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   Table of Contents - Current issue
Coverpage
November 2021
Volume 12 | Issue 7 (Supplement)
Page Nos. 1-85

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GUEST EDITORIAL  

Regeneration through platelet rich plasma – A cell therapy with a path full of milestones, controversies and cautions! p. 1
Suruchi Garg
DOI:10.4103/idoj.idoj_589_21  
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REVIEW ARTICLES Top

Recommendations for COVID vaccination for dermatological patients on immunosuppressive/immunomodulatory therapy (IADVL Academy) p. 4
Malathi Munisamy, Bhabani S. T. P. Singh, Deepika Pandhi
DOI:10.4103/idoj.idoj_412_21  
Significant proportion of patients with dermatological disorders are on immunosuppressive or immunomodulatory therapy predisposing them to risk of acquisition of COVID-19 infection. However, the efficacy of COVID-19 vaccination among these patients is a matter of concern due to lack of adequate evidence for their protective effect owing to the drug induced immunosuppressed state. Hence, we from the IADVL academy have framed the recommendations to be followed for COVID-19 vaccination among dermatological patients on immunosuppressive therapy based on available related literature.
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Preparation of platelet-rich plasma: National IADVL PRP taskforce recommendations p. 12
Shuken Dashore, Kavish Chouhan, Soni Nanda, Aseem Sharma
DOI:10.4103/idoj.idoj_269_21  
The goal of these recommendations is to provide a framework to practitioners for implementing useful, evidence-based recommendations for the preparation of platelet-rich plasma (PRP) in various dermatological indications. The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) assigned the task of preparing these recommendations to its task force on PRP. A comprehensive literature search was done in the English language on the preparation of PRP across multiple databases. The grade of evidence and strength of recommendation was evaluated on the GRADE framework (Grading of Recommendation, Assessment, Development and Evaluation). A draft of clinical recommendations was developed on the best available evidence which was also scrutinized and critically evaluated by the IADVL Academy of Dermatology. Based on the inputs received, this final consensus statement was prepared. A total of 45 articles (meta-analyses, prospective and retrospective studies, reviews [including chapters in books], and case series) were critically evaluated and the evidence thus gathered was used in the preparation of these recommendations. This expert group recommends the use of double-spin manual method for the preparation of PRP. The recommended parameters for centrifuge are 100–300 g for 5–10 min for the first spin and 400–700 g for 10–17 min for the second spin. The recommended platelet concentration in PRP for the treatment of various dermatological conditions is 1–1.5 million platelets/μL. The activation of PRP is not required when it is injected into soft tissues.
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Updates on management of leprosy in the context of COVID-19 pandemic: Recommendations by IADVL SIG Leprosy p. 24
Abhishek Bhardwaj, Sunil Kumar Gupta, Tarun Narang, Sujai Suneetha, Swetalina Pradhan, Pooja Agarwal, Swastika Suvirya, Ankan Gupta, Namrata Chhabra, Angoori Gnaneshwar Rao, PK Ashwini, Sridhar Jandhyala, Santoshdev Rathod, P Narasimha Rao, Sunil Dogra
DOI:10.4103/idoj.idoj_513_21  
The Special Interest Group (SIG) on leprosy thought it to be prudent to revisit its previous practice recommendations through this update. During this period, the pandemic course shifted to a 'second wave' riding on the 'delta variant'. While the number of cases increased manifold, so did the research on all aspects of the disease. Introduction of vaccination and data from various drug trials have an impact on current best practices on management of diseases including leprosy. The beneficial results of using steroids in management of COVID-19, gives elbow room regarding its usage in conditions like lepra reactions. On the other hand, the increase in cases of Mucormycosis again underlines applying due caution while recommending immunosuppressants to a patient already suffering from COVID-19. This recommendation update from SIG leprosy reflects current understanding about managing leprosy while the dynamic pandemic continues with its ebbs and flows.
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SYMPOSIUM ARTICLES: IADVL PRP TASKFORCE (IADVL ACADEMY) Top

Platelet-rich plasma in androgenetic alopecia p. 31
Aseem Sharma, Kavish Chouhan, Satish Bhatia, Shuken Dashore
DOI:10.4103/idoj.idoj_328_21  
The goal of these recommendations is to provide a framework to practitioners for implementing useful, evidence-based recommendations for the preparation of platelet-rich plasma (PRP) and its use in androgenetic alopecia (AGA). The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) assigned the task of preparing these recommendations to its taskforce on PRP. A comprehensive literature search was done in the English language on the PRP across multiple databases. The grade of evidence and strength of recommendation were evaluated on the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) framework. A draft of clinical recommendations was developed on the best available evidence, which was also scrutinized and critically evaluated by the IADVL Academy of Dermatology. Based on the inputs received, the final consensus statement was prepared. A total of 30 articles (meta-analyses, prospective and retrospective studies, reviews [including chapters in books], and case series) were critically evaluated, and the evidence thus gathered was used in the preparation of these recommendations. This expert group recommends use of manual double-spin method for the preparation of PRP for AGA. Minimum three to five sessions of PRP are recommended for AGA with a gap of 1 month between the two sessions. Patients with Grade II to V Norwood Hamilton classification of AGA are the ideal subset for PRP. A total of 5 to 7 mL of PRP and 0.05 to 0.1 mL/cm2 is the recommended dose of PRP for AGA. Activation of PRP is not required when it is used for AGA. About 1 to 1.5 million platelets/μL of platelets in PRP is the recommended platelet concentration in PRP for the treatment of AGA. I-PRF (injectable platelet-rich fibrin) has also been found to be useful in AGA, although further studies are required to establish its role. PRP can also have an adjunctive role in hair transplantation procedures.
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Platelet-rich plasma in aesthetics p. 41
Soni Nanda, Kavish Chauhan, Vinma Shetty, Shuken Dashore, Satish Bhatia
DOI:10.4103/idoj.idoj_290_21  
Platelet-rich plasma (PRP) is being used as a treatment modality for skin rejuvenation since the last decade. There has been a lot of ambiguity regarding the ideal protocol to be followed and the specific indications where its use should be promoted. The use of PRP as monotherapy for skin rejuvenation, acne scars, periorbital rejuvenation, lipofilling and in combination with fractional CO2 and other resurfacing modalities is increasing rapidly. In this article, we have reviewed the current scientific evidence available and the IADVL national task force for PRP has come up with standard recommendations for use of PRP in esthetics along with the grade of evidence and strength of recommendation for each indication. The aim of this review is to provide a standard protocol for use of PRP in esthetics, for clinicians and academicians, leading to excellent results with this promising treatment modality.
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Platelet-rich fibrin, preparation and use in dermatology p. 55
Shuken Dashore, Kavish Chouhan, Soni Nanda, Aseem Sharma
DOI:10.4103/idoj.idoj_282_21  
The goal of these recommendations is to provide a framework to practitioners for implementing useful, evidence-based recommendations for the preparation of platelet-rich fibrin (PRF) and its use in various dermatological indications. The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) assigned the task of preparing these recommendations to its taskforce on platelet-rich plasma. A comprehensive literature search was done in the English language on the PRF across multiple databases. The grade of evidence and strength of recommendation was evaluated on the GRADE framework (Grading of Recommendation, Assessment, Development and Evaluation). A draft of clinical recommendations was developed on the best available evidence which was also scrutinized and critically evaluated by the IADVL Academy of Dermatology. Based on the inputs received, this final consensus statement was prepared. A total of 40 articles (meta-analyses, prospective and retrospective studies, reviews [including chapters in books] and case series) were critically evaluated and the evidence thus gathered was used in the preparation of these recommendations. This expert group recommends use of A-PRF+ protocol, that is (200 g for 8 min) for preparation of solid PRF and C-PRF protocol (700 g for 8 min) for liquid PRF. Swing out bucket model of centrifuge or the horizontal centrifuge is recommended for preparation of both PRF, and liquid PRF. Centrifugation must begin within 90–120 s of drawing of blood. PRF can be used in various indications for skin rejuvenation and nonhealing ulcers as either monotherapy or in combination with other therapies.
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SYMPOSIUM ARTICLES: IADVL SIG PEDIATRIC DERMATOLOGY (IADVL ACADEMY) Top

Recommendations for pediatric dermatology practice during COVID-19 pandemic p. 66
Ram Gulati, Bhumesh K Katakam, P S. S. Ranugha, Mrinal Gupta, T Narayana Rao, Maitreyee Panda, Malathi Munisamy, Minu J Chiramel, Neerja Puri, Sandeep Gupta, Biswanath Behera, Garima Dabas
DOI:10.4103/idoj.IDOJ_814_20  
The current scenario of the coronavirus disease (COVID-19) pandemic has resulted in a huge disease burden worldwide affecting people across all age groups. Although children get infected by coronavirus, they are less commonly affected. Only 2% of cases are being reported among patients aged less than 20 years of age and childhood cases constitute around 1–5% of them. Moreover, they are less likely to be seriously affected when compared to adults, with more than 90% of them being either asymptomatic or having mild to moderate disease. This could be attributed to less exposure or sensitivity to COVID-19, varying immune response mechanisms, differences in the expression/function of the Angiotensin Converting Enzyme 2 receptors or higher antibody levels to viruses owing to exposures to multiple respiratory infections, protective role of measles and BCG vaccine, and few associated comorbidities. However, children with certain underlying medical conditions like cardiac or respiratory disease, diabetes, immunodeficiency disorders, cancer or on immunosuppressants may be at a higher risk for developing severe disease.
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Recommendations for management of childhood psoriasis p. 71
Bhumesh Kumar Katakam, Malathi Munisamy, T Narayana Rao, Minu Jose Chiramel, Maitreyee Panda, Sandeep Gupta, P S S Ranugha, KA Seetharam
DOI:10.4103/idoj.IDOJ_965_20  
Childhood psoriasis is recognized as a potential multisystem disorder and hence it is imperative to optimize disease management to arrest progression, minimize psychological burden and evolution of metabolic syndrome. Clinical practice recommendations are necessary to assist practitioners in appropriate decision making based on available evidence. Owing to the lack of Indian recommendations on childhood psoriasis, the SIG Pediatric Dermatology under IADVL Academy undertook an evidence-based approach based on published literature on the topic, between January 2000 and July 2020 to frame the recommendations.
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