Efficacy and safety of single versus multiple intralesional immunotherapy with purified protein derivative (PPD) in the treatment of multiple verruca vulgaris.

BACKGROUND: Despite the numerous studies on the use of purified protein derivative (PPD), a protein extracted from Mycobacterium tuberculosis, in verruca vulgaris, there is no standardized regimen, and efficacy of single versus multiple injections has not been compared. METHODS: This is a randomized, open-label, superiority trial. Sixty-six patients with at least three warts in two different anatomic sites were randomized into two groups: a single injection (n = 29) and multiple injection (n = 29) groups. Patients were treated every 2 weeks until a maximum of six sessions. RESULTS: Multiple injections (79.3%) showed superior clearance rates compared to a single injection of PPD (58.6%) (P-value = 0.0236). Multiple injections also exhibited faster clearance at each time point (P = 0.048). Pain was statistically more significant in the multiple injection group (P = 0.0005). There was no statistically significant difference in incidence of adverse events (P = 0.1795). Amongst all cleared patients in both groups, there were no recurrences after 6 months. CONCLUSION: Multiple injections of warts with PPD cleared more patients with multiple common warts than the use of single injections at the end of 12 weeks and were faster in clearing patients at every time point. Single injection was better tolerated than multiple injections. Both treatments exhibited similar safety profiles and recurrence rates.

Primary cutaneous CD30+ anaplastic large cell lymphoma: report of a rare case.

Primary cutaneous anaplastic large cell lymphoma (PCALCL) is a rare type of non-Hodgkin's lymphoma comprising approximately 0.9-9.0% of all cutaneous lymphomas. PCALCL is characterized by the absence of systemic involvement, spontaneous regression and low recurrence rate especially in localized lesions.We present a 47-year-old female with a 1½-year history of two asymptomatic erythematous indurated plaques on the right arm. Skin punch biopsy revealed dense infiltrates of non-epidermotropic, large, irregularly-shaped lymphocytes with hyperchromatic and pyknotic nuclei. Immunohistochemistry revealed that these atypical cells are anaplastic lymphoma kinase (ALK) positive, CD30+, CD3-, CD20- and epithelial membrane antigen (EMA) negative. Clinical, histopathological and immunohistochemical findings are consistent with PCALCL. Work-ups revealed no systemic involvement. Short course CHOP (Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) chemotherapy resulted in total resolution of skin lesions; however, recurrence was noted 12 months after treatment. She then underwent radiotherapy and achieved complete remission.Because the clinical presentation of PCALCL can be variable, a high index of suspicion is necessary in patients presenting with chronic plaques and nodules unresponsive to topical or oral medications.

A pilot study on the efficacy and safety of autologous punch graft followed by topical psoralen plus sun exposure in Filipinos with vitiligo

BACKGROUND: Vitiligo is a common idiopathic acquired or inherited disease with loss of normal melanin pigments and functioning melanocytes from otherwise healthy looking skin. Presently, there is no universally effective medical or surgical modality for vitiligo therapy. Vitiligo skin grafting involves grafting of patients own pigment (color) bearing skin from a concealed site, such as thighs or buttocks, to the white patches. OBJECTIVE: This is a clinical series designed to conduct preliminary evaluation on the efficacy and safety of autologous punch grafting followed by topical psoralen plus sun exposure in the treatment of vitiligo among Filipino patients. It is the aim of this study to determine the length of optimal time (number of days-weeks-months) in inducing repigmentation and to document possible skin irritation and other adverse reactions. METHODS: After obtaining informed consent, eleven (11) patients diagnosed with vitiligo underwent treatment with autologous punch grafting. After 2 weeks, sun exposure with topical psoralen was instituted and continued for a maximum of 3 months. RESULTS: A 3-month follow-up showed a good repigmentation of the treated areas in 10/11 patients. None of the patients treated showed marked side effects. Koebner's phenomenon was not observed in any of the cases. The optimal time for inducing repigmentation is one to two months. CONCLUSION: The combination of punch grafting and topical psoralen plus sun exposure may be an effective alternative treatment in localized type of vitiligo.