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Background: Keloids are less responsive to any single treatment modality; hence, there is a need for combination therapy that can yield satisfactory outcomes. Objective: The present study assessed efficacy and safety of combination therapy--surgical excision or cryotherapy and intralesional corticosteroids along with 5-fluorouracil [IL (S + 5-FU)] injection, followed by silicone gel sheet (SGS) under compression therapy in the treatment of keloids. Materials and Methods: This was a retrospective, observational study comprising 21 clinically diagnosed keloid patients. All patients were treated with the stated combination therapy. Data about demographic, lesions, procedural characteristics, and treatment outcomes were reported. Results: Of 21, 11 (52.4%) patients were treated with liquid nitrogen (LN2) cryotherapy, and 10 (47.6%) patients were treated with surgical excision. Mean age was 30.8 ± 7.6 (range: 14-44) years with slight male (52.4%) predominance. A mean surface area of keloid lesion was 96.8 ± 170.5 cm3. The most frequently involved site was auricle (8 [38.1%] patients). Patients received the following types of treatments: intralesional LN2 cryotherapy (6 [28.6%]), intralesional excisional surgery (6 [28.6%]), surface LN2 cryotherapy (5 [23.8%]), and extralesional excisional surgery (4 [19.0%]). Complications of recurrence (2 [9.5%]), secondary infections (2 [9.5%]), persistent postinflammatory hypopigmentation (1 [4.8%]), and atrophic scarring with postinflammatory hyperpigmentation (1 [4.8%]) were reported. After a study period of 2.5 years, 100% cure rate was achieved. Conclusion: Combination therapy of surgical excision or cryotherapy and IL (S + 5-FU), followed by SGS under compression, was safe and effective in treating keloids. [ABSTRACT FROM AUTHOR]

Historically, nose piercing was considered as the symbol of elegance and sometimes also associated with regional ritual. In modern civilization, there has been a decreasing trend to wear nose rings and some people demand for its closure. Herein, we report a case series of three patients who were successfully managed with full-thickness skin grafting for the closure of nose piercing site. [ABSTRACT FROM AUTHOR]

Background: The utilization of smartphone-assisted evaluation is emerging in the field of histopathology. This technique improves the adequacy of samples at the bedside, avoids procedure-related complications, reduces unnecessary repeat biopsies, and saves the cost of the procedure. This study aims to compare the number of glomeruli in a renal biopsy specimen obtained by an ultrasound-guided percutaneous needle biopsy, counted at the bedside using a smartphone fitted with a 16-megapixel macro lens (Bedside method) with that observed under a light microscope after the processing of the biopsy specimen (LM method). Materials and Methods: In this prospective cohort study, 24 consecutive adult patients (48 kidney biopsy samples) who underwent kidney biopsies were enrolled. All specimens were extracted by an ultrasound-guided percutaneous renal biopsy from the lower pole of the left kidney. Patients' demographics and clinical data were prospectively collected. The number of glomeruli in all the biopsy specimens was counted using a smartphone fitted with a 16-megapixel macro lens at the bedside (Bedside method) and subsequently under a light microscope by a pathologist after processing the biopsy specimen (LM method). Seven or more glomeruli in the specimen were considered adequate in our study. Results: The mean age of patients at biopsy was 46.9 ± 16 years with slightly male predominance (54.2%). A total of 47 specimens were obtained from 24 patients. Of the 24 patients, 22 had native kidney biopsy and 2 had renal allograft biopsy. The average number of cores obtained per patient was 1.96. The length of core specimens ranged from 1.5 to 2 cm. A good agreement was found between bedside adequacy and slide adequacy, k = 0.684, P = 0.000. The positive agreement rate and negative agreement rate were 91.4% and 23.1%, respectively. Conclusion: In the modern era of technology, the smartphone is a good tool to evaluate the adequacy of biopsy specimens at the bedside. [ABSTRACT FROM AUTHOR]

Background and Objective: Few dating back, the role of visual evoked potentials changes and reduced level of intracellular magnesium have appeared in migraine patients both throughout the attacks and in the interictal periods. Moreover, there is a lack of evidence regarding the correlation between magnesium levels and visual evoked potentials. To assess the changes in the levels of magnesium in migraineurs compared to a healthy control group is our prime intention. Also, to correlate serum magnesium levels with visual evoked potentials changes within the migraineurs is a secondary part of the study. Materials and Methods: After applying inclusion and exclusion criteria as per the study protocol, in total, 80 subjects were enrolled in the study. Of which 40 were migraineurs diagnosed as per the International Headache Society criteria for severe migraine headache. Rest of 40 was nonmigraineurs served as a control group of the study. All included patient was submitted to demographic profile, previous history of the disease and drug intake, thorough clinical investigation and baseline laboratory parameters. Apart from this, the measurement of visual evoked potentials changes (4th block) and magnesium levels were done as per our standard operating procedures. Results: In migraineurs, serum total Mg level was considerably lower compared to the control group (1.79 ± 0.14 mg/dl versus 2.10 ± 0.17 mg/dl, P < 0.0001) and amplitude of P100 (P < 0.0001) was negatively correlated to reduced serum Mg level (P < 0.0001). Conclusions: As expected, both elevated visual evoked potential amplitude and reduced level of brain magnesium can be a demonstration of neuronal hyperexcitability of the optic pathways associated with a dropped threshold for migraine attacks. [ABSTRACT FROM AUTHOR]

Since introduced in 1961, intralesional (IL) agent has become an essential part of the dermatological practice. The term IL referred to the direct delivery of agent percutaneously into skin lesions. This therapeutic approach is relatively safe, easy to perform and applicable for a broad range of dermatological conditions. On the other hand, immediate side effects, including pain during administration, bleeding, high risk of infection and allergic reaction, and subsequent side effects involving skin changes such as atrophy, telangiectasia, pigmentary changes, and striae are usually associated with this modality. This review paper highlights the pros and cons of IL agents in modern dermatology practice. [ABSTRACT FROM AUTHOR]

Here, in this case, congo red stain was used for a definite diagnosis of ACD.[[12]] Various treatment modalities have been described for the treatment of ACD with varying success rates. The clinical, histopathological and treatment profile of these published cases of ACD has been compiled in [Table 1].[[4]],[[5]],[[6]],[[7]],[[8]],[[9]],[[10]]{Table 1} ACD must be differentiated from other causes of dyschromia including dyschromatosis universalis hereditaria, xeroderma pigmentosum and poikiloderma-like amyloidosis. Sir, In 1970, Morishima et al. introduced amyloidosis cutis dyschromica (ACD), a rare variant of primary cutaneous amyloidosis (PCA). [Extracted from the article]

BACKGROUND: Vitiligo-affected individuals, especially patients with darker skin tones, can suffer from negative psychosocial impacts due to unpredictable development of the condition and perceived cosmetic concerns. However, given that spontaneous repigmentation can be gained in vitiligo, many patients ask for treatment due to these cosmetic concerns. In the literature, only a few studies have been documented focusing on the outcome of various treatment modalities for vitiligo. OBJECTIVE: This article highlights the retrospective response of various treatment modalities in Indian patients with vitiligo. METHODS: A retrospective chart review was performed from July 2017 to August 2018 at our private dermatology clinic. A total of 3,000 patients were enrolled in this observational study. Patient characteristics and details of phototherapy (psoralen and ultraviolet A, narrow-band ultraviolet B, excimer laser) were noted as per a predefined format. The clinical response was evaluated as a marked response, defined as repigmentation in more than 75% of the initial lesional area. RESULTS: Of those included in this retrospective analysis, 1,996 patients received phototherapy and 1,004 patients were treated with topical monotherapy. Patients treated with phototherapy only and those treated with a combination of phototherapy and topical agents showed significantly higher clinical response rates relative to patients treated with topical monotherapy only (marked response rate: 47.8% vs. 8.7%; P<0.001 and 23.4% vs. 8.7%; P<0.001). Disease subtype predominately affected the treatment response. CONCLUSION: In Indian patients with vitiligo, phototherapy appears to be an effective treatment option for both focal and vitiligo vulgaris. Due to its reliability and minimal side effects, it can be considered a preferable treatment modality for vitiligo. [ABSTRACT FROM AUTHOR]

Background & Objective: Many studies demonstrated that migraine patients have an interictal habituation and deficit of visual evoked potentials. Controversially, other studies could not reproduce similar finding. Hence, there is a dilemma regarding what should be the ultimate conclusions. The purpose of this study was to compare amplitude and habituation of pattern reversal visual evoked potentials in migraine with aura patients and healthy volunteers. Methods: A total of 40 migraine with aura patients and 40 controls were prospectively enrolled in this cross-sectional study. Using the pattern reversal stimuli, visual evoked potential were estimated in all the participants and abnormalities were noted. Results: In migraine with aura patients, there was a statistically significant increase in the amplitude of the P100 wave due to deficient habituation after 15 min stimulation. In normal subjects, there was a decrease in the amplitude of the P100 wave due to the effect of habituation. The deficient habituation can be because of decreased serotonin levels resulting in reduced pre-activation of the cortex. Conclusion: Migraine with aura patients show evidence of abnormal cortical processing with interictal hyperactivity seen in heightened responsiveness and lack of habituation to visual evoked responses. [ABSTRACT FROM AUTHOR]

The term plaque morphea describes a variant of morphea (localized scleroderma) in which oval or round circumscribed areas of induration, pigmentary changes, and violaceous or erythematous halo (i.e., lilac ring) are found in the dermis and occasionally to the superficial panniculus. We report a case of 28-year-old male patient with recurrent plaque morphea who was treated with polydioxanone (PDO) mono threads and topical tacrolimus ointment. After the introduction of PDO mono threads, the patient was prescribed topical tacrolimus ointment for six months. After that six-month period, the lesions were softer to palpation and lighter in color. This was observed as a positive therapeutic response. Notably, no future recurrence was seen at one-year follow up. [ABSTRACT FROM AUTHOR]

Rhinophyma (Greek "nose growth") benign skin deformity characterized by tumorous growth leading to a large, bulbous, and erythematous appearing nose. It is a rare subtype of phymatous rosacea. The exact pathogenesis is still not known. It can lead to considerable cosmetic impairment with psychosocial implications and poses a risk of developing an occult malignancy. Early diagnosis and treatment is imperative to avoid these complications. Herein, we report a case of a 47-year-old man presenting with rhinophyma who was treated with ultra plus CO2laser. [ABSTRACT FROM AUTHOR]

Porokeratosis is a genodermatosis, resulting from a disorder in keratinization due to an abnormal clone of epidermal precursor, presenting with various clinical manifestations but characterized histologically by the presence of cornoid lamella. Diverse clinical variants of porokeratosis exist, which are unified by this general histological feature, but differ in morphology, distribution, and clinical course. The typical lesions of porokeratosis are described by an atrophic center surrounded by an elevated keratotic rim formed by the cornoid lamella. The lesions can be found almost anywhere on the body. We report an unusual presentation of a rare clinical variant, disseminated superficial porokeratosis. [ABSTRACT FROM AUTHOR]

Background: Rituximab, an anticluster of differentation 20 antibody, has been shown in open series studies to be effective in treating pemphigus. In the literature, lymphoma (dose of 375mg/m2, four-week infusion) and rheumatoid arthritis (two infusions of 1,000mg each, 15 days apart) are two protocols extensively used for rituximab treatment in pemphigus. Objective: We investigated whether a modified rheumatoid arthritis protocol, in which the patient received a single treatment course ranging from 2 to 5 infusions of 1,000mg of rituximab during an interval of four weeks is safe and effective in pemphigus management. Methods: Patients with pemphigus were treated with a single treatment course ranging from 2 to 5 infusions of 1,000mg of rituximab during an interval of four weeks. Clinical consensus late endpoints and desmoglein 1 and desmoglein 3 indices were monitored. Results: We enrolled 32 patients in the study: four with pemphigus foliaceus (PF) and 28 with pemphigus vulgaris (PV). The follow-up period was 98.22±20.65 weeks (range: 40-140 weeks). All 32 patients responded to therapy. Nineteen patients achieved complete remission during a median period of 46 weeks (8 on minimal therapy, 11 off therapy). Thirteen patients achieved partial remission during a median period of 46 weeks (8 on minimal therapy, 5 off therapy). Relapses were seen in five (15.63%) patients between 72 and 96 weeks (median: 96 weeks) after the start of therapy. The antidesmoglein index correlated well with clinical improvement in PV or PF. Conclusion: Modified rheumatic arthritis protocol for rituximab was shown to be effective and safe in treating patients with pemphigus. [ABSTRACT FROM AUTHOR]

Congenital melanocytic nevi are benign proliferations of cutaneous melanocytes that arise as a result of abnormal growth, development, or migration of melanoblasts. Clinically, the giant congenital nevus is greater than 20 cm in size, pigmented and often hairy. The risk of malignant melanoma for the giant nevi is almost 6%. Fifty percent of the melanomas develop by the age of 2 years and, 80% of the melanomas develop by the age of 7 years. Hence, early management is of paramount importance. Herein, we present a case of giant nevi along with a review of the literature in order to bring awareness among clinicians towards this rare albeit significant entity. [ABSTRACT FROM AUTHOR]

With chronological aging, hair turns gray. Untimely premature hair graying (PHG) may tremendously influence on cosmesis, self-credibility, and social life of the affected individuals. Consequently, early treatment is required to improve cosmetic appearance. To the best of our knowledge, until today, only one case of PHG is reported in the literature, and it occurred due to iron deficiency and successfully treated with ferrous sulfate. Herein, we delineate a case of PHG in a 14-year-old female treated with the topical formulation of Melitane 5% and oral hair supplements which resulted in boosting improvement in hair color. [ABSTRACT FROM AUTHOR]

Introduction: Even though there is the availability of multiple treatment modalities for vitiligo still its treatment remains challenging. Combination therapies of Narrowband Ultraviolet B (NB-UVB) and various topical agents or lasers are widely used in the treatment of vitiligo. Aim: To compare the efficacy of NB-UVB and topical agents including calcineurin inhibitors, antioxidants, corticosteroids, vitamin-D3 analogues and 5-fluorouracil or lasers combination therapy versus NB-UVB monotherapy for vitiligo. Materials and Methods: Data source: This was randomised controlled trials which was conducted to revealed the efficacy of NB-UVB alone or in combination with topical agents or lasers for vitiligo, manual searches of reference lists and, computerised searches of the PubMed (from 2000 to 2018) Science direct (from 1995 to 2018) and Cochrane Central Register of Controlled Trials (from 2005 to 2017) were conducted with keywords "NB-UVB" or "narrowband ultraviolet B", "Vitiligo". Study eligibility criteria: In this study, full-text articles of clinical randomised controlled trials RCTs published in English language literature were selected. Participants: Out of 549 studies, 12 studies with a total of 460 patches or patients were included in the review based on the inclusion and exclusion criteria. Apart from included 12 studies, others 537 studies were excluded due to the following reasons: inappropriate after the title and abstract screening, improper intervention and improper outcome measures, published only in abstract form, not a combination therapy, not an RCT. Intervention: For this systemic review and meta-analysis, application of NB-UVB monotherapy for one group and the combination of NB-UVB with any topical agents or lasers for another group also having treatment success (=75% regimentation) as the primary outcome and treatment failure (<25% regimentation) as the secondary outcome were selected. Study appraisal and synthesis methods: Out of 549 studies, 22 studies were assessed for methodological quality and finally, 12 studies with a total of 460 patches or patients were included in the review based on the inclusion and exclusion criteria. This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). Results: In this study, 12 randomised controlled trials comprising a total of 460 patches/patients were analysed. The obtained results suggested that combination therapy is superior compared to monotherapy in form of regimentation except calcipotriol combined with NB-UVB. Among all combination therapy, the combination of NB-UVB and antioxidants (2 studies: RR 1.77, 95% CI 0.93 to 3.35; number needed to treat 4.68, 95% CI 2.22 to 41.69) moreover topical calcineurin inhibitors (3 studies: RR 1.79, 95% CI 1.06 to 3.01; number needed to treat 10.7, 95% CI 5.85 to 62.49) was superior to NB-UVB monotherapy for vitiligo. Apart from these, success rate in other combination can't predicted because the presence of high level heterogeneity (three studies: NB-UVB combined with fractional CO2 laser group) or could not find heterogeneity as single study (four studies: Others group; NBUVB combined with ER:YAG laser ablation and 5-fluorouracil, NB-UVB combined with topical steroid and dermabrasion, NBUVB combined with 5-fluorouracil injection, NB-UVB combined with calcipotriol ointment). Limitation: The verdicts of this study are limited by small numbers of randomised controlled trials and heterogeneities among included studies. Conclusion: In conclusion, adding antioxidant and topical calcineurin inhibitors on NB-UVB yields significantly superior outcomes than NB-UVB monotherapy. For soundest clarification, more large-scale, high-quality, double-blind RCTs regarding the efficacy of topical agents or lasers plus NB-UVB combination therapy should be planned. [ABSTRACT FROM AUTHOR]

Carbon dioxide (CO2) laser ablation treatment generating 10,600nm of infrared radiation has shown promising results in patients with small-sized congenital melanocytic nevi (CMN). In this retrospective study, we evaluated the efficacy (Investigator's Global Assessment [IGA] score) and patient satisfaction for CO2 laser ablation for the treatment of small CMN in 17 adults. Of those treated with CO2 laser ablation, our findings indicate the average IGA and patient satisfaction scores were 6.41 and 3.76, respectively. Apart from these, 47.1 percent of cases obtained an IGA score of 7 and 76.5 percent of cases achieved a patient satisfaction score of 4. These results support the efficacy of CO2 laser ablation treatment and might help the clinician to guide treatment selection in patients who wish to avoid more invasive surgical options. [ABSTRACT FROM AUTHOR]