Hospital Dermatology Research Articles

Effects of low-dose photodynamic therapy on the function of human adipose mesenchymal stem cells and its mechanism

Objective: To investigate the effects of low-dose photodynamic therapy on the proliferation, regulation, and secretion functions of human adipose mesenchymal stem cells (ADSCs) and the related mechanism, so as to explore a new method for the repair of chronic wounds. Methods: The experimental research methods were adopted. From February to April 2021, 10 patients (5 males and 5 females, aged 23 to 47 years) who underwent cutaneous surgery in the Department of Dermatology of the First Affiliated Hospital of Army Medical University (the Third Military Medical University) donated postoperative waste adipose tissue. The cells were extracted from the adipose tissue and the phenotype was identified. Three batches of ADSCs were taken, with each batch of cells being divided into normal control group with conventional culture only, photosensitizer alone group with conventional culture after being treated with Hemoporfin, irradiation alone group with conventional culture after being treated with red light irradiation, and photosensitizer+irradiation group with conventional culture after being treated with Hemoporfin and red light irradiation, with sample number of 3 in each group. At culture hour of 24 after the treatment of the first and second batches of cells, the ADSC proliferation level was evaluated by 5-ethynyl-2'-deoxyuridine staining method and the migration percentage of HaCaT cells cocultured with ADSCs was detected by Transwell experiment, respectively. On culture day of 7 after the treatment of the third batch of cells, the extracellular matrix protein expression of ADSCs was detected by immunofluorescence method. The ADSCs were divided into 0 min post-photodynamic therapy group, 15 min post-photodynamic therapy group, 30 min post-photodynamic therapy group, and 60 min post-photodynamic therapy group, with 3 wells in each group. Western blotting was used to detect the protein expressions and calculate the phosphorylated mammalian target of rapamycin complex (p-mTOR)/mammalian target of rapamycin (mTOR), phosphorylated p70 ribosomal protein S6 kinase (p-p70 S6K)/p70 ribosomal protein S6 kinase (p70 S6K) ratio at the corresponding time points after photodynamic therapy. Two batches of ADSCs were taken, and each batch was divided into normal control group, photodynamic therapy alone group, and photodynamic therapy+rapamycin group, with 3 wells in each group. At culture minute of 15 after the treatment, p-mTOR/mTOR and p-p70 S6K/p70 S6K ratios of cells from the first batch were calculated and detected as before. On culture day of 7 after the treatment, extracellular matrix protein expression of cells from the second batch was detected as before. Data were statistically analyzed with one-way analysis of variance and least significant difference test. Results: After 12 d of culture, the cells were verified as ADSCs. At culture hour of 24 after the treatment, the ADSC proliferation level ((4.0±1.0)% and (4.1±0.4)%, respectively) and HaCaT cell migration percentages (1.17±0.14 and 1.13±0.12, respectively) in photosensitizer alone group and irradiation alone group were similar to those of normal control group ((3.7±0.6)% and 1.00±0.16, respectively, P>0.05), and were significantly lower than those of photosensitizer+irradiation group ((34.2±7.0)% and 2.55±0.13, respectively, P<0.01). On culture day of 7 after the treatment, compared with those in normal control group, the expression of collagen Ⅲ in ADSCs of photosensitizer alone group was significantly increased (P<0.05), and the expressions of collagen Ⅰ and collagen Ⅲ in ADSCs of irradiation alone group were significantly increased (P<0.01). Compared with those in photosensitizer alone group and irradiation alone group, the expressions of collagen Ⅰ, collagen Ⅲ, and fibronectin of ADSCs in photosensitizer+irradiation group were significantly increased (P<0.01). Compared with those in 0 min post-photodynamic therapy group, the ratios of p-mTOR/mTOR and p-p70 S6K/p70 S6K of ADSCs in 15 min post-photodynamic therapy group were significantly increased (P<0.01), the ratios of p-p70 S6K/p70 S6K of ADSCs in 30 min post-photodynamic therapy group and 60 min post-photodynamic therapy group were both significantly increased (P<0.01). At culture minute of 15 after the treatment, compared with those in normal control group, the ratios of p-mTOR/mTOR and p-p70 S6K/p70 S6K of ADSCs in photodynamic therapy alone group were significantly increased (P<0.05 or P<0.01). Compared with those in photodynamic therapy alone group, the ratios of p-mTOR/mTOR and p-p70 S6K/p70 S6K of ADSCs in photodynamic therapy+rapamycin group were significantly decreased (P<0.05). On culture day of 7 after the treatment, compared with those in normal control group, the expressions of collagen Ⅰ, collagen Ⅲ, and fibronectin of ADSCs in photodynamic therapy alone group were significantly increased (P<0.01). Compared with those in photodynamic therapy alone group, the expressions of collagen Ⅰ, collagen Ⅲ, and fibronectin of ADSCs in photodynamic therapy+rapamycin group were significantly decreased (P<0.01). Conclusions: Low-dose photodynamic therapy can promote the proliferation of ADSCs, improve the ability of ADSCs to regulate the migration of HaCaT cells, and enhance the secretion of extracellular matrix protein by rapidly activating mTOR signaling pathway.

Impact of Skin Biopsy and Clinical-Pathologic Correlation in Dermatology Inpatient Consults.

BackgroundWhile studies of hospital dermatology have demonstrated diagnostic discordance between primary teams and dermatology consultants, little is known about the impact of biopsy and clinical-pathologic correlation (CPC) in consultation. This study compares biopsy performance based on diagnostic discordance and evaluates the impact of CPC on the diagnosis.MethodsThis was a retrospective review of 376 dermatologic consultations at a single academic medical center between July 1, 2017, and June 27, 2018.ResultsBiopsy was significantly less likely to be performed when the diagnosis by the referring primary team was unspecified (p < 0.001). In 24 percent of cases, the diagnosis based on histopathology alone differed from the diagnosis reached by formal CPC consensus review with either potential or significant impact on management.ConclusionDermatologists who perform inpatient consultations and rely on hospital-based pathology services may consider a consensus review for CPC. Requests to perform a biopsy may be interpreted as a request for diagnostic assistance rather than pressure to perform a procedure.

Draping in Dermatology: A Patient's Perspective.

Patient dignity is a core component of the Canadian health care system; however, there may be challenges to maintaining patient dignity in clinical settings requiring total body skin examination (TBSE) for adequate assessment and diagnosis. As standardized TBSE draping practices have not been investigated in a dermatology setting, we sought out to investigate subjective patient experiences of draping practices. A cross-sectional study was performed using a paper survey in dermatology hospital clinics over a 6-month period to 150 patients. Draping was considered important by over 50% of patients surveyed (54.7%). Respondents who indicated that draping impacted their comfort level "a lot" or "very much" had a mean age of 52 and were more likely to be females (P < .05). Females were also more likely to answer that their body weight/shape (P < .05), physician of same (P < .01) or opposite sex (P < .001), and the degree of privacy offered by drapes (P < .001) impacted their comfort level when undressing for a TBSE. Respondents who reported that any assessed factor impacted their comfort during a TBSE were also younger (P < .05), suggesting that younger and female patients were more likely to have comfort concerns than males. Our study confirmed that most patients surveyed considered draping to be important. Our findings highlight the importance of adequate draping practices to maintain patient privacy and dignity for all patients, with special attention to younger female patients to ensure they feel as comfortable as possible. Future research should focus on how these identified patient comfort factors can be implemented into medical education.

Whatsapp based visual impression versus actual impression in patients of common skin disorders: A cross-sectional comparative study

: Nowadays with increasing use of social media platforms for each and everything, there is an increasing trend for use of whatsapp based consultation for many diseases. But what’s app base impression has many limitations and may result in error in diagnosis. : To compare Whatsapp based visual impression versus actual impression in patients of common skin disorders. : In this cross-sectional comparative study held at Department of Dermatology of tertiary care hospital and referral centre in central India, 316 patients of common skin disorders attending Dermatology department were enrolled. Photographs of skin lesions in a patient suffering from skin disorders in pre-determined categories were taken and sent to by 2 independent expert dermatologists by Whatsapp and their impression was recorded. Later same patients were independently evaluated by same investigators by actual clinical examination. It was studied whether both evaluations were matched or not. : At the end of study overall, 69% patients’ photographic and clinical impression was matched. Among different groups of disorders, like fungal, bacterial, viral, pigmentary groups, average diagnosis matched in 51% to 80% cases. Highest percentage of diagnosis matched in pigmentary type of disorders at 80% and lowest percentage of diagnosis matched was 51% for papulosquamous disorders. : Whatsapp consultation is frequently sought by patients suffering from various dermatological problems but it’s not accurate and not 100 % reliable. So clinical evaluation always has an upper hand over an impression made over a photo.

Tratamiento láser de cicatrices por quemaduras

Burn scars cause high morbidity in the form of contractures, body disfigurement, and itching, and they also have a high emotional impact that adversely affects patient quality of life. Laser therapy has proven effective in this setting. It is superior to topical treatments and can be used in conjunction with surgery, helping to reduce morbidity. The use of lasers in hospital dermatology departments, however, is still limited. Carbon dioxide laser resurfacing is the most widely used modality for reducing scar thickness, improving textural abnormalities, and treating contractures. Treatments improve mobility for patients with constrictions. Pulsed dye laser treatments are particularly useful for reducing erythema in recent burn scars and preventing subsequent hypertrophy. Pigment laser treatments with short pulse durations (nanoseconds or picoseconds) can improve hyperpigmentation. In this article, we review the evidence for the use of laser therapy for burn scars and propose a treatment algorithm.

Serum Zinc Level in Patients with Severe Genital Warts: A Case-Control Study in a Dermatology Hospital.

Background Genital warts are a common sexually transmitted disease (STD), and there is no method that completely prevents its recurrence. Recently, zinc has been used in the treatment of cutaneous warts. Nondestructive action, ease of use, and promising results with low chances of relapse were reflected in the treatment. These effects may arise from the immunomodulatory activity of zinc in the event of a viral infection. Objectives This study was aimed at identifying the relationship between the serum zinc level and the clinical characteristics of patients with genital warts. Materials and Methods A case-control study was conducted. Genital warts were diagnosed by clinical examination, and disease severity was demonstrated based on the number of affected sites or the spread of lesions. The serum zinc level was measured using atomic absorption spectrophotometry. Results A total of 78 patients with genital warts and 78 healthy volunteers were enrolled in the study. The mean serum zinc level in the genital wart group was lower than that in the control group (81.83 ± 13.99 μg/dL vs. 86.66 ± 17.58 μg/dL); however, this difference was not statistically significant (P > 0.05). The mean concentrations of serum zinc in patients having more than one affected site, spread > 2 cm2, or ten or more lesions were significantly lower than those of the control group (P < 0.05). Conclusions The results suggested that severe genital warts may be associated with a low serum zinc level in patients.

нigh prevalence of atherosclerosis comorbidity and his risk factors in patients with psoriatic arthritis compared to psoriasis without arthritis: A retrospective dermatological clinic-based study

Background and Aims : An association between atherosclerosis and psoriasis (PsO) has still limited data. Objectives: to evaluate the prevalence of atherosclerosis comorbidity and his risk factors in patients (pts) with psoriatic arthritis (PsA) compared to PsO without arthritis in a dermatological hospital cohort.Methods: 765 pts (Male-439/Female-326) with moderate-to-severy plaque PsO, age PSO pts 52.4±15,6 years were included. 274 out of 765 pts (35.8%) had PsA and 491 out of 765 pts (64.2%) had PsO alone. PsA pts were older then PsO pts – 55.3±13.7 and 50.4±17,6 (p<0.001).Results: Atherosclerosis coding as I 70 were registered often in PsA pts compared to PsO pts – in 40 out of 274 pts (14.6%) and in 35 out of 491 pts (7.3%) accordingly (p<0.001). Smoking patients was found often in PsO pts compare to PsA pts – in 230 out of 491 pts (46.9%) and in 101 out of 274 pts (36.9%) accordingly (p<0.05). In PsA pts AH coding as I 10 - I 15 was found in more cases than in PsO pts - in 260 out of 491 PsO pts (52.8%) and in 187 out of 274 PsA pts (68.2%) accordingly (p<0.001). Obesity coding as Е65-Е68 was identify in 102 out of 765 pts (13.3%). Obesity were found in more cases in PsA pts - in 53 out of 491 PsO pts (10.9%) and in 49 out of 274 PsA pts (17.9%) accordingly (p<0.001).Conclusions: Atherosclerosis found increased frequency in PsA than PsO due to share inflammation pathways between atherosclerosis and PsA. Background and Aims : An association between atherosclerosis and psoriasis (PsO) has still limited data. Objectives: to evaluate the prevalence of atherosclerosis comorbidity and his risk factors in patients (pts) with psoriatic arthritis (PsA) compared to PsO without arthritis in a dermatological hospital cohort. Methods: 765 pts (Male-439/Female-326) with moderate-to-severy plaque PsO, age PSO pts 52.4±15,6 years were included. 274 out of 765 pts (35.8%) had PsA and 491 out of 765 pts (64.2%) had PsO alone. PsA pts were older then PsO pts – 55.3±13.7 and 50.4±17,6 (p<0.001). Results: Atherosclerosis coding as I 70 were registered often in PsA pts compared to PsO pts – in 40 out of 274 pts (14.6%) and in 35 out of 491 pts (7.3%) accordingly (p<0.001). Smoking patients was found often in PsO pts compare to PsA pts – in 230 out of 491 pts (46.9%) and in 101 out of 274 pts (36.9%) accordingly (p<0.05). In PsA pts AH coding as I 10 - I 15 was found in more cases than in PsO pts - in 260 out of 491 PsO pts (52.8%) and in 187 out of 274 PsA pts (68.2%) accordingly (p<0.001). Obesity coding as Е65-Е68 was identify in 102 out of 765 pts (13.3%). Obesity were found in more cases in PsA pts - in 53 out of 491 PsO pts (10.9%) and in 49 out of 274 PsA pts (17.9%) accordingly (p<0.001). Conclusions: Atherosclerosis found increased frequency in PsA than PsO due to share inflammation pathways between atherosclerosis and PsA.

Rifampicin versus Doxycycline in Prevention of recurrent Boils (A Comparative Therapeutic Study)

Background: Suffering from recurrent boils (furunclosis) is a common problem in our locality as it is noticed by many dermatologists especially in association with increasingly hot weather. The most common causative organisms are staphylococci. Objective: The aim of the study was to shed the light upon this problem and compare two systemic therapeutic agents for the prevention of recurrence, doxycycline and rifampicin. Patient and method: One hundred thirty-five (135) Patients with recurrent boils from Al-Yarmouk teaching hospital dermatology outpatient department were included in this study; age ranged from 10 to 64 years old and out of total patients 32 were males and 103 were females. Patients were assessed by full history and clinical examination done by dermatologist. An aspirate from the content of the boil was taken from 30 patients for bacteriological culture. The patients were treated by topical with or without systemic anti-staph antibiotics followed by a preventive protocol of doxycycline100mg twice daily for two months duration in 50 patients and rifampicin 600mg for ten days in the other 85 patients. Both groups used topical sodium fucidate 2% ointment twice daily in nostrils, axilla and perineum for ten days. All were followed up for 2 years to assess the recurrence after treatment. Results: Out of 135 patients treated, 3 (2.22%) patients defaulted from follow up (they were from doxycyclin group) and out of the remainder 132, only 9 (6.8%) patients had recurrence after treatment; 7 (14.89%) patients from the doxycycline group and 3(3.52%) patients from rifampicin group. Forty 40 (85.1%) patients responded well to doxycycline without recurrence for 2 years compared to 83 (97.65%) patients treated with Rifampicin with no recurrence during the 2 years of follow up. The noticed side effects were gastric upset in doxycycline and urine discoloration in rifampicin. Conclusion: Rifampicin regimen in prevention of recurrent boils significantly showed higher effectiveness in addition to more tolerable, easier, shorter course, and fewer side effects than doxycyclin.

356 Infantile hemangioma referral delays persist despite 2019 American Academy of Pediatrics Clinical Practice Guideline: Experience at a single quaternary pediatric institution

Infantile hemangiomas (IH) are vascular tumors that often require timely treatment to reduce morbidity.1,2 The 2019 American Academy of Pediatrics (AAP) Clinical Practice Guidelines (CPG) for the Management of IH recommend referral to dermatology prior to 4 weeks of age, enabling timely treatment initiation.1 This study examines adherence to national guidelines and aims to identify barriers to appropriate referral timing & treatment. This retrospective cohort study examined IH patients, ages 0 to 24 months, referred to Phoenix Children’s Hospital (PCH) Dermatology from 1/1/2019 to 12/31/2020, following release of AAP CPG.

333 A modified delphi consensus exercise: developing a skin-directed Stevens-Johnson Syndrome/toxic epidermal necrolysis scoring system

While SCORTEN and ABCD-10 are available to provide a patient prognosis in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN), they are not intended to assess the severity, progression, or improvement in disease throughout the hospitalization. A skin-directed instrument is needed. A modified Delphi consensus using RAND/UCLA appropriateness criteria was initiated with a core group of members who have published in the topic. A two-part consensus was determined to be needed to first establish agreement on the optimal design for a cutaneous scoring instrument, terminology, morphologies, and locations of involvement. Fifty-four dermatology hospitalists agreed to participate in this study. After one round for part one, all questions and statements reached consensus. Participants consistently agreed on the need of such an instrument and that certain locations including the head and neck, chest, upper back, ocular mucosa, and oral mucosa were almost always affected by SJS/TEN. Participants also agreed on morphologic terminology and that morphologies could be differentiated into blanching erythema, dusky erythema, targetoid erythema, vesicles/bullae, desquamation, and erosions. The second part of the study will establish agreement on time course, progression, and weighting assessments and is in progress. The Delphi consensus has established that there is widespread agreement among expert dermatologists that there is a need for a skin directed scoring system, widespread agreement that specific morphologies can be differentiated consistently on both cutaneous and mucosal surfaces, and that some areas of the body are almost always affected when SJS/TEN occurs. This undertaking has so far revealed best practices as well as areas of uncertainty with SJS/TEN to help develop the framework for an SJS/TEN skin-directed scoring instrument.

The anxiety and depression disorder in adults with atopic dermatitis: experience of a dermatology hospital.

The objectives of this study are to identify the proportion of atopic dermatitis adult patients having anxiety and depression disorder and to measure the relationship between anxiety and depression disorder and characteristics of atopic dermatitis. A cross-sectional study with convenience sampling was conducted. Diagnostic criteria for atopic dermatitis were based on modified Hanifin and Raijka criteria and the severity of anxiety-depression disorder was evaluated using the hospital anxiety and depression scale. In this study, 208 patients were enrolled. The percentage of patients with anxiety and subthreshold anxiety were 11.1% and 34.1%, respectively. 5.3% of patients had depression and 39.4% of patients suffered from subthreshold depression. The proportion of patients with mixed anxiety-depressive disorder was 1.44%. Patients with severe atopic dermatitis were more likely to endure anxiety but not depression. Allergies or autoimmune diseases and scoring atopic dermatitis C were two independent risk factors of depression whereas edema and excoriation were two independent risk factors related to anxiety in atopic dermatitis patients. These findings suggest that atopic dermatitis is associated with anxiety and depression. Allergies, autoimmune diseases, pruritus, and insomnia had a correlation with anxiety and depression disorder.

Profile of Nonvenereal Female Genital Dermatoses: A Cross-Sectional Study From Eastern India.

Nonvenereal genital dermatoses may be a reason for considerable concern to the patient and often pose diagnostic dilemma to the treating physicians. The objective of the present study was to find out the demographical and clinical profile of nonvenereal genital dermatoses including systemic comorbidities in a tertiary care hospital. This was an observational study, carried out at the outpatient department of dermatology of a tertiary care hospital of Eastern India over a period of 12 months. Female patients with genital lesions were included in the study after excluding venereal disease. Results were tabulated and analyzed. A total of 189 female patients were evaluated having 39 different dermatoses. The age ranged from 2 months to 72 years with most patients belonged to the fourth decade and 70.4% patients were from reproductive age group. Most of the patients were literate (81%) and hailing from rural areas. Most of them were homemakers and belonged to lower socioeconomic status (42.3%). Itching (77.3%) was the most common presenting complaint followed by burning sensation (9.5%). Common dermatoses encountered were vulval candidiasis (40.7%), lichen sclerosus (15.3%), tinea cruris (13.8%), lichen planus (4.2%), vitiligo (3.2%), irritant contact dermatitis (2.6%), psoriasis (2.6%), lichen simplex chronicus (2.1%), among others. Most common associated comorbidity was diabetes mellitus. This study provides important data on the spectrum of vulvar diseases in Eastern Indian patients and emphasizes the importance of proper and timely diagnosing nonvenereal vulvar dermatoses.

A cross-sectional study of adverse cutaneous drug reactions with special reference to reaction time

Background: Adverse cutaneous drug reactions (ACDRs) present with different morphologies and times of onset. Knowledge about the common drugs causing them, their reaction time (time interval between drug intake and the onset of symptoms), and the clinical presentations are helpful in identifying an offending drug, especially in the setting of multiple drug therapies, thereby reducing the morbidity and mortality associated with them. Aims: This study aims to identify causative drugs and clinical patterns of ACDRs in a tertiary care center and to estimate their reaction time. Methods: Sixty-two patients diagnosed to have ACDRs who attended the department of dermatology of a tertiary care teaching hospital during an 18-month period were selected for the study. They were classified into certain, probable, or possible categories as per the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) classification. The frequency of each type of drug reaction, common causative agents, and reaction time of different drug reactions was analyzed. Results: Of the 62 patients, 40 (64.5%) were probable, 18 (29%) possible, and 4 (6.4%) were certain. The most common types of reactions encountered were fixed drug eruption (FDE) (13, 21%), drug hypersensitivity syndrome (12, 19.4%), and maculopapular rash (9, 14.5%). As a single group of drugs, antimicrobials were the most common causative agents (23, 37%) followed by anticonvulsants (16, 25.8%). As an individual drug, phenytoin was the most common causative agent (10, 16.1%), followed by paracetamol (7, 11.3%) and isoniazid (5, 8.1%). Reaction time varied from less than an hour for FDE and urticaria to 3–4 months for exfoliative dermatitis, lichenoid eruption, and folliculitis. Limitations: Small sample size was the major limitation. Conclusion: Reaction time varied from less than 24 h in FDE, urticaria, and angioedema to 3–4 months in exfoliative dermatitis, lichenoid eruption, and folliculitis.

Application of Isothermal Signal Amplification Technique in the Etiological Diagnosis of Gonorrhea and Drug Resistance Gene Detection.

Background: Isothermal signal amplification technique is developed based on the rolling ring amplification mechanism of cyclic DNA molecules in nature. This technique plays an extremely beneficial role in gonorrhea pathogen identification and drug resistance gene detection. Aims: This study analyzes the isothermal signal amplification techniques in the etiological diagnosis of gonorrhea and drug resistance gene detection. Materials and Methods: Urethral, cervical secretion, or prostatic fluid samples from 322 cases of gonorrhea collected from January 2018 to December 2021 at the STD clinic of our hospital dermatology department were selected for direct smear examination and gonococcal culture examination; DNA was extracted from urethral, cervical secretion, or prostatic fluid samples and then used for pathogen identification by SAT assay and rolling loop nucleic acid amplification technique, smear examination and pathogen culture examination methods, SAT assay, and isothermal signal amplification technique for comparative sensitivity and specificity analysis. Results: The highest rate of gonorrhea positivity was for the urine rolling loop nucleic acid amplification technique, followed by the swab rolling loop nucleic acid amplification technique, and the lowest rate of gonorrhea positivity was for the urine SAT test. The difference in the positivity rate between the two urine testing methods was statistically significant (P < 0.05). The highest sensitivity of the urine rolling loop nucleic acid amplification technique method for the detection of gonorrhea pathogens and the lowest sensitivity of the urine SAT method were statistically significant (P < 0.01). The differences in sensitivity and specificity between the swab rolling loop nucleic acid amplification technique and the swab SAT method were not statistically significant (P > 0.05). ROC curves were plotted based on sensitivity and specificity, with swab SAT assay (AUC = 0.998) > rolling loop nucleic acid amplification technique (AUC = 0.981). Comparing the negative rates of urine and swab rolling loop nucleic acid amplification technique and urine SAT assay, the differences were not statistically significant (P > 0.05). Conclusion: The isothermal signal amplification technique improves the shortcomings of gonorrhea pathogen identification means and drug resistance gene detection methods, with good detection sensitivity and specificity, simple operation, low price, and easy promotion, which has obvious advantages in clinical applications and epidemiological studies.

Necrotizing fasciitis in sub-Saharan Africa: A study of 224 cases

Background: The aim of this study was to describe the epidemiological, clinical aspects, and outcome of necrotizing fasciitis (NF) in sub-Saharan Africa. Patients and Method: We conducted a descriptive study in hospital dermatology departments in five sub-Saharan African countries over a two-year period (April 2017 to July 2019). Patients over fifteen years of age received for NF were included. Results: During the study period, 224 patients with NF were included. Their mean age was 51.9 ± 18.3 years and their sex ratio (M/F) was 1.3. NF was present in the lower limbs in 88.8% (n = 199) of the patients. The main local signs of NF were cutaneous necrosis (83.9%; n = 188) and spontaneous intense pain (75.9%; n = 170). NSAIDs (32.6%; n = 73), obesity (16.5%; n = 65), the use of decoctions/poultices (21.4%; n = 48), diabetes (16.5%; n = 37), nicotine addiction (11.6%; n = 26), alcoholism (8%; n = 18), voluntary cosmetic depigmentation (6.7%; n = 15), and HIV infection (3.8%; n = 8) were the main comorbidities. We recorded 14.7% (n = 33) of deaths. Conclusion: This study shows that NF of the lower extremities is the most often observed clinical form in sub-Saharan Africa. Some factors or comorbidities (diabetes, obesity, alcoholism, nicotine addiction) seem to be relatively frequent.

CLINICAL FEATURES OF PEMPHIGUS AT NATIONAL HOSPITAL OF DERMATOLOGY AND VENEREOLOGY FROM 2015 TO 2021.

Pemphigus is a group of autoimmune disease with several types different in clinical features and histopathology. Objectives: To investigate clinical features of pemphigus in out-patients at National Hospital of Dermatology and Venereology (NHDV). Method: We analyzed retrospectively 279 medical records of out-patients with pemphigus at NHDV from 2015 to 2020. Results: Female accounted for 62.7%. The mean age was 48.3 years old, the youngest was 14 years old and the oldest was 88 years old. The mean age of onset was 46.3 years old, the earliest onset was at 10 and the latest onset was at 88. The mean disease duration was 23.9 months, the shortest was one month and the longest was 20 years. The average hospitalization was 1.54, there was a case hospitalized 10 times. Pemphigus vulgaris accounted for the highest rate of 85.3%, the following was pemphigus erythema (10%). Pemphigus vegetans took the lowest rate of 0.4%. 83.4% of cases having lesions on both normal and seborrheic skin. 56.1% of cases were not affected at mucous membranes while only 4.4% of them free from lesions on the skin. Pemphigus vulgaris was highly developed lesions at mucosal areas more than other types. Moderate pemphigus accounted for the major cases of 68.4%. 14.1% was severe pemphigus. Mono-therapy with corticoid was the most common of (65.1%). A combination regime of corticoid and azathioprine took 12.9%. Notably, there was 3.3% having traditional treatments with herbs. Conclusions: Female accounted for 62.7%. The mean age was 48 years old; the mean age of onset was 46 years olds. Pemphigus vulgaris was the most common type and highly developed lesions at mucous membranes more than other types. Two-third suffered from moderate pemphigus. Mono-therapy with corticoid was seen the most.

IMPACT OF VITILIGO ON QUALITY OF LIFE

Introduction and objective: Vitiligo is a chronic depigmenting disorder with profound psychological effects. This study aimed to assess the quality of life (QoL) of Vietnamese patients with vitiligo. Material and method: We conducted a cross-sectional study at the National Hospital of Dermatology and Venereology in Hanoi, Vietnam. 164 patients with vitiligo older than 6 years of age who attended the hospital from July 2018 to March 2019 were recruited. Data were collected using a structured questionnaire, 39 pediatric patients aged from 6 to 15 years were administered the Children’s Dermatology Life Quality Index (CDLQI), 125 patients from 16 years old and older used the Dermatology Life Quality Index (DLQI) and Vitiligo Quality of Life index (VitiQoL). Results: In the pediatric group, the mean score on the CDLQI was 7.0 ± 5.0, indicating a moderate effect on patients’ quality of life. Most affected aspects included embarrassment, decreased self-esteem, social activities, schoolwork or vacation time, and treatment discomfort. In the older group (from 16 years old and older): The mean VitiQoL score was 55.7 ± 17.5 and the mean DLQI score was 9.7 ± 5.1. Most affected items were embarrassment, daily activities, personal relationships, leisure, and discomfort of treatment. Females were more affected than males. Patients with lesions in visible skin had greater impairment on QoL than those without lesions in these areas. Patients from urban areas tended to be more affected on the quality of life than the rural group but the difference was not statistically significant. Conclusion: Vitiligo has a moderate impact on the QoL of our patients in both pediatric and adult groups. QoL impairment was worse in female patients and patients with lesions in the visible area.

Chemical peeling with 35% glycolic acid for the treatment of disseminated facial verruca plana: A randomized, split-face, evaluator-blinded trial.

Disseminated facial verruca plana is a chronic disorder that causes significant psychological distress. However, safe and effective treatment is lacking. This study aimed to explore the efficacy and safety of 35% glycolic acid (GA) for the treatment of disseminated facial verruca plana. A split-face clinical trial was conducted to explore the efficacy and safety of using chemical peeling with 35% GA for the treatment of disseminated facial verruca plana. One side of the face was applied with 35% GA once every fortnight for a total of three times. Adapalene gel was applied every night to the other side of the face as the control. The clearance rate of lesions was evaluated at different time points. Between June 2020 and December 2020, 30 patients with disseminated verruca plana who visited the Dermatology Hospital of Southern Medical University were enrolled. After three chemical peelings with 35% GA that was applied at 2-week intervals, 15 (50%) patients achieved >70% lesion reduction. The same effective rate in the adapalene gel-treated side of the face was documented in eight patients. Subgroup analysis showed a higher clearance rate in patients with a shorter disease duration. Moreover, concurrent improvements in facial roughness were observed in the 35% GA-treated group. Adverse effects including mild erythema and desquamation were observed during chemical peeling with 35% GA. In conclusion, chemical peeling with 35% GA could be a safe and effective option for treating disseminated facial verruca plana, especially for those who desire skin improvement.

Real life long-term efficacy and safety of ixekizumab in moderate-to-severe psoriasis: A 192 weeks multicentric retrospective study-IL PSO (Italian landscape psoriasis).

Psoriasis is one of the commonest inflammatory skin diseases determining a very high impact on patients' quality of life and daily activities and relationships. Several biologic therapies have been approved through the years for the treatment of moderate-to-severe plaque psoriasis, and efficacy and safety profile have been analyzed in clinical trials. Ixekizumab is an immunoglobulin G subclass 4 monoclonal antibody that selectively targets and binds IL-17A with high specificity and affinity. Inhibiting IL-17A activity, ixekizumab reduces and turns down levels of inflammation, resulting in the clinical improvement of the disease. Long-term efficacy and safety profile of ixekizumab have been investigated and reported in the UNCOVER trials, but in literature there are only few studies based on real life experience. We present the efficacy and safety profile of ixekizumab in a cohort of 779 patients affected by moderate-to-severe plaque psoriasis and treated with ixekizumab in 11 Italian dermatology hospitals, with a follow-up of care until 192 weeks.

Determination of infection rate of cutaneous leishmaniasis among patients attending dermatology hospitals in Khartoum.

Determination of infection rate of cutaneous leishmaniasis among patients attending dermatology hospitals in Khartoum.