Treatment options in refractory chronic spontaneous urticaria.

PURPOSE OF REVIEW: Chronic spontaneous urticaria (CSU) patients sometimes do not respond to second-generation antihistamine, and 10-50% patients do not even respond to four-fold the usual dose of nonsedating H1 antihistamine, which further leads to repeated courses of oral corticosteroids to abate the symptoms. There are third-line agents approved by EAACI guidelines, which include omalizumab and cyclosporine. Certain patients are even resistant to the third-line agents. In this review, various other treatment options will be discussed in patients of refractory CSU. RECENT FINDINGS: Recently, we demonstrated azathioprine as a possible third-line option, which was found noninferior to cyclosporine in antihistamine refractory CSU. There have been trials, studies, case series and reports, which suggest other putative options for refractory CSU management. SUMMARY: Studies on the management of refractory CSU are accumulating thereby expanding the armamentarium of dermatologists and allergologist against difficult-to-treat urticaria patients.

Efficacy and safety of diode laser for facial hair reduction in hirsutism-a clinico-trichoscopic evaluation.

Background: Hirsutism is the presence of excessive terminal hair on androgen-dependent sites of the body. Lasers like Alexandrite, diode, and Nd:Yag lasers have been used for hair reduction with varying efficacy. Trichoscopy of hair is a simple noninvasive method of hair assessment. However, it has not been used in the assessment of diode laser hair reduction. Objectives: This study aimed to assess the efficacy and safety of diode laser hair reduction in skin color with the help of clinical and trichoscopic assessment. Materials and Methods: This prospective observational study included 73 patients of hirsutism recruited in 18-month period. All participants received sessions of 805 nm diode laser at monthly intervals up to six sessions. Clinical and trichoscopic evaluation along with photographs were obtained at each visit. Side effects, if any, were noted in every sitting. Results: All patients were females of Fitzpatrick skin types III-V. All clinical parameters showed statistically significant hair reduction when compared with baseline. Trichoscopic parameters of hair reduction like total hair count, terminal hair count, and terminal/vellus hair ratio showed reduction compared to baseline which was statistically significant (P < 0.05). The most common side effect noted in our study was pain followed by erythema and perifollicular edema. Conclusions: Diode laser is an effective and safe procedure for the reduction of unwanted facial hair, even in darker skin types. We also wish to emphasize that trichoscopy for the assessment of laser hair reduction is a recent, noninvasive, simple, and underutilized tool. No serious adverse events were noted in our study.

Comparing emollient use with topical luliconazole (azole) in the maintenance of remission of chronic and recurrent dermatophytosis. An open-label, randomized prospective active-controlled non-inferiority study.

BACKGROUND: Literature on emollient use in the management of chronic and recurrent dermatophytosis is limited. OBJECTIVE: To assess the efficacy of emollient in the remission maintenance of chronic and recurrent dermatophytosis. METHODS: In this randomized open-label study with the intention to treat, 80 patients with chronic recurrent dermatophytosis were randomized into two groups, where both groups were treated adequately for 6 weeks, followed by continuation of topical azole in group A and topical emollient in group B for 6 weeks. Clinical remission was determined by disappearance signs and symptoms of tinea lesions with or without hyperpigmentation. Physician and patient global assessment scores were evaluated every 2 weeks for 6 weeks to assess remission maintenance. RESULTS: A total of 80 patients of chronic and recurrent dermatophytosis were assessed for remission maintenance. The recurrence of disease occurred in 20 patients overall, wherein 7 patients (17.5%) in group A and 13 patients (32.5%) in group B at the end of the study (18 weeks); however, the difference between the two groups was not statistically significant (p = .121). The mean physician global assessment scores of group A and group B at 12 weeks were 4.45 ± 0.74 and 4.15 ± 0.92, 4.43 ± 0.90 and 4.10 ± 0.98 at 14 weeks, 4.0 ± 1.32 and 3.98 ± 1.23 at 16 weeks, 3.85 ± 1.44 and 3.90 ± 1.35 at 18 weeks, respectively. The mean patient global assessment scores of group A and group B were 4.65 ± 0.62 and 4.25 ± 0.87 at 12 weeks, 4.40 ± 0.87 and 4.17 ± 0.98 at 14 weeks, 4.18 ± 1.15 and 4.12 ± 1.30 at 16 weeks and 3.97 ± 1.33 and 3.90 ± 1.51 at 18 weeks. CONCLUSION: The present study concludes that the efficacy of emollient was not inferior to topical luliconazole for maintaining remission in chronic and recurrent dermatophytosis.

Benign Chondroid Syringoma on Chin: A Case Report and Literature Review.

Chondroid syringoma is a cutaneous adnexal tumor originating from sweat glands origin. It is rare in occurrence and usually benign, having an incidence of 0.01 to 0.098%. As these tumors are uncommon, their diagnosis is missed many times and are misdiagnosed. Hence in any case of facial skin swelling increasing slowly in size, this entity should be kept in mind as one of the possibilities and differential diagnosis. Histopathological examination of the excision biopsy gives the definitive confirmatory diagnosis. Surgically excising the swelling locally along with a surrounding normal tissue cuff is the standard treatment given which prevents recurrence. Hereby we present a 35-year-old case of facial chondroid syringoma having a focal component of eccrine hidrocystoma, keratinous cyst as well as syringocystadenoma papilliferum on the chin that was clinically suspected to be an epidermoid cyst or mucocele.

Psychosocial and financial impact of facial hair among female patients of hirsutism: A cross-sectional study.

BACKGROUND: Literature on psychosocial impact, financial burden, and worry in hirsute females with facial hair is limited. OBJECTIVE: To assess psychosocial impact and financial burden, worry among females with hirsutism. METHODS: In this cross-sectional, questionnaire based observational study, 50 females with hirsutism having facial hair were interviewed and provided with questionnaires examining the psychosocial impact and financial burden. Psychosocial impact in participants was assessed by the Dermatology Life Quality Index (DLQI) questionnaire, and the financial burden was evaluated using a composite financial burden score. Self-reported financial worry was also calculated. RESULTS: A total of 50 completed DLQI surveys and financial burden surveys were taken for analysis. The mean DLQI of 50 hirsute females was 15.98 ± 5.79. The mean value of financial burden score was 0.98 ± 1.45, and financial worry was 1.5 ± 0.90. There were 16% of total hirsute females who commonly used trimming/ shaving and Laser therapy as a treatment modality followed by 12% females who did not use any treatment modality for their facial hair. There were 10% females who used waxing and followed by 6% who used a combination of waxing, trimming, and bleaching for managing facial hair. The financial burden impact of laser therapy was significant (p = 0.013) among all treatment modalities. CONCLUSION: The present study concludes that hirsutism poses a very large effect or psychosocial impact on hirsute females with a significant financial burden with laser therapy as compared to other treatment modalities.

Comprehensive review of oral minoxidil in alopecia.

BACKGROUND: There have been various treatment modalities available for alopecia in the form of topical and systemic with a variable response. The compliance of the patients is important in reaping results in alopecia. Minoxidil has come a long-way finding its use from topical formulations to systemic at lower dose in different alopecia. OBJECTIVE: The objective of this article is to discuss various conditions in alopecia where oral minoxidil has found its role. METHODS: A comprehensive literature search was performed relating to oral minoxidil role in various alopecia. Various clinical trials, case series, and case reports were searched on PubMed and Google Scholar. The references of available studies were also reviewed to collect the additional resources. Available data from various studies and case reports were collected and consolidated to provide a concise overview of oral minoxidil indications in various alopecia. RESULTS: Oral minoxidil has been used in various non-scarring and scarring alopecia at a lower dosage with less side effects and with promising results. Androgenetic alopecia and female pattern hair loss were the two conditions where it has been used more commonly than other alopecia, providing a ray of hope along with overcoming the issues related to topical formulations and compliance.

Thick crusted plaques on the periorificial area in a young woman.

We report a young woman with periorificial erosions and thick crusts mimicking pemphigus foliaceous, who was found to have an underlying pancreatic malignancy with normal blood glucose and glycosylated haemoglobin levels. Click here for the corresponding questions to this CME article.

Current treatment modalities in granulomatous cheilitis.

BACKGROUND: Granulomatous cheilitis (GC) is a poorly understood disorder of the labial mucosa, which is a subtype under an umbrella term "orofacial granulomatosis." Several treatment modalities have been tried in the management of GC with suboptimal to optimal results. OBJECTIVE: The objective of this article is to discuss various treatment modalities, whether medical or surgical, that have been tried for the management of GC with success. METHODS: A comprehensive literature search was performed to screen articles related to the successful treatment of GC. Articles published in journals indexed in PubMed were searched along with those in Google Scholar. There was no availability of systematic review or meta-analysis on treatment of GC in the literature search. Recent data has been collected and consolidated from various case reports and case series to provide a concise overview of various treatments applied in GC. RESULTS: Various treatment modalities have been used in GC including glucocorticoids, antibiotics, immunomodulatory, and biological agents, surgical debulking, and laser therapy. No treatment modality has provided a predictable success. Intralesional corticosteroid therapy has been used more frequently either alone or in combination with other modalities.