Indian Journal of Dermatology Venereology & Leprology最新文献

Polymorphic light eruption (PMLE) is mediated by a type IVc delayed-type hypersensitivity (DTH) reaction to ultraviolet radiation (UVR) induced neoantigens. While UVR normally exerts an immunosuppressive effect with increased regulatory T-cells (Tregs) and an accentuated T helper 2 (Th2) response, PMLE shows a heightened Th1 response. Existent data in PMLE suggests a Th1-skewed immune response with reduced Treg numbers and function, lack of Langerhans cells activity, and increased CD8+ resident memory T-cells. Keratinocytes (KCs) contribute to inflammation by releasing interleukin (IL)-1β, Vascular Endothelial Growth Factor-alpha (VEGF-α), and adhesion molecules, which facilitate various immune cell infiltration. The disturbed cytokine milieu with elevated IL-1, IL-12, IL-31, IL-36, IL-15, interferon-gamma (IFN-γ), and decreased IL-4 and IL-10, contributes to disease pathogenesis. IL-15 accounts for the recurrence of lesions. Various drugs, including immunosuppressive agents and antioxidants, have been tried in PMLE with limited evidence. Emerging therapies include cytokine-targeting agents and Janus kinase inhibitors such as tofacitinib, which modulate cytokine milieu via Janus kinase/signal transducers and activators of transcription (JAK/STAT) pathways. Eradication of microbiota is a novel concept that mitigates the cytokine imbalance. Photohardening with narrow band ultraviolet B (NBUVB) or ultraviolet A (UVA) is believed to be effective as it enhances Treg activity. We emphasise the need for further cytokine profiling in PMLE to tailor targeted therapies, as there is an increasing evidence of a Th1 cytokine overexpression which is not curtailed by Treg cells, and thus, drugs targeting the implicated cytokines would achieve long-term results.

Background Dermatophytosis is reaching an epidemic-like scenario in India, with antifungal resistance adding to the problem. Self-medication is said to be one of the causes of resistance. Knowledge of self-medication practices is meagre, necessitating this study. Aim The aim of this study is to ascertain the self-medication behaviour of dermatophytosis patients, identify the factors predicting it, and elucidate the patterns of self-medication followed by dermatophytosis patients. Methods This study was conducted by recruiting patients with dermatophytosis as cases and patients with other dermatoses as controls. Self-medication frequency, clinicodemographic details, and patterns of self-medication were entered into a predesigned proforma. Results A total of 171 patients and 207 controls were recruited in the study. The total proportion of patients who self-medicated among all recruited patients was 21.7% (95% CI: 0.1764,0.2619). There was a significant difference in the proportion of those who self-medicate between dermatophytosis patients (36.8%) and other dermatological problems (9.2%), with more self-medication happening among those with dermatophytosis (P< 0.001). Topical antifungal cream was the most common medicine used for self-medication. There was no significant difference in the proportion of those who self-medicated and those who did not, in all four classes of diagnosis, i.e., naïve dermatophytosis, chronic dermatophytosis, chronic and recurrent dermatophytosis, and chronic and relapsed dermatophytosis Limitations There could be recall bias in the answers of the participants. There was no follow-up to assess outcomes of self-medication. Conclusion The proportion of dermatophytosis patients who self-medicate is lower than in previous studies from other parts of India. Similar studies from other parts of India may help us confirm and understand the geographical reasons for the differences in proportions across the country.

Background Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder with a significant impact on psychosocial health and quality of life. Despite growing prevalence in India, particularly among adults, a comprehensive, India-specific guideline incorporating recent advances is lacking. Objective To develop a standardised, evidence-based consensus on the diagnosis and management of paediatric and adult AD in India through a modified Delphi methodology. Methods A total of 14 dermatology experts across India, with over 15 years of clinical and academic experience, formed the Special Interest Group of Paediatric Dermatology under IADVL. A systematic literature review was conducted using databases such as PubMed, Embase, and Cochrane, focusing on Indian and global literature up to December 2024. Based on this, 29 draft statements were generated covering domains of diagnosis, severity assessment, non-pharmacological measures, and topical and systemic therapies. A two-round, web-based, modified Delphi process was conducted anonymously to reach consensus. Statements with ≥75% agreement were retained. Results Consensus was achieved on all 29 statements. Thirteen statements were finalised after the first round, and 16 were refined and approved in the second round. Key recommendations included the use of modified Hanifin and Rajka criteria for diagnosis, SCORAD and IGA for severity assessment, therapeutic patient education, and individualised use of moisturisers, topical corticosteroids, and topical calcineurin inhibitors. For systemic therapy, cyclosporine remains first-line for moderate-to-severe AD, with conditional recommendations for methotrexate, mycophenolate, and JAK inhibitors such as abrocitinib. Emerging therapies like topical tofacitinib and crisaborole were discussed with caution due to limited Indian data. Limitation Although several new therapies-such as abrocitinib and dupilumab-have been approved for pediatric atopic dermatitis, consensus among Delphi panelists remains limited. There is lack of sufficient clinical experience and pediatric-specific data on these agents, highlighting the urgent need for more robust studies to inform expert alignment and clinical practice. Conclusion This updated Indian consensus guideline provides comprehensive, evidence-based, and context-sensitive recommendations for diagnosing and managing AD across age groups. It addresses previously unmet needs in adult AD. This consensus is expected to enhance clinical outcomes and standardise AD management nationally.