Intralesional cryotherapy versus cryotherapy spray for the treatment of recalcitrant plantar warts: a prospective, randomized study.

BACKGROUND: Recalcitrant plantar warts are representing a therapeutic challenge. Intralesional cryotherapy (ILC) has emerged as a promising therapeutic option in recalcitrant plantar warts treatment. OBJECTIVE: To compare the clinical efficacy, safety and tolerability of (ILC) versus Cryotherapy spray (Cryo-sp) for treatment of recalcitrant plantar warts. METHODS: One hundred-thirty patients with recalcitrant plantar warts were assigned equally to two groups. Group A received ILC and group B treated with Cryo-SP. Both groups received one session at 2 weeks intervals until complete clearance or for a maximum of 5 sessions. The main outcome was complete clearance of warts guided by dermoscopy. Follow-up was carried out for 6 months after the treatment. RESULTS: Complete clearance occurred in 80.3% in group A compared to 50.8% in group B with a highly significant difference between both groups (p < .001). The clearance rate was faster in group A (1.5 ± 0.40) than group B (4 ± 1.3) (p < .001). The adverse effects were mild in group A than group B (p < .001). The recurrence rate was 2% in group A versus 23.3% in group B (p < .007).patients satisfaction was higher in ILC (p < .001). CONCLUSION: Intralesional cryotherapy is more effective, requiring few sessions with a low recurrence rate than cryo-sp.

Bacillus Calmette-Guerin polysaccharide nucleic acid vs Bacillus Calmette-Guerin vaccine in the treatment of warts: A comparative, double-blind, controlled study.

Bacillus Calmette-Guerin polysaccharide nucleic acid (BCG-PSN) is a relatively new generation, bacteria lipopolysaccharide fraction extracted from BCG vaccine. It has a strong immunomodulatory effect with higher efficacy and fewer side effects. To assess the clinical efficacy and safety of BCG-PSN vs the viable BCG vaccine in treatment of multiple warts. One hundred twenty patients with warts were allocated into three groups each containing 40 patients. Each group received intralesionally 0.1 mL of BCG-PSN, BCG vaccine, saline in group A, B, and C, respectively, for a maximum of five sessions, 3 weeks apart. Complete response occurred in 77.5% of group A vs 63.8% in group B. Partial response detected in 7.9% of control group (P < .0001). The distant warts showed 72.5% complete clearance in group A compared to 58.3% in group B (P = .19). Group A showed fewer number of sessions (P = .03) and earlier response than group B (P = .0003). A significant increase in the frequency of adverse effects was found among group B than group A (P < .0001). No recurrence was seen in both groups. BCG-PSN immunotherapy has a higher therapeutic efficacy with almost no serious side effects compared to the BCG vaccine in warts therapy.

The efficacy of microneedling alone vs its combination with 5-fluorouracil solution vs 5-fluorouracil intralesional injection in the treatment of plantar warts.

Intralesional 5-fluorouracil (IL5-FU) has been used off-label for warts treatment; however, its use was limited by intense pain. Combination treatment can offer a robust therapeutic effect. Was to assess the therapeutic efficacy, safety and tolerability of microneedling vs its combination with 5-FU solution vs IL5-FU in the treatment of plantar warts. Ninety patients with plantar warts were divided randomly into three groups each containing 30 patients. Group A received (intralesional 5-FU), group B (microneedling) while group C (microneedling and 5-FU solution). All groups received treatment for a maximum of six sessions 2 weeks apart. Complete response was observed in 86.7% of the warts treated with 5-FU and microneedling (group C) vs to 76.7% and 70% in group A and B, respectively, with no statistically significant difference (P = .36). A significant increase in the number of sessions (P = .01) and pain score (P = .001) were found among group A compared to groups B and C. Patient's satisfaction was higher in group C (P = .05). No recurrence was reported in all groups. Microneedling can be used as alternative or adjuvant therapeutic modality for plantar warts treatment and significantly associated with less pain. Combination group was superior compared to the others.

Serum prolactin level in chronic urticaria: Is bromocriptine inducing remission in chronic urticaria?

BACKGROUND: Chronic urticaria (CU) is a disturbing disease with a negative impact on quality of life. Despite of several clinical studies on CU patients, its pathogenesis is poorly understood. Prolactin (PRL) is peptide hormone has immunomodulatory effects in some immune inflammatory skin diseases. AIM: To elucidate any possible relationship between the immunomodulatory effects of PRL and CU. Besides, the study aims to investigate the crucial role of antiprolactin drugs in the management of CU patients. PATIENTS AND METHODS: The serum PRL level of 40 female patients with CU was measured using the electrochemiluminescence immunoassay. The activity of CU was assessed by European Academy of Allergology and Clinical Immunology; Global Allergy and Asthma European Network; European Dermatology Forum (EAACI/GA2LEN/EDF) activity score. Patients with high PRL level had been given anti prolactin therapy to normalize their PRL levels. Then, the disease activity was reassessed in these patients. RESULTS: The serum PRL level was high in 8 of 40 (20%) patients (43.18 ± 12.81). Half of patients with high PRL level had remission after treatment of hyperprolactinemia (p = .001). CONCLUSIONS: Serum PRL levels could not be considered as a marker of the disease activity in CU patients.

Evaluation and efficacy of carbon dioxide therapy (carboxytherapy) versus mesolipolysis in the treatment of cellulite.

BACKGROUND: Cellulite is an irregular alteration of the skin surface giving it cottage cheese appearance. Carboxytherapy is transcutaneous infusion of carbon dioxide into the affected site. Mesolipolysis aims to remove cellulite and improve skin texture. AIMS: To verify the efficacy and safety of carboxytherapy versus mesolipolysis using phosphatidylcholine (PPC) in treatment of cellulite in thighs area. METHODS: Forty-eight female patients with different grades of cellulite at thighs area were enrolled in this study. They were classified into two groups: group A received subcutaneous infusion of carboxytherapy, and group B was treated with mesolipolysis using PPC. Each group received six sessions at weekly intervals. sessions. The outcome measures and clinical assessment were based on cellulite grading scale and thigh circumference measurements. Standardized digital photography was taken before and after treatment. Patients were followed up for 6 months. RESULTS: After treatment, there was significant reduction in thigh circumference measurement p < 0.01 and cellulite grading scale p < 0.001 in both groups. The difference in cellulite grading scale and thigh circumference measurement in both groups was insignificant. CONCLUSIONS: Carboxytherapy and mesolipolysis are safe and effective in cellulite treatment. Carboxytherapy is a promising alternative therapeutic modality for cellulite treatment.