Gene Therapy and its Application in Dermatology.

Gene therapy is an experimental technique to treat genetic diseases. It is based on the introduction of nucleic acid with the help of a vector, into a diseased cell or tissue, to correct the gene expression and thus prevent, halt, or reverse a pathological process. It is a promising treatment approach for genetic diseases, inherited diseases, vaccination, cancer, immunomodulation, as well as healing of some refractory ulcers. Both viral and nonviral vectors can be used to deliver the correct gene. An ideal vector should have the ability for sustained gene expression, acceptable coding capacity, high transduction efficiency, and devoid of mutagenicity. There are different techniques of vector delivery, but these techniques are still under research for assessment of their safety and effectiveness. The major challenges of gene therapy are immunogenicity, mutagenicity, and lack of sustainable therapeutic benefit. Despite these constraints, therapeutic success was obtained in a few genetic and inherited skin diseases. Skin being the largest, superficial, easily accessible and assessable organ of the body, may be a promising target for gene therapy research in the recent future.

Comparative evaluation of effectivity and safety of topical amorolfine and clotrimazole in the treatment of tinea corporis.

BACKGROUND: Tinea corporis is a common superficial dermatophytosis seen in tropical countries. Newer molecules are constantly being introduced for its treatment. Topical clotrimazole is in vogue as the treatment for this condition for a long time. Amorolfine is a comparatively recently introduced drug for topical use in this condition. AIMS: To assess the effectivity and safety of amorolfine 0.25% cream in patients with tinea corporis, in comparison to clotrimazole 1% cream. MATERIALS AND METHODS: Patients presenting with symptoms of tinea corporis were mycologically confirmed for the presence of fungal hyphae. They were randomly divided into two groups: one group received amorolfine and the other received clotrimazole. Treatment duration was for 4 weeks and study duration was for 8 weeks. Evaluation was carried out using the standard clinical parameters on day 1, day 14, day 28 and a follow-up on day 56. Adverse effects were also recorded. Data entry was done in Excel datasheet and analyzed with Epiinfo 2002. Chi-square test and t-test were used according to the type of data. RESULTS: The patients of the two groups were matched at baseline in respect to their demographic profile. Analysis of collected data showed significant improvement in both the groups, suggesting that both the drugs were effective agents in tinea corporis infection. Between-groups comparison of mycological cure rate and clinical improvement showed no significant difference. CONCLUSION: Amorolfine 0.25% cream is found to be safe and effective, like clotrimazole, when used topically in tinea corporis.

Seasonal variation in pediatric dermatoses.

INTRODUCTION: The under-five population is a unique and vulnerable component of our society that always demands special attention. AIMS: Our present work aimed to study the seasonal variation, age-wise variation and distribution of lesions of common dermatoses of this age group. MATERIALS AND METHODS: We clinically studied all fresh cases attending the skin OPD of our hospital for one month each from summer, rainy season and winter. Total number of patients was 879. RESULTS: The top six skin diseases in our study were impetigo, miliaria, scabies, furunculosis, seborrheic dermatitis and papular urticaria. On statistical analysis, scabies and seborrheic dermatitis were more prevalent during winter while impetigo, furunculosis and miliaria were more during summer and rainy season. Papular urticaria was more frequent in the rainy season. Seborrheic dermatitis predominantly affected the infants while impetigo, furunculosis, miliaria and popular urticaria were commoner in older age groups. CONCLUSION: Distribution of lesions of common dermatoses will help diagnose difficult cases and extensive evaluation of the body parts which, by virtue of being commonly affected, are must-examine sites in under-five children.

Evening primrose oil is effective in atopic dermatitis: a randomized placebo-controlled trial.

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing, itchy dermatosis of multifactorial origin, which commonly starts in childhood. Defective metabolism of essential fatty acids leading to relative dominance of pro-inflammatory prostaglandins (PGE2 and PGF2) has been reported as an important factor in the pathogenesis of AD. Evening primrose oil (EPO) as a source of gamma-linolenic acid (GLA) has been of interest in the management of AD. AIM: To evaluate the efficacy and safety of EPO in atopic dermatitis in our patients. METHODS: Consecutive new out-patient department (OPD) patients of a referral hospital in Kolkata clinically diagnosed as having AD were randomly allocated to two groups. To the first group, evening primrose oil was supplied as 500-mg oval clear unmarked capsules, while placebo capsules identical in appearance and containing 300 mg of sunflower oil were given to the other group. Treatment continued for a period of 5 months. With pre-designed scoring system (based on four major parameters: extent, intensity, itching, and dryness), clinical evaluation was done at baseline and subsequent monthly visits. Data of the first 25 patients from each group who completed the 5 months of trial were compiled and analyzed. RESULTS: At the end of the fifth month, 24 (96%) patients of EPO group and 8 (32%) patients of placebo group showed improvement. There was significant difference in outcome of treatment between two groups (P<0.00001). No significant adverse effect was reported by any patient/guardian at any point of assessment. CONCLUSION: Evening primrose oil is a safe and effective medicine in management of AD. However, since not all researchers across the world have found the same good result, further large trials on Indian patients are needed.

Evaluation of sexually transmitted diseases/human immunodeficiency virus intervention programs for sex workers in Calcutta, India.

BACKGROUND AND OBJECTIVE: The Sonagachi Project in Calcutta, India, organized sex workers to improve working conditions. GOAL: To compare rates of sexually transmitted diseases between the Sonagachi Project and other areas in which only the National AIDS Control Organization (NACO) interventions were implemented. STUDY: A cross-sectional survey of randomly selected female sex workers. RESULTS: There was no difference in the prevalence of all STDs between the 2 areas; both were lower than reported in other surveys in 1992. Analysis using propensity scores also failed to demonstrate any difference. The number of preventive activities was similar in the Sonagachi and NACO-only areas but was more prevalent than in 1992. Sex workers in the Sonagachi area had better treatment-seeking behavior and attitudes. Both the Sonagachi and NACO strategies have resulted in lower STD rates, but the Sonagachi Project also increased the proportion who had an optimistic attitude and increased prevention and treatment-seeking behavior.