Efficacy of 810 nm diode laser in hair reduction in Indian subpopulation using a novel Gabor filter-based detection software and hair algorithm.

BACKGROUND: Diode laser (810 nm) is frequently employed for hair reduction. There are few studies determining the efficacy in Indian population. OBJECTIVES: Assessment of efficacy and safety of 810 nm diode laser in facial/axillary hair reduction and objective assessment of the improvement with dermoscopy, photographs, and novel Gabor filter-based hair detection algorithm. METHODOLOGY: This hospital-based study included 40 adult women with 108 treatment sites over 5.4 sessions (range 4-8). Evaluation of treatment areas (hair texture, density) was done using modified Ferriman-Galwey scoring. Photography and dermoscopic images were taken before each session and 6 weeks after the last. Immediate and delayed adverse reactions were noted. Assessment of efficacy was done by patient, principal, and blinded investigator using Global Aesthetic Improvement scale (GAIS) and hair detection algorithm (evaluating characteristics of dermoscopic hair). RESULTS: The fluences ranged from 16 to 29 Joules/cm2 with pulse width of 30 ms. Upper lip (n = 29, 26.9%) and chin (n = 25, 22.1%) were commonly treated areas. Improvement in hair texture and density (reduction in uniformly distributed, terminal hair from 37.1% to 13.9%) was statistically significant (p < 0.0001). Excellent improvement of 75-100% (GAIS) was noted by principal and blinded investigator in 24.1% and 33.3% total sites, respectively. The median improvement, calculated by the algorithm, was 60% for side locks, 53.9% for axilla, 24.1% for upper lip, and 14.9% for chin. Axilla and upper lip were sites associated with maximum discomfort. Epidermolysis and paradoxical hypertrichosis were seen in five patients each. CONCLUSION: The 810 nm diode laser is safe and effective in the reduction of dark, coarse terminal hairs in Fitzpatrick skin types III-V. Inter-observer variation and investigator bias in the assessment of efficacy can be successfully overcome by using the algorithm.

Guidelines for bath PUVA, bathing suit PUVA and soak PUVA.

BACKGROUND: The aim of these guidelines is to encourage dermatologists to use bath psoralen plus ultraviolet A (PUVA), bathing suit PUVA and soak PUVA in the treatment of psoriasis vulgaris and other conditions. METHODS: Evidence was collected using searches of the PubMed, MEDLINE and COCHRANE databases using the keywords "bath PUVA," "soak PUVA," "bathing suit PUVA" and "turban PUVA." Only publications in English were reviewed. RESULTS: One hundred and thirty-eight studies were evaluated, 57 of which fulfilled the criteria for inclusion. CONCLUSIONS: Both bath PUVA and bathing suit PUVA are very effective and safe treatments for generalized stable plaque psoriasis (strength of recommendation, A). Soak PUVA is very effective in the treatment of both palmoplantar psoriasis and chronic palmoplantar eczema (strength of recommendation, A).

Anything Rare is Possible: Letrozole Induced Eczematous Skin Eruption.

Letrozole is used as first line drug in postmenopausal women with early-stage or advanced hormone-sensitive breast cancer. Letrozole has favourable tolerability profile when administered once daily and significant adverse reactions occur rarely. The objective of this report is to describe a case of eczematous skin eruption that occurred during letrozole treatment. A 61-year-old female patient was admitted with lump in the left breast. FNAC, HPE were done and the patient was diagnosed to have invasive ductal breast carcinoma. After a month of completing CT and EBRT, the patient was given 2.5 mg OD tab. letrozole at night. She developed itchy skin lesions over the right thigh that later generalised, at 6- weeks of treatment. The lesion has been defined as eczematous moderate to severe drug eruption. These lesions were attributed to letrozole therapy and recurred within 24h after rechallenge. Drug eruption is associated with many drugs but this is the first such report with letrozole. We suggest of being aware of such reactions during letrozole usage.

A simple instrument designed to provide consistent digital facial images in dermatology.

Photography has proven to be a valuable tool in the field of dermatology. The major reason for poor photographs is the inability to produce comparable images in the subsequent follow ups. Combining digital photography with image processing software analysis brings consistency in tracking serial images. Digital photographs were taken with the aid of an instrument which we designed in our workshop to ensure that photographs were taken with identical patient positioning, camera angles and distance. It is of paramount importance in aesthetic dermatology to appreciate even subtle changes after each treatment session which can be achieved by taking consistent digital images.

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.

Erythema elevatum diutinum associated with scleritis.

Erythema elevatum diutinum (EED) is a chronic and rare variant of leukocytoclastic vasculitis that is being reported nowadays frequently in association with HIV infection. It clinically manifests as asymptomatic to tender erythematous papules, plaques and nodules, usually with acral distribution and is rarely accompanied by systemic complaints other than arthralgia. The reported associations include preceding upper respiratory infections, hematological malignancies, lymphomas and monoclonal gammopathies. Here we report a 45 year old man with multiple joint pains, tender nodules over palms and soles and ocular pain and congestion, who was subsequently diagnosed as a case of EED and scleritis following histopathological examination. Skin as well as ocular complaints completely subsided with Dapsone monotherapy.

Erythema nodosum leprosum as the presenting feature in multibacillary leprosy.

Leprosy is an ancient disease that has survived into the modern ages despite an intense effort to eliminate it worldwide. Here we report a case of a 32-year-old woman who had recurrent painful nodules of six months duration. Because of a lack of lesions suggestive of leprosy, she was initially diagnosed to have cutaneous vasculitis and erythema nodosum. However, because of the persistent nature of her condition she was later detected to have leprosy and erythema nodosum leprosum (ENL) with the aid of simple diagnostic tests.

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.

Epithelioid sarcoma: a diagnostic challenge.

Epithelioid sarcoma is an uncommon slow-growing soft tissue malignancy, associated with a high incidence of local recurrence and metastasis. We report a 26-year-old male with epithelioid sarcoma on the right palm with a long history of over seven years, which was initially misdiagnosed as cutaneous tuberculosis and epithelioid hemangioendothelioma, as a result of which the treatment was delayed. No metastasis was found in our patient. The patient was referred to the oncology centre where he underwent wide excision of the lesion followed by radiotherapy. The review of the literature including clinical and histological differential diagnosis is presented as it mimics inflammatory, benign tumors as well as other malignant conditions.