Photochemotherapy (PUVA) in psoriasis and vitiligo.

Phototherapy with photochemotherapy (PUVA) is a well‑known and well‑studied modality for the treatment of psoriasis, which involves systemic or topical administration of chemicals known as psoralens and administration of ultraviolet light in increasing dosages after requisite time gap. PUVA is also used in the treatment of widespread vitiligo with moderately good results, though it is being surpassed by ultraviolet B (UVB), which is equally or slightly more efficacious with fewer side effects. PUVA induces repigmentation by varying mechanisms such as stimulation of melanogenesis, immunomodulation and activation of growth factors, though the exact mechanism is still speculative. There are various studies evaluating the efficacy of PUVA in psoriasis as well as in vitiligo, either alone or in combination with other immunosuppressants like azathioprine and calcipotriene.

Efficacy and safety of Erbium-doped Yttrium Aluminium Garnet fractional resurfacing laser for treatment of facial acne scars.

Background: Treatment of acne scars with ablative fractional laser resurfacing has given good improvement. But, data on Indian skin are limited. A study comparing qualitative, quantitative, and subjective assessments is also lacking. Aim: Our aim was to assess the improvement of facial acne scars with Erbium-doped Yttrium Aluminium Garnet (Er:YAG) 2940 nm fractional laser resurfacing and its adverse effects in 25 patients at a tertiary care teaching hospital. Methods: All 25 patients received four treatment sessions with Er:YAG fractional laser at 1-month interval. The laser parameters were kept constant for each of the four sittings in all patients. Qualitative and quantitative assessments were done using Goodman and Barron grading. Subjective assessment in percentage of improvement was also documented 1 month after each session. Photographs were taken before each treatment session and 1 month after the final session. Two unbiased dermatologists performed independent clinical assessments by comparing the photographs. The kappa statistics was used to monitor the agreement between the dermatologists and patients. Results: Most patients (96%) showed atleast fair improvement. Rolling and superficial box scars showed higher significant improvement when compared with ice pick and deep box scars. Patient's satisfaction of improvement was higher when compared to physician's observations. No serious adverse effects were noted with exacerbation of acne lesions forming the majority. Conclusion: Ablative fractional photothermolysis is both effective and safe treatment for atrophic acne scars in Indian skin.Precise evaluation of acne scar treatment can be done by taking consistent digital photographs.

A double blind randomized pilot clinical trial comparing the safety, tolerability and efficacy of combination of topical sodium fusidate and betamethasone valerate in biopolymer versus combination of fusidic acid and betamethasone valerate in the treatment of infected eczema.

Background: Eczema or dermatitis is a reaction pattern of the skin manifesting as itching, inflammation, redness, and swelling of the skin. There is currently no cure for eczema, but the condition can be controlled with a good treatment plan and newer strategies in formulation of existing drug can improve efficacy and acceptability. Aims: To evaluate the efficacy, tolerability and safety of topical Sodium Fusidate and Betamethasone Valerate in biopolymer Versus Combination of Fusidic acid and Betamethasone Valerate in the Treatment of Infected Eczema. Methods: This was a 6 week study in which patients had screening and randomization visit (day 0, visit 1), treatment assessments visits at week 2 (visit 2) and week 4 (visit 3) and a follow-up visit (visit4). The blinded medication was dispensed to patients. During visit 2 (after 2 weeks), a detailed skin examination and modified eczema scoring (12 points eczema score and 12 points of infection score with total of 24 points), Visual analogue scale for pruritus and global score index were carried out. Any adverse event was recorded. During visit 3 (week 4), clinical examination and laboratory examination (Hb%, TC, DC, ESR) was performed. Adverse events and patient compliance were also recorded during these visits. Results and Conclusions: Topical sodium fusidate and betamethasone valerate in biopolymer has shown to be more efficacious than topical sodium fusidate and betamethasone valerate. Both the combinations were well tolerable and safe.

Cutaneous metastases from carcinoma breast: The common and the rare.

Cancer metastasis is quite devastating to the patient as well as the physician and may herald the onset, dissemination or recurrence of malignancy. Breast carcinoma metastasis is the most common carcinoma encountered by dermatologists and it presents in various morphological and histological forms. Here, we present two varied cases, the first being the common nodular metastasis from a previously treated intraductal carcinoma and the second, the rarer variant, carcinoma erysipeloides as a heralder of the invasion of an incompletely treated disease.

Chronic idiopathic urticaria: comparison of clinical features with positive autologous serum skin test.

BACKGROUND: Chronic idiopathic urticaria (CIU), in its extremely severe form, can pose a therapeutic challenge to the treating physician. It has been noted that in one third of such patients, autoantibodies against the IgE receptor are seen and such patients have more severe and unremitting urticaria. AIM: To compare clinical features of autoimmune urticaria with those of other CIU patients. METHODS: We conducted a prospective study in an attempt to correlate the clinical features with autoantibodies, indirectly detected via the autologous serum skin test (ASST), which is the simplest and the best in vivo clinical test for detection of basophil histamine-releasing activity. DISCUSSION: Out of 100 patients with chronic idiopathic urticaria, 34 showed a positive reaction to the autologous serum skin test and it was found that the frequency and severity of attacks was higher in these patients. CONCLUSION: ASST may be used as a simple and cost-effective test for the classification of chronic urticaria, which has proven to be a therapeutic challenge to the treating physician.