Clinical trials have proved the efficacy of antihistamines in the treatment of chronic idiopathic urticarial (CIU). Second-generation antihistamines are recommended as first-line therapy for CIU. This article reviews the newer second-generation antihistamines in light of recent advances in the understanding of their pharmacology, efficacy, and safety profile. A Google scholar search for second-generation antihistamines was done using the words “second generation H₁antihistamines,” “bilastine,” “ebastine,” “olopatadine,” “rupatadine,” “levocetirizine,” “fexofenadine,” “desloratadine,” “histamine,” “allergy,” and “urticaria.” All the articles were retrieved and classified into review articles, studies, double-blinded trials, and case reports. The final data were then analyzed and presented in a narrative fashion.

Background: Cutaneous eruptions are the most frequently reported adverse reactions to drugs. The pattern of cutaneous adverse drug reactions (CADRs) and the causative drugs keeps changing every year. Objective: The study was designed to ascertain the different clinical patterns of CADRs and to determine the causative agents. Materials and Methods: A prospective observational nonrandomized hospital-based study was carried out over a period of 6 months. The CADRs as observed in the outpatient and inpatient Departments of Dermatology were recorded. Naranjo's algorithm was used to determine the causality assessment. Clinical pattern of these adverse drug cutaneous reactions was studied. Causality assessment was done with the help of Naranjo's algorithm. Results: A total of fifty patients diagnosed to have CADRs were included in the study. The most common type of CADRs was urticaria (30%) followed by fixed drug eruption (FDE) (24%) and maculopapular eruption (12%). Antimicrobial agents (AMAs) (48%) were responsible for majority of the detected reactions, followed by nonsteroidal anti-inflammatory drugs (24%), antihypertensives (8%), and antiepileptics (4%). A total of 41 reactions (82%) showed probable causal association, 4 reactions had possible association (8%), and 5 cases of cutaneous drug reaction (10%) showed definite causal association with the drug. Conclusion: A wide clinical spectrum of CADRs ranging from FDE to mild maculopapular rash to serious Stevens–Johnson syndrome was observed. Most of these drug eruptions were caused by AMAs. The occurrence of CADRs in the present study was in concurrence to various studies conducted in India.

Introduction: Viral warts are caused by human papillomavirus. Although various treatment modalities are available, many of them result in the partial clearance of warts or recurrence. Immunotherapy has been tried in the recent times with variable success rates. We undertook a study to evaluate the safety and efficacy of immunotherapy using tuberculin purified protein derivative (PPD) for the treatment of viral warts. Materials and Methods: A total of 45 patients were included in the study. Each patient was injected with 10 TU of tuberculin PPD (0.1 ml) intralesionally in the largest wart at 2 weekly interval. A total of maximum six treatment sessions were conducted. Resolution of viral warts was considered as the clinical end point of the study. The clinical assessment was done by photographic measurements at baseline, before each treatment session, and 3 weeks after the completion of treatment. Results: A total of 62.2% patients (28 out of 45) showed complete clearance at injected and distant warts, eight patients (17.8%) showed partial clearance, and nine patients (20%) showed no improvement. No significant side effects were observed except for localized hair loss around injected viral wart over the scalp. Conclusion: Tuberculin PPD immunotherapy was found to be a safe and effective treatment modality for the treatment of viral warts.

Toxic epidermal necrolysis (TEN) is an acute life-threatening disease associated with a high mortality. Systemic corticosteroids, cyclosporine, and intravenous gamma globulins have been used in the treatment with variable results. We report five cases of TEN treated successfully with cyclosporine monotherapy. All the patients presented with severe disease. All the patients received cyclosporine 3–5 mg/kg/day for an average duration of 5–10 days depending on the clinical response. All the patients recovered without any sequel. No significant side effects were noted in all the five patients except for one patient who developed acute nephrotoxicity. All the five patients were discharged from the hospital by the end of 2 weeks, thus decreasing the hospital stay due to a favorable outcome and early recovery. Cyclosporine in TEN patients is not only a lifesaving drug, but also it is cost-effective. This case series demonstrates the safety and efficacy of the short course of cyclosporine monotherapy in the treatment of TEN.

Lichen planus (LP) is a chronic inflammatory dermatosis of unknown etiology characterized by pruritic violaceous papules. Here, we share our experience of a long standing case of disseminated hypertrophic LP treated with oral acitretin. A 48-year-old married male, presented with multiple highly itchy dark raised lesions over bilateral legs since 15 years. There was no history of any preceding trauma, any recent drug intake before eruption, dental metal fillings, hepatitis, or any other infection. Patient was treated with oral antihistamines and topical moisturizers and topical steroid and salicylic acid combination ointments in the past with only temporary relief. Clinical examination revealed multiple hyperpigmented keratotic papulonodular lesions over bilateral legs and few on feet. Mucous membranes were normal. He was started on acitretin 25 mg twice daily along with oral hydroxyzine 25 mg and topical moisturizer and clobetasol and 6% salicylic acid ointment. After 2 weeks, patient noted up to 30–40% improvement in lesions and some became flat. Furthermore, itching was reduced. His lipid and liver profile showed no abnormality. Acitretin 25 mg bid and antihistamines were continued along with moisturizer for another 2 weeks. Since patient tolerated acitretin well without any major side effects,except for mucosal dryness and slight hair loss, it was continued for another 1 month. At the end of 2 months, there was almost 90% improvement in most of the lesions. Acitretin was stopped after 4 months. There was no recurrence reported up to 6 months posttreatment. Our case of HLP showed a good response to acitretin and it can be considered one of the treatment options for such severe, highly itchy cases of LP affecting quality of life.

Disulfiram, given for alcohol de-addiction, can induce multiple skin reactions and systemic adverse reactions, which can be fatal at times. Here, we report a case of toxic pustuloderma due to disulfiram in a 47-year-old Indian male.

Leprosy complicated by hepatitis is one condition wherein the usual multidrug therapy cannot be used and alternate regimens are required. The World Health Organization and the Indian Association of Leprologists have recommended an alternative combination therapy of clarithromycin, ofloxacin, and clofazimine to be prescribed in such cases. However, in some cases, this combination therapy may fail to control or worsen the hepatitis. One such case of leprosy, complicated by hepatitis, who did not tolerate the recommended hepatosafe regimen was successfully treated with monthly rifampicin, ofloxacin, and minocycline, and is hence reported.

Zonisamide is a sulfonamide anticonvulsant now being increasingly used in the management of seizure disorders. We report possibly, the first case of a photosensitive lichenoid drug eruption due to zonisamide in a middle-aged male.

Warts are classified under one sided diseases as external local maladies. They often have individualistic and immunological basis as also familial tendencies. Warts are included under miasm sycosis. Although warts are local diseases, they are treated with internal remedy which is based on comprehensive understanding of the patient. This includes local symptoms, i.e. morphology and location of lesion, mental makeup of the person, and physical characteristics. This is what is called totality of symptoms. A constitutional remedy thus selected eradicates the complaint locally as well as internally, thereby providing long lasting relief from complaints. Common remedies include Calcarea carbonica, Causticum, Dulcamara, Natrum muriaticum, Nitric acidum, and Thuja occidentalis. Homeopathic concept and homeopathic treatment of warts has been described.