The Aestheticians Journal | April 2022 issue | E-Journal by The Aestheticians Journal

Total Pages : 36 April 2022 Vol 15* Issue-1 100

Recurrent, Resistant Fungal InfectionsA Case Report Herpes Zoster After Covid VaccinationA Case Report Let’s Talk Tresses - HAIR AESTHETICS

Postbiotic – A New Paradigm in Acne Management Prevalence and Species Profile of Genital Candidiasis among Pregnant Women Attending STI/RTI Clinic at a Tertiary Referral Centre Part-II

If Undelivered, return to Paradigm Infocom Pvt. Ltd. 22, 2nd floor, Shreeji Bhavan, 275-279 Samuel Street, Masjid Bunder (W), Mumbai-4000 03

EXECUTIVE EDITOR & PUBLISHER Dom Daniel

CORPORATE OFFICE 22, Shreeji Bhavan, 275-279, Samuel Street, Masjid Bunder (W), Mumbai-4000 03, INDIA.

EMAIL: theaestheticiansjournalindia@gmail.com Website: theaestheticiansjournal.com

TEL: +91 22 2345 1404 +91 22 2345 5844

Printed, Published, Edited and Owned by Dom Daniel Printed at Swastik Printer, Gala No.9 & 10, Vishal Industrial Estate, Bhandup (West), Mumbai- 400078. Published at 22 Shreeji Bhavan, 275/279, Samuel Street, Masjid Bunder (West), Mumbai - 400003. India.

“The Aestheticians Journal” takes no responsibility for unsolicited photographs or material

ALL PHOTOGRAPHS, UNLESS OTHERWISE INDICATED, ARE USED FOR ILLUSTRATIVE PURPOSE ONLY.

Views expressed in this Journal are those of the contributors and not of the publisher. Reproduction in whole or in parts of texts or photography is prohibited. Manuscripts, Photographs and art are selected at the discretion of the publisher free of charge (advertising excluded). Whether published or not, no material will be returned and remains the property of the publishing house, which may make use of it as seen fit. This may include the withdrawal of publication rights to other publishing houses.

Dermatologists on the Frontline during COVID-19 Pandemic The world has changed dramatically since the COVID-19 pandemic began and it has substantially impacted medical practice worldwide. Soon after the spread of COVID-19 worldwide, reports of cutaneous manifestations related to the disease appeared. Dermatologists have been focusing on demystifying the skin manifestations related to COVID-19, also they have been redeployed in inpatient, outpatient, and emergency departments. Ultimately the dermatologist on the frontline who can differentiate among various eruptions and etiologies of pruritus, including drugadverse effects, underlying skin disease, and pulmonary disease. Teledermatology has also provided vital dermatology care as the COVID-19 pandemic forced ambulatory clinics to cease or limit in-person visits. Dermatologists can best continue to provide expert care in the time of a global pandemic, with careful attention to strategies that minimize further disparities in access, and possibly identify opportunities to clarify priorities in dermatologic research and clinical care. Dermatologists should remain focused on their important role in the midst of this international health care crisis, continue to learn and contribute, and consider how they can best diagnose and safely and effectively treat patients with COVID-19–related skin manifestations while retaining the highest quality for all patients who require dermatologic care. Rigorous research, careful self-reflection, and strengthened commitment to core values in dermatology and the relevance as a specialty are now more important than ever. - Dom Daniel Executive Editor & Publisher

Published for the period of April-2022

April 2022

Postbiot

ic – A New

Paradigm

in Acne Manage

Postbio

ment

tic – A Acne M New Paradigm anagem in ent Dr. Niti

Khunge

MD, DDV , DNB

Head, Profe ssor & Consultan VM Medi t Dermatolo cal Colle New Delh ge & Safda gist, i, India rjang Hosp ital, Abstract: Acne prevalent is inflammatora highly condition formulation y s. sites. Althouinvolving sebac skin eous Introd gh it clearl from an uction: interplay y develops factors; Acne, of multip the exact being le remains elusive.It cause of acne prevalent and one of the believed highly is increa multif condi between that the interasingly practi tion observed actorial skin ce, occur in ction immunity skin microbes s prima clinical and host puberty with playsan rily in this disease, important role almost 95%. 1 a prevalence at microbial with pertu of rbed It is a compositio activity chronic n found condition and not Probiotics inacne which is patients. but only seen in adole are increa and their scent age products too can continue in recen singly used in in t skincare be where acne treatm adulthood defined years. Postb ent iotics are well.requir ed as any subst would in early 1 through Appro forties the metabance derived of of a probio people ximately 80 perce as olic activit are affect nt tic micro which y betwe exerts organism, and en the onset ed by acne a direct beneficial 30 years of puber or indire of age. 2 ty ct The extraceffect on the host. Although ellular of probio the patho metab acne genesis antimicrobi tic bacteria olites are still remains of unclear, al activit have multiple against there ies, prote cause reasons acne, skin which and impro ct follicle s acne such as sebac condi s, ve an eous extrac tion.LactoSporin, androgen-in hyper-kerat inization, produced ellular duced by B. metabolite sebum produ excessive MTCC ction, inflam and coagu 5856. stable matio LactoSporilans hair bacterial colon at follicle ization n nis temperaturean acidic pH and acnes. 3,4 s by Cutibacteri of with antim range of 70 um to 90 °C, Skin icrobial various activity microbiome again patho st skin: including genic protects bacteria, the and a potenCutibacterium Apart from reductase t inhibitor of acnes 5-alpha acne, there all these cause activit a skin is one more s of protectivey.LactoSporin factor which is wide has beenimportant application postbiotic with uncov ered: the recen in cosm etic its interactions microbiome tly and with the innate

08 Postbiotic – A New Paradigm in Acne Management Dr. Niti Khunger, MD, DDV, DNB 08

April 2022

Herpes

zoster

after Covid

vaccin

ation-

Herpe vaccin s zoster afte r ationA Case Covid Repor t Dr. Girish A Case

Report

MD, DDV L, Specialis t/ ESIC Mod HOD Head of Departm Bangalo el Hospital and ent, re, Karn PGIMSR ataka, Rajajinag India ar,

12 Herpes Zoster after Covid Vaccination- A Case Report Dr. Girish M S, MD, DDVL 12 8 April 2022

Herpes zoster known (HZ) is as comm only by a react shingles. 1 (e.g. It is caus ivation keratitis, virus ed seco of infection. varicella zoste ndary iridocyclitis immunity glauc r (e.g. Cell‑medi pneumoni oma) or visce , ated reactivatio plays a role a, hepa ral n. Varic in this Clinic titis). 3 is one ella zoste al prese of the ntation r virus zoste eight that r infec of herpe are patho herpes virus s humans. 2 es with prod tion usually genic roma begins only The incid zoster for as pain, fever l symptoms ence is stron , mala such gly corre of herpes itch, and immune ise, lated status. 1 paresthesi headache, increased The age‑ to the precede the rash by as which related to seve complicatioincidence of a ral few HZ days in hours ns is result of most patie thought and its Usually affec the nts. 2 immunity decline in cell‑m to be a dermatom ting a single, unilateral e, ediated lesion (imm higher macu s appe incidence unosenescenc ar proxi lopapular with age e), distally, of mally progressi and socia comorbidit vesic to changes. 3 ies ng les that l‑environm to clear become ental eventually cloudy Herpes crust and days. over in zoster Lesions 7 to 10 caused is a viral usually by react disease weeks after heal 2 zoster ivation to 4 and pigm onset, but of varic virus scar¬ ella‑ dormant entation which in the changes ring remains common. 4 sensory the crani are ganglia al nerve ganglia of As the or the initial dorsal after a vari¬ root virus (VZV infection. 1 previ ) infec cella zoste Varicella ous varicella viral r known tion particles is comm resolves, as chick and travel only in child enpox; dorsal ren while it occu root gang to cranial occurs rs they are herpes lia, wher in adult zoster antibodies shielded e Herpes s or the from . The zoster blood elderly .1 laten burden is virus t and remains that can a major healt may react of any h mediated age. 2 Its affect indivi immunity ivate as cell‑ complicatio duals all of the be derm contributin wanes. Not atological ns bacterial g facto (e.g. seco may understood, rs are but unde ndary condi¬tion (e.g. long‑infection), r the neurologic s, the term virus replic right paresis, al caus pain, segmental with ing a nonspe¬c stroke), ates, ophthalm malaise, ific prod rome ological abno headache rmal skin , fever , or sensation s (e.g.,

Recurren

t, Resistan

Recurr ent, Re sistan A Case t fungal Infec tionsReport t fungal

Infection

s- A Case

Recurrent, Resistant Fungal Infections- A Case Report

Dr. K. Lak

MBBS,

shmipra

DDVL

Consultant Dermatolog Aditya ist Polly Hyderabad Clinic Attapur,

Dr. K. Lakshmiprasad, MBBS, DDVL

18 April 2022

Report

Prevalence and Species Profile of Genital Candidiasis among Pregnant Women Attending STI/RTI Clinic at A Tertiary Referral Centre Part-II

sad

Cutaneous more than fungal infectio ns affect one-fourth popula in an of world’ tion. increasing Among s infectio numbe all fungal immunocomp ns, superf r of romise are the The icial mycos d most freque es antifun intrinsic resista patients. human nt forms infectio nce of some gal therapy to than 20%–2 ns, affectin observ genera g more ed in 5% of popula development , along the world’ tion. 1 with the of resista s treatm nce during ent in Tinea corporis major proble others, is becom fungal is a ing a m in the infectio common of these n that mimics other diseases. 3 management annular many lesions corporis, The widesp also popula . Tinea read as ‘ringw rly known antifungal mostly use orm,’ is a superf dermatophyt immun OTC therap of icial marke ocompromise y in skin, other e infection d individuals d the of the than on onset (tinea the hands drug manuu resistance. 1 of antifungal m), pedis), scalp (tinea feet (tinea resistance repres Antifun gal areas (tinea barbaecapitis), beard clinical challen ents a major ge to faciei), respon ), face groin sible for clinicians nails (onych (tinea cruris) (tinea fungal treating infectio invasiv , and omyco ns due unguiu arsena sis or to the limitede m). Tinea l of tinea corporis presen antifungal systemically ts as availab agents 4 a well-de typically le sharply . marcated, Funga circum scribed, l circular, resistance oval or microb can iological annular, mildly erythe be matous, Microb scaly patch or iologic with a clinica al or plaque depen l. raised resistance ds on scaling leading and various edge, factors body. Mild central clearin which g on have establifungal due to pruritus geneti is comm the The pathog fungi. Clinica c alteration shed on. 2 in the l resista of fungal enesis and to host nce is severity or drug-r due on various infection depends Antifungal resista elated factors 1 . nonimmunol immunologica nce a signific ant conce is becoming l and ogical Pathog who are rn enic fungi factors 1 in charge to clinicians . of of life-threatenin are the cause patients at high risk caring for mycos g for invasiv infectio ns availab es. Resistance e to curren le antifun tly gal agents can

Prevalen

ce and

Species

Profile

of Genital

Prevale nc of Geni e and Species ta Pregna l Candidiasis Profile nt am STI/RTI Women Atten ong di Cl Referra inic ata Terti ng ar l Centre Part-II y Dr. Rajesh Candidia

sis among

Pregnan

t Women

Attendin

g STI/RTI

Clinic ata

Tertiary

Referral

Centre

Part-II

Rajago

MD., DNB palan ., MNA MS Professor and HOD Departmen t Governme of Skin, STDs & Lepro nt sy, Erode, Tami Erode Medical College, lnadu

Dr. V. Sud

MD., DV Professor and HOD Departmen Prevalence t of Skin, ACS and Species STDs WomeMedi n Attend cal Profile & Leprosy, ingColle ge, Retired STI/RT ChenofnaiGenital Candid I Clinic Director, Professor ata Tertiary Referr iasis among Pregna Institute al Centre and HOD of nt Part-II Madr PartasIIMediVenereology cal Colle ge, Chen Preva nai

Dr. Rajesh Rajagopalan, MD., DNB., MNAMS

lence and Specie Wome s Profile n Attend of Genita ing STI/RT l Candi I Clinic diasis

Dr. V. Sudha, MD., DV 24

24 April 2022

DISTRIBUTI ata Tertia among ry Referr ON OF Pregnant INFEC al Centre TIONS Infectio Part-II ns AMON G PREG Vulvovaginal NANT WOME Candidiasis Total No. Syphilis N 124 Hepatitis-B Percentage 66 (%) Trichom 47.7 oniasis 46 Genital 25.4 herpes 28 Chlamy 17.7 dia cervicit 26 Genital is 10.8 warts 21 HIV 10 20 Non-gonococc 8.1 16 al urethrit Bacterial 7.7 is 12 vaginos is Non specific 6.2 6 Chancroid genital ulcer 4.6 4 Molluscum 2.3 contagiosum 2 Scabies 1.5 2 0.8 2 0.8 0.8

[Type text]

Let’s Talk

Tresses

-HAIR

AESTHE

TICS

Let’s Ta lk Tres AESTHE ses - HAIR TICS Dr. Anju

Jha

MD, Derm atology Consultan t Dermatolo Mediwell gist Skin Clini Vasundha c, Vaish ali, Ghaz ra Encla iabad, ve, Delh i. Invest in

Let’s Talk Tresses - HAIR AESTHETICS Dr. Anju Jha, MD, Dermatology 30 30 April 2022

April 2022

your hair,

It is the cuticle crown layer makes you prone to African Never take hair more breaka off ge. Each has a keratinocyte protein Although aceous epicuticle, membrane, dermatologis covere in manag the ts are d with ing experts that include a lipid s 18-me the aesthe scalp and hair layer thyl eicosa disease, acid (18 MEA). tics of therapies noic some cosme still remain tic It consis is taught elusive ts of about . hair cosme Little approximately fusiform spindle that prescr cells tics so arrang iptions 100 micron are mostly on active ed longitu s long substa based has dinally. nce for of the microfibrils Spindle scalp and treatment cell and my within usually the hair macrofibrils cystein disregards fibre structu e-rich bonds matrix. the right re. Prescr that hold Disulfid shamp ibing other e the protein oo or correct are the conditioner, advice most import s to the that hold regarding hair proced ant bonds the keratin different They ures will in increas go are respon protein togeth ing patien a long way shape er. sible for and compl t`s adhes of hair. the final iance These ion to be knowle to treatm bonds broken dge about have ent. A like during structu permin the hair proced re and g and ures shaft hydrog straigh unders diversity tening en bonds tanding of hair the which are weake . The types and are import are affecte proced r bonds ant. ures wetting d even . The cells by hair Struct of the cortex melano ure of somes hair contain that are colour The hair respon of the sible for is a compl hair. Hair to presen the shaft ex structu colour is due re and eumela ce of pheom has three – cuticle elanin nin (brown main region (red) or , cortex or black). s and medul medulla is presen la. The The medulla t in coarse is at the is absen core of t in fine r hair and It is rich in hair fibre. hair of glycogen children. presen and citrullin The cuticle t in only e. It is thick hair is a chemic and is lost region of the scalp ally resista and consis in ageing nt gray hair. t offlap scales overlap The structu (keratin ping ocytes). re of unproc genera The cuticle perfectly lly formed essed designed is by 6-8 scales hair is Asians, and its slightly thick for layer remain outerm less than s smoot and even ost Caucasians dries when h, well less in protected, wetted African and resist s. A thin into cortex diffusio . This n structu mainta ral integrit ins the y.

Editorial Board Dr. Niti Khunger

Dr. V. Sudha

Dr. Girish M S

Dr. K. Lakshmiprasad

Dr. Rajesh Rajagopalan

Dr. Anju Jha

MD, DDV, DNB Head, Professor & Consultant Dermatologist, VM Medical College & Safdarjang Hospital, New Delhi, India

MD, DDVL Senior SPECIALIST Grade-1/HOD Department of Dermatology, ESIC Hospital, Ezhukone, Kerala

MD., DNB., MNAMS Professor and HOD Department of Skin, STDs & Leprosy, Government Erode Medical College, Erode, Tamilnadu

April 2022

MD., DV Professor and HOD Department of Skin, STDs & Leprosy, ACS Medical College, Chennai Retired Director, Professor and HOD Institute of Venereology Madras Medical College, Chennai

MBBS, DDVL Consultant Dermatologist Aditya Polly Clinic Attapur, Hyderabad

MD, Dermatology Consultant Dermatologist Mediwell Skin Clinic, Vaishali, Ghaziabad, Vasundhara Enclave, Delhi.

April 2022

Postbiotic – A New Paradigm in Acne Management

Postbiotic – A New Paradigm in Acne Management Dr. Niti Khunger

MD, DDV, DNB Head, Professor & Consultant Dermatologist, VM Medical College & Safdarjang Hospital, New Delhi, India Abstract: Acne is a highly prevalent inflammatory skin condition involving sebaceous sites. Although it clearly develops from an interplay of multiple factors; the exact cause of acne remains elusive. It is increasingly believed that the interaction between skin microbes and host immunity plays an important role in this disease, with perturbed microbial composition and activity found in acne patients. Probiotics and their products are increasingly used in skin care in recent years. Postbiotics are defined as any substance derived through the metabolic activity of a probiotic microorganism, which exerts a direct or indirect beneficial effect on the host. The extracellular metabolites of probiotic bacteria have antimicrobial activities, protect against acne, and improve skin condition. LactoSporin, an extracellular metabolite produced by B. coagulans MTCC 5856. LactoSporin is stable at an acidic pH and temperature range of 70 to 90°C, with antimicrobial activity against various pathogenic bacteria, including Cutibacterium acnes and a potent inhibitor of 5-alpha reductase activity. LactoSporin is a skin protective postbiotic with wide application in cosmetic formulations. 8

April 2022

Introduction: Acne, being one of the highly prevalent and multifactorial skin condition observed in clinical practice, occurs primarily at puberty with a prevalence of almost 95%.1 Approximately 80 percent of people are affected by acne between the onset of puberty and 30 years of age.2 It is a chronic condition which is not only seen in adolescent age but can continue in adulthood too where acne treatment would be required in early forties as well.1 Although the pathogenesis of acne still remains unclear, there are multiple reasons which lead to acne such as hyperkeratinization and obstruction of the sebaceous follicle, androgen-induced excessive sebum production, inflammation and bacterial colonization of pilosebaceous units by Cutibacterium acnes.3,4 Skin microbiome the skin:

protects

Apart from all these causes of acne, there is one more important factor which has been recently uncovered: the microbiome and its interactions with the innate immune system.5

Postbiotic – A New Paradigm in Acne Management

It is increasingly believed that the interaction between skin microbes and host immunity plays an important role in this disease, with perturbed microbial composition and activity found in acne patients.6 The microbiome is emerging as a major contributor to protect the skin from inflammatory conditions. The term ‘microbiome’ refers to microorganisms (bacteria, viruses and fungi) and their environment.7 The skin microbiome is divided into ‘normal’ commensal skin microbes, which live in homeostasis with the host and form the resident microbiome, and the pathogen microbes from the environment, which temporarily live on the skin and form the transient microbiome.8 A microbial imbalance or ‘dysbiosis’, compared with the normal distribution in healthy tissues, has been suggested to be involved in the pathophysiology of inflammatory acne.9 Also, the skin is continuously exposed to exogenous and endogenous factors, a disruption in the microbiome creates dysbiosis. This perturbation of the skin microbiome can cause skin diseases such as acne, eczema infections, allergies, autoimmune diseases, and aging.10 Therapeutic strategies to preserve the skin microbiota are becoming increasingly popular in recent years. Acne management: Anti-acne therapy targets the etiopathological factors such as anti-comedogenic, antiinflammatory, antimicrobial agents and hormonal therapy.11

Among these, topical and systemic drugs like retinoids and antibacterial are commonly used in clinical practice. Some of the topical anti-acne agents are associated with adverse events such as peeling effect, redness of the skin, skin irritation and skin dryness or flaking of the skin. Often, natural products are preferred over conventional therapy due to their long history of use and better patient tolerance and safety profiles.12

microbiota are mediated by their metabolites.

Role of Probiotics Prebiotics in Acne:

and

• Lower chance for microbial translocation

There is an increased use of probiotics and prebiotics in recent years, which restores the gut microbiome and normalizes the intestinal microflora in several skin conditions like atopic dermatitis, acne, burn injuries, and scars. They also rejuvenate the skin and improve innate skin immunity. However, the application of live bacteria on skin poses several challenges.13

• Lower chance for microbial infection

More recently, the chemical by-products of bacterial fermentation, such as antimicrobial peptides and fragments of dead bacterial cells, termed “Postbiotics,” have gained considerable attention for their beneficial physiological effects. Role of Postbiotics in Acne: Postbiotic is a relatively new term used to describe microbial metabolites.These include shortchain fatty acids, extracellular metabolites, functional proteins, cell lysates and other products derived from a probiotic that can influence the microbiome composition.10 The concept of postbiotics has evolved since most of the beneficial effects of

Benefits and advantages of Postbiotics: Postbiotics are also reported to induce health benefits similar to that of probiotics, although they do not contain live organisms.14 Several practical advantages over the probiotic and prebiotic: • Biological activity in nonviable state

• Improved inflammatory defence • Favourable physiochemical properties (solubility) • Favourable pharmacokinetic properties (absorption, distribution, metabolism, and excretion) They are advantageous over the antibiotics and chemicals by reducing sebum, reducing inflammation and restoring skin microbiome by allowing friendly bacteria to grow.15 Postbiotics have a long shelf life, are safe and possess multiple health benefits. They have been evaluated for anti-inflammatory, immunomodulatory, antiobesogenic, antihypertensive, hypocholesterolemic, antiproliferative and antioxidant benefits.16 Antimicrobial proteins produced from useful bacteria are one of the expanding fields of research due to conventional antibiotic resistance and are reported to be less toxic than other chemical antimicrobial agents.10 Most April 2022

Postbiotic – A New Paradigm in Acne Management

of the bacteria, both Gramnegative and Gram-positive, and Archaea produce bacteriocin or bacteriocin-like substances. They are categorized based on their size, structure, mode of action, antimicrobial potency, immunity mechanisms and target cell receptors. Bacteriocins are harmless to the human body and the surrounding environment, as they are sensitive to proteases, and have been used as food additives since ancient times. Various research groups have reported the presence of bacteriocins in the Bacillus genus. Health benefits Postbiotics:

The Lactobacillus species (probiotics) and their metabolites are reported to improve skin hydration, elasticity, gloss, and reduce the extent of wrinkles in the skin. Several human clinical studies suggest that probiotic components not only exert dermal beneficial property through the gastrointestinal route but also help via topical application.13 The topical application of probiotics is reported to modify the skin barrier function, increase the antimicrobial properties of the skin, and protect against acne and erythema. LactoSporin – Postbiotic for Skin care: Bacillus coagulans MTCC 5856 (LactoSpore) is a nonpathogenic Gram-positive, endospore forming patented probiotic strain. It is a facultative anaerobe, grows optimally at a slightly acidic pH range of 5.5 to 6.2 and a temperature of 37°C. The strain produces L(+) lactic 10

April 2022

acid as a primary product after germination and prevents the growth of pathogenic microbes in the GI tract and has received the Generally Regarded As Safe (GRAS) status from USFDA.17,18

membrane while preserving the natural skin homeostasis by altering the skin microflora, skin lipids and immune system, a significant reduction in inflammatory lesions and pustules.

LactoSporin is an extracellular metabolite produced by B. coagulans MTCC 5856 under specific growth conditions.19 LactoSporin is reported to have anti-microbial activity and has been evaluated in a clinical study for efficacy against acne.20 LactoSporin is found to be safe as a cosmetic ingredient and has been successfully registered as per the Cosmetics Regulation (Regulation (EC) No 1223/2009).

LactoSporin showed antimicrobial activity against various skin pathogens like P. aeruginosa, an opportunistic pathogen, and S. aureus and S epidermidis, the two most important skin pathogens. Most importantly, it is found to be effective against C. acnes, the acne-causing bacteria, showing a minimum inhibitory concentration of 4%.

Benefits of LactoSporin on skin microbiome:20,21

Role of LactoSporin in acne management:20,21

LactoSporin is a promising ingredient in maintaining the healthy skin by balancing the skin microbiome level. LactoSporin is a postbiotic that is thermostable and stable at an acidic pH. It can maintain the skin microbiome balance by acting as an antimicrobial agent– by inhibiting P acne proliferation, reducing noninflammatory lesions, improving the signs of inflammation, reducing the sebum secretion (inhibiting 5-alpha reductase enzyme) and thus helps in preserving skin structure. LactoSporin is highly suitable for mild-to-moderate acne vulgaris treatment.

As per reported evidence, LactoSporin 2% w/w cream is a safe antiacne formulation with efficacy comparable to the standard treatment of benzoyl peroxide 2.5% gel. The onset of efficacy of LactoSporin are starting from three days— especially for closed comedones so providing a quicker benefit than benzoyl peroxide.

Studies have shown the efficacy of bacteriocin (antimicrobial proteins) in inhibiting the inflammatory skin bacteria, such as S. epidermidis, S. aureus, S. pyogenes and C. acnes. The bacteriocin activity depends upon its amphiphilic nature, selectivity, and ability to disrupt the bacterial cytoplasmic

LactoSporin is very useful and safe mode of treatment for acne management because of the following benefits • Reduces the sebaceous secretion by its 5-alpha reductase inhibitory & antimicrobial properties • Provide protection against photo-toxicity that is induced by UV-A and UV-B radiation, and reduce inflammation • Safe without any irritancy • Is a potent antioxidant and shown activity in reducing both free radical generation and

Postbiotic – A New Paradigm in Acne Management

oxidative stress • Inhibits glycation and collagenase activity, so provides youthful skin • Beneficial conditions

seborrheic

• Offered clinical efficacy, and User/patient satisfaction • Suitable for mild-to-moderate acne vulgaris treatment • Reduces oiliness greasiness from the face

and

• Efficacious in reducing acne, acne spots, and redness • Reduce the non-inflammatory lesions in both open and closed comedones and improved the signs of inflammation, like redness and skin elevation • Controls closed comedones because of its Anti-DHT activity by inhibiting the 5-alpha reductase enzyme, thus reducing the secretion of sebum Conclusion: Acne is a multifactorial inflammatory disease, generally known as a disorder of adolescence, which has both physical and emotional impacts on human health. The conventional therapies offer only the temporary management of acne and are also associated with undesirable effects. Alternative therapies with minimal observed risks and holistic managements of the problem are in high demand. The microbiome is emerging as a major contributor to protect the skin from inflammatory conditions. Postbiotic is a relatively new term to classify the metabolites, cell components derived from a probiotic that can influence the microbiome composition. LactoSporin, an extracellular metabolite secreted by B. coagulans MTCC5856 is used as a postbiotic in acne treatment. It shows antimicrobial activity against various skin

pathogens like P. aeruginosa, an opportunistic pathogen, and S. aureus and S epidermidis, the two most important skin pathogens with significant effect in acne causing bacteria C. acnes. LactoSporin could soon be an edge over the standard treatment for acne due to its multiple benefits. References: 1. Indian J Dermatol. 2018 Jul-Aug; 63(4): 328–331 2. https://www.prnewswire.com/newsreleases/indian-acne-market-reportfor-2016-2025-300576955 3. Toyoda, M.; Morohashi, M. Pathogenesis of acne. Med. Electron. Microsc. 2001, 34, 29–40 4. Sutaria, A.H.; Schlessinger, J. Acne vulgaris. In StatPearls [Internet]; StatPearls Publishing: Treasure Island, FL, USA, 2019 5. American Journal of Clinical Dermatology (2020) 21 (Suppl 1):S18–S24

14. Zolkiewicz, J.; Marzec, A.; Ruszczynski, M.; Feleszko, W. Postbiotics-A Step Beyond Pre- and Probiotics. Nutrients 2020, 12, 2189 15. JeremyAH et al. Inflammatory events are involved in acne lesion initiation.J. Invest. Dermatol.121, 20-27 (2003) 16. Aguilar-Toalá, J.; Garcia-Varela, R.; Garcia, H.; Mata-Haro, V.; GonzálezCórdova, A.; Vallejo-Cordoba, B.;HernándezMendoza, A. Postbiotics: An evolving term within the functional foods field. Trends FoodSci. Technol. 2018, 75, 105–114 17. Majeed, M.; Nagabhushanam, K.; Natarajan, S.; Arumugam, S.; Pande, A.; Majeed, S.; Ali, F. A Double-Blind, PlaceboControlled, Parallel Study Evaluating the Safety of Bacillus coagulans MTCC 5856 in Healthy Individuals. J. Clin. Toxicol. 2016, 6, 283 18. Majeed, M.; Nagabhushanam, K.; Natarajan, S.; Sivakumar, A.; Eshuis-de Ruiter, T.; Booij-Veurink, J.; de Vries, Y.P.; Ali, F. Evaluation of genetic and phenotypic consistency of Bacillus coagulans MTCC 5856: A commercial probiotic strain. World J. Microbiol. Biotechnol. 2016, 32, 60

6. J Clin Med. 2019 Jul; 8(7): 987 7. Hall JB, Cong Z, Imamura-Kawasawa Y, Kidd BA, Dudley JT, Thiboutot DM, et al. Isolation and identification of the follicular microbiome: implications for Acne research. J Invest Dermatol. 2018;138(9):2033–40 8. Grice EA, Segre JA. The skin microbiome. Nat Rev Microbiol. 2011;9(4):244–53

19.

Majeed, M.; Nagabhushanam, K.;

Arumugam, S.; Ali, F. Method of producing partially products

purified from

extracellular Bacillus

metabolite

coagulans

and

biological applications thereof. U.S. Patent No. 9,596,861,2017 20.

Majeed,

M.;

S.;

Mundkur,

L.;

9. Ramasamy S, Barnard E, Dawson TL Jr, Li H. The role of the skin microbiota in acne pathophysiology. Br J Dermatol. 2019;181(4):691–9

Nagabhushanam,

10. Majeed et al. Novel topical application of postbioitic, Lactosporin. Cosmetics 2020, 7(3), 70

Randomized, Comparative Clinical Study to

11. Jappe, U. Pathological mechanisms of acne with special emphasis on Propionibacterium acnes and related therapy. ActaDerm. Venereol. 2003, 83, 241–248 12. Fox, L.; Csongradi, C.; Aucamp, M.; du Plessis, J.; Gerber, M. Treatment Modalities for Acne. Molecules 2016,21, 1063

K.;

Majeed,

Rajalakshmi, H.R.; Shah, K.; Beede, K. Novel Topical Application of a Postbiotic, LactoSporin®, in Mild to Moderate Acne: A Evaluate its Efficacy, Tolerability and Safety. Cosmetics 2020, 7, 70 21.

Majeed

Nagabhushanam K, Lawrence L, Arumugam S, Mundkur L. Skin Protective Activity of LactoSporin® - the Extracellular Metabolite from

Bacillus

Coagulans

MTCC

5856.

Cosmetics. 2020; 7(4):76

13. Majeed et al. Skin protective activity of lactosporin. Cosmetics 2020, 7, 76 April 2022

Herpes Zoster After Covid Vaccination- A Case Report

Herpes Zoster After Covid VaccinationA Case Report Dr. Girish M S

MD, DDVL Senior SPECIALIST Grade-1/HOD Department of Dermatology, ESIC Hospital, Ezhukone, Kerala Herpes zoster (HZ) is commonly known as shingles.1 It is caused by a reactivation of varicella zoster virus infection. Cell‑mediated immunity plays a role in this reactivation. Varicella zoster virus is one of the eight herpes viruses that are pathogenic only for humans.2 The incidence of herpes zoster is strongly correlated to the immune status.1 The agerelated increased incidence of HZ and its complications is thought to be a result of the decline in cell-mediated immunity (immunosenescence), higher incidence of comorbidities with age and social-environmental changes.3 Herpes zoster is a viral disease caused by reactivation of varicellazoster virus which remains dormant in the sensory ganglia of the cranial nerve or the dorsal root ganglia after a previous varicella infection.1 Varicella is commonly known as chickenpox; it occurs in children while herpes zoster occurs in adults or the elderly.1 Herpes zoster is a major health burden that can affect individuals of any age.2 Its complications may be dermatological (e.g. secondary bacterial infection), neurological (e.g. long-term pain, segmental 12

April 2022

paresis, stroke), ophthalmological (e.g. keratitis, iridocyclitis, secondary glaucoma) or visceral (e.g. pneumonia, hepatitis).3 Clinical presentation of herpes zoster infection usually begins with prodromal symptoms such as pain, fever, malaise, headache, itch, and paresthesias which precede the rash by a few hours to several days in most patients.2 Usually affecting a single, unilateral dermatome, maculopapular lesions appear proximally to distally, progressing to clear vesicles that become cloudy and eventually crust over in 7 to 10 days. Lesions usually heal 2 to 4 weeks after onset, but scarring and pigmentation changes are common.4 As the initial varicella zoster virus (VZV) infection resolves, viral particles travel to cranial and dorsal root ganglia, where they are shielded from blood antibodies. The virus remains latent and may reactivate as cellmediated immunity wanes. Not all of the contributing factors are understood, but under the right conditions, the virus replicates, causing a nonspecific prodrome with malaise, headache, fever, or

Herpes Zoster After Covid Vaccination- A Case Report

abnormal skin sensations (e.g., itching, burning, pain). Classic HZ rash is grouped vesicles on an erythematous base in a dermatomal distribution. The classic rash typically appears after two to three days, with new lesions appearing over three to five days.4 Acute zoster is painful, but does not incur lasting morbidity. However, there is a potential for neurologic and inflammatory complications that cause patients and physicians great and lasting difficulty. The relationship between zoster infection and destruction of neurons and satellite cells has been well established, with neurologic damage beginning even before the characteristic zoster rash appears.5 Here we report a case on Herpes Zoster 12 days after Covid vaccination. Case Report A 48-year old male presented to our outpatient department with complaints of grouped vesicles over an erythematous base in a L2 dermatomal distribution. The history showed Herpes Zoster seen 12 days after Covid vaccination 2nd dose.

based diagnostic tools can be used for confirmation in patients with atypical clinical presentations for HZ.6

B Figure.1 (A & B): Grouped vesicles over an erythematous base in a L2 dermatomal distribution Diagnosis The diagnosis of herpes zoster is generally diagnosed clinically, once the rash has appeared.3 Although herpes zoster is difficult to identify during the prodrome, the appearance of the typical exanthema aids in diagnosis. Testing is typically not needed, but it may be considered in patients with recurring lesions that are suspicious for herpes simplex, or in those with suspected zoster sine herpete, in which the virus causes pain without lesions. Testing may also be considered in atypical presentations, such as the widely disseminated lesions that may occur in immunocompromised patients. Testing is also helpful in differentiating herpes zoster from other vesicular dermatoses, such as contact dermatitis and dermatitis herpetiformis.4 In most patients, the history and classic dermatomal appearance of the rash permits a clinical diagnosis of HZ. Laboratory-

Prior to the rash occurring and for atypical cases, diagnosis can require laboratory confirmation, using PCR analysis which can detect VZV DNA rapidly and accurately. HZ can sometimes be confused with HSV (herpes simplex virus) or a number of other conditions.3 VZV DNA PCR (varicella zoster virus - Deoxyribonucleic acid - polymerase chain reaction) has the highest sensitivity and specificity and has become the gold standard for diagnosis.6 Most lesions develop between dermatomes T1 and L2, although the ophthalmic (first) division of the trigeminal nerve is affected in 15% of cases. Adjacent dermatomes are affected in 20% of cases, and lesions occasionally cross the midline, especially on the back.4 Due to the frequent itching or pain that develops before the appearance of the rash (zoster sine herpete), there can be a chance of delayed diagnosis. Following the prodromal phase, the active phase begins when the patients manifest the characteristic skin lesions such as erythematous papules or macules which progress to vesicles in 12−24 hours, to pustules in 1−7 days, and eventually crust over in 14−21 days (resolution phase). The chronic phase of the disease is associated with the development of post‑herpetic neuralgia, involvement of cranial nerves, and involvement of visceral organs.2

Discussion Herpes

zoster April 2022

viral 13

Herpes Zoster After Covid Vaccination- A Case Report

syndrome caused by reactivation of the varicellazoster virus.1 It is seen more commonly among individuals aged ≥ 50 years, those with immunocompromised status, and those on immunosuppressant drugs.2 It is a primarily a disease of nerve tissue but the acute and longerterm manifestations require multidisciplinary knowledge and involvement in their management.3 The incidence of herpes zoster ranges from 1.2 to 3.4 per 1000 persons per year among younger healthy individuals while incidence is 3.9 to 11.8 per 1000 persons per year among patients older than 65 years. There is no seasonal variation seen with herpes zoster. Recurrences are most common in patients who are immunosuppressed.1 HZ and its complications (particularly postherpetic neuralgia) create a significant burden for the patient, carers, healthcare systems and employers. Prevention and treatment of HZ complications remain a therapeutic challenge despite recent advances.3 Treatment options The goals of treatment are to hasten the healing of skin lesions, decrease the risk of viral dissemination, limit the severity and duration of acute and chronic pain, and minimize complications of the infection, such as PHN, encephalitis, myelitis, cranial and peripheral palsies, and acute retinal necrosis. These goals can be achieved through the use of antiviral drugs.7 The management of HZ with antiviral drugs and analgesics frequently reduces acute rash 14

April 2022

and pain and may prevent some complications. Antiviral drugs have been shown to reduce acute pain and rash severity, accelerate rash resolution and reduce duration of pain.3 Acyclovir is considered the “gold standard” of treatment. As the oral prodrug of acyclovir, valacyclovir is a safe and effective alternative to its parent compound. Famciclovir, the prodrug of penciclovir, has more extensive bioavailability compared with acyclovir, and its active metabolite has a longer half-life, allowing a simpler dosing regimen.7 The prodrugs valacilovir and famciclovir have a more convenient dosing schedule and more constant blood concentrations than acyclovir. Paracetamol alone or in combination with a weak opioid (e.g. codeine) is frequently used as analgesia. Topical application of lidocaine patches and treatment with 8% capsaicin patches may provide relief for some patients and avoids systemic side effects.3 Corticosteroids improve the pain associated with acute HZ and can be used for this purpose after consideration is given to relative contraindications such as hypertension, diabetes mellitus, glaucoma, osteoporosis, peptic ulcer disease. Mild pain of HZ can be treated with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDS). Tricyclic antidepressants (TCAs) have a role in pain control in both acute HZ and PHN. Classified as anticonvulsants, gabapentin and pregabalin have a role in neuropathic pain relief in both

acute HZ and PHN. Topical lidocaine is one of the best tolerated options for pain control in PHN. It is easily administered and has minimal systemic absorption.6

Herpes Zoster After Covid Vaccination- A Case Report

1: Pharmacologic Therapies for Acute Table 1:Table Pharmacologic Therapies for Acute Herpes Zoster4Herpes Agent

Dosage (adult)

Antivirals Acyclovir

Adverse effects

Zoster 4

Notes

Cost*

800 mg orally five Diarrhea, Dosing adjustments times per day for encephalopathy, required for seven days erythema immunocompromise multiforme, d patients (10 mg headache, per kg intravenously malaise, nausea, every eight hours) Stevens- Johnson and for patients with syndrome, creatinine clearance vomiting ≤ 50 mL per minute per 1.73 m2(0.83 mL per second per m2) Approved for use in children (10 mg per kg intravenously every eight hours) Famciclovir 500 mg orally Confusion, Dosing adjustment three times per headache, required for patients day for seven nausea, Stevens- with creatinine days Johnson clearance ≤ 60 mL syndrome per minute per 1.73 m2 (1.00 mL per second per m2) Valacyclovir 1,000 mg orally Similar to acyclovir Dosing adjustment (Valtrex) three times per required for patients day for seven with creatinine days clearance ≤ 50 mL per minute per 1.73 m2 Adjunctive therapy Corticosteroids Prednisolone: 40 Dyspepsia, nausea, Associated with (e.g., prednisone, mg orally per day vomiting accelerated time to prednisolone) (days 1 to 6), 30 crusting and healing mg per day (days of lesions and 7 to 10), 20 mg resolution of pain; per day (days 11 no benefit in to 14), 10 mg per preventing day (days 15 to postherpetic neuralgia 18), 5 mg per day (days 19 to 21)

$20 for 45 800mg generic tablets

$32 for 21 500mg generic tablets ($522 for brand name) $24 for 21 1,000- mg generic tablets ($424 for brand name) Varies

Prednisone: 60 mg orally per day

April 2022

Herpes Zoster After Covid Vaccination- A Case Report

(days 1 to 7), 30 mg per day (days 8 to 14), 15 mg per day (days 15 to 21) Analgesics Acetaminophen

325 to 1,000 mg Headache, Infant and child $7 for 100 orally every four hepatotoxicity, dosage: 10 to 15 mg generic tablets to six hours as hypersensitivity, per kg orally every needed nausea, rash four to six hours as (maximum: needed (maximum: 4,000 mg per 4,000 mg per day) day) Nonsteroidal anti- 400 mg orally Abdominal Infant and child $7 for 100 inflammatory every four to six discomfort, dosage (six months generic tablets drugs (e.g., hours as needed dyspepsia, and older): 5 to 10 ibuprofen) (maximum: gastrointestinal mg per kg orally 2,400 mg per bleeding and every six to eight day) perforation, hours as needed myocardial (maximum: 2,400 infarction, mg per day) nausea *—Estimated retail cost for one treatment course based on information obtained at http://www.goodrx.com and http:// www.walgreens.com (accessed April 4, 2017).

Conclusion HZ is a common disease with the highest burden in older adults who frequently have at least one chronic disease. HZ and its complications represent a significant burden on the patients, caregivers, the healthcare economy and employers.3 Patients who experience only acute infection may regain their usual QOL once the flare-up subsides. During the peak of a zoster flare, however, the effect on QOL is similar to that of serious chronic diseases, such as diabetes, cardiovascular disorders, and depression.7 Risk factors and complications associated with herpes zoster depend on the age, immune status, and the time of initializing treatment.2 Elderly patients 16

April 2022

with herpes zoster are at risk of becoming physically impaired by fatigue, anorexia, and insomnia.7 It is believed that zoster occurs due to the failure of the immune defense system to control the latent replication of the virus. Individuals who maintain a high level of immunity rarely develop shingles.1

References 1. Nair PA, Patel BC. Herpes Zoster. [Updated 2021 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https:// www.ncbi.nlm.nih.gov/books/ NBK441824/ 2. Koshy E, Mengting L, Kumar H, Jianbo W. Epidemiology, treatment and prevention of herpes zoster:

A comprehensive review. Indian J Dermatol Venereol Leprol. 2018 May-Jun;84(3):251-262. doi: 10.4103/ijdvl.IJDVL_1021_16. PMID: 29516900. 3. Johnson RW, Alvarez-Pasquin MJ, Bijl M, et al. Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective [published correction appears in Ther Adv Vaccines. 2016 Jan;4(1-2):32]. Ther Adv Vaccines. 2015;3(4):109-120. doi:10.1177/2051013615599151 4. Saguil A, Kane S, Mercado M, Lauters R. Herpes Zoster and Postherpetic Neuralgia: Prevention and Management. Am Fam Physician. 2017 Nov 15;96(10):656663. PMID: 29431387. 5. Weinberg JM. Herpes zoster:

Herpes Zoster After Covid Vaccination- A Case Report

epidemiology, natural history, and common complications. J Am Acad Dermatol. 2007 Dec;57(6 Suppl):S130-5. doi: 10.1016/j. jaad.2007.08.046. PMID: 18021864. 6. John AR, Canaday DH. Herpes Zoster in the Older Adult. Infect Dis Clin North Am. 2017 Dec;31(4):811-826. doi: 10.1016/j. idc.2017.07.016. PMID: 29079160; PMCID: PMC5724974. 7. Cohen KR, Salbu RL, Frank J, Israel I. Presentation and management of herpes zoster (shingles) in the geriatric population. P T. 2013;38(4):217-227.

April 2022

Recurrent, Resistant Fungal Infections- A Case Report

Recurrent, Resistant Fungal InfectionsA Case Report Dr. K. Lakshmiprasad MBBS, DDVL Consultant Dermatologist Aditya Polly Clinic Attapur, Hyderabad

Cutaneous fungal infections affect more than one-fourth of world’s population. Among all fungal infections, superficial mycoses are the most frequent forms of human infections, affecting more than 20%–25% of the world’s population.1 Tinea corporis is a common fungal infection that mimics many other annular lesions. Tinea corporis, also popularly known as ‘ringworm,’ is a superficial dermatophyte infection of the skin, other than on the hands (tinea manuum), feet (tinea pedis), scalp (tinea capitis), beard areas (tinea barbae), face (tinea faciei), groin (tinea cruris), and nails (onychomycosis or tinea unguium). Tinea corporis typically presents as a well-demarcated, sharply circumscribed, oval or circular, mildly erythematous, annular, scaly patch or plaque with a raised leading edge, scaling and central clearing on the body. Mild pruritus is common.2 The pathogenesis and severity of fungal infection depends on various immunological and nonimmunological factors.1 Pathogenic fungi are the cause of life-threatening infections 18

April 2022

in an increasing number of immunocompromised patients. The intrinsic resistance to antifungal therapy observed in some genera, along with the development of resistance during treatment in others, is becoming a major problem in the management of these diseases.3 The widespread use of antifungal mostly OTC therapy in immunocompromised individuals marked the onset of antifungal drug resistance.1 Antifungal resistance represents a major clinical challenge to clinicians responsible for treating invasive fungal infections due to the limited arsenal of systemically available antifungal agents.4 Fungal resistance can be microbiological or clinical. Microbiological resistance depends on various fungal factors which have established due to genetic alteration in the fungi. Clinical resistance is due to host or drug-related factors.1 Antifungal resistance is becoming a significant concern to clinicians who are in charge of caring for patients at high risk for invasive mycoses. Resistance to currently available antifungal agents can

Recurrent, Resistant Fungal Infections- A Case Report

develop secondary to acquired mechanisms following exposure to these drugs.4 Case Report A 48-years old female patient presented to our out patient department with complaints of itchy lesions over the lower abdomen and groins for 2 years. There was history of severe itchy lesions which worsens with sweat. Rapid spread of infection with extending lesions and irregular shape and margins with scales. She was a frustrated patient with 2 years ongoing treatment for Tinea Corporis because the lesions are recurred after treatment. Discussion In the present case, I treated with Do Beyond method. Through the new methods tried as it is economically viable and result oriented.(as cost factor becomes economic burden on the family and more so unaffordable when more number of family members are infected.) Do Beyond, helps patients with recalcitrant fungal infection who are frustrated and visited several Doctors. These patients have lot of acceptance levels to new

methods of treatments as they are seeking relief. The attempt towards Do Beyond, was approached with different methods 1. In method one I have advised the patients to wash all the lesions with DM water (Demineralized water) i.e. it is just H2O without any electrolytes salts and minerals, followed with oral antifungals.This approach has helped the patient, as she came back with a feedback that it has given her lot of relief. This confirms that DM water works on fungal infections. Which means this treatment is creating unfavourable environment for the fungus. (-eve ambience) 2. In method two these patients have been advised to apply the DM water mixed with diluted acid (10% H2SO4 – Battery top up water) and washed it off after 5 to 10 seconds when sting feeling starts. The process is recommended on every alternate day to avoid skin barrier disruption, and this routine is followed till the fungal infection disappears. During this course of treatment all the innovator capsules and greater and brutal tropical are avoided and only use of moisturizers are advised.

The patients are reviewed after one month. The results are so rewarding, and through this approach the cost of the treatment to the patient has come down drastically. 3. In method three the approach was through Cryotherapy ( + orals and minus tropical anti fungals) here Cryotherapy is through spray or by application for short time like 10 seconds spray and thawing and spray 10 seconds again. This procedure is repeated once in week till it subsides. 4. In method four the approach was short term exposure to UV chamber; it is known fact that UV light is incorporated as a germicidal in all the drinking water plants and this works as fungicidal also. 5. In method five the approach was recommending the Pharmacies to make soaps and body washes with less than 5.5 pH. i.e. less than the skin pH, so that the fungus finds it difficult to survive in an in- ambient superficial in the long run. It is not to forget the patients seen are only tip of the iceberg, the path is long to chase hunt and kill so DO Beyond.

b Figure 1 (a & b): Before treatment

April 2022

Recurrent, Resistant Fungal Infections- A Case Report

Figure 2 (a&b): 2 months after treatment

Conclusion

3. George M. Eliopoulos, Sofia Perea,

The recurrent and recalcitrant fungal infection, day by day is becoming more and aggressively persistent and Dermatologists have become vocal spectators. Therefore, Do Beyond, New methods have to be searched for economically viable and commendable results as cost factor becomes economic burden on the family and more so unaffordable when more number of family members are infected. In the presented case, patient got extremely gratifying results with even restoration of color with medical treatment and chemical peeling effect. The application of nail paint signifies her life is returning back. Happiness…..!!!!

References 1.

Pai V, Ganavalli A, Kikkeri NN.

Antifungal

resistance in dermatology.

Indian J Dermatol 2018;63:361-8. 2. Leung AKC, Lam JM, Leong KF, Hon KL. Tineacorporis: an updated review. Drugs in Context 2020; 9: 2020-5-6. DOI: 10.7573/dic.2020-5-6 20

April 2022

Thomas

Patterson,

Antifungal

Resistance in Pathogenic Fungi, Clinical Infectious Diseases, Volume 35, Issue 9, 1 November 2002, Pages 1073–1080, https://doi.org/10.1086/344058 4.

Wiederhold

NP.

Antifungal

resistance: current trends and future strategies to combat. Infect Drug Resist.

2017;10:249-259https://doi.

org/10.2147/IDR.S124918

NEWS

Oral tofacitinib produces hair regrowth in children with alopecia areata Alopecia areata (AA) is a complex autoimmune condition that causes non-scarring hair loss. It typically presents with sharply demarcated round patches of hair loss and may present at any age. Hair loss can take many forms ranging from loss in well-defined patches to diffuse or total hair loss, which can affect all hair bearing sites. Patchy alopecia affecting the scalp is the most common type. Recently conducted small study shows oral tofacitinib, a Janus kinase inhibitor, helped regrow hair in three-quarters of pediatric patients with alopecia areata (AA). The 11 pediatric patients, ages 8-18 years, all with a diagnosis of AA, were treated with tofacitinib. Eight patients, or nearly 73%, experienced hair regrowth, while the other three (27.3%) did not, as the investigators reported in the retrospective chart review. A success rate of 73% is very good. No serious adverse events occurred, and adverse events of any kind were limited, the researchers found. It is important to get information into the literature about potential treatments for severe alopecia areata because there is no [Food and Drug Administration]–approved therapy at the present time. The researchers found no correlation between the dose, duration of treatment, or the presence of comorbidities and clinical response. Oral tofacitinib has been shown to be effective and well tolerated for AA in adults, the researchers said. They referred to recent studies that have used JAK inhibitors, including tofacitinib, in an effort to inhibit T-cell activation and halt disease progression in adult and pediatric patients with AA. Patients are very happy with regrowth of their hair, noting that severe AA affects self-esteem and quality of life.

Mandelic acid is one of the largest alpha hydroxy acidsfor sensitive or aging and thin skin types Chemical peels are cosmetic treatments that can be applied to the face. They’re used to improve the appearance or feel of the skin. There are a number of reasons people may get chemical peels. They may be trying to treat a variety of things, including, acne scars, hyperpigmentation, scars, wrinkles and fine lines etc. Acids peels are used to elicit a chemical exfoliation of the skin by hydrolyzing amide bonds between keratinocytes, reducing corneocyte adhesion, as well as inducing an inflammatory reaction stimulating tissue remodeling. Release of cytokines such as interleukin (IL)-1 and IL-6 by keratinocytes activates fibroblasts to increase the production of matrix metalloproteinases. These are involved in the production of hyaluronic acid and new collagen formation. Recent studies have shown its efficacy in reducing sebum content, acne, acne scarring, and hyperpigmentation. In clinical practice however, the most effective use of this acid is on sensitive skin. It is a great tool for clinicians to use as an effective exfoliant in less acid tolerant skin types. In commercially available concentrations of 5%-45%, mandelic acid can be used alone or in combination with other beta hydroxy peels, depending on the indication. Most dermatologists and patients prefer in-office peels that induce noticeable peeling and resurfacing of the skin. Mandelic acid is one of the largest alpha hydroxy acids, a lipophilic acid that penetrates the skin slowly and uniformly, making it an ideal peel in sensitive or aging and thin skin types. Although many mandelic acid peels are available, however, there is a paucity of studies comparing their benefits and efficacies.

April 2022

NEWS

Acne's Genetic Secrets Could Bring Better Treatments Acne is a skin condition that occurs when hair follicles become plugged with oil and dead skin cells. It causes whiteheads, blackheads or pimples. Acne is most common among teenagers, though it affects people of all ages. Acne leads to significant morbidity that is associated with residual scarring and psychological disturbances such as poor self-image, depression, and anxiety, which leads to a negative impact on quality of life. According to new study researchers said the discovery of new genetic variants associated with acne could help doctors identify people at high risk and perhaps point the way to new treatments. Despite major treatment advances in other skin conditions, progress in acne has been limited, researcher said. As well as suffering from the symptoms of acne, individuals describe consequent profound, negative impacts on their psychological and social well-being. It's exciting that this work opens up potential avenues to find treatments for them, researcher added. For the study, the researcher’s team examined whole genome data collected worldwide from more than 20,000 people with acne and more than 595,000 without the skin condition. The analysis revealed 29 new genetic variants that are more common in people with acne, bringing the total number of known variants to 46. A number of the newly identified variants are in genes linked to other skin and hair conditions. This may help improve understanding about the causes of acne, which could be a mix of factors, according to the researcher’s. The investigators also found that people with the highest genetic risk of acne are more likely to have severe cases. Further research is required, but this suggests that it may be possible to identify people at risk of severe disease so they can receive early treatment, the study team said. We know that the causes of acne are complicated, with a mix of biological factors such as genetics and hormones, and environmental factors. Understanding the genetics of the condition will help us to disentangle some of these causes, and find the best way to treat the condition. This is a really promising area for further study, and opens up a lot of avenues for research.

Antifreeze cream prevents frostbite injuries to skin, study suggests Atopic Skiers, hikers, soldiers and others exposed to extreme cold temperatures can experience frostbite -- a painful injury that occurs when ice crystals form in the skin. Many extremely cold areas are also remote, and delays in frostbite treatment can result in severe wounds, scarring and even limb amputation. Frostbite not only kills skin cells, but can also harm deeper tissues like muscle and bone, sometimes causing secondary infections and permanent nerve damage. Common therapies, such as rapid rewarming of the affected limb, aim to reverse tissue freezing, but by the time of treatment, many cells have already died. Recently, scientists have developed frostbite prevention strategies, such as electric heaters sewn into clothing or transgenic antifreeze proteins, but such approaches are often costly, impractical or have safety concerns. Therefore researchers wanted to test the frostbite prevention properties of a combination of synthetic molecules commonly used in labs to cryopreserve cells. Dimethyl sulfoxide (DMSO) keeps ice crystals from forming inside cells, whereas poly(vinyl alcohol) (PVA) prevents ice crystals in the spaces between cells, which can damage membranes. The researchers first tested the ability of different amounts of DMSO and PVA, alone or in combination, to prevent the death of cultured cells in a dish that were exposed to a freezing temperature. They found that 2% DMSO combined with 1.6 mg/mL PVA yielded the highest cell survival (about 80%), while protecting the cell membrane and cytoskeleton. This combination, which the researchers called SynAFP (synthetic cryopreservative agents), also allowed cells to divide and express proteins more normally after cold stress. Then, the team mixed SynAFP with a commercial aloe vera cream and applied it to the skin of mice 15 minutes before a cold challenge. The cream reduced frostbite wound size, tissue damage and inflammation, and sped healing, compared with no treatment. The cream did not prevent frostbite when applied 30 minutes or more before the cold challenge; however, multiple applications did not damage skin. The effects of the antifreeze cream in people, and how frequently it needs to be reapplied, must still be determined, the researchers said. 22

April 2022

NEWS

New hair dyes avoid allergic reactions Hair dyes and hair colors are products intended to impart color to the hair.The main ingredient used in coaltar dyes caused allergic reactions in some people. A bad dye job is bad enough on its own, but an itchy and irritating allergic reaction to it is even worse. And people who become allergic to hair dye can develop reactions to many other common substances, transforming a simple cosmetic treatment into a big problem. Researchers have developed a range of permanent hair dyes that avoid the allergenic properties of traditional formulations. When applied as hair color, paraphenylenediamine (PPD) -- a common ingredient in permanent dyes -- undergoes a chemical reaction that turns the hair a dark color that won't wash out over time. This reaction, however, can also produce compounds that bind proteins in the user's skin, causing allergic responses, such as eczema and facial swelling. PPD can also sensitize users to other substances, including a compound commonly found in sunscreens and cosmetics, as well as common pigment and ink compounds. Alternatives have been proposed, but they generally are not water-soluble, and the safety of some of the compounds is not well understood. Researchers wanted to create new alternatives that would avoid the problems of PPD while still providing permanent hair coloring. The team prepared seven dyes based on PPD with modifications to the aromatic amine core. The modifications were chosen to potentially make the compounds less reactive toward proteins and less able to be absorbed into skin. All seven compounds permanently colored hair samples, producing a range of hues from rosy pinks to deep blacks that did not fade, even after three weeks of daily washing. The team then examined the dyes in a test commonly used in the cosmetics industry to determine if a product is a skin sensitizer. Five of the modified dyes were "weak" sensitizers, whereas PPD was "moderate." Another test showed that the new compounds generated a reduced inflammatory response in cells compared to PPD. These results suggest that the new dyes can effectively color hair while also avoiding the potential allergenic and sensitization risks of more traditional ones.

Pimple secret popped: How fat cells in the skin help fight acne Acne is a common skin disease that causes pimples. Pimples form when hair follicles under skin clog up. Most pimples form on the face, neck, back, chest, and shoulders. It is one of the disease of the pilosebaceous unit that causes noninflammatory lesions (open and closed comedones), inflammatory lesions (papules, pustules, and nodules), and varying degrees of scarring. No one knows exactly what the causes of acne. Hormone changes, such as those during the teenage years and pregnancy, probably play a role. There are many myths about what causes acne. It's known that hair follicles assist in the development of a pimple, but new research suggests the skin cells outside of these hair follicles play a larger role. According to researchers these findings may transform the way we treat acne. Previously, it was thought that hair follicles were most important for acne to develop. In this study, they looked at the cells outside of the hair follicle and found they had a major effect on controlling bacteria and the development of acne. The cells are called fibroblasts, common in connective tissues throughout the body. In skin, they produce an antimicrobial peptide called cathelicidin, which plays a key role in acne development, researcher said. To counter an infection within a hair follicle, the surrounding skin undergoes a process called reactive adipogenesis in which fibroblasts transform into fat cells. Cathelicidin is produced as well to help combat the infection by suppressing bacteria that can cause acne. The discovery of cathelicidin's role came as a surprise. They began their research wanting to understand the biology of acne and specifically looked at the role of fibroblasts, which typically provide structural support in the deeper layers of the skin. What they uncovered instead was that these cells were activated to produce large amounts of an important antimicrobial, cathelicidin, in response to acne-causing bacteria called Cutibacterium acnes. The research team performed skin biopsies on acne patients treated for several months with retinoids, a class of chemicals derived from vitamin A found to promote skin health. To the researchers' surprise, the drug enhanced cathelicidin expression after treatment, thus finding an additional, unknown mechanism for why retinoids help treat acne. To support these findings, researchers studied skin lesions on mice injected with the acne-causing bacteria and observed similar treatment responses in the mice. Cathelicidin being so highly expressed in acne biopsy tissue was a very interesting finding to us. Knowing this will be helpful in developing a more targeted therapy to treat acne. Currently, retinoid treatment focuses on controlling the development of lipids in skin cells. One major side effect of these drugs are their teratogenic effects, causing fetal abnormalities in pregnant people. This limits the use of these drugs to only severe cases. The research team hopes these findings may assist in developing a more targeted approach to treating acne. This research could assist in identifying new treatment options that specifically target the fibroblast's ability to produce cathelicidin. Thus creating a therapeutic for acne that would be more selective with potentially less harmful side effects. April 2022

Prevalence and Species Profile of Genital Candidiasis among Pregnant Women Attending STI/RTI Clinic at a Tertiary Referral Centre Part-II

Prevalence and Species Profile of Genital Candidiasis Among Pregnant Women Attending STI/RTI Clinic at a Tertiary Referral Centre Part-II Dr. Rajesh Rajagopalan

MD., DNB., MNAMS Professor and HOD Department of Skin, STDs & Leprosy, Government Erode Medical College, Erode, Tamilnadu

Dr. V. Sudha

MD., DV Professor Prevalence and and HOD Species Profile of Genital Candidiasis among Pregnant Women Attending Clinic ata Referral Centre Part-II Department of STI/RTI Skin, STDs & Tertiary Leprosy, ACS Medical College, Chennai Retired Director, Professor and HOD Part II Institute of Venereology Madras Medical College, Chennai DISTRIBUTION OF INFECTIONS AMONG PREGNANT WOMEN Infections Vulvovaginal Candidiasis Syphilis Hepatitis-B Trichomoniasis Genital herpes Chlamydia cervicitis Genital warts HIV Non-gonococcal urethritis Bacterial vaginosis Non specific genital ulcer Chancroid Molluscum contagiosum Scabies

April 2022

Total No. 124 66 46 28 26 21 20 16 12 6 4 2 2 2

Percentage (%) 47.7 25.4 17.7 10.8 10 8.1 7.7 6.2 4.6 2.3 1.5 0.8 0.8 0.8

Prevalence and Species Profile of Genital Candidiasis among Pregnant Women Attending STI/RTI Clinic at a Tertiary Referral Centre Part-II

COMPARISION OF INFECTIONS AMONG MARRIED PREGNANT WOMEN (n=200) AND UNMARRIED PREGNANT WOMEN (n=260) Infections Vulvovaginal Candidiasis Syphilis Hepapitis-B Trichomoniasis Genital herpes Chlamydia cervicities Genital warts HIV Non-gonococcal urethritis Bacterial vaginosis Nonspecific genital ulcer Chancroid Molluscum contagiosum Scabies

Married (n=200) Total No Percentage % 96 48 64 32 34 17 26 13 22 11 16 8 20 10 12 6 10 5 4 2 2 1 2 1 2 1 0 0

Unmarried (n=60) Total Percentage No % 28 46.7 2 3.3 12 20 0 0 6 10 5 8.3 0 0 4 6.7 2 3.3 2 3.3 0 0 2 3.3 0 0 2 3.3

DISTRIBUTION OF INFECTIONS AMONG HIV POSITIVE PREGNANT WOMEN (n-=16) Infection Vulvovaginal Candidiasis Genital herpes Hepatitis B Syphilis (Early latent) Genital wards Non-gonococcal urethritis Scabies

Total No 12 4 4 2 2 2 2

Percentage (%) 75 25 25 12.5 12.5 12.5 12.5

[Type text] April 2022

Prevalence and Species Profile of Genital Candidiasis among Pregnant Women Attending STI/RTI Clinic at a Tertiary Referral Centre Part-II

CONCOMITANT INFECTIONS IN THE STUDY GROUP OF PREGNANT WOMEN Infections Candidiasis + Hepatitis B Candidiiasis + Genital herps Candidiiasis + HIV Candidiiasis + Genital warts Candidiiasis + Non-gonococcal urethritis Candidiiasis + Molluscumcontagiosum Candidiiasis + Non-specific genital ulcer Syphilis + Hepatitis B Syphilis + Candidiasis Syphilis + Trichomoniasis Syphilis + Non-gonococcal urethritis Syphilis + Genital herps Syphilis + HIV Trichomoniasis + Candidiasis Trichomoniasis + Hepatitis B Trichomoniasis + Genital herps Trichomoniasis + Non-gonococcal urethritis Non-gonococcal urethritis + HIV Non-gonococcal urethritis + Hepatitis B Non-gonococcal urethritis + Genital warts Genital herpes + HIV Genital warts + HIV Genital warts + Hepatitis B HIV + Hepatitis B HIV + Scabies

Total No 16 16 12 12 2 2 2 22 20 4 4 2 2 14 2 2 2 2 2 2 4 2 2 4 2

Percentage 6.2 6.2 4.6 4.6 0.8 0.8 0.8 8.5 7.7 1.5 1.5 0.8 0.8 5.4 0.8 0.8 0.8 0.8 0.8 0.8 1.5 0.8 0.8 1.5 0.8

DISTRIBUTION OF INFECTIONS AMONG HUSBANDS (n=164) OF MARRIED PREGNANT WOMEN Infections Syphilis Hepatitis B Genital herpes HIV Candidalbalanitis Non-gonococcal urethritis [Type text] Anogenital warts Non-specific genital ulcer Chancroid Gonorrhoea 26

April 2022

DISCUSSION

Total no 52 20 10 10 8 8 6 2 2 2

Percentage 37.7 12.2 6.1 6.1 4.9 4.9 3.7 1.2 1.2 1.2

Prevalence and Species Profile of Genital Candidiasis among Pregnant Women Attending STI/RTI Clinic at a Tertiary Referral Centre Part-II

DISCUSSION In this study, majority of the pregnant women were in the age group of 2024, followed by 25-29. A significant number of pregnant women were below 19 years. This study has confirmed that adolescent sexual activity has increased resulting in rise in unintended pregnancy rate.

women were asymptomatic. Genital discharge, genital sore and itching in genitalia were the most common symptoms noticed among the study group.

In the study, cervical erosion, soddening of vulva, genital ulcer and genital warts were the important clinical signs noted. Erosion of cervix was seen in nearly oneMajority of the pregnant women third of pregnant women (n=76, belonged to lower socio-economic 29.2%). Signs of HIV infection like strata. Lower socio-economic status loss of weight, oral candidiasis, oral often co-exist with poor nutritional hairy leukoplakia were noted in a status of pregnant women especially seropositive pregnant women. In anemia which in turn affect the course the study group, 8 cases were found of the diseases and their obstetric to be HIV seropositive. In this study, outcomes. Majority in this study were mucopurulent vaginal discharge was married. A considerable number of commonly seen. Vaginal discharge pregnant women were unmarried. apart from vaginal infection may They form an important risk group for also be caused by mucopurulent acquiring STDs including HIV infection cervicitis, so it is essential to examine as they are exposed to high risk cervix of all patient with vulvovaginal sexual behavior. complaints using speculum. Vaginal Majority of the pregnant women discharge is definitely an important had visited the STD outpatient co-factor for STD/HIV transmission. department for checkup. Most The usual description of discharge of them were referred cases. A in vulvovaginal candidiasis is white, good number of pregnant women curd like and adherent. In this study, presented with various genitourinary only 20% of the pregnant women had symptom on their own along with their the above said clinical sign. Majority partners. Nearly half of the pregnant of these patients had no symptoms women reported only for checkup. while the rest complaint of itching in However on clinical examination and genitalia. The clinical presentation completion of investigations, it was is similar in both HIV infected and found that 115 (88.5%) pregnant seronegative Figure 1: VVC with Genital Herpes pregnant in HIV + women women were found to be suffering although severity of symptoms were from one or other infections. This noted in the former. shows that majority of the pregnant

About 50% of the pregnant women had genital candidiasis. Candida Spp was insolated more with culture method (47.7%) than with KOH mount (21.5%) and Gram stain (30%). Hence to detect VVC in pregnancy, culture is the gold standard. This study confirmed the aspect that vulvovaginal candidiasis is more common in pregnancy and was the most common condition among HIV positive pregnant women (n=6). Most of the seropositive women with VVC were symptomatic (Figure -1). Oral thrush was noted in seropositive women in addition to VVC. Recurrent, recalcitrant and therapy resistant VVC reported in HIV positive pregnant women was not encountered in our study. Vulvovaginal candidiasis coexisted with many other STDs in the study. Species isolation was done using germ tube test and looking for the production of large, thick walled, terminal chlamydospores in cornmeal agar.

Figure 1: VVC with Genital Herpes HIV + Microscopic morphologic features of Candida Spp seen inin Cornmeal Tween 80

agar Microscopic morphologic features of Candida Spp seen in Cornmeal Tween 80 agar Candida Spp

Blastoconidia

C.albicans

Spherical clusters at regular Chlamydospores intervals on pseudohyphae pseudohyphae

C.tropicalis

Produced randomly along hyphae or pseudohyphae Present but not characteristic

C.parapsilosis C.keyfr

Pseudohyphaeor hyphae on

Pseudohyphae present but not characteristic Sagebrush appearance. Large (giant) hyphae present Elongated lie parallel to Pseudohyphae present but pseudohyphae not characteristic April 2022

Prevalence and Species Profile of Genital Candidiasis among Pregnant Women Attending STI/RTI Clinic at a Tertiary Referral Centre Part-II

Carbohydrate Fermentation Test Findings Albicans species (85.5%) Carbohydrate Fermentation Test Findings predominated this study. Non Candida Spp with Fermentation of Sugars albicans Spp formed a sizeable number of isolates Urease percentage (14.5%) among the isolated Spp.5,6,7 All patient with GLUCOSE MALTOSE SUCROSE symptomatic genital candidiasis had LACT OSE positive isolates (Figure-2). Species C.albicans AG A A of candida (albicans vs non albicans) (n=53) G which is gaining importance in the era C.tropicalis AG A A of HIV and anti-fungal drug (azole) (n=4) G G resistance was done as the clinical C.parapsilosis AG manifestation of both are clinically 8,9 (n=2) indistinguishable. Percentage of non C.Kefyr AG A albicans Spp is raising dramatically (n=2) G AG and some of non albicans Spp, C.albicans Spp in the presence of Candida glabrata (Torulopsis stringently followed in all clients HIV are resistant or less susceptible glabrata) was isolated in a single to enable them to bring partners to azole therapy. Among the noncase. Our study confirms the fact that for management when so advised albicans Spp isolated (n=9), Candida there is increased frequency of other especially in chronic, recurrent, glabrata, C.Kefyr, C.parapsilosis, candida species isolated in recent recalcitrant and therapy resistant C.tropicalis were isolated times, although C.Albicans is still genital candidiasis.10,11,12 in increasing order of frequency. responsible for majority of isolates. To conclude, there is an urgent Carbohydrate fermentation test It could be noted from this study need to mount effective, rational was the method followed to detect that the prevalence data Candidiasis and feasible intervention programs them. Candida to be tested was were almost the same in married and to combat the high prevalence grown freshly on blood agar and was unmarried pregnant women. of symptomatic/symptomless suspended in saline. 0.2 ml of saline suspension was added in to each of In our study Candidiasis and syphilis candidiasis in pregnancy, co existing the sugar tubes (glucose, maltose, were the predominant infections in disorders like anemia, diabetes, HIV/ sucrose and lactose) and incubated pregnant women. Severity of VVC STDs by making optimum use of the at 370 C for ten days. Acid (A) and symptomatology with signs like existing health and social welfare soddening, excoriations, services. Optimum therapy should gas (G) formation was noted in each severe linear erosions were observed in HIV be ensured to prevent evolving of sugar tubes. seropositive women. Uncontrolled azole resistance in the era of limited studies conform to our study which antifungal drug spectrum and invasive reports the increased prevalence and life threatening fungal pathogens.13,14 severity of VVC in HIV seropositive References women.11 Hence it is suggested that HIV serologic testing can be done in 1. King K Holmes, Per Anders Mardh, women with recurrent symptoms. As P Friederick Sparling. March 1999. [Type text] our number of sero-positive pregnant “Sexually Transmitted Diseases” – women was meager, other findings 3rd Edition – McGraw Hill international cannot be compared or generalized edition : 1089-132. with available data. 2. Sheldom H Cheery, Irwin R Co-infection with two or more Merkat.4th Edition 1991. “ infections organisms occurred in significant in Pregnancy” Complications of percentage of our study group. pregnancy – Medical, surgical, Occurrence of more than one STDs gynaecological, psychosocial and noted in this study must make any perinatal–Williams/Wilkins:302-8 clinician suspicious of possible 3. Sobel J. Vaginal infections in Figure 2: Candida Colonies in SDA concomitant STD pathogens. adult women. Med Clin N Am. Contact slip practice should be 28

April 2022

Prevalence and Species Profile of Genital Candidiasis among Pregnant Women Attending STI/RTI Clinic at a Tertiary Referral Centre Part-II

1990;74(6):1573–602. 4. Oviasogie F, Okungbowa F. Candida species amongst pregnant women in Benin city, Nigeria: effect of predisposing factors. Afr J ClinExpMicrobiol. 2009;10(2):92–8. 5. Abruquah H. Prevalence and antifungal susceptibility of Candida species isolated from women attending a gynaecological clinic in Kumasi, Ghana. J Sci Technology (Ghana). 2012;32(2):39–45. 6. Feglo P, Narkwa P. Prevalence and antifungal susceptibility patterns of yeast isolates at the KomfoAnokye teaching hospital (KATH), Kumasi, Ghana; 2012.

12. Bitew A, Abebaw Y. Vulvovaginal candidiasis: species distribution of Candida and their antifungal susceptibility pattern. BMC Womens Health. 2018;18(1):94. 13. Rati R, Patel J, Rishi S. Vulvovaginal Candidiasis and its Antifungal Susceptibility Pattern: Single center experience. International Journal of Medical Research and Review 2015;3(1). 14. Amar C, Ashish J, Hajare V, Belagali Y. Study of prevalence and antifungal susceptibility of candida. Int J Pharm Bio Sci. 2013;4(2):361–81.

7. Sasikala G, Agatha D, Janagond BA, Thenmozhivalli PR. Characterization of Candida and its antifungal susceptibility pattern from patients with vaginal candidiasis in a Tertiiary care hospital in South India. J Pharmaceutical Biomed Sci. 2013;30(30):51–6. 8. Al-akeel RA, El-kersh TA, Al-Sheikh YA, Al-Ahmadey ZZ. Prevalence and comparison for detection methods of Candida species in vaginal specimens from pregnant and non pregnant Saudi women.Afr J Microbiol Res. 2013;7(1):56–65. 9. James GD, Essieen UC, Victoria MD. Prevalence and antifungal susceptibility profile of Vulvovaginal candidiasis amongst women of reproductive age in Jos Metropolis, Nigeria. World J Pharmaceutical Life Sci. 2017;3(3):152–6. 10. Meizoso T, Rivera T, FernándezAceñero M, Mestre M, Garrido M, Garaulet C. Intrauterine candidiasis: report of four cases. Arch Gynecol Obstet. 2008;278(2):173–6. 11. Vijaya D, Dhanalakshmi TA, Kulkarni S. Changing trends of vulvovaginal candidiasis. J Laboratory Phys. 2014;6(1):28. April 2022

Let’s Talk Tresses-HAIR AESTHETICS

Let’s Talk Tresses HAIR AESTHETICS Dr. Anju Jha

MD, Dermatology Consultant Dermatologist Mediwell Skin Clinic, Vaishali, Ghaziabad, Vasundhara Enclave, Delhi.

Invest in your hair, It is the crown you Never take off Although dermatologists are experts in managing scalp and hair disease, the aesthetics of some cosmetic therapies still remain elusive. Little is taught about hair cosmetics so that prescriptions are mostly based on active substance for treatment of the scalp and usually disregards the hair fibre structure. Prescribing the right shampoo or conditioner, correct advice regarding different hair procedures will go a long way in increasing patient`s adhesion and compliance to treatment. A knowledge about the hair shaft structure and understanding the diversity of hair types and procedures are important. Structure of hair The hair is a complex structure and the shaft has three main regions – cuticle, cortex and medulla. The medulla is present in coarser hair and is absent in fine hair of children. The cuticle is a chemically resistant region and consist offlap overlapping scales (keratinocytes). The cuticle is generally formed by 6-8 scales thick for Asians, slightly less than Caucasians and even less in Africans. A thin 30

April 2022

cuticle layer makes African hair more prone to breakage. Each keratinocyte has a proteinaceous membrane, the epicuticle, covered with a lipid layer that includes 18-methyleicosanoic acid (18 MEA). It consists of fusiform spindle cells approximately 100 microns long arranged longitudinally. Spindle cell has microfibrils and my macrofibrils within cysteine-rich matrix. Disulfide bonds that hold the proteins to the other are the most important bonds that hold the keratin protein together. They are responsible for the final shape of hair. These bonds have to be broken during procedures like perming and straightening. The hydrogen bonds are weaker bonds which are affected even by hair wetting. The cells of the cortex contain melanosomes that are responsible for colour of the hair. Hair colour is due to presence of pheomelanin (red) or eumelanin (brown or black). The medulla is at the core of hair fibre. It is rich in glycogen and citrulline. It is present in only thick hair of the scalp and is lost in ageing gray hair. The structure of unprocessed hair is perfectly designed and its outermost layer remains smooth, well protected, dries when wetted and resist diffusion into cortex. This maintains the structural integrity.

Let’s Talk Tresses-HAIR AESTHETICS

Weathering of hair Damage of cuticle results in weathering of hair. Ultraviolet exposure, repeated chemical procedures, strong blow drying, repeated combing and brushing are contributory factors. Disrupment of cuticle exposes the cortex to damage resulting in split ends also called trichoptilosis. Hard water has high concentration of dissolved minerals specially calcium and magnesium and at times are not rinsed out completely and cause mineral buildup contributing to deposits on hair. This makes the hair dull, rough and lustreless. Lemon rinse, apple cider vinegar or water softening showerhead can be used. The use of hair drying at a distance of 15 cm with continuous motion causes minimal damage to hair. Thermal treatment decomposes tryptophan residues to kynurenine type oxidation products. Care of Hair Shampoo The main work of shampoo is cleansing the scalp but lot of expectations are shouldered like, adding volume, rendering softness, ultraviolet protection and protection of the coloured hair. The pH of scalp is 5.5 and hair shaft pH is 3.67. An alkaline pH may increase the negative electrical net charge on hair shaft fibre and cause more frizz or friction. Hence the final pH of shampoo should be around 5.5. An ideal shampoo should consist of : • cleansing agents or surfactants • additives for stability of products • hair conditioning agents Cleansing agent or surfactant is the most important ingredient. It can be anionic or cationic or amphoteric or non-ionic. Anionic cleansers are deep cleansing

agents and includes ammonium lauryl sulfate, sodium lauryl sulfate, sodium lauryl sarcosinate and sodium lauryl sulfate. Cationic cleansers are more of hair softeners and mild cleanser containing trimethyl alkylammonium chloride and chlorides and bromides of Benzalkonium ions. Amphoteric agents usually are mild cleanser and have excellent dermatological properties. There are two types of amphoteric compounds - alkylimino propionates and amido betaines. Coca amido propyl betane is used in sulphate free shampoo. Non ionic surfactant used are cetyl alcohol and stearyl alcohol. They do not ionize in aqueous solution. Choosing a shampoo An appropriate shampoo should be selected for cleansing. The pediatric shampoos usually have an alkaline pH of 7. This is usually done to keep the pH closer to tear physiological pH (no tears concept). Adults with bleached or dyed hair should not use pediatric shampoos as they are more alkaline. For adolescence or young adult, with dandruff and oily scalp, anionic surfactant-based cleanser will be needed for proper and deep cleansing of scalp. Cationic cleanser can be used in people with sensitive scalp and to minimize the frizz. Ones using hair dye and bleach hair can use cationic or amphoteric based shampoo with or without nonionic compounds. It is important to remember that with increasing ingredients and additives in shampoo it is the final interaction of ingredients and pH which has the final effect. Conditioners Conditioner are used to decrease friction, detangle the hair, minimize frizz and improve combability. Conditioner should be capable of restoring the hydrophobicity of the

hair fibre and neutralise the static electricity. An ideal conditioner should have following properties: Improve combability Mimetize the hair natural lipid outer layer:18-MEA Restore hydrophobicity Seal the cuticle- Minimize frizz by neutralizing the net negative charge Enhance shine, smoothness and manageability. The anti-static and lubricating substance includes polymers, oils, waxes, hydrolyzed amino acids and silicone, specially dimethicone. Conditioners flatten the cuticles and seal the gaps that exposes the cortex to damage. Bleached and chemically treated hair have high affinity to conditioning ingredients as they have low isoelectric point and more porous than the virgin hair. Deep conditioners are mostly in cream formulation and contains concentrated conditioning agents like ammonium protein or quaternary ammonium salts which provide more smoothening effect with better gloss. It is mainly used in parlors following chemical processes. OIL Oils play an important role in protecting hair from damage. Sebum is the natural oil produced by sebaceous glands. The main property of the oil is the hydrophobicity it renders to the hair. Some oils can penetrate the hair and reduce the amount of water absorbed in the hair. Thus, it can decrease the hygral fatigue. Amongst the different oils available, coconut oil is the only oil found to reduce the protein loss for both damaged and un-damaged hair when used as a prewash grooming product. The oil can fill the gap between cuticle cells and prevent April 2022

Let’s Talk Tresses-HAIR AESTHETICS

the penetration of surfactants during cleansing. Coconut oil is a triglyceride of lauric acid and has high affinity for proteins and due to its low molecular weight and straight linear chain, is able to penetrate the hair shaft. Moroccan argan oil has gained popularity as it is rich in tocopherols and other powerful antioxidants. As dermatologists most of the times we restrict the use of oil on scalp in patients with seborrheic capitis and acne vulgaris. The use of oil can however be advised as a prewash on rough and damaged hair to avoid frizz and easy combability. Hair Colour and Dye Permanent dyes Permanent hair colours are the most commonly used hair colours because of their longevity. The permanent dyeing is an oxidation reaction that allows the pigment to get inside the cortex. The pigments are para-phenylenediamine, para-toluenediamine and paraaminophenol. They combine with hydrogen peroxide to liberate oxygen. The entry of dye is facilitated by ammonia. In the so called “ammonia free” dye, this work is done by alkaline agents like sodium carbonate and ethanolamine. Both substances remove the natural cuticle lipid, the 18-methyleicosanoic acid, which confers hydrophobicity to the hair fibre. Once inside the cortex the colour is retained. The roots need to be touched after 15-30 days and the product must be carefully applied to only the new growth. Demi permanent dye Demi permanent dyes do not contain ammonia or ethanolamine and hence are gentler on hair. Hydrogen peroxide is low or 2% as compared to 6% in permanent colours. They only reach the cuticle. The effect lasts for 8-15 shampoos. 32

April 2022

Semi-permanent hair colours The products used are mainly anthraquinone, aromatic amines or aminonirobenzenes. They do not require hydrogen peroxide. The colour is applied on shampooed hair and rinsed after 20 minutes of application. It can be removed after 6-8 shampoos. A patch test is also recommended. Safe use of hair colours and dye Paraphenylenediamine (PPD) is the major component of oxidation hair dyes and it is a sensitizer of prime concern. 2-nitro phenylenediamine and 4-nitrophenylenediamine are currently banned in US and Europe due to carcinogenic potential. PPD undergoes coupling reaction in presence of oxidizing agent with higher pH specially more than 9 pH forming a Bandrowsky’s base (C18H18N6). This base contributes to carcinogenic and other adverse effects. This base formation can be stopped by an optimum pH. Section 149 in the Drugs and Cosmetics rules, 1945 of Central Government act regarding labelling of hair dyes containing dyes, colours and pigments, states that-Hair dyes containing para-phenylenediamine or other device, colours and pigments, shall be labelled in English and local languages and these shall appear on both the inner and outer labels. “Caution-This product contains ingredients which may cause skin irritation in certain cases and so a preliminary test according to the accompanying direction should first be made. Cleanse a small area of skin behind the ear or inner surface of forearm. Apply a small quantity of the hair dye as prepared for use to the area and allow it to dry. After 24 hours wash the area gently with soap and water. If no irritation or

inflammation is apparent it may be assumed that no hypersensitivity to the dye exists. The test should however be carried out before each and every application. This preparation should on no account be used for dyeing eyebrows and eyelashes as severe inflammation of the eye or even blindness may result. Vegetable dye (Henna) Red Henna is dried and powdered leaf of lawsonia inermis. Its usage can cause rarely allergic contact dermatitis by the active ingredient 2- hydroxy 1, 4 naphthoquinone. The active ingredient is obtained by treating leaves with sodium bicarbonate. Lawsone is potent oxidant of G6PD deficienct cells and can cause lifethreatening haemolysis in children with G6PD deficiency. Black Henna contains paraphenylenediamine. Hence patch test is recommended in patients with contact dermatitis. A number of herbal and ayurvedic dyes are available in India and recommended in people allergic to para dyes eg. Vegetal, Indus Valley, Optima hair dye, Godrej hair colour. The ingredients mainly includes Indigo (Indigoferra tinctoria), Henna (Lawsonia Inermis), coffee (Coffee arabica), Brahmi (Bacopa monniera), Kattha (Acacia catechu) and Amla (Emblica officinalis). The application is however cumbersome and might require repeat applications to give the desired colour. Hair Procedures Hair bleaching Hair bleaching is a process where a lighter shade is wanted from an existing one. Bleaching involves two steps namely, stripping hair of all eumelanin and then using a toner to get the required shade. This process is capable of only bleaching eumelanin and not pheomelanin. A mix of

Let’s Talk Tresses-HAIR AESTHETICS

hydrogen peroxide and ammonia with or without ammonium or potassium persulfate as a booster is used for opening of the cuticle and stripping the eumelanin from the cortex. When extreme colour change is done that is from black or dark brown to blonde, the process requires boosters that can result in serious damage to the hair shaft. Hair bleaching is a time bound process where the hairdresser checks the colour of the hair every 10 to 15 minutes. The total duration depends on the final colour required. The hair is then washed with the specialised shampoo. The next step is application of the hair colour that may be a semi-permanent or a permanent dye. This is left for half an hour and hair is rinsed with water to remove all colour. Conditioning is necessary as the hair structure is now damaged. This process is called toning. Highlighting is a process by which isolated sections of hair are either lightened or darkened. This is done by the foil method where strands of hair are separated a comb and laid over an aluminium foil sheet, and then painted with the mixture of hydrogen peroxide and pigment. Dip dyeing is a process where only hair ends are coloured with the dye different from the base. Ombre is a trend where hair is dyed to give a shaded colour. Hair bleaching products may cause serious systemic reactions or anaphylaxis and can aggravate eczematous dermatitis especially in hairdressers. Hair Straightening Hair straightening is done using straighteners or hair relaxer. Hair straighteners are called chemical relaxers and effect of hair straightening is permanent. Alkaline straighteners contain 1 to 10% Sodium Hydroxide (lye relaxer), lithium hydroxide, calcium hydroxide or a combination of ingredients such

as guanidin carbonate and calcium hydroxide (no lye relaxer). The high pH (9 to 14) of emulsion swells the hair, thus opening cuticles scales which allows the alkaline agent (OH-) to enter the cortex. The straightening products reacts with keratin, breaking and rearranging the disulfide bridges which makes the spiral keratin molecule soft and straight. This process is called “lanthionization”. One third of cystine amino acid is substituted by lanthionyl residues forming a stable thioester crosslink. Disulphide bonds are cleaved, the hair is mechanically straightened using a comb to restructure the position of disulphide bonds between new polypeptide keratins. The relaxers are applied on prewashed hair, and after usage, must be rinsed off with running water. Permanent straightening can be achieved but wrong technique can cause scalp burn and hair breakage. No lye relaxer like ammonium thioglycolate are better than alkaline relaxers and there is no lanthionin formation. 90% of initial cystine content is retained with 10% additional cysteine as cysteic acid. This means use of thioglycolate cause less protein loss than the hydroxides. Thioglycolate and hydroxides are not mutagenic and show no evidence of carcinogenicity. The no lye relaxer (guanidine hydroxide) are less irritating to the scalp than lye relaxer (sodium hydroxide). Both are incompatible with bleached or dyed hair. It is always advisable to perform compatibility test by the hair professional on few strands of hair. Hair Keratin Smoothening

Treatment/

on formaldehyde or glutaraldehyde but on formaldehyde releasers such as methyl and glycoxylic acid. Both these products release formaldehyde during blow dry and hot iron application. It is not a hair straightening product. The hair is remodeled straight because water breaks hydrogen bonds of the molecule. The formaldehyde crosslinks the keratin filament in a perfect alignment so that the hair is set straight and shines like virgin hair. It is more popular because it gives the hair natural smooth and shiny look which is not possible with chemical relaxers. It is compatible with bleached hair and permanent dyes. The effect of formaldehyde and formaldehyde releasing products on salon workers and clients during keratin hair smoothing treatment can exceed the occupational exposure limits. The carcinogenic potential and genotoxic response has been seen in various studies. It is advisable that pregnant females should not expose themselves to such treatment. New products and lots of innovative development are evolving in Hair Care industry. The ultimate aim is to maintain a smooth glossy and prevent hair aging. As a dermatologist it is our responsibility to have a better understanding of hair care products so that we can advise and treat better.

Hair

Hair smoothening is also known as Brazilian blowout or keratin treatment or cysteine treatment or hair botox. The use of formaldehyde formulation became popular in Brazil since 2003. The product use today are based not April 2022

SUBSCRIBE TO

INDIA’S ONLY JOURNAL ON AESTHETIC DERMATOLOGY

Pay Rs. 600/- ONLY

“The Aestheticians Journal”

Get Your Annual Subscription of

is available for subscriptions strictly to MD, DNB, DDV, MS, Mch only on submission of Credentials along with the payment.

Demand Draft to be Drawn in favour of The AESTHETICIANS Journal

The Publisher retains the right to accept OR reject any application for subscription should it be presented without supporting credentials.

The AESTHETICIANS Journal

All Payments to be sent to: The AESTHETICIANS Journal

22, Shreeji Bhavan, 275-279, Samuel Street, Masjid Bunder (W.), Mumbai- 400 003, INDIA Tel: +91 22 23451404 Email: theaestheticiansjournalindia@gmail.com

The Publisher decision to accept or reject any application for subscription is ﬁnal.

Since we are governed by Indian Postal Service, we need your complaints in written on theaestheticiansjournalindia@gmail.com Please send your complaints by 15th of every month failing which no complaint will be entertained.

Annual Subscription Form Rs. 600/-

Clinic Name: _____________________________________________________________ Doctor’s Name: ___________________________________________________________ Address: ____________________________________ City: _______________________ ____________________________________________ Pincode Pincoce:: ____________________ State: _________________ Tel: _________________ Mobile: _____________________ E-mail: ______________________________________ DD Details: __________________

April 2022

admin@mitchellusa.co.in