RESUMO
Introduction: Follicular unit extraction (FUE) is a safe and effective procedure in the hands of an expert. Side effects, particularly those which can lead to significant morbidity or mortality, are unacceptable as the procedure is done purely for cosmetic reasons. Any modification that decreases the risk associated with the procedure should be promoted. Aim and Objective: The study was conducted to determine whether FUE can be carried out effectively with the elimination of nerve blocks and bupivacaine from the procedure. Materials and Methods: The study was conducted in 30 patients suffering from androgenetic alopecia. The donor areas was anesthetized using lignocaine with adrenaline just below the area to be harvested. The anesthetic was injected intradermally resulting in the development of wheals in continuity, forming a linear line. From our previous experience, we found intradermal administration of lignocaine to give better anesthetic effect as compared to subcutaneous administration, although the former is more painful. This was followed by injection of tumescent into the donor area and donor harvesting, which lasted for a couple of hours. The recipient area was anesthetized using a similar technique of linear injection of anesthetic just ahead of the proposed hair line. Results: The total amount of lignocaine with adrenaline consumed during the surgery ranged from a minimum of 6.1 ml to 8.5 ml, with an average of 7.6 ml. The average duration of the entire surgery was 6.5 h, ranging from 4.5 to 8.5 h. None of the patients experienced any pain during the entire surgery, and there were no significant side effects related to anesthetic administration in any patient. Discussion: We found lignocaine with adrenaline to be a very safe and effective anesthetic agent for field block anesthesia in FUE. The exclusion of bupivacaine and nerve blocks from the procedure of FUE can further increase the safety of the procedure, particularly for beginners and in cases where the area to be covered is not extensive (Norwood-Hamilton grades 3, 4, and 5).
RESUMO
Background: Pemphigus is a group of potentially fatal autoimmune mucocutaneous blistering diseases. Rituximab (RTX) is a chimeric anti-CD20 (anti-cluster of differentiate 20) monoclonal antibody being increasingly used and becoming the first-line therapy in the management of pemphigus. Aims and Objectives: This was an observational study to evaluate the efficacy and safety of rituximab in patients of pemphigus vulgaris (PV) who either did not respond or relapsed after conventional therapeutic regimens and in treatment naive pemphigus patients. Materials and Methods: The study included pemphigus patients coming to our immunobullous clinic who did not respond to conventional therapy or relapsed after receiving conventional therapy as well as fresh cases between January 2019 and October 2021. All enrolled patients received two doses of rituximab (1 gram in each) as intravenous infusions two weeks apart as per the rheumatoid arthritis protocol. The efficacy and safety were evaluated by assessing pemphigus area and activity score (PAAS) before and after the therapy, clinical response, and any adverse events during follow-up. Results: Sixteen (ten males and six females) patients were included in the study. The age of these patients ranged from 27 to 60 years, with a mean of 43.8 ± 9.8 years. There were 15 (93.75%) patients with PV (14 mucocutaneous type and 01 mucosal) and one (6.25%) with pemphigus foliaceus. Among these patients, nine (56.25%) were relapse cases, four (25%) were non-responders, and three (18.75%) were fresh cases who received rituximab as first-line therapy. Fourteen (87.5%) patients reached complete remission off therapy over a median time of 6.36 months (ranging from 18 weeks to 35 weeks). Rituximab was well-tolerated by our patients, and no serious adverse events were observed. The main limitation of our study was the small sample size and the lack of a comparison group. Conclusion: Rituximab is a safe and effective treatment for pemphigus.
