Comparative evaluation of therapeutic efficacy and safety of black peel versus 25% trichloroacetic acid peel in mild to moderate acne vulgaris: a split face study.

Introduction: Peeling has withstood the test of time as a simple, minimally invasive method to renew the skin, despite the introduction of more advanced procedures like lasers. Materials and Methods: Thirty patients (or 60 sites) with age ranging from 15 to 45 years with mild-to-moderate acne vulgaris were included in the study. Assessment at baseline was done by the global acne grading system score for including mild and moderate acne patients. Results: On grading the improvement according to the 5-point Global Assessment Scale (GAS), it was found that in area A (black peel), 6.7% of patients showed excellent improvement, 86.7% of patients showed good improvement, and 6.7% of patients showed fair improvement. In area B (25%TCA peel), 6.7% of patients showed excellent improvement, 80% of patients showed good improvement, and 13.3% of patients showed fair improvement. Discussion: None of the patients showed poor or worse outcomes in any of the areas. The difference between the groups was not significant (P = 0.688). Conclusion: There is a paucity of data in the literature regarding the comparison of black peel with other conventional peels in the treatment of acne vulgaris. To the best of our knowledge, this is the first study comparing black peel with TCA peel in the treatment of acne vulgaris.

IADVL SIG Pediatric Dermatology (Academy) Recommendations on Childhood Alopecia Areata.

Alopecia areata (AA) is a chronic inflammatory disease characterized by nonscarring alopecia. In contrast to adult onset AA, the epidemiology, clinical characteristics, and therapy of childhood AA are less explored. This study aims at providing recommendations for the management of childhood AA. The special interest group (SIG) in pediatric dermatology under the Indian Association of Dermatology, Venereology and Leprosy (IADVL) conducted online meetings from February 2021 to September 2021, intending to identify the critical aspects in the diagnosis and treatment of AA. The classification, diagnosis, and tools for assessment of disease activity of childhood AA have been described in this study, along with recommendations for topical and systemic therapy, including newer therapeutic options.

A study on clinical spectrum of lichen sclerosus in a tertiary care Centre in North India.

Introduction: Lichen sclerosus (LS) is a chronic dermatosis frequently located over labial, perineal, and perianal areas. The etiology is multifactorial and includes genetic, autoimmune, hormonal, and infectious aspects. Materials and Methods: A series of twenty genital LS patients was carried out to evaluate the signs, symptoms, complications, and affliction of quality of life. Results: Eighteen out of twenty patients were female between 30 and 73 years and showed smooth, glistening, and whitish plaques. The mean duration was 8.4 years. Itching and burning was the most common symptom (75%) corresponding to excoriation and fissuring of genitalia (75%). Malignancy was seen in two cases (10%). The mean Vulvar Quality of Life Index was 9.2, higher in younger patients. Discussion: LS is a disorder of older age group with female preponderance. It is a source of significant morbidity, and long-standing cases predispose to vulvar malignancy. Conclusion: To conclude, early diagnosis with proper counselling of the patient and his/her partner regarding various aspects of disease are essential for a wholesome approach.

Case report of co-existing keratotic balanitis and squamous cell carcinoma in a 42-year-old male.

Although a number of premalignant and malignant lesions affect the genitalia of men, such as condyloma acuminata, erythroplasia of queyrat, squamous cell carcinoma, hyperkeratotic balanitis is rare and a patient showing both hyperkeratotic and well-differentaited squamous cell carcinoma is rarer. We report the case of a 42-year-old male, who had a hyperkeratotic plaque like lesions over the glans, with accompanied atrophic areas.

A Randomized Comparative Study of MIP and MMR Vaccine for the Treatment of Cutaneous Warts.

OBJECTIVES: To evaluate and compare the efficacy of MMR vaccine and MIP vaccine for resolution of Cutaneous warts (Cw). METHODS: The hospital-based prospective randomized interventional study was done where a total of 60 patients of Cw were divided into two groups of 30 patients each: Group A received 0.1 ml of intralesional injection of MIP vaccine and Group B received 0.5 ml of MMR vaccine. The treatment protocol involved three intralesional injection of vaccines at intervals of 3 weeks (maximum of three injections). The follow-up was done every 4 weeks for at least 24 weeks for the comparison of the two groups. The primary outcomes were the decrease in size of the wart or clearance of primary warts. The secondary outcomes were the improvement in the distant warts and any complications related to the use of vaccines. The data were entered in MS Excel and analyzed using SPSS 17.0 version. A P value of <0.05 was considered statistically significant. RESULTS: The baseline demographic and wart characteristics were comparable between the two groups (P > 0.05). As compared to MMR, MIP showed an early (9.41 vs 11.71 weeks, P = 0.027), and a significantly higher complete response (90% vs 76.67%) with P < 0.05. The less duration of the warts was significantly associated with the higher complete response (P < 0.05) in both the groups. The common side effects were erythema/inflammation [19 (63.34%)] in Group A and pain during the injection [19 (63.34%)] in Group B with P < 0.0001. CONCLUSION: In conclusion, MIP intralesional injections have a quicker response and are more efficacious compared to MMR in the treatment of Cw, though each vaccine carries its own sets of side effects.

Atrophic Dermatofibroma in a Young Female: A Rare Entity.

Introduction: Atrophic dermatofibroma is a rare variant of dermatofibroma which is many times underdiagnosed. Case Report: We report a case report of a 29-year-old female who came to the dermatology department with black-colored lesions on the lower leg for the past 7 years. Histopathological examination revealed a non-encapsulated dermal tumor involving upper to deep reticular dermis and extending to superficial subcutis. There was epidermal hyperplasia, and at the center of the lesion a slight epidermal atrophy was present. Discussion: It is a commonly underdiagnosed variant of dermatofibroma. Histopathologically, this disorder presents as a decrease in at least 50% of the thickness of the dermis relative to the adjacent dermis. The case is rare and hence reported.

Recommendations for Pediatric Dermatology Practice during COVID-19 Pandemic.

The current scenario of the coronavirus disease (COVID-19) pandemic has resulted in a huge disease burden worldwide affecting people across all age groups. Although children get infected by coronavirus, they are less commonly affected. Only 2% of cases are being reported among patients aged less than 20 years of age and childhood cases constitute around 1-5% of them. Moreover, they are less likely to be seriously affected when compared to adults, with more than 90% of them being either asymptomatic or having mild to moderate disease. This could be attributed to less exposure or sensitivity to COVID-19, varying immune response mechanisms, differences in the expression/function of the Angiotensin Converting Enzyme 2 receptors or higher antibody levels to viruses owing to exposures to multiple respiratory infections, protective role of measles and BCG vaccine, and few associated comorbidities. However, children with certain underlying medical conditions like cardiac or respiratory disease, diabetes, immunodeficiency disorders, cancer or on immunosuppressants may be at a higher risk for developing severe disease.

Comparative Study of Diode Laser Versus Neodymium-Yttrium Aluminum: Garnet Laser Versus Intense Pulsed Light for the Treatment of Hirsutism.

INTRODUCTION: Lasers are widely used for the treatment of hirsutism. But the choice of the right laser for the right skin type is very important. Before starting with laser therapy, it is important to assess the skin type, the fluence, the pulse duration and the type of laser to be used. AIMS: To compare the efficacy and side effects of Diode laser, Neodymium-yttrium aluminum - garnet (Nd: YAG) laser and intense pulsed light (IPL) on 30 female patients of hirsutism. MATERIALS AND METHODS: Thirty female patients with hirsutism were selected for a randomised controlled study. The patients were divided into three groups of 10 patients each. In group I patients diode laser was used, in group II patients long pulsed Nd: YAG laser was used and in group III, IPL was used. The patients were evaluated and result graded according to a 4-point scale as excellent, >75% reduction; good, 50-75% reduction; fair; 25-50% reduction; and poor, <25% reduction in hair density. RESULTS: It was seen that the percentage of hair reduction after two sessions of treatment was maximum (40%) in the diode laser group, followed by 35% hair reduction in the Nd: Yag laser group and 10% hair reduction in the IPL group. The percentage of hair reduction after four sessions of treatment was maximum (64%) in the diode laser group, followed by 62% hair reduction in the Nd: Yag laser group and 48% hair reduction in the IPL group. The percentage of hair reduction after eight sessions of treatment was maximum (92%) in the diode laser group, followed by 90% hair reduction in the Nd: YAG group and 70% hair reduction in the IPL group. CONCLUSIONS: To conclude for the Indian skin with dark hairs, the diode laser still stands the test of time. But, since the diode laser has a narrow margin of safety, proper pre and post-procedure cooling is recommended. Although, the side effects of Nd: YAG laser are less as compared to the diode laser, it is less efficacious as compared to the diode laser.

Efficacy of Modified Jessner's Peel and 20% TCA Versus 20% TCA Peel Alone for the Treatment of Acne Scars.

INTRODUCTION: There is a paucity of studies on the use of chemical peels for acne scars among the Asian population. A trichloroacetic acid (TCA) and Jessner's combination chemical peel, originally described by Monheit, is said to be better than a TCA peel alone. AIMS: The aim of the study was to compare the efficacy of 20% TCA and Jessner's solution versus 20% TCA alone for the treatment of acne scars. MATERIALS AND METHODS: : The patients were divided into two groups of 25 patients each. Chemical peeling was done in both the groups. In Group I, chemical peeling with Jessner's peel followed by 20% TCA was done and in Group II patients chemical peeling with 20% TCA peel alone was done. RESULTS: In Group I (Jessner's peel and 20% TCA), mild improvement of acne scars was seen in 8% cases, moderate improvement in 32% cases and marked improvement of acne scars was seen in 60% patients. In Group II (20% TCA), mild improvement of acne scars was seen in 32% cases, moderate improvement in 40% cases and marked improvement of acne scars was seen in 28% patients. But, the difference in improvement of acne scars was not statistically significant in both the groups (P value > 0.05).

A study on fractional erbium glass laser therapy versus chemical peeling for the treatment of melasma in female patients.

INTRODUCTION: Melasma is a commonly acquired hypermelanosis and a common dermatologic skin disease that occurs on sun-exposed areas of face. AIMS: To assess the efficacy and safety of non-ablative 1,550 nm Erbium glass fractional laser therapy and compare results with those obtained with chemical peeling. MATERIALS AND METHODS: We selected 30 patients of melasma aged between 20 years and 50 years for the study. The patients were divided into two groups of 15 patients each. Group I patients were subjected to four sessions of 1,550 nm Erbium glass non-ablative fractional laser at 3 weeks interval. In group II patients, four sessions of chemical peeling with 70% glycolic acid was performed. RESULTS: After 12 weeks of treatment, percentage reduction in Melasma Area and Severity Index (MASI) score was seen in 62.9% in the laser group and 58.7% in the peels group. CONCLUSION: It was observed that 1,550 nm fractional laser is as effective as 70% glycolic acid peel in reducing MASI score in patients with melasma.

Comparative study of 15% TCA peel versus 35% glycolic acid peel for the treatment of melasma.

BACKGROUND: Chemical peels are the mainstay of a cosmetic practitioner's armamentarium because they can be used to treat some skin disorders and can provide aesthetic benefit. OBJECTIVES: To compare 15% TCA peel and 35% glycolic acid peel for the treatment of melasma. MATERIAL AND METHODS: We selected 30 participants of melasma aged between 20 and 50 years from the dermatology outpatient department and treated equal numbers with 15% TCA and 35% glycolic acid. RESULTS: Subjective response as graded by the patient showed good or very good response in 70% participants in the glycolic acid group and 64% in the TCA group. CONCLUSIONS: There was statistically insignificant difference in the efficacy between the two groups for the treatment of melasma.

A clinical and histopathological profile of patients with cutaneous tuberculosis.

Extrapulmonary tuberculosis constitutes about 10% of all cases of tuberculosis, and cutaneous tuberculosis makes up only a small proportion of these cases. Despite prevention programs, tuberculosis is still progressing endemically in developing countries. Commonest clinical variant of cutaneous tuberculosis in our study was lupus vulgaris seen in 55% patients followed by scrufuloderma seen in 25% patients followed by orificial tuberculosis, tuberculosis verrucosa cutis, papulonecrotic tuberculid, and erythema induratum seen in 5% each. The commonest site of involvement was limbs seen in 50% patients followed by neck seen in 25% patients, face in 15%, and trunk in 10% patients. Maximum percentage of patients (55%) had duration of cutaneous tuberculosis between 6-12 months followed by 35% between 13-24 months, 5% had duration of cutaneous tuberculosis less than 6 months, and the rest 5% had duration more than 24 months. The commonest histopathological feature in our study was tuberculoid granuloma with epitheloid cell and Langhans giant cells seen in 70% patients, hyperkeratosis was seen in 15% patients and AFB bacilli were seen in 5% patients.

Modified Jaipur block for the treatment of post-herpetic neuralgia.

Post-herpetic neuralgia means pain which occurs for longer than one to three months after the resolution of the rash of herpes zoster. We conducted a study of 30 patients having post herpetic neuralgia. All the patients were treated with modified Jaipur block consisting of local subcutaneous infiltration of 2% Xylocaine, 0.5% bupivacaine and methylprednisolone. In our study, it was seen that 20% patients had complete relief of pain after first injection, 60% patients had complete relief of pain after second injection, 10% patients had complete relief of pain after third injection, and only 10% patients did not respond to treatment. The non-responders were either old (over 60 years) or had pain lasting for more than two years.

Intra-operative myocardial ischaemia and infarction in patients with coronary artery disease undergoing prostatectomy/cholecystectomy.

Fifty patients over the age of 40 years of either sex (28 males and 22 females) having definite coronary artery disease as indicated by history of previous myocardial infarction, angina or ECG evidences of myocardial infarction (silent myocardial infarction), undergoing non-cardiac surgery were studied. In order to detect the incidence of myocardial ischaemia during the peri-operative period, continuous monitoring of electrocardiogram was performed in all patients for 24 hours, beginning from the morning of surgery using a 2-channel Holter recorder. Intra-operative events besides myocardial ischaemia were noted. CK-MB isoenzyme assay was done on days 0, 1, 2, 3, 5, 7 postoperatively in all patients. CK-MB and ECG were also done whenever indicated. The incidences of intra-operative and postoperative ischaemia were 40% and 48% respectively. The incidence of postoperative myocardial ischaemia in patients with intra-operative myocardial ischaemia was found to be significantly higher than those patients without intra-operative myocardial ischaemia. The rate of myocardial ischaemia and peri-operative myocardial infarction was lower in patients on beta-blockers than those patients who were not on these drugs though a statistical difference was not reached. The rate of peri-operative myocardial infarction was also found to be higher in patients who had intra-operative hypertensive or hypotensive episodes though a statistical significance was not reached. Patients who had either pre-operative or peri-operative myocardial ischaemia had greater incidence of peri-operative myocardial infarction than those patients without myocardial ischaemia but the difference was not statistically significant.

A study on the management of hidradenitis suppurativa with retinoids and surgical excision.

BACKGROUND: Hidradenitis suppurativa is a chronic skin condition involving the apocrine glandular zones. Affected patients may present with acute abscesses, but the condition often progresses to a chronic state with persistent pain, sepsis, sinus tract, fistula formation, purulent discharge, and dermal scarring. The treatment of patients with severe disease can be difficult and may require complex surgical intervention. MATERIALS AND METHODS: For this study, we selected 30 patients from the outpatient department. The patients were divided into two groups of 15 patients each. In patients of group I, oral acitretin 0.5 mg/kg body weight was given alone. Oral acitretin was given for a period of 12 weeks, and follow-up of the patients was done every 4 weeks for a period of 6 months. In patients of group II, oral acitretin 0.5 mg/kg was given plus a wide surgical excision was done. RESULTS AND DISCUSSION: In our study, the commonest site of involvement of hidradenitis suppurativa was axilla in 83.3% patients, perineum was involved in 13.3% patients, and periumbilical involvement was seen in 3.3% patients. The commonest clinical feature was nodules seen in 90% patients; pain was seen in 60% patients, dermal scarring in 73.3% patients, malodorous discharge in 33.3% patients, abscess in 30% patients, and fistulous tracts were seen in 20% patients. The recurrence rate was low (20%) in group II patients in whom oral acitretin was given plus surgical excision was done as compared with group I (40%) in whom oral acitretin was given alone.

A study of pathogenesis of acanthosis nigricans and its clinical implications.

BACKGROUND: Acanthosis nigricans (AN) is a dermatosis characterized by thickened, hyperpigmented plaques, typically on the intertriginous surfaces and neck. Common in some populations, its prevalence depends on race. Clinicians should recognize AN; it heralds disorders ranging from endocrinologic disturbances to malignancy. In this review, we discuss the pathogenesis of AN and its clinical implications and management. MATERIALS AND METHODS: We selected 30 patients for the study. Diagnosis of associated disorders was established by history, physical examination, body mass index (BMI), hormone measurements by radioimmunoassays of thyroidnfunction tests, free testosterone, 17 (OH) progesterone, dehydroepiandrosterone sulfate (DHEAS), cortisol, gonadotropins, prolactin, immunoreactive insulin, and C-peptide levels. RESULTS AND DISCUSSION: In our study, the flexural involvement (flexures of groins, knees and elbows) was seen in 40% patients, lip involvement was seen in 6.6% patients, and dorsal involvement was seen in 3.3% patients each. Increased serum testosterone levels were seen in 13.3% patients and increased DHEAS levels were seen in 20% patients. Regarding the types of AN, obesity induced AN or pseudo-AN was seen 70% patients, syndromic AN was seen in 23.35% patients and malignant AN was seen in 6.6% patients. The commonest histopathological feature of patients with AN was hyperkeratosis, seen in 100% patients, papillomatosis was seen in 90% patients, dermal infiltrate of lymphocytes and plasma cells was seen in 60% patients, horn pseudocysts were seen in 30% patients, and irregular acanthosis was seen in 26.6% patients.