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Background: Melasma is a pigmentary disorder affecting mainly face . Various treatment modalities available as topicals, superficial chemical peels and lasers but none till date gives promising results, until date quest for the best treatment modality is on., Aim: To study the effect of oral and topical Tranexamic acid (TXA) and modified Kligman's regimen in treatment of melasma., Method: Patients having melasma were enrolled after consent for voluntary participation. A detailed history and clinical examination was done. Total 60 patients were enrolled and randomized in three groups, 20 received oral TXA 250 mg twice daily, 20 topical TXA and 20 received modified Kligman's regimen for 8 weeks along with sunscreen MASI(Melasma area severity index) was calculated at baseline, at end of 4 & 8 weeks. MASI score was compared with that at the end of the study. Based on reduction in mean MASI the therapeutic response was graded. Pre and post treatment photographs was also compared. Statistical analysis done by using student square T test , ANOVA And TUKEY test., Results: Reduction in MASI score was observed in all the groups but greater reduction in MASI score with modified Kligman's regimen by 30% followed with oral TXA by 25% reduction and least with topical TXA by 5%., Conclusion: Although modified Kligman's regimen is comparatively more efficient but due to its side effects in long term usage oral tranexamic acid could be a promising therapeutic approach for melasma., (© 2020 Wiley Periodicals, Inc.)

Background: Dermal arteritis of the nasal philtrum is a rarely reported condition commonly affecting large breed dogs., Objective: To describe the effective treatment of nasal philtrum arteritis with topical tacrolimus in one dog., Animal: A 9-year-old, intact male German shorthair pointer dog was presented with well-demarcated deep erythematous ulcers targeting exclusively the skin of the nasal philtrum, accompanied by frequent series of haemorrhage., Methods: Complete blood count, serum chemistry profile, urinalysis, histopathological examination and immunohistochemistry of skin biopsies., Results: The presence of a V-shaped ulcer with subendothelial spindle cell proliferation resulting in stenosis of dermal arteries and arterioles on histological evaluation, together with a well-demarcated deep nasal philtrum ulcer was consistent with arteritis of the nasal philtrum. Treatment was initiated with twice daily oral doxycycline and niacinamide in conjunction with topical fluocinolone cream. Over the course of two years, the lesions progressed with frequent bleeding episodes. A novel surgical approach provided deep resection of all grossly affected tissue; four months later a recurrence of fissures and occasional mild bleeding from the original site was noted and there was no improvement after another two months of oral doxycycline/niacinamide and topical fluocinolone treatment. Topical application of 0.1% tacrolimus twice daily resulted in complete healing of the ulceration and normalization of the epidermis. Over the subsequent 15 months, the dog's lesions remained in remission with topical tacrolimus application twice daily., Conclusions and Clinical Importance: Topical tacrolimus ointment appeared effective at inducing and maintaining lesion remission in this dog with nasal philtrum arteritis., (© 2017 ESVD and ACVD.)

Background: Acute generalized exanthematous pustulosis (AGEP) is a rare skin condition typically caused by medications. The objective of this study was to examine the clinical features, causes, and outcomes of AGEP at a sole tertiary care center., Methods: A retrospective review of patients with AGEP (European Study of Severe Cutaneous Adverse Reactions score of ≥ 5) seen at Mayo Clinic (Rochester, MN, USA) between January 1, 1996, and December 31, 2013, was conducted., Results: Of 28 patients (mean age at onset: 56 years), 17 (61%) were women. The development of AGEP was attributed to medications in 25 patients (89%), with clindamycin the most common culprit (six patients). Three patients (11%) had mucous membrane involvement, and 21 (75%) showed systemic involvement. Ten patients (36%) received systemic corticosteroids for treatment of AGEP. Skin findings resolved within 15 days in 26 patients (93%) (mean time to resolution: 7.6 days). In three patients (11%), generalized skin eruptions or dermatitis developed weeks to months after the resolution of AGEP. Twenty-four patients (86%) had a personal history of drug reactions before the development of AGEP., Conclusions: A previous history of drug reactions and clindamycin causation were more common in the present cohort than in prior reports. A small subset of patients experienced new-onset non-AGEP skin eruptions within a few months of the resolution of AGEP., (© 2017 The International Society of Dermatology.)

Background: For an effective treatment of vitiligo, it is as important to arrest the progression of the disease (if it is still active) as it is to induce repigmentation in existing lesions. In patients having limited and slow-spreading vitiligo, we evaluated the efficacy of levamisole to control the activity of the disease process and to induce repigmentation of the vitiliginous areas., Methods: Levamisole was given to 64 patients in an oral dose of 150 mg on two consecutive days every week for periods varying from 4-48 months. In 14 patients levamisole was used alone, in 38 patients it was combined with topical 0.1% fluocinolone acetonide acetate ointment massaged on the lesions once a day, and in 12 patients it was combined with topical 0.05% clobetasol propionate used in the same way. There was no other adjuvant therapy., Results: In 34 of the 36 patients (94%) having active disease, the progression of the disease could be arrested within 2-4 months. A variable degree of spontaneous repigmentation of the vitiliginous areas was seen in 9 patients (64%) treated with levamisole alone, 33 patients (87%) treated with levamisole and topical fluocinolone, and all the 12 patients treated with levamisole and topical clobetasol. The side effects with levamisole were minimal except in two cases where treatment had to be discontinued. Topical fluocinolone was fairly safe in the Indian patients, but clobetasol frequently produced atrophy and telangiectasia., Conclusions: Levamisole seems to be a simple, safe, and fairly effective remedy for controlling the activity of the disease process in vitiligo patients who have limited and slow-spreading disease. Some patients develop spontaneous repigmentation as well. To achieve a faster rate of repigmentation, levamisole can be combined with other treatment methods such as topical corticosteroids.

A double-blind, parallel comparison was made of the short-term efficacy and safety of three times daily regimens of 0.05% clobetasol propionate cream and 0.05% fluocinonide cream in 114 adolescent and adult patients with psoriasis and 113 with eczema. After 2 weeks of topical applications, patients were assessed according to (1) investigators' overall judgment of clinical response, (2) degree of severity of specific signs and symptoms, and (3) patients' evaluation of improvement. In all three response categories in psoriasis, and in two of three in eczema, clobetasol was statistically significantly superior to fluocinonide (p less than 0.05-p less than 0.001). Healing commenced more rapidly with clobetasol and there was no indication of tachyphylaxis. In contrast, the healing rate with fluocinonide slowed noticeably after the first week, and there was a greater tendency to relapse following fluocinonide treatment. Both regimens were safe: drug-related side effects were generally mild and occurred most commonly with fluocinonide therapy in eczema patients. Overall, drug-related effects occurred in 4% of patients receiving clobetasol and 12% receiving fluocinonide (p less than 0.05). Transient morning plasma cortisol reductions below 5 micrograms/dl occurred in 6% of clobetasol-treated patients, reverting to normal within 1 week of the end of treatment.

The effectiveness and safety of fluocinonide 0.05% in a cream base (FAPG cream: fatty acid propylene glycol) were evaluated in 105 patients with recalcitrant corticosteroid-responsive dermatoses that had failed to respond adequately to at least two weeks' previous treatment with one of 21 other topical corticosteroid preparations. At the end of the three weeks, 66 (71.0%) of the 93 patients who qualified for analysis showed excellent to moderate improvement with fluocinonide. Side effects were rare and of a minor nature. The general effectiveness of fluocinonide is indicated in this single-blind trail in which excellent or moderate results predominated in 8 of the 12 different diagnosis.

Working independently, eight investigators evaluated the clinical effectiveness of fluocinonide 0.05% in a three-week double-blind paired comparison trial of 240 patients. Half the investigators compared fluocinonide emollient cream with betamethasone valerate 0.1% cream in the treatment of atopic dermatitis, while the remaining four compared the study drug with triamcinolone acetonide 0.1% cream in the treatment of psoriasis. Statistical analysis showed clinical responses favored fluocinonide p = 0.021 (Wilcoxon Signed Rank) for the atopic dermatitis group and p = 0.001 (Wilcoxon Signed Rank) for the psoriasis group.