an effective alternative treatment modality in excellent safety and efficacy. Aims and Objectives: The aim of this study was to assess the safety and efficacy of 3% polidocanol in liquid form in pyogenic granuloma as a sclerosant. Settings and Design: This was a retrospective study of cases treated between March 2019 and February 2020 at two different private institutes. Materials and Methods: The study included 30 patients with 30 pyogenic granulomas treated with 3% polidocanol liquid. Individuals with comorbid conditions such as diabetes, hypertension, thyroid disorders, and those who were on medications were excluded from the study. Two units of 3% polidocanol solution were injected with an insulin syringe at the base of the lesion. Changes in lesions and adverse events were recorded and injections were repeated after a gap of 2 weeks if needed. Result: In 28 patients, there was complete resolution of the lesion within 4 weeks and 2 patients received a second injection of polidocanol. All the patients tolerated the procedure and the lesions resolved without any significant sequelae. Discussion: The advantages of 3% polidocanol sclerotherapy are that it is a safe, easy, effective, and minimally invasive procedure with little discomfort to the patient and very minimal complications as compared with other modalities. Conclusion: Polidocanol 3% solution is an effective sclerosant for the treatment of pyogenic granuloma.The aim of this study was to assess the safety and efficacy of 3% polidocanol in the liquid form in PG as a sclerosant.

Globally local: Hyper-local modeling for accurate forecast of COVID-19.

IMPORTANCE: Assumption of a well-mixed population during modeling is often erroneously made without due analysis of its validity. Ignoring the importance of the geo-spatial granularity at which the data is collected could have significant implications on the quality of forecasts and the actionable clinical recommendations that are based on it. OBJECTIVE: This paper's primary objective is to test the hypothesis that the characteristic dynamics defining the trajectory of the pandemic in a region is lost when the data is aggregated and modeled at higher geo-spatial levels. DESIGN: We use publicly available confirmed SARS-CoV-2 cases and deaths from January 1st, 2020 to August 3rd, 2020 in the United States at different geo-spatial granularities to conduct our experiments. To understand the impact of this hypothesis, the output of this study was implemented in Tampa General Hospital (TGH) to provide resource demand forecast. RESULTS: The Mean Absolute Percentage Error (MAPE) in the forecast confirmed cases can be 30% higher for modeling at the state-level than aggregating model results at the scale of counties or clusters of counties. Similarly, modeling at a state-level and crafting policy decisions based on them may not be effective - county-level forecasts made by partitioning state-level forecasts are 3x worse for confirmed cases and 20x worse for deaths relative to the same model at the county level. By leveraging these results, TGH was able to accurately allocate clinical resources to tackle COVID-19 cases, continue elective surgical procedures largely uninterrupted and avoid costly construction of overflow capacity in the first two epidemic waves. CONCLUSIONS AND RELEVANCE: Accurate forecasting at the county level requires hyper-local modeling with county resolution. State-level modeling does not accurately predict community spread in smaller sub-regions because state populations are not well mixed, resulting in large prediction errors. Actionable decisions such as deciding whether to cancel planned surgeries or construct overflow capacity require models with local specificity.

Efficacy and Safety Evaluation of High-density Intense Pulsed Light in the Treatment of Grades II and IV Acne Vulgaris as Monotherapy in Dark-skinned Women of Child Bearing Age.

Background: Acne vulgaris is a self-limiting, chronic inflammatory disorder of the pilosebaceous unit characterized by exacerbations and remissions. It is often the early manifestation of puberty, and in girls it appears relatively early. In women, acne tends to become aggravated during the menstrual period, pregnancy, and in those who are on progesterone. Acne treatment is divided into two parts: topical and systemic. For Grades 1 and 2 acne, topical treatment is sufficient, while for Grades 3 and 4 acne, systemic drugs such as tetracyclines and retinoids are required to control the symptoms. Chemical peeling with glycolic and salicylic acids, cryosurgery with liquid nitrogen or carbon dioxide, and narrowband ultraviolet light are a few of the supportive procedural treatments available for Grades 3 and 4 acne. Objective: The author sought to determine the efficacy and safety of intense pulsed light (IPL) therapy (Magma-F-SR; FormaTK Systems, Tirat Carmel, Israel) in the treatment of Grades 3 and 4 acne as monotherapy in women of child-bearing age. Materials and Methods: One-hundred female patients with Grades 3 and 4 acne were enrolled in this study. All patients were treated with IPL using a 530nm to 1,200nm filter once a week for a total duration of six weeks. Patient and physician scores were assessed at Weeks 1 and 6 after the last treatment. Clinical photographs were also reviewed to determine the degree of efficacy. Adverse effects were noted. Results: Eighty percent of the patients involved in this study reported a significant reduction in lesion count compared to baseline. The adverse events were minimal-to-mild erythema. Conclusion: IPL therapy with 530nm to 1,200nm filter is an effective and safe modality of treatment as monotherapy in managing inflammatory Grades 3 and 4 of acne vulgaris in women of child-bearing age.

Success Rate of Conventional Dacryocystorhinostomy in Post-acute Dacryocystitis Compared to Endonasal Dacryocystorhinostomy in Acute Dacryocystitis.

PURPOSE: To determine the success rate of conventional dacryocystorhinostomy (DCR) and endoscopic DCR performed in patients with acute dacryocystitis. METHODS: Records of patients with acute dacryocystitis and operated during 2007-2008 were reviewed. Patients who completed a follow-up of 60 months were included in our study. Demographic characteristics, surgery types, success rate, and follow-up periods were recorded. Success was defined as the elimination of epiphora, absence of dacryocystitis, and negative syringing test result (i.e., unrestricted flow of irrigated saline to the nose). RESULTS: A total of 67 patients were operated during the period. Fifty-seven patients completed the follow-up of 60 months. The mean age in the conventional and endoscopic groups was 39.5 ± 8.5 and 39.5 ± 8.4 years, respectively. The participants included 33 female and 24 male patients. Endoscopic DCR was performed in 28 (endoscopic group) and conventional DCR (conventional group) in 29 patients. Conventional DCR was performed after subsidence of the acute attack, which took an average of 10 days (range, 9-19 days). After a period of 60 months, patency on syringing and resolution of epiphora was documented in 26 patients in the conventional group (success rate, 89.7%) and 23 patients in the endonasal group (success rate, 82.1%) (P = 0.654). CONCLUSION: The success rates of conventional and endonasal DCR during a follow-up period of five years in patients with acute dacryocystitis are almost similar.

Giant Parapharyngeal Space Pleomorphic Adenoma of the Deep Lobe of Parotid Presenting as Obstructive Sleep Apnoea: A Case Report & Review of the Diagnostic and Therapeutic Approaches.

INTRODUCTION: Salivary gland tumours constitute about less than 4 % of all head and neck tumours. Pleomorphic adenoma, also called benign mixed tumour, is the most common tumour of the salivary glands. About 80-90 % of these tumours occur in the major salivary gland mainly parotid gland and 10 % of them occur in the minor salivary glands. AIMS AND METHODS: Aim of this case report is to discuss the unique case of giant parotid pleomorphic adenomas arising in the deep lobe involving the parapharyngeal space and difficulty in respiration at sleep during nights repoted at this institute. The patient was undergoing treatment for obstructive sleep apnea syndrome when she reported at this institute for disturbed sleep. Diagnosis was based on computed tomography scan and magnetic resonance imaging and cytology by means of fine needle aspiration biopsy. CONCLUSION: An exhaustive pre-operative diagnostic algorithm is mandatory before approaching such lesions involving parapharyngeal space. Fine needle aspiration biopsy is, in our opinion, mandatory to avoid histological surprises. The surgical approach varies according to the location of the tumour and should provide excellent visibility with wide surgical exposure to secure local neurovascular structures.

Unusual foreign body in mid face.

Cases of foreign bodies in the antrum and nasal cavity are reported in the literature but the size and location of foreign body in this case made it unique and challenging. A large exploded fragment was successfully removed through Lefort I osteotomy approach. Foreign bodies in maxilla and antrum can be removed by different approaches: Caldwell-Luc operation, nasal and antral endoscopic surgery. The foreign body was lying horizontally in posterior maxilla occupying both the maxillary sinuses and nasal cavity. The foreign body was so big in size that the nasal endoscopic approach and Caldwell-Luc operation might be inadequate for its retrieval.