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Rifaximin, a semi‐synthetic derivative of rifamycin is a BCS class IV drug having poor physicochemical properties. These poor physicochemical properties pose a major challenge in dosage form production and limited bioavailability restricts the systemic use of rifaximin. This study focuses on the improvement of physicochemical properties and in‐vivo bioavailability of rifaximin by utilizing co‐crystallization approach. Co‐crystallization of rifaximin with l‐proline (amino acid) resulted in improvement of physicochemical properties like saturation solubility, dissolution rate, flow‐ability, and 1.5‐fold improvement in anti‐microbial activity as compared to pure rifaximin. Ex‐vivo permeation rate was improved approximately two‐fold and in an in‐vivo study utilizing Sprague Dawley rats, relative bioavailability was estimated to be 785.5967±55.8986. The data suggest exponential improvement of both, physicochemical properties and bioavailability in the co‐crystallized form of rifaximin. This study might be a first step for the use of rifaximin in systemic infections and may open a path for rifaximin as a drug of choice for various bacterial infections. [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]

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]

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]

Background: Vitiligo is an acquired disorder characterized by depigmented macules or patches on the skin due to the loss of functional melanocytes. Segmental vitiligo (SV) is a subtype of vitiligo refractory to treatment. Objective: We studied safety and efficacy of 308-nm monochromatic excimer light (MEL) in combination with 0.1% tacrolimus ointment for the treatment of SV. Methods: Fifty patients with SV were enrolled. MEL was given on alternate dates in combination with topical tacrolimus. Clinical photographs were taken once a month. Two independent dermatologists analyzed and graded the results. Results: Five patients were lost to follow-up. Concerning overall treatment success, 77.8 percent of patients demonstrated at least 75-percent repigmentation. More specifically, 35.6 percent of patients showed complete (100%) repigmentation (Grade 5), whereas 42.2 percent of patients showed more than 75-percent repigmentation (Grade 4). Conclusion: Combination therapy with topical 0.1% tacrolimus and a 308-nm excimer lamp appears to be efficacious with a good safety profile. The duration of disease was a statistically significant factor inversely correlated with treatment success rate. The site of vitiligo also plays a significant part in the outcome, as facial lesions responded best to the treatment. [ABSTRACT FROM AUTHOR]

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., Competing Interests: FUNDING:No funding was provided for this article. DISCLOSURES:The authors report no conflicts of interest relevant to the content of this article., (Copyright © 2021. Matrix Medical Communications. All rights reserved.)

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., Competing Interests: FUNDING:No funding was provided for this study. DISCLOSURES:The authors have no conflicts of interest relevant to the content of this article., (Copyright © 2020. Matrix Medical Communications. All rights reserved.)

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/m 2 , 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., Competing Interests: FUNDING:No funding was provided for this study. DISCLOSURES:The authors have no conflicts of interest relevant to the content of this article., (Copyright © 2020. Matrix Medical Communications. All rights reserved.)