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Background: Onychomycosis is a common but difficult to treat nail disorder. Treatment strategies thus far have included oral and topical antifungals, surgical treatment and recently lasers have emerged as a therapeutic modality., Objective: The objective of this study was to assess whether efinaconazole together with laser would result in greater clinical and mycologic cure and lower rate of relapse compared to efinaconazole alone., Methods: Thirty subjects were randomized to either self-apply efinaconazole 10% once daily for 48 weeks, or follow the same treatment plan but also receive six treatments with a 1064 nm Nd: YAG laser every 4 weeks. The primary endpoint was to assess the proportion of subjects who achieved complete cure at week 52., Results: The combination therapy group showed significantly quicker mycological cure at the 48- and 52-week follow-up., Conclusion: Both efinaconazole and combination with laser were efficacious treatment, but the combination therapy leads to quicker resolution with fewer rate of relapse.

Background: Plaque-type palmoplantar psoriasis (PPTP) is a chronic recalcitrant dermatosis with treatment modalities ranging through topical, phototherapy or systemic. Phototherapy options include various forms of ultraviolet B (UVB) and ultraviolet A with prior psoralen sensitization (PUVA). Currently, few comparative studies have been reported., Purpose: To compare Broad-Band UVB (BB-UVB) versus paint PUVA (p-PUVA) in regard to efficacy and safety in the treatment of PPTP., Methods: A retrospective non-randomized cohort study comprised of all the patients with PPTP treated in our phototherapy centre during 2010-2012, either with BB-UVB or p-PUVA., Results: Among the 248 patients included in this study, 122 received BB-UVB and 126 followed p-PUVA treatment. About 36 (30%) and 53 (42%) had complete remission, 29 (24%) and 59 (47%) responded partially and 57 (47%) and 14 (11%) patients did not improve with BB-UVB and p-PUVA, respectively. The odds ratio for remission (p-PUVA: BB-UVB) was 7.9. Duration of remission was 21.9 ± 1.34 months for p-PUVA and 16.75 ± 1.83 months for BB-UVB., Conclusion: Both BB-UVB and p-PUVA are good therapeutic options for PPTP. P-PUVA emerges as the superior treatment modality, yielding a better and more extended response. BB-UVB represents a feasible alternative in patients with milder disease or possible contraindications for p-PUVA.

Purpose: A variety of medications and procedures are available for the treatment of warts, but it appeared the treatment response in systemic lupus erythematosus (SLE) patients is poor. It is necessary to investigate the feasibility, safety and efficacy of local thermotherapy for extensive viral warts., Materials and Methods: A SLE patient on systemic steroid developed extensive viral warts on both her hands and feet for months. She had a high score of SLE Disease Activity Index (SLEDAI), up to 30, and was extensively treated with high and prolonged dosage of corticosteroid and intermittent use of cyclophosphamide. We applied local hyperthermia at 44 °C on a target lesion for 30 min on days 1, 2, 3, 17, 18, a protocol which has been successfully used in treating viral warts. There was no sign of clinical response in a 3-month follow-up. Then we treated the patient on a once-a-week protocol., Result: All the lesions cleared in ten weeks and there was no sign of recurrence., Conclusion: This observation suggests that more intensive local hyperthermia is required for clearing viral warts in SLE.

Cosmetic improvement in nail appearance is a great concern to patients with onychomycosis. Although oral and topical treatments for onychomycosis can potentially eradicate the infection, unsightly nails may remain despite negative mycology. Laser-based devices have been approved for the temporary clearance of nails with onychomycosis, thus providing a means of improving the aesthetic appearance of the nails. A retrospective chart review of patients treated with a Nd:YAG 1064-nm laser and debridement for onychomycosis, and terbinafine 1% cream for associated tinea pedis, between July 2012 and February 2014 was performed to ascertain the proportion of patients who achieved clinical outcomes. A temporary improvement in the appearance of the target nail was observed in 78% of patients and the affected area of the nail plate was reduced by at least 50% from baseline in 46% of patients. It appears that patients whose great toenails are potentially infected with non-dermatophyte molds may particularly benefit from laser therapy. Higher clinical outcome rates were observed with administration of four or more treatments, but additional observations and/or studies are needed to optimize the regimen of laser therapy to improve the cosmetic appearance of infected nails.

Background: Rubbing the skin and trauma may influence the persistence of psoriasis over time., Objectives: To assess the impact of a new fabric made with a special fluorine-synthetic fiber in improving plantar psoriasis., Methods: A total of 20 patients with symmetrical lesions were randomized to receive on one side a sock made of fluorine-synthetic fiber and on the other side a sock made of cotton fabric for 4 weeks. The main outcome was the percentage reduction of lesional area., Results: In an intention-to-treat analysis, the median lesion reduction was 11.95% in fluorine-synthetic fiber arm and 11.89% in cotton arm (p = 0.776). Among secondary outcomes, patient global satisfaction showed a statistically significant median score of 32 toward fluorine-synthetic fiber arm (p = 0.011)., Conclusion: In spite of our main negative results, it is important to continue investigating on the relation between textiles and skin disorders to improve patient well-being.

Background and Objectives: Palmoplantar warts are often hard to treat. They tend to relapse and the course of therapy is frustrating in many cases. The erbium:YAG laser(Er:YAG) with a wavelength of 2.94 rm is capable of achieving a rapid and precise ablation of warts, but about 14% of patients are non-responders as shown in a previous study. Podophyllotoxin is an established antimitotic agent derived from podophyllum plant resin, approved for human papilloma virus (HPV)-induced genital warts. The combination of both ablative Er:YAG laser and topical 0.5% podophyllotoxin solution in hard-to-treat palmoplantar HPV warts was investigated., Patients and Methods: Thirty-five patients with hard-to-treat warts(palmar or plantar) with a mean age of (32.2+12.1) years, range 17-50 years, with various pretreatments that had failed, were treated once by Er:YAG laser ablation with a spot size of 3 mm, a frequency between 8 Hz and 10 Hz, and a fluence of 5.7-11.3 J/cm2. After wound healing, topical podophyllotoxin 0.5% solution was applied for 3 days followed by a break of 4 days. Four to six treatment cycles with podophyllotoxin were performed., Results: After laser treatment followed by topical podophyllotoxin cream a complete response was observed in 31 patients (88.6%). Two patients with plantar warts and a complete response showed a relapse within 3 months after treatment (5.7%). None of the patients developed pigmentary changes,wound infections or scarring., Conclusion: The therapy of hard-to-treat warts with a combination of Er:YAG laser and topical podophyllotoxin is safe and effective. Compared with laser alone, the CR percentage seems to be higher and the percentage of relapses reduced.

The usual management of opportunistic fusarium infection in the immunocompromized patient is with systemic antifungals, despite which little impact is made on the mortality which approaches 100%. We describe a case of fusarium infection of the foot in a bone marrow transplant recipient which was successfully managed with local wide excisional surgery and intravenous liposomal amphotericin B.

Many of the painful foot problems seen in adults are easily treated. Bunions and bunionettes often respond to a change to wide, soft-toed shoes or sandals and the temporary use of a mild anti-inflammatory agent. Initial treatment of plantar keratoses is trimming and use of cushioning shoe inserts. Diffuse keratoses may require reconstructive surgery if metatarsal deformity is the cause. Seed corns and soft corns respond to trimming, and alleviation of pressure with padding and wearing of open-toed shoes is beneficial in these lesions as well as in hard corns. Surgical resection of any underlying exostosis may be required for hard or soft corns or "pump bumps," which are caused by pressure from the shoe's heel. In all cases, patients should be advised to change to shoes that provide plenty of room in the toe box and that minimize friction on painful areas.

The most common blistering diseases encountered in children are impetigo, burns, acute dermatitis, friction blisters, viral blisters, insect bite reactions, and linear IgA dermatosis. Diagnosis should be based on specific clinical manifestations and, when necessary, results of a Tzanck test or skin biopsy. A search for an intact blister is always warranted when erosions, oozing, or crusts are noted.