ABSTRACT
Psoriasis is a common skin disorder affecting approximately 1% of the general population. The treatment of psoriasis depends on the body surface area involvement, quality of life impairment and associated co-morbidities. Special population comprising of pregnant women, lactating mothers, elderly individuals and children, is more vulnerable. They are not included in drug trials; rendering the data for use of systemic treatment scant and is mainly based on anecdotal evidence. In this narrative review, we discuss systemic treatment options in this special population. Though couples planning a family are not considered a special population, they form a subset that require special therapeutic consideration and have also been included in this review.
ABSTRACT
Alopecia areata (AA) and trichotillomania (TTM) are the two common causes of localised non scarring alopecia. While AA is an autoimmune disorder, TTM is an impulse control disorder which makes the treatment of the two entities completely different. Trichoscopy is a non-invasive tool used to diagnose hair disorders, which not only is extremely helpful in diagnosing AA and TTM but also differentiates them from other hair disorders as well. The aim of our study is to describe the various trichoscopic features of AA and TTM and to compare the frequency of each trichoscopic feature in order to establish diagnostic clues for differentiating AA and TTM. Trichoscopy was performed on clinically diagnosed cases of AA and TTM with DL4 dermoscope and the images were analysed by 2 dermatologists independently. The frequency of trichoscopic features in AA and TTM was compared using chi square test. Twenty-four patients of TTM and 50 patients of AA were included in the study with mean age of AA being 30 years and mean age of TTM being 23.4 years. Exclamation mark hair, tapered hair, coudability hair, pigtail hair, clustered vellous hair, clustered regrowing hair and white hair were significantly more in alopecia areata. Conversely broken hair of different length, trichoptilosis, flame hair, mace hair, coiled hair, hair powder, fractured hair, v sign and burnt matchstick sign were the common features in TTM. To conclude, even though there is an overlap of trichoscopic features in AA and TTM, it is possible to distinguish the two if an assemblage of specific features are present.
ABSTRACT
Background: Melasma is a common dermatosis in both men and women showing varying degrees of success with treatment. Relapse of melasma is high in dark skin types, which necessitates the need for finding a modality of treatment, which not only treats but also prevents relapse. Aims: To study the effectiveness of platelet-rich plasma (PRP) in patients of melasma both clinically and dermoscopically in dark skin types. Materials and Methods: A prospective study of 20 female patients of Fitzpatrick skin type IV-V with mixed type of melasma and bilateral involvement of the face were enrolled for the study. PRP was injected intradermally at 4 weeks interval for three sittings, and the results were assessed clinically (by modified melasma area and severity score) and dermoscopically. Patients were counselled to ensure strict sun protection measures. Patient satisfaction was noted at baseline, 4 weeks, 8 weeks, and 12 weeks. Patients were followed up for 3 months to see for any relapse of the pigmentation. The follow-up showed no relapse of melasma in these patients. Statistical Analysis: Analysis of variance was used with Bonferroni correction for modified melasma area and severity score at various time interval. Subject global aesthetic improvement scale (SGAIS) and physician global esthetic improvement scale (PGAIS) were expressed in counts. P-value ≤ 0.05 was considered significant. Results: Modified melasma area and severity score and dermoscopic changes showed statistically significant improvement compared at the end of study in mild to severe cases. The subjective assessment was made by PGAIS. Patient satisfaction levels (assessed by SGAIS) also showed significant improvement in successive weeks of treatment. Few patients had mild redness and burning post procedure, which resolved spontaneously after few hours. Conclusion: From this study we concluded that PRP shows a significant improvement in melasma after 12 weeks of treatment with no relapse even after 3 months. Hence, PRP may be used not only as an adjuvant but also as a first line treatment in the view of longer sustained results when combined with strict sun protection. There is a paucity of studies showing results of PRP treatment in dark skin types, which is more resistant to treatment than lighter skin. Moreover, clinical improvement should not be the only parameter to decide on stopping treatment as chances of relapse can be higher. Dermoscopic evaluation helps in determining the changes in vasculature (telangiectasias) and pigmentation (dots and globules), which are better indicators of success of treatment.
