Shedding Light on Acne Scars: A Comprehensive Review of CO2 vs. Erbium-Doped Yttrium Aluminium Garnet (Er:YAG) Laser Therapy.

Acne scars pose a significant cosmetic concern and can have a profound impact on individuals' self-esteem and quality of life. Laser therapy has emerged as a promising treatment modality for improving the appearance of acne scars by promoting collagen remodeling and tissue regeneration. This comprehensive review compares two commonly used laser modalities, CO2 and erbium-doped yttrium aluminum garnet (Er:YAG), focusing on their mechanisms of action, efficacy, safety profiles, and patient outcomes. While CO2 lasers offer deeper tissue penetration and the potential for more significant improvement in severe acne scars, Er:YAG lasers provide a gentler approach with a lower risk of post-inflammatory hyperpigmentation. Recommendations for clinical practice include tailoring treatment approaches to individual patient characteristics, educating patients about treatment expectations and post-treatment care, considering combination therapies for enhanced outcomes, and implementing regular follow-up care. Areas for further research include long-term outcome studies, investigation of laser therapy in ethnically diverse populations, exploration of combination therapies, and evaluation of emerging laser technologies. This review aims to provide clinicians and patients with valuable insights to inform treatment decisions and optimize outcomes in managing acne scars.

Drug-Induced Pseudoporphyria: A Case Report.

Pseudoporphyria is an uncommon dermatosis resembling porphyria cutanea tarda (PCT). The exclusion of true porphyria, especially PCT, is critically essential for diagnosing pseudoporphyria. It has an unknown underlying pathophysiology with a normal or near-normal porphyrin profile. Pseudoporphyria has been associated with chronic renal failure and hemodialysis, medications, and tanning beds. In drug-induced pseudoporphyria cases, eliminating the suspected photosensitizing drug improves the disease typically within weeks to months (on average eight weeks). In genetically predisposed individuals, phototoxic metabolites may trigger the development of skin fragility, bullae, milia, and scarring on the dorsum of the hands and other sun-exposed areas. Wearing a broad-spectrum sunscreen and maintaining strict ultraviolet protection is essential in cases of pseudoporphyria. We report the case of a 20-year-old male who presented to us with complaints of photosensitivity and multiple erosions with irregular scars over photo-exposed areas involving the dorsum of the hands and face predominantly. The patient was evaluated further to determine the underlying cause. A wood's lamp examination of the urine was done, which did not show fluorescence. Based on clinical and laboratory findings, the diagnosis of pseudoporphyria was made, and the patient was started on the oral antimalarial agent hydroxychloroquine sulfate with strict sun protection.

Efficacy of Microneedling and CO2 Laser for Acne Scar Remodelling: A Comprehensive Review.

Acne scarring is a prevalent issue affecting millions worldwide, with significant psychological and social implications. Microneedling and CO2 laser therapy have emerged as promising modalities for acne scar remodelling. Microneedling induces controlled micro-injuries to stimulate collagen production, while CO2 laser therapy precisely ablates scar tissue. This comprehensive review evaluates the efficacy, safety, and comparative benefits of microneedling and CO2 laser therapy. Literature synthesis reveals both modalities to improve acne scars, albeit with different mechanisms and risks. Factors influencing treatment selection and the role of combination therapy are discussed. Future directions include optimising protocols and exploring novel techniques. Overall, microneedling and CO2 laser therapy offer valuable options for acne scar management, empowering individuals to address the physical and emotional burden of scarring.

Successful Management of Folliculitis Decalvans.

Folliculitis decalvans (FD) is a rare disease that causes inflammation on the scalp, leading to scarring alopecia. It commonly affects young and middle-aged men and is characterized by pustules, papules, scarring, hemorrhagic crusts, and erosions. The exact cause of FD is not fully understood, but it is believed that Staphylococcus aureus may play a role in its development. The condition is thought to be influenced by a combination of genetic, allergic, infectious, and immunological factors. This report describes a 20-year-old male patient who experienced painful pustules on his scalp for six months. The pustules first appeared on the occipital region and then spread to the crown. The patient was diagnosed with FD after a thorough clinical and pus culture examination. Treatment involved a month-long prescription of doxycycline (100 mg BD) and topical ozenoxacin (2%), which led to successful remission of the lesions.

Lucio Phenomenon: An Unusual Case of Skin Necrosis.

Introduction: Lucio leprosy is a non-nodular diffuse type of lepromatous leprosy first described by Lucio and Alvarado. Lucio phenomenon is a rare vasculonecrotic reaction characterized by cutaneous necrosis with minimal constitutional features. Case Presentation: We describe an unusual case of a 53-year-old man from Central India who had blisters, ulcers, and widespread erosions on his foot, forearms, and arms. The diagnosis of lepromatous leprosy with the Lucio phenomenon was established after thorough evaluation by clinical findings, histopathological findings, and slit-skin smear examination. Conclusion: Lucio phenomenon is an uncommon cause of cutaneous infarction and necrosis. Primary care physicians should keep a high index of suspicion in patients with cutaneous necrosis and minimal constitution features. Since leprosy is a relatively curable disease, primary care physicians should think of a rare form of lepromatous leprosy presenting with cutaneous necrosis, especially in non-endemic zones.

The study on the prevalence of Mongolian spots in the neonates.

Background: Mongolian Spots (MS) generally exist at the time or under the first few weeks of the neonate life-cycle, often considered a birthmark, characterized by hyper-pigmented marks especially bluish-black hue that cannot vanish easily and are generally found on the lumbosacral region. As this MS is reminiscent of bruises and appears to be caused by abuse, this may raise questions about the possibility of abuse. Hence, it is significant to identify MS bruises. The objective of the study was to assess the prevalence of MS in neonates by using the parameters like location, method of delivery, gestational age, and, weight at birth. Methodology: 500 neonates were enrolled in the study for the evaluation of the prevalence of Mongolian spots. The study design was cross-sectional, observational, and conducted for two and a half years. The neonate's whole skin surface, including the hand palms, scalps and soles, mucous membranes, genitalia, hair, and nails, was inspected in adequate light. The changes were seen (physiological and pathological) over the skin, so the details were reviewed, analyzed, and documented. Photographic records were kept to document the study. Descriptive statistics were analyzed by t-test and Chi-square test and the inferential statistics were analyzed by proportions and Chi-square test. Results: From the 500 neonates, 408 (81.6%) were reported to have Mongolian spots. Based on the site of locations 337 (82.60%) neonates were found with spots maximum on the sacrococcygeal area and rarely on the extremities 4 (0.98%). 221 (54.1%) were found with normal vaginal delivery, and males have more predominance 247 (60%). Based on the gestational age full term was 366 (89.71%), with the birth at a weight of more than 2.5 kg found in 349 (85.54%). Conclusion: The study concluded that the maximum number of neonates had been found with Mongolian spots and it is very common among neonates. This study will enlighten the awareness of the physician to distinguish the other lesions from other cutaneous skin conditions. The only drawbacks of this research study are a smaller sample size and limited study duration. The study of diameter, size, and dimensions of spots are not included. More intervention studies are required to compare MS with other skin conditions and their therapies. Further research is required for the study of the dimensions of marks on the neonate's body.

Association of acanthosis nigricans with metabolic syndrome - An analytic cross-sectional study

Abstract Background: Globally, few studies have been undertaken to assess the association of acanthosis nigricans (AN) with metabolic syndrome (MS). Most of the available studies have either focused on a particular age group, gender, ethnicity or on a single component of MS. Objectives: To determine the association between AN and MS as a whole and with all individual components of MS in adult patients of either gender. Material and methods: This was a cross-sectional study with a comparative group. Eighty-one subjects were recruited in each group. Fasting plasma glucose (FPG) and lipid profile were done. MS was defined by using the international diabetic federation (IDF) criteria. Association of body mass index (BMI), waist circumference, blood pressure, FPG, high-density lipoprotein (HDL) and triglycerides (TG) with AN was assessed by Pearson's chi-square test followed by univariate and multivariate analysis. Results: The prevalence of MS was found to be significantly higher in the group with AN. On univariate analysis, a significant association of AN was found with BMI, waist circumference, high systolic and diastolic blood pressure, HDL, and TG. Multivariate analysis revealed a significant association between waist circumference, high systolic and diastolic blood pressure, and high TG levels with AN. The risk of MS was found to be eight times higher in cases of AN. Study limitations: The small sample size and single-center data are the limitations of the present study. Conclusion: AN is strongly associated with MS as a whole and with its individual components including increased waist circumference, hypertension, and dyslipidemia.

Association of acanthosis nigricans with metabolic syndrome - An analytic cross-sectional study.

BACKGROUND: Globally, few studies have been undertaken to assess the association of acanthosis nigricans (AN) with metabolic syndrome (MS). Most of the available studies have either focused on a particular age group, gender, ethnicity or on a single component of MS. OBJECTIVES: To determine the association between AN and MS as a whole and with all individual components of MS in adult patients of either gender. MATERIAL AND METHODS: This was a cross-sectional study with a comparative group. Eighty-one subjects were recruited in each group. Fasting plasma glucose (FPG) and lipid profile were done. MS was defined by using the international diabetic federation (IDF) criteria. Association of body mass index (BMI), waist circumference, blood pressure, FPG, high-density lipoprotein (HDL) and triglycerides (TG) with AN was assessed by Pearson's chi-square test followed by univariate and multivariate analysis. RESULTS: The prevalence of MS was found to be significantly higher in the group with AN. On univariate analysis, a significant association of AN was found with BMI, waist circumference, high systolic and diastolic blood pressure, HDL, and TG. Multivariate analysis revealed a significant association between waist circumference, high systolic and diastolic blood pressure, and high TG levels with AN. The risk of MS was found to be eight times higher in cases of AN. STUDY LIMITATIONS: The small sample size and single-center data are the limitations of the present study. CONCLUSION: AN is strongly associated with MS as a whole and with its individual components including increased waist circumference, hypertension, and dyslipidemia.

Comparison of Oral Azathioprine and Oral Mini Pulse Steroid in the Treatment of Vitiligo: An Open-Label Randomized Controlled Trial.

Background: Vitiligo is a common acquired depigmentory skin disorder supposed to be of autoimmune aetiology. Different immunosuppressants have been tried with varying success. Azathioprine has been less studied in vitiligo. Aims and Objectives: To study the efficacy of oral azathioprine and compare with systemic steroid in the treatment of vitiligo. Materials and Methods: It was an interventional study with multi-armed (three), parallel group, an open-label, randomized controlled trial with allocation ratio of 1:1:1. Patients of vitiligo aged between 18 and 60 years having more than 5% body surface involvement were included in the study. Patients were divided into three groups. Group A-patients received oral azathioprine 50 mg OD daily, group B-patients received combination of oral azathioprine 50 mg OD and PUVASOL and group C-patients received combination of betamethasone oral mini pulse (OMP) and PUVASOL. All the groups were treated for 1 year. Repigmentation was evaluated by vitiligo area severity index (VASI), and stabilization was evaluated by vitiligo disease activity (VIDA). Results: Group A, group B and group C showed 24.24%, 53.24% and 47.28% improvement in VASI score, respectively, at the end of 1 year. Group B and group C showed statistically significant superior repigmentation as compared to azathioprine monotherapy. Though azathioprine and betamethasone showed equivalent efficacy, azathioprine has a better safety profile. Side effects were minimal in azathioprine groups, whereas 50% patients developed various side effects in group C. Conclusion: Azathioprine is safe and effective option in the treatment of vitiligo.

Azathioprine-Induced Marrow Suppression in Dermatology Patients - Analysis of 18 Patients.

Background: Azathioprine is an immunosuppressant used to treat several immunological disorders. As a purine analog, it inhibits DNA synthesis and cell multiplication. However, marrow suppression is a serious complication associated with azathioprine. Aim: To analyze the marrow suppression caused by azathioprine in dermatology patients. Material and Method: This is a retrospective analysis of the records of 18 patients who presented with marrow suppression secondary to azathioprine which was used for the treatment of various dermatological diseases. Results: The analysis includes 18 patients, 15 females and 3 males with the average age being 25.88 years. All except two patients received 1 mg/kg of oral azathioprine once daily. Leukopenia was seen in 13 patients (with severe leukopenia in 7 patients), thrombocytopenia in 8, and low hemoglobin in 14 patients. Isolated low hemoglobin was seen in four patients, isolated leukopenia in four patients, and only one patient presented with isolated thrombocytopenia. Six patients had pancytopenia. The duration from the starting dose to reporting of marrow suppression ranged from 10 days to 1 year. Eight out of 18 patients presented with anagen effluvium, 2 patients with oral ulcers, and 1 patient with an upper respiratory tract infection. All the patients recovered within 1 month. Conclusion: Marrow suppression due to azathioprine can occur with a low dose of 1 mg/kg. Hair loss and oral ulcers serve as early warning signs for marrow suppression.

Efficacy of salicylic acid peel in dermatophytosis.

BACKGROUND: Treatment of dermatophytosis is becoming costlier and challenging. AIMS AND OBJECTIVES: To study the efficacy of salicylic acid peel in dermatophytosis. METHODS: Twenty-five patients (20 males and 5 females) having dermatophytosis with positive potassium hydroxide (KOH) mounts were enrolled in the study. Salicylic acid 30% was applied over the lesions weekly for 4 weeks, thereafter patients were followed up weekly for 4 weeks. RESULTS: Of the 25 patients, 22 (88%) patients showed clinical and microbiological cure 1 week after the last application, while the remaining 3 patients were nonresponders. Nine (41%) patients of the 22 responders showed recurrences indicating that 4 weeks' treatment is not sufficient in some patients to eradicate fungus and may require longer treatment. LIMITATIONS: A relatively small sample size and lack of long-term follow-up are the shortcomings of our study. CONCLUSION: Salicylic acid peel is a cheap and useful option in the treatment of dermatophytic infection.

Study of oral tranexamic acid, topical tranexamic acid, and modified Kligman's regimen in treatment of melasma.

BACKGROUND: Melasma is a pigmentary disorder affecting mainly face . Various treatment modalities available as topicals, superficial chemical peels and lasers but none till date gives promising results, until date quest for the best treatment modality is on. AIM: To study the effect of oral and topical Tranexamic acid (TXA) and modified Kligman's regimen in treatment of melasma. METHOD: Patients having melasma were enrolled after consent for voluntary participation. A detailed history and clinical examination was done. Total 60 patients were enrolled and randomized in three groups, 20 received oral TXA 250 mg twice daily, 20 topical TXA and 20 received modified Kligman's regimen for 8 weeks along with sunscreen MASI(Melasma area severity index) was calculated at baseline, at end of 4 & 8 weeks. MASI score was compared with that at the end of the study. Based on reduction in mean MASI the therapeutic response was graded. Pre and post treatment photographs was also compared. Statistical analysis done by using student square T test , ANOVA And TUKEY test. RESULTS: Reduction in MASI score was observed in all the groups but greater reduction in MASI score with modified Kligman's regimen by 30% followed with oral TXA by 25% reduction and least with topical TXA by 5%. CONCLUSION: Although modified Kligman's regimen is comparatively more efficient but due to its side effects in long term usage oral tranexamic acid could be a promising therapeutic approach for melasma.

Alopecia Areata Treated with Oral Azathioprine: A Case Series.

Alopecia areata is commonly encountered non scarring alopecia with clinical presentations ranging from localised bald patches to extensive involvement. Clinical course is variable ranging from self limiting disease to chronic relapsing and recalcitrant disease. Topical and oral corticosteroids; nonetheless being front line agents for the treatment of alopecia areata;are not advocated for long term administration due to potentially undesirable systemic side effects. Hence the need of steroid sparing immunosuppresive agents like Azathioprine is warranted which have desired therapeutic action without much systemic adverse effects. We report a case series of 4 patients of alopecia areata treated with systemic azathioprine monotherapy.

Use of Low-dose Oral Warfarin in Three Cases of Livedoid Vasculopathy.

We hereby present our experience of low-dose oral warfarin in the management of three cases of livedoid vasculopathy.

Angiolymphoid hyperplasia with arterial ectasia and arteriovenous malformation: Response to intra-arterial embolization.

Angiolymphoid hyperplasia with eosinophilia is a rare disease characterized by vascular proliferation of unknown origin. The lesions are mostly seen in the head and neck region and are characterized by papules or nodules. A 20-year-old man presented with a 1 year history of reddish papulo-nodular lesions overlying a pulsatile swelling on the left auricular area. Histopathology was suggestive of angiolymphoid hyperplasia with eosinophilia. B-mode ultrasonography, color Doppler and angiography revealed arterial ectasia and arteriovenous malformation of the left auricular artery. Such malformations have been reported previously, in association with angiolymphoid hyperplasia with eosinophilia. The cutaneous lesions responded well to transarterial embolization of the nidus.