A Study to Evaluate the Role of Intradermal and Intralesional Measles, Mumps, Rubella (MMR) Vaccine in Treatment of Common Warts.

BACKGROUND: Warts are common cutaneous viral infection with a wide range of therapeutic modalities. Various agents have been tried for immunotherapy in warts. OBJECTIVES: Determine the role of intralesional and intradermal measles, mumps, rubella (MMR) vaccine in the treatment of common warts; to compare the efficacy of intralesional versus intradermal MMR vaccine. METHODS AND MATERIALS: Patients diagnosed with verruca vulgaris were divided into two groups. In study group A, the individuals were injected with an intralesional MMR vaccine of 0.3 mL in the representative wart (largest) once in 3 weeks till there is complete clearance or maximum of four injections whichever is earlier, while in study group B, the individuals were injected with an intradermal MMR vaccine of 0.3 mL over the unilateral deltoid muscle area at similar intervals. RESULTS: There were 33 patients in each group. In group A, 10 (30.3%) patients showed complete, 9 (27.3%) marked, 6 (18.2%) moderate, 3 (9.1%) mild, and 5 (15.2%) no response. In group B, seven (21.2%) patients showed complete, one (3.0%) marked, one (3.0%) moderate, four (12.1%) mild, and 20 (60.6%) no response. There were minimal side effects in the form of pain, erythema, itching at the injection site in a few patients, only one patient had syncope. CONCLUSION: We conclude that the MMR vaccine is an effective and safe modality of treatment for verruca vulgaris without any serious adverse effects. Also, the intralesional route showed better results in comparison to the intradermal route when we consider the treatment of a representative wart.

Anagen effluvium secondary to Gloriosa superba ingestion.

Anagen effluvium, the shedding of anagen hair, leads to diffuse non-scarring alopecia. We report two cases of anagen effluvium in the same family secondary to the ingestion of tubers of Gloriosa superba, which contains the antimitotic alkaloid colchicine. Both patients developed anagen effluvium and gastroenteritis 1-2 weeks after consuming the tubers. In addition, one of them had bicytopenia, pleural effusion, hematuria and altered liver function tests. Both were managed conservatively and counseled regarding the reversible nature of the hair loss. Follow-up at 3 months showed regrowth of hair in both the cases.

A rare case of diffuse cutaneous leishmaniasis in an immunocompetent patient from sub-Himalayan India.

Diffuse cutaneous leishmaniasis (DCL) is a rare variant of cutaneous leishmaniasis (CL) characterised by multiple (≥10), widespread, slowly progressive, cosmetically disfiguring, non-ulcerating nodules without visceral involvement. The disease is resistant to chemotherapy and characterized by relapses. We present a rare case of a patient with DCL who had extensive lesions (282) and who was HIV negative from a new focus of leishmaniasis in sub-Himalayan India. A favourable response with a regression of the lesions was observed after a month of treatment with intravenous and intralesional sodium stibogluconate with oral pentoxiphyline. Familiarity with such exceptional cases in immunocompetent individuals may facilitate diagnosis and a promising treatment outcome.

Clinico-epidemiological trends of leprosy in Himachal Pradesh: a five year study.

This retrospective study was done to determine the epidemiological and clinical profile of leprosy patients in a tertiary care centre, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. In this study, we included patients registered from January 2004 to December 2008 with the urban leprosy clinic of our tertiary care centre. Data regarding demographic details, clinical features, treatment and complications was extracted from the records of the leprosy clinic. 163 patients attended the clinic during this period with male to female ratio of 3:1. Majority of patients (47.8%) were in the middle age group (20-40 years) and 13.49% patients were < 20 years of age. In the clinical disease spectrum, 53.98% patients were in the borderline spectrum followed by lepromatous leprosy (33.12%) and polar tuberculoid leprosy (5.52%). Pure neuritic and indeterminate leprosy accounted for 3.06% each. Histoid lesions were present in 7.4% of lepromatous leprosy patients. 9.2% patients had definite history of contact in the family or neighborhood. 28.22% patients were immigrants either from Nepal or adjoining states of Himachal Pradesh. Epidemiological studies and contact tracing can decrease the disease burden and morbidity associated with the disease. Multidrug therapy (MDT) helps preventing and reducing the disease progression, severity and disabilities.

Severe form of type 2 reaction in patients of Hansen's disease after withdrawal of thalidomide: case reports.

Thalidomide, a racemic glutamic acid analogue, was first developed in 1954 and subsequently marketed in Europe, Australia and Canada as a sedative and anti-emetic. It was approved by the Food and Drug Administration (FDA) in the USA in 1998 for the treatment of the cutaneous manifestations of moderate to severe erythema nodosum leprosum (ENL) and suppression of the cutaneous manifestations of ENL recurrences. It is a good choice for management in patients who are dependent on corticosteroids. Common side effects of thalidomide are teratogenicity, peripheral neuropathy, sedation and constipation. We report 4 cases of Hansen's disease with recurrent ENL who were adequately managed on thalidomide. On sudden withdrawal of thalidomide, they relapsed with severe type 2 reaction including necrotic ENL.