Dermatology Department Of Hospital Research Articles

Pattern of skin diseases among patients attending Hawassa university comprehensive specialized hospital, Hawassa, Ethiopia

<p><strong>Background</strong>: Spectrum of skin diseases varies from region to region due to several factors such as genetics, socioeconomic and environmental. This study aimed to determine the pattern of various skin disorders appearing in the dermatology department of a tertiary care hospital.</p><p><strong>Methods</strong>: All patients attending the dermatology clinic of the Hawassa university comprehensive specialized hospital, from January 2017 to December 2018 were included in this retrospective analysis. The medical records of the patients were obtained from registry books. </p><p><strong>Results: </strong>A total of 7727 patients attended the dermatology clinic of HUCSH. Out of these samples, 18.1% of patients repeatedly came to the hospital for a follow up visit related to their diseases, while 81.9% were enrolled as new cases.</p><p>There were more males (51.9%) than females. More than three quarter of the cases were aged above 16 years while less than a quarter were children below 16 years. Eczema was diagnose in 2734 (35.4%), being the most common cause for attendance, followed by infectious disease (23.3%) and disease of the skin appendages (12.1%).</p><p class="abstract"><strong>Conclusions</strong>: Eczema was the most common skin disease seen in our study, followed by infectious disease and disease of the skin appendages. Concerted effort need to be made to control these conditions and training of the primary health care providers and education of General Practitioners in Dermatology must emphasize these common conditions, with the aim of improving primary health care and alleviating the burden of hospital care.</p>

Advanced basal cell carcinomas of the face: A Moroccan series

Background: Basal cell carcinoma (BCC) is the most common cutaneous skin malignancy. 85% of BCCs affect the face, a region particularly rich in noble organs. Although BCC progresses slowly, considerable local destruction and mutilation may be observed. Material and Methods: We performed a retrospective review of the database stored by our institution. All patients with histologically confirmed mutilating basal cell carcinoma of the face hospitalized at the dermatology department of the university hospital in Fez, Morocco, from 2015 through 2020 were evaluated. Results: Nine patients were included, with the tumors located in the lips, temporal region, orbital region, and cheeks, with sizes varying from 5 to 11 cm. Conclusion: In the series, we were able to highlight the high-risk character of the subpopulation living in rural areas and the role of smoking as a major risk factor.

An observational study on ocular manifestations in patients of psoriasis in a tertiary care hospital in western India

BackgroundThe aim of the study is to observe the ocular manifestation in patients of psoriasis. MethodsAll the diagnosed cases of Psoriasis by the dermatology department of this tertiary care hospital were included in this study. Relevant details of the history pertaining to disease duration, type of psoriasis, and treatment undertaken including ocular symptoms were obtained. Disease severity was quantified using the PASI score. Complete ocular examination including intraocular pressure, Schirmer I and II tests, Tear Film Breakup Tme (TBUT); was carried out for all the patients. ResultsOf 126 patients of psoriasis, ocular manifestations were seen in 76 patients (60.3%). Dry eyes (27%) and blepharitis (15.9%) were the most common ocular manifestations. Uveitis was seen in 3.2% of the patients of which 75% patients were HA B27-positive psoriatic arthritis, which was statistically significant (p = 0.001). There was no statistical correlation between duration of the disease and ocular manifestations (p value is 0.077 using chi square test). The ocular manifestations were more common in patients with PASI score 10 when compared with the patients with PASI score 10 (p value = 0.028) which was statistically significant. ConclusionsIn our study, prevalence of ocular manifestation was 60.3% which increased with the increasing PASI score. Dry eyes and blepharitis were the most common manifestations. Hence, routine ocular examination is recommended in patients with psoriasis.

Characterization of rosacea in Chinese: An analysis of 254 cases.

Rosacea is a common chronic inflammatory dermatosis with uncertainty of etiology. Although clinical features and risk factors of the disease in Caucasians have been reported, this information in Chinese is largely unavailable. To analyze the clinical features and associated risk factors of rosacea in Chinese. A questionnaire was given to outpatients with rosacea who visited the dermatology department of the first affiliated hospital of Kunming Medical University from June 2018 to March 2019. Analyses included demographic characteristics of subjects, clinical characteristics, and risk factors of rosacea. A total of 254 outpatients completed the questionnaire. The ratio of female to male was 5.68:1.00. The mean age at onset was 31.18±10.23years. Erythematotelangiectatic subtype accounted for 51.60%, while 39% of the subjects were of papulopustular subtype. The rest were phymatous type (9.40%). Subjects with flushing, persistent facial erythema, and telangiectasia accounted for 91.73%, 90.55%, and 83.07%, respectively. One hundred and thirteen subjects (44.49%) had papules or pustules, and 24 subjects (9.40%) were with phymatous changes. The most commonly involved sites were the cheeks (93.31%), followed by the nose (82.68%), the perioral area (61.42%), and the forehead (51.97%). The clinical symptoms included burning (93.70%), dryness (90.55%), and itching (75.59%). The main risk factors were sun exposure (90.94%), temperature change (87.40%), etc. Fifty-one (20.08%) patients had comorbidities. Rosacea mainly affects young females. The common signs and symptoms include flushing, persistent facial erythema, and burning. Sun exposure and temperature changes are the common risk factors. Patients can have comorbidities of systemic disorders.

Comparison of 5% minoxidil lotion monotherapy versus its combination with autologous platelet rich plasma in androgenetic alopecia in hundred males

BackgroundAndrogenetic alopecia (AGA) is the most common form of alopecia in men, affecting 70% by the age of 20 years. The present study was conducted with the objective of comparing the efficacy of monotherapy with topical 5% minoxidil and its combination with intradermal platelet rich plasma (PRP), in male AGA. MethodsThis observational study was conducted at the dermatology department of a tertiary care hospital over a duration of 2 years. 100 patients with AGA were selected and divided randomly into 2 treatment arms: Group A (MM): received topical 5% Minoxidil monotherapy for 12 months and; Group B (M + PRP): received combination therapy of PRP and topical 5% Minoxidil for 12 months. The following parameters were subsequently analyzed on follow up: Physician-assessed global photography by a 4-point improvement scale and trichoscopic improvement of mean hair diameter. ResultsThe combination was statistically superior to the monotherapy group in promoting hair growth in men with AGA for both measures of hair growth – photographic assessment and trichoscopic mean diameter. ConclusionWe hereby conclude that intradermal PRP injections should be offered to all patients with AGA along with the existing therapeutic modalities, for faster hair regrowth and improved compliance.

Serum Levels of 25-Hydroxyvitamin D in Patients with Seborrheic Dermatitis: A Case-Control Study.

Several autoimmune papulosquamous skin conditions such as psoriasis, systemic lupus erythematous, and lichen planus have been associated with vitamin D deficiency or correlated with serum vitamin D level. This study was aimed at comparing the 25-hydroxyvitamin D (25(OH)D) status in patients with facial or scalp seborrheic dermatitis with healthy subjects. This case-control study included 289 patients (118 with psoriasis and 171 sex- and age-matched control subjects) from the outpatient clinic of two hospital dermatology departments in the west of Mazandaran province, Iran. All patients and control subjects were studied during one season to avoid seasonal variations in vitamin D levels. Serum mean ± standard deviation of 25(OH)D levels were significantly lower in seborrheic dermatitis patients than in control subjects (20.71 ± 8.16 vs. 23.91 ± 7.78, P = 0.007). Serum 25(OH)D levels were negatively associated with the risk of developing seborrheic dermatitis (odds ratio (OR): 0.898, 95% confidence interval (Cl): 0.840–0.960, P = 0.002). Also, vitamin D under 30 ng/ml was associated with OR: 4.22 (95% Cl: 1.077–16.534, P = 0.039) for seborrheic dermatitis. The severity of scalp disease was significantly associated with serum 25(OH)D level (P = 0.003). Cases with severe scalp scores had significantly lower serum 25(OH)D level compared to moderate OR score (P = 0.036). A similar trend was not seen in the facial disease. The 25(OH)D values are significantly lower in seborrheic dermatitis patients than in healthy subjects. Furthermore, the scalp disease severity was associated with lower serum 25(OH)D level. Our results may suggest that vitamin D may play a role in the pathogenesis of seborrheic dermatitis.

Risk factors associated with necrotizing fasciitis of the lower limbs: A multicenter case-control study

ObjectiveThe aim of this case-control study was to identify risk factors associated with necrotizing fasciitis (NF) of the lower limbs. Patients and methodsWe conducted a prospective case-control study in hospital dermatology departments in 5 sub-Saharan African countries over a 2-year period (April 2017 to July 2019). The cases were patients with NF of the lower limbs and the controls were patients with leg erysipelas. Each case was matched with two controls for age (±5 years) and sex. We analyzed local and general factors. ResultsDuring the study period, 159 cases (73 females, 86 males) were matched with 318 controls. The mean age was 48.5±15.8 years for cases and 46.5±16.2 years for controls (P=0.24). The main local signs of NF were cutaneous necrosis (83.7%), pain (75.5%) and induration (42.1%). Multivariate analysis showed the following to be independent risk factors associated with NF of the lower limbs: obesity (odds ratio [OR]=2.10; 95% confidence interval [CI]: 1.21–3.42), diabetes (OR=3.97; 95% CI: 1.95–6.13), nicotine addiction (OR=5.07; 95% CI: 2.20–11.70), use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR=7.85; 95% CI 4.60–14.21) and voluntary cosmetic depigmentation (OR=2.29; 95% CI: 1.19–3.73). ConclusionOur study documents the role of NSAID use at the onset of symptoms as a risk factor for NF of the lower limbs. However, the originality of our study consists in the identification of voluntary cosmetic depigmentation as a risk factor for NF of the lower limbs in sub-Saharan Africa patients. Our results also identified typical overarching factors such as diabetes, obesity and nicotine addiction. Knowing these factors and taking them into account will enable optimization of management strategies for these conditions.

Evaluation of corticosteroid use pattern and their adverse effects in patients visiting the dermatology department of a tertiary care teaching hospital in Warangal, India

Introduction: Corticosteroids have become a mainstay of pharmacotherapy in dermatology because of their anti-inflammatory and immunosuppressive properties. However, misuse and sudden cessation of these drugs may render a patient to develop numerous adverse effects (AEs). Adverse drug reactions (ADRs) are important causes of mortality in both hospitalized and ambulatory patients. Early detection, evaluation, and monitoring of ADRs are essential to reduce harm to patients. Therefore, to achieve optimum benefit with the least AEs, safe and effective use of these agents is very crucial. Objective: To examine the corticosteroid use pattern, to assess the frequency of misuse and the associated AEs that are encountered in dermatological practice. Materials and Methods: A prospective observational study was conducted in the dermatology department of a tertiary care teaching hospital, Warangal for a period of six months. All patients using at least one corticosteroid either topically or systemically were included in the study. Informed consent was taken from patients. Results: A total of 151 participants were included in the study. Among them, 56% of females developed ADRs compared with males (44%). Among patients using topical corticosteroids (TCs), the most frequently reported ADRs include facial erythema (7.31%), acne (17.07%), and hyperpigmentation of the face (2.43%). The AEs associated with oral corticosteroids include weight gain (19.51%) and taenia corporis (19.5%). Conclusion: Corticosteroids have extreme importance in dermatological practice. However, inappropriate and prolonged users render a patient to develop several AEs. Precise drug regimens and proper patient counseling can help in minimizing and managing the AEs associated with inappropriate use.

Is the Frequency of Seborrheic Dermatitis Related to Climate Parameters?

Objectives:The aim of this study was to determine the frequency of seborrheic dermatitis (SD) by months and seasons in Istanbul, Turkey, and to examine the relationships between SD frequency and meteorological data, such as average temperature (°C), average humidity (%), average sunshine duration, and solar radiation per months.Methods:The study was conducted at Dermatology Department of Haseki Training and Research Hospital. The data of all adult patients who applied to the dermatology outpatient clinic between June 2018 and May 2020 were obtained. Monthly average climate data values of Istanbul between the same period were requested from the Turkish Ministry of Agriculture and Forestry, General Directorate of Meteorology.Results:During the study period, SD was diagnosed in 5316 patients (5.9% of the outpatient clinic). Among these, 2721 (51.2%) were male, 2595 (48.8%) were female, and mean age was 35.9±15.1 years-old. With respect to monthly distributions, SD frequency was 7.3% in December, 7.1% in February, 6.7% in November, and 6.6% in January; whereas June (3.8%) and July (3.9%) represented the lowest proportion of patients. Frequency of SD was similar in the autumn and winter seasons, despite considerable difference in average temperature. The frequency of SD was found to be strongly and inversely correlated with temperature values (r=–0,646, p<0.001) and monthly maximum humidity value (r=–0.609, p=0.001), while it was also moderately correlated with solar radiation levels (r=–0.442, p=0.027). Minimum or average humidity values and sunshine durations (daily and monthly) were not associated with frequency of SD. Spearman’s Rho correlation was calculated to assess the directional relationships between continuous variables.Conclusion:Our study shows that environmental factors such as low temperature, low ultraviolet index, and low humidity are critical factors that increase the likelihood of SD development. These data support previous studies in terms of indicating that SD frequency might be increased in climate conditions favoring the growth of Malassezia species.

Psychological burden of psoriatic patients in a German university hospital dermatology department.

Psoriasis has a strong impact on patients' lives and is closely linked to psychiatric disorders such as depression, anxiety and substance-related disorders, especially dependence on alcohol and nicotine. The aim of our study was to systematically assess the psychiatric comorbidity and possible associations between psychological factors, disease severity and dermatology-related quality of life in psoriatic patients from a high-need university hospital dermatology department. Consecutive psoriatic patients (new and permanent patients) at the Department of Dermatology, University Hospital Essen, Germany, were asked to fill out a paper-based questionnaire. In the first part of the questionnaire, baseline demographics, pre-existing mental disorders and data on substance abuse were collected. In the second part of the questionnaire, mental and physical health was explored using different validated self-rating tests. The current Psoriasis Area and Severity Index (PASI) was documented by a dermatologist. Patients with signs of mental disorders were offered an appointment with a board-certified psychiatrist. Between August 2016 and February 2019, 228 consecutive psoriatic patients (138 men [60.5%], 90 women [39.5%]; mean age, 48.3years [standard deviation, 13.6; range, 18-80]) participated in the study. Approximately 50% of the patients had evidence of suffering from mental health problems, mostly depression and anxiety, as well as alcohol dependence. Patients with a PASI of 3 or more showed a statistically significant reduced Dermatology Life Quality Index (DLQI) and a significantly impaired psychological as well as physical quality of life. DLQI correlated with all psychological test results. The data indicate a significant psychological burden in a tertiary psoriatic population. Our findings underscore the importance of screening psoriatic patients for psychiatric disorders, with a focus on depression, anxiety as well as alcohol and nicotine dependence, in a multidimensional approach involving psychiatrists and psychologists.

The prevalence of SARS-CoV-2 infection and the severity of the course of COVID-19 in patients with psoriasis treated with biologic therapy

Background Biologics are used for the treatment of patients with moderate to severe psoriasis. According to the recommendations of major global dermatological associations, patients who had not reported clinical symptoms or close contact with a confirmed/probable COVID-19 case in the last 14 days can continue biologic therapy. Objective The aim of our study was to determine the prevalence of SARS-CoV-2 infection, its clinical manifestations and the influence of COVID-19 on the course of the underlying disease in patients with moderate to severe psoriasis and aggressive psoriatic arthritis undergoing biologic therapy. Material and methods All 61 patients with moderate to severe psoriasis treated with biologics in the Dermatology Department of Central Clinical Hospital of Ministry of the Interior and Administration in Warsaw were enrolled into the study. Firstly, the medical histories of these patients were assessed for occurrence of severe adverse events, COVID-19 symptoms and deaths. Afterwards, the prevalence of serum anti-SARS-CoV-2 antibodies, and severity of COVID-19 were assessed. Results Ten patients in the study group have developed anti-SARS-CoV-2 antibodies. One patient presented with mild COVID-19 symptoms. Conclusion While our study had a small sample size, ongoing biologic treatment in psoriasis was not associated with severe form of COVID-19.

18307 Antibiotic prescribing practice for acne within a UK hospital dermatology department

Acne is a common inflammatory skin condition, characterised by blockage and inflammation of the pilosebaceous unit. Treatment is aimed at reducing severity of lesions and to limit scarring, with topical and oral antibiotics remaining popular initial treatment options. There is growing concern regarding antimicrobial resistance and recent initiatives advise antibiotic stewardship when treating acne. These include avoiding antibiotic monotherapy, limiting the use of antibiotics for short periods, and combining oral antibiotics with topical retinoids and benzoyl peroxide.

Clinico-microbiological study of dermatophytosis in the tertiary care hospital, KMC &amp; H, Chinakondrupadu, Guntur

Dermatophytosis is the most important group of superficial fungal infections caused by dermatophytes and clinical manifestations vary depending on the causal agent and on the host immune response. The present study was undertaken to assess the clinical profile of dermatophytic infections and to identify the causative fungal species in various clinical presentations among the patients attending the dermatology department of Katuri Medical College and Hospital, Guntur, Andhra Pradesh.: A Hospital-based cross-sectional study conducted at Katuri Medical College and Hospital, Guntur, Andhra Pradesh where suspected cases of dermatophytosis attending the outpatient department of Dermatology, KMC &amp; H, Chinakondrupadu, Guntur conducted during January 2018 to May 2019. Specimen collected was subjected to potassium-hydroxide (KOH) wet preparation (10% KOH for skin and hair; 40% KOH for nail)the specimen was inoculated into a test tube containing Sabouraud's dextrose agar with 0.05% chloramphenicol and 0.5% cycloheximide.Out of 163 cases, 73 (44.79%) were males and 90 (55.21%) were females. Male-to-female ratio was 0.81:1. Majority of the patients belonged to the age group of 31 – 40 years. Tinea corporis was the most common clinical type observed among 95 cases (58.28%). Mixed dermatophytosis was observed in 54(33.13%) cases. Out of which majority were T corporis + T cruris (66.67%) clinical types. 33.12% of the cases showed culture positive isolates. T. mentagrophytes was the commonest (78.8%) isolate identified in Culture medium. Tinea corporis was the most common clinical type observed in the present study. T. mentagrophytes was the commonest (78.8%) isolate identified in culture medium.

Association between metabolic syndrome and acne in teenage girls: a cross-sectional study

Background: Acne is a common chronic inflammatory skin disease predominantly occurring during adolescence; this condition adversely affects a person’s self-esteem and can be associated with metabolic disorders. This study aimed to investigate the prevalence of metabolic syndrome and its components in adolescent girls with acne compared to a control group. Materials and Methods: In this cross-sectional study,105 adolescent girls aged 12-18 years were assigned to either the acne (case; n=55) or control group (n=50). The case group was selected from the Dermatology Department of a general hospital in Tehran, Iran, between January and August 2017. Acne lesions were confirmed and graded by a dermatologist. Clinical and biochemical parameters were evaluated for all participants. Results: The prevalence of metabolic syndrome in patients with and without acne was 18.2% and 14%, respectively. As a result, metabolic syndrome was not correlated with acne in adolescent girls (P=0.561). In addition, the mean body mass index (P=0.89), waist circumference (P=0.62), mean systolic and diastolic blood pressures (P=0.57 and 0.62, respectively), fasting blood sugar (P=0.59), total cholesterol, and low-density lipoprotein cholesterol levels were comparable between the studied groups (P>0.05). Moreover, triglyceride levels were significantly lower in the acne group (P=0.028), whereas this group featured a higher level of high-density lipoprotein cholesterol (P=0.02). However, the logistic regression results showed that none of the measured lipids were associated with acne. Conclusion: The findings indicated that metabolic syndrome and its components (representing metabolic imbalance) were not correlated with acne in adolescent girls.

A predictive model for differential diagnosis between rosacea and sensitive skin: a cross-sectional study.

A predictive model for differential diagnosis between rosacea and sensitive skin: a cross-sectional study.

Clinical and Neuroimaging Analysis of 24 Cases of Sturge-Weber Syndrome

To analyze the clinical manifestations and neuroimaging characteristics of Sturge-Weber syndrome (SWS), to describe the manifestations of facial port-wine stains (PWS) of SWS, and to explore the screening opinions for SWS. A retrospective analysis was performed on the general condition, clinical manifestations, and neuroimaging results of 24 SWS patients from the dermatology department of West China Hospital of Sichuan University between 2017 and 2019. Three different facial PWS distribution methods (traditional anatomical distribution, facial trigeminal nerve distribution, and facial embryological vasculature distribution) in SWS patients were Analysed. Among the 24 patients, 50% were male and 50% were female, with an average age of (18.9±14.0) years (range 1 to 54 years old). 12 cases were SWS type Ⅰ, and the other 12 cases were type Ⅱ. All patients had facial PWS at birth, and the facial PWS of 13 cases (54.2%) were thickened. According to the anatomical division, all the PWS involved the upper and middle face (above the oral commissure); according to the trigeminal nerve distribution, 100% (24/24) patients involve the V2 area; according to the distribution of facial embryological vasculature, 95.8% (23/24) of the patients involved frontal region. 22 patients had ophthalmic abnormalities, the most common was glaucoma (70.8%), and 4 patients had a history of epilepsy. The typical neuroimaging presentations of SWS include leptomeningeal enhancement, cortical calcification, enlarged choroid plexus, focal cerebral atrophy, abnormal intracranial vessels, and local thickening of the skull. Early intervention is recommended for facial PWS in patients with SWS , and ophthalmological screening should be performed on children with PWS found in any part of the upper and middle face after birth. Moreover, neuroimaging examination (MRI) for patients with high suspicion of SWS should be performed after 1 year old, and regular ophthalmological examination and intraocular pressure measurement is necessary.

Correlation between serum vitamin D levels and severity of vitiligo

Objective To correlate between serum vitamin D levels and severity of vitiligo. Background Vitiligo is an acquired depigmentary disorder that affects more than 0.5–1% of the worldwide population. Vitamin D has been implicated in the pathogenesis of various autoimmune diseases. The correlation between vitiligo and vitamin D is discussed in this study. Patients and methods This case–control study was conducted on 60 patients with vitiligo and 60 age-matched and sex-matched healthy individuals. All patients were recruited from the Outpatient Clinic of Dermatology and Andrology Department of Shebeen El-Kom University Hospital between 1 May 2018 and 31 August 2018. Blood samples were taken, and serum levels of vitamin D were measured by enzyme-linked immunosorbent assay technique. Serum levels of vitamin D were statistically analyzed in relation to Vitiligo Area Severity Index (VASI) score using Spearman coefficient test. Results The patients had higher serum vitamin D levels than the controls with highly significant difference (P Conclusion There was no significant correlation between vitamin D levels and VASI score. Future larger controlled studies are required to obtain a wider assessment of the relationship between vitamin D level and vitiligo disease severity.

A clinical and dermatoscopic study of melasma

Melasma is an acquired hypermelanosis that occurs exclusively in sun-exposed area mostly on face and rarely on the neck and forearms. It is more common in women and in Asians. Exact pathogenesis remains elusive, however, genetic predisposition and ultraviolet light exposure seem to play an important role.The aim of this study was to evaluate facial melasma clinically and dermatoscopically and to compare the consistency of the findings with respect to each type of melasma. Dermatoscopy is increasingly being used for diagnosis of pigmentary disorders other than malignancy. Hospital based cross sectional descriptive study. Study was conducted in the Dermatology department of Yenepoya Medical College and Hospital on 110 patients during the period of December 2016 to June 2018.Clinical examination includes standard dermatological examination along with Wood’s lamp and dermatoscopic examination (Detailed format attached).Heine Delta 20 plus Dermatoscope was used for evaluation of the lesions.: A total of 110 patients with clinical diagnosis of melasma attending the Department of dermatology in Yenepoya medical college were studied during a period of 18 months. Maximum number of patients (35.5%) belonged to the age group between 31 and 40 years. Study showed a female preponderance (69.1%) . On the basis of Fitzpatrick skin type, patients with Type IV (90%). With respect to occupation housewives (60%) and manual labourers /farmers (25.5%) formed the majority indicating chronic sunexposure to be a leading cause for melasma. Patients having Centrofacial pattern predominated with 59.1% of the total. In 43.6% of the women cycles were regular, 5.45% had irregular cycles and 20.9% of the women had attained menopause. We found that 66.4% of the patients had a moderate MASI score. Under Wood’s lamp examination patchy enhancement was seen in 56.4% of the patients indicating a mixed pattern. Among the various patterns observed reticuloglobular pattern dominated our study with 85.45% of patients being positive for the pattern. In our study patients presented with some additional features under dermatoscopy namely telangiectasia (36.1%), followed by depigmentation (24.5%). On the basis of dermatoscopy, 64.5% predominantly showed an epidermal pattern.Dermoscopy serves as useful tool in assessing the type of melasma based on the MASI score.

A study of effectiveness and safety of topical combination therapy for acne vulgaris patients in dermatology department of a tertiary care teaching hospital

Background: Acne vulgaris is a dermatological disorder characterised by formation of comedones and inflammatory lesions. Acne is one of the most common reason for visiting a dermatologist in early adulthood. The current line of management for mild to moderate acne is topical medications with antimicrobials and retinoids. The present study assessed the effectiveness and safety of topical combination therapy for mild to moderate acne vulgaris.Methods: An observational, prospective and comparative study conducted on newly diagnosed acne vulgaris patients who were treated with topical combination therapy. Changes in the total, inflammatory and non-inflammatory lesion counts, investigator global assessment (IGA) and dermatology life quality index (DLQI) scales were recorded to check effectiveness. Treatment emergent adverse events were recorded in suspected ADR reporting form for safety assessment.Results: Participants (n=97) were treated with three topical combination treatments either clindamycin-benzoyl peroxide (group-A), clindamycin-adapalene (group-B) or benzoyl peroxide-adapalene (group C). Majority of participants (42.3%) were treated with clindamycin-benzoyl peroxide group. Reduction from baseline of total, inflammatory and non-inflammatory lesion counts were highly significant within group comparison (p&lt;0.001), but between group differences were not significant. Significant improvement in DLQI and IGA scores were noted in all three groups, but between group comparison showed no significant differences. All three groups were safe and well tolerated and equally improve participant’s quality of life.Conclusions: all three topical combination drugs for mild acne vulgaris had similar effectiveness in terms of reduction in acne lesions with similar safety profile.

Livedo Racemosa: Clinical, Laboratory, and Histopathological Findings in 33 Patients.

Livedo racemosa is a cutaneous finding characterized by a persistent, erythematous, or violaceous discoloration of the skin, in a broken, branched, discontinuous, and irregular pattern. A retrospective review of 33 cases with clinical diagnosis of livedo racemosa over the past 6 years was evaluated in the dermatology department of a tertiary care hospital. We found predominance in Caucasian women (78.8%); age ranged from 8 to 81 years, with a mean age of 36 years. Livedo racemosa was described as generalized in 12 patients (36.4%), although the main localization was on lower limbs (42%). After laboratory testing and histopathological examinations, 12 patients (36.4%) were classified with idiopathic livedo racemosa; secondary diseases were diagnosis in 21 patients (63.6%), including Sneddon's syndrome, cutaneous polyarteritis nodosa, systemic lupus erythematosus, and others. Medical history of thrombotic events was described in 8 (24.2%) patients, and also 8 (24.2%) patients had abnormal results for 2 or more thrombophilia laboratory tests. Skin biopsy showed no histological abnormalities in 11 cases (33.3%), thrombosis of dermal blood vessels in 10 (30.3%), intimal/subintimal thickening in 7 (21.2%), and vasculitis in 5 (15.2%). In conclusion, livedo racemosa is a clinical feature that might be correlated to vascular disorders, such as thrombotic and/or hypercoagulable states, autoimmune diseases, and neoplastic diseases, or it can be secondary to specific medications. It is essential to establish a correct approach in cases of livedo racemosa, which includes anamnesis, physical examination, laboratory test, histological examination, and complementary examination according to clinical findings, in order to diagnosis underlying causes.