Patient Perspectives of the Impact of Psoriatic Disease on Quality-of-Life in India: Sub-analysis from the Global Psoriasis and Beyond Survey.

Background: Psoriatic disease (PsD), including plaque psoriasis (PsO) and psoriatic arthritis (PsA), comprises a wide spectrum of manifestations and significantly impacts quality-of-life (QoL). Here, we assessed patients' understanding of PsO and PsA as a systemic disease, its impact on their physical and emotional well-being, and patients' experiences with healthcare professionals for shared treatment decision-making. Materials and Methods: The Global Psoriatic Disease and Beyond Survey was a cross-sectional, qualitative, online survey conducted on patients with moderate-to-severe PsO with/without concomitant PsA. This analysis reports findings from Indian patients. Results: Of the 261 surveyed patients, 27% with PsO reported concomitant PsA, of whom 89% reported PsA severity as moderately or highly active. Overall, 92% had heard the term "PsD," and 90% knew their condition was a systemic disease. Few were aware of PsD manifestations (palmoplantar psoriasis, 49%; nail psoriasis, 43%; axial symptoms, 40%; PsA, 34%) and comorbidities (cardiovascular disease, 33%; obesity, 30%; diabetes, 28%). Eighty-nine percent of patients indicated their skin problems had a "very-large" to "extreme-large" impact on QoL. Ninety-seven percent of patients experienced discrimination and stigmatization from others. Eighty-one percent of patients were not involved in deciding treatment goals. Few (PsO, 6%; PsA, 9%) patients were dissatisfied with current treatment; ≥50% patients reported incomplete relief of skin symptoms (PsO) and joint symptoms (PsA) as the reason for dissatisfaction. Conclusion: Lack of awareness of the manifestations and comorbidities associated with PsD and poor QoL highlights the need for patient education, shared treatment decision-making, and a multidimensional approach to PsD management in India.

Prescribing Patterns in the Treatment of Topical Steroid Damaged Face Patients: A Cross-Sectional, Survey-Based Observational Study among Practicing Dermatologists in an Eastern State of India.

Introduction: Topical steroid damaged face (TSDF) is a common occurrence in the current scenario, where darker - skinned people believe having lighter-colored skin improves their prospects in all aspects of life. This has led to the abuse of topical corticosteroids with unrealistic expectations driven by ignorance of the adverse effects, particularly in the Indian population. As TSDF is virtually an epidemic in India and there is no treatment protocol for dermatologists, we conducted this study to find out what dermatologists prescribe and, in turn, serve as a foundation to develop guidelines in the future. Materials and Methods: Forty dermatologists from Odisha, India, were selected to complete the questionnaire, containing 18 questions about diagnosis, treatment and necessary referral for ocular complications. Results: All participants were frequently diagnosing and treating TSDF. A total of 92.5% of the participants preferred initiating systemic therapy with isotretinoin or doxycycline as the drug of choice. Clindamycin and tacrolimus were preferred by 55% and 50% of participants, respectively, as the topical drug of choice. A total of 62.5% of the participants advised physical sunscreens and mild cleansers to be used with water at room temperature to wash their face. To reduce facial erythema, brimonidine was advised by 45% of participants. Conclusion: Standardized guidelines for managing TSDF are the need of the hour.

The Efficacy and Safety of High Dose (10 mg) of Desloratadine (Dazit® 10) in the Treatment of Chronic Spontaneous Urticaria in India: A Phase III, Multicentric, Open-Label, Single-Arm Study.

BACKGROUND: Chronic spontaneous urticaria (CSU) is a debilitating affliction that affects diverse quality of life (QoL) parameters such as sleep, self-esteem, and daily activities. Second-generation antihistamines, such as desloratadine, are more effective and safer in managing CSU. Desloratadine is a nonsedating, potent, and highly selective H1 receptor antagonist. At its daily dose of 5 mg, almost half of CSU patients do not show symptomatic improvement. European Academy of Allergy and Clinical Immunology (EAACI)/Global Allergy and Asthma European Network (GA2LEN)/European Dermatology Forum (EDF) (EuroGuiDerm)/Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI) guidelines recommend increasing the dosage to up to four times in such nonresponsive patients. However, there is insufficient clinical evidence in Indian settings. METHOD: We evaluated the efficacy and safety of 10 mg desloratadine (OD) in 256 nonresponsive patients with moderate to severe CSU. The primary outcome was the change in Urticaria Activity Score (UAS7) from baseline to four weeks. Additionally, change in Chronic Urticaria Quality of Life (CU-Q2oL) scores during the course of treatment was also evaluated. RESULT: The mean UAS7 scores showed a significant reduction from 31.9 ± 4.8 at baseline to 18.2 ± 8.1 at the end of the study (p < 0.0001). The use of a higher dose of desloratadine also decreased the CU-Q2oL scores significantly from 59.8 ± 14.7 at baseline to 35.4 ± 10 at four weeks (p < 0.0001). The incidence of adverse events (AEs) possibly linked to the drug was low (1.6%), and no serious adverse events were reported. CONCLUSION: Results indicated improvements in the disease severity as well as its positive impact on participants' QoL. This study confirms the efficacy and safety of daily use of a twofold dose of desloratadine in nonresponsive moderate to severe CSU patients.

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.

10% Thioglycolic Acid Peel in the Treatment of Pigmented Purpuric Dermatoses: A Pilot Study.

Pigmentary purpuric dermatosis (PPD) is a chronic dyspigmentation characterized by reddish-brown, irregular maculae with dermal hemosiderin deposition, usually affecting the legs. The -SH group in the thioglycolic acid (TGA) strongly binds to iron molecule, solubilizes it, and clears the pigment. We conducted a longitudinal, right-left leg study for assessing the effectiveness and side effects of TGA 10% peel in treating PPD. For preparation of 10% TGA peel, 80% TGA was diluted with distilled water to 10% concentration by mixing 0.5 mL of acid with 3.5 mL of water before every peel session. The peel was applied on the left leg, weekly for 6 weeks. Assessment was done at baseline and at weeks 3 and 6. Any improvement was noted by the patient and another independent dermatologist. The right leg was untreated. Any side effects during peel application and afterwards were noted. According to the patient assessment, 4/10 patients observed mild improvement, 5/10 patients had moderate improvement, and only a single patient had marked improvement. In the physician assessment, 2/10 patients had >50% improvement, 5/10 patients had 30-40% improvement, and 3/10 patients had 10-20% improvement. Side effects included slight burning during application and foul odor. A single patient had intense erythema and mild swelling of the leg after peel application. 10% TGA is effective in the partial clearance of PPD dyspigmentation with weekly sessions for 6 weeks without any serious side effects.

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.

Stewart-Treves Syndrome in the Lower Limb after Arthroplasty- A Case Report.

Stewart-Treves Syndrome is a rare and fatal condition where cutaneous angiosarcoma-a high-grade malignant tumor originating in the vascular and lymphatic endothelium-classically develops in the upper limbs post-mastectomy, with radiation therapy and axillary lymph node dissection. There are very few reports of the syndrome developing in the lower limbs, without any preceding malignancy or radiation therapy. The median development time is 11 years. Angiosarcoma originates in the vascular and lymphatic vessels, and the diagnosis is based on histopathology and immunohistochemistry findings. We report an unusual presentation of the Stewart-Treves Syndrome in an elderly female involving the lower limb with preexisting chronic lymphedema, where the tumor developed 15 months after total knee arthroplasty.

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.