Dermatology Consultation Research Articles

ACTINIC KERATOSIS, SCOPING REVIEW

Introduction: actinic keratoses, also called senile keratoses or solar keratoses, are benign intraepithelial neoplasms common in dermatologic consultation. Individuals with actinic keratoses may present with irregular, reddish, scaly papules or plaques on areas of the body exposed to solar radiation. These dysplastic proliferations of keratinocytes have the potential for malignant transformation and may progress to squamous cell carcinoma. Objective: to detail the current information related to actinic keratosis, etiology, epidemiology, pathophysiology, histopathology, clinical presentation, evaluation, diagnosis, treatment and prognosis. Methodology: a total of 32 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 21 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: actinic keratosis, solar keratosis, dysplastic proliferations of keratinocytes, squamous cell carcinoma. Results: actinic keratosis is a common condition associated with chronic sun exposure, especially in older people, with a prevalence up to 60 years of age. Exposure to ultraviolet radiation is the main risk factor, and individuals with fair skin, outdoor work or compromised immune systems. Diagnosis is made through clinical observation, dermoscopy and in some cases biopsy. Treatments include options such as cryotherapy, excision, light-based therapies and topical medications such as 5-fluorouracil, with a personalized approach depending on lesion characteristics and patient response. Conclusions: actinic keratosis is a relevant dermatologic condition that requires constant vigilance due to its potential to progress to malignant forms. Preventive education on photoprotection and self-care, together with adequate and personalized treatment, are essential to control the disease and minimize the risk of serious complications, such as carcinoma. KEY WORDS: Keratosis, Dysplasia, Keratinocytes, Carcinoma, Ultraviolet.

Implementation of teledermatological consultations at Leipzig University Medical Center

Numerous patients admitted to ageneral hospital present skin changes as secondary findings. Approximately 800 dermatological consultations are performed annually at the Leipzig University Medical Center. The aim of this study was, after implementation of teledermatological consulting, the retrospective evaluation of that and the resulting satisfaction of the physicians involved. We carried out an analysis of all consultation requests, which were answered using store-and-forward technology via the photo documentation app imitoCAM® (imito AG Zurich/Switzerland) and the clinical information system SAP® (SAP Deutschland SE & Co. KG Walldorf/Germany) from 1February to 31July 2023, as well as of questionnaires on satisfaction, which were sent to the participating physicians after the consultation. Our analysis included 419 consultation requests, 90of which were answered teledermatologically. The consultation dermatologists stated that 92% of the cases could be solved using only telemedical instruments. Moreover, 90.9% of the consulting physicians rated the technical implementation as good to very good and 47.5% of the consultation dermatologists estimated atime saving of at least 30-60 min. Our study shows the enormous potential of teledermatology in the inpatient setting. Implementation of teleconsultation enables more efficient consultations, reduces time- and cost-intensive transportation and offers patients amore comfortable dermatological evaluation with reduced risk of infection.

The Absence of Emergency Dermatology Consultation Services in Ontario Hospitals.

The Absence of Emergency Dermatology Consultation Services in Ontario Hospitals.

Retrospective Epidemiology of Dermatomycosis in Kinshasa, Democratic Republic of Congo, From 2000 to 2023

ABSTRACTBackgroundAlthough cutaneous mycoses are a global public health problem, very few data are available in the Democratic Republic of Congo (DRC).ObjectivesThis study aimed to describe the retrospective clinical epidemiology of dermatomycosis and their associated risk factors in dermatological consultations in Kinshasa, DRC.MethodsA retrospective study based on the medical records of patients seen in the departments of dermatology of 2 major hospitals in Kinshasa from March 2000 to August 2023 was carried out. The diagnosis of the various types of dermatomycoses was established based on the dermatologist's clinical examination. Patient demographic and clinical data were collected for study purposes.ResultsOf 27,439 patients consulted at the two sites, 1142 were diagnosed with dermatomycosis (4.16%). Young women aged 27 (17–43) were most affected. Diagnosed patients shared a history of skin mycoses (26%), use of skin‐lightening products (19%) and diabetes mellitus (9.6%). Among these patients, 59.3% suffered from dermatophytosis (tinea), 39.1% from malassesiosis and 1.2% from candidal dermatosis. While tinea was predominantly found in children (81.88%, p < 0.001), pruritus and pain in the lesions were preferentially reported by the dermatophytosis patients [65.25% (p < 0.001) and 79.1% (p < 0.001), respectively]. Tinea corporis (45.5%), tinea capitis (20.4%), tinea pedis (19.3%) and onychomycosis (10.2%) were the main nosological entities in the dermatophytosis group, and their distribution on the body surface depended on patients' age (p < 0.001) and sex (p = 0.012).ConclusionsDominated by dermatophytosis, dermatomycosis are frequent in dermatological consultations in Kinshasa. While clinical diagnosis remains an important element in the description of dermatomycosis, a better epidemiological understanding would also require biological identification of the fungi involved, which was lacking in this study.

Assessment and Management of Dermatological Issues in Hospitalized Geriatric Patients: A Retrospective Study in a Tertiary Care Hospital.

Skin problems, typically overlooked in elderly patients hospitalized for systemic diseases, can no longer be ignored. This study aimed to investigate the presence and management of dermatological problems in hospitalized elderly patients. This retrospective study involved dermatology consultations for 712 elderly patients (aged ≥ 65 years) hospitalized between October 2022 and October 2023. The departments that requested the most consultations were physical therapy and rehabilitation (n = 108, 15.2%), internal medicine (n = 64, 9%), and pulmonary disease (n = 52, 7.3%). Consultations were most frequently requested between the seventh and 14th day of hospitalization. The most common reasons for consultation were dermatitis (n = 185; 26%), fungal infections (n = 164; 23%), bacterial infections (n = 54; 7.6%), cutaneous drug reactions (n = 45; 6.3%), and viral infections (n = 44; 6.2%). The most common dermatological diagnoses were xerotic eczema, maculopapular drug eruptions, tinea cruris, tinea ungium, tinea pedis, contact dermatitis, cellulitis, shingles, and xerosis cutis. These results underscore the importance of convenient access to outpatient services for elderly patients and the need for primary healthcare facilities to have staff trained in geriatric dermatology to ensure optimal care for the aging population.

Diagnostic stewardship and dermatology consultation in cellulitis management: a systematic literature review and meta-analysis.

Cellulitis is a common skin infection often requiring antibiotic treatment. However, misdiagnosis and inappropriate antibiotic use contribute to antibiotic resistance and healthcare costs. We aimed to evaluate the impact of dermatology consultation on treatment modification in patients with suspected cellulitis and to determine whether dermatologists' evaluation can be used as a reference to diagnose suspected cellulitis. We explored MedLine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane CENTRAL, Web of Science, and Scopus and Embase, including publications from database inception to July 25, 2023. Studies were included if they evaluated treatment modifications involving the use of antibiotics for patients with suspected cellulitis with and without dermatology consultation. We excluded comments or reviews, pilot studies, and studies without a non-dermatology control group, treatment modifications, the use of antibiotics, or patients with cellulitis. Of the 49 full-text articles, 14 studies met the selection criteria.This systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Of five independent reviewers (GYC, IP, MG, MKH, and AMRP), two abstracted data for each article using a standardized abstraction form. We used the Downs and Black scale to evaluate study quality. Subgroup analysis was conducted regarding readmission rate within 30 days for two independent populations seen by a non-dermatologist physician or a dermatologist. We employed random-effects models to obtain pooled mean differences. Heterogeneity was assessed using the I-squared value. The impact of dermatology consultation on treatment modification involving antibiotics in patients with suspected cellulitis and readmission rates in 30 days. Dermatology consultation changed initial treatment plans involving antibiotics from 47 to 96% of the time, improving diagnostic accuracy and, consequently, antibiotic stewardship of cellulitis. Dermatology consultation was not significantly associated with lower readmission rates in 30 days (pooled OR = 0.56, 95% CI: 0.25 to 1.25, I2 = 0%). Dermatology consultation in patients with suspected cellulitis may improve diagnosis and management, thereby reducing antibiotic misuse, unnecessary tests, and prolonged hospitalizations.

Skin Cancer Detection Using Machine Learning

Skin-related issues often serve as indicators of underlying health problems in other parts of the human body, adversely affecting an individual's overall fitness and well-being. However, such issues are frequently ignored, as they are perceived to be either painless or have minimal to no impact on daily life. To address this challenge, this system was developed with the aim of early detection of skin cancer. The system enables users to upload images or videos of the affected area in real-time, utilizing a skin cancer detector to identify existing conditions, determine the cancer type (if present), and provide instant feedback. The system is precisely configured to deliver highperformance results, offering real-time recommendations for medications or treatments based on its findings. By reducing the stress and inconvenience associated with hospital visits for dermatological consultations, this system empowers individuals to identify skin-related issues accurately and make informed decisions about seeking further medical attention from a qualified dermatologist. Powered by image processing using OpenCV, a convolutional neural network (CNN), and machine learning techniques, the system excels in recognizing various skin conditions with high accuracy. It can detect conditions such as nevus, vascular lesions, seborrheic keratosis, basal cell carcinoma, melanoma, pigmented benign keratosis, squamous cell carcinoma, dermatofibroma, and actinic keratosis, while also recommending appropriate remedial health solutions.

Inpatient Dermatology referrals: What is the burden? A retrospective review of 14 years of dermatology inpatient referrals.

The lack of dermatological knowledge by non-dermatologists is exposed by the increasing number of requests made for inpatient dermatological consultations. Patients have been commenced on inappropriate treatment because of poor dermatology training. To determine the burden and accuracy of inpatient dermatology referrals. A retrospective cohort study using paper inpatient dermatology referrals from one Health Board between June 2007 and July 2021. Data analysis included timing of referrals; referring speciality; diagnosis and treatment. Descriptive statistics, using Excel, were used for analyses. The average number of referrals per year was 106 (79-166). The most frequent day of referral was Monday (26%). Most referrals were from medical teams (73%).Differential diagnosis was suggested by the referring team in 59% of referrals. In only 29% of referrals the dermatology team agreed with the differential diagnosis. There was discrepancy in the correctness of diagnosis in all categories, however the paediatricians were most likely to offer a correct differential (44%). In 44% of referrals treatment was commenced by the referring team, most commonly antibiotics. There is an extra burden on dermatology teams to cover inpatients. Our figures highlight two important issues - the need for better dermatological education in medical schools to improve diagnosis accuracy and management of conditions as well as the need to recognise the need for an inpatient dermatology service to review inpatient referrals and advise in diagnosis and management of dermatology cases on the wards, and to protect the service from being uncoupled from the main hospital.

Phenotypic and Molecular Identification of M.Canis

The current study was conducted to compare morphological and molecular identification methods for the fungus M.canis isolated from 42 patients with dermatophytosis who were clinically diagnosed by a dermatologist, after review by a consultant dermatologist and venereologist in Al-Muthanna Governorate at Al-Hussein Teaching Hospital. In the period from January to November 2024, using traditional methods of isolation and laboratory identification, and molecular methods using polymerase chain reaction (PCR) technology.

A novel operational protocol for the establishment of a medical facility for receiving returning hostages: structure, process and outcomes

BackgroundOn October 7, 2023, Hamas carried out an unprecedented attack on the State of Israel and kidnapped 251 people into captivity to the Gaza Strip. Several months later, as part of a humanitarian exchange deal, 105 hostages were released in five phases and admitted to one of six hospitals throughout the country for treatment. Shamir Medical Center (SMC) was one of these facilities. This study aims to describe the structure, process and outcomes of establishing a comprehensive, multi-step, operational protocol for receiving hostages returning from captivity.MethodThe process of preparing SMC as a receiving center, the establishment of procedures for implementation of the medical protocol, and the assessment of multi-disciplinary team preparedness and implementation and outcomes in an institutional protocol are described.Results24 returning hostages were received at SMC. Social workers, dietitians and translators were used by 100% of the majority group of returning hostages from the same country of origin and the sole individual from the other country of origin utilized a dietitian, social worker, ENT consultations, and a hearing test. Among the majority group, orthopedic and dermatological consultations were utilized by 17.4% and 13% received an ENT consultation. Of the administered imaging, 13% received a chest X-ray, 8.7% received a limb X-ray, 17.4% received a head CT scan, and 4.3% received an abdominal CT. In addition, 21.7% were provided antibiotic therapy. Protocol efficacy was measured by assessing time to various operational aspects of protocol implementation and medical procedures such as mean hours to room assignment, primary physician evaluation and social worker session. No correlation between age and operational variables was found.ConclusionThis novel operational protocol was successfully implemented and may serve as a framework for managing similar unpredictable sensitive events in the case of future need.

Evaluation of Rheumatologists' Teledermatology Practices and Perspectives.

In their regular practice, rheumatologists often come across patients with skin and nail abnormalities, so they need dermatology consultations. A new option available today is the use of telemedicine for dermatology consultations. The aim of this study is to assess how frequently rheumatologists use this method, known as teledermatology (TD), and to investigate their perspectives. This study is a survey of rheumatologists in Türkiye. The survey, generated with Google Docs, was e-mailed to rheumatologists who are members of the Turkish Rheumatology Association and asked them to complete it. A total of 122 rheumatologists completed the survey, with 85 women (70%) and 37 men (30%). The rheumatologists claimed that they encounter a mean of 6.60 (SD: 6.90) patients with skin/ nail lesions each week in their clinical practice and consult them for face-to-face (FTF) dermatology examinations for a mean of 12.3 (SD: 15.56) patients every month. Of the rheumatologists who took part in the trial, 38.5% said they experienced the TD approach. Most of them (n: 30, 62.5%) use TD “occasionally.” A significant proportion of rheumatologists stated that they used TD to consult with dermatologists in their personal networks (54.2%), dermatologists at the hospital where they work (47.2%), or dermatologists with advanced academic training in their field (45.8%). Most rheumatologists (60.8%) reported that, following TD, they only refer their patients to FTF examinations if the dermatologist requests it (e.g., for a biopsy). Some of the rheumatologists (37.5%) stated that TD would be effective in all skin lesions, but most rheumatologists (52.1%) stated TD would be more beneficial for special skin/nail lesions like infectious skin lesions or inflammatory dermatoses. This study showed that a considerable number of rheumatologists use TD. Most rheumatologists schedule TD consults with dermatologists to gain speed for diagnosis and due to a lack of appointment availability from dermatologists. In rheumatology practice, clinicians have noted that they found TD effective for a wide range of skin/nail lesions.

Findings of the British Association of Dermatologists Career Survey of Dermatologists in Training and New Consultant Dermatologists 2023.

Previous surveys of UK dermatology trainees have identified key patterns regarding future career intentions that can help to inform workforce planning as consultant vacancies continue to grow. We invited all doctors training in dermatology, as well as all dermatology doctors who have completed training between 2018-2023 to complete separate surveys over a six-week period. These surveys explored: career locations, working patterns, pull factors towards particular posts, and push factors away from NHS consultant posts. The findings of these surveys confirm persisting trends towards less than full time working, ongoing limited geographical mobility of trainees, and a reducing appetite for academic work all identified in previous surveys. This survey offers the first insight into the working lives and factors influencing these career choices of consultants who completed their dermatology training between 2018-2023.

Therapeutic burden in hidradenitis suppurativa: a cross-sectional study of 557 patients.

Therapeutic burden (TB) has been identified as a potential predictor of response to biologic therapy in hidradenitis suppurativa (HS). We aim to analyze the determinants of TB in real-world clinical settings among HS patients to explain this concept and its utility as an additional tool for guiding therapeutic decision-making. We conducted a cross-sectional study including all consecutive HS patients attending a specialized HS clinic between 2017 and 2024. The primary variable was TB, defined as the cumulative sum of prior systemic treatment cycles and surgical interventions for HS. We analyzed whether sociodemographic or clinical factors were associated with a higher TB. We included 557 HS patients. Of these, 50.81% were women, and the mean age was 41.87 (14.19) years. Most patients (62.30%) were referred from general dermatology consultations. The mean disease duration was 17.52 (11.51) years. Regarding disease severity, 46.50% presented with Hurley II, and 42.19% had an IHS-4 score between 4 and 10. Before their baseline visit, 9.70% of patients had received biological therapy, mostly adalimumab (88.89%). The mean TB was 2.42 (2.25) systemic medical and/or surgical interventions. Referral from general dermatology or other hospital departments, older age, longer disease duration, greater HS severity, presence of pilonidal sinus, and prior biological therapy were significantly associated with higher TB. Our findings suggest that TB comprehensively captures HS severity and progression factors. This metric could prove valuable in aiding decision-making for HS patients by indicating when a change in therapy might be necessary.

Cost-Utility Analysis of Teledermatology Units in Primary Care Centers Versus Face-to-Face Dermatology Consultations in the Hospital.

To perform an economic evaluation to determine whether or not teledermatology (TD) units in primary care (PC) centers offer an alternative in terms of cost-utility and cost per quality-adjusted life years (QALYs) to conventional dermatology consultations (face-to-face dermatology [F-F/D]) at the hospital from the perspective of the Public Health System (PHS) and the patients. This is a randomized, controlled, nonblinded, and multicenter study. During 6 months, data from 450 patients (TD: 225 vs. F-F/D: 225) were collected. From both perspectives, costs, quality of life, and costs per QALYs were analyzed. The QALY scores were estimated from the EuroQol-5D-5L (EQ5D-5L) questionnaire responses. From the perspective of the PHS, the cost per patient was 53.04% lower in the TD group (p < 0.001). Hospital visits decreased by 72.43% in the TD group (p < 0.001). From the patients' perspective, TD reduced costs per patient by 77.59% (p < 0.001). The cost per QALY was 63.34% higher in the F-F/D group (p < 0.001). The TD group's total costs were 56.34% lower (p < 0.001). Furthermore, patients in the TD group gained 0.05 QALYs more than those in the F-F/D group (p = 0.004). This study shows that TD units in PC represent a significant cost-effective alternative to conventional hospital follow-up. To enhance TD in PC, it is important to introduce remote consultation platforms incorporating artificial intelligence for prediagnosis. This will enable general practitioners and nurses to make more accurate initial assessments. It is also crucial to provide thorough training to healthcare personnel using these technologies to ensure more efficient and personalized care. Public health nurses will benefit from gaining new skills in managing digital tools, which will help in the early identification of dermatological diseases and reduce unnecessary referrals to specialists. This will optimize resources and improve response times for patients.

Dermatologist's role in managing cutaneous adverse events of anticancer drugs: a retrospective analysis of 538 hospital dermatology consultations in Japan.

Dermatologist's role in managing cutaneous adverse events of anticancer drugs: a retrospective analysis of 538 hospital dermatology consultations in Japan.

Balanitis of Zoon treated with 30% salicylic acid lotion – A case series

Balanitis of Zoon or balanitis circumscripta plasmacellularis is a non-venereal balanitis affecting middle-aged uncircumcised men. It follows a benign protracted course with a minimal tendency for spontaneous resolution. Chronicity of disease and genital distribution is sufficient to evoke anxiety among subjects and is the primary reason for dermatological consultation. Many topical modalities (antibiotics, antifungals, and immunomodulators) have been resorted to as therapeutic measures with variable and unsatisfactory results and recurrences. Circumcision is a definitive and curative treatment. However, 30% salicylic acid (SA) lotion can prove to be a promising therapeutic alternative, especially for subjects reluctant for circumcision. We are presenting a case series of 10 patients with balanitis of the Zoon treated with 30% SA lotion.

Time from Diagnostic Suspicion to In-Person Evaluation in Skin Cancer Using Teledermatology.

Introduction: Early diagnosis of skin cancer is crucial for improving prognosis. Teledermatology (TD) usage can optimize referrals and reduce waiting times. This study aims to evaluate waiting times at the critical referral nodes in teleinterconsultations that raised suspicion of skin malignancy in the Chilean TD platform of the public health care system. Materials and Methods: A cross-sectional observational study that analyzed asynchronous teleinterconsultations and raised suspicion for skin malignancy following the teledermatologist evaluation was uploaded on the Chilean Ministry of Health's TD platform from January 1 to June 30, 2022. Results: Out of 20,522 teleinterconsultations, 1,853 raised suspicion of skin cancer. Among them, 1,119 patients were assessed by in-person examination, while 669 were still on the waiting list. Response times averaged 3.98 days for TD diagnostic suggestions. Overall referral times averaged 75.98 days from initial teleinterconsultation to the final specialist in-person evaluation. Waiting times showed significant differences among health care services and geographic regions. Discussion: In resource-limited settings, TD serves as a valuable tool to optimize referrals and manage the demand for oncologic dermatological consultation. The long waiting times emphasize the need for targeted interventions, especially in regions with longer delays. Conclusion: While TD has shown to be an effective tool in optimizing referrals, waiting times still exceed international recommendations, even in urban centers. The considerable heterogeneity in referral times within health care services and geographic regions highlights the necessity of establishing standardized referral protocols and explicit deadlines to fulfill teleinterconsultations that raise suspicion of skin malignancy in the Chilean public system.

[Artículo traducido] Un nuevo paradigma en el tratamiento del prurito del cuero cabelludo: hallazgos del estudio SCALP-PR

PurposeThe “Impact of scalp pruritus in dermatological consultations in Spain: The SCALP-PR trial” was initiated to address the common yet often insufficiently examined issue of scalp pruritus in dermatology. This condition leads to an uncontrollable urge to scratch, affecting the patients’ quality of life and potentially causing scalp damage. This study aimed to explore the prevalence, patient profile, underlying conditions, and therapeutic approaches for scalp pruritus in Spain, and to assess the safety and efficacy profile, as well as the tolerability of a non-pharmacologic treatment. MethodsFrom 2021 through 2022, 75 dermatologists enrolled a total of 359 patients in a study on scalp pruritus, approved by the Bellvitge University Hospital Research Ethics Committee, Barcelona, Spain. This evidence-based research combined a meta-analysis with observational study techniques focused on real-world evidence to examine the therapeutic impact on quality of life (QoL). Utilizing the Dermatology Life Quality Index (DLQI) for QoL assessments, the study evaluated the effectiveness of the topical product over 15 days. Data collection was conducted via an eCRF and analyzed with statistical methods to provide reliable insights into the management of scalp pruritus. ResultsThe prevalence of scalp pruritus in Spain was found to be 6.9%, predominantly among women with a mean age of 52.5 years. The leading causes identified were seborrheic dermatitis and pruritus of undetermined etiology or sensitive scalp. Stress was noted as a key factor, with corticosteroids and hygienic measures being common therapies. The topical product demonstrated significant reductions in pruritus and scratching in more than 90% of patients after 15 days. Improvements were also seen in dermatological quality of life, with 87.1% of patients showing enhancements in DLQI scores. The product was well-received thanks to its cosmetic properties, with high ratings in texture, ease of application, and fragrance. ConclusionThe topical product studied is a safe, effective, and cosmetically appealing treatment, improving scalp pruritus in various etiologies for most patients. The results highlight the need for patient-center treatments in dermatology, providing important insights for clinical practice and future research.

A50-year-old patient with pancreatitis revealing pancreatitis, panniculitis, and polyarthritis syndrome-acase report and review of the literature.

The combination of pancreatitis, panniculitis, and polyarthritis (PPP) is arare systemic syndrome that occurs in patients with acute or chronic pancreatitis or pancreatic malignancies. A50-year-old male patient presented with polyarthritis increasing for 1week and consequent inability to walk unaided. In addition, the patient had several isolated nodules on the lower extremities without any tenderness to pressure. Laboratory tests showed elevated pancreatic enzymes indicative of pancreatitis, which was thereafter confirmed by abdominal CT scan, with signs of chronic pancreatitis and concrements in the pancreatic duct. The diagnosis of panniculitis was established by dermatological consultation. Considering all these clinical features, PPP syndrome was diagnosed. In accordance with the pre-existing literature, oral glucocorticoid therapy and nonsteroidal anti-inflammatory drugs (NSAIDs) were given but failed to improve pain and polyarthritis. In the further clinical course, due to the persistent increase in lipase and amylase, endoscopic retrograde cholangiopancreatography (ERCP) was performed, showing small concrements in the pancreatic duct. During the intervention, the pancreatic duct was widened, the small concrements were removed, and apancreatic duct stent was then implanted. Following ERCP, an instant decrease in pancreatic enzymes was observed, accompanied by aclear and sustained improvement of joint swellings and pain. With the typical triad of clinical findings in mind, one should consider PPP syndrome in the context of acute or chronic pancreatitis as well as in pancreatic malignancies. All involved disciplines (gastroenterology, dermatology, and rheumatology) should be familiar with this rare but severe condition. The prognosis depends on the extent of the functional deficit of the extremities and the progression of the underlying disease.

Isolation and Diagnosis of Dermatophytes of the Hand Tinea and Sensitivity Study to the Antifungals Griseofulvin

The study was conducted during the month of October 2022 until April 2023, with the aim of isolating and diagnosing the fungi that cause skin diseases from patients visiting the dermatology consultation affiliated with Salah al-Din General Hospital who were diagnosed as infected by dermatologists for the period from 1/6/2022 to 1/ 12/2023 For both sexes, aged between 10 and 60 years, by taking skin samples from the area of infection after wiping them with cotton saturated with 70% alcohol for the purpose of sterilization to get rid of any contaminants. Which was diagnosed clinically by a dermatologist in the dermatology consultation at Salah al-Din General Hospital and outpatient clinics. To evaluate the effectiveness of anti-griseofulvin in inhibiting the isolated fungi, the percentage of dermatophyte infections recorded by positive direct microscopic examination was only (88) patients, representing (88%) of the total number of patients. While the number of negative cases by negative direct microscopic examination was (59), or (59%). As for positive laboratory culture results, there were (79) patients, in the rate of (79%). While the number of negative cases by laboratory culture was (21), in the rate of (21%). The fungal genera that cause skin infections, such as Trychophyton and Microsporum, were isolated, with the genus Trichophyton being the most frequent, with 76 isolates belonging to several species, such as T. mentagrophytes, with a number of 29 isolates, then the fungus T. rubrum, with a number of isolates of 22, then the fungus T. terreste, with a number of isolates of 15, and then fungus T. schoenleinii, with a number of 10 isolates, while only three isolates of the M. canis type were recorded in the genus Microsporum. The results of the susceptibility test of the isolated fungi to Griseofulvin showed that the fungus T. mentagrophytes is more sensitive to the antichrysofulvin, as the average diameter of inhibition reached 32 mm compared to the control, followed by T. rubrum, which had an average diameter of inhibition of 16 mm compared to the control.