Clinico-Pathological Correlation in Dermatological Disorders: A Retrospective Audit of 332 Skin Biopsies from a Tertiary Care Center.

Background: Skin biopsy is a frequently employed tool by the dermatologists with several factors that are known to influence its diagnostic yield as well as interpretation. The objective of our study was to analyze the clinico-pathological concordance and discordance rates in various dermatological conditions and study the factors affecting the same. Materials and. Methods: We retrospectively analyzed 332 biopsies conducted over a period of 1 year and looked for clinico-pathological correlation and tabulated the results. Results: The overall concordance rate observed in the present study was 70.48% (234 out of 332). Out of 234 concordant cases, 175 of them (74.8%) were concordant with the first differential diagnosis mentioned on the histopathology requisition form, thus revealing an acceptable level of clinico-pathological correlation. The concordance was observed to be 66.87% when only one differential was mentioned on the requisition forms, whereas it increased to 73.96% when more than one diagnosis was offered (P = <0.00001). However, the adequacy of clinical description on the histopathological requisition form was not observed to significantly impact the clinico-pathological correlation in the present study. Conclusion: An acceptable level of clinico-pathological concordance was observed in the present study thus reinforcing skin biopsy as an indispensable tool in the dermatological practice. However, continuous effort in the form of regular audits in the department, interdepartmental discussions between pathologists and clinicians, and repeat biopsies in case of discordancy would help in identifying and addressing the deficiencies that impact the diagnostic yield of histopathology and which would ultimately result in better patient care.

Indian Traditional Treatments for Psoriasis: A Critical Appraisal of Available Evidence Supporting Efficacy.

OBJECTIVE: To examine data from studies supporting the clinical efficacy of medical approaches from India traditional systems of medicines like Ayurveda, Unani, Siddha, and Homeopathy for psoriasis using outcome indicators employed in clinical practice and research. METHODS: Searches were conducted between December 2019 and September 2020 in databases PubMed, Scopus, Web of Science and Ovid Medline using search terms including traditional, complementary, psoriasis, Kushtha, Ayurveda, Siddha, Unani, Homeopathy and clinical. Controlled trials, case series and case reports published from India were included. RESULTS: Data of 17 selected studies were extracted. Treatment efficacy in terms of improvement in Psoriasis Area and Severity Index (PASI) score or/and percentage reduction in score (PASI 50, PASI 75 and PASI 90) or/and patient-reported outcomes using instruments like Dermatology Life Quality Index and Psoriasis Disability Index were noted. All studies reported good improvement as per the study specific outcome. However, study characteristics, including study design, sample size, follow-up period, inclusion and exclusion criteria were heterogeneous, and the choice of outcome measures was not adequate to conclude the effectiveness of intervention. The use of some herbs as common ingredients in several formulations across different systems of medicines were noted in analyzing individual formulation. CONCLUSIONS: Future studies must incorporate a comprehensive study design with specific outcome measures like PASI, PASI 75, PASI 90, quality of life parameters, compliance to medications, adverse reactions, remission period, relapse rate and cost-effectiveness with long term follow-up. The currently available evidence on the roles of these herbs at molecular level in psoriasis is preliminary.

Novel bioactive formulation derived from the conditioned medium of mesenchymal stromal cells reduces under-eye dark circles in human volunteers.

BACKGROUND: Under-eye dark circles are a common condition observed in dermatology practice. Mesenchymal stromal cell-derived conditioned medium (MSC-CM) contains an array of growth factors and cytokines reported to promote periorbital rejuvenation and may be useful in removing the dark circle around the eyes. AIMS: The aim of the present study was to evaluate the safety and efficacy of developed bioactive formulation containing mesenchymal stromal cell-derived conditioned medium in reducing the under-eye dark circles. PATIENTS/METHODS: We tested the safety profile of MSC-CM along with antioxidants, in vitro using human melanocytes cultures. The bioactive formulation containing MSC-CM was developed and tested for physicochemical parameters. The dermatological safety was evaluated by primary irritant patch-test under complete occlusion on healthy human subjects. To elucidate its safety and efficacy, monocentric, open-label, single-arm study was carried out in 20 Indian female subjects for the duration of 12 weeks. Parameters such as eye puffiness, radiance, skin smoothness, even skin tone, periorbital fine lines and wrinkles, crow's feet, whitening, pigmentation, skin tightening, and refreshing/soothing effect were used to investigate the rejuvenating property of the bioactive formulation. RESULTS: Mesenchymal stromal cell-derived conditioned medium along with antioxidants decreased the melanin content compared to the CM alone in the melanocyte cultures. Besides, the bioactive formulation was safe and emerged as a non-irritant product. Improvement in the majority of the clinical parameters assessed through efficacy study was observed within 4 weeks of topical application of the formulation twice daily, and showed continued improvement for 12 weeks as evaluated by the dermatologists as well as self-assessment by the subjects. CONCLUSION: The bioactive formulation containing MSC-CM was safe and effective in reducing the under-eye dark circles and was beneficial in improving the overall appearance of the eye area.

Clothes-on PUVA in psoriasis: single blind randomized comparative trial on 21 patients.

BACKGROUND: PUVASOL therapy has an inherent drawback of patient compliance in that Indian female patients with psoriasis lesions on covered parts of the body are reluctant to expose themselves. In this study we tried to evaluate a new method of administering PUVA therapy wearing a fabric. AIM: To compare the efficacy and safety of PUVA administration with and without wearing clothes in psoriasis. METHOD: We first found the UV transmissibility of plain woven, lightweight cream colored cotton fabric with 30 x 30 threads per square cm. area and calculated its sun protection factor (SPF). A single blind, randomized, comparative, clinical trial was then conducted on 21 patients with psoriasis vulgaris who were treated with bath PUVA. The study group received ultraviolet light while wearing a gown made up of the above cotton fabric and the control group received ultraviolet light without wearing the gown. The study group was given an UV dose higher in proportion to the SPF of the worn fabric so that blockage caused by cloth could be neutralized. The cloth-uncovered areas were covered with a sunscreen. UVA from artificial light source was used for better patient monitoring. RESULTS: After 12 PUVA treatments both the treatments were found to be equally effective, and there were no differences in the side effects. CONCLUSION: Thus we conclude that PUVA can be given wearing a fabric provided the UV dosage is increased proportional to the SPF of the fabric. The same fabric may be used for PUVASOL therapy.