Dermatologic care of the lesbian, gay, bisexual and transgender community of India.

Background In the Indian subcontinent, the lesbian, gay, bisexual, transgender, and queer community, commonly referred to as the third gender or transgender, is expected to exceed one million by 2030. Data on dermatologic conditions of the transgender population is deficient. Aims This study aimed to identify the common dermatological concerns and dermatologic procedures of the lesbian, gay, bisexual, transgender, and queer community of India. Methods This cross-sectional survey analysed the transgender participants of a non-institutionalised population in India via health camps that included 51 adult participants who self-identified as trans men and trans women. Results This study included 51 participants aged 20-49 years, of which the majority (94%) were trans women. The common dermatological problems were terminal hairs over the face, beard distribution, androgenetic alopecia, scars of gender-affirming surgeries, facial melanosis with topical steroid damaged skin and the need for facial feminisation procedures among trans women, while trans men had testosterone-related acne, androgenetic alopecia. Overall, 40.6% of participants reported dissatisfaction with one or more of their body parts. Laser hair removal was the most common gender-affirming dermatologic procedure. Conclusion This study provides an essential overview of the common dermatological conditions and procedures in the Indian lesbian, gay, bisexual, transgender, and queer community. Lesbian, gay, bisexual, transgender, and queer persons have insufficient access to dermatological services due to inadequate exposure and fear of discrimination. Even though transgender patients also present with similar dermatologic conditions as the general population, they have distinct cosmetic and treatment concerns during the period of transition owing to hormone-related or surgery-related changes. Addressing these challenges through enhancing dermatology residency training programs should be the focus of tomorrow. Limitations Considering convenience sampling and representative bias, further studies need to be conducted involving multiple study locations and larger sample sizes.

Risk of cutaneous carcinogenesis with phototherapy in Indian subpopulation: A 10-year analysis and a review of literature.

Phototherapy is an extremely effective and established therapeutic modality in a variety of dermatological disorders. However, there has been a constant concern with respect to its long-term usage as some of the studies have identified the risk of cutaneous malignancy associated with phototherapy. The carcinogenic potential of PUVA has been demonstrated in most US studies; however, the studies done on Asian and Arabian-African population have not corroborated similar findings, thus suggesting that the darker skin may confer protection against the development of cutaneous malignancy following phototherapy. The main aim of the present study was to assess the safety of phototherapy (bath PUVA and NBUVB) in Indian population (Fitzpatrick skin types IV and V) with respect to its carcinogenic potential and to determine the maximum cumulative dose that our patients could tolerate without developing any untoward complications such as cutaneous malignancy. All patients who received phototherapy between January 2006 and October 2016 were enrolled in the study. Details such as cumulative dose, number of phototherapy sessions received, indication for phototherapy, adverse effects such as pigmentary changes, new growths on the skin surface following the therapeutic sessions were entered in a predesigned proforma. This ambispective study had 1300 patients who had received phototherapy over a period of 10 years. A total of 929 patients had received PUVA, and the remaining 371 patients had received NBUVB for various dermatological indications. The average follow-up period for PUVA was 3 years and 6.5 years for NBUVB. The maximum cumulative dose of UVA and UVB that could be safely administered in our patients was 2085 J/cm2 and 1985 mJ/cm2, respectively. None of our patients developed any features of cutaneous malignancy during their follow-up. Both bath-PUVA and NBUVB are safe and efficacious in treating patients of darker skin types (IV and V). The risk of developing cutaneous malignancy is negligible in this subset of patients. However, more studies need to be done on the Asian population to substantiate the same.

Impact of a Psychodermatological Education Package on the Subjective Distress, Family Burden, and Quality of Life among the Primary Caregivers of Children Affected with Epidermolysis Bullosa.

BACKGROUND: Epidermolysis bullosa (EB) has profound effect on the subjective distress, family burden, and quality of life (QOL) of the primary caregivers (PCG). Knowledgeable PCG can efficiently manage children with these skin diseases and also improve their QOL. OBJECTIVES: To assess the subjective distress, family burden, and QOL, to develop and assess the short-term effectiveness of a psycho-dermatological education package (PDEP) for the PCG of children with EB. METHODS: In this interventional study, 30 PCG of EB were assessed for subjective distress, family burden, and QOL. PDEP, a structured educational tool explaining the disease and its care and stress management, was developed by the authors for the PCG and administered to them after one month of enrolment. They were reassessed after three months and compared with the baseline assessment scores. For comparison, 37 PCG of CI were also studied. RESULTS: The mean age (years) of the subjects was 28.7 ± 6.7 for EB and 30.5 ± 4.6 for CI. The mean or median (range) baseline scores for subjective distress, family burden and QOL of PCG (n = 20) of EB were 8.4 ± 7.9, 6.5 (0-30); 28.5 ± 17.5, 24 (7-77) and 12.6 ± 6.7, 11.5 (4-28) and for PCG (n = 14) of CI were 12 ± 4.3, 38.9 ± 16.2 and 17.7 ± 3.6 respectively. The PDEP improved the QOL (p = 0.01), knowledge (p < 0.01) and practices (p < 0.001) for PCG of EB and it improved subjective distress (p < 0.001), QOL (p < 0.01) and knowledge (p < 0.01) for PCG of CI. CONCLUSIONS: PDEP is an effective educational tool in improving the QOL and knowledge of PCG, which in turn provides efficient management and psychological support to children affected with EB and CI. It should, therefore, be routinely used for educating the PCG of children with EB and CI.

A Survey of Treatment Practices in Management of Psoriasis Patients among Dermatologists of Kerala.

INTRODUCTION: The management of psoriasis is a daily challenge for dermatologists as most patients present with varied morphological presentations and exacerbations at every visit. This exerts a heightened responsibility on the dermatologists to tailor their treatments according to each patient. AIMS: This study was conducted to assess the variation in treatment practices in the management of psoriasis patients among dermatologists of Kerala. MATERIALS AND METHODS: A questionnaire-based survey was conducted among the practicing dermatologists of Kerala, South India. CONCLUSIONS: At the end of this questionnaire-based study, we concluded that there is a wide variation in the treatment practices among practicing dermatologists of Kerala. Dermatology Life Quality Index (DLQI) is not assessed by majority of dermatologists while planning treatment. Most dermatologists rely on body surface area while planning treatment due to time constraints and did not perform PASI (Psoriasis Area and Severity Index) or PGA (Physician Global Assessment) scoring. Satisfaction and challenges related to current therapies also impact treatment rates. Our dermatologists adhered to their own individual guidelines while treating and expressed a dire need for a unified guideline.

Phototherapy in Vitiligo: Assessing the Compliance, Response and Patient's Perception about Disease and Treatment.

CONTEXT: Vitiligo is a chronic, benign, but emotionally frustrating autoimmune disorder of depigmentation, with an incidence of 0.25-2.5% in India, the treatment of which is equally frustrating to the patient, as well as the doctor. Phototherapy is the first line treatment in many cases, which needs to be given at frequent sittings for long periods of time. As there is no satisfactory, short term treatment, many vitiligo patients, though enthusiastic in the beginning, become defaulters after a few weeks or months. AIMS: This study was conducted to assess the compliance to phototherapy (PUVA and NB-UVB), determine the reasons for non-compliance, to calculate the overall response to phototherapy and to know about the patients' perception about improvement of lesions. MATERIALS AND METHODS: All files of the patients who attended phototherapy for Vitiligo in the department for a period of 4 years from January 2007 were analyzed and the patients were contacted via mail or telephone and were made to answer questionnaire regarding their disease. CONCLUSIONS: At the end of this retrospective questionnaire based study we concluded that only a quarter of the patients underwent regular phototherapy, among which the younger patients and those with widespread disease and facial lesions were more compliant. Educational status and sex had no impact on default status.