Dermatological Research and Reviews

  • Single Oral Dose of Ivermectin as a New Therapeutic Trial for Contacts of Patients with Scabies

    Background: Scabies is one of the common epidemic and endemic diseases worldwide. Many topical therapeutic modalities for scabies are available. Topical ivermectin has been used effectively in treatment of scabies but there is no oral effective therapy that prevents contacts to get scabies. Objective: To evaluate the effectiveness of oral ivermectin in prevention of scabies contacts to get scabies. Patients and Methods: The study is a single-blinded therapeutic study that was conducted in the Center of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq during the period from April 2018 through October 2019.Two hundred sixty healthy scabies contacts were included in this study, their ages ranged from 5-60 years with a mean ± SD of 19.3± 1.9 years. All these contacts were screened for active scabies and they were all free. The contacts of scabies were treated by ivermectin tablet 200 microgram per kg as a single dose after 2 hours from dinner. They were seen regularly after 4 weeks to be re-examined and to record any scabies and drug side effects. Results: The response after four weeks of single dose therapy of healthy contacts showed that 245 (94%) from 260 were free of scabies and only 15(6%) contacts showed infection with scabies and this was statistically significant Chi-square (c2= 148, P-value less than 0.00000001. No any side effects were noticed in any treated contacts. Conclusion: Oral single ivermectin dose is an effective therapy to prevent scabies contacts to get infection. It an easy method of prevention which is very useful in condition of scabies outbreaks and epidemics to stop the rapid spread of the disease.

  • Keratosis Pilaris Rubra Totalis: Clinical and Histopathological Study with New insights

    Background: Keratosis pilaris rubra (KPR) is a common but unrecognized follicular keratinizatioin. It is a common skin problem among Iraqi population and most cases were misdiagnosed as dermatitis as there are few reports in medical literature. Objective: To do full clinical and histopathological evaluation of KPR in Iraqi population. Patients and Methods: This is case descriptive, clinico-histopathological outpatient based study. It was done in the Center of Dermatology and Venereology, Baghdad Teaching Hospital, Medical City, Iraq during the period from March 2016 to October 2017. Sixty patients were enrolled in this study. History and dermatological examination were carried out for all patients. Skin biopsy was done for 10 patients for histopathological study using Hematoxylin and Eosin stain. Results: A total of the 60 patients were diagnosed as KPR during the study period. Thirty nine (65%) males and 21 (35%) females. The age at onset of disease ranged from since birth to 8 (2.9± 2.17) years . Facial involvement included the cheeks in 60 (100%) patients. Other sites of involvement included the arms where the lateral aspects involved in 60 (100%) patients and the medial aspect 11 (18.3%), thighs including the buttocks in 51 (85%), trunk 25 (41.6%), legs 22 (36.6%) and the neck 15 (25%).The rash was erythematous all over but most obvious on the sides of face presenting as red, rough face. Histopathological evaluation showed follicular plugging in (100%) with dilatation of both superficial and deep vascular plexus in (75%) of cases. Limitation: The main limitation of this study was the lack of follow up data related to the subject of the study. Conclusion: KPR is a common condition among Iraqi population and this study is the largest study carried out all over the world. As most areas of body are involved, the name keratosis pilaris rubra totalis is…

  • Oral Ivermectin should be considered as a Magic Therapy for Scabies with 98% Cure

    Background: Scabies is one of the commonest endemic pruritic diseases all over the worldwide. Many topical therapeutic options for scabies are available, but none of them could be accepted by many patients as all of them need covering the whole body by ointment overnight. Accordingly patients are looking for safe oral therapy like many other diseases. Objective: To assess the effectiveness of oral ivermectin in the treatment of scabies. Patients and Methods: This single, blinded, therapeutic work was conducted in the Center of Dermatology and Venereology, Baghdad Teaching Hospital, Baghdad, Iraq during the period from April 2018 through October 2019. Fifty of patients with scabies were involved in this study. All socio-demographic data that related to the disease were obtained from each patient. History and clinical examination was done for each case to establish the diagnosis. Fifty patients treated by ivermectin tablet 200 microgram per kg as a single dose on empty stomach and repeated after one week. The patients were seen regularly every 2 weeks for 4 weeks duration after stopping therapy, to re-asses cure and to report any local or systemic side effects. Results: A total of 50 patients were included in this study, 21 (42%) males and 29 (58%) females. The ages of males ranged from 5-47 with a mean 20.90±13.034 years; while the age range of females ranged from 3-67 (30.69±18.766) years. At the end of four weeks after stopping therapy , the response to treatment was as follows: Response in 49 (98%) patients and no response in 1 (2%) patients. No cutaneous or systemic side effects were noticed in any patients, while the recurrence or relapse rate was documented in 2 (4%) patients. Conclusion: Oral ivermectin had achieved cure of scabies in 98% of patients, hence it should be considered as a mass treatment in…

  • 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…