Expert consensus on the management of acne in India

Acne, a common cutaneous disorder, is estimated to affect a significant proportion of the population at some point in their lifetime. It is one of the most common presentations reported in dermatological consultations in India. Treatment options for acne include topical, oral and procedural therapies. Patients with mild acne can be treated with topical therapies; however, those with moderate to severe acne require systemic cure. Oral antibiotic treatment, hormonal therapies and isotretinoin are the mainstay systemic therapies for acne. Additionally, procedural therapeutic modalities in dermatology include chemical peels, laser therapy, micro needling techniques, to name a few. Scientific advances are continually improving knowledge of acne and contributing to refinement of treatment options. Hence, it is vital for clinicians to regularly update their clinical practice patterns to reflect current standard. An experts’ panel discussion involving dermatologists from across India was conducted, to outline a practical approach for the management of acne. The present consensus document focuses on the assessment of acne, use of topical treatments, role of systemic therapy and procedures in treating acne and post-inflammatory hyperpigmentation. It also emphasizes the role of patient education and counselling on prophylactic and treatment strategies in acne management

Consensus statement for the diagnosis and treatment of urticaria: A 2017 update

This article is developed by the Skin Allergy Research Society of India for an updated evidence-based consensus statement for the management of urticaria, with a special reference to the Indian context. This guideline includes updated definition, causes, classification, and management of urticaria. Urticaria has a profound impact on the quality of life and causes immense distress to patients, necessitating effective treatment. One approach to manage urticaria is by identification and elimination of the underlying cause(s) and/or eliciting trigger(s) while the second one is by treatment for providing symptomatic relief. This guideline recommends the use of second-generation nonsedating H1-antihistamines as the first-line treatment. The dose can be increased up to four times to meet the expected results. In case patients still do not respond, appropriate treatment options can be selected depending on the associated medical condition, severity of the symptoms, affordability of the drugs, and accessibility of modern biologics such as omalizumab

CONSENSUS STATEMENT ON THE MANAGEMENT OF URTICARIA

This consensus statement was developed by Special Interest Group – Urticaria (IADVL). Urticaria, a heterogeneous group of diseases, often cannot be recognized by its morphology. Due to non-specific and non-affordable diagnosis, management of urticaria, especially chronic urticaria, is very challenging. This guideline includes definition, causes, classification and management of urticaria. Urticaria has a profound impact on the quality of life and causes immense distress to patients, necessitating effective treatment. One approach to manage urticaria is identification and elimination of the underlying cause(s) and/or eliciting trigger(s), while the second one is treatment aimed at providing symptomatic relief. This guideline recommends use of second-generation non-sedating H1 antihistamines as the first-line treatment. The dose can be increased up to four times to meet the expected results. In case patients still do not respond, appropriate treatment options can be selected depending on the cost

Position statement for the use of omalizumab in the management of chronic spontaneous urticaria in Indian patients

Chronic spontaneous urticaria (CSU) affects 1% of the world population and also their quality of life, and 50% of these patients are refractory to H1-antihistamines. Omalizumab is a humanized monoclonal anti-IgE antibody that binds with free IgE antibodies and reduces the circulating levels of free IgE. This reduction in free IgE prevents mast-cell degranulation. The EAACI/GA2LEN/EDF/WAO guidelines recommend omalizumab as the third-line of therapy as an add-on to antihistamines. The recommended dose of omalizumab is 300 mg, 4 weekly in the management of CSU refractory to standard of care with H1-antihistamines in adults and adolescents ≥12 years of age. In some patients, a dose of 150 mg may be acceptable. Omalizumab has a good safety profile. However, due to the biologic nature of the drug, all patients administered omalizumab must be observed for 2 h after administration for anaphylactoid reactions. There have been no studies on the effect of impaired renal or hepatic function on the pharmacokinetics of omalizumab. While no particular dose adjustment is recommended, omalizumab should be administered with caution in these patients