Leishmaniasis is endemic in the Indian subcontinent with predominance of visceral leishmaniasis (VL) due to Leishmania donovani. Cutaneous leishmaniasis (CL) is uncommon, and mucocutaneous leishmaniasis (MCL) is rarely reported in this region. Recent reports reveal a changing epidemiology and atypical manifestations. A retrospective study of 52 suspected cases with cutaneous and mucosal involvement seen from January 2008 to December 2018 in a tertiary care setting in a non-endemic state in southern India is reported. Twelve patients were confirmed to have leishmaniasis; seven had MCL, two had CL, and three had post-kala-azar dermal leishmaniasis (PKDL). All cases were male, with a median age of 41.5 years (interquartile range, 30–55.5 years), and the median duration of the disease was 6 years (interquartile range, 1–9.5 years). Patients with MCL had mucosal involvement including destructive ulcero-proliferative lesions due to delayed diagnosis; none had a history of travel to countries endemic for MCL and all were attributable to L. donovani species. On the other hand, Leishmania major which was the causative species in both CL patients was associated with travel to the Middle East. Patients with PKDL presented with multiple plaques and hypopigmented patches; one had concomitant VL and all were from endemic areas. Hitherto uncommon MCL, caused by potentially atypical variants of L. donovani, has emerged as a new manifestation of leishmaniasis in this region. A high index of suspicion based on lesions seen and history of travel combined with PCR-based diagnostics are required to confirm diagnosis for the various skin manifestations of leishmaniasis.
Human hair follicles (HFs) express the olfactory receptor OR2AT4, whose specific stimulation ex vivo by the synthetic sandalwood-like odorant, Sandalore Ò , prolongs anagen, and suppresses apoptosis by up-regulating intra-follicular IGF-1 mediated signalling. To study whether this effect of Sandalore Ò is clinically relevant, we conducted a double-blinded, placebo-controlled trial involving 60 female volunteers affected by telogen effluvium. 30 patients were randomly assigned to a verum group applying once daily a solution containing 1% Sandalore Ò , and 30 patients were included in a placebo group that applied natural sandalwood oil, which has the same odor as Sandalore Ò but does not stimulate OR2AT4. The trial lasted 24 weeks. The read-out parameters were the degree of hair shedding, hair density, anagen/catagen-telogen ratio, hair mass index (hair volume), hair thickness, and patient selfassessment questionnaire. Sandalore Ò 1% reduced hair shedding, increased hair volume and increased the percentage of anagen HFs significantly more than placebo. Hair thickness and density were not affected. Most effects were seen after 8 weeks and maintained at week 24. Subjectively, individuals in the treatment group were "more satisfied" than in the placebo group regarding hair appearance and overall results. This clinical trial confirmed the anagenmaintaining effects of Sandalore Ò seen ex vivo and provides the first evidence that a cosmetic odorant can positively impact on human hair growth in vivo, encouraging the use of topical "olfactotherapy" with Sandalore Ò as adjunct therapy of hair disorders characterized by excessive hair shedding.
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