An Indian Expert Group Review of Acanthosis Nigricans with Recommendations for Early Detection and Timely Management.

INTRODUCTION: Acanthosis nigricans (AN) is a visible cutaneous manifestation of several underlying systemic conditions, such as prediabetes, diabetes mellitus (DM), polycystic ovarian syndrome (PCOS), metabolic syndrome (MS), and malignancy. AN is commonly seen in obese individuals and is a proven skin marker of insulin resistance (IR). Its typical clinical presentation and location, especially on the nape of the neck, allows for easy visual identification. Obesity, IR, and other noncommunicable diseases (NCD) are on the rise in India, with many cases being undiagnosed or missed. Every sixth diabetic in the world is Indian. AN can thus play a vital role in screening, early identification, and reduction of morbidity, especially of IR-related disorders. Currently, there are no national or international multidisciplinary guidelines or recommendations for AN. OBJECTIVE: To review published current literature and evidence on AN, its associations, and management. To recommend an approach to clinical identification of AN, associated/underlying disorders, investigations, and management, including lifestyle modifications. To sensitize and familiarize clinicians and healthcare workers across India with AN presentations. This will enable early detection of conditions such as IR, prediabetes, DM, PCOS, malignancy, etc., in practice and in the community. MATERIALS AND METHODS: The PCOS Society of India constituted a multispecialty Expert Working Group with representation from various national societies to review all published scientific evidence. Expert group meetings were conducted to provide recommendations. CONCLUSION: Acanthosis nigricans is a simple, non-invasive, cost-effective screening tool for early identification of IR. It is important to integrate and disseminate information and training on AN across medical specialties. The government of India has launched several National Health Programmes to help address the rising burden of NCD in the population. AN would provide a simple screening tool to pick up undiagnosed or missed cases.

Laser Skin Rejuvenation With Fractional 1064 Q-switched Nd:YAG In 252 Patients: An Indian Experience.

OBJECTIVE: The objective of our study was to present the results and safety profile of fractional 1064 Q-switched Nd: YAG laser treatment in skin rejuvenation in Indian patients with Fitzpatrick skin type III-VI. MATERIALS AND METHODS: We studied our clinical data of 252 patients who underwent treatment for facial skin rejuvenation with the Q switched Nd:YAG laser 1064 wavelength, using the fractional mode of 5mm spot size with fluences from 1.2 J ~ 2 J/cm2 and the energy ranging from 300-500 mJ, a repetition rate of 7Hz and pulse duration of 8 ns for 6 sessions at two weekly intervals. We evaluated results with the aid of clinical photography taken before start of treatment, on 3rd and 5th sessions along with patient satisfaction and dermatologist assessment scores. Any adverse events were also recorded. RESULTS: At the end of 6 sessions, both patients and dermatologists reported visible improvement in skin texture and tone. The laser sessions resulted in an immediate improvement in skin texture and tone in the first session itself that increased over 3 sessions and then stabilized. Transient erythema was reported in a few cases. No hypo- or hyperpigmentation were noted. CONCLUSIONS: The 1064 QSNYL is popularly used for skin rejuvenation especially in the Asian countries. But there is lack of substantial clinical data to validate the clinical results. We present the first study that shows the fractional 1064 Qswitched ND:YAG laser is a safe and effective option for skin rejuvenation in skin types III-VI.

Efficacy of a Low Fluence, High Repetition Rate 810nm Diode Laser for Permanent Hair Reduction in Indian Patients with Skin Types IV-VI.

Background: The study's aim is to evaluate the novel "in motion" technique for permanent hair removal using a low level fluence/high repetition rate on patients with a dark skin type over different areas of the body. Objectives: To assess fluence, accumulative energy, and number of treatments needed to achieve a significant hair reduction and patient satisfaction with minimal side effects, low discomfort levels, and high safety profile in a skin type IV-VI Indian patients. Methods: Seventy-one Indian female patients with skin type IV-VI were enrolled in the study. All patients were treated with a low fluence, high repetition rate 810nm diode laser using a predetermined set of parameters for 5 to 6 treatments in 1- to 3-month intervals. Hair reduction was measured by patients' satisfaction and all adverse effects were documented. Results: Results obtained a high degree of patient satisfaction and a very low record of adverse events. Treatments were complication-free for dark skins and a reasonable schedule or sessions and intervals. The discomfort during the sessions was negligible.