Publications by authors named "Sanjeev Aurangabadkar"

22 Publications

  • Page 1 of 1

Recommendations for Cutaneous and Aesthetic Surgeries during COVID-19 Pandemic.

J Cutan Aesthet Surg 2020 Apr-Jun;13(2):77-94

Department of Dermatology, Ashwini Rural Medical College, Solapur, Maharashtra, India.

Background: Amid the coronavirus disease 2019 (COVID-19) pandemic, dermatologists must be prepared to restructure their practice of procedural dermatology and cutaneous aesthetic surgeries. The COVID-19 pandemic has presented several challenges and has ushered in several changes in practice such as teledermatology, with many physicians adopting virtual consultations and treatments. Performing procedures in the times of COVID-19 pandemic presents challenges such as risk of transmission to doctors and staff due to potential aerosolization, release of virus droplets during the procedures, and risk of virus transfer through the instruments both in the peri- and postoperative period. This can have several medical, administrative, and legal implications.

Objectives: This document aimed to outline best practices that can be followed in this scenario to perform cutaneous surgeries and procedures to ensure safer skin surgery.

Recommendations: Standard precautions include social distancing of at least 1 m, hand hygiene, appropriate use of personal protective equipment (PPE), safe injection practices, sterilization and disinfection of medical devices, environmental cleaning, and respiratory hygiene. It is generally advisable to see patients only by appointments. Each clinic should have a special area at entry for screening patients and providing sanitizers and masks. Procedures, which are of short duration, performed on nonfacial areas are considered as low risk and require donning surgical mask. Procedures involved with minimal invasiveness and bleeding, short duration procedures on the face such as injectables, chemical peels, and aerosol-generating procedures on nonfacial areas are considered moderate risk. These procedures need apron with head cover, N95 mask, face shield, double gloves, and smoke evacuator with high-efficiency particulate air (HEPA) or ultralow particulate air (ULPA) filter. Aerosol and plume-regenerating procedures (such as ablative lasers on the face), prolonged surgeries on head (such as hair transplantation), intraoral, and intranasal procedures are considered high risk. These procedures must be carried out with full body cover with surgical gown, head cover, N95 mask, face shield, double gloves, and smoke evacuator. Physicians should be aware of local epidemiological situation and adhere to the relevant guidelines issued by the relevant governmental agencies.
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http://dx.doi.org/10.4103/JCAS.JCAS_83_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394118PMC
August 2020

A Prospective Open-labeled Study of Tattoo Removal with Q-Switched Nd:YAG Laser Utilizing the R0 Technique and Correlation with Kirby-Desai Scale.

J Cutan Aesthet Surg 2019 Apr-Jun;12(2):95-104

Dr. J. W. Aurangabadkar New Skin Clinic, Hyderabad, Telangana, India.

Introduction: The Q-switched Nd: YAG (QSNY) laser is considered the standard device of choice for laser tattoo removal. Newer concepts such as R0 , R20 methods aided in faster clearance of tattoos. The Kerby-Desai scale [KD scale] has been proposed to predict the approximate number of sessions needed for tattoo clearance.

Objective: To access the efficacy of R0 technique for tattoo removal in skin types IV to VITo evaluate the Kerby-Desai scale and its correlation to the number of sessions actually required for tattoo clearance.

Material And Methods: Twenty-two patients with single colored amateur were treated using modified R0 technique and the number of sessions were corelated with Kirby Desai scale.

Results: We found that R0 method require significantly less sessions than predicted by KD scale.

Conclusion: Tattoo removal with the R0 technique using PFD allows faster clearing of tattoos and significantly cuts down the total treatment duration needed for tattoo removal.
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http://dx.doi.org/10.4103/JCAS.JCAS_72_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676804PMC
August 2019

Laser Toning in Melasma.

J Cutan Aesthet Surg 2019 Apr-Jun;12(2):76-84

Consultant Dermatologist, Dr. J W Aurangabadkar New Skin clinic, Hyderabad, Telangana, India.

Melasma is a common acquired disorder of hyperpigmentation. A variety of treatment options has been suggested for the management of melasma. A range of different lasers had been tried in the treatment of melasma. Q-switched Nd-YAG laser (QSL) is the most commonly used laser in the treatment of melasma. Recently, laser toning or low-fluence, multi-pass technique has become popular in treatment of melasma. Authors aimed to review the procedure, its effectiveness, combination therapies using laser toning, and complications of laser toning. A PubMed search was made using keywords such as laser toning, QSL, melasma, and lasers in melasma, and relevant articles were reviewed.
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http://dx.doi.org/10.4103/JCAS.JCAS_179_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676813PMC
August 2019

Laser Dermatology in the Subcontinent: Coming of Age!

J Cutan Aesthet Surg 2019 Apr-Jun;12(2):75

Skin and Laser Clinic, Hyderabad, Telangana, India.

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http://dx.doi.org/10.4103/JCAS.JCAS_66_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676808PMC
August 2019

Optimizing Q-switched lasers for melasma and acquired dermal melanoses.

Indian J Dermatol Venereol Leprol 2019 Jan-Feb;85(1):10-17

Department of Dermatology, Skin and Laser Clinic, Hyderabad, Telangana, India.

The Q-switched Nd:YAG laser is an established modality of treatment for epidermal and dermal pigmented lesions. The dual wavelengths of 1064nm and 532nm are suited for the darker skin tones encountered in India. Though this laser has become the one of choice for conditions such as nevus of Ota, Hori's nevus and tattoos, its role in the management of melasma and other acquired dermal melanoses is not clear. Despite several studies having been done on the Q-switched Nd:YAG laser in melasma, there is no consensus on the protocol or number of sessions required. Acquired dermal melanoses are heterogenous entities with the common features of pigment incontinence and dermal melanophages resulting in greyish macular hyperpigmentation. This article reviews the current literature on laser toning in melasma and the role of the Q-switched Nd:YAG laser in stubborn pigmentary disorders such as lichen planus pigmentosus. As the pathology is primarily dermal or mixed epidermal-dermal in these conditions, the longer wavelength of 1064nm is preferred due to its deeper penetration. Generally multiple sessions are needed for successful outcomes. Low fluence Q-switched Nd:YAG laser at 1064nm utilizing the multi-pass technique with a large spot size has been suggested as a modality to treat melasma. Varying degrees of success have been reported but recurrences are common on discontinuing laser therapy. Adverse effects such as mottled hypopigmentation have been reported following laser toning; these can be minimized by using larger spot sizes of 8 to 10mm with longer intervals (2 weeks) between sessions.
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http://dx.doi.org/10.4103/ijdvl.IJDVL_1086_16DOI Listing
April 2019

Standard Guidelines of Care: Performing Procedures in Patients on or Recently Administered with Isotretinoin.

J Cutan Aesthet Surg 2017 Oct-Dec;10(4):186-194

Skinnovation Laser Clinic, New Delhi, India.

Background: Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13--retinoic acid) states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring.

Objective: The Association of Cutaneous Surgeons (I) constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration.

Materials And Methods: Data were extracted from the literature through a PubMed search using the keywords "isotretinoin," "safety," "scarring," "keloids," "hypertrophic scarring," and "pigmentation." The evidence was then labeled and circulated to all members of task force for review.

Results: The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued. The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration.
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http://dx.doi.org/10.4103/JCAS.JCAS_110_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820835PMC
March 2018

Lasers in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group.

Indian J Dermatol 2017 Nov-Dec;62(6):585-590

Consultant Dermatologist, Skintrendz, Himayat Nagar, Hyderabad, India.

Lasers have come up as the newest therapeutic modality in dermatological conditions including melasma. In this article, as a group of experts from Pigmentary Disorders Society in collaboration with South Asian Pigmentary Disorders Forum (SPF), we have tried to discuss the lasers which have been used in melasma and formulate simple consensus guidelines. Following thorough literature search, we have summarised the rationale of using the lasers and the supporting evidences have also been provided. It is clear that laser cannot be the first line treatment for melasma. However, it can be used as an adjuvant therapy in resistant cases, provided the selection of patient and counselling has been done properly.
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http://dx.doi.org/10.4103/ijd.IJD_488_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724305PMC
December 2017

Chemical Peels in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group.

Indian J Dermatol 2017 Nov-Dec;62(6):578-584

Dermatologist Specialist, Dr RML Hospital and PGIMS, New Delhi, India.

Melasma is a notorious dermatosis, often resistant to treatment. Chemical peeling constitutes an acceptable option of management of melasma (of any type and duration). In this article, as a group of experts from Pigmentary Disorders Society (PDS) in collaboration with South Asian Pigmentary Forum (SPF), we have tried to elaborate the various chemical peeling agents for the treatment of melasma. Besides, we have reviewed the indications, mechanism of action, rationality and the detailed procedure of peeling. The evidence in favor of various peeling agents have been summarized as well.
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http://dx.doi.org/10.4103/ijd.IJD_490_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724304PMC
December 2017

Medical Management of Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group.

Indian J Dermatol 2017 Nov-Dec;62(6):558-577

Consultant Dermatologist, Solapur, Maharashtra, India.

Melasma is one of the most common hyperpigmentary disorders found mainly in women and dark-skinned patients. Sunlight, hormones, pregnancy, and genetics remain the most implicated in the causation of melasma. Although rather recalcitrant to treatment, topical agents such as hydroquinone, modified Kligman's Regime, azelaic acid, kojic acid, Vitamin C, and arbutin still remain the mainstay of therapy with sun protection being a cornerstone of therapy. There are several new botanical and non botanical agents and upcoming oral therapies for the future. There is a lack of therapeutic guidelines, more so in the Indian setup. The article discusses available evidence and brings forward a suggested treatment algorithm by experts from Pigmentary Disorders Society (PDS) in a collaborative discussion called South Asian Pigmentary Forum (SPF).
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http://dx.doi.org/10.4103/ijd.IJD_489_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724303PMC
December 2017

Surgical Outcome in Patients Taking Concomitant or Recent Intake of Oral Isotretinoin: A Multicentric Study-ISO-AIMS Study.

J Cutan Aesthet Surg 2016 Apr-Jun;9(2):106-14

Skinnovation Laser Clinic, New Delhi, India.

Background: The current standard recommendation is to avoid surgical interventions in patients taking oral isotretinoin. However, this recommendation has been questioned in several recent publications.

Aim: To document the safety of cosmetic and surgical interventions, among patients receiving or recently received oral isotretinoin.

Materials And Methods: Association of Cutaneous Surgeons, India, in May 2012, initiated this study, at 11 centers in different parts of India. The data of 183 cases were collected monthly, from June 2012 to May 2013. Of these 61 patients had stopped oral isotretinoin before surgery and 122 were concomitantly taking oral isotretinoin during the study period. In these 183 patients, a total of 504 interventions were performed. These included[1] 246 sessions of chemical peels such as glycolic acid, salicylic acid, trichloroacetic acid, and combination peels;[2] 158 sessions of lasers such as ablative fractional laser resurfacing with erbium-doped yttrium aluminum garnet and CO2, conventional full face CO2 laser resurfacing, laser-assisted hair reduction with long-pulsed neodymium-doped yttrium aluminum garnet, diode laser, and LASIK surgery;[3] 27 sessions of cold steel surgeries such as microneedling, skin biopsy, subcision, punch elevation of scars, excision of skin lesion, and wisdom tooth extraction;[4] 1 session of electrosurgery.

Results: No significant side effects were noted in most patients. 2 cases of keloid were documented which amounted to 0.4% of side effects in 504 interventions, with a significant P value of 0.000. Reversible transient side effects were erythema in 10 interventions and hyperpigmentation in 15.

Conclusion: The study showed that performing dermatosurgical and laser procedures in patients receiving or recently received isotretinoin is safe, and the current guidelines of avoiding dermatosurgical and laser interventions in such patients taking isotretinoin need to be revised.
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http://dx.doi.org/10.4103/0974-2077.184054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924407PMC
July 2016

Clinical photography in dermatology using smartphones: An overview.

Indian Dermatol Online J 2015 May-Jun;6(3):158-63

Department of Dermatology, Skin and Laser Clinic, Brij Tarang, Green Lands, Begumpet, Hyderabad, India.

The smartphone is one of the biggest revolutions in the era of information technology. Its built in camera offers several advantages. Dermatologists, who handle a specialty that is inherently visual, are most benefited by this handy technology. Here in this article, we attempt to provide an overview of smartphone photography in clinical dermatology in order to help the dermatologist to get the best out of the available camera for clinical imaging and storage.
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http://dx.doi.org/10.4103/2229-5178.156381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439742PMC
May 2015

Newer trends in laser tattoo removal.

J Cutan Aesthet Surg 2015 Jan-Mar;8(1):25-9

Private Practice, Koti, Hyderabad, Telangana, India.

Q switched lasers are the current gold standard for laser tattoo removal. Though these systems are generally quite effective in clearing tattoos & have an established safety record, certain limitations exist while following the standard protocol. To overcome these limitation newer techniques such as multipass method, combination treatments with chemical agent and other laser have been introduced. These methods help in faster, less painful and complication free tattoo removal.
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http://dx.doi.org/10.4103/0974-2077.155070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411588PMC
May 2015

Shifting paradigm in laser tattoo removal.

J Cutan Aesthet Surg 2015 Jan-Mar;8(1):3-4

Department of Dermatology and Laser Surgery, Skin and Laser Clinic, Hyderabad, Telengana, India.

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http://dx.doi.org/10.4103/0974-2077.155061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411589PMC
May 2015

Tretinoin Nanogel 0.025% Versus Conventional Gel 0.025% in Patients with Acne Vulgaris: A Randomized, Active Controlled, Multicentre, Parallel Group, Phase IV Clinical Trial.

J Clin Diagn Res 2015 Jan 1;9(1):WC04-9. Epub 2015 Jan 1.

Clinical Research Department, Cadila Healthcare Ltd ., Ahmedabad, India .

Background: Conventional topical tretinoin formulation is often associated with local adverse events. Nanogel formulation of tretinoin has good physical stability and enables good penetration of tretinoin into the pilo-sebaceous glands.

Aim: The present study was conducted to assess the efficacy and safety of a nanogel formulation of tretinoin as compared to its conventional gel formulation in the treatment of acne vulgaris of the face.

Materials And Methods: This randomized, active controlled, multicentric, phase IV clinical trial evaluated the treatment of patients with acne vulgaris of the face by the two gel formulations locally applied once daily at night for 12 wk. Acne lesion counts (inflammatory, non-inflammatory & total) and severity grading were carried out on the monthly scheduled visits along with the tolerability assessments.

Results: A total of 207 patients were randomized in the study. Reductions in the total (72.9% vs. 65.0%; p = 0.03) and inflammatory (78.1% vs. 66.9%; p = 0.02) acne lesions were reported to be significantly greater with the nanogel formulation as compared to the conventional gel formulation. Local adverse events were significantly less (p = 0.04) in the nanogel group (13.3%) as compared to the conventional gel group (24.7%). Dryness was the most common adverse event reported in both the treatment groups while peeling of skin, burning sensation and photosensitivity were reported in patients using the conventional gel only.

Conclusion: In the treatment of acne vulgaris of the face, tretinoin nanogel formulation appears to be more effective and better tolerated than the conventional gel formulation.
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http://dx.doi.org/10.7860/JCDR/2015/10663.5469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4347160PMC
January 2015

Evidence-based treatment for melasma: expert opinion and a review.

Dermatol Ther (Heidelb) 2014 Dec 1;4(2):165-86. Epub 2014 Oct 1.

Department of Dermatology, Skin Diagnosis Centre, Mahabodhi Mallige Hospital, Manipal Hospital, 98, HAL Airport Road, Bangalore, 560017, Karnataka, India,

Introduction: Melasma is one of the most common pigmentary disorders seen by dermatologists and often occurs among women with darker complexion (Fitzpatrick skin type IV-VI). Even though melasma is a widely recognized cause of significant cosmetic disfigurement worldwide and in India, there is a lack of systematic and clinically usable treatment algorithms and guidelines for melasma management. The present article outlines the epidemiology of melasma, reviews the various treatment options along with their mode of action, underscores the diagnostic dilemmas and quantification of illness, and weighs the evidence of currently available therapies.

Methods: A panel of eminent dermatologists was created and their expert opinion was sought to address lacunae in information to arrive at a working algorithm for optimizing outcome in Indian patients. A thorough literature search from recognized medical databases preceded the panel discussions. The discussions and consensus from the panel discussions were drafted and refined as evidence-based treatment for melasma. The deployment of this algorithm is expected to act as a basis for guiding and refining therapy in the future.

Results: It is recommended that photoprotection and modified Kligman's formula can be used as a first-line therapy for up to 12 weeks. In most patients, maintenance therapy will be necessary with non-hydroquinone (HQ) products or fixed triple combination intermittently, twice a week or less often. Concomitant camouflage should be offered to the patient at any stage during therapy. Monthly follow-ups are recommended to assess the compliance, tolerance, and efficacy of therapy.

Conclusion: The key therapy recommended is fluorinated steroid containing 2-4% HQ-based triple combination for first line, with additional selective peels if required in second line. Lasers are a last resort.
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http://dx.doi.org/10.1007/s13555-014-0064-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4257945PMC
December 2014

Buying a laser - tips and pearls.

J Cutan Aesthet Surg 2014 Apr;7(2):124-30

Partner, Trialbase, Advocates, Bangalore, Karnataka, India.

Unlabelled: Lasers and aesthetic procedures have transformed dermatology practice. They have aided in the treatment of hitherto untreatable conditions and allowed better financial remuneration to the physician. The availability of a variety of laser devices of different makes, specifications and pricing has lead to confusion and dilemma in the mind of the buying physician. There are presently no guidelines available for buying a laser. Since purchase of a laser involves large investments, careful consideration to laser specifications, training, costing, warranty, availability of spares, and reliability of service are important prerequisites. This article describes various factors that are needed to be considered and also attempts to lay down criteria to be assessed while buying a laser system that will be useful to physicians before investing in a laser machine.

Practice Points: Meticulous planning of the type of machine, specifications, financial aspects, maintenance and warranties is important.It is wise to sign a contract or agreement between the buyer and seller before purchase of a laser which covers key aspects of installation, after sales service and maintenance of the machine.Adequate training is essential; understanding laser physics and laser-tissue interaction goes a long way in getting the best out of the machine.The credibility of the dealer and company should be ascertained in order to be assured of after-sales service.Buying used machines, sharing of equipment to offset high initial investments is a good option but even more care is required to ensure proper functioning and maintenance.
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http://dx.doi.org/10.4103/0974-2077.138363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134647PMC
April 2014

A cross-sectional, multicentric clinico-epidemiological study of melasma in India.

Dermatol Ther (Heidelb) 2014 Jun 19;4(1):71-81. Epub 2014 Mar 19.

Department of Dermatology, Manipal Hospital, Bangalore, 560017, Karnataka, India,

Background: Melasma is one of the most common pigment disorders seen by a dermatologist and often occurs among women with darker complexion (skin type IV-VI).

Aims: The present study aimed to investigate the epidemiology of melasma in the Indian population and to focus on the regional variability in the demographics, clinical manifestations and factors that precipitate this condition.

Methods: The present multicentric study conducted across four regions in India enrolled patients (>18 years) diagnosed with melasma on Wood's light examination. Patients were examined to identify the distribution of melasma. Various precipitating and etiological factors for melasma were documented.

Results: The mean age of the 331 enrolled patients with melasma was 37.2 ± 9.3 years. The prevalence of melasma was higher in females with a female to male ratio of approximately 4:1. The overall population with family history was 31%, highest in the northern region (38.5%) and lowest in the eastern region (18.2%). The two prominent patterns of distribution were centrofacial (42%) and malar (39%). Only 35% of the patients were using sunscreens. Of these, 10% of the patients used sunscreen with SPF >50. The usage of sunscreens was observed to be highest in the north (69%). About 51% of women with multiple pregnancies had a history of melasma when compared with single women (25%) or with no pregnancy (24%).

Conclusions: In conclusion, the result of the study showed that there was a regional variability in the demographics, clinical manifestations and factors that precipitate melasma among patients in India. There was a strong correlation between the family history and prevalence of melasma. Sun exposure is a major precipitating factor in melasma, but only 10% of the patients used sunscreen with SPF >50. Other factors such as concomitant medication, chronicity of disease, multiple pregnancies and use of oral contraceptives might precipitate melasma.
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http://dx.doi.org/10.1007/s13555-014-0046-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065278PMC
June 2014

Assessment of the Response and Improving Outcomes of Nevus of Ota with Q-switched Nd : Yag Laser.

J Cutan Aesthet Surg 2013 Oct;6(4):194-5

Skin and Laser Clinic, Hyderabad, Andhra Pradesh, India.

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http://dx.doi.org/10.4103/0974-2077.123400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3884882PMC
October 2013

Comorbidities in psoriasis.

Indian J Dermatol Venereol Leprol 2013 Jul;79 Suppl 7:S10-7

Department of Dermatology, Skin and Laser Clinic, Hyderabad, India.

Moderate to severe psoriasis is associated with concomitant diseases that may have a significant impact on patients. It is necessary for the treating physician to recognize these concomitant diseases, known as comorbidities, early as they influence the management options. Important comorbidities are psoriatic arthritis, metabolic syndrome, Crohn's disease, depression, and cancer. Patients with severe psoriasis may be at an increased risk for myocardial infarction and this subgroup of patients tends to have a reduced life expectancy. The presence of co-morbid diseases is associated with an increase in concomitant medication, some of which may worsen psoriasis; conversely, systemic treatment of psoriasis with certain drugs may impact the co-morbid conditions. As dermatologists are the primary health-care providers for psoriasis, adequate knowledge of comorbidities helps in choosing the appropriate therapy as well as timely intervention.
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http://dx.doi.org/10.4103/0378-6323.115506DOI Listing
July 2013

Fractional lasers in dermatology--current status and recommendations.

Indian J Dermatol Venereol Leprol 2011 May-Jun;77(3):369-79

Cutis Laser Aesthetic Skin Solutions, Mumbai, Maharashtra, India.

Introduction: Fractional laser technology is a new emerging technology to improve scars, fine lines, dyspigmentation, striae and wrinkles. The technique is easy, safe to use and has been used effectively for several clinical and cosmetic indications in Indian skin.

Devices: Different fractional laser machines, with different wavelengths, both ablative and non-ablative, are now available in India. A detailed understanding of the device being used is recommended.

Indications: Common indications include resurfacing for acne, chickenpox and surgical scars, periorbital and perioral wrinkles, photoageing changes, facial dyschromias. The use of fractional lasers in stretch marks, melasma and other pigmentary conditions, dermatological conditions such as granuloma annulare has been reported. But further data are needed before adopting them for routine use in such conditions.

Physician Qualification: Any qualified dermatologist may administer fractional laser treatment. He/ she should possess a Master's degree or diploma in dermatology and should have had specific hands-on training in lasers, either during postgraduation or later at a facility which routinely performs laser procedures under a competent dermatologist or plastic surgeon with experience and training in using lasers. Since parameters may vary with different systems, specific training tailored towards the concerned device at either the manufacturer's facility or at another center using the machine is recommended.

Facility: Fractional lasers can be used in the dermatologist's minor procedure room for the above indications.

Preoperative Counseling And Informed Consent: Detailed counseling with respect to the treatment, desired effects and possible postoperative complications should be provided to the patient. The patient should be provided brochures to study and also adequate opportunity to seek information. A detailed consent form needs to be completed by the patient. Consent form should include information on the machine, possible postoperative course expected and postoperative complications. Preoperative photography should be carried out in all cases of resurfacing. A close-up front and 45-degree lateral photographs of both sides must be taken.

Laser Parameters: There are different machines based on different technologies available. Choice parameters depend on the type of machine, location and type of lesion, and skin color. Physician needs to be familiar with these requirements before using the machine.

Anesthesia: Fractional laser treatment can be carried out under topical anesthesia with eutectic mixture of lidocaine and prilocaine. Some machines can be used without any anesthesia or only with topical cooling or cryospray. But for maximal patient comfort, a topical anesthetic prior to the procedure is recommended.

Postoperative Care: Proper postoperative care is important in avoiding complications. Post-treatment edema and redness settle in a few hours to a few days. A sunscreen is mandatory, and emollients may be prescribed for the dryness and peeling that could occur.
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http://dx.doi.org/10.4103/0378-6323.79732DOI Listing
August 2011

QYAG5 Q-switched Nd:YAG Laser Treatment of Nevus of Ota: An Indian Study of 50 Patients.

J Cutan Aesthet Surg 2008 Jul;1(2):80-4

Consultant Dermatologist and Laser Surgeon, Skin and Laser Clinic, Hyderabad, Andhra Pradesh, India.

Background: Nevus of Ota is very common in Asian patients. The condition is more common in females, with a male-female ratio of 1:4.8. Most patients seek treatment early in life due to the psychological trauma and cosmetic disfigurement. The Q-switched lasers have changed the way we approach the condition and have become the mainstay of therapy.

Aims And Objectives: To evaluate long-term safety and efficacy of pigmented lesion laser Palomar QYAG5 Q-switched Nd:YAG in 50 Indian patients.

Materials And Methods: Fifty patients of nevus of Ota underwent multiple treatments (average 6 sessions) carried out over a period of 1year with a Q-switched Nd:YAG laser (QYAG5, Palomar, USA). Of the 50 patients, 2 were males; and the rest, females. Five patients had a bilateral involvement. Skin types treated included phototypes 4 and 5. The response after subsequent treatments was documented through serial photographs that were taken before and after the completion of treatments. Patients were followed up for a period of 1 year after the last session. Response to treatment was graded based on physician's global assessment.

Results: Excellent improvement was noted in a majority of the patients at the end of the treatments. Greater-than-60% improvement was seen in 66% of the patients. The remaining patients had moderate clearing of pigmentation (30%-60% improvement). No significant adverse effects were seen immediately after the treatments and on long-term follow-up. Transient post-inflammatory hyperpigmentation was observed in 5 (10%) patients, which cleared with use of sunscreens and bleaching agents within 2 months. No textural change or scarring was seen. Hypopigmentation (guttate type) was observed in 1 (2%) patient, which resolved within 3 months. No recurrence was observed after 1 year of follow-up.

Conclusion: This study validates the superior efficacy of Q-switched Nd:YAG laser when compared to conventional methods for treatment of nevus of Ota.
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http://dx.doi.org/10.4103/0974-2077.44164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840905PMC
July 2008

Study of upper gastrointestinal tract involvement in pemphigus by esophago-gastro-duodenoscopy.

Indian J Dermatol Venereol Leprol 2006 Nov-Dec;72(6):421-4

Department of Dermatology, Osmania Medical College, Hyderabad, India.

Introduction: Involvement of upper gastrointestinal tract in pemphigus vulgaris is not uncommon.

Aim: To study the involvement of upper gastrointestinal tract (UGIT) with the help of esophago-gastro-duodenoscopy (EGD) in patients of vesiculobullous dermatoses with emphasis on pemphigus vulgaris.

Methods: Forty-two patients (M-22, F-20) with vesiculobullous dermatoses, diagnosed on the basis of clinical features and skin histopathology as pemphigus vulgaris (PV)-40 patients and pemphigus foliaceus (PF)-2 patients were included in the study. The EGD was performed and mucosa of the esophagus, stomach and first part of the duodenum were examined. Mucosal biopsies were taken from the lower esophagus in 26 patients of PV and studied after H and E staining.

Results: On EGD, esophageal involvement was seen in 67% patients of PV (27/40). Of these, Grade I esophagitis was observed in seven, Grade II in 11, Grade III in four and Grade IV involvement was seen in five patients of PV. Three PV patients had associated esophageal candidiasis. Involvement of esophageal mucosa was also observed in one out of two patients of PF. Gastric mucosa was involved in 52% and duodenal mucosa in 20% of PV patients. Acantholysis was observed in seven out of 26 (27%) esophageal biopsies of PV patients. Two patients of PV vomited a tube-like structure, indicative of 'esophagitis dissecans superficialis'. The involvement of the gastric mucosa in patients with history of oral corticosteroid intake (60%) was compared to the group without history of oral corticosteroids (30%).

Conclusion: Among PV patients under study, significant involvement of oral (87%), esophageal (67%), gastric (52%) and duodenal mucosa (20%) was observed.
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Source
http://dx.doi.org/10.4103/0378-6323.29337DOI Listing
January 2007
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