Gaurav Deshmukh

Abstract

Despite the increasing incidence of adult acne in recent times practical guidelines for management of these patients are lacking in India setup. Thus, to develop practical consensus-based recommendations on diagnosis and management of acne in adult patients an expert panel was finalized. The consensus was developed using Delphi method. Panel members were asked to complete two Delphi surveys one for diagnosis and another for management. Experts reached consensus on practical approach of diagnosis and management of patients with adult acne based on available evidence and their personal experience. Experts recommended that a holistic treatment approach consisting of standard therapy, adjuvant therapy and cosmetic use should be first choice treatment strategy in adult acne patients. Experts also commented that treatment choices should be individualized based on the specific characteristics of each patient and be tailored to suit this particular population. Keywords: Adult acne, Consensus, Management, Diagnosis, Female acne.

Open full article page

Abstract

Background: Hyperkeratinization and changes in skin pH play very important role in pathogenesis of tinea infections resulting in treatment failure in multiple patients. The objective of the current consensus was to provide an experience-driven approach regarding the management of hyperkeratotic tinea infection with combination of topical antifungal and keratolytic agents. Materials and Methods: 9 experts in the field of dermatology participated in digital meeting to discuss the role of combination of topical antifungal and keratolytic agent based on prevalidated questionnaire consisting of 18 questions. Questions were graded on a scale of 1 to 10 (1 being not recommended and 10 being strongly recommended). Results: During the meeting panellists discussed regarding the pathophysiological aspects of hyperkeratotic tinea infection, impact of hyperkeratinization or scaling and changes in skin pH on management of patients with tinea infection, ideal topical antifungal and keratolytic agent and the rationale for combination, frequency, duration and method of application, initiation of therapy, safety of combination and precautions to be taken during treatment period. After the end of meeting total 18 recommendations were made based on a thorough discussion, available evidence and practical experience of the experts. Conclusion: This consensus will help in management of patients with hyperkeratotic tinea infection and will improve the treatment outcomes in these patients. Keywords: Hyperkeratotic tinea infections, Keratolytic, Combination, Luliconazole, Salicylic acid.

Open full article page

Abstract

Introduction: There is alarming rise in cases of dermatophytosis in India. Standard treatment recommendations are no longer working. Combination of topical and systemic antifungal drugs is one of the most frequently used treatment strategy. Materials and Methods: This was an open label, prospective, interventional, non-comparative study. Effectiveness endpoints were percentage of patients achieving complete cure, clinical cure and mycological cure at the end of the treatment period from baseline. Safety was assessed by analyzing the AEs and monitoring of liver function tests. Results: 66 patients were included in the study. 75.75%, 86.36% and 81.8% patients achieved complete cure, clinical cure and mycological cure respectively at the end of the study period. There was improvement in each symptom during study duration as observed during each follow up visit on week 2, 4 and 6. Total of 10.60% reported 1 or more drug related AE. Nausea was most common side effect followed by vomiting, headache and edema of face. All the AEs were mild in nature and resolved during study. Conclusion: To conclude the result of this study shows that the combination therapy of oral itraconazole and topical amorolfine represents an improved treatment strategy for patients with recalcitrant multisite tinea infections. Keywords: Itraconazole, Amorolfine, Dermatophytosis, Combination Therapy.

Open full article page

Abstract

Introduction: Wide spread, inappropriate use of antifungal drugs in dermatophytosis has resulted in rise in minimum inhibitory concentration (MIC) values and reduced response. Hence there is a need for a different antifungal with a novel mechanism of action. Materials and Methods: This was an open-label, randomised, prospective, interventional, comparative, double-arm study. The patients were treated with either topical ciclopirox olamine or luliconazole twice daily for 6 weeks. All the patients were taking oral itraconazole 100mg twice daily for 4 weeks. Effectiveness endpoints were percentage of patients achieving complete cure, clinical cure and mycological cure at the end of the treatment period from baseline. Safety was assessed by analyzing the AEs and monitoring of liver function tests. Results: 92 patients were included in the study. 44 and 43 patients completed the study in ciclopirox and luliconazole group respectively. 84.09%, 88.63% and 86.36% patients achieved ccomplete, clinical and mycological cure rate in ciclopirox group respectively. 83.72%, 88.37% and 86.04% patients achieved complete, clinical and mycological in luliconazole group respectively. 10.63% patients in the Ciclopirox group and 10.86% in the Luliconazole group reported one or more drug related AE. Nausea, skin rash, head ache and vomiting were AEs reported. Conclusion: The results of this study prove that Ciclopirox is novel antifungal agent which is efficacious and safe in the management of dermatophytosis. Keywords: Ciclopirox, Luliconazole, Efficacy, Safety, Dermatophytosis.

Open full article page