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Sandhu S, Neema S, Bhatnagar A, Kishore K, Kothari R, Patil C. Dermoscopy of mudi-chood disease (hair-heat disease): A traditional hair grooming related dermatoses in South Indian women. J Eur Acad Dermatol Venereol 2024; 38:e77-e78. [PMID: 37595946 DOI: 10.1111/jdv.19438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Sunmeet Sandhu
- Department of Dermatology, 7 Air Force Hospital, Kanpur, India
| | - Shekhar Neema
- Department of Dermatology, Base Hospital Lucknow, Lucknow, India
| | - Anuj Bhatnagar
- Department of Dermatology, Command Hospital Air Force Bangalore, Bangalore, India
| | - Karthi Kishore
- Department of Dermatology, Command Hospital Air Force Bangalore, Bangalore, India
| | - Rohit Kothari
- Department of Dermatology, Command Hospital Air Force Bangalore, Bangalore, India
| | - Chetan Patil
- Department of Dermatology, Command Hospital Air Force Bangalore, Bangalore, India
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Bhatnagar A, Singh GK, Deshpande SK, Mitra B, Mitra D, Agrawal V, Reddy S, Patil C, Sandhu S. Use of secukinumab in erythrodermic psoriasis: A single center experience. Med J Armed Forces India 2023; 79:S6-S12. [PMID: 38144608 PMCID: PMC10746748 DOI: 10.1016/j.mjafi.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/16/2021] [Indexed: 11/19/2022] Open
Abstract
Background Erythrodermic psoriasis is an acute inflammatory condition presenting as erythema and scaling involving more than 90% of body surface area in patients with a history of psoriasis vulgaris. If not treated promptly, metabolic complications and infections due to acute skin failure can cause significant morbidity and mortality in this condition. Interleukin-17 (IL-17) is considered to be the key player in initiating the inflammatory cascade in psoriasis. IL-17 blockers have been successfully used in the management of psoriasis vulgaris. However, its use in unstable erythrodermic psoriasis is limited to isolated case reports. Methods We hereby report an observational study of nine patients of unstable psoriatic erythroderma successfully managed with injection secukinumab and followed up over the next 24 months. Results Nine patients were managed during the study period, and a successful outcome was noted in all the patients. The Psoriasis Area and Severity Index response rate improved by at least 75% from baseline in 33.3% (3⁄9) at week 4 and improved to 88.9% (8⁄9) at week 12. None of the patients had a recurrence of erythroderma till 24 months of followup. Conclusion The study concluded that secukinumab is quick, safe, and efficient in psoriatic erythroderma, and there was no relapse of erythroderma in any of the patients in the 24 months of followup.
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Affiliation(s)
- Anuj Bhatnagar
- Senior Advisor (Dermatology), Command Hospital (Air Force), Bengaluru, India
| | | | | | - Barnali Mitra
- Classified Specialist (Pediatrics), Command Hospital (Air Force), Bengaluru, India
| | - Debdeep Mitra
- Classified Specialist (Dermatology), Command Hospital (Air Force), Bengaluru, India
| | - Vivek Agrawal
- Senior Advisor (Surgery & Vascular Surgery), Command Hospital (Air Force), Bengaluru, India
| | - Suresh Reddy
- Vascular Surgeon, Army Hospital (Research & Referral), Delhi Cantt, India
| | - Chetan Patil
- Classified Specialist (Dermatology), Command Hospital (Air Force), Bengaluru, India
| | - Sunmeet Sandhu
- Graded Specialist (Dermatology), Command Hospital (Air Force), Bengaluru, India
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Chi KN, Sandhu S, Smith MR, Attard G, Saad M, Olmos D, Castro E, Roubaud G, Pereira de Santana Gomes AJ, Small EJ, Rathkopf DE, Gurney H, Jung W, Mason GE, Dibaj S, Wu D, Diorio B, Urtishak K, Del Corral A, Francis P, Kim W, Efstathiou E. Niraparib plus abiraterone acetate with prednisone in patients with metastatic castration-resistant prostate cancer and homologous recombination repair gene alterations: second interim analysis of the randomized phase III MAGNITUDE trial. Ann Oncol 2023; 34:772-782. [PMID: 37399894 PMCID: PMC10849465 DOI: 10.1016/j.annonc.2023.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Patients with metastatic castration-resistant prostate cancer (mCRPC) and BRCA alterations have poor outcomes. MAGNITUDE found patients with homologous recombination repair gene alterations (HRR+), particularly BRCA1/2, benefit from first-line therapy with niraparib plus abiraterone acetate and prednisone (AAP). Here we report longer follow-up from the second prespecified interim analysis (IA2). PATIENTS AND METHODS Patients with mCRPC were prospectively identified as HRR+ with/without BRCA1/2 alterations and randomized 1 : 1 to niraparib (200 mg orally) plus AAP (1000 mg/10 mg orally) or placebo plus AAP. At IA2, secondary endpoints [time to symptomatic progression, time to initiation of cytotoxic chemotherapy, overall survival (OS)] were assessed. RESULTS Overall, 212 HRR+ patients received niraparib plus AAP (BRCA1/2 subgroup, n = 113). At IA2 with 24.8 months of median follow-up in the BRCA1/2 subgroup, niraparib plus AAP significantly prolonged radiographic progression-free survival {rPFS; blinded independent central review; median rPFS 19.5 versus 10.9 months; hazard ratio (HR) = 0.55 [95% confidence interval (CI) 0.39-0.78]; nominal P = 0.0007} consistent with the first prespecified interim analysis. rPFS was also prolonged in the total HRR+ population [HR = 0.76 (95% CI 0.60-0.97); nominal P = 0.0280; median follow-up 26.8 months]. Improvements in time to symptomatic progression and time to initiation of cytotoxic chemotherapy were observed with niraparib plus AAP. In the BRCA1/2 subgroup, the analysis of OS with niraparib plus AAP demonstrated an HR of 0.88 (95% CI 0.58-1.34; nominal P = 0.5505); the prespecified inverse probability censoring weighting analysis of OS, accounting for imbalances in subsequent use of poly adenosine diphosphate-ribose polymerase inhibitors and other life-prolonging therapies, demonstrated an HR of 0.54 (95% CI 0.33-0.90; nominal P = 0.0181). No new safety signals were observed. CONCLUSIONS MAGNITUDE, enrolling the largest BRCA1/2 cohort in first-line mCRPC to date, demonstrated improved rPFS and other clinically relevant outcomes with niraparib plus AAP in patients with BRCA1/2-altered mCRPC, emphasizing the importance of identifying this molecular subset of patients.
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Affiliation(s)
- K N Chi
- University of British Columbia, BC Cancer-Vancouver Center, Vancouver, Canada.
| | - S Sandhu
- Peter MacCallum Cancer Center, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - M R Smith
- Massachusetts General Hospital Cancer Center, Boston, USA; Harvard Medical School, Boston, USA
| | - G Attard
- University College London Cancer Institute, London, UK; University College London Hospitals, London, UK
| | - M Saad
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - D Olmos
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid
| | - E Castro
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Roubaud
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | | | - E J Small
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco
| | - D E Rathkopf
- Memorial Sloan Kettering Cancer Center, New York, USA; Weill Cornell Medicine, New York, USA
| | - H Gurney
- Macquarie University, Macquarie Park, Australia
| | - W Jung
- Keimyung University Dongsan Hospital, Daegu, South Korea
| | - G E Mason
- Janssen Research & Development, LLC, Spring House
| | - S Dibaj
- Janssen Research & Development, LLC, San Diego
| | - D Wu
- Janssen Research & Development, LLC, Los Angeles
| | - B Diorio
- Janssen Research & Development, LLC, Titusville
| | - K Urtishak
- Janssen Research & Development, LLC, Spring House
| | | | - P Francis
- Janssen Research & Development, LLC, Bridgewater
| | - W Kim
- Janssen Research & Development, LLC, Los Angeles
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Cass SH, Tobin JWD, Seo YD, Gener-Ricos G, Keung EZ, Burton EM, Davies MA, McQuade JL, Lazar AJ, Mason R, Millward M, Sandhu S, Khoo C, Warburton L, Guerra V, Haydon A, Dearden H, Menzies AM, Carlino MS, Smith JL, Mollee P, Burgess M, Mapp S, Keane C, Atkinson V, Parikh SA, Markovic SN, Ding W, Call TG, Hampel PJ, Long GV, Wargo JA, Ferrajoli A. Efficacy of immune checkpoint inhibitors for the treatment of advanced melanoma in patients with concomitant chronic lymphocytic leukemia. Ann Oncol 2023; 34:796-805. [PMID: 37414216 DOI: 10.1016/j.annonc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/25/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have revolutionized the management of advanced melanoma (AM). However, data on ICI effectiveness have largely been restricted to clinical trials, thereby excluding patients with co-existing malignancies. Chronic lymphocytic leukemia (CLL) is the most prevalent adult leukemia and is associated with increased risk of melanoma. CLL alters systemic immunity and can induce T-cell exhaustion, which may limit the efficacy of ICIs in patients with CLL. We, therefore, sought to examine the efficacy of ICI in patients with these co-occurring diagnoses. PATIENTS AND METHODS In this international multicenter study, a retrospective review of clinical databases identified patients with concomitant diagnoses of CLL and AM treated with ICI (US-MD Anderson Cancer Center, N = 24; US-Mayo Clinic, N = 15; AUS, N = 19). Objective response rates (ORRs), assessed by RECIST v1.1, and survival outcomes [overall survival (OS) and progression-free survival (PFS)] among patients with CLL and AM were assessed. Clinical factors associated with improved ORR and survival were explored. Additionally, ORR and survival outcomes were compared between the Australian CLL/AM cohort and a control cohort of 148 Australian patients with AM alone. RESULTS Between 1997 and 2020, 58 patients with concomitant CLL and AM were treated with ICI. ORRs were comparable between AUS-CLL/AM and AM control cohorts (53% versus 48%, P = 0.81). PFS and OS from ICI initiation were also comparable between cohorts. Among CLL/AM patients, a majority were untreated for their CLL (64%) at the time of ICI. Patients with prior history of chemoimmunotherapy treatment for CLL (19%) had significantly reduced ORRs, PFS, and OS. CONCLUSIONS Our case series of patients with concomitant CLL and melanoma demonstrate frequent, durable clinical responses to ICI. However, those with prior chemoimmunotherapy treatment for CLL had significantly worse outcomes. We found that CLL disease course is largely unchanged by treatment with ICI.
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Affiliation(s)
- S H Cass
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - J W D Tobin
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - Y D Seo
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - G Gener-Ricos
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston
| | - E Z Keung
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - E M Burton
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - M A Davies
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - J L McQuade
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - A J Lazar
- Departments of Pathology and Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, USA
| | - R Mason
- Gold Coast University Hospital, Southport
| | | | - S Sandhu
- Peter Macallum Cancer Centre, Melbourne
| | - C Khoo
- Peter Macallum Cancer Centre, Melbourne
| | - L Warburton
- Fiona Stanley Hospital, Perth; Edith Cowan University, Joondalup; Future Health Research and Innovation Fund/Raine Clinician Research Fellowship
| | - V Guerra
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston
| | | | - H Dearden
- Melanoma Institute Australia, The University of Sydney, Sydney
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; The University of Sydney Charles Perkins Centre, Sydney; The University of Sydney Royal North Shore and Mater Hospitals, Sydney
| | - M S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney; Westmead Hospital, Sydney, Australia
| | - J L Smith
- Westmead Hospital, Sydney, Australia
| | - P Mollee
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - M Burgess
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - S Mapp
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - C Keane
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - V Atkinson
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | | | | | - W Ding
- Mayo Clinic, Rochester, USA
| | | | | | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; The University of Sydney Charles Perkins Centre, Sydney; The University of Sydney Royal North Shore and Mater Hospitals, Sydney
| | - J A Wargo
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA.
| | - A Ferrajoli
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston
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Sandhu S, Bhatnagar A, Suhag D. Dermoscopy of cutaneous larva migrans. Indian J Dermatol Venereol Leprol 2023; 89:763-764. [PMID: 35593294 DOI: 10.25259/ijdvl_316_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 12/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Sunmeet Sandhu
- Department of Dermatology, Command Hospital Air Force Bangalore, Bengaluru, Karnataka, India
| | - Anuj Bhatnagar
- Department of Dermatology, Command Hospital Air Force Bangalore, Bengaluru, Karnataka, India
| | - Devinder Suhag
- Department of Dermatology, Command Hospital Air Force Bangalore, Bengaluru, Karnataka, India
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Sandhu S, Neema S, Yuvraj Singh P, Dangwal V, Kothari R. Dermoscopy of nevus sebaceus: A cross-sectional study of 22 cases. Indian J Dermatol Venereol Leprol 2023; 0:1-6. [PMID: 38031703 DOI: 10.25259/ijdvl_629_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 05/22/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Sunmeet Sandhu
- Department of Dermatology, 7 Air Force Hospital, Kanpur, India
| | - Shekhar Neema
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Vidhu Dangwal
- Department of Pathology, Military Hospital Kirkee, Pune, India
| | - Rohit Kothari
- Department of Dermatology, Command Hospital Air Force, Bangalore, India
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Li J, Sandhu S, Thomas C, Bettger JP. Volunteers as a resource for asset mapping and maintaining a living resource directory: lessons from an academic-community partnership. Perspect Public Health 2023:17579139231180807. [PMID: 37477122 DOI: 10.1177/17579139231180807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIMS Health and social services are fundamental to public and population health, and disruptions can have devastating effects on individuals of all ages. During the first wave of the COVID-19 pandemic, the availability of health and social services rapidly changed. Existing resources experienced changes in operation and mode of service delivery, while new resources emerged to address escalating needs. Both the general public and service providers lacked access to accurate information on availability and access, and existing service directories became obsolete or unreliable. To address this gap, a committee of university students expanded its volunteer base, partnered with a local non-profit organization, and invested in maintaining a centralized, up-to-date resource directory for the region. METHODS/RESULTS Student volunteers sourced and consolidated existing county-level directories to curate more than 370 resources across 12 healthcare and social care domains in a Google Sheets platform. This directory was publicly accessible, available in English and Spanish, adjustable to community feedback and needs, disseminated through the local health system intranet, synthesized into paper handouts for food pantries, and utilized to curate a directory aimed toward older adult needs. Students worked in a tiered leadership model and mobilized quickly to respond to immediate community needs. CONCLUSION This academic-community partnership engaging student volunteers can be a low-cost, high-value resource to support public health systems meet the information needs of their community, particularly during periods of crisis or rapid changes in service availability.
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Affiliation(s)
- J Li
- Trinity College of Arts & Sciences, Duke University, Durham, NC, USA
| | - S Sandhu
- Trinity College of Arts & Sciences, Duke University, Durham, NC, USA
- Harvard Medical School, Boston, MA, USA
| | - C Thomas
- Trinity College of Arts & Sciences, Duke University, Durham, NC, USA
- Harvard Medical School, Boston, MA, USA
| | - J P Bettger
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, PA, USA
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Kothari R, Sandhu S, Walia GK, Kumar A, Kishore K, Bhatnagar A. Dermoscopy of Vesicular Cutaneous Larva Migrans. Indian J Dermatol 2023; 68:472-473. [PMID: 37822404 PMCID: PMC10564183 DOI: 10.4103/ijd.ijd_754_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Affiliation(s)
- Rohit Kothari
- From the Department of Dermatology, Command Hospital Air Force, Bengaluru, Karnataka, India E-mail:
| | - Sunmeet Sandhu
- Department of Dermatology, 7 Air Force Hospital, Kanpur, Uttar Pradesh, India
| | - Gurpreet K Walia
- Department of Pathology, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - Arun Kumar
- From the Department of Dermatology, Command Hospital Air Force, Bengaluru, Karnataka, India E-mail:
| | - Karthi Kishore
- From the Department of Dermatology, Command Hospital Air Force, Bengaluru, Karnataka, India E-mail:
| | - Anuj Bhatnagar
- From the Department of Dermatology, Command Hospital Air Force, Bengaluru, Karnataka, India E-mail:
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Ranjan E, Sandhu S, Sharma AS. Acrokeratosis Verruciformis of Hopf: A Series of 3 Cases with Clinical, Histopathological and Dermoscopic Features. Indian J Dermatol 2023; 68:489. [PMID: 37822398 PMCID: PMC10564209 DOI: 10.4103/ijd.ijd_57_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Affiliation(s)
- Eeshaan Ranjan
- From the Department of Dermatology, Military Hospital, Jammu, Jammu and Kashmir, India
| | - Sunmeet Sandhu
- Department of Dermatology, 7 Air Force Hospital, Kanpur, Uttar Pradesh, India E-mail:
| | - Ajay S Sharma
- Department of Pathology, Military Hospital, Jammu, Jammu and Kashmir, India
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Neema S, Kothari R, Rout A, Mani S, Bhatt S, Sandhu S. Systemic treatment of psoriasis in special population. Indian J Dermatol Venereol Leprol 2023; 0:1-8. [PMID: 37317756 DOI: 10.25259/ijdvl_7_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/21/2023] [Indexed: 06/16/2023]
Abstract
Psoriasis is a common skin disorder affecting approximately 1% of the general population. The treatment of psoriasis depends on the body surface area involvement, quality of life impairment and associated co-morbidities. Special population comprising of pregnant women, lactating mothers, elderly individuals and children, is more vulnerable. They are not included in drug trials; rendering the data for use of systemic treatment scant and is mainly based on anecdotal evidence. In this narrative review, we discuss systemic treatment options in this special population. Though couples planning a family are not considered a special population, they form a subset that require special therapeutic consideration and have also been included in this review.
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Affiliation(s)
| | - Rohit Kothari
- Department of Dermatology, Command Hospital Air Force, Bengaluru, Karnataka, India
| | | | - Siddharth Mani
- Department of Dermatology, INHS Sanjivani Kochi, Kerala, India
| | - Siddharth Bhatt
- Department of Dermatology, INHS Asvini, Mumbai, Maharashtra, India
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Kothari R, Mohamed M, Vivekanandh K, Sandhu S, Sinha P, Bhatnagar A. Hyper-Immunoglobulin E Syndrome: Case Series of 6 Children from India. Indian Dermatol Online J 2023; 14:379-382. [PMID: 37266097 PMCID: PMC10231702 DOI: 10.4103/idoj.idoj_472_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/14/2022] [Accepted: 12/25/2022] [Indexed: 06/03/2023] Open
Abstract
Hyper-immunoglobulin E syndrome is a rare primary immunodeficiency syndrome characterized by severe atopic dermatitis, recurrent pulmonary and staphylococcal skin infections. Its diagnosis requires a high degree of suspicion, typical clinical features, and not mere rise in serum IgE levels. Genetic studies are not always possible in a resource poor setting in developing countries. In this case series, all children had recurrent eczematoid rash, secondary infections, multiple episodes of hospitalization for pulmonary infection and raised serum IgE levels. Diagnostic genetic study was feasible in only one of the cases which revealed pathogenic homozygous deletions of exons 15 to 18 (Transcript: NM_203447) in DOCK8 gene. The main goal of management of hyper-immunoglobulin E syndrome is aggressive treatment of infections and optimum skin care. Our case series highlights various characteristic, presentations, and management of this rare syndrome childhood cases. Awareness of these manifestations may facilitate early identification and contribute to optimal care of patients as representative data on the same is limited in literature.
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Affiliation(s)
- Rohit Kothari
- Department of Dermatology, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - Muneer Mohamed
- Department of Dermatology, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - K Vivekanandh
- Consultant Dermatologist, Edappal Hospitals Pvt Limited, Kerala, India
| | - Sunmeet Sandhu
- Department of Dermatology, Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari, Tamil Nadu, India
| | - Preema Sinha
- Department of Dermatology, 7 Air Force Hospital, Kanpur, India
| | - Anuj Bhatnagar
- Department of Dermatology, Command Hospital Air Force, Bengaluru, Karnataka, India
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Bolt J, Sandhu S, Mohammadi A. Effect of Coenzyme Q10 Supplementation on Sarcopenia, Frailty, and Falls: A Scoping Review. J Nutr Health Aging 2023; 27:586-592. [PMID: 37498106 DOI: 10.1007/s12603-023-1943-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 07/28/2023]
Abstract
Coenzyme Q10 (CoQ10) is well-known for its antioxidant effects and has been highlighted in research related to aging and many age-related conditions. However, there is limited research on the benefit of CoQ10 supplementation in conditions impacting the physical robustness of older adults, such as sarcopenia, frailty, falls and osteoporosis. This scoping review identified and summarized 4 studies that assessed the effects of exogenous CoQ10 on outcomes relating to sarcopenia, frailty, and falls. Results of the studies showed statistically significant improvements in a variety of physical robustness related outcomes, however several limitations of these studies prevent conclusive recommendations from being drawn regarding the benefit of CoQ10 supplementation in these conditions. A well-designed randomized control trial assessing the benefit of CoQ10 supplementation on clinically relevant outcomes related to sarcopenia, frailty, and falls may be warranted.
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Affiliation(s)
- J Bolt
- Jennifer Bolt, 505 Doyle Ave, Kelowna, British Columbia, Canada, V1Y 6V8, Phone: 250-469-7070 ext. 13459, , ORCiD ID: 0000-0001-7597-8036
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Patil C, Bhatnagar A, Hiremath R, Sandhu S, Suhag D, Kumar M, Valarmathi T. A spectrum of dermatological manifestations associated with hypothyroid condition – A pilot study. BLDE Univ J Health Sci 2023. [DOI: 10.4103/bjhs.bjhs_21_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Mani S, Raut A, Neema S, Khandare M, Golas P, Sandhu S, Kothari R, Rajput GR, Oberoi B. Trichoscopy in Alopecia Areata and Trichotillomania in Skin of Colour: A Comparative Study. Indian J Dermatol 2023; 68:78-84. [PMID: 37151271 PMCID: PMC10162753 DOI: 10.4103/ijd.ijd_587_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Alopecia areata (AA) and trichotillomania (TTM) are the two common causes of localised non scarring alopecia. While AA is an autoimmune disorder, TTM is an impulse control disorder which makes the treatment of the two entities completely different. Trichoscopy is a non-invasive tool used to diagnose hair disorders, which not only is extremely helpful in diagnosing AA and TTM but also differentiates them from other hair disorders as well. The aim of our study is to describe the various trichoscopic features of AA and TTM and to compare the frequency of each trichoscopic feature in order to establish diagnostic clues for differentiating AA and TTM. Trichoscopy was performed on clinically diagnosed cases of AA and TTM with DL4 dermoscope and the images were analysed by 2 dermatologists independently. The frequency of trichoscopic features in AA and TTM was compared using chi square test. Twenty-four patients of TTM and 50 patients of AA were included in the study with mean age of AA being 30 years and mean age of TTM being 23.4 years. Exclamation mark hair, tapered hair, coudability hair, pigtail hair, clustered vellous hair, clustered regrowing hair and white hair were significantly more in alopecia areata. Conversely broken hair of different length, trichoptilosis, flame hair, mace hair, coiled hair, hair powder, fractured hair, v sign and burnt matchstick sign were the common features in TTM. To conclude, even though there is an overlap of trichoscopic features in AA and TTM, it is possible to distinguish the two if an assemblage of specific features are present.
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Affiliation(s)
- Siddharth Mani
- From the Department of Dermatology, INHS Sanjivani, Kochi, Kerala, India
| | - Aradhana Raut
- From the Department of Dermatology, INHS Sanjivani, Kochi, Kerala, India
| | - Shekhar Neema
- From the Department of Dermatology, INHS Sanjivani, Kochi, Kerala, India
| | - Manish Khandare
- From the Department of Dermatology, INHS Sanjivani, Kochi, Kerala, India
| | - Prateksha Golas
- From the Department of Dermatology, INHS Sanjivani, Kochi, Kerala, India
| | - Sunmeet Sandhu
- From the Department of Dermatology, INHS Sanjivani, Kochi, Kerala, India
| | - Rohit Kothari
- From the Department of Dermatology, INHS Sanjivani, Kochi, Kerala, India
| | | | - Bhavni Oberoi
- From the Department of Dermatology, INHS Sanjivani, Kochi, Kerala, India
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Neema S, Sandhu S, Radhakrishnan S. Brooke-Spiegler syndrome. Indian J Dermatol Venereol Leprol 2023; 89:139-140. [PMID: 33666057 DOI: 10.25259/ijdvl_355_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/01/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Shekhar Neema
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Sunmeet Sandhu
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - S Radhakrishnan
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
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Kothari R, Szepietowski JC, Bagot M, Sandhu S, Patil A, Grabbe S, Goldust M. Mycosis fungoides in pediatric population: comprehensive review on epidemiology, clinical presentation, and management. Int J Dermatol 2022; 61:1458-1466. [PMID: 35193164 DOI: 10.1111/ijd.16098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/29/2021] [Accepted: 01/06/2022] [Indexed: 12/26/2022]
Abstract
Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma. However, it is rare in pediatric population. Most of the cases of pediatric MF present with hypopigmented patches and/or various other forms, which may often mimic common childhood dermatoses, thereby causing a delay in the diagnosis. There are no established treatment guidelines for pediatric MF. As the progression of childhood MF is extremely rare and it has an indolent course, it is usually diagnosed at an early stage (IA, IB, IIA), and hence phototherapy with a response rate of >80% is a well-established effective treatment in children. However, as recurrences are frequently seen on stopping the therapies, a maintenance regimen and long-term follow-up is equally important. This article reviews the epidemiological factors, clinical presentations, diagnosis, and various treatment modalities used in pediatric MF. We analyzed and compared the data of almost 616 childhood MF cases from various studies undertaken from 1988 to 2021.
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Affiliation(s)
- Rohit Kothari
- Department of Dermatology, Armed Forces Medical College, Pune, India
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Martine Bagot
- Faculté de Médecine Paris Diderot, AP-HP, Service de Dermatologie, Hôpital Saint-Louis, Paris, France
| | - Sunmeet Sandhu
- Department of Dermatology, Command Hospital Air Force, Bangalore, India
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Neema S, Sandhu S, Kashif AW. Dermoscopy of Cylindroma. Indian Dermatol Online J 2022; 13:818-819. [PMID: 36386727 PMCID: PMC9650748 DOI: 10.4103/idoj.idoj_500_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 06/16/2023] Open
Affiliation(s)
- Shekhar Neema
- Assoc Prof (Dermatology), Armed Forces Medical College, Pune, Maharashtra, India
| | - Sunmeet Sandhu
- Senior Resident (Dermatology), Armed Forces Medical College, Pune, Maharashtra, India
| | - A. W. Kashif
- Assoc Prof (Pathology), Armed Forces Medical College, Pune, Maharashtra, India
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Bhatt S, Kothari R, Tripathy DM, Sandhu S, Babaei M, Goldust M. Emerging drugs for the treatment of acne: a review of phase 2 & 3 trials. Expert Opin Emerg Drugs 2022; 27:241-261. [PMID: 35929974 DOI: 10.1080/14728214.2022.2110239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Acne vulgaris is one of the commonest dermatoses encountered in a dermatology clinic. Although the inflammatory processes are centered around the pilosebaceous unit, a myriad of external factors that alter the pathogenesis have been hypothesized. Newer therapies are focused on targeting these as possible scaffolds for drug development. Existing topical and oral medications have considerable overlap between pharmacotherapy and cosmeceuticals directed toward acne treatment making new drug development extremely competitive and financially burdening. Teratogenicity associated with retinoids, cutaneous adverse effects of topical anti-acne medications, and lack of long-term remission induction are a few hindrances that have to be tackled by novel therapies. AREAS COVERED Numerous topical and systemic medications for acne vulgaris are undergoing clinical trials presently. The review has dealt with anti-acne drugs undergoing phase II and III clinical trials with emphasis on the rationale of various combinations in tandem with the complex pathogenesis of the disease. EXPERT OPINION The current strategies in new drug development target sebocyte function, neo-inflammatory mediators, and methods combatting drug resistance while broadening the anti-microbial spectrum against Cutibacterium acnes. A holistic approach is pivotal to strengthen the management protocol for acne to achieve precision dermatological practice.
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Affiliation(s)
| | - Rohit Kothari
- Dermatology, Command Hospital Air Force, Bengaluru, India
| | | | | | - Mahsa Babaei
- Dermatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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Dimitriou F, Namikawa K, Reijers ILM, Buchbinder EI, Soon JA, Zaremba A, Teterycz P, Mooradian MJ, Armstrong E, Nakamura Y, Vitale MG, Tran LE, Bai X, Allayous C, Provent-Roy S, Indini A, Bhave P, Farid M, Kähler KC, Mehmi I, Atkinson V, Klein O, Stonesifer CJ, Zaman F, Haydon A, Carvajal RD, Hamid O, Dummer R, Hauschild A, Carlino MS, Mandala M, Robert C, Lebbe C, Guo J, Johnson DB, Ascierto PA, Shoushtari AN, Sullivan RJ, Cybulska-Stopa B, Rutkowski P, Zimmer L, Sandhu S, Blank CU, Lo SN, Menzies AM, Long GV. Single-agent anti-PD-1 or combined with ipilimumab in patients with mucosal melanoma: an international, retrospective, cohort study. Ann Oncol 2022; 33:968-980. [PMID: 35716907 DOI: 10.1016/j.annonc.2022.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/15/2022] [Accepted: 06/07/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Mucosal melanoma (MM) is a rare melanoma subtype with distinct biology and poor prognosis. Data on the efficacy of immune checkpoint inhibitors (ICIs) is limited. We determined the efficacy of ICIs in MM, analysed by primary site and ethnicity/race. PATIENTS AND METHODS Retrospective cohort study from 25 cancer centres in Australia, Europe, USA and Asia. Patients with histologically confirmed MM were treated with anti-PD1+/-ipilimumab. Primary endpoints were response rate (RR), progression-free survival (PFS), overall survival (OS) by primary site (naso-oral, urogenital, anorectal, other), ethnicity/race (Caucasian, Asian, Other) and treatment. Univariate and multivariate Cox proportional hazard model analyses were conducted. RESULTS In total, 545 patients were included: 331 (63%) Caucasian, 176 (33%) Asian and 20 (4%) Other. Primary sites included 113 (21%) anorectal, 178 (32%) urogenital, 206 (38%) naso-oral and 45 (8%) other. 348 (64%) received anti-PD1 and 197 (36%) anti-PD1/ipilimumab. RR, PFS and OS did not differ by primary site, ethnicity/race or treatment. RR for naso-oral was numerically higher for anti-PD1/ipilimumab (40%, 95% CI 29-54%) compared with anti-PD1 (29%, 95% CI 21-37%). 35% of patients that initially responded progressed. Median duration of response (mDOR) was 26 months (95% CI 18-NR [Not Reached]). Factors associated with short PFS were ECOG PS ≥3 (p<0.01), LDH >ULN (p=0.01), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01). Factors associated with short OS were ECOG PS ≥1 (p<0.01), LDH >ULN (p=0.03), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01). CONCLUSIONS MM has poor prognosis. Treatment efficacy of anti-PD1+/-ipilimumab was similar and did not differ by ethnicity/race. Naso-oral primaries had numerically higher response to anti-PD1/ipilimumab, without difference in survival. The addition of ipilimumab did not show greater benefit over anti-PD1 for other primary sites. In responders, mDOR was short and acquired resistance was common. Other factors, including site and number of metastases were associated with survival.
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Affiliation(s)
- F Dimitriou
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Department of Dermatology, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - K Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - I L M Reijers
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E I Buchbinder
- Melanoma Disease Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02481, USA
| | - J A Soon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - A Zaremba
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - P Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, 49585Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - M J Mooradian
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - E Armstrong
- Department of Medicine, Melanoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Y Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - M G Vitale
- Istituto Nazionale Tumori IRCCS Fondazione 'G. Pascale', Napoli, Italy
| | - L E Tran
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - X Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - C Allayous
- APHP Hôpital Saint-Louis, Dermatology Department, DMU ICARE, Paris, France
| | - S Provent-Roy
- Dermatology Service, Department of Medicine, Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - A Indini
- Unit of Medical Oncology, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - P Bhave
- Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia
| | - M Farid
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - K C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - I Mehmi
- Department of Hematology/Oncology, The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, 11800 Wilshire Blvd Suite 300, Los Angeles, CA, 90025, USA
| | - V Atkinson
- Princess Alexandra Hospital, Greenslopes Private Hospital, University of Queensland, Queensland, Australia
| | - O Klein
- Department of Medical Oncology, Austin Health, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, Victoria
| | - C J Stonesifer
- Columbia University Irving Medical Center, New York City, New York, USA
| | - F Zaman
- Alfred Hospital, Melbourne, Victoria, Australia
| | - A Haydon
- Alfred Hospital, Melbourne, Victoria, Australia
| | - R D Carvajal
- Columbia University Irving Medical Center, New York City, New York, USA
| | - O Hamid
- Department of Hematology/Oncology, The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, 11800 Wilshire Blvd Suite 300, Los Angeles, CA, 90025, USA
| | - R Dummer
- Department of Dermatology, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
| | - A Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - M S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia
| | - M Mandala
- Unit of Medical Oncology, University of Perugia, Perugia, Italy
| | - C Robert
- Dermatology Service, Department of Medicine, Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - C Lebbe
- Université de Paris, APHP Hôpital Saint-Louis, Dermatology Department, DMU ICARE, INSERM U-976, Paris, France
| | - J Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - D B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - P A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione 'G. Pascale', Napoli, Italy
| | - A N Shoushtari
- Department of Medicine, Melanoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - R J Sullivan
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - B Cybulska-Stopa
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Poland
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, 49585Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - L Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - S Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - C U Blank
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia.
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20
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Kundu N, Kothari R, Shah N, Sandhu S, Tripathy DM, Galadari H, Gold MH, Goldman MP, Kassir M, Schepler H, Grabbe S, Goldust M. Efficacy of botulinum toxin in masseter muscle hypertrophy for lower face contouring. J Cosmet Dermatol 2022; 21:1849-1856. [PMID: 35176198 DOI: 10.1111/jocd.14858] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/14/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Masseter muscle hypertrophy (MMH) usually presents with cosmetic concerns as it may lead to widening of the lower face. Apart from the traditional surgical approaches, botulinum toxin type A (BTA) injection is a non-invasive treatment option available. There are no standard guidelines for this procedure. OBJECTIVES To study the efficacy of botulinumtoxin A in MMH for lower face contouring. METHODOLOGY The Cochrane Library, PubMed/MEDLINE, Google-scholar, Science-Direct database, and ResearchGate from inception until September 2021 were searched using the keywords "botulinumtoxin type A," "masseter muscle hypertrophy," "lower face contouring," and "masseter botox." All available retrospective and prospective studies, case-series, case-reports, and expert reviews were included with an emphasis on efficacy of BTA in MMH and units injected into the muscle, points of placement, adverse events, and the duration of its effect. Reference lists of the resultant articles, as well as relevant reviews, were also searched. RESULT 40 articles were shortlisted for the review, of which 14 studies with sample-size ≥10 in accordance with the study requirements were summarized in a tabular form for analysis and easy comparison and reference. CONCLUSION BTA injection is a non-invasive, safe, and effective treatment for MMH. The optimum number of BTA units could not be ascertained due to wide variability in the studies as well as ethnicity of patients and extent or some measurement of MMH. The points of placement of injection should be well within the boundaries of the masseter muscle. The maximum effect of BTA after a single injection session is usually seen in ~3 months, and the duration may last for 6-12 months. Multiple injection sessions may be required to maintain a long-term effect. Injection technique and total number of injection units of neuromodulator must be individualized for each patient.
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Affiliation(s)
| | - Rohit Kothari
- Dermatology, Command Hospital Air Force, Bengaluru, India
| | - Nimish Shah
- Cardiff University, Cardiff, UK.,University of South Wales, Pontypridd, UK
| | | | | | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Michael H Gold
- Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, Tennessee, USA
| | - Mitchel P Goldman
- Cosmetic Laser Dermatology: A West Dermatology Company, San Diego, California, USA.,Department of Dermatology, University of California, San Diego, California, USA
| | | | - Hadrian Schepler
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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21
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Pathania V, Sandhu S, Sengupta P, Kaur K. Cutaneous aspergillosis masquerading in sporotrichoid morphology in an immunocompetent host. Med J Armed Forces India 2022; 78:235-238. [PMID: 35463556 PMCID: PMC9023546 DOI: 10.1016/j.mjafi.2020.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022] Open
Abstract
Primary cutaneous aspergillosis is an uncommon opportunistic infection, generally seen in immunocompromised individuals. However, many atypical presentations have been reported recently particularly with the increased domain of immunosuppression. Sporotrichoid pattern of aspergillosis where it invades deep lymphatics have rarely been reported and never in immunocompetent individuals previously. We hereby report a case of a 29 years old immunocompetent individual with no comorbidities who presented with multiple painful erythematous papules and nodules over the left upper limb in a sporotrichoid pattern. Microscopy revealed branched septate hyphae and culture on Sabouraud dextrose agar grew powdery greenish colonies which showed hyaline branched septate hyphae with brush-like conidiophores and globose conidia in chains. Histopathology from one of the nodules was consistent with deep fungal infection. A diagnosis of Aspergillus chivalieri was made based on 18S rRNA sequencing of the isolate. The patient showed a satisfactory response to oral Itraconazole over 12 weeks.
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22
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Patil CC, Bhatnagar A, Hiremath RN, Mitra D, Sandhu S, Chand S. Photodermatosis and high UV index in Jorhat (north east India) due to single time zone: A study. Photodermatol Photoimmunol Photomed 2022; 38:178-180. [PMID: 34582596 DOI: 10.1111/phpp.12733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Chetan C Patil
- Department of Dermatology, Command Hospital Air Force, Bangalore, India
| | - Anuj Bhatnagar
- Department of Dermatology, Command Hospital Air Force, Bangalore, India
| | | | - Debdeep Mitra
- Department of Dermatology, Command Hospital Air Force, Bangalore, India
| | - Sunmeet Sandhu
- Department of Dermatology, Command Hospital Air Force, Bangalore, India
| | - Satish Chand
- Department of Dermatology, Command Hospital Air Force, Bangalore, India
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Bhatnagar A, Rai R, Kumar S, Mitra B, Chopra A, Singh GK, Mitra D, Patil C, Sandhu S. Safety and Efficacy of Restoring Facial Symmetry Using Polydioxanone Thread Face Lift Technique in Patients with Facial Palsy. J Clin Aesthet Dermatol 2022; 15:26-29. [PMID: 35309880 PMCID: PMC8884188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Facial nerve palsy often leads to functional and physiological impairment in patients and they often suffer from social stigma. The use of polydiaxone (PDO) threads has long been used to treat facial furrows and age-related sagging in the face. The basic principle of the thread lift procedure is placing cogged threads in the subcutaneous plane along a planned trajectory. The efficacy and ease of this procedure compared to a traditional face lift has made PDO threads a popular option in the past three decades. METHODS We treated 50 patients with a drooping face on one side following facial paralysis with thread lifting and botulinum injections to control contralateral hypertrophy and ipsilateral synkinesis. The Facial Grading System or the serial Sunnybrook Facial Grading System (SB scores) was used to assess at all the visits and serial photographs were recorded. RESULTS Following the threading procedure, all 50 patients displayed improved facial symmetry. There was significant improvement in the baseline SB scores compared to the scores over following year, with all the scores having significant p value less than 0.05. CONCLUSION Based on our results, subdermal suspension with re-absorbable threads in conjunction with botulinum toxin constitutes an efficient and safe procedure for face lifting and rejuvenation of a drooping face as a result of long-lasting facial paralysis.
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Affiliation(s)
- Anuj Bhatnagar
- Drs. Bhatnagar, Kumar, B. Mitra, Patil, D. Mitra, and Sandhu are with Command Hospital Air Force Bangalore in Bangalore, India
- Dr. Rai is with Command Hospital Air Force Pune in Pune, India
- Dr. Chopra is with Command Hospital Western Command in Panchkula, India
- Dr. Singh is with Base Hospital Delhi Cantt in New Delhi, India
| | - Roma Rai
- Drs. Bhatnagar, Kumar, B. Mitra, Patil, D. Mitra, and Sandhu are with Command Hospital Air Force Bangalore in Bangalore, India
- Dr. Rai is with Command Hospital Air Force Pune in Pune, India
- Dr. Chopra is with Command Hospital Western Command in Panchkula, India
- Dr. Singh is with Base Hospital Delhi Cantt in New Delhi, India
| | - Sanjay Kumar
- Drs. Bhatnagar, Kumar, B. Mitra, Patil, D. Mitra, and Sandhu are with Command Hospital Air Force Bangalore in Bangalore, India
- Dr. Rai is with Command Hospital Air Force Pune in Pune, India
- Dr. Chopra is with Command Hospital Western Command in Panchkula, India
- Dr. Singh is with Base Hospital Delhi Cantt in New Delhi, India
| | - Barnali Mitra
- Drs. Bhatnagar, Kumar, B. Mitra, Patil, D. Mitra, and Sandhu are with Command Hospital Air Force Bangalore in Bangalore, India
- Dr. Rai is with Command Hospital Air Force Pune in Pune, India
- Dr. Chopra is with Command Hospital Western Command in Panchkula, India
- Dr. Singh is with Base Hospital Delhi Cantt in New Delhi, India
| | - Ajay Chopra
- Drs. Bhatnagar, Kumar, B. Mitra, Patil, D. Mitra, and Sandhu are with Command Hospital Air Force Bangalore in Bangalore, India
- Dr. Rai is with Command Hospital Air Force Pune in Pune, India
- Dr. Chopra is with Command Hospital Western Command in Panchkula, India
- Dr. Singh is with Base Hospital Delhi Cantt in New Delhi, India
| | - Gautam Kumar Singh
- Drs. Bhatnagar, Kumar, B. Mitra, Patil, D. Mitra, and Sandhu are with Command Hospital Air Force Bangalore in Bangalore, India
- Dr. Rai is with Command Hospital Air Force Pune in Pune, India
- Dr. Chopra is with Command Hospital Western Command in Panchkula, India
- Dr. Singh is with Base Hospital Delhi Cantt in New Delhi, India
| | - Debdeep Mitra
- Drs. Bhatnagar, Kumar, B. Mitra, Patil, D. Mitra, and Sandhu are with Command Hospital Air Force Bangalore in Bangalore, India
- Dr. Rai is with Command Hospital Air Force Pune in Pune, India
- Dr. Chopra is with Command Hospital Western Command in Panchkula, India
- Dr. Singh is with Base Hospital Delhi Cantt in New Delhi, India
| | - Chetan Patil
- Drs. Bhatnagar, Kumar, B. Mitra, Patil, D. Mitra, and Sandhu are with Command Hospital Air Force Bangalore in Bangalore, India
- Dr. Rai is with Command Hospital Air Force Pune in Pune, India
- Dr. Chopra is with Command Hospital Western Command in Panchkula, India
- Dr. Singh is with Base Hospital Delhi Cantt in New Delhi, India
| | - Sunmeet Sandhu
- Drs. Bhatnagar, Kumar, B. Mitra, Patil, D. Mitra, and Sandhu are with Command Hospital Air Force Bangalore in Bangalore, India
- Dr. Rai is with Command Hospital Air Force Pune in Pune, India
- Dr. Chopra is with Command Hospital Western Command in Panchkula, India
- Dr. Singh is with Base Hospital Delhi Cantt in New Delhi, India
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Mitra D, Bhatnagar A, Sandhu S, Talukdar K. Asymptomatic linear lesions over chest and axilla. Indian Dermatol Online J 2022; 13:814-815. [DOI: 10.4103/idoj.idoj_445_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 11/06/2022] Open
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Neema S, Sandhu S, Mukherjee S, Vashisht D, Vendhan S, Sinha A, Vasudevan B. Comparison of interferon gamma release assay and tuberculin skin test for diagnosis of latent tuberculosis in psoriasis patients planned for systemic therapy. Indian J Dermatol 2022; 67:19-25. [PMID: 35656280 PMCID: PMC9154176 DOI: 10.4103/ijd.ijd_681_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Latent tuberculosis infection (LTBI) is a common yet difficult problem to diagnose in tuberculosis endemic countries. Both tuberculin skin test (TST) and interferon-gamma release assay (IGRA) are used for the diagnosis of LTBI. Aims: The aim of the study is to compare TST and IGRA in patients planned for systemic treatment of psoriasis. Methods: It was a diagnostic study conducted in a tertiary care centre during the study period from January 20 to December 20. Patients more than 18 years of age with chronic plaque psoriasis planned for systemic therapy were included. Psoriasis area severity index (PASI), history of tuberculosis in past or family and BCG vaccination were recorded. Complete blood count, radiograph of the chest, tuberculin skin test and interferon-gamma release assay were performed in all patients. Statistical analysis was performed using statistical package for social sciences (SPSS version 20, Chicago). Results: A total of 75 patients, including 48 males and 27 females, were included in the study. The mean age and mean duration of disease were 46.08 (±12.16) and 4.59 (±3.8) years, respectively. Seventy-one (94.6%) patients had BCG scar, and two (2.6%) had a history of tuberculosis in a family member. The TST and IGRA were positive (>10 mm) in 23 (30.6%) and 16 (21.3%) patients, respectively. Either TST or IGRA was positive in 28 (37.3%) patients. Out of these 28 patients, concordance was seen in 11 (39.2%) and discordance in 17 (60.7%). Discordance was TST+/IGRA − in 12 (42.8%) and TST−/IGRA + in five (17.8%) patients. Abnormality in radiograph of the chest and computed tomography (CT) scan of the chest were seen in five (6.6%) and nine (12%) patients, respectively. The patients with either TST or IGRA + were more likely to have abnormal chest radiographs than those who were TST−/IGRA− (OR: 11.3, 95% CI: 1.24–102.3, P = 0.03). The TST and IGRA showed fair agreement ( = 0.364, P = 0.003). ROC curve was plotted for the absolute value of TST in mm considering IGRA as the gold standard. The area under the curve was 0.805 (95%CI: 0.655–0.954). For the TST positivity cut-off of 10 and 15 mm, specificity was 77.3% and 95.5%, respectively; the sensitivity was 68.8% irrespective of the cut-off value. Limitation: Small sample size and lack of follow-up are the biggest limitations of the study. The lack of a gold standard in the diagnosis of LTBI is an inherent yet unavoidable flaw in the study. Conclusion: Reactivation of LTBI is a concern in a patient planned for immunosuppressive therapy. We suggest the use of both TST and IGRA rather than two-step testing (TST followed by IGRA) or IGRA alone for the diagnosis of LTBI, especially in patients with a high risk of reactivation. The positivity on either test should prompt further evaluation and treatment decisions should be taken considering the risk-benefit ratio of treatment rather than test results alone.
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Neema S, Sandhu S, Kinra P. Dermoscopy of erythrokeratoderma variabilis. Indian Dermatol Online J 2022; 13:556-557. [PMID: 36262565 PMCID: PMC9574131 DOI: 10.4103/idoj.idoj_386_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/21/2020] [Accepted: 07/17/2020] [Indexed: 11/25/2022] Open
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Patil C, Hiremath R, Bhatnagar A, Kandpal R, Sandhu S, Sreenivas A. Cutaneous myiasis (Cordylobia Anthropophaga): An interesting case report of a patient returning back from Central Africa. Med J DY Patil Vidyapeeth 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_675_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mitra D, Bhatnagar A, Singh G, Sandhu S. Successful treatment of refractory chronic bullous disease of childhood with rituximab. Indian Dermatol Online J 2022; 13:248-251. [PMID: 35287397 PMCID: PMC8917490 DOI: 10.4103/idoj.idoj_223_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/03/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic bullous disease of childhood is a rare subepidermal bullous disease with a hallmark of linear IgA deposition along basement membrane zone seen on direct immunofluorescence. We report a case of a 2-year-old male child, who had recurrent and multiple bullous eruptions over body and he was not responding to conventional therapy. He had earlier developed a drug reaction to dapsone which is considered the drug of choice for this condition. We report successful management of this case with injection rituximab which is a chimeric monoclonal antibody against CD20, which is primarily found on the surface of B cells.
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Chand S, Arora S, Bhatnagar A, Dabas R, Suhag D, Pal R, Sandhu S, Patil C, Paul D, Rout A. Skin prick test in chronic idiopathic urticaria: A retrospective analysis. Med J DY Patil Vidyapeeth 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_596_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Neema S, Sandhu S, Vasudevan B, Vendhan D S, Sinha A, Tripathy D, Patrikar S. The use of screening tools for cardiovascular risk assessment in psoriasis – A case- control study. Indian Dermatol Online J 2022; 13:46-51. [PMID: 35198467 PMCID: PMC8809143 DOI: 10.4103/idoj.idoj_421_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/15/2021] [Accepted: 07/29/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Psoriasis is a common, T-cell-mediated disease, affecting 0.44–2.8% of the general population in India. It is associated with a higher risk of cardiovascular disease possibly due to chronic inflammation. Those patients with severe psoriasis are at a higher risk of death due to cardiovascular disease. The use of scoring tools may help the care providers to assess cardiovascular risks in these patients. Aims: The aim of this study was to assess the cardiovascular risks in patients with severe psoriasis using the commonly used risk-assessment tools (Framingham risk score [FRS] and Pooled cohort equations [PCE]) and to understand the utility of these tools in practice. Methods: It is a case-control study performed in the dermatology outpatient department of a tertiary care center during the study period from January to December 2020. Consenting adults with chronic plaque psoriasis and psoriasis area and severity index (PASI) more than 10 were included in the study. The FRS and PCE risk scores were calculated for the patients and age- and sex-matched healthy controls. Results: A total of 213 patients were assessed and 30 patients were excluded. Of the 183 patients, 152 patients were assessed using FRS and 135 patients using PCE. Equal number of age- and sex-matched healthy controls were also assessed. The mean age of the patients assessed using the FRS and PCE was 47 ± 10.9 and 52.84 ± 8.9 years, respectively. The mean age of the controls was 45.52 ± 8.7 and 51.76 ± 8.1 years in the FRS and PCE groups, respectively. The male to female ratio was 1.92:1 and 2:1 in the FRS and PCE risk-score groups, respectively. The mean PASI score was 16.45 ± 7.88 and 15.6 ± 7.6 in the two groups, respectively. The 10-year risk estimate using FRS in the patients ranged from 0 to 26.9%. The mean and median estimates were 4.95 ± 5.7 and 2.8%, respectively, while 2.65 ± 4.7 and 0.8% in the controls (P = 0.001). The 10-year risk estimate in the patients using the PCE risk score ranged from 0.3 to 39.6%. The mean and median estimate in the patients was 8.17 ± 9.9 and 5.2%, respectively while they were 5.68 ± 7.5% and 2.6% in the controls (P = 0.024). The agreement between the FRS and PCE was found to be poor (Ϗ, 0.049). There was no statistically significant correlation of PASI to either the PCE risk score (P = 0.498) or FRS (P = 0.630). Limitations: A small sample size, and study in a tertiary care center may have resulted in sampling bias. Conclusion: Psoriasis is associated with a higher risk of cardiovascular disease. These tools may help a dermatologist in the primary prevention of cardiovascular disease. It can also help in the awareness of the increased risk of cardiovascular disease in patients.
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Sandhu S, Pathania V, Vashisht D, Sengupta P. Disseminated secondary erythema migrans: Typical and atypical presentation of a rare disease in India. Med J DY Patil Vidyapeeth 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_484_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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32
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Kothari R, Kishore K, Sandhu S, Bhatnagar A, Pal R, Chand S. Systemic Contact Dermatitis To Spices: Report Of A Rare Case. Contact Dermatitis 2021; 86:323-325. [PMID: 34939681 DOI: 10.1111/cod.14031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Rohit Kothari
- Senior Resident, Dermatology, Command Hospital Air Force, Bengaluru, India
| | - Karthi Kishore
- Resident, Dermatology, Command Hospital Air Force, Bengaluru, India
| | - Sunmeet Sandhu
- Assistant professor, Dermatology, 7 Air Force Hospital, Kanpur, India
| | - Anuj Bhatnagar
- Professor, Dermatology, Command Hospital Air Force, Bengaluru, India
| | - Reetika Pal
- Resident, Dermatology, Command Hospital Air Force, Bengaluru, India
| | - Satish Chand
- Assistant Professor, Dermatology, Command Hospital Air Force, Bengaluru, India
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Singh PY, Sandhu S, Neema S, Pathania V. Successful Outcome of Follicular Unit Extraction in a Patient with Alopecia Due to Hansen's Disease. J Cutan Aesthet Surg 2021; 14:377-378. [PMID: 34908787 PMCID: PMC8611713 DOI: 10.4103/jcas.jcas_125_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Prince Yuvraj Singh
- Department of Dermatology, Command Hospital (WC), Chandi Mandir, Haryana, India
| | - Sunmeet Sandhu
- Department of Dermatology, Armed Forces Medical College, Pune, India
| | - Shekhar Neema
- Department of Dermatology, Armed Forces Medical College, Pune, India
| | - Vikas Pathania
- Department of Dermatology, Armed Forces Medical College, Pune, India
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Singh GK, Mitra B, Bhatnagar A, Mitra D, Talukdar K, Das P, Patil C, Sandhu S, Sinha A, Singh T. Unusual Spurts of Rosacea Like Dermatoses, Posing a Diagnostic Dilemma During Covid-19 Pandemic: A Cross-Sectional, Observational Study From a Tertiary Care Centre. Indian J Dermatol 2021; 66:401-404. [PMID: 34759399 PMCID: PMC8530062 DOI: 10.4103/ijd.ijd_759_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: The gradual opening of healthcare system since second week of May 2020 following lockdown imposed due to corona virus pandemic saw spurts of cases of unexplained central facial dermatoses in subset of previously healthy people. The aim of the study was to find out the cause and establish the definitive diagnosis of unusual occurrence of facial dermatoses on previously healthy people so that an appropriate management can be offered to the patients. Materials and Methods: It was a cross-sectional, observational study carried during May 15 to July 15, 2020 at a tertiary dermatology center. All cases presented with erythema on face and papular or pustular lesions on central facial area of not more than 2 months of duration were included in the study. Results: Total 81 patients visited skin OPD with facial dermatoses of various types during this period, out of which 21 patients fulfilled the inclusion criteria. This was 0.72% (21/2900) of total skin OPD of the 2 months. All the patients had been using face masks during this period of symptoms due to the ongoing coronavirus situation. Dermatological examination revealed only erythema on the central area of face (n = 10), erythema and few papules (n = 3), erythmatous papules and pustules (n = 5), and erythematous papules, pustules, and telengiectasia (n = 3). All the skin biopsies showed predominantly epithelioid cells, noncaseating granuloma with a variable degree of infiltrate. Conclusion: There has been a definite change in the lifestyle due to the current Covid-19 pandemic. People are compulsorily using face masks to avoid the spread of Covid-19 infection. This change in behavior has brought out a surge of rosacea like lesions on the covered area of face. Partly, it can be explained by change in innate immunity due to excessive sweating and change in microenvironment of skin.
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Affiliation(s)
| | - Barnali Mitra
- Department of Pediatrics, Base Hospital Delhi Cantt, New Delhi, India
| | - Anuj Bhatnagar
- Department of Dermatology, Command Hospital Air Force, Bangalore, Karnataka, India
| | - Debdeep Mitra
- Department of Dermatology, Base Hospital Delhi Cantt, New Delhi, India
| | - Krishna Talukdar
- Department of Dermatology, Jorhat Medical College and Hospital, Jorhat, Assam, India
| | - Pankaj Das
- Department of Dermatology, Base Hospital Delhi Cantt, New Delhi, India
| | - Chetan Patil
- Department of Dermatology, Command Hospital Air Force, Bangalore, Karnataka, India
| | - Sunmeet Sandhu
- Department of Dermatology, Venereology and Leprosy, Command Hospital Air Force, Bangalore, Karnataka, India
| | - Anwita Sinha
- Department of Dermatology, Venereology and Leprosy, Affiliated Faculty, Armed Forces Medical College, Military Hospital, Kirkee, Pune, Maharashtra, India
| | - Teghveer Singh
- Department of Dermatology, Base Hospital Delhi Cantt, New Delhi, India
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Kothari R, Tripathy DM, Sandhu S, Vashisht D, Bhatt S, Rathod AG. An uncommon phenomenon with common medications in a case of bi-segmental vitiligo. Dermatol Ther 2021; 35:e15199. [PMID: 34757637 DOI: 10.1111/dth.15199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Rohit Kothari
- Dermatology, Command Hospital Air Force, Bengaluru, Karnataka, India
| | | | - Sunmeet Sandhu
- Dermatology, 7 Air Force Hospital, Kanpur, Uttar Pradesh, India
| | - Deepak Vashisht
- Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Siddharth Bhatt
- Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
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Mitra D, Bhatnagar A, Suhag D, Sandhu S. A Rare Case Report of BCG Induced Balanitis in a Patient with Transitional Cell Carcinoma of Urinary Bladder. Indian Dermatol Online J 2021; 12:745-749. [PMID: 34667763 PMCID: PMC8456258 DOI: 10.4103/idoj.idoj_158_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/11/2021] [Accepted: 05/13/2021] [Indexed: 11/04/2022] Open
Abstract
Primary Bacillus Calmette-Guérin (BCG) infection of the glans penis is not a very common entity and has been rarely reported in literature. BCG has been used as an adjuvant therapy in patients of transitional cell urinary bladder carcinoma following transurethral resection of bladder tumor. We report a 66-year-old male patient who was being managed for urinary bladder carcinoma with nine sittings of adjuvant BCG therapy. He developed painless swelling with multiple pustules over glans penis and prepuce along with inguinal lymphadenopathy. He had a BCG inoculation scar over his arm and his chest X-ray was within normal limits. His workup for sexually transmitted disease was negative. The biopsy from the nodule on prepuce revealed mixed inflammatory infiltrate comprising of neutrophils, lymphocytes, and eosinophils along with numerous congested blood vessels and hemosiderin macrophages. Mycobacterium tuberculosis gene expert from tissue was positive for acid fast bacilli (AFB). Fine-needle aspiration cytology from the right inguinal lymph node also revealed AFB on Ziehl-Neelsen stain. The BCG immunotherapy was stopped and the patient was started on a standard four-drug antitubercular therapy comprising isoniazid, rifampicin, ethambutol, and pyrazinamide along with daily doses of pyridoxine. The edema resolved and papules subsided within 2 weeks after starting antitubercular therapy. This is a very rare presentation although intravesical BCG therapy is a very common treatment modality, hence this report is intended to increase awareness of this condition in dermatologists and venereologists.
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Affiliation(s)
- Debdeep Mitra
- Department of Dermatology, Command Hospital Air Force, Bangalore, Karnataka, India
| | - Anuj Bhatnagar
- Department of Dermatology, Command Hospital Air Force, Bangalore, Karnataka, India
| | - Devinder Suhag
- Department of Dermatology, Command Hospital Air Force, Bangalore, Karnataka, India
| | - Sunmeet Sandhu
- Department of Dermatology, Command Hospital Air Force, Bangalore, Karnataka, India
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Rokni GR, Mohammadnezhad F, Saeedi M, Shadi S, Sharma A, Sandhu S, Gupta A, Goldust M. Efficacy, tolerability, and safety of montelukast versus finasteride for the treatment of moderate acne in women: A prospective, randomized, single-blinded, active-controlled trial. J Cosmet Dermatol 2021; 20:3580-3585. [PMID: 34648685 DOI: 10.1111/jocd.14462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acne is a chronic inflammatory skin disease which involves the pilosebaceous unit. Tissue inflammation isone of the crucial mechanisms, amongst others. Of the various cytokines, leukotriene B4 (LT-B4) is the most potentleucocyte chemotactic mediator. Montelukast is an antagonist of the LT-B4 receptor. Finasteride is an antiandrogen whichspecifically inhibits the 5α-reductase enzyme. AIMS This study aimed at comparing the efficacy, tolerability and safety of montelukast versus finasteride in the treatmentof moderate acne in women. PATIENTS/METHOD This randomized, single-blinded, prospective trial over 12 weeks recruited 65 female subjects with moderate acne vulgaris (Global Acne Grading System Scale) for evaluation. One group (n = 30) received oral montelukast (10 mg PO daily), while the second group (n = 25) received oral finasteride (2.5 mg PO daily) in combination with topical clindamycin 2% solution. Lesion count and acne severity were evaluated at time intervals of 0 (baseline), 4, 8, and 12 weeks. Adverse effects of the drugs were noted. RESULTS Both lesion count and severity of acne decreased significantly after treatment in both the groups as compared to the baseline. The acne severity score reached from 33.93 in time zero to 20.6 in the 12th week and 35.71 at baseline to 16.43 at the end of treatment in the Montelukast and Finasteride groups, respectively. Side effects were noted in 3 patients and 2 patients in the monteleukast and finasteride group, respectively, which were transient and non-serious in nature proving the satisfactory tolerability and safety of these two drugs. CONCLUSION The results of this study show that both montelukast and finasteride have good efficacy in the treatment of acne. Finasteride has more efficacy than montelukast for treating moderate acne in normo-androgenic women.
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Affiliation(s)
- Ghasem Rahmatpour Rokni
- Department of Dermatology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Farzaneh Mohammadnezhad
- Department of Dermatology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Majid Saeedi
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shiva Shadi
- Department of Dermatology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Aseem Sharma
- Dermatology Unit, Skin Saga Centre for Dermatology, Mumbai, India
| | | | | | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Neema S, Sandhu S, Gupta A, Jagadeesan S, Vasudevan B. Unconventional treatment options in psoriasis: A review. Indian J Dermatol Venereol Leprol 2021; 88:137-143. [PMID: 34623042 DOI: 10.25259/ijdvl_22_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/01/2021] [Indexed: 11/04/2022]
Abstract
Psoriasis is a common skin disease that affects 1-3% of the general population. The treatment depends on body surface area involved, quality of life impairment and associated comorbidities. The treatment options include topical therapy, phototherapy, conventional systemic therapy (methotrexate, cyclosporine and acitretin), biologics and oral small molecules (apremilast and tofacitinib). Despite the availability of newer therapies such as biologics and oral small molecules, many a time, there is a paucity of treatment options due to the chronic nature of the disease, end-organ toxicity of the conventional drugs or high cost of newer drugs. In these scenarios, unconventional treatment options may be utilized as stand-alone or adjuvant therapy. In this review, we have discussed these uncommonly used treatment options in the management of psoriasis.
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Affiliation(s)
- Shekhar Neema
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Sunmeet Sandhu
- Department of Dermatology, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - Ankan Gupta
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Soumya Jagadeesan
- Department of Dermatology, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | - Biju Vasudevan
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
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Sandhu S, Bhatnagar A, Kumar H, Dixit PK, Paliwal G, Suhag DK, Patil C, Mitra D. Leukocytoclastic vasculitis as a cutaneous manifestation of ChAdOx1 nCoV-19 corona virus vaccine (recombinant). Dermatol Ther 2021; 34:e15141. [PMID: 34546608 PMCID: PMC8646583 DOI: 10.1111/dth.15141] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/28/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Abstract
With the present COVID-19 vaccination drive across the world, adverse skin reactions post COVID-19 vaccine is expected. Majority of these reactions seen were transient or local injection site reactions. However, as the larger population is being vaccinated, certain uncommon dermatological presentations including leukocytoclastic vasculitis, pityriasis rosea, and exacerbation of pre-existing autoimmune diseases are now being reported. Among all the COVID-19 vaccines, most of these reactions are seen with messenger ribonucleic acid-based Pfizer/BioNTech (BNT162b2) and Moderna (mRNA-1273) vaccine. We report two cases of leukocytoclastic vasculitis following ChAdOx1 nCoV-19 corona virus vaccine (recombinant) that bring out potential new dermatological manifestations of recombinant corona virus vaccine being administered across the European, South American, and Asian countries. It is important for all health care workers and patients to be aware of the corona virus vaccine associated adverse cutaneous reactions.
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Affiliation(s)
- Sunmeet Sandhu
- Department of Dermatology, Command Hospital Air Force Bangalore, Bangalore, Karnataka, India
| | - Anuj Bhatnagar
- Department of Dermatology, Command Hospital Air Force Bangalore, Bangalore, Karnataka, India
| | - Harish Kumar
- Department of Medicine, Command Hospital Air Force Bangalore, Bangalore, Karnataka, India
| | - Prashant Kumar Dixit
- Department of Medicine, Command Hospital Air Force Bangalore, Bangalore, Karnataka, India
| | - Gourang Paliwal
- Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Devinder Kumar Suhag
- Department of Dermatology, Command Hospital Air Force Bangalore, Bangalore, Karnataka, India
| | - Chetan Patil
- Department of Dermatology, Command Hospital Air Force Bangalore, Bangalore, Karnataka, India
| | - Debdeep Mitra
- Department of Dermatology, Command Hospital Air Force Bangalore, Bangalore, Karnataka, India
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Varadaraj G, Sangeetha B, Sandhu S, Santhiya G. Four Cases of Multisystem Inflammatory Syndrome in Adults Associated with SARS-COV-2 Infection - An Overview of Clinical Features, Diagnosis and Treatment. J Assoc Physicians India 2021; 69:11-12. [PMID: 34472807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The varied spectrum of presentation of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is intriguing. Multisystem inflammatory syndrome in children (MIS-C) is a well described and documented condition that is associated with the active or recent COVID-19 infection. A similar presentation in adults is termed as Multisystem inflammatory syndrome in Adults (MIS-A). With only very limited cases reported from the west, MIS-A is considered a rare and serious complication of COVID-19. However, it is not as uncommon as we think. Many cases go undiagnosed for lack of COVID -19 like symptoms and unawareness among treating clinicians about this newer clinical entity. Further, antibody testing and inflammatory markers are not easily available in many of the Indian hospitals especially in rural India where the second wave had been intense, thereby making it difficult for the diagnosis of MIS-A. Also, there is no clear treatment guideline for MIS-A unlike MIS-C where the treatment protocol is well laid out. Awareness about MIS-A among treating clinicians can thus help in further evaluation and increased identification of the syndrome at the early stages thereby helping in the early institution of treatment. Our tertiary COVID care hospital in South India which has handled about 5200 cases of COVID-19 is been able to identify 04 cases of MIS-A proving that this clinical entity is not as rare as it is thought but lacks reporting and prompt identification. Here we describe 04 cases of MIS-A and strive to bring in the various aspects of it, including the clinical presentation, laboratory markers, diagnostic criteria and treatment considerations in this post second wave of the COVID-19 pandemic in India.
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Affiliation(s)
- G Varadaraj
- Graded Specialist, Department of Medicine, Command Hospital Air Force, Bangalore, Karnataka Corresponding Author
| | - B Sangeetha
- Graded Specialist, Department of Pediatrics,Command Hospital Air Force, Bangalore, Karnataka
| | - Sunmeet Sandhu
- Graded Specialist, Department of Dermatology, Command Hospital Air Force, Bangalore, Karnataka
| | - G Santhiya
- Anesthetist, CGHS Hospital, Chennai, Tamil Nadu
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Dabas R, Varadaraj G, Sandhu S, Bhatnagar A, Pal R. Kawasaki-like multisystem inflammatory syndrome associated with COVID-19 in an adult: a case report. Br J Dermatol 2021; 185:859-861. [PMID: 34115386 PMCID: PMC9214080 DOI: 10.1111/bjd.20574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/04/2021] [Accepted: 05/30/2021] [Indexed: 12/16/2022]
Affiliation(s)
- R Dabas
- Department of Dermatology, Command Hospital Air Force Bangalore, Bengaluru, India
| | - G Varadaraj
- Department of Medicine, Command Hospital Air Force Bangalore, Bengaluru, India
| | - S Sandhu
- Department of Dermatology, Command Hospital Air Force Bangalore, Bengaluru, India
| | - A Bhatnagar
- Department of Dermatology, Command Hospital Air Force Bangalore, Bengaluru, India
| | - R Pal
- Department of Dermatology, Command Hospital Air Force Bangalore, Bengaluru, India
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Vashisht D, Neema S, Venugopalan R, Pathania V, Sandhu S, Vasudevan B. Dermatology practice in the times of the COVID-19 pandemic. Indian J Dermatol Venereol Leprol 2021; 87:603-610. [PMID: 33969653 DOI: 10.25259/ijdvl_364_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 12/01/2020] [Indexed: 12/27/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is implicated in the ongoing pandemic across the globe since December 2019. It was first notified by China from Wuhan on 31 December 2020 and transmission to healthcare workers was first reported on 20 January 2020. Human-to-human transmission is mainly by droplet infection. At present no effective vaccine is available. Our speciality needs to collectively address the urgent issue of risk of transmission in dermatology practice. A case series of Coronavirus Disease 2019 (COVID-19) from Wuhan described that 41.3% of their patients may have acquired the infection from the hospital. Of all the infected health care workers, 77.5% worked in general wards and departments. These data highlight the significant risk of nosocomial transmission of COVID-19 and also the higher risk in general wards and departments compared to the emergency room or intensive care unit. Dermatology patients are generally seen in clinics and in outpatient departments in hospitals. Patients wait together in the waiting area, intermingle and then are seen by the physician in their chamber. This can cause transmission of the pathogen among patients and from patient to physician. Social distancing, hand hygiene and the use of personal protective equipment are important for preventing the spread of infection and dermatology practices also have to incorporate these aspects. Telemedicine is becoming an important tool for the management of dermatology patients in these times. At-risk patients in dermatology also need to be given priority care. Protocols for the use of immunosuppressants and biologics in dermatology during the pandemic are being developed.
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Affiliation(s)
- Deepak Vashisht
- Department of Dermatology, AFMC and Command Hospital, Pune, Maharashtra, India
| | - Shekhar Neema
- Department of Dermatology, AFMC and Command Hospital, Pune, Maharashtra, India
| | - Ruby Venugopalan
- Department of Dermatology, AFMC and Command Hospital, Pune, Maharashtra, India
| | - Vikas Pathania
- Department of Dermatology, AFMC and Command Hospital, Pune, Maharashtra, India
| | - Sunmeet Sandhu
- Department of Dermatology, AFMC and Command Hospital, Pune, Maharashtra, India
| | - Biju Vasudevan
- Department of Dermatology, AFMC and Command Hospital, Pune, Maharashtra, India
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Owen CN, Bai X, Quah T, Lo SN, Allayous C, Callaghan S, Martínez-Vila C, Wallace R, Bhave P, Reijers ILM, Thompson N, Vanella V, Gerard CL, Aspeslagh S, Labianca A, Khattak A, Mandala M, Xu W, Neyns B, Michielin O, Blank CU, Welsh SJ, Haydon A, Sandhu S, Mangana J, McQuade JL, Ascierto PA, Zimmer L, Johnson DB, Arance A, Lorigan P, Lebbé C, Carlino MS, Sullivan RJ, Long GV, Menzies AM. Delayed immune-related adverse events with anti-PD-1-based immunotherapy in melanoma. Ann Oncol 2021; 32:917-925. [PMID: 33798657 DOI: 10.1016/j.annonc.2021.03.204] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/09/2021] [Accepted: 03/28/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Immune-related adverse events (irAEs) typically occur within 4 months of starting anti-programmed cell death protein 1 (PD-1)-based therapy [anti-PD-1 ± anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA4)], but delayed irAEs (onset >12 months after commencement) can also occur. This study describes the incidence, nature and management of delayed irAEs in patients receiving anti-PD-1-based immunotherapy. PATIENTS AND METHODS Patients with delayed irAEs from 20 centres were studied. The incidence of delayed irAEs was estimated as a proportion of melanoma patients treated with anti-PD-1-based therapy and surviving >1 year. Onset, clinical features, management and outcomes of irAEs were examined. RESULTS One hundred and eighteen patients developed a total of 140 delayed irAEs (20 after initial combination with anti-CTLA4), with an estimated incidence of 5.3% (95% confidence interval 4.0-6.9, 53/999 patients at sites with available data). The median onset of delayed irAE was 16 months (range 12-53 months). Eighty-seven patients (74%) were on anti-PD-1 at irAE onset, 15 patients (12%) were <3 months from the last dose and 16 patients (14%) were >3 months from the last dose of anti-PD-1. The most common delayed irAEs were colitis, rash and pneumonitis; 55 of all irAEs (39%) were ≥grade 3. Steroids were required in 80 patients (68%), as well as an additional immunosuppressive agent in 27 patients (23%). There were two irAE-related deaths: encephalitis with onset during anti-PD-1 and a multiple-organ irAE with onset 11 months after ceasing anti-PD-1. Early irAEs (<12 months) had also occurred in 69 patients (58%), affecting a different organ from the delayed irAE in 59 patients (86%). CONCLUSIONS Delayed irAEs occur in a small but relevant subset of patients. Delayed irAEs are often different from previous irAEs, may be high grade and can lead to death. They mostly occur in patients still receiving anti-PD-1. The risk of delayed irAE should be considered when deciding the duration of treatment in responding patients. However, patients who stop treatment may also rarely develop delayed irAE.
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Affiliation(s)
- C N Owen
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - X Bai
- Massachusetts General Hospital, Boston, USA; Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - T Quah
- Westmead and Blacktown Hospitals, Sydney, Australia
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - C Allayous
- Dermatology Department, Université de Paris, AP-HP Saint-Louis Hospital, INSERM, Paris, France
| | - S Callaghan
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - R Wallace
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | - P Bhave
- The Alfred Hospital, Melbourne, Australia
| | - I L M Reijers
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N Thompson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - V Vanella
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - C L Gerard
- Lausanne University Hospital, Lausanne, Switzerland
| | - S Aspeslagh
- University Hospital Brussels, Brussels, Belgium
| | - A Labianca
- Papa Giovanni XXIII Cancer Center Hospital, Bergamo, Italy
| | - A Khattak
- Fiona Stanley Hospital and Edith Cowan University, Perth, Australia
| | - M Mandala
- University of Perugia, Unit of Medical Oncology, Santa Maria misericordia hospital, Perugia, Italy
| | - W Xu
- Princess Alexandra Hospital and The University of Queensland, Brisbane, Australia
| | - B Neyns
- University Hospital Brussels, Brussels, Belgium
| | - O Michielin
- Lausanne University Hospital, Lausanne, Switzerland
| | - C U Blank
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S J Welsh
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Haydon
- The Alfred Hospital, Melbourne, Australia
| | - S Sandhu
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | - J Mangana
- Dermatology, Department of Dermato-Oncology, University Hospital Zurich, Zürich, Switzerland
| | - J L McQuade
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - P A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - L Zimmer
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - D B Johnson
- Vanderbilt University Medical Center, Nashville, USA
| | - A Arance
- Hospital Clinic Barcelona, Barcelona, Spain
| | - P Lorigan
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - C Lebbé
- Dermatology Department, Université de Paris, AP-HP Saint-Louis Hospital, INSERM, Paris, France
| | - M S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Westmead and Blacktown Hospitals, Sydney, Australia
| | | | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia.
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
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Mukherjee S, Neema S, Sinha P, Sandhu S, Kashif AW, Radhakrishnan S. Dermoscopic Demonstration of Darier Sign. Dermatol Pract Concept 2021; 11:e2021114. [PMID: 33614209 DOI: 10.5826/dpc.1101a114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2020] [Indexed: 10/31/2022] Open
Affiliation(s)
| | - Shekhar Neema
- Department of Dermatology, Armed Forces Medical College, Pune, India
| | - Preema Sinha
- Department of Dermatology, Armed Forces Medical College, Pune, India
| | - Sunmeet Sandhu
- Department of Dermatology, Armed Forces Medical College, Pune, India
| | - A W Kashif
- Department of Pathology, Armed Forces Medical College, Pune, India
| | - S Radhakrishnan
- Department of Dermatology, Armed Forces Medical College, Pune, India
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Sandhu S, Raman DK, Sood A, Sinha P, Singh PY, Dixit PK. Cytomorphological Patterns of Nerve Aspirates in Pure Neuritic Leprosy-A Single Centre Cross-Sectional Observational Study. J Cytol 2021; 38:14-20. [PMID: 33935387 PMCID: PMC8078620 DOI: 10.4103/joc.joc_182_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/17/2020] [Accepted: 11/30/2020] [Indexed: 11/04/2022] Open
Abstract
Background Pure neuritic leprosy (PNL) poses a diagnostic challenge because of absence of skin patches, inconclusive skin biopsies and nerve conduction studies. Nerve biopsy though the diagnostic gold standard, is invasive, requires expertise, and may not be feasible in all cases. Fine needle aspiration cytology (FNAC) of accessible thickened nerves can be utilized as a minimally invasive diagnostic modality in PNL. This study was carried out to describe cytomorphological patterns of nerve aspirates in patients of PNL for diagnosis and classification of leprosy and study its advantage, if any, over skin biopsy. Methods Twenty-seven treatment naive clinically diagnosed patients of PNL were included in this cross-sectional study carried out from January 2017 to December 2018 at a tertiary care centre in Western India. FNAC was done from a clinically involved nerve and aspirates were evaluated for cytomorphological characteristics and the presence of Acid-Fast Lepra bacilli. Results Nerve aspirates were diagnostic in 10 (37%) patients while 17 (63%) aspirates showed non-specific or no inflammation. Of the diagnostic aspirates, six (22.2%) were classified as tuberculoid leprosy, three (11.1%) as lepromatous and one (3.7%) as borderline leprosy. Mycobacterium leprae were demonstrated among three (11.1%) of these aspirates. In comparison, only three (11.1%) skin biopsies were diagnostic of leprosy with features of indeterminate spectrum. Remaining 24 skin biopsies showed normal histology in 20 (74.1%) cases to perivascular lymphocytic infiltrate in four (14.8%) cases. Conclusion Our study demonstrates that FNAC of clinically thickened nerves has a better diagnostic yield than skin biopsy in PNL and shows all spectrums of leprosy. It also offers the advantage of sampling major nerve trunks without the fear of residual neurological deficit. However, most of the smears were paucicellular and a negative aspirate does not rule out leprosy.
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Affiliation(s)
- Sunmeet Sandhu
- Department of Dermatology, Command Hospital, Airforce Bangalore, India
| | - Deep K Raman
- Department of Pathology, Command Hospital, Lucknow, India
| | - Aradhana Sood
- Department of Dermatology, Base Hospital, Lucknow, India
| | - Preema Sinha
- Department of Dermatology, Base Hospital, Lucknow, India
| | - Prince Y Singh
- Department of Dermatology, Command Hospital, Chandimandir, Haryana, India
| | - Prashant K Dixit
- Department of Medicine, Command Hospital, Airforce Bangalore, India
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Sinha P, Sandhu S, Kothari R, Neema S. Uncommon presentation of methotrexate-induced toxic erythema of chemotherapy. Pigment Int 2021. [DOI: 10.4103/pigmentinternational.pigmentinternational_27_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Shankar P, Vashisht D, Pathania V, Sharma S, Sandhu S, Venugopal R. A retrospective clinico-epidemiological study of leprosy cases treated at a tertiary care hospital in Western Maharashtra. Med J DY Patil Vidyapeeth 2021. [DOI: 10.4103/mjdrdypu.mjdrdypu_285_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sandhu S, Neema S, Vashisht D, Venugopal R, Sengupta P, Radhakrishnan S. Drug reaction with eosinophilia and systemic symptoms: A single center descriptive observational study. Dermatol Ther 2020; 34:e14670. [PMID: 33314590 DOI: 10.1111/dth.14670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 12/17/2022]
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse cutaneous drug reaction with mortality up to 10%. It is a rare condition with risk varying between 1 in 1000 and 1 in 10 000 drug exposures. The aim of the study was to describe clinical features, management and drugs responsible for causing DRESS. The study was retrospective, observational study. The data of patients admitted to hospital with diagnosis of DRESS during study period (March 2018 to February 2020), were retrieved and analyzed. The descriptive data of patients were summarized. The continuous variables were summarized as mean ± SD and/or median, depending on the skewness of the data. The categorical variables were expressed as absolute numbers, frequency, and proportions (%). The data was tabulated and analyzed in Microsoft Excel 2019 version. A total of 20 patients who met inclusion criteria (probable or definite DRESS as per RegiSCAR criteria) were included in the study. The mean age of the patients was 41.2 ± 15.7 years. The average latency period was 26.45 ± 5.65 days (range: 7-60). The commonest culprit drugs were dapsone and phenytoin, each in five (25%) patients. Commonest morphology of rash was morbilliform in 13 (65%) patients. One patient with targetoid rash had multi-organ involvement. Facial edema, periorbital edema, and conjunctival injection were seen in 17 (85%), seven (35%), and six (30%) cases, respectively. Eosinophilia was present in 18 (90%) patients with mean (±SD) value of 1976 ± 840 cells/μl. Liver was the commonest internal organ involved in 14 (70%) patients and kidney in three (15%) patients. The initial dose of prednisolone for treatment varied from 0.75 to 2 mg/kg/day. The mean duration of steroid treatment was 64 ± 21 days. Two patients were treated with intravenous methylprednisolone and one with intravenous immunoglobulin. Two patients (10%) had recurrence of adverse drug reaction >6 months after completion of initial treatment and two (10%) developed autoimmune thyroiditis during follow-up. Small sample size and retrospective nature of the study were main limitations. Selection bias is a possibility as study was carried out in tertiary care center. Tests for incriminating culprit drugs such as patch test, intradermal test, and lymphocyte transformation test were not performed. DRESS is a rare disease that can be diagnosed early with high index of suspicion and treated successfully with steroids. The internal organ involvement is common in DRESS and requires a thorough evaluation.
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Affiliation(s)
- Sunmeet Sandhu
- Department of Dermatology, Command Hospital Airforce Bangalore, India
| | - Shekhar Neema
- Department of Dermatology, Armed Forces Medical College, Pune, India
| | - Deepak Vashisht
- Department of Dermatology, Armed Forces Medical College, Pune, India
| | - Ruby Venugopal
- Department of Dermatology, Armed Forces Medical College, Pune, India
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Neema S, Radhakrishnan S, Kinra P, Sandhu S. Two Cases of Squamous Cell Carcinoma of the Penis - A Dermoscopic View. Dermatol Pract Concept 2020; 11:e2020097. [PMID: 33354403 DOI: 10.5826/dpc.1101a97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2020] [Indexed: 10/31/2022] Open
Affiliation(s)
- Shekhar Neema
- Department of Dermatology, Armed Forces Medical College, Pune, India
| | - S Radhakrishnan
- Department of Dermatology, Armed Forces Medical College, Pune, India
| | - Pratik Kinra
- Department of Pathology, Armed Forces Medical College, Pune, India
| | - Sunmeet Sandhu
- Department of Dermatology, Armed Forces Medical College, Pune, India
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Neema S, Radhakrishnan S, Kinra P, Sandhu S. Two Cases of Squamous Cell Carcinoma of the Penis—A Dermoscopic View. Dermatol Pract Concept 2020. [DOI: 10.5826/dpc.1004a97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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