Angiolymphoid hyperplasia with eosinophilia (ALHE) is an idiopathic acquired condition characterized by erythematous papulo-nodular lesions with a predilection for the head and neck. The lesions are cosmetically disfiguring, resistant to most medical and surgical therapies and tend to recur. We report the novel use of radiofrequency equipment in the management of nodular ALHE on forehead of a 53-year-old man. Intra-lesional radiofrequency ablation was done using a modified 18 gauge intravenous cannula and three sittings over a period of four years yielded cosmetically acceptable results with no recurrence and minimal side effects.

Background Monoclonal antibodies are explored for their therapeutic potential in Psoriasis. Objectives To evaluate Risankizumab in the moderate to severe psoriasis with regard to efficacy, tolerability and safety Data sources PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and clinicaltrials.gov, databases were searched for relevant RCTs. The reference lists of relevant publications were also scanned manually to identify any further studies not indexed in the searched databases. Study eligibility criteria Only RCT aiming to evaluate the role of Risankizumab in the treatment of moderate to severe psoriasis were considered eligible for this systematic review. Interventions Intervention group was patients taking Risankizumab and placebo or other monoclonal antibody was considered as control group. Study appraisal and synthesis methods Cochrane review manager 5 (RevMan) version 5.3 was used for data synthesis and meta‐analysis. Quality assessment of included randomized controlled trials was done with Cochrane Collaboration risk of bias assessment tool, version 2.0 (ROB‐2). Overall Grading of evidence for study objectives was performed with GRADE Pro GDT software. Results A total of seven studies were included in analysis with total of 1533 and 710 patients in Risankizumab and standard care groups, respectively. Statistically significant increase in percentage of individual achieving PASI90 (OR= 11.01 (95% CI = 8.67‐13.99), DLQI‐01 (OR= 6.95 (95% CI = 5.53‐8.75), sPGA‐01 (OR= 14.22 (95% CI = 11.10‐18.22); sPGA‐0 (OR= 6.39 (95% CI = 4.79‐8.54) in risankizumab group as compared to control, with high quality of evidence. Increased risk of infections with risankizumab as compared to placebo ((OR= 1.44 (95% CI = 1.13‐1.83), high quality evidence), while no difference in SAE among two groups. Strengths Analysis of all outcome data from RCTs. Conclusions In the light of evidence from systematic review on effectiveness of Risankizumab, we propose treatment with risankizumab for psoriasis patients not responding to available treatment.

Background Although intralesional triamcinolone acetonide(TA) is the most commonly prescribed treatment for localized alopecia areata(AA), the literature regarding the optimal concentration for attaining better efficacy with the most acceptable side effects is scarce. Objectives To compare hair regrowth and local side effects of various concentrations of intralesional TA in scalp AA using clinical and dermoscopic parameters. Material and methods A double‐blind randomized control trial with four treatment groups [10‐mg/ml, 5‐mg/ml, 2.5‐mg/ml TA and normal saline (NS)] was conducted between March‐2018 and August‐2019. After recruitment, each AA patch was divided into quadrants and randomized before first injection. Injections were given and outcome parameters were analyzed every 4‐weekly till 12‐weeks. Statistical analysis was done by R software employing Generalised Estimation Equation. p‐value <0.05 was considered significant. Results Out of 105‐patients (168‐AA patches), 75‐patients (121‐patches) completed the study. Hair regrowth scale (RGS) of all TA concentrations were better than NS group (p<0.001). Other parameters such as quadrants with poor clinical response and dermoscopic disease activity signs were also favorable in TA groups in comparison to NS. However the evidence of atrophy and telangiectasia was maximum in 10‐mg/ml group. Conclusion 10‐mg/ml TA showed a comparatively better response at the cost of increased adverse effects. Based on the clinical benefit and adverse risk assessment from our study, it may be better to start with 2.5‐mg/ml intralesional TA in limited scalp AA patients. It can be implied that the concentration of TA can be increased as a step‐up regimen based on the serial clinical and dermoscopic response.

Design: Interventional, prospective, four arm randomized control.Setting: Outpatient department, Department of Dermatology, Venereology and Leprology, AIIMS Jodhpur (Rajasthan), India.Participants: Two hundred patients.Methods: The intervention administered in the groups were normal saline (A), vitamin D₃ (B), MIP (C), and MMR (D). The injections were given into the largest wart at 2‐weekly intervals until complete clearance or for a maximum of seven sittings. Post‐treatment clearance of the injected wart and the distant wart was compared on the basis of change in wart number, percentage clearance, and mean time to complete clearance. Side effects were recorded.Results: A total of 197 patients were recruited. The mean percentage improvement in the injected and non‐injected warts was 68.4% and 66.8%, respectively. Intention to treat analysis (ITT) showed that complete clearance of lesions in injected wart occurred in placebo, vit D₃, MMR, and MIP arms in 64%, 66%, 58%, and 55% patients, respectively (p > 0.05), while in the non‐injected warts in 62%, 64%, 52%, and 53%, respectively (p > 0.05). The mean time to achieve complete clearance of wart was fastest in MIP at 7.1 weeks followed by MMR at 7.2 weeks, VIT D₃ at 7.4 weeks and in placebo group 7.8 weeks (p > 0.05). Side effects noted were fever, pain, erythema, and swelling which was highest in VIT D₃ group (p < 0.05).Conclusion: The efficacy of immunotherapies was comparable to placebo with minimal side effects.