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.

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Shwitra or Shwet-Kushtha can be co-related with skin disease "vitiligo" in biomedicine. According to Ayurveda, the skin is one of the essential sense organs. Vata and bhrajaka pitta reside in the skin (called twak in Sanskrit). As the skin covers the whole body, bhrajaka pitta should be maintained in a proper state, and it needs continuous care. An imbalance in Vata and bhrajaka pitta may cause skin diseases. The first step (Step 1) in Ayurvedic management of vitiligo is purification therapies (shodhana karma) using herbal decoction of Psoralea corylifolia (bakuchi kwatha) and Euphorbia neriifolia (snuhi) aimed to induce multiple bouts of purgation. In the next step (Step 2), oil massage using oil selected on the basis of patient examination (rogi pariksa) and disease (roga). Step 3 is the exposure of lesions to the sun rays as long as the patient can tolerate (Soorya pada santhapam in Ayurveda). Herbomineral preparations include topical application of herbal Lepa, powders made up of medicinal plants (Curna), herbalized ghee preparations similar to paste (Ghrita, semi-solid preparations taken orally, by licking (Avaleha), herbalized oil preparations (Thaila), fermented solutions (Asava-Arista), and tablets (Vati/Gutika). Various minerals and metallic salts (Rasousadha) are also used. Bakuchi oil is Ayurvedic medicinal oil prepared from the dried fruits of P. corylifolia, and sesame oil is a popular therapy for vitiligo in Ayurveda that contain psoralen to stimulate melanocytes when exposed to ultraviolet light exposure. Details of above-mentioned therapy are discussed. Scientific rationale behind the use of these medications needs to be further explored with modern methods and research.

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Hand, foot and mouth disease (HFMD), an acute viral illness caused by coxsackieviruses or enteroviruses, is predominantly encountered in children under 10 years of age. Although it is usually self-resolving, there are a few rare cases which have an extremely aggressive clinical presentation and need to be treated on a priority. Many affected children present with florid or unusual lesions; are highly febrile, with high irritability or listlessness; and also refuse to eat. Such cases could be considered as severe ones. With no specific effective antiviral available to tackle HFMD cases, acyclovir may be used in severe cases for its antiviral effect. We describe three such cases of HFMD in children, treated with oral acyclovir, with gratifying results.

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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.

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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.

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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.

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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.

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Introduction: Topical mupirocin, fusidic acid, and nadifloxacin are used in the treatment of superficial bacterial infections. This study was undertaken to assess the efficacy and safety of these three topical antibiotics in the treatment of superficial bacterial infection of the skin. Aims: To compare the efficacy and safety profile of 2% mupirocin versus 2% fusidic acid versus 1% nadifloxacin cream in the treatment of superficial bacterial infections. Materials and Methods: A randomized study in treatment-naive cases of uncomplicated bacterial skin infections attending the out-patient Department of Dermatology was done. A total of 90 patients of bacterial infections of the skin were included, which were randomly allocated to three different study groups. After diagnosis was confirmed clinically, grading of the lesions was done with regard to parameters such as erythema, edema, vesiculation, pustulation, crusting, and scaling. Score was applied to each parameter as 0-absent, 1-mild, 2-moderate, and 3-severe. Gram staining was performed. The lesions were graded on subsequent visits on day 4, day 18, and day 14. The results were subjected to analysis of variance test, followed by the Dunnett's test. Results: Fusidic acid cream showed faster reduction of the scores at the end of the first visit. The differences noted in the efficacy of the three drugs were not statistically significant. No significant side effects were observed. Conclusion: This study documents the equality in the comparative safety and efficacy of mupirocin, fusidic acid, and nadifloxacin in the treatment of uncomplicated superficial bacterial infections at our center.

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Janus kinase (JAK) inhibitors are a new addition in the armamentarium of drugs in the treatment of autoimmune dermatoses. They have proven to be valuable in treating a variety of inflammatory dermatoses with lesser side effects compared to their biological counterparts. This review throws light on JAK inhibitors and their role in dermatologic diseases.

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Background: Molluscum contagiosum(MC) is one of the most common cutaneous viral infection observed in children. Though, it is benign and self-limiting, treatment is often sought for cosmetic reasons. Existing invasive therapeutic modalities are generally not well tolerated in children because of pain and risk of scarring. Immunomodulatory potential of cimetidine is well established. We thus extrapolated the same to ranitidine and conducted this study. Aim: To assess the efficacy of oral ranitidine in treatment of molluscum contagiosum in immunocompetent children. Methods: A multicentre longitudinal study was conducted in the dermatology departments of tertiary care hospitals in Ahmedabad and Wardha, India over a period of 4 months. 24 children with MC were included. Oral ranitidine was started in dose of 5 mg/kg/day in two divided doses for 8 weeks. Follow up was done very 15 days and changes in number and size of lesions were noted. Results: Mean age of patients was 5.08 years. 19 patients completed the study. 15 patients had improvement in the lesions at the end of 8 weeks while 4 patients did not show any improvement. Complete clearance was seen in 14 patients(73.6%) and 1 patient had decrease in size of the lesions without change in the number. Mean duration of complete clearance of lesion was 6.5 weeks. Conclusion: Oral ranitidine may be considered as a safe and effective alternative therapeutic option in widespread MC in immunocompetent children where invasive painful procedures are less desirable.

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Many studies suggested the use of tranexamic acid (TA) as a treatment modality for melasma, however, there are many limitations in the use of oral and intravenous dosage forms of TA because of adverse effects and contraindications resulted by its thrombolytic property. Topical application of TA is not effective because of its poor penetration through epidermis. Intradermal injections into the localized lesions of melasma regions or intralesional administration of TA were reported to be effective way of treatment for melasma with minimum risk of adverse effects. We report a case of a 40-year-old woman, who was treated with a minimum effective dilution of intradermal TA at localized hyperpigmented regions. The results were noted and analyzed with photographs taken during the treatment and by considering the patient satisfaction scores. The patient showed good improvement at the end of 4 weeks.

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Oral bepotastine is a nonsedative second-generation antihistamine with an action on other inflammatory mediators. It also acts as a mast cell stabilizer and leukotrienes inhibitor. Its distribution in the brain is very limited. We explored the currently available literature on bepotastine besilate to assess the pharmacodynamics and pharmacokinetics of the drug and its role in pruritus and urticaria. Bepotastine is generally well tolerated in the elderly population and pediatric patients. Safety of bepotastine in children >2 years of age, pregnant and lactating females is not known. Bepotastine has got very minimal side effect. In comparison to many other second-generation antihistamines, it has got the quicker onset of action, and it maintains its efficacy over the time. It is a promising agent in the treatment of urticaria, allergic rhinitis, and pruritus associated with different skin disorders.

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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.

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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.

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Unsupervised and long-term use of fluorinated/potent topical steroids on the face can lead to side effects such as acne, skin thinning, photosensitivity, and a typical clinical presentation of a topical steroid-dependent face (TSDF) with rebound flushing, burning, dryness, and scaling on attempted withdrawal of the potent topical steroid cream. To evaluate the response of a commercially available nasal decongested solution of xylometazoline 0.05% in patients of long-term potent topical steroid abuse on the face. Two patients with a history of long-term, indiscriminate, and unsupervised topical steroid use on the face were asked to use a commercially available nasal decongestant solution, on face. Patients were asked to use the decongestant solution on face, once daily for 2 weeks. Follow-up after 2 weeks demonstrated excellent improvement in flushing and erythema. Side effects reported were transient tingling and stinging sensation. Xylometazoline, being an alpha-adrenergic agonist, presents an effective new option for treatment in patients of flushing and erythema, resulting from long-term topical steroid use on face.

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Rituximab (RTX) is a specific mouse and human chimeric monoclonal antibody that has found to have numerous applications in dermatology. Though initially approved by the US FDA for treating rheumatoid arthritis and non-Hodgkin's lymphoma; currently its approval has extended to involve the pemphigus group of disorders; both as a first line drug as well as a therapeutic strategy for recalcitrant cases of pemphigus, unresponsive to conventional therapy. Apart from pemphigus, there have been a number of cutaneous disorders where rituximab has been found to be useful. This review will give a bird's eye view of the applications of rituximab in dermatology.

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Clofazimine is a synthetic dye that has been used in the treatment of leprosy since many years. Its role in the treatment of lepra reactions was subsequently recognized. When the dose of 300 mg/day is used, it doubles the serum concentration of the drug and supposedly exerts potent anti-neutrophilic effect and inhibits of prostaglandins. Our personal experience with high dosages of clofazimine in type II lepra reactions and review of the literature suggests that clofazimine has been extremely useful in providing good and satisfactory results in leprosy patients suffering from these embarrassing conditions. The anti-inflammatory effect of clofazimine is greatly useful in managing recurrent and chronic type II reactions with its steroid-sparing effect and providing an alternate and in expensive option.

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