Acne is a chronic inflammatory skin disease that involves the pathogenesis of four major factors, such as androgen-induced increased sebum secretion, altered keratinization, colonization of Propionibacterium acnes, and inflammation. Several acne mono-treatment and combination treatment regimens are available and prescribed in the Indian market, ranging from retinoids, benzoyl peroxide (BPO), anti-infectives, and other miscellaneous agents. Although standard guidelines and recommendations overview the management of mild, moderate, and severe acne, relevance and positioning of each category of pharmacotherapy available in Indian market are still unexplained. The present article discusses the available topical and oral acne therapies and the challenges associated with the overall management of acne in India and suggestions and recommendations by the Indian dermatologists. The experts opined that among topical therapies, the combination therapies are preferred over monotherapy due to associated lower efficacy, poor tolerability, safety issues, adverse effects, and emerging bacterial resistance. Retinoids are preferred in comedonal acne and as maintenance therapy. In case of poor response, combination therapies BPO-retinoid or retinoid-antibacterials in papulopustular acne and retinoid-BPO or BPO-antibacterials in pustular-nodular acne are recommended. Oral agents are generally recommended for severe acne. Low-dose retinoids are economical and have better patient acceptance. Antibiotics should be prescribed till the inflammation is clinically visible. Antiandrogen therapy should be given to women with high androgen levels and are added to regimen to regularize the menstrual cycle. In late-onset hyperandrogenism, oral corticosteroids should be used. The experts recommended that an early initiation of therapy is directly proportional to effective therapeutic outcomes and prevent complications.

Background: The prevalence of dermatophytes varies with season, geographical area, socio-economic factors and effective management strategies. Aims: The aim of the study was to assess the prevalence of pathogenic dermatophytes, clinical types of dermatophyte fungal infection, and in vitro antifungal drug susceptibility testing against dermatophytes. Methods: Three hundred and ninety five patients with dermatophytosis were enrolled from five cities (Mumbai, Delhi, Lucknow, Kolkata and Hyderabad) across India. All patients were subjected to clinical examination and investigations, including potassium hydroxide microscopy, fungal culture and antifungal drug susceptibility testing. Results: Trichophyton rubrum was the most common species identified (68.4%), followed by T. mentagrophytes (29.3%). Within species, T. mentagrophytes was prevalent in humid environmental conditions (Mumbai and Kolkata), whereas T. rubrum was prevalent in noncoastal areas (Delhi, Lucknow and Hyderabad). Tinea corporis (71.4%) and tinea cruris (62.0%) were the common clinical types observed. antifungal drug susceptibility testing data indicated that minimum inhibitory concentration required to inhibit the growth of 90% of organisms (MIC-90) was lowest for griseofulvin (0.25–3.0 μg/mL). Among oral antifungals, the mean MIC of itraconazole was within the range (0.84 [0.252] μg/ mL), whereas high mean MIC values were reported for terbinafine (0.05 [0.043] μg/mL). Among topical agents, lowest mean MIC values were reported for luliconazole (0.29 [0.286] μg/mL), eberconazole (0.32 [0.251]) μg/mL and amorolfine (0.60 [0.306]) μg/mL. Limitations: Lack of correlation between in vitro antifungal susceptibility and clinical outcome and absence of defined MIC breakpoints. Conclusion: T. rubrum was the most common, followed by T. mentagrophytes as an emerging/codominant fungal isolate in India. Tinea corporis was the most common clinical type of dermatophytosis. Mean MIC of terbinafine was above the reference range, while it was within the range for itraconazole; griseofulvin had the lowest mean MIC. Luliconazole presented the lowest mean MIC values across cities.

BACKGROUND Acne vulgaris is a universal skin disease affecting both genders. Acne affects more than 85% of the teenagers as well as some adults and persists in large number of people in their 20s and 30s age. A single-center clinic-based study from a teaching hospital in India reported prevalence of acne among boys and girls between 12-17 years of age as 50.6% and 38.13%, respectively. Combination therapy is an effective approach in the management of acne as it can simultaneously act on several pathogenic mechanisms. The current (2016) European Dermatology Forum (EDF) guidelines recommend combination therapy for all grades of acne as initial treatment. The aim of the study is to evaluate efficacy, safety and patient satisfaction of a bioinnovative fixed-dose combination of adapalene (micronised) 0.1% plus benzoyl peroxide (microencapsulated) 2.5% gel in the treatment of acne. MATERIALS AND METHODS In this prospective survey, acne patients treated with adapalene (micronised) 0.1% plus benzoyl peroxide (microencapsulated) 2.5% for four weeks were enrolled. Grade of acne, investigator global assessment and patient satisfaction scores were noted at baseline, week 2 and week 4. Safety was assessed by recording adverse events and incidence of dryness, erythema or irritation. Global adverse event score was calculated by adding the number of adverse events at week 2 and 4. RESULTS A total of 412 patients with mean duration of acne was 6.98 (5.81) months were enrolled. Number of patients with grade 3 or 4 acne reduced from 202 (49%) at baseline to 73 (17.7%) at week 2 and 31 (7.5%) at week 4, whereas number of patients with grade 1 acne increased from 27 (6.6%) at baseline to 155 (37.6%) after 2 weeks and 277 (67.2%) at 4 weeks (p=0.001, both at 2 and 4 weeks). Number of patients with severe acne reduced from 47 (11.4%) at baseline to 17 (4.1%) after week 2 and 8 (1.9%) after 4 weeks. The improvement in investigator global assessment after treatment at 2 and 4 weeks was statistically significant (p=0.001). After 4 weeks of treatment, 374 (95.6%) patients were either satisfied or more than satisfied. Mean global adverse event score reduced from 2.35 (±2.27) at week 2 to 1.68 (±1.88) after 4 weeks with 28.5% in mean global adverse event score (p=0.001). CONCLUSION Technologically-enhanced formulation of adapalene (micronised) 0.1% plus benzoyl peroxide (microencapsulated) 2.5% is significantly effective and very well tolerated in patients with acne.

Contact dermatitis is one the commonest dermatological condition which is managed by topical corticosteroids. Mid potent topical corticosteroids are commonly prescribed but there is no any comparative data between mometasone furoate and fluticasone propionate in the management of dermatitis.A real world retrospective study was conducted across India to compare the clinical assessment of mometasone 0.1% cream and fluticasone 0.005% cream in the management of contact dermatitis at 236 dermatology clinics.A data of 1106 patients were included in this analysis in which 598 were included in mometasone group while 508 in fluticasone group. At the end of 2 weeks, 216 patients (36.1%) in mometasone and 129 patients (25.4%) in fluticasone group achieved complete clearance of symptoms (p<0.05). Additionally, in mometasone group, 354 patients (59.2%) were found to achieve improvement whereas 293 patients (57.7%) achieved the same in fluticasone group. On further sub group analysis on aggravating factors, it was found that, mometasone was statistically significant in relieving symptoms of dermatitis due to artificial jewellery, detergent and occlusive foot ware than fluticasone. Moreover, mometasone demonstrated significant results in physician and patient global assessment as well. Patients in both groups tolerated therapy well.Both, mometasone furoate and fluticasone propionate were effective and safe in treatment of eczema/dermatitis. But mometasone furoate had shown significantly better effectiveness as compared to fluticasone in all predisposing factors for the disease.

<p class="abstract">Dermatophytosis continues to be a worldwide public health problem, predominantly in developing countries like India. Early diagnosis and appropriate management are imperative to enhance patient outcomes and improve quality of life of individuals with dermatophytosis. Multiple focused group discussions involving 76 dermatologists across 36 cities in India were conducted to provide a consensus clinical viewpoint of expert dermatologists to gain insights toward effective diagnosis and management of Indian subjects with dermatophytosis. These discussions mainly aimed at reviewing current literature on prevalence, etiology, diagnosis and management of dermatophytosis and highlighting variations in diagnostic and treatment approaches in routine clinical practice. The current article summarizes the experts’ clinical viewpoint on overall management of dermatophytosis. Diagnosis of dermatophytosis involves clinical observation, microscopic examination and dermoscopy. Molecular techniques have certain advantages over conventional microscopy and culture methods but are associated with issues of cost and technique complexity. Oral itraconazole 200 mg–400 mg daily and terbinafine 500 mg/day could be considered for recalcitrant tinea infections. Topical azoles like luliconazole, sertaconazole, and terbinafine could be beneficial. A combination of oral and topical antifungal drugs is effective in patients with steroid-modified and difficult-to-treat tinea infections. Also, patient counselling and use of adjunctive therapies like antihistamines, retinoids, and moisturizers are essential for managing tinea infections.  </p><p class="abstract"> </p>