Ayman Yosef

Treatment of recalcitrant warts with intralesional measles, mumps, and rubella vaccine: a promising approach

Recalcitrant warts represent a frustrating challenge for both patients and physicians. Although many destructive and immunotherapeutic modalities are available for the treatment of warts, an ideal, universally effective approach has not been explored to date. Recently, intralesional antigen immunotherapy has shown promising efficacy in the treatment of warts. The aim of the study was to evaluate the efficacy and safety of intralesional measles, mumps, and rubella (MMR) vaccine in the treatment of recalcitrant warts.

Lichen myxedematosus: diagnostic criteria, classification, and severity grading

Lichen myxedematosus (LM) is a rare, chronic idiopathic disorder characterized clinically by waxy, closely set papules and histopathologically by diffuse dermal mucin deposition and fibroblast proliferation. The most recent classification of LM was proposed in 2001; however, it seems to be complex, confusing, and imprecise. Herein, we present seven cases of LM to evaluate the validity of the current classification, to propose new diagnostic criteria and classification, and to suggest a clinically relevant severity grading system for this rare disorder.

Intralesional Antigen Immunotherapy for the Treatment of Warts: Current Concepts and Future Prospects

Many destructive and immunotherapeutic modalities have been used for the management of warts; however, an optimal treatment with high efficacy and absent or low recurrence has not been explored to date. Recently, the use of intralesional immunotherapy with different antigens has shown promising efficacy in the treatment of warts. We review the different aspects of this new modality, including candidates, types of warts treated, dosage, number and interval between treatment sessions, mode of action, efficacy, adverse effects, recurrence rate, advantages, disadvantages, current place and future prospects. A literature review revealed that healthy immune subjects are the best candidates, and a pre-sensitization test is usually done before the start of therapy. The dosage, the number and interval between sessions, and the success rates varied among the different studies. The mode of action is still uncertain, but is essentially mediated through stimulation of T helper-1 cell cytokine response. Adverse effects are mild and generally insignificant, and the recurrence rate is absent or low. Intralesional antigen immunotherapy seems to be a promising, effective and safe treatment modality for viral warts. Future well-designed and controlled studies would help to more clearly define its place in the challenging field of wart therapy.

Generalized eruptive keratoacanthoma: a diagnostic and therapeutic challenge

Generalized eruptive keratoacanthoma (GEKA) is an extremely rare variant of keratoacanthoma that poses significant diagnostic and therapeutic challenges.

Treatment of recalcitrant warts with Bacillus Calmette–Guérin: a promising new approach

Recalcitrant warts represent a therapeutic challenge for both patients and physicians. Recently, intralesional immunotherapy by different antigens has been proved effective in the treatment of different types of warts. We describe a case of a 48‐year‐old male who presented with troublesome huge common wart on the left little toe of 5 years duration and not responding to many lines of therapy. Nearby and distant common and plantar warts have also been observed. Intralesional Bacillus Calmette–Guérin (BCG) vaccine was injected into the huge wart of the little toe at 2‐week intervals for five sessions. Follow‐up was made every month for 6 months. A gradual decrease in the size of the injected wart was observed until reaching complete clearance by the end of the fifth session. Untreated nearby common and distant warts disappeared completely by the end of the third session. BCG injection was associated with erythema and edema with or without pustules, at the site of injection. A flu‐like illness that rapidly subsided within 3 days was also observed with each injection. No recurrence was observed after the 6‐month follow‐up period. Intralesional immunotherapy with BCG vaccine seems to be a promising effective and safe treatment modality for recalcitrant warts.

Febrile ulceronecrotic Mucha-Habermann disease: proposed diagnostic criteria and therapeutic evaluation

Febrile ulceronecrotic Mucha–Habermann disease (FUMHD) is a rare severe variant of pityriasis lichenoides et varioliformis acuta characterized clinically by aggressive ulceronecrotic skin lesions associated with high fever and histologically by features typical of pityriasis lichenoides et varioliformis acuta. Despite the continuous addition of new case reports, no definite diagnostic criteria have been established, and an optimum treatment is still waiting. Herein, we review the different aspects of this rare entity, including pathogenesis, clinical and histopathological features, differential diagnosis, course, prognosis, and outcome. Different diagnostic and therapeutic challenges associated with FUMHD are also evaluated and discussed. We propose two sets of diagnostic criteria to define the disease more precisely and to avoid missing cases. The first comprises constant clinical and histopathological features that are always present in every case, the combination of which is necessary for diagnosis. The second set includes variable features that may be present in some cases and to which any emerging finding could be added. Although different therapeutic options have been used, there is no optimum therapy for FUMHD, and the disease still represents a therapeutic challenge.

Sweet's syndrome: diagnostic criteria revisited

The diagnosis of Sweets syndrome (SS) is based on a set of criteria that requires the presence of two major and at least two minor criteria. In some cases, however, the diagnosis is not as straightforward due to the absence of certain criteria. The objective of the present study was to review the clinical, histopathological, and laboratory features of the current diagnostic criteria for SS, and to evaluate their validity in the cases reported in the literature as well as in 40 patients treated at our institution. Our comprehensive review of the current criteria for SS reveals that the two major criteria have been consistently present in all cases – including ours – since the first description of SS in 1964. With regard to the minor criteria, on the other hand, there has been marked variability between different studies, and many cases failed to fulfill the requirement of showing two minor criteria. In order to simplify the diagnosis, avoid misdiagnosis, and allow for prompt treatment, we propose two sets of revised diagnostic criteria for SS. The first set comprises constant clinical and histopathological features that must be present and are by themselves sufficient for the diagnosis of SS to be established. The second set includes variable features whose absence does not warrant ruling out SS.

Sweet-Syndrom: Revision der diagnostischen Kriterien

Die Diagnose des Sweet‐Syndroms (SS) gründet sich auf eine Reihe von Kriterien, von denen mindestens zwei Haupt‐ und zwei Nebenkriterien erfüllt sein müssen. In einigen Fällen ist die Diagnose aufgrund des Fehlens bestimmter Kriterien jedoch nicht so einfach. Ziel der vorliegenden Studie war es, die klinischen, histopathologischen und Labormerkmale der aktuellen Diagnosekriterien für das SS zu überprüfen und ihre Aussagekraft anhand der publizierten Fälle sowie bei 40 in unserem Institut behandelten Patienten zu beurteilen. Unsere umfassende Prüfung der aktuellen Kriterien für das SS ergab, dass seit seiner Erstbeschreibung im Jahr 1964 die beiden Hauptkriterien bei allen Fällen – einschließlich unserer – durchweg vorhanden waren. Andererseits gab es hinsichtlich der Nebenkriterien deutliche Unterschiede zwischen den verschiedenen Studien und bei vielen Patienten war die Bedingung, dass zwei Nebenkriterien vorhanden sein müssen, nicht erfüllt. Wir schlagen hier zwei Gruppen von revidierten Diagnosekriterien für das SS vor. Dies geschieht mit dem Ziel, die Diagnose zu vereinfachen, Fehldiagnosen zu vermeiden und eine sofortige Behandlung zu ermöglichen. Die erste Gruppe umfasst konstante klinische und histopathologische Merkmale, die vorhanden sein müssen und die per se für die Diagnose eines SS ausreichen. Die zweite Gruppe enthält veränderliche Merkmale, deren Fehlen es nicht erlaubt, ein SS auszuschließen.

Follicular Stem Cells in Androgenetic Alopecia

Although the pathogenesis of androgenetic alopecia (AGA) is poorly understood, recent studies suggest that compromising the integrity of the follicular bulge area and or sebaceous gland may play a role. This study was designed to evaluate the role of follicular bulge stem cells in AGA. Twenty patients with AGA (17 males and 3 females) with a mean age of 24.05 ± 1.6 were the subjects of this study. A 4 mm punch biopsy specimen was obtained from both occipital skin and frontal affected area of scalp of each patient and embedded in paraffin. Tissue sections were immunostained using the Cytokeratin 15(CK 15) Ab-1 mouse monoclonal antibody. Cytokeratin 15 immunoreactivity was observed both in the frontal and occipital skin biopsies in the follicular bulge region and outer root sheath in all 20 AGA patients (100%). This study suggests that follicular stem cells in the bulge region are not the target in AGA. Further studies using other stem cell markers are recommended to clarify the role of follicular stem cells in AGA pathogenesis.

Adalimumab as a successful treatment for acne fulminans and bilateral acute sacroiliitis with hip synovitis complicating isotretinoin therapy

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