Department Of Dermatology Research Articles

Topical Antifungal Therapy Combined with Nail Abrasion for the Treatment of Dermatophytoma: Single-Center Results — A Secondary Publication

Objective: Recently, topical antifungal agents have become available for the treatment of dermatophytoma. However, there are few reports of topical onychomycotic agents in combination with debridement of dermatophytoma. Methods: Twelve patients with dermatophytoma diagnosed and treated between April 2017 and March 2020 at the Department of Dermatology, Kansai Rosai Hospital were selected, including two patients with lesions on both toe nails and 14 nails. At the initial visit, the affected nail plate was removed and topical treatment was administered. The observation was terminated when the lesions were completely healed within 1 year. If the patients were not completely healed, the initial efficacy was determined at the date of the first visit closest to 1 year after the start of treatment. The second efficacy evaluation was conducted at the last visit or when the concomitant drug was changed. Results: Three patients dropped out of the study before the time of the initial efficacy evaluation. In the second efficacy evaluation, eight nails were completely healed, one nail was significantly healed, and one nail was effective. Conclusions: Dermatophytoma can be treated with topical onychomycotic agents in combination with surgical debridement to improve efficacy.

Contact Allergy to Allergens in the Swedish Baseline Series Overrepresented in Diabetes Patients with Skin Reactions to Medical Devices - A Retrospective Study from Southern Sweden.

Allergic contact dermatitis is reported among individuals using continuous glucose monitoring systems and insulin pumps. The aim of this study was to describe contact allergy patterns for allergens in the Swedish baseline series and medical device-related allergens among users. Contact allergy to baseline series allergens and isobornyl acrylate was compared between diabetes patients and dermatitis patients patch-tested at the Department of Occupational and Environmental Dermatology during 2017 to 2020. Fifty- four diabetes patients and 2,567 dermatitis patients were included. The prevalence of contact allergy to fragrance mix II and sesquiterpene lactone mix was significantly higher in diabetes patients compared with dermatitis patients. Of the diabetes patients 13.0% and of the dermatitis patients 0.5% tested positive to sesquiterpene lactone mix (p < 0.001). Of the diabetes patients 7.4% and of the dermatitis patients 2.3% tested positive to fragrance mix II (p = 0.041). Of the diabetes patients 70.4% tested positive to medical device-related allergens. Of the diabetes patients 63.0% and of the dermatitis patients 0.2% were allergic to isobornyl acrylate (p < 0.001). In conclusion, not only medical device-related contact allergies, but also contact allergy to baseline series allergens (fragrance mix II and sesquiterpene lactone mix), is overrepresented in diabetes patients who use medical devices.

Diagnostic Value of Anti-Desmoglein 1 and 3 Antibodies and Anti-BP180 and 230 Antibodies in Autoimmune Bullous Dermatoses

Objective: To analyze and evaluate the value of the anti-epidermal intercellular desmosome antibodies, anti-desmoglein (Dsg) 1, and anti-Dsg3, as well as the anti-epidermal basement membrane hemidesmosomes antibodies, anti-BP180, and anti-BP230 in the diagnosis of pemphigus and bullous pemphigoid. Methods: Patients with pemphigus or bullous pemphigoid treated in the Department of Dermatology of Dalian Dermatosis Hospital from July 2019 to July 2021 were selected. They were clinically diagnosed with histopathological and indirect immunofluorescence methods. They were divided into the pemphigus group (n = 102) and the bullous pemphigoid group (n = 175). Additionally, 120 patients who were ruled out of pemphigus and bullous pemphigoid during the same period were selected as the control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect anti-Dsg1, anti-Dsg3, anti-BP180, and anti-BP230 antibodies. Indirect immunofluorescence (IIF) was used to detect the IgG levels of the anti-epidermal intercellular desmosome antibodies and anti-epidermal basement membrane hemidesmosomes antibodies. The positive rate, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic rate of each antibody were evaluated and analyzed comprehensively. Results: In the pemphigus group, bullous pemphigoid group, and control group, the positive rates of anti-Dsg1 are respectively 83.3% (85/102), 0 (0/175), and 1.7% (2/120); the positive rates of anti-Dsg3 are 41.1% (42/102), 0 (0/175), and 0 (0/120), respectively; the positive rates of BP180 are 5.9% (6/102), 85.7% (150/175), and 5% (6/120), respectively; the positive rates of BP230 are 1.9% (2/102), 57.7% (101/175), and 1.7% (1/120), respectively. Meanwhile, the positive rates of anti-epidermal intercellular desmosome antibodies are 69.6% (71/102), 0 (0/175), and 0 (0/120), respectively; the positive rates of anti-epidermal basement membrane hemidesmosome antibodies are 0% (0/102), 51.4% (90/175), and 0 (0/120), respectively. Among the patients with pemphigus, the sensitivity, specificity, PPV, NPV, and diagnostic rates of the anti-epidermal intercellular desmosome antibody test were 65.1%, 100%, 100%, 85.2%, and 92.2%; for anti-Dsg1, respectively, 83.3%, 99.3%, 97.7%, 88.7%, and 95.2%; for anti-Dsg3, respectively, 41.1%, 100%, 100%, 83.1%, and 84.9%. Among the patients with bullous pemphigoid, the sensitivity, specificity, PPV, NPV, and diagnostic rates of the anti-epidermal basement membrane hemidesmosomes antibody test were 51.4%, 100%, 100%, 72.3%, and 78.6%; for anti-BP180, respectively, 85.7%, 94.6%, 92.6%, 89.4%, and 90.7%; for anti-BP230, respectively, 57.7%, 98.2%, 96.2%, 74.7%, and 80.1%. Conclusion: The detection of autoantibodies in serum and the confirmation of the specific target antigens could complement each other to reduce clinical missed diagnosis and increase the positive diagnostic rate if the two tests were conducted simultaneously. The positive result of the anti-epidermal intercellular desmosome antibody and the anti-epidermal basement membrane hemidesmosomes antibody has better accuracy in diagnosing pemphigus and bullous pemphigoid. In contrast, the negative result is of great value in ruling out pemphigus and bullous pemphigoid.

Prevalence Of Skin Manifestations In Patients With Polycystic Ovarian Syndrome

Objective: This study aimed to determine the prevalence of cutaneous manifestations in PCOS patients. Method: This cross-sectional study was conducted in the dermatology department, Combined Military Hospital, Peshawar, from 1st January 2021 to 30th June 2021. After obtaining ethical approval from the hospital's ethical and research committee, a total of 50 patients aged 15 to 45 years were included in the study fulfilling the inclusion criteria. Written informed consent was taken from each patient. All patients underwent general physical, systemic and dermatological examination. Venous blood sampling was done after overnight fasting for hormonal assays (TSH, LH, FSH, prolactin and testosterone), glucose, and lipid levels. An ultrasound scan was done for the detection of ovarian cysts. Results: Mean age was 26.96 years ± 5.42 SD. The mean BMI was 26.04 Kg/m2 ± 5.10 SD. Mean FSH and LH levels were 6.86 IU/L ± 5.41 SD and 12.11 IU/L ± 8.75 SD respectively. Among them, 88% were married, 36% had menstrual irregularities and 72% had infertility. Hirsutism, acne, acanthosis nigricans, and androgenic alopecia were noted in 72%, 54%, 42%, and 20% of the patients respectively. Conclusion: Cutaneous manifestations can play an important role in the diagnosis of PCOS and also contribute an important portion of the symptoms experienced by patients suffering from PCOS. Keywords: PCOS, Skin manifestations, Hyperandrogenism, Hirsutism, Acne.

Personal, financial and time burden in inherited ichthyoses: Asurvey of 144 patients in a university-based setting.

Patients with inherited ichthyosis suffer from scaling due to mutations affecting the epidermal barrier. Symptomatic treatment with ointments, bathing and mechanical scale removal can alleviate the disease, but therapy is time and cost intensive. We investigated costs, time and disease burden of ichthyoses. The study addresses difficulties of the healthcare situation for patients with ichthyoses and reveals potential improvements. We developed a questionnaire addressing time and financial effort for the treatment. Additionally, we collected data of the Dermatology Life Quality Index (DLQI) and the Pruritus Life Quality (5PLQ) questionnaires to determine the impact of ichthyosis and associated pruritus on quality of life (QoL). We recruited 144 patients with ichthyosis (median age: 23; 53.5% female) from the Department of Dermatology in Muenster (Germany) and the German patient support group including common, rare and syndromic subtypes. Eighty-seven percent reported applying topical therapeutics at least once per day, 66.4% several times with an overall median duration of 15 min. Highest single expenditure of time was due to balneotherapy (n = 115; median bathing time: 40 min). In 81.9%, the health insurance did not completely cover the costs for topical treatment causing additional financial burden to the patient with a median of 71 € per quarter, herein creams being the largest cost factor (50 €). Patients with Netherton syndrome showed the highest median expenditure (170 €). The QoL impairment under treatment was moderate (median DLQI: 8.5 points). Pruritus was prevalent in 79.9% and showed a distinct impact on QoL (median 5PLQ: 7.5 points) without any significant difference between the subtypes (p = 0.37). Patients suffering from ichthyoses have a large and lifelong overall burden in mild and severe subtypes. Since continuous topical treatment is required, financial and psychosocial support needs to be considered beyond dermatological care.

Comparative Efficacy of Intralesional Chloroquine With Intralesional Meglumine Antimoniate in the Treatment of Cutaneous Leishmaniasis.

This comparative prospective study was conducted at the Department of Dermatology, Pak Emirates Military Hospital, Rawalpindi, from August 1, 2018, to January 31, 2019 (six months). This study aimed to compare the efficacy of intralesional chloroquine with intralesional meglumine antimoniate in the treatment of cutaneous leishmaniasis. A total of 64 patients fulfilling the inclusion criteria reporting to the Department of Dermatology, Pak Emirates Military Hospital were included in this study. Informed consent was taken and demographic data including patients' hospital registration number, age, gender, and number of lesions were noted. The subjects were randomly assigned into two groups. In group A, intralesional chloroquine was injected two times per week, and in group B, intralesional meglumine antimoniate was injected two times per week. The efficacy of both treatments was noted after eight weeks of treatment. Frequency and percentages were computed for qualitative variables like gender and number of lesions. Mean±standard deviation was presented for quantitative variables like age. Analysis was done to compare the proportion of both groups. Chi-square test was applied to compare the efficacy of both groups, p≤0.05 was taken as significant. In this study, the mean age of patients was 29.69±08.95 years. There were 63 (98.44%) males and one (1.56%) female. In this study, efficacy was achieved in six (18.8%) patients in group A, while in 17 (53.1%) patients in group B. This difference was statistically significant, i.e., p=0.004. This study concluded that intralesional meglumine antimoniate is more effective in treating cutaneous leishmaniasis than intralesional chloroquine.

Clinical and microbiological characteristics of onychomycosis in a tertiary hospital: a cross-sectional study

BACKGROUND Onychomycosis is a common fungal nail infection with a low cure rate. While dermatophytes are the most common causal agent for onychomycosis, the incidence of Candida and nondermatophyte mold (NDM) onychomycosis is increasing. This study aimed to analyze the clinical and microbiological characteristics of patients with onychomycosis. METHODS Patients who visited the Department of Dermatology and Venereology, Cipto Mangunkusumo Hospital, and were diagnosed with onychomycosis from 2017 to 2022 were included. Diagnosis was established through clinical examination, supported by the result of direct microscopic examination with potassium hydroxide. RESULTS Of 171 patients, 93.6% had onychodystrophy, 65.5% were females, and 62.0% were aged 19–59 years. Most patients had onychodystrophy in more than three nails, affecting fingernails (31.6%) and toenails (34.5%). Interestingly, 84.8% of patients had no history of nail diseases. The median onset of disease was 24.0 (1–1,040) weeks, while the median onychomycosis severity index was 10.0 (2–40). Most cases were caused by Candida albicans (48.3%). Fusarium was the only NDM documented (2.3%). Some patients were resistant to itraconazole (11.4%) and miconazole (4.5%). Overall, 49.1% of the patients were declared not cured. CONCLUSIONS Candida was the predominant cause of onychomycosis, and onychodystrophy was the dominant feature. Current treatment regimens with systemic or topical antifungal agents did not yield satisfactory results, with more than half of the patients deemed not cured.

A retrospective clinicopathological study of erythema nodosum.

Erythema nodosum (EN) may be idiopathic or secondary, and usually resolves naturally within 1-2 months. In atypical EN cases, the rash extends beyond the lower limbs to the upper limbs and trunk, and histopathological findings may be accompanied by vasculitis in addition to septal panniculitis. Few studies have examined the differences in the clinical characteristics of patients with EN based on rash distribution. We retrospectively examined whether there was a correlation with clinical information, such as the presence or absence of underlying diseases, by classifying the patients into two groups: the lower limbs group (the EN rash was confined to the lower limbs) and the beyond lower limbs group (the EN rash appeared beyond the lower limbs). Among the 86 adult patients diagnosed with EN at the Dermatology Department of Fujita Medical University between 2015 and 2020, there were 65 cases of the lower limbs group and 21 cases of the beyond lower limbs group. The frequency of underlying diseases was significantly higher in the beyond lower limbs group (76.2%, 16 cases) than in the lower limbs group (40.0%, 26 cases; P < 0.005). Vasculitis was more notable in the beyond lower limbs group (P < 0.05). Significantly higher vasculitis was noted in the EN group with underlying diseases (30.2%, 13 cases) than in the idiopathic EN group without underlying diseases (11.6%, 5 cases; P < 0.05). Neutrophil extracellular traps were positive in approximately 40% of cases in both groups. In the beyond lower limbs group, the possibility of severe cases with underlying diseases, vasculitis, and inflammation must be considered for effective treatment.

Effectiveness of combination use of intralesional steroid with 5-fluorouracil in the treatment of keloid patients

Background: Keloids are a common problem with significant recurrence rates despite intralesional steroid treatment and 5-fluorouracil in combination with triamcinolone may be superior to triamcinolone alone. Objectives: To evaluate the effectiveness of the combination use of intralesional steroids with 5-fluorouracil in the treatment of keloid. Methods: The study was a descriptive cross-sectional study and was conducted at the Department of Dermatology and Venereology, Khwaja Yunus Ali Medical College (KYAMC), Enayetpur, Sirajganj, from July 2020 to June 2021. A total of 100 patients with keloid were included in this study. These patients were subjected to history, clinical examination, and investigations. In all cases, informed written consent was taken from the Participants and a separate case record form was used during data collection. Collected data were analyzed by the statistical software IBM SPSS 25. Results: This study shows that the majority (68%) of patients belonged to the age group of 21-30 years. The mean age was 26.43±7.77 years. Regarding sex, 56% were females and 44% were males with a male-female ratio of 1.3:1. 52% of patients had a duration of lesion up to 1 year, 22% of patients had 1-2 years and 26% of patients had &gt;2 years. The most common site of keloid was the chest (38%), then face (32%), upper extremity (16%), shoulder (6%), back (4%). The most common presenting symptoms were pruritis (56%), then 38% were cosmetic disfigurement, 32% were skin discoloration, 28% were pain and 18% were restriction of movement. Trauma was the commonest factor seen in 34% of the patients followed by ear piercing (22%) and infection (20%). Other causes were spontaneous (10%), acne (6%), burns (6%), and post-surgical keloid (2%). 16 had a positive family history of the keloid disease. The majority (70%) had good outcomes followed by excellent outcomes in 22% and 8% had average outcomes. It was observed that most patients (88%) did not have any adverse effects. Only 12% had adverse effects seen as skin ulceration (6%), skin atrophy (4%) and telangiectasia (2%). Conclusion: This study revealed that the combination use of intralesional steroids with 5-fluorouracil in the treatment of keloid seems to offer the balanced benefit of faster and more efficacious response with fewer adverse effects. Treatment has to be individualized and can be combined with one or more modalities to aim for better efficacy and safety. Mediscope 2024;11(1): 41-47

Quality of life in post-herpetic neuralgia in the dermatology department of Hospital Luis Vernaza

Introduction: Shingles (HZ) is the result of the reactivation of the varicella zoster virus. The main complication of HZ is post-herpetic neuralgia (PHN), pain that appears in the affected dermatome 3 months after the resolution of the cutaneous lesions. Despite the limited evidence, PHN significantly influences the patient's quality of life (QL), affecting their functional capacity, emotional state and work capacity in the active population. The objective of the present investigation was to evaluate the quality of life in NPH. Previous studies have not been done in this institution and statistics on the subject are nil in Ecuador. Materials and Methods: The study was descriptive, observational, retroprospective with a non-experimental and transversal level. The universe consisted of 141 patients with a diagnosis of PHN treated at the outpatient clinic of the dermatology service of the Luis Vernaza hospital during the period from January 1 to December 31, 2016, with a sample of 92 patients, who underwent an interview and a physical examination, using a data sheet that included the DN4 and EQ-5D-5L questionnaires. Excel tables were used to record the data. Results: Of the total of 92 patients who participated in the study, tingling was the most frequent symptom. Regarding the symptomatic load related to QL in PHN, the friction pain and numbness with P values of 0.00 show a strong statistical significance followed by a puncture with a P value of 0.03. The scatter plot to assess the level of PHN severity and its relation to quality of life indicates that QL is related to neuropathic pain (NP). The average DN4 was 4/10. 82 % of cases, with or without neuropathic pain, had a better QL; 18 %, accompanied by NP, reported affectation in their QL. The average index value of the EQ5D5L was 0.814. Conclusions: It was concluded that the quality of life is affected in patients with postherpetic neuralgia.

Comparison of Efficacy of Topical Betamethasone Dipropionate and Topical Minoxidil in Patients With Alopecia Areata.

Background and objective Alopecia areata (AA) is a reiterative and nonscarring type of hair loss that can affect any hairy area of the body, particularly the scalp. It manifests as patchy or confluent hair loss with variations in demographics and ethnicity. There are numerous treatment options available, including topical and systemic steroids, topical minoxidil, dithranol, tacrolimus, psoralen and ultraviolet therapy (PUVA), contact immunotherapy, and oral immunosuppressive drugs. However, no previous contrast for efficacy is present between the topical betamethasone versus topical minoxidil alone in our population. This study aims to compare the efficacy of topical betamethasone dipropionate versus topical minoxidil in patients with AA. Methodology A nonrandomized controlled study was conducted at the Department of Dermatology, Jinnah Hospital Lahore, incorporating the data of patients between July 26, 2016, and January 26, 2017, after obtaining institutional ethical approval. One hundred patients with alopecia, either on the scalp or any other hairy part, from both genders, aged between 18 and 50 years, were included in the study. Two groups were created, and patients were assigned to these groups based on the clinician's choice. Group A patients were administered betamethasone dipropionate (0.05%) lotion twice daily on affected areas for 12 weeks. Group B patients were administered minoxidil (5%) solution twice daily on affected areas for 12 weeks. A four-week follow-up plan was followed. A five-point scale score system was used for alopecia grading. After 12 weeks, the hair regrowth score (RGS) was used to compare the efficacy of treatment between the two groups. Results A total of 100 patients with grades S1 to S3 AA of less than three months duration were enrolled. Two groups were created, with 50 patients in each group. The mean age in Group A was 29.08 ± 6.51 years, while in Group B, it was 29.38 ± 6.62 years. In Group A, there were 76% males and 24% females, while in Group B, there were 74% males and 26% females. Comparison of efficacy of topical betamethasone dipropionate versus topical minoxidil in patients with AA demonstrated a greater efficacy of 74% (Grade 3 and Grade 4 responses) in Group A, while in Group B, only 42% of patients showed efficacy. A statistically significant difference was found, with a P-value of 0.001. No serious side effects were noted. Conclusions Our study concluded that topical betamethasone dipropionate (0.05%) lotion has statistically significantly higher efficacy compared to topical minoxidil (5%) solution in patients with AA.

A study on drug usage pattern of antibiotics in patients with skin disorders

Antibiotics are the crucial drugs of choice, and they are the greatest contributors to the treatment of bacterial skin diseases. The objective of the present study is to assess the drug usage patterns of antibiotics in the Department of Dermatology, Venereology, &amp; Leprosy (DVL). A Cross-Sectional Study was conducted with ethical approval for a period of 6 calendar months. Patients were recruited according to the eligibility criteria. Relevant details were collected according to the objectives and analyzed using Microsoft Excel. During the study period, 200 patients were recruited, of which 64% were male. Most patients were in the age group of 21-40 (36%). The most commonly reported disease during our study was secondary pyoderma occurring over eczema (29.5%), followed by Psoriasis (9.5%). Penicillin (32%) and Cephalosporin (32%) were the most prescribed categories. Mainly, a duration of less than or equal to 1 week was recommended. A total of 680 drugs were prescribed, and the average number of drugs per encounter with an antibiotic was 4.50%. The percentage of encounters with injections was 12%, and the percentage of medicine from the Essential Medicine List (EML) was 43%. Most drugs were prescribed from the access groups according to the World Health Organization (WHO) AWARE (Access, Watch, Reserve) classification. According to the AWARE classification, drugs with lower resistance potential were commonly practiced here. This reflects good prescribing practice. The findings provide insight that, during our study period, the burden of bacterial skin diseases is lower in this locality when compared with other skin diseases.

Defining the Minimal Important Change and Meaningful Change Value of the Disease Activity Index for Psoriatic Arthritis: A Chinese Longitudinal Study.

To determine the minimal important change (MIC) and meaningful change value (MCV) of the Disease Activity Index for Psoriatic Arthritis (DAPSA) and the effect size (ES) of DAPSA. This was a retrospective cohort study, recruiting 106 patients who agreed to participate in the research from the Department of Dermatology, Xiangya Hospital, between November 1, 2019, and April 1, 2023. An anchor-based method using linear regression analyses was used to determine the MICs and MCVs of the DAPSA. The anchor question assessed whether the patient's well-being had changed since their previous visit, employing a 5-point Likert scale that ranged from "much improved" to "much deteriorated." The overall MIC value was 8.4 (95% CI 0.01-16.75). The MIC improvement was 9.5 (95% CI 0.89-18.14) and MIC deterioration was 1.1 (95% CI -9.81 to 12.05). The overall MCV was 10.5 (95% CI 4.34-16.72). MCV improvement was 11.4 (95% CI 5.95-16.95) and MCV deterioration was 1.1 (95% CI -9.81 to 12.05). The ES was 0.6. A change in DAPSA of 8.4 is indicative of an MIC, offering physicians an additional means to contextualize the patient's perception of disease activity during treatment, and a change in DAPSA of 10.5 is likely to be regarded as MCV. These values can enhance the utility of DAPSA in psoriatic arthritis clinical trials.

The prevalence of dry eye in patients with psoriasis attending a tertiary care hospital in western Maharashtra

: Psoriasis affects 0.5–11.4% of adults. Psoriasis is caused by a complicated chain of immune cells and cytokines, containing tumour necrosis factors (TNF), interleukin (IL)-17, 22, and 23. Psoriasis causes systemic inflammation, which can cause arthritis, cardiovascular disease, and metabolic syndrome. Our study explores dry eye in Western Maharashtra's psoriasis patients at a tertiary care hospital. A tertiary care hospital outpatient dermatology and ophthalmology department psoriasis patients were included in a cross-sectional research. Patient ages spanned from 20 to 60 years. The anterior and posterior ocular segments were examined, and dry eye was assessed. OSDI, Schirmer's test, TBUT, and corneal and conjunctiva staining has been scored. The PASI score has been received. Degree of dry eye was assessed using Dews dry eye grading system. Dry eye was present in 63.1 percent of people. Cases included 24.4% with mild dryness in their eyes. Moderate dryness made up 46.3% of cases, and severe dryness made up 29.3% of cases. The PASI score and dry eye did not have a statistically significant connection (P=0.355). A PASI score of 10 to 25 indicated the most severe case of dry eye, followed by a score of 10 (29 eyes) and &amp;#62;25. (23 eyes). A total of 81.5 percent of eyes had abnormal OSDI scores, 56.2 percent had abnormal TBUT scores, and 49.2 percent had abnormal Schirmer Test results. Dry eye in psoriasis patients requires dermatologist-ophthalmologist teamwork for comprehensive therapy. Psoriasis, especially in long-lasting cases, can lead to meibomian gland dysfunction.

A clinicoepidemiological study of pattern of skin disorders among diabetes mellitus in a tertiary care centre

Diabetes Mellitus (DM), a most common metabolic disorder affects every organ of the body including skin causing increased morbidity and serious impact on quality of life. Aim of this study is to analyse the prevalence and pattern of cutaneous manifestations among type 1 and type 2 DM correlating it with the mean duration of diabetes. This was an observational study conducted on 200 consecutive patients with DM attending dermatology department. Apart from detailed history, thorough clinical examination and relevant investigations were done. Skin biopsy were done in cases with diagnostic ambiguity. Cutaneous infections occurred in majority (70.5%). Among fungal infections (59.5%) candidiasis was the most common (28%). Pruritus and neuropathy were observed in 37% and 33% respectively and was more common in type 1 DM. Leg ulcer was observed in 8.5%. Vitiligo, oral lichen planus, granuloma annulare were seen common among type 1 DM. Psoriasis, acrochordon, acanthosis nigricans, cutaneous amyloidosis, bullous pemphigoid and diabetic bulla were common in Type 2 DM. Mucor mycosis, scleredema diabeticorum, cheiroarthropathy and perforating dermatoses were uniquely observed among prolonged uncontrolled diabetics. Candidiasis was found to be an early manifestation of diabetes. Poor glycemic control and longer duration of diabetes were associated with an increased frequency and number of skin disorders. Skin manifestations are more common among undiagnosed and uncontrolled diabetics..

Real-life data over 36 weeks of guselkumab treatment in psoriasis patients: A single-center study from Turkey.

Psoriasis is an important health problem responsible for morbidity and workforce loss. In recent years, anti-IL-23 drugs have become essential in psoriasis treatment. This study aimed to investigate the efficacy and safety of guselkumab therapy, recently used in Turkey, by examining real-life data over 36 weeks. A total of 39 psoriasis patients (>18 years old) who received guselkumab treatment between December 2021 and December 2022 in the dermatology department of our hospital were included in the study. Patients" ages, sexes, body mass index (BMI), comorbidities, duration of illness, drugs used before guselkumab treatment, clinical response to guselkumab treatment, and side effects, if any, were recorded. Psoriasis Area and Severity Index (PASI) scores at baseline and Weeks 4, 12, 24, and 36 were evaluated, as well as the Dermatology Life Quality Index (DLQI) at the beginning and end of the study. The PASI scores at Weeks 4, 12, 24, and 36 and the DLQI at Week 36 decreased statistically compared with baseline (p < 0.05). The PASI score at baseline and Weeks 4, 24, and 36 did not differ between groups based on IL-17 use (p > 0.05). No significant correlation was observed between BMI, disease duration, and PASI scores at baseline and Weeks 4, 12, 24, and 36. No side effects were observed in any of the patients during treatment. This study includes real-life data on the use of guselkumab therapy for psoriasis in the Turkish population. Based on the results, guselkumab is a highly effective and safe treatment.

Discontinuation of Fumaric Acid Esters is Affected by Depressive Symptomatology: A Retrospective Analysis.

Fumaric acid esters (FAEs) remain a widespread therapy option for moderate-to-severe psoriasis. However, drug survival of FAEs is limited by adverse events (AEs) or inadequate treatment response. Depressive disturbances are highly prevalent in psoriasis patients and are hypothesized to be associated with the reporting of AEs and therapy discontinuation. This study's aim was to analyze whether psoriasis patients with comorbid depressive symptomatology are more likely to discontinue treatment with FAEs due to AEs and/or inadequate treatment response. Data were retrospectively extracted from the records of patients starting therapy with FAEs in the Department of Dermatology, University Hospital Essen, Germany between 2017 and 2022, covering the first 52 weeks of treatment. Psoriasis severity and depressive symptomatology, as well as AEs and therapy discontinuation, were analyzed. Psoriasis patients (N = 95, 47.37% female) with depressive symptomatology (42.11%) were more likely to discontinue therapy due to patient-reported AEs, while the total number of reported AEs was not associated with depression. The results support the hypothesis that among psoriasis patients with depressive symptoms, the associated introspection and somatization may result in increased sensitivity for AEs and thus in quicker therapy discontinuation. In these patients, the occurrence of nocebo effects should be minimized, e.g. by special communication techniques.

COMPARISON OF THE EFFICACY OF INTRALESIONAL 5% FU VERSUS INTRALESIONAL TRIAMCINOLONE IN PATIENTS PRESENTING WITH KELOID AND HYPERTROPHIC SCAR AT TERTIARY CARE HOSPITAL, KARACHI

Despite the fact that keloids and hypertrophic scars are frequent benign hyper-proliferative growths of dermal fibroblasts, the clinical concerns, such as physical and psychological issues, are serious and impairing, and there are few effective therapies. Although 5-fluorouracil (5-FU) and intralesional triamcinolone acetonide (TAC) are widely used to manage both scars, their effectiveness is still debatable. To compare the efficacy of intralesional 5% FU versus intralesional triamcinolone in patients presenting with keloid and hypertrophic scar at Tertiary Care Hospital, Karachi. This RCT study was conducted on patients presenting with keloid and hypertrophic scars at the Outpatient Department of Dermatology, JPMC, Karachi, meeting inclusion criteria. A brief history of demographic information and written informed consent were taken from each patient. A total of 158 patients were enrolled in the study and were randomly allocated to Group A, Intralesional triamcinolone group, and B: Intralesional 5% FU group twice weekly for a total of 4 sessions. During each visit, the keloid height was measured, photographed again, and documented. Efficacy was labeled if patients with keloid and hypertrophic scar in either group showed ≥ 50% reduction in height. Comparison of efficacy between groups showed a significant difference as the efficacy rate was higher in patients treated with 5-FU 45mg as compared to the patients administrated with TAC 10mg (70.9% vs. 50.6%; P-value=0.009). This analysis revealed that irrespective of the patient's age, sex, illness duration, or lesion site, intra-lesional 5-fluorouracil (5-FU) offered the significant benefit of a faster and more effective response than triamcinolone (TAC) in the treatment of keloids and hypertrophic scars.

Treatment Adherence Among Malagasy Patients with Atopic Dermatitis Seen at the Department of Dermatology, Antananarivo, Madagascar

Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by intense pruritic eczematous lesions. Poor adherence to treatment is a major factor limiting treatment outcomes in patients with AD. This study aimed to assess treatment adherence in Malagasy patients with AD. It was conducted over one year in children and adult patients with AD seen at the Department of Dermatology University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar. Morisky Medication Adherence Scale-8 (MMAS-8) was used to assess patients’ treatment adherence. We included 44 children and 21 adults. The mean age was 4.29 ± 4.13 years and 35.28 ± 16.88 years, respectively. All of our patients receive topical treatment and no specific oral treatment such as biotherapy or immunosuppressant. A low adherence rate was observed in 61.90% of adult patients and the mean MMAS-8 score was 2.56 ± 1.6. In children, the mean MMAS¬8 score was 5.9 ± 1.53 and poor adherence was seen in 45.45%. The adherence level was significantly associated with age, educational status, and marital status (p &amp;lt; 0.05). Low treatment adherence is preponderant among Malagasy patients with AD. We did not find significant correlations between adherence levels and monthly income, frequency of follow-up, severity of AD, or insurance coverage.

A Qualitative Study on the Perception of Atopic Dermatitis by Malagasy Young Patients Regarding Self-Management

Atopic dermatitis (AD) is a chronic disease that usually begins in childhood and can persist at any age. It is essential for adolescents entering to adulthood to have a complete understanding of this disease, including its self-management responsibilities. This study aimed to explore Malagasy adolescents and young adults’ perceptions of atopic dermatitis regarding the concept of self-management. This is a qualitative study using semi-structured interviews with adolescent and young adult patients suffering from AD, who were followed up at the Dermatology Department of the University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar. Interviews were recorded, transcribed verbatim, and analyzed using NVivo software version 10.2.2 (QSR International, Doncaster, Australia). Five male and seven female patients with mild to severe AD were included according to the Patient-Oriented Eczema Measure (POEM). The mean age was 19.83 years and the mean interview duration was 21.3 minutes. Despite a relatively long duration of AD, the nature of this condition, and the principles and goals of treatment are still poorly understood among young people. Consequently, many still hope for a complete cure for their AD. Our patients adhered to treatment and did not fear topical corticosteroids. This study highlights the importance of providing information about atopic dermatitis during childhood, and emphasizes the need to recommunicate this information directly to these patients during adolescence, aiming for an optimal transition process regarding disease self-management.