Newsletter April 2014 Issue: II

Society of Ladies in Dermatology is an initiative to bring together lady dermatologists to

further academic interactions among our peers. The second meet of SOLID (Chennai) held

on March 9 th, 2014 was an interesting blend of academia and entertainment.

BOARD MEMBERS

President: Dr.S. Shobana MD, DD

Secretary: Dr. Samna Pramod, DDVL

ADVISORY BOARD

Dr. D. Prabhavathy MD, DD

Dr. K. N. Sarveshwari MD, DD, DNB

Dr. Maya Vedamurthy MD, DD

Dr. Parvathi Padmanabhan MD, DD

EDITORIAL BOARD

Dr. Shwetha Rahul MD.DVL

Dr. S. Varalakshmi DDVL

Dr. Sindhuja MD.DVL

EXECUTIVE BOARD

Dr.T.K. Anandi MD

Dr. Renuka Ramakrishnan MD

Dr. Vidya gives an insight into ‘Facial melanoses’ and

newer advances in their management

PRESIDENT’S MESSAGE:

Dear Ladies,

Greetings and Warm wishes to all members of SOLID!

The SOLID had its second meeting on March 9th 2014 to coincide with Women's Day

celebrations. Dr T. S.Vidya from Bengaluru shared her views on the practical management of

facial melanoses. The interactive session that followed was very lively and stimulating. We

were also addressed by Dr Nagabooshanam regarding issues in medical malpractice and how

to safeguard ourselves. M/s New India Assurance explained the various policies available for

doctors to insure themselves against litigation. An entertainment session followed which was

full of camaraderie and good natured ribbing. On the whole, it was a truly enjoyable session.

On a more serious note, it is common knowledge that most, if not all of us, suffer from the

"Sitting Disease". This condition affects all of those who spend long hours sitting in our cars,

consultation rooms as well as in front of the television. Sitting disease is known to make us

more prone to diabetes, hypertension, cardiac disease and obesity. To counter the ill effects of

prolonged sitting one needs to get NEAT - non-exercise activity thermogenesis. Would you like

to know more? Then ladies, welcome to the third meeting of SOLID!

With best wishes,

Dr Shobana S.

From the editor’S desk:

Dear colleagues,

We are two meetings old and we are already making a SOLID impact with

our e journal! We thank the contributors for the excerpts from the guest talks

and articles. However, we have a long journey ahead, rather an unending one, in

our pursuit of continuing medical education.

We urge and would appreciate a more active participation from members

with new ideas, articles, and clinical cases.

Warm regards,

Editorial Team

Facial Melanoses

Facial melanoses was the topic discussed elaborately by Dr. Vidya .T.S.

They are a complex group of diagnostic problems resulting from disruption of melanin cycle,

factors stimulating melanocytes and ultraviolet radiation. The following are the common

contributors to it:

I. Melasma: Face is the most commonly affected site and may extend to ‘V’ of neck.

According to the site (in the face) it could be,

Centro facial

Malar

Mandibular.

According to course it is classified into:

Transient type – disappears within a year of withdrawal of hormonal status.

Persistent type

II. Erythema dyschromicum perstans – Asymptomatic enlarging persistant macules of

variable size over face, trunk and limbs.

III. Lichen planus pigmentosus

IV. Riehl’s melanosis.

V. Erythrose peribuccale pigmentaire of Brocq

VI. Poikiloderma of Civatte.

VII. Erythromelanosis follicularis of face and neck.

VIII. Nevus of Ota.

IX. Periorbital melanosis.

X. Addison’s disease.

XI. Exogeneous Ochronosis.

XII. Post chikungunya pigmentation: Asymptomatic brownish black pigmentation

involving centrofacial area in the form of freckles like macules or slate colored

pigmentation.

XIII. Acanthosis nigricans.

Treatment:

a) Life style modification - Avoiding peak hours of sunlight.

b) Photo protection - Clothes and sunscreens (opaque sunscreen).

c) Avoiding provoking factors

d) Lightening agents – topical-hydroquinone – 2 to 4%, Azelaic acid 10 to 20%, Modified

kligman’s formula (Hydroquinone, tretinoin and fluocinolone acetonide) and kojic acid.

e) Chemical peeling: TCA, Jessners solution, alpha hydroxy acids, kojic acid and salicylic

acid.

f) Topical corticosteroids- can be tried for a short duration.

g) Lasers:

Combination of pulsed Co2 laser and alexandrite laser gives a better reduction in MASI.

Q switched alexandrite laser combined with TCA and jessners solution gives good to

excellent response.

Erbium YAG laser effective in women with melasma.

Q switched ruby laser is ineffective in melasma.

For melasma the consensus is that first line therapy should consist of effective topical

therapies mainly fixed triple combinations.

New therapeutic modalities:

1) Lactic acid peels for melasma.

2) 10% zinc sulphate solution for melasma.

Twice daily application for 2 months showed 50% improvement.

3) Rucinol serum for melasma.

Inhibits activity of both tyrosinase and TRP-1 involved in melanogenesis.

Applied twice daily for 3 months showed significant improvement with good tolerability

and acceptance.

4) N-acetylglucosamine and niacinamide

Inhibits melanin high stability and tolerance present.

5) Vitamin C with Vitamin E and ferrulic acid:-

Being a potent anti oxidant mixed with vitamin C & vitamin E, ferrulic acid gives added

photo protection.

Other agents which can be tried- Grape seed extract, polypodium, oat meal extract,

silymarin, tea tree.

Pediatric drugs and dosages commonly used in

dermatological practice

By Dr. Shwetha Rahul

ANTIBIOTICS

S.NO DRUG DOSAGE(mg/kg/da

y) DOSING SCHEDULE (DIVIDED DOSE)

1 Amoxicillin 20-50

8-12 hrly Cap 250,500,

Dispersable tab 125,250 mg

(BD/TDS)

Dry syrup125 mg/5ml,250mg/5ml;

Drops 100mg/ml;

Inj 250/500mg per vial

2 Amoxcillin-

Clavulanate 20-50 BD

Suspension 125+ 31.25,

Syp 200+ 28.5,

Tab 250+125,500+125

Inj 500+125mg, 1g+0.2g

3 Cephalexin 25-50 Q ID/BD

Cap-250,500

Tab-(DT)125,250

SYP-125mg/5ml

Drops-100mg/ml

4 Cefuroxime 15-30(oral)

50-100 (i.v) BD

Tab.125,250,500,

Suspension-125mg/5ml,

250mg/5ml, Injection-

250,750,1.5g/vial

5 Cefaclor 20 BD

CAP 250,500 mg DTab-

125,250mg

Syp 125mg/5ml, Drops 50mg/ml

6 Cefaperazone 100-150(IV) BD/TDS Inj 250 mg/500mg/1g/1.5g/2g

with sulbactum 0.5/1g

7 Cefotaxime 100-150(IV) TDS/QID Inj 125 mg, 250mg, 500mg,1g

8 Azithromycin

Day 1 :

10 mg/kg/day

Day 2-5 : 5mg/kg/d

OD

Kid Tab 100mg ;

Tab 250,500mg

Dry Syp 100,200mg/5ml

9

Doxycycline

(contraindicate

d in children

<8 yrs)

2 BD

Syp 25mg/5ml,

Drops 10mg/ml

Cap / disp tab 100mg

10 Erythromycin 30- 50 QID Susp / syp 100, 125 mg/ 5 ml

Drops 100mg/ml,Tab 250, 500 mg

11 Gentamycin 5-7.5 (IV) BD/TDS INJ 40 mg

12 Cotrimoxazole 6-12 mg

trimethoprim BD

Tab-80(T)+400(S) ,DS

Tab160+800

Syrup/susp 40mg trimethoprim

+ 200 mg sulfamethoxazole/ 5ml

13 Metronidazole 30mg/kg QID Tab 200 /300/400 mg

Syp/susp 200mg/5ml

14 Rifampicin 10-20 OD/BD Susp 100mg/5ml, 200 mg/ 5ml

Cap 150, 300,450, 600 mg

ANTIVIRAL DRUGS: S.NO DRUG DOSAGE Available as:

1. Acyclovir:

Varicella in

immunocompetent 20 mg /kg/dose QID for five days QID

Varicella in

immunocompromised

20mg/kg/dose i.v at a constant rate

over 1 hr TDS for seven days TDS

ANTI FUNGAL DRUGS:

S.NO DRUG DOSAGE(mg/kg/day) Can be given from the

age of:

1 Griseofulvin

10-20mg/kg

(In 2 divided doses)

4 mnths

2 Fluconazole 3 mg/kg/day Birth

3 Itraconazole 5mg/kg/day 6 mnths

4 Ketoconazole 3-6mg/day 2 yrs

5 Terbinafine 5mg/kg/day 2 yrs

6 Amphotericin- B 0.5-1mg/kg/day

ANTISCABETIC DRUG:

S.N

O DRUG DOSAGE(mg/kg/day)

DOSING SCHEDULE

(DIVIDED DOSE)

1 Ivermectin 0.2mg/kg/day Tab- 3, 6,12 mg, susp -1.5/3 mg +

400/200mg albendazole

ANTIHISTAMINICS: S.NO DRUG DOSAGE(mg/kg) DOSING SCHEDULE / Available as:

1. Diphenhydramine 5mg/ kg /day

TDS/QID

(divided dose)

Syp 12.5mg/5ml

Cap 25mg, 50 mg

2.

Chlorpheniramine

maleate

3-5 mths: 0.5 mg BD

6-18 mnths: 1-1.5 mg

BD/TDS

2-5 yr: 1mg BD/TDS

Injectable:

0.35 mg/kg/day in

divided doses 4-6

hrly

Syp 2mg/ 5ml

Tab 4 mg

Inj 10mg/ml

3

Dexchlorpheniramine

maleate

2-5yr: 0.5mg/dose

6-11 yr: 1mg/dose

TDS Syp 2mg/5ml, Tab 2

mg

4

Hydroxyzine 2mg/kg/day TDS/QID

(divided dose)

Syp 10mg/5ml

drop 6mg/ml

Tab- 10 mg, 25mg

Inj 25mg/ml

5

Cetrizine

2-5yrs-2.5mg/dose

>6yrs -5-10mg/dose

OD Syp 5mg/5ml,

Tab 5,10 mg

6

Loratidine 2-5yrs-5mg

>6yrs-10mg OD

Syp 1mg/ml, 5mg/5ml

Tab-10 mg

7

Montelukast

( To avoid in child<2

yrs)

2-5yrs- 4mg

6-14yrs- 5mg HS Tab-4,5,10mg

ANTI-INFLAMMATORY DRUGS:

S.N

O DRUG

DOSAGE

(mg/kg/day)

DOSING SCHEDULE /AVAILABLE

AS:

(DIVIDED DOSE)

1 Prednisolone. 0.5-2 OD/BD

Tab 5,10,20,30,40 mg, syp

15mg/5ml

2 Paracetamol 30-60

TDS/QI

D

Syp 125mg/5ml,

Drops:30mg/ml

drops:30mg/ml

IMMUNOSUPPRESSANTS:

S.NO DRUG DOSAGE(mg/kg/day) DOSING SCHEDULE (DIVIDED

DOSE)

1 Cyclosporine 3-5mg/kg/day In two divided dose

2 Azathioprine 1-2.5mg/kg/day

3 Methotrexate 0.2-0.4mg/kg/week In single or divided dose

MISCELLANEOUS:

S.NO DRUG DOSAGE(mg/kg/day) DOSING SCHEDULE

/AVAILABLE AS

1 Zinc 0.5-1mg/kg/day 1-3 divided doses

2 Vit- A

<1 yrs: 100,000 u every 4-6

months

>1 yrs: 200,000 u every 4-6

months

Available as Inj 1lakh IU/2ml

Drops 1.5 lakh IU/ml

>8yrs:1-3 days 1lakhs u/day

4-14 days 50000 u /day

3

Calcium

supplementation

Neonate: 50-150mg/kg/24 hrs

Child: 45-65mg/kg/24 hrs Available as syp 250mg/5ml

4 Omeprazole

0.5-1mg/kg/dose OD or BD

5-10kg- 5mg OD

10-20kg- 10mg OD

More than 20 kg- 20mg OD

Available as Cap 20/40mg.

2mg/ml solution

5 Ranitidine

4-10mg/kg/day,

Divided dose 8-12 hrs

Tab 150,300mg

Inj 25mg/ml

REGISTRATION DETAILS: Eligibility criteria : MD, DD Dermatology

MD, DDVL, DNB Dermatology, Venereology and Leprosy

Registration fees : Nil

The registration form is attached separately. The filled registration form along

with a copy of the required certificates (undergraduate, postgraduate degree and

registration certificates) and one passport size photograph needs to be mailed to the

following address:

Dr. Samna Pramod

2A Ramkamal flats, No. 18, Sivaganga Road, Nungambakkam, Chennai 600034

Ph: 044 28267719

You can e mail your articles / case presentations to:

vara18vara@gmail.com, drsindhuderm@gmail.com

Or contact: Dr. Varalakshmi {9444140971} Dr. Sindhuja{9840457041}