Background: Erythema nodosum leprosum (ENL) is a reactional state observed in the lepromatous spectrum of leprosy. Currently, systemic steroids and thalidomide constitute the backbone of ENL therapy. Aim: The aim of this study was to evaluate the efficacy of apremilast as a standalone steroid-sparing drug for ENL and its combination with aspirin for selected cases. Materials and Methods: This was a pilot study on 10 patients having recrudescence of ENL following reduction of prednisolone dose to 20mg. Apremilast (30 mg twice daily) was administered to these patients as prednisolone was gradually tapered. The severity of ENL was evaluated based on the 16-item ENLIST ENL Severity Scale (EESS). If the EESS score reduced to zero with 20 mg of prednisolone following apremilast addition, patients were considered apremilast responsive. In case the EESS score reduced by> 50% then low-dose aspirin was added to the therapeutic regimen with gradual taper of steroids, and patients were accordingly evaluated. Those patients not responding to apremilast were labeled non-responders and were switched to thalidomide after appropriate investigations. Results: Out of 10 patients, 1 demonstrated complete clinical response with apremilast. In 5 patients the EESS score with apremilast had reduced by 50% or more; and following the addition of low-dose aspirin complete clinical cure was obtained. The remaining 4 patients were apremilast unresponsive. Conclusion: Apremilast may not be an effective standalone steroid-sparing drug for ENL in all patients. EESS scoring is a valuable tool in assessing treatment responses in all patients with ENL. Low-dose aspirin shows efficacy in those ENL patients demonstrating partial response to apremilast.

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Melasma is a common acquired pigmentary disorder predominantly affecting women of childbearing age and Fitzpatrick skin types IV–VI. It negatively impacts the quality of life due to its chronic and relapsing nature. It occurs due to a complex interplay between genetics, hormonal influences, inflammation, oxidative stress, and chronic photodamage. Therefore, a multimodality approach is essential for its treatment. It encompasses photoprotection, topical and oral therapy, and various procedures such as chemical peels, microneedling, lasers, and light treatment. The gold-standard treatment remains topical modified Kligman’s formula, consisting of hydroquinone, corticosteroid, and retinoid, in different concentrations. However, it may cause various adverse effects due to its unsupervised and chronic use. Therefore, novel treatment modalities should not only focus on reducing melanin synthesis and other influencing factors but also have a high safety profile. Among them, botanicals or plant-based extracts have gained massive popularity in the recent past. These compounds have been investigated extensively for their therapeutic activity against pigmentation, efficacy, and safety. Currently, they act as adjuncts to existing topicals. However, there is a paucity of data for their use as monotherapy. This review focuses on newer as well as existing botanicals for the treatment of melasma. Data extraction was done by searching words like botanicals, plant extracts, melasma, and depigmenting agents in databases: Pubmed, Google Scholar, Scopus, and others over the last 20 years.

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Staphylococcal carriage status is very common, and it is important for the dermatologist to be aware of its clinical manifestations, the mechanisms by which they produce colonization, and the therapeutic options available to eliminate them.

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Background: Conventional treatment of systemic sclerosis with drugs for symptom control and broad-spectrum immunosuppression has remained unsatisfactory. Depletion of B-lymphocytes, which are a crucial element in pathogenesis, with rituximab (RTX) has produced encouraging results. Objective: This study aimed to retrospectively analyze the safety and efficacy of RTX in systemic sclerosis. Materials and Methods: Baseline, 6- and 12-month follow-up data of 13 systemic sclerosis (11 diffuse and 2 limited) patients (10 adult and 3 adolescent) who received 4 infusions of 500 mg RTX at 2-weekly intervals was accessed and retrospectively analyzed. Results: Modified Rodnan Skin Score progressively improved from a baseline of 22.2 ± 7.97 to 17.7 ± 7.95 at 6 months (P < 0.05) and 14 ± 7.12 at 12 months (P < 0.05 vs. baseline and 6-month), and mouth opening increased from 2.23 ± 0.44 fingers to 3.5 ± 0.52 fingers at 12 months (P < 0.05). Pruritus and melanoderma improved in all those affected. Raynaud’s phenomenon improved in 12/13, whereas digital ulcers improved significantly in 9/12 patients. Arthritis remitted in the six affected patients, and percentage predicted forced vital capacity improved from a baseline of 70 ± 9.09 to 76.54 ± 7.5 at 12 months (P < 0.05). There were no serious adverse effects. Conclusion: RTX showed good outcome in cutaneous, joint, and pulmonary features of systemic sclerosis without any significant adverse event.

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Introduction: Cutaneous adverse drug reactions (CADRs) are the most common adverse reactions attributed to drugs in which any type of skin reaction can be mimicked, induced, or aggravated. Aim and Objectives: To study the morphological patterns of various types of CADRs. Materials and Methods: It was a descriptive cross-sectional study carried out from November 2017 to September 2019, where medical records of diagnosed cases of CADRs were analyzed in a predesigned proforma with respect to demographic data, clinical features, treatment history (topical and oral), offending drug, temporal association with a skin eruption, investigations, and treatment outcome. Statistical analysis was done using mean, median, and proportion. Results: A total of 180 patients with CADRs were enrolled. There was a male preponderance with the mean age being 32.9 ± 2.9 years. The most common CADR reported was fixed drug eruption (n = 77). Steven Johnson syndrome was the most common (n = 7) severe cutaneous adverse reaction. The mean duration of latency was 6.2 (±8.61 days). Antimicrobial drugs accounted for most of the benign as well as severe CADRs (41.4%). Among all cases, 43.9% of patients had mild CADR and 16.7% had severe CADR. Causality assessment using the Naranjo adverse drug reaction probability scale, 70% had a possible association, 18.3% probable and 11.7% had a doubtful association. Conclusion: Early identification of CADR is important to reduce morbidity and mortality. Patient education is required to avoid self-administration of drugs and re-administration of the same offending drugs to prevent further morbidity. Immediate withdrawal of the culprit drug/drugs with adequate management can be lifesaving.

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Nicolau syndrome, often referred to as embolia cutis medicamentosa or livedoid dermatitis, is an uncommon cutaneous adverse drug reaction that develops at the site of injection of some specific pharmaceuticals. Commonly seen with NSAIDS given intra-muscularly, it can be observed with a variety of drugs given subcutaneously, intra-articularly and sometimes intravenously. Here, we present a rare case of Nicolau syndrome following an intramuscular injection of Vitamin B-12 over gluteal region that turned out to be fatal.

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