Safety and efficacy of intralesional polidocanol sclerotherapy in the treatment of plantar warts: a pilot study.

Plantar warts are common skin lesions that continue to represent a therapeutic challenge. They are still resistant to therapy and are highly recurrent, despite the diverse number of treatments available. Therapies targeting vasculature, such as pulsed dye laser, have been used successfully in the treatment of plantar warts. Polidocanol, a detergent sclerosant approved for the sclerotherapy of incompetent and dilated saphenous veins, has also been used as an off-label therapy for a wide range of skin conditions with vascular components such as hemangiomas and pyogenic granuloma. The current, open-label, prospective, pilot study aimed to evaluate the safety and efficacy of the intralesional polidocanol 3% in the treatment of plantar warts. Twenty patients (11 females and 9 males), with plantar warts, aged 12-50 years received biweekly sessions of intralesional polidocanol 3% until complete clearance or for a maximum of 6 sessions. Response to treatment was graded as complete (100% clearance), partial (50-99%), and no response (< 50%). At the end of the study, 12 (60%) patients achieved complete clearance of their warts after 1-5 sessions, 5 (25%) patients had only partial response, and 3 (15%) patients did not achieve any clearance of their warts. The procedure was largely tolerable by patients. Pain at the injection site and bruises were reported by 9 (45%) and 2 (10%) patients, respectively. Both side effects resolved spontaneously and completely within a few days. The findings of the current study suggest that intralesional injection of 3% polidocanol in biweekly sessions may be a safe, effective, and tolerable method for the treatment of plantar warts.

Comparing the efficacy and safety of IL-17 inhibitors for treatment of moderate-to-severe psoriasis: a randomized double blind pilot study with a review of literature.

Introduction: Psoriasis is a chronic skin disease in which interleukin-17A (IL-17A) has been found to play an important role. Commercially available anti-IL-17 drugs include brodalumab, ixekizumab (IXE), and secukinumab (SEC). Aim: To compare the safety and efficacy of IXE and SEC in patients with moderate-to-severe plaque psoriasis. Material and methods: The patients were randomized to the IXE or SEC group. Effectiveness was estimated by Physician's Global Assessment (PGA), Psoriasis Area and Severity Index (PASI), and Dermatology Life Quality Index (DLQI). Safety was assessed by documentation of adverse effects (AEs), routine laboratory values, and injection-site and allergic reactions. Results: There were 155 patients in the IXE group and 158 in the SEC group. At week 12, PASI 75 was 76.77% (IXE) vs. 67.09% (SEC); PASI 90 42.58% (IXE) vs. 32.28% (SEC); PGA score of 0 or 1 at week 40 (79.52% vs. 74.4%) and at week 52 (61.83% vs. 58.12%) (p < 0.001). Also, DLQI score improvement was more pronounced in the IXE group. The rates and types of AEs were similar in both groups. Conclusions: Although both groups demonstrated a robust clinical response, a significant improvement in patient quality of life, and a satisfactory safety profile, the IXE group scored a notch higher.

A Randomized Controlled Ixekizumab Vs Secukinumab Trial to Study the Impact on Sexual Activity in Adult Patients with Genital Psoriasis.

Introduction: There is limited data on the effects of biologic therapies on genital psoriasis and sexual activity. Recently, Ixekizumab was reported to be effective. Aim: To compare the efficacy of ixekizumab and secukinumab for the treatment of genital psoriasis and sexual inadequacy in adult patients with moderate-to-severe psoriasis. Patients and methods: We assessed adult patients with moderate-to-severe psoriasis having genital involvement. They were randomly assigned in a 1:1 ratio to receive either ixekizumab (80 mg/2 weeks after 160-mg initial dose) or secukinumab (300 mg subcutaneous injection at Weeks 0, 1, 2, 3, and 4 then every 4 weeks). The severity was assessed using Genital Psoriasis Symptoms Scale (GPSS), and impact on sexual health by evaluating the Massachusetts General Hospital-Sexual Functioning Questionnaire (MGH-SFQ). Results: Twenty eight patients on ixekizumab, and 26 on secukinumab showed improvement in genital psoriasis symptoms, beginning week 2 (GPSS total and individual items), and from week 4 onwards, improvement in sexual activity was seen with both drugs. Conclusion: Both genital psoriasis symptoms and impact on sexual activity improved rapidly and significantly with both the IL-17 inhibitors. Limitations included small number of patients and lack of follow-up period.

Clinical and mycologic characteristics of onychomycosis in diabetic patients.

The aim of the study was to examine the relative prevalence of dermatophytic, yeast and non-dermatophytic mould onychomycosis among diabetic patients, and to compare it with nondiabetic patients. The study included 460 consecutive diabetic patients and the same number of nondiabetic age-matched subjects attending dermatology clinics at Farwaniya Hospital, Kuwait, over a period of 4 years. All patients were examined clinically and mycologically for any evidence of onychomycosis. All cases of clinically suspected and/or mycologically proven onychomycosis were prescribed terbinafine tablets 250 mg orally per day continuously for 6-12 weeks. The prevalence of clinical onychomycosis in the diabetic and control group was 18.7% (86 cases) and 5.7% (26 cases), respectively. Elderly diabetic patients were at an increased risk of developing onychomycosis. Toenails were affected in 54 (62.8%), fingernails in 20 (23.3%), and both fingernails and toenails in 12 (14%) cases in diabetic group. Distal subungual onychomycosis was the most common clinical presentation, recorded in 67.4% of patients, followed by total dystrophic onychomycosis in 11.6% of patients. Culture positivity alone was seen in 16 (18.6%), both culture and KOH positivity in 52 (60.5%), and positive KOH alone in 10 (11.6%) cases; 8 cases had negative KOH examination and culture, but were PAS positive. Dermatophytes were the most common isolate. Seven percent cases treated for onychomycosis from the diabetic group were evaluated as unsuccessful (relapsed) at the end of the study. This study confirmed that diabetic patients are at a high risk of having or contracting onychomycosis. Onychomycosis was found to correlate significantly with increasing age and male gender. These findings reinforce the importance of attending to infections in diabetics to reduce the associated morbidity. Managing onychomycosis in diabetics may require systemic antifungal treatment, physical measures and patient education.

Tropical medicine rounds: Treatment of Old World cutaneous leishmaniasis with dapsone, itraconazole, cryotherapy, and imiquimod, alone and in combination.

BACKGROUND: Cutaneous leishmaniasis (CL) is a major public health problem. The currently available therapies are expensive, not freely available, toxic, and not always curative. A simple, effective, noninvasive therapeutic approach is required for the treatment of CL. AIMS: To determine the clinical patterns of CL and to report our experience in the management of CL. METHODS: One hundred and ten patients with CL seen between January 2005 and December 2007 were included in this study. The diagnosis was based on clinical features, parasitologic diagnosis, histopathology, and culture. Each patient was treated according to disease severity with either topical (cryotherapy or imiquimod) or systemic (itraconazole or dapsone) monotherapy, or a combination of these modalities. RESULTS: CL was more common in adult expatriate men, with the upper limbs as the most commonly affected site. Noduloulcerative CL was the most common presentation (84.6%). Atypical CL was found in 18 patients. Skin biopsy was the most common diagnostic technique (66.6%). Monotherapy showed an overall success rate of 56.41%, whereas combination therapy was successful in 69.56% of cases. Cryotherapy alone was successful in 68.18% of cases. Imiquimod alone was ineffective. CONCLUSION: A stepwise approach represents a rational and practical way of confirming CL. A combination of itraconazole/dapsone and topically applied imiquimod is safe, simple, and effective for the treatment of CL. More studies are needed to establish the role of such an approach. Cryotherapy is also safe, simple and effective for the treatment of CL.