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Introduction: Plantar warts are associated with high transmissibility and morbidity. Among the available therapeutic options, none is uniformly effective or virucidal. Salicylic acid is the first-line therapy but approximately one-third of lesions could not resolve and become recalcitrant despite repeated treatment. Cryotherapy is widely accessible with low cost but may be complicated by pain, blister formation, hemorrhage, infection, excessive granulation tissue formation, and hyper-/hypo-pigmentation. Hence, alternative treatment modalities are essential., Methods: Three patients with debilitating plantar warts refractory or intolerant to cryotherapy were treated with a course of Zijinding (a traditional Chinese medicine preparation) paste prepared with white vinegar., Results: All three patients showed excellent clinical response with Zijinding application with evolution of lesions to scabs and subsequently healthy skin within 1.5 to 5 months of treatment. Treatment was well tolerated and had no significant side effects with excellent compliance recorded for all three patients. There was no relapse for at least 10 months after stopping the treatment., Conclusion: Topical Zijinding could be a promising alternative modality for the treatment of plantar warts. Further clinical trials on the comparison of Zijinding and other treatment modalities of plantar warts are warranted. Further studies are required to investigate the mechanism of action of Zijinding and to isolate the active ingredient., (© 2019 The Authors. Journal of Cosmetic Dermatology Published by Wiley Periodicals, Inc.)

Onychomycosis is a fungal nail infection caused by dermatophytes, nondermatophyte molds, and yeasts. This difficult-to-treat chronic infection has a tendency to relapse despite treatment. This paper aims to offer a global perspective on onychomycosis management from expert physicians from around the world. Overall, the majority of experts surveyed used systemic, topical, and combination treatments approved in their countries and monitored patients based on the product insert or government recommendations. Although the basics of treating onychomycosis were similar between countries, slight differences in onychomycosis management between countries were found. These differences were mainly due to different approaches to adjunctive therapy, rating the severity of disease and use of prophylaxis treatment. A global perspective on the treatment of onychomycosis provides a framework of success for the committed clinician with appreciation of how onychomycosis is managed worldwide., (© 2018 The International Society of Dermatology.)

Background: Diphenylcyclopropenone (DPCP) immunotherapy has been used to treat warts, particularly in patients, such as children, who cannot endure treatment-related pain and in patients with large numbers of warts. However, the efficacy of DPCP immunotherapy remains subject to much controversy. Specifically, cure rates and treatment durations have varied across reports, primarily because of the lack of large-scale studies., Methods: We performed an uncontrolled, open-label study to investigate the efficacy of DPCP immunotherapy for the treatment of cutaneous warts. A total of 170 patients with warts were enrolled in this uncontrolled, open-label study from 2006 to 2012. Each patient was sensitized with 0.1% DPCP. Two weeks after sensitization, DPCP was applied to warts once per week., Results: We achieved high clearance rates in 141 of 170 patients (82.9%) and 434 of 511 lesions (84.9%). Immunotherapy with DPCP was much more effective when the lesions were located on the hands and when the patient was aged < 20 years. The mean ± standard deviation number of applications was 9.02 ± 2.59. At the end of treatment, the most common final concentration was 0.1%, and most (77.0%) patients used a final concentration of > 0.005%. Side effects occurred in 36 patients, but no serious adverse effects occurred, and blistering at the sensitized site was the most common adverse effect., Conclusions: Immunotherapy with DPCP is an effective and well-tolerated option for the treatment of recalcitrant warts., (© 2014 The International Society of Dermatology.)

Background: Populous euphratica tree which belongs to Salicaceae family is naturally distributed in many parts of the world. Our purpose was to compare the therapeutic effects of smoke of its burnt leaves with conventional cryotherapy in patients with warts., Methods: Sixty consecutive wart patients were randomly treated with leaves of Populous euphratica tree (Group A) or conventional cryotherapy (Group B) and were followed up for 22 weeks., Results: The respective end results in group A and group B were; Complete cure rates 66.7% vs. 46.4% (P= NS), partial resolution rates 8.3% vs. 14.3% (P= NS). The recurrence rate however, was 4.2% in group A and 32.2% in group B patients (P= 0.024)., Conclusion: The smoke of burnt leaves of Populus euphratica tree can be equally effective for treatment of hand and foot warts as cryotherapy.

Background: Hyperhidrosis (excessive, uncontrollable sweating) can be embarrassing and disabling, significantly impacting social and professional performance and quality of life. Treatments aim to reduce sweating, but few are effective, often carrying the risk of significant side-effects. The aims of this study were to evaluate the efficacy and safety of botulinum toxin type A (BTX-A) for plantar hyperhidrosis and to investigate the role of the Dermojet as a potential injection technique., Methods: Ten adult patients (five men, five women), aged 19-51 years, with severe, previously unresponsive, plantar hyperhidrosis, were recruited to this single-center, open-label, noncomparative study. The hyperhidrotic area of each foot was injected over 15-20 sites without analgesia with 50 U BTX-A + 5 mL sterile saline using a Dermojet. Patients were followed up for 8 months with monthly sweat reduction assessments using Minor's iodine-starch test. Patients provided a treatment self-assessment after completion of follow-up., Results: Within 7 days post-treatment, eight patients reported significantly decreased sweating, and seven patients were symptom free for up to 5 months. Patient self-assessment showed that seven of the 10 patients were satisfied with their treatment. One minor adverse event was reported comprising a temporary localized hematoma (one patient)., Conclusions: Intracutaneous BTX-A injection using the Dermojet offers a simple, safe, and effective alternative for treatment of plantar hyperhidrosis.

Background: Onychomycosis is a common fungal infection of the toenails which has historically been regarded as a cosmetic problem. A previous study has suggested that this is not the case and that toenail and fingernail onychomycosis adversely impacts patient quality of life (QOL)., Methods: A survey was used to self-assess the physical symptoms and psychosocial dimensions of toenail onychomycosis in 93 patients. Positive responses scored one point each, and points were summed for each patient., Results: Ninety-two per cent of patients reported experiencing negative psychosocial and/or physical effects. Forty-four per cent indicated that their toenails had a negative effect on their self-image, and 41% reported experiencing pain or discomfort as a result of onychomycosis., Conclusions: Toenail onychomycosis has a significant impact on the overall QOL of patients, and should be evaluated further to develop guidelines for total patient care.

We describe two patients with cutaneous myiasis caused by Dermatobia hominis. Three larvae were removed successfully by a simple technique that involved the injection of each larva with 2 mL of lidocaine, making surgical extraction by incision and exploration unnecessary.