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He X, Jin S, Dai X, Chen L, Xiang L, Zhang C. The Emerging Role of Visible Light in Melanocyte Biology and Skin Pigmentary Disorders: Friend or Foe? J Clin Med 2023; 12:7488. [PMID: 38068540 PMCID: PMC10707362 DOI: 10.3390/jcm12237488] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/22/2023] [Accepted: 12/01/2023] [Indexed: 09/03/2024] Open
Abstract
Electromagnetic radiation, notably visible light (VL), has complicated effects on human skin, particularly pigmentation, which have been largely overlooked. In this review, we discuss the photobiological mechanisms, pathological effects, clinical applications and therapeutic strategies of VL at varying wavelengths on melanocyte biology and skin pigmentary disorders. Different VL wavelengths may impose positive or negative effects, depending on their interactions with specific chromophores, photoaging, ROS production, circadian rhythm and other photon-mediated reactions. Further in vivo and in vitro studies are required to establish the pathologic mechanisms and application principles of VL in pigmentary disorders, as well as optimal photoprotection with coverage against VL wavelengths.
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Affiliation(s)
| | | | | | | | - Leihong Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, China; (X.H.); (S.J.); (X.D.); (L.C.)
| | - Chengfeng Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, China; (X.H.); (S.J.); (X.D.); (L.C.)
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2
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Mahajan VK, Patil A, Blicharz L, Kassir M, Konnikov N, Gold MH, Goldman MP, Galadari H, Goldust M. Medical therapies for Melasma. J Cosmet Dermatol 2022; 21:3707-3728. [PMID: 35854432 DOI: 10.1111/jocd.15242] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/11/2022] [Indexed: 01/19/2023]
Abstract
Melasma is a common malady affecting all races with a higher incidence in Hispanics, Middle Eastern, Asians and African origin females (Fitzpatrick skin phototypes III-V). Women are affected much more often than men. Melasma remains a significant cause of cosmetic morbidity and psychosocial embarrassment affecting quality of life necessitating effective and reliable treatment. Unfortunately, treatment remains unsatisfactory due to limited efficacy, adverse effects and relapses after stopping treatment. Although chemical peels, laser and light therapies and dermabrasion may have utility, the evidence available for their efficacy is limited and they often cause post inflammatory hyperpigmentation particularly in individuals with darker skin types. Medical therapies remain mainstay in the management of melasma. The triple combination, hydroquinone 4%, tretinoin 0.05% and fluocinolone acetonide 0.01% (Triluma, Galderma, Ft. Worth Texas, often modified incorporating different corticosteroids) remains the only US FDA approved treatment for melasma and is the gold standard due its demonstrated efficacy across ethnicities. Oral tranexamic acid alone or in combination with other modalities has also shown significant efficacy. Several cosmeceuticals and botanical extracts used as skin lightening agents have been demonstrated to be useful. Physical sunscreens containing zinc oxide, iron oxide, titanium dioxide, and silicones provide photoprotective and camouflage effect. We propose that a multimodality approach to the treatment of melasma is the most effective treatment approach. This review is focused on the medical therapies for melasma.
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Affiliation(s)
- Vikram K Mahajan
- Department of Dermatology, Venereology & Leprosy Dr. Rajendra Prasad Government Medical College Kangra, Tanda, India
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Leszek Blicharz
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Martin Kassir
- Founding director, Worldwide laser institute, Dallas, USA
| | | | - Michael H Gold
- Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA
| | - Mitchel P Goldman
- Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, CA, USA.,Department of Dermatology, University of California, San Diego, CA, USA
| | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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3
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Abstract
Melasma is a benign yet psychologically debilitating skin condition that is prevalent among women of darker phenotypes, and particularly in Asian women. This potentially preventable condition can lead to skin discoloration that is hard to treat and can frequently recur. This review aims to (1) highlight the pathophysiology of melasma, (2) describe its important risk factors, and (3) identify prevention methods, available treatment options, and potential complications of melasma. By raising awareness of this condition, we hope that physicians and patients will be able to be better informed to discuss screening options and to avoid preventable risk factors, especially in patients who are predisposed to the disease.
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Affiliation(s)
- Michelle X Wu
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Ruth Antony
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Harvey N Mayrovitz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
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4
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Mehrabi JN, Bar-Ilan E, Wasim S, Koren A, Zusmanovitch L, Salameh F, Isman Nelkenbaum G, Horovitz T, Zur E, Song Lim T, Mashiah J, Artzi O. A review of combined treatments for melasma involving energy-based devices and proposed pathogenesis-oriented combinations. J Cosmet Dermatol 2021; 21:461-472. [PMID: 33794033 DOI: 10.1111/jocd.14110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/27/2021] [Accepted: 03/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Melasma is an acquired disorder of hyperpigmentation, affecting a million individuals worldwide. Energy-based devices (EBDs) employed to treat melasma include various types of lasers, intense pulsed light (IPL), and radiofrequency (RF). Recent studies have attempted to address recalcitrant and recurring melasma by combining energy-based devices with topical or oral medications. OBJECTIVE This article reviews EBDs-based augmented treatment for melasma and suggests practical pathogenesis-oriented treatment regimens. Treatment algorithms are proposed to address various components of melasma. METHODS A systematic PubMed search was conducted acquiring information from various studies on combination treatments of melasma involving EBDs. RESULTS The 286 retrieved articles were filtered by title to contain at least one type of energy-based modality such as laser, IPL, or RF along with at least one other treatment method. Based on their subject matter, combinations were further categorized into the subheadings: laser plus medication, laser plus laser, and IPL- and RF-containing treatment methods. CONCLUSION There are many energy-based combination treatments that have been explored for mitigation of melasma including laser therapy with medication, multi-laser therapies, IPL, RF, and microneedling devices. Melasma is an exceedingly difficult condition to treat, however, choosing the appropriate tailor-made treatment combination can improve the final outcome.
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Affiliation(s)
- Joseph N Mehrabi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Efrat Bar-Ilan
- Department of Dermatology and Venereology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Shehadeh Wasim
- Department of Dermatology and Venereology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Amir Koren
- Department of Dermatology and Venereology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Artzi Treatment and Research Center, Tel Aviv, Israel
| | | | - Fares Salameh
- Artzi Treatment and Research Center, Tel Aviv, Israel
| | | | | | - Eyal Zur
- Compounding Solutions, a pharmaceutical consultancy company, Tel-Mond, Israel
| | | | - Jacob Mashiah
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Dermatology and Venereology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Pediatric Dermatology Unit, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ofir Artzi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Dermatology and Venereology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Artzi Treatment and Research Center, Tel Aviv, Israel
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5
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Iranmanesh B, Khalili M, Mohammadi S, Amiri R, Aflatoonian M. The efficacy of energy-based devices combination therapy for melasma. Dermatol Ther 2021; 34:e14927. [PMID: 33665885 DOI: 10.1111/dth.14927] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/04/2021] [Accepted: 02/22/2021] [Indexed: 12/24/2022]
Abstract
Melasma is a recalcitrant pigmentary disease with a complex pathogenesis. Monotherapy often results in unsatisfactory results with high recurrence rate. In this review article, we evaluate efficacy of energy-based devices combination therapy for melasma. We reviewed published literature since 2010 up to November 2020 regarding adjuvant therapy of energy-based devices with other treatment modalities in the treatment of melasma. After final selection, we assessed 49 articles. Energy-based devices include lasers, non-coherent lights, radiofrequency, iontophoresis, sonophoresis, microneedling, and microdermabrasion. Adjuvant therapies other than energy-based devices were lightening agents, chemical peels, platelet rich plasma (PRP) and mesotherapy. Combination of Q-switched neodymium-doped: yttrium, aluminum, and garnet (QSNY) with either intense pulsed light therapy (IPL) or pulsed-dye laser (PDL) are recommended in recalcitrant melasma in patients with light skin photo types and with dilated skin vessels (especially with PDL). Combination of fractional microneedling radiofrequency or microneedling with QSNY leads to promising results and is a safe treatment modality, especially in darker skin types. Application of topical lightening agents in combination with laser therapy leads to higher efficacy with less adverse effects (post-inflammatory hyperpigmentation) and rebound of melasma. Combination of ablative techniques with QSNY is not recommended, due to the high risk of permanent adverse effects such as guttate hypopigmentation and exacerbation of melasma.
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Affiliation(s)
- Behzad Iranmanesh
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Khalili
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Saman Mohammadi
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Rezvan Amiri
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahin Aflatoonian
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
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6
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Babbush KM, Babbush RA, Khachemoune A. Treatment of melasma: a review of less commonly used antioxidants. Int J Dermatol 2020; 60:166-173. [PMID: 32815582 DOI: 10.1111/ijd.15133] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/28/2020] [Accepted: 07/20/2020] [Indexed: 12/27/2022]
Abstract
Melasma, a common cause for seeking dermatologic care, is a chronic condition of skin hyperpigmentation. With a poorly understood pathogenesis, and no universal cure, melasma is a challenge for many dermatologists. For decades, there has been investigation into the role of oxidative stress in melasma. In this literature review, we introduce the role of oxidative stress in melasma and discuss the function of various topical and oral antioxidant therapies for patients suffering from melasma. Numerous studies have shown efficacy of various antioxidant therapies for treatment of hyperpigmentation, and in this review, we focus primarily on those with less widespread use. Vitamin E, niacinamide, polypodium leucotomos, pycnogenol, grape seed extract, amino fruit acids, phytic acid, zinc, silymarin, Korean red ginseng powder, plant extracts, and parsley all have well-demonstrated evidence of antioxidant properties, and these substances have been studied in the context of skin hyperpigmentation. Although there is conflicting evidence of their therapeutic efficacy, the use of these naturally occurring substances is promising for patients and medical providers seeking alternative therapeutic options.
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Affiliation(s)
- Kayla M Babbush
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Remy A Babbush
- Department of Food Science, Cornell University, Ithaca, NY, USA
| | - Amor Khachemoune
- Department of Dermatology, State University of New York Downstate, Brooklyn, NY, USA.,Department of Dermatology, Veterans Health Administration, Brooklyn, NY, USA
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7
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Rejinold NS, Kim HK, Isakovic AF, Gater DL, Kim YC. Therapeutic vitamin delivery: Chemical and physical methods with future directions. J Control Release 2019; 298:83-98. [DOI: 10.1016/j.jconrel.2019.01.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 12/31/2022]
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9
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Abstract
A blemish free, even-toned skin is universally associated with healthy skin. This reasoning makes people desire to have a flawless skin. Melanin is a naturally occurring pigment in humans. This pigment is responsible for skin, hair, and eye color, therefore determines our race and phenotypic appearance. On darker skin types, it is common that melanin production processes malfunctions. These malfunctions often lead to overproduction and secretion of melanin. As a result, unwanted pigmentary problems such melasma occur. Due to unknown etiology and its recurrence in nature, melasma is challenging to treat. The current available melasma treatment options often produce undesired side effects and suboptimum results. First-line topical treatments usually involve hydroquinone or topical steroids. Apart from the irritant reactions, this treatment mode is not suitable for all skin types. Skin care specialists are in search of an effective long-term cosmetics and cosmeceuticals to address hypermelanosis problems. Understanding of naturally occurring depigmenting agents provides an opportunity for more effective ways to manage melasma in all skin types. This review considers the benefits of naturally occurring ingredients which could help address skin pigmentation problems and broaden the choice for skin-lightening treatments.
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Affiliation(s)
- Mpofana Nomakhosi
- a Laser Research Centre, Faculty of Health Sciences , University of Johannesburg , Doornfontein , South Africa
| | - Abrahamse Heidi
- a Laser Research Centre, Faculty of Health Sciences , University of Johannesburg , Doornfontein , South Africa
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10
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Ustuner P, Balevi A, Ozdemir M. A split-face, investigator-blinded comparative study on the efficacy and safety of Q-switched Nd:YAG laser plus microneedling with vitamin C versus Q-switched Nd:YAG laser for the treatment of recalcitrant melasma. J COSMET LASER THER 2017; 19:383-390. [DOI: 10.1080/14764172.2017.1342036] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Pelin Ustuner
- Medical Faculty, Dermatology Department, Istanbul Medipol University, İstanbul, Turkey
| | - Ali Balevi
- Medical Faculty, Dermatology Department, Istanbul Medipol University, İstanbul, Turkey
| | - Mustafa Ozdemir
- Medical Faculty, Dermatology Department, Istanbul Medipol University, İstanbul, Turkey
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11
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Sarkar R, Aurangabadkar S, Salim T, Das A, Shah S, Majid I, Singh M, Ravichandran G, Godse K, Arsiwala S, Arya L, Gokhale N, Sarma N, Torsekar RG, Sonthalia S, Somani VK. Lasers in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group. Indian J Dermatol 2017; 62:585-590. [PMID: 29263531 PMCID: PMC5724305 DOI: 10.4103/ijd.ijd_488_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lasers have come up as the newest therapeutic modality in dermatological conditions including melasma. In this article, as a group of experts from Pigmentary Disorders Society in collaboration with South Asian Pigmentary Disorders Forum (SPF), we have tried to discuss the lasers which have been used in melasma and formulate simple consensus guidelines. Following thorough literature search, we have summarised the rationale of using the lasers and the supporting evidences have also been provided. It is clear that laser cannot be the first line treatment for melasma. However, it can be used as an adjuvant therapy in resistant cases, provided the selection of patient and counselling has been done properly.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | | | - T Salim
- Consultant Dermatologist, Cutis Institute of Dermatology and Aesthetic Sciences, Calicut, Kerala, India
| | - Anupam Das
- Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Swapnil Shah
- Consultant Dermatologist, Solapur, Maharashtra, India
| | - Imran Majid
- Dermatology, Govt Medical College, Srinagar, Kashmir, India
| | - Mohan Singh
- Consultant Dermatologist, Mohan Singh Diseases Hospital, Phagwara, Punjab, India
| | - G Ravichandran
- Senior Consultant and Coordinator, Dermatology, Apollo Hospitals, Chennai, India
| | - Kiran Godse
- Dermatology, D Y Patil Hospital, Navi Mumbai, India
| | - Shehnaz Arsiwala
- Consultant Dermatologist, Saifee Hospital, Prince Aly Khan Hospital, Mumbai, India
| | - Latika Arya
- Consultant Dermatologist, L A Skin & Aesthetic Clinic, New Delhi, India
| | - Narendra Gokhale
- Consultant Dermatologist, Sklinic Skin Clinic, Indore, Madhya Pradesh, India
| | - Nilendu Sarma
- Dermatology, Dr. B.C. Roy Postgraduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - R G Torsekar
- Consultant Dermatologist, Fortis Hospital, Mulund, Mumbai, India
| | - Sidharth Sonthalia
- Consultant Dermatologist, Skinnocence: The Skin Clinic, Gurgaon, Haryana, India
| | - V K Somani
- Consultant Dermatologist, Skintrendz, Himayat Nagar, Hyderabad, India
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12
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Sarma N, Chakraborty S, Poojary SA, Rathi S, Kumaran S, Nirmal B, Felicita J, Sarkar R, Jaiswal P, D'Souza P, Donthula N, Sethi S, Ailawadi P, Joseph B. Evidence-based Review, Grade of Recommendation, and Suggested Treatment Recommendations for Melasma. Indian Dermatol Online J 2017; 8:406-442. [PMID: 29204385 PMCID: PMC5707834 DOI: 10.4103/idoj.idoj_187_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Treatment of melasma is known to be less satisfactory, often incomplete, and relapse is frequent. Although many treatment options are available, they are either known to be unsafe on long-term use or their long-term safety profile is unknown. Patients often use various drugs, even topical steroid-based preparation without any medical supervision for long period of time, making the skin unsuitable for many of the drugs available. Thus, there has been gross disparity among the treating physician about what drugs and what regimen are best suitable for various categories of melasma patients and in different situations. With this background, numerous newer drugs, mostly combinations of some proprietary molecules or even unknown plant extracts, have flooded the market for the management of melasma. Information on efficacy or safety of these products are almost unknown. Studies on Asian people, especially Indian population, are far less commonly available. Therapeutic guideline for use on Indian patients with melasma is almost missing. Extrapolation of data from Caucasian people for use on Asian people may not be scientifically justifiable because Caucasian and Asian people are known to have inherent difference in their response as well as tolerance to the drugs used for melasma. With this background, we have extensively evaluated, following a strict, scientifically designed protocol, all the available studies on melasma management till May 2016 and prepared this document on level of evidence, grade of recommendation and suggested therapeutic guideline for melasma as per the method proposed by Oxford Centre of Evidence-Based Medicine. Various ethical, social, logical, regional, and economic issues in the context of Indian and similar populations were given due importance while preparing the suggested therapeutic recommendation.
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Affiliation(s)
- Nilendu Sarma
- Department of Dermatology, Dr B C Roy Post Graduate Institute of Pediatric Science, Kolkata, West Bengal, India
| | | | - Shital A Poojary
- Department of Dermatology, K J Somaiya Medical College, Mumbai, Maharashtra, India
| | | | - Sendhil Kumaran
- Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Balakrishnan Nirmal
- Department of Dermatology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Joan Felicita
- Department of Dermatology, Dr. Somervell Memorial CSI Medical College, Karakonam, Trivandrum, Kerala, India
| | - Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, Basaidarapur, New Delhi, India
| | - Prashansa Jaiswal
- ESI- Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, India
| | - Paschal D'Souza
- ESI- Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, India
| | - Nagaraju Donthula
- Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sumit Sethi
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, Basaidarapur, New Delhi, India
| | - Pallavi Ailawadi
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, Basaidarapur, New Delhi, India
| | - Bebisha Joseph
- Department of Dermatology, Dr. Somervell Memorial CSI Medical College, Karakonam, Trivandrum, Kerala, India
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