Febrile ulceronecrotic Mucha-Habermann disease (FUMHD) is a rare severe variant of pityriasis lichenoides et varioliformis acuta characterized clinically by aggressive ulceronecrotic skin lesions associated with high fever and histologically by features typical of pityriasis lichenoides et varioliformis acuta. Despite the continuous addition of new case reports, no definite diagnostic criteria have been established, and an optimum treatment is still waiting. Herein, we review the different aspects of this rare entity, including pathogenesis, clinical and histopathological features, differential diagnosis, course, prognosis, and outcome. Different diagnostic and therapeutic challenges associated with FUMHD are also evaluated and discussed. We propose two sets of diagnostic criteria to define the disease more precisely and to avoid missing cases. The first comprises constant clinical and histopathological features that are always present in every case, the combination of which is necessary for diagnosis. The second set includes variable features that may be present in some cases and to which any emerging finding could be added. Although different therapeutic options have been used, there is no optimum therapy for FUMHD, and the disease still represents a therapeutic challenge.

We propose two sets of diagnostic criteria to define the disease more precisely and to avoid confusion associated with the other classification. The first set comprises constant clinical and histopathological features that are always present in every case, and the second set includes associated features that were variably reported in some patients. LM is then subclassified according to the presence or absence of systemic manifestations into a systemic severe form (scleromyxedema) and a non-disabling, pure cutaneous form.

No abstract

Background The burden of human papillomavirus (HPV) infection and HPV‐associated diseases is consistently growing worldwide. Several combination therapies are being tested nowadays for the treatment of recalcitrant warts, with promising results. Aims To evaluate the potential therapeutic role of combined bivalent HPV vaccine (Cervarix) and Candida antigen versus candida antigen alone in the treatment of multiple recalcitrant warts. Patients/Methods Forty patients with recalcitrant warts were enrolled into this study. They were divided into two groups (A and B), each including 20 patients. Patients in the group (A) received intralesional Candida antigen injection alone for five sessions at 2‐week intervals. Patients in the group B received combined treatment of bivalent recombinant HPV vaccine and intralesional Candida antigen. Candida antigen was administered as in the group A, while Cervarix vaccine was given intramuscularly at 0, 1, and 6 months as scheduled. Follow‐up was made monthly for 6 months to detect any possible recurrence. Results Eight patients (40%) in the group (A) showed complete clearance of warts after intralesional Candida antigen injection alone, while 14 patients (70%) in the group (B) showed complete regression of warts after the combined therapy. No significant side effects were reported in both groups, and no recurrence was detected. Conclusion Bivalent human papillomavirus vaccine combined with Candida antigen is a promising, effective, and safe modality for the treatment of multiple recalcitrant warts.

Intralesional immunotherapy by different antigens has shown promising efficacy and safety in the treatment of warts. However, the use of these antigens for the treatment of plane warts has been investigated in two studies only. To evaluate the efficacy and safety of three antigens; Measles Mumps, Rubella vaccine (MMR), Candida antigen, and purified protein derivative (PPD) in the treatment of multiple plane warts. The study included 120 patients who were randomly assigned to three groups, 40 patients in each group. Each agent was injected intralesionally at a dose of 0.1 mL into the largest wart at 2-week intervals until complete clearance or for a maximum of five sessions. Complete clearance of warts was observed in 55% of the PPD group, in 70% of the Candida antigen group, and in 62.5% of the MMR group. No statistically significant difference in the therapeutic response was found between the three groups. Intralesional antigen immunotherapy seems to be a promising well-tolerated and effective therapeutic option for the treatment of multiple plane warts, with relatively higher efficacy of Candida antigen.