Biologics in psoriasis: Indian experience Shrichand G Parasramani, Jisha Pillai Indian Journal of Drugs in Dermatology 2019 5(1):1-5

Janus Kinase Inhibitors in Dermatology Aditya Kumar Bubna Indian Journal of Drugs in Dermatology 2019 5(1):6-13 Janus kinase (JAK) inhibitors are a new addition in the armamentarium of drugs in the treatment of autoimmune dermatoses. They have proven to be valuable in treating a variety of inflammatory dermatoses with lesser side effects compared to their biological counterparts. This review throws light on JAK inhibitors and their role in dermatologic diseases.

Real-life efficacy and safety of secukinumab: A single-center, retrospective observational study with 52-week follow-up Shekhar Neema, S Radhakrishnan, Sehdev Singh, Biju Vasudevan, Manas Chatterjee Indian Journal of Drugs in Dermatology 2019 5(1):14-18 Background: Secukinumab is a fully human monoclonal antibody against interleukin-17. Phase III trials have shown encouraging results in chronic plaque psoriasis. The real-life data for safety and efficacy of secukinumab are limited. Methodology: This was a retrospective, single-center, observational study conducted in a tertiary care center of East India between January 2016 and December 2017. Patients with chronic plaque psoriasis who were initiated on injection secukinumab during the study period and completed 52 weeks of observation period were included in the study. Analysis was performed using SPSS version 25. Results: Twenty patients were recruited in the study. Mean age of the patients was 46 years and mean duration of disease was 11 years. Eleven (55%) patients were biologic experienced and Nine (45%) patients were biologic naïve. Mean Psoriasis Area and Severity Index (PASI) score at baseline was 17.05 (±6.7). Fifteen (75%) patients achieved PASI75 at 4 weeks. Seventeen (85%) patients achieved PASI75, 13 (65%) achieved PASI90, and 10 (50%) patients achieved PASI100 at 12 weeks. Eighteen (90%), 10 (50%), and 7 (35%) patients maintained PASI75, PASI90, and PASI100 response, respectively, at the end of 52 weeks. Adverse effects were seen in 6 (30%) patients over 52 weeks. Drug discontinuation was required because of severe exacerbation of eczema and recalcitrant vulvovaginal candidiasis in one patient each. Conclusion: Secukinumab is an effective drug for the management of chronic plaque psoriasis even in patients who have previously been treated with systemic drugs and other biologics; however, adverse effects are more common as compared to what trial data suggest. Limitations of Study: Small sample size and retrospective study design are main limitations of the study. Strength of Study: This is first real-life data with 52 weeks follow up from India.

A comparative study between topical adapalene (0.1%) versus a combination of topical adapalene (0.1%) and intense pulsed light therapy in the treatment of inflammatory and noninflammatory facial acne vulgaris: A split-face randomized controlled trial Shah Karan, Jadhav Vikrant, Gugle Anil Indian Journal of Drugs in Dermatology 2019 5(1):19-25 Introduction: Acne vulgaris is a common dermatological disorder encountered in dermatology practice. Various treatment modalities are available for acne. Lasers and light-based therapies are also gaining popularity with good clinical results. The choice of treatment depends on the type and severity of acne. Aims:(1) To evaluate the efficacy and safety of topical adapalene (0.1%) gel in facial acne vulgaris. (2) To evaluate the efficacy and safety of topical adapalene (0.1%) gel in combination with intense pulsed light (IPL) in facial acne vulgaris. (3) To compare the above results. Materials and Methods: A total of 50 patients with facial acne were included. IPL device equipped with an acne treatment filter emitting light between 430 and 1200 nm was used. Adapalene 0.1% in gel form was used. One side of the face was treated with plain adapalene gel and another side with a combination of daily application of adapalene, with fortnightly exposure of IPL. A total of four sittings of IPL at the interval of 15 days were given. Final evaluation was done 2 weeks after the last session of IPL. Results: On adapalene + IPL-treated side, statistically significant reduction in comedones started from the 2nd visit,P < 0.05. On the 6th visit, there was statistically significant difference in mean comedones (P < 0.05) between two sides. After the study (9 weeks), the mean reduction in inflammatory lesion was 69.98% for adapalene-treated side and 79.92% for combination therapy. Conclusion: IPL therapy with 430–1200 nm wavelength filter is an effective adjuvant therapy when used with adapalene 0.1 gel. It gives an additional benefit in the treatment of acne. We can avoid systemic antibiotics and retinoids using adapalene and IPL combination in mild-to-moderate acne.

Oral ranitidine: A promising novel therapeutic option in molluscum contagiosum in children Pooja Agarwal, Bhushan Madke, Priyanka Bodar Indian Journal of Drugs in Dermatology 2019 5(1):26-29 Background: Molluscum contagiosum(MC) is one of the most common cutaneous viral infection observed in children. Though, it is benign and self-limiting, treatment is often sought for cosmetic reasons. Existing invasive therapeutic modalities are generally not well tolerated in children because of pain and risk of scarring. Immunomodulatory potential of cimetidine is well established. We thus extrapolated the same to ranitidine and conducted this study. Aim: To assess the efficacy of oral ranitidine in treatment of molluscum contagiosum in immunocompetent children. Methods: A multicentre longitudinal study was conducted in the dermatology departments of tertiary care hospitals in Ahmedabad and Wardha, India over a period of 4 months. 24 children with MC were included. Oral ranitidine was started in dose of 5 mg/kg/day in two divided doses for 8 weeks. Follow up was done very 15 days and changes in number and size of lesions were noted. Results: Mean age of patients was 5.08 years. 19 patients completed the study. 15 patients had improvement in the lesions at the end of 8 weeks while 4 patients did not show any improvement. Complete clearance was seen in 14 patients(73.6%) and 1 patient had decrease in size of the lesions without change in the number. Mean duration of complete clearance of lesion was 6.5 weeks. Conclusion: Oral ranitidine may be considered as a safe and effective alternative therapeutic option in widespread MC in immunocompetent children where invasive painful procedures are less desirable.

Successful Treatment of Pyogenic Granuloma with Sclerotherapy Neelima Bansal, Vasudha A Belgaumkar, Ravindranth B Chavan, Bhavana Ravindra Doshi Indian Journal of Drugs in Dermatology 2019 5(1):30-33 Pyogenic granuloma (PG) is a common benign vascular proliferation that usually occurs on the skin and mucosa. Various treatment options exist in literature with no clear consensus. Our objective was to evaluate the efficacy and safety of sclerotherapy (sodium tetradecyl sulfate [STS]) in PG. This case series included 15 patients of PG, treated with intralesional injection of the STS (3%, 30 mg/ml) solution. All patients showed complete resolution of PG, without any major complication or recurrence during a 6-month follow-up period.

Sorafenib-Induced Cutaneous Toxicities: Four Different Presentations Pooja Bains, Saurabh Sharma Indian Journal of Drugs in Dermatology 2019 5(1):34-37 Sorafenib is a multikinase inhibitor which is used in the treatment of hepatocellular carcinoma and renal cell carcinoma. The cutaneous toxicities due to sorafenib can affect the daily activities of patients, resulting in interruption or dose modification of therapy. We report four cases of adverse cutaneous effects of sorafenib along with their management. The cases represent the wide spectrum of sorafenib cutaneous toxicities from mild to severe.

Thalidomide-induced leukocytoclastic vasculitis in leprosy Vasudha Abhijit Belgaumkar, Pallavi Prataprao Patil, Ravindranath Brahmadeo Chavan, Prernaa R Suryataley Indian Journal of Drugs in Dermatology 2019 5(1):38-41 Thalidomide has become the gold standard for the treatment of erythema nodosum leprosum (ENL) within a few decades of its serendipitous discovery for this condition. It has also demonstrated efficacy in dermatoses such as recalcitrant oral aphthae, prurigo nodularis, and pyoderma gangrenosum. Despite a good safety profile, thalidomide is known to cause side effects such as sedation, constipation, peripheral neuropathy, and thromboembolism. Although rare and anecdotal, adverse cutaneous drug reactions (ACDRs) have been reported. Both thalidomide and its newer analogs have been implicated for maculopapular, urticaria-angioedema, Steven–Johnson-like, toxic epidermal necrolysis, and acneiform eruptions. Only a few cases of leukocytoclastic vasculitis (LCV) occurring in patients of multiple myeloma on this drug have been described till date. However, this unusual presentation of ACDR due to thalidomide in leprosy has not been hitherto documented. Herein, we describe a patient of lepromatous leprosy with ENL who developed thalidomide-induced LCV and discuss myriad aspects such as immunopathogenesis with emphasis on the possible role of various cytokines such as interleukin (IL)-2, IL-6, IL-12, and tumor necrosis factor-alpha.

“PRIDE” Complex: A Report of Two Cases Shashank Krishna Agrawal, Bhagyashree Babanrao Supekar, Vaishali Wankhade, Rajesh Pratap Singh Indian Journal of Drugs in Dermatology 2019 5(1):42-45 Epidermal growth factor receptor inhibitors are currently widely used for the treatment of nonsmall cell lung cancer and head-and-neck malignancy. These are associated with constellation of cutaneous reactions termed as PRIDE complex which comprises papulopustules and/or paronychia, regulatory abnormalities of hair growth, itching, and dryness. We report two cases of PRIDE complex, diagnosed clinically and histopathologically in patients of nonsmall cell carcinoma of the lung being treated with erlotinib and gefitinib.

Drug-induced Henoch-Schonlein purpura with severe gastrointestinal involvement Nibedita Dixit, Chinmoy Raj, Debasmita Behera, Maitreyee Panda Indian Journal of Drugs in Dermatology 2019 5(1):46-48