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.

High versus low dose oral isotretinoin in the treatment of cutaneous and genital warts

Although oral isotretinoin has been considered as a potential therapeutic option for the treatment of different types of warts, the optimum dosage regimen is not yet well-established. To evaluate the efficacy and adverse effects of high versus low doses of oral isotretinoin in the treatment of cutaneous and genital warts. The study included 100 patients who were randomly assigned to two groups, 50 patients in each. Group 1 received 0.6 mg/kg/day (high dose isotretinoin) and Group 2 received 0.3 mg/kg/day (low dose isotretinoin). In both groups, therapy was given daily until resolution was achieved or for a maximum of 3 months. Complete clearance of warts was observed in 76% of the high dose isotretinoin group and in 46% of the low dose isotretinoin group. There was a statistically significant difference in the therapeutic response between the two groups. Recurrence was higher in the low dose group (26%) than the high dose group (7.8%). Adverse effects were mild and tolerable. High dose of systemic isotretinoin is more effective than low dose and seems to be a promising well-tolerated and effective therapeutic option for the treatment of cutaneous and genital warts.

Oral isotretinoin versus acitretin in male patients with multiple recalcitrant common warts: A randomized, double-blinded placebo-control study

BACKGROUND

Management of multiple recalcitrant common warts represents a therapeutic challenge. Both oral isotretinoin and acitretin have shown a promising efficacy in the treatment of various types of warts. However, a comparative study of the two medicines in wart treatment has not yet been conducted.

OBJECTIVE

The aim of this study was to assess the efficacy and adverse effects of oral isotretinoin versus acitretin in the treatment of multiple recalcitrant common warts.

METHODS

This study was conducted on 75 adult male patients with recalcitrant multiple common warts. The patients were randomly assigned to three groups: group 1 (30 patients) received oral isotretinoin, group 2 (30 patients) received acitretin, and group 3 received oral placebo (15 patients). The treatment was given daily until complete clearance or for a maximum of 3 months.

RESULTS

Complete clearance of the treated lesions was observed in 18 patients (60%) of the isotretinoin group, in 22 patients (73.3%) of the acitretin group, and in 0 patients (0%) of the placebo group. A statistically significant difference was observed in the therapeutic response between the treatment groups, and the placebo group was observed. Adverse effects of the used drugs were mild and transient.

CONCLUSION

Oral isotretinoin and acitretin are promising effective modalities with minimal side effects for the treatment male patients with multiple recalcitrant common warts with a relative superiority of acitretin.

Evaluation of the brown alga, Sargassum muticum extract as an antimicrobial and feeding additives

Plant disease administration is difficult due to the nature of phytopathogens. Biological control is a safe method to avoid the problems related to fungal diseases affecting crop productivity and some human pathogenic bacteria. For that, the antimicrobial activity of the seaweed Sargassum muticum methanol and water extracts were investigated against human bacterial pathogens and fungal plant pathogens. By using 70 percent methanol, the seaweed powder was extracted, feeding additives assay, ultrastructure (TEM). Results revealed significant inhibition of S. muticum methanol extract against Salmonella typhi (25.66 mm), Escherichia coli (24.33 mm), Staphylococcus aureus (22.33 mm) and Bacillus subtilis. (19.66 mm), some fungal phytopathogens significantly inhibited Fusarium moniliforme (30.33mm), Pythium ultimum (26.33 mm), Aspergillus flavus (24.36mm), and Macrophomina phaseolina (22.66mm). Phytochemical investigation of S. muticum extract showed the presence of phenolic and flavonoid compounds. Results suggested that there is an appreciable level of antioxidant potential in S. muticum (79.86%) DPPH scavenging activity. Ultrastructural studies of Fusarium moniliforme hypha grown on a medium containing S. muticum extract at concentration 300mg/ml showed a thickening cell wall, disintegration of cytoplasm, large lipid bodies and vacuoles. In conclusion, our study revealed The antibacterial activity of S. muticum extract significantly against some Gram positive, Gram negative bacteria and antifungal activity against some phytopathogenic and some mycotoxin producer fungi. Flavonoids, phenolic play an important role as antioxidants and antimicrobial properties. Such study revealed that S. muticum methanol extract could be used as ecofriendly biocontrol for phytopathogenic fungi and feeding additives to protect livestock products.

Topical calcipotriol combined with urea 20% versus intralesional injection of triamcinolone acetonide, 5-fluorouracil, and methotrexate in the treatment of nail psoriasis: A comparative study

BACKGROUND

There is no consistently effective treatment for psoriatic nails. Topical and intralesional modalities have been recently investigated and showed promising efficacy and safety.

OBJECTIVE

To compare the efficacy and safety of intralesional injection of 5-fluorouracil (5-FU), methotrexate (MTX), triamcinolone acetonide (TA) versus topical calcipotriol plus urea 20% in the treatment of nail psoriasis.

METHODS

This study included 60 patients with nail psoriasis who were randomly assigned to 4 groups, each containing 15 patients. The first 3 groups received intralesional injection of 0.1 ml of 5-FU (group A), MTX (group B), and TA (group C) into the nail matrix and bed monthly for 3 months. Group D received a topical combination of calcipotriol/urea 20% twice daily for 3 months. Therapeutic response was assessed every month for 3 months using the target nail psoriasis severity index (NAPSI).

RESULTS

The mean percentage of improvement was significantly higher in topical calcipotriol/urea combination (57.1 ± 26.4) than intralesional TA (44.2 ± 32.7), intralesional MTX (37.7 ± 14.2), and intralesional 5-FU (29.6 ± 14). Adverse effects were mild and insignificant in the studied groups.

CONCLUSION

Topical calcipotriol/urea combination seems to be more effective and safe than intralesional injections of 5-FU, MTX and TA. This article is protected by copyright. All rights reserved.

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

BACKGROUND

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.

AIM

To assess the efficacy and safety of intralesional Candida antigen versus intralesional PPD in the management of recalcitrant plantar warts.

PATIENTS AND METHODS

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 two weeks until clearance or for a maximum of 5 sessions.

RESULTS

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 3 groups.

CONCLUSIONS

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. This article is protected by copyright. All rights reserved.

Microneedling combined with pimecrolimus, 5-fluorouracil and trichloroacetic acid in the treatment of vitiligo: A comparative study

BACKGROUND

Treatment of vitiligo represents a highly therapeutic challenge in spite of the continuous development of new modalities. Combination therapies of vitiligo can help improve treatment response, and reduce recurrence potential.

OBJECTIVE

To compare the efficacy and adverse effects of microneedling combined with 5-fluorouracil, pimecrolimus, and TCA in the treatment of localized, stable vitiligo.

METHODS

The study included 75 patients with non-segmental, stable vitiligo who were randomly assigned to three equal groups: group 1 received a combination of microneedling and 5-FU, group 2 received microneedling and pimecrolimus, and group 3 received microneedling and TCA. The procedure was done every 2 weeks for a maximum of 6 sessions.

RESULTS

Combined microneedling and TCA was associated with the highest degree of repigmentation followed by combined microneedling + 5-fluorouracil, and lastly combined microneedling + pimecrolimus. The difference between the three groups was statistically significant in favor of the combined microneedling and TCA. Pain, erythema, post-inflammatory hyperpigmentation, infection, and scarring were variably reported adverse effects in the 3 groups.

CONCLUSION

Combination therapy seems to be a promising modality for the treatment of vitiligo. Combined microneedling and TCA is superior to combined microneedling with either 5-fluorouracil or pimecrolimus.

Correlation of serum interleukin 17 and macrophage migration inhibitory factor levels with clinical response to intralesional Candida antigen and their potential use as predictors of clinical outcome in patients with multiple common warts

BACKGROUND

Candida antigen injection is one of the most widely used intralesional immunotherapy in the treatment of warts. It acts through the induction of systemic immune response. The pattern of cytokines production may play an integral role in its mechanism of action.

AIM

To investigate the possible relation between serum levels of IL17 and MIF, and the clinical response to intralesional Candida antigen in multiple common warts.

METHODS

A total of 90 patients with multiple common warts were divided into 2 groups. Sixty patients received intralesional Candida antigen injection into the largest wart, controlled against thirty patients who had intralesional saline, as placebo. The injection was done at a 2-week interval for 5 doses. Blood samples were obtained from both groups, and serum levels of IL17A and MIF were estimated at baseline and 2 weeks after the last session using ELISA kits.

RESULTS

Complete clearance of warts was statistically higher in the Candida antigen group (40% of the patients) compared to the saline group (p < 0.05). The serum levels of IL17 had significantly declined from baseline, while the level of MIF had risen after intralesional Candida antigen injection, but not in the saline group. At a cutoff level of 316 pg/ml, IL17 had a sensitivity of 83.3% to predict therapeutic response.

CONCLUSION

IL17A and MIF may have possible roles in the mechanism of action of Candida antigen in the treatment of common warts. At a certain level, serum IL17A may be a potential predictor of response to treatment.

H syndrome: A review of treatment options and a hypothesis of phenotypic variability

H syndrome is a rare autosomal recessive disorder with clinical features comprising: hyperpigmentation, hypertrichosis, hearing loss, heart anomalies, low height, hypogonadism and hepatosplenomegaly. H syndrome results from loss-of-function mutations in SLC29A3 which leads to abnormal proliferation and function of histiocytes. Herein, we discuss the considerable phenotypic heterogeneity detected in a consanguineous Egyptian family comprising of four affected siblings, two of which are monozygotic twin and the possible therapeutics. The phenotypic variability may be attributed to the role of histiocytes in the tissue response to injury. Such variable expressivity of H syndrome renders the diagnosis challenging and delays the management. The different treatment approaches used for this rare entity are reviewed.

Atypical presentations of erythema nodosum leprosum: Diagnostic and therapeutic aspects

Classic erythema nodosum leprosum (ENL) is characterized clinically by abrupt eruption of tender erythematous nodules, papules and plaques. Variable atypical patterns have been described, for example pustular, bullous, ulcerative, necrotic and Sweet's syndrome-like ENL. We aim to review previously reported cases of atypical ENL addressing the diagnostic and therapeutic aspects of these uncommon presentations. A search of medical literature for all cases of atypical ENL was conducted in the PubMed database till 2020. Data of patients with atypical ENL were collected and analyzed to describe the epidemiological, clinico-histological and therapeutic features. The major five clinically described presentations of atypical ENL include vesiculo-bullous lesions (46 % of patients), ulcero-necrotic lesions (41 %), erythema multiforme-like lesions (28 %), Sweet's syndrome-like lesions (11 %) and pustules (9 %). The skin lesions were accompanied by fever and constitutional symptoms in all patients. Oral steroids and thalidomide were the main lines of therapy in most of the reported patients. Dermatologists and pathologists should keep in mind the clinical variability of ENL to avoid misdiagnosis and delayed management. Early recognition can help control disease progression and save the patients from further complications.

Intralesional Measles, Mumps, and Rubella Vaccine Versus Intralesional Candida Antigen in the Treatment of Common and Plantar Warts

BACKGROUND

Intralesional immunotherapy has been effectively used in the treatment of warts; however, comparative studies between different antigens are limited.

OBJECTIVE

To evaluate the efficacy and safety of intralesional measles, mumps, and rubella (MMR) vaccine compared with intralesional Candida antigen for the treatment of multiple common and plantar warts.

METHODS

Sixty-eight adult patients with multiple common and plantar warts were randomly assigned into two groups, each containing 34 patients. The first group received intralesional MMR vaccine, while the second group received intralesional Candida antigen. Each treatment was injected into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions.

RESULTS

The overall therapeutic response was higher in the Candida antigen group (73.5%) compared with the MMR group (67.7%); however, the difference was not statistically significant. Complete clearance of common warts was higher in the Candida antigen group, while that of plantar warts was higher in the MMR group. Adverse effects were transient and well tolerated in both groups. No recurrence was detected during the 6-month follow-up period.

CONCLUSION

Intralesional MMR and intralesional Candida antigen showed comparable efficacy and safety in the treatment of common and plantar warts.

Intralesional Antigen Immunotherapy in the Treatment of Periungual Warts

BACKGROUND

Intralesional immunotherapy using different types of antigens is considered an effective and safe treatment option for different types of warts. However, there are few studies that illustrate the use of these antigens in the treatment of periungual warts as a distinct type of warts.

OBJECTIVE

To evaluate the efficacy and safety of three antigens: measles, mumps, rubella (MMR) vaccine, Candida antigen, and purified protein derivative (PPD) in the treatment of periungual warts.

METHODS

The study included 150 patients who were randomly assigned to 3 groups with 50 patients in each. Each agent was injected intralesionally at a dose of 0.1 mL into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions.

RESULTS

Complete clearance of warts was observed in 70%, 80%, and 74% in PPD, Candida antigen, and MMR vaccine groups, respectively. There was no statistically significant difference regarding the therapeutic response between the 3 studied groups. Adverse effects were transient and insignificant in the 3 groups. No recurrence of the lesions was reported in any of the studied groups.

CONCLUSIONS

Intralesional antigen immunotherapy seems to be an effective therapeutic option for the treatment of periungual warts.

The use of trichloroacetic acid as a depigmenting therapy in universal vitiligo

BACKGROUND AND OBJECTIVES

Several modalities have been used to clear residual facial pigmentation in patients with extensive vitiligo; however, the ideal depigmenting agent does not yet exist. The use of trichloroacetic acid (TCA) for depigmentation in universal vitiligo has been recently reported. We aim to evaluate the efficacy and safety of TCA 100 % as a depigmenting therapy for recalcitrant facial pigmentation in Egyptian patients with universal vitiligo.

PATIENTS AND METHODS

The study included 50 patients with universal vitiligo who had residual spotted pigmentation on the face causing psychological distress. TCA was focally applied to cover the pigmented patches at 100 % concentration. The treatment was repeated every two weeks until complete depigmentation or for a maximum of five treatment sessions.

RESULTS

Excellent response to TCA treatment (> 90 % depigmentation) was reported in 80 % of the studied cases, partial response (50-90 % depigmentation) in 12 % and poor response (< 50 % depigmentation) in 8 % of the cases. Minor adverse effects were reported e.g. burning sensation, erosions and local infection.

CONCLUSIONS

TCA seems to be a cost-effective and well tolerated therapeutic option for the treatment of recalcitrant residual pigmentation in patients with extensive vitiligo. This modality is associated with reduced downtime and minimal adverse effects.

Biosafety Level 2 cabinet UV-C light exposure of sports antidoping human urine samples does not affect the stability of selected prohibited substances

The current study examined the stability of several antidoping prohibited substances analytes in urine after 15-min exposure to UV-C light in a Biosafety Level 2 cabinet. The urine matrices were exposed within the original antidoping bottles with the aim to destroy DNA/RNA and possible SARS CoV-2. The analytes small molecules Phase I and Phase II metabolites and peptides, in total 444, endogenous, internal standards, and prohibited substances, pH, and specific gravity in urine were studied. The accredited analytical methods were used by Anti-Doping Laboratory Qatar for the comparison of data of the same urine samples analyzed with and without UV-C exposure. In the study conditions, no problems of stability were detected in the substances spiked in the urine samples exposed in the UV-C irradiation.

Microbotox for the treatment of wide facial pores: A promising therapeutic approach

BACKGROUND

Microbotox is the injection of multiple microdroplets of diluted onabotulinum toxin A into the upper dermis. It has been previously used in one study only to decrease pore size and to improve skin texture.

AIMS

To evaluate the efficacy and safety of microbotox in the treatment of wide facial pores.

METHODS

Thirty-five patients with wide facial pores received a single session of microbotox. Objective measurements regarding improvement of pore size (0-4 scale) were recorded by two-blinded dermatologists. The improvements were confirmed by dermoscopic examination. Patient satisfaction was measured by Likert satisfaction scale (1-5 scale). Follow-up of the patients was done for 1 year.

RESULTS

After a single treatment session, the total average of improvement was 87.2%. The average improvement of pore size was 3.7 (0-4 scale). The average patient satisfaction after the end of therapy was 4.7. Dermoscopic evaluation confirmed the reduction in the size and number of pores. There were no serious or long-term side effects.

CONCLUSIONS

A single treatment session of microbotox appears to be safe and effective for the reduction of facial pore size. Improvement of skin texture and oiliness was also observed.

Disseminated vegetating infantile bromoderma: A dramatic response to systemic steroids

Bromoderma is a rare hypersensitivity reaction caused by bromide intake. It was relatively frequent in the early years of the previous century because of the common use of bromide-containing solutions in pediatrics due to their antispasmodic, expectorant, sedative, and anticonvulsant effects. Although recently prohibited in many countries, bromides are still used as an adjuvant anticonvulsant drug and still present in some over the counter antispasmodics and analgesics. Bromoderma usually present with pustular and vegetating lesions that may represent a diagnostic challenge for dermatologists. We describe a severe case of vegetating bromoderma that showed an excellent response to the withdrawal of the bromide-containing medication associated with systemic steroid administration.

Intralesional immunotherapy for the treatment of anogenital warts in pediatric population

BACKGROUND

The prevalence of anogenital warts is increasing in adults as well as in pediatric population. The treatment of anogenital warts is challenging, particularly in children as most conventional modalities are painful and associated with high recurrence rates.

OBJECTIVES

To evaluate the efficacy and safety of intralesional immunotherapy for the treatment of anogenital warts in pediatric patients.

METHODS

Forty child presenting with multiple anogenital warts were randomly assigned into 3 groups. The first group (15 patients) received intralesional MMR vaccine, the second group (15 patients) received intralesional Candida antigen and the third group (10 patients) received intralesional saline as a control. Each modality was injected into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions.

RESULTS

Highly significant difference was found between the therapeutic response of anogenital warts to both MMR vaccine and Candida antigen compared to intralesional saline (p = .005). No significant difference was observed between MMR vaccine and Candida antigen groups (p = .885). Side effects were mild and no recurrence was detected in the 6 month follow-up period.

CONCLUSIONS

Intralesional immunotherapy is a promising effective and well-tolerated treatment modality for multiple anogenital warts in children.

Calprotectin in acne vulgaris: A possible contributory role

BACKGROUND

Acne vulgaris (AV) is a common inflammatory skin disease involving dysfunction of the pilosebaceous unit. Many mechanisms for the pathogenesis of acne have been postulated; however, the precise pathogenesis is still uncertain.

AIM

Evaluation of the level of serum calprotectin in patients with AV and its correlation with the different clinical variables of the disease, particularly severity.

PATIENTS AND METHODS

This is a case-control study that included ninety subjects who were subdivided into two groups; group I, which included sixty patients complaining of AV with different grades of severity, and group II that included thirty apparent healthy age and sex-matched participants as a control group. Severity of AV was determined according to the Global Acne Grading System (GAGS). Serum calprotectin level was measured in both patients and controls by the enzyme-linked immunosorbent assay (ELISA) method.

RESULTS

A highly statistically significant difference in the serum calprotectin level was found between patients with AV and control subjects. A highly significant positive correlation was found between the serum calprotectin levels and the severity of acne. Similarly, a significant positive correlation was found between serum calprotectin levels and the duration of the disease.

CONCLUSION

Serum calprotectin levels are increased in acne patients and are positively correlated with its severity.

Intralesional antigen immunotherapy for the treatment of plane warts: A comparative study

Intralesional immunotherapy by different antigens has shown promising efficacy and safety in the treatment of warts. However, the use of these antigens for the treatment of plane warts has been investigated in two studies only. To evaluate the efficacy and safety of three antigens; Measles Mumps, Rubella vaccine (MMR), Candida antigen, and purified protein derivative (PPD) in the treatment of multiple plane warts. The study included 120 patients who were randomly assigned to three groups, 40 patients in each group. Each agent was injected intralesionally at a dose of 0.1 mL into the largest wart at 2-week intervals until complete clearance or for a maximum of five sessions. Complete clearance of warts was observed in 55% of the PPD group, in 70% of the Candida antigen group, and in 62.5% of the MMR group. No statistically significant difference in the therapeutic response was found between the three groups. Intralesional antigen immunotherapy seems to be a promising well-tolerated and effective therapeutic option for the treatment of multiple plane warts, with relatively higher efficacy of Candida antigen.

Successful treatment of doughnut warts with intralesional Candida antigen immunotherapy

BACKGROUND

Doughnut warts, also called ring or annular warts, are a distinctive type of warts with central clearing and annular recurrence. There are very few studies illustrating this uncommon phenomenon and its treatment.

AIMS

To present 15 cases of doughnut warts and evaluate the efficacy and safety of Candida antigen intralesional immunotherapy in their treatment.

METHODS

The study included 15 patients presenting with doughnut warts who were previously treated with destructive modalities for their original warts. All patients were injected intralesionally by Candida antigen at a dose of 0.2 mL into the base of doughnut wart until complete clearance or for a maximum of 5 sessions.

RESULTS

Complete clearance was achieved in 12 patients (80%), partial response in 2 patients (13.3%), and no response in 1 patient (6.7%). Complete response was observed after two sessions in 5 patients, after three sessions in 4 patients, and after four sessions in 3 patients. Adverse effects were minimal and insignificant.

CONCLUSIONS

Doughnut warts represent a unique and rare type of wart recurrence. Intralesional Candida antigen immunotherapy seems to be a promising and effective therapeutic modality for the treatment of such a rare entity.

Intralesional versus intramuscular bivalent human papillomavirus vaccine in the treatment of recalcitrant common warts

BACKGROUND

Despite the availability of different therapeutic modalities, treatment of recalcitrant common warts is still challenging. Cervarix (GlaxoSmithKline, Brentford, UK), a recombinant bivalent human papillomavirus (HPV) vaccine, has shown promising efficacy in the treatment of warts.

OBJECTIVES

To evaluate the beneficial effects and tolerability of intramuscular versus intralesional bivalent HPV vaccine in the treatment of recalcitrant common warts.

METHODS

The study included 44 adult patients with multiple recalcitrant common warts; 22 patients received intramuscular injection of bivalent HPV vaccine at 0, 1, and 6 months or until complete clearance of warts, and the other 22 patients received intralesional injection of 0.1 to 0.3 mL of bivalent HPV vaccine into the largest wart at 2-week intervals until complete clearance or for a maximum of 6 sessions.

RESULTS

Complete clearance of warts was observed in 18 patients (81.8%) of the intralesional group and 14 patients (63.3%) of the intramuscular group; however, the difference was not statistically significant. Adverse effects were transient and insignificant, and no recurrence was reported in either group.

LIMITATIONS

Small study sample and different dosing schedules.

CONCLUSIONS

Bivalent HPV vaccine, particularly by intralesional injection, seems to be a potential therapeutic option for the treatment of multiple recalcitrant common warts.

Combination therapy versus monotherapy in the treatment of recalcitrant warts: A clinical and immunological study

BACKGROUND

Treatment of recalcitrant warts represents a continuing therapeutic challenge. Combination therapies can help improve treatment response, decrease adverse effects, and reduce recurrence.

OBJECTIVE

To compare the efficacy, safety and immunological effects of a combined acitretin-intralesional Candida antigen against acitretin alone and Candida antigen alone for intractable warts.

METHODS

Sixty adult patients with intractable warts were included in this study. Patients were subdivided into three groups, each containing 20 patients. Acitretin alone was taken by patients of group I, Candida antigen alone was injected in patients of group II, and group III received a combination of intralesional Candida antigen and acitretin. Serum cytokine levels of IL-10 and IFN-γ were measured before and after therapy in the studied groups.

RESULTS

Total resolution of warts was achieved in 8 patients (40%) of the acitretin alone group, 9 patients (45%) of the Candida antigen alone group and 15 patients (75%) of the combination therapy group. The therapeutic response was statistically higher in the combined acitretin-Candida antigen group as compared with either agent alone. Adverse effects were non-significant in the three groups. There were no statistically significant differences in the serum levels of IFN-γ and IL-10 between responders and non-responders after therapy in the three studied groups.

CONCLUSION

The combination therapy of acitretin + Candida antigen is superior to either agent alone. Serum cytokine levels of IL-10 and IFN-γ were not associated with clearance or persistence of warts in any of the studied groups.

Topical silymarin versus hydroquinone in the treatment of melasma: A comparative study

BACKGROUND

Melasma is a highly prevalent hyperpigmentation disorder with a high relapsing rate and a negative impact on the psychological state of the affected patients. The exact pathogenesis of melasma is not completely elucidated; however, ultraviolet induced oxidative stress has an important role in its pathogenesis. Silymarin, antioxidant drug, reduces the harmful effects of solar ultraviolet radiation such as inflammation, immune responses, DNA damage, and pigmentation.

OBJECTIVES

To assess the efficacy and safety of topical silymarin with different concentrations (0.7% and 1.4%) versus hydroquinone 4% in the treatment of melasma.

METHODS

Forty-two adult female patients with melasma were assigned to three equal groups each containing 14 patients; group1 was treated by silymarin 0.7% cream, group 2 was treated by silymarin 1.4% cream and group 3 was treated by hydroquinone 4% cream. The duration of treatment was 3 months.

RESULTS

MASI score was significantly reduced in all groups at the end of third month; however, there were no significant differences in the therapeutic response between the three studied groups. No side effects were recorded with silymarin, while hydroquinone was associated with significant adverse effects.

CONCLUSIONS

Silymarin cream might serve as an effective and safe treatment modality for melasma.