Expert opinion on current and emerging treatment options in androgenetic alopecia and telogen effluvium: an Indian perspective

<p class="abstract">The diagnosis and management of hair loss needs an organized and systematic approach for recognizing pattern of hair loss and identification of hair loss etiology. Early and specific diagnosis is essential to initiate appropriate treatment in the early phases of hair loss. Topical minoxidil and oral finasteride are the only approved drugs for androgenetic alopecia (AGA). Various other treatment options are widely used but have limited clinical evidence. Similarly, there are no specific treatments recommended for telogen effluvium (TE). However, the treatment may become challenging with increasing availability of new formulations and drugs with no substantial evidence to support them. Multiple focused group discussions were conducted among Indian dermatologists to gain expert opinion on appropriate management of AGA and TE in the current scenario. This article summarizes the consensus clinical viewpoints for topical and oral medications, role of nutritional supplements, and other adjunctive therapies in managing AGA and TE. The panel highlighted that the choice of treatment for AGA and TE depends on the individual hair loss pattern and response to medications. A brief discussion on the use of shampoos and procedures has also been highlighted. </p>

Expert consensus statement on diagnosis and management of sensitive skin in current clinical practice

<p class="abstract">Sensitive skin is a very commonly seen entity in current dermatological practice that has a significant impact on quality of life. The pathophysiology, classification, diagnosis, and treatment of sensitive skin have evolved over the years, with new studies trying to bring about new robust evidence about the same. The current consensus aims at providing a comprehensive overview on evidence and experience-based approaches for sensitive skin. A total of 35 experts in the field of clinical dermatology participated in expert group meetings organized via teleconference webinar. Current evidence elaborating various aspects like classification, diagnosis, and management of sensitive skin along with clinical experience of experts were discussed in detail. The prerequisites for selecting suitable products, importance of cosmeceuticals as adjunctive therapy and the need for avoiding triggering factors in individuals with sensitive skin as well as associated dermatological disorders were also described. In addition to medical history, physical examination and routine investigations, a draft checklist and its clinical relevance in accurately diagnosing sensitive skin were emphasized upon by the experts. The overall management encompasses avoidance of individual trigger factors, thorough topical therapy using mild, non-irritating ingredients along with adjunctive therapies like moisturizers, sunscreens, and cleansers. The “two-week” strategy was described to be a useful approach for treating sensitive skin. This review article provides a consensus clinical viewpoint of expert dermatologists for effective evaluation, differential diagnosis and appropriate pharmacological as well as non-pharmacological management of sensitive skin in Indian subjects.</p>

Genital nodular scabies in Indonesian adolescent boy

<p class="abstract">Scabies is an infection caused by infestation and sensitization to the parasitic mite <em>Sarcoptes</em> <em>scabiei</em> <em>var</em>. <em>hominis</em>. World Health Organization (WHO) in 2017 declared that scabies was included as Neglected Tropical Diseases (NTD) and become a significant health concern in many developing countries. According to the Global Burden of Disease Study in 2015, Indonesia was the first place among 195 countries with the greatest scabies burden. Nodular scabies is an uncommon clinical variant in classical scabies cases, characterized by persistent pruritic nodules due to immune response against the mites and their products (eggs and scybala). This variant was occurring in about 7% of scabies patients. The incidence and prevalence of nodular scabies are still unknown. Nodular scabies is usually found in young children and affect the male genitalia, especially in the scrotum. The diagnosis of nodular scabies generally can be made clinically and supported by a history of receiving adequate anti-scabies treatment. Active infestation form or atypical manifestations of nodular scabies might be confused the diagnosis. Diagnostic tools such as dermoscopic and skin biopsy may aid in differentiating them. Histopathology features also can rule out the differential diagnosis. Corticosteroid (topical or injection) and topical inhibitor calcineurin (tacrolimus) was reported effective in treating nodular scabies. We reported an Indonesian adolescent boy who has been diagnosed with scabies complained of persistent pruritic nodules on his genital for several months despite adequate anti scabies therapy being given. Intralesional corticosteroid injection was the options treatment of this case due to the nodular lesion being resistant with topical corticosteroids, while topical tacrolimus is difficult to obtain in our region.</p>

Clinical pattern of cutaneous infestations in pediatric age group attending a tertiary care centre

<p class="abstract"><strong>Background:</strong> Skin diseases are a serious health concern for children of all ages, and they are linked to a high rate of morbidity. In comparison to adults, children's dermatological problems are more impacted by socioeconomic position, dietary habits, climatic exposure, and the external environment. The purpose of this study was to determine the prevalence of infestations among pediatric patients who visited the dermatology outpatient department in a tertiary care hospital.</p><p class="abstract"><strong>Methods:</strong> From December 2019 to September 2020, all newly diagnosed, untreated male and female pediatric patients (from neonates to adolescents of 14 years of age) attending dermatology outpatient department (OPD) were assessed to determine the prevalence of Infestations within the pediatric population. A thorough history was gathered, followed by a meticulous dermatological examination and if indicated, regular investigations were done and were recorded in predesigned performa.<strong></strong></p><p class="abstract"><strong>Results:</strong> The analysis included 50 patients who had been infested. There were 43 cases (86%) of scabies and 7 cases (14%) of pediculosis capitis.</p><p class="abstract"><strong>Conclusions:</strong> The infestations in the pediatric age group are associated with a high communicable rate so it’s important to diagnose these conditions early to contain the spread and limit the morbidity.</p>

Dermoscopy as a diagnostic tool to differentiate between tinea pedis and plantar psoriasis

<p><strong>Background</strong>: Clinical differentiation between tinea pedis and plantar psoriasis may sometimes be challenging, with consequent diagnostic delays and unnecessary therapies; in such cases histopathological analysis helps to differentiate the 2 conditions. In this study we used a dermoscope as a non-invasive tool to investigate the significance of specific dermoscopic features and to improve their non-invasive differentiation.</p><p><strong>Methods:</strong> A clinical diagnosis of plantar psoriasis/tinea pedis was made on basis of accepted literature and proved by histopathology. Image capturing was performed using a dermoscope. Based on combination of history, clinical, and dermoscopic examination conclusive diagnosis with specific dermoscopic features for each disease was achieved.</p><p><strong>Results:</strong> The 15 patients of biopsy proven tinea pedis and 17 patients of biopsy proven plantar psoriasis were selected. We found that the presence of whitish powdery scales located in the furrows with apparently uninvolved skin in between was significant in tinea pedis whereas the presence of silvery white scales on a pinkish red erythematous background with regularly distributed red dots was significant in plantar psoriasis.</p><p><strong>Conclusions:</strong> Dermoscopy showed significant patterns in tinea pedis and plantar psoriasis due to their well-known different histological and physio pathological background, with white diffuse scales reflecting the dry and hyperkeratotic nature of plantar psoriasis and the red dots signifying the pin point blood vessels seen clinically as Auspitz sign. The peculiar scaling in tinea pedis might result from the predilection of dermatophytes to proliferate in moist environment, such as the furrows.</p>

Female pattern hair loss among Saudi women and hematological changes associated with it - case controlled study

<p class="abstract"><strong>Background:</strong> Female pattern hair loss is a problematic condition. The availability of a rapid indicator is crucial. The current study compared female pattern hair loss patients with healthy controls regarding hematological parameters and vitamin D levels.</p><p class="abstract"><strong>Methods:</strong> We included 78 females with female pattern hair loss and 50 healthy subjects in the control group. We collected a detailed medical history and performed a systematic clinical examination. Blood samples were collected including complete blood count, serum ferritin, and vitamin D.<strong></strong></p><p class="abstract"><strong>Results:</strong> A significant increase in positive family history and acne among the study than the control group. Most patients had mild disease (55.1%). Female pattern hair loss was significantly associated with a reduction in red blood cell count, hemoglobin, hematocrit, mean cell volume, mean cell hemoglobin, mean cell hemoglobin concentration, red cell distribution width, serum ferritin and serum vitamin D. Among the patient’s group, the disease severity was positively correlated with disease duration and patient age. The correlation with duration was moderate (r=0.366). The disease duration was positively correlated with body mass index and negatively correlated with red blood cell count, hemoglobin concentration, hematocrit, red cell indices, ferritin and vitamin D. Disease duration was also inversely correlated with vitamin D levels.</p><p class="abstract"><strong>Conclusions:</strong> Family history, body mass index, acne, hirsutism and irregular period were high among Saudi women. The disease was moderately severe. FPHL was associated with a significant reduction in hematological parameters and lower serum ferritin that indicated iron deficiency could play a crucial role in the development or progression of the disease. As a preventable etiology, restoring iron stores may provide at least an adjunct therapeutic option.</p>

Expert opinion on current and emerging treatments in dermatophytosis

<p class="abstract">Dermatophytosis continues to be a worldwide public health problem, predominantly in developing countries like India. Early diagnosis and appropriate management are imperative to enhance patient outcomes and improve quality of life of individuals with dermatophytosis. Multiple focused group discussions involving 76 dermatologists across 36 cities in India were conducted to provide a consensus clinical viewpoint of expert dermatologists to gain insights toward effective diagnosis and management of Indian subjects with dermatophytosis. These discussions mainly aimed at reviewing current literature on prevalence, etiology, diagnosis and management of dermatophytosis and highlighting variations in diagnostic and treatment approaches in routine clinical practice. The current article summarizes the experts’ clinical viewpoint on overall management of dermatophytosis. Diagnosis of dermatophytosis involves clinical observation, microscopic examination and dermoscopy. Molecular techniques have certain advantages over conventional microscopy and culture methods but are associated with issues of cost and technique complexity. Oral itraconazole 200 mg–400 mg daily and terbinafine 500 mg/day could be considered for recalcitrant tinea infections. Topical azoles like luliconazole, sertaconazole, and terbinafine could be beneficial. A combination of oral and topical antifungal drugs is effective in patients with steroid-modified and difficult-to-treat tinea infections. Also, patient counselling and use of adjunctive therapies like antihistamines, retinoids, and moisturizers are essential for managing tinea infections. </p><p class="abstract"> </p>

Expert consensus on the use of sunscreen agents: Indian perspective

<p class="abstract">Sunscreens have been widely known to play an integral part in photoprotection. Both physical and chemical sunscreens have been extensively used for prevention and management of several conditions induced by ultraviolet rays such as sunburn, photoaging, skin cancer, and phototoxic reactions. Currently, sunscreens are available in different formulations like creams, lotions, gels, sticks, and sprays. Forty experts in the field of clinical dermatology participated in the expert group meetings organized via teleconference webinar to discuss definitions, diagnoses, and management. Current evidence on the use of sunscreen agents along with clinical experience of experts was discussed. The application of an adequate amount of sunscreen with an appropriate sun protection factor is imperative, and must be in accordance to skin type and exposure pattern of an individual. As part of a complete sun protection regimen, the judicious use of sunscreens must be combined with avoidance of midday sun exposure and protective clothing. There is an undeniable need to improve public education and awareness regarding use of sunscreens. This review article provides a consensus clinical viewpoint of expert dermatologists on effective use of sunscreens to assist in clinical decision-making for healthcare professionals.</p>

Atopic dermatitis and its association with serum immunoglobulin E levels: our experience in KVG medical college and hospital, Karnataka

<p><strong>Background:</strong> Eczema is an inflammatory skin reaction which presents as acute, subacute and chronic forms. Eczemas persisting for more than 6 weeks or characterized by thickening and discoloration of skin is typical of chronic eczema. Atopic dermatitis (AD) is a type of chronic or chronically relapsing eczematous skin disorder. To determine the percentage of AD in all forms of chronic eczema by using HRC. We also estimated serum immunoglobulin E (IgE) levels and determined its correlation with chronic eczemas and with various clinical parameters of HRC.</p><p><strong>Methods:</strong> A total of 50 patients with chronic eczema meeting defined inclusion and exclusion criteria were enrolled in this cross-sectional study after taking an informed consent and approval of institutional ethical committee. All patients were subjected to a detailed history based on a questionnaire. A thorough clinical examination was done to determine all major and minor clinical parameters of HRC for AD. Blood samples were collected and AEC and total serum IgE levels were determined.</p><p><strong>Results:</strong> Most of our study patients were females (64%). Majority of males (77.7%) were farmers and majority of females (56.2%) were housewives assisting in fieldwork activities. Various causes of chronic eczema were clinically diagnosed AD (34%), chronic actinic dermatitis (8%), polymorphic light eruption (4%), airborne contact dermatitis (10%), phyto-photodermatitis (10%), chronic hand and/or foot eczema (16%) and seborrheic dermatitis (2%). Thirty-two patients (64%) satisfied HRC. Among all clinical parameters of HRC, pruritus and xerosis were the commonest in AD patients. Serum IgE level was raised in 58% of chronic eczema and 68.7% of AD patients.</p><p><strong>Conclusions:</strong> Serum IgE levels showed significant association with typical morphology and distribution of lesions, early age of onset and perifollicular accentuation.</p><h2> </h2>

Evaluation of skin irritation and skin sensitization potential of Venusia max lotion (paraben-free, alcohol-free, mineral oil-free, animal origin free) using human repeat insult patch test

<p class="abstract"><strong>Background:</strong> Topical exposure to chemicals from cosmetics can lead to adverse skin effects or skin irritation. This study aimed to investigate the skin irritation and sensitizing potential of a moisturizer Venusia max lotion (paraben-free, alcohol-free, mineral oil-free, animal origin free (PAMA) free).</p><p class="abstract"><strong>Methods:</strong> In this single-center, non-randomized, observational study, skin irritation, and skin sensitization potential of a test product was assessed using the human repeat insult patch test (HRIPT) technique. Approximately 0.04 g of the test product and filter papers dipped in 0.9% isotonic saline solution (~0.04 ml of solution) were filled in different wells of patch chambers and applied occlusively, on the back of each participant. Scoring of the skin reactions in the induction phase and challenge phase was done using Draize and international contact dermatitis research group (ICDRG) scales respectively. Scores were compared to the baseline and the negative control (isotonic saline).<strong></strong></p><p class="abstract"><strong>Results:</strong> In total 234 participants (50 with sensitive skin), 224 and 221 participants completed the induction phase and challenge phase respectively. Scores for the induction phase for Venusia max lotion (PAMA free) and isotonic saline were 0.46 and 0.06 respectively. The mean cumulative score of erythema and oedema for Venusia max lotion (PAMA free) was below 2. For the challenge phase, none of the participants showed any positive reactions at any time point for test product and isotonic saline.</p><p class="abstract"><strong>Conclusions:</strong> Test product Venusia max lotion (PAMA free) found to be non-irritant and hypoallergenic. Thus, it can be used without fear of skin irritation or sensitization.</p>