Summary We are facing an onslaught of chronic and recurrent dermatophytosis in epidemic proportions never encountered previously. There is a dearth of studies assessing the quality of life (QoL) and psychological morbidity in patients with superficial dermatophytosis. Our aim was to assess QoL and psychological morbidity in a sample of Indian patients suffering from dermatophytosis by using Dermatology Life Quality Index (DLQI) questionnaire and General Health Questionnaire (GHQ), respectively. This was a single‐centre, cross‐sectional study where consecutive patients of first episode, chronic or recurrent dermatophytosis were invited to participate. In addition to DLQI and GHQ12, patients' demographic data, duration and symptoms of dermatophyte infection, were also documented and recorded in the case record form. We recruited 196 patients who satisfied the inclusion criteria. The mean total DLQI score was 13.41 ± 7.56 (range 0‐30). The main items in the questionnaire influenced by the disease were “symptoms and feelings,” followed by “daily activities,” “leisure” and “personal relationships.” Age of the patient and body surface area involved had a significant impact on the QoL in our study (P ≤ 0.05). The mean GHQ‐12 score was 16.98; 84.9% of patients had a score higher than or equal to 12 indicating significant psychological distress. GHQ‐12 was found to have significant correlation with the DLQI score. Quality of life issues and psychosocial aspect should be considered while managing dermatophytosis as education about the disease, its management and prognosis may go a long way in improving the adherence to treatment and overall outcome in these patients.
Tranexamic acid (TXA), a plasmin inhibitor, is an antifibrinolytic drug widely used to prevent and treat hemorrhage. We evaluated the effects of oral TXA clinically and immunohistopathologically in patients of refractory melasma. To evaluate the efficacy of oral TXA in patients with refractory melasma and correlate histopathological and immunohistochemical changes in pretreatment and post‐treatment skin biopsies in patients willing to undergo biopsy. Thirty patients with refractory melasma were treated with oral TXA 500 mg twice daily along with a sunscreen and followed up. Modified MASI score (MMASI) and melasma quality of life (MELASQOL) were noted at baseline and after treatment. In patients willing to undergo skin biopsy, a 2 mm punch biopsy was obtained for histopathology and immunohistochemistry examination both before and after treatment with TXA. Clinical, histopathological, and immunohistochemical parameters were compared and correlated. Clinical improvement in melasma correlated in a perfect linear relationship with quality of life, decrease in epidermal pigmentation and decrease in Melan A staining on immunohistochemistry. Based on our observations, TXA can be said to have an inhibitory action on melanin synthesis and melanocyte proliferation. Future studies are required to further characterize the effects of TXA on the histopathology and immunohistochemistry of melasma, to standardize dosing schedule, duration of treatment and long term outcome, of which there are no definitive guidelines at present.
Background: Robust evidence for the efficacy of rituximab monotherapy in pemphigus is lacking. The effects of rituximab on T-regulatory cells (Tregs) in pemphigus have not been studied. Objective: The primary objective was to assess the efficacy of rituximab monotherapy in severe pemphigus vulgaris. The secondary objectives were to assess whether counts of different subsets of Tregs in the peripheral blood correlate with baseline clinical severity and whether clinical response in severe pemphigus is associated with an alteration in the Treg count. Methods: Eighteen eligible subjects with severe pemphigus vulgaris were recruited and were treated with 1 g of intravenous rituximab on days 0 and 15. Efficacy was assessed in terms of disease control, time to disease control, complete remission off therapy, and relapse. Flow cytometric analysis of CD4+CD25+FoxP3, IL-10-secreting Tr1, and TGF-β secreting Th3 regulatory cells was performed. Clinical evaluation and flow cytometric analysis of Tregs was performed periodically until follow-up at 26 weeks. Results: Rituximab monotherapy was able to induce complete remission in all but 5 (68.75%) patients and was well tolerated. No direct relationship between clinical severity and CD4+CD25+FoxP3 cell counts was found. There were inverse correlations between serially measured values of the cutaneous and mucosal Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Th3 cell count. Conclusion: Rituximab is a safe and effective monotherapy option for severe pemphigus. As the immunological findings were somewhat different from those observed in other autoimmune conditions treated with rituximab, further studies are required to substantiate the findings of our study in pemphigus patients.
Furthermore, (Fig. 1b) when PASI % clearance scores are calculated, we show that initial responders at 3-6 months i.e. PASI 75/90/100 were 89.3%, 77.7% and 52.4%, respectively, and 96.5%, 82.4% and 57.6%, respectively, at 12 months (available data up to 3 years). Our data compare favourably with Bissonnette et al., 4 although the two cohorts are again quite different. There is evidence that biologic naive responders may have better drug survivals than biologic experienced responders. 6 In our analyses, [Fig. 1c] demonstrates that the survival curves practically overlap and do not show this putative difference. Some caution must be exercised in this interpretation, as our cohort is not large. In conclusion, our analyses of real-world Secukinumab drug survival and PASI data for patients with moderate to severe psoriasis provide evidence that the drug achieves high PASI clearance with some sustainability of response. No difference in Secukinumab drug survival between biologic naive versus biologic experienced patients was detected but larger studies are required. In future, we need to answer the highly relevant questions about whether patients on long-term treatment with biologics and PASI 90/100 responses can safely stop their treatments, and if relapse does occur, whether restarting treatment with the same biologic will be as effective. The cost implications (savings) of these 'supervised treatment stoppages' to the NHS would be massive.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.