Filarial nematode infection presenting as subcutaneous swellings is uncommon and often mimics other benign subcutaneous swellings. While individual cases are documented, few case series explore this specific presentation. This study aims to examine patients with histopathologically or radiologically confirmed filarial nematode infection manifesting as subcutaneous swellings of various parts of the body. A retrospective analysis was conducted at a teaching hospital in Kerala from January 2015 to December 2020, reviewing all excised subcutaneous swellings confirmed as nematode infection. Since filarial nematode infestation presenting as a subcutaneous swelling is an uncommon presentation, a high index of suspicion is required for the diagnosis and should be one of the differential diagnosis of benign subcutaneous swelling, especially in endemic areas.

Treatments for moderate-to-severe alopecia areata (AA) have limited efficacy. Methotrexate, a conventional immunosuppressant, has been used for AA, while Janus kinase/signal transducer and activator of transcription (JAK-STAT) inhibitors like tofacitinib have shown promising results. To compare the efficacy of tofacitinib and methotrexate in moderate-to-severe AA. Thirty-six patients aged 18-60 years with a severity of alopecia tool (SALT) score >40 were randomized to receive either tofacitinib (5-10 mg twice daily) or methotrexate (0.3-0.5 mg/kg weekly) for 6 months, followed by 3-month follow-up. Primary outcomes measured the proportion achieving a SALT score ≤20 at 6 months. Secondary outcomes included patient-reported outcome (PRO) on scalp hair assessment, dermatology life quality index (DLQI), patient health questionnaire (PHQ) scores, relapse rates, and alkaline phosphatase (ALP) activity in scalp biopsies. At 6 months, 50% of tofacitinib patients achieved a SALT score ≤20 vs. 33.3% with methotrexate ( P = 0.31). A ≥ 90% SALT improvement occurred in 33.3% of tofacitinib and 11.1% of methotrexate patients ( P = 0.10). The tofacitinib group had greater scalp hair PRO score reductions. Both groups showed significant DLQI and PHQ improvements, with no intergroup differences. Adverse events were reported in 38.8% of tofacitinib and 33.3% of methotrexate patients ( P = 1). ALP activity was inconclusive. Small sample size, open-label design, lack of stratification, and baseline imbalances that may affect achievable improvement and comparative interpretation. In this pilot trial, both tofacitinib and methotrexate improved SALT score, PRO score, and psychological outcomes, but the tofacitinib group showed greater efficacy. Larger studies are warranted to confirm findings and investigate ALP activity.

Alopecia areata (AA) is a chronic, immune-mediated disorder characterized by nonscarring hair loss. Emerging evidence suggests that AA is associated with systemic inflammation, metabolic dysregulation, and coagulation abnormalities. However, data on these associations in the Indian population remain limited. To evaluate coagulation parameters, metabolic profiles, and inflammatory markers in Indian patients with AA and assess their correlation with disease severity. A case-control study was conducted at a tertiary care center in North India, including 110 AA patients and 110 age- and sex-matched healthy controls. Coagulation parameters (D-dimer, fibrinogen, prothrombin time, and activated partial thromboplastin time), metabolic markers [fasting blood glucose, lipid profile, body mass index (BMI)], and inflammatory markers [C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)] were analyzed. Disease severity was assessed using the Severity of Alopecia Tool (SALT) score. Correlation and multivariate regression analyses were performed to identify predictors of severe AA. AA patients exhibited significantly elevated D-dimer ( P < 0.001) and fibrinogen levels ( P < 0.001) compared to controls, indicating a hypercoagulable state. The prothrombin time was also prolonged ( P = 0.03). Metabolic abnormalities, including higher fasting blood glucose ( P < 0.001) and total cholesterol ( P = 0.008), were observed. Inflammatory markers (CRP and ESR) were significantly elevated in AA patients. A strong positive correlation was found between SALT scores and D-dimer levels (r = 0.64, P < 0.001). Multivariate regression analysis identified D-dimer (95% CI: 1.58-4.20), fibrinogen (95% CI: 1.41-3.11), CRP (95% CI: 1.23-2.97), and BMI (95% CI: 1.18-2.46) as independent predictors of severe AA. Cross-sectional study design and lack of longitudinal follow-up. Indian AA patients exhibit significant coagulation abnormalities, metabolic dysregulation, and systemic inflammation, with these factors correlating with disease severity. These findings suggest that AA extends beyond a localized dermatological disorder and may have systemic implications. These associations imply a link rather than causality due to the cross-sectional nature of the study. Further research is warranted to explore the role of targeted therapies in mitigating these risks.

Narrowband ultraviolet B (NBUVB) phototherapy is an established treatment for vitiligo. However, real-world practices vary significantly, particularly in dosing strategies, maintenance schedules, and the use of minimal erythema dose (MED) testing, impacting treatment outcomes. To assess NBUVB phototherapy practices among Indian dermatologists, evaluate patient characteristics and treatment outcomes, and identify variations in clinical protocols. An online, questionnaire-based survey was conducted among 80 Indian dermatologists who responded actively using NBUVB. The questionnaire was validated through expert review, pilot testing, and reliability assessment before deployment. Validation included content validation by three senior dermatologists with more than 15 years of phototherapy experience to ensure item relevance and clarity. A pilot test among 10 dermatologists confirmed internal consistency. Data were analyzed using descriptive statistics. Among 80 respondents (response rate of 5%), 65% had >10 years' experience. Most respondents (52.5%) used only NBUVB whole-body units, while others employed combination or targeted phototherapy devices. MED testing was performed by only 30%, typically using visual test dose methods; 70% used empirical starting doses. A 200 mJ/cm² starting dose was most common (60%). Maintenance therapy was administered every 1-2 weeks in 75%. Early clinical improvement was observed after 10-20 sessions, and >50% re-pigmentation in vitiligo occurred after 50-70 sessions in 85%. Acral vitiligo showed a mixed response, with poor or limited response in 60% of cases. Mild erythema (80%) and burning (60%) were the most reported side effects. The study is limited by self-reported data, possible recall bias, and lack of detail on MED testing procedures. There is marked variability in NBUVB protocols among Indian dermatologists. Emphasizing standardized guidelines and MED-based personalized dosing could improve therapeutic outcomes and patient safety in vitiligo management.

Vitiligo is an autoimmune disorder characterized by the destruction of epidermal melanocytes, leading to white lesions devoid of pigmentation. The destruction of epidermal melanocytes is driven by tissue-resident and circulating immune cells that maintain an inflammatory milieu. Two percent of the global population suffers from vitiligo, with a higher prevalence reported in the Indian population. Narrow-band UV-B (NBUVB) phototherapy is commonly used as an economical, non-invasive, and well-tolerated treatment modality. NBUVB promotes the migration of melanocyte stem cells (MelSC) to the epidermis, thus restoring pigmentation in affected individuals. This study aimed to investigate the histological and gene expression changes in Indian vitiligo patients pre- and post-NBUVB phototherapy. Indian patients with stable vitiligo underwent NBUVB monotherapy, administered thrice weekly for three months, to induce repigmentation. Single 3 mm skin biopsies were taken from vitiligo lesions pre- and post-NBUVB phototherapy for histopathological and gene expression analysis. A contralateral pigmented region was considered as the control skin from the same patient. Following NBUVB monotherapy, melanocytes were restored in the epidermis of vitiligo patients and produced melanin pigment. The mean area of pigmentation post-NBUVB therapy was 2.94% ± 0.97%, compared to 0.11% ± 0.19% in vitiligo lesions before NBUVB therapy. Following NBUVB phototherapy, melanocytes migrating from the hair bulge upregulated key genes in melanocyte differentiation (PAX3) and melanogenesis (KIT, TYR, DCT/TRP2). In addition to the favorable clinical outcome of repigmentation, NBUVB was effective in reducing the skin T-cells, indicating successful immunosuppression. The major limitation of our study was the limited sample size of our patient cohort. Our study reaffirms the therapeutic efficacy of NBUVB in promoting repigmentation in an Indian cohort of vitiligo patients. Furthermore, NBUVB is effective in reducing CD3+ skin-resident T-cells, widely considered a major contributor to the pathogenesis of the disease.