Detection of Steroids in Topical Fairness Preparations Using Histamine Wheal Test.

Topical corticosteroid (TC) abuse is a common, worldwide, problem. One of the recent emerging concerns is the adulteration of TC in fairness cream. The presence of TC in skin-whitening cosmetic creams can be detected by high-performance liquid chromatography (HPLC). Since HPLC is expensive, time-taking and not easily available, we suggest the use of histamine wheal test as a simple and inexpensive test to detect the presence of topical steroids in fairness cream.

Oral Tranexamic Acid for the Treatment of Melasma: Evidence and Experience-Based Consensus Statement from Indian Experts.

Melasma, a chronic pigmentary skin condition mainly affecting the face, remains a challenge despite the availability of several options for treatment. Many melasma patients are not satisfied with treatment outcomes. Tranexamic acid (TXA), an anti-fibrinolytic drug has shown promising results in patients with melasma. Evidence from several clinical studies has surfaced on efficacy and tolerability of TXA in these patients. It can be used as monotherapy or adjuvant with other therapies. Currently, there is no published consensus or guideline document for its use in the treatment of melasma. TXA is available for oral use, topical use as well as an injection. In this article, a consensus of Indian experts is prepared based on the available literature and experience with use of oral TXA in melasma. This review article might help clinicians for use of oral TXA appropriately while treating melasma.

Occupational Dermatoses.

Occupational skin diseases (OSDs) are one of the major problems in working life. Among occupational diseases, 30-45% are skin diseases. Contact dermatitis accounts for the greatest part (95%) of OSDs. It adversely affects the quality of life of workers. Classification of OSD is too difficult as there are geographical variations in the occupational groups affected. However, commonly affected occupational groups are agricultural workers, healthcare workers, construction workers, metal workers, cleaners, housekeepers, food handlers, hairdressers, beauticians, and mechanics. Because of the unorganized workplace, lack of a proper notification system for occupational dermatoses, and under-reporting of cases, there is a paucity of information regarding the magnitude of the problem of OSD in India. Although in India many studies have been conducted on individual small occupational groups, data on the complete epidemiology of OSD is limited. In this article, we have tried to compile the common OSDs in various occupations.

Mal De Meleda with Flexural Involvement.

Mal de Meleda is a rare variety of palmoplantar keratoderma with an autosomal recessive mode of inheritance and an estimated prevalence of 1 in 100,000 in general population. The disease is associated with consanguinity, starts in infancy, and characterized by progressive palmoplantar keratoderma spreading to dorsum of hands and feet. Involvement of extensors of knee and elbow were well described in literature. We report a rare case of Mal de Meleda with flexural involvement, which has not been reported in literature.

Hyphal Index Following a Potassium Hydroxide Mount in Dermatophytosis.

Dermatophytes are fungi that invade and proliferate over structures containing keratin. The potassium hydroxide (KOH) mount is a commonly performed investigation to detect the presence or absence of fungal elements. This study is an attempt to semi-quantify the KOH mount done for dermatophytosis and to validate the Hyphal Index (HI). HI is determined by the number of fungal elements present in the mount, in a method similar to the bacillary index in leprosy. This simple semi-quantification assessment is proposed as a prognostic tool in the management of dermatophytosis.

Platelet rich fibrin in the management of established dry socket

OBJECTIVES: Dry socket may occur secondary to the removal of any tooth. However, most dry socket cases develop in the third molar region. Dry socket is multifactorial in nature and has been treated using various modalities with varying success rates. This study assessed the efficacy of platelet rich fibrin (PRF) in established dry socket. MATERIALS AND METHODS: Ten patients of either sex aged from 41 to 64 years with established dry socket according to established criteria were treated using PRF. Evaluation was performed by observing the reduction of pain using visual analogue scale, analgesic tablet use over the follow-up period, and healing parameters. RESULTS: Pain was reduced on the first day in all patients with decreased analgesic use. Pain was drastically reduced during follow-up on the first, second, third, and seventh days with a fall in pain score of 0 to 1 after the first day alone. The pain scores of all patients decreased to 1 by the first day except in one patient, and the scores decreased to 0 in all patients after 48 hours. Total analgesic intake ranged from 2 to 6 tablets (aceclofenac 100 mg per tablet) over the follow-up period of 7 days. Healing was satisfactory in all patients by the end of the seventh day. CONCLUSION: PRF showed early pain reduction in established dry socket with minimal analgesic intake. No patients had allergic reactions to PRF as it is derived from the patient's own blood. PRF showed good wound healing. Our study suggests that PRF should be considered as a treatment modality for established dry socket.

Disaster Management and the Role of Oral Maxillofacial Surgeons.

"Disaster" the word itself suggests an event resulting in great loss and misfortune. In this developing world, India is becoming more powerful and is shining across the world. But we are still left to deal with various disasters, so that no harm comes to mankind. India has the occasional national disaster to which we have to promptly respond. Like the rest of the world, India has become a terror prone nation and recent attacks since the last decades affected not only the function but also it made citizens insecure. As we are in a large nation so, no matter how large a disaster it may be; we have to overcome it. The oral and maxillofacial region in a human body is very delicate with complicated anatomy, which decides the life of a human being. The management of disaster is a multitask approach, in which maxillofacial surgeon plays an important role. It is a very difficult task to operate in disaster zone. It is essential for a surgeon to make quick and important decisions under stressful conditions. Usually the surgeries are performed in a well-equipped hospital but, when it comes to disaster zone the surgeon have to treat the patient with a minimal armamentarium available within a fraction of time. The surgical competence in a disaster field is an alarming situation. Disaster management itself is not an alarming situation but the time management is important for better outcomes. A surgeon however should be trained, so that he should not miss injuries for better outcomes along with personal safety. The article discusses about disaster management strategy and guidelines for both oral maxillofacial surgeons and the statuary body to make maxillofacial surgeon as part of disaster management team for better outcomes.

Lepromatous leprosy treated with combined chemotherapy and immunotherapy (injection BCG): three case reports.

BACKGROUND: Lepromatous leprosy is associated with suppressed cell-mediated immunity (CMI). This results in failure of the body to mount an efficient immune response and may render chemotherapy ineffective. The lack of sufficient response may mimic drug resistance. Three case reports in which the immunity was stimulated by administering Injection BCG are presented. All three patients were initially anergic and showed no reaction at the Mantoux testing site, showing an inability to mount type IV hypersensitivity and characterized by live bacilli in smears. Following 1-4 doses of Injection BCG, all three showed dead bacilli in smears. CASE REPORTS: The first case, a 61-year-old man with lepromatous leprosy who continued to show live bacilli in smears after prolonged chemotherapy, was administered a total of four BCG injections, following which he achieved clearance. The second, a 40-year-old man with borderline lepromatous leprosy and severe type 2 reactions, achieved bacterial clearance and control of severe reactions following a single injection. The third, a 67-year-old man with histoid leprosy, achieved effective bacterial killing with a single dose of Injection BCG. RESULTS: All three patients achieved good results when chemotherapy was combined with Injection BCG. Following Injection BCG, all three showed a reaction at the Mantoux testing site. CONCLUSIONS: Suppressed CMI may be responsible for the lack of response in recalcitrant cases of lepromatous leprosy. These case reports would lead to the trend in combination therapy (immunotherapy combined with chemotherapy) for such cases, and help lower the tendency for inappropriate diagnosis of drug-resistant leprosy.

Effects of hard water on hair.

BACKGROUND: Hardness of water is determined by the amount of salts (calcium carbonate [CaCO3] and magnesium sulphate [MgSO4]) present in water. The hardness of the water used for washing hair may cause fragility of hair. OBJECTIVE: The objective of the following study is to compare the tensile strength and elasticity of hair treated in hard water and hair treated in distilled water. MATERIALS AND METHODS: 10-15 strands of hair of length 15-20 cm, lost during combing were obtained from 15 volunteers. Each sample was cut in the middle to obtain 2 sets of hair per volunteer. One set of 15 samples was immersed in hard water and the other set in distilled water for 10 min on alternate days. Procedure was repeated for 30 days. The tensile strength and elasticity of the hair treated in hard water and distilled water was determined using INSTRON universal strength tester. RESULTS: The CaCO3 and MgSO4 content of hard water and distilled water were determined as 212.5 ppm of CaCO3 and 10 ppm of CaCO3 respectively. The tensile strength and elasticity in each sample was determined and the mean values were compared using t-test. The mean (SD) of tensile strength of hair treated in hard water was 105.28 (27.59) and in distilled water was 103.66 (20.92). No statistical significance was observed in the tensile strength, t = 0.181, P = 0.858. The mean (SD) of elasticity of hair treated in hard water was 37.06 (2.24) and in distilled water was 36.84 (4.8). No statistical significance was observed in the elasticity, t = 0.161, P = 0.874. CONCLUSION: The hardness of water does not interfere with the tensile strength and elasticity of hair.

Intravitreal bevacizumab for incontinentia pigmenti.

Two eyes of two siblings affected with incontinentia pigmenti having severe proliferative retinopathy are reported. Both cases showed complete resolution of new vessels after a single injection of intravitreal bevacizumab. At 7 months of follow-up, the first case revealed vascularization to the mid-periphery including a vascularized fovea (which was avascular before injection) but recurrence of some peripheral neovascularization, which was treated by conventional laser. The second case had no recurrence. No ocular or systemic adverse effects were observed. Intravitreal bevacizumab as an adjunct therapy in incontinentia pigmenti with macular ischemia could be beneficial.