Sweet syndrome unresponsive to corticosteroid therapy managed with ayurveda medication: A case report.

BACKGROUND: Sweet syndrome (SS) is characterized by sudden appearance of multiple, painful erythematous, papular-nodular skin lesions accompanied by a fever and myalgia. SS resembles Visphota (Bullous eruption disorders) in Ayurveda. SS is a scarcerare skin condition, and Ayurvedic management of this condition is not reported. Therefore, this case report is prepared after taking informed consent from the patient. CASE PRESENTATION: A 34-year-old male patient presented with a complaint of the appearance of multiple blisters over the upper and lower extremities, forehead, and chest with mild fever, congestion of the eye, joint pain, and muscular stiffness for the last two weeks. He has been on oral prednisolone for ten weeks by a dermatologist. The patient has no history of taking drugs in the previous four months before the onset of the skin lesions. The patient was prescribed Nagaradi Kasya (Amrttam Kasaya), Siddha Makardwaja (Plain), Kaisara Guggulu (KG), Ashwagandha ghana vati, and Avipatikar Churna in recommended dose for two weeks. Fifty percentage lesions disappear along systemic symptoms within seven days and complete remission of lesions in fifteen days. The medication was stopped after fifteen days and observed for one year. There is a significant reduction of inflammatory markers like-erythrocyte sedimentation rate (ESR), Total Leucocyte Count (TLC), and C Reactive protein (CRP) after the treatment compared to the baseline also. CONCLUSION: Ayurvedic modalities may be a better treatment option in rare skin conditions like sweet syndrome, where corticosteroid usage failed to improve. More evidence of the usefulness of the Ayurvedic therapeutic approach must be gathered.

Photocatalytic activity of biosynthesized silver nanoparticle fosters oxidative stress at nanoparticle interface resulting in antimicrobial and cytotoxic activities.

Inside the biological milieu, nanoparticles with photocatalytic activity have potential to trigger cell death non-specifically due to production of reactive oxygen species (ROS) upon reacting with biological entities. Silver nanoparticle (AgNP) possessing narrow band gap energy can exhibit high light absorption property and significant photocatalytic activity. This study intends to explore the effects of ROS generated due to photocatalytic activity of AgNP on antimicrobial and cytotoxic propensities. To this end, AgNP was synthesized using the principle of green chemistry from the peel extract of Punica granatum L., and was characterized using UV-Vis spectroscope, transmission electron microscope and x-ray diffraction, and so forth. The antimicrobial activity of AgNP against studied bacteria indicated that, ROS generated at AgNP interface develop stress on bacterial membrane leading to bacterial cell death, whereas Alamar Blue dye reduction assay indicated that increased cytotoxic activity with increasing concentrations of AgNP. The γH2AX activity assay revealed that increasing the concentrations of AgNP increased DNA damaging activity. The results altogether demonstrated that both antimicrobial and cytotoxic propensities are triggered primarily due interfacial ROS generation by photocatalytic AgNP, which caused membrane deformation in bacteria and DNA damage in HT1080 cells resulting in cell death.

Clinicomycological Profile of Pediatric Dermatophytoses: An Observational Study.

Background/Objectives: There has been a recent explosion in the incidence of dermatophytic infections globally, especially in tropical countries including India. This increase is associated with a change in the clinical pattern and mycological profile with poor response to treatment, in adults and children. Limited studies in India have focused on pediatric dermatophytoses. Our study's primary objective was to assess the clinicomycological profile of pediatric dermatophytosis in our region and secondarily to understand the association of lifestyle factors with poor response to treatment. Methods: This was an observational study including children ≤16 years of age, clinically diagnosed with tinea. Clinical and lifestyle data regarding site, affected surface area, duration of infection, previous treatment, possible sources of infection, overcrowding, and bathing practices were collected. Samples were collected for potassium hydroxide mount and fungal culture. Results: A total of 183 children participated in our study. The most common diagnosis was tinea corporis. Tinea cruris was more frequent in preadolescents, where males were more affected. Positive associations were seen between increased duration of infection, increased household infection, infection among playmates, irregular bathing, and use of steroid creams. The most common organism isolated was Trichophyton mentagrophytes/interdigitale (55.19%) followed by Trichophyton rubrum (14.75%). Conclusions: There is a change in the mycological profile of pediatric dermatophytosis with an increase in Trichophyton mentagrophytes/interdigitale infection. Important sources of infection in children must be identified in chronic and recurrent cases. Misinformed and ignorant use of steroid creams is an important reason for recurrent infection.

Therapeutic Inertia in the Management of Psoriasis: A Quantitative Survey Among Indian Dermatologists and Patients.

Purpose: The primary objective of the study was to understand the therapeutic inertia in treatment and management of plaque psoriasis among dermatologists, along with determining the preferred treatment choices for management of plaque psoriasis; it also included the resulting treatment satisfaction among patients. The secondary objective was to identify the gaps in terms of knowledge and attitude among dermatologists and the expectations of patients. Patients and Methods: A multicentre, cross-sectional quantitative survey was conducted among dermatologists and patients with moderate to severe plaque psoriasis across India. The interviews were conducted either face to face or via telephone between September and November 2020, using structured and validated questionnaires based on specific themes. The data obtained were statistically analysed, wherever applicable. Results: Overall, 207 adult patients with moderate-to-severe plaque psoriasis and 303 dermatologists were interviewed. Post experiencing symptoms, 44% of the patients visited general physicians for treatment and there was an average 7.8-month delay by the patients to consult a dermatologist. Approximately one-fourth of patients used home remedies before seeking medical help. One-third of dermatologists used the Psoriasis Area and Severity Index (PASI) for assessing the disease severity. Majority of dermatologists preferred combination therapy for their patients. The lack of quick resolution and side effects were the major reasons for changing the treatment. Overall, only 35% of the patients complied to current treatment. Satisfaction with existing forms of therapies was highest for mild plaque psoriasis (62%) as confirmed by dermatologists, while 52% of the overall patients were satisfied with their therapy. Majority of the patients (64%) affirmed living with plaque psoriasis impacted their lives. Conclusion: This first-of-its-kind survey in India highlighted the gaps in terms of the disease journey between dermatologists and patients. The survey emphasises the need for shared decision-making and may benefit dermatologists in suggestive modifications of the treatment algorithm and disease management in clinical settings.

Haematologic-Related Malignancy-Induced Eosinophilic Dermatoses (He Remained): A Narrative Review.

He remained(Hematologic Related Malignancy- induced Eosinophilic dermatoses) is a new eponym introduced to describe a dermatoses previously described under several terminologies such as eosinophilic dermatoses of haematological malignancy, exaggerated arthropod bite reactions, insect bite-like reactions and T-cell papulosis associated with B-cell malignancies. This chronic relapsing remitting disease has a pleomorphic presentation mimicking a variety of dermatological conditions. The underlying pathophysiology is however poorly understood. It is a paraneoplastic phenomenon hence an underlying haematological malignancy must always be looked for. Response to conventional modalities of treatment such as oral corticosteroids is rapid and satisfactory. Other newer modalities are also in the pipeline. In this manuscript, we present a narrative review of this recently described entity with data identified via a search on 27 September, 2021 in PubMed, EMBASE and MEDLINE using the term 'Eosinophilic dermatoses of haematological malignancy' AND 'Hematologic related malignancy-induced eosinophilic dermatoses'. A total of 67 cases reported in the literature from the year 2012 onward have been included. The literatures pertaining to insect bite-like reactions and exaggerated insect bite hypersensitivity have been excluded in this review.

Coronavirus disease 2019 vaccination in patients with psoriasis: A position statement from India by SIG psoriasis (IADVL Academy).

Coronavirus disease 2019 (COVID-19) pandemic has affected every sphere of life including management of psoriasis. The availability of COVID-19 vaccines has given rise to hope and at the same time some apprehensions as well. With the general population becoming eligible for vaccination, there is some confusion, on the eligibility of patients with different medical conditions and patients on immunosuppressive or immunomodulating medications for COVID-19 vaccination. Dermatologists treating psoriasis patients frequently face questions from them, whether they can undergo coronavirus disease 2019 vaccination. A PUBMED search was performed using the following strategy: 'COVID-19' AND 'Vaccine' AND 'Psoriasis'. We also performed a PUBMED search using the following strategy: 'SARS-CoV-2' AND 'Vaccine' AND 'Psoriasis'. All articles irrespective of language and publication date were included to arrive at this position statement. This position statement deals with the safety, eligibility and modifications of treatment, if needed among psoriasis patients with regards to the coronavirus disease 2019 vaccines currently available in India.

Ayurveda panchakarma treatment success in a case of chronic spontaneous urticaria non-responding to conventional medicine-A case study.

This is a case study of a 34-year-old male patient of Chronic Spontaneous Urticaria (CSU) with severe generalised itching and rashes all over the body since 17 years. The patient has no significant relief with conventional antihistamine therapies, AST (Autologous serum therapy) and Omalizumab (OMA). He was clinically assessed and managed with Ayurvedic Panchakarma procedures like Snehapana(therapeutic administration of unctuous formulation like ghee, oil), Vamana, Virechana and internal medication in line of Seethapitta Chikitsa. The patient was asked to monitor hives and itching daily for one week using a validated weekly Urticaria Activity Score (UAS7) at the baseline, after Vamana, after Virechana and after follow up. The Quality of life was assessed at the baseline and after follow-up using Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL). The assessment showed complete remission in disease activity and improvement in Quality of life as per the scores. The hematological and biochemical investigations reflect the safety and efficacy of Ayurveda in management of CSU.

Treating Vitiligo at the Angle of Lips: A Narrative Review.

Vitiligo is a common autoimmune depigmentary disorder seen among Indian patients. It has a significant impact on the self-esteem of the patient. Specific sites including acral areas, joints, and lips are usually resistant to medical therapy and thus transfer of melanocytes is mandatory for the treatment. Vitiligo at the angle of lips is distinct from the vitiligo on other sites, with respect to response to therapy, lack of hair follicles, and high mobility of the area. Our aim was to review the various therapeutic modalities available for the treatment of vitiligo at this site. In our narrative review, we searched databases including PubMed, Google Scholar, and EBSCO with a full strategic search with keywords "Vitiligo," "leucoderma," "mucosal vitiligo," "lips," "labial," "angle of lips," "Minipunch grafting," "Suction Blister epidermal Grafting," "SBEG," "Micropigmentation," "tattooing," and "Excision" from 2005 to 2021. The relevant articles were extracted and included in the review. Various modalities including suction blister grafting, miniature punch grafting, split-thickness grafting, and micropigmentation have been reviewed with their advantages and disadvantages. Various potential modalities of therapy have also been proposed in the review.

Systemic Management of Psoriasis Patients in Indian Scenario: An Expert Consensus.

BACKGROUND: Psoriasis is a common inflammatory disease with significant comorbidities, and regardless of its extent, it affects the patients' quality of life. The various modalities of treating psoriasis comprise topical or systemic medications, phototherapy, and an array of biologic agents. There is a lack of Indian recommendations on the management of psoriasis with these different modalities and challenges faced by the clinicians in day-to-day practice. AIM: To develop India-specific consensus for systemic management of patients with moderate-to-severe psoriasis. METHOD AND RESULTS: A panel of dermatology experts, based on the evidence and international recommendations, coupled with their own clinical experience, developed recommendations for systemic management of patients with moderate-to-severe psoriasis. CONCLUSION: These recommendations are meant to provide guidance in terms of choice of systemic therapies, dosing, effectiveness, and safety. It also addresses clinical challenges that may be experienced during psoriasis management.

Re-pigmentation of Vitiligo Involving Angle of Lip Using Radiofrequency Cautery and Topical 5-Fluorouracil.

Vitiligo involving the angle of lip is a therapeutically challenging site because of the small and delicate area, high mobility, and lack of hair follicles. Dermabrasion combined with topical 5-fluorouracil cream has shown promising results in various studies involving different sites. Here we present a novel technique of using radiofrequency cautery for abrasion of epidermis followed by application of 5-fluorouracil cream. This technique has the advantage of being simple, easy, cost-effective with less downtime. A single session can yield excellent pigmentation in small areas such as the angle of lip.