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.

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.

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.

Fractional Carbon Dioxide Laser versus Fractional Carbon Dioxide Laser with Autologous Intralesional Platelet-rich Plasma in the Treatment of Stable, Non-segmental Vitiligo: A Randomized Comparative Study.

BACKGROUND: The treatment of vitiligo is often challenging and requires a multi-modality approach. Fractional carbon dioxide (FCO2) laser has been studied as an adjuvant therapy in cases of vitiligo. Autologous platelet-rich plasma (PRP) is rich in growth factors, which may contribute to the growth of melanocytes, and thus help in the repigmentation of vitiligo patches. We aimed to study the combination of these two modalities for the treatment of vitiligo. AIMS AND OBJECTIVE: The aim of this study was to compare the efficacy and safety of FCO2 laser with PRP and FCO2 laser alone as an adjuvant therapy in stable non-segmental vitiligo (NSV) patients. SETTINGS AND DESIGN: A prospective, randomized, comparative, open-label interventional study was carried out for a period of 18 months from December 2017 to June 2019, at a tertiary care hospital. MATERIALS AND METHODS: Seventy patients with stable, NSV were assessed for eligibility; 66 patients were randomized equally into two groups. Group A received treatment with FCO2 laser with intralesional PRP, whereas Group B was treated with FCO2 laser alone. Patients in both the groups were treated with one therapy session and were followed up monthly for a period of 3 months. All the patients received topical psoralen with ultraviolet A (UVA) PUVA-sol treatment. Baseline and monthly assessments were done by VITILIGO AREA SEVERITY INDEX and standardized photographs. RESULTS: VASI score reduction was significantly more in the Group A with (mean ± standard deviation [SD]) 9.5 ± 0.22, 5.8 ± 1.12, and 3.6 ± 1.81 as compared to Group B 11.9 ± 2.83, 9.9 ± 3.11, and 8.9 ± 3.46 at each subsequent follow-up visits, respectively. Side effects such as burning sensation, erythema, and crusting were seen less frequently and lasted for a short period in Group A in comparison to those in Group B. CONCLUSION: Combination of FCO2 laser and autologous intralesional PRP has a synergetic effect in treating patients with vitiligo as an adjuvant therapy with minimal adverse effects.

Clinicomycological Study of Dermatophytosis in a Tertiary Care Hospital in Eastern India: A Cross-sectional Study.

INTRODUCTION: Dermatophytosis is a fungal infection of the skin, hair, and nails. In the past several years, it has emerged as a general public health problem in our country. Studies from different regions reveal varying patterns of etiological distribution of the disease. AIMS AND OBJECTIVES: To estimate the prevalence of different fungal species associated with dermatophytosis and to find out any possible association of the type of fungus with different clinical parameters of the disease. MATERIALS AND METHODS: This was a cross-sectional study among 311 clinically diagnosed dermatophytosis cases from a tertiary care center in eastern India. Potassium hydroxide (KOH) mount and fungal culture were done from samples of skin, hair, and nails, and various clinical parameters were analyzed. RESULTS: There was a male preponderance among cases and maximum patients belonged to third decade of life. Most common presentation was tinea corporis et cruris (39.5%). Family history was positive in 48.8% of cases. Trichophyton mentagrophytes was the most common fungal species (79.91%) grown in culture followed by Trichophyton rubrum (13.53%). Majority of patients had a mild body surface area involvement. We did not find statistically significant association of any clinical parameters with type of organism isolated. CONCLUSION: Trichophyton mentagrophytes was the most common isolated fungal species. This is in contrast to several studies where T.rubrum was the frequently found organism. There was no significant association of any clinical parameters like body surface area, number of sites, or duration of diseasewith fungal species isolated in culture.

Association of Skin Tag with Metabolic Syndrome and its Components: A Case-control Study from Eastern India.

BACKGROUND: Skin tags are benign polyps, usually found in the natural folds of the skin. Some studies have found an association of skin tags with obesity, diabetes, hypertension, and atherogenic lipid profile. Metabolic syndrome refers to co-occurrence of these cardiovascular risk factors such as insulin resistance, obesity, dyslipidemia, and hypertension. AIMS AND OBJECTIVES: To find out any possible association of skin tags with metabolic syndrome and its components. MATERIALS AND METHODS: A case-control study was conducted including 140 participants. Seventy patients with skin tags were considered cases, and 70 age- and sex-matched patients without skin tags were considered as controls. Various anthropometric and biochemical parameters were compared and analyzed between the two groups. RESULTS: Univariate analysis revealed significantly higher waist circumference, high triglyceride, and low high-density lipoproteins (HDLs) in cases compared to controls. The prevalence of diabetes, hypertension, and metabolic syndrome was significantly higher in patients with skin tags, and risk of developing metabolic syndrome was 11.13 times higher in cases compared to controls (P < 0.05). Multivariate logistic regression analysis revealed high waist circumference and low serum HDL had significant association with skin tags. CONCLUSION: Risk of development of metabolic syndrome is significantly higher in patients with skin tags. Among the various components of metabolic syndrome, only high waist circumference and low serum HDLs are significantly associated with skin tags.

Narrow-band UVB Phototherapy does not Consistently Improve Quality of Life in Psoriasis Patients: A Prospective Observational Study from Eastern India.

INTRODUCTION: Psoriasis is a chronic inflammatory and proliferative condition of the skin which is well-known to impair the patients' quality of life (QoL). Of the various treatment modalities, narrowband UVB (NBUVB) phototherapy is one of the standard treatments for moderate to severe plaque psoriasis with minimal side-effects compared to other systemic therapies. OBJECTIVES: To study whether NBUVB phototherapy administration improves QoL in plaque-type psoriasis and to find the correlation between clinical severity of psoriasis and patients' QoL by using psoriasis area severity index (PASI), dermatology life quality index (DLQI), and psoriasis disability index (PDI) tools before and after NBUVB phototherapy. MATERIALS AND METHODS: Thirty-seven patients with plaque psoriasis involving >10% of body surface area (BSA) underwent NBUVB phototherapy thrice weekly for 36 sessions. Clinical severity of psoriasis was assessed by PASI and impact of psoriasis on quality of life by DLQI and PDI. Assessment was done at the baseline, 18th, and 36th session. RESULTS: After 36 sessions of NBUVB phototherapy, mean reduction in PASI was 79.6% which was statistically significant. On the other hand, DLQI and PDI did not show significant improvement and did not correlate with PASI. CONCLUSION: NBUVB phototherapy reduces clinical severity of psoriasis. However, clinical severity and QoL impairment is independent of one another. DLQI and PDI do not improve proportionate to clinical improvement.

Suction Blister Epidermal Grafting for Vitiligo Involving Angles of Lip: Experience of 112 Patients.

BACKGROUND: Lip vitiligo is usually resistant to medical modalities of treatment, and in all these cases, surgery offers a hope. Suction blister grafting (SBG) has been tried since long for lip vitiligo with high rate of success. There have been no long-term follow-up studies of patients with SBG at a difficult-to-treat site like angles of lip, which prompted us to conduct this study. AIMS AND OBJECTIVES: To assess the pigmentation rate and patient satisfaction of SBG on vitiligo involving angles of lip. MATERIALS AND METHODS: This is a prospective study conducted on 112 patients with stable vitiligo involving angles of lip. SBG was carried out in all the patients using the standard procedure. Patients were advised to apply topical psoralen followed by sun exposure (PUVASOL) for 8-12 weeks after operation. The patients were followed up at 3, 6, 12, 18, and 24 months for assessment of pigmentation and overall satisfaction. RESULTS: We found a pigmentation success rate of 83.7%, 84.9%, 85.7%, 78.3%, and 77.8% in the patients who were followed up at 3, 6, 12, 18, and 24 months, respectively. A total of 77.8% of patients who came for follow-up at the end of 24 months were very happy with the treatment. DISCUSSION: Our data show clearance of vitiligo and persistence of pigmentation gained through SBG in 77.8% of cases at the end of 2 years as well as excellent patient satisfaction in the cohort of patients who followed up with us. CONCLUSION: SBG is an easy and cost-effective way of repigmentation of vitiligo involving angles of lip.

Fractional CO2 Laser vs Fractional CO2 with Topical Platelet-rich Plasma in the Treatment of Acne Scars: A Split-face Comparison Trial.

BACKGROUND: It is a challenge to treat acne scars and a multimodal combination approach is necessary. While fractional CO2 lasers (FCLs) are an established treatment option, the role of platelet-rich plasma (PRP) in the treatment of acne scars is not established though it is being used extensively in other fields of medicine owing to its healing properties. We combined the two methods to assess the proposed synergistic action on acne scars. AIMS AND OBJECTIVES: To evaluate the effect of FCL alone vs FCL combined with PRP on the quality of acne scars. MATERIALS AND METHODS: This is a left-right split-face comparison study with 30 patients with moderate-to-severe acne scars. The patients underwent three sessions of FCL and FCL + topical PRP on right and left sides of the face, respectively, at monthly intervals. RESULTS: There was significant improvement on both sides of the face (right side, P = 0.001; left side, P = 0.0001), but the difference between the right and the left sides of the face was not statistically significant (P = 0.2891). The symptoms of redness, edema, and pain on the treated areas with laser were significantly lesser on the FCL + PRP (left) side as compared to the FCL-only (right) side. CONCLUSION: Both methods were effective in management of acne scars. Addition of PRP does not improve the scar quality; however, the downtime and inflammation associated with laser treatment gets significantly reduced on the PRP-treated side.

Mucous membrane graft for cicatricial ectropion in lamellar ichthyosis: an approach revisited.

A 26-year-old woman with congenital lamellar ichthyosis presented with bilateral cicatricial ectropion of the upper and lower eyelids. There was severe exposure keratopathy with corneal perforation in the left eye. The generalized skin involvement necessitated the use of an alternative to correct the cicatricial ectropion. Mucous membrane graft harvested from the oral cavity was used to correct the cicatricial ectropion of upper and lower eyelid of both eyes. Six months after treatment, the mucous membrane graft was keratinized and a significant reduction in lagophthalmos was seen. Mucous membrane graft offers a promising alternative to correct cicatricial ectropion in lamellar ichthyosis.

Methotrexate in resistant ENL.

This is a report of a case of steroid resistant severe Type 2 reaction that was managed with methotrexate and prednisolone. Synergistic action of both the drugs in severe Type 2 reaction make them one of the preferred combinations in the absence of other agents such as thalidomide.