Chronic urticaria, a heterogenous skin condition can be difficult to treat in many patients. It can adversely affect patient’s quality of life. Bilastine is a useful armamentarium for the management of chronic urticaria. This second generation H1 antihistamine is distinguished from most of its counterparts. Non-sedating potential, fast onset and longer duration of action, less risk of drug interactions and once daily administration make it an attractive option for use. In patients with chronic urticaria, not showing satisfactory response to standard doses, its dose can be increased up to four fold. In this review, we discuss the evidence of higher dose of bilastine in chronic urticaria and its place in therapy.

Introduction: Pruritus is a common and unpleasant symptom associated with multiple skin diseases. As histamine plays a central role in pruritus pathology, H1 antihistamines are frequently used in its management. Bilastine is a potent second-generation antihistamine approved for the management of urticaria. However, there are few studies showing its effectiveness and safety in pruritus associated with skin diseases. Materials and Methods: In this multicenter, open-label study, patients with pruritus associated with various skin diseases received bilastine 20 mg once daily for 4 weeks. Patients were evaluated for improvement in their pruritus based on the 5D itch score and Dermatology Life Quality Index (DLQI). Safety of bilastine was assessed by monitoring the incidence of adverse events during the study period. Results: A total of 116 patients with urticaria (n = 22), eczema/dermatitis (n = 27), lichen planus (n = 9), pPsoriasis (n = 11), dermatophytosis (n = 42), and others (n = 5) were included in the study. There was a significant improvement in the 5D itch score at the end of therapy (16.18 ± 2.81 vs. 6.20 ± 1.38 P < 0.0001) in all patients. Bilastine improved the DLQI at week 4 in all disease groups (11.83 ± 4.97 vs. 2.15 ± 2.68; P < 0.0001). The treatment was well tolerated. Conclusion: Bilastine is associated with significant improvement in pruritus associated with multiple dermatological disorders with a very good safety profile.

Background: Conventional antifungals are becoming resistant against dermatophytosis due to development of recalcitrant tinea. These patients may get benefit from newer topical antifungals or combination therapy. Topical antifungal therapy is the mainstay in the treatment of dermatophytosis. Aims/Objectives: To evaluate the safety and effectiveness of topical amorolfine in tinea infection in real-world settings. Materials and Methods: This was a real-world retrospective study; data was collected from 106 centers across India on the usage of amorolfine in the management of tinea infections. The treatment response was evaluated at the end of 2 and 4 week. It was determined by the reduction in severity of the classic symptoms of disease viz. pruritus, burning sensation, erythema, and scaling and crusting at Week 2 and Week 4 of treatment. The severity of symptoms was classified and quantified as mild (1), moderate (2), and severe (3). Safety was determined based on the occurrence of any adverse events during the treatment. Results: An improvement in symptoms score was observed for all the classic symptoms of infection viz. pruritus, burning sensation, erythema, and scaling and crusting at Week 2 and Week 4 compared to baseline. Mean total symptom score (TSS) was reduced to 0.88 ± 1.19 from 7.18 ± 2.84 at week 4 (P < 0.05). Only 10 (0.73%) patients out of 1358 showed mild and non-treatment-related adverse events. Conclusion: Amorolfine alone or in combination therapy with oral antifungals in real world clinical setting represents an improved treatment strategy for patients with tinea infections.

Vitiligo is a multifactorial disorder characterized by the loss of functional melanocytes. Even though not a life-threatening disorder, many suffer enormous stigma and psychiatric comorbidities. The treatment of vitiligo still remains a challenge. To get therapeutic success, there has been a continuous search for newer treatment modalities. We hereby report the case series of five patients of stable vitiligo who were resistant to topical therapies. These patients were given intradermal platelet-rich plasma at 4-week interval for a total of four injections. Out of five patients, two showed excellent response and two patients showed moderate response to the treatment, whereas there was no response seen in one patient.

Diacerein belongs to the class of anthraquinone derivatives which has anti-inflammatory, analgesic, and antipyretic properties. The principal mechanism of action of diacerein is to inhibit the interleukin-1β system and related downstream signaling. Several rheumatology societies such as the European League against Rheumatism (EULAR) and the Osteoarthritis Research Society International (OARSI) have introduced diacerein in their therapeutic guidelines as a treatment option in osteoarthritis. We hereby report the case of a 56-year-old man suffering from chronic plaque psoriasis who was prescribed diacerein by an orthopedician for bilateral knee osteoarthritis. We observed a dramatic improvement in the psoriatic skin lesions with the achievement of Psoriasis Area Severity Index 75 at 12 weeks, without objectively observed adverse drug event. This suggests a probable role of diacerein as an oral biological agent in the therapeutic armamentarium of chronic plaque psoriasis

Ponatinib is a third-generation tyrosine kinase inhibitor (TKI) which is used as a chemotherapeutic agent in the treatment of chronic myeloid leukemia. Despite being relatively less toxic than other older TKIs, it still has various adverse effects including skin rash. Cutaneous manifestations have varied presentations such as lichenoid, pityriasiform, ichthyosiform, and pityriasis rubra pilaris-like rash. We present here a 35-year-old male with chronic myeloid leukemia who developed a unique pattern of symmetrical rash to Ponatinib which was successfully treated with topical tacrolimus and reduction of dose of the drug.

Diphtheria, pertussis, tetanus (DPT) is a live attenuated vaccine included in the national immunization schedule. Common adverse effects of this vaccine include localized pain, erythema, and high-grade fever. Rarely, it can cause severe localized or generalized reactions such as Nicolau’s syndrome (NS), erythema multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). A 6-year-old boy developed severe pain over left gluteal region, immediately after DPT vaccine, followed by local ulceration. Two days later, he also developed mucocutaneous lesions. Clinical features were consistent with NS and SJS-TEN overlap. Concomitant NS with SJS-TEN overlap after DPT vaccine is rare and has not been reported earlier.

Livedoid vasculopathy (LV) is a chronic prothrombotic disease of cutaneous microcirculation resulting in cutaneous ischemia and infarction. Chronic disease often results in painful ulcerations and atrophie blanche on the lower extremities, predisposing affected patients toward infection and high morbidity. Treatment of LV is often difficult and prolonged. Owing to the postulated pathophysiology of vasculopathy, rivaroxaban has been recently suggested as a treatment modality and seems to induce significant improvement in some patients. Compared with other treatments such as classic anticoagulants or intravenous immunoglobulin, rivaroxaban is far more convenient as it does not require injection, international normalized ratio monitoring or hospitalization. Herein, we report the successful treatment of recalcitrant LV in two Indian patients with oral rivaroxaban along with a review on use of rivaroxaban in LV.

Photoallergic reactions are Type IV hypersensitivity reactions localized to photo-exposed areas, with generalization in severe cases. Diagnosis is based on history, photo-patch testing and clinico-histopathological correlation. A 47-year-old man developed multiple, erythematous plaques over V-area of neck, retroauricular area, extensor aspect of both forearms after oral cefixime post-cholecystectomy. He had similar episode of lesser severity two months ago after oral Cefixime. Histopathology showed acanthotic epidermis, foci of spongiosis causing vesiculation with lymphocytes. Upper dermis showed infiltrate of lymphocytes and neutrophils along with perivascular infiltrate. Diagnosis was photoallergic reaction to Cefixime. Lesions completely subsided with oral steroids, hydroxychloroquine, antihistamines, sunscreen and emollients over two months. Cephalosporins have multiple side-effects including hypersensitivity, rash, Steven–Johnson syndrome and toxic epidermal necrolysis. Cephalosporin induced photoallergy is not reported. Hence, cephalosporins should be added to the existing list of systemic drugs causing photoallergic reactions.