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Melasma is one of the commonly reported pigmentory disorders in the Indian population. Numerous therapeutic modalities are available. However, very few have produced complete satisfactory response. 4-n-Butylresorcinol 0.3% cream has recently been introduced in India as a new hypopigmenting agent. It is a resorcinol derivative and acts by inhibiting both tyrosinase and tyrosinase-related protein-1. The available published literatures are with 4-n-butylresorcinol 0.1% cream, and there is paucity of clinical studies with 4-n-butylresorcinol 0.3% cream. Furthermore, considering the fact that Indian skin is more prone to irritation with hypopigmenting agents, our study explores the efficacy, safety, and tolerability of 4-n-butylresorcinol 0.3% cream in Indian subjects with melasma. Fifty-two subjects with melasma participated in this open-label, single arm, observational study. All the patients were advised twice daily application of 4-n-butylresorcinol 0.3% cream for 8 weeks over the areas of melasma. Assessment parameters included modified Melasma Area Severity Index (mMASI) score. Digital photographs of all the patients at baseline, week 4, and week 8 were taken. During this 8-week study period, all the adverse events were observed and recorded. All the 52 subjects completed the study. Out of 52 subjects, 90.38% were females. The mean age of patients was 38.5±7.8 years. Mean ± standard error of MASI score measurements showed a significant decrease from baseline score of 14.73±0.59 to 11.09±0.53 after week 4 (P<0.001) and 6.48±0.43 at week 8 (P<0.001). The digital photographs of the study subjects taken at week 4 and week 8 also showed decrease in melasma pigmentation compared to baseline photograph and correlated with the changes in the mMASI score. The treatment was well tolerated by all the study subjects. No adverse reactions were reported throughout the study period. Our data suggest that the 4-n-butylresorcinol 0.3% cream is safe, effective, and well tolerated in Indian patients with melasma.

Acne is a chronic and recurring inflammatory skin disease. It remains one of the most disturbing skin conditions that adversely affect an individual’s daily life. The therapeutic targets for acne include excessive sebum production, follicular hyper-keratinization, bacterial colonization by P. acnes, and inflammation. Currently, retinoic acid is the only agent effective against all four targets of acne therapy. However, its several side effects limit its wide application. Bakutrol™ is a topical formulation containing 0.5% bakuchiol from Cullen corylifolium. (Psolarea corylifolia). Bakuchiol is a popular skin care cosmetic ingredient due to its retinol-like functionality. A prospective, open-label, single-arm study was conducted to evaluate the safety and efficacy of Bakutrol™ in patients (n=50) with facial acne. The participants were instructed to apply BakutrolTM cream as a thin layer over the acne lesions twice daily for 60 days. Key outcomes evaluated were safety and efficacy in controlling P. acnes infection. Application of BakutrolTM resulted in 36.14% reduction in P. acne bacterial load. Video-dermoscopy and photographic images showed the reduction of inflammatory lesions. BakutrolTM demonstrated an excellent safety profile as there were no adverse events seen during the study period. In summary, Bakutrol™ face- cream is a natural, safe, and effective treatment of facial acne. Its effect on both inflammatory and non-inflammatory lesions of acne makes it a promising agent for the treatment of acne and even for the post-inflammatory hyper-pigmentation in acne.

Acne occurs when hair follicles are clogged with dead skin cells and oil from the skin that forms a bump on the skin, called comedones.1,2 Acne can occur at all ages; however, it is the most common skin disease in the age group of 12 to 24 years, affecting about 80% of teenagers and young adults.2 According to the Global Burden of Disease Study 2019, acne is the eighth most common skin disease, with an estimated global prevalence of 9.4% for all ages.3 Over the last decade and a half, the prevalence has increased by around 5%.4 Multiple etiological factors are involved in the development of acne. Four key pathological processes include i) androgen-induced increased sebum hyperproduction, ii) altered follicular keratinization that leads to comedones, iii) colonization and proliferation of duct by Propionibacterium acnes, and iv) complex inflammatory process involving both innate and acquired immunity.4, 5 Genetics, diet, environmental pollution, social environment, and lifestyle are the etiological factors that contribute to the pathogenesis of acne.4,5 Several studies have found that acne adversely affects the social life, self-esteem, appearance, and quality of life of individuals. [...]acne is often co-morbid with mental disorders, including depression and anxiety. The study was conducted as per the clinical research guidelines established by the Supplements and Cosmetics Act, 1940 of India, Supplements and Cosmetics Rules, 1945 of India, Ethical Guidelines for Biomedical Research on Human Participants, 2006 of Indian Council of Medical Research (ICMR) in India, the principles enunciated in the Declaration of Helsinki and the ICH-harmonized tripartite guideline regarding Good Clinical Practice (GCP). Other key exclusion criteria were the use of systemic corticosteroids, antibacterial, immunosuppressant drugs, or abradant facial procedures in the past 30 days, the presence of other concurrent facial skin diseases, and patients who are photosensitive or who are likely to engage in activities that involve excessive or prolonged exposure to sunlight, patients with drug-induced acne, with menopausal disorders, had a history of significant reactions to topical acne treatments, or a known allergy or hypersensitivity to any listed ingredients and use of oral retinoid within six months of baseline visit. 2.3 Interventional agent and treatment:

Harrington and Dunsmore found different autoimmune diseases (pernicious anemia, hypothyroidism, thyrotoxicosis and diabetes mellitus) in eight of their 50 morphea patients [5] The simultaneous occurrence of morphea and autoimmune thyroiditis has been reported by several authors. Thyroid hormones act on nuclear receptors of human fibroblasts and intermediate the regulation of collagen synthesis and degradation.

Hyper IgE Syndrome (HIES) is a rare multi system genetic immunodeficiency disorder, with immunological and non-immunological features. Immunolgical features are 1) Recurrent cutaneous abscesses, 2) Atopic dermatitis like lesions, 3) Sino pulmonary infections, 4) Elevated serum IgE levels and 5) Abnormal neutrophil chemotaxis. Non immunological features include cranio facial and skeletal abnormalities. We are reporting a girl with classical features of HIES with umbilical hernia with her younger brother suffering from right sided inguinal hernia, as both herniae are hitherto unreported in patients with HIES.