Sunil Chaudhry

Vitiligo is also known as Safed Daagh, Safed Kodh, Phuleri and Savitra in vernacular. Vitiligo causes social and psychological distress, affecting 0.1 to 2 Percent global population. The pathology demonstrates depigmentation of the skin, with loss of melanocytes by autoreactive cytotoxic T cells. The vitiligo-infiltrating lymphocytes were T lymphocytes, and most were CD8+The elevated levels of H2O2 in the skin mediate the production of proinflammatory cytokines like IL-1β, IL6, and IL-8 indirectly by activating the calreticulin pathway. Autoimmunity in vitiligo is driven by the IFN-?-CXCL10 cytokine (motif chemokine ligand) signaling pathway. No drug can stop the process of vitiligo. Most of the drugs are used in combination. Light therapy can help to restore some color. Topical steroids, calcineurin inhibitors, and narrow-band ultraviolet (UV)–B phototherapy are widely used. New depigmenting therapies are emerging such as helium-neon (He–Ne) lasers and prostaglandin E2 analogs. In cases of stable disease, surgical procedures such as skin grafting, blister grafting, orCellular suspension transplant are often tried. Ruxolitinib is the first medication that can restore pigment in patients with nonsegmental vitiligo. Tildrakizumab is also being evaluated in form of Topical Cream. Unfortunately, vitiligo is life long condition which is difficult to treat with satisfaction.   Keywords: Vitiligo, Disease, Pathogenesis, Melanocytes, Steroids, Biologicals

Going grey has a perception of person getting old and not attractive. Therefore, lot of remedies are tried to colour the affected part of scalp. Use of measures to colour hair or use of medications to change the grey hair to black is only a temporary phenomenon which may not last long as the melanin a pigment which imparts colour to hair is gradually decreased. Men have greying much faster than women. Thyroid hormones [triiodothyronine (T3) and tetraiodothyronine (T4)] and the central neuroendocrine regulator of the hypothalamic–pituitary–thyroid (HPT) axis, thyrotropin-releasing hormone (TRH), which is produced within human scalp stimulate melanin production. Thus, both in hypo and hyperthyroid state greying can occur. This is also altered in Postmenopausal changes include decreased anagen hairs in the frontal scalp, lower growth rates. The preferred action is to have balanced diet, adequate vitamins, avoiding excessive exposure to sun and lubrication of hair regularly with any oil.   Keywords: Greying of hairs, Para-aminobenzoic.

There is a relatively higher incidence of penile cancer in India 3.32 per 100 000 men, whereas Jewish men have the lowest incidence. The risk factors include phimosis, balanitis, and no circumcision. Human papillomavirus accounts for 40% of cases. Other factors include obesity, smoking, Psoralen UV- A therapy. Penile cancer is common above the age of 50 years. 95% of penile cancer is a squamous cell, carcinoma. Treatment of Penile carcinoma is stage wise, where surgery, partial or total penectomy, radiation therapy, or chemotherapy are a mainstay. Laser therapy is often used in the treatment of both CIS and low-grade/stage invasive disease. The neoadjuvant regimen often used is TIP, which consists of 4 cycles of paclitaxel, ifosfamide, and cisplatin. Nimotuzumab EGFR-antibody treatment as an alternative salvage treatment for advanced penile cancer. Immune Checkpoints blockades such as cabozantinib are evaluated in resistant diseases. Avelumab is currently tested in penile cancer patients in two ongoing trials.   Keywords: Penile cancer, HPV, Squamous cell, Checkpoint inhibitors, Penectomy

The median survival of patients with newly diagnosed MM was approximately 2.5 years, before the introduction of Proteasome inhibitors and immunomodulators. Bortezomib, thalidomide, lenalidomide, and the introduction of autologous stem cell transplantation (ASCT) have substantially improved overall survival (OS), which now ranges from 5 to 7 years.Several three-drug (triplet) combination regimens have shown better efficacy in, multiple myeloma. Currently, many MM cell antigens, such as daratumumab which is targeted therapy, vaccines (dendritic cell, myeloma derived protein and peptides) are combined with autologous stem cell transplantation. Treatment of Multiple myeloma expensive ranging between 11000 to 13000 USD. Keywords: Myeloma, Bortezomib, Proteasome inhibitor, Panobinostat, Daratumumab, Elotuzumab

The past 15 years have seen increased usage of factor Xa inhibitor anticoagulants such as rivaroxaban, apixaban, and edoxaban, along with dabigatran (competitive direct thrombin inhibitor), which have been used increasingly in various clinical settings, for the prevention and treatment of thrombosis. In many ways Factor Xa inhibitors have replaced the use of warfarin, which requires prudent monitoring . Factor Xa inhibitor short half-lives, compared to warfarin’s, provide some assurance that the drug concentrations will decline rapidly when therapy is discontinued in patients with normal renal function. Good haemostatic efficacy was achieved in 83% patients on apixaban and 80% patients on rivaroxaban . Major bleeding events in nonvalvular atrial fibrillation patients on rivaroxaban were 3.6% per year and on apixaban were 2.13% per year in respective landmark trials conducted. Some drawbacks of Factor Xa inhibitors include uncertainty about dosing in some patient populations (eg, renal dysfunction, marked extremes of body weight), and their higher drug cost. Keywords: Anticoagulant, Pulmonary embolism, Venous thromboembolism

The aim of clinical research is to impart knowledge that will improve human health or improve understanding of human physiology. Although, till the end of 20 century pregnancy was always under exclusion criteria, now pervasive exclusion of pregnant women in clinical trials is currently not justified. Pregnancy brings in an array of anatomical, physiological and biochemical changes that can impact the pharmacokinetics of important medications. Pregnancy is often accompanied by chronic diseases like diabetes, hypertension, tuberculosis, HIV, depression which can require long term therapy. This indicates a need for studies being conducted exclusively in pregnant women. Current communication narrates ethical and regulatory aspects of inclusion of pregnant women in clinical trials. Keywords: Special populations, Pregnant or nursing women, Pharmacokinetics, Informed consent, Paternal consent

Key customers of the pharmaceutical industry are qualified medical practitioners. To be able to stand their ground the sales representative needs training about medical terminology, the relevant disease, the molecule being marketed and some competitor information. A short induction could be followed by ongoing refresher training either face to face or online. The medical department has a major role to play here. Product launch training is planned by medical and marketing team based on the feature benefits of the product being launched. The training unit of the medical department of pharma companies are an inseparable part of the whole marketing effort. Keywords: Training, Salesforce, Performance, Customer orientation, Effectiveness

Biologic drugs and subsequently developed biosimilars treat chronic inflammatory autoimmune conditions such as rheumatoid or psoriatic arthritis, ankylosingspondylitis, crohn's disease, ulcerative colitis, and psoriasis. Biologics can target the cancer in a specific way and may work synergistically with chemotherapy to improve outcome. It is expected that in the next five years, 50% of biological products will originate from biotechnology. Biological products, including those manufactured by biotechnology, tend to be heat sensitive and susceptible to microbial contamination. There are no expected clinically meaningful differences in efficacy and safety between a biosimilar and the biologic drugs which are authorized for sale. The global market for is dominated by oncology (nearly 39% share) whereas the total market size is expected to reach nearly 70 billion by 2025. Biosimilar are generally marketed at prices 25 to 40 percent below original branded . The number of  approved by US FDA are nearly 30. There are about 25 top global manufacturers of . Many Domestic companies in India are making strong presence even in regulated markets.. Bioslogics Price (BPCIA) guidelines in the United States (US), mention that a biosimilar can be designated as “interchangeable”, whereby it may be substituted for the reference product (original biological drug). Keywords: Biosimilar, Biologic, Biosimilar market, Pharmacovigilance, Regulatory Knowledge

Cystic Fibrosis (CF) or Mucoviscidosis is an inherited condition. In cystic fibrosis transmembrane conductance regulator (CFTR) protein does not functions properly i.e regulation of fluids and salts outside the cells. Cystic fibrosis affects exocrine glands eg., the mucus-secreting and sweat glands in the respiratory and digestive systems. The frequency of common mutation F508del (deletion of phenylalanine residue at position 508) in children is between 19% and 34%. The estimate frequency of CF as 1:10,000 to 1:40,000 in children. There is no cure for cystic fibrosis, but treatment can reduce symptoms and complications to improve quality of life. Close monitoring and early, aggressive intervention is recommended to slow the progression of CF, which can lead to possible longer life. Keywords: Cystic fibrosis transmembrane conductance regulator (CFTR) protein, Pseudomonas aeruginosa, Sweat Chloride, Pancreatic enzyme replacement therapy, Ivacaftor.

Vertigo is a sense of spinning dizziness. There is no ideal medicine for treatment of vertigo and dizziness. The duration of dizziness/vertigo: attacks may last for seconds or minutes (as in vestibular paroxysm) or hours (as in Menière’s disease or vestibular migraine). Diagnosis and treatment of vertigo remains a challenge for many physicians. Many drugs produce dizziness and vertigo side effects such as some antibiotics , diuretics, mucolytics and NSAIDs . Symptoms of Vertigo are usually managed with vestibular suppressants. Steroids are useful in selected patients. Neurosurgical treatment is chosen in lesions such as hematomas, tumors, vascular lesions, pathology of the cervical spine (cervicalspondylopathy) Keywords: Peripheral and Central Vertigo, Benign Paroxysmal Positional Vertigo, Meiners disease

Medical sales representatives are a key link between medical and pharmaceutical companies and healthcare professionals. The Medical Sales representative is a high-risk sector with job stress. It requires more skills, wider knowledge and emotional stability than the other professions Due to extensive traveling, and waiting time, target issues, work-life balancing problems and lack of job security the medical representative life cycle is full of psychological stress. E-learning is use of technology for learning outside the boundaries of the physical classroom. New E training modules are more useful which facilitate distance learning, which are safer in new covid era. Product Training can be conferred at specific website created by Pharmaceutical companies. Keywords: Digital learning,Internet connectivity,Modular trainings

There is growing market for cosmetics, which is one of major indication of Botulin toxin, that is expected to grow at CAGR of 8%. The market size was about USD 4.85 billion in 2019. Botulinum toxin is a produced by the bacterium Clostridium botulinum which prevents the release of the neurotransmitter acetylcholine. Botulin toxin has pan indications in neurology, musculoskeletal disorders low back pain, oncology and in cosmetology. The toxin has reasonable side effect profile. Botulin Toxin causes muscle weakness, fatigue, flu-like symptoms, dry mouth, dizziness and skin rash can be reported. Keywords: Botulin toxin (BoNT), Acetylcholine release, Neurological conditions, Cosmetology.

The incidence of nausea or vomiting changes much with etiopathogenesis. Multiple neurohumoural pathways lead to nausea and vomiting. The various classes of antiemetics target different pro-emetic pathways to alleviate nausea and vomiting. Some drugs target more than one pathway. It is demonstrated that combination therapy is more effective than single anti-emetic agent. Keywords: Vomiting, Chemoreceptor trigger zone, Aprepitant, Cannabinoid receptor agonist, 5 HT receptor antagonist, Neurokinin receptor antagonists.

Irritable bowel syndrome (IBS), also referred to as mucus colitis, nervous colon, and spastic colitis is a long-term chronic gastrointestinal disorder that can cause continuous discomfort. IBS has a significant impact on patients’ quality of life due to physical suffering, psychological co-morbidity, social disability and economic non-productivity. It is more common in females and in lower socioeconomic groups. The diagnosis declines with age (with most affected individuals younger than age 50) The diagnosis of IBS relies on a symptom-based classification system known as Rome criteria. The low FODMAP diet is recommended for patients with digestive disorders like Irritable Bowel Syndrome. Current therapy of IBS focuses on the major symptoms experienced by patients. The novel approach in the treatment of IBS is based either on targeting specific receptors in the gastrointestinal tract that are known to be involved in the pathogenesis of the disease. Keywords: Irritable bowel syndrome (IBS), Bloating, Rome Criteria, FODMAP, 5HTagonists and antogonists.

Trigeminal Neuralgia (TN) is orofacial pain restricted to one or more divisions of the trigeminal nerve Attacks of intense, electric shock-like facial pain can occur without warning or be triggered by touching specific areas of the face by movements, brushing, laughing or following emotional stimuli. The exact cause of trigeminal neuralgia is not fully elucidated, a blood vessel is often found compressing the nerve. TN dramatically reduces the quality of life of affected individuals not only due to pain attacks but also to other disease-associated comorbidities, such as anxiety and depression. The Therapy used is often conservative with variable results. Keywords: Pain, Anxiety, Carbamazepine, Stem cells, Microvascular decompression.

Alopecia areata (AA) is a nonscarring, autoimmune hair loss on the scalp, and/or body. The AA occurs in people of all ages and affects 1–2%. Patients with the disease can face significant emotional and psychological stress as a result, there is no cure for the condition. Many therapeutic modalities have been used to treat alopecia areata, with variable efficacy and safety profiles. Unfortunately, none of these agents is curative or preventive. The treatment plan is designed according to the patient’s age and extent of disease. Global Alopecia Treatment Market is valued at USD 2.54 billion in 2018 and expected to reach USD3.98 billion by 2025 with the CAGR of 5.80% over the forecast period. Keywords: Alopecia areata, Corticosteroids, JAK inhibitors, Minoxidil.

Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease characterised by chronic, progressive scarring of the lungs. It is a relatively rare disease, afflicting those 50–70 years of age, slightly more common among men than women, without racial predilection. The most common complaint is progressive shortness of breath. Pulmonary function testing reveals a restrictive Ventilatory defect with a diminished diffusion capacity Despite advances in therapy progress has been challenged by a poor understanding of pathological mechanisms and patient heterogeneity, including variable progression. The outcome of the disease is poor and patients often succumb to mortality in few years. Keywords: Smoking, Hypersensitivity, Autoimmune, Occupation, Idiopathic pulmonary fibrosis nintedanib, Pirfenidone.

Age-related macular degeneration (AMD) is the most common cause of blindness in the elderly population worldwide. The clinical spectrum of AMD comprises of drusen, hyperplasia of the retinal pigment epithelium (RPE), atrophy and choroidal neovascularization (CNV). These changes affect the macula of the retina and subsequently may affect central or reading visual acuity. The pharmacological therapies include photodynamic therapy (PDT), steroids, vascular endothelial growth factor (VEGF) inhibitors, extracellular matrix(ECM) modifiers, gene therapy and nutrition supplements. Keywords: Agerelated macular degeneration (AMD), ie2 (Tyrosineprotein kinase) anti VEGF ranibizumab bevacizumab aflibercept.

Psoriasis is a life-long disease that requires long-term treatment. The long-term use of conventional systemic treatments is limited mostly by poor tolerability and cumulative toxicity. Psoriasis significantly impairs the quality of life of patients .In contrast, the long-term use of biologics is more advisable, because of better tolerability and safety, although their cost hinders their clinical usage Evidence suggests that PASI 100 (i.e., complete clearance of psoriasis) may be achievable for many patients with moderate-to severe psoriasis using biologics in development brodalumab and ixekizumab or secukinumab that inhibit interleukin (IL)-17. Keywords: Psoriasis, Inflammation, TCell Activation biologics.

Pruritus or itch is defined as an unpleasant sensation of the skin that provokes the urge to scratch. Histamine is one of the most important mediators of itch, although other chemical substances have also been implicated. In 10–50% of adults with persistent pruritus, it can be an important dermatologic clue for the presence of a significant underlying systemic disease such as renal insufficiency, cholestasis, hematologic disorder, or malignancy. Antihistamines are used in the management of allergic conditions. They are useful for treating the itching that results from the release of histamine. Desloratadine and fexofenadine are registered for use in infants six months and older, while loratadine and cetirizine can be used from 12 months of age. A new era of antipruritic drugs targeting specific neural receptors, itchy cytokines, and small molecules is swiftly approaching. Ultraviolet B, broad band or narrow band, Acupuncture, Transcutaneous electrical stimulation are supportive methods. Keywords: Pruritis, Chronic eczema, Antihistamines, Steroids.

Young males are more likely to experience first-episode psychosis, compared to women in the same age group. Prevalence of schizophrenia is 2.5/1000 and which seems to be the only disorder whose prevalence is consistent across cultures and over time. Genetic factors play an important role in the causation of schizophrenia; the risk of illness is approximately 10% for a first-degree relative and 3% for a second-degree relative. According to the American Psychiatric Association, second-generation (atypical) antipsychotics with the exception of clozapine are the agents of choice for first-line treatment of schizophrenia. Clozapine is not recommended because of its risk of agranulocytosis. A combination of antipsychotic showed an improvement in symptoms, but the side effects need to be monitored. Keywords: Psychosis, Schizophrenia, Dopamine, Extrapyramidal symptoms, Cognitive impairment.

Tinnitus can vary widely with regard to pitch, loudness, description of sound, special localization, and temporal pattern. Tinnitus is sometimes the first sign of hearing loss in older people. It also can be a side effect of various medications (antibiotics, cancer drugs, quinine medications, antidepressants, aspirin) If the condition is left unattended for a prolonged period, it can also lead to psychological problems. Extensive reviews of randomized clinical trials have revealed that only nortriptyline, amitriptyline, alprazolam, clonazepam, and oxazepam are more beneficial than placebo. Keywords: Tinnitus, Sytematic review, Hearing impairment, Antidepressants, Benzodiazepines.

The efficacy of the placebo (‘I shall please’) is variable, depending on both the type of disorder and the effectiveness of the treatment itself. The efficacy of the placebo is usually considered to be about 20–30% and produced by the effect of psychological variables, such as expectations, conditioning, etc. A phenomenon that is a placebo in a given science does not have to remain a placebo forever; it depends on the progress and advancement of scientific research, Recently use of placebo has taken myopic stance for ethical research in life style diseases or any other acute or chronic illness with some exceptions. Keywords: Placebo, Placebo effect, Nocebo, Cancer research.

Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, and poor concentration. Depression shall become the second largest illness in terms of morbidity by another decade. 50-65% of patients respond to the first antidepressant. No particular antidepressant agent is superior to another in efficacy or time to response. Depression is less prevalent among older adults than among younger adults but can have serious consequences. Choice can be guided by matching patients’ symptoms to side effect profile, presence of medical and psychiatric co morbidity. The adequate treatment of residual symptoms following an acute depressive episode, including insomnia symptoms, may prevent relapse. In the near future, developments are likely to remain focused on monoamine neurotransmitters, with the aim of finding agents that are either more effective, better tolerated or that have a faster onset of action than existing options. Keywords: Depression, Tricyclics, SSRI, SNRI, MAOI.

Insomnia remains a common clinical concern that is associated with negative daytime consequences for patients and represents a significant public health problem. The reported prevalence of insomnia is 9% in the general population and about 30% suffer from occasional insomnia. The medications approved for treating insomnia represent 4 fundamental pharmacodynamic categories with key actions related to receptors for g - aminobutyric acid (GABA), melatonin, histamine, or orexin/hypocretin. Addiction and insomnia frequently co-exist, as lack of sleep creates multiple physical and emotional issues that some individuals will attempt to self-medicate with drugs or alcohol. Keywords: Insomnia, Hypnotics, Pharmacological, Nonpharmacological, Treatment options.

Telemedicine enables exchange of medical information from one location to another using electronic communication, which is proposed to improve patient health status. In US. Published record of telemedicine was in the first half if the 20th century where ECG was transmitted over telephone. National Telemedicine Taskforce by the Health Ministry of India, in 2005, paved way for the success of various projects like the ICMR-arogyasree. 1 Telemedicine helps family physicians by giving them easy access to specialty doctors and helping them in close monitoring of patients. Indian Medical Association is training doctors adequately to use telemedicine to provide apt benefit to patients and protect themselves and their patients during Covid era. Keywords: Telemedicine, Faster access, Patient safety, Softwares, Epidemiological surveillance, Covid era.

Obesity is one of the most common medical problems in India and a risk factor for illnesses such as hypertension, diabetes, degenerative arthritis, kidney disease and myocardial infarction. In India, more than 135 million individuals were affected by obesity. According to ICMR INDIAB study 2015, prevalence rate of obesity and central obesity are varies from 12% to 31% and 17%–36% respectively. Medications are formulated to reduce energy intake, increase energy output or decrease the absorption of nutrients. Drugs cannot replace diet, exercise and lifestyle modification, which remain the cornerstones of obesity, In 2014 the global economic impact of obesity was estimated to be US $2.0 trillion or 2.8% of the global gross domestic product (GDP) treatment. Obesity also imposes costs in the form of lost productivity and foregone economic growth as a result of lost work days, lower productivity at work, mortality and permanent disability. Keywords: Obesity, Body mass index, Drug therapy, Herbal drugs, Metabolic Syndrome.

40 per cent of people over the age of 65 experience some form of memory loss, called as the age related memory impairment. This might be due to hormone and proteins (Growth factors) which repair the brain cells decline with age. Certain conditions such as age, stress, disease and excessive emotional response may lead to loss of memory, loss of learning ability and altered mood and behaviour. These conditions may be treated by using nootropic agents which can help to improve learning abilities and memory Keywords: Short term memory, Long term memory, Nootropics, Alzheimer’s disease, Dementia.

Erectile dysfunction (ED) or impotence mainly affects men who are older than 50 years of age, and is mostly defined as the inability to obtain or maintain a penile erection sufficient enough for sexual intercourse. ED is a multifaceted condition that may involve any one or more of several different organic causes. Conversely, it may also be psychogenic in nature. The global Erectile Dysfunction Drugs Market size was valued USD 1.65 billion in 2016 and is expected to reach a valuation of USD 2.95 billion at a CAGR of 6.5% by 2023, as per Market Research Future (MRFR). Keywords: Erectile dysfunction, Impotence, NO (Nitic oxide), 5 Phosphodiesterase inhibitors.

Aging is a gradual, continuous process of natural change that begins in early adulthood. During early middle age, many bodily functions begin to gradually decline. Aging is a multifaceted biological process that affects all organs and organ systems of the body. Dietary restriction and exercise have been found to extend human lifespan. Exercise, Dietary supplements, antioxidants, preventive intervention can delay aging process. Keywords: lifespan, Longevity, Aging, Oxidative stress, Coenzyme Q10.

What is written without effort in general read without pleasure (Samuel Johnson) Scientists communicate the fruits of their labour mostly in writing and for mostly in scientific journals. Conferences and other forms of verbal communication, including the evening news, play important role but written word reaches the widest audience and constitutes the archival message (Kenneth Rothman). The current years have messiah of information on internet Keywords: Health website, drug information, safety of medicinal product.

Healthcare expenditure is becoming a significant challenge for the financial sustainability of national health systems even in high economies. HEOR (Health Economic Outcome Research) analytics plays an increasingly vital role in a drug’s approval and reimbursement with payers. In broad terms, health economists study the functioning of healthcare systems and health-affecting behaviors such as smoking, diabetes, and obesity. Keywords: Cost Effective Analysis, Cost Benefit Analysis, Cost Minimization Analysis, health economics, precision medicine

Fixed dose combinations (FDCs) are generally considered desirable options in chronic diseases such as tuberculosis, cardiovascular diseases & diabetes, tropical diseases such as malaria & in HIV and in Cancer. FDCs are useful in chronic conditions especially when multiple disorders often co-exist The advantages of the FDC are basically patients compliance, simple dosage schedule, better efficacy, cheaper shipment & packaging activities. The drawbacks of FDCs are (a) Pharmacodynamic mismatch between the two ingredients, one drug having additive/antagonistic effect leading to reduced efficacy or enhanced side effects, (b) Pharmacokinetic disparity having peak efficacy at different time zone, (c) Chemical non compatibility leading to decreased shelf life, (d) Drug interactions due to common metabolizing pathways, and (e) limitations of dose titration of individual ingredients. As per Rule 122 E of Drugs and Cosmetics Act 1940, the FDCs are considered as New Drugs where the Central Drugs Standard Control Organization (CDSCO), ensures proper clinical data is submitted for the approval into the market. Appendix VI of Schedule Y (Drugs & Cosmetics Rules 1945) mentions the requirements for marketing approval of various types of FDCs. Keywords: Fixed dose combinations (FDCs ), Patient Compliance, New Drug

Lichen planus (LP) is a chronic inflammatory mucocutaneous disease of unknown aetiology with an estimated incidence of 0.5%–4.0% having a female preponderance at a ratio of 1.5:1. Oral lichen planus (OLP) is commoner than the cutaneous form and tends to be more persistent and more refractory to the treatment. The prevalence of oral lichen planus in Indian population is around 3% with more female predilection. Oral lesions occur in 50%–70% of the patients with lichen planus. LP is considered to be a T-cell-mediated autoimmune skin disease, in which CD8+ cytotoxic T lymphocytes are major mediators. TNF-? and IL-10, interferon-gamma (IFN-?), IL-4, and IL-8, have been suggested to have an important role in the pathogenesis of OLP. The complications of Lichen Planus include post-inflammatory hyperpigmentation, scarring alopecia, dyspareunia, oesophageal stenosis & possible malignant transformation. Mucocutaneous site biopsy can confirm the diagnosis when taken from the edge of a plaque. There is no cure for Lichen Planus, the management is often performed with the use of antihistamines, corticosteroids, retinoids, immunomodulators, phototherapy and immunosuppressives. Inconsistent results are shown by griseofulvin and chloroquine derivatives. (further prospective studies are needed).   Keywords: Oral lichen planus (OLP), Autoimmune, Steroids, Methotrexate, Tacrolimus, Phototherapy, Surgical excision, Laser usage

Malignant tumor which that arises from uncontrolled proliferation of melanocytes is melanoma. Its rare tumor in India, compared to other tropical countries. Fair skin populations have higher incidences of melanoma. The relative mortality is reduced to nearly half with scrupulous use of sunscreens - SPF 50 blocks 98% of UVB rays. Melanomas are observed more in countries like Australia and New Zealand (due to actinic rays (UV B rays) of light) and thus guidelines from their ministry of health has been published. First line drugs for melanoma unresectable stage III or IV metastatic disease include Pembrolizumab and Nivolumab. Studies have shown that Pembrolizumab improved overall survival (OS) compared with ipilimumab. Ipilimumab/Nivolumab combination was significantly better than ipilimumab monotherapy. Similarly nivolumab/ipilimumab combination therapy was better than compared with ipilimumab monotherapy regardless of BRAF mutation status. Vemurafenib and Dabrafenib (Tyrosine kinase inhibitors) were developed to inhibit BRAF with mutations at V600. Dabrafenib/Trametinib or Vemurafenib/Cobimetinib combinations were better than monotherapy. Surgery remains the best option for cure in localized, invasive melanoma, with good overall survival rate.   Keywords: Metastatic melanoma, Immunotherapy, Targeted therapy BRAFV600, chemotherapy, Radiotherapy, Surgery

Keywords : Sex/Gender differences, Pharmacokinetics, Pharmacodynamics, Adverse drug events, and