Unusual presentation of Erythema Elevatum Diutinum mimicking a giant wart on the heels of a Filipino male : A case report

@#Erythema elevatum diutinum (EED) is a rare condition believed to be a form of chronic recurrent leukocytoclastic vasculitis possibly secondary to vascular immune complex deposition. The disease is characterized by symmetrical, red, brownish-purple, and yellow papules, plaques, and nodules distributed mainly over the extensor surfaces of the extremities. We report a 61-year-old male with an atypical presentation of such disease as a giant warty lesion on the heels. Histologically, a spectrum from leukocytoclastic vasculitis to vessel occlusion and dermal fibrosis is seen in EED. These histological findings were present in the histopathological reading of the patient which established its diagnosis and further ruled out verruca vulgaris. The disease is associated with many disease entities, which include human immunodeficiency virus, malignant conditions, chronic infection, and autoimmune and connective tissue disorders. None of these conditions was present in the patient as manifested in the history, physical, and laboratory examinations. However, the patient has a low hemoglobin and a G6PD deficiency which makes him a bad candidate for dapsone therapy which is the main treatment for EED. Tetracycline, niacinamide and plain vaseline + salicylic acid were given initially for 4 weeks but no improvement was noticed. It was then shifted to 10mg intralesional corticosteroid and urea paste 40%. Niacinamide still was given. There was a marked thinning of the lesions. The medications were continued and were slowly tapered. More improvement of the lesions was observed.

A randomized, double-blind, controlled trial on the efficacy and safety of 1.5% Carica Papaya Latex Cream compared to 1% Terbinafine Cream in the treatment of localized Tinea Corporis and/or Tinea Cruris

Background@#Tinea corporis and cruris are superficial fungal infections mainly caused by dermatophytes. The antifungal effect of carica papaya latex cream has been demonstrated in clinical studies, however, larger population and comparative studies to standard antifungal agents are needed to further strengthen this conclusion. This study determined the efficacy and safety of 1.5% carica papaya latex in cream base as treatment for tinea corporis and/or cruris compared to 1% terbinafine cream. @*Methods@#This is a randomized, double-blind controlled trial wherein subjects with a clinical diagnosis of tinea corporis or cruris confirmed by microscopy applied terbinafine or carica papaya latex cream twice daily for 6 weeks. The efficacy and safety were assessed 2, 4, and 6 weeks using clinical and mycological cure parameters. The incidence of adverse effects was likewise evaluated. @*Results@#90 subjects were randomized, 45 in carica papaya group and 45 in the terbinafine group. Both groups had statistically comparable improvements based on symptoms and mycological cure rates. Adverse events are significantly higher in the papaya latex cream group. @*Conclusion@#Carica papaya latex cream is as effective as terbinafine cream in the treatment of tinea corporis and/or cruris, but it has a higher incidence of adverse events.