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   Table of Contents - Current issue
January-June 2021
Volume 7 | Issue 1
Page Nos. 1-50

Online since Friday, June 25, 2021

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Food and drug interactions in dermatology: Maximizing drug safety and efficacy through intelligent dispensing p. 1
Anwita Sinha, Shekhar Neema
Drug interaction is a common phenomenon and awareness about it has increased with the availability of online applications. The optimization of prescription also requires a physician to be aware of interaction of prescription drugs with food and herbs. Patients also commonly pose the question to prescribers about food–drug interactions, especially in our country. The prescriber should be aware of common food–drug interactions in dermatology for safe and effective prescription practices.
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Crisaborole for the treatment of atopic dermatitis in Indian patients: An evidence-based consensus statement Highly accessed article p. 7
Kiran Godse, Abhiesh De, Nidhi Sharma, Murlidhar Rajagopalan, Bela Shah, Mukesh Girdhar, Vijay Zawar, Kupra Shankar, Gauri Godse, Anant Patil
Atopic dermatitis is a chronic inflammatory dermatological condition associated with intense pruritus seen in all age groups and ethnic diversities. It can have a significant impact on the quality of life. The options for treatment include skincare, topical therapies, systemic therapies, and phototherapy. Treatment of atopic dermatitis may be associated with several challenges including suboptimal efficacy, risk of adverse events, and limited patient satisfaction. A better understanding of the pathophysiology of atopic dermatitis has resulted in the evaluation of many treatment options. Phosphodiesterase 4 plays a role in the pathogenesis of atopic dermatitis and hence can be a target for treatment. Crisaborole 2% ointment is a phosphodiesterase 4 enzyme inhibitor approved for the treatment of mild-to-moderate atopic dermatitis in patients above 2 years of age by the USFDA. Currently, it is not approved for use in Indian patients. In this article, the role and potential place of crisaborole in the management of atopic dermatitis in Indian patients based on global experience and evidence is discussed.
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Ligelizumab: A promising option on the horizon for the management of chronic spontaneous urticaria p. 12
Kiran Godse, Anant D Patil, Gauri Godse
Chronic spontaneous urticaria may pose challenges for the treatment in some patients. Different options for the management of chronic urticaria include second-generation antihistamines, leukotriene receptor antagonists, omalizumab (anti-IgE antibody), and immunosuppressants. Omalizumab, a monoclonal antibody, is a valuable option for patients not responding to up-dosing (up to 4 times) of second-generation antihistamine. However, in about one-fourth of the patients, omalizumab may not be effective in controlling symptoms. Considering this, there is a need to identify the drugs for effective treatment. Ligelizumab is a novel anti-IgE monoclonal antibody with higher affinity to IgE than omalizumab. In phase 2b clinical trial, it is found to be effective and well tolerated in patients with chronic spontaneous urticaria. When approved, it may be beneficial for patients who cannot receive or have suboptimal efficacy with omalizumab.
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Oral itraconazole and topical eberconazole therapy in the treatment of tinea cruris and corporis p. 15
Dattatray G Saple, Sushrut Save, Swagata Arvind Tambe
Background: Dermatophytosis is a common fungal infection in India. In recent times, there has been a change in the course of the disease with an increase in the number of chronic, widespread, and recurrent cases. Aims and Objectives: The aim of this study is to (1) To study the clinical efficacy of itraconazole as a monotherapy in the treatment of tinea cruris and corporis and (2) To study the predictors of noncompliance to treatment in recurrence of infection. Methods: The current study was an unblinded prospective study conducted at a private clinic on 100 randomly selected patients, with a clinical and mycological diagnosis of tinea cruris and corporis. A detailed history was taken regarding the total duration of disease, duration of previous therapy, causes of noncompliance to previous treatmentand associated comorbidities after obtaining informed consent. The patients were put on a regime of oral itraconazole 100 mg twice daily and topical eberconazole twice daily for 12 weeks. Patients were followed up at 2, 6, 12 weeks, 6 months, and 1 year. Statistical analysis was performed using the SPSS software version 22. using appropriate statistical tests. Results: In our study, the mean age of the participants was 38 years, with the male: female ratio being 2.15:1. Only nine patients were treatment naïve, whereas 91 had received treatment previously. Most common factor responsible for discontinuation of therapy was partial relief which was mistaken as cure by the patient. Clinical cure rate at 2, 6, and 12 weeks was 38%, 68%, and 83%, respectively. Mycological cure rate at 2, 6, and 12 weeks was 56%, 81%, and 83%, respectively. Conclusion: itraconazole 100 mg twice daily is an effective and safe treatment for tinea cruris and corporis. Improving the patient's compliance and treatment adherence enhances the rate of clinical as well as mycological cure and avoids recurrences.
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Topical 0.1% adapalene gel versus 0.1% adapalene and 2.5% benzoyl peroxide combination gel in the treatment of mild-to-moderate acne vulgaris: An open-label randomized controlled pilot study p. 20
Madai Puthiyaveedu Amrutha, Joy Bifi, Thyvalappil Anoop, Sreenivasan Ajayakumar, K Radhakrishnan, Sridharan Rajiv
Introduction: The combination of adapalene (ADA) benzoyl peroxide (BPO) offers a safe and effective alternative avoiding long-term antibiotic use in the management of acne vulgaris. Aims: The aim of this study was is to compare the clinical efficacy and tolerability of 0.1% ADA with combination of 0.1% ADA and 2.5% BPO in the treatment of mild-to-moderate acne vulgaris. Methods: All patients were instructed to apply the given topical medications to whole face, excluding lips and eyelids, once a day at night after washing and moistening the facial skin. Follow-up was done once every 4 weeks up to 12 weeks from the start of treatment. Efficacy of treatment arms was assessed by 4 parameters, namely percentage change of total lesion counts (TLCs), Acne severity index, success rate, and response rate. Statistical analysis was performed using the SPSS software version 16.0. Data were analyzed using the Chi-square test, Fisher's exact test, and Mann–Whitney U test. P < 0.05 was considered to indicate statistical significance. Results: Thirty-eight patients were in Group A (ADA-BPO) and 38 patients in Group B (ADA alone). At the end of 12 weeks, Group A had significantly less TLC as well as significant percentage change in total lesions than Group B. Group A was significantly better than Group B in TLC response rate also. Conclusions: The combination gel of 0.1% ADA and 2.5% BPO was superior to 0.1% ADA gel in terms of efficacy. Tolerability was comparable for both the drugs.
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A multicentric, prospective and retrospective analysis of Stevens–Johnson syndrome, toxic epidermal necrolysis and Stevens–Johnson syndrome/toxic epidermal necrolysis overlap: An Indian perspective p. 24
Ramesh Marne Bhat, Jyothi Jayaraman, Navyashree Suresha, Sukumar Dandekeri, Myfanwy Joanne D'souza
Background: Stevens Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) represent adverse drug reactions characterized by generalized rash, blisters, epidermal detachment, mucosal and systemic involvement presenting as dermatological emergencies. Drugs are the most common culprits implicated in the pathogenesis of SJS /TEN. The primary step in the management of SJS/TEN is identification and stopping the offending drug. Materials and methods: This was a multi-centric retrospective as well as prospective observational study conducted in 7 tertiary care hospitals including Father Muller Medical College Hospital , Mangalore, India. A detailed evaluation of the hospital in patient record for 10 years retrospective from September 2015 and all new cases of SJS/TEN as well as SJS-TEN overlap presenting to these centres for 1 year prospective was performed. Detailed history was taken and clinical examination was recorded and different modalities of treatment was noted and compared. Results: A total of 152 patients with clinical diagnosis of SJS ,TEN and SJS-TEN overlap were analysed. Males were more commonly affected than females and history of drug intake was present in 118 patients (77.6%). The most common drugs which caused SJS/ TEN in our study were antibiotics in 40 patients (26.3%) followed by anti epileptics in 35 patients (23%) and nevirapine in 10 patients (6.5%). In our study the most common finding on cutaneous examination was maculopapular rash (19.3%). Conclusion: SJS and TEN form part of a spectrum of severe cutaneous drug reactions that can lead to high morbidity which can be reduced by early withdrawal of the offending drug and timely intervention. Individuals with known drug allergies need to be educated and drug allergy card has to be carried.
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Dual drug reactions induced by a single drug: A rare phenomenon p. 29
Angoori Gnaneshwar Rao, Vangali Srikanth Reddy, Kousar Fathima, M Tejal, Divya Muppirala, Preethi Sunki, CH Sruthi, Jayshree Jhawar, Vidyadharani Myneni
It is rare to encounter a dual drug reaction induced by a single drug. Herein, we present a case of such dual drug reaction caused by Urtica urens, a homeopathic drug in a young farmer who consumed U. urens for relief from common cold. He was relieved of symptoms of drug reaction following dechallenge and symptomatic treatment.
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Generalized bullous fixed drug eruption due to fluconazole: A report of two cases p. 32
Anuva Bansal, Vineet Relhan, Bijaylaxmi Sahoo
Fixed drug eruption (FDE) is characterized by the development of well-demarcated erythematous to violaceous plaques, within minutes to hours of the intake of an offending drug. It is known as “fixed” because subsequent exposure to the implicated drug leads to the development of lesions at the same sites that were involved at the time of the previous drug exposure. Fluconazole, a widely used antifungal agent, has a good safety profile, and limited data exist on the development of bullous FDE due to fluconazole. Herein, we report a series of two cases presenting with a generalized bullous FDE (GBFDE), following the consumption of fluconazole. A temporal correlation, typical morphological features, symptoms, and a past history of FDE due to fluconazole were essential clues to the diagnosis. Furthermore, we utilized the Naranjo adverse drug reaction probability scale for causality assessment. Discontinuation of the drug was followed by the resolution of lesions in 7–10 days. GBFDE is an uncommon entity and requires immediate diagnosis as well as prompt discontinuation of the offending agent to minimize the complications.
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Lichenoid drug eruption due to isoniazid presenting as generalized exfoliative dermatitis in an immunocompromised patient p. 36
Preema Sinha, Siddharth Bhatt, Prateek Kinra, Subramaniyan Radhakrishnan, Shivali Awasthi
Lichenoid drug eruption is characterized by multiple discrete violaceous shiny papules often becoming confluent. It is a common benign adverse drug reaction and has been extensively described in the literature with various drugs. Here, we report an unusual presentation of lichenoid drug eruption in the form of generalized exfoliative dermatitis with hair loss in a patient of human immunodeficiency virus infection due to isoniazid.
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Lichen planus pemphigoides versus bullous pemphigoid: A diagnostic dilemma of cutaneous adverse event in a case of nonsmall cell lung cancer treated with durvalumab p. 40
Ketki Shekhar Bhoite, Sunanda Arun Mahajan, Shefali A Saini
Monoclonal antibodies targeting the immune checkpoint pathways including programmed cell death 1 and programmed cell death ligand-1 have been used in several malignancies. Dermatological toxicities ranging from more common pruritus to rare autoimmune bullous reactions and lichenoid eruptions are an emerging consequence. We report a case of a 74-year-old male diagnosed with nonsmall cell lung carcinoma. He was treated with injection durvalumab following which he developed an itchy, erythematous to hyperpigmented, papular eruption over body. It was diagnosed as a lichenoid drug eruption based on clinicohistopathological correlation and was treated with topical corticosteroids and emollients. Following this, he presented with tense bullae all over the body including the areas of previous lichenoid eruption, associated with pruritus. The histopathology, immunofluorescence, and serology were diagnostic of bullous pemphigoid. However, considering the history, lichen planus pemphigoides (LPP) was the closest differential diagnosis. We treated him with systemic corticosteroids and tetracycline with resolution of the lesions in few weeks and was advised against the continuation of durvalumab therapy. In this article, we have highlighted this adverse event as well as a way to differentiate between LPP and bullous pemphigoid.
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Bosentan: A newer option to treat digital ulcers in patients of systemic sclerosis p. 44
Shreeparna Deb, Pankaj Kumar Tiwary, Anupama Singh
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Imatinib mesylate-induced psoriasiform drug reaction: A case of dose-dependent cutaneous toxicity p. 46
Aditya Holani, Swapna Khatu, Rajvardhan Bagane, Aishwarya Bedi
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Imatinib mesylate-induced palmoplantar keratoderma p. 49
Niharika Jha, Bimal Kanish, Anuradha Bhatia
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