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Sarkar R, Verma B, Mendiratta V. Use of oral melatonin in recalcitrant melasma. Int J Dermatol 2024. [PMID: 38650083 DOI: 10.1111/ijd.17201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/01/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Rashmi Sarkar
- Lady Hardinge Medical College and Maulana Azad Medical College, New Delhi, India
| | - Bharati Verma
- Lady Hardinge Medical College and Maulana Azad Medical College, New Delhi, India
| | - Vibhu Mendiratta
- Lady Hardinge Medical College and Maulana Azad Medical College, New Delhi, India
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Sarkar R, Lakhani R. Chemical Peels for Melasma: A Systematic Review. Dermatol Surg 2024:00042728-990000000-00737. [PMID: 38530985 DOI: 10.1097/dss.0000000000004167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Melasma is a common chronic, relapsing pigmentary disorder that causes psychological impact. Chemical peels are a well-known therapeutic modality used for accelerating the treatment of melasma. OBJECTIVE To review the published evidence on the efficacy and safety of chemical peels in the treatment of melasma. METHODS A systematic review was done. A meta-analysis could not be done due to the heterogeneity of data. RESULT The authors conducted a PubMed search and included prospective case series of more than 10 cases and randomized controlled trials (RCTs) that have studied the safety and/or efficacy of chemical peel in melasma. Out of 24 studies, 9 were clinical/comparative trials and 15 were RCTs. The total sample size was 1,075. The duration of the study varied from 8 to 36 weeks. Only 8 studies were split face. All studies used self-assessment, physician global assessment, and Melasma Area and Severity Index (MASI) for quantifying the results. Glycolic acid was found to be the most safe and effective in melasma. CONCLUSION Chemical peels were found to be safe and effective in the management of melasma.
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Affiliation(s)
- Rashmi Sarkar
- All authors are affiliated with the Department of Dermatology and Sexually Transmitted Diseases, Lady Hardinge Medical College and associated Hospitals, Central Delhi, New Delhi, India
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Labbouz S, Khan S, Gohara M, Lucas J, Sarkar R, Murrell DF, Dodiuk-Gad RP. Meeting report: Women's Dermatology Society Forum at the 25th World Congress of Dermatology, Singapore, 2023. Int J Womens Dermatol 2024; 10:e125. [PMID: 38240008 PMCID: PMC10796140 DOI: 10.1097/jw9.0000000000000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/16/2023] [Indexed: 01/22/2024] Open
Affiliation(s)
- Sofia Labbouz
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sidra Khan
- Department of Dermatology, Manchester University Foundation Trust, Manchester, UK
- Department of Clinical Sciences and International Public Health, The Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mona Gohara
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Jennifer Lucas
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Dedee F. Murrell
- Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Roni P. Dodiuk-Gad
- Department of Dermatology, Emek Medical Center, Afula, Israel
- Department of Dermatology, Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
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Sarkar R, Narayan R V, Vinay K, Lakhani R, Sinha S, Mysore V, Sendhil Kumaran M, Bhalla M, Das A, Swarnkar B, Mohan Thappa D, Podder I, Ojha Sharma R, Kumar Somani V, Barua S, Jagadeesan S, Dogra S. Prescribing practices of tranexamic acid for melasma: Delphi consensus from the Pigmentary Disorders Society. Indian J Dermatol Venereol Leprol 2024; 90:41-45. [PMID: 37609738 DOI: 10.25259/ijdvl_1157_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/22/2023] [Indexed: 08/24/2023]
Abstract
Introduction There is ambiguity regarding usage of tranexamic acid for melasma in India, be it in its pre-administration evaluation, administration route, dosing or monitoring. Hence, we conducted this study to understand various tranexamic-acid prescribing patterns and provide practical guidelines. Materials and methods A Google-form-based questionnaire (25-questions) was prepared based on the key areas identified by experts from the Pigmentary Disorders Society, India and circulated to practicing dermatologists across the country. In rounds 2 and 3, the questionnaire was re-presented to the same group of experts and their opinions were sought. The results of the practitioners' survey were denoted graphically alongside, to guide them. Consensus was deemed when at least 80% of respondents chose an option. Results The members agreed that history pertaining to risk factors for thromboembolism, cardiovascular and menstrual disorders should be sought in patients being started on oral tranexamic-acid. Baseline coagulation profile should be ordered in all patients prior to tranexamic-acid and more exhaustive investigations such as complete blood count, liver function test, protein C and S in patients with high risk of thromboembolism. The preferred oral dose was 250 mg orally twice daily, which can be used alone or in combination with topical hydroquinone, kojic acid and sunscreen. Repeated dosing of tranexamic-acid may be required for those relapsing with melasma following initial tranexamic-acid discontinuation. Coagulation profile should ideally be repeated at three monthly intervals during follow-up, especially in patients with clinically higher risk of thromboembolism. Treatment can be stopped abruptly post improvement and no tapering is required. Limitation This study is limited by the fact that open-ended questions were limited to the first general survey round. Conclusion Oral tranexamic-acid provides a valuable treatment option for melasma. Frequent courses of therapy may be required to sustain results and a vigilant watch is recommended for hypercoagulable states during the course of therapy.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and Hospitals, New Delhi, India
| | - Vignesh Narayan R
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ridhima Lakhani
- Department of Dermatology and Venereology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Surabhi Sinha
- Department of Dermatology, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Venkataram Mysore
- Dermatology Section, Venkat Centre for Skin and Plastic Surgery, Bangalore, Karnataka, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mala Bhalla
- Department of Dermatology, Skin Office, Government Medical College and Hospital, Chandigarh, India
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Bhavesh Swarnkar
- Dermatology Section, Swarnkar Superspeciality Center, Indore, Madhya Pradesh, India
| | | | - Indrashis Podder
- Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Richa Ojha Sharma
- Dermatology Section, Twacha Skin Clinic, Road Opposite Bal Bharti School, Dwarka, Delhi, India
| | | | - Shyamanta Barua
- Department of Dermatology, Assam Medical College & Hospital, Dibrugarh, Assam, India
| | - Soumya Jagadeesan
- Department of Dermatology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Narayan RV, Katoch S, Sarkar R. The Key Areas and Unmet Need of Mentorship Programs in Indian Dermatology: A Survey Based Analysis. Indian Dermatol Online J 2024; 15:64-68. [PMID: 38283010 PMCID: PMC10810393 DOI: 10.4103/idoj.idoj_245_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/04/2023] [Accepted: 07/13/2023] [Indexed: 01/30/2024] Open
Abstract
Background Mentorship programs for dermatologists have been in vogue in the West for many years, but have been on a hiatus in India. Recently, there is renewed interest, and mentorship programs are gaining momentum across the country to guide and nurture young dermatologists to attain their full potential. However, what constitutes an ideal mentorship program is still an enigma. Materials and Methods We developed a multiple-choice questionnaire (Google-form), enquiring post graduates and dermatologists about their general opinion of mentorship, its key areas and what constituted an ideal mentorship-program. These were distributed via email and WhatsApp and responses were collected over a month's period. The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) for Windows. Results We received 202 responses and majority of the respondents were private practitioners (32.2%) and post graduate students (29.7%). Respondents felt that mentorship should be undertaken at the beginning of postgraduation (37.1%) or just after its completion (23.8%), and should focus on academic and research related issues (55.0%). Communication (95.5%) was an important factor for the program to be successful, and on an average, must be of seven weeks duration, with a mentor : mentee ratio of 1:2. We found a significant association between the designation of the respondent and their perceived ideal time for a mentorship program (P<0.001, Chi Square Test), seeking of mentorship beyond the program duration (P<0.01, Chi Square Test) and the type of mentorship program (P=0.01, Chi square test). Conclusion Our survey concluded that a well-planned short mentorship program of six to eight weeks duration with a low mentee to mentor ratio with an informal style of mentoring in the formative years of one's career would be suitable in the Indian Dermatology scenario. Communication and availability emerged as important elements for a successful mentor mentee relationship. The positive effects of a well-planned mentorship program extend beyond its duration and enrich both the mentor and mentee.
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Affiliation(s)
- R Vignesh Narayan
- Department of Dermatology, Venereology and Leprology, MS Ramaiah Medical College, Bangalore, Karnataka, India
| | - Saloni Katoch
- Department of Dermatology, Venereology and Leprosy, Dr. K. N. Barua Institute of Dermatological Sciences, Guwahati, Assam, India
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and Hospital, New Delhi, India
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Mohta A, Sarkar R, Narayan RV, Deoghare S, Arora A. Terra Firma-Forme Dermatosis-More Than Just Dirty. Indian Dermatol Online J 2024; 15:99-104. [PMID: 38283007 PMCID: PMC10810366 DOI: 10.4103/idoj.idoj_424_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 01/30/2024] Open
Affiliation(s)
- Alpana Mohta
- Department of Dermatology, Venereology and Leprology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Rashmi Sarkar
- Department of Dermatology Lady Hardinge Medical College, New Delhi, India
| | - R Vignesh Narayan
- Department of Dermatology, Venereology and Leprology, MS Ramaiah Medical College, Bangalore, Karnataka, India
| | - Shreya Deoghare
- Deparmtent of Dermatology, Venereology and Leprology, DY Patil Medical College, Pune, Maharashtra, India
| | - Aakanksha Arora
- Department of Dermatology, Venereology and Leprology, Sardar Patel Medical College, Bikaner, Rajasthan, India
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Sarkar R, Katoch S. Chemical Peels in Treatment of Melasma. Dermatol Clin 2024; 42:21-32. [PMID: 37977681 DOI: 10.1016/j.det.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Superficial chemical peels are one of the most popular skin resurfacing procedures in a dermatologists' clinic today due to quick application process, fast recovery, good patient acceptance, and excellent cosmetic results. The role of various peeling agents like glycolic acid, salicylic acid, trichloroacetic acid, Jessner's solution, retinoic acid, and lactic acid in the management of melasma has been established as that of an additional or maintenance therapy. This article details the current evidence and recommendations for the use of chemical peels in the treatment of melasma, a chronic and recurrent hyperpigmentary disorder.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and SSK and KSC Hospital, New Delhi 110001, India.
| | - Saloni Katoch
- Dr. KN Barua Institute of Dermatological Sciences, Guwahati, Assam, India
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Sarkar R, Handog EB, Das A, Bansal A, Macarayo MJ, Keshavmurthy V, Narayan V, Jagadeesan S, Pipo E, Ibaviosa GM, Podder I, Bansal S. Topical and Systemic Therapies in Melasma: A Systematic Review. Indian Dermatol Online J 2023; 14:769-781. [PMID: 38099013 PMCID: PMC10718129 DOI: 10.4103/idoj.idoj_490_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Melasma is an acquired disorder, which presents with well-demarcated, brown-colored hyperpigmented macules, commonly involving the sun-exposed areas such as the face. It is a chronic and distressing condition, affecting the patients' quality of life, and has been conventionally treated with "first-line" agents including hydroquinone (HQ) alone or as a part of a triple combination cream (TCC), while "second-line" options include chemical peels, and third line options include laser therapy. Materials and Methods A systematic search was performed for all topical and systemic treatments for melasma up till May 4, 2021, using the PubMed and EMBASE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The search terms "melasma" and "treatment" were used to search for the relevant articles on both these databases, and a total of 4020 articles were identified. After removing the duplicate entries and screening the titles, abstracts, and full-text articles, we identified 174 randomized controlled trials (RCTs) or controlled clinical trials. Results Based on our review, HQ, TCCs, sunscreens, kojic acid (KA), and azelaic acid receive grade A recommendation. Further large-scale studies are required to clearly establish the efficacy of topical vitamin C, resorcinol, and topical tranexamic acid (TXA). Several newer topical agents may play a role only as an add-on or second-line drugs or as maintenance therapy. Oral TXA has a strong recommendation, provided there are no contraindications. Procyanidins, Polypodium leucotomos (PL), and even synbiotics may be taken as adjuncts. Discussion Several newer topical and systemic agents with multimodal mechanisms of action have now become available, and the balance seems to be tipping in favor of these innovative modalities. However, it is worth mentioning that the choice of agent should be individualized and subject to availability in a particular country.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
| | - Evangeline B. Handog
- Department of Dermatology, Asian Hospital and Medical Center, Muntinlupa City, Metro Manila
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, India
| | - Anuva Bansal
- Department of Dermatology, BLK-MAX Super Speciality Hospital, New Delhi, Delhi, India
| | - Ma. Juliet Macarayo
- Department of Dermatology, Angeles University Foundation Medical Center, Angeles, Pampanga
| | | | | | - Soumya Jagadeesan
- Department of Dermatology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Eugenio Pipo
- Department of Dermatology, Northside Doctors Hospital, Ilocos Sur, Philippines
| | | | - Indrashis Podder
- Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kamarhati, Kolkata, West Bengal, India
| | - Shivani Bansal
- Department of Dermatology, All India Institute of Medical Sciences, Bathinda, Punjab, India
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Dogra S, Sharma A, Mehta H, Sarkar R. Emerging role of topical Janus kinase inhibitors in dermatological disorders: a review. Clin Exp Dermatol 2023; 48:1102-1112. [PMID: 37235767 DOI: 10.1093/ced/llad188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
Janus kinase (JAK) refers to a family of tyrosine kinases that are involved in the production of proinflammatory mediators in response to various extracellular signals. The JAK-signal transducer and activator of transcription (STAT) pathway is an appealing target in many inflammatory illnesses as this pathway modulates immune cell activation and T-cell-mediated inflammation in response to several cytokines. The practical considerations of prescription for topical and oral JAK inhibitors (JAKis) in atopic dermatitis, vitiligo and psoriasis have been covered in prior publications. Currently, the US Food and Drug Administration has approved the topical JAKi ruxolitinib for atopic dermatitis and nonsegmental vitiligo. None of the remaining first- or second-generation topical JAKis have been approved for topical application in any dermatological indications so far. For this review, the PubMed database was searched using 'topical' and 'JAK inhibitor' or 'Janus kinase inhibitor' or the names of individual drug molecules as the keyword in the title with no date limits. The description of topical JAKi usage in dermatology from the literature was evaluated in each abstract. The current review concentrates on emphasizing the rising use of topical JAKis in both approved and off-label dermatological applications for both old and novel conditions.
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Affiliation(s)
- Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Apoorva Sharma
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hitaishi Mehta
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and associated Hospitals, New Delhi, India
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Sarkar R, Sinha S, Sachdeva S, Dogra S, Karajagi N, Devaraj DK, Jindal R, Malhotra A. Strategic Development Plan for the Indian Association of Dermatologists, Venereologists and Leprologists (IADVL): Consolidating Five Decades of Experience and Moving Forward on a Global Platform. Indian Dermatol Online J 2023; 14:692-697. [PMID: 37727559 PMCID: PMC10506807 DOI: 10.4103/idoj.idoj_190_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 09/21/2023] Open
Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, LHMC and Associated KSCH and SSK Hospital, New Delhi, India
| | - Surabhi Sinha
- Department of Dermatology, Venereology and Leprosy, Dr. Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Soumya Sachdeva
- Department of Dermatology, Venereology and Leprosy, Saraswathi Institute of Medical Sciences, Hapur, Uttar Pradesh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Niket Karajagi
- BE, MBA, Founder and Director, Atyaasaa Consulting Private Limited, Elite Gardens, Pune, Maharashtra, India
| | - Dinesh K. Devaraj
- MD, FRCP (Glasgow), Department of Dermatology, Dr. Dinesh’s Skin and Hair Clinic, Chennai, Tamil Nadu, India
| | - Rashmi Jindal
- Department of Dermatology, Himalayan Institute of Medical Sciences, Swami Ram Himalayan University, Dehradun, Uttarakhand, India
| | - Amit Malhotra
- MD, Director, Department of Dermatology, Dermatology and Laser Services, Maple Clinic, Indrapuram, Uttar Pradesh, India
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Jindal AK, Sil A, Aggarwal R, Vinay K, Bishnoi A, Suri D, Rawat A, Kumaran MS, Saikia B, Sarkar R, Gupta L, Kumar DD, Jindal R, Sukumaran TU, Ouseph J, Longhurst H, Pawankar R, Singh S, Dogra S. Management of hereditary angioedema in resource-constrained settings: A consensus statement from Indian subcontinent. Asia Pac Allergy 2023; 13:60-65. [PMID: 37388810 PMCID: PMC10287105 DOI: 10.5415/apallergy.0000000000000100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 07/01/2023] Open
Abstract
Hereditary angioedema (HAE) is an uncommon disorder characterized clinically by recurrent episodes of nonitchy subcutaneous and/or submucosal swellings. The estimated prevalence of HAE is ~ 1: 10,000 to 1: 50,000. There are no prevalence data from India, however, estimates suggest that there are 27,000 to 135,000 patients with HAE in India at present. The majority of these, however, remain undiagnosed. Replacement of plasma-derived or recombinant C1-esterase inhibitor (C1-INH) protein, administered intravenously, is the treatment of choice during the management of acute episodes of angioedema (i.e., "on-demand treatment") and is also useful for short-term prophylaxis (STP) and long-term prophylaxis (LTP). This has been found to be effective and safe even in young children and during pregnancy. Until recently, none of the first-line treatment options were available for "on-demand treatment," STP or LTP in India. As a result, physicians had to use fresh frozen plasma for both "on-demand treatment" and STP. For LTP, attenuated androgens (danazol or stanozolol) and/or tranexamic acid were commonly used. These drugs have been reported to be useful for LTP but are associated with a significant risk of adverse effects. Intravenous pd-C1-INH, the first-line treatment option, is now available in India. However, because there is no universal health insurance, access to pd-C1-INH is a significant challenge. HAE Society of India has developed these consensus guidelines for India and other resource-constrained settings where plasma-derived C1-INH therapy is the only available first-line treatment option for the management of HAE and diagnostic facilities are limited. These guidelines have been developed because it may not be possible for all patients to access the recommended therapy and at the recommended doses as suggested by the international guidelines. Moreover, it may not be feasible to follow the evaluation algorithm suggested by the international guidelines.
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Affiliation(s)
- Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Archan Sil
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ridhima Aggarwal
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Suri
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Biman Saikia
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Lalit Gupta
- Department of Dermatology, RNT Medical College, Udaipur, India
| | | | - Rashmi Jindal
- Department of Dermatology, Himalayan Institute of Medical Sciences, Dehradun, India
| | | | - Jose Ouseph
- Government Medical College, Alappuzha, Kerala, India
| | - Hilary Longhurst
- Department of Immunology, Auckland City Hospital, Te Toka Tumai
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Surjit Singh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and Hospital, New Delhi, India
- Correspondence to: Rashmi Sarkar, MBBS, MD, Department of Dermatology, Lady Hardinge Medical College and Hospital, New Delhi, India.
| | - Shreya Deoghare
- Department of Dermatology, Dr. D. Y. Patil Medical College and Hospital, Pune, India
| | - Saloni Katoch
- Dr. KN Barua Institute of Dermatological Sciences, Guwahati, Assam, India
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Godse K, Sarkar R, Mysore V, Shenoy MM, Chatterjee M, Damisetty R, Shah S, Vedamurthy M, Aurangabadkar S, Srinivas C, Ganjoo A, Das S, Patil A. Oral Tranexamic Acid for the Treatment of Melasma: Evidence and Experience-Based Consensus Statement from Indian Experts. Indian J Dermatol 2023; 68:178-185. [PMID: 37275826 PMCID: PMC10238972 DOI: 10.4103/ijd.ijd_266_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Melasma, a chronic pigmentary skin condition mainly affecting the face, remains a challenge despite the availability of several options for treatment. Many melasma patients are not satisfied with treatment outcomes. Tranexamic acid (TXA), an anti-fibrinolytic drug has shown promising results in patients with melasma. Evidence from several clinical studies has surfaced on efficacy and tolerability of TXA in these patients. It can be used as monotherapy or adjuvant with other therapies. Currently, there is no published consensus or guideline document for its use in the treatment of melasma. TXA is available for oral use, topical use as well as an injection. In this article, a consensus of Indian experts is prepared based on the available literature and experience with use of oral TXA in melasma. This review article might help clinicians for use of oral TXA appropriately while treating melasma.
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Affiliation(s)
- Kiran Godse
- From the Department of Dermatology, Dr. DY Patil Medical College, Navi Mumbai, Maharashtra, India
| | - Rashmi Sarkar
- Dermatology at Lady Hardinge, Medical College and Associated Hospitals, Delhi University, New Delhi, Delhi, India
| | - Venkataram Mysore
- Consultant Dermatologist, Venkat Center for Skin ENT and Plastic Surgery, Bengaluru, Karnataka, India
| | - Manunath M. Shenoy
- Department of Dermatology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
| | - Manas Chatterjee
- Brig Med 14 Corps and Consultant Dermatologist, Leh, Ladakh, India
| | - Rajetha Damisetty
- Consultant Dermatologist, Mohana Skin and Hair Clinic, Hyderabad, Telangana, India
| | - Swapnil Shah
- Consultant Dermatologist, Solapur, Maharashtra, India
| | - Maya Vedamurthy
- Consultant Dermatologist, Apollo Hospitals, Chennai and RSV Skin and Research Centre, Chennai, Tamil Nadu, India
| | - Sanjeev Aurangabadkar
- Consultant Dermatologist, Skin and Laser Clinic, Begumpet, Hyderabad, Telangana, India
| | | | - Anil Ganjoo
- Department of Dermatology and Venereology, Saroj Hospital and Heart Institute, New Delhi, Delhi, India
| | - Sudip Das
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, Maharashtra, India
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Bikash C, Sarkar R. Topical management of acne scars: The uncharted terrain. J Cosmet Dermatol 2023; 22:1191-1196. [PMID: 36606377 DOI: 10.1111/jocd.15584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/02/2022] [Accepted: 12/11/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Scarring is a common but difficult to manage consequence of acne vulgaris. The intricate balance between the degradation of collagen and its inhibition is disturbed during the formation of acne scars. We mostly rely on invasive, non-topical modalities for the treatment of acne scars which may not be indicated in all patients. There is also a need for maintainence therapies after these procedures. REVIEW The topical agents can be utilized as individual therapy, in combination with other modalities or delivered through assisted technology like iontophoresis. Retinoids have long been tried to prevent and treat acne scars. Tacrolimus and glycolic acid are among the newer sole agents that have been explored. Ablative lasers like Er:YAG, CO2 and Microneedling are being used in combination with topical agents like silicone gel, plasma gel, lyophilized growth factors, platelet rich plasma, insulin, and mesenchymal stem cells. These procedures not only increase the permeability of the topical agents but also concomitantly improve acne scars. Iontophoresis has proven beneficial in increasing the delivery of topical estriol and tretinoin. CONCLUSION There is lack of evidence to support the widespread use of these topical agents, and therefore, there is need for further well designed studies.
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Affiliation(s)
- Chingshubam Bikash
- Department of Dermatology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Meghalaya, India
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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15
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Sarkar R, Vinay K, Bishnoi A, Poojary S, Gupta M, Kumaran MS, Jain A, Gurumurthy C, Arora P, Kandhari R, Rathi S, Zawar V, Gupta V, Ravivarma VN, Rodrigues M, Parsad D. A Delphi consensus on the nomenclature and diagnosis of lichen planus pigmentosus and related entities. Indian J Dermatol Venereol Leprol 2023; 89:41-46. [PMID: 35593293 DOI: 10.25259/ijdvl_804_2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/01/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although well known in clinical practice, research in lichen planus pigmentosus and related dermal pigmentary diseases is restricted due to lack of consensus on nomenclature and disease definition. AIMS AND OBJECTIVES Delphi exercise to define and categorise acquired dermal pigmentary diseases. METHODS Core areas were identified including disease definition, etiopathogenesis, risk factors, clinical features, diagnostic methods, treatment modalities and outcome measures. The Delphi exercise was conducted in three rounds. RESULTS Sixteen researchers representing 12 different universities across India and Australia agreed to be part of this Delphi exercise. At the end of three rounds, a consensus of >80% was reached on usage of the umbrella term 'acquired dermal macular hyperpigmentation'. It was agreed that there were minimal differences, if any, among the disorders previously defined as ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis and pigmented contact dermatitis. It was also agreed that lichen planus pigmentosus, erythema dyschromicum perstans and ashy dermatosis did not differ significantly apart from the sites of involvement, as historically described in the literature. Exposure to hair colours, sunlight and cosmetics was associated with these disorders in a significant proportion of patients. Participants agreed that both histopathology and dermatoscopy could diagnose dermal pigmentation characteristic of acquired dermal macular hyperpigmentation but could not differentiate the individual entities of ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis, lichen planus pigmentosus and pigmented contact dermatitis. LIMITATIONS A wider consensus involving representatives from East Asian, European and Latin American countries is required. CONCLUSION Acquired dermal macular hyperpigmentation could be an appropriate conglomerate terminology for acquired dermatoses characterised by idiopathic or multifactorial non-inflammatory macular dermal hyperpigmentation.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shital Poojary
- Department of Dermatology, K. J. Somaiya Medical College, Mumbai, Maharashtra, India
| | - Monisha Gupta
- Department of Dermatology, Liverpool Hospital, The Skin Hospital, NSW, Conjoint University of NSW, Western Sydney University, Sydney, Australia
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay Jain
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
| | - Chethana Gurumurthy
- Department of Dermatology, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Pooja Arora
- Department of Dermatology, Dr RML Hospital and ABVIMS, New Delhi, India
| | | | - Sanjay Rathi
- Dr. Rathi's Skin Clinic, Siliguri, West Bengal, India
| | - Vijay Zawar
- Department of Dermatology Dr. Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | - Vishal Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Vignesh Narayan Ravivarma
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Michelle Rodrigues
- Chroma Dermatology, Pigment and Skin of Colour Centre, Melbourne, Australia
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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16
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Meena A, Sarkar R. Acitretin in dermatology. Apollo Med 2023. [DOI: 10.4103/am.am_145_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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17
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Sarkar R, Swarnkar B. Raynaud's phenomenon: A brush up! Indian Dermatol Online J 2023; 14:248-255. [PMID: 37089827 PMCID: PMC10115340 DOI: 10.4103/idoj.idoj_311_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 03/12/2023] Open
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18
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Swarnkar B, Sarkar R. Childhood Cutaneous Mastocytosis: Revisited. Indian J Dermatol 2023; 68:121. [PMID: 37151240 PMCID: PMC10162768 DOI: 10.4103/ijd.ijd_264_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Cutaneous mastocytosis is a neoplasm characterized by the proliferation and accumulation of mast cells in the skin. There can be involvement of other organ systems as well. Cutaneous manifestations can vary from mastocytoma to maculopapular lesions to diffuse cutaneous form. There can be symptoms associated with mast cell mediators release like itching, flushing, hypotension, diarrhoea, abdominal pain, and anaphylaxis. Hence, the mainstay of treatment is avoidance of triggers causing these mediators to release, anti-histamines, topical/intra-lesional/systemic steroids, mast cell-targeted therapy, epinephrine, and omalizumab depending upon the severity of symptoms/signs. Childhood cases usually have a good prognosis except in a few cases, especially those with systemic involvement. Such situations might warrant cytoreductive therapy, polychemotherapy, or autologous stem cell transplantation. Here, we intend to review the English literature on childhood cutaneous mastocytosis.
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Affiliation(s)
- Bhavya Swarnkar
- From the Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Sarkar
- Department of Dermatology, LHMC and Associated KSCH and SSK Hospital, New Delhi, India
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19
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Zeiser R, Russo D, Ram R, Hashmi S, Chakraverty R, Moritz Middeke J, Giebel S, Sarkar R, Gowda M, Gunes S, Stefanelli T, Lee SJ, Teshima T, Locatelli F. P1389: RUXOLITINIB DEMONSTRATES A GREATER CORTICOSTEROID-SPARING EFFECT THAN BEST AVAILABLE THERAPY IN PATIENTS WITH CORTICOSTEROID-REFRACTORY/DEPENDENT CHRONIC GRAFT-VS-HOST DISEASE. Hemasphere 2022. [PMCID: PMC9429566 DOI: 10.1097/01.hs9.0000848416.66197.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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20
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Sarkar R, Roychoudhury P, Kumar S, Dutta S, Konwar N, Subudhi PK, Dutta TK. Rapid detection of Actinobacillus pleuropneumoniae targeting the apxIVA gene for diagnosis of contagious porcine pleuropneumonia in pigs by Polymerase Spiral Reaction. Lett Appl Microbiol 2022; 75:442-449. [PMID: 35616177 DOI: 10.1111/lam.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022]
Abstract
Actinobacillus pleuropneumoniae is the primary etiological agent of contagious porcine pleuropneumonia associated with serious economic impact on pig husbandry worldwide. Diagnosis of the disease by existing techniques including isolation and identification bacteria followed by serotyping, serological techniques, conventional PCR, real-time PCR and LAMP assays are cumbersome, time consuming, costly and not suitable for rapid field application. A novel isothermal polymerase chain reaction (PSR) technique is standardized for all the reagents, incubation time and incubation temperature against A. pleuropneumoniae. Sensitivity of the assay was determined against various dilutions of purified DNA and total bacterial count. Specificity of the assay was determined against 11 closely related bacterial isolates. The relative sensitivity and specificity was compared with bacterial isolation, conventional PCR and real-time PCR assays. The PSR assay for specific detection was standardized at 64o C for 30 minutes incubation in a water bath. The result was visible by the naked eye after centrifugation of the reaction mixture or after incorporation of SYBR Green dye as yellow-green fluorescence. The technique was found to be 100% specific and equally sensitive with real-time PCR and 10 times more sensitive than conventional PCR. The PSR assay could be applicable in detection of the organisms in porcine nasal swabs spiked with A. pleuropneumoniae. This is the first ever report on development of PSR for specific detection of A. pleuropneumoniae and can be applied for early diagnosis at field level.
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Affiliation(s)
- R Sarkar
- Department of Veterinary Microbiology, Central Agricultural University, Selesih, Aizawl, Mizoram-796 014, India
| | - P Roychoudhury
- Department of Veterinary Microbiology, Central Agricultural University, Selesih, Aizawl, Mizoram-796 014, India
| | - S Kumar
- Department of Veterinary Microbiology, Central Agricultural University, Selesih, Aizawl, Mizoram-796 014, India
| | - S Dutta
- Department of Veterinary Microbiology, Central Agricultural University, Selesih, Aizawl, Mizoram-796 014, India
| | - N Konwar
- Department of Veterinary Microbiology, Central Agricultural University, Selesih, Aizawl, Mizoram-796 014, India
| | - P K Subudhi
- Department of Veterinary Microbiology, Central Agricultural University, Selesih, Aizawl, Mizoram-796 014, India
| | - T K Dutta
- Department of Veterinary Microbiology, Central Agricultural University, Selesih, Aizawl, Mizoram-796 014, India
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21
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Nayak PB, Sarkar R, Otrofanowei E, Iniego-Rodas MCA, Konnikov N, Kassir M, Parmar NV, Reizner G. Virtual mentorship in dermatology. Int J Dermatol 2022; 61:895-899. [PMID: 35388484 DOI: 10.1111/ijd.16189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/12/2022] [Accepted: 03/13/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Preethi B Nayak
- Department of Dermatology, Cutis Academy of Cutaneous Sciences, Bengaluru, India
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and Hospital, New Delhi, India
| | - Erere Otrofanowei
- Department of Medicine, College of Medicine, Consultant Physician, University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Nellie Konnikov
- Department of Dermatology, Boston VA Healthcare system, Boston, Massachusetts, USA
| | | | - Nisha V Parmar
- Department of Dermatology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - George Reizner
- Department of Dermatology, University of Wisconsin, Madison, Wisconsin, USA
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22
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Bikash C, Sarkar R, Relhan V, Singh S. Role of Platelet-Rich Plasma Therapy as an Adjuvant in Treatment of Melasma. Dermatol Surg 2022; 48:429-434. [PMID: 35143442 DOI: 10.1097/dss.0000000000003403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The management of melasma is an ongoing challenge. Platelet-rich plasma (PRP) therapy has been reported to be beneficial, but there is paucity of studies on PRP therapy in melasma. OBJECTIVE To compare the efficacy of PRP therapy and hydroquinone versus hydroquinone alone in melasma. MATERIALS AND METHODS Thirty patients were randomized to receive PRP microinjections on one side and normal saline on the other in a total of 3 sittings. Patients were concurrently advised 4% hydroquinone (HQ) cream application on both sides of the face. Efficacy was evaluated with hemi-modified Melasma Area Severity Index (MASI) scoring and a 4-scale patient satisfaction grading. RESULTS Majority of the subjects (53.3%) in PRP + HQ group and 76.7% in HQ group had 25% to 50% improvement in their MASI scores. However, 40% in the PRP + HQ group and only 3.3% in the HQ group had 51% to 75% improvement. The difference in the percentage improvement was statistically significant. There was a greater percentage of subjects reporting a good response among the HQ + PRP group (53.3%) as compared with the HQ group (27%). CONCLUSION Microinjections of PRP combined with topical HQ has better efficacy than topical HQ alone.
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Affiliation(s)
- Chingshubam Bikash
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
| | - Vineet Relhan
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | - Sarika Singh
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
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23
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Nathues A, Hoffmann M, Schmedemann N, Sarkar R, Thangjam G, Mengel K, Hernandez J, Hiesinger H, Pasckert JH. Brine residues and organics in the Urvara basin on Ceres. Nat Commun 2022; 13:927. [PMID: 35194036 PMCID: PMC8863799 DOI: 10.1038/s41467-022-28570-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 01/24/2022] [Indexed: 11/09/2022] Open
Abstract
Ceres is a partially differentiated dwarf planet, as confirmed by NASA's Dawn mission. The Urvara basin (diameter ~170 km) is its third-largest impact feature, enabling insights into the cerean crust. Urvara's geology and mineralogy suggest a potential brine layer at the crust-mantle transition. Here we report new findings that help in understanding the structure and composition of the cerean crust. These results were derived by using the highest-resolution Framing Camera images acquired by Dawn at Ceres. Unexpectedly, we found meter-scale concentrated exposures of bright material (salts) along the crater's upper central ridge, which originate from an enormous depth, possibly from a deep-seated brine or salt reservoir. An extended resurfacing modified the southern floor ~100 Myr after crater formation (~250 Myr), long after the dissipation of the impact-generated heat. In this resurfaced area, one floor scarp shows a granular flow pattern of bright material, showing spectra consistent with the presence of organic material, the first such finding on Ceres beyond the vast Ernutet area. Our results strengthen the hypothesis that Ceres is and has been a geologically active world even in recent epochs, with salts and organic-rich material playing a major role in its evolution.
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Affiliation(s)
- A Nathues
- Max Planck Institute for Solar System Research, Justus-von-Liebig-Weg 3, 37077, Goettingen, Germany.
| | - M Hoffmann
- Max Planck Institute for Solar System Research, Justus-von-Liebig-Weg 3, 37077, Goettingen, Germany
| | - N Schmedemann
- Institut für Planetologie, WWU Münster, Münster, Germany
| | - R Sarkar
- Max Planck Institute for Solar System Research, Justus-von-Liebig-Weg 3, 37077, Goettingen, Germany
| | - G Thangjam
- School of Earth and Planetary Sciences, National Institute of Science Education and Research, NISER, HBNI, Bhubaneswar, India
| | - K Mengel
- Max Planck Institute for Solar System Research, Justus-von-Liebig-Weg 3, 37077, Goettingen, Germany
| | - J Hernandez
- Max Planck Institute for Solar System Research, Justus-von-Liebig-Weg 3, 37077, Goettingen, Germany
| | - H Hiesinger
- Institut für Planetologie, WWU Münster, Münster, Germany
| | - J H Pasckert
- Institut für Planetologie, WWU Münster, Münster, Germany
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24
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Sarkar R, Verschoore M, Gupta M. Women leadership in dermatology: Moving towards gender equality. Indian Dermatol Online J 2022; 13:3-9. [PMID: 35198461 PMCID: PMC8809162 DOI: 10.4103/idoj.idoj_652_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/10/2021] [Accepted: 12/09/2021] [Indexed: 11/04/2022] Open
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25
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Sarkar R, Yadav J, Soni S, Mendiratta V. Psoriatic lesions over keloidal plaques after intralesional triamcinolone. Indian Dermatol Online J 2022; 13:519-520. [PMID: 36262588 PMCID: PMC9574141 DOI: 10.4103/idoj.idoj_570_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/10/2021] [Accepted: 11/04/2021] [Indexed: 12/02/2022] Open
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26
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Otrofanowei E, Anaba E, Akinkugbe A, Adeife-Cole O, Ayanlowo O, Ikebudu V, Sarkar R. Knowledge and use of sunscreens among traders at an urban market in Lagos, Nigeria. Pigment Int 2022. [DOI: 10.4103/pigmentinternational.pigmentinternational_39_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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27
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Grover C, Jindal R, Sarkar R, Gupta L. IADVL academy position statement on emerging dermatoses in India: Monkeypox. Indian Dermatol Online J 2022; 13:559-569. [PMID: 36304649 PMCID: PMC9595165 DOI: 10.4103/idoj.idoj_437_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 11/23/2022] Open
Abstract
As we were on the road to recovery from the coronavirus disease-19 (COVID-19) pandemic, the world is waking up to yet another potential adversary. Monkeypox (or human monkeypox) caused by monkeypox virus (an orthopox virus) is fast emerging in more than 80 countries worldwide, where it has never been historically reported. We in India, have already seen the advent of this outbreak since July 2022, with a progressive rise in number of cases being seen. Though the virus is not a novel virus; it is presenting with atypical manifestations as compared to our conventional knowledge of the disease. Through this document, the Indian Association of Dermatologists, Venereologists, and Leprologists Academy aims to sensitize dermatologists toward recognizing the clinical features and responding promptly, to contain the outbreak at the earliest. In view of the non-availability of specific antiviral drugs as well as vaccines; early detection, isolation, and prevention of spread form the mainstay of our approach towards the outbreak, which has been declared to be a “Public Health Emergency of International Concern” by the World Health Organization.
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28
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Narang I, Das A, Sarkar R. Mentorship in Dermatology-A Beginner's Guide. Indian Dermatol Online J 2021; 12:907-911. [PMID: 34934732 PMCID: PMC8653712 DOI: 10.4103/idoj.idoj_293_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 11/04/2022] Open
Abstract
Mentoring albeit is a recently described and popular phenomenon in medicine, is not a new one. All medical specialties have a complex, intertwined relationship between their physicians and trainees who are in different stages of their careers. How a specialty evolves depends on the thread woven by these relationships. This article outlines the concept of mentorship and introduces its various aspects in dermatology. This article attempts to answer what, why, how, when, and where related to mentoring in dermatology, including e-mentorship. The article also includes personal reflections of the authors who are involved in this process.
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Affiliation(s)
- Isha Narang
- Department of Dermatology, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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29
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Bansal A, Sarkar R. Women in Dermatology Leadership: Results from a Nationwide Survey. Indian Dermatol Online J 2021; 12:834-840. [PMID: 34934718 PMCID: PMC8653714 DOI: 10.4103/idoj.idoj_279_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Significant progress has been made in the representation of women at various fronts in dermatology. Nonetheless, women fall far behind their male counterparts when it comes to leadership roles as indicated by recent research data. Materials and Methods: This was a cross-sectional study amongst 180 dermatologists. Anonymous surveys were sent to 300 dermatologists across India, in March 2021, consisting of 14 questions, discussed and made by the two authors, the senior author having held leadership positions in dermatology. Results: Amongst the 180 respondents, 79% were female, and 21% were male. Significant attrition of women dermatologists in academic institutions, with increasing experience in the field was observed. A higher percentage of men had been in a leadership position as compared to women. (P > .05). The majority of the female respondents agreed that women had to struggle more than men to be accepted as leaders. (P < 0.05) Most women reduced their working hours to cater to household responsibilities, and almost 70% of the women agreed to having experienced burnout as a result of low job satisfaction or an absence of work-life balance (P < 0.05). More women agreed to having faced discrimination at the workplace (P < 0.05). Conclusion: Gender-based gaps in dermatology leadership still exist with regard to the number of women occupying higher academic ranks. Possible solutions include gender sensitization, creating a room for equivalent leadership opportunities, mentorship and family support, which may help tip the balance in favor of gender parity in dermatology.
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Affiliation(s)
- Anuva Bansal
- Department of Dermatology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
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Datta D, Sarkar R, Podder I. Parental Stress and Quality of Life in Chronic Childhood Dermatoses: A Review. J Clin Aesthet Dermatol 2021; 14:S19-S23. [PMID: 34980963 PMCID: PMC8562944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Chronic dermatoses, such as atopic dermatitis, vitiligo, and psoriasis, can affect children. Apart from impacting the pediatric patient's quality of life, these disorders can also have a profound impact on the quality of life of their parents or closest caregivers and other family members. In an effort to better understand the relationship between parental stress and chronic dermatoses in children, we reviewed the available literature, which is scarce. Data indicate that the negative impact that chronic dermasoses in children can have on their parents is often overlooked during dermatologic consultation. Increased parental/caregiver stress can contribute to poor psychological adjustment of the parent to the child, potentially leading to a decreased level of childcare. Financial burden caused by prolonged therapy may further impact the parental care of the child. We as healthcare professionals should address parental and caregiver stress and incorporate appropriate measures to ensure optimal care of children with chronic dermatoses.
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Affiliation(s)
- Debatri Datta
- Dr. Datta is a consultant dermatologist at Oliva Skin Clinic, in Kolkata, West Bengal, India
- Dr. Sarkar is with the Department of Dermatology, LHMC and associated KSCH and SSK Hospital in New Delhi, India
- Dr. Podder is with the Department of Dermatology, College of Medicine and Sagore Dutta Hospital in Kolkata, West Bengal, India
| | - Rashmi Sarkar
- Dr. Datta is a consultant dermatologist at Oliva Skin Clinic, in Kolkata, West Bengal, India
- Dr. Sarkar is with the Department of Dermatology, LHMC and associated KSCH and SSK Hospital in New Delhi, India
- Dr. Podder is with the Department of Dermatology, College of Medicine and Sagore Dutta Hospital in Kolkata, West Bengal, India
| | - Indrashis Podder
- Dr. Datta is a consultant dermatologist at Oliva Skin Clinic, in Kolkata, West Bengal, India
- Dr. Sarkar is with the Department of Dermatology, LHMC and associated KSCH and SSK Hospital in New Delhi, India
- Dr. Podder is with the Department of Dermatology, College of Medicine and Sagore Dutta Hospital in Kolkata, West Bengal, India
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Ahmed ZH, Agarwal K, Sarkar R. Hand Dermatitis: A Comprehensive Review with Special Emphasis on COVID-19 Pandemic. Indian J Dermatol 2021; 66:508-519. [PMID: 35068506 PMCID: PMC8751728 DOI: 10.4103/ijd.ijd_281_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hand dermatitis (HD) is a chronic, relapsing, and remitting inflammatory condition that adversely affects the quality of life of the individual and gravely impacts the mental and socioeconomic well-being by causing professional hindrance and often leading to loss of wages. Despite being one of the most common skin conditions seen by dermatologists, it is often underreported. With the coronavirus pandemic ongoing, there is an emphasis on hand hygiene-being a widely publicized and important preventive measure to control the spread of the Coronavirus disease (COVID-19) virus. Emphasis on hand hygiene has led to a surge in HD, and the presence of HD, in turn, leads to compromised hand hygiene practices and this breach in the skin barrier contributes to another portal of entry of infective agents. We undertook a comprehensive English literature search across multiple databases such as PubMed, SCOPUS, EMBASE, MEDLINE, and Cochrane using keywords and MeSH items to obtain and review several relevant articles. Thus, this review focuses on various clinical, diagnostic as well as therapeutic aspects of this much prevalent and debilitating skin condition which deserves more attention especially during the times of the COVID-19 pandemic where the utmost emphasis is being given to handwashing leading to a vicious cycle of a surge in the cases of HD and compromised skin barrier causing increased susceptibility to the COVID-19 infection.
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Affiliation(s)
- Ziaul Haque Ahmed
- From the Department of Dermatology, Assam Medical College, Dibrugarh, Assam, India
| | - Komal Agarwal
- Department of Dermatology, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and Hospital, New Delhi, India
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Sarkar R, Bhargava S, Mendiratta V. Virology and Etiopathogenesis of COVID-19 with Special Reference to Cutaneous Implications. Indian J Dermatol 2021; 66:231-236. [PMID: 34446945 PMCID: PMC8375542 DOI: 10.4103/ijd.ijd_467_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Severe Acute Respiratory Virus Corona Virus 2 (SARS-CoV-2) has got its name Corona from Latin meaning “crown.” It has crown-like spikes present on the surface, which encloses the RNA, genetic material of this deadly virus. The virus attacks pneumocytes after binding with the angiotensin-converting enzyme 2 (ACE2) of the cell surface, which ultimately leads to chemotaxis followed by leukocyte infiltration, increased permeability of blood vessels and alveolar walls, and decreased surfactant in the lung leading to various symptoms. Skin provides a window to the internal changes of the body and also to mechanisms that are not readily visible. Commonly observed skin manifestations include vesicular lesions, maculopapular exanthema, urticarial eruptions, livedo or necrosis, and other forms of vasculitis, chilblain-like lesions. The skin lesions are attributed to either the virus directly affecting the skin or interferon dysregulation due to viral RNA or vascular involvement associated with alteration in coagulation or drug-induced skin manifestations. Observation of skin involvement and the vasculature due to SARS-CoV-2 illustrates the need for a precise stratification and differential diagnostic valuation so that the mechanisms of this novel virus are clearer for better management of the condition in the future. Vascular skin lesions are not seen in all the patients of COVID, but certain lesions should definitely alarm us to evaluate for coagulation abnormalities, complement levels, and skin biopsy, especially in critically ill patients. This review attempts to outline the pathogen briefly and the pathomechanism behind the development of various cutaneous manifestations.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and Associated KSCH and SSK Hospital, New Delhi, India
| | - Shashank Bhargava
- Department of Dermatology, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India
| | - Vibhu Mendiratta
- Department of Dermatology, Lady Hardinge Medical College and Associated KSCH and SSK Hospital, New Delhi, India
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Agarwal K, Podder I, Sarkar R. Pigmented transverse nasal band: A review. Indian J Dermatol Venereol Leprol 2021; 88:144-147. [PMID: 34379951 DOI: 10.25259/ijdvl_820_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/01/2021] [Indexed: 11/04/2022]
Abstract
Pigmented transverse nasal band/groove is an asymptomatic benign condition, characterized by the development of erythematous to hyperpigmented, well-demarcated, transverse groove at the junction of middle and lower two-third of the nasal dorsum. Although the pathogenesis is unclear, embryologic origin seems to be the most plausible hypothesis. This condition is often associated other related dermatological conditions such as milia, comedones, seborrheic dermatitis and atopic dermatitis. Diagnosis is mostly clinical, while reassurance is the mainstay of therapy. In persistent cases, topical retinoids have been used. In this article, we have reviewed the different aspects of this condition including treatment, along with the recent updates to create awareness about this dermatological entity.
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Affiliation(s)
- Komal Agarwal
- Department of Dermatology, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India
| | - Indrashis Podder
- Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and Hospitals, New Delhi, India
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Gupta M, Barman KD, Sarkar R. A Comparative Study of Microneedling Alone Versus Along with Platelet-Rich Plasma in Acne Scars. J Cutan Aesthet Surg 2021; 14:64-71. [PMID: 34084010 PMCID: PMC8149985 DOI: 10.4103/jcas.jcas_190_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Context: There are several modalities of treating acne scars. The combination of microneedling and platelet-rich plasma (PRP) is a synergistic approach to treat acne scars. Aims: The aim was to compare the efficacy of microneedling alone versus microneedling with PRP in acne scars. Materials and Methods: This was a split face study conducted on 36 patients with acne scars who underwent four sessions of microneedling with PRP on right side and microneedling alone on left side at monthly interval. The total scars with subtypes and Ecchelle D’Evaluation Cliniques des Cicatrices D’Acne (ECCA) score were assessed at baseline and second, fourth, and sixth visits. Visual analog score (VAS) was evaluated by both physicians and patients. Statistical Analysis: The statistical analysis was carried out using Statistical Package for Social Sciences. Paired-t test and Wilcoxon signed rank test were used to compare the results. Results: Mean age was 23.7±3.2 years with 17 male and 19 female patients. The mean total scars on right and left sides declined from 42.14±21.15 to 25.08±14.14 and 43.28+23.08 to 27.17±15.68, respectively, with insignificant differences (P-value = 0.094). ECCA score on right and left sides declined from 88.31±32.78 to 62.92±23.68 and 89.58±32.43 to 66.25±23.89, respectively (P-value = 0.058). VAS evaluated by patient and physician showed maximum improvement at second and third visits, respectively. Conclusions: This study showed no added advantage of topical application of PRP over microneedling in acne scars.
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Affiliation(s)
- Meghna Gupta
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | - Krishna Deb Barman
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
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Pollock S, Taylor S, Oyerinde O, Nurmohamed S, Dlova N, Sarkar R, Galadari H, Manela-Azulay M, Chung HS, Handog E, Kourosh AS. The dark side of skin lightening: An international collaboration and review of a public health issue affecting dermatology. Int J Womens Dermatol 2021; 7:158-164. [PMID: 33937483 PMCID: PMC8072511 DOI: 10.1016/j.ijwd.2020.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 11/07/2022] Open
Abstract
Skin lightening (SL) for cosmetic reasons is associated with profound negative impacts on well-being and adverse effects on the skin, resulting in immense challenges for dermatologists. Despite current regulations, lightening agents continue to dominate the cosmetic industry. In this review, our international team of dermatologists tackles the topic of SL as a global public health issue, one of great concern for both women's health and racial implications. We have examined SL in Africa, Asia, the Middle East, and the Americas. We aim to inspire a global discourse on how modern dermatologists can utilize scientific evidence and cultural competency to serve and protect patients of diverse skin types and backgrounds. In doing so, we hope to promote healthy skin and inclusive concepts of beauty in our patients and society.
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Affiliation(s)
- Samara Pollock
- Massachusetts General Hospital, Department of Dermatology, Boston, MA, United States
- Boston University School of Medicine, Boston, MA, United States
| | - Susan Taylor
- Perelman School of Medicine Department of Dermatology, Philadelphia, PA
| | - Oyetewa Oyerinde
- Massachusetts General Hospital, Department of Dermatology, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | | | - Ncoza Dlova
- University of KwaZulu Natal, Dermatology Department, South Africa
| | - Rashmi Sarkar
- Lady Hardinge Medical College and Hospital, New Delhi, India
| | - Hassan Galadari
- United Arab Emirates University, Department of Dermatology, Dubai, United Arab Emirates
| | | | - Hae Shin Chung
- Yonsei University College of Medicine, Seoul, South Korea
| | - Evangeline Handog
- Perelman School of Medicine Department of Dermatology, Philadelphia, PA
- Asian Hospital and Medical Center, Department of Dermatology, Philippines
| | - A. Shadi Kourosh
- Massachusetts General Hospital, Department of Dermatology, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Kalita A, Talukdar M, Sarma K, Kalita PC, Barman NN, Roychoudhury P, Kalita G, Choudhary OP, Doley PJ, Debroy S, Keneisenuo K, Sarkar R. Lymphocyte subsets in the small intestine of piglets fed with probiotic and zinc: a qualitative and quantitative micro-anatomical study. Folia Morphol (Warsz) 2021; 81:82-90. [PMID: 33438190 DOI: 10.5603/fm.a2020.0148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Piglet mortality is a real concern to the pig farmers. The major cause is due to the late maturation of the immune system and dietary changes in post-weaned piglets. The potential role of probiotic and zinc in the stimulation of the immune system is well established. Hence, the present study was undertaken to evaluate alterations of T and B cells in the small intestine after dietary inclusion of probiotic and zinc in pre and post-weaned piglets. MATERIALS AND METHODS A total of 18 healthy LWY piglets, irrespective of sex obtained from 3 litters at the age-group of 20, 30 and 60 days. They were divided into a control group fed with basal diet and a treatment group fed with probiotic and zinc supplement along with the basal diet, consisting of three animals in each group. The piglets were weaned at 28 days of age. After sacrificing the animals at day 20, 30 and 60 from both the groups, the abdominal cavity was opened and small intestinal tissue samples were collected, processed and stained by indirect immunofluorescence technique. The slides were evaluated under the fluorescent light microscope. The data were statistically analyzed. RESULTS The different T and B cell subsets were recorded in the lining epithelium, core of villus, crypt area of LP and PP area. The number of CD4+, CD8+, IgA+ and IgM+ cells was higher in the treated piglets than the control group of animals, irrespective of segments of intestine and age-group. CONCLUSIONS It can be concluded that the dietary supplementation of probiotic and zinc was found to be good additives as they can stimulate the immune response in piglets, especially during the critical early post-weaning period.
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Affiliation(s)
- A Kalita
- Departemtn of Veterinary Anatomy and Histology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), 796015 Selesih, Aizawl, Mizoram, India
| | - M Talukdar
- Department of Veterinary Anatomy and Histology, College of Veterinary Science, Assam Agricultural University, Khanapara, 781022 Guwahati, Assam, India
| | - K Sarma
- Department of Veterinary Anatomy and Histology, College of Veterinary Science, Assam Agricultural University, Khanapara, 781022 Guwahati, Assam, India
| | - P C Kalita
- Departemtn of Veterinary Anatomy and Histology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), 796015 Selesih, Aizawl, Mizoram, India
| | - N N Barman
- Department of Veterinary Microbiology, College of Veterinary Science, Assam Agricultural University, Khanapara,, 781022 Guwahati, Assam, India
| | - P Roychoudhury
- Department of Veterinary Microbiology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), 796015 Aizawl, Mizoram, India
| | - G Kalita
- Department of Livestock Production and Management, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), 796015 Aizawl, Mizoram, India
| | - O P Choudhary
- Departemtn of Veterinary Anatomy and Histology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), 796015 Selesih, Aizawl, Mizoram, India.
| | - P J Doley
- Departemtn of Veterinary Anatomy and Histology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), 796015 Selesih, Aizawl, Mizoram, India
| | - S Debroy
- Departemtn of Veterinary Anatomy and Histology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), 796015 Selesih, Aizawl, Mizoram, India
| | - K Keneisenuo
- Departemtn of Veterinary Anatomy and Histology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), 796015 Selesih, Aizawl, Mizoram, India
| | - R Sarkar
- Departemtn of Veterinary Anatomy and Histology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), 796015 Selesih, Aizawl, Mizoram, India
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Sarkar R, Verma S, Sahoo B. Study of contact sensitivity to cosmetic allergens in melasma. Pigment Int 2021. [DOI: 10.4103/pigmentinternational.pigmentinternational_50_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Devadasan S, Sarkar R, Barman KD, Kaushik S. Role of Serum Melatonin and Oxidative Stress in Childhood Atopic Dermatitis: A Prospective Study. Indian Dermatol Online J 2020; 11:925-929. [PMID: 33344341 PMCID: PMC7734999 DOI: 10.4103/idoj.idoj_77_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/03/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Many factors have been implicated in the pathogenesis of atopic dermatitis (AD) and recently the role of oxidative damage has been postulated. Objectives: To study the levels of oxidants and antioxidants including melatonin in the blood of children with AD and their association with the severity of AD. Methods: Thirty patients with atopic dermatitis, aged 6 months to 12 years, and equal number of age and sex-matched controls were included. Clinical characteristics and baseline severity assessment using SCORAD (scoring atopic dermatitis) severity index were noted. Blood superoxide dismutase, blood glutathione peroxidase, serum malondialdehyde, and serum melatonin levels were measured in cases and controls and results were compared. Results: The serum levels of malondialdehyde and melatonin were significantly higher among the cases compared to controls. The blood levels of superoxide dismutase and glutathione peroxidase were higher in cases but the difference with controls was not statistically significant. There was no significant correlation between these markers and the severity of the disease. Conclusions: Oxidative stress was increased in cases of childhood AD compared to the control group in this study. No correlation between oxidative stress and the severity of the disease was found. Larger studies are warranted.
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Affiliation(s)
- Shanthy Devadasan
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | - Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | - Krishna Deb Barman
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | - Smita Kaushik
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
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Bhargava S, Sarkar R. Impact of COVID-19 Pandemic on Dermatology Practice in India. Indian Dermatol Online J 2020; 11:712-719. [PMID: 33235835 PMCID: PMC7678512 DOI: 10.4103/idoj.idoj_240_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/02/2020] [Accepted: 07/22/2020] [Indexed: 11/22/2022] Open
Abstract
Background: COVID-19 pandemic has disrupted healthcare systems throughout the globe. It has affected dermatology practice to a great extent. Since most of the consultations (except emergencies) in dermatology are deferred as a precautionary measure, dermatologists have taken the route of virtual appointments in order to continue treating patients in the present lockdown state. However, the concept of telemedicine is quite new for doctors as well as for patients in India. Material and Methods: An online questionnaire was circulated among Indian dermatologists which included participant demographics, changes in their practice and teaching during COVID-19, use of virtual or e-health technologies, and attitudes/opinions on their experiences. We also wanted to understand doctor perspectives on their own roles, wellness, and hospital responses to the pandemic. Results: A total of 260 responses from qualified dermatologists of different parts of India were received between 1st and 8th April 2020 and were analyzed. Two-thirds of the respondents were within 10 years of starting practice. Virtual consultations have increased by almost three-fold during the pandemic, which is a major change noticed in the practice when we compare before and during the pandemic. Earlier the focus of teledermatology (TD) was mainly for follow-up care (85%), whereas during the pandemic, both new and follow-up patients were provided virtual consultations. The number of patients coming to them for a consultation has drastically reduced. Only 2% of the responders are still performing minor procedures with proper care. Almost two-thirds do not have systems in place to train their residents and fellows due to the disruptions caused by the pandemic. The rest of them have started to take the virtual route of teaching through webinars, virtual rounds, and providing access to online journals to continue their teaching. Only 18.6% of dermatologists at work were provided with personal protective equipment. TD has opened new doors to virtual consultation and it was evident that 54.4% of doctors are willing to continue it in the future even after the pandemic is over. Conclusion: TD platforms hold great promise to improve access to high-quality dermatologic care in the future. Results from this survey of Indian dermatologists suggest that TD is the future of dermatology as it will be accessed by patients in remote areas and it is a cost-effective move for the patients.
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Affiliation(s)
- Shashank Bhargava
- Department of Dermatology, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
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Abstract
Rosacea is a relatively common inflammatory dermatosis in persons with fair skin. It is uncommonly reported in people with skin of color (darker skin tone; Fitzpatrick skin types IV, V or VI). Apart from reduced incidence, underreporting due to decreased awareness might also be a probable explanation. Rosacea commonly presents with telangiectasias and persistent facial erythema on the sun-exposed parts, which can be distressing to the patient and affect the quality of life. The diagnosis is made clinically, in the absence of any confirmatory investigation. Several treatment modalities have been employed to date with varying results. Light-based therapies should be used cautiously in the colored skin to avoid distressing pigmentation. This article focuses on the pathogenesis, clinical features, treatment recommendations and other aspects of this uncommon disorder along with a review of the literature.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | - Indrashis Podder
- Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Soumya Jagadeesan
- Department of Dermatology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Ballani I, Sarkar R. Newer injection points for facial contouring with hyaluronic acid filler-Case Report. J Cosmet Dermatol 2020; 20:67-70. [PMID: 32949082 DOI: 10.1111/jocd.13726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/19/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hyaluronic fillers have been used for filling in folds and contour the face according to global aesthetic standards to achieve a smooth ogee curve on the face. But sometimes these result in a bulkier look to the face thus preventing more people from opting for these procedures. Although M.D codes have now been given to guide the injecting physicians for various points of injections on the face, they need to be used judiciously and tailored to individuals, using the lateral points of the face first. AIMS Patients still come to physicians to get the midface and nasolabial folds corrected but a proper aesthetic evaluation is essential and it was observed that targeting the peripheral points of the face leads to better tightening of the face and a slimmer look for the patient. A case was injected on peripheral points including some newer points not mentioned in the M.D codes. These points are on the forehead along the hairline and the mastoid process. Safety and efficacy of injecting on these particular points were evaluated. METHODS 2-ml hyaluronic acid syringes (20 mg conc) were used to give bolus injections on the peripheral points of the face, including a new point on mastoid process and peripheral points on forehead. RESULTS A good aesthetic outcome was achieved resulting in slimming of face with patient satisfaction and without any complications. CONCLUSION A good nonsurgical contouring of a young face can be achieved with 2 ml hyaluronic acid injection when the correct points are injected.
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Affiliation(s)
- Indu Ballani
- Dermatology, BLK Memorial Hospital, New Delhi, India.,Private Clinic, Ballani Skin Aesthetics, New Delhi, India
| | - Rashmi Sarkar
- Department of Dermatology, LHMC and Associated KSCH and SSK Hospital, New Delhi, India
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Sarkar R, Bhargava S, Chander R, Rathod D, Singh AK. Webinars as a mode of e-discussion by Indian dermatologists during the COVID-19 era: A boon or a bane? Dermatol Ther 2020; 33:e14220. [PMID: 32820852 PMCID: PMC7461185 DOI: 10.1111/dth.14220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
| | - Shashank Bhargava
- Department of Dermatology, R. D. Gardi Medical College, Ujjain, India
| | - Ram Chander
- Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
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Bhargava S, Sarkar R, Kroumpouzos G. Mental distress in dermatologists during COVID-19 pandemic: Assessment and risk factors in a global, cross-sectional study. Dermatol Ther 2020; 33:e14161. [PMID: 32770716 PMCID: PMC7435490 DOI: 10.1111/dth.14161] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 01/16/2023]
Abstract
There is a sparsity of data regarding the mental health status of dermatologists during COVID-19 pandemic. Evaluate the effects of pandemic on mental health of dermatologists on a large scale and identify risk factors for mental distress. 733 dermatologists were included in this cross-sectional, web-based survey. Mental distress was reported by 77.2% of responders. Considerable percentages of participants experienced stress (73.9%), irritation (33.7%), insomnia (30%), or depression (27.6%), and 78.6% were overwhelmed with the amount of pandemic information they were receiving. Mental distress was significantly associated with practice years, volume of patients seen per week before pandemic, personal protective equipment availability at hospital (P = .001 for each), practice location (continent; P < .001), and participant's assessment that the healthcare system was not equipped for the pandemic (P = .003). Stress was associated with hospital service (P = .003), and depression with being overwhelmed with the amount of pandemic information received (P = .004). In a logistic model, teledermatology use was the most powerful predictor of mental distress (OR, 1.57 [95% CI, 1.07-2.32]). Mental distress was common among dermatologists during this pandemic. Teledermatology use was the most powerful predictor of mental distress. Preventative strategies and psychosocial interventions should be implemented.
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Affiliation(s)
- Shashank Bhargava
- Department of Dermatology, R.D. Gardi Medical College, Ujjain, India
| | - Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.,GK Dermatology PC, Weymouth, Massachusetts, USA
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Sarkar R, Vartak S, Acharya S, Kursam NK, Mane A, Mehta S, Charugulla SN. Comparative Study to Evaluate Tolerability of Topical 5% Minoxidil Novel Formulation and Alcohol-Based Conventional Solutions in Treatment of Androgenetic Alopecia in Indian Men: Randomized Double-Blind Study. Dermatol Ther (Heidelb) 2020; 10:469-479. [PMID: 32277388 PMCID: PMC7211774 DOI: 10.1007/s13555-020-00374-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Patients with androgenetic alopecia treated with alcohol-based minoxidil topical solutions often report local irritation, dryness, and redness of the scalp. We evaluate the in-use tolerance of 5% minoxidil novel formulation topical solution-test product (TP)-compared with 5% minoxidil alcohol-based topical solutions-reference product 1 (RP1) and reference product 2 (RP2)-in Indian men with androgenetic alopecia. METHODS In this randomized double-blind study, patients aged ≥ 18 years with androgenetic alopecia were randomized 1:1:1 to apply TP, RP1, and RP2 twice daily for 30 days. The safety endpoints included mean hydration, mean redness, and mean scaling on scalp. RESULTS All screened patients (N = 100) were enrolled and randomized to TP (n = 33), RP1 (n = 33), or RP2 (n = 34). At day 30, the mean (SD) hydration was significantly increased in patients treated with TP [9.74 (4.98)] but significantly reduced in patients treated with RP1 [3.28 (2.67)] or RP2 [3.03 (1.57)] (p-value 0.001). The mean (SD) score for redness was significantly decreased in the TP group [0.01 (0.04)], (p-value, 0.009) at day 30 compared with baseline, while no change was observed in the RP1 [0.08 (0.13)] or RP2 [0.11 (0.17)] group. After 30 days of treatment, no significant difference was observed in the mean score of scaling in any of the three groups. CONCLUSIONS Twice daily application of 5% minoxidil novel formulation for 30 days significantly improved hydration and reduced redness of the scalp. Hence, 5% minoxidil novel formulation could be a safer alternative in treating men with androgenetic alopecia who are sensitive to alcoholic formulations. TRIAL REGISTRATION Clinical Trial Registry of India; CTRI/2018/11/016431.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | | | - Shivani Acharya
- Dr. Reddy's Laboratories Pvt Ltd, Ameerpet, Hyderabad, India
| | | | - Amey Mane
- Dr. Reddy's Laboratories Pvt Ltd, Ameerpet, Hyderabad, India
| | - Suyog Mehta
- Dr. Reddy's Laboratories Pvt Ltd, Ameerpet, Hyderabad, India
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Sarkar R, Vartak S, Acharya S, Kursam NK, Mane A, Mehta S, Charugulla SN. Correction to: Comparative Study to Evaluate Tolerability of Topical 5% Minoxidil Novel Formulation and Alcohol-Based Conventional Solutions in Treatment of Androgenetic Alopecia in Indian Men: Randomized Double-Blind Study. Dermatol Ther (Heidelb) 2020; 10:481. [DOI: 10.1007/s13555-020-00381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Marsili F, Travaglini M, Stinco G, Manzoni R, Tiberio R, Prignano F, Mazzotta A, Cannavò SP, Cuccia A, Germino M, Bongiorno MR, Persechino S, Florio T, Pettinato M, Tabanelli M, Sarkar R, Aloisi E, Bartezaghi M, Orsenigo R. Effectiveness of cyclosporine A in patients with moderate to severe plaque psoriasis in a real-life clinical setting in Italy: the TRANSITION study. J DERMATOL TREAT 2020; 33:401-407. [PMID: 32349568 DOI: 10.1080/09546634.2020.1757017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Cyclosporine A (CsA) is one of the systemic therapeutic options for moderate-to-severe psoriasis, based on its efficacy and rapidity of action. The current study investigated the response to CsA in patients with moderate-to-severe plaque psoriasis.Materials and Methods: TRANSITION was an observational, cross-sectional, multicentre study which evaluated the proportion of partial- and suboptimal-responders among patients with moderate-to-severe plaque psoriasis treated with continuous CsA for ≥12 weeks. Patients demonstrating a Psoriasis Area and Severity Index (PASI) response of ≥90, ≥75 and <90, ≥50 and <75 and <50 were defined as responders, suboptimal-responders, partial-responders, and non-responders, respectively.Results: A total of 196 patients (mean age, 46.6 years; 62.8% males) from 14 sites in Italy were evaluated. At the study visit, the mean (SD) PASI score was 4.2(5.5) compared with 15.3(7.1) prior to the last CsA cycle. For response categories, 39.8%, 22.4%, 16.8%, and 20.9% of patients were responders, suboptimal-responders, partial-responders, and non-responders to CsA treatment. Overall, 28.6% of patients permanently discontinued treatment with CsA (lack of efficacy [10.2%], poor tolerability and voluntary discontinuation [3.6% each], and other [11.7%]).Conclusion: Patients were only partially satisfied with CsA treatment, reporting measurable impact on quality of life. Only 40% patients showed a satisfactory response to CsA.
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Affiliation(s)
- F Marsili
- Unit of Dermatology, Versilia Hospital, Lido di Camaiore, Lucca, Italy
| | - M Travaglini
- Centro per la cura della Psoriasi, Hospital "Di Summa-Perrino", Brindisi, Italy
| | - G Stinco
- Institute of Dermatology, Department of Medicine, University Hospital, Udine, Italy
| | - R Manzoni
- Division of Dermatology, Azienda Sanitaria Locale of Biella, Ponderano, Italy
| | - R Tiberio
- SCDU Dermatology, AOU Maggiore della Carità, Novara, Italy
| | - F Prignano
- Department of Health Science Dermatology Unit, University of Florence, Firenze, Italy
| | - A Mazzotta
- Dermatology Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - S P Cannavò
- Dermatology Unit, University Hospital Policlinico "G. Martino", Messina, Italy
| | - A Cuccia
- Unit of Dermatology, San Donato Hospital, Arezzo, Italy
| | - M Germino
- Department of Dermatology, Hospital Policlinico Città di Udine, Udine, Italy
| | - M R Bongiorno
- Dermatology Unit, University Hospital Policlinico "P. Giaccone", Palermo, Italy
| | - S Persechino
- Dermatology Unit, NESMOS Department, S. Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - T Florio
- Dermatology Unit, Hospital Di Venere-Carbonara di Bari, Bari, Italy
| | - M Pettinato
- Dermatology Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - M Tabanelli
- U.O.C. Dermatologia Ravenna AUSL Romagna, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - R Sarkar
- Novartis Pharma AG, Basel, Switzerland
| | - E Aloisi
- Novartis Farma SpA, Origgio, Italy
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Sarkar R, Devadasan S, Choubey V, Goswami B. Melatonin and oxidative stress in melasma - an unexplored territory; a prospective study. Int J Dermatol 2020; 59:572-575. [PMID: 32141063 DOI: 10.1111/ijd.14827] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/09/2019] [Accepted: 01/29/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Melasma, an acquired disorder of hyperpigmentation, is the most common pigmentary disorder in India. Many factors are implicated in the pathogenesis, and recently the role of oxidative damage including melatonin has been postulated. This study was undertaken to evaluate the role of oxidative stress and serum melatonin in pathogenesis of melasma. METHODS Seventy-five patients with melasma and an equal number of age and sex-matched controls were included in the study. Clinical characteristics were noted, and baseline severity assessment using modified Melasma Area and Severity Index (MASI) was done in all patients. Serum melatonin, catalase, protein carbonyl, and nitric oxide levels were measured and compared between cases and controls. RESULTS The serum levels of melatonin and catalase were significantly lower among the cases as compared to controls, while the serum levels of protein carbonyl and nitric oxide were significantly higher in cases compared to controls. There was no statistically significant correlation between these markers of oxidative stress and severity of the disease. CONCLUSIONS Oxidative stress is increased in patients with melasma compared to the control group in this study. A state of melatonin deficit also exists in patients with melasma. No correlation between the oxidative stress and severity of the disease was found. Further and larger studies including therapeutic trials with powerful antioxidants are warranted.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | - Shanthy Devadasan
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | - Vikrant Choubey
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | - Binita Goswami
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
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Kumaran M, Hanumanthu V, Ashraf R, Sarkar R. Staff and clinic protection during COVID pandemic. Pigment Int 2020. [DOI: 10.4103/pigmentinternational.pigmentinternational_75_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sarkar R, Swarnkar B. Neonatal and infantile erythroderma revisited. Indian J Paediatr Dermatol 2020. [DOI: 10.4103/ijpd.ijpd_93_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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