Methotrexate monotherapy versus methotrexate and apremilast combination therapy in the treatment of palmoplantar psoriasis: A prospective, randomised, assessor-blinded, comparative study.

BACKGROUND: Palmoplantar psoriasis is a chronic debilitating condition which significantly impairs quality of life. OBJECTIVES: To assess the efficacy and safety of the combination of apremilast and methotrexate compared with methotrexate monotherapy in the treatment of palmoplantar psoriasis. Also, to study the impact on treatment on the Dermatology Life Quality Index and Palmoplantar Quality of Life Index. METHODS: A total of 64 patients were randomised to two groups in a 1:1 ratio - Group A received both methotrexate and apremilast in combination, while Group B received only methotrexate, for 16 weeks. The primary endpoints were the mean score of Modified Palmoplantar Psoriasis Area and Severity Index at week 16, the proportion of patients achieving modified palmoplantar psoriasis area severity index-75 and/or Palmoplantar Psoriasis Physician Global Assessment score 0/1 at week 16. RESULTS: A significantly higher proportion of patients in Group A achieved Modified Palmoplantar Psoriasis Area and Severity Index-75 at week 16 (43% in Group A vs 30% in Group B). The Modified Palmoplantar Psoriasis Area and Severity Index score was significantly lower in the combination group at week 16 (4.03 ± 2.05 in Group A and 5.89 ± 2.31 in Group B, P-value = 0.002). About 80% of patients in the combination group with baseline Palmoplantar Psoriasis Physician Global Assessment ≥3 achieved Palmoplantar Psoriasis Physician Global Assessment 0/1 compared to 60% in Group B. The combination group showed a significantly higher reduction in Dermatology Life Quality Index and Palmoplantar Quality of Life Index scores compared to the methotrexate alone group (P-value = 0.025). No notable adverse events were observed. LIMITATION: The limitations of the study were single blinding, small sample size and a lack of longer follow up to assess the rate of relapse. We did not account for attrition during sample size calculation. Also, due to the paucity of data regarding the use of apremilast in palmoplantar psoriasis, definitive comparisons could not be made with previous studies. CONCLUSION: The combination of apremilast and methotrexate has superior efficacy and a similar safety profile as compared to methotrexate monotherapy for the treatment of moderate to severe palmoplantar psoriasis.

Dermatological Manifestations of COVID-19 in Children.

CONTEXT: The clinical picture of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection differs from adults as do the cutaneous manifestations. In this review, we summarize the varied morphological manifestations of SARS-CoV-2 infection in the pediatric population. EVIDENCE ACQUISITION: A comprehensive literature search was conducted (23 September, 2021) across multiple databases (PubMed, EMBASE, MEDLINE and Cochrane) with the relevant keywords. An additional filter of age group between 0-18 years was kept in each of the searches. RESULTS: Chilblains constitute the most common cutaneous manifestation of pediatric coronavirus disease (covid-19). Other commonly reported manifestations include maculopapular rash, urticaria, erythema multiforme, and papulovesicular eruptions. Majority of children with these manifestations are asymptomatic, highlighting the need to clinically suspect and appropriately manage such patients. A subset of pediatric patients develop severe multisystem involvement termed as multi-system inflammatory syndrome in children (MIS-C) that has varied mucocutaneous manifestations. CONCLUSION: A wide variety of dermatological manifestation of SARS-CoV-2 infection is reported, and both the pediatrician and dermatologist need to be aware of the same to suspect and diagnose COVID-19 infection in children.

Re-pigmentation of Vitiligo Involving Angle of Lip Using Radiofrequency Cautery and Topical 5-Fluorouracil.

Vitiligo involving the angle of lip is a therapeutically challenging site because of the small and delicate area, high mobility, and lack of hair follicles. Dermabrasion combined with topical 5-fluorouracil cream has shown promising results in various studies involving different sites. Here we present a novel technique of using radiofrequency cautery for abrasion of epidermis followed by application of 5-fluorouracil cream. This technique has the advantage of being simple, easy, cost-effective with less downtime. A single session can yield excellent pigmentation in small areas such as the angle of lip.

Combination of 1064-nm Q-switched neodymium-doped yttrium-aluminum-garnet laser with Modified Jessner's peel for the treatment of Nevus of Ota: A case series of seven patients.

1064-nm Q-switched Nd: YAG (neodymium-doped yttrium-aluminium-garnet) laser is widely used for the treatment of Nevus of Ota but multiple treatments are necessary for clinical improvement. Superficial chemical peeling using Modified Jessner's solution has been used for the treatment of facial pigmentation but repetitive chemical peeling can cause irritation and post-inflammatory hyperpigmentation. In this series, we evaluated seven patients who were treated with a combination of 1064-nm Q-switched Nd: YAG laser and Modified Jessner's peel for eight sessions with 85.7% patients showing more than 50% reduction in pigmentation. The added therapeutic benefit of the combination helped to achieve a significant reduction in pigmentation faster with a lesser number of sessions and reduced cost.

Rising trends of symmetrical drug related intertriginous and flexural exanthem due to Itraconazole in patients with superficial dermatophytosis: A case series of 12 patients from eastern part of India.

SDRIFE (symmetrical drug related intertriginous and flexural exanthem) is a benign self-limiting adverse drug reaction (ADR) primarily affecting the intertriginous, gluteal and flexural regions symmetrically in the absence of systemic involvement. It is considered to be a variant of baboon syndrome. Pathogenesis is poorly understood but is thought to be result of a delayed hypersensitivity response after exposure to the drug. Commonly implicated drugs are beta-lactam antibiotics. With the rising incidence of dermatophytosis in the Indian subcontinent, the use of oral anti fungals has become rampant. SDRIFE due to itraconazole has been rarely reported in literature. We hereby present a series of 12 patients presenting with SDRIFE due to itraconazole, which is by far the largest reported in existing literature. This case series highlights the importance of identifying these cutaneous adverse drug reactions in a setting where itraconazole is commonly being used.