ObjectiveWe compared the physician-assessed diagnostic likelihood of SLE resulting from standard diagnosis laboratory testing (SDLT) to that resulting from multianalyte assay panel (MAP) with cell-bound complement activation products (MAP/CB-CAPs), which reports a two-tiered index test result having 80% sensitivity and 86% specificity for SLE.MethodsPatients (n=145) with a history of positive antinuclear antibody status were evaluated clinically by rheumatologists and randomised to SDLT arm (tests ordered at the discretion of the rheumatologists) or to MAP/CB-CAPs testing arm. The primary endpoint was based on the change in the physician likelihood of SLE on a five-point Likert scale collected before and after testing. Changes in pharmacological treatment based on laboratory results were assessed in both arms. Statistical analysis consisted of Wilcoxon and Fisher’s exact tests.ResultsAt enrolment, patients randomised to SDLT (n=73, age=48±2 years, 94% females) and MAP/CB-CAPs testing arms (n=72, 50±2 years, 93% females) presented with similar pretest likelihood of SLE (1.42±0.06 vs 1.46±0.06 points, respectively; p=0.68). Post-test likelihood of SLE resulting from randomisation in the MAP/CB-CAPs testing arm was significantly lower than that resulting from randomisation to SDLT arm on review of test results (−0.44±0.10 points vs −0.19±0.07 points) and at the 12-week follow-up visit (−0.61±0.10 points vs −0.31±0.10 points) (p<0.05). Among patients randomised to the MAP/CB-CAPs testing arm, two-tiered positive test results associated significantly with initiation of prednisone (p=0.034).ConclusionOur data suggest that MAP/CB-CAPs testing has clinical utility in facilitating SLE diagnosis and treatment decisions.

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Background Melasma is a hypermelanotic disorder, which poses therapeutic challenge. Tranexamic acid (TA) and glutathione are novel therapies for the treatment of melasma. Aim To compare the therapeutic efficacy of localized intradermal microinjections (mesotherapy) of TA versus microinjections of glutathione for the treatment of melasma. Methods This prospective, comparative study was carried out to assess the therapeutic efficacy of TA and glutathione in 64 patients with dermal melasma after obtaining written informed consent, over a period of 12 weeks. Face of the patient was divided into two halves (split face); right cheek was injected with TA and the left with glutathione, at baseline (zero), 4th, 8th, and 12th weeks. The treatment response was assessed by using visual analog scale (VAS); photographs were taken to ascertain the improvement and its percentage was calculated. A parametric test, Student t test, and Z test were applied wherever applicable. P-value of <0.05 was considered statistically significant. Results Out of 64 enrolled, 50 patients completed the study and it was found that the reduction in VAS score from baseline to 8th week and baseline to 12th week was significant in both the groups (P < 0.05). However, the mean difference in improvement percentage between baseline and 8th week and baseline and 12th week with TA was found to be more significant than glutathione. Conclusion This study revealed that both TA and glutathione intradermal microinjections are effective in the treatment of melasma but TA is more effective.

Prurigo Nodularis (PN) is a rare chronic skin disorder of unknown etiology. Here we are describing a case of 14 year old girl having prurigo nodularis with no other systemic illness.

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