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Background: Tacrolimus, a topical calcineurin inhibitor (TCI) with immunomodulatory effects, is considered a viable treatment option for vitiligo. A consensus building exercise was undertaken to determine the role and clinical utility of topical tacrolimus in the management of vitiligo using input from experts in the field of dermatology. Methods: Seventeen experts collaborated to create consensus statements using a modified Delphi methodology. A questionnaire on effectiveness, safety and utility of topical tacrolimus in different types of vitiligo, duration, frequency, monotherapy and combination and other aspects was shared, and a concordance rate of 75% was preset to have consensus. A physical meeting was conducted to discuss statements, which did not achieve consensus. Results: Amongst 34 statements derived from round one, consensus was not achieved for 9 statements. In the second round, consensus was achieved for 2/9 statements, hence in the physical meeting, discussion was done to reframe the remaining seven statements. Apart from these 34 statements, questions pertaining to "Vitiligo: types and presentation in clinical practice", where consensus was not intended, are presented as descriptive statements. Conclusion: Topical tacrolimus ointment has a favorable risk benefit profile to be used as one of the first-line agents for vitiligo. Combination of topical tacrolimus and narrow band Ultraviolet-B (NBUVB) was recommended as an effective treatment for non-segmental vitiligo. Recommended frequency of application was once or twice daily for optimal results. Apart from a transient burning sensation, topical tacrolimus has a favorable safety profile. [ABSTRACT FROM AUTHOR]

The article "Deciphering the landscape of hereditary angioedema in India: Perspective for Indian dermatologists" published in the Indian Journal of Dermatology, Venereology & Leprology provides insights into hereditary angioedema (HAE) in India. It highlights the genetic causes, clinical manifestations, and management strategies for HAE, emphasizing the need for awareness and timely diagnosis. The article also discusses the availability of first-line treatment options in India and the importance of specialized care for patients with HAE. Additionally, it mentions patient advocacy groups like HAE India that aim to raise awareness and improve access to medications for individuals with HAE. [Extracted from the article]

Dermatological disorders constitute a significant proportion of primary health care (PHC) setups. The pattern of dermatological disorders varies among different countries and different parts of the same country owing to climatic and geographical variations, level of education, access to health care, etc. To study the clinical spectrum of patients presenting with dermatological disorders at an urban health center (UHC) in East Delhi. To identify the various risk factors associated with dermatological disorders in study subjects. A total of 1,148 patients who reported skin diseases for the first time at the Dermatology Outpatient Clinic at UHC in East Delhi were recruited. Detailed demographic data, history, and examination and potential risk factors of skin diseases (socioeconomic status, level of education, occupation, comorbidities, and addictions) were recorded on a predesigned proforma. A total of 616 (53.7%) patients had infectious dermatoses and 532 (46.3%) had non-infectious dermatoses. Among the infectious dermatoses, fungal diseases (44.8%) were the most common followed by parasitic infections (31.17%) and bacterial infections (9.74%). Among the non-infectious group, eczematous disorders (28.01%) were the most common, followed by pigmentary disorders (21.62%) and acne (19.55%). A significant association between level of education, occupation, and comorbidities with the distribution of infectious and non-infectious dermatoses was found. As a significant proportion of patients with a vivid spectrum of dermatological disorders present at the PHC setups, therefore dermatologists supervise that specialty clinics should be held regularly at these centers along with the availability of all the basic investigations to aid diagnosis and management. [ABSTRACT FROM AUTHOR]

Probiotics are viable microorganisms that confer health benefits when administered to the host in adequate amounts. Over the past decade, there has been a growing demand for the use of oral and topical probiotics in several inflammatory conditions such as atopic dermatitis, psoriasis, acne vulgaris, etc., although their role in a few areas still remains controversial. The objective of this article is to shed light on understanding the origin and implications of microbiota in the pathophysiology of these dermatological conditions and the effect of probiotic usage. We have conducted a comprehensive search of the literature across multiple databases (PubMed, EMBASE, MEDLINE, and Google Scholar) on the role of probiotics in dermatological disorders. Commensal microbes of the skin and gastrointestinal tract play an important role in both health and disease. Increased use of probiotics has asserted a good safety profile, especially in this era of antibiotic resistance. With the advent of new products in the market, the indications, mechanism of action, efficacy, and safety profile of these agents need to be validated. Further studies are required. Oral and topical probiotics may be tried as a treatment or prevention modality in cutaneous inflammatory disorders, thus facilitating decreased requirement for topical or systemic steroids and antimicrobial agents. Tempering microbiota with probiotics is a safe and well‑tolerated approach in this era of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

This article presents the findings of a study conducted among Indian dermatology residents to assess the prevalence and patterns of dermoscope use and the ability to identify common pigmentary dermatoses of the face. The study found that the prevalence of self-purchased dermoscopes increased with higher monthly stipends, but limited access and inadequate training were identified as potential reasons for variations in dermoscope use. The study also revealed that dermatology residents had higher accuracy in identifying dermatoses through clinical images compared to dermoscopic images. The study suggests the need for formal dermoscopy training in residency overseen by a program director. However, the study acknowledges limitations, including selection bias and the exclusion of certain graduates. [Extracted from the article]

Rash and fever are some of the most common chief complaints present in paediatric dermatology emergencies. The spectrum of differential diagnosis is broad, including many different infectious and some non-infectious agents. A systematic approach involving detailed history taking, careful clinical examination along with particular attention to epidemiological features are the most important factors to make a diagnosis. This article reviews the morphological patterns of various causes of fever with rash in children, including infectious as well as non-infectious causes, with special emphasis on the Indian scenario. We intend to highlight the clinical characteristics of each cause, which will not only help make a clinical diagnosis but also distinguish benign versus life-threatening causes of skin rash in febrile paediatric patients and provide early medical intervention. [ABSTRACT FROM AUTHOR]

The Indian Association of Dermatologists, Venereologists, and Leprologists (IADVL) has established the I-CuReD registry in India to collect data on rare skin disorders. The registry has recorded 323 patients with genodermatoses, with epidermolysis bullosa and congenital ichthyosis being the most common diseases. The article provides detailed information on the demographics, symptoms, and diagnostic methods used for these patients. The study found a lower number of cases compared to other countries and highlights the need for further research in this area. The authors acknowledge the limitations of their study and hope for more comprehensive studies in the future. [Extracted from the article]

Introduction: Acanthosis Nigricans (AN) is an acquired disorder of keratinization. It presents as hyperpigmentation, velvety texture of skin that can involve any part of the body including the face. Different topical, systemic therapies, or physical therapies including laser have been explored. However, there are not many randomized controlled studies for the majority of therapy alternatives besides lifestyle modifications and weight reduction. Objectives: The aim of this study was to compare the effectiveness of 15% trichloroacetic acid (TCA) and 35% glycolic acid (GA) peel for AN. Materials and Methods: Forty participants were included and randomized into two groups. In groups A and B, peeling with 15% TCA and 35% GA was done, respectively. The effectiveness of each peel was assessed using changes in the Acanthosis Nigricans Area and Severity Index Score (ANASI) and Physician Assessment Score. Statistical analysis included Wilcoxon-Mann-Whitney test, Friedman test, and generalized estimating equations. Results: The overall change in ANASI over time was compared in the two groups using the generalized estimating equations method. A significant difference was observed in the trend of ANASI over time between the two groups (P < 0.001). TCA peel group showed more change in ANASI as compared with GA peel group. Conclusion: In our research, 15% TCA has a better efficacy when compared with 35% GA peel after three sessions of chemical peeling. We therefore recommend the use of 15% TCA peel in AN as a safe and effective treatment option. However, more comprehensive randomized control studies are required for supporting data. [ABSTRACT FROM AUTHOR]

Introduction There is ambiguity regarding usage of tranexamic acid for melasma in India, be it in its pre-administration evaluation, administration route, dosing or monitoring. Hence, we conducted this study to understand various tranexamic-acid prescribing patterns and provide practical guidelines. Materials and methods A Google-form-based questionnaire (25-questions) was prepared based on the key areas identified by experts from the Pigmentary Disorders Society, India and circulated to practicing dermatologists across the country. In rounds 2 and 3, the questionnaire was re-presented to the same group of experts and their opinions were sought. The results of the practitioners' survey were denoted graphically alongside, to guide them. Consensus was deemed when at least 80% of respondents chose an option. Results The members agreed that history pertaining to risk factors for thromboembolism, cardiovascular and menstrual disorders should be sought in patients being started on oral tranexamic-acid. Baseline coagulation profile should be ordered in all patients prior to tranexamic-acid and more exhaustive investigations such as complete blood count, liver function test, protein C and S in patients with high risk of thromboembolism. The preferred oral dose was 250 mg orally twice daily, which can be used alone or in combination with topical hydroquinone, kojic acid and sunscreen. Repeated dosing of tranexamic-acid may be required for those relapsing with melasma following initial tranexamic-acid discontinuation. Coagulation profile should ideally be repeated at three monthly intervals during follow-up, especially in patients with clinically higher risk of thromboembolism. Treatment can be stopped abruptly post improvement and no tapering is required. Limitation This study is limited by the fact that open-ended questions were limited to the first general survey round. Conclusion Oral tranexamic-acid provides a valuable treatment option for melasma. Frequent courses of therapy may be required to sustain results and a vigilant watch is recommended for hypercoagulable states during the course of therapy. [ABSTRACT FROM AUTHOR]

Background: Mentorship programs for dermatologists have been in vogue in the West for many years, but have been on a hiatus in India. Recently, there is renewed interest, and mentorship programs are gaining momentum across the country to guide and nurture young dermatologists to attain their full potential. However, what constitutes an ideal mentorship program is still an enigma. Materials and Methods: We developed a multiple-choice questionnaire (Google-form), enquiring post graduates and dermatologists about their general opinion of mentorship, its key areas and what constituted an ideal mentorship-program. These were distributed via email and WhatsApp and responses were collected over a month's period. The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) for Windows. Results: We received 202 responses and majority of the respondents were private practitioners (32.2%) and post graduate students (29.7%). Respondents felt that mentorship should be undertaken at the beginning of postgraduation (37.1%) or just after its completion (23.8%), and should focus on academic and research related issues (55.0%). Communication (95.5%) was an important factor for the program to be successful, and on an average, must be of seven weeks duration, with a mentor: mentee ratio of 1:2. We found a significant association between the designation of the respondent and their perceived ideal time for a mentorship program (P<0.001, Chi Square Test), seeking of mentorship beyond the program duration (P<0.01, Chi Square Test) and the type of mentorship program (P=0.01, Chi square test). Conclusion: Our survey concluded that a well-planned short mentorship program of six to eight weeks duration with a low mentee to mentor ratio with an informal style of mentoring in the formative years of one's career would be suitable in the Indian Dermatology scenario. Communication and availability emerged as important elements for a successful mentor mentee relationship. The positive effects of a well-planned mentorship program extend beyond its duration and enrich both the mentor and mentee. [ABSTRACT FROM AUTHOR]

Introduction: Melasma is an acquired disorder, which presents with well-demarcated, brown-colored hyperpigmented macules, commonly involving the sun-exposed areas such as the face. It is a chronic and distressing condition, affecting the patients' quality of life, and has been conventionally treated with "first-line" agents including hydroquinone (HQ) alone or as a part of a triple combination cream (TCC), while "second-line" options include chemical peels, and third line options include laser therapy. Materials and Methods: A systematic search was performed for all topical and systemic treatments for melasma up till May 4, 2021, using the PubMed and EMBASE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The search terms "melasma" and "treatment" were used to search for the relevant articles on both these databases, and a total of 4020 articles were identified. After removing the duplicate entries and screening the titles, abstracts, and full-text articles, we identified 174 randomized controlled trials (RCTs) or controlled clinical trials. Results: Based on our review, HQ, TCCs, sunscreens, kojic acid (KA), and azelaic acid receive grade A recommendation. Further large-scale studies are required to clearly establish the efficacy of topical vitamin C, resorcinol, and topical tranexamic acid (TXA).Several newer topical agents may play a role only as an add-on or second-line drugs or as maintenance therapy. Oral TXA has a strong recommendation, provided there are no contraindications. Procyanidins, Polypodium leucotomos (PL), and even synbiotics may be taken as adjuncts. Discussion: Several newer topical and systemic agents with multimodal mechanisms of action have now become available, and the balance seems to be tipping in favor of these innovative modalities. However, it is worth mentioning that the choice of agent should be individualized and subject to availability in a particular country. [ABSTRACT FROM AUTHOR]

This article provides an overview of the role of the skin microbiome in atopic dermatitis (AD) and explores the potential benefits of using microbiome-containing moisturizers for AD management. It emphasizes the importance of maintaining microbial balance in AD therapies and suggests further research is needed to determine the effectiveness of these products. The article also mentions the use of probiotics and prebiotics in AD treatment, as well as the potential of balneotherapy in optimizing microbial diversity and reducing the severity of AD lesions. Overall, it offers valuable insights into the current understanding of the skin microbiome in AD and its implications for treatment. [Extracted from the article]

Background: Fever with rash is common among children and is seen by both dermatologists and pediatricians. The various causes of fever with rash in children include viral infections, bacterial infections, rickettsial species, collagen vascular diseases, and drug hypersensitivity rash. Viral exanthems are by far the most common cause of fever with rash in children. Common viral etiologies are measles, rubella, varicella, adenovirus, herpes simplex virus (HSV) 1 and 2, human herpes virus 6, human herpes virus 7, Epstein-Barr virus, coxsackie, dengue, chikungunya, influenza A and B, and hepatitis B. Aims: The study aimed to study the magnitude of various viral causes of fever with rash in children and to study the various morphological patterns of rash. Materials and Methods: This was a hospital-based observational study which included 90 children presenting to the dermatology and pediatrics outpatient department with fever and rash. Immunoglobulin M antibody testing for measles, rubella, varicella, HSV, chikungunya virus, dengue virus, and hepatitis B virus was done. Reverse transcription-polymerase chain reaction for COVID-19 virus was done when suspected. Results: The most common etiology of fever with rash was viral (51.1%). Out of all viruses isolated, measles was the most common (15.55%), followed by Chikungunya (14.44%). Maculopapular rash was the most common morphology of rash (40%) found in patients. Among the patients having maculopapular rash, measles was the most common virus isolated. Conclusion: Viral exanthems should be considered a strong differential in all children presenting with fever and rash. [ABSTRACT FROM AUTHOR]

Janus kinase (JAK) refers to a family of tyrosine kinases that are involved in the production of proinflammatory mediators in response to various extracellular signals. The JAK–signal transducer and activator of transcription (STAT) pathway is an appealing target in many inflammatory illnesses as this pathway modulates immune cell activation and T-cell-mediated inflammation in response to several cytokines. The practical considerations of prescription for topical and oral JAK inhibitors (JAKis) in atopic dermatitis, vitiligo and psoriasis have been covered in prior publications. Currently, the US Food and Drug Administration has approved the topical JAKi ruxolitinib for atopic dermatitis and nonsegmental vitiligo. None of the remaining first- or second-generation topical JAKis have been approved for topical application in any dermatological indications so far. For this review, the PubMed database was searched using 'topical' and 'JAK inhibitor' or 'Janus kinase inhibitor' or the names of individual drug molecules as the keyword in the title with no date limits. The description of topical JAKi usage in dermatology from the literature was evaluated in each abstract. The current review concentrates on emphasizing the rising use of topical JAKis in both approved and off-label dermatological applications for both old and novel conditions. Currently, the Food and Drug Administration has approved the topical Janus kinase inhibitor (JAKi) ruxolitinib for atopic dermatitis and nonsegmental vitiligo. None of the remaining first- or second-generation topical JAKis have been approved for topical application in any dermatological indications so far. The current review concentrates on emphasizing the rising use of topical JAKis in both approved and off-label dermatological applications for both old and novel conditions. [ABSTRACT FROM AUTHOR]

Background: Facial acanthosis nigricans (AN) is usually a misdiagnosed facial melanosis, most commonly seen in obese individuals. Though it is also associated with metabolic syndrome, malignancy, drug intake, or syndromes. The randomized controlled trials for treatment options are lacking. Aims: This review aims to focus on the clinical presentation of facial AN, clues for the diagnosis, close mimickers, and treatment options available. Methods: Literature search for this review was done on PubMed and Science direct. Only articles in English literature were included. Results: By reviewing the literature, we inferred that only subtle differences are present among different facial melanosis. Hence, for the diagnosis of AN, a thorough history and examination is a must and, along with this, dermoscopy plays a crucial role. Conclusion: Facial AN is a marker for multiple systemic diseases. Hence, diagnosing AN well on time, will give us an edge in recognizing systemic disease early. The treatment options for facial AN are not much studied. There is much scope for studying the same in future. [ABSTRACT FROM AUTHOR]

This article discusses the use of oral melatonin as a treatment for recalcitrant melasma, a common hyperpigmentary disorder. The study reports on a series of seven cases in which patients with melasma were treated with a 3mg melatonin tablet once daily for 12 weeks, along with the use of broad-spectrum sunscreen. After the treatment period, all patients reported lightening of pigmentation and a decrease in the severity of melasma. No side effects were reported. The article concludes that melatonin is a safe and effective treatment option for melasma, but further research is needed to fully understand its potential. [Extracted from the article]

Introduction: Scarring is a common but difficult to manage consequence of acne vulgaris. The intricate balance between the degradation of collagen and its inhibition is disturbed during the formation of acne scars. We mostly rely on invasive, non‐topical modalities for the treatment of acne scars which may not be indicated in all patients. There is also a need for maintainence therapies after these procedures. Review: The topical agents can be utilized as individual therapy, in combination with other modalities or delivered through assisted technology like iontophoresis. Retinoids have long been tried to prevent and treat acne scars. Tacrolimus and glycolic acid are among the newer sole agents that have been explored. Ablative lasers like Er:YAG, CO2 and Microneedling are being used in combination with topical agents like silicone gel, plasma gel, lyophilized growth factors, platelet rich plasma, insulin, and mesenchymal stem cells. These procedures not only increase the permeability of the topical agents but also concomitantly improve acne scars. Iontophoresis has proven beneficial in increasing the delivery of topical estriol and tretinoin. Conclusion: There is lack of evidence to support the widespread use of these topical agents, and therefore, there is need for further well designed studies. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction Raynaud's phenomenon manifests as episodic vasospasm leading to acral vascular compromise following emotional stress or exposure to a cold environment. A meta-analysis (92% cases with systemic sclerosis-associated Raynaud's) revealed that these agents significantly decrease Raynaud's condition score by -0.46, frequency by -0.49, and daily duration of episodes by -14.62 min. For patients with secondary Raynaud's, the severity based on the visual analog scale and frequency of episodes (episodes/week) dropped by a mean difference of -0.48 and -3.15 respectively.[[28]] I Phosphodiesterase 5 inhibitors i These are second-line agents for Raynaud's phenomenon. In Raynaud's case, vasoconstriction is mediated by neuropeptide dysregulation and 2-adrenoreceptors upregulation.[[5]] I Central mechanisms i - Stress-induced Raynaud's phenomenon suggests the involvement of our nervous system in its pathophysiology. [Extracted from the article]

Background: Although well known in clinical practice, research in lichen planus pigmentosus and related dermal pigmentary diseases is restricted due to lack of consensus on nomenclature and disease definition. Aims and Objectives: Delphi exercise to define and categorise acquired dermal pigmentary diseases. Methods: Core areas were identified including disease definition, etiopathogenesis, risk factors, clinical features, diagnostic methods, treatment modalities and outcome measures. The Delphi exercise was conducted in three rounds. Results: Sixteen researchers representing 12 different universities across India and Australia agreed to be part of this Delphi exercise. At the end of three rounds, a consensus of >80% was reached on usage of the umbrella term ‘acquired dermal macular hyperpigmentation’. It was agreed that there were minimal differences, if any, among the disorders previously defined as ashy dermatosis, erythema dyschromicum perstans, Riehl’s melanosis and pigmented contact dermatitis. It was also agreed that lichen planus pigmentosus, erythema dyschromicum perstans and ashy dermatosis did not differ significantly apart from the sites of involvement, as historically described in the literature. Exposure to hair colours, sunlight and cosmetics was associated with these disorders in a significant proportion of patients. Participants agreed that both histopathology and dermatoscopy could diagnose dermal pigmentation characteristic of acquired dermal macular hyperpigmentation but could not differentiate the individual entities of ashy dermatosis, erythema dyschromicum perstans, Riehl’s melanosis, lichen planus pigmentosus and pigmented contact dermatitis. Limitations: A wider consensus involving representatives from East Asian, European and Latin American countries is required. Conclusion: Acquired dermal macular hyperpigmentation could be an appropriate conglomerate terminology for acquired dermatoses characterised by idiopathic or multifactorial non-inflammatory macular dermal hyperpigmentation. [ABSTRACT FROM AUTHOR]

Amyloidosis describes a group of diseases characterized by abnormal extracellular deposition of a fibrillar protein in tissues. It comprises of a spectrum of diseases ranging from a mild asymptomatic cutaneous involvement to a progressive life-threatening multisystem disorder. Primary localized cutaneous amyloidosis (PLCA) is characterized by pruritus, hyperpigmentation, and lichenification. Demonstration of amyloid in dermal papillae by various techniques confirms the diagnosis. Three types are described, macular, lichen/papular, and nodular. Majority of cases of PLCA are sporadic but an autosomal dominant family history may be present in up to 10% of cases. Exact pathogenesis is not elucidated yet, but several factors like friction, sunlight, genetics, atopy, immune dysregulation have been implicated. Pathogenic mutations in oncostatin M receptor and the interleukin (IL)-31 receptor A gene (IL31RA) have an important role to play in the pathogenesis of both familial and sporadic PLCA. Nodular amyloidosis, the rarest type of PLCA, is known to progress to systemic amyloidosis in 7% to 15% of cases, hence a long-term follow up is recommended. The plethora of treatment options reported to be beneficial in cutaneous amyloidosis underscores the fact that none of the modality is universally effective. [ABSTRACT FROM AUTHOR]

Introduction/Background: Acitretin is a second-generation systemic retinoid. Its clinical applications are virtually exclusively limited to dermatology. It has anti-inflammatory, antiproliferative, and antikeratinizing effects. However, there is a lack of articles summarizing the relevant literature in a systemic way. Methods: A PubMed search was performed using keywords such as "retinoids," "acitretin," "etretinate," and "retinoid embryopathy" to identify relevant original articles, case series, and case reports. Results: The most commonly used application of acitretin, a second-generation systemic retinoid is in the treatment of psoriasis. It has been used in various other dermatological disorders (keratoderma, ichthyosis, pityriasis rubra pilaris, and lichen planus) as a stand-alone therapy or may be combined with other topical and systemic agents. As the drug is not an immunosuppressive agent, hence can be given safely to patients suffering from human immunodeficiency virus and taking highly active antiretroviral therapy. The drug can be given safely in the pediatric as well as the adult population. Although adverse effects are common usually minor and self-limiting and can be managed easily without stopping the drug. The main side effects of the drug include teratogenicity, hepatotoxicity, and hyperlipidemia which should be monitored regularly. It should be avoided or used cautiously in patients taking methotrexate, cyclosporine, and corticosteroids. Conclusions: This article has discussed various uses of acitretin in dermatology, its side effect profile, indication, contraindication, and drug interactions. The drug can be administered safely and successfully with the right patient selection, progressive dose increase, careful monitoring, and appropriate patient counseling. [ABSTRACT FROM AUTHOR]

Introduction: Public health awareness on sun-protection practices especially sunscreen use is established in developed countries compared with some other tropical African countries. Open-market traders in Nigeria, who typically have black skin, spend up to 8 hours in daylight with unprotected sun exposure. Aim: To determine prevalence of the knowledge of sunscreen use and to discover if adequate and appropriate sunscreen use is practiced by market traders. Methods: Cross-sectional study on 307 consenting traders at Sandgrouse Market in Lagos, Nigeria. Demographic data and responses to questions on sun exposure and its effects, knowledge and use of sunscreen, source of knowledge, and frequency of application were documented with a predesigned study questionnaire. Data were analyzed with SPSS 22. Results: More females (207; 67.4%) were observed and the mean age was 42.7 ± 12.8 years, though most were within the 35- to 39-year age range. One-third (102; 33.2%) were unaware that sun exposure could damage the skin and only 30 (9.8%) were aware of or knew what sunscreen meant. Commercials or advertisements were the most common source of knowledge and females were significantly more aware of sunscreens (P= 0.018). Conclusion: There is poor knowledge and awareness of the use of sunscreen among urban market traders in Nigeria who have prolonged unprotected exposure during their daily activities. Females were significantly more aware of sunscreens than males but there was no significant difference in the use pattern. [ABSTRACT FROM AUTHOR]

As we were on the road to recovery from the coronavirus disease‑19 (COVID‑19) pandemic, the world is waking up to yet another potential adversary. Monkeypox (or human monkeypox) caused by monkeypox virus (an orthopox virus) is fast emerging in more than 80 countries worldwide, where it has never been historically reported. We in India, have already seen the advent of this outbreak since July 2022, with a progressive rise in number of cases being seen. Though the virus is not a novel virus; it is presenting with atypical manifestations as compared to our conventional knowledge of the disease. Through this document, the Indian Association of Dermatologists, Venereologists, and Leprologists Academy aims to sensitize dermatologists toward recognizing the clinical features and responding promptly, to contain the outbreak at the earliest. In view of the non‑availability of specific antiviral drugs as well as vaccines; early detection, isolation, and prevention of spread form the mainstay of our approach towards the outbreak, which has been declared to be a “Public Health Emergency of International Concern” by the World Health Organization. [ABSTRACT FROM AUTHOR]

Skin colour usually depends upon melanin, haemoglobin, and carotenoids. Pigmentary disorders indicate an increased amount of melanin, leading to a darker colour of the skin, called hypermelanosis. Addison's disease is a rare endocrinal disorder with severe oral and systemic manifestations. Any form of diffuse skin hyper-pigmentation which is more pronounced on sun-exposed areas mimics Addison's disease and is called Addisonian pigmentation. Pigmentation often precedes other manifestations by months to years and hence can lead to early diagnosis and can prevent life-threatening adrenal crisis. The most common cause of adrenal insufficiency in developing countries is tuberculosis. A similar pattern of pigmentation has been reported in Cushing's syndrome, ectopic ACTH-producing tumours, vitamin B12 deficiency, and thyrotoxicosis. Addisonian pigmentation can be a manifestation of multiple systemic diseases; hence, an inter-disciplinary approach is needed with extensive clinical and laboratory evaluation. It is not merely a cosmetic concern. Not much data are available in the literature regarding this entity. This brief review serves as an important source for clinicians to stay up-to-date regarding the history, clinical presentation, differential diagnosis, and management of this entity. [ABSTRACT FROM AUTHOR]

Pigmented transverse nasal band/groove is an asymptomatic benign condition, characterized by the development of erythematous to hyperpigmented, well-demarcated, transverse groove at the junction of middle and lower two-third of the nasal dorsum. Although the pathogenesis is unclear, embryologic origin seems to be the most plausible hypothesis. This condition is often associated other related dermatological conditions such as milia, comedones, seborrheic dermatitis and atopic dermatitis. Diagnosis is mostly clinical, while reassurance is the mainstay of therapy. In persistent cases, topical retinoids have been used. In this article, we have reviewed the different aspects of this condition including treatment, along with the recent updates to create awareness about this dermatological entity. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 11-month-old girl diagnosed with primary cutaneous B-cell lymphoma, a rare condition in infants. It states that the child presented with a single red raised lesion on her right pre-auricular area, and histological and immunohistochemical findings confirmed cutaneous B-cell lymphoma, but despite initial chemotherapy, she was lost to follow-up, highlighting the rarity and diagnostic challenges of this condition in infants.

Introduction The recent decades have seen a fantastic change for women in the medical profession with a steady increase in the number of female medical students who represent around 50% of students in medical schools in the United States today.[[1]] However, we can observe that this influx has not been accompanied by a similar increase of females in medical, academic, and leadership roles. Many events were then organized under the leadership of Dr. Rashmi Sarkar; different activities that created and strengthened the Indian female dermatology network, including symposia, lectures, social networks, and WhatsApp groups. This program was designed in a business school, directed by Niket Karajagi under the leadership of founder and president, Dr. Rashmi Sarkar and, Dr. Michèle Verschoore. [Extracted from the article]

Mentoring albeit is a recently described and popular phenomenon in medicine, is not a new one. All medical specialties have a complex, intertwined relationship between their physicians and trainees who are in different stages of their careers. How a specialty evolves depends on the thread woven by these relationships. This article outlines the concept of mentorship and introduces its various aspects in dermatology. This article attempts to answer what, why, how, when, and where related to mentoring in dermatology, including e-mentorship. The article also includes personal reflections of the authors who are involved in this process. [ABSTRACT FROM AUTHOR]

Background: Significant progress has been made in the representation of women at various fronts in dermatology. Nonetheless, women fall far behind their male counterparts when it comes to leadership roles as indicated by recent research data. Materials and Methods: This was a cross-sectional study amongst 180 dermatologists. Anonymous surveys were sent to 300 dermatologists across India, in March 2021, consisting of 14 questions, discussed and made by the two authors, the senior author having held leadership positions in dermatology. Results: Amongst the 180 respondents, 79% were female, and 21% were male. Significant attrition of women dermatologists in academic institutions, with increasing experience in the field was observed. A higher percentage of men had been in a leadership position as compared to women. (P >.05). The majority of the female respondents agreed that women had to struggle more than men to be accepted as leaders. (P < 0.05) Most women reduced their working hours to cater to household responsibilities, and almost 70% of the women agreed to having experienced burnout as a result of low job satisfaction or an absence of work-life balance (P < 0.05). More women agreed to having faced discrimination at the workplace (P < 0.05). Conclusion: Gender-based gaps in dermatology leadership still exist with regard to the number of women occupying higher academic ranks. Possible solutions include gender sensitization, creating a room for equivalent leadership opportunities, mentorship and family support, which may help tip the balance in favor of gender parity in dermatology. [ABSTRACT FROM AUTHOR]

Hand dermatitis (HD) is a chronic, relapsing, and remitting inflammatory condition that adversely affects the quality of life of the individual and gravely impacts the mental and socioeconomic well-being by causing professional hindrance and often leading to loss of wages. Despite being one of the most common skin conditions seen by dermatologists, it is often underreported. With the coronavirus pandemic ongoing, there is an emphasis on hand hygiene—being a widely publicized and important preventive measure to control the spread of the Coronavirus disease (COVID-19) virus. Emphasis on hand hygiene has led to a surge in HD, and the presence of HD, in turn, leads to compromised hand hygiene practices and this breach in the skin barrier contributes to another portal of entry of infective agents. We undertook a comprehensive English literature search across multiple databases such as PubMed, SCOPUS, EMBASE, MEDLINE, and Cochrane using keywords and MeSH items to obtain and review several relevant articles. Thus, this review focuses on various clinical, diagnostic as well as therapeutic aspects of this much prevalent and debilitating skin condition which deserves more attention especially during the times of the COVID-19 pandemic where the utmost emphasis is being given to handwashing leading to a vicious cycle of a surge in the cases of HD and compromised skin barrier causing increased susceptibility to the COVID-19 infection. [ABSTRACT FROM AUTHOR]

Severe Acute Respiratory Virus Corona Virus 2 (SARS-CoV-2) has got its name Corona from Latin meaning "crown." It has crown-like spikes present on the surface, which encloses the RNA, genetic material of this deadly virus. The virus attacks pneumocytes after binding with the angiotensin-converting enzyme 2 (ACE2) of the cell surface, which ultimately leads to chemotaxis followed by leukocyte infiltration, increased permeability of blood vessels and alveolar walls, and decreased surfactant in the lung leading to various symptoms. Skin provides a window to the internal changes of the body and also to mechanisms that are not readily visible. Commonly observed skin manifestations include vesicular lesions, maculopapular exanthema, urticarial eruptions, livedo or necrosis, and other forms of vasculitis, chilblain-like lesions. The skin lesions are attributed to either the virus directly affecting the skin or interferon dysregulation due to viral RNA or vascular involvement associated with alteration in coagulation or drug-induced skin manifestations. Observation of skin involvement and the vasculature due to SARS-CoV-2 illustrates the need for a precise stratification and differential diagnostic valuation so that the mechanisms of this novel virus are clearer for better management of the condition in the future. Vascular skin lesions are not seen in all the patients of COVID, but certain lesions should definitely alarm us to evaluate for coagulation abnormalities, complement levels, and skin biopsy, especially in critically ill patients. This review attempts to outline the pathogen briefly and the pathomechanism behind the development of various cutaneous manifestations. [ABSTRACT FROM AUTHOR]

Introduction: Melasma is a relatively common hypermelanotic disorder characterized by symmetrical light to gray-brown macules and patches involving photoexposed areas. Multiple factors have been implicated in the etiopathogenesis, including genetic factors, UV radiation, pregnancy, oral contraceptive pills (OCPs), thyroid dysfunction, and cosmetics. However, the role of cosmetics has not been well studied in melasma patients. The present study was designed to study the contact sensitivity to cosmetic allergens in patients with melasma. Material and Methods: Thirty patients with and thirty without melasma who visited Dermatology OPD between October 2015 and March 2017 were recruited according to selection criteria and were sequentially patch and photopatched with Indian cosmetic and fragrance series. Results: The mean age of melasma patients was 32.10 ± 6.62 years with female to male ratio of 1.72:1. Sixteen (53%) patients were found to show positive reactions on patch and photopatch testing with Indian cosmetic and fragrance series. Among 32 allergens tested, 15 allergens were found eliciting positive reaction. Thiomersol was the most common contact sensitizer eliciting positive reaction in six (38%) patients, followed by cetrimide, hexamine, and sorbitan each in three patients (19%). In the control group, only one (3.3%) subject showed positive contact allergy pattern. The results were significant (P < 0.001). Conclusion: A possible consideration of the pigmented cosmetic dermatitis and cosmetic contact sensitivity is recommended in the etiologic factors of melasma especially, in nonpregnancy/ lactation induced melasma or when it is not associated with hormone therapy. Contact sensitizers might also have a role in melasma that is recalcitrant to all standard therapies. [ABSTRACT FROM AUTHOR]

Context: There are several modalities of treating acne scars. The combination of microneedling and platelet-rich plasma (PRP) is a synergistic approach to treat acne scars. Aims: The aim was to compare the efficacy of microneedling alone versus microneedling with PRP in acne scars. Materials and Methods: This was a split face study conducted on 36 patients with acne scars who underwent four sessions of microneedling with PRP on right side and microneedling alone on left side at monthly interval. The total scars with subtypes and Ecchelle D'Evaluation Cliniques des Cicatrices D'Acne (ECCA) score were assessed at baseline and second, fourth, and sixth visits. Visual analog score (VAS) was evaluated by both physicians and patients. Statistical Analysis: The statistical analysis was carried out using Statistical Package for Social Sciences. Paired-t test and Wilcoxon signed rank test were used to compare the results. Results: Mean age was 23.7±3.2 years with 17 male and 19 female patients. The mean total scars on right and left sides declined from 42.14±21.15 to 25.08±14.14 and 43.28+23.08 to 27.17±15.68, respectively, with insignificant differences (P-value = 0.094). ECCA score on right and left sides declined from 88.31±32.78 to 62.92±23.68 and 89.58±32.43 to 66.25±23.89, respectively (P-value = 0.058). VAS evaluated by patient and physician showed maximum improvement at second and third visits, respectively. Conclusions: This study showed no added advantage of topical application of PRP over microneedling in acne scars. [ABSTRACT FROM AUTHOR]

Background: Hyaluronic fillers have been used for filling in folds and contour the face according to global aesthetic standards to achieve a smooth ogee curve on the face. But sometimes these result in a bulkier look to the face thus preventing more people from opting for these procedures. Although M.D codes have now been given to guide the injecting physicians for various points of injections on the face, they need to be used judiciously and tailored to individuals, using the lateral points of the face first. Aims: Patients still come to physicians to get the midface and nasolabial folds corrected but a proper aesthetic evaluation is essential and it was observed that targeting the peripheral points of the face leads to better tightening of the face and a slimmer look for the patient. A case was injected on peripheral points including some newer points not mentioned in the M.D codes. These points are on the forehead along the hairline and the mastoid process. Safety and efficacy of injecting on these particular points were evaluated. Methods: 2‐ml hyaluronic acid syringes (20 mg conc) were used to give bolus injections on the peripheral points of the face, including a new point on mastoid process and peripheral points on forehead. Results: A good aesthetic outcome was achieved resulting in slimming of face with patient satisfaction and without any complications. Conclusion: A good nonsurgical contouring of a young face can be achieved with 2 ml hyaluronic acid injection when the correct points are injected. [ABSTRACT FROM AUTHOR]

Owing to the recent coronavirus (COVID-19) pandemic, there is a concern regarding the use of systemic immunosuppressive agents. There are no guidelines at present regarding the use of immunosuppressants. The main aim at this time should be to keep the dermatoses under control without exposing the patient to increased risk of infection and the consequent morbidity. In vitiligo, immunosuppressive agents are utilized in stabilization of progressive disease. An informed decision regarding the use of immunosuppressive agents can be made only after understanding the immune response to coronavirus, reviewing the mechanism of action of drug and evidence from previous studies on risk of infection. This review briefly discusses the mechanism of action and the safety data of various immunosuppressants used in vitiligo. [ABSTRACT FROM AUTHOR]

Humanity has been obsessed with the partiality towards fair skin since time immemorial leading to unhealthy practices. The recent manifestation of this obsession is the huge number of fairness creams which has flooded the Indian cosmetic market. Some corticosteroid creams are also used as fairness creams because of the side-effect of hypopigmentation which is mistaken for fairness. Such misuse of topical corticosteroids leads to unwanted physical and psychological side-effects which have been collectively described as "Topical steroid dependent/damaged face" (TSDF). Concerted efforts by professional and social organizations [such as IADVL and Pigmentary Disorders Society (PDS)], politicians and media representatives, to fight this social menace of fairness craze and fairness creams have started yielding some positive results recently. [ABSTRACT FROM AUTHOR]

Rosacea is a relatively common inflammatory dermatosis in persons with fair skin. It is uncommonly reported in people with skin of color (darker skin tone; Fitzpatrick skin types IV, V or VI). Apart from reduced incidence, underreporting due to decreased awareness might also be a probable explanation. Rosacea commonly presents with telangiectasias and persistent facial erythema on the sun-exposed parts, which can be distressing to the patient and affect the quality of life. The diagnosis is made clinically, in the absence of any confirmatory investigation. Several treatment modalities have been employed to date with varying results. Light-based therapies should be used cautiously in the colored skin to avoid distressing pigmentation. This article focuses on the pathogenesis, clinical features, treatment recommendations and other aspects of this uncommon disorder along with a review of the literature. [ABSTRACT FROM AUTHOR]

Background: Many factors have been implicated in the pathogenesis of atopic dermatitis (AD) and recently the role of oxidative damage has been postulated. Objectives: To study the levels of oxidants and antioxidants including melatonin in the blood of children with AD and their association with the severity of AD. Methods: Thirty patients with atopic dermatitis, aged 6 months to 12 years, and equal number of age and sex-matched controls were included. Clinical characteristics and baseline severity assessment using SCORAD (scoring atopic dermatitis) severity index were noted. Blood superoxide dismutase, blood glutathione peroxidase, serum malondialdehyde, and serum melatonin levels were measured in cases and controls and results were compared. Results: The serum levels of malondialdehyde and melatonin were significantly higher among the cases compared to controls. The blood levels of superoxide dismutase and glutathione peroxidase were higher in cases but the difference with controls was not statistically significant. There was no significant correlation between these markers and the severity of the disease. Conclusions: Oxidative stress was increased in cases of childhood AD compared to the control group in this study. No correlation between oxidative stress and the severity of the disease was found. Larger studies are warranted. [ABSTRACT FROM AUTHOR]

There is a sparsity of data regarding the mental health status of dermatologists during COVID‐19 pandemic. Evaluate the effects of pandemic on mental health of dermatologists on a large scale and identify risk factors for mental distress. 733 dermatologists were included in this cross‐sectional, web‐based survey. Mental distress was reported by 77.2% of responders. Considerable percentages of participants experienced stress (73.9%), irritation (33.7%), insomnia (30%), or depression (27.6%), and 78.6% were overwhelmed with the amount of pandemic information they were receiving. Mental distress was significantly associated with practice years, volume of patients seen per week before pandemic, personal protective equipment availability at hospital (P =.001 for each), practice location (continent; P <.001), and participant's assessment that the healthcare system was not equipped for the pandemic (P =.003). Stress was associated with hospital service (P =.003), and depression with being overwhelmed with the amount of pandemic information received (P =.004). In a logistic model, teledermatology use was the most powerful predictor of mental distress (OR, 1.57 [95% CI, 1.07‐2.32]). Mental distress was common among dermatologists during this pandemic. Teledermatology use was the most powerful predictor of mental distress. Preventative strategies and psychosocial interventions should be implemented. [ABSTRACT FROM AUTHOR]