Retinoic acid and glycolic acid combination in the treatment of acne scars.

INTRODUCTION: Acne is a prevalent condition in society affecting nearly 80-90% of adolescents often resulting in secondary damage in the form of scarring. Retinoic acid (RA) is said to improve acne scars and reduce postinflammatory hyperpigmentation while glycolic acid (GA) is known for its keratolytic properties and its ability to reduce atrophic acne scars. There are studies exploring the combined effect of retinaldehyde and GA combination with positive results while the efficacy of retinoic acid and GA (RAGA) combination remains unexplored. AIM: The aim of this study remains to retrospectively assess the efficacy of RAGA combination on acne scars in patients previously treated for active acne. MATERIALS AND METHODS: A retrospective assessment of 35 patients using topical RAGA combination on acne scars was done. The subjects were 17-34 years old and previously treated for active acne. Case records and photographs of each patient were assessed and the acne scars were graded as per Goodman and Baron's global scarring grading system (GSGS), before the start and after 12 weeks of RAGA treatment. The differences in the scar grades were noted to assess the improvement. RESULTS: At the end of 12 weeks, significant improvement in acne scars was noticed in 91.4% of the patients. CONCLUSION: The RAGA combination shows efficacy in treating acne scars in the majority of patients, minimizing the need of procedural treatment for acne scars.

Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride.

BACKGROUND: Finasteride acts by reducing dihydrotestosterone levels, thereby inhibiting miniaturization of hair follicles in patients with androgenetic alopecia (AGA). Oral finasteride is associated with side effects such as decreased libido, sexual dysfunction, and gynecomastia. AIM: The aim of the following study is to assess the efficacy of maintaining hair growth with 5% topical minoxidil fortified with 0.1% finasteride in patients with AGA after initial treatment with 5% topical minoxidil and oral finasteride for two years. MATERIALS AND METHODS: A retrospective assessment was done in 50 male patients aged 20-40 years with AGA. All the patients had been initially treated with topical minoxidil and oral finasteride for a period of two years, after which the oral finasteride was replaced with topical minoxidil fortified with finasteride. Five of 50 patients had discontinued the treatment for a period of 8-12 months and were then resumed with only topical minoxidil fortified with finasteride. The patients' case sheets and photographs were reviewed by independent observers and the efficacy of minoxidil-finasteride combination was assessed. RESULTS: Of the 45 patients who underwent a continuous treatment for AGA, 84.44% maintained a good hair density with topical minoxidil-finasteride combinatio. Of the five patients who discontinued oral finasteride for 8-12 months, four demonstrated good improvement in hair density when treatment was resumed with topical minoxidil-finasteride combination. CONCLUSION: Topical finasteride can be considered for hair density maintenance after initial improvement with oral finasteride, thereby obviating the indefinite use of oral finasteride.

Follicular occlusion tetrad.

Follicular occlusion tetrad is a symptom complex consisting of four conditions having a similar pathophysiology. It includes Hidradenitis suppurativa, acne conglobata, dissecting cellulitis of the scalp and pilonidal sinus. The exact pathogenesis of this group of disease is unknown but evidence suggests that they share the same pathological process initiated by follicular occlusion in apocrine gland bearing areas. Though each of these conditions is commonly encountered singly, follicular occlusion tetrad as a symptom complex has been rarely reported in the literature.

Safety of performing invasive acne scar treatment and laser hair removal in patients on oral isotretinoin: a retrospective study of 110 patients.

BACKGROUND: It is reported that patients on oral isotretinoin have greater risk of developing scars and delayed wound healing with invasive procedures. It is recommended that these procedures be resumed 6-12 months after the last dose of oral isotretinoin. AIM: To assess and compare the safety and look for delayed wound healing, during invasive acne scar treatment and laser hair removal on (a) patients who were on oral isotretinoin, and (b) patients who were not on oral isotretinoin. METHODS: A comparative, retrospective study of 110 patients was done. Fifty-five patients with either acne scars or hirsutism who underwent procedures while on oral isotretinoin, and 55 patients who were not on oral isotretinoin were selected and grouped into A and B respectively. Group A patients were on 0.5 mg/kg/day isotretinoin orally through the entire procedure duration, while group B patients received topical medications alone. The subjects from both groups underwent invasive acne scar treatment and laser hair removal. Clinical and photographic assessment was done at baseline followed by four sessions with an interval of six weeks between each. RESULTS: Isotretinoin had not resulted in any untoward effects in patients who underwent the procedures. Atypical scarring, delayed wound healing, keloids, or hypertrophic scars were not observed in any patient. CONCLUSION: Isotretinoin does not appear to delay wound healing, and hence invasive procedures can be considered on patients on oral isotretinoin without any compromise on the outcome.

Conjugal leprosy: A rarity.

Leprosy is a chronic infectious disease but conjugal leprosy in India is a rarity. Various hypotheses have been postulated to explain this rare phenomenon. Here we describe a family in South India, three members of which have been confirmed to be suffering from leprosy.

Palmar involvement in lichen planus.

Palmoplantar involvement in lichen planus is rare and often does not have the classically described clinical morphology, making it difficult to establish the diagnosis. We report a case in which asymptomatic solitary hyperpigmented patches with mild hyperkeratosis on the palms were the sole manifestation of lichen planus. Histopathology confirmed our diagnosis.

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.

Yellow nails following hemodialysis in chronic renal failure: is it yellow nail syndrome or a variant?

Yellow nail syndrome (YNS) is triad of yellow nails, lymphedema, and respiratory tract involvement. The exact pathogenesis of nail changes in YNS is unknown. We present a case of yellow nails and localized lymphedema secondary to artificial AV fistula in a 55-year-old chronic renal failure patient on hemodialysis for 5 years. To the best of our knowledge, this is the first case of yellow nail syndrome reported in association with artificial AV fistula.