Background:prolonged isotretinoin therapy for various skin diseases causes change in various parameters of lipid profile. Aim: to find out the effect of low dose isotretinoin on various parameters of lipid profile.Methods:A clinic based observational study with 60 patients of various skin diseases carried out in a skin outpatient department of a tertiary care hospital in eastern India. Patients were prescribed isotretinoin for relevant indications. Baseline lipid profile was checked and repeated after three months. The results were compared with the baseline lipid levels.Result:Out of 60 patients (male-32, female-28) hyperlipidemia was present in 25% (15 out of 60) patients at the end of three month's therapy. Among the hyperlipidemia, hyper triglyceridemia was the commonest (16.67%, 10 out of 60 patients) followed by elevation of VLDL (11.67%, 7 out of 60 patients), elevation of LDL (10%, 6 out of 60), hypercholesterolemia (5%, 3 out of 60). Combination of hyperlipidemia was present in 11.67% patients. Among the male patients 28.12%, while in females 21.43% had hyperlipidemia at the end of the study. Among the hyperlipidemic females, hypertriglyceridemia was present in 83.3% (5 out of 6) of patients, while in male it was 55.5% (5 out of 9 patients).Conclusion:Low dose Isotretinoin therapy causes variable rise in various parameters of lipid profile. It should be used cautiously in patient with risk factors of metabolic syndrome and frequent monitoring of serum lipid profile is needed.
Introduction: Pyogenic granulomas are benign vascular lesions of the skin and mucosa which are often a source of concern because of their recurrent bleeding even with minimal trauma. Current treatment for pyogenic granuloma is ablative; no medical therapy is standardized to date. Timolol, due to its vasoconstrictive effect, vascular growth factor inhibition and apoptosis promotion properties, is a potential therapeutic option. Objectives: To assess the effectiveness and safety of topical timolol in the treatment of pyogenic granulomas. Methods: A two-centre, double-blind and placebo-controlled trial (Registration CTRI/2019/04/018581) was conducted. Patients of either sex were recruited with pyogenic granuloma lesions of less than eight weeks duration. Topical treatment with 0.5% timolol or matching glycerin placebo was continued for six weeks. Changes in color, size, bleeding tendency, physicians’ and patients’ global assessments and adverse events were assessed. Results: Forty subjects were randomized between the two groups which were comparable in age, sex, duration of illness and baseline lesion size.Significant improvement was noted with timolol, with color change from first follow-up onwards and lesion size reduction from second follow-up onward. Patients’ assessment of bleeding tendency also showed imrovement from the second visit onward. Between-group comparison showed significant difference with respect to percentage reduction in size (timolol 40.9%, placebo 3.4%; P = 0.002). Rescue treatment (electrosurgery) was required in five patients on placebo and in one in the timolol group (P = 0.182). Complete resolution occurred in 2 (10%) patients with timolol and in no patients on placebo (P = 0.231). Limitations: We observed effects of treatment for only six weeks. Conclusion: Topical timolol may be a treatment option for early pyogenic granulomas but complete resolution is unlikely in six weeks. Studies of longer duration are required to assess resolution and recurrence rates.
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