A short, 8-week course of imiquimod 5% cream versus podophyllotoxin in the treatment of anogenital warts: A retrospective comparative cohort study.

BACKGROUND: Studies comparing head-to-head treatment modalities for anogenital warts are lacking. AIM: We sought to compare a short, 8-week course of imiquimod 5% cream to versus the standard 4 week course of podophyllotoxin in the treatment of anogenital warts and to assess factors that may affect response to treatment. METHODS: This was a retrospective cohort study. We reviewed medical files of otherwise healthy patients with a first episode of anogenital warts who were treated with either a short, 8-week course of imiquimod or the standard 4-week course of podophyllotoxin. Inverse probability of treatment weighted (IPTW). Logistic regression was employed to evaluate factors that may affect response to therapy. RESULTS: The study included 347 patients. In patients with lesions on dry, keratinized anatomical sites, the complete clearance rates were 7.6% for imiquimod and 27.9% for podophyllotoxin (P < 0.001). In patients with lesions on moist, partially keratinized sites, no difference between the treatments was revealed. Significant predictors of > 50% reduction in wart area were location of lesions [odds ratio (OR) (95% confidence interval (CI)): 3.6 (1.84-7.08), P = 0.0002] for "partially keratinized" versus "keratinized" sites and treatment used [OR (95% CI): 1.79 (1.08-2.97), P = 0.024] for podophyllotoxin versus imiquimod. LIMITATIONS: The retrospective design of the study was a limitation that we mitigated against with the use of IPTW logistic regression. CONCLUSION: A standard 4 week course of Podophyllotoxin was more effective than an 8-week course of imiquimod only for lesions on keratinized sites. Treatment with podophyllotoxin and location of lesions on partially keratinized sites were independent predictors of >50% reduction in wart area.

Narrow band ultraviolet-B versus Goeckerman therapy for psoriasis with and without acitretin: A retrospective study.

BACKGROUND: Narrow band ultraviolet-B (NB-UVB) is now one of the most widely used modalities in the treatment of psoriasis. However, despite its high efficacy, conventional Goeckerman treatment has fallen out of favor in recent years and some institutions are now using NBUVB with coal tar as their regimen. OBJECTIVE: To evaluate the efficacy of NB-UVB, Goeckerman therapy and the effect of addition of retinoid to the treatment regimen in the treatment of psoriasis,. PATIENTS AND METHODS: A retrospective analysis of 65 patients who underwent 81 courses of treatment in our department was undertaken. The efficacy of NB-UVB and Goeckerman therapy individually, and in combination with acitretin was assessed. Data were analysed to evaluate the contribution of acitretin to these modalities. RESULTS: PASI-75 responses in the NB-UVB, retinoid+NB-UVB (re-NB), Goeckerman and retinoid+Goeckerman (re-Goeckerman) groups were achieved for 12 of 31 patients (39%), 13 of 21 patients (62%), 15 of 17 patients (88%) and 10 of 12 patients, respectively. The addition of acitretin to both modalities reduced both the number of sessions and the cumulative ultraviolet-B dose delivered. LIMITATIONS: This is a retrospective study, the patients were not randomized and the number of patients in the treatment groups were dissimilar. CONCLUSION: Goeckerman therapy is more effective than NB-UVB phototherapy. Although the addition of acitretin to both NB-UVB and Goeckerman therapy did not contribute to treatment outcomes in terms of PASI-75 responses, it enabled a reduction in UV exposures and enhanced efficacy.

A comparative study on efficacy of high and low fluence Q-switched Nd:YAG laser and glycolic acid peel in melasma.

BACKGROUND: Melasma is acquired symmetric hypermelanosis characterized by light-to-deep brown pigmentation over cheeks, forehead, upper lip, and nose. Treatment of this condition is difficult and associated with high recurrence rates. With the advent of newer therapies, there is interest in the use of glycolic acid peels and Q-switched Nd:YAG laser (QSNYL) in high and low fluence for this disorder. AIMS: To compare the therapeutic efficacy of low fluence QSNYL, high fluence QSNYL, and glycolic acid peel in melasma in three study groups of 25 patients each. METHODS: Seventy-five Indian patients diagnosed as melasma were included. These patients were randomly divided in three groups (Group A = 25 patients of melasma treated with low-fluence QSNYL at weekly intervals, Group B = 25 patients of melasma treated with glycolic acid peel at 2 weeks intervals, Group C = 25 patients of melasma treated with high-fluence QSNYL at 2 weeks intervals). Study period and follow-up period was of 12 weeks each. Out of the 75 patients included, 21 patients in Group A, 19 patients in Group B, and 20 patients in Group C completed the study. Response to treatment was assessed using melasma area and severity index score. RESULTS: Significant improvement was recorded in all the three groups. The improvement was statistically highly significant in Group A as compared to Group C (P<0.005), significant in Group A as compared to Group B (P<0.05), and also in Group B when compared to Group C (P<0.05). Low-fluence QSNYL was associated with least side effects. CONCLUSIONS: This study shows the efficacy of low-fluence QSNYL and glycolic acid peel in melasma. These could be an effective treatment options compared to conventional methods for the treatment of melasma.

Comparative study of trichloroacetic acid versus glycolic acid chemical peels in the treatment of melasma.

BACKGROUND: Melasma is a common cause of facial hyperpigmentation with significant cosmetic deformity. Many modalities of treatment are available, but none is satisfactory. AIM: This study was designed to compare the therapeutic response of melasma in Indian women to glycolic acid (GA 20-35%) versus trichloroacetic acid (TCA 10-20%) for chemical peeling. METHODS: Forty nonpregnant female patients with a minimum melasma area and severity index (MASI) of 10 were recruited in the study. After a detailed history and clinical examination under natural light, MASI was calculated and color photographs were taken of all the patients. The patients were advised to carry out a prepeel program of daily application of 12% GA cream or 0.1% tretinoin at night for 2 weeks. They were then treated with graded concentrations of 20-35% GA facial peel every 15 days in GA group and 10-20% TCA in the second group. RESULTS: Objective response to treatment evaluated by reduction in MASI scoring after 12 weeks was by 79% reduction (from 26.6 to 5.6) in GA group and by 73% reduction in TCA group (from 29.1 to 8.2) but this difference was not significant. Patients with epidermal-type melasma showed a better response to treatment than those with mixed-type melasma (P<0.05). Subjective response, as graded by the patient, showed good or very good response in 75% in GA group and 65% in TCA group. No relation of treatment response to age and duration of melasma could be established in this study. CONCLUSIONS: A prepeel program of daily application of 12% GA cream at night for 2 weeks, followed by graded increase in GA and TCA concentrations proved to be an equally effective treatment modality for epidermal and mixed melasma. There are hardly any major side effects, and regular use of sunscreens prevents chances of postpeel hyperpigmentation. GA peel is associated with fewer side effects than TCA and has the added advantage of facial rejuvenation.

Ichthyosis bullosa of Siemens: response to topical tazarotene.

In 1937, Siemens described a Dutch family with superficial blistering, flexural hyperkeratosis, and characteristic mauserung appearance. Since then, less than 20 kindreds with this condition have been described in the English dermatologic literature. A 14-year-old boy presented with history of recurrent blistering and peeling of skin since the age of 1 month, predominantly seen over limbs and trunk, often associated with secondary infection. His mother also had similar symptoms from childhood. On examination, the child had typical mauserung peeling of the skin and dirty gray hyperkeratosis in a rippled pattern over flexures. Skin biopsy from the boy showed intracorneal blistering with epidermolytic hyperkeratosis in the upper spinous layers. The typical history and clinical features along with characteristic histological findings confirmed our diagnosis of ichthyosis bullosa of Siemens. It must be differentiated from other conditions with epidermolytic hyperkeratosis and skin peeling, such as bullous ichthyosiform erythroderma of Brocq and peeling skin syndrome. Our patient responded well to 0.05% topical tazarotene gel over four weeks.

Crusted scabies: clinical and immunological findings in seventy-eight patients and a review of the literature.

OBJECTIVES: To describe the clinical and immunological features of crusted scabies in a prospectively ascertained cohort of 78 patients. METHODS: All patients requiring inpatient treatment for crusted scabies in the 'top end' of the northern territory of Australia over a 10 year period were prospectively identified. Demographics, risk factors, and immunological parameters were retrospectively compiled from their medical records and pathology databases. RESULTS: More than half the patients with crusted scabies had identifiable immunosuppressive risk factors. Eosinophilia and elevated IgE levels occurred in 58% and 96% of patients, respectively, with median IgE levels 17 times the upper limit of normal. Seventeen percent had a history of leprosy but 42% had no identifiable risk factors. There was a decrease in mortality after the introduction of a treatment protocol consisting of multiple doses of ivermectin combined with topical scabicides and keratolytic therapy. CONCLUSIONS: Crusted scabies often occurs in patients with identifiable immunosuppressive risk factors. In patients without such risk factors, it is possible that the crusted response to infection results from a tendency to preferentially mount a Th2 response. The treatment regime described was associated with a reduction in mortality. This is the largest reported case series of crusted scabies.