Background Psoriasis is a T-cell mediated chronic inflammatory, a papulosquamous disease involving complex interactions between the innate and adaptive immune system and commonly manifested by skin lesions. It is characterized by hyperproliferation of keratinocytes and inflammatory infiltration in the epidermis and dermis. Chronic psoriasis can be a risk factor for developing comorbid diseases that share common immune pathophysiology and can be triggered by environmental factors in genetically susceptible individuals. Aim To study the clinico-demographic profile, determine the most common triggering factors and determine comorbidities' coexistence in patients with psoriasis at a tertiary care centre. Study Design A cross-sectional study. Methods A teaching hospital-based cross-sectional study including 231 psoriasis patients visiting skin outpatient department (OPD) was conducted by the dermatology departmentat Sri Krishna hospital, Karamsad, India following acceptance of the study proposal by the human research ethics committee. This study was outcome of the dissertation topic of the author during dermatology residency. Total 5 qualified dermatologists working in the dermatology department and 3 resident doctors took part in the study as evaluators. After taking informed consent, detailed history regarding aggravating factors, progress and morbidities was taken with clinical examinations, and the diagnosis was purely clinical. Data were analysed using statistical package for the social sciences (SPSS). Result Our study revealed a peak incidence of psoriasis in the fourth and fifth decade of life with male preponderance (1.9:1). The most commonly found psoriasis type was psoriasis vulgaris, and chronic plaque psoriasis and the most common site of involvement was extensors and trunk. Pruritis was the most disabling complaint (91.34%), and the disease course was progressive. Aggravating factors included stress, winter season, implant insertion, smoking, alcohol consumption, tobacco chewing and obesity. Koebner phenomenon was commonly found with implant insertion in psoriasis patients (76.2%). Family history was one of the well established risk factors for developing psoriasis (14.2%). Our study's most commonly found nail changes were pitting (35.49%) and dystrophic changes (18.61%). Palmoplantar keratoderma (4.76%) and vitiligo (4.76%) were the most commonly found dermatological condition with psoriasis and have been associated with various comorbidities such as cardiovascular disorder, metabolic syndrome, psoriatic arthritis and psychiatric disorders. As it was a cross-sectional study, no controls were used. Conclusion The study shows male preponderance and extensors, trunk as common sites of psoriatic lesion presentation. Aggravating factors included stress, winter season, implant insertion, smoking, alcohol consumption, tobacco chewing and obesity. Screening is encouraged for symptoms of psoriatic arthritis, cardiovascular diseases and metabolic
{"title":"Clinical Descriptive Study of Psoriasis in India: Triggers, Morbidities and Coincidences","authors":"P. Naik","doi":"10.17140/drmtoj-6-144","DOIUrl":"https://doi.org/10.17140/drmtoj-6-144","url":null,"abstract":"Background Psoriasis is a T-cell mediated chronic inflammatory, a papulosquamous disease involving complex interactions between the innate and adaptive immune system and commonly manifested by skin lesions. It is characterized by hyperproliferation of keratinocytes and inflammatory infiltration in the epidermis and dermis. Chronic psoriasis can be a risk factor for developing comorbid diseases that share common immune pathophysiology and can be triggered by environmental factors in genetically susceptible individuals. Aim To study the clinico-demographic profile, determine the most common triggering factors and determine comorbidities' coexistence in patients with psoriasis at a tertiary care centre. Study Design A cross-sectional study. Methods A teaching hospital-based cross-sectional study including 231 psoriasis patients visiting skin outpatient department (OPD) was conducted by the dermatology departmentat Sri Krishna hospital, Karamsad, India following acceptance of the study proposal by the human research ethics committee. This study was outcome of the dissertation topic of the author during dermatology residency. Total 5 qualified dermatologists working in the dermatology department and 3 resident doctors took part in the study as evaluators. After taking informed consent, detailed history regarding aggravating factors, progress and morbidities was taken with clinical examinations, and the diagnosis was purely clinical. Data were analysed using statistical package for the social sciences (SPSS). Result Our study revealed a peak incidence of psoriasis in the fourth and fifth decade of life with male preponderance (1.9:1). The most commonly found psoriasis type was psoriasis vulgaris, and chronic plaque psoriasis and the most common site of involvement was extensors and trunk. Pruritis was the most disabling complaint (91.34%), and the disease course was progressive. Aggravating factors included stress, winter season, implant insertion, smoking, alcohol consumption, tobacco chewing and obesity. Koebner phenomenon was commonly found with implant insertion in psoriasis patients (76.2%). Family history was one of the well established risk factors for developing psoriasis (14.2%). Our study's most commonly found nail changes were pitting (35.49%) and dystrophic changes (18.61%). Palmoplantar keratoderma (4.76%) and vitiligo (4.76%) were the most commonly found dermatological condition with psoriasis and have been associated with various comorbidities such as cardiovascular disorder, metabolic syndrome, psoriatic arthritis and psychiatric disorders. As it was a cross-sectional study, no controls were used. Conclusion The study shows male preponderance and extensors, trunk as common sites of psoriatic lesion presentation. Aggravating factors included stress, winter season, implant insertion, smoking, alcohol consumption, tobacco chewing and obesity. Screening is encouraged for symptoms of psoriatic arthritis, cardiovascular diseases and metabolic","PeriodicalId":39105,"journal":{"name":"Open Dermatology Journal","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78421576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mai Hasegawa, T. Ogawa, Tatsuo Fukai, R. Ueki, S. Ikeda
Progestogen hypersensitivity (PH) is a cyclical dermatosis that occurs in fertile women during the luteal phase of the menstrual cycle. The clinical presentation is variable and non-specific. We report the case of a 42-year-old woman with a 10-year history of itchy skin lesions that recurred monthly. Determined with her basal body temperature chart, her skin symptoms were related to progesterone surges. Skin examinations revealed multiple and extensive monomorphic red papules, mainly on her arms and legs, as well as on her chest and back. She had no history of associated fever or dyspnea. Her hair, nails and mucous membranes were normal. A blood test at the time of the worst skin eruption revealed mild elevation of serum thymus and activation-regulated chemokines and eosinophilia. Her total serum IgE level was normal. She showed a delayed skin reaction to progesterone. Ultra-low-dose combined oral contraceptives (COCs) improved her symptoms by suppressing ovulation. Accordingly, a diagnosis of progestogen hypersensitivity was made. A T-helper (Th)2 response rather than a Th1 response was suggested to be involved in this case. Atopic dermatitis (AD) can be classified into the major extrinsic type with high serum IgE levels and the minor intrinsic type with normal IgE levels. PH and AD share similarities in that they present with eczema, IgE-mediated sensitization and delayed hypersensitivity responses, and their pathophysiology remains to be fully elucidated because of their heterogeneous aspects. The symptoms of this case were in line with IgE-low AD rather than IgE-high AD, which implicates endogenous progesterone as a trigger.
{"title":"A Case of Progestogen Hypersensitivity","authors":"Mai Hasegawa, T. Ogawa, Tatsuo Fukai, R. Ueki, S. Ikeda","doi":"10.17140/drmtoj-6-145","DOIUrl":"https://doi.org/10.17140/drmtoj-6-145","url":null,"abstract":"Progestogen hypersensitivity (PH) is a cyclical dermatosis that occurs in fertile women during the luteal phase of the menstrual cycle. The clinical presentation is variable and non-specific. We report the case of a 42-year-old woman with a 10-year history of itchy skin lesions that recurred monthly. Determined with her basal body temperature chart, her skin symptoms were related to progesterone surges. Skin examinations revealed multiple and extensive monomorphic red papules, mainly on her arms and legs, as well as on her chest and back. She had no history of associated fever or dyspnea. Her hair, nails and mucous membranes were normal. A blood test at the time of the worst skin eruption revealed mild elevation of serum thymus and activation-regulated chemokines and eosinophilia. Her total serum IgE level was normal. She showed a delayed skin reaction to progesterone. Ultra-low-dose combined oral contraceptives (COCs) improved her symptoms by suppressing ovulation. Accordingly, a diagnosis of progestogen hypersensitivity was made. A T-helper (Th)2 response rather than a Th1 response was suggested to be involved in this case. Atopic dermatitis (AD) can be classified into the major extrinsic type with high serum IgE levels and the minor intrinsic type with normal IgE levels. PH and AD share similarities in that they present with eczema, IgE-mediated sensitization and delayed hypersensitivity responses, and their pathophysiology remains to be fully elucidated because of their heterogeneous aspects. The symptoms of this case were in line with IgE-low AD rather than IgE-high AD, which implicates endogenous progesterone as a trigger.","PeriodicalId":39105,"journal":{"name":"Open Dermatology Journal","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72907635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Badryia Al Lenjawi, Rasheed Prieiyl, D. Mendoza, Lowlwa Al Meslaman, Hashim Mohamed
Necrotizing fasciitis is a soft tissue bacterial infection that spreads rapidly resulting in the destruction of muscles, skin, and underlying tissue. Necrotizing fasciitis is defined as a fast and progressive inflammatory infection of the fascia leading to secondary necrosis of the subcutaneous tissue moving along the facial plane. Fournier gangrene is a type of necrotizing fasciitis involving the scrotum and perineal area. Patients suffering from acute necrotizing fasciitis require an effective regimen which includes surgical removal of devitalized tissues, systemic antimicrobials and mitigating underlying systemic disease processes. The burden of treating wounds following surgical debridement, on the other hand, can be challenging especially in the third world where resources are scarce resulting in suboptimal wound coverage and function. At primary care level we had the opportunity of using natural honey in 5 patients with non-healing wounds in either the lower limb or scrotum due to acute necrotizing fasciitis. This natural noninvasive approach offers a cost-effective and efficacious alternative to dermatotraction, skin grafting and negative pressure wound therapy. In these patients, the use of natural honey led to the restoration of the appearance and function of the fasciotomy wound especially in patients with co-morbidities or those refusing skin grafting due to cost, religious factors, etc. The authors present the clinical results followed by a discussion on the therapeutic properties of natural honey. This case series demonstrates the efficacy of topical raw honey as a catalyst for speeding the healing process by secondary intention thereby offering a safe and efficacious alternative for managing various wounds resulting from acute necrotizing fasciitis.
{"title":"Natural Honey as a Safe and Efficacious Alternative to Skin Grafting Post-Surgical Excision for Necrotizing Fasciitis at Primary Care Level: A Preliminary Study","authors":"Badryia Al Lenjawi, Rasheed Prieiyl, D. Mendoza, Lowlwa Al Meslaman, Hashim Mohamed","doi":"10.17140/drmtoj-6-143","DOIUrl":"https://doi.org/10.17140/drmtoj-6-143","url":null,"abstract":"Necrotizing fasciitis is a soft tissue bacterial infection that spreads rapidly resulting in the destruction of muscles, skin, and underlying tissue. Necrotizing fasciitis is defined as a fast and progressive inflammatory infection of the fascia leading to secondary necrosis of the subcutaneous tissue moving along the facial plane. Fournier gangrene is a type of necrotizing fasciitis involving the scrotum and perineal area. Patients suffering from acute necrotizing fasciitis require an effective regimen which includes surgical removal of devitalized tissues, systemic antimicrobials and mitigating underlying systemic disease processes. The burden of treating wounds following surgical debridement, on the other hand, can be challenging especially in the third world where resources are scarce resulting in suboptimal wound coverage and function. At primary care level we had the opportunity of using natural honey in 5 patients with non-healing wounds in either the lower limb or scrotum due to acute necrotizing fasciitis. This natural noninvasive approach offers a cost-effective and efficacious alternative to dermatotraction, skin grafting and negative pressure wound therapy. In these patients, the use of natural honey led to the restoration of the appearance and function of the fasciotomy wound especially in patients with co-morbidities or those refusing skin grafting due to cost, religious factors, etc. The authors present the clinical results followed by a discussion on the therapeutic properties of natural honey. This case series demonstrates the efficacy of topical raw honey as a catalyst for speeding the healing process by secondary intention thereby offering a safe and efficacious alternative for managing various wounds resulting from acute necrotizing fasciitis.","PeriodicalId":39105,"journal":{"name":"Open Dermatology Journal","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78392535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Terra firma-forme dermatosis (TFFD) belongs to the group of “dirty dermatoses” and represents a not well-known and surely underestimated skin condition. Clinical Cases We present 2 cases of TFFD and present clinical and dermatoscopical findings. Results We present specific dermatoscopical findings of TFFD. Conclusion We propose the denomination “chromosome arms” sign for Terra firma-forme dermatosis
{"title":"The Dermoscopic “Chromosome Arms Sign” for Terra Firma-Forme Dermatosis","authors":"M. Cutrone, J. V. Gysel, R. Grimalt","doi":"10.17140/drmtoj-6-146","DOIUrl":"https://doi.org/10.17140/drmtoj-6-146","url":null,"abstract":"Introduction Terra firma-forme dermatosis (TFFD) belongs to the group of “dirty dermatoses” and represents a not well-known and surely underestimated skin condition. Clinical Cases We present 2 cases of TFFD and present clinical and dermatoscopical findings. Results We present specific dermatoscopical findings of TFFD. Conclusion We propose the denomination “chromosome arms” sign for Terra firma-forme dermatosis","PeriodicalId":39105,"journal":{"name":"Open Dermatology Journal","volume":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75501801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Addressing structural inequality in dermatology – where do we go from here?","authors":"","doi":"10.46439/derma.1.002","DOIUrl":"https://doi.org/10.46439/derma.1.002","url":null,"abstract":"","PeriodicalId":39105,"journal":{"name":"Open Dermatology Journal","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81050481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Laamari, H. Baybay, S. Mrabat, Z. Douhi, S. Elloudi, F. Mernissi
{"title":"Hidradenoma Papilliferum","authors":"K. Laamari, H. Baybay, S. Mrabat, Z. Douhi, S. Elloudi, F. Mernissi","doi":"10.17140/drmtoj-5-140","DOIUrl":"https://doi.org/10.17140/drmtoj-5-140","url":null,"abstract":"","PeriodicalId":39105,"journal":{"name":"Open Dermatology Journal","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87785115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lowlwa Al Meslamani, Badriya Al Lenjaw, Shawkia Al Majid, Hashim Mohamed
P psoriasis is a disabling condition that is difficult to treat and is present in up to 40% of patients with plaque psoriasis.1 It is a disabling condition that can manifest in a hyperkeratotic plaque-type, pustular form or combination. In comparison with plaque psoriasis on other areas of the body, palmoplantar psoriasis leads to a disproportionately greater impairment of health-related quality of life (HRQoL).2 Psoriasis is a multifactorial condition influenced by numerous factors in its presence and severity, such as stress, exercise, alcohol, obesity, etc. Patients with palmoplantar psoriasis have difficulty walking, suffer a significant amount of pain in the palms and soles which may lead to an inability to work.2-4 Palmoplantar psoriasis typically represents a difficult to treat variety of psoriasis and unlike plaque-type psoriasis, pustular psoriasis is characterized by homozygous or compound heterozygous interleukin-36 (IL36RN) gene mutations leading to aberrations in IL-36R antagonist function.5 The thickened horny layer of palmar and plantar6 epidermis partially causes low bioavailability of classic topical anti-psoriatic drugs, hence the unsatisfactory results after prolonged usage. Systemic treatment on the other hand may include psoralen-UVA (PUVA), systemic retinoids and a combination of both,7,8 but they often fail to give convincing results.9 Tumor necrosis factor (TNF) antagonists are successfully being used in the treatment of psoriasis. However, unexpected side effect of TNF antagonists include the new onset or worsening of psoriatic skin lesions,10-15 eczematous eruptions, bacterial infections, herpes simplex, cutaneous lymphomas, lichenoid eruptions, erythema multiforme, acute generalized exanthematous pustulosis and lupus erythematosus pustulosis. Acitretin, cyclosporins lead to quick remissions but recurrence rate limits their wide application. Here we present a case report in which a patient with palmoplantar pustular psoriasis showed complete healing with raw natural honey.
{"title":"Palmoplantar Psoriasis Successfully Treated with Raw Natural Honey: A Case Report","authors":"Lowlwa Al Meslamani, Badriya Al Lenjaw, Shawkia Al Majid, Hashim Mohamed","doi":"10.17140/drmtoj-4-133","DOIUrl":"https://doi.org/10.17140/drmtoj-4-133","url":null,"abstract":"P psoriasis is a disabling condition that is difficult to treat and is present in up to 40% of patients with plaque psoriasis.1 It is a disabling condition that can manifest in a hyperkeratotic plaque-type, pustular form or combination. In comparison with plaque psoriasis on other areas of the body, palmoplantar psoriasis leads to a disproportionately greater impairment of health-related quality of life (HRQoL).2 Psoriasis is a multifactorial condition influenced by numerous factors in its presence and severity, such as stress, exercise, alcohol, obesity, etc. Patients with palmoplantar psoriasis have difficulty walking, suffer a significant amount of pain in the palms and soles which may lead to an inability to work.2-4 Palmoplantar psoriasis typically represents a difficult to treat variety of psoriasis and unlike plaque-type psoriasis, pustular psoriasis is characterized by homozygous or compound heterozygous interleukin-36 (IL36RN) gene mutations leading to aberrations in IL-36R antagonist function.5 The thickened horny layer of palmar and plantar6 epidermis partially causes low bioavailability of classic topical anti-psoriatic drugs, hence the unsatisfactory results after prolonged usage. Systemic treatment on the other hand may include psoralen-UVA (PUVA), systemic retinoids and a combination of both,7,8 but they often fail to give convincing results.9 Tumor necrosis factor (TNF) antagonists are successfully being used in the treatment of psoriasis. However, unexpected side effect of TNF antagonists include the new onset or worsening of psoriatic skin lesions,10-15 eczematous eruptions, bacterial infections, herpes simplex, cutaneous lymphomas, lichenoid eruptions, erythema multiforme, acute generalized exanthematous pustulosis and lupus erythematosus pustulosis. Acitretin, cyclosporins lead to quick remissions but recurrence rate limits their wide application. Here we present a case report in which a patient with palmoplantar pustular psoriasis showed complete healing with raw natural honey.","PeriodicalId":39105,"journal":{"name":"Open Dermatology Journal","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90497006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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