Development of Consensus Recommendations on the Management of Vitiligo and the Role of Decapeptide in Vitiligo by the Delphi Method.

Background: Treatment of vitiligo is still a challenge in dermatology. Literature is sparse on the definitive clinical role of basic fibroblast growth factor (bFGF) in vitiligo patients. Aims: We decided to generate a consensus in an attempt to answer some critical questions related to the management of vitiligo and the role of bFGF. Materials and Methods: A Delphi method among 21 experts across India was conducted. A consensus (agreement was 75% or greater) was taken on 27 statements on the prevalence, epidemiology, and treatment of vitiligo and the role of bFGF in the management of vitiligo. The consensus process was completed after two rounds. Results: Topical corticosteroid therapy is the first-line therapy for vitiligo; however, its adverse effects are widely known, especially in sensitive areas. Topical calcineurin inhibitors are preferred in stable vitiligo of the face, neck, genitals, or intertriginous regions as an alternative to topical corticosteroids. Topical bFGF is a relatively newer therapy with a promising role in stable vitiligo. bFGF is safe and effective in inducing repigmentation of vitiligo lesions. Combination therapy of bFGF with other topical therapies, phototherapy, and surgical procedures can be beneficial in patients of vitiligo. Conclusion: This consensus would complement the currently available literature on bFGF and help the practitioner to recognize the unmet need in the treatment of vitiligo.

Intralesional Agents in Dermatology: Pros and Cons.

Since introduced in 1961, intralesional (IL) agent has become an essential part of the dermatological practice. The term IL referred to the direct delivery of agent percutaneously into skin lesions. This therapeutic approach is relatively safe, easy to perform and applicable for a broad range of dermatological conditions. On the other hand, immediate side effects, including pain during administration, bleeding, high risk of infection and allergic reaction, and subsequent side effects involving skin changes such as atrophy, telangiectasia, pigmentary changes, and striae are usually associated with this modality. This review paper highlights the pros and cons of IL agents in modern dermatology practice.

A Retrospective Study of 3,000 Indian Patients with Vitiligo Treated with Phototherapy or Topical Monotherapy.

BACKGROUND: Vitiligo-affected individuals, especially patients with darker skin tones, can suffer from negative psychosocial impacts due to unpredictable development of the condition and perceived cosmetic concerns. However, given that spontaneous repigmentation can be gained in vitiligo, many patients ask for treatment due to these cosmetic concerns. In the literature, only a few studies have been documented focusing on the outcome of various treatment modalities for vitiligo. OBJECTIVE: This article highlights the retrospective response of various treatment modalities in Indian patients with vitiligo. METHODS: A retrospective chart review was performed from July 2017 to August 2018 at our private dermatology clinic. A total of 3,000 patients were enrolled in this observational study. Patient characteristics and details of phototherapy (psoralen and ultraviolet A, narrow-band ultraviolet B, excimer laser) were noted as per a predefined format. The clinical response was evaluated as a marked response, defined as repigmentation in more than 75% of the initial lesional area. RESULTS: Of those included in this retrospective analysis, 1,996 patients received phototherapy and 1,004 patients were treated with topical monotherapy. Patients treated with phototherapy only and those treated with a combination of phototherapy and topical agents showed significantly higher clinical response rates relative to patients treated with topical monotherapy only (marked response rate: 47.8% vs. 8.7%; P<0.001 and 23.4% vs. 8.7%; P<0.001). Disease subtype predominately affected the treatment response. CONCLUSION: In Indian patients with vitiligo, phototherapy appears to be an effective treatment option for both focal and vitiligo vulgaris. Due to its reliability and minimal side effects, it can be considered a preferable treatment modality for vitiligo.

Case Report on Rare Clinical Variant of Porokeratosis: Disseminated Superficial Porokeratosis.

Porokeratosis is a genodermatosis, resulting from a disorder in keratinization due to an abnormal clone of epidermal precursor, presenting with various clinical manifestations but characterized histologically by the presence of cornoid lamella. Diverse clinical variants of porokeratosis exist, which are unified by this general histological feature, but differ in morphology, distribution, and clinical course. The typical lesions of porokeratosis are described by an atrophic center surrounded by an elevated keratotic rim formed by the cornoid lamella. The lesions can be found almost anywhere on the body. We report an unusual presentation of a rare clinical variant, disseminated superficial porokeratosis.

Rhinophyma Successfully Treated with Ultra Plus CO2 Laser: Report of a Case and Literature Review.

Rhinophyma (Greek "nose growth") benign skin deformity characterized by tumorous growth leading to a large, bulbous, and erythematous appearing nose. It is a rare subtype of phymatous rosacea. The exact pathogenesis is still not known. It can lead to considerable cosmetic impairment with psychosocial implications and poses a risk of developing an occult malignancy. Early diagnosis and treatment is imperative to avoid these complications. Herein, we report a case of a 47-year-old man presenting with rhinophyma who was treated with ultra plus CO2 laser.

Modified Rheumatoid Arthritis Protocol for Rituximab in Pemphigus: A Retrospective Case Series.

Background: Rituximab, an anticluster of differentation 20 antibody, has been shown in open series studies to be effective in treating pemphigus. In the literature, lymphoma (dose of 375mg/m2, four-week infusion) and rheumatoid arthritis (two infusions of 1,000mg each, 15 days apart) are two protocols extensively used for rituximab treatment in pemphigus. Objective: We investigated whether a modified rheumatoid arthritis protocol, in which the patient received a single treatment course ranging from 2 to 5 infusions of 1,000mg of rituximab during an interval of four weeks is safe and effective in pemphigus management. Methods: Patients with pemphigus were treated with a single treatment course ranging from 2 to 5 infusions of 1,000mg of rituximab during an interval of four weeks. Clinical consensus late endpoints and desmoglein 1 and desmoglein 3 indices were monitored. Results: We enrolled 32 patients in the study: four with pemphigus foliaceus (PF) and 28 with pemphigus vulgaris (PV). The follow-up period was 98.22±20.65 weeks (range: 40-140 weeks). All 32 patients responded to therapy. Nineteen patients achieved complete remission during a median period of 46 weeks (8 on minimal therapy, 11 off therapy). Thirteen patients achieved partial remission during a median period of 46 weeks (8 on minimal therapy, 5 off therapy). Relapses were seen in five (15.63%) patients between 72 and 96 weeks (median: 96 weeks) after the start of therapy. The antidesmoglein index correlated well with clinical improvement in PV or PF. Conclusion: Modified rheumatic arthritis protocol for rituximab was shown to be effective and safe in treating patients with pemphigus.

Giant Congenital Melanocytic Nevi Successfully Treated with Combined Laser Therapy.

Congenital melanocytic nevi are benign proliferations of cutaneous melanocytes that arise as a result of abnormal growth, development, or migration of melanoblasts. Clinically, the giant congenital nevus is greater than 20 cm in size, pigmented and often hairy. The risk of malignant melanoma for the giant nevi is almost 6%. Fifty percent of the melanomas develop by the age of 2 years and, 80% of the melanomas develop by the age of 7 years. Hence, early management is of paramount importance. Herein, we present a case of giant nevi along with a review of the literature in order to bring awareness among clinicians towards this rare albeit significant entity.

Recurrent Plaque Morphea Successfully Treated with PDO Mono Threads and Topical Tacrolimus Ointment.

The term plaque morphea describes a variant of morphea (localized scleroderma) in which oval or round circumscribed areas of induration, pigmentary changes, and violaceous or erythematous halo (i.e., lilac ring) are found in the dermis and occasionally to the superficial panniculus. We report a case of 28-year-old male patient with recurrent plaque morphea who was treated with polydioxanone (PDO) mono threads and topical tacrolimus ointment. After the introduction of PDO mono threads, the patient was prescribed topical tacrolimus ointment for six months. After that six-month period, the lesions were softer to palpation and lighter in color. This was observed as a positive therapeutic response. Notably, no future recurrence was seen at one-year follow up.

Case report on premature hair graying treated with Melitane 5% and oral hair supplements.

With chronological aging, hair turns gray. Untimely premature hair graying (PHG) may tremendously influence on cosmesis, self-credibility, and social life of the affected individuals. Consequently, early treatment is required to improve cosmetic appearance. To the best of our knowledge, until today, only one case of PHG is reported in the literature, and it occurred due to iron deficiency and successfully treated with ferrous sulfate. Herein, we delineate a case of PHG in a 14-year-old female treated with the topical formulation of Melitane 5% and oral hair supplements which resulted in boosting improvement in hair color.

Retrospective Analysis of the Efficacy of 10,600nm Carbon Dioxide Laser Ablation for Small Congenital Melanocytic Nevi in Adults.

Carbon dioxide (CO2) laser ablation treatment generating 10,600nm of infrared radiation has shown promising results in patients with small-sized congenital melanocytic nevi (CMN). In this retrospective study, we evaluated the efficacy (Investigator's Global Assessment [IGA] score) and patient satisfaction for CO2 laser ablation for the treatment of small CMN in 17 adults. Of those treated with CO2 laser ablation, our findings indicate the average IGA and patient satisfaction scores were 6.41 and 3.76, respectively. Apart from these, 47.1 percent of cases obtained an IGA score of 7 and 76.5 percent of cases achieved a patient satisfaction score of 4. These results support the efficacy of CO2 laser ablation treatment and might help the clinician to guide treatment selection in patients who wish to avoid more invasive surgical options.

Localized unilateral basaloid follicular hamartoma along Blaschko's lines on face.

Basaloid follicular hamartoma (BFH) is a rare hamartoma of hair follicle. Clinical presentations may vary but are united by the same histopathological features in the form of folliculocentric basaloid or squamoid cell proliferation in the superficial dermis, which represents malformed and distorted hair follicles. It is important to recognize this entity as its simulant is basal cell carcinoma, a low-grade malignancy. Here, we report a case of localized unilateral BFH in a Blaschkoid distribution on the face of a 14-year-old female.

Complications of medium depth and deep chemical peels.

Superficial and medium depth peels are dynamic tools when used as part of office procedures for treatment of acne, pigmentation disorders, and photo-aging. Results and complications are generally related to the depth of wounding, with deeper peels providing more marked results and higher incidence of complications. Complications are also more likely with darker skin types, certain peeling agents, and sun exposure. They can range from minor irritations, uneven pigmentation to permanent scarring. In very rare cases, complications can be life-threatening.