Isotretinoin as a promising option in the treatment of facial papules of frontal fibrosing alopecia.

Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia characterized by hairline recession, pruritus, and facial papules (FP). Various therapies are used to stabilize disease activity and induce remission. However, FP of FFA is resistant to treatment in many cases. In this review, we searched the PubMed and Google Scholar databases to screen the published literature on treatment options for FP in the context of FFA. Overall, 12 studies were included in this review. Available literature suggests a noticeable improvement in resistant-to-treatment FP in FFA patients with oral isotretinoin. The available evidence is limited and is derived from retrospective studies and case reports/series. Systemic isotretinoin can be considered a promising therapeutic regimen for treating resistant-to-treatment FP of FFA patients. However, more extensive, well-designed studies are necessary for confirmatory evidence.

Effect of Right Nostril Breathing on Cardiorespiratory Parameters and Reaction Time in Young, Healthy Humans: An Interventional Study.

Background and Objective: Yogic breathing helps in reduction of stress and strain in the body. Right and left nostril breathings (RNB and LNB, respectively) have different effects on cardiorespiratory parameters. The study was performed to examine the effect of RNB exercise on cardiorespiratory parameters and reaction time in young, healthy human volunteers. Materials and Methods: In this prospective, interventional study, 110 young healthy volunteers underwent systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR), respiratory rate (RR), vital capacity (VC), peak expiratory flow rate (PEFR), and reaction time (RT) examination before and after 2 weeks of performing 45 min of RNB exercise daily. Results: There was notable increment in SBP (113.39 ± 17.72 vs. 117.74 ± 10.83 mmHg, P = 0.002) and DBP (67.64 ± 10.32 vs. 71.27 ± 8.68 mmHg, P = 0.002). PR increased nonsignificantly (86.44 ± 12.65/min vs. 87.32 ± 13.43/min, P = 0.476). Significant decrease in RR (14.40 ± 2.48/min vs. 12.31 ± 2.23/min, P < 0.0001) was observed. VC (3.57 ± 0.57 vs. 3.82 ± 0.55 L/min, P < 0.0001) and PEFR (441.36 ± 50.22 vs. 468.91 ± 53.66 L/min, P < 0.0001) also increased significantly. Substantial reduction in auditory reaction time (ART) (165.58 ± 32.18 vs. 147.42 ± 23.39 ms, P < 0.0001) and visual reaction time (VRT) (191.04 ± 37.94 vs. 165.86 ± 28.74 ms, P < 0.0001) was seen. After engaging in cardiorespiratory exercise, the maximal heart rate (MHR) remained unchanged (P = 0.929). Conclusion: RNB results in increase in blood pressure, heart rate, VC, and PEFR and decrease in ART and VRT. Further studies in patients with cardiorespiratory diseases are necessary to understand its clinical utility.

Cardiac Autonomic Reactivity Tests in Type A and Type B Personalities.

BACKGROUND: A considerable link between personality types and cardiovascular diseases (CVDs) has been seen. Autonomic responses in both type A and type B personality individuals were found to be influenced by their personality traits. The study suggests further research on cardiac autonomic functions in larger sample sizes and the use of non-invasive screening techniques like cardiovascular reflex tests to stratify participants' risk of future illness. OBJECTIVE: This study aimed to assess autonomic stress reactivity tests in type A and type B personalities using cardiovascular reflex tests. METHODS: This study was conducted at the Department of Physiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. The Hunter-Wolf Personality Questionnaire Scale was used to identify 60 adults, 30 of whom were classified to have type A personality and 30 have type B personality, from the psychiatry department. Autonomic function tests, such as the handgrip tests, cold pressor test, deep breathing test (DBT), lying-to-standing test (LST), and Valsalva maneuver, were performed and recorded for each subject. IBM SPSS Statistics for Windows, version 21 (released 2012; IBM Corp., Armonk, New York, United States) was used for the compilation and analysis of data. RESULTS:  The E:I (expiration-to-inspiration) ratio and delta heart rate of the type A personality patients both significantly decreased (p = 0.000*) as compared to the type B personality patients (1.18 ± 0.03 versus 1.25 ± 0.77 and 1.18 ± 0.03 versus 1.25 ± 0.77). The Valsalva ratio of the type A personality patients decreased (1.38 ± 0.10) as compared to the type B personality patients (1.48 ± 0.18), which was statistically significant (p = 0.001*). The 30:15 ratio in the type A personality patients was significantly decreased (p = 0.03*) compared to the type B personality patients (1.12 ± 0.05 versus 1.15 ± 0.10). The handgrip test and cold pressor test results were statistically insignificant. CONCLUSION: Compared to the type B personality patients, which exhibited an increase in both parasympathetic and sympathetic reactivity, the type A personality patients exhibited a reduction in resting cardiovascular parameters and resting autonomic tone. Consequently, in order to stratify the participants' risk of future illness, we recommend employing non-invasive procedures, such as cardiovascular reflex tests, as a screening technique.

Recurrent facial microcystic adnexal carcinoma and hair transplantation on scar site.

Microcystic adnexal carcinoma (MAC) is a rare kind of cutaneous neoplasm with a very aggressive local infiltration that destructs the affected tissues. Its rate of recurrence is high and it mostly involves the face and scalp regions and most of the patients get affected in the fourth or fifth decades of their life. Here in, we report a 61-year-old woman with a right-sided eyebrow MAC lesion with recurrency. Total excisional surgery was performed. A-T Flap surgery was applied on the involved area, and after a 2-year period of follow-up, with no recurrency, hair transplantation with follicular unit transplantation method was successfully performed on the scarred area. Although microcystic adnexal carcinoma is an uncommon neoplasm; dermatologists and ophthalmologists should consider it as a differential diagnosis, due to its aggressive local infiltration. Complete surgical excision and long-term follow-up must be applied to manage the disease. Also, hair transplantation with follicular unit transplantation technique can be considered as a beneficial method for treating scars resulted from MAC excisional surgery.

Oral Tranexamic Acid for the Treatment of Melasma: Evidence and Experience-Based Consensus Statement from Indian Experts.

Melasma, a chronic pigmentary skin condition mainly affecting the face, remains a challenge despite the availability of several options for treatment. Many melasma patients are not satisfied with treatment outcomes. Tranexamic acid (TXA), an anti-fibrinolytic drug has shown promising results in patients with melasma. Evidence from several clinical studies has surfaced on efficacy and tolerability of TXA in these patients. It can be used as monotherapy or adjuvant with other therapies. Currently, there is no published consensus or guideline document for its use in the treatment of melasma. TXA is available for oral use, topical use as well as an injection. In this article, a consensus of Indian experts is prepared based on the available literature and experience with use of oral TXA in melasma. This review article might help clinicians for use of oral TXA appropriately while treating melasma.

Comparative effectiveness and safety of topical methimazole 5% monotherapy versus combination of Q-Switched Nd: YAG Laser and topical methimazole 5% in patients with refractory melasma.

INTRODUCTION: Melasma is an acquired pigmentary disorder which currently has no definitive treatment. Although topical drugs containing hydroquinone are the basis of treatments, they are usually associated with recurrence. We aimed to evaluate the effectiveness and safety of monotherapy with topical methimazole 5% versus combination of Q-Switched Nd: YAG Laser and topical methimazole 5% in patients with refractory melasma. METHODS: A total of 27 women with refractory melasma were included. We applied topical methimazole 5% (once a day) with three passes of QSNd: YAG laser (Wavelength: 1064 nm, pulse energy: 750 mJ, fluence: 1.50  J/cm2 , spot size: 4 × 4 mm, hand piece: fractional, JEISYS company) for six sessions on the right half of the face, and topical methimazole 5% (once a day) on the left half of the face, for each patient. The treatment course was 12 weeks. Evaluation of effectiveness was done with the Physician Global Assessment (PGA), Patient Global Assessment (PtGA), Physician satisfaction (PS), Patients satisfaction (PtS), and mMASI score. RESULTS: PGA, PtGA, and PtS were not significantly different between the two groups at any time (p > 0.05). PS in the laser plus methimazole group was significantly better than methimazole group at 4th, 8th, and 12th weeks (p < 0.05). The rate of PGA improvement in the combination group was significantly better than the monotherapy over time (p < 0.001). The changes of mMASI score between the two groups did not significantly differ at any time (p > 0.05). There was no significant difference in the adverse events between the two groups. CONCLUSION: Combination therapy with topical methimazole 5% and QSNY laser can be considered as an effective way to treat refractory melasma.

Non-laser treatment for tattoo removal.

Tattoos are increasingly gathering attention in the young population, especially in second to fourth decade of life. With such trends, rate of its removal also has been on the rise. Treatment options for tattoo removal besides lasers are surgery, radiofrequency, infrared light, cryotherapy, dermabrasion and salabrasion. Unfortunately, none of these procedures are associated with satisfactory cosmetic results due to adverse effects such as scarring and dyspigmentation. Although laser treatment has become the gold standard for tattoo removal, it is also associated with some limitations. Some tattoo inks are resistant to laser, and multiple sessions and multiple wavelengths may be required for its complete removal. Considering these limitations, other treatment modalities for tattoo removal must be explored. This article highlights the non-laser treatment options for tattoo removal. We reviewed all published literature identified from electronic databases (MEDLINE and PubMed) till August 2021 to highlight the non-laser treatment options for tattoo removal.

Artificial intelligence in Dermatopathology.

INTRODUCTION: Ever evolving research in medical field has reached an exciting stage with advent of newer technologies. With the introduction of digital microscopy, pathology has transitioned to become more digitally oriented speciality. The potential of artificial intelligence (AI) in dermatopathology is to aid the diagnosis, and it requires dermatopathologists' guidance for efficient functioning of artificial intelligence. METHOD: Comprehensive literature search was performed using electronic online databases "PubMed" and "Google Scholar." Articles published in English language were considered for the review. RESULTS: Convolutional neural network, a type of deep neural network, is considered as an ideal tool in image recognition, processing, classification, and segmentation. Implementation of AI in tumor pathology is involved in the diagnosis, grading, staging, and prognostic prediction as well as in identification of genetic or pathological features. In this review, we attempt to discuss the use of AI in dermatopathology, the attitude of patients and clinicians, its challenges, limitation, and potential opportunities in future implementation.

Clinical update on cutaneous and subcutaneous sarcomas.

BACKGROUND: Cutaneous sarcomas are uncommon cancers that can have a wide range of clinical symptoms and lead to considerable cutaneous as well as systemic morbidity. AIM: The objective of this review article is to discuss epidemiology, clinical features, diagnosis, and therapy of different types of cutaneous sarcomas. MATERIAL AND METHODS: Literature was screened to retrieve articles from PubMed/Medline and Google Scholar and related websites. Cross-references from the relevant articles were also considered for review. Review articles, clinical studies, systematic reviews, meta-analyses, and relevant information from selected websites were included. RESULTS AND DISCUSSION: Cutaneous sarcomas have a negative effect on the quality of life. In their diagnosis, clinical presentation and histological evaluation are crucial. Complete surgical removal is the solution for more or less all cutaneous and subcutaneous sarcomas. The prognosis for cutaneous sarcomas is generally favorable since they tend to recur locally with distant metastases only on rare occasions. Patients having advanced disease should be treated in the setting of clinical trials if possible; choices include radiation therapy and systemic medicines. The value of innovative immunotherapy cannot be determined decisively at this time due to a paucity of relevant trials. CONCLUSION: As cutaneous sarcomas are rarely diagnosed based on clinical findings, histology plays an important role in the diagnosis. They have a relatively favorable prognosis if treated properly. Patients should be treated at specialized centres.

Comparison of the efficacy of carboxytherapy versus fractional CO2 laser therapy for the treatment of periorbital dark circles: A randomized clinical trial.

BACKGROUND: Periorbital dark circles (PDC) is one of the most common cosmetic issues in today's society. Only moderate degree of improvement has been achieved by various available treatment options. The present study aimed to compare the clinical efficacy of carboxytherapy and fractional CO2 laser therapy in the management of PDC. METHODS: In this split face study, 30 patients with bilateral PDC aged between 23 and 52 years were recruited who underwent carboxytherapy (n = 30) on PDC of one side of the face and fractional CO2 laser therapy (n = 30) on the PDC of other side. The entire treatment comprised of four sessions of each therapy with an interval of 2 weeks each time. The assessment was based on both subjective methods (patients' satisfaction and physician's judgment) and objective method (based on digital standard photographs). The degree of improvement from the patient's point of view (patient satisfaction) and physician's point of view (physician satisfaction) was assessed in different therapy sessions in comparison with the improvement after first session. RESULTS: The study included 30 patients with mean age of 38.22 ± 8.3 years. The mean disease duration was 45 ± 12.3 months. After the second therapy session, patients' satisfaction was remarkably better in the fractional CO2 laser therapy group than the carboxytherapy group, over the time. According to the physician satisfaction, the improvement rate was higher after the second and sixth weeks in the fractional CO2 laser therapy group than the carboxytherapy group; whereas in other sessions, there were no statistically significant differences. There were no significant side effects observed in either group post-treatment each time. CONCLUSION: Fractional CO2 laser therapy is a better option to treat PDC than carboxytherapy. Also, mild side effects (including erythema, pain, and discomfort) were reported in both groups; with no significant difference between the groups.

Adult and juvenile dermatomyositis treatment.

INTRODUCTION: Dermatomyositis is a rare autoimmune inflammatory condition affecting skin and muscles. The disease can be seen in both adults and children. It can be associated with malignancy. Considering involvement of skin in the disease, many patients consult dermatologists for its treatment. Hence, knowledge about its presentation, complications, prognosis, and treatment is necessary. OBJECTIVE: The objective of this review article is to provide comprehensive information about treatment of dermatomyositis. METHODS: In this review article, we reviewed the published literature on adult and juvenile dermatomyositis to highlight the treatment. Articles published in peer-reviewed journals including reviews, clinical trials, case series, and case reports published in electronic database (MEDLINE/PubMed) through January 2021, cross references of respective articles and trials from clinicaltrials.gov were included for qualitative analysis of the literature. RESULTS: Treatment options for dermatomyositis include traditional immunosuppressive agents and immunomodulatory therapy. High-dose corticosteroids represent the first line of treatment while other immunosuppressive agents are also used, either in combination with or as an alternative to corticosteroids, after initial treatment failure. Some biological agents have been used for the treatment of dermatomyositis with variable responses. CONCLUSION: Although several treatment options are available, several questions remain unanswered about the optimal treatment of dermatomyositis.

COVID-19 and artificial intelligence: Experts and dermatologists perspective.

INTRODUCTION: Artificial intelligence (AI) has an important role to play in future healthcare offerings. Machine learning and artificial neural networks are subsets of AI that refer to the incorporation of human intelligence into computers to think and behave like humans. OBJECTIVE: The objective of this review article is to discuss perspectives on the AI in relation to Coronavirus disease (COVID-19). METHODS: Google Scholar and PubMed databases were searched to retrieve articles related to COVID-19 and AI. The current evidence is analysed and perspectives on the usefulness of AI in COVID-19 is discussed. RESULTS: The coronavirus pandemic has rendered the entire world immobile, crashing economies, industries, and health care. Telemedicine or tele-dermatology for dermatologists has become one of the most common solutions to tackle this crisis while adhering to social distancing for consultations. While it has not yet achieved its full potential, AI is being used to combat coronavirus disease on multiple fronts. AI has made its impact in predicting disease onset by issuing early warnings and alerts, monitoring, forecasting the spread of disease and supporting therapy. In addition, AI has helped us to build a model of a virtual protein structure and has played a role in teaching as well as social control. CONCLUSION: Full potential of AI is yet to be realized. Expert data collection, analysis, and implementation are needed to improve this advancement.

Low-dose Oral Minoxidil in the Treatment of Alopecia: Evidence and Experience-based Consensus Statement of Indian Experts.

Alopecia is a highly prevalent condition worldwide including in India. There are different types of alopecia with differing etiology, presentation, and hence treatment. Androgenetic alopecia represents the most common form of hair loss affecting male as well as female population termed as male and female pattern hair loss, respectively. Several treatment options are available for the treatment of alopecia with often unsatisfactory results resulting in psychological distress among such patients. Topical minoxidil is known to be effective in the treatment of alopecia. However, oral minoxidil is not currently approved for the treatment of alopecia. This expert consensus is prepared to provide guidance to the clinicians regarding the use of oral minoxidil in the treatment of alopecia. Extensive literature review was performed to prepare the draft consensus which was then revised based on the suggestions and comments from the experts. The final draft was circulated to the experts for review and approval. This consensus document provides overview of evidence related to oral minoxidil and consensus from the experts for its use in the treatment of minoxidil.

Epidemiological, clinical and mycological characteristics of pityriasis versicolor: Results of a study from a teaching hospital in rural part of Northern India.

Background and Objectives: Pityriasis versicolor is a common fungal infection of the skin which leads to the formation of scaly and discoloured small lesions on skin. The main objective of this study is to describe clinical and mycological characteristics and the predisposing factors in patients with pityriasis versicolor. Material and Methods: In this prospective, observational, hospital-based cross-sectional study, patients of all ages with clinically suspected lesions of pityriasis versicolor were included. After detailed history and thorough clinical examination, skin scrapings were examined with 10% potassium hydroxide (KOH) under light microscope. The scrapings were also subjected to culture examination. Results: A total of 113 patients [78 (69.0%) male; 35 (31%) female] were included in the study. A total of 87 (76.9%) patients were from rural area. Outdoor occupation and positive family history of pityriasis versicolor was present in 65 (57.5%) and 38 (33.6%) patients, respectively. Recurrent episodes were reported by 66 (60%) patients. Excessive sweating and oily skin were seen in 36 (31.8%) and 24 (21.1%) patients, respectively. History of occlusive clothing was present in 22 (19.4%) patients. Chest, back, and shoulders were affected in 36 (31.8%), 22 (19.4%), and 08 (07.0%) patients, respectively. Hypopigmented lesions were seen in 97 (85.8%) patients. Patches and macules were observed in 60 (53.1%) and 53 (46.9%) patients, respectively. A total of 27 (23.8%) patients reported mild prutitus. A total of 79 (69.9%) patients were KOH positive and culture negative, whereas 26 (23.0%) patients were KOH as well as culture positive. Eight (7.0%) patients were both KOH and culture negative. Conclusion: Pytiriasis versicolor is more common in young adults and males with the most common presentation of hypopigmentation lesions. In our study population, presentation with large patches was more common than macular lesions. Pruritus was more in patients with large patches than those with macules.

Artificial Intelligence in Hair and Nail Disorders.

Artificial intelligence (AI), a field of computer science, aims at simulating human intelligence with computers. Though AI has surpassed dermatologists in skin cancer detection, it still lags behind various other specialties like radiologists in broader adoption. Newer AI applications are becoming increasingly accessible. AI plays a role in various areas, such as medical image recognition, auxiliary diagnosis, and drug research and development. Dermatology has a prime position in implementation of AI in medical research due to its larger clinical, dermoscopic, and histopathological image database. Hence, it is crucial to consider the potential and emerging role of AI in dermatology clinical practice. There are already studies focusing on various skin disorders like cancer, psoriasis, atopic dermatitis, etc. This article provides an overview of AI and its applications in hair and nail disorders at present and its future potential. J Drugs Dermatol. 2022;21(10):1049-1052. doi:10.36849/JDD.6519.

Angiogenic potential of Bambusa vulgaris leaves: Results of an in-vitro study with chicken embryo chorioallantoic membrane (CAM) model.

BACKGROUND: Herbal compounds have an important place in the management of wounds. However, very few compounds have been tested for their proangiogenic potential. OBJECTIVE: The objective of study was to evaluate angiogenic potential of Bambusa vulgaris Schrad. plant extract. MATERIAL AND METHODS: Chicken embryo chorioallantoic membrane model was used for estimation of angiogenic potential of B. vulgaris leaves extract with different concentrations. Angiogenic potential was estimated using focal application method and AbGel™ sponge application method. The test samples were loaded on eight embryonic development day of embryonic development of chick embryo and angiogenesis was observed on eleventh embryonic development day. Counting of blood vessels and photographic evaluation was done for estimation of angiogenic potential. The sponge specimen was examined for histological changes. Angiogenic potential of B. vulgaris leaves extract was compared against Plermin©. RESULTS: All tested concentrations (85 mcg, 170 mcg, 255 mcg, 340 mcg and 425 mcg/disc) of B. vulgaris showed angiogenic potential as indicated by increase in the number of blood vessels. Maximum growth in blood vessels was seen at the concentration of 255 mcg. Photographic evaluation showed changes in angiogenesis with B. vulgaris leaves extract. Angiogenic potential was also confirmed on histological examination. Plermin control groups also showed the growth of blood vessels measured by counting the number of blood vessels in photographic evaluation. The growth of blood vessels with Plermin 40 mcg was similar to B. vulgaris 255 mcg. CONCLUSION: The results of current study suggest angiogenic potential of B. vulgaris Schrad leaves as confirmed by visual observation and histological examination.

Treatment of Scalp Psoriasis.

Scalp involvement is seen in a majority of individuals with psoriasis, a chronic autoimmune skin disease with variable phenotypes. Occasionally, isolated scalp involvement is observed; and this causes significant psychosocial morbidity. Management of scalp psoriasis is difficult, in part due to the difficulty of applying topical agents and its refractory nature. Various treatment options are available with variable efficacy. Topical agents include topical steroids, keratolytics, tar and anthralin compounds, vitamin D analogues, and vitamin A derivatives. The combination treatment of topical betamethasone and calcipotriene is the most effective topical therapy. Systemic agents include conventional agents such as methotrexate, cyclosporine, and oral retinoids. Biologics offer a greater efficacy, with near complete or complete clearance of the scalp. In this article we review the published literature on adult and scalp psoriasis to highlight its treatment. Articles published in peer-reviewed journals were included for qualitative analysis of the literature, including reviews, clinical trials, case series, case reports published in the electronic database (MEDLINE/PubMed) through June 2021, cross references of respective articles, and trials from clinicaltrials.gov. J Drugs Dermatol. 2022;21(8):833-837. doi:10.36849/JDD.6498.

New Biologics and Oral Drugs in Treatment of Moderate to Severe Psoriasis.

Psoriasis is known to have no definitive cure, which is in common with other inflammatory disorders. Various treatment options are available, and they help in decreasing the disease activity and improving symptoms. These therapeutic agents are administered according to disease severity. The improvement is assessed by the Psoriasis Area and Severity Index (PASI) and Investigator Global Assessment (IGA), in which the appearance and extension of the lesions are taken into account. We searched for English-language literature regarding phase 2 and phase 3 trial drugs in the treatment of psoriasis in the following databases: PubMed, Scopus, Embase, Google Scholar, The Cochrane Library, and EBSCO, Clinicaltrials.gov. The keywords used include psoriasis, biologics, plaque psoriasis, systemic treatments, IL17 inhibitors, phase 2 trial, JAK inhibitor, and IL12/23 inhibitors. The search included only articles published in English.J Drugs Dermatol. 2022;21(8):826-831. doi:10.36849/JDD.6443.