Ramji Gupta

Methotrexate–betamethasone weekly oral pulse in psoriasis

Objectives: Methotrexate in psoriasis helps to clear the lesions fast but remission is short. To produce long‐term remission, methotrexate has been combined with betamethasone. Methods: A total of 40 patients with psoriasis (plaque type: 36, erythrodermic: four) were included in an open randomized study. Twenty‐eight patients received weekly 15 mg methotrexate and 3 mg betamethasone orally and 12 patients received weekly 15 mg methotrexate orally alone until the Psoriasis Area Severity Index (PASI) scores were reduced to 95–100% of the baseline scores. Follow‐up was carried out until relapse of the lesions. Results: Methotrexate combined with betamethasone orally weekly cleared the lesions in 27.13±2.39 (24.74–29.52) days with a remission period of 91.78±14.19 (77.59–105.97) days, whereas methotrexate alone took 33.09±5.61 (27.48–38.70) days to clear the lesions with a remission period of 20.30±2.50 (17.80–22.80) days. Conclusions: Methotrexate combined with betamethasone cleared the lesions faster and with a longer remission period compared with methotrexate alone.

Dexamethasone cyclophosphamide pulse therapy in lichen amyloidosus: A case report

Objective: To clear the itching and lesions of lichen amyloidosus completely, which is a chronic, troublesome disease of the skin with variable results from various therapeutic modalities. Methods: Dexamethasone cyclophosphamide pulse (DCP) therapy was given to a 53‐year‐old man with lichen amyloidosus of 3 months duration. DCP therapy comprises an intravenous infusion of 100 mg dexamethasone in 500 ml of 5% glucose over 1–1½ hours on 3 consecutive days. On day 1, cyclophosphamide 500 mg was also given through the same drip. DCP therapy was repeated at 4‐week intervals. In between, the patient received 50 mg of cyclophosphamide orally daily. Results: The itching stopped completely after five DCP sessions and all the lesions cleared after nine DCP sessions with no relapse during 30 months of follow‐up after stopping the treatment. Conclusion: DCP therapy is an effective alternative for lichen amyloidosus.

Dexamethasone cyclophosphamide pulse therapy in systemic lupus erythematosus: a case report.

Objective: To put systemic lupus erythematosus (SLE) in remission for a prolonged period. Methods: Dexamethasone cyclophosphamide pulse (DCP) therapy was used in a 40-year-old female with SLE of 3 years’ duration. DCP therapy comprises an intravenous infusion of 100 mg dexamethasone in 500 ml of 5% glucose over 1–1½ hours on 3 consecutive days along with cyclophosphamide 500 mg in the same drip on the first day. This was repeated at 4-week intervals till 9 months after all the lesions cleared. In between the DCP therapy she was given 50 mg cyclophosphamide orally daily. Results: The skin lesions cleared with 11 DCP therapies. There was no relapse 24 months after stopping all treatment. Conclusion: DCP therapy appears to put SLE into prolonged remission.

Topical adapalene in the treatment of plantar warts; Randomized comparative open trial in comparison with cryo-therapy

Background: Various therapeutic modalities, which are available for treating plantar wart, have not been successful every time. Aims: To evaluate topical adapalene under occlusion in the treatment of plantar warts and compare it with cryo-therapy. Materials and Methods: 50 patients with 424 plantar warts were included in this single center, two arm, prospective, randomized, control, open study. Patients were allocated randomly into two groups consisting of 25 patients each. Group A patients having 299 plantar warts were treated using adapalene gel 0.1% under occlusion while Group B patients having 125 warts were treated using cryo-therapy. All the patients were evaluated weekly till the clearance of all the warts and the results compared. Result: All the warts of 25 patients of Group A that were treated using adapalene gel 0.1% cleared in 36.71 ± 19.24 (55.95-17.47) days except those in one patient. In Group B, warts in all except one treated by cryo-therapy cleared in 52.17 ± 30.06 (82.23-22.11) days. There were no side effects like scar formation, irritation, erythema, or infections with adapalene group while in the cryo group scar was seen in 2 patients, pain in 24, erythema in 10, and infection in 3 patients. Conclusion: Adapalene gel 0.1% under occlusion is an effective, safe and easy to use treatment for plantar warts and may help clear lesions faster than cryo-therapy.

Fixed drug eruption due to ornidazole.

A 56-year-old male developed an ulcer on his glans penis and mucosae of upper and lower lips 3 days after taking ofloxacin, cephalexin, and ornidazole. Clinically, a provisional diagnosis of fixed drug eruption was made. The causative drug was confirmed by an oral provocation test which triggered a reactivation of all lesions only with ornidazole.

Plantar warts treated with topical adapalene

Background: Treatment of plantar warts caused by human papilloma virus (HPV) strain types 1, 2 and 4 is often difficult and a challenging problem. Various therapeutic modalities available for treating this problem have not been uniformly successful. Purpose: The purpose of present study is to evaluate the efficacy of adapalene applied locally with occlusion in plantar warts. Materials and Methods: A total of 10 patient with 118 plantar warts were included in an open study. All were treated by applying adapalene gel 0.1% after paring of warts if needed followed by occlusive dressing with polythene paper in each patient. The effects of the treatment were evaluated every week till the clearance of all warts. Findings: Adapalene was used in 10 patient having 118 plantar warts. All the warts cleared in 39±15.07 days. There was no side effects like scar formation, irritation, erythema or infection with adapalene. Conclusion: Adapalene clears the plantar warts faster compared to other modalities available. Limitation: Need trial with large number of patients.

Drug rash due to levamisole

Levamisole, a commonly used anti-helminthic, has been found to have microfilaricidal, immunostimulant and immunomodulator activities. Its side effects include nausea and vomiting, metallic taste, diarrhea, malaise, insomnia, sensory stimulation, hyperallergic state, dizziness, headache, blurred vision, fatigue and fever. Prolonged use of this drug may cause agranulocytosis, cutaneous necrosis, vasculitis, ataxia, purpura involving the ear, thrombocytopenia and psychosis. Hypersensitivity due to levamisole is rare. Recently, we reported a case of fever due to levamisole. Here we report a patient of vitiligo who developed repeated episodes of fever along with itching and redness of the palms, soles and legs on intake of levamisole. On rechallenge with levamisole he developed the same symptoms within 5 hours.

Dexamethasome- cyclophosphamide pulse therapy for systemic sclerosis

It may also be added that as many as 14 dermatologists in various institutions have used dexamethasone cyclophosphamide pulse therapy (DCP)/dexamethasone pulse therapy (DP) regimen for about 300 systemic sclerosis patients[8] and found satisfactory recoveries. DCP therapy consists of transfusing 100 mg dexamethasone dissolved in 500 ml 5% glucose over one to two hours, for three consecutive days every month, along with cyclophosphamide 500 mg on day one in the same drip and 50 mg daily, orally, in between the pulses. In DP only dexamethasone 100 mg is transfused in 500 ml 5% glucose over one to two hours for three consecutive days every month. It is used in those patients where cyclophosphamide is contraindicated.