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RESIDENT’S PAGE
Guidelines for writing a research project synopsis or protocol
Jayadev Betkerur
November-December 2008, 74(6):687-690
DOI:10.4103/0378-6323.45136  PMID:19172017
  245,421 1,493 1
REVIEW ARTICLES
Glutathione as a skin whitening agent: Facts, myths, evidence and controversies
Sidharth Sonthalia, Deepashree Daulatabad, Rashmi Sarkar
May-June 2016, 82(3):262-272
DOI:10.4103/0378-6323.179088  PMID:27088927
Glutathione is a low molecular weight thiol-tripeptide that plays a prominent role in maintaining intracellular redox balance. In addition to its remarkable antioxidant properties, the discovery of its antimelanogenic properties has led to its promotion as a skin-lightening agent. It is widely used for this indication in some ethnic populations. However, there is a dichotomy between evidence to support its efficacy and safety. The hype around its depigmentary properties may be a marketing gimmick of pharma-cosmeceutical companies. This review focuses on the various aspects of glutathione: its metabolism, mechanism of action and the scientific evidence to evaluate its efficacy as a systemic skin-lightening agent. Glutathione is present intracellularly in its reduced form and plays an important role in various physiological functions. Its skin-lightening effects result from direct as well as indirect inhibition of the tyrosinase enzyme and switching from eumelanin to phaeomelanin production. It is available in oral, parenteral and topical forms. Although the use of intravenous glutathione injections is popular, there is no evidence to prove its efficacy. In fact, the adverse effects caused by intravenous glutathione have led the Food and Drug Administration of Philippines to issue a public warning condemning its use for off-label indications such as skin lightening. Currently, there are three randomized controlled trials that support the skin-lightening effect and good safety profile of topical and oral glutathione. However, key questions such as the duration of treatment, longevity of skin-lightening effect and maintenance protocols remain unanswered. More randomized, double-blind, placebo-controlled trials with larger sample size, long-term follow-up and well-defined efficacy outcomes are warranted to establish the relevance of this molecule in disorders of hyperpigmentation and skin lightening.
  195,804 1,846 -
LETTER TO EDITOR
Foreign body in the vagina of a 3½-year-old child: Sexual abuse or a childish prank?
L Padmavathy, N Ethirajan, L Lakshmana Rao
March-April 2004, 70(2):118-119
PMID:17642584
  101,112 412 -
STUDIES
Efficacy of desonide 0.05% cream and lotion in steroid-responsive dermatoses in Indian patients: A post-marketing surveillance study
Dimple A Bhankharia, Percy H Sanjana
September-October 2004, 70(5):288-291
PMID:17642640
BACKGROUND: Desonide, a non-halogenated, low-potency topical steroid, is indicated in the treatment of steroid-responsive dermatoses. AIMS: A post-marketing surveillance study was conducted to evaluate the efficacy and safety of DesowenTM (Desonide 0.05%) cream and lotion in Indian patients for the treatment of steroid-responsive dermatoses of mild to moderate severity. METHODS: A 3-week, multicenter, open-label, non-comparative Phase IV trial involving 1789 patients from 229 centers across India was conducted between January and August 2003. RESULTS: Of the 1789 patients, 1483 patients completed the treatment as per protocol. At the end of the therapy, 98.5% of the patients showed an improvement in their dermatitis from baseline. More than half of the patients showed a greater than 75% improvement in their signs and symptoms. No adverse effects were noted in any of the patients. Both the lotion and cream were found to be equally effective. CONCLUSIONS: Desonide 0.05% is a safe and effective low-potency corticosteroid for the treatment of mild to moderate dermatoses in Indian patients. No clinically apparent side-effects were observed in infants less than 1 year of age.
  100,316 480 2
DERMATOSURGERY SPECIALS
Disinfection, sterilization and operation theater guidelines for dermatosurgical practitioners in India
Narendra Patwardhan, Uday Kelkar
January-February 2011, 77(1):83-93
DOI:10.4103/0378-6323.74965  PMID:21220895
Modern day dermatologists conduct different esthetic and surgical procedures, with risk of infective complications. Hence, infection control practices need to be established in dermatological practice to minimize the risk of exogenous infections. These practices include hand washing, cleaning, sterilization, disinfection, operation theater sterilization and specifications. Proper hand washing after examination of each patient and prior to any surgery with a formulation containing alcohol alone or as a combination with other agents reduces the chances of transferring infections to and from patients. Sterilization and disinfection constitute the most important aspect of infection control. Disinfectants and disinfecting procedures vary according to the environment and equipment. Proper knowledge of different processes/agents for sterilization and disinfection is essential. Disinfectants for use in hospitals should always be freshly prepared and should be of adequate strength. Sterilization is carried out most commonly using steam sterilizers or ethylene dioxide sterilizers. The waste generated during practice is a potential source of nosocomial infections and should be treated as per the proper protocol and guidelines. Trained staff to carry out these practices is essential.
  98,078 1,120 1
REVIEW ARTICLE
Treatment of keloids and hypertrophic scars
Sharad Mutalik
January-February 2005, 71(1):3-8
DOI:10.4103/0378-6323.13777  PMID:16394352
Clinicians always find it difficult to treat hypertrophic scars and keloids. Various treatment modalities are available. Intralesional corticosteroids, topical applications, cryotherapy, surgery, laser therapy, and silicone sheeting are the widely used options. Radiation therapy can also help in cases of recalcitrant keloids. Most recently, pulsed-dye laser has been successfully used to treat keloids and hypertrophic scars. There are no set guidelines for the treatment of keloids. Treatment has to be individualized depending upon the distribution, size, thickness, and consistency of the lesions and association of inflammation. A combination approach to therapy seems to be the best option.
  95,802 2,602 60
RESIDENT’S PAGE
Tzanck smear: A useful diagnostic tool
Lalit Kumar Gupta, MK Singhi
July-August 2005, 71(4):295-299
DOI:10.4103/0378-6323.16632  PMID:16394449
  93,540 3,876 17
RESIDENTS«SQ» PAGE
Wood's lamp
Lalit Kumar Gupta, MK Singhi
March-April 2004, 70(2):131-135
PMID:17642589
  87,382 2,635 3
REVIEW ARTICLES
Improving adherence to antiretroviral therapy
KC Nischal, Uday Khopkar, DG Saple
September-October 2005, 71(5):316-320
DOI:10.4103/0378-6323.16780  PMID:16394454
Antiretroviral therapy (ART) has transformed HIV infection into a treatable, chronic condition. However, the need to continue treatment for decades rather than years, calls for a long-term perspective of ART. Adherence to the regimen is essential for successful treatment and sustained viral control. Studies have indicated that at least 95% adherence to ART regimens is optimal. It has been demonstrated that a 10% higher level of adherence results in a 21% reduction in disease progression. The various factors affecting success of ART are social aspects like motivation to begin therapy, ability to adhere to therapy, lifestyle pattern, financial support, family support, pros and cons of starting therapy and pharmacological aspects like tolerability of the regimen, availability of the drugs. Also, the regimen's pill burden, dosing frequency, food requirements, convenience, toxicity and drug interaction profile compared with other regimens are to be considered before starting ART. The lack of trust between clinician and patient, active drug and alcohol use, active mental illness (e.g. depression), lack of patient education and inability of patients to identify their medications, lack of reliable access to primary medical care or medication are considered to be predictors of inadequate adherence. Interventions at various levels, viz. patient level, medication level, healthcare level and community level, boost adherence and overall outcome of ART.
  88,257 880 29
Lichenoid tissue reaction/interface dermatitis: Recognition, classification, etiology, and clinicopathological overtones
Virendra N Sehgal, Govind Srivastava, Sonal Sharma, Shruti Sehgal, Prashant Verma
July-August 2011, 77(4):418-430
DOI:10.4103/0378-6323.82389  PMID:21727689
Lichenoid tissue reaction or interface dermatitis embrace several clinical conditions, the prototype of which is lichen planus and its variants, drug induced lichenoid dermatitis, special forms of lichenoid dermatitis, lichenoid dermatitis in lupus erythematosus, and miscellaneous disorders showing lichenoid dermatitis, the salient clinical and histological features of which are described to facilitate their diagnosis. Background of lichenoid reaction pattern has been briefly outlined to enlighten those interested in this entity.
  81,341 1,551 2
FOCUS
Systemic skin whitening/lightening agents: What is the evidence?
Munisamy Malathi, Devinder M Thappa
November-December 2013, 79(6):842-846
DOI:10.4103/0378-6323.120752  PMID:24177629
  77,093 1,251 1
SYMPOSIUM DERMATOPATHOLOGY
Appearances in dermatopathology: The diagnostic and the deceptive
Bhushan Madke, Bhavana Doshi, Uday Khopkar, Atul Dongre
May-June 2013, 79(3):338-348
DOI:10.4103/0378-6323.110769  PMID:23619438
Dermatopathology involves study of the microscopic morphology of skin sections. It mirrors pathophysiologic changes occurring at the microscopic level in the skin and its appendages. Sometimes, we come across certain morphologic features that bear a close resemblance to our physical world. These close resemblances are referred to as "appearances" in parlance to dermatopathology. Sometimes, these "appearances" are unique to a certain skin disorder and thus help us to clinch to a definitive diagnosis (e.g., "tadpole" appearance in syringoma). However, frequently, these appearances are encountered in many other skin conditions and can be therefore be misleading. In this paper, we attempt to enlist such "appearances" commonly found in the dermatopathologic literature and also enumerate their differential diagnoses.
  73,204 3,081 -
REVIEW ARTICLES
Nail changes and disorders among the elderly
Gurcharan Singh, Nayeem Sadath Haneef, Uday A
November-December 2005, 71(6):386-392
DOI:10.4103/0378-6323.18941  PMID:16394478
Nail disorders are frequent among the geriatric population. This is due in part to the impaired circulation and in particular, susceptibility of the senile nail to fungal infections, faulty biomechanics, neoplasms, concurrent dermatological or systemic diseases, and related treatments. With aging, the rate of growth, color, contour, surface, thickness, chemical composition and histology of the nail unit change. Age associated disorders include brittle nails, trachyonychia, onychauxis, pachyonychia, onychogryphosis, onychophosis, onychoclavus, onychocryptosis, onycholysis, infections, infestations, splinter hemorrhages, subungual hematoma, subungual exostosis and malignancies. Awareness of the symptoms, signs and treatment options for these changes and disorders will enable us to assess and manage the conditions involving the nails of this large and growing segment of the population in a better way.
  72,395 1,530 33
SYMPOSIUM-NAILS-PART II
Nail avulsion: Indications and methods (surgical nail avulsion)
Deepika Pandhi, Prashant Verma
May-June 2012, 78(3):299-308
DOI:10.4103/0378-6323.95444  
The nail is a subject of global importance for dermatologists, podiatrists and surgeons. Nail avulsion is a frequently undertaken, yet simple, intriguing procedure. It may either be surgical or chemical, using 40% urea. The former is most often undertaken using the distal approach. Nail avulsion may either be useful for diagnostic purposes like exploration of the nail bed, nail matrix and the nail folds and before contemplating a biopsy on the nail bed or for therapeutic purposes like onychocryptosis, warts, onychomycosis, chronic paronychia, nail tumors, matricectomy and retronychia. The procedure is carried out mostly under local anesthesia with or without epinephrine (1:2,00,000 dilution). Besides the above-mentioned indications, the contraindications and complications of nail avulsion are briefly outlined.
  70,942 756 4
ORIGINAL ARTICLE
A study on the pH of commonly used soaps/cleansers available in the Indian market
Gulrez Tyebkhan
November-December 2001, 67(6):290-291
PMID:17664779
Cleansers, commonly referred to as soaps (though all soaps are cleansers, all cleansers are not soaps), are an important adjuvant in the treatment of any dermatological condition. In order to recommend a cleanser, many aspect should be taken into consideration one important being its pH. pH of a cleanser tends to have an impact on the skin in several ways viz. alteration of bacterial flora and pH, moisture content and irritation. A study was conducted to evaluate the pH of various commonly available soaps/cleansers available in the Indian market. Most of the commonly used soaps have an alkaline pH.
  70,822 38 -
CONTINUING MEDICAL EDUCATION
Treatment of lymphatic filariasis: Current trends
K Anitha, RK Shenoy
March-April 2001, 67(2):60-65
PMID:17664709
  70,819 0 -
RESIDENT’S PAGE
Appearances in clinical dermatology
Bhushan Madke, Bhavana Doshi Chougule, Sumit Kar, Uday Khopkar
September-October 2014, 80(5):432-447
DOI:10.4103/0378-6323.140304  PMID:25201846
  66,542 2,304 -
RECOMMENDATIONS
Standard guidelines of care for chemical peels
Niti Khunger
January 2008, 74(7):5-12
PMID:18688104
Chemical peeling is the application of a chemical agent to the skin, which causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. Indications for chemical peeling include pigmentary disorders, superficial acne scars, ageing skin changes, and benign epidermal growths. Contraindications include patients with active bacterial, viral or fungal infection, tendency to keloid formation, facial dermatitis, taking photosensitizing medications and unrealistic expectations. Physicians' qualifications : The physician performing chemical peeling should have completed postgraduate training in dermatology. The training for chemical peeling may be acquired during post graduation or later at a center that provides education and training in cutaneous surgery or in focused workshops providing such training. The physician should have adequate knowledge of the different peeling agents used, the process of wound healing, the technique as well as the identification and management of complications. Facility : Chemical peeling can be performed safely in any clinic/outpatient day care dermatosurgical facility. Preoperative counseling and Informed consent : A detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and should clearly mention if more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, presentations, and personal discussions. The need for postoperative medical therapy should be emphasized. Superficial peels are considered safe in Indian patients. Medium depth peels should be performed with great caution, especially in dark skinned patients. Deep peels are not recommended for Indian skin. It is essential to do prepeel priming of the patient's skin with sunscreens, hydroquinone and tretinoin for 2-4 weeks. Endpoints in peels: For glycolic acid peels: The peel is neutralized after a predetermined duration of time (usually three minutes). However, if erythema or epidermolysis occurs, seen as grayish white appearance of the epidermis or as small blisters, the peel must be immediately neutralized with 10-15% sodium bicarbonate solution, regardless of the duration of application of the peel. The end-point is frosting for TCA peels, which are neutralized either with a neutralizing agent or cold water, starting from the eyelids and then the entire face. For salicylic acid peels, the end point is the pseudofrost formed when the salicylic acid crystallizes. Generally, 1-3 coats are applied to get an even frost; it is then washed with water after 3-5 minutes, after the burning has subsided. Jessner's solution is applied in 1-3 coats until even frosting is achieved or erythema is seen. Postoperative care includes sunscreens and moisturizers Peels may be repeated weekly, fortnightly or monthly, depending on the type and depth of the peel.
  62,030 3,266 5
REVIEW ARTICLES
Acute skin failure: Concept, causes, consequences and care
Arun C Inamadar, Aparna Palit
November-December 2005, 71(6):379-385
DOI:10.4103/0378-6323.18007  PMID:16394477
Acute skin failure is a state of total dysfunction of the skin resulting from different dermatological conditions. It constitutes a dermatological emergency and requires a multi-disciplinary, intensive care approach. Its effective management is possible only when the underlying pathomechanism of each event is clear to the treating clinician. The concept of skin failure is new to non-dermatologist clinicians and sketchy among many dermatologists. Here the pathomechanism of skin failure has been analyzed and a guideline for monitoring has been provided. There is a need for intensive care units for patients with acute skin failure.
  59,334 4,130 14
SYMPOSIUM-HAIR DISORDERS
Premature graying of hair
Deepika Pandhi, Deepshikha Khanna
September-October 2013, 79(5):641-653
DOI:10.4103/0378-6323.116733  PMID:23974581
Premature graying is an important cause of low self-esteem, often interfering with socio-cultural adjustment. The onset and progression of graying or canities correlate very closely with chronological aging, and occur in varying degrees in all individuals eventually, regardless of gender or race. Premature canities may occur alone as an autosomal dominant condition or in association with various autoimmune or premature aging syndromes. It needs to be differentiated from various genetic hypomelanotic hair disorders. Reduction in melanogenically active melanocytes in the hair bulb of gray anagen hair follicles with resultant pigment loss is central to the pathogenesis of graying. Defective melanosomal transfers to cortical keratinocytes and melanin incontinence due to melanocyte degeneration are also believed to contribute to this. The white color of canities is an optical effect; the reflection of incident light masks the intrinsic pale yellow color of hair keratin. Full range of color from normal to white can be seen both along individual hair and from hair to hair, and admixture of pigmented and white hair is believed to give the appearance of gray. Graying of hair is usually progressive and permanent, but there are occasional reports of spontaneous repigmentation of gray hair. Studies evaluating the association of canities with osteopenia and cardiovascular disease have revealed mixed results. Despite the extensive molecular research being carried out to understand the pathogenesis of canities, there is paucity of effective evidence-based treatment options. Reports of repigmentation of previously white hair following certain inflammatory processes and use of drugs have suggested the possibility of cytokine-induced recruitment of outer sheath melanocytes to the hair bulb and rekindled the hope for finding an effective drug for treatment of premature canities. In the end, camouflage techniques using hair colorants are outlined.
  61,565 1,847 1
REVIEW ARTICLE
Platelet-rich plasma in dermatology: Boon or a bane?
Arshdeep , M Sendhil Kumaran
January-February 2014, 80(1):5-14
DOI:10.4103/0378-6323.125467  
There has been a recent spurt in application of platelet-rich plasma (PRP) in dermatology and aesthetic medicine. However, the details regarding use of PRP in various dermatological indications ranging from hair restoration to chronic ulcers are dispersed in literature, herein we have tried to focus all under one heading. Overall, PRP seems to be a promising therapeutic modality but the level of evidence as of now, from the available published data is low. This review will also stimulate readers to carry out well designed, larger population based trials, so as to validate its use in dermatology practice.
  59,144 4,092 3
SEMINAR
Relationship between nickel allergy and diet
Ashimav Deb Sharma
September-October 2007, 73(5):307-312
DOI:10.4103/0378-6323.35733  PMID:17921609
Nickel is a ubiquitous trace element and it occurs in soil, water, air and of the biosphere. It is mostly used to manufacture stainless steel. Nickel is the commonest cause of metal allergy. Nickel allergy is a chronic and recurring skin problem; females are affected more commonly than males. Nickel allergy may develop at any age. Once developed, it tends to persist life-long. Nickel is present in most of the dietary items and food is considered to be a major source of nickel exposure for the general population. Nickel content in food may vary considerably from place to place due to the difference in nickel content of the soil. However, certain foods are routinely high in nickel content. Nickel in the diet of a nickel-sensitive person can provoke dermatitis. Careful selection of food with relatively low nickel concentration can bring a reduction in the total dietary intake of nickel per day. This can influence the outcome of the disease and can benefit the nickel sensitive patient.
  61,764 1,202 38
REVIEW ARTICLES
Phenomena in dermatology
Bhushan Madke, Bhavana Doshi, Sushil Pande, Uday Khopkar
May-June 2011, 77(3):264-275
DOI:10.4103/0378-6323.79695  PMID:21508564
For a better understanding of various dermatoses, it is imperative for any physician practising dermatology to have a good theoretical knowledge of the underlying pathophysiologic processes involved in various systemic diseases involving the skin. For an easy grasp over this topic, we have discussed the various phenomena under three broad categories, like (a) clinical - Meyerson, Meirowsky, pathergy, Renbok, (b) laboratory - LE cell, prozone and (c) histopathology - Splendore-Hoeppli.
  58,483 3,774 5
Newer and upcoming therapies for melasma
Rashmi Sarkar, Shikha Chugh, Vijay K Garg
July-August 2012, 78(4):417-428
DOI:10.4103/0378-6323.98071  
Melasma is one of the most common and distressing pigmentary disorders presenting to dermatology clinics. The precise cause of melasma remains unknown; however, there are many possible contributing factors. It is notably difficult to treat and has a tendency to relapse. The existing and most tried topical therapy is hydroquinone and the triple combination with tretinoin and corticosteroids, which is considered the gold standard for melasma. Besides that, azelaic acid, kojic acid, arbutin, ascorbic acid, glycolic acid and salicylic peels have also been tried with limited success. However, multiple novel topical agents are being investigated for their potential as hypopigmenting agents with unique mode of action. But, further trials are required to study their efficacy and safety before they can be further recommended. The article highlights these newer formulations and also briefly mentions about the newer chemical peels and the much hyped lasers in treating this difficult and frustrating condition.
  59,032 2,496 4
RESIDENT’S PAGE
"Pseudo" conditions in dermatology: Need to know both real and unreal
Mohan H Kudur, Manjunath Hulmani
November-December 2012, 78(6):763-773
DOI:10.4103/0378-6323.102387  PMID:23075655
There are 'n' number of names and terminologies in dermatology. The real and unreal names lead to lot of confusion to the residents and practitioners of dermatology. The word 'pseudo' means 'unreal', 'false' or 'fake', and it has deep roots in dermatology providing herculean task to differentiate and understand the real conditions/diseases/signs in dermatology. We have made an attempt to list and describe the pseudo and associated real conditions in dermatology.
  58,454 2,526 -
Online since 15th March '04
Published by Wolters Kluwer - Medknow