Guidelines on the use of fifi nasteride in androgenetic alopecia.

Background: Finasteride is a widely used drug in dermatology for the treatment of androgenetic alopecia. There are many reports of associated sexual side effects. This article reviews the use of once-daily 1 mg fi nasteride in androgenetic alopecia and its associated sexual adverse effects. Methods: A literature search was performed to collect data on the use of fi nasteride in male pattern baldness. Relevant literature published till March 2014 was obtained from MEDLINE, EMBASE, CINAHL, Cochrane registers and LILACS. The keywords “fi nasteride”, “male pattern baldness” and “androgenetic alopecia” were used for literature search. Similarly, a search was done for fi nasteride in female pattern hair loss with keywords “female pattern baldness”, “fi nasteride” and “female pattern alopecia”. All systematic reviews, meta-analyses, national guidelines, randomized controlled trials, prospective open label studies and retrospective case series in the English literature were reviewed. Results: Two hundred sixty two studies were evaluated, twelve of which fulfi lled the inclusion criteria. Conclusions and Recommendations: Current evidence on the safety of fi nasteride indicates that it is safe but there is growing concern about its sexual side effects. In view of this, proper information should be provided to patients prior to starting treatment (Level of recommendation 1+, Grade of recommendation B). The reported sexual side effects are few and reverse with stoppage of the drug (Grade of recommendation B) but further studies are required.

Targeted phototherapy.

Background: Targeted phototherapy is a new form of phototherapy which has many advantages and disadvantages over conventional phototherapy. This article reviews the different technologies and outlines recommendations based on current evidence. Methods: A literature search was performed on targeted phototherapy to collect data. Relevant literature published till March 2014 was obtained from PubMed, EMBASE, and the Cochrane Library. Keywords like “targeted phototherapy”, “excimer laser”, “excimer lamp”, “Nonchromatic ultraviolet light”, “vitiligo”, and “psoriasis”, were used for literature search. All systematic reviews, meta-analysis, national guidelines, randomized controlled trials (RCT), prospective open label studies and retrospective case series in English were reviewed. Results: Three hundred and forty studies were evaluated, 24 of which fulfi lled the criteria for inclusion in the guidelines. Conclusions and Recommendations: All forms of targeted phototherapy are useful in vitiligo. Good responses were seen in localized involvement, resistant lesions and in children in whom their use is more accepted and convenient (Level of evidence 2+, Grade of recommendation B). Similarly it is useful in psoriasis, either alone or in combination with drugs, even in resistant forms such as palmoplantar psoriasis. In view of expense and practical application, their use is limited to resistant lesions and localized disease. (Level of evidence 2+, Grade of recommendation B). But in other conditions there is no convincing evidence for its use. (Level of evidence 3+, Grade of recommendation C).

Knowledge, Attitude And Practices Regarding AYUSH Among The Allopathic Doctors In Mandya District.

Abstracts: Background & Objective: Integration of complementary or alternative medicine (CAM) with allopathy medicine is a feasible solution to the human resource shortage in India. The scope of this integration will be influenced by the acceptance of CAM by allopathic practitioners. Objective is to assess the knowledge, attitude and practice regarding AYUSH system of medicine among medical officers in Mandya district. Methodology: A cross-sectional study was carried out over a period of 3 months involving 70 medical officers from various PHC in Mandya district. A pretested and structured questionnaire about the knowledge, attitude and practice regarding AYUSH was administered to all the medical officers. Data was entered in excel sheet and results were expressed in terms of percentage and proportions. Results: The average age of the study subjects was 34.85 ± 5.58 years. The most common source of information about AYUSH among study subjects was from colleagues/friends/ relatives. Only 35% of them had referred a patient to an Ayurveda practitioner and 35% had prescribed ayurveda medicines. Regarding the safety of ayurvedic medicine, 65% felt that ayurveda medicines need more scientific testing. Only 30% felt that AYUSH and allopathy should be integrated. Conclusion: The study concludes that the knowledge of the study subjects was inadequate; majority of them felt that ayurveda medicines need more scientific testing. Most of them were of the opinion that AYUSH and allopathy should not be integrated. But in practice nearly half of them were prescribing ayurveda medicines in their routine practice.

Giant congenital melanocytic nevus (bathing trunk nevus) associated with lipoma and neurofibroma: Report of two cases.

Giant congenital melanocytic nevi are rare and occur in about one out of every 2,00,000 to 5,00,000 births. There is a significant association between bathing trunk nevus and neurofibromatosis and lipomatosis. Apart from this, association of bathing trunk nevus with abnormalities like spina bifida occulta, meningocele, club foot and hypertrophy or atrophy of deeper structures of a limb, have been described. We are herewith reporting two cases of bathing trunk nevi. In our first case, an eight-year-old girl presented with a bathing trunk nevus studded with multiple, large nodules. Histopathological examination of the biopsy taken from one nodule revealed features of both neurofibroma and lipoma. To the best of our knowledge, features of both these hamartomas in one nodule of a single patient are probably not reported in the literature. In our second case, a 12-year-old girl presented with bathing trunk nevus and she had spina bifida occulta. She also had lipoma in the lesion of bathing trunk nevus. Both of our patients had satellite melanocytic nevi over the face, forearm, upper back and legs. Our second patient, in addition, had small melanocytic nevi over the medial canthus and sclerocorneal junction of the right eye. By the time this girl presented to us, the melanocytic nevus started fading in color and it had become brownish. We are reporting these cases for their peculiarities and for their rare features.

Three cases of Dowling Degos disease in two families.

Dowling Degos disease is a rare condition inherited as autosomal dominant trait characterized by numerous, asymptomatic, symmetrical, progressive, small, round-pigmented macules over axillae and groins, face, neck, arms and trunk, scattered comedo-like lesions (dark dot follicles) and pitted acneiform scars. Histopathology is diagnostic. We are hereby reporting three cases of Dowling Degos disease belonging to two families. Our first and second case belonged to the same family, whereas our third case belonged to different family. In our series, all the patients had onset after puberty. All three cases had reticulate pigmentation over face and/or flexures, black comedones and follicular pits. On histopathological examination of the skin biopsy taken from the lesion over the back, all these patients showed classical histopathological features of Dowling Degos disease. We feel that one should investigate the patient presenting with reticulate pigmentation over the face and flexures with blackish comedone-like lesions, because histopathological features of this condition are unmistakable.