Snehal P. Desale ¹, Anil S. Gugle ¹, Rahul Kote ¹, Vikrant Jadhav ¹

Affiliations
1 Department of Dermatology, Venerology and Leprology, Dr. Vasantrao Pawar Medical College, Hospital, and Research Centre, Vasantdada Nagar, Adgaon, Nashik-422003, IN

Abstract

Background: Melasma, one of the common aesthetically displeasing entities, continues to be a difficult problem to treat. Chemical peeling is one new weapon in the therapeutic armamentarium of melasma. Intense Pulsed Light (IPL) is a noncoherent, broad-spectrum light, ranging from 500 to 1200 nm. Intense Pulsed Light (IPL) treatment is a good option for patients with melasma. Aims and Objective: To compare the efficacy of glycolic acid peel and intense pulsed light in the treatment of melasma. Setting: Outpatient department of Dermatology, Venerology Leprology of a tertiary health care centre with an attached medical college. Material and Methods: 60 patients of melasma were recruited in the study. Patients were randomly allocated into two groups: one group (glycolic acid 50%) and another group (IPL) with 30 patients in each group. All the participants were subjected to undergo pre-peel programme of daily application of sunscreens (day time) and 0.025% retinoic acid at bed time for two weeks in GA peel group. 4 peels were carried out at 2 weekly intervals. Four sessions of IPL were done at 3 weeks interval. MASI scoring and coloured photographs (without reavealing identity) of each patient were taken before each peel and at the end of the follow-up period i.e. 2 weeks after 4^th sitting in GA peel group and 3 weeks after 4^th sitting in IPL group. Side effects, if any, were also recorded. Statistical Analysis Used: SYSTAT version-12. Results: In both the groups there was constant decrease in MASI scores after each sitting as compared to pre-peel scores. However, the comparison of mean MASI scores i.e. both pre-peel and after each peel, between the two groups showed statistically significant difference (p<0.05). Local reactions, such as burning sensation and erythema during the peel were not significant with both the groups. Conclusions: Glycolic Acid (GA) peel (50%) is more efficacious&safe treatment modality in melasma compared to IPL.

Keywords

Glycolic Peel, Intense Pulse Light, Melasma.

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Amruta Mohite , Anil S. Gugle , Rahul Kote , Vikrant M. Jadhav

Abstract

Aim: The aim of our study was to evaluate the efficacy, safety and relapse rate of systemic Ketoconazole, systemic Itraconazole and topical Oxiconazole in the treatment of pityriasis versicolor. Study design: 94 patients who had pityriasis versicolor were included in the study. The patients were given Ketoconazole, Itraconazole and Oxiconazole randomly and were followed up at the interval of 15 days, 1 month and 3 months for assessement of clinical and mycological cure. Results: In assessment of clinical parameters maximum improvement in scaling, pigmentation and pruritus was seen in Oxiconazole group compared to itraconazole and ketoconazole group. During the study it was observed that rate of clinical cure was maximum in Oxiconazole group (76.67%) as compared to Itraconazole (58.82%) and Ketoconazole group (46.66%). Mycological cure during visit 2 in Oxiconazole group was (83.33%), as compared to (88.2%) Itraconazole group and (88.7%) Ketoconazole group. During visit 3, mycological cure was present in 93.3% cases in Oxiconazole group, 94.1% in Itraconazole group and 93.3% in Ketoconazole group. During visit 4 mycological cure was assessed which showed 88.7% cure rate in Oxiconazole group compared to 88.2% in Itraconazole group and 88.7% in Ketoconazole group. These results suggested presence of relapse in 6.6% cases in both Oxiconazole and Ketoconazole group and 5.9% cases in Itraconazole group. There were no side effects with oxiconazole group while cases treated with ketoconazole and itraconazole had side effects like nausea and urticaria. Conclusion: According to the present study we conclude that topical Oxiconazole therapy was more effective as compared to systemic Itraconazole and Ketoconazole therapy in early improvement of scaling, pigmentation and pruritus secondary to Pityriasis versicolor with no significant side effects.

Keywords

Efficacy, Itraconazole, Ketoconazole, Pityriasis Versicolor, Topical Oxiconazole.

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Anil S. Gugle , Vikrant M. Jadhav , Rahul Kote , Milind Devidas Deshmukh , Aditi Vijay Dalvi

Abstract

Background: Androgenetic alopecia (AGA) more commonly known as male pattern baldness affects up to 50% of men worldwide. Tretinoin prolongs anagen phase and increases percutaneous absorption of minoxidil three fold. Azelaic acid is an inhibitor of 5 alpha reductase and could be an effective agent in the treatment of androgen related pathology of human skin. Aims and Objective: 1) To study the efficacy of topical minoxidil 5% in treatment of androgenetic alopecia. 2) To study the efficacy of combination of topical minoxidil 5%, topical azelaic acid 1.5% and topical tretinoin 0.01% in treatment of androgenetic alopecia. 3) To compare the efficacy of foresaid topical preparation in treatment of androgenetic alopecia Setting: Outpatient department of Dermatology, Venerology Leprology of a tertiary health care centre with an attached medical college. Material and methods: Topical minoxidil 5 % lotion was used in 23 (50%) patients of the present study. Combination of topical minoxidil 5%, azelaic acid 1.5 % and tretinoin 0.01 % lotion was used in 23 (50 %) patients of the present study. Statistical analysis used: Epi info version 7. Results: There was statistically significant increase in hair number and thickness after treatment in both the groups. The comparison of the increase of hair number and thickness was statistically insignificant. Conclusions: Topical Minoxidil 5% is equally effective to combination of topical Minoxidil 5%, azelaic acid 1.5% and tretinoin 0.01% in treatment of androgenetic alopecia.

Keywords

Androgenetic Alopecia, Azelaic Acid, Minoxidil, Tretinoin.

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Anil S. Gugle , Vikrant M. Jadhav , Rahul Kote , Milind Devidas Deshmukh , Divyank Vankawala

Abstract

Introduction: Warts are benign tumours that commonly involve skin and other epithelial tissues. There is no single treatment modality that is 100% effective. In multiple warts, especially on face, palms, and soles destructive procedure are inappropriate and impractical. Homologous autoimplantation is a simple technique, which helps in inducing cell mediated response, causing clearance of warts. Aims and objectives: To evaluate the effect of homologous autoimplantation therapy in treatment of multiple warts. To study the untoward effects of this treatment. Material and methods: A total of 49 patients of viral warts were included in study. Homologous autoimplantation of wart was done and regular follow up was done to see the result. Results: Out of 49 patients, in 24 patients there was good response, 14 showed moderate response, 5 showed poor response and in 6 patients there was no response. Conclusion: Homologous autoimplantation is an easy, minimally invasive technique which clears multiple, recurrent and recalcitrant warts.

Keywords

Homologous Autoimplantation, Warts.

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Rupinder Kaur , Anil Gugle , Rahul Kote , Vikrant Jadhav

Abstract

Background: Psoriasis is a chronic, disfiguring, inflammatory and proliferative condition of skin influenced by both genetic and environmental factors. The prevalence of psoriasis vary from 0.1% to 3% in different population1. The pathogenesis of psoriasis is interplay of various inflammatory cytokines and chemokines which play an important role in the pathogenesis of various other systemic diseases. Psoriasis has been reported to be associated with metabolic syndrome which increases the risk of Coronary Artery Disease. Aim: To study the prevalence of metabolic syndrome among patients of psoriasis vulgaris. Setting and Study Design: This is a case-control study and was conducted at the out-patient clinic of Department of Dermatology, Venereology and Leprology of a tertiary care centre. Materials and Methods: Study was approved by the Institutional ethical committee. The patients were included in two study groups. 50 patients diagnosed with psoriasis vulgaris were included as cases. Fifty age and sex matched controls were included in the control group. The detailed demographic history, duration of disease, family history and personal history was taken. Patients were assessed for severity of psoriasis using PASI score and blood sample collected was analyzed for fasting blood sugar levels and serum lipid profile. The data collected was evaluated using Chi Square test and unpaired t test. Results: Total 50 patients were included as cases and controls respectively out of which 11 (22%) were females and 39 (78%) were males. The mean age of cases and controls was 45.85 and 46.04 respectively. The mean duration of psoriasis in cases was 78.86 months. The mean PASI score was the prevalence of Metabolic Syndrome in psoriasis vulgaris was 46% in our study. Conclusion: Metabolic syndrome is a significant morbidity which predisposes the patients for Coronary Artery Disease. The patients of psoriasis vulgaris should be routinely screened for hypetension, Type II diabetes mellitus and dyslipidemias.

Keywords

Dyslipidemia, Hypertension, Metabolic Syndrome, PASI Score, Psoriasis vulgaris

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Madhavi Maruti Thombare ¹, Rahul Kote ², Anil Gugle ³, Manoj Pawar ², Shrikant Kumavat ⁴

Affiliations
1 PG Resident, Department of Dermatology, Venerology and Leprology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
2 Associate Professor, Department of Dermatology, Venerology and Leprology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
3 Professor and Head, Department of Dermatology, Venerology and Leprology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
4 Senior Resident, Department of Dermatology, Venerology and Leprology, Dr. Vasantrao Pawar Institute of Medical Sciences and Research, Nashik – 422003, Maharashtra, IN

Abstract

Background: Leprosy is caused by Mycobacterium leprae, which chiefly affect skin and peripheral nerves. Leprosy expresses itself in different clinicopathological forms depending upon underlying immunity of the host. Histopathology is considered gold standard for accurate diagnosis especially in early disease, however, clinicopathological correlation is a must for appropriate diagnosis and classification of disease that will in-turn affect the treatment and overall prognosis of the patient. The present study of clinicohistopathological correlation among leprosy patients in this post elimination era was undertaken. Aims and Objectives: To study the clinical and histopathological correlation among leprosy patients. Materials and Methods: Present study consists of 54 patients of newly diagnosed leprosy cases at Department of Dermatology, Venerology and Leprology from November 2016 to October 2018. Skin punch biopsy and slit skin smear taken from patients. Histopathological examination by staining with H&E and Fite-Faraco stain for tissue AFB and Ziehl-Neelsen staining of SSS for presence of AFB. Results: In this study, 35 cases (64.81%) showed clinicohistopathological concordance and 19 cases (35.19 %) were discordant according to Ridley-Jopling spectrum. Conclusion: Histology should be performed in all suspected patients of leprosy if feasible, for exact allocation of the patient across the spectrum for accurate treatment and to identify the vulnerable patients in borderline spectrum as they are prone for reactions, neuritis and thus deformities and it also aids in achieving terminal goal of leprosy elimination.

Keywords

Clinicohistopathological Concordance, Leprosy, Ridley-Jopling Classification.

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Madhur Bharat Kelkar ¹, Rahul Kote ², Anil S. Gugle ³, Manoj Pawar ², Shrikant Kumawat ⁴

Affiliations
1 PG Resident, Department of Dermatology, Venereology and Leprology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422002, Maharashtra, IN
2 Associate Professor, Department of Dermatology, Venereology and Leprology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, IN
3 Professor and Head, Department of Dermatology, Venereology and Leprology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, IN
4 Senior Resident, Department of Dermatology, Venerology and Leprology, Dr. Vasantrao Pawar Institute of Medical Sciences and Research, Nashik – 422003, Maharashtra, IN

Abstract

Background: Chronic Renal Failure (CRF) patients develop myriad of cutaneous findings. Novel cutaneous changes are being described since the introduction of hemodialysis, which prolongs the life expectancy, and thus more time for the skin changes to develop. Aims & Objectives: We aimed to evaluate the prevalence of dermatologic manifestations among the patients suffering from Chronic Renal Failure (CRF) who are on hemodialysis. Methods: 93 patients with CRF receiving hemodialysis were evaluated for skin, hair and nail changes. Results: All the enrolled patients experienced some skin problem. The most prevalent cutaneous manifestation was xerosis (54.8%), followed by pallor (21.5%), pruritus (19.35%) and dyspigmentation (18.3%). Other dermatologic manifestations included Kyrle’s disease (5.4%); fungal (5.4%), bacterial (6.5%) and viral (3.2%) infections and purpura (9.7%). Recorded nail changes were half and half nail (21%), koilonychia (39.78%), onychomycosis (1.08%), onychorrhexis (6.45%), splinter hemorrhages (1.08%), and Beau’s lines (2%). Hair changes included sparse hair (18.28%), and brittle and lustreless hair (11.83%). Oral cavity manifestations were enlarged tongue with teeth indentations (23.65%). Conclusions: CRF is associated with multiple skin, hair and nail manifestations

Keywords

Dyspigmentation, Koilonychia, Onychomycosis, Pruritus, Xerosis.

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Shwetal Rathi ¹, Vijay Zawar ², Rahul Kote ³, Vivek Nikam ⁴

Affiliations
1 Former PG Resident, Department of Dermatology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, Maharashtra, IN
2 Professor and Head, Department of Dermatology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, Maharashtra, IN
3 Associate Professor, Department of Dermatology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, Maharashtra, IN
4 Assistant Professor, Department of Dermatology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, Maharashtra, IN

Abstract

Tinea incognito caused by of over the counter and overuse of topical steroids resulting in various clinical presentations making it difficult to diagnose. Now-a-days over the counter use of topical combinations containing steroids have increased. We present here a case of an adult female presented with lichenified plaque over both bottocks, abdomen and lower limbs associated with itching with history of over the counter application of topical steroid containing combination on her own. KOH mount of skin scraping confirmed the diagnosis. Treatment with systemic and topical antifungals for 6 weeks resulted into remarkable improvement.

Keywords

Over the Counter Drugs, Steroids, Tinea Incognito, KOH Mount

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