Microneedling and 10% TCA constitute an innovative combination treatment for DC with encouraging results and minor side effects.

Background: Studies comparing head-to-head treatment modalities for anogenital warts are lacking. Aim: We sought to compare a short, 8-week course of imiquimod 5% cream to versus the standard 4 week course of podophyllotoxin in the treatment of anogenital warts and to assess factors that may affect response to treatment. Methods: This was a retrospective cohort study. We reviewed medical files of otherwise healthy patients with a first episode of anogenital warts who were treated with either a short, 8-week course of imiquimod or the standard 4-week course of podophyllotoxin. Inverse probability of treatment weighted (IPTW). Logistic regression was employed to evaluate factors that may affect response to therapy. Results: The study included 347 patients. In patients with lesions on dry, keratinized anatomical sites, the complete clearance rates were 7.6% for imiquimod and 27.9% for podophyllotoxin (P < 0.001). In patients with lesions on moist, partially keratinized sites, no difference between the treatments was revealed. Significant predictors of > 50% reduction in wart area were location of lesions [odds ratio (OR) (95% confidence interval (CI)): 3.6 (1.84–7.08), P = 0.0002] for “partially keratinized” versus “keratinized” sites and treatment used [OR (95% CI): 1.79 (1.08–2.97), P = 0.024] for podophyllotoxin versus imiquimod. Limitations: The retrospective design of the study was a limitation that we mitigated against with the use of IPTW logistic regression. Conclusion: A standard 4 week course of Podophyllotoxin was more effective than an 8-week course of imiquimod only for lesions on keratinized sites. Treatment with podophyllotoxin and location of lesions on partially keratinized sites were independent predictors of >50% reduction in wart area.

Background: Warts represent a common skin disorder that may cause pain and cosmetic deformities. Although their spontaneous clearance can occur at any time, the high rate of transmission makes their treatment absolutely necessary. Materials and Methods: 139 patients diagnosed with warts participated in our study, which involved dipping a cotton bud in an 85% formic acid solution and applying it to the warts for 3 seconds once weekly. A dermatologist examined the patients in a well-lighted room at baseline and after 4, 6, and 10 weeks of treatment. Results: After completing the treatment, 79 out of the 139 patients (56.8%) showed complete remission of warts, 20 (28.8%) were partially cured, and 40 (14.4%) showed no change. Formic acid caused a first-degree chemical burn in 5 patients in the sixth week of treatment, resulting in a ten-day intermission until its next application. Only 15 patients (10.8%) complained about a burning sensation, which appeared after 6 applications in 8 patients and after 10 applications in the other 7 patients. Among the patients cured completely, 52 (65.8%) needed 10 weeks of treatment, 19 (24.05%) needed 6 weeks, and 8 (10.15%) achieved complete remission after 4 weeks. Conclusions: Our study demonstrated that formic acid is a safe and economic therapeutic option for the treatment of warts that produces favorable results with few adverse effects.

Interventions often result in statistically significant quality of life (QoL) improvement, but may not reach the threshold of clinical importance. The minimal clinically important difference (MCID) is the minimal score change of relevance clinically. We introduce the concept of 2MCID, a score change at least twice the usual threshold (i.e. 8 for DLQI), highlighting therapies changing by this higher threshold. A systematic review was conducted of the use of QoL instruments and of the impact of psoriasis treatments in randomized controlled trials (RCTs). 388 search terms were used to conduct searches in six databases adhering to PRISMA guidelines. Two assessors independently reviewed abstracts: a third resolved differences. Of 3646 screened publications, 99 articles (100 trials) involving 33,215 subjects met inclusion eligibility criteria. Of these 100 trials, 37 reported MCID; 32 DLQI, 10 SF-36 and 6 EQ-5D. 33 trials tested topical therapy, 18 systemic, 39 biologics, 9 phototherapy and 10 other interventions. For studies with treatment endpoint or assessment at 12 weeks, the interventions with the greatest average DLQI impact in each category were: Liquor Carbonis Distillate 15% (>1MCID, 5.8 pts), ciclosporin 3-5 mg/kg (>1MCID, 6.6 pts), secukinumab 300 mg (>2MCID, 11.4 pts), PUVAsol 0.6 mg/kg + isotretinoin 0.5 mg/kg (>2MCID, 11.2 pts) and educational programme (1MCID, 4 pts). Clolobetasol spray 0.05% (8 points, 4 weeks), ustekinumab 90 mg (8, 12), etanercept 50 mg (8.7, 24) and MTX 15 mg (8.7, 16) also reached 2MCID. The concept of '2MCID' adds meaning to score change when comparing therapies and results across different QoL instruments, though this requires further validation. However secukinumab and PUVAsol + isotretinoin both reached 2MCID at 12 weeks, according well with clinical experience.

Harlequin syndrome is a rare disorder of the autonomic nervous system, presenting as unilateral reduced flushing and sweating of the face induced by exercise, stress, or heat. It is caused by a cervical sympathetic deficit located at the preganglionic or postganglionic level on the non-flushing side. We present a case of an 8 year old with harlequin syndrome and review the other dermatological conditions for which the term "harlequin" is part of the nomenclature.