Dermatology Research and Practice最新文献

Background: Pemphigus vulgaris is a rare bullous autoimmune dermatosis whose evolution and prognosis are unpredictable.

Aim: The objective was to analyze long-term outcomes in patients with pemphigus vulgaris by identifying the factors that are able to influence prognosis, in particular the phenotype of pemphigus vulgaris, age at onset, multiplicity of mucosal involvement, relapse and remission rates, and survival functions.

Methods: A retrospective analysis of a cohort of 31 patients followed for pemphigus vulgaris during the period from January 2004 to January 2014. Inclusion criteria were a diagnosis of pemphigus vulgaris confirmed by histopathology and direct immunofluorescence (DIF) and a period of follow-up of at least five years from the diagnosis. The following information was collected by a single investigator.

Results: In total, 67.7% of patients presented a mucocutaneous pemphigus vulgaris. Male-female sex ratio was 2.4. The median duration of patient's follow-up was estimated at 7 (6-9) years. Multiple mucosal involvement in the oral cavity and at other mucosal sites was significantly associated with severe mucocutaneous pemphigus vulgaris (p=0.01). Multiple relapses were significantly associated with the disease severity (p=0.04).

Conclusion: Poor prognosis factors were severe mucocutaneous type of pemphigus vulgaris and multiple mucosal involvement in the oral cavity and at other mucosal sites.

Background: Chronic urticaria (CU) is a common skin disease; however, its etiology is rarely recognized. Infection due to Helicobacter pylori (H. pylori) has been shown in some studies to play a significant role in the pathogenesis of CU.

Objective: This study was conducted to determine the association between CU and H. pylori infection among patients attending the Regional Dermatology Training Center, Northern Tanzania, from October 2018 to April 2019. Methodology. A matched case-control study that included 55 cases and 55 controls matched by age and sex was conducted. Data were collected through direct interviews, and the results of laboratory investigations were recorded in the extraction sheet. An enzyme-linked immunosorbent assay test was used to detect H. pylori antigen in the stool samples. Conditional logistic regression was used to measure the association between CU and H. pylori.

Results: The total number of participants in this study was 110 patients (55 cases and 55 controls), whereby the median age was 31 (IQR 27-45) among controls versus 34 (IQR: 22-46) years among the cases. Both cases and controls had the same number of females and males. There was no significant association between CU and baseline characteristics of the participants. There was an association between CU and H. pylori infection, such that subjects with CU had a higher number of positive H. pylori test (15/55 = 27%) versus controls (6/55 = 10.1%) (p = 0.0225). The adjusted odds of CU among patients who were positive for H. pylori were sixfolds higher (OR = 6.9; CI: 1.3-36.2; p = 0.021) than those of patients who were negative for H. pylori.

Conclusion: There was a strong and significant association between CU and H. pylori infection. We recommend investigating for H. pylori in all cases of CU and conducting further trials on H. pylori eradication.

Background: It is expected that a combination of amniotic membrane stem cell metabolite product (AMSC-MP) and vitamin E after fractional CO₂ laser as laser-assisted drug delivery (LADD) will provide better effects in photoaging treatment as the combination reaches the target. This promises an option for photoaging therapy in the future.

Materials and methods: Sixty women with photoaged skins were involved in this experimental study. They were then divided into two groups. The treatment group received a topical combination of AMSC-MP and vitamin E, and the control group received AMSC-MP alone after fractional CO₂ laser. The treatment was repeated three times.

Result: The Janus assessment results showed a significant difference in pores in the third observation, and the average pore improvements in the treatment group were better than the control group. Wrinkle, UV spot, and polar spot did not show any significant difference.

Conclusion: A combination of the amniotic membrane stem cell metabolite product (AMSC-MP) and vitamin E after fractional CO₂ laser as LADD only improves pores in photoaged skins.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has affected 210 countries and territories around the world. The virus has spread rapidly, and the disease is still extending up to now. The pathophysiology for SARS-CoV-2 has not been well elucidated, and diverse hypotheses to date have been proposed. Initially, no skin manifestations were observed among patients with COVID-19, but recently a few cases have been described. In this review, we discuss these various cutaneous manifestations and skin problems related to personal protective equipment, as well as different cutaneous anti-COVID-19 drug-associated reactions. We also focus on the currently proposed managements of these rare manifestations.

Radical ablative surgery is the gold standard treatment of head skin cancer. The authors expose their experience with a new artificial dermis (Pelnac®), analyzing retrospectively the overall morbidity and aesthetic outcomes. 16 consecutive patients underwent two surgical procedures under local anesthesia. The first involved the tumor removal and application of the ADM. In the second, the exposed tissue was covered with a split-thickness skin graft. On follow-up (6 months), tumor recurrences, quality of scars (using the Vancouver Scar Scale), and patient reported outcomes (using FACE-Q Skin Cancer Module) were evaluated. 10 were males and 6 females, with a mean age of 73 years (61-89). The follow-up ranged from 12 to 48 months (mean: 30). The sites of skin tumor were scalp (12 cases), forehead (2), cheek (1), and zygomatic area (1). Nine patients underwent previous local surgery; two received radiotherapy. The average length of hospital stay was 3.2 days. The mean surface area of the defect was 59.15 cm² (16.9-89.5). In three cases, the surgical bed was bone without periosteum. The malignant tumors excised were basal cell carcinoma (68.75%), squamous cell carcinoma (18.75%), malignant melanoma (6.25%), and sarcoma (6.25%). The mean operating time was 41 minutes for the first operation (25-55) and 34 for the second (25-48). No significant problems were observed and 15 patients (93.75%) had 100 percent intake of graft. The mean time of healing was 39 days (32-45). At 6 months post-op, no tumor recurrence. Satisfactory cosmetic and functional results were obtained in all patients as shown by the VSS Scale and FACEQ skin cancer module mean scores. We believe that the artificial dermis is a reliable alternative to flaps and should be considered an excellent option in head reconstruction for skin cancer, especially in critical patients (old, with large and deep defects, with recurrent tumors, required radiotherapy).

Background: Cryotherapy (freezing by liquid nitrogen) is an effective and widely used method for treatment of common warts. Patients often need multiple sessions at variable intervals. Protocols used by different dermatologists vary in terms of freezing time, the number of cycles, and the intervals between sessions.

Aim: To compare the efficacy (cure rates) and safety (complications, early and late) of two cryotherapy treatment protocols for common viral warts.

Method: A prospective observational study was conducted; it involved 80 patients with common warts on the hands and feet who were treated with cryotherapy done by two dermatologists who use different protocols; group 1 (45 patients) were treated by a single cycle of 10 seconds of freezing at 2 weekly intervals, and group 2 (35 patients) received a single cycle of 20 seconds of freezing at 4-weeks intervals. The two protocols were compared in terms of cure rate and complications 1-2 months after the final treatment. Recurrence rate and late complications were assessed at 9-12 months after the final treatment.

Results: Group 1 patients achieved higher cure rate than group 2, 77.8% and 54.3%, respectively (P=0.001). Early (blistering) and late complications (dyspigmentation and scarring) were comparable in both groups. Pain score associated with protocol 1 (5.2/10) was less than protocol 2 (6.4/10) (P=0.004). Recurrence rate (17%) was comparable in both groups. Association between cure rate and duration of warts (P=0.022) and also association between cure rate and the mean number of warts (P=0.001) were demonstrated.

Conclusions: Cryotherapy is an effective and safe treatment for common viral warts of hands and feet. The impact of shorter intervals on cure rate was more significant than increasing freezing time with longer intervals between freezing sessions. The study was approved by the local IRB committee (285-2018).

The work attempts to obtain a multifunctional plant extract derived from Moringa tree leaves. Obtained results indicate a strong antioxidant potential of the tested extracts. It was shown that Moringa oleifera leaf extract is a rich source of flavonoid and phenolic compounds. Furthermore, it shows a strong antioxidant activity by scavenging free radicals. In vitro toxicity studies showed that the tested extracts in concentrations up to 5% showed a positive effect on cell proliferation and metabolism and may contribute to the reduction of oxidative stress in cells. It was noted that the tested model formulation of cosmetic (1% SCS) with the addition of different types of extracts might contribute to the reduction of skin irritation and improve the safety of the product.

Background: The overall well-being, sense of stigmatization, and treatment outcome of persons with vitiligo are largely dependent on their social acceptance and this is linked with perception and attitude of this disease in a given population. Therefore, this study assessed the knowledge and attitude of the public towards vitiligo.

Methods: A cross-sectional survey was carried out using a self-reported questionnaire distributed to adults living in Mekelle city, Northern Ethiopia from August to November 2019. Individuals who were 18 to 65 years of age and not suffering from vitiligo were included in the study. A self-administered questionnaire that contains a demographic, knowledge, and attitudes parts was used to collect data. Data were entered using Epi Data® version 3.1 and analyzed using SPSS® version 21.

Results: Of the total 368 subjects, 300 completed the questionnaires giving 81.5% response rate. The mean age was 30 ± 8.3 years and the male-to-female ratio was 1.14 : 1. Friends or families were reported as the most common source of information (70%) about vitiligo. The overall vitiligo knowledge was sufficient in 68.3% of the participants. Higher vitiligo-related knowledge scores were recorded by people older than 30 and below 50, those of secondary school graduated or more, urban-dwellers, persons who had heard about vitiligo, and persons having families or friends affected by vitiligo. Attitudes towards vitiligo were positive in 43.3% of participants. This was more prevalent among employed persons, those of secondary school graduated or more, and persons having families or friends affected by vitiligo. Moreover, sufficient knowledge was significantly related to positive attitudes towards the disease (p < 0.0001).

Conclusion: Even though the majority of the respondents had sufficient knowledge, we still found misconceptions and negative attitudes towards vitiligo. Therefore, it is still crucial to educate the public about vitiligo to ultimately improve the well-being of patients with vitiligo.

Background: Vitiligo is not a well-studied disease in Ethiopia. Therefore, this study assessed its clinico-epidemiological profile and treatment patterns.

Methods: An institutional-based cross-sectional study was conducted in conveniently selected dermatologic clinics of Mekelle city, Ethiopia. A two-phased study was conducted, in which the first was to determine prevalence of vitiligo while the second phase was to describe the clinico-epidemiological profile and treatment pattern of vitiligo. Four-hundred three randomly selected dermatological patients were included in the first phase study. The second phase study included vitiligo cases from the first phase study and additional vitiligo cases found in a two months period prospective study.

Results: Of the 403 randomly selected dermatological patients who presented in the year 2017 to 2019, the prevalence of vitiligo was 13.15%. Of the 79 cases with vitiligo, nearly two-thirds (50, 63.3%) were males with five years as the median age at onset of the disease. Positive family history of vitiligo was recorded in about one-third (25, 31.6%) of the cases. Limbs (48, 44.5%) followed by the head and neck (26, 24%) were the most commonly affected parts of the body at the onset of the disease. The most prevalent clinical form of vitiligo was vulgaris (39.2%) followed by the focal type (26.6%). Emotional upset (24, 33.8%) and physical traumas (23, 32.4%) were the frequently reported triggering factors of vitiligo. Three-fourths (75.5%) of the cases had prescriptions of topical corticosteroids, and 24.5% of them had prescriptions of sun screen lotion.

Conclusion: The prevalence of vitiligo was found to be high. The clinico-epidemiological profile of vitiligo in Ethiopia was similar with that found globally. However, treatment options of vitiligo were very limited in Ethiopia.

Background: Uses of general anaesthesia in outpatient invasive procedures have increased, especially in dermatology. Being uncooperative, children often require general anaesthesia, since surgical skin operations are mostly painful.

Aim: The purpose of this study is to evaluate the safety, significant adverse events, and the complication rates related to general anaesthesia, when used among pediatric population undergoing skin procedures.

Methods: We conducted a first retrospective cohort study of patient chart review during the period from September 1, 2017 through September 2019. All patients admitted for pediatric skin procedures during this period have participated in our study. We reviewed selected charts to document any unexpected admissions, adverse events, or complications. Surgical outcomes and anaesthesia complications were reviewed by three anesthesiologists. We assessed inter-rater reliability.

Results: A total of 211 procedures were reported for 211 patients with 19 diagnoses. No adverse events related to anaesthesia were recognized, apart from minor complications noticed in twelve patients. The kappa value range is between 0.78 and 1.00 (95% C.I., 0.46809 to 1.00).

Conclusion: Dermatologist and pediatricians can safely do necessary procedures under general anaesthesia with the supervision of pediatric-trained anesthesiologists while considering other safety and risk precautions and the pediatric age group.