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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 5 | Issue 2
Page Nos. 75-122

Online since Monday, December 16, 2019

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REVIEW ARTICLE  

Review of oral anticholinergics in the treatment of palmoplantar hyperhidrosis Highly accessed article p. 75
Swetalina Pradhan, Bhushan Madke, Chandra Sekhar Sirka
DOI:10.4103/ijdd.ijdd_40_18  
Hyperhidrosis (HH) is the excessive production of sweating, which can be primary and focal or secondary. The most commonly affected sites are the armpits, palms, soles, and face. It causes much discomfort and affects self-esteem and quality of life. Many treatment options have been proposed, both medical and surgical. Several recent studies have documented the effectiveness of oral anticholinergics in both focal and generalized HH regardless of age, gender, and weight. This article is an attempt to update the current status of oral anticholinergics in the treatment of palmoplantar HH.
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ORIGINAL ARTICLES Top

Real-world experience on the effectiveness and tolerability of apremilast in patients with plaque psoriasis in India p. 83
Shrichand Parasramani, Jayakar Thomas, Leelavathy Budamakuntla, Dhiraj Dhoot, Hanmant Barkate
DOI:10.4103/ijdd.ijdd_16_19  
Introduction: Apremilast, a phosphodiesterase-4 inhibitor, has been recently approved for the management of plaque psoriasis in India in 2017. However, no real-world experience pertaining to apremilast has been documented. Materials and Methods: A retrospective review of medical records was conducted of all patients across India who were prescribed apremilast for an entire 16 weeks. The primary endpoint was the percentage of patients achieving the Psoriasis Area and Severity Index (PASI) 75 at 16 weeks. The secondary endpoints were as follows: (i) change in mean PASI; (ii) change in mean body surface area (BSA); (iii) percentage of patients who achieved PASI 50, 90, and 100; and (iv) adverse events (AEs) reported. Results: We analyzed the records of 105 patients. Mean age was 41 years and mean disease duration was 6.75 years. All the patients had previously received some forms of systemic treatment. Forty-three patients (41%) achieved ≥ PASI 75 of which four patients (3.8%) and five patients (4.76%) achieved PASI 100 and PASI 90, respectively at week 16. Moreover, 28 patients (26.7%) demonstrated PASI 50 response. Baseline mean PASI score of 14.78 reduced to 4.5 (−69.55%), whereas mean BSA score of 24.4 reduced to 8.24 (−66.3%). Nine patients discontinued apremilast due to adverse effects. Thirty-five patients (33.3%) had one or more AEs, diarrhea being the most common (30.5%) followed by nausea (20.3%). Most AEs were mild to moderate in severity. Conclusion: These results, from a real-world setting in India, confirm the effectiveness and tolerability of apremilast as seen in clinical trials.
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Assessment of cutaneous adverse drug reactions in a tertiary care hospital p. 89
Juny Sebastian, Madhan Ramesh, Chanchal Anandhy Mahin, Linda Jose, Vijayalaxmi Nagappa Sirasgi, Adhirai Raveendran
DOI:10.4103/ijdd.ijdd_6_18  
Introduction: Cutaneous adverse drug reactions (CADRs) are one of the significant clinical problems not only in dermatology practice but also in any areas where drug is involved. Aim: The aim of this study was to determine the incidence, pattern, predictors, and direct cost associated with the management of CADRs. Methodology: It was a prospective, observational study which involved both spontaneous reporting and intensive monitoring. Study patients were followed throughout their hospital stay. Where a CADR was detected, all the required data were collected and analyzed. Bivariate regression analysis was used to determine the predictors of CADRs. Results: The incidence of CADRs was 25.01%. Drug classes most commonly implicated in CADRs were antibiotics (29.055%), nonsteroidal anti-inflammatory drugs (17.31%), antineoplastic drugs (11.17%), and antitubercular drugs (10.05%). Majority (66.48%) of the reactions were “probable” in their causality category. Serious CADRs accounted for 1.67%. There was a significant association between the occurrence of CADRs and the use of ≥2 medications, adult patients, and male gender. The total and average costs incurred in the management of CADRs were INR 61,116/- and 734/-, respectively. Conclusion: Among the study population, adults, male gender, and patients receiving ≥2 medications and patients who presented with ≥2 comorbidities were identified as the predictors for the development of CADRs. Hence, it is important to monitor closely the patients with the identified risk factors for the CADRs to minimize the complications associated with the CADRs.
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Assessment of knowledge and attitude towards sun exposure and photoprotection measures among Indian patients attending dermatology clinic p. 94
Vivek Kumar Dey
DOI:10.4103/ijdd.ijdd_19_19  
Background: Many skin diseases are known to be either initiated or aggravated by excessive ultraviolet (UV) exposure. High cumulative levels of UV radiation may lead to tanning, burning, photoaging, photoallergic and phototoxic reactions, immunosuppression, and even skin cancers. Many international studies have found that the level of knowledge, attitudes, and practices of the general public toward sun exposure and sun protection measures is good in the Western countries, especially in countries with high incidence of skin cancers compared to Asian countries and Middle East. In India, the incidence of skin cancer is not very high, but UV exposure has definitely increased in the past few decades. Little is known about the knowledge and attitude of Indians toward sun exposure and sun protection due to the paucity of research in this arena. Aims and Objectives: This study was aimed at exploring the knowledge and attitudes of Indians toward sun exposure and sun protection measures. Materials and Methods: A cross-sectional survey was conducted using a predesigned questionnaire related to the knowledge, behavior, and attitudes toward sun exposure and sun protection of the participants visiting a dermatology outpatient clinic for various dermatological problems. Results: total of 324 patients were studied. Participants were divided into five age groups of equal number of male and female participants. Mean age was 37.7 ± 13.15. Overall awareness and knowledge was poor and only 14% were using regular sunscreen. Females had better knowledge and attitude toward sun exposure and protection. The most commonly used sun protection measure was avoiding sun during peak hours of the day. Conclusion: The level of knowledge regarding sun exposure hazards was very low among the study population, and sun prevention behaviors were also very poor. Regular use of sunscreen was practiced only by a small fraction of our population. Knowledge of sun exposure and photoprotection was better in urban, young participants, female gender, and also positively associated with higher education and socioeconomic status. Participants from urban background, females, and middle-aged participants had better attitude toward photoprotection.
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BRIEF REPORT Top

Comparison of effectiveness of oral tranexamic acid with that of the topical modified Kligman's formula in the treatment of melasma p. 100
Aditi Bansal, Vidyadhar R Sardesai
DOI:10.4103/ijdd.ijdd_52_19  
Context: Melasma is an acquired disorder of hyperpigmentation presenting over the face. Modified Kligman's formula is used most commonly as treatment modality. Considering the various side effects of individual components of topical modified Kligman's formula, the use of oral tranexamic acid might be a better and safer alternative for the treatment of melasma. Aims: This study aims to compare the efficacy of oral tranexamic acid with that of topical modified Kligman's formula in the treatment of melasma. To assess the degree of improvement in pigmentation objectively using Melasma Area and Severity Index at baseline and after 4 weeks of treatment with oral tranexamic acid and topical modified Kligman's formula and to compare the side effects, if any, associated with both the modalities. Settings and Design: This was randomized, comparative, prospective, open-labeled study. Methods: This study was done in a tertiary care hospital from September 2018 to June 2019. Overall, 40 patients with clinical diagnosis of melasma were included in the study. Statistical Analysis Used: Paired t-test and unpaired t-test. Results: Improvement was noted in patients belonging to both the groups. After applying paired t-test, it was found that results were statistically significant in both the treatment groups. When both the groups were compared statistically using unpaired t-test, both the groups showed statistically equivalent results. Conclusions: Both oral tranexamic acid and modified Kligman's formula were equally effective in the treatment of melasma. Oral tranexamic acid is a better and safer alternative than the modified Kligman's formula to initiate the treatment in melasma.
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CASE REPORTS Top

Inverse psoriasis with pityriasis amiantacea treated successfully with dapsone p. 104
Snehal Balavant Lunge, Manjunathswamy Basavapurad Swamy, Ashiwini Shivashankar Tatawati
DOI:10.4103/ijdd.ijdd_26_19  
Inverse psoriasis, also known as intertriginous psoriasis, presents itself as erythematous plaques with poor or nondesquamation in skin flexion folds. Inverse psoriasis is a rare form of psoriasis associated with pityriasis amiantacea. This condition affects the intertriginous areas, making it difficult to diagnose and treat. Here, we report a case with lesions in the intertriginous area with pityriasis amiantacea in a patient of achondroplasia, who showed improvement with dapsone.
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D-penicillamine-induced elastosis perforans serpiginosa in a case of Wilson's disease p. 107
Shefali Saini, Vidya D Kharkar, Aabha Nagral
DOI:10.4103/ijdd.ijdd_53_19  
The use of D-penicillamine has been well established in various disorders, mainly Wilson's disease, cystinuria, and rheumatoid arthritis. Elastosis perforans serpiginosa (EPS) is a rare perforating dermatosis, occurring as an uncommon sequel of long-term high-dose D-penicillamine therapy. We present a rare case of EPS in a known case of Wilson's Disease on D-penicillamine therapy. Biopsy revealed characteristic “lumpy-bumpy” elastic fibers, a finding specific to penicillamine-induced EPS.
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LETTERS TO EDITOR Top

Good response to metronidazole in a case of erosive genital lichen planus p. 110
Vidya Kharkar, Anuja Sunkwad
DOI:10.4103/ijdd.ijdd_46_19  
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Severe cutaneous adverse reaction after oral rechallenge test in a patient with fixed drug eruption due to doxycycline p. 112
Satyendra Kumar Singh, Ayushi Bohara
DOI:10.4103/ijdd.ijdd_20_19  
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Solitary keratoacanthoma resolved after a single intralesional 5-fluorouracil therapy p. 113
Amita Mhatre, Hari Shivaram Pathave
DOI:10.4103/ijdd.ijdd_32_19  
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A curious case of development of verruca vulgaris over the site of autoimplantation: Subsequently treated with measles, mumps and rubella vaccine p. 115
Alpana Mohta, Umesh Gautam, Ramesh Kumar Kushwaha, Suresh Kumar Jain
DOI:10.4103/ijdd.ijdd_47_19  
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VIVA VOCE Top

Secukinumab in psoriasis p. 118
Col Manas Chatterjee, Sushil Pande
DOI:10.4103/ijdd.ijdd_62_19  
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WHAT’S IN NEWS Top

News from regulatory corner: Safety communication and recent drug approvals p. 121
Manasi Shirolikar
DOI:10.4103/ijdd.ijdd_65_19  
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