Tazarotene is as effective and tolerable as imiquimod in the treatment of verruca plana, a comparative randomized clinical trial.

BACKGROUND: Plane warts when multiple and recurrent present a therapeutic challenge acting as a source of reinfection causing frustration and affecting patient's quality of life. For lesions of large numbers in cosmetically significant sites, topical treatment is preferred to avoid potential sequelae. OBJECTIVES: To evaluate and compare the efficacy and tolerability of tazarotene 0.1% gel versus imiquimod 5% cream for the treatment of plane warts. METHODS: In a parallel three-arm randomized controlled trial, 60 patients were randomized into imiquimod, tazarotene or placebo groups. Patients applied the corresponding treatment once daily at night for a maximum of 12 weeks. Primary outcomes were percentage of respondents with complete clearance in the three studied groups, the type and frequency of side effects in each group. RESULTS: Both active treatments resulted in significant improvement compared to baseline and to placebo group (P=0.001). Imiquimod 5% treated group showed complete clearance in 50% of cases, partial response in 15%, and no response in 35%. Tazarotene 0.1% gel showed complete clearance in 40% of cases, partial response in 40%, and no response in 20%. No significant difference was detected between imiquimod and tazarotene groups (P=0.190). CONCLUSIONS: Compared to imiquimod, tazarotene 0.1% gel for the treatment of plane warts seems to offer equivalent treatment response, maintained efficacy without recurrence, safer profile regarding dyspigmentation with an advantageous cheaper cost.

Narrowband ultraviolet B phototherapy combined with intralesional injection of either latanoprost or platelet-rich plasma for stable nonsegmental vitiligo.

BACKGROUND: Narrowband ultraviolet B (NB-UVB) phototherapy is the cornerstone of vitiligo treatment. Its combination with other treatments usually yields a better response. Latanoprost, a prostaglandin F2α analog, and autologous platelet-rich plasma (PRP) have been reported to be effective for vitiligo. AIM: To evaluate the efficacy of NB-UVB combined with intralesional latanoprost or PRP for stable nonsegmental vitiligo (NSV). METHODS: Sixty patients with stable NSV were recruited and randomly allocated to two equal groups. NB-UVB phototherapy was administered twice a week for all patients. Additionally, group A received intralesional latanoprost injections once weekly, while group B received intralesional autologous PRP injections every 2 weeks. RESULTS: At 24 weeks, excellent repigmentation response was observed in 26.7% and 13.3% of patients in the latanoprost/NB-UVB and PRP/NB-UVB groups, respectively, with no significant difference in degrees of repigmentation between the two groups. However, the Vitiligo Extent Score for a Target Area (VESTA) score was significantly higher in the latanoprost/NB-UVB group (p = .032). Moreover, lesions located on nonacral skin responded significantly better than those on acral skin. Only erythema was significantly higher in the PRP/NB-UVB group, while the recurrence of depigmentation was significantly higher in the latanoprost/NB-UVB group. CONCLUSIONS: Both latanoprost and PRP have the potential to be effective add-on therapies to NB-UVB phototherapy for stable NSV, with latanoprost resulting in a greater repigmentation response and PRP producing a more stable response.

A comparative clinico-dermoscopic study of intralesional injection of combined digoxin and furosemide, Candida antigen, and vitamin D3 for multiple warts.

BACKGROUND: Immunostimulatory and antiproliferative therapies have been widely used for the treatment of multiple warts. Recently, anti-HPV activity of ionic contra viral therapy (ICVT) which is comprised of combined digoxin and furosemide has been demonstrated. AIM: To evaluate and compare the effectiveness and safety of intralesional injection of Candida antigen, vitamin D3, and combined digoxin and furosemide in the treatment of multiple warts. PATIENTS AND METHODS: Seventy-five patients with numerous warts were randomly assigned to one of three equal groups: Candida antigen, vitamin D3, or a combination of digoxin and furosemide. In the Candida antigen group, injections into the biggest wart were done. In the vitamin D3 and combined digoxin/furosemide groups, the agent was injected into each wart with a maximum of five injected warts. Injections were repeated every 2 weeks until clearance or for a total of five sessions. RESULTS: There was a statistically significant difference in the overall therapeutic response among the studied groups in favor of the intralesional Candida antigen group (60%), followed by the vitamin D3 group (48%) and the ionic contraviral therapy group (28%) (p = 0.02). However, the difference between both Candida antigen and vitamin D groups was not significant (p = 0.59). CONCLUSIONS: Intralesional Candida antigen immunotherapy and vitamin D3 antiproliferative therapy are significantly more effective than ICVT. LIMITATIONS: Short follow-up period and relatively small sample size.

Intralesional Versus Intramuscular Hepatitis B Virus Vaccine in the Treatment of Multiple Common Warts.

BACKGROUND: Hepatitis B virus (HBV) vaccination is associated with stimulation of humoral and cell-mediated immunity. Intralesional HBV vaccine has been recently used as an immunotherapy of common warts with relatively low success rate. AIM: To assess the efficacy and safety of intralesional versus intramuscular (IM) HBV vaccine in the treatment of multiple common warts. PATIENTS AND METHODS: The study included 60 patients with multiple common warts who were randomly assigned to 2 groups: intralesional HBV vaccine or IM HBV vaccine. In the intralesional HBV vaccine group, the vaccine was injected into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions. Intramuscular HBV vaccine group received 3 injections in the deltoid muscle at 0, 1, and 6 months. RESULTS: Complete wart clearance was reported in 7 patients (23.3%) of the intralesional HBV vaccine group and 15 patients (50%) of the IM HBV vaccine group. The difference was statistically significant in favor of the IM group ( p = .0479). Adverse effects were mild and insignificant in the 2 groups. CONCLUSION: HBV vaccine, particularly the IM form seems to be a promising, well-tolerated therapeutic option for the treatment of warts. LIMITATIONS: Short follow-up period and small sample size.

Serum immunoglobulin E and Interleukin-17 levels in patients with chronic plaque psoriasis: A case-control study.

BACKGROUND: Psoriasis is a skin disorder mainly mediated by T helper (Th)-1 and Th-17 cells. Recently, high serum immunoglobulin (Ig)-E levels were detected in psoriatic patients. The etiopathogenesis of IgE overproduction in psoriatic patients is still unknown, but IL-17 has been suggested to be responsible for this abnormality. OBJECTIVE: To compare levels of IgE and IL-17 in the sera of patients with chronic plaque psoriasis (CPP) to healthy subjects. METHODS: This study included 40 patients with CPP and 40 age- and sex-matched healthy individuals. Serum IgE and IL-17 concentrations were measured using the enzyme-linked immunosorbent assay (ELISA) technique. RESULTS: Levels of IgE and IL-17 were significantly higher in the sera of psoriatic patients than in controls (p = 0.001 and 0.024, respectively). Psoriatic patients with abnormally high serum IgE levels had higher serum IL-17 levels than those with normal serum IgE levels, but the difference was statistically insignificant (p = 0.080). Furthermore, no significant correlation was found between serum IgE and IL-17 concentrations in psoriatic patients (p = 0.385). CONCLUSIONS: It is possible that IgE and IL-17 interact in psoriasis pathogenesis; however, this was not evident in the current study, possibly due to the small sample size. Therefore, other potential causes of elevated IgE levels in psoriatic patients should be investigated. Moreover, the interaction between IgE and IL-17 should be investigated in patients with other clinical variants of psoriasis.

Voriconazole is superior to combined itraconazole/isotretinoin therapy and itraconazole monotherapy in recalcitrant dermatophytosis.

BACKGROUND: There has been an emergence of recalcitrant, recurrent, and difficult-to-treat tinea. Monotherapy with oral antifungals leads to partial clearance or high recurrence of lesions. Isotretinoin is a good adjuvant to systemic antifungals in chronic dermatophytosis. Voriconazole could be a future alternative due to its efficacy against dermatophytes and little resistance. OBJECTIVE: To evaluate the efficacy and safety of oral itraconazole, combined itraconazole/isotretinoin therapy, and voriconazole for recalcitrant tinea. PATIENTS AND METHODS: This study included 90 patients with chronic, recurrent and/or recalcitrant tinea. They were equally divided into three groups: itraconazole monotherapy, combined itraconazole/isotretinoin therapy, and voriconazole monotherapy. All patients received treatments for 6 weeks. The clinical response was classified as either a complete or incomplete clinical cure. Potassium hydroxide microscopy and culture were performed to identify mycological cure. Patients with complete cure were followed up for another 6 months to detect any recurrence. RESULTS: Complete clinical cure was observed in 53.3% of the itraconazole group, 70% of the itraconazole/isotretinoin group, and 83.3% of the voriconazole group. Mycological cure was detected in 56.7% of the itraconazole group, 83.3% of the itraconazole/isotretinoin group, and 86.7% of the voriconazole group. There was a statistically significant difference between the three groups in favour of voriconazole, then the combined group. No significant adverse effects were observed. The recurrence rate was significantly lower in the voriconazole group compared with the other two groups. CONCLUSIONS: Voriconazole could be a future alternative for the treatment of recalcitrant dermatophytosis.

Triple Intralesional Antigen Immunotherapy versus Monoantigen in the Treatment of Multiple Recalcitrant Warts.

INTRODUCTION: Warts can be resistant to treatment or recur despite the use of various destructive and immunotherapeutic modalities. Combination immunotherapy might contribute to better response rates. The aim of this study was to assess the effectiveness and safety of a triple intralesional immunotherapy combination composed of purified protein derivative (PPD), Candida antigen, and measles-mumps-rubella vaccine (MMR), versus each agent alone, in the management of multiple recalcitrant warts. METHODS: In total, 160 patients with numerous resistant extragenital warts were included in the research. They were randomly assigned to one of four groups (each with 40 patients): PPD, Candida antigen, and MMR, or combination of the three antigens. Injections into the biggest wart were repeated every 2 weeks until clearance or for a total of five sessions. RESULTS: Complete wart clearance was reported in 31 patients (77.5%) who received triple-antigen immunotherapy, 23 patients (57.5%) who received intralesional PPD, 29 patients (72.5%) injected with Candida antigen, and 25 patients (62.5%) who received MMR. The combined therapy was found to be superior to the other therapies and had the lowest recurrence rate, but the difference was not statistically significant. CONCLUSIONS: Triple intralesional antigen immunotherapy is as safe as, and more effective than, monoantigen immunotherapy, and can be added to the armamentarium against recalcitrant human papilloma virus (HPV) infections.

Intralesional immunotherapy for multiple recalcitrant plantar warts: Candida antigen is superior to intralesional purified protein derivative.

Treatment of recalcitrant plantar warts represent a highly challenging issue for both patients and physicians. Candida antigen and purified protein derivative (PPD) have shown promising efficacy in the treatment of warts, however no previous studies have compared both antigens for recalcitrant plantar warts. To assess the efficacy and safety of intralesional Candida antigen versus intralesional PPD in the management of recalcitrant plantar warts. The study included 120 adult patients with multiple recalcitrant plantar warts. They were randomly assigned to one of three groups; Candida antigen, PPD, or normal saline. Injections into the largest wart were repeated every 2 weeks until clearance or for a maximum of five sessions. Complete wart clearance was reported in 33 patients (82.5%) of the Candida antigen group, in 22 patients (55.6%) of the PPD group, and in one patient (5%) of the control saline group. A statistically significant difference was found between the studied groups in favor of Candida antigen. Adverse effects were mild and insignificant in the three groups. Intralesional antigen immunotherapy by Candida antigen or PPD is a promising, safe, and cost-effective therapeutic option for multiple recalcitrant plantar warts, with statistically significant superiority of Candida antigen.

A practical guide to the safety of topical medications for the pediatric population.

Prescribing topical therapy for a child could be a challenging matter. This is due to the higher susceptibility of children to local and systemic side effects of topical drugs than adults. Herein, we provide clinicians with a practical guide regarding the side effects, precautions, and lower age limit of commonly prescribed topical medications for the pediatric population.

Acitretin: Could it be a new therapeutic player in the field of onychomycosis?

BACKGROUND: Onychomycosis represents a therapeutic challenge. The complete cure rate with itraconazole pulse therapy remains unsatisfactory implying the need for an effective therapeutic regimen. Given the successful treatment of recurrent dermatophytosis with isotretinoin and itraconazole, we investigated the therapeutic use of acitretin in onychomycosis. AIM: To evaluate and compare the efficacy of combined itraconazole and acitretin versus monotherapy with each in onychomycosis. PATIENTS AND METHODS: The study included 135 adult patients with finger- and/or toenail onychomycosis. They were equally subdivided into 3 groups: itraconazole pulse therapy, acitretin and combined itraconazole/acitretin therapy. The drugs were administered for 3 months. Evaluation of severity was done by onychomycosis severity index score. Potassium hydroxide microscopy and culture were performed at baseline and at the end of the study. RESULTS: Mycological and complete cure of onychomycosis was observed in 51.1% and 20% of the itraconazole group, 28.9% and 28.9% of the acitretin group, and 80% and 53.3% of the combined group. There was a statistically significant difference between groups in favour of the combined itraconazole/acitretin therapy (P ≤ .05). LIMITATIONS: Small sample and short therapy duration. CONCLUSIONS: Acitretin could be a powerful therapeutic player in the field of onychomycosis, with greater efficacy when combined with itraconazole.