Dermatology Research and Practice最新文献

Background: Nail psoriasis is a challenging chronic condition affecting patients functionally and psychologically. Nail involvement is observed in 15-80% of psoriatic patients with occasional presence of isolated nail psoriasis.

Objectives: To evaluate dermoscopic features of nail psoriasis and correlate them clinically.

Methods: The study included fifty subjects with nail psoriasis. Psoriasis skin and nail severity was evaluated using psoriasis area severity index (PASI) and nail psoriasis severity index (NAPSI). Dermoscopy of the nails (onychoscopy) was performed, and features were recorded and analyzed.

Results: The most common clinical and dermoscopic findings were pitting (86%) and onycholysis (82%). Among all dermoscopic features of nail psoriasis, only longitudinal striations and subungual hyperkeratosis were significantly higher in patients with moderate to severe psoriasis than in patients with mild psoriasis (P=0.028; P=0.042, respectively). PASI scores correlated positively but none significantly with NAPSI scores (r = 0.132, P=0.360), and similarly, no significant correlation was observed between the duration of psoriasis and the dermoscopic NAPSI (r = 0.022, P=0.879).

Conclusion: Dermoscopy can serve as a useful tool for early diagnosis of psoriatic nail changes not always visible to the naked eye and is a non-invasive easy-to-use confirmatory tool for nail changes in psoriatic disease or in isolated nail involvement.

Background: Severe cutaneous adverse drug reactions (SCARs), although rare, are known to be associated with significant morbidity and mortality. SCARs include drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), and acute generalized exanthematous pustulosis (AGEP). Studies on SCARs are limited in Saudi Arabia. This study aims to characterize SCARs at a tertiary care center in Saudi Arabia.

Methods: A cross-sectional study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia. All inpatient and emergency department consultations to dermatology were electronically reviewed during the period from January 2016 to December 2020. All patients who developed an adverse cutaneous drug reaction were enrolled. Detailed analysis was performed only for SCARs. The culprit medication was determined based on the latency period, history of previous intake of the medication, and drug notoriety.

Results: There were 3050 hospital consultations to dermatology during the study period. Cutaneous adverse drug reactions constituted 253 (8.3%) cases. A total of 41 patients with SCARs were identified, accounting for 16.2% of all cutaneous drug reactions. Antibiotics and anticonvulsants were the most common causative drug groups accounting for 28 (68.3%) and 9 (22%) cases, respectively. DRESS was the most common SCAR. The latency period was the longest for DRESS and shortest for AGEP. Vancomycin was responsible for approximately a third of DRESS cases. Piperacillin/tazobactam was the most common cause for SJS/TEN and AGEP. The majority of drugs causing AGEP were antibiotics. The mortality rate was the highest in SJS/TEN (5/11 (45.5%)), followed by DRESS (1/23 (4.4%)) and AGEP (1/7 (14.3%)).

Conclusion: SCARs are rare in Saudis. DRESS appears to be the most common SCAR in our region. Vancomycin is responsible for most cases of DRESS. SJS/TEN had the highest mortality rate. More studies are required to further characterize SCARs in Saudi Arabia and Arabian Gulf countries. More importantly, thorough studies of HLA associations and lymphocyte transformation tests among Arabs with SCARs are likely to further improve patient care in the Arabian Gulf region.

Background: Molluscum contagiosum (MC) is a common viral skin infection primarily affecting children which is difficult to treat using available therapeutic approaches. The sulfated polysaccharide named calcium spirulan (Ca-SP) has demonstrated antiviral effects against herpes simplex virus in keratinocytes in vitro, and a cream containing 1.5% Ca-SP and 1% of a defined microalgae extract (Spiralin^®) effectively prevented herpes labialis in a trial with susceptible individuals. This observational study aimed to show antiviral effects of a similar formulation (Spirularin^® VS) against MC in children.

Methods: Children with active MC lesions were treated with Spirularin^® VS cream twice daily on affected skin over several months and asked to return for follow-up visits after 1 to 3 months. Clinical status of MC infection was documented at baseline and follow-up visits.

Results: Of the 31 children enrolled in the study, 26 completed treatment and returned for control visits. Spirularin^® VS cream was applied twice daily over a period of 1 to 9 months (mean treatment duration 3.9 months). 19/26 (73.1%) children achieved complete clearance of MC lesions with no clinical evidence of bacterial skin infection during treatment. No irritative skin reactions or unpleasant symptoms were observed or reported.

Conclusion: This open-label observational study suggests that a cream formulation containing 1.5% Ca-SP and 1% Spiralin® may be an effective and safe treatment option for children with active MC lesions. The high rate of complete clearance of MC lesions and lack of adverse reactions warrant further investigation in larger, controlled trials.

The treatment options for mycosis fungoides (MF) have been expanding but unfortunately many of the currently used treatment modalities are unavailable in Egypt and other African/Arab countries. In addition, there is a lack of consensus on the treatment of hypopigmented MF (HMF), which is a frequently encountered variant in our population. We aimed to develop regional treatment guidelines based on the international guidelines but modified to encompass the restricted treatment availability and our institutional experience. Special attention was also given to studies conducted on patients with skin phototype (III-IV). Treatment algorithm was formulated at Ain-Shams cutaneous lymphoma clinic through the collaboration of dermatologists, haematologists, and oncologists. Level of evidence is specified for each treatment option. For HMF, phototherapy is recommended as a first line treatment, while low-dose methotrexate is considered a second line. For early classical MF, we recommend Psoralen-ultraviolet A (PUVA), which is a well-tolerated treatment option in dark phenotype. Addition of either retinoic acid receptor (RAR) agonist and/or methotrexate is recommended as a second line. Total skin electron beam (TSEB) is considered a third-line option. For advanced stage, PUVA plus RAR agonist and/or methotrexate is recommended as first line, TSEB or monochemotherapy is considered a second line option. Polychemotherapy is regarded as a final option. All patients with complete response (CR) enter a maintenance and follow-up schedule. We suggest a practical algorithm for the treatment of MF for patients with dark phenotype living in countries with limited resources.

Background: Alopecia areata (AA) is a common form of noncicatricial hair loss of unknown cause, affecting 0.1-0.2% of the general population. Most evidence supports the hypothesis that it is disease of the hair follicle of autoimmune nature mediated by T-cells, with important cytokine role. Objective of the Study. The objective of this study is to study the association and changes in serum levels of interleukin-15 (IL-15) and tumor necrosis factor-α (TNF-α) in patients with AA in relation to the type, activity, and disease duration. Patients and Methods. Thirty-eight patients with AA and 22 individuals without the disease as controls were enrolled in this case-controlled study conducted in the Department of Dermatology in the Al-Kindy Teaching Hospital and Baghdad Medical City, Iraq, during a period from the 1st of April 2021 to the 1st of December 2021. Serum concentrations of IL-15 and TNF-α assessed using the enzyme-linked immunosorbent assay.

Results: The mean serum concentration values for IL-15 and TNF-α were higher significantly in patients with AA than in controls (2.35 versus 0.35 pg/mL and 50.11 versus 20.92 pg/mL, respectively). IL-15 and TNF-α showed no statistically significant differences in level in terms of the type, duration, and activity of the disease, but TNF-α significantly higher in those with totalis-type than in other types.

Conclusion: Both IL-15 and TNF-α are markers for alopecia areata. The level for these biomarkers was not affected by duration or disease activity, but it was affected by the type of disease, as the concentrations of IL-15 and TNF-α were higher in patient with Alopecia totalis than in other types of Alopecia.

Background: Lichen planopilaris (LPP) is a rare inflammatory disorder of the scalp that causes cicatricial alopecia. No therapeutic approach has been approved for this disease due to the rare frequency. Methotrexate and corticosteroid are commonly considered second- or third-line therapy. The efficacy of a combination of methotrexate and corticosteroid has been reported in some dermatological and immunological diseases. However, the efficacy of this combination in LPP is not clear. Therefore, this study aimed to compare the impact of methotrexate alone and in combination with corticosteroid on LPP.

Materials and methods: This randomized clinical trial was performed on 28 patients who referred to the dermatology clinic affiliated with Isfahan University of Medical Sciences, Isfahan, Iran during February 2015-December 2016, and 24 of them completed the trials. Fourteen patients received 15 mg methotrexate per week alone and the other fourteen subjects received 200 mg prednisolone plus 15 mg methotrexate per week. The primary outcome was Lichen planopilaris activity index (LPPAI) score. Moreover, we evaluated photographic changes and symptoms during the study.

Results: The mean of LPPAI in both groups decreased during the follow-up with a similar pattern of LPPAI changes in both groups. No statistically significant difference was found between the two intervention groups regarding the LPPAI score. We found no difference in the symptoms and photographic assessments in methotrexate and combination therapy groups during follow-up. In both groups, exclusively one adverse effect was reported.

Conclusions: Our results showed that methotrexate therapy with and without corticosteroids had similar efficacy and safety.

Background: Attention to the administration of probiotics for the treatment of psoriasis has recently increased.

Aim: In the present study, improvements in dermatology life quality index (DLQI), psoriasis area severity index (PASI), and visual analogue scale (VAS) scores in the psoriasis patients receiving Lactocare® probiotic were compared to psoriasis patients receiving placebo.

Methods: A total of 52 psoriasis patients were included in this study and randomly divided into treatment and placebo (control) groups. The control group received topical hydrocortisone associated with placebo; in the treatment group, Lactocare® was administrated orally associated with hydrocortisone. The mean of VAS, DLQI, and PSAI scores was recorded and evaluated pretreatment and post-treatment in both groups for 3 months. The mean of the scores in the control groups was compared to the treatment group. Intragroup analysis was preformed with a comparison of the mean of these scores at baseline 4-, 8-, and 12-weeks post-treatment.

Results: In the treatment group, a significant decrease was seen in PASI, VAS, and DLQI scores compared to the control group on week 12 post-treatment.

Conclusion: Oral administration of Lactocare® probiotic (two times daily) associated with administration of topical hydrocortisone resulted in the improvement of PASI, DLQI, and VAS scores in the patients with psoriasis after 12 weeks of treatment. PASI reduction occurred in all patients who received probiotics.

Fordyce angiokeratoma is a benign lesion commonly developing on the scrotal skin. The incidence increases with age. About half of these lesions may be symptomatic and frequently cause itching and bleeding. Although the treatment is not always considered necessary, several treatment methods are used for symptomatic cases, especially for cosmetic purposes. Treatment options include surgical excision, laser ablation, electrocoagulation, cryotherapy, and sclerotherapy. The most widely used methods are electrocoagulation and cryotherapy. Although these two methods are similarly effective and safe, there are differences in means of patient comfort and cosmetic outcomes. Patient comfort can be defined as pain management during the procedure and the healing period. Bleeding and wound infection are other parameters that may decrease patient comfort. Patients would prefer treatment methods with less or no pain and shorter recovery periods, healthcare providers, and insurance. The cosmetic result is another critical issue, especially for patients with multiple lesions. Treatment methods avoiding genital scars are more likely to meet the aesthetic demands of the patients.

Chemical substances used during batik processing may affect the physiological function of the batik worker's skin barrier. This study assessed the level of transepidermal water loss (TEWL), skin hydration, and skin acidity in 61 batik workers from the batik center in Paseseh village, Tanjung Bumi subdistrict, Madura Island, Indonesia. Forty-five batik workers involved in dry work including drawing patterns on the cloth with wax and sixteen batik workers involved in wet work including dyeing the cloth with a dye bath were included in this study. The mean TEWL level in the dry work section was 59.87 ± 11.94 g/m²/h on the palmar and 29.00 ± 13.09 g/m²/h on the dorsal side of the hand, while the mean TEWL in the wet work section were 47.39 ± 9.66 g/m²/h on the palmar and 37.07 ± 10.00 g/m²/h on the dorsal side of the hand. The mean skin hydration level in the dry work section was 49.80 ± 19.16 arbitrary units (a.u.) for the palmar side and 52.77 ± 16.21 a.u. for the dorsal side of the hand, while the mean levels of skin hydration in the wet work section were 47 ± 12.73 a.u. and 62.94 ± 10.09 a.u. for palmar and dorsal side, respectively. The mean levels of skin acidity in the dry work section were 5.45 ± 0.19 for the palmar side and 5.30 ± 0.20 for the dorsal side of the hand, while the wet work section had 5.30 ± 0.19 and 5.10 ± 0.19 for the palmar and dorsal side of the hand, respectively. The TEWL levels were found to be higher on the palmar side of the hand in both the dry work and wet work sections, which was consistent with the measurement of skin hydration levels that were lower on the palmar side of the hand. The mean skin pH levels for both work sections were considered within the normal range.

Objective: There is insufficient evidence to generate skin cancer screening guidelines at the population level, resulting in arbitrary variation in patient selection for screening skin examinations. This study was aimed at developing an easy-to-use predictive model of nonmelanoma skin cancer (NMSC) risk on screening total body skin examination (TBSE).

Methods: This epidemiologic assessment utilized data from a prospective, multicenter international study from primarily academic outpatient dermatology clinics. Potential predictors of NMSC on screening TBSE were identified and used to generate a multivariable model that was converted into a point-based scoring system. The performance characteristics of the model were validated in a second data set from two healthcare institutions in the United States.

Results: 8,501 patients were included. Statistically significant predictors of NMSC on screening TBSE included age, skin phototype, and history of NMSC. A multivariable model and point-based scoring system using these predictors exhibited high discrimination (AUC = 0.82).

Conclusion: A simple three-variable model, abbreviated as CAP (cancer history, age, phototype) can accurately predict the risk of NMSC on screening TBSE by dermatology. This tool may be used in clinical decision making to enhance the yield of screening TBSE.