ABSTRACT
Acne is a chronic inflammatory skin disease that involves the pathogenesis of four major factors, such as androgen-induced increased sebum secretion, altered keratinization, colonization of Propionibacterium acnes, and inflammation. Several acne mono-treatment and combination treatment regimens are available and prescribed in the Indian market, ranging from retinoids, benzoyl peroxide (BPO), anti-infectives, and other miscellaneous agents. Although standard guidelines and recommendations overview the management of mild, moderate, and severe acne, relevance and positioning of each category of pharmacotherapy available in Indian market are still unexplained. The present article discusses the available topical and oral acne therapies and the challenges associated with the overall management of acne in India and suggestions and recommendations by the Indian dermatologists. The experts opined that among topical therapies, the combination therapies are preferred over monotherapy due to associated lower efficacy, poor tolerability, safety issues, adverse effects, and emerging bacterial resistance. Retinoids are preferred in comedonal acne and as maintenance therapy. In case of poor response, combination therapies BPO-retinoid or retinoid-antibacterials in papulopustular acne and retinoid-BPO or BPO-antibacterials in pustular-nodular acne are recommended. Oral agents are generally recommended for severe acne. Low-dose retinoids are economical and have better patient acceptance. Antibiotics should be prescribed till the inflammation is clinically visible. Antiandrogen therapy should be given to women with high androgen levels and are added to regimen to regularize the menstrual cycle. In late-onset hyperandrogenism, oral corticosteroids should be used. The experts recommended that an early initiation of therapy is directly proportional to effective therapeutic outcomes and prevent complications.
ABSTRACT
The human immunodeficiency virus (HIV) is associated with decreased immunity. There is depletion of CD4 cells. The objective of this study was to evaluate the effect of mycobacterium w on CD4 cell count in HIV + ve patients. A total of fifty patients were randomly assigned to one of the three treatment groups: (A) Mycobacterium w alone (n=17) (B) mycobacterium w plus two antiretroviral agents (n=16) (C) Mycobacterium w plus HAART (highly active antiretroviral therapy; (n=17). Mycobacterium w was administered intradermally at the dose of 0.1 ml in both deltoid region (first dose). The subsequent four doses of mycobacterium w were 0.1 intradermal in the deltoid region of one arm at monthly intervals. CD4 cell count in all the HIV + ve patients was measured at baseline and after five months period. CD4 counts was increased by 108.96%, compared to baseline, in the patients receiving both mycobacterium w and HAART, suggesting a synergistic action. However, significant increase (80.22% compared to baseline)was also seen in patients receiving mycobacterium w along, suggesting that myobacterium w was an effective immune response enhancer. Mycobacterium w was well tolerated by all patients.
