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 (AV) malformations presenting as nodular lesions over scalp. Depending on the size and intracranial extension, they can vary from asymptomatic lesions to being potentially lethal due to secondary haemorrhage. Being a vascular lesion, clinically misdiagnosed cases may lead to devastating outcome on any kind of diagnostic surgical intervention. Here we report a case of a 45-years-old lady presented with multiple papulonodular lesions over scalp, diagnosed as cirsoid aneurysm. This article is protected by copyright. All rights reserved.

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.

Sexually transmitted infections and human immunodeficiency virus coinfection: Scenario in Western India

Context:

Sexually transmitted infections (STIs) have a well-established synergistic relationship with human immunodeficiency virus (HIV) infection. Coinfection with HIV and STI can increase the probability of HIV transmission to an uninfected partner by increasing HIV concentrations in genital lesions, genital secretions, or both. Concurrent HIV infection alters the natural history of the classic STIs.

Aims:

The aim was to study the current scenario of STIs with HIV co-infection, and to recognize different manifestations of STIs than the classical presentation in people living with HIV/AIDS (PLHIV).

Settings and Design:

It was an open, cross-sectional, descriptive study carried out in the setting of state government hospital with attached antiretroviral therapy referral center.

Subjects and Methods:

The sample size of the study was duration based (30 months).

Inclusion Criteria:

All PLHIV presenting to the department of dermatology with STIs were included in the study.

Exclusion Criteria:

Non-STI causes of genital ulceration were excluded in the study.

Results:

The study includes total (n = 484) patients living with HIV/AIDS, prevalence of different STIs was in the following order, herpes simplex virus infections 24.17%, human papillomavirus infections 8.88%, molluscum contagiosum 7.43%, secondary syphilis 4.33%, gonorrhea 1.85%, chancroid 1.44%, and granuloma inguinale 0.41%. Of all the patients with herpes simplex virus infections, 45.6% (n = 57) had multiple recurrences (>6/year). The incidence of mixed STI was 17.29% in the present study.

Conclusions:

The study represents decreasing trends in bacterial STIs and the rise of viral STIs. Atypical presentations of classic STIs were more frequent than non-HIV-infected individuals.

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.

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.

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.

Carboplatin-induced Fanconi-like syndrome in rats: amelioration by pentoxifylline

INTRODUCTION

Carboplatin is a congener of cisplatin used in the treatment of ovarian, head and neck and small-cell lung cancer. However, the clinical efficacy of carboplatin is marred by the development of ROS-dependent nephrotoxicity. The pathophysiological damage inflicted upon the kidney by carboplatin closely resembles to that of Fanconi syndrome.

AIMS AND OBJECTIVES

The present study aimed at inducing Fanconi-like syndrome in rats by administration of carboplatin. Objectives of the study involved evaluation of biochemical parameters coherent to Fanconi-like syndrome. Further, an attempt was made to evaluate the potential therapeutic effect of pentoxifylline in this condition.

RESULTS

The results of the study demonstrated that the urinary excretion profile of carboplatin treated rats closely resembled to that of patients suffering from Fanconi-like condition. Pentoxifylline was able to ameliorate this nephrotoxic condition as suggested by the change in levels of membrane bound ATPases, MDA and GSH. The urinary levels of tyrosine and cysteine correlate well with that of Fanconi-like condition in animals and humans.

CONCLUSION

In lieu of these observations, our study suggested that carboplatin-induced renovascular damage resembles to Fanconi-like condition which can be mitigated by pentoxifylline.

Protective effect of coenzyme Q10 in simvastatin and gemfibrozil induced rhabdomyolysis in rats

Administration of simvastatin (80 mg/kg, po. evening dose) and gemfibrozil (600 mg/kg, po twice) for 30 days produced significant decrease in the level of reduced glutathione, superoxide dismutase, catalase and increase in the level of lipid peroxidation and various serum parameters (creatine phosphokinase, lactate dehydrogenase, serum glutamate oxaloacetate transaminase, creatinine, urea and blood urea nitrogen). This suggested involvement of oxidative stress in rhabdomyolysis. Increase in the level of reduced glutathione, superoxide dismutase, catalase and decrease in the level of lipid peroxidation and serum parameters after administration of antioxidant CoQ10 (10 mg/kg.ip) proved the protective effect of CoQ10 in rhabdomyolysis.

Effect of cadmium on contractile response to spasmogens in vascular and nonvascular tissues

In rat isolated aorta low concentration of CdCl2 (4.8 x 10(-8) M) produced a significant increase in pD2 value of KCl and noradrenaline (NA) with an increase in the maxima, while higher concentration of CdCl2 (1.44 x 10(-5) M) produced a significant rightward shift of the dose-response curve with a depression of maxima. In rat isolated portal vein 4.8 x 10(-7) M CdCl2 produced a significant increase in the pD2 value of KCl with an increase in the maxima, while higher concentration of CdCl2 (4.8 x 10(-5) M) produced a significant rightward shift of the dose-response curve of KCl and NA with a depression of maxima. In rat isolated vas deferens and anococcygeus muscle 4.8 x 10(-8) M CdCl2 produced a significant increase in pD2 value of KCl with an increase in the maxima, while higher concentrations of CdCl2 (4.8 x 10(-6) M and 1.44 x 10(-5) M) produced a significant rightward shift of the dose-response curve of KCl and NA. It is suggested that enhancement and reduction of response to KCl and NA, in presence of different concentrations of CdCl2 might be due to the alteration in the fluxes of calcium ion since these spasmogens produce their action by increasing the availability of calcium ions for the contractile machinery.

The acute pressor response to cadmium in rats

In rats, acute i.v. administration of CdCl2 (0.5 and 1 mg/kg) produced a depressor response followed by a pressor response, while the acute i.p. administration of CdCl2 (0.5 and 1 mg/kg) produced only a pressor response. Phentolamine (5 mg/kg, i.v.), hexamethonium (10 mg/kg, i.v.), propranolol (2 mg/kg, i.v.) and indomethacin (20 mg/kg, i.p.) as well as bilateral adrenalectomy, acute reserpinization and chemical sympathectomy by guanethidine did not modify the acute pressor response to CdCl2. Verapamil (1 mg and 2 mg/kg, i.v.) and nifedipine (0.25 and 0.5 mg/kg, i.v.) prevented the acute pressor response to CdCl2 administered by either i.v. or i.p. route. Phentolamine (10 micrograms/ml) could not prevent the rise in perfusion pressure of the rat hindquarter due to intra-arterial CdCl2 administration. However, verapamil (50 and 100 micrograms/ml) prevented rise in perfusion pressure. It is concluded that cadmium ion might mimic calcium ion and produce a direct contractile effect on the vascular smooth muscle.

Cadmium-induced hypertension in rats

Chronic cadmium chloride (CdCl2, 0.5 and 1.0 mg/kg, i.p.) treatment in female albino rats for 2 weeks resulted in elevation of blood pressure. In chronic CdCl2-treated rats the pressor responses to different doses of noradrenaline, angiotensin II and depressor responses to acetylcholine and isoprenaline were unaltered. In rat hindquarter preparation there was elevation of perfusion pressure and the sensitivity of vascular bed to noradrenaline was increased in the CdCl2-induced hypertensive rats. Complete bilateral adrenalectomy or chemical sympathectomy or treatment with captopril did not prevent the development of CdCl2-induced hypertension. Treatment with verapamil (15 mg/kg/day, p.o.) or nifedipine (10 mg/kg/day, p.o.) for 2 weeks prevented the development of hypertension with chronic CdCl2 treatment. It is suggested that chronic treatment of rats with CdCl2 induces hypertension. It is possible that cadmium mimics the calcium ion for the induction of hypertension in rats.