Tranexamic Acid in Melasma


Melasma occurs as symmetrical and irRegular tan-brown macules on the face. It is predominantly seen on the malar areas of cheek, forehead and chin. Ultraviolet (UV) radiation exposure, genetic susceptibility, and hormonal imbalance are considered to be most important aetiological factors. Melasma is more common in women and is a common cosmetic concern among indian population.

Topical medications have some efficacy in treating the epidermal-type melasma, but not in the dermal or mixed types. Prolonged application duration, slow response, limited efficacy, and undesirable recurrence are the major disadvantages of topical therapies causing patients to stop treatment. Topical bleaching agents may irritate the skin and cause PIH or result in exogenous ochronosis. The most effective and safe treatment for melasma is yet to be determined.

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There is increased evidence showing interaction between keratinocytes and melanocytes in the process of melanogenesis through the PA (plasminogen) activation system.  Thus rationale to adding TA (tranexamic acid) , a PA inhibitor, as an adjuvant in the treatment of melasma to increase the efficacy of previous treatments and reduce the chances of recurrence. TRANEXAMIC ACID is used as an antifibrinolytic agent, and is found to inhibit plasminogen-keratinocyte interaction by decreasing the tyrosinase activity, causing decreased melanin synthesis from the melanocytes. Its use in melasma is a novel concept. The patients should be screened for contraindications and risk factors prior to the commencement of oral therapy.

Intralesional tranexamic acid is a safe and effective treatment option of melasma with no risk of PIH, thrombotic or bleeding tendency; 6-12 MONTHLY SESSIONS ARE RECOMMEDNDED. The inclusion of maintenance topical therapy and strcit sun protection is strongly recommended to improve efficacy and decrease the recurrence of melasma.


Botulinum Toxin For Palmo Planter Hyperhidrosis


Primary Focal Hyperhidrosis is a disorder that results in considerable functional and psychosocial impairment. Patients experience symptoms for years before presenting to their dermatologists.

Multiple treatment modalities exist. Their efficacy depends on the body area affected and  severity of the sweating, and  patient’s tolerance and response to previous treatments. Healthcare professionals should be aware of the risks, benefits, cost, and reasonable expectations associated with the available treatment modalities. Conservative measures

are attempted before invasive and irreversible options, even in patients with severe hyperhidrosis.

BTX-A provides excellent efficacy in achieving anhidrosis and improves patients’ quality of life for a relatively long duration. Along with DIGITAL IONTOPHORESISIS, BOTOX

may be considered a first-line therapy for moderate-to-severe PALMO-PLANTER  HYPERHIDROSIS

Treatment options should be tailoredto each patient individually, taking risks, benefits, cost, and convenience into account.

Palmar Hyperhidrosis

Efficacy of BTX-A on palmar Hyperhidrosis both quantitatively and subjectively  is around 80–90%.. The duration of anhidrosis is approximately 6 months, and ranges from 4 to 12 months.

Adverse Events

Transient weakness of the intrinsic hand muscles is the most noteworthy adverse event when using BTX for palmar HH.The weakness usually begins after 1–3 days and resolves within 10–14 days.   handgrip strength is generally normal in most patients, yet finger pinch strength is often reduced i.e poor fine motor control.

Pain and soreness during thprocedure and for up to 1–2 days due to the multiple injections into the palm.Proper anesthesia ensures patient compliance.  Mild numbness and paresthesias, are transient in treated patients.


The dose required to effectively treat palmar symptoms ranges from 100 to 240 U of Botox. Doses should be tailored , with injections of approximately 2–3 U of Botox_ spaced every 1–2 cm.


Should Adults Between 27-45 Years of age be Vaccinated Against HPV?

HPV vaccination provides most benefit when given before a person is exposed to any HPV. CDC recommends HPV vaccination at age 11–12 years. HPV vaccination is also recommended through age 26 years for anyone who did not get vaccinated when they were younger.

Vaccination is not recommended for everyone older than age 26 years. HPV vaccination in age range 27-45 years provides minimal benefit because most people have alraedy been exposed to HPV. However, some adults might be at risk for new HPV infection and may benefit from vaccination.

For adults between 27–46 years, clinicians can consider discussing HPV vaccination with few people who are most likely to benefit. HPV vaccination is not discussed with most adults over age 26 years.

Most sexually active adults have already been exposed to HPV , although not necessarily to all of the HPV types prevented by vaccination. At any age, having a new sex partner is a risk factor for getting a HPV infection. People who are in a long-term, mutually monogamous relationship are less likely to get a new HPV infection.

HPV vaccination prevents new HPV infections but does not treat existing infections or diseases.

Reference: Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices | MMWR (



  • What is Follirich GFC Therapy?

Follirich Growth Factor Concentrate (GFC) Therapy is a ground-breaking hair loss treatment that utilizes the body’s inherent natural powers and capacity for self-healing. It is a non-surgical innovative treatment; useful as

  • A stand-alone treatment,
  • To improve the recovery and results of hair transplant surgery
  • Add-on treatment
  • Benefits of Follirich GFC Therapy
  • Rejuvenates hair follicle
  • Stimulates hair growth
  • Reduces hair fall
  • Strengthens hair shaft
  • Increases hair volume
  • Improves hair thickness
  • How Follirich works?

It is a pure, highly safe, and concentrated preparation engineered from using a person’s own blood for superior results.

Various Growth Factors such as 

PDGF (Platelet-derived Growth Factor) activates hair growth and stimulates mesenchymal stem cells.

VEGF (Vascular endothelial Growth Factor) stimulates the production of new blood vessels around the hair root.

IGF-1(Insulin-like Growth Factor-1) Increases hair growth and maintains hair follicle growth.

EGF (Epidermal Growth Factor) activates hair growth as well as stimulates new blood vessels around the hair root.

These Growth Factors are involved in tissue regeneration, tissue repair and stem cell migration, differentiation, and proliferation.

  • Is Follirich right for you?

Hair loss is one of the most common signs of today’s stressful and demanding lifestyle. Androgenic Alopecia (Male Pattern Hair Loss/MPHL* ) and Female Pattern Hair Loss ( FPHL**) are two most common  causes of hair loss. Hair loss impairs the quality of life and is also associated with significant psychological morbidity. The current treatment options like medications (minoxidil, finasteride etc.), vitamins, and antioxidants are not very effective. The need of daily applications, cost, longer duration of traetment and various side effects makes the patient’s compliance & effectiveness limited.

Any candidate in early stages of Alopecia as judged by the treating doctor is a fit candidate for Follirich GFC therapy. Follirich is equally effective in both males and females.

  • How is Follirich prepared?

Step 1- collection of blood(8ml)

Step 2- activation of platelets and release of growth factors

Step 3-seperation of GFC

Step 4- collection of growth factors (3-4 ml).

Step 5- application of GFC


Next Generation Therapy

Latest, Innovative



  • No Platelet loss
  • High concentration of Growth Factor
  • Naturally regenerates damaged tissue


  • Highly safe
  • Prepared from one’s own blood
  • Contamination free
  • Free from unwanted cells-less pain


  • Sterile,
  • Low chances of infection


  • Easy, rapid, and consistent GFC preparation
  • Requires less sessions.
  • Lunch time procedure


  • 8 hrs – at room temperature
  • 7 days – at 4 ℃


  • Single step closed system
  • Non pyrogenic
  • Zero RBCs and WBCs

Precautions after using Follirich

There are no activity restrictions after GFC therapy. You may shampoo/shower / condition your hair normally several hours after treatment and resume normal daily activities soon after.

Any other precaution if advised by treating doctor.

Some mild inflammation, redness and numb-ness of scalp may be present for several hours due to injection pricks.

Possible side effects of Follirich

Since GFC is pure and does not contain any RBCs or WBCs (unwanted cells), risk of pain and inflammation due to GFC is minimal. The symptoms are generally due to injection related inflammation and usually resolves in 7 days or less.


Hand hygiene recommendations during COVID Pandemic

COVID-19 pandemic has resulted in worldwide hand hygiene and hand cleansing awareness. proper hand hygiene decreases the spread of transmissible disease.

The virus is believed to spread via direct contact, indirect contact, and droplet contactaccording to Centers for Disease Control and Prevention (CDC). To decrease virus transmission, the CDC recommends 20 second hand wash with water and soap; or if soap and water is unavailable, sanitizer with at least 60% alcohol can be used.

Hand hygiene products are available as: liquid or bar soaps, synthetic detergents, antiseptic hand washes, and alcohol-based hand sanitizers (ABHSs). Each may alter skin barrier integrity and function, increasing the risk of hand dermatitis.

Best hand hygiene practices to mitigate COVID-19–hand dermatitis.

Use of soaps and synthetic detergents

  • Wash hands with lukewarm or cool water and soap for at least 20 seconds.
  • Avoid hot and very cold water.
  • Non-frictional, pat drying (don’t rub).
  • Immediate application of moisturizer after cleansing.
  • Products with antibacterial ingredients are not necessary for proper hand hygiene.
  • Soaps or synthetic detergents should be devoid of allergenic surfactants, preservatives, fragrances, or dyes preferred.
  • Synthetic detergents with added moisturizers preferred.
  • Dry hands are with frequent use of soaps.

Use of ABHS (alcohol based hand sanitizers)

  • At least 60% alcohol content is recommended.
  • Handsanitizers should be devoid of allergenic surfactants, preservatives, fragrances, or dyes.
  • ABHSs with added moisturizers preferred.
  • Dry hands common with frequent use. Application of a moisturizer after sanitizer is recommended.

Use of moisturizers

  • Avoid using moisturizer jars to prevent double dipping and potentially contaminating the product.
  • Prefer moisturizers packaged in tubes instead.
  • Look for pocket-sized moisturizers for frequent reapplication.

Treatment of hand dermatitis

  • Application of a topical steroid to mitigate dermatitis.
  • Seek a dermatology consultation for patch testing.
  • Irritants should be identified and avoided.
  • The use of barrier moisturizing creams ishelpful;
  • Switch to less-irritating products.

Risk factors for hand dermatitis

  • Hand washing
  • Frequent hand washing
  • Washing hands with dish detergent or antiseptic soaps
  • Using very hot or very cold water for hand washing
  • Use of disinfectant wipes on hands
  • Working with irritants such as bleach
  • Pre-existing atopic dermatitis