Real-life treatment of cutaneous warts with cantharidin podophyllin salicylic acid solution.

Patients often request treatment of their burdensome cutaneous warts. However, a safe and effective treatment for cutaneous warts is lacking. This study evaluates treatment outcome, side effects, and patient satisfaction after topical application of cantharidin 1% podophyllin 2% salicylic acid 30% (CPS1) solution in a large series of children and adults with cutaneous warts. Fifty-two children and 83 adults with warts, treated with CPS1 solution between October 2012 and October 2014, were included. Complete clearance of warts occurred in 86.5% of children and 62.7% of adults treated with CPS1 solution (p < .01). Resolution of warts was partial in 3.9 and 24.1% and absent in 9.6 and 13.2% of children and adults respectively. Side effects were present in 41.2% of children and 46.3% of adults (p = .7). Most common side effects were blistering, pain, and burning sensation. No serious adverse events occurred. On a 10-point scale, median patient satisfaction score was 9.0 (interquartile range 7.8-10.0) and 8.0 (interquartile range 5.1-9.7) for children and adults respectively (p < .01). CPS1 solution is a safe and promising treatment modality with a high clearance and high patient satisfaction rate for the management of cutaneous warts, particularly in children.

The efficacy of pulsed dye laser treatment for inflammatory skin diseases: a systematic review.

BACKGROUND: The position of the pulsed dye laser (PDL) in the treatment of inflammatory skin diseases is still unclear. Evidence-based recommendations are lacking. OBJECTIVES: We sought to systematically review all available literature concerning PDL treatment for inflammatory skin diseases and to propose a recommendation. METHODS: We searched for publications dated between January 1992 and August 2011 in the database PubMed. All studies reporting on PDL treatment for an inflammatory skin disease were obtained and a level of evidence was determined. RESULTS: Literature search revealed 52 articles that could be included in this study. The inflammatory skin diseases treated with PDL consisted of: psoriasis, acne vulgaris, lupus erythematodes, granuloma faciale, sarcoidosis, eczematous lesions, papulopustular rosacea, lichen sclerosis, granuloma annulare, Jessner lymphocytic infiltration of the skin, and reticular erythematous mucinosis. The efficacy of PDL laser treatment for these inflammatory skin diseases was described and evaluated. LIMITATIONS: Most conclusions formulated are not based on randomized controlled trials. CONCLUSIONS: PDL treatment can be recommended as an effective and safe treatment for localized plaque psoriasis and acne vulgaris (recommendation grade B). For all other described inflammatory skin diseases, PDL seems to be promising, although the level of recommendation did not exceed level C.

A comparative study of pulsed 532-nm potassium titanyl phosphate laser and electrocoagulation in the treatment of spider nevi.

OBJECTIVE: To assess the clinical efficacy and safety of potassium titanyl phosphate (KTP) laser treatment and electrocoagulation (EC) for the treatment of spider nevi (SN). METHOD: A randomized single-blind intrapatient comparison study was performed. A blinded observer and patients reported the clinical treatment outcome and pain on a visual analogue scale (0-10). Side effects were noted if present. RESULTS: Mean physician-rated clinical efficacy scores+/-standard error of the mean were 7.7+/-0.7 for KTP laser and 6.2+/-0.9 for EC treatment (p=.05). Patient-rated mean clinical efficacy of KTP laser was 8.3+/-0.6 and of EC was 7.3+/-0.7 (p=.09). Stratification for potential confounding bias, such as location of SN, central bulging vein, and diameter (p=.25) of the treated SN did not reveal any statistically significant differences between the treatments. Treatment with KTP or EC did not result in scarring or pigmentary changes. Pain was reported for KTP treatment (3.1+/-0.4) and EC (6.4+/-0.7) (p<.05). CONCLUSION: Clinical efficacy of KTP laser and EC for SN is comparable, although there is a tendency toward an advantage in favor of the KTP laser. KTP laser treatment was less painful.

[A man with a nail defect of the middle finger]. / Een man met een nagelafwijking aan zijn middelvinger.

A 64-year-old man had central nail loss and a tumour on the nailbed of his right middle finger (digitus III), due to an amelanotic malignant melanoma.

Efficacy and safety of pulsed dye laser treatment for cutaneous discoid lupus erythematosus.

BACKGROUND: Treatment of chronic discoid lupus erythematosus (CDLE) with a pulsed dye laser (PDL) has shown promising results, although outcomes in previous studies were not validated and laser parameters were inconsistent. OBJECTIVE: We conducted an open prospective study to assess the efficacy and safety of PDL for the treatment of recalcitrant CDLE, using a validated scoring method and a fixed treatment schedule. METHODS: Twelve patients with active CDLE lesions were treated with PDL (585 nm, fluence 5.5 J/cm(2), spot size 7 mm) 3 times with an interval of 6 weeks followed by a 6-week follow-up period. Treatment outcomes were evaluated by 3 observers using the validated Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Cosmetic results and adverse events were recorded. RESULTS: A significant decline in "active" CLASI was observed after 6 weeks, after 12 weeks, and at follow-up. Baseline active CLASI was 4.4 +/- 0.2 (mean +/- SEM), reaching 1.3 +/- 0.3 after follow-up (P < .0001). Individual scores for erythema and scaling/hypertrophy significantly declined 6 weeks after treatment. The "damage" CLASI (dyspigmentation, scarring, and atrophy) did not show any significant change during or after therapy. The observed clinical improvement was confirmed by two independent observers by clinical assessment of photographs (r = 0.87 and r = 0.89; both P < .05). The treatment was well tolerated, only minimal pain was reported, and the cosmetic result was fair. LIMITATIONS: Small sample size and short follow-up duration were limitations. CONCLUSION: PDL treatment is an effective and safe therapy for patients with refractory CDLE.

Validation of clinical and image skin scoring systems for a single chronic discoid lupus erythematosus lesion.

OBJECTIVE: The purpose of this study was to achieve a validated clinical and image scoring system for a single chronic discoid lupus erythematosus (CDLE) lesion. METHODS: Fifteen patients with a CDLE lesion were scored twice by four observers and clinical photographs were taken. These pictures were assessed by the same four observers at two time points. Patients were scored using the DLE-Skin Score (DLE-SS). In addition, the DLE-Photo Score (DLE-PS) was calculated. Statistical analysis was carried out by measuring inter- and intra-observer agreement for both methods and by measuring the correlation between the DLE-SS and DLE-PS. RESULTS: Both the DLE-SS and DLE-PS proved reliable methods in the assessment of CDLE. The inter-observer variability of the DLE-SS and DLE-SS was low. The intra-observer variability was estimated to be 0 in both methods. The correlation coefficient between the DLE-SS and DLE-PS was high (0.81). CONCLUSION: Both the DLE-SS and the DLE-PS are reliable and easy-to-use methods to score disease activity in CDLE patients, and can be used in monitoring single target lesions in clinical trials.

Pulsed dye laser versus treatment with calcipotriol/betamethasone dipropionate for localized refractory plaque psoriasis: effects on T-cell infiltration, epidermal proliferation and keratinization.

BACKGROUND: Selective photothermolysis of diseased capillaries by pulsed dye laser (PDL) treatment has been described as a mechanism for long-lasting clearance of psoriatic plaques. AIM: To evaluate PDL and a two-compound formulation of calcipotriol/betamethasone dipropionate ointment for the treatment of localized, recalcitrant plaque psoriasis. METHODS: Eight psoriatic patients were treated for 4 weeks with both PDL and topical calcipotriol/betamethasone dipropionate in an open, intra-patient, left-right comparison. Biopsies were analyzed for T-cell subsets, cells expressing NK-receptors, epidermal proliferation, differentiation and epidermal thickness. RESULTS: After active treatment, both treatments showed statistically significant but comparable improvements of T-cell subsets, epidermal proliferation, differentiation and epidermal thickness. In line with the clinical results, after an 8-week follow-up period statistically significant further reductions were observed for dermal CD3(+), CD4(+), CD45RO(+), CD2(+) T cells, epidermal CD3(+), CD8(+), CD45RO(+), CD2(+), CD25(+) T cells and the epidermal parameters for the PDL-treated plaques, in contrast to the topically treated plaques. CONCLUSION: After 8 weeks of follow-up, PDL treatment for localized and recalcitrant plaque psoriasis resulted in persistent reductions of activated and memory effector T-helper cells in the dermis, cytotoxic T cells in the epidermis, and normalization of epidermal proliferation and keratinization, in contrast to treatment with calcipotriol/betamethasone dipropionate ointment.