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Background:A combination of topical retinoid and antibacterial therapy is often advocated for acne to enhance therapeutic efficacy.Aims:A preliminary study to evaluate the efficacy and tolerability of a topical fixed combination of nadifloxacin (1%) and adapalene (0.1%) in the treatment of mild to moderate acne in Indian patients.Materials and Methods:This was an open-labeled, phase 3 non-randomized, non-comparative study conducted at five centers (Ahmedabad, Nagpur, Thane, Bangalore, and Mumbai) across India. Of 119 enrolled patients with mild to moderate acne, 117 patients were evaluated at the end of the study for efficacy parameters. A fixed combination of nadifloxacin (1%) and adapalene (0.1%) topical gel was applied at the affected area once at night for a period of 8 weeks. Reduction in the total, inflammatory and non-inflammatory lesion counts from the baseline, investigator global assessment (IGA) and reduction in the severity of acne as per combined acne severity classification were the primary efficacy variables measured at 2 weeks, 4 weeks, and 8 weeks.Results:Overall, 98.3% patients showed a statistically significant progressive reduction in non-inflammatory lesion counts, inflammatory lesion counts, and total lesion counts over the study duration. By the end of 8 weeks, 75% of the patients had their global assessment scores approaching to normal healthy skin score. The adverse events were mild to moderate in severity.Conclusion:This preliminary study shows that a fixed combination of 1% nadifloxacin and 0.1% adapalene topical gel could be an effective and well-tolerated option for the treatment of mild to moderate acne vulgaris. However, further well-controlled, randomized and comparative evaluation of this combination is necessary.

Norwegian (crusted) scabies is a highly contagious form of scabies which can evolve into erythroderma at times. We herein report a case of a 29-year-old male patient, an established case of epidermolysis bullosa dystrophica (EBD), presented to us with asymptomatic generalized scaling and crusting of 2 months duration. On examination patient also had dystrophic nails, anonychia and joint contractures. With a high index of suspicion, a scraping for KOH mount had done, which showed numerous scabies mites, eggs and faecal pellets. The patient was started on weekly oral Ivermectin (200mcg/kg) and topical 5% permethrin application. There was dramatic response within 1-2 weeks. This case is presented to highlight the diagnostic challenge that erythroderma may be due to Norwegian scabies or the primary entity- epidermolysis bullosa dystrophica (EBD). The association of EBD and Norwegian scabies has been reported in literature. A simple bedside test like scraping can nail the diagnosis, provided there is a high index of suspicion.