BACKGROUND: Keloids are overgrowths of fibrous tissue following cutaneous injuries. They are often symptomatic and troubling cosmetically, with significant psychosocial burden for the patient. A safe, cost-effective alternative treatment for keloids will definitely be beneficial.
OBJECTIVES: This study aims to determine the efficacy of intralesional 5-fluorouracil versus triamcinolone acetonide in the treatment of keloids as to reduction of keloid volume, improvement of symptoms and cosmetic appearance. Adverse effects and recurrences between the two treatment groups will likewise be evaluated.
METHODS: This is a single-blind, randomized, controlled trial. Fourteen patients with 2 or more keloids on the same site or symmetrically distributed, with no co-existing morbidity and with informed consent, were included in the study. Patients received both intralesional injections of 5-fluorouracil (5-FU, Utoral 50 mg/mL) and triamcinolone acetonide (TAG, Kanolone 10 mg/mL). One keloid was injected with 5-FU and one with TAG. They were submitted to 1-6 treatment sessions with an average interval of 2 weeks between each session. Measurements of keloid volume using alginate impression material and digital photographs were taken before treatment, 2 weeks and 2 months post-treatment. Occurrence of adverse effects, improvement of symptoms, as well as cosmetic outcome, was likewise recorded.
RESULTS: Both 5-fluorouracil and triamcinolone acetonide were shown to be effective in the treatment of keloid. Comparing the two, 5-FU statistically proved to be better, by having greater volume reduction, more symptom improvement, and higher scores on patient's assessment of cosmetic outcome. Adverse sequelae were pain, hyperpigmentation, and ulceration which healed in 1 - 2 weeks with topical antibiotic ointment. Corticosteroid side effects such as telangiectasia and atrophy were not appreciated with the 5-FU group. There was no recurrence during the follow-up period of 8 weeks in any of the patients.
CONCLUSION: Five-fluorouracil was shown to be effective in reducing keloid volume, improving symptoms of pain and pruritus, and cosmetic outcome, as compared to triamcinolone acetonide. Likewise, it was found to be safe. Adverse effects associated with corticosteroids were not seen. No recurrence was noted two months post-treatment.

Human ; Male ; Female ; Adult ; Young Adult ; Adolescent ; Anti-bacterial Agents ; Glucuronic Acid ; Hexuronic Acids ; Hyperpigmentation ; Injections, Intralesional ; Keloid ; Pruritus ; Telangiectasis ; Triamcinolone Acetonide

Scrotal Leiomyoma is an extremely rare benign tumor originating from the tunica dartos muscle. It usually presents as a solitary, painless, unilateral, slow growing mass that is occasionally pedunculated. We report a case of a 31-year-old man, presenting clinically with multiple papules resembling Angiokeratoma of Fordyce but with a histopathologic diagnosis of Scrotal Leiomyoma. Scrotal Leiomyoma has not been reported to present clinically in this manner and our report is probably the first of its kind.

Human ; Female ; Adult ; Angiokeratoma ; Leiomyoma ; Muscles ; Scrotum ; Skin Neoplasms

BACKGROUND

Surgical treatments are the first-line therapy for basal cell carcinoma (BCC). However, for patients who are not candidates for surgery, non-surgical options, such as pulsed dye laser (PDL), may be considered.

OBJECTIVE

This study aimed to review the existing literature on the efficacy, tolerability, and safety of PDL in the treatment of BCC.

METHODOLOGY

A systematic review and meta-analysis of PDL for BCC were conducted. The primary outcomes assessed were clearance and recurrence rates. The secondary outcome was the incidence of adverse events.

RESULTS

The review included 11 studies (4 randomized controlled trials, 6 cohort studies, and 1 case series) comprising a total of 204 patients and 295 BCCs. Most BCCs were low-risk histologically and predominantly located on low-risk areas. The meta-analysis revealed an overall clearance rate of 69% and a recurrence rate of 32%, with follow-up periods ranging from 1 to 72 months. However, there was substantial and statistically significant heterogeneity across all studies. The most frequently reported adverse effects included pigmentary changes, primarily hypopigmentation, and varying degrees of scarring.

CONCLUSION

PDL is a safe and tolerable option for treating BCC, though it is not recommended as a sole treatment due to the higher clearance rates and lower recurrence rates associated with other modalities. PDL may be considered an alternative for non-surgical candidates with small or superficial BCCs. Further research is needed to establish standardized parameters for its use in BCC treatment.

Human ; Carcinoma, Basal Cell ; Lasers ; Tumors ; Neoplasms

BACKGROUND

Molluscum contagiosum is a benign viral infection affecting children, sexually active adults, and immunocompromised individuals. Modified autoinoculation (MAI) is a procedure in which a solitary lesion of molluscum contagiosum lesion is inoculated in the affected skin to stimulate an immune response, thereby clearing the infection.

OBJECTIVE

This study aimed to compare the efficacy and safety of modified autoinoculation versus curettage in the treatment of molluscum contagiosum infection.

METHODS

This study was an assessor-blinded, randomized therapeutic trial performed at the Department of Dermatology of Jose R. Reyes Memorial Medical Center. 52 patients with newly diagnosed molluscum contagiosum that had not been previously treated were assigned randomly using computer-generated randomization to either curettage or MAI. 26 patients were allocated in each treatment group. Patients were followed-up every 2 weeks for 3 months and at 6 months to evaluate clearance and recurrence rates along with adverse events.

RESULTS

Curettage was significantly a more effective treatment than MAI in achieving higher clearance rates and reducing recurrences. Adverse events did not differ significantly.

CONCLUSION

While MAI was a less invasive alternative, curettage remains superior in terms of efficacy and recurrence prevention. However, MAI may still be considered for patients seeking a less painful procedure, especially in children and those with extensive lesions.

Curettage ; Molluscum Contagiosum

BACKGROUND: Most manufacturers of commercially available botulinum toxin A (BTX-A) recommend that the vials should be used within 24 hours after reconstitution to ensure efficacy, which in some instances would mean wastage of remaining reconstituted solution. Several studies have evaluated the efficacy of stored reconstituted BTX-A and have concluded that the use of BTX-A reconstituted and refrigerated for up to 6 weeks prior to administration does not significantly alter its efficacy in the treatment of facial rhytides. OBJECTIVES: Our study aimed to compare the clinical efficacy and safety of freshly reconstituted BTX-A and BTX-A reconstituted 1, 2 or 3 months prior to administration in the treatment of axillary hyperhidrosis. METHODOLOGY: Patients with primary axillary hyperhidrosis were enrolled in this pilot study. Freshly reconstituted BTX-A and BTX-A reconstituted 1, 2 and 3 months prior were administered in 4 pre-determined areas in the same patient. The degree of hyperhidrosis was assessed subjectively using Hyperhidrosis Disease Severity Scale (HDSS) and objectively using Minor’s iodine starch test followed by Sweating Intensity Visual Scale (SIVS) at 0, 2, 6 and 12 weeks after administration. RESULTS: Five patients were enrolled in the study. Kruskall-Wallis test showed that HDSS at baseline was significantly different from follow-up periods with noted improvement from baseline to 2 weeks follow-up. Using Kruskall-Wallis test, SIVS was found to be not significantly different among these 4 treatment areas. In addition, significantly improved SIVS scores were noted as early as 2 weeks after administration in all 4 areas of treatments. There were no noted adverse effects in all patients at baseline and at all follow-up visits. CONCLUSION The clinical efficacy and safety of BTX-A reconstituted 1, 2 and 3 months prior to administration is comparable to that of freshly reconstituted BTX-A in the treatment of axillary hyperhidrosis.

Erythema elevatum diutinum (EED) is a rare condition believed to be a form of chronic recurrent leukocytoclastic vasculitis possibly secondary to vascular immune complex deposition. The disease is characterized by symmetrical, red, brownish-purple, and yellow papules, plaques, and nodules distributed mainly over the extensor surfaces of the extremities. We report a 61-year-old male with an atypical presentation of such disease as a giant warty lesion on the heels. Histologically, a spectrum from leukocytoclastic vasculitis to vessel occlusion and dermal fibrosis is seen in EED. These histological findings were present in the histopathological reading of the patient which established its diagnosis and further ruled out verruca vulgaris. The disease is associated with many disease entities, which include human immunodeficiency virus, malignant conditions, chronic infection, and autoimmune and connective tissue disorders. None of these conditions was present in the patient as manifested in the history, physical, and laboratory examinations. However, the patient has a low hemoglobin and a G6PD deficiency which makes him a bad candidate for dapsone therapy which is the main treatment for EED. Tetracycline, niacinamide and plain vaseline + salicylic acid were given initially for 4 weeks but no improvement was noticed. It was then shifted to 10mg intralesional corticosteroid and urea paste 40%. Niacinamide still was given. There was a marked thinning of the lesions. The medications were continued and were slowly tapered. More improvement of the lesions was observed.
Glucosephosphate Dehydrogenase Deficiency ; Niacinamide