Evaluation of efficacy and safety of oral terbinafine and itraconazole combination therapy in the management of dermatophytosis.

Background: There has been an alarming increase in recalcitrant dermatophytosis in recent years. The standard treatment guidelines no longer seem effective in achieving clearance and results in high failure rates.Objective: To evaluate the efficacy and safety of oral terbinafine and itraconazole combination therapy in the management of dermatophytosis.Methods: Clinically diagnosed and KOH positive patients of tinea corporis/cruris/faciei were randomly divided into three groups and given terbinafine 250 mg, itraconazole 200 mg and a combination of both once daily taken on the same day respectively for 3 weeks. Partial responders at the end of the therapy were given same treatment for additional 3 weeks. Clinical parameters namely itching, erythema, and scaling were evaluated at baseline, 3, 6, and 9 weeks. Adverse effects were noted at the end of therapy.Results: Maximum clinical and mycological cure was achieved in group III (receiving combination therapy) (90%) followed by group II (receiving itraconazole) (50%) and group I (receiving terbinafine) (35%). The combination therapy of oral terbinafine and itraconazole was found to be as safe as monotherapy without any significant adverse effects.Conclusions: The combination of systemic terbinafine and itraconazole therapy may be an effective and safe therapeutic strategy in the management of dermatophytosis.

Intralesional radiofrequency treatment for venous lake.

BACKGROUND: Venous lakes are asymptomatic, cosmetically unacceptable vascular malformations commonly present over the lips. Most of the lesions do not warrant any therapeutic intervention. OBJECTIVE: We herein report a 20-year-old male patient with venous lake who was treated using intralesional radiofrequency (RF) by modified insulated intravenous cannula as an extended probe. METHODS: An RF ablation was performed under local infiltration anesthesia using intravenous infusion cannula as an extended insulated probe to deliver current. RESULTS: The venous lake was obliterated immediately post-procedure with minimal inflammatory change. It showed good cosmetic results with minimal scarring and no recurrence at 18 months of follow-up. CONCLUSIONS: Intralesional RF using modified insulated probe is a useful alternative treatment and may be considered to treat small venous lakes.

Lucio Phenomenon: A Rare Presentation of Hansen's Disease.

Lucio phenomenon (LP) is a rare reactional state seen in cases of diffuse lepromatous leprosy. Lucio leprosy is a pure, primitive, and diffuse form of lepromatous leprosy. It is observed almost exclusively in Mexico and Central America and is considered a globally restricted phenomenon. However, isolated cases are being reported worldwide. Patients with Lucio leprosy often present with manifestations of LP, which includes purpuric macules with multiple and extensive areas of ulceration with bizarre-patterned, angulated borders mainly affecting the extremities. LP is difficult to recognize, especially in nonendemic countries, which can lead to a delay in its diagnosis and management. We report a case of LP due to its occurrence in the classical form of lepromatous leprosy and rarity in North India.

Psoriasis Herpeticum due to Varicella Zoster Virus: A Kaposi's Varicelliform Eruption in Erythrodermic Psoriasis.

Kaposi's varicelliform eruption (KVE) or eczema herpeticum is characterized by disseminated papulovesicular eruption caused by a number of viruses like Herpes simplex virus I and II, Coxsackie virus, and Vaccinia and Small pox viruses in patients with pre-existing skin disease. The occurrence of KVE with psoriasis has been reported recently as a new entity psoriasis herpeticum. The rare causation of psoriasis herpeticum due to Varicella zoster virus in a patient with underlying psoriasis is being reported for the first time.

Transient infantile patterned hyperpigmentation.

Patterned transient pigmentation along lines of creases occurring in a newborn is rare. A case report of this entity is described, along with a review of all six cases described in the literature so far.

Comparative efficacy of cetirizine and levocetirizine in chronic idiopathic urticaria.

H1 receptor antagonists are the mainstay of treatment for chronic idiopathic urticaria. Newer hydroxyzine derivatives such as cetirizine and levocetirizine have been found to be equally efficacious in preclinical studies in patients with chronic idiopathic urticaria. In this study, the clinical efficacy of cetirizine and levocetirizine has been studied sequentially in individual patients. Fifty chronic idiopathic urticaria patients received 10 mg of levocetirizine daily for 6 weeks. Some 45 patients out of these showed reasonably good clinical efficacy on a visual analog scale to qualify for comparison with levocetirizine. A total of 30 patients completed the study period of 6 weeks each of cetirizine and levocetirizine sequentially. Thus, the clinical efficacy of cetirizine and levocetirizine was comparable with a marginal advantage of better antipruritic effect with levocetirizine, probably at the cost of increased sedation.

Microdermabrasion: Reappraisal and brief review of literature.

BACKGROUND: Microdermabrasion (MDA) is a recently introduced noninvasive, nonsurgical, office-based esthetic procedure for revitalizing and rejuvenating the skin. It is a closed-loop vacuum-assisted abrasive procedure, which uses the physical action of inert crystals to exfoliate the skin. OBJECTIVE: The aim was to evaluate the procedure of MDA in postacne scarring, melasma, and facial rejuvenation, and review the relevant literature. METHODS: Ten patients each of postacne scarring, melasma, and facial rejuvenation were treated by a series of weekly MDA sittings alone or in conjunction with a topical retinoid. The results were assessed by patient questionnaire and an objective assessment by two independent observers. The literature was reviewed to find indications and efficacy of MDA. RESULTS: All the patients of postacne scarring, melasma, and facial rejuvenation reported a mild but definite improvement, which increased when MDA was performed in conjunction with a topical retinoid. Most of the literature based on subjective and patient-dependent assessment parameters points toward a marginal improvement in the skin appearance following repeated procedures. CONCLUSION: Reappraisal of this potentially useful procedure points toward a need for well-designed clinical trials and studies with a long follow-up based on objective assessment parameters.

Lindane neurotoxicity in childhood.

Lindane (gamma-benzene-hexachloride) has been widely used as an antiscabetic and a pediculicidal agent for the past 50 years with reasonably good efficacy. After its initial use as a first-line therapy, there have been several reports of its neurotoxicity, especially among infants and young children. Literature review reveals that the risk of its neurotoxicity is minimal if used properly and strictly according to the prescribed recommendations. However, following availability of other safer and equally efficacious alternatives, it is now being regarded as a second-line therapy for scabies and pediculosis.

Micropigmentation: tattooing for medical purposes.

BACKGROUND: Micropigmentation, also known widely as tattooing, is being commonly used esthetically to camouflage various medical conditions related to dermatology and plastic surgery. OBJECTIVE: The aim was to review the procedure of tattooing and its various latest medical indications. METHODS: Peer review of the literature on micropigmentation through a MEDLINE search was done to enumerate its various medical indications. RESULTS: The literature review revealed widespread acceptance of micropigmentation for a spectrum of diseases of cosmetic importance, especially in mucosal vitiligo. Micropigmentation is also being used for various medical indications, such as burn scars, alopecia areata, and nipple-areola reconstruction. CONCLUSIONS: The procedure is relatively easy, provides permanent camouflage, and is generally devoid of any significant adverse effects. However, a number of infections can be transmitted from one patient to another if the universal precautions for sterilization of instruments used for micropigmentation are not adhered to.

Reversible neurotoxicity after an overdose of topical lindane in an infant.

Lindane (gamma benzene hexachloride) is a widely prescribed topical scabicide because of its efficacy and cost-effectiveness. Although toxicity from a single proper application of lindane is generally not observed, the hazards of repeated applications, industrial exposure, and accidental ingestion have been well documented. We herein describe an infant with reversible neurotoxicity following repeated applications of 1% lindane for the treatment of scabies. The role of factors predisposing to increased absorption and the recommendations to minimize potential neurotoxicity are emphasized.