Our purpose in assembling this paper is 2-fold. First, we hope to review in-depth the properties on itraconazole pellet-capsules and what clinicians should know when considering oral itraconazole and discuss the potential value of treating superficial dermatophyte infections with oral antifungal therapy. Second, we hope to address some of the concerns of the recent epidemic of chronic recalcitrant widespread dermatophytosis in India, with emphasis on better treatment but also considering some of the necessary prophylaxis hygiene measures. An in-depth review of itraconazole (as pellet-capsules), a triazole antifungal will be presented with focus on the pharmacokinetic properties which lead to the development of the 1-week pulse dosing for skin and nail infections. Finally, recommendations for best usage of itraconazole pellet-capsules for management of dermatophytosis will be summarized in this paper.

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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.

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Apremilast is an oral phosphodiesterase 4 inhibitor, now approved by the Food and Drug Administration in the management of psoriatic arthropathy (PsA). As biologic therapy is associated with significant amounts of adverse effects, newer treatment options with an efficacious outcome, sans the toxicity, is something all clinicians would implement readily in their therapeutic regimens. Apremilast is one such drug which has shown promise in the management of psoriasis, PsA, and a few other dermatologic disorders. This review will throw light on the dermatologic perspective regarding apremilast.

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Background: Various medications are used for the treatment of various diseases. Ironically, adverse drug reactions (ADRs) also accompany the use of these medications and are as old as the medicine itself. These drug reactions can range from mild transient erythema at one end of the spectrum to severe cutaneous ADRs (SCADRS) that include Steven–Johnson syndrome (SJS), toxic epidermal necrolysis, acute generalized exanthematous pustulosis, and drug reaction with eosinophilia and systemic symptoms complex (DRESS). Aim: This study aims to study the clinical and epidemiological aspects of severe cutaneous adverse drug reactions (SCADRS) at a referral center of Jammu region, with special reference to the role of corticosteroids in the management. Materials and Methods: The study was carried out between July 2015 and December 2015, at a tertiary hospital after permission from Ethical Committee of the institution. A total of 44 patients were included in the study which included outpatients as well as inpatients admitted after written informed consent. The Naranjo ADR probability scale was applied to indicate the causality of the drug with the SCADRS. Results: In the study, a total of 44 patients were included in the study. Males outnumbered the females, and maximum patients were in the age group of 21–40 years. SJS was the most common SCARD found followed by DRESS. Antiepileptic class of drug was found to be most commonly implicated. Immediate withdrawal of the culprit drug and administration of systemic steroids reverted the SCARD in maximum patients. Conclusion: Severe cutaneous adverse drug reactions can be associated with serious morbidity as well as mortality. Their knowledge and prompt recognition are essential for clinicians as early recognition, and immediate withdrawal of the culprit drug/drugs with adequate management can be lifesaving.

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Lichen planus is a common inflammatory disorder affecting skin, mucus membranes, nails, and hair. At least two-thirds of cases occur between 30 and 60 years of age. Lichen planus can affect the mucosal surfaces of mouth, genitalia, conjunctiva, esophagus, anus, and urethra. Oral lichen planus is relatively common than lichen planus of other mucosal areas. Oral lichen planus is very refractory to treatment. Oral and topical steroids, topical tacrolimus, azathioprine, cyclosporine, and dapsone are the drugs used to treat oral lichen along with acitretin. We hereby report the successful treatment of oral lichen planus with acitretin in three patients.

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Background: There are many destructive and immunotherapeutic options available for the treatment of common warts, but no treatment is 100% effective and usually cause pain and scarring. Recently, intralesional immunotherapy with skin test antigens and vaccines has been shown to be effective in the management of warts. We evaluated the efficacy of Measles Mumps Rubella (MMR) vaccine injection in the treatment of cutaneous warts. Aim: To study the efficacy of intralesional MMR vaccine in the treatment of common warts. Materials and Methods: A case–control study was conducted in AVBR Hospital, Sawangi (Meghe), Wardha, in 2015–2016. Forty clinically diagnosed cases of cutaneous common wart were selected in the study and were put randomly into two groups (20 in each group). Group 1: included twenty patients subjected to intralesional injection of 0.5 ml MMR vaccine. Group 2: included twenty patients as a control group and subjected to intralesional injection of 0.5 ml saline. These injections were repeated every 3 weeks intervals for maximum three injections. Follow-up of patients was done every 6 months for clinical assessment of results and to study recurrence. Results: A significant difference was found between the therapeutic responses of common warts to MMR. Vaccine and normal saline (control) group. At the end of 9 weeks (third visit), about 65% patients treated with MMR vaccine showed complete clearance compared with 5% of the control group. Grade 3 response was 20% versus 10% respectively; whereas Grade 2 response was observed in 10% versus 25%, respectively, and as regards no response, it was 5% versus 60% in MMR vaccine and control group, respectively. Conclusion: We found that the treatment of common warts by MMR vaccine is effective, with good cure rates, and excellent safety profile.

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Hand, foot and mouth disease (HFMD), an acute viral illness caused by coxsackieviruses or enteroviruses, is predominantly encountered in children under 10 years of age. Although it is usually self-resolving, there are a few rare cases which have an extremely aggressive clinical presentation and need to be treated on a priority. Many affected children present with florid or unusual lesions; are highly febrile, with high irritability or listlessness; and also refuse to eat. Such cases could be considered as severe ones. With no specific effective antiviral available to tackle HFMD cases, acyclovir may be used in severe cases for its antiviral effect. We describe three such cases of HFMD in children, treated with oral acyclovir, with gratifying results.

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Nicolau syndrome, also known as embolia cutis medicamentosa or livedoid dermatitis, is a rare cutaneous adverse drug reaction seen at the site of injection of some particular drugs. It was first reported by Freudenthal in 1924 and Nicolau in 1925 as an adverse effect of bismuth salts used in syphilis. Typically, this syndrome is clinically manifested by intense burning or stabbing pain at the site of injection and retiform hemorrhagic patches with or without vesiculations and ulceration with a variable degree of tissue necrosis. To the best of our knowledge, <50 cases of Nicolau syndrome have been reported in medical literature which occurred following intramuscular administration of diclofenac sodium. Here, we report a 26-year-old female typically presenting with pathognomic signs and symptoms of NS after taking intramuscular injection of diclofenac.

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Generalized bullous fixed drug eruption is bullous type of fixed drug eruption characterized by sharply defined bullae at the same site following administration of offending drug. GBFDE has aggressive course unlike conventional FDE and requires aggressive treatment. Mucosa is usually spared and constitutional symptoms are mild. We came across two cases of GBFDE in which culprit drugs were B-Lactam antibiotics.

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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.

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Bilastine is a new second generation H1-antihistamine approved for the symptomatic treatment of allergic rhinitis (AR) and chronic urticaria (CU) in patients older than 12 years of age. AR and urticaria are very common clinical conditions that represent one of the most frequent reasons for a patient to visit their general practitioner or allergist or dermatologist. Bilastine, with its efficacy and safety profile epitomizes the evolution of research on antihistamines.

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