Fractional ablative carbon dioxide (CO2) laser treatment is commonly documented with displayed parameters such as pulse energy, power, pulse duration, density level and number of passes. These settings are device-specific inputs, not a portable description of the tissue dose. This perspective proposes a six-dimensional tissue-dose model that represents treatment as a state vector comprising ablation geometry, coagulation geometry, treated fraction, spatial distribution, heat accumulation and healing reserve. The framework was developed through a targeted narrative synthesis of foundational fractional photothermolysis studies, histologic and computational dosimetry work, wound-healing investigations, clinical consensus statements and complication literature. A targeted PubMed, Crossref, journal-archive and web search through 19 August 2026 did not identify a previously published framework integrating the same six dimensions. The model separates the delivered tissue insult from device settings and treats healing reserve as a biological and anatomical constraint on the acceptable exposure. It explains why equal millijoules, equal nominal density or equal total energy can produce different lesion geometry, local overlap, thermal burden and recovery. The framework is intended for treatment planning, cross-platform reporting, education and prospective data collection; it is not a validated dose calculator and does not support universal presets. Validation should combine expert content assessment, platform-specific histology or optical imaging, a common clinical data dictionary and prospective prediction of efficacy, delayed healing, postinflammatory hyperpigmentation and scarring. A shared six-dimensional vocabulary may improve reproducibility while preserving the site-and patient-specific judgment required for safe fractional ablative laser therapy.
Background: Hair fall is one of the most common cosmetic concerns among young adults and is influenced by genetic, environmental, nutritional, hormonal, and lifestyle factors. With the rapid increase in digital device usage, screen time has emerged as a potential lifestyle factor affecting overall health. The present study aimed to assess the association between screen time, sleep duration, stress levels, and hair fall among young adults. Methods: A cross-sectional questionnaire-based study was conducted among 300 young adults aged 15-25 years. Data regarding demographic characteristics, average daily screen time, sleep duration, perceived stress, family history of hair fall, medical conditions affecting hair, and hair fall characteristics were collected using a structured online questionnaire. Descriptive statistics were used to summarize the data. Associations between lifestyle factors and hair fall were assessed using Chi-square tests. A p value less than 0.05 was considered statistically significant. Results: Among 300 participants, 57.3% belonged to the age group of 21-25 years and 66.3% were females. Increased hair fall during the preceding six months was reported by 65.3% of participants. Significant associations were observed between screen time and increased hair fall (χ2=10.624, p=0.014), screen time and hair fall severity (χ2=15.377, p=0.018), and stress levels and increased hair fall (χ2=11.793, p=0.019). No significant association was found between sleep duration and increased hair fall (χ2=3.028, p=0.387). Conclusions: Higher screen time and elevated stress levels were significantly associated with self-reported hair fall among young adults. These findings highlight the importance of lifestyle modification and stress management in maintaining hair health.
Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disorder frequently associated with metabolic comorbidities. Given the anti-inflammatory and metabolic effects of GLP-receptor agonists (GLP-1Ras), these agents have been proposed as a potential adjunctive therapy for HS. Methods: A retrospective chart review identified 151 HS patients prescribed a GLP-1RA between January 2020 and January 2025. After excluding individuals younger than 18 years and those initiating biologics, long-term immunomodulators, or anti-hormonal therapies after GLP-1RA start, 22 patients met inclusion criteria. Clinical improvement was assessed qualitatively through provider documentation of symptom or disease-status improvement. Results: Among 22 patients, 63.6% demonstrated clinical improvement following GLP-1RA therapy. The cohort included 10 Black, 6 Hispanic, 5 White, and 1 Asian patient. Semaglutide was the most common agent (n=14), followed by tirzepatide (n=7), and exenatide (n=1). Race was significantly associated with improvement (p= 0.025). 92% of non-Black patients improved compared with 30% of Black patients (p= 0.011). This disparity persisted after adjusting for HS severity, treatment duration, comorbidities, insurance type, and income. No significant associations were observed for gender, age, ethnicity, comorbidities, or insurance type. Conclusions: GLP-1RAs may offer symptomatic benefit for HS, with nearly two-thirds of patients showing improvement. However, marked racial differences in response highlight the need for equitable HS research and investigation into biological, structural, and socioeconomic contributors to treatment variability. Larger prospective studies are warranted to clarify therapeutic efficacy and drivers of demographic disparities.
Background: Proper cleansing is essential for maintaining skin barrier integrity, hydration, and overall skin health. Harsh cleansers can disrupt the stratum corneum, increase transepidermal water loss (TEWL), and alter skin pH, particularly in sensitive or barrier-compromised skin. This study evaluated the efficacy and in-use tolerability of Venusia® cleanser, a non-foaming formulation, in adults with different skin types. Methods: In this single-centre, single-arm, non-randomized interventional study, participants with all skin types used Venusia® cleanser for 15 days. Efficacy was assessed using TEWL (VapoMeter), skin pH (pH meter), and pore-cleansing (3D imaging) at baseline, immediately post-application (15–20 minutes), and on day 15. In-use tolerability was evaluated using the Draize scale for erythema and oedema, along with participant self-assessment questionnaires on day 15. Results: During the study period, 77 healthy adults with a mean age of 35.64 years were enrolled, and 76 participants completed the study. Of these, 14.5% participants had sensitive skin. TEWL decreased significantly by 9.1% at 15–20 minutes and by 17.5% at day 15 (p<0.01), indicating improved barrier function. Skin pH remained within the physiological acidic range (5.0–6.0), with a modest but significant increase of 5% at day 15 (p<0.01). Pore depth showed no significant change. Self-assessments revealed high satisfaction: 100% of participants found the cleanser gentle and easy to use, 100% reported improved skin softness and smoothness, while 98.7% experienced effective cleansing without dryness, and 98.7% observed a healthy, radiant appearance of the skin after use. No participant experienced any skin intolerance or adverse events during the study period. Conclusions: Venusia® cleanser is a well-tolerated and effective non-foaming cleanser suitable for all adult skin types, demonstrating efficacy and high user acceptability.
Background: Paederus dermatitis (PD) is an acute irritant contact dermatitis caused by pederin, a vesicant toxin in the hemolymph of beetles of the genus Paederus. Despite its occurrence across tropical India, published data from north India and documented institutional cluster outbreaks among young adults remain scarce. Methods: A descriptive observational study was conducted at a tertiary care teaching hospital in Greater Noida, Uttar Pradesh, over 15 days in April 2026. All 106 patients clinically diagnosed with PD from a single university hostel campus were consecutively enrolled. Data on demographics, symptom onset, morphological patterns, sites of involvement, and risk factors were recorded using a structured proforma. Descriptive statistics- frequencies, percentages, mean and standard deviation were used for analysis. Results: Of 106 patients (60 males, 46 females), the mean age was 20.27±1.48 years (range 18-24). Mean duration of symptoms at presentation was 1.86±0.74 days. The predominant symptoms were erythema (97.2%) and burning sensation (95.3%). Linear erythematous plaque was the most common morphological pattern (67.9%), followed by kissing lesions (38.7%), herpetiform lesions (38.7%), Nairobi eye variant (21.7%), and erythematous patch with central gray necrotic area (18.9%). The neck was the most frequently involved site (76.4%). Sleeping with windows open (69.8%) and proximity to campus vegetation (100%) were the predominant risk factors. Conclusions: This study reports one of the first institutional cluster outbreaks of Paederus dermatitis from north India, occurring in April- a pre-monsoon season not previously highlighted for PD in this region. The diverse morphological spectrum, including herpetiform and kissing variants, highlighting the importance of clinical awareness to prevent misdiagnosis in hostel settings.
Background: Periorbital hyperpigmentation, puffiness, and fine lines are common dermatological concerns adversely impacting quality of life. Conventional therapies, including hydroquinone and retinoids have safety limitations in pregnant and lactating women, necessitating exploration of botanical alternatives. This study evaluated the safety and efficacy of a natural-origin EqualsTwo® under eye gel in improving periorbital concerns within this sensitive population. Methods: In this prospective, open-label, single-arm exploratory study, 72 women (12 pregnant, 60 lactating; aged 22-40 years) were enrolled; 65 completed the trial. Participants applied approximately 0.2 gm of the investigational product twice daily for 42 days. Dermatological assessments were performed using a 6-point grading scale for dark circles, Investigator's Global Assessment Scale for puffiness, and Allergan fine lines scale. Melanin concentration and fine-line metrics (count, length, width, depth) were assessed using the Antera 3D system, supported by subject-reported outcomes. Safety was monitored throughout. Results: By day 42, 55.38% of participants achieved grade 0 for both dark circles and puffiness, while 66.15% demonstrated minimal fine lines. Instrumental assessments revealed a 10.47% reduction in melanin concentration (p<0.0001), 32.36% decrease in fine-line count (p<0.0001), 86.22% reduction in line depth (p<0.0001), and 69.98% decrease in line width (p<0.0001). All participants reported visible improvements in hydration, softness, and firmness. 100% participants expressed satisfaction, and no adverse events were recorded. Conclusions: The investigation product demonstrated improvements across all periorbital parameters with no treatment related adverse events, supporting botanical formulations as effective alternatives in pregnant and lactating women.
Background: This study is aimed to evaluate the efficacy and safety gentle anti-dandruff regime in the management of dandruff in healthy, Indian participants suffering from dandruff. Methods: A total of 55 subjects with clinically diagnosed moderate dandruff were selected based on inclusion and exclusion criteria. Study was conducted in 3 phases, wash-off phase for 2 weeks, treatment phase for 4 weeks, followed by a regression phase of 1 week (during which anti-dandruff regime was withdrawn. Participants applied anti-dandruff regime on their scalp as per the instructions provided during the treatment (thrice a week). This is a regime of anti-dandruff shampoo and anti-dandruff scalp treatment. Results: Regime showed reduction in dandruff flakes from first treatment and show improvement till the end of treatment phase, and maintained the lower dandruff levels below the baseline levels even after 1 week of product withdrawal. There were no reported side effects like oiliness/redness/irritation etc., during treatment and regression phase. Conclusions: Anti-dandruff regime is a safe and highly effective solution designed to combat dandruff, while simultaneously improving overall health of the scalp and hair.
Cutaneous tuberculosis (CTB) is a rare manifestation of extra-pulmonary tuberculosis; tuberculosis verrucosa cutis (TBVC) presents as a slowly enlarging verrucous lesion, often misdiagnosed due to its atypical presentation. A 22-year-old male driver presented with a 2-year history of a pruritic, intermittently discharging, well-defined verrucous plaque with central depigmentation over the medial right foot, gradually enlarging to ~7×5 cm. KOH and fungal cultures were negative; Tuberculin skin test was strongly positive. Histopathology revealed pseudoepitheliomatous hyperplasia, mid-dermal well-formed tuberculoid granulomas with Langhans giant cells and neutrophilic microabscesses. No organisms were seen. Biopsy samples for cartridge based nucleic acid amplification test (CBNAAT) documented mycobacterium tuberculosis (MTB) genome. Imaging ruled out bone involvement. Diagnosis of TBVC was made, and anti-tuberculosis (ATT) therapy was initiated with clinical improvement. This case underscores the importance of considering TBVC in chronic verrucous skin lesions, particularly in endemic areas, and highlights the diagnostic value of histopathology and CBNAAT testing. The diagnostic puzzle was resolved using nucleic acid amplification testing of the biopsy sample, which should be considered in all skin lesions suspected of tuberculosis.
Severe atopic dermatitis (AD) represents a complex, chronic inflammatory dermatosis characterized by a profoundly debilitating course, significant comorbid burden and a substantial deterioration in quality of life. The pathophysiological paradigm has evolved beyond a purely T-helper 2 (Th2)-centric model to incorporate a broader spectrum of immune dysregulation, including roles for Th22, Th17 and IL-31-driven pathways, alongside crucial epithelial barrier dysfunction mediated by filaggrin and other structural protein deficiencies. This shift has catalyzed the development and clinical deployment of novel, targeted systemic agents that move beyond traditional immunosuppressants. This exhaustive review synthesizes contemporary evidence from recent clinical trials, real-world efficacy studies and international consensus guidelines to critically appraise the current therapeutic arsenal. We provide a detailed analysis of the pharmacodynamics, clinical trial data and safety profiles for biologic agents such as dupilumab, tralokinumab and lebrikizumab, which selectively inhibit key interleukins. Furthermore, we examine the emerging role of Janus kinase (JAK) inhibitors, including abrocitinib, upadacitinib and baricitinib, focusing on their rapid onset of action and the nuanced risk-benefit calculus mandated by their safety advisories. The review also contextualizes the enduring, though carefully circumscribed, role of conventional systemic immunosuppressants like cyclosporine, methotrexate and mycophenolate mofetil in the modern treatment algorithm. Particular emphasis is placed on therapeutic sequencing, combination approaches, management of secondary infections and strategies for long-term disease control while mitigating adverse effects. The concluding synthesis projects future directions, including combination biologic therapy and personalized medicine approaches guided by endotypic stratification, underscoring the transformative nature of current systemic treatments in altering the disease trajectory for patients with severe atopic dermatitis.
Ultraviolet radiation is a well-established cause of photoaging and malignancy, yet sun protection remains absent from elite sport even as FIFA adds cooling breaks and physicians publicly push for stronger heat protocols ahead of the 2026 World Cup. Roughly 1,200 athletes, plus coaches and officials, will play summer matches across high-UV regions. Predicted mean UV indices were calculated across all 2026 host cities using NASA satellite data, with values ranging from 6-10 (high to extreme risk). FIFA’s medical regulations address heat exposure but not UV. Feasible, low-cost fixes—standardized sunscreen provision, reapplication education, UV-informed scheduling—could close this gap using infrastructure FIFA already has. The World Cup offers dermatology a rare, high-visibility platform to model occupational sun-safety policy.
Background: Kaposi’s sarcoma (KS) is a rare AIDS-defining malignancy strongly associated with human herpesvirus 8 (HHV-8). Although KS is considered uncommon in India owing to its low HHV-8 seroprevalence, regions with high HIV prevalence, such as Northeast India, may exhibit a higher burden of KS. This study investigated the clinical characteristics and outcomes of KS cases in Nagaland, a region with a high HIV prevalence. Methods: This retrospective observational study analyzed the demographics, clinical characteristics, and treatment outcomes of 16 KS cases diagnosed between 2011 and 2024 in Nagaland. Results: The mean age of the patients was 45 years (±13.57) mean (±SD), and the male-to-female ratio was 1.7:1. Mucocutaneous lesions were the predominant presentation, while four patients exhibited pulmonary involvement. The median CD4 count at diagnosis was notably low at 54 cells/mm3 (IQR 47-262.5)). Six patients had coexisting opportunistic infections, such as tuberculosis, and two patients had Pneumocystis carinii pneumonia. Four patients improved with antiretroviral treatment (ART) alone, while four received liposomal doxorubicin along with ART, showing varying outcomes. Three patients died, likely due to systemic involvement and comorbidities. One patient was HIV-naïve, suggesting classic KS. Conclusions: This study provides initial evidence that may challenge the previously held notion of KS rarity in India by documenting a notable burden in Nagaland, India. Increased vigilance is warranted in areas with high HIV prevalence, and further research is needed to understand the epidemiology and optimize treatment strategies in this region.
Background: This study is aimed to evaluate the efficacy and safety of ayurvedic anti-dandruff regime (Indulekha - Svetakutaja oil and dandruff treatment shampoo) in the management of dandruff in healthy, Indian participants suffering from dandruff. Methods: A total of 53 subjects with clinically diagnosed moderate dandruff were selected based on inclusion and exclusion criteria. Study was conducted in 3 phases, wash-off phase for 2 weeks, treatment phase for 4 weeks, followed by a regression phase of 2 weeks (during which ayurvedic anti-dandruff regime was withdrawn). Participants applied anti-dandruff regime on their scalp as per the instructions provided. Results: After 4 weeks of treatment, ayurvedic anti-dandruff regime demonstrated a significant reduction in dandruff flakes in 100% of participants, resolution of scalp itch in 100% participants with reduced levels of histamines (by 30%) and oxidative stress marker on scalp as measured by 13-hydroxyoctadecadienoic acid (HODE) by 50%. There were no reported side effects like oiliness/redness/irritation, during treatment and regression phase. Conclusions: Ayurvedic anti-dandruff regime is a safe and highly effective solution designed to combat dandruff and oxidative stress on scalp, while simultaneously improved overall health of the scalp and hair.
Mid-face volume loss from skeletal resorption, soft-tissue atrophy, and reduced dermal support is a key feature of facial ageing. Hyaluronic acid fillers such as Restylane® offer predictable, minimally invasive contour restoration. Combination approaches with adjunctive therapies may enhance results. This retrospective case series reviews individualized multimodal plans for mid-face augmentation using Restylane® fillers. 5 adults (3 males, 2 females; 35–50 years) presented with moderate-to-severe mid-face volume loss with malar hollowing, prominent nasolabial folds, and reduced cheek projection. Treatment plans combined Restylane® fillers (Lyft, Classyc, Defyne, Volyme, Vital) with energy-based devices, botulinum toxin A, and chemical peels, tailored to anatomical needs. Assessments used global aesthetic improvement scale, Medicis midface volume scale, and wrinkle severity rating scale. All patients showed improved contour and skin quality with no adverse events. Multimodal protocols integrating Restylane® fillers with complementary treatments provide effective, individualized mid-face rejuvenation. Prospective studies are needed to validate these findings.
Background: Dermatophytosis, is a very frequent fungal infection of skin prevailing in underprivileged countries. As drug resistance of monotherapy is rising rapidly, combination therapy is blooming as the preferred choice. Itraconazole and terbinafine are widely used antifungal drugs in Bangladesh. Although many studies on monotherapy of these drugs have been done for the treatment of fungal infections, but study on their combined use showing difference with cure rates and recurrence rates in our country is still inadequate. Objectives were to determine and compare the clinical outcome of monotherapy with terbinafin or itraconazole comparing with combined therapy in various dermatophytosis (tinea infections). Methods: Clinically diagnosed patients suffered from various tinea infections at multiple private clinics in Gazipur district of Bangladesh were treated from January to June 2025. Total 150 patients were divided into three groups (Itraconazole only, terbinafine only and combination of both). The therapeutic effects were evaluated by clinical cure rate by clinical symptoms, mycological cure rate by mycology examination, adverse effects, and recurrence rates of disease. Results: The data of patients were evaluated biweekly period and at 4 and at end of 8 weeks of therapy. In the combined group, the symptoms were significantly cured, in comparison to the terbinafine or itraconazole group (p1<0.05 and p2<0.05). The clinical cure rate, mycological cure rate, recurrence rate showed 92%, 90% and 4% in combined group, 78%, 74% and 14% in terbinafine group, 74%, 70% and 18% in Itraconazole group respectively. The combination therapy achieved better results. Adverse effects were less in each group during follow-up. The 96% patients was satisfied with combined treatment. Conclusions: Combination therapy is more efficacious than monotherapy for treatment of tinea infections and demonstrates more successful strategy for treating resistant dermatophytosis.
Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare adnexal malignancy, most commonly affecting the scalp, and typically characterised by slow growth, marked local invasiveness and a high rate of local recurrence. Distant metastasis however remains uncommon. We report a case of a 58-year-old woman with a 6-year history of a progressively enlarging tender alopecic scalp lesion. Histopathology demonstrated a dermal basaloid neoplasm with tubular, nested and cribriform architecture and prominent perineural invasion, consistent with adenoid cystic carcinoma. Immunohistochemical studies highlighted a ductal cell component positive for cytokeratin 7 and CD117, and a myoepithelial cell component positive for smooth muscle actin and p40. Initial staging with 18F-fluorodeoxyglucose-positron emission tomography/ computed tomography (18F-FDG PET/CT) showed no significant metabolic activity or metastatic disease. Given emerging evidence of prostate-specific membrane antigen (PSMA) expression in adenoid cystic carcinoma, 68Ga-PSMA PET/CT was performed and demonstrated moderate uptake confined to the primary scalp lesion without regional or distant disease. The patient underwent staged wide local excision with clear histological margins and split-thickness skin graft reconstruction. Six-month follow-up 68Ga-PSMA PET/CT showed no evidence of residual or recurrent disease. To the authors’ knowledge this is first documented case of PSMA-avid PCACC and suggests that 68Ga-PSMA PET/CT may have a role in staging and surveillance of this rare tumour. Further studies are required to support these findings.
Lichen planus (LP) is a chronic, T-cell-mediated inflammatory dermatosis involving the skin and mucous membranes, with multiple clinical variants. Zosteriform lichen planus (ZLP) is a rare variant characterized by a unilateral, dermatomal or band-like distribution that may mimic herpes zoster. While mucosal LP, particularly oral lichen planus, has been associated with malignancy, the role of cutaneous LP, especially ZLP as a paraneoplastic manifestation remains unclear. A 54-year-old woman presented with a one-year history of asymptomatic violaceous papules and plaques arranged in a unilateral, band like pattern over the left chest extending to the neck, without crossing the midline. The distribution corresponded to C3-T2 dermatomes. Mucosa, scalp, and nails were uninvolved. Clinical findings suggested zosteriform lichen planus, which was confirmed on histopathology. During follow-up, six months after the onset of cutaneous lesions, the patient developed a palpable lump in the left breast. Imaging revealed a suspicious lesion, and histopathology examination confirmed invasive ductal carcinoma. Notably, the malignancy was ipsilateral to the cutaneous eruption. The temporal sequence, strict dermatomal localization, and absence of known triggers raised suspicion of a paraneoplastic association. The association between LP and malignancy is controversial, with stronger evidence for oral LP and lichen planus pemphigoides. In this case, a neuro-immunologic mechanism may be implicated, wherein tumour related immune activation selectively affects contiguous dermatomes, leading to a localized lichenoid eruption. To our knowledge, ZLP has not previously been reported as a paraneoplastic manifestation. This case highlights a rare presentation of ZLP potentially associated with underlying breast carcinoma and suggests a possible paraneoplastic role.
Scarring alopecias are a group of inflammatory disorders resulting in irreversible hair loss and significant psychosocial burden. Standard therapies often yield incomplete responses, prompting exploration of alternative treatments. Laser-based therapies, including low-level laser therapy (LLLT), superluminescent diode (sLED) therapy, long-pulsed Nd:YAG, and excimer lasers, have emerged as potential options. This meta-analysis aims to evaluate the clinical effectiveness of laser-based interventions in treating scarring alopecias. A systematic search of PubMed, Cochrane CENTRAL, and Scopus was conducted, following PRISMA guidelines. Studies included were non-randomized clinical studies reporting outcomes after laser-based interventions for scarring alopecias. Data extraction and risk of bias assessment (ROBINS-I) were performed independently by two reviewers. Due to heterogeneity, descriptive synthesis and qualitative forest plots were generated. Seven studies involving 51 patients were included. Conditions studied included lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), dissecting cellulitis (DCS), folliculitis decalvans (FD), and acne keloidalis nuchae (AKN). Laser interventions were associated with clinical or trichoscopic improvement in all studies. Two studies reported complete or near-complete disease remission. No significant adverse events were reported. Risk of bias was serious or critical in all studies, primarily due to small sample sizes and lack of controls. Laser-based therapies demonstrate promising clinical benefits in scarring alopecias, particularly in disease stabilization and symptom improvement. However, due to the high risk of bias and methodological limitations, high-quality randomized controlled trials are needed to confirm these findings.
Background: Pruritus is one of the most common subjective symptoms in dermatological diseases and significantly affects the quality of life of psoriasis patients. Psoriasis is a chronic inflammatory skin disease with complex and multifactorial pathogenesis. Methods: A hospital-based descriptive cross-sectional study was conducted at Khartoum Dermatology and Venereology Teaching Hospital from August 2019 to August 2020. Sixty adult psoriasis patients fulfilling the inclusion criteria were enrolled in the study. Data were collected using structured questionnaires and analyzed using SPSS version 25.0. Results: Among the study participants, 50% were older than 40 years and 56.7% were males. Plaque psoriasis was the most common clinical type (41.8%). Pruritus was reported in 68.3% of patients, with localized pruritus observed in 60% of cases. Severe pruritus was present in 45% of patients, while weather was identified as the main aggravating factor by 46% of participants. Medications were reported as the primary relieving factor by 97.6% of patients. Conclusions: Pruritus is highly prevalent among psoriasis patients and represents an important clinical symptom that may significantly affect patients’ quality of life. Proper evaluation and management of pruritus should be integrated into psoriasis care.
Background: Dermatophytosis is highly prevalent in South Asia and increasingly chronic and treatment‑resistant, with poor responses to standard systemic regimens in Bangladesh. This study compared dose‑based terbinafine and itraconazole monotherapies and their combination to identify an optimal regimen. Methods: In a randomized, open‑label, parallel‑group trial at a tertiary hospital, adults (18-60 years) with KOH‑confirmed tinea corporis/cruris/faciei were assigned to: T1 (terbinafine 250 mg/day), I1 (itraconazole 200 mg/day), T+I (terbinafine 250 mg+itraconazole 200 mg/day), T2 (terbinafine 500 mg/day), or I2 (itraconazole 400 mg/day). Follow‑up at weeks 2, 4, 6 and 8 assessed total symptom score (itching, erythema, scaling; 0-9), Physician global assessment, composite cure (clinical plus negative KOH) and safety. Results: One hundred fifty patients (30/group) were randomized with comparable baselines. Symptom scores declined significantly in all arms (p<0.001 within‑group). Week‑8 composite cure was highest with I2 (96.3%), followed by T+I (89.7%) and I1 (83.3%); T1 and T2 had higher failure (both 51.9%). Adverse events were mild and infrequent. Conclusions: Itraconazole, particularly 400 mg/day, achieved the best efficacy with good tolerability, whereas escalating terbinafine to 500 mg/day conferred no benefit. Treatment of contemporary dermatophytosis in Bangladesh should prioritise itraconazole‑based regimens.
Background: Cutaneous drug reactions mainly Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) and their overlap are rare but potentially fatal reactions endangers patient’s life, they are characterized by epidermal necrosis which causes erosions of the mucous membranes, extensive detachment of the epidermis. Drugs are the major causes of SJS\TEN. The types of the drugs depend on the prevalent diseases in the country and the protocols of management in that country. The aim of this study was to determine prevalence, causative factors and their correlation with SJS / TEN and their overlap, among patients admitted to Khartoum Dermatology and Venereology Hospital from January 2010 to September 2020. Methods: This retrospective cross-sectional study investigated 295patients with severe cutaneous reactions. Information collected included participants’ socio-demographic variables, clinical characteristics of the disease and the possible triggers. Data were analyzed using SPSS version 23.0. Results: The main age distribution was between 20-40 years in (42.7%), 48.8% of the cases had SJS, 44.4% had TEN and only 6.8% had SJS\TEN overlap. Seventy-two percent of the patients had no past history of similar condition. Sixty-six percent of the patients developed cutaneous symptoms from first till the seventh day after drugs intake. Drugs were determined to be the causative agent in 90.5% followed by other risk factors 7.5% mainly; chicken pox and dukhan dermatitis, (2%) of cases were idiopathic. The most common drugs implicated were antibiotics (75.6%), followed by NSAIDs (37.6 %). Patients who passed away during the study period were 24/295 cases (8.1%), 16 patients due to TEN, 6 patients with SJS and 2 patients with SJS/TEN overlap. Conclusions: SJS was the most common subtype of SJS/TEN in Khartoum Dermatology Hospital but most deaths occur among TEN patients. Women and persons aged 21–40 years were the most affected groups and was attributed to use of drugs, especially antibiotics (Ciprofloxacin), followed by NSAIDs (Diclofenac sodium).
