Intralesional Quadrivalent Human Papilloma Virus Vaccine Versus Candida Antigen in the Treatment of Multiple Recalcitrant Non-Genital Warts.

INTRODUCTION: Warts are the most prevalent clinical manifestation of Human Papilloma Virus (HPV) infections, which vary in morphological pattern depending on the site of the body affected. OBJECTIVES: To evaluate the safety and efficacy of intralesional quadrivalent HPV vaccine versus candida antigen in treatment of multiple recalcitrant non-genital warts. METHODS: A randomized-control clinical trial included 60 cases with multiple recalcitrant warts who were randomly distributed into three groups; Group I included 20 patients who received intralesional candida antigen at a dose of 0.3 mL of 1/1000 solution, Group II included 20 patients who received intralesional quadrivalent HPV vaccine at a dose of 0.3ml and Group III included 20 patients who received intralesional injection 0.3 ml of normal saline 0.9% as a control group). Each agent was injected at the base of the largest wart every three weeks until it was completely cleared, or for a total of four sessions. RESULTS: the highest response rate was detected in the quadrivalent HPV vaccine group (75% complete response) followed by the candida vaccine group (40% complete response and 15% partial response). Also, regarding the distant response rate, the highest response rate was detected in the quadrivalent HPV vaccine group (72.7% complete response and 27.3% partial response) followed by the candida vaccine group (33.3% complete response and 50% partial response). CONCLUSIONS: Intralesional immunotherapy appears to be effective and safe in treating multiple recalcitrant non-genital warts, with intralesional quadrivalent HPV vaccine outperforming intralesional candida antigen.

Fractional Carbon Dioxide Laser versus Trichloroacetic Acid 20% Peel in the Treatment of Acanthosis Nigricans: A Split Neck Comparative Study.

Background: Acanthosis nigricans (AC) is a common chronic skin disorder clinically presenting as velvety, hyperpigmented lesions that can affect any part of the body, including the face.OBJECTIVE: We sought to evaluate and compare the efficacy and safety of fractional CO2 laser and TCA 20% peel in the treatment of pseudo-acanthosis nigricans. Methods: The current study adopted an experimental, comparative split-neck design. It included a total of 20 patients with bilateral pseudo-acanthosis nigricans of the neck. Each patient was subjected to four sessions, spaced three weeks apart, involving fractional CO2 laser therapy on the right side and TCA 20% application on the left side. The evaluation of cases involved the utilization of the ANASI score and the assessment conducted by two dermatologists blinded to the treatment, both prior to and three months following the treatment. Results: Regarding Clinical improvement, 20% of the Fractional CO2 laser side had excellent improvement, and 45 percent had marked improvement. In contrast, the TCA 20% peel side had 2 percent marked improvement, 50 percent moderate improvement, and 40 percent mild improvement. In terms of response to therapy sessions, there was a statistically significant difference between the studied treatment sides (p<0.001). Regarding ANASI score differences between treated sides before and after treatment, a statistically significant reduction in ANASI score was observed, with a higher percentage of reduction in the Fractional CO2 laser side compared to the TCA 20% peel side. Limitations: The primary limitations are the small sample size and short follow-up period. Conclusion: In the treatment of pseudo-acanthosis nigricans, it appears that fractional CO2 laser and TCA 20% are promising, effective, and well-tolerated modalities. However, the Fractional CO2 laser was associated with a better response.

Intradermal injection of tranexamic acid versus platelet-rich plasma in the treatment of melasma: a split-face comparative study.

Millions of people throughout the world suffer from the acquired condition of hyperpigmentation known as melasma. Melasma is characterized by symmetrically oriented hyperpigmented macules and patches. Many treatment options are available with variable degrees of efficacy and tolerability. The aim of the work was to evaluate and compare the effectiveness and safety of intradermal tranexamic acid (TXA) versus intradermal platelet-rich plasma (PRP) in the treatment of various types of melasma. The current split-face prospective study included 40 cases with melasma. Tranexamic acid (TXA) was injected intradermally into the right side of the face by using a concentration of 4 mg/ml, while platelet-rich plasma (PRP) was injected intradermally into the left side. In both sides, a total of three sessions of treatment were provided, once every 4 weeks. Digital photographs were taken before each treatment session and 3 months after the last session. The modified melasma area severity index (mMASI) grading system and dermoscopy were used to assess the improvement in the condition. The disease severity and percentage of improvement were assessed by mMASI score before and after therapy across both sides of the face. along with determining the degree of satisfaction and side effects among the included cases. The mean mMASI score before therapy in the TXA side was 4.59 ± 2.87, while in the PRP side, the mean mMASI score before therapy was 4.72 ± 2.72 with no statistically significant difference between the two sides (p = 0.841). After 3 months of treatment, the mean mMASI score in the TXA-treated side was 2.49 ± 1.58 with a mean percentage of decrease of 45.67 ± 8.10%, while in the PRP side, the mean mMASI score after treatment was 2.17 ± 1.41 with a mean percentage of decrease of 53.66 ± 11.27%. There was a high statistically significant decrease in the mMASI score after treatment on both sides (p < 0.001); however, the percentage of score reduction in the PRP side compared to the TXA side was statistically higher. Intradermal injection with PRP revealed higher efficacy in the treatment of melasma as compared to TXA injection with no significant difference regarding the associated side effects.

Topical calcipotriol combined with urea 20% versus intralesional injection of triamcinolone acetonide, 5-fluorouracil, and methotrexate in the treatment of nail psoriasis: A comparative study.

There is no consistently effective treatment for psoriatic nails. Topical and intralesional modalities have been recently investigated and showed promising efficacy and safety. To compare the efficacy and safety of intralesional injection of 5-fluorouracil (5-FU), methotrexate (MTX), triamcinolone acetonide (TA) versus topical calcipotriol plus urea 20% in the treatment of nail psoriasis. This study included 60 patients with nail psoriasis who were randomly assigned to 4 groups, each containing 15 patients. The first 3 groups received intralesional injection of 0.1 ml of 5-FU (group A), MTX (group B), and TA (group C) into the nail matrix and bed monthly for 3 months. Group D received a topical combination of calcipotriol/urea 20% twice daily for 3 months. Therapeutic response was assessed every month for 3 months using the target nail psoriasis severity index (NAPSI). The mean percentage of improvement was significantly higher in topical calcipotriol/urea combination (57.1 ± 26.4) than intralesional TA (44.2 ± 32.7), intralesional MTX (37.7 ± 14.2), and intralesional 5-FU (29.6 ± 14). Adverse effects were mild and insignificant in the studied groups. Topical calcipotriol/urea combination seems to be more effective and safe than intralesional injections of 5-FU, MTX, and TA.

Intralesional vitamin D3 in treatment of alopecia areata: A randomized controlled clinical trial.

BACKGROUND: Alopecia areata (AA) is a common non-scarring, inflammatory type of hair loss that affects people of all ages and genders. AIMS: To evaluate the safety and efficacy of intralesional vitamin D3 injection in the treatment of alopecia areata. PATIENTS AND METHODS: A randomized controlled clinical trial included a total of 60 adult patients with localized alopecia areata were randomly assigned into two groups. Group I consisted of thirty patients who received 1ml of intralesional injection of vitamin D3 every 4 weeks for a maximum of 3 sessions. Group II consisted of thirty patients who received intralesional injection of normal saline 0.9% every 4 weeks for 3 sessions as a control group. All patients had their serum levels of 25-hydroxy vitamin D, TSH, antithyroglobulin, and thyroid peroxidase antibodies estimated before starting treatment. The 5-point semiquantitative regrowth score (RGS) and dermoscopy were used to evaluate the therapeutic response. RESULTS: There was statistically significant difference with p-value <0.001 between two study groups regarding degree of improvement. Dermoscopic findings that explain signs of activity were decreased, and signs of improvement were appeared after the third months of treatment being better in intralesional vitamin D group. The adverse effects were negligible and transient, and there was no recurrence of lesions. CONCLUSION: Intralesional vitamin D3 is an effective treatment option for localized patchy (not more than 40% of scalp distribution) alopecia areata. There is no relation between serum vitamin D3 and efficacy of treatment, so measuring vitamin D3 before starting treatment is not advised.

Intralesional Candida antigen versus intralesional vitamin D3 in the treatment of recalcitrant multiple common warts.

BACKGROUND: There are various therapies available for recalcitrant common warts; however no specific therapy has been established as entirely effective. AIMS: To assess the efficacy and safety of intralesional Candida antigen injection of vs. intralesional vitamin D3 injection in the treatment of multiple recalcitrant common warts. PATIENTS AND METHODS: A total of 80 adult patients with multiple common warts were randomly assigned to one of three groups in this study. Thirty patients were assigned to Group I, who received a 0.3 ml intralesional injection of Candida antigen. Thirty patients were assigned to Group II, who received a 0.6-ml (60 000 IU) intralesional injection of vitamin D3. Twenty patients were in Group-III, who received 0.3 ml of normal saline as a control. Each agent was injected at the base of largest wart every 3 weeks until full clearance has been obtained, or for a maximum of four sessions. RESULTS: In the Candida antigen, vitamin D3, and saline groups, complete wart clearance was observed in 76.7 percent, 20%, and 0.0 percent, respectively. The side effects were negligible and transient, and there was no recurrence of the lesions. CONCLUSION: Intralesional injection of Candida antigen is as a safe, simple, cost-effective treatment modality for multiple recalcitrant common warts and it outperforms intralesional vitamin D3.

Intralesional Antigen Immunotherapy in the Treatment of Periungual Warts.

BACKGROUND: Intralesional immunotherapy using different types of antigens is considered an effective and safe treatment option for different types of warts. However, there are few studies that illustrate the use of these antigens in the treatment of periungual warts as a distinct type of warts. OBJECTIVE: To evaluate the efficacy and safety of three antigens: measles, mumps, rubella (MMR) vaccine, Candida antigen, and purified protein derivative (PPD) in the treatment of periungual warts. METHODS: The study included 150 patients who were randomly assigned to 3 groups with 50 patients in each. Each agent was injected intralesionally at a dose of 0.1 mL into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions. RESULTS: Complete clearance of warts was observed in 70%, 80%, and 74% in PPD, Candida antigen, and MMR vaccine groups, respectively. There was no statistically significant difference regarding the therapeutic response between the 3 studied groups. Adverse effects were transient and insignificant in the 3 groups. No recurrence of the lesions was reported in any of the studied groups. CONCLUSIONS: Intralesional antigen immunotherapy seems to be an effective therapeutic option for the treatment of periungual warts.

Successful treatment of doughnut warts with intralesional Candida antigen immunotherapy.

BACKGROUND: Doughnut warts, also called ring or annular warts, are a distinctive type of warts with central clearing and annular recurrence. There are very few studies illustrating this uncommon phenomenon and its treatment. AIMS: To present 15 cases of doughnut warts and evaluate the efficacy and safety of Candida antigen intralesional immunotherapy in their treatment. METHODS: The study included 15 patients presenting with doughnut warts who were previously treated with destructive modalities for their original warts. All patients were injected intralesionally by Candida antigen at a dose of 0.2 mL into the base of doughnut wart until complete clearance or for a maximum of 5 sessions. RESULTS: Complete clearance was achieved in 12 patients (80%), partial response in 2 patients (13.3%), and no response in 1 patient (6.7%). Complete response was observed after two sessions in 5 patients, after three sessions in 4 patients, and after four sessions in 3 patients. Adverse effects were minimal and insignificant. CONCLUSIONS: Doughnut warts represent a unique and rare type of wart recurrence. Intralesional Candida antigen immunotherapy seems to be a promising and effective therapeutic modality for the treatment of such a rare entity.

Calprotectin in acne vulgaris: A possible contributory role.

BACKGROUND: Acne vulgaris (AV) is a common inflammatory skin disease involving dysfunction of the pilosebaceous unit. Many mechanisms for the pathogenesis of acne have been postulated; however, the precise pathogenesis is still uncertain. AIM: Evaluation of the level of serum calprotectin in patients with AV and its correlation with the different clinical variables of the disease, particularly severity. PATIENTS AND METHODS: This is a case-control study that included ninety subjects who were subdivided into two groups; group I, which included sixty patients complaining of AV with different grades of severity, and group II that included thirty apparent healthy age and sex-matched participants as a control group. Severity of AV was determined according to the Global Acne Grading System (GAGS). Serum calprotectin level was measured in both patients and controls by the enzyme-linked immunosorbent assay (ELISA) method. RESULTS: A highly statistically significant difference in the serum calprotectin level was found between patients with AV and control subjects. A highly significant positive correlation was found between the serum calprotectin levels and the severity of acne. Similarly, a significant positive correlation was found between serum calprotectin levels and the duration of the disease. CONCLUSION: Serum calprotectin levels are increased in acne patients and are positively correlated with its severity.

Incidence and risk factors associated with the patency of ductus arteriosus in preterm infants with respiratory distress syndrome in Kuwait.

OBJECTIVE: Patent ductus arteriosus (PDA) is considered to be an important cause of morbidity and mortality among preterm infants. The aim of this study is to determine the incidence of PDA in ventilated preterm infants with respiratory distress syndrome (RDS) and to evaluate the role of some antenatal risk factors on its occurrence in our population. METHODS: The case records of the preterm infants of <34 weeks gestational age, who were ventilated for RDS at the neonatal intensive care unit of Maternity Hospital, Safat, Kuwait, between March 1998 and February 1999, were reviewed. Diagnosis of PDA was based on echocardiographic findings. The association between the risk factors chosen and the PDA was also evaluated. RESULTS: A total of 101 infants whose gestational ages ranged between 25-33 weeks, and birth weights between 685-1580 grams were included. Fifty-four had a significant PDA (53.4%). Maternal diabetes and antepartum hemorrhage (APH), birth weights, gestational ages, multiplicity and gender of the infants were found to be related to the incidence of PDA. CONCLUSION: The incidence of PDA in our ventilated preterm infants with RDS is similar to those reported from other neonatal units outside Kuwait. There are some factors that may identify babies, who are prone to develop PDA, which need to be confirmed by further prospective studies using a larger population.