A Study of Comparison and Evaluation of Various Intralesional Therapies in Cutaneous Warts.

Background: The study compares the efficacy of four immunotherapeutic agents, measles mumps and rubella (MMR), purified protein derivative (PPD), Candida extract, and vitamin D3, in the treatment of multiple cutaneous warts. Aim and Objectives: To observe the clinical responses and safety of different intralesional immunotherapeutic agents and compare their efficacy. Materials and Methods: Hundred patients with multiple (>5) cutaneous warts were enrolled in the study and randomized into four groups: Group A: MMR, Group B: PPD, Group C: Candida extract, and Group D: Vitamin D. Target wart was selected, and the intralesional injections were given at three weekly intervals for a maximum of three doses. Response was observed in target and distant warts three months after the last injection. Results: Intralesional vitamin D3 had the highest efficacy, while MMR had the lowest efficacy in clearance of target wart. Intralesional Candida extract had the highest efficacy, while vitamin D3 had the lowest efficacy in clearance of distant warts. Intralesional Candida extract was the most effective treatment for both local and distant warts. Side effects were minimal and transitory in nature. Conclusion: Intralesional immunotherapy is a safe, affordable, and efficacious treatment for warts.

Platelet-Rich Plasma in Androgenetic Alopecia: Is It Really Worth the Hype?

Introduction: Androgenetic alopecia (AGA) is defined as progressive, patterned hair loss that occurs as a result of androgen-mediated conversion of terminal hairs to vellus hairs. By the age of 60 years, 45% of men and 35% of women develop AGA. The Hamilton-Norwood scale is used to assess the extent and severity of AGA and classify the stages of male pattern hair loss in men, whereas the Ludwig scale is preferred for women. Currently, U.S. Food and Drug Administration-approved treatments for AGA include oral finasteride and topical minoxidil. Due to the limited number of effective therapies for AGA, platelet-rich plasma (PRP) has become an effective alternative treatment. A number of studies on PRP have shown promising results, leading to increased hair density and thickness with minimal or no side effects. Aims: We aim to study the safety, efficacy, and side effects of PRP therapy in patients of AGA and to study demographic data in the form of age, sex, age of onset of hair loss, and grade of AGA in patients. Materials and Methods: Fifty patients, 38 males and 12 females, with AGA were enrolled in the study. PRP was prepared using a double-spin method. Upon activation, PRP was injected in the involved areas of scalp once every 2 weeks for 6 months. Follow-up photos were taken every 3 months. Results: At 6 months, majority of the patients (45%) were unsatisfied and showed no change in hair growth after PRP therapy and few patients were lost in follow-up. Adverse effects were minimal and no long-term serious adverse effects were noted. Conclusion: We conclude from the results in our study that PRP therapy is not significantly effective in treatment of AGA. There is a need to develop standard protocols with regard to total length of PRP therapy and spacing between the two sessions of PRP for AGA.

A puzzling case of multiple asymptomatic nodules over scalp-A case report.

Cirsoid aneurysms (CAs) of the scalp are rare arteriovenous malformations presenting as nodular lesions of the scalp. Depending on the size and intracranial extension, they can vary from asymptomatic to potentially lethal from secondary hemorrhage. Being vascular clinically misdiagnosed cases may lead to a devastating outcome from any kind of diagnostic surgical intervention. Here, we report a case of a 45-year-old woman who presented with multiple papulonodular lesions on the scalp, diagnosed as CA.

Subcutaneous Basidiobolomycosis Treated Successfully with Oral Itraconazole: A Case Report.

Basidiobolomycosis is an opportunistic fungal infection with a high morbidity and mortality rate. It is known to cause invasive disease in immunocompromised persons but it may produce only cutaneous or subcutaneous infections in an immunocompetent patient. Treatment is difficult due to its fulminant course and lack of effective anti-fungal drugs. But here, we report a rare case of Basidiobolomycosis detected in an immunocompetent patient-without any debilitating illness, which showed a complete response to itraconazole 200 mg daily without any surgical intervention.

Clinical Features of Mycetoma and the Appropriate Treatment Options.

Mycetoma is a chronic, suppurative and debilitating granulomatous infection seen mainly in tropical and subtropical areas and is now declared as a neglected tropical disease by the World Health Organization. The clinical diagnosis is usually characterized by a classical triad of localized swelling, underlying sinus tracts, and production of grains or granules, but unusual presentations are also seen. It is classified into eumycetoma caused by the fungus, and actinomycetoma caused by the bacteria. The clinical presentation of both is almost similar and a definite diagnosis is essential before starting the treatment as it differs for both. Surgical debulking followed by a prolonged course of medical therapy now forms the mainstay of treatment due to the long course of the disease and suboptimal response. This review focuses on the various usual as well as unusual clinical presentations of mycetoma, established treatment regimens as well as recent changes in the mode of administration of drugs and newer drugs for mycetoma.

Histopathological evaluation of cutaneous reactions to tattoos: Study at a tertiary care center.

BACKGROUND: Tattooing has been around for many years and is becoming an increasingly common fashion trend. As there are often few regulatory laws regarding the practice, an increase in the incidence of cutaneous reactions to tattoo inks is noted. These include allergic reactions, granulomatous dermatitis, infections, lichenoid dermatoses, and sometimes malignancy. The present study examines the histopathological changes seen in patients with cutaneous reactions to tattoo ink. METHOD: A prospective observational study was conducted over 18 months in the dermatology clinic of a tertiary care center in western India. The study population included 22 patients with cutaneous reactions over the tattoos. Punch biopsy specimens were sent to study the pattern of histopathological response. RESULTS: All 22 patients studied were between the ages of 17 and 35 years. The mean duration of development of reaction was 8.1 months. Most of the reactions were seen in black ink tattoos performed by amateurs. Perivascular and spongiotic dermatitis suggestive of allergic response was the most common feature on histopathology. Granulomatous response and lichenoid response were seen in five and three biopsies, respectively. CONCLUSION: Legalization is needed for this practice to prevent tattoo reactions. Histopathological evaluation is important as tattoo reactions may be associated with skin infections and malignancies.

Disabilities in leprosy: an open, retrospective analyses of institutional records

Abstract Background and objectives: Leprosy remains a leading cause of peripheral neuropathy and disability in the world. Primary objective of the study was to determine the incidence of deformities present at a time of diagnosis and new deformities that patients develop over follow up period. Material and methods: An open, retrospective cohort study was performed at a tertiary medical center in western India. Recruitment phase of the study was of 2 years (2009-2010) followed by observation/follow up phase of 7 years till 31st December 2017. New patients with leprosy and released from treatment cases who presented with deformity as defined by WHO disability grade (1998) and subsequently developing new deformities during the follow up period of up to 7 years were included in the study. Results: The study included 200 leprosy patients. Of the total 254 deformities, 168 (66.14%) deformities were noticed at the moment of diagnosis, 20 (7.87%) deformities occurred during the follow up phase. Of all patients, 21.25% had Grade 1 deformity and 6.31% had Grade 2 or more severe deformity. Deformities of hand were most common in 44.48%, followed by feet 39.76%, and face 15.74% respectively. Limitation of study: Mode of inclusion of patient was self-reporting during follow up phase so there is possible under reporting of the disabilities. Conclusion: New deformities continue to develop in certain forms of leprosy even after release from treatment. Long-term & regular follow up of patients who have been released from treatment is required.

Disabilities in leprosy: an open, retrospective analyses of institutional records.

BACKGROUND AND OBJECTIVES: Leprosy remains a leading cause of peripheral neuropathy and disability in the world. Primary objective of the study was to determine the incidence of deformities present at a time of diagnosis and new deformities that patients develop over follow up period. MATERIAL AND METHODS: An open, retrospective cohort study was performed at a tertiary medical center in western India. Recruitment phase of the study was of 2 years (2009-2010) followed by observation/follow up phase of 7 years till 31st December 2017. New patients with leprosy and released from treatment cases who presented with deformity as defined by WHO disability grade (1998) and subsequently developing new deformities during the follow up period of up to 7 years were included in the study. RESULTS: The study included 200 leprosy patients. Of the total 254 deformities, 168 (66.14%) deformities were noticed at the moment of diagnosis, 20 (7.87%) deformities occurred during the follow up phase. Of all patients, 21.25% had Grade 1 deformity and 6.31% had Grade 2 or more severe deformity. Deformities of hand were most common in 44.48%, followed by feet 39.76%, and face 15.74% respectively. LIMITATION OF STUDY: Mode of inclusion of patient was self-reporting during follow up phase so there is possible under reporting of the disabilities. CONCLUSION: New deformities continue to develop in certain forms of leprosy even after release from treatment. Long-term & regular follow up of patients who have been released from treatment is required.

Acquired cutis laxa secondary to Sweet syndrome in a child (Marshall syndrome): A rare case report.

Sweet syndrome is rare in the pediatric population and usually responds well to treatment, resolving without sequelae. Marshall syndrome is a rare pediatric skin disease characterized by loss of elastic tissue (cutis laxa) secondary to acquired, localized neutrophilic dermatitis without any internal organ involvement. Only few cases of Marshall syndrome (acquired cutis laxa type II) have been reported. Systemic steroids and dapsone show excellent results in Sweet syndrome. Although there is no satisfactory treatment for cutis laxa, dapsone can be used in the acute phase for control of swelling.

Preparation of Platelet-rich Fibrin Membrane over Scaffold of Collagen Sheet, its Advantages over Compression Method: A Novel and Simple Technique.

INTRODUCTION: Platelet-rich fibrin (PRF) is compressed by using various tools to make platelet-rich fibrin membrane (PRFM). Preservation of platelets and plasma content of PRFM depends on the compression method used. To overcome limitations of compression method, we prepared PRFM over scaffold of collagen sheet without using any compression device. AIMS AND OBJECTIVE: To prepare PRFM without using any compression device over a scaffold of collagen sheet and to evaluate its efficacy in chronic nonhealing ulcer. MATERIALS AND METHODS: PRFM was prepared, with minor modification in Choukron's protocol, over a collagen sheet without using compression device. To study its efficacy and reproducibility, total 15 patients over 18 years of age with chronic, nonhealing ulcers of more than 3 months of various causes were included and patients with active wound infection were excluded. RESULTS: We were able to prepare and reproduce PRFM by our technique. It overcomes the limitations of compression method with comparable efficacy to compression method. Results obtained on comparison at week 0, 3, and 6, by paired t-test, were found to be statistically significant (P < 0.0001). CONCLUSION: Preparation of PRFM with the method described is easy and reproducible. Use of collagen sheet synergistically improved wound healing.

Prescription and Usage Pattern of Topical Corticosteroids among Out-patient Attendees with Dermatophyte Infections and Its Analysis: A Cross-sectional, Survey-based Study.

BACKGROUND: There is scarce scientific data on topical corticosteroids (TCS) prescription by non-dermatologists including registered medical practitioners, ayurvedic, homeopathic practitioners, and over-the-counter (OTC) use of TCS-containing creams. OBJECTIVE: The main objective of this study is to analyze the prescription and usage pattern of topical steroids among out-patient attendees with dermatophyte infection. To study health-seeking behavior of patients with dermatophyte infections. MATERIAL AND METHODS: An open, cross-sectional, duration-based study of 3 months. Inclusion criteria: Patients with dermatophytosis having a history of topical steroid application; either prescribed or purchased OTC and used themselves. Exclusion criteria: Patients who were not willing to give informed consent. Patient's data like socio-demographic profile, duration, frequency, site of application, contents of the topical cream used, prescriber information, and patients' desire to continue the use of topical steroids were recorded. RESULTS: Total of 18.40% (n = 503) patients were already using cream-containing TCS at the time of presentation to the tertiary dermatology care center. The study shows that almost half of the patients (48.90%) were using unprescribed TCS. Registered medical practitioners were the most common source of TCS creams prescription (59.92%) in the prescribed group, while 26.07% patients were prescribed TCS by dermatologists. Clobetasol propionate (47.91%), was most common steroid agent used. CONCLUSION: Patients are able to get "prescription-only" drugs as OTC products. Such OTC use of TCS puts patients at risk of steroid modified dermatophytosis and topical steroid damaged skin. Even dermatologists may be culprit in creating menace of steroid abuse.

Oral Antifungal Therapy: Emerging Culprits of Cutaneous Adverse Drug Reactions.

INTRODUCTION: Antifungals are one of the most widely used drugs in dermatology practice for dermatophytosis. Oral antifungal therapy against superficial dermatophytosis is generally associated with a low incidence of adverse events in an immunocompetent population. However, lately, cutaneous adverse drugs reactions (CADRs) have been reported with varying incidence rates in the patients on oral antifungal therapy with many uncommon morphological patterns. The present, observational study was conducted over a period of 4 months to report the cases which presented with antifungal therapy-associated CADRs. MATERIALS AND METHODS: It was an observational, prospective study carried out at a tertiary care center in Western India over a period of 4 months. All patients diagnosed with superficial dermatophytic infections (clinically and fungal hyphae seen on 10% potassium hydroxide mount) started on oral antifungal therapy, presenting with cutaneous manifestation other than the primary dermatophytosis were included. The incidence of CADRs due to oral antifungal agents and the percentage of each clinical type of the CADR observed was calculated. RESULTS: The incidence of CADRs due to antifungal drugs was 8.3 per 10,000 patients. In total, 35 cases were reported out of 4,208 cases of dermatophytosis. Terbinafine was the most common causative drug, accounting for nearly 83% of cases, followed by itraconazole for 14% cases, and griseofulvin for 2.8% of cases. CONCLUSION: The role of systemic antifungals must not be overlooked in any patient with a CADR and should be reported as a trend indicator.

Monoclonal Gammopathy of Undetermined Significance-associated Scleromyxoedema.

Scleromyxoedema is a rare generalized cutaneous mucinosis, which in absence of thyroid disease, occurs almost invariably in patients with monoclonal gammopathies. A 54-year-old female patient presented with complaint of tightening of skin on the extremities, abdomen, forehead, gradually progressive since 1 year, episodes of generalized tonic-clonic convulsions, and acute psychosis since 5 days. Cutaneous examination revealed nonpitting edema over the face and sclerodermoid changes over extremities. Laboratory investigations showed presence of M-band on serum-protein electrophoresis and monoclonal spike of IgG lambda component on immunofixation. Magnetic resonance imaging of the brain showed periventricular subcortical lacunar infarcts. Skin biopsy with mucin staining was suggestive of scleromyxoedema. All other investigations were normal. Bone marrow biopsy showed a mild focal increase in plasma cells. The cutaneous, serological, and electrophoretic findings as well as the clinical profile of the patient were consistent with the diagnosis of monoclonal gammopathy of undetermined significance associated with scleromyxoedema. This case is presented because of its rare occurrence.