Surabhi Sinha

Immunomodulators in warts: Unexplored or ineffective?

Cutaneous warts are known to be recurrent and often resistant to therapy. Resistant warts may reflect a localized or systemic cell mediated immune (CMI) deficiency to HPV. Many modalities of treatment are in use; most of the provider-administered therapies are destructive and cause scarring, such as cryotherapy, chemical cauterisation, curettage, electrodessication and laser removal. Most patient-applied agents like podophyllotoxin have the risk of application-site reactions and recurrence. Thus immunotherapy is a promising modality which could lead to resolution of warts without any physical changes or scarring and in addition would augment the host response against the causative agent, thereby leading to complete resolution and decreased recurrences. Immunomodulators can be administered systemically, intralesionally or intradermally, and topically. A few agents have been tried and studied extensively such as cimetidine and interferons; others are new on the horizon, such as Echinacea, green tea catechins and quadrivalent HPV vaccine, and their efficacy is yet to be completely established. Though some like levamisole have shown no efficacy as monotherapy and are now used only in combination, other more recent agents require large and long term randomized placebo-controlled trials to clearly establish their efficacy or lack of it. In this review, we focus on the immunomodulators that have been used for the treatment of warts and the studies that have been conducted on them.

Multiple verrucous hemangiomas: A case report with new therapeutic insight

Verrucous hemangioma is an uncommon congenital vascular malformation, which may clinically masquerade angiokeratoma, lymphangioma circumscriptum, or malignant melanoma. Differentiation is essential owing to varied therapeutic and prognostic implications. We present a rare case of multiple verrucous hemangiomas in a teenage girl who presented with multiple warty lesions over the dorsal aspect of the left foot since birth. Magnetic resonance imaging (MRI) scan was suggestive of a vascular malformation, and skin biopsy showed ectatic blood vessels extending from the papillary dermis into the subcutaneous tissue, diagnostic of verrucous hemangioma. A combination of 0.05% halobetasol propionate with 3% salicylic acid ointment was advised. This therapeutic intervention resulted in significant resolution of the warty lesions over a period of 2 months, following which surgical excision was performed. The implication is that we can use a combination of super potent topical steroid with salicylic acid as an adjunct to surgical resection.

Bizarre extensive erythematous plaques on the abdomen

We present a rare case report of a 28-year-old man with a five-month history of bizarre extensive erythematous plaques on the abdomen extending in a dermatomal fashion to the left upper back.

Wolf's isotopic nonresponse in healed herpes zoster in erythroderma.

217 Indian Journal of Dermatology, Venereology and Leprology | Volume 84 | Issue 2 | March-April 2018 References 1. Puizina‐Ivic N, Bezic J, Marasovic D, Gotovac V, Carija A, Bozic M. Angiosarcoma arising in sclerodermatous skin. Acta Dermatovenerol Alp Pannonica Adriat 2005;14:20‐5. 2. Fonder MA, Douglas DK. Angiosarcoma complicating systemic sclerosis: A case report. Cutis 2008;81:468‐72. 3. Kubota N, Fujisawa Y, Nakamura Y, Tanaka R, Saito A, Maruyama H. Angiosarcoma of the Scalp in a Patient with System Sclerosis. The Journal of Dermatology 2015:42:102‐4. 4. Carter B, Jaworsky C, Fox M. Systemic sclerosis associated angiosarcoma: A case report and review of the literature. Int J Dermatol Clin Res 2016;2(1):14‐7. 5. Arbiser JL, Larsson H, Claesson‐Welsh L, Bai X, LaMontagne K, Weiss SW, et al. Overexpression of VEGF 121 in immortalized endothelial cells causes conversion to slowly growing angiosarcoma and high level expression of the VEGF receptors VEGFR‐1 and VEGFR‐2 in vivo. Am J Pathol 2000;156:1469‐76. 6. Shah AA, Rosen A, Hummers L, Wigley F, Casciola‐Rosen L. Close temporal relationship between onset of cancer and scleroderma in patients with RNA polymerase I/III antibodies. Arthritis Rheum 2010;62:2787‐95. How to cite this article: Mendiratta V, Rana S, Manickavasagam S, Nangia A, Chander R. Cutaneous angiosarcoma in a patient with systemic sclerosis: First case from India. Indian J Dermatol Venereol Leprol 2018;84:214-7.

Antifungal efficacy of amphotericin b against dermatophytes and its relevance in recalcitrant dermatophytoses: A commentary

© 2018 Indian Dermatology Online Journal | Published by Wolters Kluwer Medknow Dermatophytoses are the most common fungal infections worldwide, and are especially frequent in tropical and subtropical regions due to the high temperature and relative humidity.[1] The most common clinical form of dermatophytosis in Indian studies is tinea corporis followed by tinea cruris.[2] Tinea corporis et cruris is the most common mixed clinical type.[2]

Biology of hair pigmentation and its role in premature canities

In today’s world, physical appearance and the desire to look young are very important. Skin and hair play a powerful role in this as they impart much information, not only about our race, ethnicity, and health but also about gender and age. We experience a significant change in pigmentation during our journey of life from birth to puberty and then to young adulthood, middle age, and beyond. Graying of hair is a conspicuous sign of aging. It is said that 50% of the people have 50% gray hair by the age of 50. Premature graying or premature canities is defined as graying that occurs before the age of 20 in Caucasians, before 25 in Asians, and before 30 in Africans. The pathogenesis of premature canities is not yet clear but various hypotheses have been suggested including alteration in pH and cysteine levels in melanosomes, the role of trace metal ions, vitamin B12 and folic acid, vitamin D3, and oxidative stress. Along with increased awareness, there is an increased demand for treatment modalities but the options are limited and unsatisfactory. Various topical preparations containing phytic acid, amino acids, peptides, acetyl hexapeptide-1, melitane, capixyl, pea proteins, etc. are already available in the market. Currently, research is focusing on topical liposome targeting melanins, genes, and proteins selective to hair follicles for therapeutic and cosmetic modification of hair.

Recalcitrant hypertrophic herpes genitalis in HIV-infected patient successfully treated with topical imiquimod: TANDON et al.

Herpes Simplex Virus type 2 is the primary cause of genital ulceration worldwide. The presence of atypical features like deep ulcerations, hypertrophic, or pseudotumoural lesions or unusual location can be a marker for co‐infection with HIV. These immunocompromised patients are usually resistant to the conventional antiviral treatment. We present a case of an HIV‐infected patient with hypertrophic herpes genitalis, refractory to conventional oral antiviral therapy, who was successfully treated with a combination of oral valcyclovir and topical application of 5% imiquimod.

Erythroderma secondary to lichen planus in a child.

1. Rodríguez Díaz E, Álvarez Cuesta V, Blanco Barrios S, Galache Osuna C, Requena Caballero C. Dermatosis eosinofílicas (I). Actas Dermosifiliogr 2003;94:65-79. 2. Ada S, Seckin D, Tarhan E, Buyuklu F, Cakmak O, Arikan U. Eosinophilic ulcer of the tongue. Australas J Dermatol 2007;48:248-50. 3. Kuske H. Tumorfoermige eosinophile granulome der haut. Dermatologica 1952;104:254-9. 4. Gerbig AW, Zala L, Hunziker T. Tumorlike eosinophilic granuloma of the skin. Am J Dermatopathol 2000;22:75-8. 5. Ortonne N, Wechsler J, Bagot M, Grosshans E, Cribier B. How to cite this article: Cieza-Díaz ED, Blanco CC, Heffernan JA, Ochaita PL. Facial involutive tumors: A case of tumor-like eosinophilic granuloma of the skin. Indian J Dermatol Venereol Leprol 2016;82:87-9. Received: February, 2015. Accepted: July, 2015. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Aplasia cutis congenita with fetus papyraceus

We present a case of 8 h old newborn girl with symmetrical, stellate type of truncal aplasia cutis congenita. She was the survivor twin as the other fetus died at gestational age of 13 weeks and 5 days.

Lichen planus presenting as generalized reticulate pigmentation with sole involvement

A 61-year-old Indian male presented with gradually progressive generalized reticulate brownish pigmentation of the trunk, upper limbs, and lower limbs. The face and neck area were conspicuously spared. There was no oral, scalp or nail involvement. However, the soles showed bilaterally symmetrical well-demarcated erythematous hyperkeratotic plaques. There was no history of violaceous pruritic lesions over the body. Histopathological features of the trunk as well as sole lesions were consistent with findings of lichen planus (LP). LP pigmentosus is a variant of LP seen in Indian and other darker-skinned populations and most commonly presents as diffuse pigmentation over sun-exposed areas, mainly the face and neck. Our patient, however, presented with reticulate pattern of pigmentation, sparing the face and neck, along with lesions over both the soles. Such a manifestation in the absence of typical lesions of LP is very rare and to our knowledge this is the first such case reported from the Indian subcontinent.