Dermatology Outpatient Clinic Research Articles

Our Experience in Treating Infantile Hemangioma: Prognostic Factors for Relapse After Propranolol Discontinuation.

Infantile hemangioma (IH) is a common benign tumor in infants. While most cases exhibit a self-limiting nature, some require medical treatment to avoid complications. Propranolol is the first-line therapy for IH, it has a high success rate, and is safe to use. Unfortunately, some patients might experience rebound growth after propranolol discontinuation. Currently, it is unclear which factors predict this phenomenon. This study aimed to identify factors affecting the rebound growth of IH after propranolol cessation. We also aimed to identify predictors for an excellent response to oral propranolol. We performed a retrospective cohort study using clinical data from all patients referred to our clinic with IH and placed on systemic oral propranolol between January 2009 to December 2023 in the dermatology outpatient clinic of Rambam Healthcare Campus. Out of a total of 552 patients with IH, 301 received oral propranolol for at least 6months. A relapse phenomenon was observed in 38 (12.6%) patients. We found a significant association between limb involvement and the least likelihood of hemangioma rebound (p < 0.001). An excellent response to oral propranolol was observed in 57.8% of patients. Younger age at initiation of oral propranolol was associated with an excellent response (p = 0.015). Also, IHs located on the limbs (67) showed a higher rate of excellent response to oral propranolol compared to other anatomical sites (p = 0.02). Interestingly, patients who were treated with a dose of 2mg/kg/day were associated with excellent response to treatment (p = 0.007). IHs located on the limbs demonstrated less rebound growth and a better treatment response. When oral propranolol was initiated earlier or when the target dose was 2mg/kg/day, there was a higher rate of excellent response to treatment.

The State of the Art of Image Guided Superficial Radiation Therapy Treatment of Non-melanoma Skin Cancer in Outpatient Dermatology Clinics in the United States and Review of the Literature.

Image guided superficial radiation therapy (IGSRT) is a novel technology which combines traditional superficial radiation therapy (SRT) with high resolution dermal ultrasound (HRDUS) to treat non-melanoma skin cancers (NMSC). Since development, IGSRT use has expanded dramatically in outpatient clinics. We review the IGSRT literature and state-of-the-art operating principles in US dermatologic practices. A literature search of electronic databases (Medline, Pubmed, Cochrane Library, Science Direct) combined with various authors' published and unpublished documents, procedures, and clinical experience with IGSRT were synthesized for this paper. Studies have demonstrated IGSRT consistently delivers high cure rates (> 99%) with low complications for early stage (stage0, I, or II) squamous cell and basal cell carcinomas. Control rates are statistically superior to non-image guided SRT and external beam radiation (XRT) as well as Mohs micrographic surgery (MMS). This improvement is attributed to invivo dermal tumor visualization via HRDUS and using an interdisciplinary approach to deliver care. IGSRT use in the dermatologic clinic for early stage NMSCs has become common practice and continues to expand. While the safety and cosmetic benefits of SRT/XRT have been long documented, IGSRT represents a significant leap forward in efficacy (statistically significant) by adding in vivo dermal tumor imaging. Results rival and appear on one study to surpass tumor control obtained with MMS. A contributing factor to the success may be the availability and use of an interdisciplinary team approach that includes dermatologists, radiation therapists, radiation oncologists, and medical physicists. The high tumor control rates, minimal side effects, favorable cosmesis, and ability to treat multiple lesions per session using IGSRT are establishing this modality as a standard first-line therapy for early stage NMSCs in dermatology clinics. IGSRT may represent the most effective option for the non-surgical treatment of early stage NMSC to date.

Stigmatization and perceived health status in patients with hidradenitis suppurativa: an observational multicenter study in Europe.

Hidradenitis suppurativa (HS) can severely affect the quality of life (QoL) and is linked to psychological distress, including anxiety, depression, and reduced self-esteem. Stigmatization due to physical appearance may significantly contribute to the psychological burden and impact on QoL for HS patients. This study investigates the association between stigmatization, depression, anxiety, and health- and disease-related variables among HS patients in Europe. This observational cross-sectional multicenter study was conducted across 22 dermatological outpatient clinics in 17 European countries. Data collected included sociodemographic variables, general health variables, disease-related variables, perceived stigmatization (PSQ), and mental health (PHQ-2, GAD-2). Of the 5487 dermatological patients, 142 (2.6%) were diagnosed with HS, and data from 135 patients (70.1% women, mean age 38.2 years) who completed the PSQ questionnaire were analyzed. Scores on the stigmatization measure indicated that significant stigmatization levels were present in the sample. Linear regression models revealed a significant relationship between stigmatization and both the duration of HS and the presence of itch. Similar findings were noted for the PSQ "confused/staring behavior" scale with depression. The PSQ "absence of friendly behavior" scale was inversely associated with general health status, whereas the "hostile behavior" scale was positively linked to depression. HS patients experience significant stigmatization linked to disease duration, itch, and depression. Comprehensive management, including screening for psychosocial co-morbidity, is essential, as is providing access to psychological interventions that support patients to both manage internal distress and the potential reactions of others.

LC-OCT for early diagnosis and characterization of dermatologic adverse events to oncologic drugs and correlation to histopathology.

Targeted and immune therapies have recently been associated with the occurrence of multiple cutaneous toxicities, often challenging to differentiate by clinical examination alone without histology. Line-field confocal optical coherence tomography (LC-OCT) is a non-invasive and innovative imaging technique that has been shown to be almost as effective as histology in diagnosing several skin conditions. Our study aimed to assess the effectiveness of LC-OCT in predicting the clinical evolution of early maculopapular eruptions related to antineoplastic targeted therapy and immunotherapy. In the period between May 2023 and December 2023, consecutive patients with clinical cutaneous maculopapular reactions caused by oncologic targeted therapy or immunotherapy were enrolled at the dermatologic outpatient clinic of the Fondazione Policlinico A. Gemelli IRCCS, Rome. Patients underwent clinical dermatological examination, video-dermoscopy, LC-OCT, and incisional skin biopsy of a target cutaneous lesion. To investigate the evolutionary pattern of maculopapular lesions (psoriasic eruption, lichenoid eruption, eczematous eruption, bullous eruption), LC-OCT and histopathological images have been compared based on specific characteristics (hyperkeratosis, acanthosis, spongiosis; papillomatosis; lichenoid inflammatory infiltrate; presence of intraepidermal/subepidermal cleavage plan with formation of a bulla). Eighteen patients were included in this study (11 males, 7 females, median age 64.5). LC-OCT demonstrated an overall concordance with histology of 77.8%, with a Cohen's Kappa of 0.69 (P < 0.0001). Sensitivity exceeded 70%, and specificity was ≥88.2%. The Area Under the Curve (AUC) ranged from 0.9 to 1 for psoriasis and lichenoid eruption and from 0.7 to 0.9 for eczematous and bullous eruption. LC-OCT appears to be a promising tool for the early differential diagnosis of adverse skin reactions related to targeted therapy and immunotherapy, offering the potential to avoid skin biopsies in fragile cancer patients.

A marker of systemic inflammation in hidradenitis suppurativa patients without cardiovascular disease: aortic arch calcification.

In this study, we aimed to investigate whether there is a relationship between aortic arch calcification (AAC) and hidradenitis suppurativa (HS) in HS patients without cardiovascular disease. In this study, patients over 18 years of age who applied to the dermatology outpatient clinic between January 2023 and February 2024 were followed up with the diagnosis of HS without cardiovascular disease, and a healthy control group matched in terms of age and gender were included retrospectively. In total, 130 patients with HS without cardiovascular disease and 130 control patients were included in the study. AAC was significantly higher in the HS group compared to the control group (p = 0.028). In the multivariate analysis, we found that age and HS were independent predictors of AAC (OR: 1.048 (1.009-1.089); p = 0.015, OR: 3.158 (1.181-8.445); p = 0.022, respectively). When we divided the groups as having AAC (grade 1-3) and not having AAC (grade 0), the rate of HS disease was significantly higher in the group with AAC compared to the group without AAC (75.0% vs. 47.5% p = 0.010). AAC is observed more frequently in patients with HS without cardiovascular disease than in healthy individuals. Moreover, HS can be considered as an independent predictor of AAC. AAC may contribute to developing treatment strategies in HS patients without cardiovascular disease.

Different Pathways of Skin Aging: Objective Instrumental Evaluation.

Background/Objectives: Hypertrophic and atrophic skin aging represent two distinct phenotypes: hypertrophic aging is marked by deep wrinkles and a leathery texture, whereas atrophic aging is characterized by overall skin thinning, increased vascularity, and a higher risk of non-melanoma skin cancers. This study aims to elucidate the characteristics and differences between hypertrophic and atrophic facial aging subtypes using two non-invasive imaging devices: VISIA® and dynamic optical coherence tomography (D-OCT). Methods: We retrospectively evaluated patients who had presented to the outpatient dermatological clinic at Policlinico Umberto I hospital in Rome, Italy for a non-invasive facial imaging check-up. We included 40 patients aged 60-75 who were imaged with VISIA® and dynamic optical coherence tomography (D-OCT). Based on the number of UV spots and amount of red found on VISIA®, subjects were grouped into four subgroups (PIGM, RED, CONTROL, PIGM + RED), and trends among them were analyzed. Results: We found a strong correlation between VISIA® red area scores and D-OCT vascular density at 300 µm depth, confirming VISIA®'s effectiveness for assessing facial vascularity. Wrinkle count was highest in areas with UV spots, particularly in the PIGM and PIGM + RED groups. Conversely, low attenuation coefficients and dermal density were observed in regions with low UV spots but high red areas. Intermediate subgroups (CONTROL and PIGM + RED) displayed varying parameters. Conclusions: Non-invasive imaging devices are effective in evaluating facial aging and distinguishing between aging subtypes. This study identified two intermediate aging types in addition to the hypertrophic and atrophic subtypes.

Assessing systemic inflammatory markers in psoriasis: A retrospective study.

Psoriasis is a chronic inflammatory disease often associated with serious cardiovascular comorbidities. The aim of this study was to investigate the systemic inflammatory burden in psoriasis by examining various inflammatory markers and to assess the relationship between these markers and the severity of the disease. This retrospective study was conducted on medical records of patients who visited the dermatology outpatient clinic between 1 January 2016 and 31 December 2022. The study included patients with psoriasis vulgaris and healthy volunteers. Demographic data, Psoriasis Area and Severity Index score, C-reactive protein, monocyte-high-density lipoprotein cholesterol ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, and Systemic Inflammation Response Index were analysed and compared. A total of 278 psoriasis patients and 90 healthy volunteers were analysed. Compared to the control group, psoriasis patients showed significantly higher systemic immune-inflammation index, Systemic Inflammation Response Index, neutrophil-to-lymphocyte ratio, monocyte-high-density lipoprotein cholesterol ratio, serum C-reactive protein levels, neutrophil count, monocyte count, body mass index, and waist circumference (p < 0.001, p = 0.001, p < 0.001, p = 0.014, p < 0.001, p < 0.001, p = 0.046, p < 0.001, and p = 0.011, respectively). Among patients with severe psoriasis (Psoriasis Area and Severity Index >10), systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and serum C-reactive protein levels were significantly higher compared to patients with mild/moderate psoriasis (Psoriasis Area and Severity Index ≤10). In the ROC curve analysis, the optimal cut-off (AUC, sensitivity, specificity) values for neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and platelet-to-lymphocyte ratio were found to be 2.11 (0.592, 62%, 57%), 552.9 (0.579, 61%, 58%), and 111.9 (0.578, 64%, 46%), respectively. The inflammatory parameters that showed correlation with Psoriasis Area and Severity Index were systemic immune-inflammation index, Systemic Inflammation Response Index, neutrophil-to-lymphocyte ratio, monocyte-high-density lipoprotein cholesterol ratio, monocyte-to-lymphocyte ratio, and C-reactive protein. The findings of this study suggest that systemic immune-inflammation index, Systemic Inflammation Response Index, neutrophil-to-lymphocyte ratio, monocyte-high-density lipoprotein cholesterol ratio, and C-reactive protein values have the potential to serve as simple and cost-effective markers for assessing the inflammatory burden in individuals with psoriasis.

Frequency of cutaneous drug reactions in the outpatient dermatology clinic at the National Institute of Cardiology Ignacio Chávez over a ten-year period

Cutaneous adverse drug reactions, or pharmacodermias, are the most common form of adverse drug reactions (ADR). It was our interest to know their epidemiological behavior in a tertiary hospital level in Mexico. We stablished the frequency of ADR in 61 infants and adults hospitalized patients and those seen in the outpatient Dermatology Clinic at the National Institute of Cardiology Ignacio Chávez in Mexico City (INCICh) over a period of 10 years. The most frequently diagnosed pharmacodermias were acneiform dermatitis, cutaneous hyperpigmentation and maculopapular exanthema mainly associated to prednisone, hydroxychloroquine, cephalothin, amiodarone and vitamin B-complex, although we registered less frequently more severe and hazardous reactions. These results were consistent with other reports in our country. Multiple drugs administered at a time was an important causative factor for the ADR. It is necessary for every practitioner to develop skills that permit the identification of these dermatoses in order to correctly manage each case and diminish the morbimortality associated.

Possible Role of Platelet-Rich Plasma in the Treatment of Patients with Postherpetic Neuralgia: A Prospective, Single-Arm, Open-Label Clinical Study

Abstract Background: Currently, no treatment can fully and finally treat postherpetic neuralgia (PHN). Objectives: This study aimed to evaluate the possible efficacy of autologous intralesional platelet-rich plasma (PRP) injection in treating patients with PHN. Materials and Methods: A prospective, single-arm, open-label clinical study was conducted on 45 patients with PHN attending the Dermatology Outpatient Clinics of Sohag University Hospital, Egypt, between November 2019 and November 2021. Patients were subjected to full clinical general and dermatologic examinations. Patient’s assessment included; severity of pain through visual analogue scale (VAS), numerical rating scale (NRS), and verbal rating scale (VRS), in addition to Medical Outcomes Study 36 Item Short-Form (SF-36). Patients were treated by autologous PRP injection every 2 weeks for 2 months (4 sessions). Patients were evaluated before every session and 3- months after the last session. Results: There was a significantly decreased VAS, NRS, VRS, and SF-36 questionnaire values in the last session and three months after the last session. There was a highly significant moderate correlation between both scales (VAS and VRS) and patient’s age in years and who have aggravating factors. Likewise, there was a significant moderate positive correlation between scales (VAS and VRS) and the disease duration, medical co-morbidities, and associated myalgia. Limitations: These findings require further confirmations on more inclusive large-sized multicenter, randomized, placebo-controlled, clinical trials with longer follow-up. Conclusion: This clinical pilot study concluded that autologous intralesional PRP injection was an effective therapeutic option for patients with PHN.

Clinico-epidemiological profile of dermatology patients: a one-year study at a newly established tertiary care centre in India

Background: Dermatology is predominantly an outpatient specialty focused on the diagnosis and treatment of dermatoses affecting the skin. We conducted a study on the demographic and clinical characteristics of patients attending the outpatient clinic to better understand the clinico-epidemiological profile and to predict morbidity patterns within the specific geographical region. Methods: A retrospective study was conducted over the past year, encompassing all patients who visited the outpatient dermatology clinic at AIIMS, Raebareli. The study systematically documented a range of dermatoses, including disorders affecting the skin, hair, and nails. Results: A total of 4,188 patients were included in the study, comprising 2,681 (64%) adults, 978 (23.4%) geriatric patients, and 529 (12.6%) pediatric patients. Among these, 1,311 patients primarily suffered from infections, followed by 752 patients with dermatitis. Of those with infections, 1,024 (78%) were diagnosed with fungal infections, while scabies was observed in 126 patients (9.6%). In the adult group, 756 (28.2%) patients had infections, while 429 (16%) patients were affected by dermatitis. Similar patterns were observed in both the geriatric and pediatric groups, with infections being the most prevalent, affecting 214 and 341 patients, respectively. Conclusions: Based on the findings of this study, it can be concluded that infections, particularly fungal infections, are the most prevalent dermatological conditions across all age groups in the population studied. Dermatitis also emerged as a significant concern, particularly among adult patients. The high prevalence of infectious dermatoses, especially in geriatric and pediatric patients, highlights the need for targeted public health interventions and preventive measures.

Value of Sulfotransferase Enzyme Assay in Predicting Minoxidil Response in Patients with Androgenetic Alopecia

Abstract Background Androgenetic Alopecia (AGA) is the most common type of progressive nonscarring hair loss in men and women. AGA features a progressive miniaturization of the hair follicle leading to transformation of terminal hair to vellus hair. These results from an alteration of hair cycle dynamic in which anagen phase duration gradually decreases and that of the telogen phase increases. Objective To compare Minoxidil result among patients with low versus high sulfotransferase activity in order to evaluate the validity of sulfotransferase enzyme testing before minoxidil use. Patients and Methods This was a prospective observational study that was conducted at Dermatology outpatient clinic, Ain Shams University Hospital on 60 male patients presenting with androgenetic alopecia grade II, III, IV. Results Vellus hair count/cm2 increased from baseline (17.4±9.2) to Month-4 (20.1±9.6), the differences (2.7±5.6) were statistically significant (p &amp;lt; 0.001). Terminal hair count/cm2 increased from baseline (6.1±3.3) to Month-4 (9.5±6.3), the differences (3.4±5.3) were statistically significant (p &amp;lt; 0.001). Terminal hair percent increased from baseline (25.7±3.6) to Month-4 (29.8±8.2), the differences (4.1±8.8) were statistically significant (p &amp;lt; 0.001). Total hair count/cm2 increased from baseline (23.5±12.4) to Month-4 (29.6±15.3), the differences (6.1±10.2) were statistically significant (p &amp;lt; 0.001). Mean hair width increased from baseline (0.04±0.02) to Month-4 (0.06±0.03), the differences (0.02±0.03) were statistically significant (p &amp;lt; 0.001). Less than half of the study cases showed increasing response (46.7%). Baseline Sulfotransferase enzyme was higher in responder cases (0.78±0.37) than in non-responder cases (0.31±0.16), the differences were statistically significant (&amp;lt;0.001). Conclusion The clinical response to 5% minoxidil commonly seen after 3-6 months and approximately 40% of patients will experience hair growth. considering the long time of treatment needed to produce a response by minoxidil in AGA, Sulfotransferase enzyme assay has a significant impact on minoxidil response in hair follicles and can be used as a diagnostic test perior the use of minoxidil to exclude the nonresponders.

A Clinicodemographic Analysis of Egyptian Females Condyloma Accuminata Patients

Abstract Background Human papillomavirus (HPV) is the most common viral infection of the reproductive tract in women and men. Although most HPV infections resolve spontaneously, persistent infections can lead to precancerous lesions and cancer of the cervix, vagina, vulva, anus and penis. HPV related cancers accounted for an estimated 4.5% of all cancers worldwide in 2012. Objective To describe the patients’ demographic features, clinical presentations, sexual aspects, and possible risk factors of codyloma accuminata among female patients treated at Dermatology, venereology and Andrology outpatient clinics of Ain Shams University hospitals and Al-Houd Al-Mrsoud hospital, Cairo, Egypt. Patients and Methods This prospective cross sectional clinical study was conducted on 500 female patients aged above 18 years old with condyloma accuminata. Results Most of the studied patients (71.2%)gave a history of no condom use, (13.7%) of patients gave history of occasional condom use while the rest 7.5% weren’t sexually active. Most of the patients (61.3%) gave a history of cryotherapy, (8.6%) patients gave a history of chemical cautery, (4.5%) patients gave a history of electro surgery and (2.1%) patients gave a history of immunotherapy. Among the studied patients those had chemical cautery as a treatment modality had the highest recurrence rate. Conclusion The main risk factors for condyloma accuminata are young age, unprotected sexual intercourse, multiple sex partners and lower socioeconomic and educational levels. Smoking or alcohol together with immunosuppressive medications and chronic diseases as well as other STDs are possible risk factors. History of medical intervention as laser hair removal of genital area, colonoscopy and vaginal ultrasound could play a role in condyloma accuminata transmission in non-sexual active women. Condyloma accuminata occurred in more than one genital sites in relation to laser hair removal of genital areas compared to mostly one site in sexual transmission.

Evaluation of Chlorophyllin – IPL Mediated Photodynamic Therapy in Treatment of Periungual and Subungual Warts

Abstract Background Periungual and subungual warts are warts that develop around the nail plate in the form of epithelial thickening and fissures that cause pain and may extend below the nail plate and affect the nail matrix and cause permanent nail deformity. They are caused by human papilloma virus. Frequent nail trauma as in nail biters and immune suppression are the main predisposing factors. Treatment of periungual and subungual warts presents a great challenge due to their site and high risk of recurrence. Many treatment methods have been tried as physical destruction by cryocautery, electro cautery and lasers, chemical destruction by salicylic acid, Antimitotics as bleomycin and 5-fluorouracil, Retinoids and immune therapy as intralesional candida antigen, vitamin D derivatives and zinc. However, these methods may be difficult to apply in periungual warts and also may cause severe destruction of the nail. Photodynamic therapy is a promising, effective, easy and safe line of treatment for warts. It works through interaction between the photosensitizer, light source and oxygen causing cell damage and apoptosis of the infected cells. There are several photosensitizers used in photodynamic therapy like ALA, MAL and methylene blue. Chlorophyllin is a novel photosensitizer that have been experimented in PDT in dermatological and in non-dermatological fields and showed promising results. Aim The aim of this study is to assess the efficacy and safety of chlorophylline-IPL mediated PDT in periungual and subungual warts. Patients and Methods This is a randomized controlled clinical trial. Sixty patients with periungual and subungual warts were recruited, examined and evaluated at dermatology outpatient clinic of Dermatology, Venereology and Andrology Department, Ain Shams University Hospitals. They were divided into two groups: Methylene blue group (30 patients) received MB/IPL/PDT sessions for 5 sessions maximum and chlorophylline group (30 patients) received chlorophyllin/IPL/PDT sessions for 5 sessions maximum. Each pateint was evaluated and photographed clinically and dermoscopically before the start of the study and 2 weeks after the end of sessions and response was assessed by clinical and dermoscopic score (poor, good, very good and excellent according to reduction in size of warts in mm). Pateints were also evaluated for pain and satisfaction at the end of the study. Results In MB group: (44.4%) showed poor response,(14.8%) showed good response,(25.9%) showed very good response and (14.8%) showed excellent response, while in chlorophylline group : (63%) showed poor response,(33.3%) showed good response and (3.7%) showed excellent response. These results denoted statistically significant decrease in size of warts in the two groups, the results were better in the methylene blue group. satisfaction score of patients which was (mean±SD:4.52 ± 1.87) in methylene blue group versus (mean±SD:3.41 ± 1.53) in chlorophyllin group with statistically significant difference showing higher satisfaction in methylene blue group. Conclusion Methylene blue and chlorophylline are effective photosensitizers in photodynamic therapy of periungual and subungual warts. However, Methylene blue is more effective than chlorophylline. Further studies for chlorophyllin are needed.

The Value of Non-Cultured Adipose Derived Stem Cells (ADSCs) in Mechanically Micro Emulsified Adipose Tissue (Nanofat) together with Platelet-Rich Plasma (PRP) in Female Pattern Hair Loss (FPHL)

Abstract Background Female pattern hair loss (FPHL) is the most common cause of non- scaring alopecia in females and it significantly affects individuals' overall quality of life. Managing this condition poses a regular challenge in dermatological practice due to the limited supporting evidence for many therapeutic options, frequently resulting in unmet patient expectations. Nanofat grafts, generated by emulsification and filtering of microfat, contain growth factors and Adipose Derived Stem Cells (ADSCs) that can induce tissue regeneration and improve tissue quality Objective To assess the efficacy of Platelets Rich Plasma (PRP) added to Nanofat in Female Pattern Hair Loss (FPHL) Methods This is an Interventional study, which included 20 female patients with female pattern hair loss (FPHL) after exclusion of other causes of alopecia. Patients were selected from the outpatient clinic of Dermatology of Ain Shams University Hospitals from December 2022 till May 2023. Results In our study, 20 FPHL patients aging from 18 to 50 years. They were treated by Nanofat with PRP. They were followed up at12 and 24 weeks clinically by photography and trichoscopically by counting terminal and vellus hair and assessing the change in terminal and vellus hair thickness which were analyzed using image J data analysis software. Mean terminal hair count was increased highly significantly in number, as it increased from 73.90 hair/cm2 before treatment to 120.05 hair/cm2. There were high statistically significant decrease in vellus hair count, decreased from 46.60 to 25.20 (p &amp;lt; 0.001). There was high statistically significant increase in terminal hair thickness after treatment from 0.044 to 0.062 after 6months, (p &amp;lt; 0.001). There was high statistically significant increase in vellus hair thickness after treatment from 0.020 to 0.026 after 6 months from 0.020 to 0.023, p &amp;lt; 0.001 Conclusion The procedure seems safe, effective, well-tolerated by all the patients with encouraging response from these patients. We observed no adverse side effects in any. patient

Alitretinoin versus phototherapy as the first-line treatment in adults with severe chronic hand eczema: the ALPHA RCT.

Hand eczema is common and a cause of morbidity and occupational disability. When education, irritant/contact allergen avoidance, moisturisation and topical corticosteroids are insufficient to control chronic hand eczema, ultraviolet therapy or systemic immune-modifying drugs are used. There is no treatment pathway generally accepted by UK dermatologists. Compare alitretinoin and ultraviolet therapy as first-line therapy in terms of disease activity at 12 weeks post planned start of treatment. Prospective, multicentre, open-label, two-arm parallel group, adaptive randomised controlled trial with one planned interim analysis, and an economic evaluation. UK secondary care dermatology outpatient clinics. Patients with severe chronic hand eczema unresponsive to at least 4 weeks of treatment with potent topical corticosteroids. Natural logarithm of the Hand Eczema Severity Index + 1, 12 weeks post planned start of treatment. Participants randomised 1:1 by minimisation to alitretinoin or ultraviolet therapy for 12 to 24 weeks. Blinded primary end-point assessor. Intention-to-treat population: 441 (100.0%) participants; 220 (49.9%) alitretinoin and 221 (50.1%) ultraviolet therapy. At least one dose was received by 212 (96.4%) alitretinoin and 196 (88.7%) ultraviolet therapy participants. The unadjusted median (interquartile range) relative change in hand eczema severity index at 12 weeks was 30% (10-70%) of that at baseline for alitretinoin compared with 50% (20-100%) for ultraviolet therapy. There was a statistically significant benefit of alitretinoin compared with ultraviolet therapy at 12 weeks, with an estimated fold change or relative difference (95% confidence interval) = 0.66 (0.52 to 0.82), p = 0.0003 at 12 weeks. There was no evidence of a difference at 24 or 52 weeks, with the estimated fold change (95% confidence interval) equal to 0.92 (0.798 to 1.08) and 1.27 (0.97 to 1.67), respectively. Fifty-nine per cent allocated to alitretinoin and 61% allocated to ultraviolet therapy achieved a clear/almost clear assessment during the trial period. Differential treatment compliance observed: 145 (65.9%) alitretinoin and 53 (24.0%) ultraviolet therapy participants confirmed compliance (≥80% received, no treatment breaks > 7 days during first 12 weeks). High levels of missing data were observed. One hundred and thirty-five reportable adverse events across 79 participants, 55 (25.0%) alitretinoin and 24 (10.9%) ultraviolet therapy. Four serious adverse events (two alitretinoin, two ultraviolet therapy). Four pregnancies reported (three alitretinoin, one ultraviolet therapy). No new safety signals were detected. As a first-line therapy, alitretinoin showed more rapid improvement and superiority to ultraviolet therapy at week 12. This difference was not observed at later time points. Alitretinoin is cost-effective at weeks 12 and 52. Ultraviolet therapy is cost-effective after 10 years, with a high degree of uncertainty. Hand eczema severity index may be a useful primary outcome measure for hand eczema trials; ALPHA results will inform future trials. Treatment compliance was poor for ultraviolet therapy. Regular twice weekly treatment was not received by most patients. Assessment of long-term effects of randomised treatments was complicated by use of second-line treatments post treatment phase. Further analysis of substudies and pilot data will provide valuable information for future studies. A clear need for better therapeutic approaches for severe chronic hand eczema remains. Future studies will need to further address long-term benefits of treatments given. This trial is registered as ISRCTN80206075. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/186/01) and is published in full in Health Technology Assessment; Vol. 28, No. 59. See the NIHR Funding and Awards website for further award information.

Study of Skin Microbiome in Patients with Alopecia Areata: Case Control Study

Abstract Background Alopecia areata (AA) is a non-scarring, inflammatory, autoimmune form of hair loss caused by immunological attack on the hair follicle. Patchy alopecia areata affecting the scalp is the most common type. Alopecia areata affects nearly 2% of the general population at some point during their lifetime. Objective To study skin microbiome in patients with alopecia areata compared to healthy controls in Egyptian patients. Subjects and Method This study included 50 subjects (25 patients and 25 controls). The patients were recruited from those attending the dermatology outpatient clinic of Ain Shams university Hospital in the period between October 2021-2022. The procedures were explained to the patients and controls and informed consent was obtained. Results AA patients showed no significant difference in Staphylococcus epidermidis gene expression or in the ratio between them among the patient’s group and healthy subjects. There was a statistically significant negative correlation between the relative gene expression of Staphylococcus epidermidis and the SALT score. Staphylococcus epidermidis gene expression was not significantly correlated with age or duration of last attack. Conclusion Quantifying the relative gene expression of Staphylococcus especially Staphylococcus epidermidis targeting the 16S region may help to assess the severity of alopecia areata as disequilibrium of the microorganisms may be involved in this disease severity.

Understanding Perceptions and Experiences on Acceptability of Oral Ivermectin, Topical Permethrin, and their Combination in the Treatment of Adult Filipino Patients with Scabies: A Multiple Case Study.

Oral ivermectin, a broad-spectrum anti-parasitic drug, alone or in combination with permethrin, may be a cheaper and more convenient alternative drug to topical permethrin alone in the treatment of classic scabies. There are no previous studies on the treatment acceptability of the three interventions among individual patients with scabies in the Philippines.The purpose of this study was to understand the experiences and perceptions on treatment acceptability for oral ivermectin, topical permethrin or combination treatment among patients with scabies using the multiple-case study approach. We conducted a qualitative multiple case study among adult Filipino patients with classic scabies who were prescribed oral ivermectin, topical permethrin or its combination at a government tertiary hospital dermatology outpatient clinic from December 2022 to September 2023. Semi-structured interviews were used as the primary source of data and analyzed together with chart reviews, Dermatology Life Quality Index (DLQI) scores, and clinical images. Interviews were transcribed, coded, and triangulated with other secondary data. A three-person research team employed a reflexive and iterative process of familiarization, coding, and thematic analysis using a modified Theoretical Framework of Acceptability (TFA) to generate case descriptions, within-case analyses, and cross-case syntheses. The acceptability of scabies treatments (permethrin, ivermectin, and combination therapy) was generally positive. Permethrin, used in three patient cases, was generally perceived as effective but itch relief varied. The burden of whole-body application of permethrin was context-dependent, influenced by living arrangements and family support. Perceived affordability of permethrin was linked to socioeconomic status. Ivermectin, used by one patient case, was perceived as highly effective with no side effects. Its single dose use did not interfere with patient routine. Combination therapy was also considered effective but potential antagonistic effects and the cost of adding permethrin made it less preferred. Reluctance in taking oral pills was noted. All patients valued medical advice and deferred to their physicians for treatment decisions. All three treatment options were considered effective and safe. Patients generally preferred permethrin over oral ivermectin due to its topical nature and perceived lower side effects. However, affordability and logistical challenges, especially for large households and low-income families, were noted with permethrin. Oral ivermectin elicited hesitation due to its controversial role in COVID-19 and veterinary use. Concerns about added costs and potential antagonism in combination therapy were raised. Despite these considerations, patients ultimately relied on physicians for treatment decisions. This study underscores the importance of understanding patient perspectives, experiences, and the patient-physician relationship in choosing scabies interventions. Addressing patient concerns, providing education, and ensuring ease of use and affordability can enhance treatment acceptability and adherence for better outcomes.

Evaluating the Prevalence of Migraine Headache among Patients with Female-Pattern Baldness

Background: According to WHO, migraine is a neurological disorder that has ranked third among the most prevalent medical conditions. Androgenetic alopecia (AGA), on the other hand, is a patterned hair loss disorder due to excessive response to androgens, affecting about half of the world's population. This disorder is presented by progressive hair loss in males and females after puberty, and sex hormones influence both diseases. Methods: A total of 50 women with clinically diagnosed AGA and a mean age of 37.5 referring to dermatology outpatient clinics of Shiraz University of Medical Sciences during 2020 were included in this study. The control group consisted of 50 women of similar age without alopecia. Hair loss was evaluated using the Ludwig classification, and the Persian versions of migraine screen questionnaire (MS_Q) and migraine disability assessment tests (MIDAS) were used to assess migraine among participants. Pain intensity was also measured using the Visual Analog scale (VAS). Results: According to the MS_Q Questionnaire, seven females (14%) in the case group and six females (12%) in the control group had migraines, and no significant correlation was observed between migraine and AGA (P = 0.766). There was no significant correlation between Ludwig score and migraine disability score in the case group with migraine (Spearman correlation coefficient = 0.367, P = 0.419). The only significant positive correlation was between Ludwig score and visual analog scale (VAS) in the case group with migraine (Spearman correlation coefficient = 0.844, P = 0.017) Conclusions: Based on the results, no significant correlation was found between migraine and androgenetic alopecia.

Dermatologic Conditions in Down Syndrome: A Multi-Site Retrospective Review of International Classification of Diseases Codes.

As the population and life expectancy of people with Down syndrome increases, identifying common skin conditions throughout the lifespan will help inform clinical care and research. We sought to evaluate dermatologic conditions diagnosed in pediatric and adult patients with Down syndrome. This multicenter retrospective study analyzed demographic and outpatient visit International Classification of Diseases codes of patients with Down syndrome evaluated at outpatient dermatology clinics in the United States or Canada between 2011 and 2021. A total of 1529 patients with Down syndrome were identified from eight academic medical centers: 50.8% were children (0-12 years), 25.2% were adolescents (13-17 years), and 24% were adults (18 years and older). Eczematous dermatitis was the most common diagnosis overall (26%), followed by folliculitis (19.3%) and seborrheic dermatitis (15.6%). Other notable diagnoses included dermatophyte infections (13%), alopecia areata (11.6%), and psoriasis (6.7%). About 4.3% of visits included a code for high-risk medication use. Eczematous dermatitis, alopecia areata, and folliculitis were the most common diagnoses observed in children; folliculitis, hidradenitis suppurativa, and eczematous dermatitis in adolescents; and seborrheic dermatitis, eczematous dermatitis, and folliculitis in adults. Dermatologic conditions in patients with Down syndrome vary by age, but are most often eczematous, adnexal, and cutaneous autoimmune disorders. This multicenter retrospective review identifies skin diseases that should be prioritized for clinical care guideline development and research in the Down syndrome community.

Brein en blaren: een bijzondere band

Bullous pemphigoid (BP) is a dermatological autoimmune disease characterized by itch and blisters. Sometimes the blisters are preceded by years of itching and eczematous patches, which can cause a delay in recognition of BP. The disease is caused by production of autoantibodies against the hemidesmosomal proteins BP180 and BP230 at the dermal-epidermal junction. An association between BP and neurodegenerative disorders, such as Parkinson’s disease, is known. However, this association is not commonly known amongst health care professionals, but is of clinical significance. Neurodegenerative disorders (including Parkinson’s disease) are thought to disrupt the blood brain barrier, resulting in exposure of neuronally located BP180 and BP230 to the immune system. In most studies that have examined the association between BP and Parkinson’s disease (and other neurodegenerative disease), BP develops several years after the diagnosis of Parkinson’s. We present a case of a patient with proven bullous pemphigoid who developed clinical features of Parkinson’s disease during follow-up at the dermatology outpatient clinic. After neurological analysis, the patient most likely suffered from long-standing Parkinson’s disease.