A Comparative Analysis of Efficacy of Intralesional Mumps-Measles-Rubella Vaccine Versus 5-Fluorouracil in the Treatment of Palmoplantar Warts.

Background: Palmoplantar warts are quite resistant to treatment, so treating them is a challenge as ablative modalities lead to pain, temporary immobility, secondary infections, and scarring. The treatment of warts using immunotherapeutic methods and cytotoxic methods is being increasingly used to overcome drawbacks in the treatment of warts. Aim: To evaluate the efficacy and safety of intralesional mumps-measles-rubella (MMR) vaccine versus 5-fluorouracil (5-FU) in the treatment of palmoplantar warts. Materials and Methods: A total of 36 patients were divided into two groups of 18 each, MMR and 5-FU groups, respectively. The patients in the MMR group were given 0.1ml - 0.5ml of intralesional MMR vaccine in each lesion depending on the dimensions of the lesion and was repeated at 2 weekly intervals until complete clearance or a maximum of six doses. The patients in the 5-FU group were given 0.1ml - 0.5ml of intralesional injection of a solution containing 4 mL of 250 mg/mL of 5-FU and 1 mL of a mixture of 20 mg/mL (2%) lidocaine and 0.0125 mg/mL of epinephrine, which was given at 2 weekly intervals until complete clearance or maximum six doses. Results: In our study, warts had resolved in all 18 (100%) patients belonging to the MMR group by the 12th week, whereas 11 (61.11%) patients still had warts among the patients belonging to the 5-FU group (i.e., warts had resolved only in 7 (38.89%) patients at the end of 12th week), which was found to be statistically significant (P-value < 0.05). Limitation: Smaller sample size and lack of follow-up to evaluate for possible recurrence. Conclusion: MMR vaccine is a safe and effective treatment modality for palmoplantar warts compared to 5-FU.

A Cross-Sectional Study to Assess the Role of Dermoscopy in Differentiating Palmar Psoriasis, Chronic Hand Eczema, and Eczema in Psoriatico.

BACKGROUND: Overlapping clinical features often make the differentiation between palmar psoriasis, hand eczema, and eczema in psoriatico a difficult task. In such cases, history and biopsy often aid in the diagnosis. Dermoscopy acts as a link between clinical dermatology and dermatopathology. AIM: To study the dermoscopic features in biopsy-proven cases of palmar psoriasis, hand eczema, and eczema in psoriatico. METHODS: A 1-year cross-sectional study was conducted using a video dermatoscope, Dinolite premier AM4113ZT, on 60 patients having clinical diagnosis of either of palmar psoriasis, hand eczema, and eczema in psoriatico. Statistical analysis was performed using R i386 3.6.3 software. RESULTS: Among 60 patients, 38 were psoriatics followed by 14 of eczema and 8 of eczema in psoriatico. On dermoscopy, characteristic features of psoriasis lesions were diffuse scaling in 76.3% (29/38), white scales in 60.5% (23/38), and dotted vessels in 76.3% (29/38) along with regular distribution of vessels in 71% (27/38); in hand eczema lesions, diffuse scaling in 78.5% (11/14), white and yellow scales in 57.1% (8/14), and dotted vessels in 78.5% (11/14) along with a patchy distribution of vessels in 57.1% (8/14); in eczema in psoriatico, diffuse scaling in 75% (6/8), white and yellow scales in 62.5% (5/8), and dotted vessels in 87.5% (7/8) along with regular distribution of vessels in 50% (4/8). CONCLUSION: The various patterns and combinations reflecting specific features give an insight into the cases of palmar psoriasis, hand eczema, and eczema in psoriatico on dermoscopy. However, a study with larger sample size is required to validate the findings of our study. LIMITATIONS: Inability to perform a patch test for eczema due to unavailability.

1-Year Hospital-Based Observational Study of Trichoscopy Findings and Disease Activity in Alopecia Areata.

INTRODUCTION: Alopecia areata (AA) is a chronic, non-scarring type of alopecia that presents as patchy hair loss over the scalp and other parts of the body. The diagnosis of AA can sometimes be challenging. Trichoscopy can be used to observe certain follicular patterns, shaft changes, and interfollicular pattern which help in diagnosing and determining the disease activity in AA. MATERIALS AND METHODS: This study was a 1-year hospital-based observational cross-sectional study consisting of 60 patients clinically diagnosed with AA. Trichoscopic examination of the scalp and hair was performed using a videodermatoscope-Dinolite premier AM4113ZT model, trichoscopic images were recorded, and results were analyzed statistically. RESULTS: AA was more common in males 39/60 cases (65%) with male to female ratio of 1.85:1. Scalp was the most frequently involved site, seen in 52/60 cases (86.67%) and patchy alopecia was the most frequent clinical pattern of presentation (83.33%). The characteristic follicular features noted were black dots, yellow dots, and empty hair follicles. Black dots were the commonest finding (63.33%) and represented a marker for active disease. The characteristic hair patterns noted were broken hair, micro-exclamation mark hair, coudability hair, all of which were commonly seen in active cases. 72% of cases that had clinically inactive disease showed active disease on trichoscopy. CONCLUSION: Trichoscopic features of AA are characteristic and they not only provide an important clue to the diagnosis in doubtful cases but also help in assessing disease activity in AA.

Granulomatous variant of giant centrifugal miliaria profunda.

Two infants presented with multiple asymptomatic papules and geographic and annular plaques over the extensor aspect of the upper and lower extremities and trunk. Skin biopsy of both lesions showed plugged and hyperplastic dilated acrosryingia and deep dermal ducts, along with granulomatous inflammatory reaction. These lesions showed self-healing with complete resolution. A previous report described similar clinical and histopathologic features and labeled it giant centrifugal miliaria profunda. Because of the large granulomatous plaques and deep infiltrate, we propose that it was a granulomatous variant of giant centrifugal miliaria profunda. We report these cases for their rarity and self-healing nature.

A study of clinicopathologic profile of 15 cases of hypopigmented mycosis fungoides.

BACKGROUND: Mycosis fungoides (MF) is cutaneous lymphoma of the T-cell lineage. Hypopigmented MF is a clinical variant of MF, described mainly in Asians. This is a retrospective clinicopathologic analysis of hypopigmented MF at a tertiary care center. AIMS: To describe the clinicopathologic profile of hypopigmented MF. METHODS: Records of clinicopathologic notes over a 5-year period ranging from January 2005 up to December 2009 were reviewed over a period of 3 months, of which 15 cases were diagnosed with hypopigmented MF based on clinicopathologic correlation. RESULTS: Hypopigmented MF was found to be more common in males, and between second and fourth decades of life. The latent period between onset and diagnosis was around 3.83 years. Most of the patients were asymptomatic 80% (12/15), with skin changes of subtle atrophy in 46.66% (7/15), scaling in 20% (3/15) and focal changes of poikiloderma in 26.66% (4/15) patients. Most common sites of distribution of the lesions were the trunk and extremities. Many of the cases had been clinically mistaken for Hansen's disease prior to correct diagnosis. Marked epidermotropism and tagging of epidermis by large lymphocytes characterizes the condition histopathologically. Of the 15 cases, immunohistochemistry was possible in 10 cases, of which 8 showed predominant CD8 positive epidermotropic infiltrates and two cases showed absence of CD8 positive and CD4 positive lymphocytic infiltrate in the epidermis. CONCLUSION: Hypopigmented MF presents as hypopigmented asymptomatic patches without any erythema or infiltration in its early stage and mimics Hansen's disease. Skin biopsy clinches the diagnosis.