Comparative study of halobetasol and tacrolimus in treatment of Lichen Planus.

INTRODUCTION : Lichen Planus is one of the most itchy dermatoses. It is prevalent worldwide with no social or climatic predilection. It affects the skin, mucous membrane, nails and hair. Itching is a constant feature of lichen planus and the lesions heal with pigmentation which may be persistent and intense in dark skinned people. Spontaneous remissions can occur after varying amounts of time. An autoimmune mechanism has been proposed with the involvement of activated T cells directed against an unknown antigen in the skin or mucosa. Certain infections have also been associated with lichen planus but the cause and effect relationship remains controversial. There are no evidence-based recommendations for the treatment of lichen planus. Many of the recommendations of the experts are based on their personal experience. Most of the published trials are observational and are not always prospective. Only a few randomized controlled trials have been performed. However treatment with medium to high-potency topical corticosteroids is generally recommended as the first-line therapy for localised lichen planus. Topical Tacrolimus, a calcineurin inhibitor is used extensively in the treatment of atopic dermatitis. Unlike topical corticosteroids, it does not cause skin atrophy. Topical Tacrolimus in addition to its inhibitory effect on cytokine production causes alterations in epidermal antigenpresenting dendritic cells that may result in decreased immunologic response to antigens. Topical tacrolimus has been used in oral lichen planus but to our knowledge not in cutaneous lichen planus except for a single case report. The possible role of activated T cells in the pathogenesis of lichen planus as well as the extensive safety profile makes topical tacrolimus an attractive option for the treatment of cutaneous lichen planus. However there are no head to head comparisons of corticosteroids and tacrolimus in the treatment of lichen planus. Towards this goal we performed a prospective, randomised, open label clinical trial comparing the therapeutic efficacy of a topical corticosteroid 0.05% halobetasol propionate with a topical calcineurin inhibitor 0.1% tacrolimus in adults with localised cutaneous lichen planus. AIM OF THE STUDY : To compare the efficacy of topical halobetasol and topical tacrolimus in the treatment of localised cutaneous lichen planus lesions. Agents compared: 1) 0.05% Halobetasol propionate ointment, 2) 0.1% Tacrolimus ointment. CONCLUSION : In this study, males and females were found to be equally affected with lichen planus. * Increased prevalence was noted in the age group of 20-40 years. * The predominant blood group in this study was blood group O. * The predominant type of lichen planus was the classical type. * After 2 weeks of study period, topical halobetasol caused a significant reduction in symptoms (p value = 0.018) and clearance rates (p value=0.021) compared to tacrolimus in localised cutaneous lichen planus. * After 8 weeks of follow-up, topical tacrolimus resulted in lower relapse rates compared to halobetasol (p value = 0.04). * In the halobetasol group, there was no change in rate of response with respect to site of involvement, blood group or duration of lesions. * In the tacrolimus group, o better response was seen over the exposed parts compared to the non-exposed parts ( p value = 0.02) o Patients with blood group O and shorter duration of lesions responded better compared to other blood groups and long-standing lesions. However, the differences were not statistically significant. * This is the first study comparing topical halobetasol and topical tacrolimus head-to-head. Prospective randomized trials with more subjects are needed before any treatment recommendations can be made based on the conclusions of our study

Cutaneous manifestations of internal malignancy

Background: Many malignancies affecting the internal organs display cutaneous manifestations which may be either specific (tumor metastases) or nonspecific lesions. Aims: The study is aimed at determining the frequency and significance of cutaneous manifestations among patients with internal malignancy. Materials and Methods: 750 cases of proven internal malignancy, who attended a cancer chemotherapy center in South India, were studied. Specific infiltrates were confirmed by histopathology, fine needle aspiration cytology (FNAC) and marker studies. Results: Out of the 750 patients with internal malignancy, skin changes were seen in a total of 52 (6.93%) patients. Conclusion: Cutaneous metastases (specific lesions) were seen in 20 patients (2.66%): contiguous in 6 (0.8%), and non-contiguous in 14 (1.86%). Nonspecific skin changes were seen in 32 patients (4.26%). None of our patients presented with more than one type of skin lesions. Herpes zoster was the most common nonspecific lesion noticed in our patients, followed by generalized pruritus, multiple eruptive seborrheic keratoses, bullous disorder, erythroderma, flushing, purpura, pyoderma gangrenosum, insect bite allergy and lichenoid dermatitis

ALKAPTONURIA

A case of alkaptonuria, a rare disorder with autosomal recessive inheritance, is reported here. The patient had palmar pigmentation in addition to the usual features of alkaptonuria

Chemistry and biochemistry of Terpenoids from Curcumaand related species

Several curcuminoids have been identified from rhizome of the common spice Curcuma longa (Zingaberaceae) and related plant species. Curcuminoids are known to display several pharmacological properties summed up in numerous papers and reviews. In addition to curcuminoids, more than 250 mono-, sesqui- di-, and triterpenoids have been identified from curcuma species. These lipophilic compounds have better absorption than curcuminoids and also exhibit a wide spectrum of pharmacological properties. Little attention has been paid to these lipophilic compounds, which may be as physiologically active, if not more, as curcuminoids. This review focuses on Curcuma terpenoids and their physiological properties