Dermatological Research and Reviews

  • Topical Therapy of Vitiligo Using Sunlight Exposure with Lactic Acid Cream (10%) Versus Methoxsalene Solution

    Background Vitiligo is a common autoimmune disease to which multiple therapies have been used. Lactic acid in different modes of preparation like 15% topical solution and 1% intralesional injection has been tried effectively in treatment of vitiligo. Objectives to test the efficacy of lactic acid cream10% with sunlight exposure in treatment of vitiligo, and to be compared with topical methoxsalene solution with sunlight exposure. Materials and Methods This is an interventional, therapeutic, single blinded, comparative study that was conducted in the Center of Dermatology, Medical City, Baghdad, Iraq, between April 2018 and June 2019. Patients with generalized and localized vitiligo were included. The diagnosis of vitiligo was based on clinical characteristic loss of skin pigmentation and supported by woods light examination. The demographic features were recorded. Physical examination was done to determine the site and number of patches per patient. The patients were divided into two groups: group A patients, were treated with lactic acid 10% cream followed by sunlight exposure. While in group B, the patients were treated with topical methoxsalene solution followed by sunlight exposure. All patients were assessed, and the surface area of each patch was measured before starting the treatment and every month for 3 months of treatment. The side effects were also recorded. A follow up visit after 3 months was done. A reduction rate in the surface area of vitiliginous patch was calculated. Results sixty patients, 41 (68.3%) females and 19 (31. 7%) males with a female to male ratio was 2.15:1. Their ages ranged between 3 – 42 years with mean± SD of 23.36±11.95 years. The disease duration ranged between 12-120 months. Total number of the lesions was 78 patches with a mean of 1.3 lesions per patient. No statistically significant differences were found between the two groups regarding demographic nor clinical features…

  • Follicular Dermatoses in Iraqi Patients (Clinical and Histopathological Evaluation)

    Background: Follicular dermatoses are skin diseases that involved the hair follicle either early or during the course of the disease. Objective: To collect a number of dermatoses where there is follicular involvement, to be studied and analysed in order to reach a conclusion that hair follicles are the most important target area in the pathogenesis of these dermatoses. Patients and Methods: This is a descriptive, clinical and histopathological study that was carried out at the Centre of Dermatology and Venereology, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq during the period from December 2017 to August 2019. Forty patients with follicular dermatoses were included and all socio- demographic data related to the disease was obtained from each patient, in addition to clinical examination was performed for each patient. Lesional biopsies were done for 20 patients, for histopathological examination by Haematoxylin and Eosin (H&E). Results: The mean age ± SD was 30.2±16.96 years, 25 patients were males and 15 patients were females, the clinical diagnosis of follicular diseases was established for all skin diseases included in the present work. The histopathological findings of lesional biopsies were mainly: perifollicular lymphocytes, follicular invasion and degeneration, follicular plugging, fibrous tract remnant, perifollicular melanophages and hair follicle cyst. Conclusion: The result of the present study does encourage us to suggest that almost all skin diseases included in this study start initially on the hair follicle and then spread to involve the adjacent epidermis.

  • Clinical and Histopathological Evaluation of Prurigo Nodularis

    Background: Prurigo nodularis (PN) is a well-defined chronic recognized entity as a cause of severe chronic itching. However, this medical problem is not well studied and evaluated previously in Iraqi population. Objective: To do full clinical and histopatholgical evaluation of patient with PN. Patients and methods: This study is an observational cross sectional that was conducted at the Center of Dermatology, Medical City Teaching Hospital. All cases with classical PN and localized variant where collected. Full clinical evaluation was carried out. Biopsies were taken from 10 patients out of 50 with prurigo nodularis processed and stained with Hematoxylin and Eosin. Results: Fifty patients were included, there were 22 (44%) males and 28 (56%) females ,their ages ranged from less than 20-60 years with mean ± SD of age (40 ± 16) years .The common associated disease was atopic dermatitis in 36 (72%) patients, while family history of disease was seen in 24 (48%) patients, psychological factor was seen in 30 (60%) patients . The clinical picture was excoriated nodular lesions commonly on limbs with symmetrical fashion in 40 (80%) of cases while localized pattern was detected in 10 (20%) of patients. Histopatholgical evaluation in ten patients had shown hyperkeratosis (100%), acanthosis (60%), and pseudoepithelamatous hyperplasia (40%). Eosinophils were seen in one patient. Conclusion: This study showed classical prurigo nodularis in 80% of cases while localized in 20% of the patients. It is a disease of middle age patients, more in females than males. Family and personal history of atopic dermatitis was a high finding the histopathology is typical of prurigo nodularis with sparse eosinophils.

  • Vitiligo Treated by Soaking in an Earth Pond Containing KELEA Activated Water

    Vitiligo completely regressed in two patients who spent several hours for each of three consecutive days in a pond that contains water with a heightened quantity of a non-thermal activity attributed to a natural force called KELEA (Kinetic Energy Limiting Electrostatic Attraction). KELEA is further defined as the source of cellular energy, which comprises the alternative cellular energy (ACE) pathway. The ACE pathway differs from the cellular energy obtained from food metabolism. It is expressed as an added dynamic (kinetic) quality of the body’s fluids. The body utilizes the ACE pathway in both chemical and electrical cellular reactions, including the recovery and regenerative processes following cellular damage. The ACE pathway supports the higher levels of brain functioning including the likelihood of improving upon the presumed KELEA receiving capacity of the brain. The ACE pathway can also limit the triggering and maintenance of the inflammatory response. Each of these activities is presumably involved in the clinical regression of the vitiligo in the two patients. Enhancing the ACE pathway may provide an effective therapeutic approach for many patients with vitiligo.

  • 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