Pharmacology and Therapeutics of Collagen-Based Stimulator Drug and Drug Supplement: Delivery (Management) and Approaches (Strategies).

While compiling a dissertation on collagen-based stimulator drug and drug supplements, it was considered relevant to dwell into the background, the vary basis of the subject, taking cognizance of bovine (animal) as well as human source collagen preparations. Impediments in the manufacture of source materials accompanied by complications were discouraging, bringing forth the advent of drug compositions primarily affecting collagen tissue augmentation replacing successfully the prior one. Calcium Sculptra, poly-L-lactic acid (PLLA), and calcium hydroxylapalite (CaHA) are now considered for use. There drug delivery management and strategies as well as mechanism constituted the subject matter; however, uniform availability of these drugs and drug supplements is the major handicap for their free use.

Dermoscopy Update: Review of Its Extradiagnostic and Expanding Indications and Future Prospects.

The technique of dermoscopy has come a long way since its inception for characterization of suspicious nevi for early detection of dysplastic changes in predisposed individuals. Not only has its scope expanded to aid in quick diagnosis of a majority of nonmelanocytic disorders of the skin, hair, and nails, but it is being rightfully exploited for a plethora of nondiagnostic uses. Its use in the diagnosis of various pigmentary, papulosquamous, and infectious disorders and disorders of the scalp and hair, nails, and mucosa bears testimony to the ongoing expansion of its protean indications across skin types. Dermoscopy has transformed the conventional approach to dermatological diagnosis from clinicopathological correlation to clinico-dermoscopic-pathological correlation. It aids in convincing an otherwise reluctant patient to agree to biopsy and guides the selection of optimum site for the same. Dermoscopic clues suggestive of stability or activity of the lesion and/or disease in various dermatoses are being accrued. Early assessment of therapeutic response to treatment is helpful for physicians, patients, and researchers conducting clinical studies. Aesthetic uses of dermoscopy are opulent and being explored. Dermoscopy has also provided the much-needed balancing act of interaction between practitioners and the new generation of patients. Last but not the least, dermoscopy has resulted in patients' better understanding of their disorders and improved compliance with treatment protocols.

Erectile Dysfunction/Impotence: An Update of Drugs, Drug Delivery/Management, and Approaches or Strategies.

Erectile dysfunction/impotence, a universal phenomenon, is a type of sexual dysfunction, the incidence of which is unknown. Certainly, its management options has changing scenario, in particular, take cognizance of phosphodiesterase type 5 inhibitors being the pivot, the highlight of which form the main stay of stage first, supplemented by drugs of stage second and technique adoptive for stage third, emphasizing their relative merits.

Pharmacology and Therapeutics of Corticosteroids Sparing Maintenance Immunosuppressive/Adjunct Therapy Drugs.

Glucocorticoids, corticosteroids/steroids sparing (replacement) maintenance immunosuppressive/adjunct drugs delivery has always been a challenging overture. Azathioprine, cyclophosphamide, dapsone, immunoglobulin, and interferon are agents in this category. The pharmacology and pharmacokinetics of the preceding drugs include specific recommendations, generic names, availability, mode of administration, dosage schedule, and the essentials of drug management.

Comparative Evaluation of Molecular Tests Vis-à-Vis Culture and Treatment Response in the Diagnosis of Cutaneous Tuberculosis.

The clinical diagnosis of cutaneous tuberculosis (CT) was based on criteria of reinfection and reactivation. Laboratory tests are mandatory but have limitations, thus demanding continuous innovation. In our study, we took punch biopsies from lesions on 48 patients. Half of these biopsies underwent histopathologic investigation, and the other half were analysed using the BACT Alert 3D system, the Amplified Mycobacterium Tuberculosis Direct Test (AMTDT), and DNA amplification by polymerase chain reaction (PCR) using primers specific for the M. tuberculosis 16SrRNA complex. Patients were given antitubercular therapy for 6 weeks. A positive response was indicative of CT. Histopathology was suggestive, although no acid-fast bacilli could be demonstrated. In vitro culture recovery of M. tuberculosis was possible in six (12.5%); only two (4%) were positive on AMTDT, and 14 (29%) on real-time PCR. Regression of skin lesions was remarkable after antitubercular therapy, irrespective of a laboratory result. AMTDT and real-time PCR are seen to be of low value in the diagnosis of CT. They are limited by high cost, their paucibacillary nature, and technical errors. On comparing has AMTDT and PCR, the latter was found to be superior. High percentages of negative results were also investigated; extensive involvement of skin has yielded positive PCR results, probably due to low immunity and high bacterial load.

Acquired Lymphangiectasia of the Scrotum.

A 56-year-old man presented with multiple, skin-colored, raised eruptions of the scrotum that had been present for 2 years. Their onset had been gradual, and they had been increasing in size, resulting in cosmetic disfigurement. A year previously, he had been operated on for a bilateral vaginal hydrocele with partial excision and eversion of the sac (Jabouley method).1 There had been no extramarital or unprotected sexual contact, other hospitalizations, or major surgery, swelling of the legs, or long periods of incumbency. Cutaneous examination revealed multiple, discrete and/or coalescing verrucous papules distributed on the upper portion of the scrotum and associated with edema of the penis (Figure 1). The inguinal lymph nodes were not enlarged. Complete blood counts and ultrasonography of the abdomen were normal. Tissue sections stained with hematoxylin and eosin showed hyperkeratosis and multiple ectatic vessels, primarily confined to the papillary dermis, abutting the overlying epidermis, and demarcated by a single endothelial lining. The dilated vessels contained homogenous eosinophillic material (Figure 2).

Acrodermatitis Enteropathica Presenting with Recurrent Diarrhea and Vomiting in an Infant Reluctant to Breastfeed, and a Peculiar Erythemato-Eczematous Eruption around the Oral and Anogenital Regions.

A 6-month-old, 4-kg, dehydrated girl, an Indian native, was admitted with recurrent episodes of diarrhea that had occurred since age 2 months. She had stopped breastfeeding. She had also had concomitant vomiting and loss of appetite. Later, the mother noticed progressively increasing erythematous eruptions around the anogenital and the oral region. The baby had been born to a short-stature mother and was delivered by lower segment cesarean section. Regular antenatal follow-up was normal.

Footwear Contact Dermatitis: A Prospective Cross-Sectional Study of 108 Outpatients from Delhi, India.

Footwear contact dermatitis is a common problem with multifactorial exogenous, as well as endogenous, etiologies. Patch testing is the gold standard for detection of the possible contactants. A cross-sectional study was conducted in 108 outpatients over a period of 18 months. Demographic data comprising age, sex, and occupation were collected. Details of clinical and laboratory investigations were used to define the incriminating ingredient(s), subsequently confirmed by patch test using Indian standard and footwear series approved by the Contact and Occupational Dermatitis Forum of India. Reading and interpretation were carried out according to the International Contact Dermatitis Research Group (ICDRG) guidelines. Of the 108 patients, 64 were girls or women and 44 boys or men. Although footwear contact dermatitis affected all age groups, most individuals were 21 to 40 years old. The morphology and distribution of the lesions were very specific. Patch testing was helpful, the primary sensitizing agent being mercapto mix, followed by mercaptobenzothiazole, potassium dichromate, and paraphenylenediamine. Footwear contact dermatitis is an extraordinary entity, requiring a high level of expertise (or knowledge) to determine its etiology through history, clinical examination, and patch testing.

Tuberous Sclerosis Complex: A Classic Presentation.

An 11-year-old girl presented with an insidiously evolving, reddish-brown, small, hard, elevated lesion, occupying the midsection of her face, which had been present since early childhood. There were also a few small white spots over the trunk. There was no history of seizures or visual deficit, and no burning on exposure to sunlight. There were no known congenital defect noted at birth, and her parents were nonconsanguineous. There was no significant family history. There were numerous 2- to 4-mm reddish-brown papules located symmetrically on the nose, nasolabial folds, and cheeks (Figure 1A). In addition, there was an uneven 3-cm plaque in the lumbosacral region that resembled orange peel-a shagreen patch (Figure 1B). There were also two well-defined, 5- to 10-mm, hypomelanotic, ivory-white macule(s) with irregular margins (Figure 1C). The buccal mucosa and nails were unremarkable, and indirect ophthalmoscopic and slitlamp examination of the eye was normal. Laboratory studies were unremarkable. Ultrasonography of the abdomen was normal, as were abdominal and chest x-rays.

Oral Mucosal Lesions in a Cross-Sectional Study of 200 Dermatologic Outpatients.

Oral mucosal lesions (OMLs) present with a variety of manifestations, emanating largely from tobacco chewing, smoking, and consumption of alcohol. Evolution of the lesions may be facilitated by poor oral hygiene and restorative dental materials, as well as by trauma, infections, and immune-mediated diseases. Two hundred consecutive patients seen at a pre-eminent dermatologic clinic formed the study group. They were interviewed about clinical manifestations, duration of the lesion, patient's age and sex, and incriminating factors. After informed consent had been gained, a thorough clinical examination was performed to define the precise morphology, site, and distribution of lesions. Confirmation of the clinical diagnosis by histopathology and other relevant techniques was confirmed.

Oral Lichen Planus: A Cross-Sectional/Descriptive Study of 33 Patients.

Oral lichen planus (OLP), a well-known entity, is often neglected; however, its assessment is considered essential for evolving future strategies for treatment. Thirty-three patients with OLP from 200 consecutive patients with oral mucosal lesions were studied according to demography. Tobacco chewing, smoking, and alcohol intake were recorded. Examination of the oral cavity, using a head light and tongue depressor, was undertaken to define the morphology of the lesion(s). Colored photographs were an essential part of the process. OLP, a frequently encountered manifestation of oral mucosal lesions, was responsible for 16.50% of the total number of lesions. There was a preponderance of lesions in women aged 40 to 59 years, in contrast to men in the same age group. The duration of the lesions was variable, and tobacco chewing/smoking and amalgam fillings might have exacerbated them. Morphology ranged from a reticular, erythematous pattern to an erosive one. The diagnosis is largely clinical, but it can be confirmed by histopathology.