International Journal of Research in Dermatology

Concomitant primary and secondary syphilis: a case series from a reference center in Mexico

Wed, 30 Oct 2024 00:00:00 +0530

Primary syphilis is characterized by the presence of a chancre and secondary syphilis by the presence of syphilis. The presence of chancres within secondary syphilis have been reported, however, this form of presentation is rare. Patients with synchronous diagnosis of primary and secondary syphilis were included. They underwent a reverse sequence algorithm for syphilis diagnosis with a rapid syphilis test, if positive, a rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) tests were performed. A total of 15 patients were included. All were men. In primary syphilis, penile chancre predominated in 13 patients (86.6%), and one (6.7%) was in the tongue. In secondary syphilis syphilitic roseola was the most common type of presentation in 10 patients (66.6%), followed by the palmoplantar plaques in 6 patients (40%) and condyloma lata in 2 patients (13.3%). One patient presented alopecia in a “moth-eaten” pattern and this presentation coexisted with a condyloma lata and the palmoplantar plaques. Other patient presented with syphilitic roseola, palmoplantar plaques and condyloma lata. Clinical presentation as coexistent primary-secondary syphilis will become more frequent. First contact physicians and dermatologists would have to take more in consideration infrequent and atypical clinical forms of this disease.

Suspected nocardiosis in an immunosuppressed patient: a case report highlighting diagnostic challenges and management strategies

Wed, 30 Oct 2024 00:00:00 +0530

Nocardiosis is a rare but potentially fatal opportunistic infection caused by Nocardia species, predominantly affecting immunocompromised individuals. This case report details the clinical course, diagnostic workup, and management of a 63-year-old female with a history of renal transplantation. Initial investigations, including imaging studies, revealed multiple cavitary pulmonary nodules and a solitary brain lesion, raising concerns for disseminated infection. The diagnostic challenge was compounded by the broad differential diagnosis in this patient population, including fungal, mycobacterial, and other opportunistic infections. Empirical antimicrobial therapy was initiated, and subsequent microbiological confirmation of Nocardia asteroides from bronchoalveolar lavage specimens established the diagnosis. Despite initial therapeutic response, the patient developed worsening neurological symptoms indicative of CNS involvement, necessitating prolonged treatment with a combination of trimethoprim-sulfamethoxazole and imipenem. This report underscores the importance of early recognition, comprehensive diagnostic evaluation, and individualized therapeutic approaches in managing suspected nocardiosis in immunocompromised patients. Furthermore, it discusses the diagnostic pitfalls, highlights the need for a high index of suspicion, and reviews current therapeutic recommendations for both pulmonary and disseminated nocardiosis, providing a valuable reference for clinicians managing similar cases.

Porokeratotic eccrine and ostial dermal duct nevus

Wed, 30 Oct 2024 00:00:00 +0530

Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare benign eccrine nevoid hamartoma with only a few cases reported till date. It is characterized by asymptomatic or mildly pruritic pitted comedone-like papules on palms or soles and keratotic papules and plaques in a linear pattern on the extremities, usually present in childhood. We present here three interesting cases of the same. Diagnosis was confirmed by histopathology which showed parakeratotic columns overlying mature eccrine sweat glands in dermis and dyskeratotic cells of lower epidermis.

Skin disorders in patients with type 2 diabetes mellitus in Khartoum Dermatology and Venereology Teaching Hospital

Zainab M. R. Mohamed — Fri, 06 Sep 2024 00:00:00 +0530

Background: Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose, which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn't make enough insulin. About 1 in 11 adults worldwide now have diabetes mellitus (DM), 90% of whom have type 2 DM (T2DM). One of the most common manifestations of diabetes are skin complications, such as dryness of the skin, bacterial and fungal infections. Objectives were to study the frequency and pattern of skin disorders in patients with T2DM at Khartoum dermatology and venereology teaching hospital (KDVTH) in Khartoum, Sudan during August 2016 to December 2016.

Methods: This was prospective, observation descriptive, cross-sectional hospital-based study used a quantities method. A total convenient sample technique enrolled 100 points during the study period.

Results: One hundred diabetic patients (64% male and 36% female) were included in the study. The age group varies between (25 and >70 years), the commonest cutaneous manifestations were xerosis which was found in 45 patients (45%), fungal infection found in 36 patients (36%). Serum HbA1c level was done for each case.

Conclusions: The study concluded that the most prevalent cutaneous diseases among patients were xerosis fungal infection, eczema, bacterial infections, and scabies respectively. A significant relationship between duration of DM and level of HB A1C and the presence of cutaneous manifestations was observed.

Epidemiology of skin diseases among children attending the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State: a retrospective observational study

Brittani Remé, Ndidi Enwereji, Chinechelum N. Anyanechi, Uche R. Ojinmah — Wed, 30 Oct 2024 00:00:00 +0530

Background: Numerous studies have examined skin disease trends in Nigeria, revealing a shift towards increased allergic dermatoses. This research assessed the patient landscape at a clinic and satellite site in Obukpa, Nigeria.

Methods: A retrospective study of patients seen in the skin clinic of the university of Nigeria teaching hospital (UNTH), Ituku Ozalla, and the rural outpost in Obukpa between November 2009 and 2018 was carried out. A total of 1851 patients' data were analyzed. Diagnosis was based on clinical findings.

Results: There were more females (n=1007 [54.4%]) than males (n=844 [45.6%]). Most of the patients were of school age (6-12 years), and the most typical skin disease category was infectious disorders (32.5%), another categories/miscellaneous group (27.7%). Nearly all patients that presented to the rural outpost in Obukpa resided in the surrounding area of Nsukka (93.4%).

Conclusions: Comparing the study findings with an earlier one from the same center, there is no change in pattern, with infectious disorders being the most common skin disease category. However, these are largely preventable and emphasize the need for public enlightenment campaigns and policies to discourage the over-the-counter purchase of prescription-strength corticosteroid creams and antibiotics by parents and caregivers, a prevalent practice before seeking medical attention for their children. In addition, there is an urgent need to strengthen dermatologic training in primary health care settings, especially among pediatricians in Nigeria, to improve access to care.

Evaluating treatments for male androgenetic alopecia: clinical profile and comparative efficacy of platelet rich plasma and minoxidil with finasteride

Mehak Gupta, V. K. Garg — Mon, 02 Sep 2024 00:00:00 +0530

Background: Androgenetic alopecia (AGA) is a common, hereditary, and androgen-dependent disorder characterized by progressive hair thinning on the scalp, affecting both men and women. It arises from follicular miniaturization, leading to the conversion of terminal hair into vellus hair.

Methods: This study is a single-center, prospective, open-label, randomized, placebo-controlled trial with four parallel arms designed to evaluate treatments for male pattern baldness. Eighty patients were randomized into four groups: Group 1 received topical minoxidil and finasteride solution, group 2 received PRP alone, group 3 received PRP with minoxidil and finasteride solution, and group 4 received normal saline (NS). Interventions were administered monthly over three months, followed by a three-month follow-up period. Treatment effects were assessed using measures such as patient self-assessment, global photography, and the hair pull test.

Results: Group 3 (combined treatment) showed the most significant improvement in the hair pull test after six months (73.33% negative tests), followed by group 2 (PRP treatment) with 60% improvement. Patient satisfaction scores were highest in group 3 across all follow-ups (F1 to F5), demonstrating superior treatment response compared to other groups (p<0.001). Global photography assessments indicated varying results among groups, with group 4 recording the highest proportion of fair improvements (58.5%). Group 3 exhibited the highest percentage of patients with above-average improvement.

Conclusions: Our study provides valuable insights into managing AGA, emphasizing the effectiveness of combining PRP with topical treatments compared to individual therapies and placebo.

Method development and process validation in dermatology: assessing methods of UV exposure for inducing skin tanning and efficacy evaluation of anti-tanning agents

Mon, 02 Sep 2024 00:00:00 +0530

Background: Understanding the differential impacts of natural versus artificial UV exposure and validating a method to evaluate tanning prevention products are crucial for advancements in dermatological research and skincare. This study aimed to develop and validate a process for inducing skin tanning using natural sunlight and artificial UV-lamps, determining the optimal UV dosages to induce controlled tanning and erythema.

Methods: Six adults aged 18 to 55 were exposed to natural sunlight and a 365nm UV-lamp, with incremental exposure times and doses. Sunlight exposure was at 7600 μW/cm² for 20, 35, and 50 minutes, while the UV-lamp provided 78, 97.5, and 117 mJ/cm² doses. Skin tan and erythema were measured using Mexameter® MX-18-probe on days 1, 3, and 7. Test products A and B were applied to evaluate their protective efficacy, with untreated sites as controls. Safety assessments included dermatological evaluations for adverse effects.

Results: Sunlight exposure led to a mean erythema index (EI) increase of 40.22, 42.55-, and 47.12-units post-exposure, and mean melanin index (MI) increase of 37.78, 46.22, and 59.20 units by day 3. UV-lamp exposure resulted in less consistent increases, with maximum EI rise of 12.09 units and MI rise of 7.79 units. Test products significantly prevented tanning and erythema compared to untreated sites, with no adverse effects observed.

Conclusions: Direct sunlight exposure was more effective than artificial UV-light in reliably inducing tanning and erythema, establishing it as a method for such studies. The UV-lamp doses were insufficient for consistent results. The study validated a method for evaluating anti-tanning products, confirming their efficacy and safety. These findings support further research and optimization in UV exposure techniques, standardizing a method to induce tanning using direct sunlight exposure.

Clinico-epidemiological profile of dermatology patients: a one-year study at a newly established tertiary care centre in India

Shradha Singh, K. Geetha, Amrita Upadhyaya, Teesta Gusain — Fri, 04 Oct 2024 00:00:00 +0530

Background: Dermatology is predominantly an outpatient specialty focused on the diagnosis and treatment of dermatoses affecting the skin. We conducted a study on the demographic and clinical characteristics of patients attending the outpatient clinic to better understand the clinico-epidemiological profile and to predict morbidity patterns within the specific geographical region.

Methods: A retrospective study was conducted over the past year, encompassing all patients who visited the outpatient dermatology clinic at AIIMS, Raebareli. The study systematically documented a range of dermatoses, including disorders affecting the skin, hair, and nails.

Results: A total of 4,188 patients were included in the study, comprising 2,681 (64%) adults, 978 (23.4%) geriatric patients, and 529 (12.6%) pediatric patients. Among these, 1,311 patients primarily suffered from infections, followed by 752 patients with dermatitis. Of those with infections, 1,024 (78%) were diagnosed with fungal infections, while scabies was observed in 126 patients (9.6%). In the adult group, 756 (28.2%) patients had infections, while 429 (16%) patients were affected by dermatitis. Similar patterns were observed in both the geriatric and pediatric groups, with infections being the most prevalent, affecting 214 and 341 patients, respectively.

Conclusions: Based on the findings of this study, it can be concluded that infections, particularly fungal infections, are the most prevalent dermatological conditions across all age groups in the population studied. Dermatitis also emerged as a significant concern, particularly among adult patients. The high prevalence of infectious dermatoses, especially in geriatric and pediatric patients, highlights the need for targeted public health interventions and preventive measures.

Comorbid diseases and severity in psoriasis patients at Khartoum Dermatology and Venereology hospital, August-December 2019

Zainab M. R. Mohamed, Maisoon Mohammed Omar — Fri, 04 Oct 2024 00:00:00 +0530

Background: Psoriasis is recognized as a multisystemic disease characterized by systemic inflammation. This study explores the association between psoriasis severity and co-morbid conditions, including hypertension, diabetes, psoriatic arthritis, nail psoriasis, and symptoms such as cough and dyspnea, along with psychological factors like social isolation and sleep disturbances. Objectives were to identify co-morbid diseases associated with different severity levels of psoriasis as measured by the psoriasis area and severity index (PASI) scores at Khartoum dermatology and venereology teaching hospital (KDVTH) from August to December 2019.

Methods: This prospective, observational, descriptive, cross-sectional study enrolled 150 psoriasis patients using a quantitative approach. The PASI score was used to assess disease severity.

Results: Among the 150 participants (58.6% male, 41.4% female), the distribution of psoriasis severity was 18.7% severe, 30.6% moderate, and 50.6% mild. Significant co-morbidities were observed in severe cases: hypertension (46.4%), diabetes (28.6%), psoriatic arthritis (39.2%), and nail psoriasis (32.2%). Notably, 25% of patients were on lipid-lowering medications. Social isolation and sleep disturbances were prevalent in 30% of moderate and 57% of severe cases.

Conclusions: Severe psoriasis is significantly associated with multiple co-morbidities, which can adversely affect patients' prognosis and quality of life. Addressing these associations may enhance management strategies for psoriasis patients.

A survey on healthcare professionals’ perspective on the use of benzoyl peroxide cleanser for acne management

Anupam Das, Swetha Thangavel, Dyotona Sen, Sameer Jadhwar — Thu, 10 Oct 2024 00:00:00 +0530

Background: Acne vulgaris is a prevalent chronic dermatological condition affecting adolescents and young adults, with significant consequences on quality of life if left untreated. Effective management strategies are crucial to prevent scarring and psychological distress associated with acne. This study investigated the role of cleansers in acne management and explored healthcare professionals' perspectives and practices regarding acne treatment.

Methods: An online questionnaire-based study, involving 126 healthcare professionals [HCPs (dermatologists and cosmetologists)] and 459 acne patients was conducted to assess patients’ acne severity, adherence to cleansing regimens, preferred cleansing agents, treatment duration, adjunctive therapies, and the impact of benzoyl peroxide 5% cleanser on acne control and patient satisfaction.

Results: The majority of the patients presented with an IGA grade 3 (moderate) acne (48.59%) in the present survey. HCPs rated benzoyl peroxide as the most preferred cleansing agent for acne management in most of their patients (87.33%). Majority of the patients (41.53%) exhibited improvement within 15 days of using the benzoyl peroxide cleanser, highlighting its relatively rapid onset of action. The benzoyl peroxide treatment duration varied for patients, emphasizing the individualized nature of acne treatment. In most of the severe cases (39.87%), HCPs commonly supplemented benzoyl peroxide with topical retinoids, oral antibiotics, oral isotretinoin, or combination therapy.

Conclusions: This study emphasizes the effectiveness and preference for benzoyl peroxide-based cleansers among HCPs and patients.

Therapeutic potential of oral tofacitinib in alopecia areata: a retrospective study

Wed, 30 Oct 2024 00:00:00 +0530

Background: Alopecia areata (AA), a prevalent autoimmune disorder, poses challenges in management, particularly in severe cases. Recent advancements highlight janus kinase (JAK) inhibitors-tofacitinib demonstrating promise. However, the literature reports conflicting information on its safety profile, especially at higher doses, necessitating a comprehensive evaluation.

Methods: This retrospective analysis investigates the long-term efficacy and safety of oral tofacitinib in AA patients from January 2017 to October 2022. The study included 69 patients diagnosed with patchy multifocal AA (mfAA), alopecia totalis (AT), alopecia universalis (AU) or alopecia sub-totalis (AS). Data analysis incorporated demographic details, treatment history, autoimmune comorbidities, tofacitinib dosages, prior investigations, recurrence rates, and adverse effects. Efficacy was assessed using severity of alopecia tool (SALT) scores, with a grading system for percentage of hair regrowth.

Results: The study comprising of 58% males and 42% females, exhibited varied alopecia types. Treatment response analyzed through percent change in SALT score revealed 46.5% showed very good response to tofacitinib treatment, while 4.3% had excellent response (100% change in SALT score). 44.9% of patients showed no recurrence. Adverse effects were minimal, including acneiform eruptions and upper respiratory tract infections. Pearson correlations revealed age negatively correlated with hair regrowth percentage, suggesting older individuals exhibited lower regrowth responses.

Conclusions: Our findings endorse tofacitinib as a promising therapeutic option for the management of AA, with no serious side effects observed even during longer treatment durations. It can be regarded as the primary choice of treatment modality for moderate to severe forms of AA.

Consumer survey to evaluate the effects of Mintop serum in the management of hair fall

Wed, 30 Oct 2024 00:00:00 +0530

Background: Hair fall, or alopecia, is a common concern influenced by various factors, necessitating diverse treatment.

Methods: This single-group, non-comparative study enrolled 165 participants aged 18-55 years with hair fall complaints. Participants applied Mintop serum twice daily for 90 days. Assessments included hair pull tests, 1-minute comb tests, consumer questionnaires, and dermatologist evaluations at baseline, 1 month, and 3 months.

Results: Of the 161 participants who completed the study, significant reductions in hair fall were observed after 1 month (p<0.001) and 3 months (p<0.001) of product use. Participants reported high satisfaction with the serum’s effectiveness in reducing hair fall (100% agreement) and stimulating new hair growth (99.4% after 1 month, 100% after 3 months). Objective measures such as the hair pull test and 1-minute comb test demonstrated substantial decreases in hair shedding across the study period. No adverse events were reported.

Conclusions: Mintop Pro+ hair regrowth serum showed promising efficacy in reducing hair fall and improving hair density, strength, and overall hair health. The serum was well-tolerated without adverse effects, suggesting its potential as a safe and effective non-surgical option for managing hair loss.

The effect of topical retinoids in treatment of acne vulgaris in Khartoum Teaching Dermatological Hospital

Rania A. S. Ahmed Ali, Zainab M. R. Mohamed — Wed, 30 Oct 2024 00:00:00 +0530

Background: Acne vulgaris is a chronic inflammatory skin disease affecting approximately 80% of young adults and adolescents. Prolonged therapy is often required for satisfactory results. Topical retinoids play a central role in acne treatment, with evidence supporting their efficacy in achieving significant improvements in acne symptoms. This study aimed to assess the effectiveness of topical retinoids in treating acne vulgaris among patients at Khartoum Dermatology and Venereal Teaching Hospital from August 2019 to August 2020.

Methods: A non-randomized interventional study was conducted at Khartoum Dermatology Teaching Hospital, covering patients diagnosed with mild to moderate acne vulgaris. Data were entered, cleaned, and analysed using statistical package for the social sciences (SPSS) version 25.0.

Results: The study included 100 patients. Of these, 38% were aged 25-35 years, and 70% were female. 92% had experienced acne symptoms for more than six months. Regarding treatment duration, 87% used topical retinoids for more than three months. Clinical improvement was observed in 83% of patients, while 14% showed no improvement, and 3% experienced worsened symptoms.

Conclusions: Topical retinoids are effective in treating mild and moderate acne vulgaris.

Enhancing patient education and engagement through digital intelligence tools in dermatology

Wed, 30 Oct 2024 00:00:00 +0530

This comprehensive digital health review examines the expanding landscape of digital intelligence tools within dermatology, specifically examining the innovative role of AI-powered applications aimed at educating and engaging patients in managing their skin health. Drawing upon a wide array of existing research, this review scrutinizes the evolution and impact of various digital tools. These include interactive apps that leverage AI algorithms to deliver tailored skincare guidance, considering factors such as skin type, concerns, and environmental factors. Additionally, the review explores the emerging use of immersive virtual reality experiences to deepen patients’ understanding of skin conditions, offering vivid simulations and educational content. These innovative approaches showcase significant promise in not only improving patient outcomes but also fostering greater treatment adherence and overall satisfaction with dermatological care. Looking ahead, future research should prioritize fine-tuning AI algorithms to further personalize patient recommendations, exploring the integration of wearable technology for real-time monitoring, and conducting longitudinal studies to evaluate the sustained effectiveness and scalability of digital intelligence tools in promoting patient education and engagement. Moreover, innovative strategies such as gamification techniques and social support platforms hold considerable potential for enhancing patient empowerment and involvement in managing their skin health. Leveraging digital intelligence tools will eventually redefine the landscape of dermatological care, empowering patients and optimizing treatment outcomes through enhanced education and engagement.

The complex pathophysiology and clinical management of epidermolysis bullosa: a comprehensive review

Martha Castro Carranza, Edgar Hiram López Cruz — Wed, 30 Oct 2024 00:00:00 +0530

Epidermolysis bullosa (EB) represents a group of rare, genetically heterogeneous disorders characterized by the formation of blisters and erosions of the skin and mucous membranes in response to minor mechanical trauma. EB is classified into four major types-EB simplex, junctional EB, dystrophic EB, and Kindler syndrome, each associated with mutations in specific genes that encode structural proteins essential for skin integrity. The clinical spectrum of EB ranges from mild forms, presenting with localized skin involvement, to severe variants that lead to widespread blistering, mutilating scarring, and significant morbidity. The pathophysiology of EB is complex, involving disruptions in the adhesion between the dermis and epidermis, leading to compromised structural stability of the skin. Current therapeutic strategies focus on symptom management, including wound care, infection prevention, and pain control, as no definitive cure exists. Advances in gene therapy, stem cell therapy, and protein replacement therapy hold promise for future treatment paradigms. This review aims to elucidate the molecular underpinnings, clinical manifestations, and emerging therapeutic approaches for EB, providing a comprehensive overview for clinicians and researchers engaged in the management and study of this challenging condition.

Optimizing pediatric psoriasis management through anti-inflammatory dietary interventions

Wed, 30 Oct 2024 00:00:00 +0530

Recent studies have increasingly focused on investigating the impact of anti-inflammatory dietary patterns, particularly emphasizing the Mediterranean diet, on the severity and progression of pediatric psoriasis. This review comprehensively examines a wide range of studies that explore the correlation between dietary intake patterns and clinical outcomes in children with psoriasis, providing a detailed synthesis of current evidence. It critically evaluates the role of specific anti-inflammatory nutrients such as polyphenols, omega-3 fatty acids, and vitamins A, D, and E, emphasizing their mechanisms in reducing inflammatory markers and modulating immune responses specific to pediatric psoriasis. Additionally, the review provides an in-depth assessment of the safety, feasibility, and long-term adherence to these dietary patterns, considering factors like dietary compliance, nutritional adequacy, and potential adverse effects. By offering a nuanced analysis, this review aims to substantiate the potential efficacy of anti-inflammatory diets as adjunctive therapies for pediatric psoriasis management, identifying existing research gaps and suggesting avenues for future investigations to optimize dietary interventions in clinical settings.

Cosmetics and skincare routine in acne prone skin

Naina Jain — Wed, 30 Oct 2024 00:00:00 +0530

The growing awareness and indulgence of the general population into cosmetics make it essential for us, as dermatologists, to know when to avoid or consume them in the management of acne. This review, therefore, deals into specifics of cosmetics, acne cosmetica and recommendations on use of cosmetics in an acne prone skin.