Comparison between the efficacy of terbinafine and itraconazole orally vs. the combination of the two drugs in treating recalcitrant dermatophytosis.

Fungal infections are a challenging to treat cutaneous condition. Approximately 20-25% of humans are affected by superficial fungal infections that invade and multiply within keratinized tissues. To compare the efficacy of either terbinafine or itraconazole orally versus the combination of the two drugs in the treatment of recalcitrant dermatophytosis. The current study included 45 patients with recalcitrant dermatophytosis who were distributed into 3 groups (each of 15 patients); Group A received terbinafine 250 mg twice a day for 4 weeks. Group B received itraconazole 200 mg twice a day for 4 weeks. Group C received terbinafine 250 mg once daily and itraconazole 200 mg once daily for 4 weeks. The patients were followed up for 12 weeks after initiation of treatment by clinical and microbiological assessment to determine the cure rate. At the end of twelve weeks, 12 (80%) patients in group A; 13 (86.7%) patients in group B and 15 (100%) patients in group C were completely cured. Despite of cure rates being higher in the combined group C; yet results were not statistically significant (p = 0.207). Clinical cure rates were non significantly higher in itraconazole + terbinafine combined group (p = 0.207). Combination of terbinafine and itraconazole had a higher clinical and mycological cure rate when compared to the use of either drug alone as monotherapy. Further randomized, multicenter, large cohort studies are warranted to validate the use of combination antifungal treatments.

Comparative study between topical methotrexate 1% gel and minoxidil 5% gel in the treatment of localized alopecia areata.

Alopecia areata (AA) is an autoimmune disease that results in non-scarring hair loss. Topical minoxidil 5% gel and methotrexate (MTX) 1% gel are important modalities used in the treatment of many dermatological diseases. We aimed to evaluate the efficacy of MTX 1% gel versus topical minoxidil 5% gel in the treatment of localized AA both clinically and dermoscopically. A total of 50 patients were randomly divided into two groups of 25 each; the first was treated with topical minoxidil 5% gel and the second was with MTX 1% gel. Dermoscopic and photographic pictures were used to follow up at baseline, 3, 6, and 12 weeks. By comparing the two therapies, we noticed that minoxidil has a statistically significant higher frequency of broken hair and black dots after 6 weeks than MTX. After 12 weeks, dermoscopic revealed that the minoxidil group had a lower frequency of vellus hair than the MTX group. Clinically after 6 weeks, minoxidil showed significantly more excellent improvement than MTX (16% vs. 0%), after 12 weeks, minoxidil and MTX showed excellent improvement (52% and 36%), respectively. There was no significant difference in side effects (erythema and itching) between the MTX and minoxidil groups. Both topical MTX 1% gel and topical minoxidil 5% gel had high efficacy in treating localized AA, with no significant differences between them as evaluated by clinical and dermoscopic examination.

Safety and efficacy of topical metformin 30% cream versus triple combination cream (Kligman's formula) in treating melasma: A randomized controlled study.

BACKGROUND: Melasma is an acquired common pigmentary condition that mostly presents as pigmented macules on the face. Triple combination creams (TCC), commonly known as kligman's formula, had been regarded as the mainstay of treatment for years. Topical metformin was recently studied for its melanopenic effects and potential use in melasma. AIM OF THE WORK: This study aimed to evaluate the efficacy and safety of using 30% metformin cream to that of triple combination creams (Kligman's formula) in treating melasma. PATIENTS AND METHODS: About 40 patients complaining of melasma were recruited for this controlled randomized trial and were divided into 2 groups. Group 1 (n = 20) subjects received 30% metformin cream whereas group 2 (n = 20) were treated with TCC for eight consecutive weeks. Pigmentation severity and improvements were assessed using the melasma area severity index (MASI) at baseline and after 8 weeks of using treatment. RESULTS: MASI score decreased dramatically from 12.18 ± 9.33 before treatment to 5.59 ± 4.61 at Week 8 with a mean decrease percentage of 55.97 ± 16.77 for group 1 (p = 0.001) and from 16.05 ± 8.73 to 7.54 ± 5.77 with a mean decrease percentage of 56.50 ± 19.44 for group 2 (p = 0.001). No significant difference was reported between the two treatment modalities regarding the reduction in melasma throughout the study period (p = 0.968). CONCLUSION: Metformin cream is a safe, potential effective treatment for melasma, which needs to be verified by long-term large scale studies in diffident populations.

Comparative study between intralesional injection of MMR, BCG, and candida albicans antigen in treatment of multiple recalcitrant warts.

BACKGROUND: Cutaneous warts represent a challenging condition to treat. OBJECTIVE: To evaluate the safety and efficacy of intralesional injection of MMR (mumps, measles, and rubella) antigen, BCG (bacillus Calmette-Guerin) vaccine, and candida antigen for the treatment of multiple warts. METHODS: A total of ninety (90) clinically confirmed adult patients complaining of recalcitrant extragenital warts of various sizes and durations were recruited in this randomized clinical trial. They were divided into three groups (A, B, and C). Each group consisted of (30) patients. Group (A) subjects received intralesional MMR injections. Group (B) subjects received intralesional BCG injection and Group (C) received intralesional candida antigen injection. RESULTS: Full clearance of warts was observed in (73.33%, 70%, and 43.33%) in groups A, B, and C, respectively. Infrequent side effects including pain, erythema, and minimal induration were reported in all groups but did not necessitate termination of treatment. CONCLUSION: All the three modalities used demonstrated a simple, safe modality with low adverse events, and with no recurrence. To achieve an optimal response with an ideal immunotherapeutic agent and ideal dose, further comparative studies are warranted and on different populations and larger sample sizes.

Occupational dermatoses: knowledge, attitudes and perceptions among motor vehicle repair workers.

Objectives. Motor vehicle repair workers are a vulnerable group for developing occupational dermatoses. They are exposed to a wide range of chemical, physical and mechanical hazards. This study aimed to assess the prevalence of occupational dermatoses among motor vehicle repair workers and their risk factors, and to evaluate the effect of a health educational program. Methods. The study was conducted among 106 motor vehicle repair workers. All participants were personally interviewed at their workshops and were subjected to the Nordic occupational skin questionnaire, dermal exposure knowledge, attitudes and perceptions questionnaire, dermatological examination and health educational program. Then, evaluation of the effects of health the program was done after 2 months. Results. Exclusively occupational dermatoses (18.9%) were followed by work-related dermatoses (17.9%). Chronic contact dermatitis was the most frequent exclusively occupational dermatoses (12.26%), followed by tar/oil acneform rash (3.77%) and mechanical injury (3.77%). Xerosis (6.6%) and hyperpigmentation (4.71%) were the most frequent work-related dermatoses. Lack of use of personal protective equipment, older age, longer duration of work, exposure to chemical hazards and car mechanics were the independent risk factors. Conclusions. A significant improvement occurred in the participants' knowledge about dermal exposure, behavioral action for prevention and overall belief (pre/post intervention) (p < 0.01).