Our purpose in assembling this paper is 2-fold. First, we hope to review in-depth the properties on itraconazole pellet-capsules and what clinicians should know when considering oral itraconazole and discuss the potential value of treating superficial dermatophyte infections with oral antifungal therapy. Second, we hope to address some of the concerns of the recent epidemic of chronic recalcitrant widespread dermatophytosis in India, with emphasis on better treatment but also considering some of the necessary prophylaxis hygiene measures. An in-depth review of itraconazole (as pellet-capsules), a triazole antifungal will be presented with focus on the pharmacokinetic properties which lead to the development of the 1-week pulse dosing for skin and nail infections. Finally, recommendations for best usage of itraconazole pellet-capsules for management of dermatophytosis will be summarized in this paper.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Introduction: Viral warts are caused by human papillomavirus. Although various treatment modalities are available, many of them result in the partial clearance of warts or recurrence. Immunotherapy has been tried in the recent times with variable success rates. We undertook a study to evaluate the safety and efficacy of immunotherapy using tuberculin purified protein derivative (PPD) for the treatment of viral warts. Materials and Methods: A total of 45 patients were included in the study. Each patient was injected with 10 TU of tuberculin PPD (0.1 ml) intralesionally in the largest wart at 2 weekly interval. A total of maximum six treatment sessions were conducted. Resolution of viral warts was considered as the clinical end point of the study. The clinical assessment was done by photographic measurements at baseline, before each treatment session, and 3 weeks after the completion of treatment. Results: A total of 62.2% patients (28 out of 45) showed complete clearance at injected and distant warts, eight patients (17.8%) showed partial clearance, and nine patients (20%) showed no improvement. No significant side effects were observed except for localized hair loss around injected viral wart over the scalp. Conclusion: Tuberculin PPD immunotherapy was found to be a safe and effective treatment modality for the treatment of viral warts.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: There are many destructive and immunotherapeutic options available for the treatment of common warts, but no treatment is 100% effective and usually cause pain and scarring. Recently, intralesional immunotherapy with skin test antigens and vaccines has been shown to be effective in the management of warts. We evaluated the efficacy of Measles Mumps Rubella (MMR) vaccine injection in the treatment of cutaneous warts. Aim: To study the efficacy of intralesional MMR vaccine in the treatment of common warts. Materials and Methods: A case–control study was conducted in AVBR Hospital, Sawangi (Meghe), Wardha, in 2015–2016. Forty clinically diagnosed cases of cutaneous common wart were selected in the study and were put randomly into two groups (20 in each group). Group 1: included twenty patients subjected to intralesional injection of 0.5 ml MMR vaccine. Group 2: included twenty patients as a control group and subjected to intralesional injection of 0.5 ml saline. These injections were repeated every 3 weeks intervals for maximum three injections. Follow-up of patients was done every 6 months for clinical assessment of results and to study recurrence. Results: A significant difference was found between the therapeutic responses of common warts to MMR. Vaccine and normal saline (control) group. At the end of 9 weeks (third visit), about 65% patients treated with MMR vaccine showed complete clearance compared with 5% of the control group. Grade 3 response was 20% versus 10% respectively; whereas Grade 2 response was observed in 10% versus 25%, respectively, and as regards no response, it was 5% versus 60% in MMR vaccine and control group, respectively. Conclusion: We found that the treatment of common warts by MMR vaccine is effective, with good cure rates, and excellent safety profile.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Apremilast is an oral phosphodiesterase 4 inhibitor, now approved by the Food and Drug Administration in the management of psoriatic arthropathy (PsA). As biologic therapy is associated with significant amounts of adverse effects, newer treatment options with an efficacious outcome, sans the toxicity, is something all clinicians would implement readily in their therapeutic regimens. Apremilast is one such drug which has shown promise in the management of psoriasis, PsA, and a few other dermatologic disorders. This review will throw light on the dermatologic perspective regarding apremilast.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Bilastine is a new second generation H1-antihistamine approved for the symptomatic treatment of allergic rhinitis (AR) and chronic urticaria (CU) in patients older than 12 years of age. AR and urticaria are very common clinical conditions that represent one of the most frequent reasons for a patient to visit their general practitioner or allergist or dermatologist. Bilastine, with its efficacy and safety profile epitomizes the evolution of research on antihistamines.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Lichen planus is a common inflammatory disorder affecting skin, mucus membranes, nails, and hair. At least two-thirds of cases occur between 30 and 60 years of age. Lichen planus can affect the mucosal surfaces of mouth, genitalia, conjunctiva, esophagus, anus, and urethra. Oral lichen planus is relatively common than lichen planus of other mucosal areas. Oral lichen planus is very refractory to treatment. Oral and topical steroids, topical tacrolimus, azathioprine, cyclosporine, and dapsone are the drugs used to treat oral lichen along with acitretin. We hereby report the successful treatment of oral lichen planus with acitretin in three patients.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Cutaneous eruptions are the most frequently reported adverse reactions to drugs. The pattern of cutaneous adverse drug reactions (CADRs) and the causative drugs keeps changing every year. Objective: The study was designed to ascertain the different clinical patterns of CADRs and to determine the causative agents. Materials and Methods: A prospective observational nonrandomized hospital-based study was carried out over a period of 6 months. The CADRs as observed in the outpatient and inpatient Departments of Dermatology were recorded. Naranjo's algorithm was used to determine the causality assessment. Clinical pattern of these adverse drug cutaneous reactions was studied. Causality assessment was done with the help of Naranjo's algorithm. Results: A total of fifty patients diagnosed to have CADRs were included in the study. The most common type of CADRs was urticaria (30%) followed by fixed drug eruption (FDE) (24%) and maculopapular eruption (12%). Antimicrobial agents (AMAs) (48%) were responsible for majority of the detected reactions, followed by nonsteroidal anti-inflammatory drugs (24%), antihypertensives (8%), and antiepileptics (4%). A total of 41 reactions (82%) showed probable causal association, 4 reactions had possible association (8%), and 5 cases of cutaneous drug reaction (10%) showed definite causal association with the drug. Conclusion: A wide clinical spectrum of CADRs ranging from FDE to mild maculopapular rash to serious Stevens–Johnson syndrome was observed. Most of these drug eruptions were caused by AMAs. The occurrence of CADRs in the present study was in concurrence to various studies conducted in India.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Warts are classified under one sided diseases as external local maladies. They often have individualistic and immunological basis as also familial tendencies. Warts are included under miasm sycosis. Although warts are local diseases, they are treated with internal remedy which is based on comprehensive understanding of the patient. This includes local symptoms, i.e. morphology and location of lesion, mental makeup of the person, and physical characteristics. This is what is called totality of symptoms. A constitutional remedy thus selected eradicates the complaint locally as well as internally, thereby providing long lasting relief from complaints. Common remedies include Calcarea carbonica, Causticum, Dulcamara, Natrum muriaticum, Nitric acidum, and Thuja occidentalis. Homeopathic concept and homeopathic treatment of warts has been described.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Generalized bullous fixed drug eruption is bullous type of fixed drug eruption characterized by sharply defined bullae at the same site following administration of offending drug. GBFDE has aggressive course unlike conventional FDE and requires aggressive treatment. Mucosa is usually spared and constitutional symptoms are mild. We came across two cases of GBFDE in which culprit drugs were B-Lactam antibiotics.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Dermatophytosis is a common, superficial fungal infection of the skin. In developing countries like India, casual attitude toward seeking medical attention and lax drug control policies lead to indiscriminate use of irrational over-the-counter (OTC) medications. Studies on OTC topical medication abuse in dermatophytosis are lacking despite its frequent occurrence. Aims: To assess the magnitude of OTC topical medication use in dermatophytosis by studying the demographic variables, source of prescription, and their adverse effects. Materials and Methods: This cross-sectional, observational, questionnaire-based pilot study was carried out in a tertiary care center. One hundred consecutive, mycologically confirmed dermatophytosis patients were questioned about the use of OTC medications and examined for adverse effects of the preparations used. Results were documented in a predesigned pro forma and the data were expressed in terms of means and proportions. Results: The study population consisted of 75 males and 25 females. Tinea cruris was the most common pattern observed. Only 32% of the patients consulted a dermatologist on developing a rash, whereas the majority (68%) used medicines suggested by others. Clobetasol-based preparations were commonly misused, and 63.23% of the study population experienced adverse effects. Furthermore, majority (89%) of the study population were unaware of steroids and their adverse effects. Conclusions: The growing threat of OTC drug abuse in India is evident from this study. Stringent drug control policies and awareness of adverse effects of OTC topical medication abuse are truly the need of the hour to control this menace.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Secukinumab is a fully human monoclonal antibody against interleukin-17. Phase III trials have shown encouraging results in chronic plaque psoriasis. The real-life data for safety and efficacy of secukinumab are limited. Methodology: This was a retrospective, single-center, observational study conducted in a tertiary care center of East India between January 2016 and December 2017. Patients with chronic plaque psoriasis who were initiated on injection secukinumab during the study period and completed 52 weeks of observation period were included in the study. Analysis was performed using SPSS version 25. Results: Twenty patients were recruited in the study. Mean age of the patients was 46 years and mean duration of disease was 11 years. Eleven (55%) patients were biologic experienced and Nine (45%) patients were biologic naïve. Mean Psoriasis Area and Severity Index (PASI) score at baseline was 17.05 (±6.7). Fifteen (75%) patients achieved PASI75 at 4 weeks. Seventeen (85%) patients achieved PASI75, 13 (65%) achieved PASI90, and 10 (50%) patients achieved PASI100 at 12 weeks. Eighteen (90%), 10 (50%), and 7 (35%) patients maintained PASI75, PASI90, and PASI100 response, respectively, at the end of 52 weeks. Adverse effects were seen in 6 (30%) patients over 52 weeks. Drug discontinuation was required because of severe exacerbation of eczema and recalcitrant vulvovaginal candidiasis in one patient each. Conclusion: Secukinumab is an effective drug for the management of chronic plaque psoriasis even in patients who have previously been treated with systemic drugs and other biologics; however, adverse effects are more common as compared to what trial data suggest. Limitations of Study: Small sample size and retrospective study design are main limitations of the study. Strength of Study: This is first real-life data with 52 weeks follow up from India.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Various medications are used for the treatment of various diseases. Ironically, adverse drug reactions (ADRs) also accompany the use of these medications and are as old as the medicine itself. These drug reactions can range from mild transient erythema at one end of the spectrum to severe cutaneous ADRs (SCADRS) that include Steven–Johnson syndrome (SJS), toxic epidermal necrolysis, acute generalized exanthematous pustulosis, and drug reaction with eosinophilia and systemic symptoms complex (DRESS). Aim: This study aims to study the clinical and epidemiological aspects of severe cutaneous adverse drug reactions (SCADRS) at a referral center of Jammu region, with special reference to the role of corticosteroids in the management. Materials and Methods: The study was carried out between July 2015 and December 2015, at a tertiary hospital after permission from Ethical Committee of the institution. A total of 44 patients were included in the study which included outpatients as well as inpatients admitted after written informed consent. The Naranjo ADR probability scale was applied to indicate the causality of the drug with the SCADRS. Results: In the study, a total of 44 patients were included in the study. Males outnumbered the females, and maximum patients were in the age group of 21–40 years. SJS was the most common SCARD found followed by DRESS. Antiepileptic class of drug was found to be most commonly implicated. Immediate withdrawal of the culprit drug and administration of systemic steroids reverted the SCARD in maximum patients. Conclusion: Severe cutaneous adverse drug reactions can be associated with serious morbidity as well as mortality. Their knowledge and prompt recognition are essential for clinicians as early recognition, and immediate withdrawal of the culprit drug/drugs with adequate management can be lifesaving.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Toxic epidermal necrolysis (TEN) is an acute life-threatening disease associated with a high mortality. Systemic corticosteroids, cyclosporine, and intravenous gamma globulins have been used in the treatment with variable results. We report five cases of TEN treated successfully with cyclosporine monotherapy. All the patients presented with severe disease. All the patients received cyclosporine 3–5 mg/kg/day for an average duration of 5–10 days depending on the clinical response. All the patients recovered without any sequel. No significant side effects were noted in all the five patients except for one patient who developed acute nephrotoxicity. All the five patients were discharged from the hospital by the end of 2 weeks, thus decreasing the hospital stay due to a favorable outcome and early recovery. Cyclosporine in TEN patients is not only a lifesaving drug, but also it is cost-effective. This case series demonstrates the safety and efficacy of the short course of cyclosporine monotherapy in the treatment of TEN.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Leprosy complicated by hepatitis is one condition wherein the usual multidrug therapy cannot be used and alternate regimens are required. The World Health Organization and the Indian Association of Leprologists have recommended an alternative combination therapy of clarithromycin, ofloxacin, and clofazimine to be prescribed in such cases. However, in some cases, this combination therapy may fail to control or worsen the hepatitis. One such case of leprosy, complicated by hepatitis, who did not tolerate the recommended hepatosafe regimen was successfully treated with monthly rifampicin, ofloxacin, and minocycline, and is hence reported.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Warts are one of the most common benign growths in the dermatological outpatient department but are many times tough to treat as they are chronic, resistant, and relapsing to available treatment. A variety of therapeutic modalities have been used with varying degree of success. However, till date, no therapeutic modality had been fully successful. Aim and Objectives: The present study was conducted to evaluate the therapeutic efficacy and safety of intralesional (IL) bleomycin injection in common warts. Materials and Methods: A total of 50 patients of common warts were enrolled in this evaluator blinded randomized placebo-controlled study. Group A consists of patients to be treated with IL bleomycin, and Group B consists of patients to be treated with IL normal saline. A total of 25 patients were enrolled in each group. Patients of both groups were asked to follow-up after 4 weeks for maximum of 4 times, i.e. at 8 weeks, 12 weeks, at the end of 6 months as a final visit, and assessed clinically every time. Results: Out of 87 wart lesions in Group A patients, 81 (93.10%) showed a complete resolution. A progressive clearance of the warts was seen, after the first injection (64%) and second injection (36%), only 6 warty growths (7%) were nonresponders to treatment. However, in Group B, only 4 (5%) showed disappearance within 12 weeks and even after 6 months of follow-up (P < 0.05 by × 2 analysis and risk ratio = 7.67). Conclusion: IL bleomycin injection was significantly safer and effective, with better patient acceptance in treating common warts.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Clinical trials have proved the efficacy of antihistamines in the treatment of chronic idiopathic urticarial (CIU). Second-generation antihistamines are recommended as first-line therapy for CIU. This article reviews the newer second-generation antihistamines in light of recent advances in the understanding of their pharmacology, efficacy, and safety profile. A Google scholar search for second-generation antihistamines was done using the words “second generation H₁antihistamines,” “bilastine,” “ebastine,” “olopatadine,” “rupatadine,” “levocetirizine,” “fexofenadine,” “desloratadine,” “histamine,” “allergy,” and “urticaria.” All the articles were retrieved and classified into review articles, studies, double-blinded trials, and case reports. The final data were then analyzed and presented in a narrative fashion.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]