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.

No abstract

considerable costs. [1] The prevalence of leg ulcers is well documented to be vary between 0.18% and 1%. [2] The three major causes of lower extremity ulcers are venous, arterial, and neuropathic. Chronic nonhealing ulcers lack the necessary growth factors (GFs) and hence do not heal well. Conventional recombinant GF products, including becaplermin (recombinant platelet-derived GF) have been approved by the Food and Drug Administration for the treatment of chronic wounds. However, the medication is in a liquid form, and, therefore, easily dissipates following wound application. In addition, it is expensive and is unaffordable in developing countries such as India. [3] Platelet-rich plasma (PRP) enhances wound healing through promotion of the healing process by the presence

No abstract

Background:Scars over the face are cosmetically and psychologically disturbing. Various techniques have been described and are being practiced in the management of these scars.Aims and Objectives:This study was undertaken to study the safety, effectiveness of using dermal grafts as fillers in the management of facial scars due to acne, chickenpox, trauma or any others.Materials and Methods:Fifteen patients with atrophic facial scars of varied aetiology and willing for surgery were considered for dermal graft technique. After pre-operative workup, subcision was done 2 weeks before planned surgery. Depending on the type of scar, grafts were inserted using pocket or road railing techniques. Scar improvement was assessed based on patient satisfaction.Results:Linear scars showed excellent improvement. Acne, varicella and traumatic scars also showed good improvement. However, two patients did not appreciate improvement due to marked surface irregularities as the scars were elevated. They were further subjected to LASER and chemical peel resurfacing.Conclusion:Dermal grafting can be used in the management of any round to oval facial scar which is soft, prominent and at least 4–5 mm across; linear scars at least 2–3 mm across and 3–4 cm in length. However, scars with prominent surface irregularities need further resurfacing techniques along with dermal grafting.Limitations:Limitations of the study include small sample size, and only subjective assessment of the scar has been taken into consideration to assess the outcome.

No abstract

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.

Context:Therapeutic wounding includes wounding the skin to induce pigmentation of the depigmented skin patches that was earlier used for repigmenting small patches of stable vitiligo. In this study, we have used the same principle to induce pigmentation in idiopathic guttate hypomelanosis (IGH) by spot peel with 88% phenol.Aims:To study the efficacy of phenol in causing repigmentation in IGH and its adverse effect profile.Settings and Design:Open prospective study.Materials and Methods:Twenty patients with 139 IGH macules were subjected to spot peel. Eighty-eight percent phenol was applied with an ear bud once a month for two sittings. Patients were assessed both subjectively and objectively after every session and at the end of 3 months of initiation of therapy.Results:Repigmentation was noted in 64% of IGH macules. More than 75% improvement was seen in 45% of the total IGH macules, while 41.5% showed 50-75% improvement at the end of three months. Persistent scabbing was the common adverse effect noted in 17.26% of lesions.Conclusion:Spot peel with 88% phenol is a safe, simple, cost-effective, outpatient procedure for IGH, which can be combined with other medical therapies.