Assessment of the Efficacy of Tranexamic Acid Solution 5% in the Treatment of Melasma in Patients of South Asian Descent.

Melasma is a common dermatologic condition affecting all skin types. Increasing rates of melasma warrant identification of a reliable topical treatment. In recent years, off-label tranexamic acid (TA) has emerged as a potential treatment of melasma. Although the mechanism of action remains unclear, it is thought that TA inhibits melanin synthesis by blocking the interaction between melanocytes and keratinocytes while reversing the abnormal dermal changes associated with melasma. Our study assessed the efficacy of TA solution 5% for the treatment of melasma in patients with darker skin types.

Comparing the Efficacy for Pulse Versus Continuous Dose Terbinafine Therapy in Patients With Onychomycosis.

Recently, treatment outcomes in patients with toenail onychomycosis have improved considerably due to more effective oral antifungal medications such as terbinafine and itraconazole. These medications can either be used continuously for several weeks at a lower dose or intermittently (pulsed) at a higher dose. Previous literature comparing pulse and continuous therapy has generated mixed results.  Our study aims to compare the efficacy, in terms of clinical cure rate, of continuous vs pulse dose terbinafine regimens for toenail onychomycosis. Sixty patients with onychomycosis of Fitzpatrick skin types IV to VI, between 15 and 65 years of age, were divided into a continuous treatment group receiving 250 mg terbinafine once daily for 12 weeks and a pulse treatment group receiving 250 mg twice daily terbinafine for 1 week repeated every 4 weeks for 12 weeks. Each patient was followed up at weeks 4, 8, and 12.  Efficacy of the continuous treatment group was significantly greater at 76.67% compared with 26.67% in the pulse treatment group. Thus, we conclude that the clinical cure rate of a continuous dose regimen of terbinafine is a superior treatment option for toenail onychomycosis. However, we also suggest further studies including combinations of multiple agents and hybrid regimen models for the optimal onychomycosis treatment.   J Drugs Dermatol. 2023;22(10):     doi:10.36849/JDD.7323R1.

Efficacy of Intralesional Vitamin D3 for Treatment of Verruca Vulgaris: A Randomized Control Study.

Cutaneous warts are benign epithelial lesions caused by human papillomavirus and are common entities, affecting nearly 10 percent of the United States population. While most warts spontaneously resolve, the immunocompromised are susceptible to recalcitrant warts which often require medical treatment. Most current therapies use either physical or chemical destruction for wart removal, but these treatments are associated with adverse effects. Intralesional vitamin D3 has the potential to demonstrate a stronger treatment response due to its ability to stimulate the immune system at the injection site via cell-mediated immunity. We sought to test the efficacy of intralesional vitamin D3 for wart treatment in a sample size of 70 patients over a three-month period. Efficacy was determined as "excellent" if there was greater than a 90-percent reduction in both size and number of lesions, "good" if there was a 60 to 89-percent reduction, and "fair" if there was less than a 60-percent reduction. Treatment efficacy was excellent in 20 (28.6%) patients, good in 29 (41.4%) patients, fair in 18 (25.7%) patients, and poor in three (4.3%) patients. Patients in the younger age group had a higher treatment efficacy compared to other treatment groups. Thus, intralesional vitamin D3 has promising qualities as a treatment for cutaneous warts and should be considered at the clinician's disposal. Vitamin D is an innovative approach for treating warts without the various side effects posed by other commonly used agents. The unique features of this treatment modality including its simplicity, safety, and efficiency make it a promising option for a very common cutaneous condition.

A Comparison of Microneedling versus Glycolic Acid Chemical Peel for the Treatment of Acne Scarring.

Background: Acne vulgaris is a common skin disease that frequently results in scarring. Scars secondary to acne can lead to physical disfigurements and a profound psychological impact. Early and effective treatment is the best means to minimize and prevent acne scarring. In patients with darker skin tones, current acne scar treatments pose complications, including dyspigmentation, further scarring, and overall unsatisfactory clinical outcomes. Objective: We sought to compare the efficacy of microneedling versus 35% glycolic acid chemical peels for the treatment of acne scars. Methods: Sixty patients with Fitzpatrick Skin Phototype IV to VI with atrophic acne scars were randomized into two groups: Group A underwent microneedling every two weeks for a total of 12 weeks and Group B received chemical peels every two weeks for a total of 12 weeks. Acne scar treatment efficacy was represented by an improvement greater than one grade from baseline according to the Goodman and Baron Scarring Grading System, measured two weeks after the completion of the last treatment session. Results: Group A demonstrated more improved outcomes in acne scar treatment compared to Group B; 73.33% (n=22) of patients in Group A achieved treatment efficacy while 33.33% (n=10) in Group B did the same. Additionally, 26.67% (n=8) in Group A showed no efficacy after treatment compared to 66.67% (n=20) in Group B. Conclusion: Microneedling provided better treatment outcomes compared to 35% glycolic acid peels for acne scar treatment in our patient population with Fitzpatrick Skin Phototypes IV to VI.

A Randomized Trial of Oral Tranexamic Acid With Fluocinolone-Based Triple Cream Versus Fluocinolone Based Triple Cream Alone for the Treatment of Melasma.

Oral tranexamic acid (TXA) is a relatively new treatment option for melasma. It is thought to reduce hyperpigmentation through inhibition of the plasminogen/plasmin pathway with resulting decreases in epidermal melanocyte tyrosinase activity, inflammatory mediators, dermal neovascularization, and mast cell numbers.

Platelet Count, Mean Platelet Volume, and Red Cell Distribution Width as Markers for Psoriasis Severity.

BACKGROUND: Psoriasis is a chronic, inflammatory skin condition that is growing in prevalence globally. Routinely available options to assess psoriasis severity and progression are limited. More options are needed to monitor disease progression as therapeutic management is based on disease severity. OBJECTIVES: This study evaluates the usage of complete blood count components (CBC) including platelet count, mean platelet volume (MPV), and red cell distribution width (RDW) as hematological markers for assessing psoriasis severity. MATERIALS AND METHODS: In this cross-sectional study of 120 patients with psoriasis, disease severity was assessed using the PASI score followed by a blood draw to determine whether correlations existed between each marker and PASI score. RESULTS: A significant, positive correlation was found between total platelet count and PASI while no such correlation was found in MPV and RDW. When stratifying for age, duration of disease, sex, and body parts involved, we found intriguing relationships and offer potential explanations for their occurrence. CONCLUSION: Our findings suggest that hematological parameters MPV, platelet count, and RDW found in the CBC are useful in identifying psoriasis severity to some extent. We foresee the use of RDW, MPV, and platelet count biomarkers as a complement to the PASI score in assessing severity for psoriasis patients, while also as a gauge for likelihood of developing comorbidities such as cardiovascular disease. J Drugs Dermatol. 2022;21(2):156-161. doi:10.36849/JDD.6127.

Association Of Clinical Diagnosis With Histopathology In Various Skin Diseases.

BACKGROUND: Dermatological diagnosis are mainly clinical; however, skin biopsies are frequently done to support clinical diagnosis when in doubt. Aim of this study is to relate the clinical diagnosis of various dermatological conditions with histopathological diagnosis. METHODS: In this descriptive prospective study, 223 patients were enrolled from dermatology OPD at Benazir Bhutto Hospital through non-probability consecutive sampling. Patients were diagnosed clinically and skin biopsies of all patients were taken after informed consent and clinical data was sent to a histopathologist. RESULTS: Patients between ages of 2-85 years were evaluated. Mean age was 39.65±19.43 years. Out of total 223 patients 112 were males and 111 were females. Clinical diagnosis was same as histopathological diagnosis in 180 (80.7%). Out of 80.7% cases, most common disorder was Eczema, 18 cases (10%). The diseases lying in the inflammatory dermatosis group have highest sensitivity, specificity, PPV and NPV, i.e., 91.2%, 90.8%, 84.1% and 86.8% respectively. The discordance between clinical and histological diagnosis was highest in infectious disease group. The concordance between clinical and histological diagnosis in infectious diseases was just 28%. CONCLUSIONS: Documenting a histological diagnosis is essential in dermatology as most of the dermatosis have mimicking clinical presentation. The inflammatory lesions have superior clinical and histopathological correlation as compared to infectious diseases and therefore dermatologists should try to biopsy infective dermatosis more often rather than relying on clinical judgment solely.