Indian Journal of Dermatology, Venereology and Leprology

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Mycosis fungoides and Sézary syndrome – Simplifying the approach for dermatologists. Part 1: Etiopathogenesis, clinical features and evaluation
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Singh, GK; Das, P; Sharma, P; Srivastava, S; Singh, V; Singh, K; Barui, S; Mulajkar, D; Dubey, IP.
Cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of extranodal non-Hodgkin’s lymphomas characterised by a cutaneous infiltration of malignant monoclonal T lymphocytes. While this broad spectrum of disease with its varied etiopathogenesis, clinical features and management options are well characterised, an approach from a dermatologist’s perspective is lacking in the literature. We strive to elucidate the approach from a clinician’s point of view, especially in respect of clinical examination, investigations, staging and management options that are available in the realm of the dermatologists. This review article is the first part out of the two, covering the etiopathogenesis, clinical features and evaluation.
Therapeutic success of tofacitinib in granuloma annulare: A retrospective case series of 15 patients
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Dev, A; Keshavamurthy, V; Chatterjee, D.
Background: Granuloma annulare (GA) is a necrobiotic granulomatous disorder that may sometimes be resistant to treatment, especially the generalised form. Tofacitinib has recently shown promise in the treatment of non-infective granulomatous dermatosis. Objectives: In this study, we aimed to evaluate the response of generalised GA to oral tofacitinib. Methods: This was a retrospective case series in patients of generalised GA who were treated with oral tofacitinib 5 mg twice a day in a tertiary care centre in north India. Baseline clinical details and histopathological findings were reviewed. Treatment response was noted in the form of clearance of lesions (complete or partial) along with the time taken to achieve the maximum response. Results: A total of 15 patients of generalised GA were included in this study, amongst whom nine patients were resistant to conventional therapies whilst the remaining were treatment naïve. Complete clearance of lesions was noted in 11 patients at a mean treatment duration of 4.4 ± 2.1 months whereas clearance was partial in four, with a mean follow-up duration post- treatment in patients who had partial clearance, which is 7.3 ± 2.8 month, with a reduction in erythema and infiltration in those lesions. Adverse effects in the form of hyperlipidemia were observed in two patients. Conclusion: Tofacitinib, a JAK-STAT inhibitor is beneficial in treating GA, especially in those with generalised and recalcitrant disease.
Recurrence rates after functional surgery versus amputation for nail squamous cell carcinoma not involving the bone: A systematic review
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Wong, H-S; Li, F; Jiang, J-Y; Huang, S-D; Ji, X; Zhu, P; Wang, D-G.
Background: Nail unit squamous cell carcinoma (nSCC) is a malignant subungual tumour. Although it has a low risk of metastasis and mortality, the tumour has a significant local recurrence rate. There is insufficient data to determine whether functional surgery is less effective than amputation for nSCC that does not involve the bone. Objectives: We aimed to investigate existing data on the outcomes of functional surgery and amputation for nSCC without bone invasion. Materials and Methods: We carried out an extensive search in PubMed, Embase, Cochrane Library, Web of Science, and Scopus for appropriate English-language academic papers, starting with the creation of individual resources until February 23, 2023. The main outcome was local recurrence. Initially, 2191 studies related to nSCC were selected. Information from every research study was retrieved and subdivided, comprising the year of publication, period, number of patients, age, gender distribution, tumour stage, type of intervention, number of recurrences, and follow-up period. Results: Ten independent studies (319 lesions) were finally selected. Mohs micrographic surgery was the most reported surgical modality, followed by wide surgical excision and amputation. Local recurrence rates between Mohs micrographic surgery, wide surgical excision and amputation treatment were nearly identical. Other surgical methods included limited surgical excision, partial ablation, and limited excision until the clearing of margins, with recurrence rates up to 50%. Conclusions: Given the functional impairment and psychological distress associated with phalanx amputation, functional surgery, including Mohs micrographic surgery and wide surgical excision , should be the preferred therapy for nSCC without bone involvement. Amputation should remain the preferred therapy for nSCC that involves the bone. Partial excision should be avoided. Further studies on whether Mohs micrographic surgery or wide surgical excision is a better option for nSCC not involving the bone are required.
High level of gamma-glutamyltransferase is a possible risk factor for psoriasis: A nationwide population-based cohort study
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Oh, JW; Han, KD; Doh, JY; Gee, HY; Lee, JH.
Background: Gamma-glutamyl transferase (GGT) has been associated with coronary heart disease, diabetes mellitus, and hypertension, but its association with psoriasis has not yet been elucidated. Aims: We conducted this study to determine the association between the risk of psoriasis and the serum GGT. Methods: We conducted a nationwide population-based study. A total of 9,939,350 people met the enrolment criteria. The study population was classified into four groups based on GGT levels and the risk of psoriasis was calculated for each group. Results: The incidence rates of psoriasis per 1,000 person-years were 2.96105 and 3.68577 in the lowest and highest GGT groups, respectively. After adjusting for age, sex, income, diabetes mellitus, hypertension, dyslipidemia, smoking, alcohol intake, exercise, and body mass index, the highest GGT group showed a significantly increased risk of developing psoriasis (hazard ratio: 1.057, 95% confidence interval: 1.044–1.07). This risk of psoriasis was significantly higher among the old age group (hazard ratio: 1.162, 95% confidence interval: 1.128–1.197) and women (hazard ratio: 1.14, 95% confidence interval: 1.117–1.164). Limitations: The limitations of this study included the retrospective design, International Classification of Diseases code- based diagnosis, small hazard ratio, and non-availability of data on covariates. Conclusion: The GGT level was found to be an independent risk factor for developing psoriasis.
Comparative study of the efficacy of azathioprine, dapsone, and NB-UVB phototherapy as steroid-sparing modalities in generalised lichen planus
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Mithra, S; Parimalam, K; Sowmiya, R.
Background: Generalised lichen planus (GLP) is a chronic disease with an overall prevalence of 1% requiring longer treatment. Limited studies are available on GLP and its treatment in the literature, unlike oral lichen planus. Objectives: To determine the best steroid-sparing treatment modality for GLP by comparing the efficacy, response, safety, side effects, and remission with azathioprine, dapsone, and narrowband UV-B (NB-UVB) along with their impact on itching severity and life quality. Methodology: Open-label, prospective, comparative, interventional study on generalised lichen planus patients treated with systemic steroids along with one of three steroid-sparing modalities. Totally 90 patients were studied including 30 patients each who received azathioprine (Group A), dapsone (Group B), and narrow band UVB (NB-UVB) (Group C), respectively, for 16 weeks. Itch severity index (ISI) and Dermatology life quality Index (DLQI) were assessed at baseline and week 24. All patients received oral prednisolone until there was no more active disease. Response was assessed in terms of occurrence of new lesions, flattening of lesions, post-inflammatory hyperpigmentation (PIH), and grading of lesions two weeks once for 6 months followed by six months of follow-up after treatment completion. Results: Females outnumbered males in all 3 groups. Mean patient ages (34, 38, and 34) and the presence of one or more co-morbidities (50%, 42.3%, 37.5%) in Groups A, B, and C, respectively, were comparable. ISI and DLQI improvement at 24 weeks were greatest with NB-UVB, followed by azathioprine and dapsone in that order; the differences in improvement between groups showed high statistical significance. At week 24, occurrence of new lesions (0%, 0%, 3.8%), flattening (100% – all groups), PIH (100% – all groups), grade 3 lesions i.e. poor response, resolution of 20-50% of lesions (7.1%, 11.5%, 0%), grade 2 lesions i.e. partial response, resolution of 50-90% of lesions (35.7%, 76.9%, 8.3%) and grade 1 lesions i.e. complete response, resolution of >90% lesions (57.1%, 11.5%, 91.3%) were noted in Groups A, B and C, respectively; the differences in the extent of resolution of lesions between the groups were highly significant statistically. Remission was seen in 100%, 76.9%, and 87.5% in Groups A, B, and C, respectively, after six months. Limitations: The sample size was small. Only 3 treatment options were compared in this study but many more options have been used for lichen planus. Long term follow-up is required. Conclusions: NB-UVB with oral steroids showed a better response in terms of improvement in DLQI, ISI, disease control, and side effects than azathioprine and dapsone. Azathioprine showed a faster response and more prolonged remission. Dapsone showed poor response with multiple side effects.
High-frequency ultrasonography for the detection of subclinical arthritis in chronic plaque psoriasis patients – A cross-sectional study
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Vendhan, S; Vasudevan, B; Rai, R; Neema, S; Krishnan, LP; Kamboj, P.
Background: Psoriatic arthritis (PsA) is seen in almost 30–40% cases of psoriasis. Psoriasis precedes the onset of PsA in 85% of cases. Delay in the diagnosis of PsA may lead to poor functional outcomes and morbidity. Screening psoriasis patients with high-frequency ultrasound helps to diagnose arthritis at an early stage leading to prompt intervention and possible reduction in the morbidity associated with the disease. Objectives: To determine the role of high frequency ultrasonography (USG) in the detection of subclinical PsA. Methods: A cross-sectional study was conducted in a dermatology and radiology department of Armed Forces Medical College, Pune between July 2021 and December 2022. Patients of chronic plaque psoriasis with no clinical evidence of arthritis were assessed using high-frequency USG. Various parameters such as bony erosions, synovial thickening, tendon thickening, tendon hypo-echogenicity, calcifications and power doppler signals were assessed. Results: A total of 117 patients were included in the study. The distal interphalangeal joint (DIP) and Achilles tendon were the most commonly affected sites. Synovial thickening in DIP was observed in 67 (57%) patients and Achilles tendon thickening was observed in 39 (33%) patients. Limitations of the study: The cross-sectional nature of the study is the major limitation. A longitudinal study will be required to understand the clinical relevance of ultrasonographic changes in these patients. Another limitation of the study is the lack of age and gender-matched controls. Future research should include such controls to ensure more accurate results. Conclusion: Subclinical arthritis is common in patients with chronic plaque psoriasis. High-frequency ultrasound is a useful tool for detecting subclinical synovitis and enthesitis in asymptomatic patients. The DIP joint and Achilles tendon ultrasound can be used for screening for early detection of PsA.
Efficacy and safety of combinations of H1 antihistamines in the treatment of urticaria: A scoping review
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Luo, M; Shen, K; Dong, X; Zhang, W; Tang, F.
The efficacy and safety of combining H1 antihistamines (AHs) for treating urticaria are currently unclear. This scoping review aims to provide a comprehensive overview of the evidence regarding the efficacy and safety of H1 AH combinations in the management of urticaria up to May 2023. The search encompassed databases such as PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and the China Biological Medicine Database. The inclusion criteria comprised randomised controlled trials (RCTs), non-randomised trials (NRTs), case reports, and case series focusing on urticaria treatment. Initially screening 12,887 studies, this review ultimately selected 109 studies involving 11,435 patients. These studies documented 43 different combination treatments across 11 types of urticaria. In comparison to monotherapy, combination therapy exhibited superior efficacy in 94 studies that reported treatment efficacy. Regarding adverse drug reactions (ADRs), 67 studies disclosed ADR incidences, with combination therapy showing lower ADR rates in 32 studies. Additionally, 7 studies reported similar ADR rates between combination therapy and monotherapy with AHs. Common ADRs included symptoms such as drowsiness, nausea, fatigue, dry mouth, dizziness, and headache, while less frequent side effects encompassed hypotension, otitis media, polyuria, rhinorrhoea, abnormal liver function, and rash. ADR rates ranged from 0% to 21% in the treatment group, and from 0.5% to 75% in the control group. Importantly, patients generally tolerated these ADRs well, with symptoms resolving upon discontinuation of treatment. The study’s findings suggest that combining AHs leads to enhanced efficacy and reduced safety risks compared to monotherapy in the context of urticaria treatment. These results advocate for considering combination therapy as a viable option in clinical practice, especially for chronic urticaria cases. Nonetheless, caution is advised, and close monitoring for potential ADRs is crucial during treatment.
High serum total IgE levels correlate with urticarial lesions and IgE deposition in perilesional skin of bullous pemphigoid patients: An observational study
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-04) Ngan, GP; Nguyen, VTH; Huu, DL.
Background: In the pathophysiology of bullous pemphigoid, besides IgG, there has been evidence that supports the role of IgE antibodies. However, there have been no studies to evaluate total serum IgE levels or detect IgE deposits in the skin of Vietnamese patients. Aim: To analyse the association between IgE levels in the serum and disease severity as well as eosinophils and IgE basement membrane zone (BMZ) deposition in Vietnamese bullous pemphigoid patients. Methods: A single-centre observational research on 35 newly diagnosed and untreated bullous pemphigoid patients. Total serum IgE levels were analysed using enzyme?linked immunosorbent assay (ELISA). For controls, we collected sera of 30 pemphigus patients and 30 elderly patients with pruritus. Perilesional skin biopsies underwent direct immunofluorescence (DIF) staining, with biopsies of pemphigus patients as controls. Results: Elevated total serum IgE was observed in 60% of bullous pemphigoid patients, the percentage in the pemphigus group and pruritus group was 20% and 40%, respectively. The mean total serum IgE level among the bullous pemphigoid group was higher than that of the pemphigus group (123.3 ± 102.4 IU/mL vs. 64.3 ± 45.1 IU/mL, p = 0.010). Total serum IgE levels of bullous pemphigoid patients correlated with higher eosinophil counts (r = 0.61; p = 0.018) and urticaria/erythema (U/E) Bullous Pemphigoid Disease Area Index (BPDAI) score (r = 0.50; p = 0.035). Among 35 bullous pemphigoid patients, 5 patients showed positive IgE DIF staining, accounting for 14.3%. Higher serum IgE levels correlated with the deposition of IgE in patients’ perilesional skin (p = 0.037). Limitations: Due to the rarity of bullous pemphigoid, the effect of the COVID-19 pandemic, and self-treatment issues in Vietnam, we could not recruit a larger number of participants. Conclusions: Total serum IgE values correlated with urticarial lesions and IgE deposition in perilesional skin of Vietnamese bullous pemphigoid patients. IgE autoantibodies present in the skin of bullous pemphigoid patients support the role of IgE in bullous pemphigoid pathogenesis.
Unilateral naevoid telangiectasia: A retrospective study of 11 paediatric cases
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-04) He, R; Zhang, N; Guo, W; Ma, L; Xu, Z; Zhang, B.
Background: Unilateral naevoid telangiectasia (UNT) is a rare disease with only sporadic cases reported. The pathogenesis remains elusive and especially in paediatric patients, effective and safe treatment is still uncertain. Objectives: The purpose of this study was to summarise the clinical characteristics of UNT, explore the possible pathogenesis and evaluate the efficacy and safety of pulsed dye laser (PDL) therapy. Methods: The epidemiological data, clinical manifestations, laboratory tests and pathological features of paediatric patients with UNT were retrospectively reviewed. PDL treatment was done on some of the patients. Clinical documents and patient images before and after treatment were assessed to evaluate efficacy and adverse events. Results: Most of the cases (9/11) presented with unilateral lesions. The laboratory results of all the 11 cases were normal. Histological examination in six cases revealed multiple, dilated veins in the reticular dermis. Vascular endothelial growth factor (VEGF) staining was positive, whereas oestrogen receptor staining was negative. Nine cases were treated with PDL which was shown to be effective and safe. Conclusion: UNT has typical clinical manifestations. The pathogenesis of this disease could be linked to VEGF; however, more research and confirmation are needed. PDL is an effective and safe treatment for UNT.
Role of cosmetic camouflage in improving quality of life in dermatological disorders: A narrative review
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-04) Arora, A; Bhalla, M.
Camouflage is a system of techniques using cosmetics to conceal, diminish and disguise visible disfigurements of pigment or texture of skin mainly over visible areas. A wide variety of options are available which can be used as camouflage cosmetics. Over the years many authors have published studies highlighting the importance of camouflage in different dermatological disorders like pigmentary, vascular, scars, acne vulgaris and many more. In this review we present 15 such studies assessing QOL in patients of dermatological diseases who were given camouflage therapy. The evidence presented here gives us an insight into the positive effects of camouflage/cover up make up when offered to patients with different dermatological conditions.
Clinico-epidemiological characteristics and long-term surgical outcome of basal cell carcinoma treated with standard excision in patients of skin of colour: A retrospective study from Northern India
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-04) Vinay, K; Mehta, H; Chatterjee, D; Reddy, A; Jain, S; Narang, T; Dogra, S.
Background: There is scant data on basal cell carcinoma (BCC) in Indian patients. This retrospective study was conducted to explore epidemiology, risk factors, clinical and pathological aspects, and long-term treatment outcomes of BCC in a cohort of North Indian patients. Methods: Data about patients registered in the dermatosurgery clinic between 01 January 2017 and 31 December 2022 with a confirmed diagnosis of BCC was collected. Results: Among the 83 patients, 56.6% were females, and the median age was 62 years (6–85 years). Most patients (81.9%) had a single BCC lesion, resulting in a total of 126 assessed lesions. The median size of BCC at presentation was 1.90 cm, with nodular BCC being the most common histopathological subtype (39.7%). Head and neck region involvement was observed in 82.5% of patients, with the malar region, nose, and periorbital region being the most commonly affected sites. Pigmentation was clinically evident in 45.2% of cases. Surgical excision was the primary treatment modality (71.1% of patients). The median follow-up duration was 40 months (6–57 months). Recurrence occurred in five patients, with a longer disease-free survival period observed in the surgically treated group (55.58 ± 0.98 months) compared to patients treated with medical or destructive therapies (43.6 ± 3.482 months) (p = 0.003). Limitations: Include retrospective study design, potential for incomplete data, selection bias, relatively small sample size and short duration follow-up to know the recurrences. Conclusion: The data from this hospital-based study indicated a slight predilection for females among North Indian patients with BCC, with most cases occurring during their seventh decade of life. The condition commonly occurred on sun-exposed areas such as the malar region and nose, with a high percentage of pigmented lesions. Recurrence following surgical excision was rare, and overall treatment outcomes were favourable.
Differential expression of serum CXCL9 and CXCL10 levels in vitiligo patients and their correlation with disease severity and stability: A cross-sectional study
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Aulakh, S; Goel, S; Kaur, L; Gulati, S; Kaur, M; Chopra, D; Sarangal, R; Batra, J.
Background: Vitiligo is an acquired disorder of pigmentation with an elusive pathogenesis, though various theories have been proposed. The presence of peri-lesional autoreactive CD8+ T cell infiltrate suggests the involvement of abnormal immune responses and autoimmunity in vitiligo. Recent studies have identified the IFN-?-CXCL9/CXCL-10 axis as a key component of the autoimmune response that perpetuates disease activity in vitiligo. Objectives: The primary objective was to estimate serum CXCL9 and CXCL10 levels in vitiligo patients compared to age- and sex-matched controls. Additionally, the study aimed to find correlations between CXCL9 and CXCL10 levels and disease severity and stability. Secondary objectives included comparing levels in segmental/nonsegmental vitiligo and stable/ progressive vitiligo and assessing the impact of age and gender. Methods: A hospital-based cross-sectional study included 60 vitiligo patients and 30 age- and sex-matched controls. Serum levels of CXCL9 and CXCL10 were assessed using Enzyme-linked immunosorbent assay (ELISA). Cases were clinically evaluated for the type of vitiligo (segmental or non-segmental), disease severity (VASI score), and disease stability (VIDA score). Statistical analysis included t-tests, chi-square tests, and correlation coefficients. P value less than 0.5 was taken as significant. Results: Serum CXCL9 and CXCL10, both, were significantly raised in vitiligo patients as compared to controls (p-value = 0.001* & 0.001* respectively) and correlated positively with both VASI score (p-value = 0.001* & 0.001* respectively) and with VIDA score (p-value = 0.032* & 0.001* respectively). Serum CXCL10 showed significant elevation in progressive vitiligo, and CXCL9 exhibited a non-significant trend. No significant difference was observed between segmental and non- segmental vitiligo. Both chemokines positively correlated with disease severity and stability, while age and gender did not significantly impact chemokine levels. Limitations: Small sample size of control population. The voluntary sampling technique led to an unequal number of patients in progressive and stable vitiligo groups, as well as in segmental and non-segmental groups. The current study did not include blister fluid analysis and the effect of therapy on the chemokine levels.Conclusion: The expression of chemokines CXCL9 and CXCL10 is markedly increased and correlated positively with disease severity & instability, underscoring their mechanistic role in vitiligo pathogenesis. The values were also higher in the progressive group than in the stable group, inferring their conceivable potential as serum biomarkers. Both serum CXCL9 and CXCL10 were significantly elevated in vitiligo patients compared to controls and they can be used as potential serum biomarkers for assessing the disease activity.
The additional effect of 5% atorvastatin shampoo in the treatment of adult patients with mild to moderate seborrheic dermatitis of the scalp: A prospective, randomised, double-blind trial
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-04) Miri, F; Sadeghi, M; Abbaspour, M; Samadi, S; Yazdanpanah, MJ.
Background: Seborrheic dermatitis (SD) is a long-lasting inflammatory skin condition that predominantly impacts regions abundant in sebaceous glands, including the scalp. Objectives: To assess the efficacy and anti-inflammatory effect of atorvastatin as an additive treatment among SD patients. Methods: In a prospective, randomised, double-blind trial, 46 patients over 18 years old with mild to moderate scalp SD were randomly assigned to receive either 2% ketoconazole shampoo or 2% ketoconazole shampoo plus 5% atorvastatin. The severity of dermatitis was assessed based on the symptom scale of seborrheic dermatitis (SSSD), and the variables of erythema, scaling, and itching, at baseline and 4 weeks after the intervention. Results: Based on our analyses, both treatment methods significantly reduced the SSSD scores. However, the average SSSD score in patients using ketoconazole shampoo plus atorvastatin decreased by an average of five points after 1 month. This reduction was comparable to the average decline of 3.5 points observed in the group using ketoconazole shampoo alone. Specifically, the severity of dermatitis, as assessed by the SSSD score, significantly decreased by 1.92 points more, in individuals using the atorvastatin-containing shampoo compared to the comparison group (P = 0.02). Limitation: This research was conducted at a single centre which limits the validity of the findings. Conclusion: The results of this study suggest that shampoo containing atorvastatin provides a statistically significant effect compared to ketoconazole shampoo alone, indicating its potential as an alternative treatment for SD. The treatment notably alleviates symptoms associated with scaling and itching which are the common manifestations of the condition.
Association between PITX2 polymorphism and androgenetic alopecia in the Indian population
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-04) Murugan, M; Sadasivam, IP; Manoharan, A; Jayakumar, S; Vetriselvan, Y; Samuel, MS; Sambandam, R.
Background: Androgenetic alopecia, also known as male pattern baldness, is a common form of hair loss influenced by environmental, hormonal, and genetic factors. According to recent research, the PITX2 gene may play a key role in the pathophysiology of androgenetic alopecia (AGA). Objectives: This study examines the association between genetic variants of the PITX2 gene and AGA risk. Methods: The genomic DNA was extracted from peripheral blood samples collected from 70 male AGA patients and 60 non-androgenetic alopecia controls. The isolated DNA was quantified and the genotype for three PITX2 polymorphisms (rs2200733, rs10033464, and rs13143308) was identified using TaqMan assays. The statistical analysis was done to determine the allele frequency of genetic variants between AGA and non-AGA groups. Results: The demographic profile of the study population showed that the AGA and non-AGA groups differed in age. The AGA group had higher blood pressure, a higher prevalence of smoking, alcohol consumption, metabolic syndrome, insulin resistance, and a higher incidence of family history. Through genetic analysis, significant correlations were found between AGA risk and specific PITX2 polymorphisms, significantly with the rs2200733 allele (OR = 6.08, p < 0.001*), the rs1003464 G allele (OR = 2.02, p < 0.019*) and the rs13143308 showed GT genotype (OR = 4.26, p < 0.001*). Conclusion: Based on our findings, the PITX2 polymorphisms may play a vital role in the development of AGA. This study also found the interactions between genetic and environmental factors in AGA pathogenesis.
Effectiveness and safety of topical autologous platelet-rich fibrin membrane with total contact cast versus perilesional injectable autologous platelet-rich plasma therapy with total contact cast in trophic ulcer due to leprosy: A randomised controlled trial
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-04) Mukherjee, A; Das, S; Roy, S; Patra, AC; Ghosh, A; Sil, A; Das, NK.
Introduction: With a vision of a 90% reduction of grade 2 disability (G2D) in the Global Leprosy Strategy by 2030, the management of trophic ulcer, a common G2D, has become a priority. Autologous injectable perilesional platelet rich plasma (PRP) is first generation, whereas autologous platelet rich fibrin membrane (PRFM) is second generation platelet concentrate helping in trophic ulcer healing by providing growth factors and cytokines. PRFM requires less amount of blood (8 mL) against 20 mL in PRP. Objectives: Evaluate the effectiveness and safety of PRFM with total contact cast versus PRP with total contact cast in leprosy trophic ulcer. Methods: Observer-blind, non-inferiority randomised controlled trial recruited clinically diagnosed leprosy trophic ulcer with wound area measurement <40 cm2 after obtaining informed consent. Calculated sample size was 26 per group considering the percentage success in the control group (PRP) 39.29% and the experimental group (PRFM) 55.55%, 5% significance- level, 80% power, non-inferiority limit 10%, and 10% drop-out rate. Randomisation was done by computer generated random number table and allocation concealment by sequentially numbered opaque sealed envelope (SNOSE) technique. PRP was prepared with first spin 1,600 rpm for 10 minutes and second spin 4,000 rpm for 10 minutes. PRFM was prepared by centrifugation at 2,600 rpm for 3 minutes. Four treatment sessions followed by two follow-ups at 2 weekly intervals were conducted. Results: Baseline clinico-demographic profile was similar in both groups. The surface area was significantly reduced (Friedman’s ANOVA P<0.001) in both PRP (from 422.48+657.30 sq cm to 247.84+635.96 sq cm) and PRFM (290.04+281.42 sq cm to 152.77+336.09 sq cm) with significant reduction from first FU onwards in both groups (Post-Hoc Dunn’s test P<0.001). Complete improvement was noted in 12% of PRP and 23% of PRFM (Fischer’s test P=0.465). Both groups showed improvement in DLQI.Limitations: Short duration of treatment and follow-up (10 weeks). Conclusion: PRFM with total contact cast is not inferior to PRP. Because of operational ease (less blood, less time), PRFM is a better alternative to PRP.
Topical treatment of pyoderma gangrenosum: A systematic review
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-04) Donnelly, H; Boffa, MJ.
Systemic immunosuppressants are the mainstay of treatment for pyoderma gangrenosum (PG), but they generally have significant side effects which may be avoided by limiting treatment to topical therapy. This review aimed to assess the efficacy and safety of topical treatments for PG. An extensive literature search identified nineteen suitable publications for analysis, including two open cohort studies, five case series and twelve single case reports. The quality of evidence in the publications was graded and data relating to topical PG treatment was extracted. The lack of randomised clinical trials investigating topical monotherapy for PG means that robust statistical analysis was not possible. The greatest weight of the current evidence for topical therapy favours either corticosteroids or calcineurin inhibitors. According to our review, both these options appear well tolerated with a few side effects and may have similar efficacy in speeding up the resolution of PG ulcers. Topical therapy could be considered for use in combination with systemic treatment. There may also be a role for isolated topical monotherapy in selected patients with PG, especially those with early or mild disease and those with idiopathic PG. However further research is needed to confirm this and establish optimal treatment approaches for this condition.
Association between chronic renal disease and psoriasis risk in diabetes patients: A Korean population-based study
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-04) Yoo, SA; Sayo, MIA; Lee, JH.
Background: Several studies have reported that psoriasis has a positive correlation with type 2 diabetes mellitus (DM). Understanding the risk of psoriasis in diabetic patients is significant because it allows for early intervention and potential insights into the common pathways between the two conditions. Objectives: We analysed the risk of psoriasis according to the estimated glomerular filtration rate (eGFR) and proteinuria level in DM patients using Korean population–based data. Methods: This study was a retrospective cohort study using data collected from the country in the form of exploratory data analysis. A total of 927,234 participants diagnosed with DM were enrolled. Patients under the age of 20 with existing psoriasis or psoriasis developed within 1 year and missing data were excluded. The development of psoriasis was the primary outcome within a follow-up period of 7.83 ± 1.68 years. Results: Of the 840,395 final participants, 28,010 (3.33%) patients developed psoriasis. In multivariate-adjusted Cox proportional hazards regression models, the DM patients with eGFR < 30 had a higher risk of psoriasis after adjustment (eGFR 60–90, hazard ratio [HR] 1 (Ref.); eGFR < 30, HR 1.173, 95% CI 1.089–1.264). In addition, there was an increased psoriatic risk of patients with DM and proteinuria after adjustment (negative, HR 1 (Ref.); 2+, HR 1.164, 95% CI 1.080– 1.254; 3+, HR 1.433, 95% CI 1.273–1.613; 4+, HR 1.508, 95% CI 1.177–1.931). Limitations: The severity of psoriasis was not measured since the occurrence of psoriasis was the outcome. Details of oral hypoglycaemic agents such as type and dose were not investigated. Conclusion: This study showed that a decrease in eGFR and aggravation of proteinuria increase the risk of psoriasis in diabetic patients. Therefore, by using eGFR and proteinuria as predictive risk factors of psoriasis in DM patients, early and proactive treatment may play a vital role in managing diabetic patients.
Mycosis fungoides and Sezary syndrome – Simplifying the approach for dermatologists. Part 2: Evaluation, staging, prognosis and treatment
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-04) Singh, GK; Das, P; Srivastava, S; Singh, K; Singh, V; Barui, S; Mulajkar, D; Dubey, IP.
Cutaneous T-cell lymphoma is a heterogeneous group of T-cell neoplasms, of which mycosis fungoides and Sezary syndrome are the most common. The prognosis depends on the stage of the disease. The early stage follows a protracted course with a five-year disease-specific survival of greater than 95% and is treated with skin-directed topical therapies, phototherapy, and oral drugs like methotrexate. Advanced disease has a five-year overall survival of less than 25% and requires management by systemic chemotherapeutic agents. This review article is the second part out of the two covering the staging, prognosis, and treatment from a dermatologist’s perspective.
Tofacitinib treatment for plaque psoriasis and psoriatic arthritis: A meta-analysis of randomised controlled trials
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-04) Wang, T; Wu, W; Zhang, X; Gan, B; Zhou, Y; Cheng, X.
Objectives: Tofacitinib is used as an oral Janus-associated kinase (JAK) inhibitor acting on JAK1 and JAK3, in treating psoriatic disease. However, there is still no consensus on the optimal dosage and duration of tofacitinib. In this study, we aimed to evaluate the effects of tofacitinib in treating psoriatic disease. Methods: A literature search was done utilising Cochrane library, Medline, EMBASE, Wiley Online library, Web of Science and BIOSIS Previews through December 18, 2022. We performed a meta-analysis of published original studies to assess the impact of tofacitinib in plaque psoriasis or psoriatic arthritis therapy based on seven randomised controlled trials (RCTs) involving 2,672 patients (receiving tofacitinib) and 853 controls (receiving placebo). Results: Compared with placebo, the treatment of 5 mg twice-daily (BID) tofacitinib for 12 weeks is sufficient to significantly alleviate the main clinical manifestations of psoriasis [?75% decrease in Psoriasis Area and Severity Index score (PASI 75): Risk ratio (RR)=4.38 (95% Confidence interval (CI) 2.51 to 7.64); ?90% decrease in PASI score (PASI 90): RR=21.68 (95% CI 4.20 to 111.85); Physician’s Global Assessment of ‘clear’ or ‘almost clear’ (PGA 0/1): RR=3.93 (95%CI 3.03 to 5.09)]. Interestingly, there was no significant difference in improvement in PGA 0/1 with 5 mg BID tofacitinib given for 16 weeks when compared with 5 mg BID tofacitinib for 12 weeks [RR=1.11 (95%CI 0.98 to 1.25)]. Additionally, the 5 mg BID tofacitinib for 16 weeks treatment schedule significantly increased the incidence of upper respiratory tract infection (URTI) [RR=1.89 (95%CI 1.06 to 3.38)] as compared to 5 mg BID tofacitinib for 12 weeks treatment schedule [RR=1.15 (95%CI 0.60 to 2.20)]. Conclusion: The 5 mg BID tofacitinib for 12 weeks treatment significantly improved psoriasis without causing too many specific adverse events. This indicated that tofacitinib is an effective treatment plan for psoriatic disease by reasonably controlling dosage and dosing time.
Clinical and immunological predictors of post-rituximab paradoxical pemphigus flare: A prospective cohort study
(Scientific Scholar on behalf of Indian Association of Dermatologists, Venereologists & Leprologists (IADVL), India., 2025-02) Gupta, V; Ahuja, R; Sindhuja, T; Imran, S; Viswanathan, GK; Tembhre, MK; Pandey, S; Khandpur, S.
Background: Paradoxical flare of pemphigus following rituximab infusion has been reported previously, however, its inci- dence or risk factors have not been studied in detail. Objectives: To evaluate the clinical and immunological predictors associated with post-rituximab paradoxical pemphigus flare. Materials and Methods: This was a prospective cohort study including adult patients with pemphigus vulgaris or foliaceus who were treated with rituximab. Patients were administered 1000 mg of intravenous rituximab on days 0 and 14 (Rheumatoid arthritis (RA) protocol), with or without oral prednisolone and/or conventional immunosuppressive agents. Baseline clinical and immunological predictors of post-rituximab pemphigus flares were assessed. Results: Fifty patients (mean age 40.44 ± 12.36 years) with a mean pemphigus disease area index (PDAI) score of 27.8 ± 15.48 were administered rituximab. Post-rituximab flare occurred in 10 (20%) patients after a mean of 14.1 ± 4.33 days after the first rituximab infusion. The mean baseline PDAI score (36.4 ± 11.7 vs. 25.6 ± 15.7, P = 0.02) and serum anti-Dsg1 levels (1216.8 ± 850.1 vs. 592 ± 562.12 RU/mL, P = 0.03) were statistically significantly higher in patients experiencing a flare. Using ROC- curve analysis, a PDAI score of ?28 (OR 8.3, 95% CI 1.5–44.7) was 80% sensitive and 67.5% specific in predicting post- rituximab flare, while serum anti-Dsg1 level of >1137.78 RU/ml had a sensitivity of 60% and specificity of 85%. There was no significant difference in terms of affected body surface area, type of pemphigus, starting prednisolone dose, oral immunosuppressive adjuvant, serum anti-Dsg3, serum anti-AchRM3, and peripheral CD19+ B cell population. Limitations: Our study is limited by a relatively small sample size. Immunological factors were not evaluated at the time of pemphigus flare. Though these unexpected pemphigus flares are likely to be associated with rituximab infusion, the possibility of spontaneous disease exacerbation cannot be entirely excluded. Conclusions: Patients with more severe pemphigus or high serum anti-Dsg1 are at risk of post-rituximab paradoxical flare, and may benefit from rituximab administration under close monitoring.

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