BACKGROUND:Rituximab has changed the paradigm for management of pemphigus vulgaris (PV). Despite its widespread use, variability exists in its use, particularly related to dosing protocols, prophylaxis, and use in special populations. This study aimed to assess dermatologists' knowledge, attitude, and practices regarding rituximab in India. MATERIALS AND METHODS:A cross-sectional questionnaire-based survey was conducted among Indian dermatologists with at least six months of clinical experience post-residency between March and June 2024. An 85-question survey was used to gather information on knowledge, attitudes, and practices related to rituximab. Descriptive statistics were employed to analyze the data and identify practice variations. RESULTS:Fifty-five dermatologists with a mean practice experience of 13 years participated. Most (78.2%) preferred rituximab as first-line adjuvant for PV, citing higher remission rates and fewer long-term adverse effects. Knowledge of rituximab's mechanism of action was excellent. However, significant practice variability was observed. The standard dose rheumatoid arthritis protocol for moderate-to-severe disease was preferred by 69.1%, whereas only 14.5% strongly supported low-dose regimens. Screening for latent tuberculosis was commonly performed (80%). Prophylaxis for Pneumocystis jirovecii pneumonia and vaccination practices were inconsistent, with only 12.7% always prescribing prophylaxis. Additionally, 61.8% used rituximab retreatment on clinical relapse, with less emphasis on immunological markers for monitoring. LIMITATIONS:The responses may not be representative of all dermatologists, especially those with less experience with rituximab. CONCLUSION:While dermatologists demonstrated strong knowledge of rituximab, significant variability in dosing, prophylaxis, and retreatment practices exists. Standardized guidelines and educational initiatives may be needed to ensure consistent use of rituximab and improve patient outcomes.
BACKGROUND:Psoriasis is a chronic inflammatory skin disease characterized by hyperproliferation of keratinocytes and immune dysregulation. Survivin, being an apoptosis inhibitor, could be a potential biomarker for psoriasis. AIM AND OBJECTIVES:To evaluate serum survivin levels in moderate to severe psoriasis patients before and after methotrexate therapy and to assess its correlation with disease severity using Psoriasis Area and Severity Index (PASI). PATIENTS AND METHODS:This study included 30 patients with moderate to severe psoriasis and 30 healthy controls. Serum survivin levels were measured at baseline and at 12 weeks of methotrexate therapy. Disease severity was assessed using PASI. RESULTS:Serum survivin levels were considerably higher in psoriasis patients than in controls (70.3 ± 16.9 vs. 22.1 ± 9.4 pg/mL; P < 0.001). Following methotrexate therapy, serum survivin levels decreased (20.9 ± 8.0 pg/mL; P < 0.001) and PASI scores reduced in tandem from 15.3 ± 4.8 to 7.5 ± 4.4 ( P < 0.001). Improvement in PASI was significantly associated with survivin reduction (r = 0.672; P < 0.001). LIMITATIONS:Small sample size, short follow-up duration, and lack of histopathological assessment or tissue survivin evaluation. Additionally, the absence of long-term follow-up and potential noncompliance with smoking/alcohol abstinence may have influenced the findings. CONCLUSION:Serum survivin levels were significantly elevated in psoriasis patients compared to healthy controls and were reduced significantly following treatment with methotrexate. These changes in serum survivin levels corresponded well with decreasing PASI scores in psoriasis patients, suggesting survivin as a potential biomarker of disease activity and therapeutic response.
BACKGROUND:The District Residency Program (DRP), introduced by the National Medical Commission (NMC), envisages a three-month mandatory posting of all Indian postgraduate (PG) residents in district hospitals. It is aimed at strengthening the district health system; however, its impact on specialty training in dermatology remains unclear. MATERIALS AND METHODS:After obtaining institutional ethical clearance, we conducted an anonymized online survey among dermatology PG residents across India, who had completed their DRP posting. It was based on a pre-designed and validated questionnaire, circulated via social media resident networks. The objective and subjective responses were collated and statistically analyzed. RESULTS:Responses from 292 dermatology residents from government (156, 53.4%), private (91, 31.2%), deemed university (35, 12.1%), and government-aided (10, 3.4%) institutions were analyzed. Majority belonged to the PG-2022 batch (185, 63.4%). A significant hindrance to academics was reported by 96 (39.2%) residents, while it remained unaffected for 46 (15.8%). Thesis work was adversely impacted for 190 (65%) residents, with 133 (45.5%)reporting significant disruption. Dermatology procedural skill training during DRP was limited with no procedural dermatology exposure being reported by 159 (54.5%) respondents, while 42 (14.4%)performed procedures supervised, and 68 (23.3%) performed unsupervised. Accommodation was not provided for 229 (78.4%), while transport was not provided for 259 (88.7%) respondents. Lack of access to hygienic meals (206, 70.5%) and safety concerns (103, 35.3%) were significant issues reported. Regarding training outcomes, communication skills reportedly improved for 133 (45.6%). Exposure to the district health system was rated adequate by only 97 (33.2%), while only 59 (20.2%)felt that DRP strengthened district services. Only 93 (31.9%) agreed with the need for DRP posting during post-graduation, while 98 (33.6%) felt that it hampered their training. LIMITATIONS:Lack of formal psychometric validation of the questionnaire, a relatively small sample size, and the use of a voluntary online Google Form survey, which may have introduced selection and response bias. CONCLUSION:Targeted reforms are essential to align the program with dermatology specialty education, while upholding public health objectives at the same time.
ABSTRACT:Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory skin disorder that predominantly affects the axillae, anogenital, and inguinal regions in the form of recurrent painful, suppurative abscesses, nodules, and fistulae. The major challenge in the management of HS lies not only in the difficulty of early diagnosis but also in the initial treatment decisions, which heavily rely on the stage of the disease. Multiple studies in the literature have concluded that clinical examination significantly underestimates the severity of HS, thus impacting treatment choices and the course of the disease. Ultrasonography (USG) is becoming a valuable aid in assessing disease extent and guiding treatment decisions in HS. For this review, the PubMed database was searched using 'USG,' 'ultrasound,' 'ultrasonography,' and 'hidradenitis suppurativa' as the keywords in the title with no date limits. The utility of USG in HS reported in the literature was evaluated by reviewing each abstract. The current review emphasizes the emerging usefulness of USG in HS, both in the diagnosis and treatment of disease.
ABSTRACT:Direct oral anticoagulants (DOACs), such as rivaroxaban and dabigatran, are widely used for thromboembolic conditions. While bleeding is the most well-recognized adverse effect, rare cutaneous hypersensitivity reactions, such as urticaria and angioedema, are increasingly reported. We describe a case series of nine patients who developed cutaneous hypersensitivity reactions to DOACs. All patients developed symptoms within 1-10 days of DOAC initiation. Rivaroxaban was associated with angioedema and urticaria, whereas dabigatran was limited to urticaria. All reactions resolved after drug discontinuation and symptomatic treatment. Dermatologic adverse effects of DOACs, although uncommon, warrant heightened clinical suspicion. A limitation of this study is the small sample size and absence of rechallenge confirmation of hypersensitivity. Management should be individualized. Increased awareness among dermatologists and physicians is crucial for timely management and pharmacovigilance.
BACKGROUND:Keloid is a benign, well-demarcated overgrowth of fibrous tissue due to abnormal wound healing in response to cutaneous injury, hampering quality of life. Multiple treatment options are available with unsatisfactory results. Cryotherapy is limited by edema, swelling, blister formation, oozing, and depigmentation. Bleomycin, a cytotoxic antibiotic, induces apoptosis with sclerosing action on endothelial cells and inhibits collagen synthesis. AIM AND OBJECTIVES:The study compared the effectiveness, safety, and quality of life in patients of keloid receiving cryotherapy versus intralesional bleomycin. PATIENTS AND METHODS:It was an institution-based, open-labelled, randomized controlled trial (CTRI/2020/08/027352). The study included treatment naïve adult consenting patients with localized keloids, randomized (1:1) into group A (spray cryotherapy) or group B (intralesional bleomycin). Infected and ulcerated keloids were excluded. Six follow-up visits were conducted at 4 weekly intervals. Sample size was 26 in each arm. Decrease in thickness, Vancouver scar scale (VSS), patient and observer scar assessment scale (POSAS), dermatology life quality index (DLQI) were evaluated. RESULTS:Mean reduction in thickness was found to be significantly more in bleomycin in comparison to cryotherapy ( P < 0.001). VSS score was found to be significantly reduced in both the treatment arms ( P < 0.001) from first follow-up onwards. VSS was found to be significantly less (analysis of co-variance [ANCOVA] test, P < 0.001) in bleomycin in comparison to cryotherapy from third follow-up (12 weeks) onwards. POSAS observer score was found to be significantly less (ANCOVA test, P < 0.001) in bleomycin in comparison to cryotherapy. DLQI was significantly improved ( P < 0.001) in bleomycin. Bulla formation and depigmentation (cryotherapy); hyperpigmentation and procedural pain (bleomycin) were the main adverse events. LIMITATIONS:The study was conducted during the COVID period, which affected the follow-up. CONCLUSION:Both spray cryotherapy and intralesional bleomycin were safe and effective agents in keloid treatment. Intralesional bleomycin was a better alternative to spray cryotherapy in reducing lesional thickness, itching, pain, stiffness, surface area, scar irregularity, and color difference associated with keloids. Thus, intralesional bleomycin has the potential to be used as monotherapy for localized keloids.
