Rituximab (RTX) is a specific mouse and human chimeric monoclonal antibody that has found to have numerous applications in dermatology. Though initially approved by the US FDA for treating rheumatoid arthritis and non-Hodgkin's lymphoma; currently its approval has extended to involve the pemphigus group of disorders; both as a first line drug as well as a therapeutic strategy for recalcitrant cases of pemphigus, unresponsive to conventional therapy. Apart from pemphigus, there have been a number of cutaneous disorders where rituximab has been found to be useful. This review will give a bird's eye view of the applications of rituximab in dermatology.

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Introduction: Warts are benign proliferations of skin and mucosa caused by the human papillomavirus (HPV). Palmoplantar warts are caused any HPV types 1, 2, 4, 27, 57 and occurs mostly in children and young adults. Among the treatment modalities, trichloroacetic acid (TCA) application along with needling after sufficient penetration causes coagulation of proteins of the infected cells of skin and causes necrosis. Aim: To study the efficacy of 100%TCA needling in the treatment of palmoplantar warts. Study Design: Longitudinal study carried out at a tertiary care center in Gujarat. Materials and Methods: Patients having palmoplantar warts between the age group of 4-50 years over a period of 8 months were included in the study as per our inclusion and exclusion criteria. 100% TCA application followed by needling using an insulin syringe was done once per week after informed consent. The necrosed skin was pared on each follow-up and the procedure was repeated till complete clearance of warts. Results: The total number of patients were 60 out of which 6 patients were irregular in follow up. In 4 patients, the treatment modality was changed after 6 weeks because of lack or response. 50 patients had complete clearance of warts. The minimum and maximum duration for complete clearance of warts were 3 weeks and 8 weeks respectively. Limitation: It gives varying results in different individuals and average duration in clearance of wart is comparatively slower as compared to some other methods. Conclusion: TCA needling is an effective treatment modality for palmoplantar warts.

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Rituximab is an anti-CD20 monoclonal antibody frequently used for the treatment of non-Hodgkin's lymphoma, chronic lymphocytic leukemia, rheumatoid arthritis, and anti-neutrophilic cytoplasmic antibody-associated vasculitis. In addition, rituximab has recently been increasingly used as an off-label treatment in a number of inflammatory and systemic autoimmune diseases. Its side effect profile includes infusion-related reactions and adverse cardiac effects such as arrhythmia and angina, particularly in patients with prior history of cardiovascular diseases. However, its detailed cardiotoxicity profile, effects on cardiac function, and its management are not well described in the literature. As the utility of rituximab expands, primary physicians, intensivist, dermatologist who use drug should be made of these serious cardiovascular adverse effect.

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Background: Infiltrative anesthetics are frequently chosen because of their proven safety record, low cost, ease of storage, widespread availability, and rapid onset of action; a good topical anesthetic agent can eliminate the use of painful injections prior to procedures. Aims: The present study was carried out to compare the eutectic mixture of local anesthetic (EMLA), cryogel, lignocaine spray, and controls for pain caused during common dermatological procedures. Methods: This study included 120 patients who were divided into four groups with 30 patients each for needle extraction for molluscum contagiosum and milia; intralesional injection for keloids and alopecia areata; radiofrequency ablation for warts, acrochordons, and intradermal nevus; and dermabrasion for surgical treatment of vitiligo. Topical anesthetics such as EMLA, cryogel, and lignocaine spray were applied and pain was assessed using visual analog scale (VAS) score. Data were analyzed using Microsoft Excel. P <0.05 was considered statistically significant. Results: The mean VAS score was highest for the control group (VAS = 5.2) and lowest for EMLA group (VAS = 1.3). There was a significant reduction in the pain with the topical anesthetic application as compared to controls. The mean VAS score for all procedures showed a significant pain reduction with topical anesthetic application as compared to controls (P < 0.05). Limitations: Lack of standardized methods of topical anesthetic application and there is the inherent limitation in the exactness of pain scoring scale available for use. Conclusion: All modalities of topical anesthesia had proven their efficacy for dermatological procedures, but in a procedure like dermabrasion, it may not be possible to use any of the topical anesthetics solely to produce sufficient anesthesia.

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Post kala-azar dermal leishmaniasis (PKDL) is a late cutaneous manifestation of visceral leishmaniasis (VL), though it can occur without a history of visceral disease. The diagnosis and treatment of PKDL is important as cases of PKDL have been known to cause outbreaks of VL. We report a case of PKDL from an area with low endemicity of VL and has presented with PKDL without VL. Due to poor tolerance to conventional amphotericin B (CAmB), he was successfully treated with Fungisome™ – Indian liposomal amphotericin B (LAmB). We want to emphasize on the successful treatment of PKDL with Fungisome™ – an Indian LAmB. This is a first such case of PKDL being treated with LAmB (Fungisome™), developed jointly by the Department of Clinical Pharmacology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, and the Department of Biochemistry, Delhi University with funding from the Department of Biotechnology. Translational research and commercialization was done by Lifecare Innovations, India.

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Introduction: Cyclophosphamide is an important steroid-sparing immunosuppressive drug that was found to be effective for the treatment of autoimmune bullous disorders such as pemphigus. However, cyclophosphamide (an alkylating drug) is a mutagenic drug and is associated with the risk of malignancies. Three cases of cancers developing due to cyclophosphamide use in pemphigus are presented. Case Report: A 50-year-old male patient of pemphigus vulgaris received over 50 g of cyclophosphamide over 3 years. He died of bladder cancer 9 years after stopping the treatment. A 57-year-old male patient, a known case of diabetes, received over 100 g of cyclophosphamide for over 4 years for pemphigus foliaceus diagnosed with bladder cancer 5 years after stopping treatment. A 50-year-old male received around 100 g of cyclophosphamide over 3 years for pemphigus foliaceus diagnosed with squamous cell carcinoma of oral mucosa 2 years after stopping treatment. Conclusion: Cyclophosphamide is a mutagenic drug and is associated with the risk of malignancy which can appear many years after stopping the treatment; hence, long-term follow-up is important.

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Introduction: Adverse drug reactions (ADRs) are common in a dermatological practice. Underreporting of ADR is a concern for dermatologists across the world. Aim: This survey aims to assess the attitudes and current reporting practices of ADRs and to understand possible causes for underreporting of ADRs amongst practising dermatologists of Maharashtra This will help to better understand, which steps will be effective to increase the reporting of ADRs. Study Design: Descriptive cross sectional questionnaire based study. Materials and Methods: The descriptive cross sectional questionnaire based study was conducted in Department of Dermatology of tertiary care hospital in central India from a period of April 2017 to September 2018.The target population was all practising dermatologists across Maharashtra. All practising dermatologists willing to participate in the survey were included while postgraduate students in dermatology and other fields, those not willing to participate in the study, doctors of non-allopathic disciplines practicing dermatology were excluded. Results: A total of 49% of the surveyed dermatologists see cases of ADRs often in their practice. Of these, the most common cutaneous adverse reaction is to topical corticosteroids. 30% of surveyed dermatologists had heard of the ADR reporting system but did not know how it is done while 27% had reported ADRs. Conclusion: The current trend of underreporting of ADRs is alarming as many dermatologists are not even aware that ADR in their practice needs to be reported.

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