BACKGROUND Diphenylcyclopropenone (DPCP) produces type IV hypersensitivity reaction, immune response being directed against a complex of contact agent hapten bound to proteins of viral origin that enhance wart regression. We wanted to evaluate the efficacy and safety of DPCP in multiple warts along with the various factors affecting DPCP response METHODS A prospective study with 49 patients older than 5 years with 5 or more warts in any area (except genital) was conducted. Patients were sensitized with 2 % DPCP solution and examined after 48 hours. Sensitization was graded as mild, moderate, severe or no sensitization. Patients with mild / moderate sensitization were further applied DPCP; patients with severe sensitization were included after subsidence of reaction and patients with no sensitization were excluded. After sensitization, weekly applications were made on warts. Concentration causing mild reaction was selected as optimal and was applied till lesion clearance. Follow up was for 3 months for recurrences. Response was graded as complete, partial and no response. RESULTS Males outnumbered females. Mean age was 23 years. Mean duration was 12 months. Recurrent and resistant warts were seen in 15 and 6 patients respectively. Mean number of warts was 15.6. 49 patients were tested for sensitization, 1 failed sensitization and 48 were continued with weekly DPCP. 2 developed distant eczematisation and 4 were lost to follow up. Out of 42, complete clearance was seen in 35 (83.3 %), partial in 3 (7.14 %) and no response in 4 (9.52 %). Local eczematisation, lymphadenopathy, hyperpigmentation were the side effects. Response was better with increasing age. Warts less than 6 months had 100 % response. There was no statistically significant difference between site and type of warts and response to DPCP, recurrent and untreated warts in terms of response and response to sensitization and final response. CONCLUSIONS DPCP is an excellent option for multiple / resistant warts with good safety profile. KEYWORDS Diphenylcyclopropenone, Multiple Warts, Safety, Efficacy, Various Factors Affecting Response

Introduction: Psoriasis is the skin disease that most frequently affects the nails. Depending on the very nail structure involved, different clinical nail alterations can be observed. Irritation of the apical matrix results in psoriatic pits, mid-matrix involvement may cause leukonychia, whole matrix affection may lead to red lunulae or severe nail dystrophy. Material and Methods: This is prospective and observational study conducted in the Department of Dermatology. Dermatological examination specified the clinical form of psoriasis, nail alterations type, and number of fingernails involved, the Psoriasis Area and Severity Index (PASI) score assessing the severity of skin involvement, and based on PASI score, patients were classified into mild (PASI<10), moderate (PASI 10-20), and severe disease (PASI>20). Nail Area Psoriasis Severity Index (NAPSI) score assessing the severity of nail involvement (pitting, leukonychia, red spots in lunula, and nail plate crumbling) and for nail bed disease (oil drop [salmon patch] discoloration, onycholysis, nail bed hyperkeratosis, and splinter hemorrhage). Results: A total of 70 patients were examined. Of the 70 cases, male preponderance was noted. Thirtyfive had early-onset psoriasis and the other 35 had late-onset disease. 48/70 (73%) patients with psoriasis had nail involvement. Among patients with nail involvement as well as those without nail involvement, the patients with mild psoriasis (PASI<10) accounted for the majority (31/48 [64.2%] and 18/22 [81.8%], respectively). Patients with moderate psoriasis accounted for 33.3% (14/48) of those with nail involvement and 9.0% (2/22) of those without nail involvement. Those with severe psoriasis (PASI>20) accounted for 10.4% (5/73) of patients with nail involvement. The most common finding among those with nail changes was pitting (33/48, 89.5%). Other common changes were leukonychia (27/48, 56.2%), Red spots in lunula (3/48, 6.25%), Splinter hemorrhage (9/48, 18.7%), Beau's lines (6/48, 12.5%), and Rough nails (18/48, 37.5%). Conclusion:The most frequent signs of nail matrix disease are pitting, leukonychia, crumbling, and red spots in the lunula, whereas salmon patches or oil spots, subungual hyperkeratosis, onycholysis, and splinter hemorrhages represent changes of nail bed psoriasis. The treatment of nail psoriasis is prolonged with both conventional and biologic therapies and the systemic side effects of the various therapies limit their use. Hence, it requires patience both on the part of the treating dermatologist and the patient.