GGRS6298662P

追加: 2026-05-26

[00:00:01]Yeah, sure.

[00:00:47]We are live now. We can start with >> Okay. Good evening everyone. I'm Dr. Reema Matai from Glenmark's medical affairs team. On behalf of Clenmark, I extend a very warm welcome to all of you for joining us today for this dermatology master class. So today's session we will be particularly focusing on three major dermatological conditions such as autotopic dermatitis, vitiligo and recurrentia.

[00:01:12]And as we all know that each of these three comes with its own set of challenges whether it is chronic relapsing nature of attopic dermatitis or the psychosocial impact of vitiligo or the frustrating regress that we usually see in dermatophytosis.

[00:01:27]But what makes it quite interesting is how the treatment approach is also quite evolving. Today we have targeted therapies like tacrolymus, licenazole and abroetanib which can be used quite effectively to manage these conditions only when it is used in a right clinical context. So in today's discussion we will be having a brief discussion on a real life casebased scenarios and try to understand how these therapies can be used optimally. So let me begin by introducing to you all our distinguished panel of experts who will be sharing their real life experiences and clinical insights. So we have among uh Dr. Nitika Dishmuk. She's the moderator for today's session. Dr. Nitka is a consultant dermatologist at Dinanat Mangeshkar Hospital in Pune. She has contributed extensively to the dermatology literature with more than 50 publications in national and international journals and has delivered more than 14 oral presentations at various national and international conferences. She's currently serving as a secretary of IADVL Pune and her major area of interest lies in clinical dermatology, aesthetic dermatology and tririccology. With this I welcome Dr. Nitika for today's session.

[00:02:41]Next we have amongst us Dr. Nitan Bert uh doctor is a consultant surgeon and hair transplant surgeon at radiant skin and hair transplant clinic at Nagpur.

[00:02:51]He's currently serving as an ordinary secretary ACSI. He's also a recipient of international society of dermatological surgery statesman award in in the year 2014 and his major area of interest lies in hair transplantation and dermat surgery. So I welcome Dr. Nitansa for today's session.

[00:03:10]Next we have among us Dr. Dr. Abijit Shindi sir sir is currently practicing as a domato cosmetologist at Aini skin care and laser clinic at Doule. Sir has roughly around two decades of experience in field of dermatology and his major area of interest lies in clinical dermatology, lasers and cosmetological procedures. So I welcome Dr. Abd Chandesa for today's session.

[00:03:36]Next I am pleased to introduce to you all our panelist Dr. Ajinka Sansa. He is currently working as a chief consultant dermatologist and director at Anand Skin, Hair and Laser Clinic at Chhatrapati Sambaji Nagar. He has also published widely in various national and international journals and his major area of interest lies in clinical dermatology, dermat surgery, lasers and cosmetological procedures. So I welcome Dr. Ajinka Surf for today's session. So without further delay, I would like to hand over the session to our moderator Dr. to Dr. Nitika man. Over to you ma'am.

[00:04:15]Okay, thank you Dr. Ima. I welcome all the panelists, Dr. Abijit S, Dr. Ajinka, Dr. Nitin Bes and we'll start our today's session.

[00:04:41]Okay. I hope my slides are visible.

[00:04:47]Okay.

[00:04:50]Am I audible, Dr. Yes. Yes, you're audible. My slides are not visible.

[00:04:55]Yeah.

[00:05:02]Slides are not visible. Okay.

[00:05:29]Yes. Now >> yes yes. So uh today we are going to discuss about the seasonal exagerations of three uh case scenarios and we are going to ask our esteemed panelists about uh their perspective in managing these three case scenarios.

[00:05:47]So uh to begin with we are going to start with Tina Sudoata which is majorly a steroid modified uh fungal overgrowth and which is considered as an epidemic uh since last uh couple of years. Second reason is an uh is a role of anti-inflammatory or you know jack inhibitors in chronic autotopic dermatitis particularly emphasizing on abrotoinip and uh autoimmune uh conditions like childhood onset which is a challenging condition to treat considering the imunological and oxidative stress the a patient is undergoing.

[00:06:26]So I'll start with the case one. This is a case scenario. Uh this is the patient if uh uh we see the P pre-treatment images. This is a typical case of tenia incognitive where the patient has been using uh chloitazole or you know higher uh topic class uh higher class of topical steroids for a longer duration of time.

[00:06:50]We can uh start with the panel discussion. Uh I start with Dr. Nitin Bes. Uh sir, I would like to ask you uh how will you manage a typical case of steroid modified uh tenia in pseudo pseudo embriata?

[00:07:12]What is your beginning line of management considering the inflammation and uh the steroid changes like skin atrophy, hypertriosis especially when the legion is on the face?

[00:07:24]Basically uh whenever a patient uh has tenia and the patient usually go for OTC over the counter creams which contains steroid most of the time and the steroids will modify the fungus in that the fungal load will keep on increasing without giving symptoms to the patient and once like patient comes to us they want a immediate relief. In that case what is more important is to give a patient uh idea once we stop the steroid what is exactly going to happen. So once we stop the steroid patient might uh experience increasing the itching as well as edyma post stoppage of the steroid cream and to counteract we'll require something which will have something more like have anti-itching uh if you are planning to just give a topicals it won't be suffice and in that case we certainly have to give uh oral anti- fungals along with a topical one and we should uh make patient aware that once we stop the steroid there there is going to be more rebound itching and the irritimma which he might notice for another one or two weeks and >> so do you prefer to taper down the topical steroid or you withdraw it right away >> usually I uh withdraw it right away and try to compensate with anti- stamin higher dose and uh that is what is what usually I do because what I feel is key if I start tapering it down patient u if having more uh symptoms >> correct >> um >> huh so that's why usually I stop immediately and give the oral uh antifungals and the topical one in topical antifungal I would like to prefer to have someone which is having a little bit of anti-inflammatory activity and uh >> what is your preferred choice of topical antifungals >> usually I prefer this lullon or iberonazole which they're having a good anti-ance anti activity plus uh I'll use a combination of two creams at a time because I don't go with one single antifungal maybe like if I >> multi modality approach >> maybe like I can use certain like cyclloparoxamine also along with that which will like act as a different level and it will try to kill the fungus like having a more fungicidal action like that so that is how I'll able to manage the steroid modify Even on CH >> if it is there then I can add some amount of if there is severe itching and all to reduce inflammation I can add some mild potent initially and then we can modify it accordingly to >> or just a sunscreen and a good moisturizer which ceramic sometimes for face conditions.

[00:10:14]>> Yes, that can be given to avoid the PH basically. Yes.

[00:10:19]>> Okay. As rightly said. So in case of chronic summer exagerbet steroid modified tenia is pseudulo imriata a multi-drug therapy with topical antifungals which can be of uh different classes not the same class and along with oral antipersical and the steroid drug topical steroid drug should be stopped right away. So this is the correct approach. Second question I would like to ask Dr. uh Savan Sir. Uh good evening Dr. Savan. So in my in in your experience or in your practice, what's uh clinical or therapeutic challenges uh does a prolonged topical steroid abuse create uh in treating uh topical steroid modified dermatitis.

[00:11:05]>> Good evening ma'am. Uh main clinical challenges is uh recurrence and increased inflammation and redness irrigage of steroid. So it will be very much difficult because patient comes again and saying I after even after your treatment I'm getting such irrima redness or sometimes oozing is there if it's a long abuse. So this one is the clinical challenge. In therapeutic challenge we have to uh start with sometimes if there is more oozing or instead of uh giving topical we we have I I always prefer giving shortterm of steroid oral for two to three days to decrease the inflammation and oozing on uh this to decrease the itching and com to comfort the patient.

[00:11:53]>> These are mainly uh recurrence and discomfort. Yes, >> it is an optional drug which in which we can give an initial you know anti-inflammatory doses of oral steroid in a very low dose for approximately 3 to 5 days.

[00:12:08]>> Yeah.

[00:12:09]>> Uh okay. And apart from recurrence what are your other challenges in managing these patients?

[00:12:17]Recurren >> any other specific case you recover >> particularly we can talk about topical damaged species where you you you notice the other uh features of >> yes local side effects at skin atropy tangexia these are the much more challenges as well because many young people young youngsters says these are stretch stretch marks we can't do anything for that >> counsel the patient >> yes we have to counil less because it will take time. Initial we have to focus on your fungal infection or tenia infection or this damage we have made.

[00:12:54]So we have to counel them more.

[00:12:58]>> Correct. Okay. Uh next question I would like to ask Dr. uh Shindai sir. Good evening Dr. Shindesh sir.

[00:13:06]>> Hello ma'am.

[00:13:07]>> Okay.

[00:13:08]>> How are you? Fine.

[00:13:09]>> Ah yes. Okay. So given the altered morphology chronicity of tenia pseudo embriata where would you position laonel? Is it your first line of topical therapy or uh uh you give it in combination with systemic antifungal always or sometimes you prefer to give it as monotherapy? What is your opinion?

[00:13:28]uh I'm uh with very difficult to treat is the steroid topical steroid abuse uh tenia uh la always my first choice because uh I find that along with the antifungal effect it has keratolytic effect too and uh the stratum corneium sloughs off and uh it works well for this iridatus areas also yes the inflammation is also reduced but when Um it is in summers I prefer liconazol but when the in winter I try using iberonazol or certakonazol again with ibonazol there is anti-inflammatory activity many of times this patients who have used this dermy 5 and all this five number tubes uh they they use it up to the quantity of 50 to 100 and they come to us with such severe tenia cruispor is extensive uh even tenia facial sometimes the scalp scalp is also affected uh that time I try um uh always I use oral itonazol uh I uh I want to mention this that there are so many companies withonazol and liconazol we have liconol starting from 250 rupees 150 rupees but I I always prefer using the best lonazol and uh they show least side effects and they give good results. The at least the patient comes to us in 7 days with 50 to 60% improvement and with a good intraconol so many in but give good results and again this very difficult to treat stria and many times the folliculitis is also associated after use of the steroids. So many times I have to prescribe uh antibiotics oral antibiotics to reduce the same part. During the second visit the patient comes with folliculitis for uncles because of the steroid abuse.

[00:15:37]Many times we have to add antibiotics along with antibiotics.

[00:15:42]>> Yes ma'am. And uh again uh the cost of therapy is the major hindrance because uh when you when you're using the best best drugs from the best companies the cost is going to be high. So counseling plays a major part here.

[00:15:58]>> You you have to uh counsel the patient well then uh it makes all the difference.

[00:16:04]>> Yes. So not only the molecule but formulation also matters considering the >> that is the most important part. Ma'am, what brand we are using that is of utmost importance.

[00:16:19]>> Okay. Next question I would like to ask Dr. Nitin Ves sir. Uh in hot and humid Indian summer does launal short treatment duration and non-steridal profile make it a preferred topical option for chronic and extensive dermatophyosis in simple language. Do you use it as a monotherapy in few cases or you use it as you know maintenance molecule after your oral antifungals are done >> usually? Uh yeah true because salary can also act like once a day on OD basis also. So like for a maintenance we can use it as a one dozing for the patient but considering summer yeah as Dr. Shindasar has also pointed out summer is a favorable molecule as compared to other ones and since it has like anti-inflammic activity it gives better result within a short span of time. So that is how I position the >> you also give the topical powder preparations also in particularly in >> my practice I never give any topical powder preparation.

[00:17:24]>> Yeah because it is not going to be penetrated inside >> that is just to like absorb the excess sweat so that any talcum can work for the >> yes that like >> yes so to summarize uh topical >> what Dr. Huh?

[00:17:45]Okay. So, uh to summarize for pseudo pseudoirriata tenia sudo emriata which is a steroid modified tenia corporis to you have to break the steroid uh dependent changes in the skin lesion by withdrawing the topical steroid uh in majority of the cases abruptly or or right away. then giving it an anti-inflammatory dose or antibacterial depending on the uh situation and then adding uh topical antifungals in current scenario or in current uh uh era.

[00:18:26]Daliconazol is what works best followed by other topical antifungals which are also in uh okay but even works much better than other molecules. Emerald also works very good. cycllopyros olamine and sartonol are other topical antipunga which are currently used for topical uh tenia tourist or corporus or superficial dermatopytosis.

[00:18:54]Okay, next case is chronic autotopic dermatitis.

[00:19:00]So the season the main seasons for automic dermatitis especially in childhood is October to December or January to March.

[00:19:11]You can consider them as spring seasons.

[00:19:13]But even uh in uh summers there could be exaggerations of this condition especially in patients who have autotopic dermatitis uh since many years for more than five years approx.

[00:19:29]So how to deal with this topical steroids? How frequently we have to use and what are the non uh topical steroid molecules which we can use for maintenance of autotopic dermatitis.

[00:19:44]Let's hear from our panelists.

[00:19:47]Uh Dr. Ashind sir.

[00:19:50]>> Yes ma'am.

[00:19:51]>> Uh this question is for you. How uh how do you manage chroic attopic dermatitis cases? A patient has come to you with the clinical symptoms of itching uh a scaling hyperpigmentation uh he's a teenage boy and he has these legions on and off uh throughout the year and he has a uh summer exaggeration. So what oral molecules do you prefer and what topical molecules do you prefer to begin with and for maintenance? Uh please guide us.

[00:20:23]uh topical I always start my treatment with uh two drugs. One is tacrolimus or pimeus and uh tacrolimus I ask them to apply this if possible in the morning after bath and in the evening and uh at night time I to use a mild mild st likeonide or sometimes fusidic acid combination with bolomethasone.

[00:20:54]uh many of times if the skin is eroded then I add a oral antibiotic along with anti-istaminics uh if the it is very severe very extensive I refrain using over steroids as as much as I can uh I use oral toastinips uh or sometimes syrup formulation topha when the child is very young Oh >> yes for hands part yes I have not used it in auto attopic dermatitis uh because where I I am from I'm from doulay we don't see many cases of attopic dermatitis because it is extremely hot and humid here we see lot of fungal lot of fungal it is a bread and butter but chronic atropic >> uh chronic atropic dermatitis as I said uh topical tyrolimas topical Uh desonite creams yes are my preferred choices.

[00:21:57]Moisturizes again. Yes.

[00:21:59]>> Yes.

[00:22:00]>> And uh counseling is very important. A premill for children I find it to be the safest amongst all oral molecules. I find >> uh no ma'am I have not tried it. It has not reached.

[00:22:15]>> You have not tried also up.

[00:22:18]>> I beg your pardon?

[00:22:19]>> You have not tried also?

[00:22:22]>> No ma'am. Um it has come to us.

[00:22:24]>> So your experience is limited to >> it has come to us just few few weeks back.

[00:22:29]>> Few weeks back >> just started using it in sorases. As I said we uh seldom get attopic dermatitis here. Uh in adults not many cases but in children yes but mostly in winters. In summers very less cases of autotopic dermatitis. But uh as I have said tacrolimus works well. Cryoral many companies have stopped but I found them to give results particularly initis cryptool works very well.

[00:23:00]>> Yes sometime I found magical results in some patients with crisperol but many companies have stopped manufacturing cris I think molecular stability.

[00:23:10]>> Yes I think only Jenb is having cris now with us. Yeah.

[00:23:15]>> Yes ma'am.

[00:23:16]>> Uh Dr. Bes sir how do you how do you manage such kind of patients? How do you start with oral and topical?

[00:23:23]Basically if any I see attopic patient not many patients are there in aur as such but during the winter there is some excess separations in that case usually I prefer to give educate the patient mostly on the lines key you have to moisturize the skin properly because that is foremost important and unless we optimize or repair the barrier it's very difficult and you have to you have to ask patient to use very gentle cleansers or maybe so free cleansers which are available nowadays And this is the base line thing they have need to perform for at least another 2 or 3 years till the skins get mature or uh like maybe as how the disease progresses. But during the flare up if there is acute flare up I usually prefer to give oral steroid if it is required essentially and also topical steroid along with that. But as a steroid sparing I'll usually start tacrolimus along with the same prescription and we'll ask patient to once taper around the topical stro as soon as possible followed by maintenance with the topical techus or maybe during the weekend therapy topical steroid and all weekday techus is the better idea if there are chances where the flare up is visible.

[00:24:41]uh this is how I believe and for systemic uh if it is un the patient is not tolerating a moderate to sever variety of autotopic then it is essential to go for a systemic therapy which can be initially to manage uh maybe oral to spread short course followed by jack inhibitors which is also very uh showing a good response and uh considering the abroin I have considered one patient but he has not used it because of the exorbitant cost. The cost was a factor for not using it. So that was one issue otherwise this is how I go about the attopic one and uh cryabor was also good molecule but now it has stopped and I'm not getting any company or promoting any any companies promoting the crisol but that also good molecule in few of the cases for a maintenance purpose.

[00:25:40]Even uh topical jag inhibitors like tophiline doesn't work well as compared with the chrissabi done.

[00:26:19]Nathan till then tell us about yourself uh where do you practice and where your UGPG?

[00:26:28]>> Yeah, I am from Nagpur.

[00:26:30]My UG is from GMC Naki and TG from uh BJ Medical Pune.

[00:26:36]>> Okay. Okay. Yes. Uh because I I'm myself from KM Pune but uh I left Pune in 2007.

[00:26:47]I I am a student of Dr. TA Sir, Dr. Ashok Parak, Dr. Para, Dr. Vid Ma'am and we had the privilege of going to Garpures sir uh once.

[00:26:59]>> Yeah. Yeah. Yeah. I also want to do >> Nan Bir is my batchmate.

[00:27:04]>> Okay. Okay. Vir is my batchmate.

[00:27:08]>> Yes.

[00:27:08]>> I joined PG in 2008.

[00:27:11]>> Yeah. Because uh we have we had left uh Pune that time.

[00:27:15]>> I had joined private medical college here in D >> in 2007. Then I I was in government medical college for three and a half years. Before me n was working there. He left then I took up the job. Yes. Yes.

[00:27:30]>> Where do you practice in Pune?

[00:27:32]>> No, I'm in Nagpur.

[00:27:34]>> You are in Nagpur. Okay.

[00:27:36]>> Yes, I'm at Nagpur.

[00:27:37]>> Okay. Yes.

[00:27:38]>> My PG is from Pune but I'm at I'm practicing in Nagpur.

[00:27:43]>> Okay. Yes. Okay. I'm in Dur. Me and my wife uh both of us are from KM Hospital Pi.

[00:27:52]>> Mhm.

[00:27:53]>> Uh student of sir. Both of us are practicing in since last 18 to 19 years.

[00:28:03]>> Yeah. Actually our teachers were Dr. Tulat sir, >> Dr. Mahajan Sat.

[00:28:08]>> Yes. Yes.

[00:28:11]>> Yes. Vijay Nur.

[00:28:16]>> Okay. Yeah. You were together.

[00:28:22]Me, Praep, Kumari were there for exam together for FCPS in Mumbai.

[00:28:29]>> Okay. Okay.

[00:28:31]So, right now like um I am like Axi secretary and trader is Nit Jensen. You might be knowing that.

[00:28:41]>> Uh can you repeat? I just missed.

[00:28:46]Right.

[00:28:46]>> Right now I'm ACSI treasure secretary and treasur is Dr. only.

[00:28:55]>> Okay. Okay.

[00:28:57]>> Root.

[00:29:00]>> No. ACSI AC.

[00:29:04]>> Okay.

[00:29:05]>> So, yes.

[00:29:08]>> Dr. Reema, can you like comment about the cost for the abro like anyways? Uh she's not there. Uh I think uh Mali from the marketing team is there in the session. Uh Mali can you just comment on the cost >> because most of the patients are not affording the level >> the drug is marketed. If you try to reduce the cost then it will be more beneficial or maybe because cost of therapy is too exorbitant for any patient.

[00:29:38]>> Exactly.

[00:29:41]Are you there in the meeting?

[00:29:44]>> Dr. Ajinkia meanwhile can you comment about your approach for the autotopis?

[00:29:50]>> Uh my approach sir first uh I will counsel the patient and avoid triggering factors. Initially start with if there are few patches I will start with topical steroids and I simultaneous with tacrolyas then topical steroid I reduce and continue with maintenance therapy with topical tacrolyas if the patches are very much body invol surface area involvement is larger one then we have to start with anti-oral anti-inflammatory first one choice is oral corticosteroid short-term and the counseling and with counseling is also there avoid triggering factors to patients like avoiding wool and dust and that take care take care of use then we will start with also counsel the use of moisturizer regularly not only in winter season in all season we have to take care they have to take care their skin care routine with moisturizers basically any attopic condition it is imperative to explain the patient to have a good education regarding the disease itself.

[00:30:57]>> Avoid the triggering factors. Have a roundthe-clock moisturization and >> try to go with the more steroid spilling agent like tacumas in a long run rather than going with the topical steroids.

[00:31:09]>> Yes.

[00:31:09]>> And uh having a good gentle cleanser is also very important because most of the time even if you are moisturizing the skin properly most of the patient try to use more harsh cleansers. So it is uh better for doctor to suggest a cleanser which is more of a soup tree and which will not hamper your uh barrier or uh which is a protective uh part in the attopic condition.

[00:31:37]Dr. Reema uh I think Dr. Nitik has also joined back okay with the rather >> Dr. Nikka has joined. Yeah, there was some technical issue from her. Yeah. So uh Dr. Dr. Netka audible.

[00:31:52]Uh, can you unmute? Yes.

[00:31:55]Dr. Netka, you're not audible.

[00:32:00]See your mute. Actually, the Dr. Nikka, you're not audible.

[00:32:27]Miss Rema, ma'am, do do you have a question here?

[00:32:31]>> You can continue.

[00:32:36]>> Sure. So, I'll just share question.

[00:32:39]>> So, can I ask the next question? Uh Hindi sir can you just give your experience regarding how to manage pediatric pitigo like what is your idea about that?

[00:32:59]>> Yeah.

[00:33:11]Shindi sir >> yes >> can you answer the first question in your clinical experience how significant are enomemental factors particular on exposure and sunburn in triggering the onset or early progression of childhood onset vitgo in genetically predisposed patient what is your take on this >> yeah um mostly uh on sun exposed areas uh when the children are having the sports period uh during the afternoons and uh with uh when they are standing for a long time in a hot sun sometimes there is scenarization and scaling then there is post-inflammatory hypopigment uh many times on the face around the orbits so and uh only the such cases do I find this excerbation of uh this hyperpigmentation after intense sun exposure on the hands as well as face around the eyelids in children. Yes. Uh otherwise uh mostly uh vitiligo >> am I audible?

[00:34:32]>> Yes. Yes ma'am. Um so your which question have you completed right now?

[00:34:40]>> First one. First one. First one.

[00:34:43]>> Okay. So shall I take over?

[00:34:45]>> Yeah. Yeah please. Please.

[00:34:46]>> Okay. So I think Dr. Abijit Sashidas was uh talking about uh his clinical experience in childhood vitiligo and genetically predisposed conditions.

[00:34:58]We'll start with the secondh question that will be for Dr. Uh Sans uh how do you balance the role of sun exposure at the potential oxidative stress as a trigger in vitiligo against the use of phototherapy in pediatric patients? In simple language, when do you start phototherapy in uh childhood onset vitiligo patients and how do you proceed with it? Which which wavelength or which kind of UV rays do you prefer?

[00:35:28]Uh I prefer phototherapy when larger surface area is involved with I will start safe with narrow band UV therapy uh 311 wavelength narrow band UV therapy for pediatric patients and simultaneous for management uh there any topical steroid for short-term like mild steroids with clobetasone and dazonide associated with in nighttime application I will suggest tacolyas and daytime for phototherapy in larger area with narrow band therapy narrow band UVB therapy >> what oral imunom modulator do you prefer >> in childhood >> in childhood uh childhood in initial my suggestion is oral minipulse therapy uh because it's safe for I will suggest it's safe imunom modulator then if not control with then oral tophasa senative can be started.

[00:36:28]>> Okay. Have you used cycllosporin as well?

[00:36:31]>> Uh no for not vil for not vitiligo.

[00:36:35]>> Okay. Uh Dr. Bes sir what is your experience about it? How do you proceed with childhood vitiligo with oral and topical management and phototherapy?

[00:36:45]>> In my experience the childhood veticular patients are like good responders to the topical therapy only. So usually I start with a topical therapy where I place like try to give a topical steroid tacrolimus with some um preparations like peptide which will help us to repigment it faster only in cases where there's a rapidly progression then I'll add oral miniples with the banisol uh four and as per the weight depending on the weight and most of the time this works well with the pediatric patient if there is like issue where the progression is there in spite of having finish of the oral miniples then I usually start with green which is preferred from my point of view followed by toacetin if patient is not tolerating the aatio cream.

[00:37:36]>> Okay.

[00:37:37]>> And where do you place phototherapy? Do you start it in uh visit one or you wait till the photo exaggeration is under control and then you introduce phototherapy.

[00:37:47]phototherapy usually I advise patient like when I am giving decapitate along with that I'll ask the patient to have a mild sun exposure around 5 to 10 minutes in the morning uh which can be given usually photo excavation is only present if there is a random UV exposure wherein like you are standing in sun for a long period of time and there is intense UV exposure which might trigger the gnarization but somehow you give them for a small period of time this the phototherapy will works well and naro and UB is the choice but I at my center I don't have a narrowan UD I can uh I advise patient to go for a exam laser if yeah exam laser no I don't go for kasol I ask them to go for exam if possible or if not I'll ask them to purchase all handheld UVB lamp if essential and if it is not responding at all but uh with my experience what I feel is key only this uh topical therapy do give a good uh pigmentation over a period of time. Only thing is you have to handle the patient for a long period of time because patients are little anxious about the bitgo. Mostly the parents patients are not worried as such but parents are so much anxious about having white patches they we have to consult them and handle them properly and eventually the outcome is very good at the end of like 3 to four months.

[00:39:10]>> Do you prefer weekend regimens for topical steroids in between? Usually I once I feel the steroid role is over then I usually taper it down by giving alternative twice a week by a week on different days.

[00:39:25]>> Fine.

[00:39:27]Uh Dr. Abij Shinda sir uh what are the key factors influencing parental acceptance of topical tacrolimas for long-term use in children and how do you address uh the safety concerns?

[00:39:39]uh topical tacrolymus uh can use uh for very very long time till uh tacrolymus and pacrolyus they are very safe no side effects at all sometimes uh initially uh one or two patient may complain of burning with tacrolyus but I don't find uh any other side effect apart from that and instead of using uh mid potency steroids for a long time it it is better to use the topical tacrolyus and uh so I find it to be very safe and the results are good uh and u they are steroid sparing that is most important oral steroids I seldom use in children after this uh tophacet is available I use it orally also tablet form also syrup form but again uh once we taper or stop there are chances of recurrence lot of patients come with recurrence so we have to taper it very slowly uh I've not seen uh any other not any major side effects with tophacetin also in children >> correct >> yes >> okay so to summarize pediatric vitiligo which is a challenging condition particularly when parental anxiety is concerned about the social stigma associated with it and uh generally when one or two lesions are there it is not considered that aggressive but depending on the site of the lesion particularly if it is acroacial kind of itiligo we have to think about the aggression the age of the patient and the disease morphology and also consider the factors that the child is going to be exposed to sunlight for a longer duration of time considering his um school or any other uh climatic exposures I will recommend key we have to add some other molecules like sunscreen, moisturizers along with topical tacas which works very good in such kind of patient that Dr. Shindeser and Besar and Sans are appropriately mentioned. Plus for initial few months we have to give an intensive uh induction therapy I could say with the oral steroids or uh cycllosporine or topicative molecule with appropriate monitoring and then taper of these molecules once the repigmentation uh has started and maintain them on a on a lower non-steroidal safe molecule or topartic cycin lower doses. is until uh complete repigmentation is achieved. So uh to summarize I would like to thank all the panelists Dr. Besar, Dr. Shindasa, Dr. Sans for joining the panel discussion on uh three cases. I hope the discussion was uh productive and informative for all the uh uh joint participants. Uh I hand over the uh uh screen to Dr. Ree.

[00:42:44]>> Yeah. Um so thank you so much um uh Dr. for the presentation and thank you so much panelist for sharing your experience and clinical insight and highlighting the role of tacrolyas in vitiligo and etopic dermatitis and also how in recurrentia like counseling is the main stay and definitely how we have to use judiciously the steroids or else you end up getting patients with folliculitis and again you have to treat the patients with oral antibiotics and especially in summer how likenazole is preferred over other antifungal so thank you so much panelist Thank you so much uh moderator for highlighting these points. So before uh we wind up this session uh I would like to highlight a short scientific update regarding approv uh this is a recently published uh case series evaluating the clinical outcomes of abroetanib in four Indian patients with refractory prorig nodilaris and proigos simplex the patients were previously treated with conventional treatments like cycllosporin mtoxic to facetip and other antihistamines and imunosuppressants but since the patients were quite intolerant and there was no adequate response so the patient was shifted to abroetanip 100 to 200 mg once daily so what they observed the doctors observed was there was a marked reduction in proritis within 3 to 7 days and there was progressive flattening of the nodules and a reduction in the pigmentation over 8 to 16 weeks and it also improved patients quality of life and there was no major adverse events that were reported during this treatment. So most of the patients they typically they were typically started off with 100 mg except for one patient where the dose had to be escalated from 100 mg to 200 mg for an optimal control. So this case case series highlights the supports the role of Jack 1 inhibition uh where an abroetanib can be considered as a potential therapeutic option in treating refractory proono nodularis and or prorigo simplex.

[00:45:08]>> I have tried in few patients. So >> how is that the cost was very much but yes the response I have used in prora nodularis.

[00:45:17]>> Okay. And so how many chronic and itchy condition so definitely helps but cost is a major issue cost >> uh so we have it around 35,000 >> okay from a very well affluent she that time the cost was 65,000 >> thousands now it has >> now I I hope the cost reduces further I've also used in that also works very well in autotopic dermatitis but I I find mediocre results of insasis.

[00:45:51]Abroinib and work very well with autotopic dermatitis as compared to topic. Uh and in sorasis the thing is reverse.

[00:46:02]>> What the difference between like abua and up both are jack one inhibitor only I guess.

[00:46:06]>> Yeah selective jack. Both are selective uh jack one inhibitor but like when higher concentration it is seen that sitan shows a panjack kind of activity and also the side effects are also much more within you compare it with abro >> only because of the fear of reactivation of TB >> becomes the first line then toarticid so these three molecules come safety profile wise 25,000 for 60 tablets or what? 30 tablets.

[00:46:46]>> No, I think only 10 10 tablets sir.

[00:46:48]35,000 for 10. No, Dr. >> uh uh for one month >> for one month dosing >> we have around 35 to 38.

[00:46:59]>> Okay. So 30 tablets >> it is like,000 >> around 50,000 per day. You can remember when launched in India that time the cost was on similar lines 25,000 >> but they have given like a very like it is 164 rupees no >> I think the company had patency to the moment patency is relieved then the cost declines it is somewhat like that I don't know about the logistics >> but I hope the cost declines very soon >> I 64 rupees and this is almost >> around 1,000,5 500. Yeah, it's a bit costly sign. Um, so my question to Dr. Nitika is like since you've experienced using like up sitin and abroin. So what would be the particular patient profiles like what are the patient profiles you would try using abroet or >> these kind of patient are frustrated patients who are uh not getting relieved by any other molecule then only the patient is going to ready to shell out so much amount of money from their pocket. Second patient base is going to be chronic uh autotopic dermatitis or chloronodularis kind of conditions >> where the itching is unbearable >> uh exaggerated by any change of weather and plus somewhat to some extent I cover it under their routine insurance also.

[00:48:23]So it depends on what kind of uh medical insurance the patient has considering I'm attached to dinat mangeskar and sometimes even the overseas patient they have a good uh cover under medical insurance. So those kind of patients do consider taking abro in current uh financial logistics. So what is your like idea mean what is your experience after stopping the city whether patient has Relax.

[00:49:16]Okay. Um so thank you so much Dr. Nikka for sharing your experience regarding these.

[00:49:22]>> Thank you Dr. Biser for taking over this slide in between. Suddenly my internet technical issue is >> okay I think seam is over like >> yeah so we have we have come to an end of our session. So first of all let me thank Dr. Anitka ma'am for effortlessly leading the panel discussion and also to Dr. for leading the panel discussion. Thank you so much our panelists Dr. Bajjita Dr. Ajink sir for sharing your insights and clinical experience. I would also thank the participants for joining us in today. We look forward to your continued support and our further medical educational programs and also I would like to thank the GSP marketing and the sales team and also the technical team for your support in organizing this event. So thank you so much everybody.

[00:50:12]So with this I formally conclude this webinar and have a great day. Have a great evening. Thank you so much.

[00:50:18]>> Thank you very much. Thank you.

[00:50:20]>> Thank you.

[00:50:21]>> Thank you. Thank you so much. Yeah.

[00:50:41]Hello.

[00:50:57]>> An enemy position.