Common Dermatological Problem Research Articles

Cutaneous manifestations in patients attending the hematology clinic at King Fahd Hospital of the University during a 13 week-period

Background: Cutaneous disorders are common in patients with hematological diseases especially anemia. Dermatologists usually contribute to the management of these patients in parallel with other medical specialties. Aim: To report common dermatological problems in patients attending the hematology clinic at a secondary care hospital. Materials and methods: The study was conducted at the hematology clinic of King Fahd Hospital of the University during a thirteen week period starting 17 th of November, 2013 till 31 st of January, 2014. All patients were fully examined and a consultative opinion was given to the attending hematologist. Data sheet was filled and analyzed by SPSS (Statistical Package for the Social Sciences) software version 17.0. Results: 138 patients were seen during the period of 13 weeks. There were 27 males and 111 females. Hemoglobin level was less than 10 gm/dl in 40.6% of patients. The most common reported cutaneous features were diffuse alopecia, hair thinning, pallor, pruritus, fragile skin, easy brusability, dry mouth and gum bleeding in descending frequency. Conclusion: Hematology patients suffered from variable dermatological disorders which suggest the importance of the initial dermatology consultation for those patients as part of their management plan.

Recurrent furunculosis in returning travelers: newly defined entity.

Bacterial skin infection is a common dermatologic problem in travelers, which usually resolves without sequela. In contrast, post-travel recurrent furunculosis (PTRF) is a new unique entity of a sequential occurrence of many furuncles seen after returning home from a trip to the Tropics. The objective of this study was to characterize the disease course and possible causes of PTRF. A retrospective study was conducted on a group of young, healthy individuals (16 males and 5 females), who presented with PTRF after returning from tropical countries. In all patients, the first furuncle appeared toward the end of the trip and continued for several months after returning home. The average duration of disease was 8.4 months with an average of 4.2 recurrences. Along the disease course, subsequent recurrences became shorter and milder with longer inter-recurrence intervals. Bacterial cultures most commonly grew methicillin-sensitive Staphylococcus aureus (MSSA, 76.5%). Nasal colonization was demonstrated in 47% of patients. There were neither companion travelers nor family members experiencing furuncles. PTRF should be defined as a clinical entity with prolonged travel to the Tropics being its major risk factor. In the author's opinion, a transient immune change in a subpopulation of travelers ignites a series of recurrent furuncles, resolving upon restoration of normal immunity.

The enemy of the feet: blisters in ultraendurance runners.

Blisters are the most common dermatologic problem in ultraendurance runners. Their incidence, localization, pain scores, and risk factors in field conditions are poorly understood. We conducted an observational field-based cohort study during the 5-day multistage 2010 and 2011 Al Andalus Ultimate Trail (219 km). Daily postrace data on blister frequency, localization, severity, and preventive measures from 50 ultramarathon runners were collected through the direct interview technique. After 4 days of running (182 km), blisters occurred in 76% of the participants (P < .001 versus stage 1) compared with 34% after day 1, 54% after day 2, and 72% after day 3 (P < .001 versus stage 1). Most of the blisters formed on the toes (65%) (P < .001), followed by blisters on other locations of the foot: the ball of the foot (16%), heel (14%), and sole (5%). Blisters were more painful toward the end of the race, and those on the sole and heel tended to be the most painful, although this did not reach statistical significance. Prophylactic measures studied (type and fabric of socks; application of antiperspirants, talcum powder, or lubricant to feet; and prophylactic taping) did not show any reduction in blister rates. The only predictive marker for reduced blister incidence was previous ultramarathon experience in men (r = -0.44, P < .05). Blisters are extremely common in multistage ultramarathon races. Race experience in male ultramarathon runners is associated with reduced blister rates.

Subcutaneous (deep) fungal infections.

Fungal infection is a common clinical problem in dermatology. While most cases in practice are superficial infections, invasive subcutaneous mycoses are important to recognize and treat, as these conditions often have significant morbidity and mortality. Deep fungi demonstrate species-specific syndromes and may be identified by clinical and histological features in addition to serological evaluation and culture. Identification of the common innoculation subcutaneous mycoses, as well as those associated with pulmonary primary infection and dissemination to the skin is important, as treatments vary by organism and clinical setting. This overview will help to identify the key dermatological presentations of subcutaneous fungal infection, and the clues they give to cause.

Seasonal variation of common skin diseases in pediatric age group a retrospective study conducted in a medical college of Nepal

INTRODUCTION: Seasonal variation in disease frequency has been observed for centuries. The direct effects of climate on the skin play a small but significant role in determining the geographical and seasonal variation of many skin disorders also in pediatric age group. In our country Nepal where there is a wide range of climates and where pediatric population of 0 to 14 years constitutes 34.19% of the total population there is a need for studying the seasonal variation of pediatric dermatoses separately. MATERIAL AND METHODS: A retrospective study was conducted in the outpatient department of dermatology of Nepal Medical College and Teaching Hospital for a period of 1 year. The total patients were divided according to 4 seasons spring, summer, autumn and winter and analyzed with Chi square test. RESULTS: Out of total 2032 patients 52% was male and 48% was female. Majority of the visits was in the winter season, followed by summer, spring and autumn. The five most common dermatological problems in the pediatric age group were impetigo, lichen urticatus, scabies, seborrheic eczema and milaria. lichen urticatus, seborrheic eczema and milaria showed statistically very significant seasonal variation but impetigo and scabies did not. The age wise variation of these common dermatoses was also statistically highly significant. CONCLUSION: Many common dermatoses in the pediatric age group show seasonal variation and age wise variation. DOI: http://dx.doi.org/10.3126/jucms.v2i1.10483 Journal of Universal College of Medical Sciences (2014) Vol.2(1): 7-11

Serum Level of Macrophage Migration Inhibitory Factor (MIF) in Egyptians With Alopecia Areata and Its Relation to the Clinical Severity of the Disease

Alopecia areata (AA) is a common dermatological problem that manifests as sudden loss of hair without any inflammation or scarring. Various cytokines are implicated in the pathogenesis of this disease. Macrophage migration inhibitory factor (MIF) is located at an upstream position in the events leading to the possible dysregulated immuno-inflammatory responses, and the high level of this cytokine in AA may suggest a role of MIF in the pathogenesis of AA. This case-control study was carried out on 31 AA patients with different grades of severity and 15 apparently healthy subjects. Serum MIF level was measured by ELISA, and was correlated with the clinical severity of the disease using SALT (severity of alopecia tool) scoring system. In this study, there was a significant elevation in serum MIF levels in AA patients in comparison with controls. There was also a positive correlation between MIF levels and clinical severity and disease duration. MIF seems to have an essential role in the etiopathogenesis of AA. So, it is considered to be a promising target in the therapy of autoimmune diseases and as a future predictor of alopecia activity. Anti-MIF therapy might be added as one of the new biological treatments for AA.

Common Skin Problems in Children

Childhood dermatological problems contribute about one-third of all consultations in the setting of both pediatrics and dermatology outpatient services. Skin disorders in children may cause anxiety to parents. General Practitioners should be familiar with the common prevalent skin problems as immediate pediatric dermatology consultation may not be possible. Infections, infestations and dermatitis are the most prevalent diseases among Indian children. The scope of this review is to briefly highlight these common and other important dermatological problems in children.

Pattern of Dermatologic Disorders in Infants

Background: Pattern of skin disorders varies in different ages and in different countries. This pattern also varies among children of different ages. The prevalence pattern reflects socioeconomic, environmental and hygienic condition of a community. Objective: This study was planned to evaluate the magnitude of skin diseases and pattern of various dermatoses among children below one year of age in a major tertiary care hospital in the capital of Bangladesh. Method: A retrospective study was undertaken to determine the pattern of skin diseases during the period of January 2010 to June 2012 at the dermatology outpatient department of a tertiary care pediatric hospital in the capital of Bangladesh. Data were analyzed to determine the pattern of skin diseases in children less than one year of age, seen at the Out Patient Department (OPD) of Dhaka Shishu Hospital (DSH). Results: A total of 36608 cases were seen at the dermatological OPD of DSH out of which 9293 (25.39%) were less than one year of age. The frequency of distribution of dermatological diseases was more in male patients 58.2% than in female patients 41.8%. Neonates were 649 (7%) and rest were infants were 8644 (93%). Eczema was the most common skin disorder (55.41%) followed by impetigo &amp; other bacterial infections (27.55%) and scabies (23.44%). Cutaneous fungal infections were 13.99%, miliaria was 4.9%, erythema neonatorum 4.42%, urticaria was 2.18%, bullous lesions 1.45%, haemangioma 1.17% and pityriasis alba 1.15%. About 16 other dermatological disorders were indentified each of which was less than 1% in distribution. Conclusions: Eczema, superficial bacterial infections, scabies and superficial fungal infections were most common dermatological problem in infants. Birdem Med J 2013; 3(2): 80-84 DOI: http://dx.doi.org/10.3329/birdem.v3i2.17210

Not to be missed! Differential diagnoses of common dermatological problems in returning travellers

After systemic febrile illnesses and diarrhoea, dermatological disorders are the third most frequent health problem of returning travellers consulting travel clinics. While most travel-related dermatological problems are mild, self-limiting and rather harmless, the challenge is to pick up on dermatological clues to potentially severe or even life-threatening diseases. This article provides an overview of the most common and the 'not to be missed' dermatological diagnoses in international travellers.

Self – Medication of Anti-microbial Agents (AMAs) and Over-the-Counter Practices: A Study in Mymensingh Sadar Area

Self-medication is common in countries where prescription legislations are not strong enough and drugs are available over the counter. This study was conducted to assess the self-medication by antibiotics in Mymensingh Sadar Area population and determine the factors related to it. This descriptive study was conducted in Mymensingh Sadar Area between January 2010 and December 2010. Convenient sampling was used to select respondents from among those who came to the community pharmacies to purchase drugs for self-medication. Respondents were interviewed after they made their requests but before they were provided with information on the drugs they requested. Data were collected using structured questionnaire. Drug consumers consisted of all age categories of both genders; as well as different occupations of varying educational background levels. The most frequently reported illnesses that prompted self-medication of respondents were fever, dental pain, cough &amp; common cold, dermatological and ENT problems. Over 42% of them made their requests by telling symptoms of illness and 32.3% obtained advice from traditional healers. The most common reasons reported for self-diagnosis and self-medication were cost of physician service and non-seriousness of the disease. More than 13 different types of antibiotics were requested, the most frequent category of antibiotics being ciprofloxacin/other FQS 21%, amoxicillin 16.5%, azithromycin/erythromycin 14% and cephalosporin 13.3%. Self-medication is widely practiced for a wide range of illnesses or symptoms of illnesses and for over-the-counter. The public as well as the health care providers have to be educated on the scopes of self-medication; i.e., the type of illnesses to be self-diagnosed and self-treated and the type of drug products to be used in order to promote responsible self-medication. DOI: http://dx.doi.org/10.3329/cbmj.v2i1.14176 Community Based Medical Journal Vol.2(1) 2013 15-20

Researching accessible and affordable treatment for common dermatological problems in developing countries. An Ethiopian experience

Skin diseases are very common in rural and urban areas of Ethiopia, and traditional preparations of plant origin might represent the only alternative to synthetic drugs. Improving knowledge of traditional medicines and assessing their safety and effectiveness is necessary. We conducted a two-arm, randomized, double-blind, placebo-controlled trial assessing the efficacy of some cosmetic herbal preparations for common dermatologic problems: a 3% thyme essential oil antifungal cream and a 10% chamomile extract cream for eczema-like lesions. Ten subjects (66.5%) treated with the 3% thyme active cream were completely healed vs. four subjects (28.5%) from the placebo group (P=0.040). A large number of subjects treated with the chamomile cream were healed or improved, but no significant differences were found between active cream and placebo. A high rate of treatment acceptance was registered in both groups, no adverse effects were reported. A 3% thyme essential oil cream could represent a cheap and easily available opportunity to treat and heal mild to moderate cases of fungal infections; a common emollient cream could be a very effective intervention when treating mild to moderate cases of pityriasis alba and eczema-like lesions. Further research is needed.

Common Dermatological Problems in the Paediatric Office

Common Dermatological Problems in the Paediatric Office

Subcision for treatment of rolling acne scars in Iraqi patients: a clinical study

Acne scarring is a common dermatologic problem causing a great cosmetic disfigurement. Subcision is one of the effective modalities for treatment of rolling acne scars. To evaluate the efficacy and safety of subcision for rolling acne scars in Iraqi patients. Forty patients (21 males and 19 females) with moderate to severe grades of facial rolling acne scars were enrolled in this study. Subcision was done for all patients. Patients were followed up at 2, 6, 12 weeks, and 6 months after the last session. The response to treatment was evaluated by objective and subjective methods. Thirty-four patients completed the study and follow up period. Eight of them were complaining of severe and 26 of moderate grade of acne scars. At the end of the study, 18 (52.94%) patients had mild grade, 15 (44.11%) patients had moderate grade, and one (2.92%) patient had severe grade. This change was statistically highly significant (P-value = 0.0000001). The average scar score before treatment was 13.264 ± 1.675; and it improved to 9.47 ± 2.71 after 6 months (P-value = 0.0000001). Regarding the photographic assessment, the difference in the visual analogue scale before and after the treatment was statistically highly significant (P-value = 0.0000001). All patients were satisfied regarding the improvement after treatment with varying degrees. All reported side-effects were mild and transient. Subcision is a safe, easy to perform, well-tolerated, and valuable surgical technique for treatment of rolling acne scars.

Dermatological diseases in lizards

Lizards with dermatological disease are routinely encountered in veterinary practice and it is often challenging to establish a thorough and adequate case management for these otherwise highly visible conditions. Most skin diseases in lizards are primarily a consequence of environmental stressors such as substandard husbandry and underlying disease, facilitating the onset of mainly secondary bacterial and mycotic dermal infections. This review provides an overview of common dermatological problems in lizards and aetiology, treatment and prevention are discussed for both infectious and non-infectious conditions. Although investigational approaches may be directed by the primary clinical manifestation of dermatological problems, the importance of a multidirectional approach cannot be over-emphasized. Proper treatment can only be initiated when the correct diagnosis has been made and husbandry issues dealt with. Current information on susceptibility patterns and on the use of appropriate chemotherapeutics in lizards is limited for the treatment of infectious causes of dermatitis.

Lactic acid as a new therapeutic peeling agent in the treatment of lifa disease (frictional dermal melanosis)

Background:Lifa disease (frictional dermal melanosis) is a common dermatological problem. Full strength lactic acid has been proved to be effective and safe peeling agent in the treatment of melasma.Objective:To assess the effectiveness and the safety of lactic acid chemical peeling in the treatment of lifa disease.Materials and Methods:This open label therapeutic trial was conducted in Department of Dermatology in Najaf and Baghdad Teaching Hospitals, from March 2007-October 2008. Full strength lactic acid (92%, pH 3.5) was used as a peeling agent. The treatment sessions were done every 2 weeks until the desired response was achieved (but not more than 6 sessions). The response to therapy was evaluated by objective and subjective methods. All patients were followed monthly for 3 months after the last treatment session.Results:52 patients with typical clinical features of lifa disease were included. All patients were slim with prominent bones and low body mass index, and gave history of using the lifa (washing agent) during bathing. The number of sessions ranged from 2-6 sessions. The pigmentation was improved in all patients as revealed by objective and subjective methods, and this response was statistically highly significant. No significant side effects were recorded in all treated patients. The improvement has been sustained without any obvious relapse throughout the follow-up period.Conclusion:Lactic acid peel is a new, non-costly mode of therapy in treating dermal melanosis in patients with lifa disease.

Evaluation of the effect of formic acid and sodium formate on hair reduction in rat.

Hirsutism is a common problem in dermatology that imposes high socioeconomical costs on medical care. Consequently, researchers are actively searching for cheaper and safer methods for therapeutic treatment. The objective of the present study is to evaluate formic oil, enriched from formic acid, for the removal of unwanted hair. In this study, 32 female rats (150–200 g) were randomly divided into four groups and maintained with normal water and food availability. A patch of skin was shaved on each rat for application of test solutions. The control group was treated with local once-daily applications of normal saline. The formic acid, acetic acid, and sodium formate groups were treated with once-daily applications of formic acid (pH 5.5), acetic acid (pH 5.5), or sodium formate, respectively. After 2 weeks, horizontally cut sample biopsies were removed, and the numbers of hair follicles were counted under high field microscopy by a specialist blinded to the treatments. Kolmogorov–Smirnov test results indicated a nonparametric distribution for the rat groups. ANOVA analysis indicated no statistically significant differences between groups (P < 0.05). There weren’t any side effects or evidence for toxicity during the study period. However, hair follicle counts showed a descending order of control, acetic acid, formic acid, and sodium formate. Although the sodium formate group had the lowest hair follicle numbers, the difference was not statistically significant (P > 0.05). Formic acid was not effective in reducing hair follicle numbers in rats.

What are the learning outcomes of a short postgraduate training course in dermatology for primary care doctors?

BackgroundThere are increasing expectations on primary care doctors to shoulder a bigger share of care for patients with common dermatological problems in the community. This study examined the learning outcomes of a short postgraduate course in dermatology for primary care doctors.MethodsA self-reported questionnaire developed by the research team was sent to the Course graduates. A retrospective design was adopted to compare their clinical practice characteristics before and after the Course. Differences in the ratings were analysed using the nonparametric Wilcoxon signed rank test to evaluate the effectiveness of the Course in various aspects.ResultsSixty-nine graduates replied with a response rate of 42.9% (69/161). Most were confident of diagnosing (91.2%) and managing (88.4%) common dermatological problems after the Course, compared to 61.8% and 58.0% respectively before the Course. Most had also modified their approach and increased their attention to patients with dermatological problems. The number of patients with dermatological problems seen by the graduates per day showed significant increase after the Course, while the average percentage of referrals to dermatologists dropped from 31.9% to 23.5%. The proportion of graduates interested in following up patients with chronic dermatological problems increased from 60.3% to 77.9%.ConclusionsGraduates of the Course reported improved confidence, attitudes and skills in treating common dermatological problems. They also reported to handle more patients with common dermatological problems in their practice and refer fewer patients.

Oral zinc sulfate treatment for viral warts: An open-label study

Viral warts, which are caused by the human papilloma virus, are a common problem in dermatology. Various modalities have been used to treat warts, but none are uniformly effective or directly antiviral. Recent studies show that oral zinc sulfate could be effective in the treatment of viral warts. Thirty-one patients with multiple, non-genital viral warts were recruited in this open-label clinical study. The patients were treated with oral zinc sulfate (10 mg/kg to a maximum dose of 600 mg/day) for 2 months and followed up with assessments for the resolution of their warts and for any evidence of recurrence after treatment. Among the 31 patients, 18 patients showed low serum zinc levels (58%). Of 26 patients who completed the study (84%), 13 (50%) showed complete resolution of their warts after 2 months of treatment. Complete responders remained free of lesions at 6-month follow-up. No serious side-effects were reported apart from nausea (16%), mild gastric pain (3%) and itching sensation (3%). Oral zinc sulfate was found to be a good option in the treatment of viral warts, as it was safe and effective without important side-effects.

Assessing adherence to dermatology treatments: a review of self-report and electronic measures

Nonadherence to prescribed medications is a common problem in dermatology, and assessing adherence can be difficult. Electronic monitors are not always practical, but self-report measures may be less reliable. To review the literature for self-report instruments and electronic monitors used to measure medication adherence in patients with chronic disease. A PubMed literature search was conducted using the terms 'scale,''measure,''self-report,''electronic,' and 'medication adherence.' Relevant articles were reviewed and selected if they addressed self-report or electronic measures of adherence in chronic disease. Eleven self-report instruments for the measurement of adherence were identified. Four were validated using electronic monitors. All produced an estimate of adherence that correlated with actual behavior, although this correlation was not strong for any of the measures. None of the scales was tested in patients who had dermatologic disease and/or used topical medications. Several electronic monitoring systems were identified, including pill counts, pharmacy refill logs, and the Medication Event Monitoring System (MEMS). Validity was higher among electronic monitoring systems compared with self-report measures. While several self-report measures of adherence have been validated in chronic disease populations, their relevance in dermatology patients has not been studied. A dermatology-specific instrument for the measurement of adherence would contribute to improved outcomes; until such a tool exists, researchers and clinicians should consider nonadherence as a possible factor in skin disease that is not responsive to treatment. Electronic monitoring provides the most reliable means of measuring adherence, and may provide additional clues to identify barriers to adherence.

Segmental pigmentation disorder

There is little published information about segmental hypo- and hyperpigmentation pigmentation disorder (SegPD) although it is a relatively common problem in paediatric dermatology. To define the spectrum of disease, clinical presentation and associations in cases of SegPD and to clarify further the terminology in defining patterned hypo- and hyperpigmentation in children. This was a retrospective review of cases in an academic paediatric dermatology practice. Thirty-nine patients referred for dermatological evaluation were diagnosed with SegPD. Demographic and clinical features, and distribution and frequency of extracutaneous abnormalities were measured. Twenty female and 19 male patients were included in the study; 33 out of the 39 were referred specifically for a pigmentation abnormality. The mean age at onset was 3·4 months (median age 0·25 months). Family history was positive in two patients. Most (30/39; 77%) had segmental hyperpigmentation whereas nine of 39 (23%) had hypopigmentation. Patches were more often delineated at the ventral midline (32/39) than on the dorsal midline (7/39). The distribution of lesions was as follows: areas of the torso were most often affected (77%) and when the face, neck, arms and legs were affected pigmentation usually extended onto the torso; six patients had SegPD localized to the face. Only three of the 39 patients had extracutaneous abnormalities - atrial septal defect, strabismus with retinal hypopigmentation and a bronchogenic cyst - but the relationship to SegPD was uncertain and none had neurological abnormalities. SegPD is a relatively common pigmentary anomaly and most affected individuals are otherwise healthy. We propose reviving the term 'segmental pigmentation disorder' coined by Metzker and colleagues to describe children with segmental and block-like hypo-/hyperpigmentation with midline demarcation.