[Consensus on HPV of the Portuguese Society of Andrology, Sexual Medicine and Reproduction: Treatment]. / Consensos em HPV Masculino da Sociedade Portuguesa de Andrologia, Medicina Sexual e Reprodução: Tratamento.

The treatment of condyloma is generally a challenge in clinical practice. Although the spontaneous resolution rate is high, a significant proportion of patients seek treatment, not because of symptomatology, but mainly for aesthetic issues and concerns related to the transmission or worsening of existing lesions. The available treatments should be applied only for clinically evident macroscopic lesions. Ideally, available therapies should have rapid action onset and clearance, resolve symptoms, reduce recurrence rate and viral load, be effective in treating small lesions, and be well tolerated. However, none of the currently available treatments is clearly more effective than the others and there is no ideal treatment for all patients or for all condyloma. Therefore, the therapeutic decision should be based on the clinician's experience, available resources, lesion morphology, size, number and location, primary or recurrent lesions, disease severity, patient preference and expectations, patient's immune competence, convenience, tolerance, cost of treatment and results of previous therapies. The available treatments are divided into three groups: applied by the patient himself (imiquimod 3.75 or 5%, podophyllotoxin .5%, synecatekines 10% or 15%), applied by the health care provider (bi- and tricloacetic acids 80%-90%, intralesional interferon alpha, cryotherapy, surgical removal, electrofulguration, laser ablation) and experimental or alternative therapies (topical cidofovir, intralesional bleomycin, photodynamic therapy). Treatment methodologies can be further divided into their action - ablative or destructive treatment (cryotherapy, electrofulguration, laser ablation, surgical excision), cytotoxic or proapoptotic treatments (podophyllotoxin .5%, 5-fluoruracil, bleomycin) and immunomodulatory treatments (imiquimod 3.75% or 5%, synecatekines 10% or 15%, intralesional interferon alpha). The overall success rate of the various treatments available ranges from 23% to 94%. Only treatments that include cryotherapy or surgical excision are suitable in condyloma with any anatomical location and that have the highest success rate in monotherapy. Recurrences are common regardless of the treatment received. In contrast, immunomodulatory therapies despite having lower initial clearance rates appear to have higher probabilities of cure in the medium term, with low recurrence rates. Some treatments may be combined with each other and the effectiveness of combined therapies appears to be superior to monotherapy (proactive sequential treatment). The consensuses for the treatment of HPV also consider special situations: immunocompromised patients, meatus and intraurethral lesions and treatment of the partner.

Research "recover from illness defense complex" helper T cell immune mechanisms based on the "Fuxie" theory clearing away heat evil thoroughly nourishing kidney treatment of recurrent blood-heat syndrome Psoriasis.

INTRODUCTION: Psoriasis vulgaris (PV) is a chronic, painful, disfiguring, and disabling dermatological disease, which affects the physical and mental health of patients and impacts their quality of life. Current conventional systemic therapies can be costly, present risks of side effects, have limited efficacy and commonly recur following treatment cessation. Some Chinese herbal medicine therapies have shown therapeutic benefits for psoriasis vulgaris, including relieving symptoms and improving quality of life, and a potential of reducing relapse rate. However, explicit evidence has not yet been obtained. METHODS AND ANALYSIS: This is a pilot randomized controlled trial with the objective of investigating the effect of Jia Wei Liang Xue Xiao Feng San granules on relapse rate of recurrent PV and the correlation between Psoriasis area severity index (PASI) and key psoriasis-related cytokine changes and the number of cells. A total of 102 participants were recruited for this study, including 72 patients with recurrent PV, 15 healthy volunteers and 15 patients with psoriasis vulgaris who have recovered for more than 1 year. A total of 72 patients, with recurrent PV, will be randomized (1:1) to receive the oral Chinese herbal medicine Jia Wei Liang Xue Xiao Feng San or the oral Acitretin Capsule treatments for a period of 8 weeks. After this period, participants whose PASI scores improvement reached more than 75%, will undergo a 52-week follow-up phase.The primary outcome measures are as follows:The secondary study outcomes will include:This trial may provide a novel regimen for recurrent PV patients if the granules decrease recurrence rate without further adverse effects. ETHICS AND DISSEMINATION: The ethics approval was provided by the Sichuan Traditional Chinese medicine regional ethics review committee. The ethics approval number is 2018KL-055. The design and the results of the study will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry (ChiCTR1900022766).

Lymphomatoid Papulosis and Other Lymphoma-Like Diseases.

Pityriasis lichenoides et varioliformis acuta and pityriasis lichenoides chronica are the 2 main subtypes of pityriasis lichenoides. They represent the acute and chronic forms of the disease; both may have clonal T cells. Several treatment modalities are used, but it has been difficult to determine efficacy because of the possibility of spontaneous remission. Cutaneous CD30+ lymphoproliferative disorders constitute many cutaneous T-cell lymphomas and comprise lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma (ALCL). Both have an excellent prognosis. Lymphomatoid papulosis often only requires observation or treatment of symptoms. First-line therapies for primary cutaneous ALCL are surgical excision or radiotherapy.

Plasma miR-126 expression correlates with risk and severity of psoriasis and its high level at baseline predicts worse response to Tripterygium wilfordii Hook F in combination with acitretin.

BACKGROUND: Treatment of psoriasis is always difficult, which requires intensive scientific research. OBJECTIVE: Tripterygium wilfordii Hook F (TwHF) with acitretin(TwHF + acitretin) is normally used in treating psoriasis. This study aimed to investigate the correlation of plasma miR-126 expression with risk and severity of psoriasis, and its predictive value of response to TwHF + acitretin treatment in psoriasis. METHODS: MiRNA-126(MiR-126) expression in plasma was analyzed in psoriasis patients at month 0 (M0), M1, M3 and M6 and in health controls (HCs) at enrollment by qPCR. Psoriasis-affected body surface area (BSA) and Psoriasis Area and Severity Index (PASI) score were used to assess severity and treatment response. RESULTS: Plasma miR-126 levels were decreased in psoriasis patients compared with HCs (P < 0.001), with area under the curve (AUC) of 0.771. MiR-126 expression was negatively correlated with PASI score (P = 0.001), and negatively associated with psoriasis-affected BSA (P = 0.825). At M6, 65.3% and 36.1% patients achieved PASI 50 and 75, respectively. MiR-126 increased at M1, M3 and M6 after TwHF + acitretin treatment when comparing with M0 (all P < 0.001). Meanwhile, miR-126 expression baseline in PASI 50 group declined when comparing with non-PASI 50 group (P < 0.001). Additionally, data revealed that the cause of high miR-126 baseline level was due to unsuccessfully achieving PASI 50 at M6 after TwHF + acitretin treatment (P < 0.001). However, miR-126 baseline expression was not a predictive factor for PASI 75 achievement (P > 0.05). CONCLUSION: Plasma miR-126 expression is negatively correlated with psoriasis risk and severity, and its high baseline level can be used as a biomarker to predict worse clinical response to TwHF + acitretin treatment in psoriasis.

Treatment of striae distensae: An evidence-based approach.

Striae distensae (SD), otherwise known as "stretchmarks," are a common presenting complaint, particularly in young healthy women. SD are hypothesized to form in a patient when the cross-linked collagen is "overstretched" and rupture of this collagen matrix causes the striae. Thus, many treatments work by increasing collagen synthesis. This review critically appraises the evidence to date for the treatment of SD, including both energy-based devices and topical treatments.

The comparison of skin rejuvenation effects of vitamin A, fractional laser, and their combination on rat.

BACKGROUND: Because of long-term exposure of skin, skin aging is an unavoidable natural law with age. Traditional Vitamin A and novel ablative fractional laser technique both have the effects of skin rejuvenation, and studies have demonstrated both of them have apparent clinical efficacy and histology-improving effects on photo-aging skin. MATERIALS AND METHODS: 45 female healthy Wistar rats were selected and the depilation areas of every rat were divided into four regions: control region(Region A), Vitamin A acid region(Region B), combination treatment region(Region C), and fractional laser region(Region D). 0.025% Vitamin A acid cream was applied to Region B and C every day for 3 weeks; Region C and D were irradiated once with 10600nm CO2 fractional laser on the first day of the trail. The skin tissue was dissected and placed into liquid nitrogen according to the design. The real-time quantitative PCR and western blotting methods were taken to detect the expression changes of miR-29a, Akt, TGF-ß, and mRNA of type III pre-collagen. RESULTS: It can be seen from the results of the real-time quantitative PCR that the mRNA expression levels of type III pre-collagen, Akt, and TGF-ß in the treatment regions are up-regulated and the expression levels of miR-29a mRNA are down-regulated compared to the Region A. The hybridization tests showed that changes of the expression of type III pre-collagen, Akt gene, miR-29a gene, and TGF-ß gene across the experiment regions are all significantly different in the third week, and the expression levels of them all achieve the highest value in the third week, the expression level of miR-29a gene achieves the lowest value in the third week, which are consistent with the results of real-time quantitative PCR. CONCLUSION: It is indicated that the combination region of Vitamin A acid and fractional laser may lead to low expression of miR-29a, thus the inhibition of downstream Akt activation is loss, Akt activation is enhanced, enhancement of the expression of TGF-ß is induced, leading to proliferation of fibroblasts, and promotion of the collagen proteins' synthesis in skin. Therefore miR-29a/Akt/TGF-ß signal pathway may participate in the skin rejuvenation mechanism of action Vitamin A acid and fractional laser. This may provide a new treatment approach for skin rejuvenation.

Adjuvant high-dose intravenous immunoglobulins for recalcitrant erosive oral lichen planus: mixed clinical responses.

BACKGROUND: Erosive oral lichen planus (OLP) is, at times, extremely difficult to treat and has a major impact on patients' quality of life. There are only limited therapeutic options, such as topical and systemic glucocorticoids, retinoids, and immunosuppressants with considerable side effects and limited efficacy upon chronic use. OBJECTIVES: In the present individualised clinical trial, we assessed the efficacy of adjuvant intravenous immunoglobulins (IVIG; 2 g/kg/monthly cycle) in addition to the oral retinoid, acitretin, in three patients with refractory OLP over a period of two to six months. MATERIALS & METHODS: The efficacy of adjuvant IVIG treatment was evaluated using the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) which measures both extent of mucosal lesions and functional sequelae. RESULTS: The three OLP patients showed mixed responses to adjuvant IVIG treatment, ranging from therapeutic efficacy to a lack of response to IVIG. CONCLUSIONS: In light of the observed therapeutic responses and a lack of good therapeutic options, adjuvant IVIG, although costly, warrants further investigation as a treatment option for OLP.

Case of punctate palmoplantar keratoderma type I treated with combination of low-dose oral acitretin and topical salicylic acid and steroid.

Palmoplantar keratodermas (PPK) are heterogeneous disorders characterized by abnormal keratinization. Especially, punctate PPK (PPPK), one of the subtypes of hereditary PPK, is a rare punctate keratoderma characterized by tiny "raindrop" keratoses having a tendency to coalesce on the edge of soles, which are exposed to sustained pressure. If typical punctate lesions are confined to the palms and soles and the patient has a family history and late onset, it can be considered as PPPK type I (PPKP1), also called Buschke-Fisher-Brauer disease. The exact etiology of PPPK has not been fully understood. Furthermore, no standardized treatment for PPPK has been established and treatment options are limited. Above all, traditional systemic retinoids have been used in several cases, but dose-related adverse effects are common. Therefore, combination of low-dose systemic retinoids and adjuvant topical therapy can be an alternative treatment option for PPPK. Herein, we report a case of PPKP1 treated with combination of low-dose oral acitretin (10 mg/day) and topical salicylic acid and steroid. Despite low capacity, low-dose acitretin showed excellent regression of the lesions by combined use of topical ointments. The supplementary topical therapy may be useful in reducing the dose of systemic retinoids and preventing potential toxicity.

Curcumin nanoparticles potentiate therapeutic effectiveness of acitrein in moderate-to-severe psoriasis patients and control serum cholesterol levels.

OBJECTIVES: In this study, nanoparticles of curcumin were developed and orally administered to moderate-to-severe psoriasis (Psoriasis Area Severity Index values, PASI > 10) patients, in a placebo controlled, double blind, randomised clinical trial to evaluate the effectiveness. METHODS: Diverse binary systems of curcumin and hydrophilic polymers were investigated to optimise solubility and stability in terms of curcumin residual content and size of the crystals. Nanocrystals of curcumin stabilised with PVP (1 : 0.5, w/w), were characterised using X-ray diffraction, differential scanning calorimetry, TEM analyses and stability studies. The formulation was evaluated with a parallel artificial membrane permeability assay to predict the passive intestinal absorption. The first group of patients was treated orally with acitretin (0.4 mg/kg per day) plus nanocurcumin (3 g/day), the second group with acitretin, for 12 weeks. KEY FINDINGS: Curcumin nanoparticles were homogeneous and stable systems. Curcumin permeability was significantly enhanced when compared with aqueous saturated solution of curcumin. The reduction in PASI was significantly higher in patients treated with curcumin (P < 0.0001) and cholesterol serum levels remained unchanged in patients treated with acitretin plus nanocurcumin. CONCLUSIONS: Curcumin nanoparticles represent an effective adjuvant therapy in moderate-to-severe psoriasis patients treated with oral acitretin, improving their lipid serum profile.

Generalized eruptive keratoacanthoma with vitiligo followed by the development of prurigo nodularis: A case report and published work review.

Herein, we report a unique case of generalized eruptive keratoacanthoma (GEKA) in a 47-year-old Chinese man presenting with extensive pruritic papules and nodules accompanied by oral lesions. He also had a 2-year history of vitiligo and long-term experience of working outdoors. Biopsies were consistent with keratoacanthoma . Interestingly, prurigo nodularis (PN) was found in histopathology at 1-year follow up. To our knowledge, this is the first report describing a case of GEKA with oral lesions complicated with vitiligo and developed with PN.

Fractional carbon dioxide (CO2) laser combined with topical tretinoin for the treatment of different forms of cystic acne.

Nodulocystic acne is prone to scarring and difficult to treat with treatments other than oral isotretinoin. The aim of this article is to discuss the role of a single session of a fractional carbon dioxide (CO2) laser combined with a topical treatment with a tretinoin and antibiotic gel for a month as a successful treatment to improve nodulocystic acne and chronic microcystic acne. Two cases were involved: the first with nodulocystic acne lesions that persisted after oral retinoids and the second with chronic microcystic acne resistant to topical treatments. After only one session of treatment with the CO2 laser and the topical treatment, a complete healing of the nodulocystic acne lesions was observed with minimal secondary effects. The microcystic acne showed great improvement. No other topical or oral treatment was needed. This treatment could be a safe and effective treatment for nodulocystic acne lesions and microcystic acne when other treatments fail. More studies should be performed to confirm our results.

Treatment of recalcitrant plantar warts with long-pulsed Nd:YAG laser versus cantharidin-podophylline resin-salicylic acid.

BACKGROUND: Treatment for recalcitrant plantar warts remains a continuing challenge as the options for treatment have differing levels of success. long-pulsed Nd:YAG laser is considered a good treatment modality in resistant plantar warts. On the other hand, high cure rates have been reported with a topical proprietary formulation consisting of 1% cantharidin, 5% podophyllotoxin, 30% salicylic acid. AIM: To compare the efficacy of 1% cantharidin, 20% podophylline resin and 30% salicylic acid (CPS) versus long-pulsed Nd:YAG laser in the treatment of recalcitrant plantar warts. METHODS: This study included 30 patients with single or multiple recalcitrant plantar warts; patients were assigned to two groups: the first group included 15 patients with 71 recalcitrant plantar warts who were treated by long-pulsed Nd:YAG laser (group I) and the second group included 15 patients with 78 recalcitrant plantar warts who received CPS (group II). The diagnosis of plantar warts was made by clinical examination. RESULTS: Fourteen patients (93%) were completely cleared of their warts with topical CPS, while 11 patients (73%) showed complete clearance with long-pulsed Nd:YAG laser with statistically significant difference between the two groups. CONCLUSION: Topical CPS is safe and efficacious and represents a promising therapeutic modality than long-pulsed Nd:YAG laser in the treatment of recalcitrant plantar warts.

Efficacy and safety of total glucosides of paeony combined with acitretin in the treatment of moderate-to-severe plaque psoriasis: a double-blind, randomised, placebo-controlled trial.

Although acitretin has been widely used for the treatment of psoriasis, additional safer and more effective approaches, including traditional Chinese medicine, are needed. To investigate the efficacy and safety of total glucosides of paeony (TGP) combined with acitretin in the treatment of moderate-to-severe plaque psoriasis. A randomised, double-blind, placebo-controlled, multi-centre clinical study was conducted. In total, 108 patients with moderate-to-severe plaque psoriasis were randomly assigned to treatment with "TGP plus acitretin" (group A) or "placebo plus acitretin" (group B) for 12 weeks. After 12 weeks of therapy, the percentage of patients achieving a 50% reduction in Psoriasis Area and Severity Index was 90% in group A and 70.5% in group B (p<0.05). The rate of serum alanine aminotransferase elevation was 6.25% in group A and 20.4% in group B (p<0.05). TGP is conducive to enhancing anti-psoriatic efficacy and reducing liver damage due to acitretin. TGP combined with acitretin is a safe and effective treatment approach for moderate-to-severe plaque psoriasis.

Salicylic acid peeling combined with vitamin C mesotherapy versus salicylic acid peeling alone in the treatment of mixed type melasma: A comparative study.

INTRODUCTION: Melasma is a distressing condition for both dermatologists and patients. We evaluated the effectiveness of salicylic acid (SA) peel and vitamin C mesotherapy in the treatment of melasma. MATERIALS AND METHODS: Fifty female patients were divided into two groups. All patients were treated with 30% SA peel every two weeks for two months. In addition, after SA peeling Group A was intradermally administered 10 vitamin C on the melasma lesion at 1-cm intervals. All patients were followed up for 6 months, during which the recurrence rates were evaluated. Digital photographs of the melasma site were taken and patients' Melasma Area and Severity Index (MASI) scores were assessed. After the treatment, the patients were asked to complete the melasma quality of life questionnaire (MelasQoL) to evaluate their satisfaction with the treatment. All the adverse effects were noted. RESULTS: The MelasQoL and MASI scores of patients in both groups significantly decreased after the treatment. Apart from a burning sensation, no adverse event was observed and all patients tolerated the treatment well. DISCUSSION: SA peel combined with vitamin C mesotherapy is a safe and effective alternative for the treatment of melasma with no significant side effects and minimal downtime.

Disseminated punctate keratoderma: a rare case report and review of the literature.

We report a rare case of a 53-year-old womanpresenting with diffuse, late-onset disseminatedhyperkeratotic papules. Biopsy showed massivehyperkeratosis overlying a crateriform epidermaldepression and hypergranulosis with mild epidermalhyperplasia. There was no parakeratosis, cornoidlamella, or dyskeratosis. Based on the clinical findingsand histopathological features, a diagnosis ofdisseminated punctate keratoderma was made. Thisis a rare subtype of palmoplantar keratoderma, whichhas a putative increased risk of malignancy. This casereport emphasizes the importance of identifyingthe clinical and histological presentation of this rarecondition; referral of the patient for age-appropriatemalignancy screening is appropriate. We also presenta concise review of treatment options.

Management of patients with psoriasis.

Stacey Croney, Clinical Nurse Lead Dermatology, Medway NHS Foundation Trust, Kent discusses the care of patients with psoriasis, including the latest drug treatments.