Prescribing practices of tranexamic acid for melasma: Delphi consensus from the Pigmentary Disorders Society.

Introduction There is ambiguity regarding usage of tranexamic acid for melasma in India, be it in its pre-administration evaluation, administration route, dosing or monitoring. Hence, we conducted this study to understand various tranexamic-acid prescribing patterns and provide practical guidelines. Materials and methods A Google-form-based questionnaire (25-questions) was prepared based on the key areas identified by experts from the Pigmentary Disorders Society, India and circulated to practicing dermatologists across the country. In rounds 2 and 3, the questionnaire was re-presented to the same group of experts and their opinions were sought. The results of the practitioners' survey were denoted graphically alongside, to guide them. Consensus was deemed when at least 80% of respondents chose an option. Results The members agreed that history pertaining to risk factors for thromboembolism, cardiovascular and menstrual disorders should be sought in patients being started on oral tranexamic-acid. Baseline coagulation profile should be ordered in all patients prior to tranexamic-acid and more exhaustive investigations such as complete blood count, liver function test, protein C and S in patients with high risk of thromboembolism. The preferred oral dose was 250 mg orally twice daily, which can be used alone or in combination with topical hydroquinone, kojic acid and sunscreen. Repeated dosing of tranexamic-acid may be required for those relapsing with melasma following initial tranexamic-acid discontinuation. Coagulation profile should ideally be repeated at three monthly intervals during follow-up, especially in patients with clinically higher risk of thromboembolism. Treatment can be stopped abruptly post improvement and no tapering is required. Limitation This study is limited by the fact that open-ended questions were limited to the first general survey round. Conclusion Oral tranexamic-acid provides a valuable treatment option for melasma. Frequent courses of therapy may be required to sustain results and a vigilant watch is recommended for hypercoagulable states during the course of therapy.

A prospective study to validate various clinical criteria used in classification of leprosy: a study from a tertiary care center in India.

BACKGROUND: Various clinical criteria are used to categorize leprosy patients into paucibacillary (PB) and multibacillary (MB), thus aiding in appropriate treatment. However, comprehensive studies validating these criteria are minimal. AIMS: To assess sensitivity and specificity of different clinical criteria individually and in combination for classifying leprosy into PB/MB spectrum. METHOD: A prospective study was conducted wherein 50 newly diagnosed, untreated leprosy cases were recruited and classified into PB and MB using the following clinical criteria: number of skin lesions (NSL), number of body areas affected (NBAA), and size of largest skin lesion (SLSL). Patients with pure neuritic leprosy, diffuse macular type of lepromatous leprosy, and with reactions were excluded. Sensitivity and specificity of these clinical criteria in classification was calculated taking histopathological findings as gold standard. RESULTS: Among 50 patients, 37 were males and 13 were females with a mean age of 32.08 ± 16.55 years. The sensitivity and specificity of NSL, NBAA, and SLSL was 94.74 and 87.1%, 94.74 and 61.29%, and 73.68 and 16.13%, respectively. Combining all three criteria, the sensitivity increased to 100%, but specificity decreased drastically to 12.9%. The ROC curve for NSL, NBAA, and SLSL showed a cutoff of ≥6 skin lesions, ≥3 body areas affected, and ≤2 cm lesion to classify as MB. CONCLUSION: The current WHO system of leprosy classification based on NSL seems to be best among available clinical criteria. Uniform and sensible application of this criteria itself assures appropriate categorizing and leprosy treatment with reasonable sensitivity and specificity.

Características clínicas y resultados en pacientes de lepra multibacilares (MB) tratados con 12 meses de MDT-MBR OMS: análisis retrospectivo de 750 pacientes de una clínica para lepra en un hospital especializado del norte de la india / No disponible

Antecedentes: La pauta de 12 meses de multiterapia (MDT) pauta multibacilar (MBR) fue implantada en la India en 1998, pero todavía adolece de información fiable sobre su posible eficacia. Objetivo: Evaluar la eficacia de la MDT MBR de 12 meses en apcientes multibacilares (MB) en nuestro centro. Metodología: Es un estudio retrospectivo que analiza las historias clínicas de 1210 pacientes registrados en la clínica para lepra de nuestra institución desde 1999 hasta 2010. Se observó un elevado Índice Bacteriano (IB) ≥ 3+, en 313 pacientes en el momento del registro. Cuatrocientos un pacientes experimentaron leproreacciones (54,9%9. ENL recurrente sólo se detectó en 14 pacientes incluso 5 años después de haber recibido el alta. La correlación clínico-histológica se examinó en 361 (49,5%) de los pacientes. Durante el periodo de seguimiento desde 9 meses a 10 años, casi todos los pacientes presentaron una aclaración evidente de sus lesiones cutáneas, incluyendo la mejoría histopatológica. Solo recidivaron 13 (1.7%). Conclusiones: Todos los pacientes respondieron sin problemas a la pauta MDT-MBR de 12 meses sin efectos adversos destacables. El índice total de recidivas fue de sólo 1,7%. Por tanto, la recomendación de la MDT MBR de 12 meses para todos los pacientes MB es robusta y práctica (AU)

Backgorund: Shortened (12 months) multidrug multibacillary regimen (MDT MBR) was implemented in India in 1998, however there is yet a paucity of crucial data on its long term outcome. Objetive. To assess the efficacy of 12 months MDT MBR in multibacillary (MB) patients at our centre. Design:This eas a retrospective study undertaken analyzing the clinic records of 1210 patients registered at the leprosy clinic of our institute form 1999-2010. Results. 730 MB patients were treated with 12 months MDT MBR over this period. High bacillary index (BI) ≥ 3+, was observed in 313 patients at the time of registration. Four hundred and one (54,9%) patients experienced lepra reactions. Recurrent ENL was observed in only 14 patients which manifested even after 5 years of stopping treatment. Clinico-histological correlation was noted in 361 (49,5%) patients. During follow up period ranging from 9 months to 19 years, nearly all patients had clearance of skin lesions including histopathological/bacteriological improvement. Only 13 (1.7%9 patients relapsed. Conclusions: all patients responded well with 12 months MDT MBR without significant side effects. The overall relapse rate was only 1.7%. Thus, the recommendation for 12 months MDT MBR for all MB patients is robust and operationally practical, a decision which seems logical (AU)