Background:Melasma is a common cause of facial hyperpigmentation with significant cosmetic deformity. Although several treatment modalities are available, none is satisfactory.Aim:To compare the therapeutic efficacy and safety of tranexamic acid (TA) microinjections versus tranexamic acid with microneedling in melasma.Materials and Methods:This is a prospective, randomised, open-label study with a sample size of 60; 30 in each treatment arms. Thirty patients were administered with localised microinjections of TA in one arm, and other 30 with TA with microneedling. The procedure was done at monthly intervals (0, 4 and 8 weeks) and followed up for three consecutive months. Clinical images were taken at each visit including modified Melasma Area Severity Index MASI scoring, patient global assessment and physician global assessment to assess the clinical response.Results:In the microinjection group, there was 35.72% improvement in the MASI score compared to 44.41% in the microneedling group, at the end of third follow-up visit. Six patients (26.09%) in the microinjections group, as compared to 12 patients (41.38%) in the microneedling group, showed more than 50% improvement. However, there were no major adverse events observed in both the treatment groups.Conclusions:On the basis of these results, TA can be used as potentially a new, effective, safe and promising therapeutic agent in melasma. The medication is easily available and affordable. Better therapeutic response to treatment in the microneedling group could be attributed to the deeper and uniform delivery of the medication through microchannels created by microneedling.

Background:Hair restoration surgery (HRS) is a very promising and sought after aesthetic procedure with very few complications. Complications may occur in the donor or the recipient area, and it may be due to surgical or idiopathic causes.Aim:The aim was to analyze the complications in male patients who underwent HRS for androgenetic alopecia (AGA).Materials and Methods:We conducted a retrospective analysis of male patients who underwent HRS for AGA from December 2010 to August 2014. Data were collected from the registers, telephonic enquiry and electronic mails. All complications during and after surgery, and their subjective feeling about hair growth was recorded.Results:Seventy-three patients were included in the analysis. A total of 65 patients had undergone follicular unit transplant, 7 patients underwent FUE, and one patient had body hair transplantation. Postoperative edema was found in 42.47% of patients, followed by sterile folliculitis in 23.29% of patients, wide donor scar in 15.07% of patients, bacterial folliculitis and numbness/paresthesia in 10.96% of patients. Other complications such as raised scar, hiccups, pruritus, excessive bleeding were found in isolated cases.Conclusion:Thorough preoperative evaluation, skillful surgical techniques, good communication and postoperative follow-up go a long way in giving satisfactory outcome with fewer complications in HRS.

Onychomycosis, traditionally referred as a non-dermatophytic infection of the nail, is now used as a general term to denote any fungal nail infection. It is an important public health problem due to its increasing incidence and has significant clinical consequences in addition to serving as a reservoir of infection. We report a case of Onychomycosis in all 10 fingers of an immunocompetent male with no co-morbid conditions caused by a non-dermatophytic fungus, Aspergillus niger. To the best of our knowledge, this is the first case of its kind to be reported.

Background: Vitiligo is an acquired, idiopathic, and common depigmentation disorder. The values of various epidemiologic parameters are often doubtful due to the methodological weaknesses of the studies. Aims: To elicit the magnitude of various epidemiological parameters and important correlates of vitiligo. Materials and Methods: Every vitiligo patient attending the outpatient department of medical colleges spread over most of the Indian states were examined over a period of 1 year. Various epidemiological and clinical variables were examined and compared with age and sex-matched controls (registered in the Clinical Trial Registry of India CTRI/2017/06/008854). Results: A total of 4,43,275 patients were assessed in 30 medical colleges from 21 Indian states. Institutional prevalence of vitiligo was 0.89% (0.86% in males and 0.93% in females, P < 0.001). The mean age at presentation and mean age at onset were 30.12 ± 17.97 years and 25.14 ± 7.48 years, respectively. Head–neck was the most common primary site ( n = 1648, 41.6%) and most commonly affected site ( n = 2186, 55.17%). Most cases had nonsegmental vitiligo ( n = 2690, 67.89%). The disease started before 20 years of age in more than 46% of cases. About 77% of all cases had signs of instability during the last 1 year. The family history, consanguinity, hypothyroid disorders, and depressed mood were significantly ( P < 0.001) higher among the cases. First, second, and third-degree family members were affected in 269 (60.04%), 111 (24.78%), and 68 (15.18%) cases, respectively. Work-related exposure to chemicals was significantly higher among cases ( P < 0.008). Obesity was less common among vitiligo cases [ P < 0.001, odds ratio (OR) 0.78, 95% confidence interval (CI): 0.71–0.86]. Conclusion: This is one of the largest studies done on vitiligo in India. The prevalence of vitiligo was found to be 0.89% among hospital attendees. Prevalence of vitiligo was higher among females than in males and prevalence of family history, consanguinity, hypothyroid disorders were higher in vitiligo than among controls.

This case report examined the natural course of reaction after accidental intramuscular administration of high dose Bacille Calmette-Guιrin (BCG) vaccine into the anterolateral aspect of thigh of a pre-term infant as a part of routine vaccination instead of intra-dermal injection into the arm. There is no consensus on the best management of this complication, although in this case healing was prolonged but was spontaneous without anti-tubercular chemotherapy.

Background:Primary focal axillary hyperhidrosis is a chronic distressing disorder affecting both the sexes. When the condition is refractory to conservative management, we should go for more promising therapies like intradermal botulinum toxin A (BtxA) injections in the axilla, and surgical therapies like subcutaneous curettage of sweat glands.Aims and Objectives:The aim of this study is to compare the efficacy, safety and duration of action of intradermal BtxA injections in one axilla and subcutaneous curettage of sweat glands in the other axilla of the same patient with axillary hyperhidrosis.Materials and Methods:Twenty patients (40 axillae) received intradermal BtxA injections on the right side (20 axillae) and underwent tumescent subcutaneous curettage of sweat glands on the left side (20 axillae). Sweat production rate was measured using gravimetry analyses at baseline and at 3 months after the procedure. Subjective analyses were done using hyperhidrosis disease severity scale (HDSS) score at baseline, at 3rd and 6th month after the procedure.Results:At 3 months post-treatment, the resting sweat rate in the toxin group improved by 80.32% versus 79.79% in the subcutaneous curettage method (P = 0.21). Exercise-induced sweat rate in the toxin group improved by 88.76% versus 88.8% in the subcutaneous curettage group (P = 0.9). There was a significant difference in the HDSS score after treatment with both the modalities. There were no adverse events with BtxA treatment compared to very minor adverse events with the surgical method.Conclusion:Both intradermal BtxA injections and tumescent subcutaneous curettage of sweat glands had a significant decrease in the sweat rates with no significant difference between the two modalities. Hence, in resource poor settings where affordability of BtxA injection is a constraint, subcutaneous curettage of sweat glands can be preferred which has been found equally effective with no or minimal adverse events.

Introduction and Objectives:The restoration of the epithelium after injury takes place by migration of epithelial cells adjoining a wound or by centrifugal migration from hair follicles. To evaluate the feasibility and potential healing capacity of scalp follicular unit grafts transplanted into the wound bed of chronic leg ulcers.Materials and Methods:Patients with chronic nonhealing ulcers of more than 6 weeks duration were selected for the study. Those with infected ulcers and uncontrolled diabetes were excluded from the study. Fifteen patients were included in the study. Follicular unit grafts were harvested under local anesthesia using small-diameter (1 mm) circular punches. A density of 5 follicular grafts/cm2 was implanted into the ulcer bed. The ulcer was dressed with Vaseline gauze and elastic bandage for 24 h. The wound area and volume were calculated by length × width × 0.7854 and length × width × depth × 0.7854, respectively. The treatment outcome was defined as the percentage in change of area and volume of the ulcer, 18 weeks after intervention.Results:A total of 15 patients with 17 ulcers were treated with the above method. Of these 17 ulcers, 11 were venous ulcers, 2 were pyoderma gangrenosum associated with varicose veins, 2 were traumatic ulcers, and 2 were trophic ulcers. The baseline mean area of the ulcer was 6.72 cm2 (SD 5.65) and baseline volume was 2.87 cm3 (SD 2.9). The final area of the ulcer at the end of 18 weeks after the procedure was 3.84 cm2 (SD 5.43) and the final volume was 1.21 cm3 (SD 2.45), which was statistically significant. The mean percentage improvement in the area and volume of the ulcer was 48.8% and 71.98%, respectively. Two patients did not respond to the treatment. There were no adverse events after the procedure.Conclusion:We conclude that follicular unit grafting into wound beds is feasible and represents a promising therapeutic alternative for managing nonhealing chronic leg ulcers.

Introduction:Flap surgeries are an excellent choice for closing large defects following trauma, excision of carcinomas or removal of large lesions. This article is a prospective interventional study of various flap surgeries performed at a tertiary care centre with their outcome in dermatosurgical unit.Materials and Methods:A total of 35 flap surgeries performed from January 2012 to December 2014 formed part of the study. Data were recorded for each case including age, sex, indications and type of flap surgery and any occurrence of complications.Results:Out of the 35 patients, basal cell carcinoma was the most common indication for surgery in 22 patients, followed by Bowen's disease in five, dermatofibroma in three and porocarcinoma in two. Other indications were squamous cell carcinoma, tuberous xanthoma, myxoid cyst and nevus sebaceous. Rhomboid flap and rotaion flap were done in 12 patients each, V-Y plasty in three patients, advancement flap, crescentic advancement flap and O-Z plasty were done in two patients each, O-Z plasty was done in two patients, A-T plasty and H plasty were done in one patient each. Common complications observed were flap necrosis seen in three patients and one patient developed hematoma on the second post-operative day, hypertrophic scar in one case and recurrence of BCC.Conclusion:Malignant and pre-malignant lesions were common indications in our study. Excellent outcome of flap surgeries promises to be a birdie stroke in the armamentarium of dermatosurgeons.