212 results on '"Godse K"'
Search Results
52. Severe chronic urticaria treated with oral mini-pulse steroid therapy
- Author
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Godse Kiran
- Subjects
Dermatology ,RL1-803 - Published
- 2010
53. Triple combination of hydroquinone, tretinoin and mometasone furoate with glycolic acid peels in melasma
- Author
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Godse Kiran
- Subjects
Dermatology ,RL1-803 - Published
- 2009
54. Olopatadine in chronic idiopathic urticaria
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Godse Kiran
- Subjects
Dermatology ,RL1-803 - Published
- 2009
55. Patch testing in chronic urticaria
- Author
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Godse Kiran
- Subjects
Dermatology ,RL1-803 - Published
- 2009
56. The Medusa Head: Dermoscopic Diagnosis of Woolly Hair Syndrome.
- Author
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Patil, S., Marwah, Manjot, Nadkarni, N., Gautam, M., and Godse, K.
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LETTERS to the editor ,HAIR diseases ,DIAGNOSIS - Abstract
A letter to the editor is presented which discusses the diagnosis of wolly hair syndrome.
- Published
- 2012
- Full Text
- View/download PDF
57. Migratory 'moles' - dermoscopic diagnosis.
- Author
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Marwah M, Gautam M, Patil S, Nadkarni N, and Godse K
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- 2012
- Full Text
- View/download PDF
58. The global impact of the COVID-19 pandemic on the management and course of chronic urticaria
- Author
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Kocatürk, Emek, Salman, Andaç, Cherrez-Ojeda, Ivan, Criado, Paulo Ricardo, Peter, Jonny, Comert-Ozer, Elif, Abuzakouk, Mohamed, Câmara Agondi, Rosana, Al-Ahmad, Mona, Altrichter, Sabine, Arnaout, Rand, Arruda, Luisa Karla, Asero, Riccardo, Bauer, Andrea, Ben-Shoshan, Moshe, Bernstein, Jonathan, Bizjak, Mojca, Boccon-Gibod, Isabelle, Bonnekoh, Hanna, Bouillet, Laurence, Brzoza, Zenon, Busse, Paula, Campos, Regis A., Carne, Emily, Conlon, Niall, Criado, Roberta Fachini Jardim, De Souza Lima, Eduardo Magalhães, Demir, Semra, Dissemond, Joachim, Doğan Günaydın, Sibel, Dorofeeva, Irina, Ensina, Luis Felipe, Ertaş, Ragip, Ferrucci, Silvia Mariel, Figueras-Nart, Ignasi, Fomina, Daria, Franken, Sylvie M., Fukunaga, Atsushi, Giménez Arnau, Ana M, Godse, Kiran, Gonçalo, Margarida, Gotua, Maia, Grattan, Clive, Guillet, Carole, Inomata, Naoko, Jakob, Thilo, Karakaya, Gul, Kasperska-Zając, Alicja, Katelaris, Constance H., Košnik, Mitja, Krasowska, Dorota, Kulthanan, Kanokvalai, Kumaran, M.Sendhil, Lang, Claudia, Larco-Sousa, José Ignacio, Lazaridou, Elisavet, Leslie, Tabi Anika, Lippert, Undine, Calderón llosa, Oscar, Makris, Michael, Marsland, Alexander, Medina, Iris V., Meshkova, Raisa, Bastos Palitot, Esther, Parisi, Claudio A.S., Pickert, Julia, Ramon, Germán D., Rodríguez-Gonzalez, Mónica, Rosario, Nelson, Rudenko, Michael, Rutkowski, Krzysztof, Sánchez Caraballo, Jorge Mario, Schliemann, Sibylle, Sekerel, Bulent Enis, Serpa, Faradiba S., Serra-Baldrich, E, Song, Zhiqiang, Soria, Angèle, Staevska, Maria, Staubach, Petra, Tagka, Anna, Takahagi, Shunsuke, Thomsen, Simon Francis, Treudler, Regina, Vadasz, Zahava, Rodrigues Valle, Solange Oliveira, Van Doorn, Martijn B.A., Vestergaard, Christian, Wagner, Nicola, Wang, Dahu, Wang, Liangchun, Wedi, Bettina, Xepapadaki, Paraskevi, Yücel, Esra, Zalewska-Janowska, Anna, Zhao, Zuotao, Zuberbier, Torsten, Maurer, Marcus, Universitat Autònoma de Barcelona, Dermatology, Göncü, Özgür Emek Kocatürk (ORCID 0000-0003-2801-0959 & YÖK ID 217219), Salman, A., Cherrez-Ojeda, I., Criado, P. R., Peter, J., Comert-Ozer, E., Abuzakouk, M., Agondi, R. C., Al-Ahmad, M., Altrichter, S., Arnaout, R., Arruda, L. K., Asero, R., Bauer, A., Ben-Shoshan, M., Bernstein, J. A., Bizjak, M., Boccon-Gibod, I., Bonnekoh, H., Bouillet, L., Brzoza, Z., Busse, P., Campos, R. A., Carne, E., Conlon, N., Criado, R. F., Lima, E. M. D., Demir, S., Dissemond, J., Gunaydin, S. D., Dorofeeva, I., Ensina, L. F., Ertas, R., Ferrucci, S. M., Figueras-Nart, I., Fomina, D., Franken, S. M., Fukunaga, A., Gimenez-Arnau, A. M., Godse, K., Goncalo, M., Gotua, M., Grattan, C., Guillet, C., Inomata, N., Jakob, T., Karakaya, G., Kasperska-Zajac, A., Katelaris, C. H., Kosnik, M., Krasowska, D., Kulthanan, K., Kumaran, M. S., Lang, C., Larco-Sousa, J. I., Lazaridou, E., Leslie, T. A., Lippert, U., Llosa, O. C., Makris, M., Marsland, A., Medina, I. V., Meshkova, R., Palitot, E. B., Parisi, C. A. S., Pickert, J., Ramon, G. D., Rodriguez-Gonzalez, M., Rosario, N., Rudenko, M., Rutkowski, K., Sanchez, J., Schliemann, S., Sekerel, B. E., Serpa, F. S., Serra-Baldrich, E., Song, Z. Q., Soria, A., Staevska, M., Staubach, P., Tagka, A., Takahagi, S., Thomsen, S. F., Treudler, R., Vadasz, Z., Valle, S. O. R., Van Doorn, M. B. A., Vestergaard, C., Wagner, N., Wang, D. H., Wang, L. C., Wedi, B., Xepapadaki, P., Yücel, E., Zalewska-Janowska, A., Zhao, Z. T., Zuberbier, T., Maurer, M., School of Medicine, AII - Infectious diseases, Kocaturk, Emek, Salman, Andac, Cherrez-Ojeda, Ivan, Criado, Paulo Ricardo, Peter, Jonny, Comert-Ozer, Elif, Abuzakouk, Mohamed, Agondi, Rosana Camara, Al-Ahmad, Mona, Altrichter, Sabine, Arnaout, Rand, Arruda, Luisa Karla, Asero, Riccardo, Bauer, Andrea, Ben-Shoshan, Moshe, Bernstein, Jonathan A., Bizjak, Mojca, Boccon-Gibod, Isabelle, Bonnekoh, Hanna, Bouillet, Laurence, Brzoza, Zenon, Busse, Paula, Campos, Regis A., Carne, Emily, Conlon, Niall, Criado, Roberta F., de Souza Lima, Eduardo M., Demir, Semra, Dissemond, Joachim, Gunaydin, Sibel Dogan, Dorofeeva, Irina, Ensina, Luis Felipe, Ertas, Ragip, Ferrucci, Silvia Mariel, Figueras-Nart, Ignasi, Fomina, Daria, Franken, Sylvie M., Fukunaga, Atsushi, Gimenez-Arnau, Ana M., Godse, Kiran, Goncalo, Margarida, Gotua, Maia, Grattan, Clive, Guillet, Carole, Inomata, Naoko, Jakob, Thilo, Karakaya, Gul, Kasperska-Zajac, Alicja, Katelaris, Constance H., Kosnik, Mitja, Krasowska, Dorota, Kulthanan, Kanokvalai, Kumaran, M. Sendhil, Lang, Claudia, Ignacio Larco-Sousa, Jose, Lazaridou, Elisavet, Leslie, Tabi Anika, Lippert, Undine, Llosa, Oscar Calderon, Makris, Michael, Marsland, Alexander, Medina, Iris, V, Meshkova, Raisa, Palitot, Esther Bastos, Parisi, Claudio A. S., Pickert, Julia, Ramon, German D., Rodriguez-Gonzalez, Monica, Rosario, Nelson, Rudenko, Michael, Rutkowski, Krzysztof, Sanchez, Jorge, Schliemann, Sibylle, Sekerel, Bulent Enis, Serpa, Faradiba S., Serra-Baldrich, Esther, Song, Zhiqiang, Soria, Angele, Staevska, Maria, Staubach, Petra, Tagka, Anna, Takahagi, Shunsuke, Thomsen, Simon Francis, Treudler, Regina, Vadasz, Zahava, Rodrigues Valle, Solange Oliveira, Van Doorn, Martijn B. A., Vestergaard, Christian, Wagner, Nicola, Wang, Dahu, Wang, Liangchun, Wedi, Bettina, Xepapadaki, Paraskevi, Yucel, Esra, Zalewska-Janowska, Anna, Zhao, Zuotao, Zuberbier, Torsten, and Maurer, Marcus
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Male ,0301 basic medicine ,STRESS ,Exacerbation ,UCARE ,pandemije ,Medizin ,Omalizumab ,SERUM ,chronic urticaria ,0302 clinical medicine ,Pandemic ,Health care ,Immunology and Allergy ,Chronic Urticaria ,treatment ,Chronic urticaria ,COVID-19 ,Cyclosporine ,SARS-CoV-2 ,Treatment ,zdravljenje ,ASSOCIATION ,Middle Aged ,cyclosporine ,omalizumab ,pandemic ,kronična urtikarija ,INFECTIONS ,GA(2)LEN ,Female ,600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit ,medicine.drug ,Adult ,medicine.medical_specialty ,Adolescent ,Coronavirus disease 2019 (COVID-19) ,Immunology ,udc:616-097 ,pandemics ,ciklosporin ,Young Adult ,03 medical and health sciences ,Patient referral ,medicine ,Humans ,In patient ,Patient Reported Outcome Measures ,Aged ,Internet ,business.industry ,DEFINITION ,Medicine ,Allergy ,Cross-Sectional Studies ,030104 developmental biology ,030228 respiratory system ,Emergency medicine ,business - Abstract
Introduction: the COVID-19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown. Aim: to understand how CU patients are affected by the COVID-19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID-19. Materials and methods: our cross-sectional, international, questionnaire-based, multicenter UCARE COVID-CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences. Results: the COVID-19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID-19 patient care, which negatively impacted on the care of urticaria patients. The rate of face-to-face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID-19, but COVID-19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID-19. Conclusions: the COVID-19 pandemic brings major changes and challenges for CU patients and their physicians. The long-term consequences of these changes, especially the increased use of remote consultations, require careful evaluation., Novartis; Sanofi; Menarini Universidad Espiritu Santo; Takeda; Allakos; AstraZeneca; CSL Behring; Genentech; Pharming; GSK; Shire/Takada; BioCryst; ResTORbio; Pearl Therapeutics, CVS Health; Law offices of Levin; Riback; Adelman; Flangel; Vedder Price; Fresenius; Taiho; Kyowa Kirin; Tanabe; Korin; Uriach Pharma; Instituto Carlos III FEDER; Menarini; Amgen; Thermo Fisher; Avene; ALK‐Abello; Bencard/Allergy Therapeutics; Celgene; Allergopharma; Faes Farma; AbbVie; Janssen; Leo Pharma; Lilly; Roche; Genesis; Menlo Therapeutics; UCB; Pfizer; Almirall; Galderma; Allergika; Beiersdorf; Biocryst; Biogen Idec; BMS; Boehringer‐Ingelheim; Eli‐Lilly; Galderma; Hexal; Klosterfrau; LEO‐Pharma; LETI‐Pharma; L´Oreal; Medice; Octapharma; Pflüger; Pharming; Regeneron; Shire; ALK‐Abello; Fraunhofer‐IZI Leipzig; Hautnetz Leipzig/Westsachsen; MSD; HAL‐Allergy; Bencard; Nestle; Nutricia; Bayer Health Care; FAES; Henkel; Allakos; Argenx; Genentech Menarini; Moxie; Aralez; Celldex
- Published
- 2021
59. How are patients with chronic urticaria interested in using information and communication technologies to guide their healthcare? A UCARE study
- Author
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Emek Kocatürk, Roberta F. Criado, Carla Ritchie, Mohamed Abuzakouk, Simon Francis Thomsen, Annia Cherrez, Jose Ignacio Larco, Carole Guillet, Agnieszka Sikora, Zuotao Zhao, Deepa Grandon, Marcus Maurer, Elena Kovalkova, Miguel Felix, Ana Giménez-Arnau, Ivan Cherrez-Ojeda, Daria Fomina, Karsten Weller, Alicja Kasperska-Zajac, Eduardo Magalhães de Souza Lima, Emanuel Vanegas, Sofia Cherrez, Paraskevi Xepapadaki, Michael Makris, Edgar Emilio Matos Benavides, Kiran Godse, Sahar Rastgoo, Rasmus Robin Maurer, Martijn B. A. van Doorn, Luis Felipe Ensina, Valeria L. Mata, Maryam Khoshkhui, Andrea Bauer, Solange Oliveira Rodrigues Valle, Nimmagadda Dheeraj Rao, German D. Ramon, Markus Magerl, Dermatology, Göncü, Özgür Emek Kocatürk (ORCID 0000-0003-2801-0959 & YÖK ID 217219), Cherrez-Ojeda, I., Vanegas, E., Cherrez, A., Felix, M., Weller, K., Magerl, M., Maurer, R. R., Mata, V. L., Kasperska-Zajac, A., Sikora, A., Fomina, D., Kovalkova, E., Godse, K., Rao, N. D., Khoshkhui, M., Rastgoo, S., Criado, R. F., Abuzakouk, M., Grandon, D., Van Doorn, M. B. A., Oliveira Rodrigues Valle, S., De Souza Lima, E. M., Thomsen, S. F., Ramón, G. D., Matos Benavides, E. E., Bauer, A., Giménez-Arnau, A. M., Guillet, C., Larco, J. I., Zhao, Z.- T., Makris, M., Ritchie, C., Xepapadaki, P., Ensina, L. F., Cherrez, S., Maurer, M., Koç University Hospital, and School of Medicine
- Subjects
Pulmonary and Respiratory Medicine ,Higher education ,media_common.quotation_subject ,Immunology ,WhatsApp ,Information and communication technologies ,NEEDS ,Article ,03 medical and health sciences ,0302 clinical medicine ,PHYSICIANS ,Excellence ,ComputerApplications_MISCELLANEOUS ,Health care ,parasitic diseases ,Immunology and Allergy ,Medicine ,030223 otorhinolaryngology ,Chronic urticaria ,media_common ,Medical education ,Internet ,Allergy ,E-mail ,business.industry ,RC581-607 ,030228 respiratory system ,Information and Communications Technology ,e-mail ,The Internet ,ICTS ,Rural area ,Immunologic diseases. Allergy ,business ,BURDEN - Abstract
Background: patients with chronic urticaria (CU) are increasingly using information and communication technologies (ICTs) to manage their health. What CU patients expect from ICTs and which ICTs they prefer remains unknown. We assessed why CU patients use ICTs, which ones they prefer, and what drives their expectations and choices. Methods: in this cross-sectional study, 1841 patients across 17 countries were recruited at UCAREs (Urticaria Centers of Reference and Excellence). Patients with CU who were >12 years old completed a 23-item questionnaire. Results: most patients were interested in receiving disease information (87.3%), asking physicians about CU (84.1%), and communicating with other patients through ICTs (65.6%). For receiving disease information, patients preferred one-to-one and one-to-many ICTs, especially web browsers. One-to-one ICTs were also the ICTs of choice for asking physicians about urticaria and for communicating with other patients, and e-mail and WhatsApp were the preferred ICTs, respectively. Many-to-many ICTs such as Facebook, Instagram, LinkedIn, and Twitter were least preferred for all 3 purposes. Living in rural areas and higher education were linked to higher odds of being interested in receiving disease information, asking physicians, and communicating with patients through ICTs. Conclusions: most patients and especially patients with higher education who live in rural areas are interested in using ICTs for their healthcare, but prefer different ICTs for different purposes, ie, web browsers for obtaining information, e-mail for asking physicians, and WhatsApp for communicating with other patients. Our findings may help to improve ICTs for CU., GA2LEN Network of Urticaria Centers of Reference and Excellence (UCARE); World Allergy Organization (WAO)
- Published
- 2021
60. Indian expert Delphi consensus on the diagnosis and management of flares of generalised pustular psoriasis.
- Author
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Aithal VV, Bhat R, Das S, Dogra S, Godse K, Shankar DSK, Nayak CS, Pai SB, Parasramani SG, Parthasaradhi A, Shah B, Tahiliani ST, Toms T, and Dahiya AK
- Abstract
Generalised pustular psoriasis (GPP) is a chronic, multisystemic, autoinflammatory disease with predominantly cutaneous manifestations, characterised by recurrent episodes of widespread, macroscopic and aseptic pustules. It has a highly unpredictable, heterogeneous and unstable clinical course. There are no consensus guidelines in India for the management of GPP. The objective of this Delphi panel study was to achieve consensus on problem areas in the understanding and management of GPP. Based on the inputs from an expert panel, 19 topics across six domains were identified as being important regarding the understanding and management of GPP. Statements were developed for these 19 topics, and consensus for the statements was sought using the modified Delphi method. Twelve experts evaluated the statements, indicating their agreement or disagreement. Consensus was considered to be reached when ≥80% of experts agreed with a statement. After two rounds of discussion, consensus was reached for 17 out of 19 (89%) statements and no consensus was achieved for two (11%) statements. We have presented the statements along with the respective degrees of consensus. Wherever relevant, clarifications or additional comments by experts are provided in the document.
- Published
- 2024
- Full Text
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61. Definition, acronyms, nomenclature, and classification of angioedema (DANCE): AAAAI, ACAAI, ACARE, and APAAACI DANCE consensus.
- Author
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Reshef A, Buttgereit T, Betschel SD, Caballero T, Farkas H, Grumach AS, Hide M, Jindal AK, Longhurst H, Peter J, Riedl MA, Zhi Y, Aberer W, Abuzakouk M, Al Farsi T, Al Sukaiti N, Al-Ahmad M, Altrichter S, Aygören-Pürsün E, Baeza ML, Bara NA, Bauer A, Bernstein JA, Boccon-Gibod I, Bonnekoh H, Bouillet L, Brzoza Z, Bygum A, Calderon O, de Albuquerque Campos R, Campos Romero FH, Cancian M, Chong-Neto HJ, Christoff G, Cimbollek S, Cohn DM, Craig T, Danilycheva I, Darlenski R, Du-Thanh A, Ensina LF, Fomina D, Fonacier L, Fukunaga A, Gelincik A, Giavina-Bianchi P, Godse K, Gompels M, Goncalo M, Gotua M, Guidos-Fogelbach G, Guilarte M, Kasperska-Zajac A, Katelaris CH, Kinaciyan T, Kolkhir P, Kulthanan K, Kurowski M, Latysheva E, Lauerma A, Launay D, Lleonart R, Lumry W, Malbran A, Ali RM, Nasr I, Nieto-Martinez S, Parisi C, Pawankar R, Piñero-Saavedra M, Popov TA, Porebski G, Prieto Garcia A, Pyatilova P, Rudenko M, Sekerel BE, Serpa FS, Sheikh F, Siebenhaar F, Soria A, Staevska M, Staubach P, Stobiecki M, Thomsen SF, Triggiani M, Valerieva A, Valle S, Van Dinh N, Vera Ayala CE, Zalewska-Janowska A, Zanichelli A, Magerl M, and Maurer M
- Subjects
- Humans, Abbreviations as Topic, Delphi Technique, Angioedema classification, Angioedema diagnosis, Consensus, Terminology as Topic
- Abstract
Background: Angioedema (AE) manifests with intermittent, localized, self-limiting swelling of the subcutaneous and/or submucosal tissue. AE is heterogeneous, can be hereditary or acquired, may occur only once or be recurrent, may exhibit wheals or not, and may be due to mast cell mediators, bradykinin, or other mechanisms. Several different taxonomic systems are currently used, making it difficult to compare the results of studies, develop multicenter collaboration, and harmonize AE treatment., Objective: We developed a consensus on the definition, acronyms, nomenclature, and classification of AE (DANCE)., Methods: The initiative involved 91 experts from 35 countries and was endorsed by 53 scientific and medical societies, and patient organizations. A consensus was reached by online discussion and voting using the Delphi process over a period of 16 months (June 2021 to November 2022)., Results: The DANCE initiative resulted in an international consensus on the definition, classification, and terminology of AE. The new consensus classification features 5 types and endotypes of AE and a harmonized vocabulary of abbreviations/acronyms., Conclusion: The DANCE classification complements current clinical guidelines and expert consensus recommendations on the diagnostic assessment and treatment of AE. DANCE does not replace current clinical guidelines, and expert consensus algorithms and should not be misconstrued in a way that affects reimbursement of medicines prescribed by physicians using sound clinical judgment. We anticipate that this new AE taxonomy and nomenclature will harmonize and facilitate AE research and clinical studies, thereby improving patient care., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
- Full Text
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62. Usage prevalence of angioedema patient-reported outcome measures: Results from the UCARE and ACARE PROMUSE study.
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Cherrez-Ojeda I, Bousquet J, Giménez-Arnau A, Godse K, Krasowska D, Bartosińska J, Szczepanik-Kułak P, Wawrzycki B, Kolkhir P, Allenova A, Allenov A, Tkachenko S, Mitrevska NT, Mijakoski D, Stoleski S, Kolacinska-Flont M, Kuprys-Lipinska I, Molinska J, Kasperska-Zając A, Zajac M, Zamłyński M, Mihaltan F, Ulmeanu R, Zalewska-Janowska A, Tomaszewska K, Al-Ahmad M, Al-Nesf MA, Ibrahim T, Aqel S, Pesqué D, Rodríguez-González M, Wakida-Kuzunoki GH, Ramon GD, Ramon GN, Neisinger S, Bonnekoh H, Rukhadze M, Khoshkhui M, Fomina D, Larenas-Linnemann D, Košnik M, Kara RO, Caballero López CG, Liu Q, Ivancevich JC, Ensina LF, Rosario N, Kvedariene V, Ben-Shoshan M, Jardim Criado RF, Bauer A, Cherrez A, Cherrez S, Chong-Neto H, Rojo-Gutierrez MI, Rudenko M, Larco Sousa JI, Lesiak A, Matos E, Tinoco I, Shijin CC, Logroño RH, Sagñay JC, Faytong-Haro M, Robles-Velasco K, Zuberbier T, and Maurer M
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- Humans, Female, Male, Adult, Prevalence, Middle Aged, Surveys and Questionnaires, Patient Reported Outcome Measures, Angioedema epidemiology
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- 2024
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63. An Open-Label, Investigator-Initiated, Single-Centre Pilot Study to Determine the Safety and Efficacy of Tofacitinib in Resistant Chronic Spontaneous Urticaria.
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De A, Pal S, Singh S, Chakroborty D, and Godse K
- Abstract
Background: Chronic spontaneous urticaria (CSU) is a distressing skin condition characterized by the recurrent appearance of itchy hives. A subset of CSU patients remains resistant to conventional treatment with high-dose antihistamines. Tofacitinib, a Janus kinase inhibitor, has shown promise in various inflammatory skin diseases. We aimed to evaluate the efficacy of oral tofacitinib in patients with CSU resistant to antihistamines., Methods: This study examined data retrospectively from seven patients who were diagnosed with CSU and were treated with tofacitinib for at least six months. These patients initially exhibited resistance to treatment with four-fold up-dosed antihistamines. One of the patients was already on omalizumab, and another was tried on cyclosporine. The patients were administered oral tofacitinib at a dosage of 5 mg twice daily for six months. Patients were followed up monthly for disease control and side effects. The response to treatment was evaluated using the urticaria activity score over 7 days (UAS7) and urticaria control test (UCT). Paired t-tests were conducted to determine the statistical significance of the results using SPSS version 25 software., Results: Six out of the seven patients demonstrated a significant improvement in both UAS7 and UCT scores after six months of treatment with oral tofacitinib. The mean UAS7 score decreased from 24.86 at baseline to 3.83 at the study endpoint ( P < 0.0001). Similarly, the mean UCT score increased from 0.57 at baseline to 14 at the study endpoint ( P < 0.0001). The standard deviations for both measures were 4.85 and 0.98 at baseline and 3.1 and 3.1 at the study endpoint for UAS7 and UCT, respectively., Conclusion: In this six-month follow-up study, oral tofacitinib demonstrated significant efficacy in treating CSU patients' resistant to high-dose antihistamines. Most patients experienced a remarkable reduction in urticaria activity and an improvement in disease control. These findings suggest that tofacitinib holds promise as a potential therapeutic option for this challenging subset of CSU patients. However, larger, randomized controlled trials are warranted to further investigate the long-term safety and effectiveness of tofacitinib in this population., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Dermatology.)
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- 2024
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64. Real-World Efficacy and Safety of Oral Tofacitinib in Patients with Refractory Moderate to Severe Atopic Dermatitis: A Multicenter Retrospective Study.
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Dhar S, De A, Sarda A, Godse K, and Lahiri K
- Abstract
Background: Atopic dermatitis (AD) has a complex etiology that includes Th2 polarization, which is accompanied by the cytokines IL4, IL-5, IL-13, and IL-31, as well as Th17 and Th22, and in chronic lesions, Th1 cells. Tofacitinib inhibits Th1-, Th2-, and Th17-associated cytokines by selectively blocking JAK1 and JAK3 receptors. We conducted a multicentric, retrospective chart analysis to study the efficacy and safety of tofacitinib in patients with moderate to severe refractory AD., Materials and Methods: We included 16 adult patients (aged >18 years) with moderate to severe AD who had previously undergone systemic therapy with inadequate response. In the baseline, demographic data, previous treatment history, severity scores (eczema area and severity index [EASI] and SCORing Atopic Dermatitis [SCORAD]), and quality of life score (Dermatology Life Quality Index [DLQI]) were noted. Baseline blood investigations, including complete blood count, liver function test, renal function test, lipid profile, and interferon gamma release assay for tuberculosis, were done. Patients were followed up every month for 6 months that included documentation of severity scores, blood investigations, and DLQI. Any adverse events, if reported, were noted., Result: All 16 patients completed the 6-month trial. Our patients were previously treated with cyclosporine (n = 10), methotrexate (n = 3), or both (n = 3). The mean EASI scores improved from 23.38 ± 9.56 at baseline to 8.50 ± 7.57 at the end of 6 months. The mean SCORAD score improved from 41.25 ± 8.69 at baseline to 14.93 ± 7.82 at the end of 6 months. Quality of life also improved as the mean DLQI improved from 15.18 ± 2.73 at baseline to 5.31 ± 4.11 at the end of the study period. No severe adverse reactions were noted, but 3 patients experienced dyslipidemia and 2 patients had altered bleeding time., Conclusion: Tofacitinib is a safe and effective treatment option for recalcitrant moderate to severe adult AD., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Dermatology.)
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- 2024
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65. Patient-Reported Outcome Measures in Atopic Dermatitis and Chronic Urticaria Are Underused in Clinical Practice.
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Cherrez-Ojeda I, Bousquet J, Giménez-Arnau A, Godse K, Krasowska D, Bartosińska J, Szczepanik-Kułak P, Wawrzycki B, Kolkhir P, Allenova A, Allenova A, Tkachenko S, Teovska Mitrevska N, Mijakoski D, Stoleski S, Kolacinska-Flont M, Kuprys-Lipinska I, Molinska J, Kasperska-Zając A, Zajac M, Zamlynski M, Mihaltan F, Ulmeanu R, Zalewska-Janowska A, Tomaszewska K, Al-Ahmad M, Al-Nesf MA, Ibrahim T, Aqel S, Pesqué D, Rodríguez-González M, Wakida-Kuzunoki GH, Ramon G, Ramon G, Neisinger S, Bonnekoh H, Rukhadze M, Khoshkhui M, Fomina D, Larenas-Linnemann D, Košnik M, Oztas Kara R, Caballero López CG, Liu Q, Ivancevich JC, Ensina LF, Rosario N, Kvedariene V, Ben-Shoshan M, Criado RFJ, Bauer A, Cherrez A, Chong-Neto H, Rojo-Gutierrez MI, Rudenko M, Larco Sousa JI, Lesiak A, Matos E, Muñoz N, Tinoco I, Moreno J, Crespo Shijin C, Hinostroza Logroño R, Sagñay J, Faytong-Haro M, Robles-Velasco K, Zuberbier T, and Maurer M
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- Humans, Female, Male, Adult, Surveys and Questionnaires, Middle Aged, Urticaria, Dermatitis, Atopic therapy, Dermatitis, Atopic diagnosis, Patient Reported Outcome Measures, Chronic Urticaria
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Background: Patient-reported outcome measures (PROMs) are validated and standardized tools that complement physician evaluations and guide treatment decisions. They are crucial for monitoring atopic dermatitis (AD) and chronic urticaria (CU) in clinical practice, but there are unmet needs and knowledge gaps regarding their use in clinical practice., Objecctive: We investigated the global real-world use of AD and CU PROMs in allergology and dermatology clinics as well as their associated local and regional networks., Methods: Across 72 specialized allergy and dermatology centers and their local and regional networks, 2,534 physicians in 73 countries completed a 53-item questionnaire on the use of PROMs for AD and CU., Results: Of 2,534 physicians, 1,308 were aware of PROMs. Of these, 14% and 15% used PROMs for AD and CU, respectively. Half of physicians who use PROMs do so only rarely or sometimes. Use of AD and CU PROM is associated with being female, younger, and a dermatologist. The Patient-Oriented Scoring Atopic Dermatitis Index and Urticaria Activity Score were the most common PROMs for AD and CU, respectively. Monitoring disease control and activity are the main drivers of the use of PROMs. Time constraints were the primary obstacle to using PROMs, followed by the impression that patients dislike PROMs. Users of AD and CU PROM would like training in selecting the proper PROM., Conclusions: Although PROMs offer several benefits, their use in routine practice is suboptimal, and physicians perceive barriers to their use. It is essential to attain higher levels of PROM implementation in accordance with national and international standards., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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66. Safety, Efficacy and Attributes of 2.5% Selenium Sulfide Shampoo in the Treatment of Dandruff: A Single-Center Study.
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Godse G and Godse K
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Background: Selenium sulfide, available as a shampoo or topical lotion at 1%, or 2.5% concentrations in India, is used as a topical antiseborrheic and antifungal for the treatment of dandruff, seborrheic dermatitis, psoriasis, and tinea versicolor. In the present study, the safety, efficacy, and attributes of 2.5% selenium sulfide shampoo were evaluated in Indian participants with dandruff., Methods: A single-center, single-arm, prospective, investigator-initiated, open-label, post-marketing interventional study was conducted on Indian subjects aged 18-70 years diagnosed with moderate dandruff who were prescribed 2.5% selenium sulfide shampoo every three days for four weeks. The primary endpoints were 1) reduction in total dandruff score assessed using a clinical grading scale for adherent and loose dandruff from baseline to weeks 1, 2, and 4, and 2) incidence of adverse events up to the end of the study. The key secondary endpoints were 1) participants' perception of shampoo attributes (dandruff reduction, scalp itch, scalp oiliness/greasiness, or fragrance) as assessed by a subjective self-assessment questionnaire post-first wash and at weeks 1, 2, and/or 4; 2) satisfaction with treatment as assessed by investigators and participants using a subjective self-assessment questionnaire at week 4; and 3) reduction in scalp sebum as assessed with a meibometer at weeks 2 and 4. Statistical analysis was performed using the Wilcoxon signed-rank test for continuous variables and the Chi-square test for categorical variables. A p-value of 0.05 was considered to be statistically significant., Results: Of 34 enrolled subjects, 30 completed the four-week study. The mean (standard deviation, SD) age of the study participants was 29.8 (7.87) years, with the majority being females (n=18; 60.0%). Mean (SD) total dandruff score significantly (p=0.001) reduced from a baseline score of 11.5 (2.15) to 7.17 (2.12) at week 1, 4.93 (1.72) at week 2, and 2.5 (1.17) at week 4. All the participants reported dandruff reduction and acceptable fragrance of the shampoo at four weeks. Absence of itching and reduction in oiliness was reported by 73.3% (n=22) of participants at week 4 and by 50.0% (n=15) of participants at week 2, respectively. All participants reported good, very good, or excellent satisfaction with the test shampoo at week 4, whereas the investigators rated the shampoo as very good or excellent in managing dandruff in all participants. At week 4, erythema was reported to be absent in all participants. No adverse events were reported during the study., Conclusions: The 2.5% selenium sulfide shampoo was found to be effective in the management of dandruff and related symptoms like itching, oiliness, and greasiness and had a good safety profile in Indian participants with dandruff., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2024, Godse et al.)
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- 2024
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67. Clinical Evaluation of the Safety and Tolerability of Film-Forming Sprays in Patients With Psoriasis and Eczema.
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Godse K, Dethe G, Sawant S, Sharma A, Pereira R, Ghate S, Kuvi S, Pawar V, Parekar R, Khalse M, and Patel K
- Abstract
Background Treating dermatological pathologies under occlusion therapy is a popular adjunct, especially in thickened, lichenified areas of psoriasis where sustained contact with topical corticosteroids plays a pivotal role. Film-forming spray (FFS) can be a novel, alternate approach along with topical treatment in this area for carefully selected cases. This study aimed to evaluate the safety profile and physical characteristics of a novel formulation of an FFS in patients with psoriasis and eczema. Methods This open-label, multicentre, comparative study included subjects diagnosed with chronic plaque psoriasis requiring topical corticosteroid therapy or those with eczema necessitating its application and occlusion therapy. The study product was applied to two groups of subjects. For patients in group 1, the FFS was applied to the skin area affected by the dermatological condition, which was covered with ointment only. In the second group, the FFS was applied to the corresponding unaffected skin area. The FFS was applied for 60-90 seconds and was observed for two hours after the application. The subjects were evaluated for primary outcomes, including safety assessment, overall physical characteristics, and appearance of FFS from local skin effects. The secondary outcomes included physical appearance characteristics and overall patient satisfaction following the application of FFS at the target sites. Further statistical assessments were conducted using the SAS software version 9.4 (2023; SAS Institute Inc ., Cary, North Carolina, United States). Result A total of 100 subjects were included in the study across 10 outpatient centers, of which 79% had psoriatic plaques and 21% had eczematous lesions. Primary outcomes showed a lack of appearance of clinical symptoms such as dryness, flakiness, or irritation. A total of 10% of subjects in group 1 had erythema, and 6% had a tingling sensation, which was transient and mild. The secondary outcomes showed that only 12% of subjects in Group 1 and 6% of subjects in Group 2 showed a feeling of stickiness at the application site. In group 1, 8% reported a cooling sensation, which disappeared in one and two minutes, and none experienced a cooling sensation in Group 2. The average drying time for FFS in subjects with dermatological conditions was 5.19 minutes compared to 1.51 minutes on unaffected skin. The film washability results indicated that 96% of subjects in group 1 reported complete removal in less than two minutes. At the end of the study period, the mean satisfaction score was 8.99. No significant adverse events were reported in the patients. Conclusion This study highlights the potential application of a novel formulation of FFS as a safe and well-tolerated option for enhancing uniform skin coverage with the topical corticosteroid in patients affected with psoriasis and eczema., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2024, Godse et al.)
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- 2024
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68. Bilastine in Refractory Chronic Spontaneous Urticaria: Disease Control and Cytokine Modulation in an Open-label Prospective Study.
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De A, Singh S, Chakraborty D, Sarda A, and Godse K
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Introduction: The treatment options for chronic spontaneous urticaria (CSU) primarily include second generation non-sedative antihistamine (SGAHs). Bilastine is a newer, nonsedating SGAH approved for urticaria in February 2019 by the Drugs Controller General of India. Its major advantages are in terms of superior efficacy, lack of drug interactions and adverse effects, including sedation, compared to conventional SGAHs. The role of cytokines in the pathogenesis of CSU is well known. However, there is a shortage of data regarding the change in serum levels of proinflammatory cytokines following H1 antihistamines. We conducted this trial to evaluate the role of bilastine in cytokine modulation and autoimmunity, thereby explaining its role in modifying the disease process in CSU., Materials and Methods: This prospective study was conducted in a tertiary institute in Kolkata on patients aged 12 years and above with a CSU >6 months. These patients had an unsatisfactory response, as per the Urticaria Activity Score 7 (UAS7), to previous antihistamine therapies in standard doses. Treatment effectiveness was determined by comparing the UAS7 at baseline with that at weeks 4, 8 and 12. Also, baseline serum interleukin-6 (IL-6) and IL-17 were compared with those at the end of the study, that is, 12 weeks., Results: Thirty patients who matched the inclusion criteria and signed informed consent were included in the study. At the end of 12 weeks, 10% of patients ( n = 3) achieved a complete treatment response (UAS = 0), whereas 43.33% of patients ( n = 13) were labelled as having well-controlled urticaria (UAS <6). At 12 weeks, the mean UAS7 score (6.47 ± 4.45) was statistically significant compared to the baseline score (25.47 ± 7.74). The mean values of serum IL-6 (pg/ml) and IL-17 (pg/ml) at baseline were 5.96 ± 5.24 pg/ml and 6.96 ± 5.97 pg/ml, respectively. At the end of treatment, that is, 3 months, the mean values were reduced to 4.61 ± 4.56 pg/ml and 5.08 ± 3.87 pg/ml. The reduction was statistically significant for both serum IL-6 ( P < 0.001) and IL-17 ( P < 0.0001)., Conclusion: We conclude that bilastine at a once-daily continuous dose of 40 mg for 3 months is safe and effective in CSU patients who are refractory to treatment at the standard doses of SGAHs. Improved symptomatic control with bilastine was also associated with better control over the inflammatory process, as suggested by the lowering of mean cytokine levels in our study., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Dermatology.)
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- 2024
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69. Efficacy and safety of ligelizumab in adults and adolescents with chronic spontaneous urticaria: results of two phase 3 randomised controlled trials.
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Maurer M, Ensina LF, Gimenez-Arnau AM, Sussman G, Hide M, Saini S, Grattan C, Fomina D, Rigopoulos D, Berard F, Canonica GW, Rockmann H, Irani C, Szepietowski JC, Leflein J, Bernstein JA, Peter JG, Kulthanan K, Godse K, Ardusso L, Ukhanova O, Staubach P, Sinclair R, Gogate S, Thomsen SF, Tanus T, Ye YM, Burciu A, Barve A, Modi D, Scosyrev E, Hua E, Letzelter K, Varanasi V, Patekar M, and Severin T
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- Adolescent, Adult, Female, Humans, Male, Chronic Disease, Double-Blind Method, Histamine H1 Antagonists therapeutic use, Omalizumab adverse effects, Randomized Controlled Trials as Topic, Treatment Outcome, Anti-Allergic Agents adverse effects, Antibodies, Monoclonal, Humanized, Chronic Urticaria drug therapy, Urticaria drug therapy
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Background: Many patients with chronic spontaneous urticaria (CSU) do not achieve complete control of their symptoms with current available treatments. In a dose-finding phase 2b study, ligelizumab improved urticaria symptoms in patients with H1-antihistamine (H1-AH) refractory CSU. Here, we report the efficacy and safety outcomes from two ligelizumab phase 3 studies., Methods: PEARL-1 and PEARL-2 were identically designed randomised, double-blind, active-controlled and placebo-controlled parallel-group studies. Patients aged 12 years or older with moderate-to-severe H1-AH refractory CSU were recruited from 347 sites in 46 countries and randomly allocated in a 3:3:3:1 ratio via Interactive Response Technology to 72 mg ligelizumab, 120 mg ligelizumab, 300 mg omalizumab, or placebo, dosed every 4 weeks, for 52 weeks. Patients allocated to placebo received 120 mg ligelizumab from week 24. The primary endpoint was change-from-baseline (CFB) in weekly Urticaria Activity Score (UAS7) at week 12, and was analysed in all eligible adult patients according to the treatment assigned at random allocation. Safety was assessed throughout the study in all patients who received at least one dose of the study drug. The studies were registered with ClinicalTrials.gov, NCT03580369 (PEARL-1) and NCT03580356 (PEARL-2). Both trials are now complete., Findings: Between Oct 17, 2018, and Oct 26, 2021, 2057 adult patients were randomly allocated across both studies (72 mg ligelizumab n=614; 120 mg ligelizumab n=616; 300 mg omalizumab n=618, and placebo n=209). A total of 1480 (72%) of 2057 were female, and 577 (28%) of 2057 were male. Mean UAS7 at baseline across study groups ranged from 29·37 to 31·10. At week 12, estimated treatment differences in mean CFB-UAS7 were as follows: for 72 mg ligelizumab versus placebo, -8·0 (95% CI -10·6 to -5·4; PEARL-1), -10·0 (-12·6 to -7·4; PEARL-2); 72 mg ligelizumab versus omalizumab 0·7 (-1·2 to 2·5; PEARL-1), 0·4 (-1·4 to 2·2; PEARL-2); 120 mg ligelizumab versus placebo -8·0 (-10·5 to -5·4; PEARL-1), -11·1 (-13·7 to -8·5; PEARL-2); 120 mg ligelizumab versus omalizumab 0·7 (-1·1 to 2·5; PEARL-1), -0·7 (-2·5 to 1·1; PEARL-2). Both doses of ligelizumab were superior to placebo (p<0·0001), but not to omalizumab, in both studies. No new safety signals were identified for ligelizumab or omalizumab., Interpretation: In the phase 3 PEARL studies, ligelizumab demonstrated superior efficacy versus placebo but not versus omalizumab. The safety profile of ligelizumab was consistent with previous studies., Funding: Novartis Pharma., Competing Interests: Declaration of interests MM is or recently was a speaker, an adviser for, or has received research funding from Amgen, Allakos, Aralez, AstraZeneca, Celldex, FAES, Genentech, GI Innovation, Kyowa Kirin, Leo Pharma, Menarini, Novartis, Moxie, MSD, Roche, Sanofi, Third Harmonic, UCB, and Uriach. LFE is or recently was a speaker or adviser for Novartis, Sanofi, and AbbVie, and has received research support from Novartis and Sanofi. AMG-A reports roles as a medical adviser for Uriach Pharma, Sanofi, Genentech, Novartis, FAES, GSK, AMGEN, Thermo Fisher, and has received research grants supported by Uriach Pharma, Novartis, and Instituto Carlos III- FEDER; she also participates in educational activities for Uriach Pharma, Novartis, Genentech, Menarini, LEO-PHARMA, GSK, MSD, Almirall, AVENE, and Sanofi. GS has received research support from Aimmune, Amgen, AstraZeneca, DBV technologies, Genentech, Kedrion, Leo Pharma, Novartis, Nuvo Pharmaceuticals, Sanofi, Stallergenes, Merck, and Schering-Plough; and is a medical adviser or has received payment for lectures from Merck, Novartis, CSL Behring, Pfizer, Anaphylaxis Canada, the Allergy Asthma and Immunology Society of Ontario, and the Canadian Hereditary Angioedema Network. MH has received lecture or consultation fees from TAIHO Pharmaceutical, Novartis, MSD, Teikoku Seiyaku, Mitsubishi Tanabe Pharma, Kaken Pharmaceutical, Kyorin Pharmaceutical, Uriach, Sanofi, and Kyowa-Kirin and GI Innovation. SS received grant, research, or clinical trial support from the National Institutes of Health, ITN, Novartis, Regeneron, and is a consultant or advisery board member for Genentech, Novartis, Medimmune, AstraZeneca, Pfizer, Allakos, Eli Lily, and Gossamer Bio. CG has recently been an adviser for Celltrion and has participated in an advisery board for Sanofi. DF is, or recently was, a speaker or adviser for Novartis, Sanofi, AbbVie, Takeda, AstraZeneca, CSL Behring, and Roche. DR received fees as lecturer and advisery board member for Novartis, Leo, Lilly, MSD, UCB, Janssen, Sanofi, Menarini, Genesis pharma, and AbbVie. FB has received payment or honoraria as speaker fees from Novartis. GWC reports having received research grants, as well as being a lecturer or having received advisery board fees, from Menarini, Alk-Abello', Allergy Therapeutics, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, Genentech, Guidotti-Malesci, GSK, Hal Allergy, Mylan, Merck, Merck Sharp & Dome, Mundipharma, Novartis, Regeneron, Roche, Sanofi-Aventis, Sanofi-Genzyme, Stallergenes-Greer, UCB Pharma, Uriach Pharma, Valeas, and Vibor-Pharma. HR reports receiving speaker's fees, advisery board fees or funds for research to the institution from Novartis Pharma, Pharming, Sanofi-Genzyme, Third Harmonic, and Leo Pharma. CI reports having received research or clinical trial support, or fees for lectures from Novartis, Sanofi, AstraZeneca, Takeda, and Stallergenes Greer. JCS reports receiving fees for being consultant or advisery board member for Leo Pharma, Novartis, Pfizer, Sanofi-Genzyme, Trevi, UCB, and Vifor; for being speaker for AbbVie, Almirall, Alvotech, Janssen-Cilag, Eli-Lilly, Leo Pharma, Novartis, Pfizer, and Sanofi-Genzyme; for being the investigator in clinical trials for AbbVie, Almirall, Amgen, AnaptysBio, BMS, Boehringer Ingelheim, Celtrion, Galderma, Galapagos, Helm, Kliniksa, Incyte, InfraRX, Janssen-Cilag, Leo Pharma, Medimmune, Menlo Therapeutics, Merck, Novartis, Pfizer, Regeneron, UCB, Teva, and Trevi. JAB reports grants and personal fees from Novartis, AstraZeneca, Allakos, Amgen, Celldex, Genentech, and Sanofi Regeneron outside the submitted work. JGP has received travel support, speakers' honoraria, and educational grants from Novartis, Sanofi Regeneron, Takeda, Pharming, and CSL Behring. KK is or recently was a speaker or adviser for Novartis, Sanofi, Takeda, and A Menarini, and has received research grants from Novartis. LA is or recently was a speaker, adviser, or has received research funding from AstraZeneca, GSK, Novartis, OM-Pharma, Regeneron, Shire, Takeda, and Sanofi-Genzyme. PS is or recently was a speaker, adviser, or has received research funding from AbbVie, Allergika, Almirall, Amgen, Beiersdorf, Biocryst, Biogen, BMS, Boehringer-Ingelheim, Celgene, CSL-Behring, Eli-Lilly, Galderma, Hexal, Janssen, Klinge, Klosterfrau, LEO-Pharma, LETI-Pharma, L'Oreal, Medice, Novartis, Octapharma, Pfizer, Pflüger, Pharming, Pierre Fabre, Regeneron, Shire, Takeda, Regeneron, Sanofi-Genzyme, und UCB Pharma. RS is Director and Founder of Samson Medical Pty, and serves on the pharmaceutical advisery board of Eli Lilly, Pfizer, Leo Pharmaceutical, and reports being on the speaker bureau of Pfizer, AbbVie, and Novartis. He has also been principal investigator in clinical trials for AbbVie, Aerotech, Akesobio, Amgen, Arcutis, Arena, Ascend AstraZeneca, Bayer, Biotherapeutics Boehringer Ingelheim, Bristol Myer Squibb, Celgene, Coherus BioSciences, Connect, Demira, Eli Lilly, Galderma, GSK, F. Hoffman–La Roche, Janssen, MedImmune, Merck, Merck Sharpe & Dohme, Novartis, Oncobiologics, Pfizer, Principia, Regeneron, Roche, Reistone Biopharma, Samson Clinical, Sanofi-Genzyme, Sun Pharma UCB, Valeant, and Zai Labs. He is President of the Australasian Hair and Wool Research Society, Vice President of the International Society of Dermatology, and The International Academy of Dermatology. SG has consulted or advised for Novartis and IgGenix. SFT is or recently was a speaker, adviser for, or has received research funding from AbbVie, Almirall, Boehringer Ingelheim, CSL, Eli Lilly, Janssen, Leo Pharma, Novartis, Sanofi, Pfizer, UCB, and Union Therapeutics. TT received clinical trial support from Novartis, AstraZeneca, Celldex Therapeutics, Genentech, and GSK. YMY has received research or clinical trial support from Novartis, Amgen, Yuhan, Takeda, and Daewoong ABa, DM, and ES are employees of Novartis Pharmaceuticals, East Hanover, New Jersey, NJ, USA. EH is an employee of Novartis Institutes for Biomedical Research, China. VV is an employee of Novartis Healthcare Private, Hyderabad, India. ABu, KL, MP, and TS are employees of Novartis Pharma, Basel, Switzerland. KG, JL, and OU report no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)
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- 2024
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70. CRUSE ® -An innovative mobile application for patient monitoring and management in chronic spontaneous urticaria.
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Neisinger S, Sousa Pinto B, Ramanauskaite A, Bousquet J, Weller K, Metz M, Magerl M, Kocatürk E, Cherrez-Ojeda I, Gimenez-Arnau AM, Parisi CAS, Altrichter S, Ensina LF, Bouillet L, Asero R, Gonçalo M, Guillet C, Rutkowski K, Bernstein JA, Hardin H, Godse K, Brzoza Z, Sousa JIL, Thomsen SF, van Doorn M, Hide M, Ye YM, Vandersee S, Lapiņa L, Peter J, Zhao Z, Han L, Nasr I, Rockmann-Helmbach H, Sørensen JA, Kara RÖ, Kurjāne N, Kurchenko AI, Kaidashev I, Tsaryk V, Stepanenko R, and Maurer M
- Abstract
Background: Chronic spontaneous urticaria (CSU) is unpredictable and can severely impair patients' quality of life. Patients with CSU need a convenient, user-friendly platform to complete patient-reported outcome measures (PROMs) on their mobile devices. CRUSE
® , the Chronic Urticaria Self Evaluation app, aims to address this unmet need., Methods: CRUSE® was developed by an international steering committee of urticaria specialists. Priorities for the app based on recent findings in CSU were defined to allow patients to track and record their symptoms and medication use over time and send photographs. The CRUSE® app collects patient data such as age, sex, disease onset, triggers, medication, and CSU characteristics that can be sent securely to physicians, providing real-time insights. Additionally, CRUSE® contains PROMs to assess disease activity and control, which are individualised to patient profiles and clinical manifestations., Results: CRUSE® was launched in Germany in March 2022 and is now available for free in 17 countries. It is adapted to the local language and displays a country-specific list of available urticaria medications. English and Ukrainian versions are available worldwide. From July 2022 to June 2023, 25,710 observations were documented by 2540 users; 72.7% were females, with a mean age of 39.6 years. At baseline, 93.7% and 51.3% of users had wheals and angioedema, respectively. Second-generation antihistamines were used in 74.0% of days., Conclusions: The initial data from CRUSE® show the wide use and utility of effectively tracking patients' disease activity and control, paving the way for personalised CSU management., (© 2024 The Authors. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.)- Published
- 2024
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71. A Patient Charter for Chronic Urticaria.
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Maurer M, Albuquerque M, Boursiquot JN, Dery E, Giménez-Arnau A, Godse K, Guitiérrez G, Kanani A, Lacuesta G, McCarthy J, Nigen S, and Winders T
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- Humans, Quality of Life, Patients, Chronic Disease, Urticaria diagnosis, Urticaria therapy, Chronic Urticaria, Angioedema diagnosis, Drug-Related Side Effects and Adverse Reactions
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Chronic urticaria (CU) is the recurring development of wheals (aka "hives" or "welts"), angioedema, or both for more than 6 weeks. Wheals and angioedema occur with no definite triggers in chronic spontaneous urticaria, and in response to known and definite physical triggers in chronic inducible urticaria. Approximately 1.4% of individuals globally will have CU during their lifetime. The itching and physical discomfort associated with CU have a profound impact on daily activities, sexual function, work or school performance, and sleep, causing significant impairment in a patient's physical and mental quality of life. CU also places a financial burden on patients and healthcare systems. Patients should feel empowered to self-advocate to receive the best care. The voice of the patient in navigating the journey of CU diagnosis and management may improve patient-provider communication, thereby improving diagnosis and outcomes. A collaboration of patients, providers, advocacy organizations, and pharmaceutical representatives have created a patient charter to define the realistic and achievable principles of care that patients with CU should expect to receive. Principle (1): I deserve an accurate and timely diagnosis of my CU; Principle (2): I deserve access to specialty care for my CU; Principle (3): I deserve access to innovative treatments that reduce the burden of CU on my daily life; Principle (4): I deserve to be free of unnecessary treatment-related side-effects during the management of my CU; and Principle (5): I expect a holistic treatment approach to address all the components of my life impacted by CU. The stated principles may serve as a guide for healthcare providers who care for patients with CU and translate into better patient-physician communication. In addition, we urge policymakers and authors of CU treatment guidelines to consider these principles in their decision-making to ensure the goals of the patient are achievable., (© 2023. The Author(s).)
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- 2024
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72. The incidence of depression and anxiety disorders in spontaneous chronic urticaria patients.
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Bangera A, Singh M, Godse K, and Patil S
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Objective : A frequent condition known as chronic urticaria (CU) is characterized by the appearance of wheals, angioedema, or both. CU lowers the quality of life and may also result in psychological discomfort. The literature survey revealed few studies dealing with depression and anxiety in these patients. Hence, Hamilton scores for depression and anxiety were used in this study to evaluate the incidence of depression and anxiety in chronic urticaria patients. Methodology: To evaluate CU patients' levels of depression and anxiety, the Hamilton Rating Scale for Depression (HDRS) and the Hamilton Anxiety Rating Scale (HAMA) were applied. Moreover, in a control group of thirty healthy volunteers, thirty CU patients were included in this study. It was essential to observe the patients' urticaria activity score, medications, age, gender, comorbidities, employment status, and income. When it came to levels of depression and anxiety, a comparison was made between the case group and the healthy group. Results: In the CU patients' group, the mean age was 26.9 years. The questionnaires showed that 14 (46%) subjects in the patient group had moderate to severe signs of anxiety, and 21 (70%) had moderate to severe symptoms of depression. Besides, in the control group,7 (23.3%) had moderate to severe signs of anxiety, and 8 (26.7%) had severe depression. Conclusion: According to the study, individuals with CU exhibit depression and anxiety symptoms more frequently than the control group. Therefore, the possibility of mental comorbidities should be considered when treating individuals with CU., (© 2023 Bangera, Singh, Godse, Patil, HBKU Press.)
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- 2023
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73. Urticaria exacerbations and adverse reactions in patients with chronic urticaria receiving COVID-19 vaccination: Results of the UCARE COVAC-CU study.
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Kocatürk E, Salameh P, Sarac E, Vera Ayala CE, Thomsen SF, Zuberbier T, Ensina LF, Popov TA, van Doorn MBA, Giménez-Arnau AM, Asero R, Criado PR, Aarestrup FM, AbdulHameed Ansari Z, Al Abri S, Al-Ahmad M, Al Hinai B, Allenova A, Al-Nesf M, Altrichter S, Arnaout R, Bartosińska J, Bauer A, Bernstein JA, Bizjak M, Bonnekoh H, Bouillet L, Brzoza Z, Calvalcanti Dela Bianca Melo AC, Campinhos FL, Carne E, Purayil SC, Cherrez-Ojeda I, Chong-Neto HJ, Christoff G, Conlon N, Jardim Criado RF, Cvenkel K, Damadoglu E, Danilycheva I, Day C, de Montjoye L, Demir S, Ferucci SM, Fomina D, Fukunaga A, Garcia E, Gelincik A, Göbel JH, Godse K, Gonçalo M, Gotua M, Grattan C, Gugala A, Guillet C, Kalyoncu AF, Karakaya G, Kasperska-Zając A, Katelaris CH, Khoshkhui M, Kleinheinz A, Kolacinska-Flont M, Kolkhir P, Košnik M, Krasowska D, Kumaran MS, Kuprys-Lipinska I, Kurowski M, Kuznetsova EV, Larenas-Linnemann D, Lebedkina MS, Lee Y, Makris M, Gómez RM, Nasr I, Neisinger S, Oda Y, Kara RÖ, Palitot EB, Papapostolou N, Salvador Parisi CA, Pesque D, Peter J, Petkova E, Ridge K, Rudenko M, Rutkowski K, Saini SS, Salman A, Sanchez J, Şekerel B, Serdotetskova SA, Serpa FS, Dikicier BS, Sidiropoulos N, Sikora A, Sørensen JA, Soria A, Kucuk OS, Thalappil SR, Tomaszewska K, Tuncay G, Unal D, Valle S, van Lindonk E, Vestergaard C, Meshkova RY, Vitchuk A, Xepapadaki P, Ye YM, Zalewska-Janowska A, Zamlynski M, and Maurer M
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- Humans, Female, Adolescent, Adult, COVID-19 Vaccines adverse effects, Retrospective Studies, Vaccination adverse effects, COVID-19 prevention & control, Urticaria drug therapy, Chronic Urticaria
- Abstract
Background: Concern about disease exacerbations and fear of reactions after coronavirus disease 2019 (COVID-19) vaccinations are common in chronic urticaria (CU) patients and may lead to vaccine hesitancy., Objective: We assessed the frequency and risk factors of CU exacerbation and adverse reactions in CU patients after COVID-19 vaccination., Methods: COVAC-CU is an international multicenter study of Urticaria Centers of Reference and Excellence (UCAREs) that retrospectively evaluated the effects of COVID-19 vaccination in CU patients aged ≥18 years and vaccinated with ≥1 dose of any COVID-19 vaccine. We evaluated CU exacerbations and severe allergic reactions as well as other adverse events associated with COVID-19 vaccinations and their association with various CU parameters., Results: Across 2769 COVID-19-vaccinated CU patients, most (90%) received at least 2 COVID-19 vaccine doses, and most patients received CU treatment and had well-controlled disease. The rate of COVID-19 vaccination-induced CU exacerbation was 9%. Of 223 patients with CU exacerbation after the first dose, 53.4% experienced recurrence of CU exacerbation after the second dose. CU exacerbation most often started <48 hours after vaccination (59.2%), lasted for a few weeks or less (70%), and was treated mainly with antihistamines (70.3%). Factors that increased the risk for COVID-19 vaccination-induced CU exacerbation included female sex, disease duration shorter than 24 months, having chronic spontaneous versus inducible urticaria, receipt of adenovirus viral vector vaccine, having nonsteroidal anti-inflammatory drug/aspirin intolerance, and having concerns about getting vaccinated; receiving omalizumab treatment and Latino/Hispanic ethnicity lowered the risk. First-dose vaccine-related adverse effects, most commonly local reactions, fever, fatigue, and muscle pain, were reported by 43.5% of CU patients. Seven patients reported severe allergic reactions., Conclusions: COVID-19 vaccination leads to disease exacerbation in only a small number of CU patients and is generally well tolerated., (Copyright © 2023 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
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- 2023
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74. A concept for integrated care pathways for atopic dermatitis-A GA 2 LEN ADCARE initiative.
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Zuberbier T, Abdul Latiff A, Aggelidis X, Augustin M, Balan RG, Bangert C, Beck L, Bieber T, Bernstein JA, Bertolin Colilla M, Berardi A, Bedbrook A, Bindslev-Jensen C, Bousquet J, de Bruin-Weller M, Bruscky D, Buyuktiryaki B, Canonica GW, Castro C, Chanturidze N, Chong-Neto HJ, Chu CY, Chularojanamontri L, Cork M, Criado RFJ, Barredo LC, Custovic A, Darsow U, Emurlai A, de Pablo A, Del Giacco S, Girolomoni G, Deleva Jovanova T, Deleuran M, Douladiris N, Duarte B, Dubakiene R, Eller E, Engel-Yeger B, Ensina LF, Filho NR, Flohr C, Fomina D, Francuzik W, Galimberti ML, Giménez-Arnau AM, Godse K, Mortz CG, Gotua M, Hide M, Hoetzenecker W, Hunzelmann N, Irvine A, Jack C, Kanavarou I, Katoh N, Kinaciyan T, Kocatürk E, Kulthanan K, Lapeere H, Lau S, Machado Forti Nastri M, Makris M, Mansour E, Marsland A, Morelo Rocha Felix M, Moschione Castro AP, Nettis E, Nicolas JF, Nosbaum A, Odemyr M, Papapostolou N, Parisi CAS, Paudel S, Peter J, Pokharel P, Puig L, Quint T, Ramon GD, Regateiro F, Ricci G, Rosario C, Sackesen C, Schmid-Grendelmeier P, Serra-Baldrich E, Siemens K, Smith C, Staubach P, Stevanovic K, Su-Kücük Ö, Sussman G, Tavecchio S, Teovska Mitrevska N, Thaci D, Toubi E, Traidl-Hoffmann C, Treudler R, Vadasz Z, van Hofman I, Ventura MT, Wang Z, Werfel T, Wollenberg A, Yang A, Weng Yew Y, Zhao Z, Zwiener R, and Worm M
- Abstract
Introduction: The integrated care pathways for atopic dermatitis (AD-ICPs) aim to bridge the gap between existing AD treatment evidence-based guidelines and expert opinion based on daily practice by offering a structured multidisciplinary plan for patient management of AD. ICPs have the potential to enhance guideline recommendations by combining interventions and aspects from different guidelines, integrating quality assurance, and describing co-ordination of care. Most importantly, patients can enter the ICPs at any level depending on AD severity, resources available in their country, and economic factors such as differences in insurance reimbursement systems., Methods: The GA
2 LEN ADCARE network and partners as well as all stakeholders, abbreviated as the AD-ICPs working group, were involved in the discussion and preparation of the AD ICPs during a series of subgroup workshops and meetings in years 2020 and 2021, after which the document was circulated within all GAL2 EN ADCARE centres., Results: The AD-ICPs outline the diagnostic procedures, possible co-morbidities, different available treatment options including differential approaches for the pediatric population, and the role of the pharmacists and other stakeholders, as well as remaining unmet needs in the management of AD., Conclusion: The AD-ICPs provide a multidisciplinary plan for improved diagnosis, treatment, and patient feedback in AD management, as well as addressing critical unmet needs, including improved access to care, training specialists, implementation of educational programs, assessment on the impact of climate change, and fostering a personalised treatment approach. By focusing on these key areas, the initiative aims to pave the way for a brighter future in the management of AD., (© 2023 The Authors. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.)- Published
- 2023
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75. Low-dose Oral Minoxidil in the Treatment of Alopecia: Evidence and Experience-based Consensus Statement of Indian Experts.
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Godse K, De A, Vedamurthy M, Shankar DSK, Shah B, Girdhar M, Bhat R, Ganjoo A, Tahiliani S, and Patil A
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Alopecia is a highly prevalent condition worldwide including in India. There are different types of alopecia with differing etiology, presentation, and hence treatment. Androgenetic alopecia represents the most common form of hair loss affecting male as well as female population termed as male and female pattern hair loss, respectively. Several treatment options are available for the treatment of alopecia with often unsatisfactory results resulting in psychological distress among such patients. Topical minoxidil is known to be effective in the treatment of alopecia. However, oral minoxidil is not currently approved for the treatment of alopecia. This expert consensus is prepared to provide guidance to the clinicians regarding the use of oral minoxidil in the treatment of alopecia. Extensive literature review was performed to prepare the draft consensus which was then revised based on the suggestions and comments from the experts. The final draft was circulated to the experts for review and approval. This consensus document provides overview of evidence related to oral minoxidil and consensus from the experts for its use in the treatment of minoxidil., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 International Journal of Trichology.)
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- 2023
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76. Oral Tranexamic Acid for the Treatment of Melasma: Evidence and Experience-Based Consensus Statement from Indian Experts.
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Godse K, Sarkar R, Mysore V, Shenoy MM, Chatterjee M, Damisetty R, Shah S, Vedamurthy M, Aurangabadkar S, Srinivas C, Ganjoo A, Das S, and Patil A
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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., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Dermatology.)
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- 2023
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77. Treatment patterns and outcomes in patients with chronic urticaria during pregnancy: Results of PREG-CU, a UCARE study.
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Kocatürk E, Al-Ahmad M, Krause K, Gimenez-Arnau AM, Thomsen SF, Conlon N, Marsland A, Savk E, Criado RF, Danilycheva I, Fomina D, Godse K, Khoshkhui M, Gelincik A, Degirmentepe EN, Demir S, Ensina LF, Kasperska-Zajac A, Rudenko M, Valle S, Medina I, Bauer A, Zhao Z, Staubach P, Bouillet L, Küçük ÖS, Baygül A, and Maurer M
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- Infant, Newborn, Pregnancy, Female, Humans, Chronic Disease, Histamine H1 Antagonists therapeutic use, Omalizumab therapeutic use, Premature Birth chemically induced, Premature Birth drug therapy, Chronic Urticaria drug therapy, Urticaria drug therapy, Urticaria epidemiology
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Background: Although chronic urticaria (CU) is a common and primarily affects females, there is little data on how pregnancy interacts with the disease., Objective: To analyse the treatment use by CU patients before, during and after pregnancy as well as outcomes of pregnancy., Methods: PREG-CU is an international, multicentre study of the Urticaria Centers of Reference and Excellence network. Data were collected via a 47-item-questionnaire completed by CU patients who became pregnant during their disease course., Results: Questionnaires from 288 CU patients from 13 countries were analysed. During pregnancy, most patients (60%) used urticaria medication including standard-dose second generation H1-antihistamines (35.1%), first generation H1-antihistamines (7.6%), high-dose second-generation H1-antihistamines (5.6%) and omalizumab (5.6%). The preterm birth rate was 10.2%; rates were similar between patients who did and did not receive treatment during pregnancy (11.6% vs. 8.7%, respectively). Emergency referrals for CU and twin birth were risk factors for preterm birth. The caesarean delivery rate was 51.3%. More than 90% of new-borns were healthy at birth. There was no link between any patient or disease characteristics or treatments and medical problems at birth., Conclusion: Most CU patients used treatment during pregnancy especially second-generation antihistamines which seem to be safe during pregnancy regardless of the trimester. The rates of preterm births and medical problems of new-borns in CU patients were similar to population norms and not linked to treatment used during pregnancy. Emergency referrals for CU increased the risk of preterm birth and emphasize the importance of sufficient treatment to keep urticaria under control during pregnancy., (© 2022 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)
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- 2023
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78. Diagnosis and Management of Urticaria in Indian Settings: Skin Allergy Research Society's Guideline-2022.
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Godse K, Patil A, De A, Sharma N, Rajagopalan M, Shah B, Tahiliani S, Girdhar M, Zawar V, Sangolli P, Shankar DK, and Dhar S
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Urticaria is a common skin disorder. Chronic urticaria, i.e., the presence of symptoms for more than six weeks, is associated with a significant adverse impact on sleep, performance, quality of life, and financial status of the patients. Although several treatment options are available, the condition can be challenging to treat for many clinicians. Several updates have been published on the subject of urticaria and its management since the publication of an updated consensus statement in 2018 by Indian experts. The objective of this consensus statement is to summarize the updates and provide concise information, including classification, diagnosis, and management of urticaria. Understanding and elimination of the underlying eliciting trigger are essential in all possible cases. The goal of pharmacological treatment is to provide symptomatic relief. Second-generation nonsedating H1 antihistamine continue to be recommended as the first-line treatment, the dose of which can be increased up to four times in patients not responding satisfactorily, in the second step. The role of omalizumab, cyclosporine, H2 antihistamines, and other options is also discussed., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Dermatology.)
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- 2022
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79. Evidence-Based Guidelines for SARS-COV-2 Vaccination of Patients of Skin Allergic Diseases and Patients on Immuno-Therapeutics.
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Das A, De A, Godse K, Sangolli P, Zawar V, Sharma N, Girdhar M, Podder I, Shah B, and Dhar S
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There is a dearth of data regarding the safety and timing of the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) vaccination of patients on immunosuppressive or immunomodulatory therapies. However, data from other vaccine trials may be extrapolated to get an idea regarding the recommendation of SARS-COV-2 vaccines. All the novel SARS-COV-2 vaccines are non-live, thus ensuring the safety of the vaccines. However, the vaccines may not be able to generate an equipotent immunogenic response in patients receiving immunotherapeutics, in comparison to those who are not. We have attempted to put forward certain statements, with respect to SARS-COV-2 vaccination of patients who are on treatment for different dermatological conditions. However, the risk-benefit ratio must be discussed between the patient and the physician, and the final call should be individualized., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Dermatology.)
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- 2022
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80. Use of Bleach Baths for Atopic Dermatitis: An Indian Perspective.
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Sharma N, Dhar S, De A, Godse K, Shankar DSK, Zawar V, Girdhar M, and Shah B
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Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder affecting 15-20% of children and 1-10% of adults. Staphylococcus aureus ( S. aureus ) infection is the most frequent complication of AD and is involved in the worsening of the disease. Systemic and topical antibiotics are used in the treatment for AD but there are concerns over increasing resistance. Bleach (sodium hypochlorite, NaOCl) baths are an inexpensive, widely accessible, alternative antibiotic treatment that may not worsen antibiotic resistance. Bleach baths are used as adjunctive treatment in AD patients to treat superinfections, although their mechanism of action is not well understood. Balancing safety concerns with efficacious treatment should be important especially for AD where the majority of patients are in pediatrics age groups. Studies available in PubMed databases were included in this review. Most suggested bleach bath improves clinical symptoms of AD and restores surface microbiome by eradicating bacteria, most notably S. aureus . Some studies have noted that this antimicrobial effect has reduced the need for topical corticosteroids. In addition, bleach seems to have strong anti-inflammatory and antipruritic effects. Overall, bleach baths seem to be safe on human skin, without disrupting the epidermal barrier function. The review concluded, although there are some advantages of use of bleach baths, more studies to investigate long-term efficacy and safety of bleach baths are required before fixing its role in the treatment of AD especially in the context of the Indian scenario., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Dermatology.)
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- 2022
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81. Experience with bilastine in the management of urticaria: Original Real-world cases of Bilastine In Treatment (ORBIT) in Asia.
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Cheong WK, Chan AWM, Ch'ng CC, Chung WH, Gabriel MT, Godse K, Mitthamsiri W, Nguyen HT, Tiongco-Recto M, and Nagrale D
- Abstract
Urticaria is a disabling condition, resulting in an impaired quality of life and sleep disruption, and can have an adverse impact on work-related or school-related performance and attendance. It is defined according to the presence of unknown (chronic spontaneous urticaria) or known (inducible urticaria) eliciting factors. Guidelines recommend second-generation H
1 -antihistamines for the first-line treatment of urticaria. Bilastine is indicated in adults, adolescents (aged ≥12 years) and children (aged ≥2 years (Mexico and some African countries), ≥4 years (Canada) or ≥6 years (Europe)) with a body weight of at least 20 kg for the symptomatic treatment of urticaria and allergic rhino-conjunctivitis. The aim of the Original Real-world cases of Bilastine In Treatment (ORBIT) study was to review real-world cases from across the Asia-Pacific region supported by evidence-based literature. Eight diverse, real-world, difficult-to-treat cases with urticaria in people aged 10-75 years are presented. Once-daily bilastine (20 mg (adults/adolescents) or 10 mg (children)) was found to be well tolerated and effective in the long-term management of chronic spontaneous urticaria and inducible urticaria., Competing Interests: Disclosure and potential conflicts of interest: WKC has served as an advisory board member for A. Menarini and been a speaker for and received honoraria from Johnson & Johnson, Novartis and A. Menarini. HTN served as an advisory board member and speaker, receiving honoraria from Novartis, Janssen and A. Menarini. MTR disclosed non-financial interests for A. Menarini for acting as an advisory board member and speaker, has received support from A. Menarini for registration at conventions, and is the immediate Past President of the Philippine Society of Allergy, Asthma and Immunology (unpaid). CCC received an honorarium from A. Menarini. MTG received honoraria from A. Menarini for lectures and has acted in an unpaid role on an advisory board for A. Menarini. KG has received honoraria from A. Menarini and received support from A. Menarini for the present manuscript. WM received support from A. Menarini for writing the present manuscript, has received honoraria from A. Menarini for lectures and panel discussion, and from GlaxoSmithKline, Organon and AstraZeneca for lectures, and has received registration support from GlaxoSmithKline and Organon for attending virtual academic meetings. AWMC and WHC had no conflicts of interest to disclose. DN is an employee of A. Menarini. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2022/03/dic.2021-12-2-COI.pdf, (Copyright © 2022 Cheong WK, Chan AWM, Ch’ng CC, Chung WH, Gabriel MT, Godse K, Mitthamsiri W, Nguyen HT, Tiongco-Recto M, Nagrale D.)- Published
- 2022
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82. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria.
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Zuberbier T, Abdul Latiff AH, Abuzakouk M, Aquilina S, Asero R, Baker D, Ballmer-Weber B, Bangert C, Ben-Shoshan M, Bernstein JA, Bindslev-Jensen C, Brockow K, Brzoza Z, Chong Neto HJ, Church MK, Criado PR, Danilycheva IV, Dressler C, Ensina LF, Fonacier L, Gaskins M, Gáspár K, Gelincik A, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Grosber M, Hamelmann E, Hébert J, Hide M, Kaplan A, Kapp A, Kessel A, Kocatürk E, Kulthanan K, Larenas-Linnemann D, Lauerma A, Leslie TA, Magerl M, Makris M, Meshkova RY, Metz M, Micallef D, Mortz CG, Nast A, Oude-Elberink H, Pawankar R, Pigatto PD, Ratti Sisa H, Rojo Gutiérrez MI, Saini SS, Schmid-Grendelmeier P, Sekerel BE, Siebenhaar F, Siiskonen H, Soria A, Staubach-Renz P, Stingeni L, Sussman G, Szegedi A, Thomsen SF, Vadasz Z, Vestergaard C, Wedi B, Zhao Z, and Maurer M
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- Chronic Disease, Humans, Prevalence, Quality of Life, Angioedema diagnosis, Angioedema etiology, Angioedema therapy, Asthma, Urticaria diagnosis, Urticaria epidemiology, Urticaria etiology
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This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria., (© 2021 GA²LEN. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)
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- 2022
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83. Chronic urticaria patients are interested in apps to monitor their disease activity and control: A UCARE CURICT analysis.
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Cherrez-Ojeda I, Vanegas E, Cherrez A, Felix M, Weller K, Magerl M, Maurer RR, Mata VL, Kasperska-Zajac A, Sikora A, Fomina D, Kovalkova E, Godse K, Rao ND, Khoshkhui M, Rastgoo S, Criado RFJ, Abuzakouk M, Grandon D, Van Doorn MBA, Rodrigues Valle SO, De Souza Lima EM, Thomsen SF, Ramón GD, Matos Benavides EE, Bauer A, Giménez-Arnau AM, Kocatürk E, Guillet C, Larco JI, Zhao ZT, Makris M, Ritchie C, Xepapadaki P, Ensina LF, Cherrez S, and Maurer M
- Abstract
Background: Information/communication technologies such as mobile phone applications (apps) would enable chronic urticaria (CU) patients to self-evaluate their disease activity and control. Yet, recently Antó et al (2021) reported a global paucity of such apps for patients with CU. In this analysis, we assessed patient interest in using apps to monitor CU disease activity and control using questions from the chronic urticaria information and communication technologies (CURICT) study., Methods: The methodology for CURICT has been reported. Briefly, a 23-item questionnaire was completed by 1841 CU patients from 17 UCAREs across 17 countries. Here, we analyzed patient responses to the CURICT questions on the use of apps for urticaria-related purposes., Results: As previously published, the majority of respondents had chronic spontaneous urticaria (CSU; 63%; 18% chronic inducible urticaria (CIndU) [CIndu]; 19% with both), were female (70%) and in urban areas (75%). Over half of patients were very/extremely interested in an app to monitor disease activity (51%) and control (53%), while only ∼1/10 were not. Patients with both urticaria types versus those with CSU only (odds ratio [OR], 1.36 [1.03-1.79]) and females versus males (OR [95% CI], 1.47 [1.17-1.85]) were more likely to be very to extremely interested in an app to assess disease control., Conclusions: Overall, half of the patients with CU were very to extremely interested in using an app to assess their disease activity and control. Development of well-designed apps, specific to disease types (CSU, CIndU, CSU + CIndU, etc), validated by experts across platforms would help improve the management and possibly outcomes of CU treatment while providing important patient information to be used in future research., (© 2021 The Authors. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.)
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- 2021
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84. Clinical Characteristics of Patients with Chronic Urticaria and Adherence to Management Guidelines by Postgraduate Students in Dermatology: A Retrospective Single Center Study.
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Reddy S, Manchanda I, Godse K, and Patil AD
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Background: Chronic urticaria is a heterogenous skin disorder representing one of the important reasons for consultation with a dermatologist. Dermatology post-graduate students play an importanrt role in the treatment of patients with chronic urticaria., Objective: The objective of the study was to describe clinical characteristics of patients with chronic urticaria and assess adherence to the guidelines by postgraduate students in the department of dermatology of a tertiary care center., Materials and Methods: In this retrospective study, prescriptions of patients with chronic urticaria and/or angioedema presenting to the outpatient department for 5 months were analyzed. Percentage of prescriptions adhering to international urticaria management guidelines was calculated. Urticaria Activity Score, percentage of patients receiving second-generation antihistamines, first-generation antihistamines, and other drugs was recorded. Comorbidities in patients with chronic urticaria were also noted., Results: A total of 60 patients (mean age 32.1 years; 58.3% male) were included in. Mean (SD) duration of urticaria at the time of study was 4.7 (2.7) months. Demographism and history of allergy to drugs was present in 45 (75%) and 4 (6.7%) patients. Mean (SD) Urticaria Activity Score was 12.5 (6.5). A total of 12 (20%) patients had comorbidities. Mean number of drugs received per patient was 1.7 (0.5). A total of 47 (78.3%) patients received second-generation antihistamines, whereas 11 (18.3%) received first-generation antihistamines. Two (3.3%) patients received combination of first-generation and second-generation antihistamines. Fexofenadine, levocetirizine, bilastine, and cetirizine was prescribed to 24 (40%), 26 (43.3%), 18 (30%), and 14 (23.3%) patients. There was no significant difference in male and female patients receiving fexofenadine ( P = 0.59) or levocetirizine ( P = 0.13)., Conclusion: Adherence to urticaria management guidelines by resident doctors in dermatology department in our institute was satisfactory., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Dermatology.)
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- 2021
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85. Effects of pregnancy on chronic urticaria: Results of the PREG-CU UCARE study.
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Kocatürk E, Al-Ahmad M, Krause K, Gimenez-Arnau AM, Thomsen SF, Conlon N, Marsland A, Savk E, Criado RF, Danilycheva I, Fomina D, Godse K, Khoshkhui M, Gelincik A, Degirmentepe EN, Demir S, Ensina LF, Kasperska-Zajac A, Rudenko M, Valle S, Medina I, Bauer A, Zhao Z, Staubach P, Bouillet L, Küçük ÖS, Ateş C, and Maurer M
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- Chronic Disease, Female, Gonadal Steroid Hormones, Humans, Pregnancy, Surveys and Questionnaires, Angioedema, Chronic Urticaria, Urticaria epidemiology
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Background: Chronic urticaria (CU) predominantly affects women, and sex hormones can modulate disease activity in female CU patients. As of now, the impact of pregnancy on CU is largely unknown., Aim: To analyze the course and features of CU during and after pregnancy., Patients and Methods: PREG-CU is an international, multicenter study of the Urticaria Centers of Reference and Excellence (UCARE) network. Data were collected via a 47-item questionnaire completed by CU patients, who became pregnant within the last 3 years., Results: A total of 288 pregnancies of 288 CU patients from 13 countries were analyzed (mean age at pregnancy: 32.1 ± 6.1 years, duration of CU: 84.9 ± 74.5 months; CSU 66.9%, CSU + CIndU 20.3%, CIndU 12.8%).During pregnancy, 51.1% of patients rated their CU as improved, 28.9% as worse, and 20.0% as unchanged.CU exacerbations most commonly occurred exclusively during the third trimester (in 34 of 124 patients; 27.6%) or the first (28 of 124; 22.8%). The risk factors for worsening of CU during pregnancy were having mild disease and no angioedema before pregnancy, not taking treatment before pregnancy, CIndU, CU worsening during a previous pregnancy, treatment during pregnancy, and stress as a driver of exacerbations. After giving birth, urticaria disease activity remained unchanged in 43.8% of CU patients, whereas 37.4% and 18.1% experienced worsening and improvement, respectively., Conclusions: These results demonstrate the complex impact of pregnancy on the course of CU and help to better counsel patients who want to become pregnant and to manage CU during pregnancy., (© 2021 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)
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- 2021
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86. Guideline for the diagnosis, treatment and long-term management of cutaneous lupus erythematosus.
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Lu Q, Long H, Chow S, Hidayat S, Danarti R, Listiawan Y, Deng D, Guo Q, Fang H, Tao J, Zhao M, Xiang L, Che N, Li F, Zhao H, Lau CS, Ip FC, Ho KM, Paliza AC, Vicheth C, Godse K, Cho S, Seow CS, Miyachi Y, Khang TH, Ungpakorn R, Galadari H, Shah R, Yang K, Zhou Y, Selmi C, Sawalha AH, Zhang X, Chen Y, and Lin CS
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- Humans, Lupus Erythematosus, Cutaneous classification, Lupus Erythematosus, Cutaneous diagnosis, Lupus Erythematosus, Cutaneous therapy, Practice Guidelines as Topic
- Abstract
Cutaneous lupus erythematosus (CLE) is an inflammatory, autoimmune disease encompassing a broad spectrum of subtypes including acute, subacute, chronic and intermittent CLE. Among these, chronic CLE can be further classified into several subclasses of lupus erythematosus (LE) such as discoid LE, verrucous LE, LE profundus, chilblain LE and Blaschko linear LE. To provide all dermatologists and rheumatologists with a practical guideline for the diagnosis, treatment and long-term management of CLE, this evidence- and consensus-based guideline was developed following the checklist established by the international Reporting Items for Practice Guidelines in Healthcare (RIGHT) Working Group and was registered at the International Practice Guideline Registry Platform. With the joint efforts of the Asian Dermatological Association (ADA), the Asian Academy of Dermatology and Venereology (AADV) and the Lupus Erythematosus Research Center of Chinese Society of Dermatology (CSD), a total of 25 dermatologists, 7 rheumatologists, one research scientist on lupus and 2 methodologists, from 16 countries/regions in Asia, America and Europe, participated in the development of this guideline. All recommendations were agreed on by at least 80% of the 32 voting physicians. As a consensus, diagnosis of CLE is mainly based on the evaluation of clinical and histopathological manifestations, with an exclusion of SLE by assessment of systemic involvement. For localized CLE lesions, topical corticosteroids and topical calcineurin inhibitors are first-line treatment. For widespread or severe CLE lesions and (or) cases resistant to topical treatment, systemic treatment including antimalarials and (or) short-term corticosteroids can be added. Notably, antimalarials are the first-line systemic treatment for all types of CLE, and can also be used in pregnant patients and pediatric patients. Second-line choices include thalidomide, retinoids, dapsone and MTX, whereas MMF is third-line treatment. Finally, pulsed-dye laser or surgery can be added as fourth-line treatment for localized, refractory lesions of CCLE in cosmetically unacceptable areas, whereas belimumab may be used as fourth-line treatment for widespread CLE lesions in patients with active SLE, or recurrence of ACLE during tapering of corticosteroids. As for management of the disease, patient education and a long-term follow-up are necessary. Disease activity, damage of skin and other organs, quality of life, comorbidities and possible adverse events are suggested to be assessed in every follow-up visit, when appropriate., (Copyright © 2021 Elsevier Ltd. All rights reserved.)
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- 2021
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87. How are patients with chronic urticaria interested in using information and communication technologies to guide their healthcare? A UCARE study.
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Cherrez-Ojeda I, Vanegas E, Cherrez A, Felix M, Weller K, Magerl M, Maurer RR, Mata VL, Kasperska-Zajac A, Sikora A, Fomina D, Kovalkova E, Godse K, Rao ND, Khoshkhui M, Rastgoo S, Criado RF, Abuzakouk M, Grandon D, Van Doorn MBA, Oliveira Rodrigues Valle S, De Souza Lima EM, Thomsen SF, Ramón GD, Matos Benavides EE, Bauer A, Giménez-Arnau AM, Kocatürk E, Guillet C, Larco JI, Zhao ZT, Makris M, Ritchie C, Xepapadaki P, Ensina LF, Cherrez S, and Maurer M
- Abstract
Background: Patients with chronic urticaria (CU) are increasingly using information and communication technologies (ICTs) to manage their health. What CU patients expect from ICTs and which ICTs they prefer remains unknown. We assessed why CU patients use ICTs, which ones they prefer, and what drives their expectations and choices., Methods: In this cross-sectional study, 1841 patients across 17 countries were recruited at UCAREs (Urticaria Centers of Reference and Excellence). Patients with CU who were >12 years old completed a 23-item questionnaire., Results: Most patients were interested in receiving disease information (87.3%), asking physicians about CU (84.1%), and communicating with other patients through ICTs (65.6%). For receiving disease information, patients preferred one-to-one and one-to-many ICTs, especially web browsers. One-to-one ICTs were also the ICTs of choice for asking physicians about urticaria and for communicating with other patients, and e-mail and WhatsApp were the preferred ICTs, respectively. Many-to-many ICTs such as Facebook, Instagram, LinkedIn, and Twitter were least preferred for all 3 purposes. Living in rural areas and higher education were linked to higher odds of being interested in receiving disease information, asking physicians, and communicating with patients through ICTs., Conclusions: Most patients and especially patients with higher education who live in rural areas are interested in using ICTs for their healthcare, but prefer different ICTs for different purposes, ie, web browsers for obtaining information, e-mail for asking physicians, and WhatsApp for communicating with other patients. Our findings may help to improve ICTs for CU., Competing Interests: I Cherrez-Ojeda has no conflicts of interest. E Vanegas has no conflicts of interest. A Cherrez has no conflicts of interest. M Felix has no conflicts of interest. K Weller is or recently was a speaker and/or advisor for, and/or has received research funding from: Biocryst, CSL Behring, Dr. Pfleger, FAES, Moxie, Novartis, Shire/Takeda, and Uriach. M Magerl is or recently was a speaker and/or advisor for, and/or has received research funding from Biocryst, CSL Behring, Kalvista Pharmaceuticals, Moxie, Novartis, Pharming, and Shire/Takeda. RR Maurer has no conflicts of interest. VL Mata has no conflicts of interest. A Kasperska-Zajac has no conflicts of interest. A Sikora has no conflicts of interest. D Fomina is or recently was a speaker and/or advisor for, and/or has received research funding from: AstraZeneca, CSL Behring, Glaxo SmithKline, MSD, Novartis, Sanofi, and Shire/Takeda. E Kovalkova has no conflicts of interest. K Godse has no conflicts of interest. N Dheeraj Rao has no conflicts of interest. M Khoshkhui has no conflicts of interest. S Rastgoo has no conflicts of interest. RFJ Criado has no conflicts of interest. M Abuzakouk has no conflicts of interest. D Grandon has no conflicts of interest. MBA van Doorn is or recently was a speaker and/or advisor for, and/or has received research funding from Abbvie, BMS, Celgene, Janssen Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, and Sanofi-Genzyme. S Valle has no conflicts of interest. E Magalhães de Souza Lima has no conflicts of interest. SF Thomsen is or recently was a speaker and/or advisor for, and/or has received research funding from: Abbvie, AstraZeneca, Celgene, Eli Lilly, Janssen, LEO Pharma, Novartis, Pierre Fabre, Roche, Sanofi, and UCB. GD Ramón has no conflicts of interest. EE Matos Benavides has no conflicts of interest. A Bauer is or recently was a speaker and/or advisor for, and/or has received research funding from Novartis, Sanofi, Genentech, Leo Pharma and Shire/Takeda. Ana M Giménez-Arnau has held roles as a Medical Advisor for Sanofi, Uriach, Genentech, Novartis, Amgen , ThemoFisher, Roche, Almirall, and has research grants supported by Instituto Carlos III- FEDER, Novartis, and Uriach; she also participates in educational activities for Almirall, Genentech, Glaxo SmithKline, LEO Pharma, Menarini, MSD, Novartis, Sanofi, Avene and Uriach. E Kocatürk is or recently was a speaker and/or advisor for Bayer, Novartis, and Sanofi. C Guillet has no conflicts of interest. JI Larco is or recently was a speaker and/or advisor for: FAES, Novartis, and Sanofi. Z-T Zhao has no conflicts of interest. M Makris is or recently was a speaker and/or advisor for, and/or has received research funding from AstraZeneca, Chiesi, Glaxo SmithKline, Novartis, and Sanofi. C Ritchie has no conflicts of interest. P Xepapadak reports personal fees from Galenica Greece, Glaxo SmithKline, Nestle, Novartis, Nutricia, and Uriach, outside the submitted work. LF Ensina is or recently was a speaker and/or advisor for, and/or has received research funding from Novartis, Sanofi, and Takeda. S Cherrez has no conflicts of interest. M Maurer is or recently was a speaker and/or advisor for, and/or has received research funding from: Allakos, Alnylam, Aralez, AstraZeneca, Biocryst, Blueprint, CSL Behring, FAES, Genentech, Kalvista Pharmaceuticals, LEO Pharma, Menarini, Moxie, MSD, Novartis, Pharming, Pharvaris, Roche, Sanofi, Shire/Takeda, UCB, and Uriach., (© 2021 The Author(s).)
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- 2021
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88. Managing Chronic Urticaria and Recurrent Angioedema Differently with Advancing Age.
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Longhurst HJ, Gonçalo M, Godse K, and Ensina LF
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- Aged, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Bradykinin therapeutic use, Humans, Angioedema diagnosis, Angioedema drug therapy, Angioedema epidemiology, Angioedemas, Hereditary diagnosis, Angioedemas, Hereditary drug therapy, Angioedemas, Hereditary epidemiology, Chronic Urticaria, Urticaria drug therapy
- Abstract
Angioedema and urticaria affect people of all ages. Accurate diagnosis and optimum management is essential for healthy aging. Older people continue to experience mast cell-mediated urticaria and angioedema, with a higher prevalence of autoimmune and a lower prevalence of autoallergic disease. Bradykinin-mediated angioedemas are more common in the elderly because of their association with angiotensin-converting enzyme inhibitor (ACEI) treatment. Acquired C1-inhibitor deficiency, another bradykinin-mediated angioedema, occurs predominantly in older people, whereas hereditary angioedema due to C1-inhibitor deficiency continues to cause symptoms, even in old age. Drug-induced angioedemas disproportionately affect older people, the most frequent users of ACEIs, aspirin, and nonsteroidal anti-inflammatory drugs. Accurate diagnosis and targeted treatment prevent unnecessary morbidity and mortality. Second-generation antihistamines with omalizumab if required are effective and well tolerated in older people with mast cell-mediated urticaria. For bradykinin-mediated angioedemas, these drugs are ineffective. C1-inhibitor replacement or blockade of kallikrein or the bradykinin B2 receptor of the contact pathway is required to treat hereditary angioedema and may be considered in other bradykinin-mediated angioedemas, if supportive treatment is insufficient. For aspirin-related angioedema and urticaria, alternative medications or, exceptionally, desensitization may be required., (Copyright © 2021 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
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- 2021
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89. Real-Life Experience of Efficacy and Safety of Bilastine in the Refractory Cases of Chronic Spontaneous Urticaria and its Effect on the Quality of Life of Patients.
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De A, Godse K, Dhoot D, and Sarda A
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Introduction: Second-generation H1-antihistamines (SGAHs) are the mainstay of treatment of chronic spontaneous urticaria (CSU). Bilastine, newer non-sedating SGAHs, was recently introduced in India after the approval of the Drugs Controller General of India. There is a paucity of evidence about the long-term efficacy and safety of Bilastine in Indian patients. We undertook this study to find the long-term efficacy and tolerability of Bilastine in patients with CSU in India., Materials and Methods: This retrospective chart analysis was conducted by analyzing electronic medical records from May 1, 2019, to March 20, 2020, to identify patients of CSU who were prescribed Bilastine. Adult patients, with CSU >6 months were included, who had an unsatisfactory response as per Urticaria Activity Score 7 (UAS7) to previous antihistamine therapies, and who continued treatment for at least 6 months were included. Treatment effectiveness was determined by retrospectively reviewing their UAS7 scores from their medical records and evaluating their scores at weeks 4, 8, 12, 16, 20, and 24. Also, DLQI was assessed and compared at baseline and week 24., Result: Forty-nine patients were found to fulfill the criteria and included in the study. At the end of 24 weeks, 51% of patients ( n = 25) achieved complete treatment response (UAS = 0), whereas 49% of patients ( n = 24) were labeled as well-controlled urticaria (UAS<6). At 24 weeks, the mean UAS7 score (1.35 ± 1.61) was statistically significant compared to the baseline score (20.2 ± 5.73). The mean score of DLQI was also reduced to 1.63 ± 1.18 at 24 weeks from 8.39 ± 2.49 at baseline ( P -value <0.001)., Conclusion: The study showed that in patients who had an inadequate response with commonly used antihistamines at a double dose or combined use, switching over to Bilastine resulted not only in relieving the symptoms of CSU but also improved the quality of life of the patients with CSU., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Journal of Dermatology.)
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- 2021
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90. The usage, quality and relevance of information and communications technologies in patients with chronic urticaria: A UCARE study.
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Maurer M, Weller K, Magerl M, Maurer RR, Vanegas E, Felix M, Cherrez A, Mata VL, Kasperska-Zajac A, Sikora A, Fomina D, Kovalkova E, Godse K, Rao ND, Khoshkhui M, Rastgoo S, Criado RFJ, Abuzakouk M, Grandon D, van Doorn M, Valle SOR, de Souza Lima EM, Thomsen SF, Ramón GD, Matos Benavides EE, Bauer A, Giménez-Arnau AM, Kocatürk E, Guillet C, Ignacio Larco J, Zhao ZT, Makris M, Ritchie C, Xepapadaki P, Ensina LF, Cherrez S, and Cherrez-Ojeda I
- Abstract
Background: Chronic urticaria (CU) is characterized by itchy recurrent wheals, angioedema, or both for 6 weeks or longer. CU can greatly impact patients' physical and emotional quality of life. Patients with chronic conditions are increasingly seeking information from information and communications technologies (ICTs) to manage their health. The objective of this study was to assess the frequency of usage and preference of ICTs from the perspective of patients with CU., Methods: In this cross-sectional study, 1800 patients were recruited from primary healthcare centers, university hospitals or specialized clinics that form part of the UCARE (Urticaria Centers of Reference and Excellence) network throughout 16 countries. Patients were >12 years old and had physician-diagnosed chronic spontaneous urticaria (CSU) or chronic inducible urticaria (CIndU). Patients completed a 23-item questionnaire containing questions about ICT usage, including the type, frequency, preference, and quality, answers to which were recorded in a standardized database at each center. For analysis, ICTs were categorized into 3 groups as follows: one-to-one: SMS, WhatsApp, Skype, and email; one-to-many: YouTube, web browsers, and blogs or forums; many-to-many: Instagram, Twitter, Facebook, and LinkedIn., Results: Overall, 99.6% of CU patients had access to ICT platforms and 96.7% had internet access. Daily, 85.4% patients used one-to-one ICT platforms most often, followed by one-to-many ICTs (75.5%) and many-to-many ICTs (59.2%). The daily ICT usage was highest for web browsers (72.7%) and WhatsApp (70.0%). The general usage of ICT platforms increased in patients with higher levels of education. One-to-many was the preferred ICT category for obtaining general health information (78.3%) and for CU-related information (75.4%). A web browser (77.6%) was by far the most commonly used ICT to obtain general health information, followed by YouTube (25.8%) and Facebook (16.3%). Similarly, for CU-specific information, 3 out of 4 patients (74.6%) used a web browser, 20.9% used YouTube, and 13.6% used Facebook. One in 5 (21.6%) patients did not use any form of ICT for obtaining information on CU. The quality of the information obtained from one-to-many ICTs was rated much more often as very interesting and of good quality for general health information (53.5%) and CU-related information (51.5%) as compared to the other categories., Conclusions: Usage of ICTs for health and CU-specific information is extremely high in all countries analyzed, with web browsers being the preferred ICT platform., Competing Interests: M Maurer is or recently was a speaker and/or advisor for, and/or has received research funding from: Allakos, Alnylam, Aralez, AstraZeneca, Biocryst, Blueprint, CSL Behring, FAES, Genentech, Kalvista Pharmaceuticals, LEO Pharma, Menarini, Moxie, MSD, Novartis, Pharming, Pharvaris, Roche, Sanofi, Shire/Takeda, UCB, and Uriach. K Weller is or recently was a speaker and/or advisor for, and/or has received research funding from: Biocryst, CSL Behring, Dr. Pfleger, FAES, Moxie, Novartis, Shire/Takeda, and Uriach. M Magerl is or recently was a speaker and/or advisor for, and/or has received research funding from Biocryst, CSL Behring, Kalvista Pharmaceuticals, Moxie, Novartis, Pharming, and Shire/Takeda. RR Maurer has no conflicts of interest. E Vanegas has no conflicts of interest. M Felix has no conflicts of interest. A Cherrez has no conflicts of interest. VL Mata has no conflicts of interest. A Kasperska-Zajac has no conflicts of interest. A Sikora has no conflicts of interest. D Fomina is or recently was a speaker and/or advisor for, and/or has received research funding from: AstraZeneca, CSL Behring, Glaxo SmithKline, MSD, Novartis, Sanofi, and Shire/Takeda. E Kovalkova has no conflicts of interest. K Godse has no conflicts of interest. N Dheeraj Rao has no conflicts of interest. M Khoshkhui has no conflicts of interest. S Rastgoo has no conflicts of interest. RFJ Criado has no conflicts of interest. M Abuzakouk has no conflicts of interest. D Grandon has no conflicts of interest. M van Doorn is or recently was a speaker and/or advisor for, and/or has received research funding from Abbvie, BMS, Celgene, Janssen Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, and Sanofi-Genzyme. S Valle has no conflicts of interest. E Magalhães de Souza Lima has no conflicts of interest. SF Thomsen is or recently was a speaker and/or advisor for, and/or has received research funding from: Abbvie, AstraZeneca, Celgene, Eli Lilly, Janssen, LEO Pharma, Novartis, Pierre Fabre, Roche, Sanofi, and UCB. GD Ramón has no conflicts of interest. EE Matos Benavides has no conflicts of interest. A Bauer has no conflicts of interest. Ana M Giménez-Arnau has held roles as a Medical Advisor for Sanofi and Uriach, and has research grants supported by Instituto Carlos III- FEDER, Novartis, and Uriach; she also participates in educational activities for Almirall, Genentech, Glaxo SmithKline, LEO Pharma, Menarini, MSD, Novartis, Sanofi, and Uriach. E Kocatürk is or recently was a speaker and/or advisor for Bayer, Novartis, and Sanofi. C Guillet has no conflicts of interest. JI Larco is or recently was a speaker and/or advisor for: FAES, Novartis, and Sanofi. Z-T Zhao has no conflicts of interest. M Makris is or recently was a speaker and/or advisor for, and/or has received research funding from AstraZeneca, Chiesi, Glaxo SmithKline, Novartis, and Sanofi. C Ritchie has no conflicts of interest. P Xepapadak reports personal fees from Galenica Greece, Glaxo SmithKline, Nestle, Novartis, Nutricia, and Uriach, outside the submitted work. LF Ensina is or recently was a speaker and/or advisor for, and/or has received research funding from Novartis, Sanofi, and Takeda. S Cherrez has no conflicts of interest. I Cherrez-Ojeda has no conflicts of interest., (© 2020 Published by Elsevier Inc. on behalf of World Allergy Organization.)
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- 2020
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91. Definition, aims, and implementation of GA 2 LEN/HAEi Angioedema Centers of Reference and Excellence.
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Maurer M, Aberer W, Agondi R, Al-Ahmad M, Al-Nesf MA, Ansotegui I, Arnaout R, Arruda LK, Asero R, Aygören-Pürsün E, Banerji A, Bauer A, Ben-Shoshan M, Berardi A, Bernstein JA, Betschel S, Bindslev-Jensen C, Bizjak M, Boccon-Gibod I, Bork K, Bouillet L, Boysen HB, Brodszki N, Broesby-Olsen S, Busse P, Buttgereit T, Bygum A, Caballero T, Campos RA, Cancian M, Cherrez-Ojeda I, Cohn DM, Costa C, Craig T, Criado PR, Criado RF, Csuka D, Dissemond J, Du-Thanh A, Ensina LF, Ertaş R, Fabiani JE, Fantini C, Farkas H, Ferrucci SM, Figueras-Nart I, Fili NL, Fomina D, Fukunaga A, Gelincik A, Giménez-Arnau A, Godse K, Gompels M, Gonçalo M, Gotua M, Gower R, Grumach AS, Guidos-Fogelbach G, Hide M, Ilina N, Inomata N, Jakob T, Josviack DO, Kang HR, Kaplan A, Kasperska-Zając A, Katelaris C, Kessel A, Kleinheinz A, Kocatürk E, Košnik M, Krasowska D, Kulthanan K, Kumaran MS, Larco Sousa JI, Longhurst HJ, Lumry W, MacGinnitie A, Magerl M, Makris MP, Malbrán A, Marsland A, Martinez-Saguer I, Medina IV, Meshkova R, Metz M, Nasr I, Nicolay J, Nishigori C, Ohsawa I, Özyurt K, Papadopoulos NG, Parisi CAS, Peter JG, Pfützner W, Popov T, Prior N, Ramon GD, Reich A, Reshef A, Riedl MA, Ritchie B, Röckmann-Helmbach H, Rudenko M, Salman A, Sanchez-Borges M, Schmid-Grendelmeier P, Serpa FS, Serra-Baldrich E, Sheikh FR, Smith W, Soria A, Staubach P, Steiner UC, Stobiecki M, Sussman G, Tagka A, Thomsen SF, Treudler R, Valle S, van Doorn M, Varga L, Vázquez DO, Wagner N, Wang L, Weber-Chrysochoou C, Ye YM, Zalewska-Janowska A, Zanichelli A, Zhao Z, Zhi Y, Zuberbier T, Zwiener RD, and Castaldo A
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- Humans, Angioedema diagnosis, Angioedema epidemiology, Urticaria
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- 2020
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92. Efficacy and safety of basic fibroblast growth factor (bFGF) related decapeptide solution plus Tacrolimus 0.1% ointment versus Tacrolimus 0.1% ointment in the treatment of stable vitiligo.
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Shah B, Godse K, Mahajan S, Grandhi S, Shendkar S, Sharma A, Teli C, Pathak R, and Parsad D
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- Adult, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Ointments, Prospective Studies, Solutions, Fibroblast Growth Factor 2 administration & dosage, Oligopeptides administration & dosage, Tacrolimus administration & dosage, Vitiligo drug therapy
- Abstract
Vitiligo is common acquired pigmentary disorder affecting skin of 1% of the world population, India 3% to 8% incidences approximately. Treatment is tough challenge. The combination treatments have proven beneficial due to different mechanisms. There is need to find drug targeting different mechanisms of action. Test medicine is decapeptide derived from basic Fibroblast Growth Factor (bFGF) treating vitiligo. The current study was to compare efficacy and safety of BFGF related decapeptide solution plus Tacrolimus 0.1% (M + T) Ointment versus Tacrolimus monotherapy 0.1% (T) Ointment in patients with stable vitiligo. The randomized, open label, comparative, prospective, multicentre study in patients with stable vitiligo was conducted. The primary endpoint was improvement in extent of repigmentation in target lesion after 12 months of treatment from baseline. The secondary endpoints were extent of repigmentation at end of 6 months, patient global assessment (PGA) and safety at end of 6 months. This shows interim analysis results. Total 94 patients were randomized to M + T (n = 40) and T (n = 44), 10 patients were lost to follow up. Extent of repigmentation (>50%) was significantly greater at end of 8 weeks in M + T group 22.5% (p ≤ .05) while 6.8% in T group. In grade of repigmentation, significant difference (p ≤ .05) was observed, M + T had better grade. PGA was significantly greater (p ≤ .05) in M + T-group than T. All these parameters showed significant improvement in M + T-group than group T at end of 6 months. No adverse events were reported during the study. It is an interim analysis report so complete data is not available for analysis. Addition of bFGF related decapeptide solution to Tacrolimus gave better results than Tacrolimus alone therapy. It also has a favorable safety profile and was well tolerated., (© 2019 Wiley Periodicals, Inc.)
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- 2019
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93. Histopathological comparison of lesional and perilesional skin in melasma: A cross-sectional analysis.
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Gautam M, Patil S, Nadkarni N, Sandhu M, Godse K, and Setia M
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- Adult, Atrophy pathology, Biopsy, Cross-Sectional Studies, Facial Dermatoses etiology, Female, Humans, Melanocytes pathology, Melanosis etiology, Middle Aged, Sunlight adverse effects, Young Adult, Epidermis pathology, Facial Dermatoses pathology, Melanosis pathology
- Abstract
Background: Melasma is a common acquired hyperpigmentary disorder of the sun exposed skin, especially the face. The pathogenesis is unclear but interplay between genetic factors, hormones and ultraviolet radiation is important. We have evaluated the histological characteristics of melasma and compared the findings with adjacent normal skin., Methods: Skin biopsies were taken from both melasma and the surrounding perilesional normal skin in 50 Indian women. The sections were stained with hematoxylin and eosin, Fontana-Masson and Verhoeff-Van Gieson stains., Results: Biopsy from melasma showed significant epidermal atrophy, basal cell hyperpigmentation and solar elastosis when compared with the perilesional skin. We found that the proportion of pendulous melanocytes was significantly higher in the lesional biopsy compared with the perilesional biopsy (76% vs 42%, P < 0.001). Similarly, pigmentary incontinence and features of solar elastosis were significantly higher in the lesional skin compared with the perilesional skin., Conclusion: The characteristic histopathological features such as epidermal atrophy, basal cell hyperpigmentation and solar elastosis suggest the role of chronic sun exposure in the pathogenesis of melasma. Presence of pendulous melanocytes is a characteristic feature of melasma. The presence of pendulous melanocytes may have prognostic implications in melasma., Competing Interests: None
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- 2019
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94. Guidelines on Management of Atopic Dermatitis in India: An Evidence-Based Review and an Expert Consensus.
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Rajagopalan M, De A, Godse K, Krupa Shankar DS, Zawar V, Sharma N, Mukherjee S, Sarda A, and Dhar S
- Abstract
Background: Atopic dermatitis (AD) is a common and chronic, pruritic inflammatory skin condition that affects all age groups. There was a dearth of consensus document on AD for Indian practitioners. This article aims to provide an evidence-based consensus statement for the management of AD with a special reference to the Indian context. This guideline includes updated definition, etiological factors, classification, and management of atopic dermatitis., Methodology: The preparation of guidelines was done in multiple phases. Indian Dermatology Expert Board Members (DEBM), recommended by the Skin Allergy Society of India, prepared 26 evidence-based recommendations for AD. An extensive literature search was done in MEDLINE, Google scholar, Cochrane, and other resources. Articles published in the past 10 years were reviewed and recommendations were graded based on the quality of evidence as per GRADE. After forming the initial structure, DEBM met in Mumbai and gave their decisions on an agree and disagree scale with an Indian perspective. Finally, their suggestions were compiled for preparing the article. After DEBM finalized the draft, a treatment algorithm was formulated for the management of AD., Results: DEBM suggested a working definition for AD. The panel agreed that moisturizers should be used as mainstay of therapy and should be continued in all lines of therapy and in maintenance phase. Topical corticosteroids and topical calcineurin inhibitors should be considered as the first line of treatment. Among systemic therapies, cyclosporin should be considered first line, followed by azathioprine, methotrexate, and mycophenolate mofetil. Phototherapy can be an effecive alternative. Empirical food restriction was recommended against., Conclusion: These guidelines should form a reference for the management of patients with AD in an evidence-based manner., Competing Interests: There are no conflicts of interest.
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- 2019
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95. Awareness of Family Physicians Towards Antihistamines.
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Zeerak S, Godse K, and Kumar S
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Background: Antihistamines are one of the commonly prescribed groups of drugs for allergic disorders and pruritus. They are broadly grouped into two generations, the second-generation ones being more effective and with less side effects. The family physicians frequently use antihistamines as patients contact them initially for their problem. It will be interesting to know the mode of selection of antihistamines by them., Materials and Methods: The study was carried out on a sample of 100 family physicians. Primary data were collected from them after taking informed consent. A pre-validated questionnaire regarding knowledge, awareness, and prescribing schedule of antihistamines was filled up. The data were then analyzed with suitable statistical tests., Results: Almost 73% of physicians prescribed second-generation antihistamines, while 27% prescribed the first-generation ones. Only 15% of them were aware about the ARIA and GA2LEN guidelines and their recommendations for prescribing second-generation antihistamines over the older first-generation antihistamines, while 85% had not heard about them previously. A minimum 7% of practitioners revealed that they updosed the same drug four times in the treatment of urticaria, while 93% did not do it., Conclusion: Even though a sizeable percentage of family physicians prescribed second-generation antihistamines, most of them were not aware of their dosing guidelines., Competing Interests: There are no conflicts of interest.
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- 2019
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96. A clinician's reference guide for the management of atopic dermatitis in Asians.
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Chow S, Seow CS, Dizon MV, Godse K, Foong H, Chan V, Khang TH, Xiang L, Hidayat S, Listiawan MY, Triwahyudi D, Gondokaryono SP, Sutedja E, Diana IA, Suwarsa O, Dharmadji HP, Siswati AS, Danarti R, Soebaryo R, and Budianti WK
- Abstract
Background: Atopic dermatitis (AD) is a common skin condition among Asians. Recent studies have shown that Asian AD has a unique clinical and immunologic phenotype compared with European/American AD., Objective: The Asian Academy of Dermatology and Venereology Expert Panel on Atopic Dermatitis developed this reference guide to provide a holistic and evidence-based approach in managing AD among Asians., Methods: Electronic searches were performed to retrieve relevant systematic reviews and guidelines on AD. Recommendations were appraised for level of evidence and strength of recommendation based on the U.K. National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network guidelines. These practice points were based on the consensus recommendations discussed during the Asia Pacific Meeting of Experts in Dermatology held in Bali, Indonesia in October 2016 and April 2017., Results: The Expert Panel recommends an approach to treatment based on disease severity. The use of moisturizers is recommended across all levels of AD severity, while topical steroids are recommended only for flares not controlled by conventional skin care and moisturizers. Causes of waning efficacy must be explored before using topical corticosteroids of higher potency. Topical calcineurin inhibitors are recommended for patients who have become recalcitrant to steroid, in chronic uninterrupted use, and when there is steroid atrophy, or when there is a need to treat sensitive areas and pediatric patients. Systemic steroids have a limited role in AD treatment and should be avoided if possible. Educational programs that allow a patient-centered approach in AD management are recommended as an adjunct to conventional therapies. Recommendations on the use of phototherapy, systemic drugs, and emerging treatments are also included., Conclusion: The management of AD among Asians requires a holistic approach, integrating evidence-based treatments while considering accessibility and cultural acceptability.
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- 2018
- Full Text
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97. Expert Consensus on The Management of Dermatophytosis in India (ECTODERM India).
- Author
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Rajagopalan M, Inamadar A, Mittal A, Miskeen AK, Srinivas CR, Sardana K, Godse K, Patel K, Rengasamy M, Rudramurthy S, and Dogra S
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- Adult, Anti-Bacterial Agents administration & dosage, Coinfection drug therapy, Consensus, Delphi Technique, Health Care Surveys, Humans, India epidemiology, Skin Diseases, Bacterial drug therapy, Skin Diseases, Bacterial epidemiology, Tinea diagnosis, Tinea microbiology, Young Adult, Antifungal Agents administration & dosage, Tinea drug therapy, Tinea epidemiology
- Abstract
Background: Dermatophytosis management has become an important public health issue, with a large void in research in the area of disease pathophysiology and management. Current treatment recommendations appear to lose their relevance in the current clinical scenario. The objective of the current consensus was to provide an experience-driven approach regarding the diagnosis and management of tinea corporis, cruris and pedis., Methods: Eleven experts in the field of clinical dermatology and mycology participated in the modified Delphi process consisting of two workshops and five rounds of questionnaires, elaborating definitions, diagnosis and management. Panel members were asked to mark "agree" or "disagree" beside each statement, and provide comments. More than 75% of concordance in response was set to reach the consensus., Result: KOH mount microscopy was recommended as a point of care testing. Fungal culture was recommended in chronic, recurrent, relapse, recalcitrant and multisite tinea cases. Topical monotherapy was recommended for naïve tinea cruris and corporis (localised) cases, while a combination of systemic and topical antifungals was recommended for naïve and recalcitrant tinea pedis, extensive lesions of corporis and recalcitrant cases of cruris and corporis. Because of the anti-inflammatory, antibacterial and broad spectrum activity, topical azoles should be preferred. Terbinafine and itraconazole should be the preferred systemic drugs. Minimum duration of treatment should be 2-4 weeks in naïve cases and > 4 weeks in recalcitrant cases. Topical corticosteroid use in the clinical practice of tinea management was strongly discouraged., Conclusion: This consensus guideline will help to standardise care, provide guidance on the management, and assist in clinical decision-making for healthcare professionals.
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- 2018
- Full Text
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98. Knowledge and Attitude of General Population toward Effects of Sun Exposure and Use of Sunscreens.
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Agarwal SB, Godse K, Patil S, and Nadkarni N
- Abstract
Background: Sun exposure causes extensive intrinsic as well as extrinsic changes in the skin. Pathogenic effects of sun exposure such as tanning, melasma, skin cancer, and aggravation of various photodermatoses such as systemic lupus erythematosus (SLE) may be prevented by the use of sunscreens. We conducted the present study to assess the knowledge and attitudes regarding sun exposure and use of sunscreens., Methods: Two thousand and thirty-seven volunteers answered the questionnaire over a period of 2 years. All adults aged 18 years and above who voluntarily agreed to participate in the study after written informed consent were included., Results: Out of 2037 volunteers, 1242 volunteers had no knowledge of sunscreens. Sixty-eight percent of the volunteers from the upper class of society knew about sunscreens, and 86% of the volunteers from the lower middle class did not know about sunscreens. Eight-one percent of the volunteers did not suffer from sunburns. Eight-four percent of the volunteers were aware that sun exposure caused darkening, but awareness about other effects of sun exposure such as wrinkling, melasma, allergy, and photo-induced cancers was less. Most of the volunteers agreed that sunscreens protected against sun damage and tanning. Fifty-eight percent of the volunteers applied sunscreen before venturing out, and 78% of the volunteers applied sunscreen only on the face. Prevention of tanning was the most common reason for the usage of sunscreens. Cosmetic appeal and irritant potential were the prominent deciding factors in choosing sunscreens., Conclusion: Awareness about protective spectrum of sunscreens, their correct method of application, and misconceptions need to be focused on. Better product development keeping in mind the Indian conditions would help in increasing the usage of sunscreens., Competing Interests: There are no conflicts of interest. What is new? The knowledge about sunscreen and its benefit, other than prevention of tanning, is low. The awareness about benefits of sunscreen is limited. Stickiness and high cost are some of the reasons for not using sunscreens.
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- 2018
- Full Text
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99. Consensus Statement for the Diagnosis and Treatment of Urticaria: A 2017 Update.
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Godse K, De A, Zawar V, Shah B, Girdhar M, Rajagopalan M, and Krupashankar DS
- Abstract
This article is developed by the Skin Allergy Research Society of India for an updated evidence-based consensus statement for the management of urticaria, with a special reference to the Indian context. This guideline includes updated definition, causes, classification, and management of urticaria. Urticaria has a profound impact on the quality of life and causes immense distress to patients, necessitating effective treatment. One approach to manage urticaria is by identification and elimination of the underlying cause(s) and/or eliciting trigger(s) while the second one is by treatment for providing symptomatic relief. This guideline recommends the use of second-generation nonsedating H1-antihistamines as the first-line treatment. The dose can be increased up to four times to meet the expected results. In case patients still do not respond, appropriate treatment options can be selected depending on the associated medical condition, severity of the symptoms, affordability of the drugs, and accessibility of modern biologics such as omalizumab., Competing Interests: There are no conflicts of interest. What is new? This guideline provides a comprehensive and evidence based analysis of evaluation and management of urticaria with an Indian perspective.
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- 2018
- Full Text
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100. Lasers in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group.
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Sarkar R, Aurangabadkar S, Salim T, Das A, Shah S, Majid I, Singh M, Ravichandran G, Godse K, Arsiwala S, Arya L, Gokhale N, Sarma N, Torsekar RG, Sonthalia S, and Somani VK
- Abstract
Lasers have come up as the newest therapeutic modality in dermatological conditions including melasma. In this article, as a group of experts from Pigmentary Disorders Society in collaboration with South Asian Pigmentary Disorders Forum (SPF), we have tried to discuss the lasers which have been used in melasma and formulate simple consensus guidelines. Following thorough literature search, we have summarised the rationale of using the lasers and the supporting evidences have also been provided. It is clear that laser cannot be the first line treatment for melasma. However, it can be used as an adjuvant therapy in resistant cases, provided the selection of patient and counselling has been done properly., Competing Interests: There are no conflicts of interest. What is new? Lasers can be used in selected patients with resistant melasma after thorough counseling and preferably after conducting test treatments.Low-fluence Q-switched (LFQS) Nd-YAG laser seems to be the best option for refractory cases of melasma, especially in individuals with darker skin tones. However, it is not recommended as monotherapy. It can be combined with other lasers, peels, and oral adjuvants.Q-switched ruby laser and Erbium YAG laser are better avoided, due to the risk of developing post-inflammatory hyperpigmentation.Fractional 1550/1540 nm non-ablative laser therapy is the only laser that has been approved by the FDA for melasma. To minimise the chances of post-inflammatory hyperpigmentation, it is advisable to use lower fluencies, variable pulses and pre-treatment with hydroquinone for4- 6 weeks before laser therapy.
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- 2017
- Full Text
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