Isotretinoin (ISO) has proven to be an extremely valuable drug for all dermatologists. Since its approval in 1982 by the US Food and Drug Administration for nodulocystic acne, it still remains the gold standard drug for the above indication till date, facing no competition from its contemporaries. Along with the treatment of nodulocystic acne, ISO has proved valuable in several other dermatoses as well. Further, even for treating acne, there have been a number of modifications as far as the prescription of ISO is concerned. This review will briefly highlight the various aspects of isotretinoin for acne and other cutaneous disorders.

Background: Reduced manual dexterity and hand comfort affect all people exposed to extreme cold. Ointment nitroglycerine 0.2% (NTG) and ointment salbutamol 0.5% (Sal) applied topically to the extremities could result in increased local blood flow and temperature, improving hand comfort and dexterity in extreme cold. Aim and Objectives: This study was designed to elucidate if the application of NTG or Sal would improve manual dexterity and hand comfort in extreme cold conditions. Materials and Methods: A double-blind, randomized controlled trial was conducted at 3500 m altitude in 105 individuals divided into three equal-sized groups. Group A received NTG, Group B placebo (white soft paraffin), and Group C Sal, for application to the extremities twice daily, for 2 weeks. Hand skin temperatures (T_sk), Pegboard scores, and a Graphic Rating Scale (GRS) for pain were compared before and after the intervention. Adverse effects and user acceptability criteria were recorded. Results: Participants of all three groups showed significant improvement in T_sk, Pegboard scores, and GRS scores postintervention, however none of the parameters were different between groups. The acceptability questionnaire scores were best in the placebo group. Conclusion: Neither NTG nor Sal was superior to placebo for improvement in hand comfort or dexterity, in extreme cold at high altitude.

Introduction: Minocycline because of its multiple advantages is considered as first-line therapy in the management of acne. However, conventional formulations of minocycline are associated with multiple side effects, thus limiting its use. Thus, extended-release formulation of minocycline was developed. Materials and Methods: This was an open-label, prospective, interventional, comparative, double-arm study. Patients with papulopustular acne were either received minocycline extended release (ER) 1 mg/kg/day or minocycline immediate release (IR) 100 mg/day for a period of 8 weeks. Safety was assessed by analyzing the adverse event (AE) profile in both the groups. Effectiveness was assessed by analyzing improvement in the mean inflammatory lesion count. Results: A total of 100 patients were included in the study, 50 in each group. A total of four AEs were reported by 2 (4.0%) patients in the ER group, whereas ten AEs were reported by 5 (10.0%) patients in the IR group. The mean inflammatory lesion count in the ER group at baseline was 14.95 ± 3.76, whereas in the IR group, it was 14.52 ± 3.38. Significant decrease in inflammatory lesion count was observed in both the groups during treatment period. Conclusion: The results of this study prove that ER formulation of minocycline is associated with better improvement in acne compared to IR formulation. The study also proves that ER formulation is associated with better safety profile compared to IR profile.

Introduction: Oral steroids are not commonly used because of fear of side effects. A study was conducted to find out if a short course of 1 week of oral steroid without tapering is effective and safe for the treatment of common eczemas. Materials and Methods: Patients with common eczemas were included in the study. There were five groups. One group each received tablet prednisolone 15 mg morning and 10 mg after dinner for 7 days, tablet methylprednisolone 16 mg morning and 8 mg night for 7 days, and tablet betamethasone 2 mg morning and 1 mg night for 7 days. One group received tablet betamethasone 3 mg once a day as a single morning dose for 7 days and the last group received tablet deflazacort 18 mg morning and 12 mg night for 7 days only. All the patients also received topical clobetasol propionate cream for 1 month. However, the maximum permissible amount of topical clobetasol propionate was 30 g in a month. Basal serum cortisol at 8 am along with ACTH stimulation test was carried out in all the patients on day 10^th. The tests were repeated on 30^th day if negative on day 10^th. Results: In all groups, rapid improvement was seen at visit 2, which further continued at visit 3. No suppressive effect on hypothalamic–pituitary–adrenal (HPA) axis was seen. Conclusion: A short course of oral steroid of 25 mg of prednisolone equivalent for a period of 7 days was found to be effective and safe, and 7 days of oral steroids do not need tapering.

A remarkable advancement is been made in the treatment of cancer, through chemotherapeutic drugs like tyrosine kinase inhibitors (TKI), etc. Chemotherapy induced cutaneous side effects are multiple and usually they are underreported. Nilotinib is a second generation TKI, which is approved for imatinib resistant CML. Various cutaneous and its appendageal changes have been noticed with the use of nilotinib usage. Here, we report such case of a 34 year old male, who is a case of CML being treated with Nilotinib for 2.5 years, presented to us with perforating folliculitis, psoriasiform dermatosis, KP like lesions, madarosis and textural changes of scalp hair.

Drug reaction eosinophilia systemic symptom (DRESS) is one of the most serious adverse drug reactions and corticosteroid is the mainstay of management. Here, we report a case of DRESS with renal involvement complicated by steroid-induced avascular necrosis of femur. The patient responded significantly with two courses of intravenous immunoglobulin given at monthly interval, and his corticosteroid dose could be tapered early.