Editor- In-Chief: CARMELA Y. DRAKE Title proper: Dermatology – Open Journal Subject: Dermatology Publisher: Openventio Publishers Dates of publication: 2016 Frequency & Medium: Quarterly, Online Language: English Country: India Indexed by: CROSSREF , ROAD , THE KEEPERS Title DOI of the Journal: http://doi.org/10.17140/issn.2743-4799
Citrobacter Freundii Skin Infection in an Immunocompetent Subject Simulating Varicella: A Treatment-Resistant Case
Citrobacter spp infections in immunocompetent subjects are rare and mainly involve the urinary and respiratory tracts. We report a case of Citrobacter freundii skin infection in an immunocompetent patient simulating varicella and having resisted empirical treatment of common bacterial skin infections on 3 occasions. The patient was 26-years-old and worked in a mining area in Kayes, Mali. He had no previous medical or surgical history and consulted for diffuse papulopustules on the integument, simulating chickenpox, for which he had received empirical treatments of common bacterial skin infections without success. In view of the persistence and appearance of new lesions, he consulted us on 2nd November 2021, where a bacteriology showed Citrobacter freundii. The patient was treated with ceftazidime and gentamycin with success (according to the patient). Citrobacter spp are facultative anaerobic Gram-negative bacilli of the Enterobacteriaceae family, frequently found in water, soil, food and the intestines of animals and humans. They are known to cause a wide spectrum of infections affecting the urinary tract, liver, biliary tract, peritoneum, intestines, bone, respiratory tract, endocardium, wounds, soft tissue, meninges and bloodstream in immunocompromised subjects. Our case is atypical in its presentation, immunocompetent subject, clinical form simulating chickenpox without extracutaneous involvement and which raised the resistance of opportunistic germs to antibiotics.
Effective Management of Refractory Folliculitis Decalvans Using Secukinumab
This case study reports the successful management of a refractory case of folliculitis decalvans in a 40-year-old female patient using Secukinumab, an interleukin-17A (IL-17A) inhibitor. The patient had a 14-year history of the condition, which had proven resistant to previous treatments, including topical Betamethasone scalp lotion, Ketoconazole shampoo, and Adalimumab. This case highlights the potential efficacy of Secukinumab as a therapeutic option for folliculitis decalvans refractory to conventional treatments.
Clinical Cases of Anterior Cervical Hypertrichosis
Anterior cervical hypertrichosis (ACH) may be only an isolated aesthetic finding, but it may also be associated with other underlying conditions, including neurological and ocular disorders. In order to recognize this uncommon entity, it is imperative to provide detailed physical examination and clinical history to exclude the possible associated abnormalities in patients with ACH. In those cases that ACH represents only a cosmetic problem for the patient, laser hair removal is recommended. We hereby presented 2 cases of ACH in two young girls and discussed about all the differential diagnoses and how to rule out associated anomalies. The most useful workout to rule out associated underlying conditions are described, and cosmetic treatment with laser hair removal devices is also commented.
Application of Delayed Keystone Flap in Management of Post-Electrical Burn Squamous Cell Carcinoma
Aim The aim of the study is the application of delayed Keystone flap in the management of post-electrical burn squamous cell carcinoma. Materials and Methods In our study, a delayed staged type 3 keystone flap was performed as first stage procedure. Result In our study, by doing a delayed staged type 3 keystone flap we were able to successfully reduce the size of the defect by 40% without necrosis of the inset flap. Conclusion Delaying of the flap is a useful method when the vascularity of the keystone flap is doubtful especially in the case of post electrical burn.
Omalizumab in Chronic Spontaneous Urticaria: Assessment of Response in Twenty-Five Patients
Background Omalizumab is a recombinant humanized monoclonal antibody against immunoglobulin E (IgE). It is approved for the treatment of chronic spontaneous urticaria (CSU) in patients ≥12-years of age. Objective We carried out a retrospective cross-sectional study in 25 patients with CSU to evaluate the characteristics of response of CSU to omalizumab treatment. Method A retrospective cross-sectional study of a convenient sample of all patients diagnosed as CSU who have been using omalizumab treatment during the study period from January 2018 to January 2020 in the Dermatology Department in King Abdulaziz Hospital, Makkah, Saudi Arabia. Results A total of 25 patients have participated in this study. The average age of patients was 40-years. Majority of the patients were female (52.0%, n=15). The average duration of illness was 1.32-years. Majority of the patients (72.0%, n=18) received two courses of omalizumab treatment. Minority of patients (28.0%, n=7) received one course of omalizumab treatment which was statistically significant (p value<0.01). Number of patients who have been using oral 2nd generation antihistamine during the first course and 2nd course was (72%, n=18 out of 25) and (50%, n=9 out of 18) respectively. Number of flare-ups during 2nd course (1.72 flares up per patient, n=31 flare-ups among 18 patients) was less than the number of flares-up during 1st course (2.96 flares-up per patient, n=74 flare-ups among 25 patients) which was statistically significant (p value<0.01). Number of patients who showed no flare-ups during the 1st and 2nd course of omalizumab treatment was (16%, n=4 out of 25 patients) and (27.77%, n=5 out of 18 patients) respectively. The average intensity of flares-up during 2nd course of omalizumab treatment was less than the average intensity of flares-up during first course of omalizumab treatment as the following; during 2nd course ( 33.33%, n=6 out of 18 patients), (27.77% n=5 out of 18 patients), (11.11%, n=2 out of 18 patients) mild, moderate and severe flares-up respectively and the severity during 1st course was (40.0%, n=10 out of 25 patients), (28.0%, n=7 out of 25 patients), (16.0%, n=4 out of 25 patients) mild, moderate and severe flares-up respectively. Conclusion According to expert’s guidelines, CSU of ≥3-years would be treated with omalizumab for a minimum of one-year. In our study, in spite of the short duration of CSU (average duration was 1.32-years), the majority of patients (72.0%, n=18) received omalizumab for 1-year (two courses of omalizumab treatment) suggesting that the majority of patients with CSU in general requires omalizumab ≥1-year. Our study also showed 5 patients who were free of any flare-up and they were not using 2nd generation antihistamines suggesting that omalizumab alone as monotherapy can be effective
Delirium of Skin Infestation: Epidemiological and Clinical Profile of 73 Patients
Background This was a descriptive and prospective study that focused on 73 cases of delirium of skin infestation (DSI) from January 1st to December 31st, 2018, in the dermatology department of the Bamako Dermatology Hospital (HDB). Aim The aim of this work was to describe the epidemiological and clinical profile of delusions of infestation (Ekbom syndrome), to deepen our knowledge of the disease in order to improve its overall management. Methods We carried out a descriptive cross-sectional study of cases of identity document (ID) seen in dermatological consultation in the HDB dermatology department between January 1st and December 31st, 2018. Now, this department is the largest dermatological reference center in the country. In our study, we have included any patient with delirium of parasitic infestation (defined as an unshakeable conviction that small vermin, insects, lice, maggots, proliferate in the skin and sometimes in the body without biological proof). Results Delirium of skin infestation constituted 0.3% of consultations in the service. The average age was 52-years with extremes ranging from 12 to 85-years. They were 45 female (62%) and 28 male (45%). The age group (25-64) was the most represented. Out-ofschool patients represented 65% of the sample. Among them, 6 cases (8%) were known in psychiatry. The agents incriminated by the patients were mainly ants, earthworms and cicadas. The specimen sign was found in 89% of cases. Insomnia was the most frequent associated sign, at 75%. The types of lesion complications observed in our patients were mainly lichenification, ulceration and excoriation. Seventy-two percent (72%) of patients have refused referral to the mental health service. The profile of Ekbom syndrome was the one of the adult women, described in the previous work. Conclusion Delirium of skin infestation is generally considered as rare disease, increasingly observed during our dermatology consultations. Its frequency is probably underestimated.
Acute Necrotizing Dermohypodermatitis Due to an Unusual Germ: Providencia Stuartii
This 33-year-old lady was hospitalised for systemic lupus and received corticosteroid therapy; upper limb edoema developed as a result. The interview revealed a theory of trauma related to a fall in the bathroom. During the examination, it was discovered that the patient’s overall health was quite poor and that her left upper limb was edematous, unpleasant to the touch, and covered in an erythematous plaque with blisters and a necrosis area. After 72-hours, ciprofloxacin, gentamycin, and amoxicillin antibiotic treatment had no noticeable effects. A bacteriological examination of the ulcer indicated the presence of Providencia stuartii, which is susceptible to cefotaxime but resistant to ciprofloxacin and amoxicillin. The biological evaluation revealed hyperleukocytosis (12,800 white blood cells/L), thrombocytopenia (103,000/L), and anaemia (9.1 g/dL). Following the administration of cefotaxime together with surgical debridement, apyrexia set in within 24-hours, and full recovery occurred three-weeks later. The search for atypical germs and the performance of an antibiogram must be mandated in front of an acute necrotizing dermohypodermatitis (AND) due to the odd location, the circumstances of the occurrence, and the clinical component.
The Dermoscopic “Chromosome Arms Sign” for Terra Firma-Forme Dermatosis
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.
Natural Honey as a Safe and Efficacious Alternative to Skin Grafting Post-Surgical Excision for Necrotizing Fasciitis at Primary Care Level: A Preliminary Study
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.
Clinical Descriptive Study of Psoriasis in India: Triggers, Morbidities and Coincidences
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 department at 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 wellestablished 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 syndromes in psoriasis patients due to its predilection with systemic comorbidities.
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.
Photobiomodulation is a non-invasive treatment modality acting at different biological levels through the non-thermal transfer of photons to the living matter via a photoelectric effect, inducing photochemical reactions in treated cells. The objective of this article is to review the literature on Photobiomodulation, its different fields of application and mechanisms of action, for establishing a comprehensive summary of evidence. The search strategy initially run searches in scientific databases MEDLINE, PubMed, EMBASE and Cochrane registries from 1990 up to March 2020, with entries Photobiomodulation, LLLT-LEDT, PDT, Photobiology, Cytochrome c Oxidase. Selection criteria was based on preferably inclusion of randomized clinical trials (RCTs), systematic reviews (SR) and studies providing qualitative and quantitative data with the best consistency, in a field where heterogeneity of light parameters is often a difficulty to comparison of findings. Publised expert opinions were also considered. A total of 80 publications were reviewed out of a thousand obtained from databases, among which were retained 9 RCTs, 6 systematic reviews, 3 meta-analysis and 2 case-reports. Differences were found in treatment parameters as wavelength, dosage, energy output, treatment length, performances of light-sources, quantity of diodes and single power of these, which may explain the paucity of high-level body of evidence in Cochrane databases. However, numerous state-of-the- art researches are also found, led by dedicated research teams paving the way to standardized methods of evaluation and comprehension of light-biological-tissues interaction and optimization of outcomes in a promising field.
PhotoBioModulation; Low-Level-Laser-Therapy (LLLT)
The Skinny on Moisturizers: A Brief Report
Objective To compare the effectiveness of 5 different skin moisturizers using JELL-O® as a model for the human skin. Methods In this study five different moisturizers (Equate®, Burt’s Bees®, Suave®, Aveeno® and Vaseline®) were applied to equivalent samples of JELL-O®. Observations were made over a 12-day period and data was collected at 15 different time intervals. The primary outcome was the height (cm) and weight (g) of the JELL-O® sample at each time interval. The study was an ex vivo experiment conducted in a home laboratory. No Institutional Review Board (IRB) approval was required since the research does not involve living organisms. Results Overall, the JELL-O® sample that had the Vaseline® applied on it had the lowest loss of height and weight. The height stayed at 100% of its original value and the weight only decreased to 97.2% of the original value by the end of the observation period. In contrast, the sample which had Suave® applied to the surface its height and weight decrease the most (42% and 28% respectively). The other moisturizers had effects intermediate between these two extremes. Conclusion Based on this ex vivo head to head study using JELL-O® as a model for the human skin the 5 moisturizers examined had widely differing levels of effectiveness with Vaseline® appearing to be the most protective against evaporative losses and Suave® appearing to be the least.
Squamous Melanocytic Tumour at an Unusual Site: An Uncommon Case and Literature Review
We herein present a case report of a 60-year-old male patient diagnosed with squamous-melanocytic tumour (SMT) in his anal region, comprised of two intermingled different phenotypic lesions. This dual tumour is quite uncommon and could potentially be challenging on both diagnose and also management. It is the first case reported on this location, moreover, the lack of consensus for these lesions makes it difficult to classify them. We reviewed the literature of similar SMT’s and discussed its histogenesis. As they are rare, their biological behavior and potential metastasis remain unclear. Therefore, close follow-up is advised.
Lupus Erythematosus Affecting the Genitalia: An Unusual Site
Cutaneous lupus erythematosus classically affects sun-exposed areas. It’s rarely affects the genitalia, and there are few cases reported in the literature. Thus, we report the different genital manifestations observed in a patient with lupus erythematosus affecting the genital area.
A 45-year-old female patient presented with an asymptomatic nodule of 6-months duration in the vulva. On examination, a well-circumscribed nodule of size 1 cm was seen on inner aspect of left labium majus (Figure 1). The nodule was firm and non-tender. Dermoscopy showed pink and white structures with curvilinear vessels (Figures 2 and 3). Differential diagnoses considered were hidradenoma papilliferum or some other adnexal tumor, pyogenic granuloma, and a remote possibility of donovaniosis or amelanotic melanoma. The nodule was excised and sent for histopathological examination, which showed a dermal tumor with cells in papillary folds, tubules, and cystically dilated spaces. These findings were those of hidradenoma papilliferum.
Allergic Contact Dermatitis by Beryllium Chloride as Unique Sensitivity: A Case Report
Beryllium can be found in silver alloy, in costume jewelry and in dental prosthesis. It is also used in aerospace industry and might be also found in precision instruments. Pure contact dermatitis to Beryllium has never been described as in this case associated with allergic contact dermatitis to jewelry. Most reports of Beryllium contact dermatitis are related to dental prosthesis and most of the cases we have seen Beryllium allergic contact dermatitis is associated with other positive allergens. We believe that this metal should be added to the dental screening as according to our findings.
Palmoplantar Psoriasis Successfully Treated with Raw Natural Honey: A Case Report
Palmoplantar psoriasis is a disabling condition linked to significant reduction in quality-of-life. It is manifested by the development of hyperkeratosis and/or recurrent batches of sterile pustules with associated erythema, scaling, and fissuring with symmetrical distribution on the palm and soles. Many modalities of treatment exist including systemic therapies such as psoralen-UVA (PUVA), retinoids, corticosteroids cyclosporine and methotrexate. Many of these systemic agents have un wanted and severe side effects besides their high cost. Furthermore, new agents such as TNF-alfa blockers have been reported to cause paradoxical induction of pustular psoriasis following their use or withdrawal. As a result safe, topical and effective alternatives are highly needed in treating this chronic condition. We describe the clinical characteristics and evolution of a 68-years-old female with palmoplantar psoriasis who was treated successfully with topical raw honey. This report provides preliminary evidence to support the use of topical raw honey under occlusive dressing in the management of palmoplantar psoriasis.
Lichen Planus Pigmentosus in North Africa: A Series of 17 Cases
Background Lichen planus pigmentosus (LPPig) is considered as a rare macular and pigmented variant of lichen planus. It is mainly reported in Indian and Latino American patients. Objective The aim of this paper is to report the characteristics of this condition in Moroccan patients. Patients and Methods Patients attending a private dermatology practice, in Casablanca, Morocco, and presenting with LPPig were consecutively enrolled. Inclusion criteria were the presence of macular pigmented lesions of the face, neck or arms, and/or cutaneous histology showing pigment incontinence with basal cell vacuolization and lichenoid infiltrate. Patients with melasma or post-inflammatory pigmentation were excluded. Demographic and medical data were collected. Results From January 2015 to December 2018, 17 patients were included, one man and 16 women, mean age 57.4±11 years. Ten patients had phototype III and five phototype IV. The mean duration of the disease was 6.7±7 years. The lesions were located on the face in all patients, with the involvement of the perioral area in 13 cases (76.4%), the forehead in 9 cases. The neck was involved in 9 cases (53%). In 7 cases (41%), frontal fibrosing alopecia was observed. Three patients had thyroiditis, three others had diabetes mellitus. Histology was performed in six cases, showing pigment incontinence and basal vacuolization. Lichenoid infiltrate was observed in four cases. Eleven patients were given tranexamic acid per os, 500 mg twice daily for 3 or 6 months. Topically, all patients but one received hydroquinone, and sixteen high potency dermocorticoids to the lesions. An the follow-up, only four patients had an excellent result with complete resolution of the lesions, in the others, the lesions stayed similar. Conclusion LPPig exits in North Africans although its prevalence is probably underestimated. This pigmentary disorder remains a challenging disease for therapy.
Demographic Characteristics and Management of Uninsured Patients with a History of Melanoma
Aims and Objectives Patients diagnosed with malignant melanoma often undergo regular follow-up care and skin checks to reduce the likelihood of recurrence. Yearly exams are more inconsistent and likely to be missed due to a lack of healthcare access and resources among the uninsured population. This study determined demographic characteristics of uninsured patients with a history of malignant melanoma. Follow-up was assessed in order to improve and ensure the highest quality of long-term care. Methods Demographics and chronic disease diagnoses were extracted from 8,857 patients managed at eight free-clinics from the Tampa Bay Area during 2016 and 2017. Patients diagnosed with malignant melanoma were specifically chosen for further chart review. A retrospective analysis of the follow-up care and health outcomes are reported. Results A total of 200 of 8,857 reported a history of malignancy; ten patients (5%) were diagnosed with malignant melanoma. The average age of these patients was 52-years-old, 70% (N=7) of whom were female. Initial treatment for 2 patients (20%) was surgical excision. Remaining patients were either observed (N=2) or did not mention treatment to their free clinic provider (N=6). Postoperative follow-up for recurrent lesions varied between patients but a commonly cited reason that prevented proper follow-up with a dermatologist in eight of the ten patients (80%) was financial restraint. Conclusions Free-clinics should be cognizant of local dermatologists who provide subsidized services to those in need due to the higher prevalence of melanoma among the uninsured. Patients should also be directed to free clinics immediately after surgery to receive recommended follow-up skin checks. With education, free-clinics can deliver higher quality dermatology management to patients by following recommended standards.
A Case of Junctional Epidermolysis Bullosa with Pyloric Atresia Due to Integrin β4 Gene Mutations
Junctional epidermolysis bullosa with pyloric atresia is a rare bullous disease with autosomal recessive inheritance caused by abnormalities in the integrin α6 (ITGA6) or integrin β4 (ITGB4) gene. Its clinical symptoms range from mild to fatal. Herein, we report a case of mild junctional epidermolysis bullosa with pyloric atresia caused by compound heterozygous mutations in the ITGB4 gene.
The Treatment of Ingrown Toenails: A Retrospective Study of Combined Wedge Resection with Phenol Versus Silver Nitrate Cauterization
Aim The aim of the current study is to retrospectively review the efficacy of phenol versus silver nitrate matricectomy for treating ingrown toenails. Methods A total of 132 charts for ingrown toenails treated at Umm Ghuwailina Primary Health Care Center, Doha, Qatar were retrospectively reviewed for association with socio-demographic characteristics, infection rate, pain level, duration of treatment, treatment modalities and their outcomes. Results A total of 64 phenol ablations and 68 silver nitrate ablations were performed on patients with stages II and III diseases. The patients were reviewed daily until the achievement of full wound healing and later on, they were regularly followed-up for a mean period of 36 months. In the phenol group, the healing period post-operatively ranged from 2 to 4 weeks with no post-operative complications including loss of sensation or nail spikes with only one recurrence (0.57%) were observed, after 16 months. On the other hand, the silver nitrate group had a longer healing period ranging from 4 to 10 weeks with post-operative complications ranging from post-operative nail bed infection (soft tissue necrosis) (43%), post-operative pain (65%). The success rate was found to be 98.8%. Treatment with phenol therapy and 96% with silver nitrate therapy respectively. Conclusion We conclude that both phenol and silver nitrate cauterization are an excellent method for the treatment of ingrowing toenail. However, phenol is far superior to silver nitrate due to its simplicity, low morbidity, pain-free course post-operatively, no postoperative infection, better satisfaction and high success rate. Before surgical intervention, 79% of patients had a severe pain score, 72% had difficulty wearing their normal footwear and 65% had the restriction of normal activities due to their ingrown toenails. Overall, 100% of phenol arm were satisfied (n=63) with the procedure whereas in the silver nitrate arm only 82% (n=56) were satisfied. No loss of sensation at the surgical site was reported in either of the arms.
Pityrosporum Folliculitis: A Case Report
Pityrosporum folliculitis (PF) is an inflammatory skin disorder that presents as a pruritic, follicular papulopustular eruption distributed on the upper trunk of young to middle aged adults. Herein, we report a 21-years old healthy male presented with 2 weeks history of persistent itchy skin lesions. Skin examination revealed multiple and extensive monomorphic papules and pustules with erythematous hallow on his forehead, chest, back, neck and upper arms. No history of associated fever or arthralgia. Hair, nails and mucous membranes were normal. Skin smear from a pustule for potassium hydroxide (KOH) was negative for hyphae and yeast. The lesions disappeared 2-weeks after ketoconazol shampoo once daily plus oral fluconazole 100 mg cap once daily. On the basis of the above clinical findings, a diagnosis of Pityrosporum folliculitis was made.
Prevention of Diabetic Foot Ulcers at Primary Care Level
Diabetic foot ulcer (DFT) prevention is best achieved at primary care level and should begin with education, appropriate protective footwear, glycaemic control and regular screening for loss of protective sensation. In the west, specialized diabetic or podiatry clinics may assess and quantify neuropathy with many tools including monofilaments, biothesiometry, corneal confocal microscopy and nerve conduction studies. Vascular assessment can be done via measuring ankle-brachial index, duplex ultrasound studies and toe pressure. Other foot assessment may include measuring plantar foot pressure using computerized dynamic foot studies (computerized insole sensor system). The ability to stratify patients based on risks is carried out on the basis of a thorough medical and surgical history in conjunction with these measurements thereby allowing clinicians to determine the type of intervention. Effective strategies for foot ulceration prevention include educating patients, their families, and healthcare workers about adequate foot care and regular foot examinations along with optimal glycaemic control and smoking cessation. Other effective clinical interventions may include, foot hygiene, debridement of calluses, management of foot deformities which may at times require prophylactic foot surgery. Counseling patients regarding daily proper footwear and hygiene should be stressed during each clinic visit. Educating, screening and managing patients with diabetic foot ulceration and or complications is an essential primary healthcare strategy to prevent unnecessary morbidity and mortality related to diabetic foot. An integrated (interdisciplinary) approach including, family physicians with special interest in the diabetic foot, diabetic educators, nurses and family members is a vital component in this regard.
Photodistributed Hyperpigmentation Induced by Lercanidipine
Hypertension (systolic blood pressure of 140 mmHg or above and/or diastolic blood pressure of 90 mmHg or above), is the most common chronic condition dealt with by primary care physicians and other health practitioners.1 Calcium channel blockers (CCBs), introduced into clinical medicine in the 1960s, are a group of compounds with distinctive structures and pharmacologic effects, are first-line treatment option for hypertension.2 In spite of their widespread use, little data have been published about the spectrum of cutaneous adverse reactions by CCBs.3-6 Cutaneous adverse reactions induced by lercanidipine, a third-generation o dihydropyridine CCBs, are uncommon.7-9 We present to our knowledge the first case of reticulated photodistributed hyperpigmentation induced by this drug.
A Case of Erythema Multiforme-Like Secondary to Black Henna Tatoo
Henna tattoos are becoming increasingly popular advertised as “harmless”. Rising incidence of allergic contact dermatitis reactions to paraphenylendiamine (PPD) in black henna tattoos has been usually described.1-3 Generalized erythema multiforme to PPD is rarely reported.4,5 We present a case of a girl who developed a localized eczematous reaction to a henna tattoo on the dorsum of her hands followed by erythema multiforme-like lesions on her extremities
Systematic Review of Oral and Topical Botanicals in Reducing Photosensitivity
Objectives: Various treatment options are available for the management of photosensitivity. The objective of this review is to evaluate the use of botanicals rich in antioxidants for photosensitivity reduction. Design: Embase and Ovid/MEDLINE databases were searched for clinical studies evaluating antioxidants from botanical sources in the management of photosensitivity. Results: Of 339 citations, 10 met the inclusion criteria. Four studies evaluated Polypodium leucotomos, two evaluated Camelia sinensis, while Hamamelis, Pistacia vera L., Citrus sinensis varieties Moro, Tarocco and Sanguinello, and Capparis spinosa were investigated in one study each. Five studies evaluated oral supplementation, four evaluated topical formulations, and one study evaluated both oral and topical antioxidants. Main results were summarized. Conclusions: There is some evidence that antioxidants derived from botanical sources may be beneficial in reducing skin erythema and photosensitivity. However, the studies included in this review have methodological limitations and large scale randomized, placebo controlled trials are needed to further evaluate the efficacy and safety of botanical antioxidants in photosensitivity reduction.
Successful Treatment of Multiple Alopecia Areata With Contact Immunotherapy: Supportive Usage of Oral Antihistamine and Topical Corticosteroid
Contact immunotherapy using diphenylcyclopropenone (DPCP) is a commonly used first-line therapeutic technique for patients with alopecia areata (AA). We present here a successful immunotherapy for AA female case with atopic diathesis, using oral antihistamine and topical corticosteroid supportively on DPCP. Courses of clinical and laboratory findings suggested that indirect effect to allergic inflammation by antihistamine drugs contributed to AA regression in our case.
Spongiosis is the hallmark of eczematous dermatitis. The mechanism underlying it is somewhat complex and is not fully understood up till now. Many factors interplay to produce spongiosis. One of these factors is Fas receptor/Fas ligand interaction.
Pattern of Children Hospitalization in a Tropical Dermatology Department: Case of the Teaching Hospital of Conakry (Guinea)
Background: Skin diseases are important morbidity factors in both resource-limited and developed countries. Aim: The objective of this work was therefore to document the different reasons for hospitalization of children in the Dermatology-Venereology Department of the Teaching Hospital of Conakry. Methods: Patients aged less than or equal to 18 years hospitalized in the Department of Dermatology and Venereology of the Teaching Hospital of Conakry (Guinea) from January 2000 through December 31, 2014 were included. Results: During this period of 14 years, a total of 227 patients were recruited. There were 122 (54%) girls and 105 (46%) boys. The boy to girl ratio was 0.85. Bacterial skin diseases (44.5%), inflammatory skin diseases (27.7%), drug reactions (14.9%), viral skin diseases (9.2%) were the most frequent skin diseases. Skin infections, mostly erysipelas and necrotizing fasciitis, accounted for 58.4% of the bacterial skin diseases. Of the non-infectious diseases, toxic epidermal necrolysis (29.4%), acute urticaria (13.7%) and atopic dermatitis (11.7%) were the most common. Conclusion: In the Dermatology Department of the Teaching Hospital of Conakry, the reason for hospitalization of children is dominated by skin infectious, in particular erysipelas and necrotizing fasciitis followed by toxic epidermal necrolyses, with significant morbidity. An improvement in the socio-economic conditions of the population could reduce the prevalence of skin infectious in specialized hospitals.