Immunotherapy has become one of the most important therapeutic tools for the treatment of warts. At present, immunotherapy for warts is usually limited to recalcitrant lesions that are not responding to conventional therapy. Although there are a lot of immunotherapeutic regimens, a minority seem to be really effective. Moreover, there is a lack of evidence-based data on their effectiveness. Common immunotherapeutic modalities used for the treatment of warts include contact sensitizers, imiquimod, intralesional interferon, and oral drugs such as levamisole, cimetidine, and zinc sulfate. Intralesional antigens such as MMR (measles, mumps, and rubella) vaccine, skin test antigens (mumps, Candida, and Trichophyton), BCG (bacillus Calmette-Guιrin) vaccine, and Candida antigen were reported as successful treatment modalities in various forms of warts. Moreover, intradermal injection of some vaccines such as purified protein derivatives was also reported as a successful regimen for the treatment of genital warts. Among the available options for treatment of warts, none is uniformly effective or viricidal. Moreover, in most cases their safety and efficacy has not been assessed in double-blind, controlled clinical trials, and thus the reproducibility of many of the listed treatments is difficult to evaluate and a possible placebo effect cannot be ruled out. In this report, the various forms of immunotherapy for warts are discussed and each regimen is evaluated in order to assess the efficacy of each form of treatment.

Background Haemangioma is the most common vascular anomaly that affects infants. Although it is self-regressing, it can block visual field and airway. It might also cause mutilation. In surgically indicated cases, the residual defect is often large enough to present as a true reconstructive problem. Aim The aim of this study is to evaluate the purse-string closure method for circular and ovoid defects after excision of haemangioma in the face and scalp. Patients and methods We operated 25 targeted lesions (25 patients) with head and neck infantile haemangiomas. Ten lesions were in the involution stage, eight lesions were still in the proliferation stage and seven lesions were ulcerated and/or bleeding. Results There were reductions in the defects' dimensions by 53.8% for the longest dimension, 75% for the shortest dimension and 88% of the defect surface area. The results were very encouraging in areas with mobile skin, but we discourage any use of this method in the areas around the mouth and the eyelid because of initial distortion of the treated areas. One scalp case developed infection and the purse string had to be removed. The number of lesions in the scalp was markedly lower than the least number to enable a statistical analysis. Conclusion The purse-string closure (Bradford Cannon closure) is a powerful tool for the closure of skin defects after haemangioma excision in the face. It should be considered a first option whenever it does not distort a vital structure such as the mouth and the eyelids. For the scalp, the value of this technique needs further study considering that there are other good options as alternatives for this technique, particularly for the scalp.

Objective The objective of this study was to assess and compare the prevalence of metabolic syndrome (MetS) in patients with psoriasis (PsO) and in those with psoriatic arthritis (PsA). Materials and methods This was a cross-sectional study with no follow-up and was performed among outpatients attending the speciality clinics of an institutional tertiary referral centre. A consecutive sample of 100 patients with PsO was included in the study. Height, weight, BMI, blood pressure and waist circumference of patients were measured at the time of enrolment. Venous samples were taken after 8 h of overnight fasting for the estimation of serum cholesterol, triglycerides and plasma glucose levels. Results MetS was seen in 62.9% (17) of patients with PsO and in 32.8% of patients with PsA. This difference was statistically highly significant (P < 0.001). Conclusion MetS is common in Asian Indian patients with PsA than in patients with cutaneous PsO only.

Background Management of keloids is still controversial. Many treatment options have been proposed for earlobe keloids, including both surgical and nonsurgical methods. However, no single method has been found completely satisfactory. Objectives To find a new treatment technic that decrease recurrent rate earlobe keloids, Aim The present study aimed to evaluate the eff ect of a combination of intralesional injection of 5-fl uorouracil (5-FU) and surgical excision on the recurrence rate of earlobe keloids. Methods From January 2012 to March 2014, a prospective study was conducted on 50 earlobe keloids on 40 patients with recurrent earlobe keloid, which was bilateral in 10 cases and unilateral in 30 cases. The patients were treated with a combination of intralesional injection of 5-fluorouracil and excision. The ages of the patients ranged from 16 to 40 years (mean age was 26.27 ± 5.16 years). The cause of keloids was ear piercing in all cases. The largest lesion was 4 cm in its greatest dimension and the smallest was 1.5 cm. Results Improvement occurred in 64% of patients with acceptable esthetic results and recurrence occurred in 36% of patients. No relevant individual changes in serum values or blood chemistry were seen. Conclusion This technique is safe, well tolerated, and effective in decreasing or almost preventing the recurrence of earlobe keloids. We recommend this technique for recurrent earlobe keloids with poor response to intralesional therapy.

Background Acne is a common skin disorder affecting the pilosebaceous unit, arising commonly during adolescence and causing psychological stress. The pathogenesis of acne is attributed to multiple factors. Clinically, it is characterized by the presence of comedones, inflammatory papules, pustules, and sometimes nodules and cysts. Propolis has been attracting the attention of researchers because of its antimicrobial, antioxidant, antiviral, and antifungal properties. Objectives The aim of this study was to evaluate the clinical and bacteriological significance of topical propolis extracts in the treatment of facial acne vulgaris. Patients and methods This study included 40 patients with facial acne vulgaris. The patients were classified into two groups: group I included 20 patients who were treated with a topical solution of ethanolic extract of propolis, and group II included 20 patients who were treated with a topical solution of ethanol only and served as the control group. Patients were evaluated clinically to assess the efficacy of therapy after treatment. Bacteriological examination was carried out before and after treatment to assess the antimicrobial effect of propolis. Results There was a highly significant clinical efficacy of topical solution of ethanolic extract of propolis in the treatment of acne vulgaris. There was a highly significant bacteriological efficacy of topical solution of ethanolic extract of propolis on gram-positive aerobic (Staphylococcus epidermidis) and gram-positive anaerobic bacteria (Propionibacterium acnes). Conclusion Topical propolis is a promising, effective, well-tolerated, safe, and alternative medication for acne vulgaris. It has anti-inflammatory and antibacterial properties. Further studies are needed for its application in different skin diseases.

Context Leprosy is a chronic granulomatous infectious disease process in humans primarily involving the skin, peripheral nerves, and nasal mucosa but capable of affecting any tissue or organ. The leprae bacilli were first observed by Hansen in 1868. Although this was the first bacterial human pathogen to be described, it continues to remain one of the least understood. Aims The aim of the study was to evaluate oral and facial manifestations in patients affected with leprosy. Materials and methods The present study was performed with an aim of reviewing oral and facial manifestations in patients suffering from leprosy. For this, 150 patients suffering from lepromatous and tuberculoid forms of leprosy were included in the study. The study was approved by the ethical committee appointed by SIBAR Institute of Dental Sciences, Guntur. Permission was also taken from asylum management and the district leprosy officer to conduct the study. All study samples were patients diagnosed with Hansen's disease by a leprologist using a bacteriological index. Results In the present study, oral and facial manifestations were observed more frequently in the lepromatous type of leprosy than in the tuberculoid form. Also, these manifestations were less pronounced in group I than in group II and were more in groups III and IV based on increased exposure to the disease process. Statistical analysis was performed using the c² -test and P values were also found to be significant. Conclusion Present day diagnostic protocols for early detection and treatment are effective in controlling the disease and in preventing further progression with severe orofacial manifestations. A dentist should be able to recognize these manifestations and treat them under the supervision of a leprologist. Protective care must be taken in treating the disease, although it should not be held as a nightmare as was considered previously.

Perforating collagenosis is an uncommon distinct dermatosis characterized by transepidermal elimination of altered collagen through the epidermis. It was first described by Mehergan et al in 1967 and till date etiology of this disease is unknown. Herein, we describe a case of acquired perforating collagenosis in a 16 year old male who presented with multiple discrete pruritic and hyperkeratotic umblicated lesions on trunk, upper and lower extrmities and scalp for more than three years. Skin biopsy revealed a typical hyperkeratotic papule with a central plug, surrounding epidermal hyperplasia, inflammatory cells and vertically oriented fibers of collagen. On Masson's trichrome staining, perforating bundles of collagen were seen extending to the surface. A diagnosis of perforating collagenosis was made. The patient during follow up subsequently developed solitary nodule over the anterior chest wall which on histopathological examination revealed well circumscribed spindle shaped neoplasm in the dermis. These cells exibited wavy nuclei in a collagenous stroma along with proliferation of Schwann cells and fibroblasts. In view of these findings, the diagnosis was modified to reactive perforating collagenosis with cutaneous neurofibroma.