Dermatological Research and Reviews

  • Diagnosis and Reporting of Dysplastic (Atypical, Clarks) Nevi – a Reassessment

    This article on dysplastic nevi was compiled and written in August 2004 but never published in a print journal. It is our opinion that now, 15 years later, the same conclusions documented in the initial article still exist. In fact, the further studies and reports strongly support the lack of malignancy (nor evidence of pre-cursors of malignancy) in correctly histologically diagnosed junctional or compound dysplastic nevi and the lack of need of re-excision of these nevi in almost all cases. 1,2,3,4

  • Does the site of a Malignant melanoma predict the likelihood of distant metastases

    Introduction: Malignant melanoma is a lethal skin cancer which is on the rise despite increasing education on sun awareness. It is most common in young Caucasian individuals however any age or ethnicity can be affected. Discussion: There are four main types of malignant melanoma which include superficial spreading MM (most common), Nodular (most lethal), Acral lentignous melanoma and Lentigo maligna melanoma. Once it has metastasized the prognosis is poor but new treatments are giving us much better outcomes. Aim: The main aim of this study is to identify which MMs are most likely to metastasize based on the location with the two main groups being above neck and below neck. Methods and results: forty-five patients were included in the study, 37 were below neck and 8 were above neck. Out of the 37 below neck MM patients, none had distant metastases , but 25% of the above neck MM patients had distant metastases. Conclusion: This small study has demonstrated that above neck malignant melanoma is more likely to metastasize than below neck malignant melanoma despite advanced Tumor scores in the below neck subgroup.

  • Treatment of Chronic Plaque Psoriasis with Etanercept and Methotrexate

    Abstract: psoriasis is a chronic multifactorial disease that has negative impact on the patient’s quality of life. Selecting appropriate treatment for each patient must be both effective and relatively safe. Methotrexate and Etanercept are systemic therapies used for moderate – severe chronic plaque psoriasis. Objective: The aim of study is to assess the efficacy of methotrexate and etanercept in the treatment of chronic plaque psoriasis. Patients and Methods: This therapeutic, interventional comparative single centre study was carried out at the Centre of Dermatology and Venereology, Baghdad Teaching Hospital, from January 2015 –July 2017. A total of 62 patients were enrolled; divided into two groups. Group I: Thirty-three patients (23 males and 10 females), their ages ranged between 15 and 65 years mean ±SD 33.13±13.07, received etanercept 50mg twice weekly for 3 months then once weekly thereafter. Group II: Twenty-nine patients (19 males and 10 females), their ages ranged between 15 and 62 years mean±SD 38.16±15.2, received methotrexate 15 mg per week for six months then tapered. Both groups were followed up monthly for 6 months and their PASI score, DLQI, side effect and pictures were recorded. Results: Seven patients defaulted from the study for unknown reason,30 patients completed in etanercept group, while 25 patients completed in methotrexate group. After 12 weeks the PASI score decrease from baseline 19.13±10.67 to 6.38±4.96 and then to 3.34±5.38 after 24 weeks treatment with Etanercept compared to reduction in PASI score from baseline 18.97±10.54 to 5.72± 4.8 to 2.95±-6.01 after 12 weeks and 24 weeks respectively. There is significant statistical effect in the two groups. Conclusions: We conclude that both are effective monotherapy for patients with moderate to severe plaque psoriasis with tolerable side effect

  • Management of Oro-Cutaneous Manifestations in Behçet disease and Recurrent Oral Aphthosis, review article

    Recurrent oral aphthosis is a major health problem affecting 20% of population. Its pathogenesis is not well elucidated, however, it’s considered as part of major criteria of Behçet disease. Many therapies advised to manage these ulcerations in both diseases and most of them are symptomatic, however, in the last decades; some of them have shown therapeutic as well as prophylactic roles. Herein, we review the different aspects of these therapies with emphasis on Iraqi experience.

  • The Effectiveness of Cream of Centella asiatica Ethanol Extract in Chitosan Nanoparticles Compared with Centella asiatica Ethanol Extract Cream, Silver Sulfadiazine Cream, and Control on Superficial Dermal Burn Healing in Rats

    Introduction: Centella asiatica extract is known to promote wound healing. Nowadays nanotechnology, especially nanoparticle is used to increase the bioavailability of active ingredients into the skin, one of which is chitosan nanoparticle. However, the effectiveness of Centella asiatica ethanol extract in chitosan nanoparticle (CAEECN) towards superficial dermal burn healing is not fully understood. Aim: To determine the effectiveness of CAEECN cream compared to Centella asiatica ethanol extract (CAEE) cream, silver sulfadiazine (SSD) cream and control in superficial dermis burn healing in Sprague-Dawley rats. Materials and Methods: A total of 20 male Sprague-Dawley rats were divided into 4 groups. After anesthetizing, 4 superficial dermis burns were made on the back of each rat and was given 4 treatments (CAEECN, CAEE, SSD, and control) afterward. Each group was sacrificed separately (respectively on day 3rd, 7th, 14th, and 21st post-burn induction). Several evaluations were macroscopic (wound size), and microscopic parameters (reepithelialization ratio and distance, wound contraction index, wound size, and angiogenesis). Results: There was no significant difference in wound size between treatments on day 0, 3, 7, 14, and 21. But three active agents (CAEECN, CAEE, and SSD) treated group showed early decrease of wound size compare to control group on day-3. Microscopically, there were no significant differences in reepithelialization ratio and distance, wound contraction index, wound size, angiogenesis. Nevertheless, CAEECN treated group showed the smallest wound size on day-3 and highest angiogenesis on day 21. Conclusion: Effectiveness of CAEECN in burn wound healing in rats showed no significant difference compared to CAEE, SSD, and control. But in three active agents (CAEECN, CAEE, and SSD) treated group, showed an early decrease of wound size compared to control group on day-3. Microscopically, CAEECN treated group showed the smallest wound size on day-3 and highest angiogenesis on day 21.

  • Volumeplasty of bulky nose using heat dermabrasion as a minor therapy

    Background: Ultrathick nasal skin and nodulation is one of the most daunting challenges in cosmetic nasal surgery. Rhinoplasty is a common surgical procedure to correct mostly gross abnormal nasal anatomical variation; however, many patients have minor bizarre shape or deformities that could not be well corrected by ordinary surgical procedures. So we should find other techniques to correct these unwanted or undesired nose shape abnormalities. Objective: The purpose of this article is to perform heat dermabrasion to reduce the size of bulky nose and to create new alar groove and to remove nose nodulations, acne or traumatic scarring. Patients and methods: In this study, we collected 40 patients with bulky nose during the period from 2009 through 2019; 21 females and 19 males and their ages ranged from 20-65 years. An Informed consent was taken from each patient before starting the study, after full explanation about the procedure. All patients had bulky nose, some had nodulation of nose and acne or traumatic scarring. Only one patient had history rhinophyma of several years duration. All patients were treated with heat dermabrasion using diathermy needle after local xylocaine anesthesia and patients were received topical antiseptic and oral antibiotics to be seen after 2 weeks. Then topical corticosteroid was used to prevent post-inflammatory pigmentation. Results:A total of 40 patients diagnosed with bulky nose were enrolled in this study; 21 (52.5%) patients were females and 19 (47.5%) were males. Age of patients ranged from 20-65 years with a mean of 42.5 years. The duration of the condition ranged from few months to several years. In all patients with bulky nose were improved and alar groove were created or maximized and gave satisfactory cosmetic results using heat dermabrasion. Post-inflammatory hyperpigmentation was noticed but overtime was gone. Conclusion: heat dermabrasion using diathermy is new simple innovative…

  • Trichotillomania is chronic obsessive compulsive disease with a diagnostic hair loss patterns

    Background: Trichotillomania (TTM) is a common cause of childhood alopecia. It’s a traumatic alopecia and is defined as the irresistible urge to pull out the hair, accompanied by a sense of relief after the hair has been plucked. The condition maybe episodic and the chronic type is difficult to treat. There seem to be an increase in the prevalence of the condition probably due to the changing life style into a more stressful one. Objective: To do full evaluation of this disease and description of hair loss patterns. Patients and methods: In this descriptive study, we collected patients with trichotillomania who had attended department of dermatology, college of medicine, university of Baghdad, Baghdad teaching hospital during the period from 2011 through 2019 where 114 cases of TTM were seen. The diagnosis was established on clinical basis after exclusion of other dermatological diseases and medical problems.Full history was taken from each patient including demographic data, presence of stressful life event as a triggering factor. Psycholgical assessment was carried out for each patient by experienced dermatologist as psychiatric referral was refused by all patients and their families.Full description of patterns of hair loss was carried out after exclusion of other causes of hair loss especially alopecia areata. Results: A total of 114 patients diagnosed with TTM were enrolled in this study,88 (77.19%) patients were females and 26 (22.8%) males with female to male ratio: 3.38:1 . Age of patients ranged from 6 – 65 years with a median age of 16 years with the commonest age range between 10-19 years in 64(56.14%) patients.While the duration of the condition ranged from 3 months to 4 years. Family history was positive in 6 (5.3%) patients, all of them were first degree relatives. Psychological evaluation showed obsessive compulsive neurosis in all patients and all patients…

  • FORMULATION AND EVALUATION OF WOUND HEALING ACTIVITY OF ALOE VERA LEAF EXTRACT ALONG WITH CURCUMA LONGA EXTRACT-BASED GEL

    Wounds result in functional disruption of living tissues. Herbs and their extracts have potential to regenerate damage skin. Purpose of this study was to evaluate the wound healing activity of aloe vera leaf extract in combination with curcuma longa extract. Both herbs possess anti-inflammatory and antibacterial properties. Gel-I and Gel-II were formulated using Carbopol 940, 3%w/w aloe vera leaf extract, 1 and 3%w/w curcuma longa extracts respectively and were applied on excision and incision wounds created on albino rabbits. Animals were divided into four groups having six animals, group-I was control, group-II received standard gel (Nitrofurazone), group-III received Gel-I, group-IV received Gel-II. Gels were evaluated for color, pH, clarity, viscosity, consistency, spreadability, extrudability, skin irritation test and stability studies. Gels were applied on excision wound once a day for 12 days. Wound treated with Gel-II showed better healing activity and greater percentage of wound contraction (p

  • Epidemiological Profile of Leprosy from 2006 to 2013 in Limoeiro, Pernambuco

    Introduction: In the epidemiological transition experienced by Brazil, the prevalence of infectious-contagious diseases is still evident. Among them, leprosy is a public health problem whose main etiological agent is Mycobacterium leprae. It is a common pathology in developing countries. Methodology: Descriptive and retrospective study, with data collection from 2006 to 2013, coming from the National System of Information of Notifiable Diseases (SINAN). Results: 93 cases of leprosy were reported in the period covered by the data search. Resulting in an average detection of 1.5 cases / 10,000 inhabitants / year. According to the analysis of the data obtained, there was a predominance of male cases (51.61%), urban residents (60.22%), age range from 30 to 39 years (23.66%), as Dimorfa being the most reported Clinical Form (39.78%). Conclusions / Considerations: It is expected that new strategies and actions will be implemented, or revised, as more specific measures for the prevention and control of leprosy in the municipality of Limoeiro, Pernambuco.

  • Histomorphometric Analysis Of Reepitelization And Collagen Matrix Of Cutaneous Wounds Treated With Hydroalcoolic Extract From The Leaves Of Conocarpus Erectus Linnaeus

    Introduction: The species Conocarpus erectus Linnaeus belonging to the Combretaceae Family, that contains 18 genera, where the genus Combretum is considered to be the largest distributed on the whole African continent, possessing about 370 species that are abundantly used in folk medicine due to its chemical diversity, its low toxicity and low cost. The species of this family are widely used as a therapeutic resource for various types of pains, colds, diarrhea, conjunctivitis, pneumonia, mumps, cancer, hypertension, infections and wound treatment. The wound healing is a process that involves the performance of several cell types, extracellular matrix and chemical mediators, in order to promote tissue reconstitution. Objective: To evaluate reepithelialization and collagen deposition through the histomorphometry of the scar tissue treated with the hydroalcoholic extract of the leaves of Conocarpus erectus Linnaeus. Methodology: For the general outline of the experiment, male Wistar rats (200-250 g) were randomly divided into four groups: Group I (Negative Control – Lanette Cream); Group II (10% FHFCS – Cream formulation of the hydroalcoholic extract of dry leaves C. erectus); Group III (Cream formulation of the hydroalcoholic extract of fresh leaves of C. erectus) and Group IV (Dexpanthenol – Standard). Each group was subdivided into four subgroups with five animals for euthanasia on the 7th and 21st day. The animals were previously anesthetized with a combination of ketamine and xylazine and were later placed in a ventral decubitus for manual trichotomy and antisepsis with 0.1% iodized alcohol, the area of incidence was marked using a metal punch with a cutting blade (± 10 mm²). Then, the treatments were started and a new layer (± 95 mg) was applied daily. Histological preparations were submitted to Hematoxylin-Eosin technique. The histological images were captured by a digital camera coupled to an optical microscope, obtaining 06 fields per slide with…