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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]

Antimicrobial stewardship refers to a well-coordinated program which promotes the scientific and rational use of antimicrobials, reduces the chances of drug resistance and improves patient outcomes. A comprehensive English language literature search was done across multiple databases (PubMed, EMBASE, MEDLINE and Cochrane) for the period 1990–2022, revealing a large volume of reports of growing resistance to established antifungal therapies, against a backdrop of irrational and unscientific prescriptions. As a result of this, antifungal stewardship, a new kid on the block, has recently garnered attention. This review article is an attempt to summarise the basic concept of stewardship programs, highlighting the dire need to implement the same in the present situation of antifungal resistance and treatment failure. [ABSTRACT FROM AUTHOR]

Skin being the largest organ of the body, is equipped with numerous functional properties. Over the past few years, intricate research into the biology of skin has led to a gamut of discoveries. Skin is now regarded as one of the most vital endocrine organs. The skin contains equivalents of the hypothalamo-pituitary-adrenal axis, hypothalamo-pituitary-thyroid axis and the appendages produce multiple hormones such as Vitamin D, sex steroids, retinoids and opioids. In this article, we will explore the role of skin as a target and source of some of the hormones of the human body, and briefly touch on the clinical applications. [ABSTRACT FROM AUTHOR]

Porokeratosis is a keratinization disorder with unclear etiopathogenesis, varied clinical presentation and characteristic histopathology, and is usually unresponsive to current therapeutic options. Until now, it was considered to be a clonal disorder with immunity, ultra violet radiation and other factors playing important roles in etiopathogenesis. It is now known that abnormalities in the mevalonate pathway are responsible for this clonal keratinization abnormality. New variants of porokeratosis like eruptive bullous, pruriginous, lichen planus like, follicular variants and porokeratoma have been described. While the cornoid lamella is the classical histopathologic feature, dermoscopy and reflectance confocal microscopy make the diagnosis clearer. Development of malignancy in a few variants is a concern. Linear, disseminated superficial actinic and giant lesions are most prone to developing malignancies. Bowen's disease, squamous cell carcinoma, basal cell carcinoma and even melanoma have been reported in cases of long-standing porokeratosis. Newer modalities of therapy such as photodynamic therapy, ingenol mebutate and HMGCoA inhibitors may play a role in the future. [ABSTRACT FROM AUTHOR]

One of the canonical features of the current outbreak of dermatophytosis in India is its unresponsiveness to treatment in majority of cases. Though there appears to be discordance between in vivo and in vitro resistance, demonstration of in vitro resistance of dermatophytes to antifungals by antifungal susceptibility testing is essential as it may help in appropriate management. The practical problem in the interpretation of antifungal susceptibility testing is the absence of clinical breakpoints and epidemiologic cutoff values. In their absence, evaluation of the upper limit of a minimal inhibitory concentration of wild type isolates may be beneficial for managing dermatophytosis and monitoring the emergence of isolates with reduced susceptibility. In the current scenario, most of the cases are unresponsive to standard dosages and duration of treatment recommended until now. This has resulted in many ex-cathedra modalities of treatment that are being pursued without any evidence. There is an urgent need to carry out methodical research to develop an evidence base to formulate a rational management approach in the current scenario. [ABSTRACT FROM AUTHOR]

Trichophyton (T.) mentagrophytes now accounts for an overwhelming majority of clinical cases in India, a new "Indian genotype" (T. mentagrophytes ITS genotype VIII) having been isolated from skin samples obtained from cases across a wide geographical distribution in this country. The conventional diagnostic methods, like fungal culture, are, however, inadequate for diagnosing this agent. Thus, molecular methods of diagnosis are necessary for proper characterization of the causative agent. The shift in the predominant agent of dermatophytosis from T. rubrum to T. mentagrophytes, within a relatively short span of time, is without historic parallel. The apparent ease of transmission of a zoophilic fungus among human hosts can also be explained by means of mycological phenomena, like anthropization. [ABSTRACT FROM AUTHOR]

Dermatophytosis has attained unprecedented dimensions in recent years in India. Its clinical presentation is now multifarious, often with atypical morphology, severe forms and unusually extensive disease in all age groups. We hesitate to call it an epidemic owing to the lack of population-based prevalence surveys. In this part of the review, we discuss the epidemiology and clinical features of this contemporary problem. While the epidemiology is marked by a stark increase in the number of chronic, relapsing and recurrent cases, the clinical distribution is marked by a disproportionate rise in the number of cases with tinea corporis and cruris, cases presenting with the involvement of extensive areas, and tinea faciei. [ABSTRACT FROM AUTHOR]

135 © 2021 Indian Journal of Dermatology, Venereology and Leprology- Published by Scientific Scholar What is new in dermatotherapy? It may improve pruritus by decreasing peripheral itch sensory neuron signaling through its direct effects on IL-4 and IL-13 and through its effects on eosinophils which results in decreased IL-31 secretion Atopic dermatitis, prurigonodularis, bullous pemphigoid FDA approved for atopic dermatitis in March 2017 Lebrikizumab 17 It is a humanized monoclonal antibody inhibiting IL-13. It is given subcutaneously at 150 mg week 0, 4 and every 12 weeks thereafter Plaque psoriasis FDA approved (April 2019) Bimekizumab 12 It is a human monoclonal IgG antibody against IL-17A and IL-17F. It is given subcutaneously at a loading dose of 320 mg and 160 mg every 4 weeks thereafter Plaque psoriasis, psoriatic arthritis It is in the Phase 3 trial Mirikizumab 13 It is a human monoclonal antibody IgG4 antibody against IL-23. [Extracted from the article]

Background: Dermatophytosis is becoming increasingly unresponsive to conventional antifungals. Newer topical antifungals may be more effective in these patients.Aims: To evaluate and compare the efficacy and safety of amorolfine 0.25% cream and sertaconazole 2% cream in limited tinea cruris/corporis.Methods: A single-center, randomized (1:1), double-blind, parallel group, active-controlled trial (CTRI/2014/12/005246) was performed. Sixty-six untreated adults with acutely symptomatic tinea cruris/corporis were included in the study. All patients had limited cutaneous involvement and were KOH mount positive. Group A received amorolfine 0.25% cream, and group B received sertaconazole 2% cream twice daily application to the lesions for 4 weeks. After the baseline visit, four follow-up visits were carried out. The outcome measures for effectiveness were clinical and mycological cure. Safety parameters studied were treatment-emergent adverse events and changes in routine laboratory parameters.Results: Both sertaconazole and amorolfine significantly reduced symptoms (P < 0.001) in both groups. However, improvement in symptoms (pruritus, burning sensation, erythema, scaling and crusting) was significantly greater in the sertaconazole group at every follow-up visit. Sertaconazole cream was also more effective than amorolfine cream in reducing the number of lesions (P = 0.002 at 12 weeks) and improving the Dermatology Life Quality Index (P < 0.001) at all the follow-up visits. Adverse events were similar in the two groups (P = 0.117). Fungal cultures became negative in 92.3% of the sertaconazole group as compared to 80% in the amorolfine group (P = 0.010).Limitations: Antifungal susceptibility testing could not be done.Conclusion: Sertaconazole 2% is superior to amorolfine 0.25%, both in terms of effectiveness and tolerability. Improvement can be appreciated from second week onwards. [ABSTRACT FROM AUTHOR]

Paternally transmitted damage to offspring is recognized as a complex issue. Each parent contributes 23 chromosomes to a child; hence, it is necessary to know the effects of both maternal and paternal pre-and peri-conceptional exposure to drugs on pregnancy outcome. While there are many studies on the effects of maternal drug exposure on pregnancy outcome, literature on paternal exposure is scarce. Of late however, paternal exposure has been receiving increasing attention. We present a brief review on the safety of commonly used drugs in dermatology, focused on retinoids, immune suppressants, anti androgens and thalidomide. [ABSTRACT FROM AUTHOR]

Background: Toxic epidermal necrolysis and Stevens-Johnson syndrome comprise life-threatening, drug-induced mucocutaneous disease spectrum. Interest in cyclosporine, a calcineurin inhibitor that can block the function of T-cells, has increased with the discovery of the importance of granulysin in apoptosis in toxic epidermal necrolysis. In our hospital, cyclosporine is given to Stevens-Johnson syndrome/toxic epidermal necrolysis patients as an adjunctive therapy.Aims: This study is an observational, record-based study comparing the effectiveness and safety of patients receiving cyclosporine versus only supportive therapy.Methodology: Medical records as bed-head tickets and laboratory investigation reports of Stevens-Johnson syndrome/toxic epidermal necrolysis patients admitted in the hospital over a period of 1 year were collected. Data regarding clinico-demographic profile, suspected drug causing Stevens-Johnson's syndrome/toxic epidermal necrolysis, SCORTEN, body surface area involved, treatment received and outcome were obtained.Results: Twenty-eight patients were analyzed. Nineteen belonged to the cyclosporine group (supportive treatment + cyclosporine), nine to supportive treatment only group. Among the suspected drugs, antiepileptics formed the major group (28.6%). Five patients in the supportive only group and one in the cyclosporine group died. Time for stabilization and reepithelialization and duration of recovery were significantly lower in the cyclosporine group (P < 0.001, P= 0.007, P= 0.01, respectively). The standardized mortality ratio was 0.32 in cyclosporine group which is nearly 3.3 times lower than the only supportive treatment.Limitations: As it was a record-based study, certain confounding factors (serum blood urea nitrogen) could not be adjusted.Conclusion: Cyclosporine (5 mg/kg/day) for 10 days from onset of Stevens-Johnson syndrome/toxic epidermal necrolysis may decrease the risk of dying, may provide faster healing of lesions and might lead to early discharge from hospital. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented that discuss the case studies of the patients with sebaceous gland hyperplasia.

A case study of a 22‑year‑old otherwise healthy male who reported with asymptomatic persistent 2‑4mm sized papules distributed over the perioral region for the preceding 2 years. It notes that the lesions had not responded to anti‑acne therapy, including benzoyl peroxide, tretinoin and adapalene. The article discusses persistent perioral papules in a young man.

The article presents a case study of a 23-year-old healthy gentleman, who was diagnosed with Dowling-Degos disease with hypopigmented lesions. The patient had developed multiple hypopigmented lesions on the trunk, face and neck. The patient has been underwent skin biopsy for both hyperpigmented and hypopigmented lesions. The patient has showed an increase in melanophages in the papillary dermis.

The article presents a case study of a 55-year-old man who was diagnosed with an asymptomatic, increasing and non-tender localized swelling affecting the left half of his upper lip. The patient then went histopathologic examination which showed atrophic epidermis and a diffuse dense infiltrate of lymphocytes, plasma cells and macrophages involving the upper and mid-dermis. The patient then advice for phospholipid derivative, miltefosine as treatment for post kala-azar dermal leishmaniasis.

A letter to the editor is presented regarding the case of an 8-month-old boy who was born with non-consanguinous parentage of skin thickening and diagnosed with bullous ichthyosiform erythroderma (BIE). [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the medical case of easy bruising caused by giant platelet, likely MYH9-related Sebastian, syndrome in a five-year-old girl complaining of recurrent bruising with minimal trauma for seven months. [ABSTRACT FROM AUTHOR]

The article describes the case of a 72-year-old man who developed linear serpentine erythematous eruption and diagnosed with operable infiltrating duct carcinoma of the left breast with lymph node positivity. Topics discussed include histopathological examination of skin biopsy, supravenous serpentine hyperpigmentation, and reaction to the patient's first dose of docetaxel infusion along the left lower limb.

The article discusses the case of an otherwise healthy 14 year old girl presented to the dermatology outpatient department of Medical College and Hospital, Kolkata, India with a 2-year history of asymptomatic dark patches confined to the right half of her torso. Skin biopsy showed elongated epidermal rete ridges with hypermelanisation of the basel layer. She was diagnosed with progressive cribriform and zosteriform hyperpigmentation a treatment of topical retinoids and emollients were tried.

The article presents a medical imaging diagnosis to a 35-year-old man with porokeratosis with cutaneous horn and squamous cell carcinoma.

A letter to the editor is presented in response to the article "Clinical efficacy of rituximab in the treatment of pemphigus: A retrospective study," by V. K. Sharma and colleagues in the 2016 issue.

Adverse effects of hydroquinone include irritant contact dermatitis, hyperpigmentation, depigmentation, conjunctival melanosis, corneal degeneration, nail discoloration and exogenous ochronosis. Irritant contact dermatitis is the most common adverse effect and it is characterized by erythema, pruritus, mild edema, burning and scaling. Depigmentation of skin (consistent with our case) is a rare adverse effect, clinically manifesting as confetti-like hypopigmented and depigmented macules. [Extracted from the article]

The article presents a case study of a 35-year-old man with paronychia and onychomadesis caused by pemphigus vulgaris.

A quiz is presented concerning the diagnosis to be made for a 25-year-old girl, who showed solitary asymptomatic papule in the left check.