Papulosquamous Diseases Research Articles

Papulosquamous scalp dermatoses: key aspects of differential diagnosis and treatment

Psoriasis and seborrheic dermatitis are common papulosquamous dermatoses. When localized only on the scalp, they often have very similar clinical manifestations and require a comprehensive differential diagnostic approach. The article presents the main comparative clinical and diagnostic characteristics of psoriasis and seborrheic dermatitis of the scalp, including trichoscopy features and pathomorphological markers. Topical therapy with glucocorticosteroids, keratolytics and agents with antifungal activity is of key importance in the treatment of papulosquamous diseases. Modern topical drugs with a fixed combination of active ingredients provide an effect on several pathogenetic mechanisms at once, are stable, compatible, and convenient for use by patients. One of the main drugs for the treatment of psoriasis and seborrheic dermatitis is a solution of betamethasone dipropionate and salicylic acid (trade name – Akriderm SK), which in terms of anti-inflammatory activity is comparable to the highest strength topical corticosteroids, while providing a faster response to therapy and effectively relieving symptoms of itching and peeling. This is confirmed by the authors’ own clinical experience and demonstrated in the clinical cases described in the article.

Spectrum of Paediatric Dermatoses in a Private Medical College

Introduction: Dermatoses in children puts a huge burden on the parents as well as their development. Severity of these dermatoses vary from location to location. Environment plays an important role, especially in children and presentation of these dermatoses maybe quite different than those in adults.
 Methods: This is a six months prospective study. All children who presented to the Paediatrics / Dermatology OPD with any skin ailment were included. Diagnosis was done clinically, investigations if required were done. Based on age, cases were divided into six groups. Skin disorders were categorized into 17 groups. The demographic data and other clinical details were recorded on a pre-designed performa.
 Results: 206 children were included in our study. Males were 136 (66.01%) and females were 70 (33.98%) with M:F ratio 1.94:1. The spectrum of skin diseases were infections and exanthems (40.29%), eczematous diseases (19.41%), disorders of sebaceous and sweat glands (13.10%), papulosquamous diseases (6.31%), hypersensitivity syndromes (5.82%), disorders of pigmentation (5.33%), disorders of hair and nail (3.39%), cutaneous tumor and tumor syndromes (1.94%), vascular disorders (1.45%), disorders of cornification (0.97%), photo-dermatoses(0.97%), histiocytosis and malignant skin tumors (0.48%), and miscellaneous (0.48%). Dermatoses according to age were neonatal (0.97%), infant (4.36%), toddlers (9.70%), preschool (18.44%), school-age-children (30.58%), and adolescents (35.92%).
 Conclusions: Skin infections and infestations being the majority explains the status of developing countries like India. This study can help identify (or diagnosing) and treating common dermatological conditions in children and this would also sensitize our fellow paediatricians to this common but often neglected aspect of childcare.

Association of metabolic syndrome and insulin resistance in papulosquamous diseases

Background: Metabolic syndrome (MetS), insulin resistance (IR) and papulosquamous diseases with shared pathophysiology leads to conglomeration of risk factors of non-communicable diseases like cardiovascular disease (CVD) and type 2 diabetes (T2D) causing high mortality worldwide. The objective is to study the association of MetS and IR in papulosquamous diseases. Methods: It is a hospital-based case-control study conducted on 200 age-sex matched cases and controls with consent. Subjects were administered a pre-validated questionnaire, diagnosis of papulosquamous diseases was based on clinical examination and skin biopsy. MetS was diagnosed based on national cholesterol education program's- adult treatment plan iii with Asian modification for abdominal circumference criteria. Fasting serum insulin levels (FI) was used as a surrogate marker of IR. Results: Mean serum HDL- C level was low and statistically significant (p=0.017). Mean fasting plasma glucose level was significantly higher in patients (p=0.008). Mean FI level was significant between cases and controls (p=0.013). IR was found in 76% of cases which was significantly higher than in controls (p<0.05). IR was highest in psoriasis 29% followed by LP 22%, PRP 19%, and LS 6% which was statistically significant (p<0.05). MetS was mostly found in psoriasis (17%), LP (9%) and least in PRP, LS. Conclusions: This study intends clinicians to do periodic MetS and IR evaluation in papulosquamous diseases. Thus, subclinical cases of non-communicable diseases can be detected and potential co-morbidities can be prevented.

A Six-Year Retrospective Analysis of Skin Biopsies in the Pediatric and Adolescent Population Performed at a Tertiary Health Care Center in India.

Hesitancy to perform skin biopsies in children or adolescents may lead to delayed diagnosis or misdiagnosis and relatively, few studies analyzing pediatric skin biopsies exist. This study aims to analyze the spectrum of skin diseases biopsied and demographic data of pediatric patients underwent skin biopsies at a tertiary health care center in India. Biopsy records over six years were analyzed, noting demographic data, disease duration, clinical differential diagnoses (CDD), final diagnosis after histopathology, disease categorization, and agreement between clinical and final diagnosis. The mean, range, and statistical significance of differences between proportions were calculated. A total of 1308 biopsy records were analyzed. A male preponderance was noted (males - 55.1%; n = 721, females - 44.9%; n = 587). Most biopsies were performed in adolescents (12-18 years; 55.2%) followed by school-age children (5-12 years; 31.4%). Preponderant disease groups biopsied comprised papulosquamous (17.7%; n = 231) and infectious diseases (14.1%; n = 184). Leprosy was the most common infectious disease (37.5%; n = 69) with most patients belonging to borderline tuberculoid spectrum. The overall diagnostic agreement was 74.7%. No correlation of final diagnosis was noted with the number of CDD offered. In more than a fifth of cases, biopsy averted misdiagnosis. This study highlights the importance of skin biopsies in pediatric patients and the relatively high clinico-histopathologic agreement. Leprosy and papulosquamous diseases were preponderant in the pediatric dermatopathology caseload.

Cutaneous and Developmental Effects of CARD14 Overexpression in Zebrafish.

Gain-of-function mutations in CARD14 have recently been shown to be involved in the pathogenesis of psoriasis and pityriasis rubra pilaris (PRP). Those mutations were found to activate the NF-kB signaling pathway. Zebrafish is often used to model human diseases in general, and in skin disorders more particularly. In the present study, we aimed to examine the effect of CARD14 overexpression in zebrafish with the aim to validate this model for future translational applications. We used light microscopy, scanning electron microscopy, histological analysis and whole mount in situ hybridization as well as real-time PCR to ascertain the effect of CARD14 overexpression in the developing zebrafish. Overexpression of human CARD14 had a marked morphological and developmental effect on the embryos. Light microscopy demonstrated a characteristic cutaneous pattern including a granular surface and a spiky pigment pattern. In situ hybridization revealed keratinocytes of uneven size and shape. Scanning electron microscopy showed aberrant production of actin microridges and a rugged keratinocyte cell surface, reminiscent of the human hyperkeratotic phenotype. Developmentally, overexpression of CARD14 had a variable effect on anterior-posterior axis symmetry. Similar to what has been observed in humans with psoriasis or PRP, NF-kB expression was higher in CARD14-overexpressing embryos compared to controls. Overexpression of CARD14 results in a distinct cutaneous pattern accompanied by hyperactivation of the NF-kB pathway, suggesting that the zebrafish represents a useful system to model CARD14-associated papulosquamous diseases.

Pattern of Skin Diseases in Al Baha Region of Saudi Arabia

With regard to dermatological diseases, knowledge of the prevalence of diseases would provide the dermatologist with sufficient background information to make an accurate diagnosis.The objective of the study is to determine the prevalence of dermatological diseases in Al-Baha region, and compare this to that reported in other regions of Saudi Arabia. The study included all new cases of skin diseases that were seen at the dermatology outpatient clinic in King Fahad Hospital, Al Baha, from January 1, 2014 to December 31, 2016. Data were collected from the patients’ medical records, and the diagnosis was made by either a dermatology consultant or specialist according to the International Classification of Diseases (ICD-10). A total of 3153 patients were included in this study, and the dermatological diseases were categorized into ten groups. Eczema had the highest prevalence (24.33%), followed by acne (17.36%), viral infections (11.1%), pigmentary disorders (7.04%), papulosquamous diseases (5.7%), fungal infections (5.28%), alopecia and urticaria (equally prevalent, 5.18%), and parasitic infection (1.37%). The remaining 619 patients (19.6%) had a dermatological diagnosis that fell into the ‘miscellaneous’ category. The results of this study were comparable to those of similar studies performed in other regions in Saudi Arabia. Eczema was the most frequent dermatological disease in Al- Baha.

Histopathological study of non-infectious papulosquamous lesions of skin

Background: Papulosquamous diseases are characterized by scaly papules and plaques with similar clinical picture which leads to diagnostic confusion. A definitive histopathological diagnosis is required for effective treatment of such diseases. Aims and Objectives: The aim of the study was to study the clinicohistopathological correlation of different non-infectious papulosquamous skin lesions. Materials and Methods: Skin punch biopsy specimens from 100 clinically diagnosed/suspected non-infectious papulosquamous skin diseases were received in the Department of Pathology at a tertiary care hospital. The specimens obtained were subjected to formalin fixation and paraffin embedding, stained with hematoxylin and eosin and studied. Results: A total of 100 cases were studied. The most common lesion was psoriasis (42) followed by lichen planus (40). Maximum numbers of cases were seen in the age group of 31–60 years (61%). Males (54%) were commonly affected. Positive clinicopathological correlation was observed in 85% cases. Conclusion: Contribution of histopathology is definitely significant in overcoming clinical diagnostic dilemma in certain papulosquamous disorders.

Papulosquamous annular diseases

Papulosquamous diseases represent a commonly encountered group of cutaneous disorders in dermatology. Lesions can present with papules and plaques in various configurations, including annular forms. Some of these disorders are expected to appear in annular configurations, such as pityriasis rosea and subcorneal pustular dermatosis. Others may either begin as or even progress to annular configurations, including psoriasis vulgaris, seborrheic dermatitis, and nummular dermatitis. We have reviewed common papulosquamous diseases that can present with annular lesions, which includes psoriasis vulgaris, pityriasis rosea, subcorneal pustular dermatosis, contact dermatitis, seborrheic dermatitis, and nummular dermatitis. For each disorder, we have discussed the details of presentation and differential diseases to be considered.

COVID-19 Salgınının İlk Aylarında Değişen Yaşam Tarzı ve Günlük Davranışların Dermatolojik Hastalıklar Üzerindeki Etkileri: Retrospektif Kesitsel Gözlemsel Çalışma

Objective: COVID-19 disease caused panic, fear of death, anxiety in people at the beginning of pandemic. This situation has dramatically changed people's lifestyle and daily behavior. The aim of our study was to determine the effects of changing lifestyle and daily behaviours on dermatological diseases in the first months of outbreak. Material and Methods: The diagnosis of the first patient with COVID- 19 in Turkey was established on 11 March 2020.In the same period, between 11 March and 30 April of 2020 and 2019, 454 versus 2.903 patients were admitted to the dermatology outpatient clinic and included in the study. The rates of dermatological diseases were compared. Pearson's chi-square test was used for statistical analysis. Results: Most of the patients were women (59.2 and 64.8%), and the average ages of the patients were 36.6±17.5 and 35.1±18.2 years for these time periods. Although admission to the hospital for those under 20 years of age due to curfew was decreased (16.8-10.1%), acne frequency increased (18.6- 21.1%, p=0.198). The frequency of psoriasis among papulosquamous diseases significantly increased (p=0.016). Urticaria (4.33-9.47%, p<0.001), drug eruptions (0.17-1.32%, p<0.001), and dermatitis and eczema (25.52-30.44%, p=0.025) significantly increased. The frequency of alopecia areata among hair disorders significantly increased (p=0.005). Rosacea (1.59-0.44%, p=0.05), bacterial infections (1.45- 0.44%, p=0.046), fungal infections (5.29-3.3%,p=0.042) and xerosis cutis (6.26-1.1%, p=0.025) significantly decreased. Admissions due to benign skin diseases (1.38-0%, p=0.012) significantly decreased. Conclusion: We consider that this study will contribute to providing the needed-evidence for the prevention and treatment of dermatological comorbidities by helping to identify the effects of changing lifestyles and daily behaviours on dermatological diseases because of the novel experimental environment created by the COVID‐19 outbreak.

Evaluation of Histomorphological Spectrum of Skin Lesions at a Teaching Institute in Agra: A Cross-sectional Study

Introduction: The skin is the largest organ system in humans. Different skin diseases consist of non specific, non infectious and infectious diseases to various neoplastic lesions. Dermatological lesions are commonly encountered in all countries and it encompasses a wide spectrum, varies from country to country and various regions within a country and influenced by sex, age and associated systemic disorders, economy, literacy, racial and social customs. The clinical presentation is restricted to only a few changes such as hyperpigmentation, hypopigmentation, macules, papules, nodules and few others. However, the spectrum of histopathology of skin disorders is varied. Accurate diagnosis of skin disorders is of utmost importance as treatment is varied for different skin disorders presenting with the similar clinical lesions. Aim: To study histomorphological spectrum and distribution of skin lesions. Materials and Methods: This hospital-based crosssectional study was conducted in Department of Pathology in collaboration with Department of Skin and Venereal Diseases, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, over a period of two years from September 2019 to August 2021. The biopsy sample taken from clinically diagnosed skin lesions sent to histology laboratory in 10% formalin. Sample was fixed in 10% neutral buffered formalin over a period of 12 to 24 hours. Paraffin wax blocks were made and 3-4 micrometer sections were taken and stained with Haematoxylin and Eosin (H&amp;E) stain and histology was studied under microscope. Special stains such as Ziehl-Neelsen (Z-N) stain and Fite stain were done, whenever required. Data was entered in Microsoft Excel excel and descriptive data was obtained. Results: Out of total 105 cases, the maximum patients were of 21-30 years of age group 30 (28.57%) cases followed by 11-20 years of age group 25 (23.81%) cases with male and female ratio M:F=1.5:1. In this study, out of total 105 cases, the most common site involved was trunk in 42 (42%) cases followed by upper limb in 25 (23.81%) cases. The most common skin lesions were non infectious 70 (66.67%) cases, followed by infectious disease 22 (20.95) cases. In non infectious papulosquamous diseases group found 25 (23.81%) cases followed by vesiculobullous and vesiculopustular diseases group 24 (22.86%) cases. Infectious diseases were seen in 22 (20.95%) cases, out of which bacterial diseases being most common in 19 (18.10%) cases followed by parasitic infection 2 (1.90%) cases. Conclusion: According to the findings of the present study the major cases of skin lesions requiring biopsy in developing countries is still psoriasis in non infectious papulosquamous diseases group. Tuberculosis and leprosy in infectious diseases category were being the leading cause of morbidity.

A convolutional neural network trained with dermoscopic images of psoriasis performed on par with 230 dermatologists

BackgroundPsoriasis is a common chronic inflammatory skin disease that causes physical and psychological burden to patients. A Convolutional Neural Network (CNN) focused on dermoscopic images would substantially aid the classification and increase the accuracy of diagnosis of psoriasis. ObjectivesThis study aimed to train an efficient deep-learning network to recognize dermoscopic images of psoriasis (and other papulosquamous diseases), improving the accuracy of the diagnosis of psoriasis. MethodsEfficientNet-B4 architecture was trained with 7033 dermoscopic images from 1166 patients collected from the Department of Dermatology, Peking Union Medical College Hospital (China). We performed a five-fold cross-validation on the training set to compare the classification performance of EfficientNet-B4 over different networks commonly used in previous studies. From the test set, 90 images were used to compare the performance between our four-class model and that of board-certified dermatologists, whose diagnoses and information (e.g., age, titles) were obtained through an online questionnaire. ResultsThe mean sensitivity and specificity of EfficientNet-B4 on the training set was 0.927± 0.028 and 0.827 ± 0.043 for the two-class task, and 0.889 ± 0.014 and 0.968 ± 0.004 four-class task. The diagnostic sensitivity and specificity of the 230 dermatologists were 0.688 and 0.903 for psoriasis, 0.677 and 0.838 for eczema, 0.669 and 0.953 for lichen planus, and 0.832 and 0.932 for the “others” group, respectively; the diagnostic sensitivity and specificity of our four-class CNN was 0.929 and 0.952 for psoriasis, 0.773 and 0.926 for eczema, 0.933 and 0.960 for lichen planus, and 0.840 and 0.985 for the “others” group, respectively. Both the 230 dermatologists and CNN achieved at least moderate consistency with the reference standard, and there was no significant difference between them (P > 0.05). ConclusionsThe two-classification and four-classification models of psoriasis established in our study could accurately classify papulosquamous skin diseases. They showed generally comparable performances to the average level of dermatologists and would provide a strong support for the diagnosis of psoriasis.

Genetic Investigation of Inverse Psoriasis.

Inverse psoriasis is considered to be a rare variant of plaque-type psoriasis and is associated with significantly impaired quality of life. Clinical manifestations and treatment options are somewhat different for each subtype. Identifying genetic variants that contribute to the susceptibility of different types of psoriasis might improve understanding of the etiology of the disease. Since we have no current knowledge about the genetic background of inverse psoriasis, whole exome sequencing was used to comprehensively assess genetic variations in five patients with exclusively inverse lesions. We detected six potentially pathogenic rare (MAF < 0.01) sequence variants that occurred in all investigated patients. The corresponding mutated genes were FN1, FBLN1, MYH7B, MST1R, RHOD, and SCN10A. Several mutations identified in this study are known to cause disease, but roles in psoriasis or other papulosquamous diseases have not previously been reported. Interestingly, potentially causative variants of established psoriasis-susceptibility genes were not identified. These outcomes are in agreement with our hypothesis that the inverse subtype is a different entity from plaque-type psoriasis.

Psychiatric morbidity, stress and quality of life among geriatric dermatology patients: Therapeutic considerations from an Indian perspective.

We aimed to determine the prevalence of psychiatric morbidities, stress and quality of life, the pattern of skin diseases and associated psychosocial factors in geriatric population. Patients aged 60 years and older were recruited. Demographics and dermatological history and findings were collected using a preset Proforma. Geriatric depression scale (GDS), hospital anxiety and depression scale (HADS), perceived stress scale (PSS), and dermatology life quality index (DLQI) were instituted in all the patients. A total of 310 patients were included in the study, 173 males and 137 females. Infectious diseases (39.6%), papulosquamous diseases (17.1%), and eczema (15.5%) were common disorders. 45.5% were depressed and 43.2% had anxiety (hospital anxiety and depression scale). 55.8% had depression (geriatric depression rating scale), 20.3% had high stress and 11% had extremely large effect on DLQI. Divorced/widowed patients experienced more depression (p = 0.037) and had more impairment in quality of life (p = 0.05). Patients living in three generation family experienced more impairment in quality of life (p = 0.000). Our study demonstrated high prevalence of psychiatric morbidities in geriatric dermatology patients. It implies the need of special care with more attention to psychiatric co morbidities. The role of psychiatry-dermatology liaison clinic may benefit these patients.

Histopathological study of non-neoplastic skin lesions in a tertiary care center

Introduction: Skin is the largest organ of our body. Non-neoplastic skin lesions are more common than neoplastic lesions. The histopathological study was done to know the prevalence of various non-neoplastic skin lesions of patients who attended the outpatient department of dermatology over a period of three years from Jan 2016-Dec2018. The present study was based on the histopathological presentation of various non-neoplastic skin lesions, their prevalence, and classifying the lesions into various categories. Materials and Methods: In this study total of 209 cases of skin lesions were taken over a period of three years. The diagnosis of these skin lesions was confirmed by histopathological examination with routine hematoxylin and eosin stain. Results: A total of 209 cases of non-neoplastic lesions were taken for the study. Out of these lesions, 63 cases (30.14 %) were non-infectious - vesiculobullous, 54 ( 25.84 %) were reported under the category of infectious etiology, 41 cases (19.62 %) of non-infectious erythematous papulosquamous diseases, 13 cases (6.22 %) of inflammatory disorders, 10 (4.78 %) cases showed connective tissue disorders. 8(3.83%) cases were reported as vasculitis and 2 cases (0.96) of fungal origin. 18 cases come under the miscellaneous category that was correlated clinically and were treated. Conclusion: In the present study of non-neoplastic skin lesions, non-infectious vesiculobullous diseases were more common. Pemphigus Vulgaris was the most common lesion. The non-neoplastic skin lesions were most commonly seen in males than females in our population of the study.

A study of geriatric dermatoses in a rural based tertiary care hospital in South India

Dermatological problems in the geriatric population are common and often underestimated.A few studies are available on the dermatologic diseases in this population. Hence, this study is undertaken to evaluate the spectrum of skin changes in the elderly population.This study was conducted in the Department of Dermatology, Sri Devaraj Urs Medical College, attached to RL Jalappa Hospital, Kolar, Karnataka, India. A total of 300 patients were recruited for this study, among them 185 (61.6 %) were males and 115 (38.4%) were females. All the patients aged more than 60 years with skin disorders attending the dermatology OPD were included in the study. A detailed physical and clinical examination was performed for all the study subjects. Patients with genodermatoses, albinism, premature aging and inherited disorders of DNA which may interfere with chronological aging skin were excluded from the study.Out of 300 patients, 185 cases (61.6%) were males and 115 cases (38.4%) were females. Pruritus was the commonest complaint in 186 patients (62%). Among the chronological changes of aged skin, wrinkling was the commonest manifestation observed in 282 (94%) cases. The most commonly observed diseases were eczematous dermatitis in 133 (44.3%) cases, followed by infections and infestations in 122 (40.6%) and papulo-squamous diseases in 33 (11%). A total of 46 (15.3%) patients were found to have papulo-squamous disorders. Psoriasis vulgaris was observed in 21 (7%) cases. Among premalignant and malignant disorders, 4 (1.3%) cases had actinic chelitis, 2 (0.6%) cases of basal cell carcinoma and 1 (0.3%) case of squamous cell carcinoma. A total of 5 patients had connective tissue disorders. The comorbid conditions included hypertension in 49 (16.3%) cases, followed by diabetes mellitus in 31 (10.3%) and 5 (1.6%) patients had hypothyroidism.Dermatological findings in geriatric population are universal and cause considerable morbidity. This would necessitate the need for conducting an exclusive evaluation for these patients.

Clinical pattern of papulosquamous dermatoses: an observational study conducted at tertiary care center, Ujjain, Madhya Pradesh, India

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Papulosquamous dermatoses is a complex group of disorder characterized by scaly papules and plaques. There is a need to study the exact, pattern and prevalence of this disorder in different age groups and their line of treatment. Objective of the study was to observe the clinical pattern of various papulosquamous dermatoses and their prevalence at tertiary care center, Ujjain.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was an observational study done in R.D. Gardi Medical college, Ujjain over a period of one year. A total of 229 cases including male and female of papulosquamous dermatoses were enrolled from the outpatient department. All patients were studied clinically and relevant data was recorded. Microsoft excel was used for data entry and analysis was done using SPSS version 23.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 139 (60.7%) males and 90(39.3%) females with overall male to female ratio was 1.54:1. Most common age group affected with papulosquamous dermatoses was 31-50 years. The clinical pattern observed was psoriasis 49.3%, lichen planus 24.5% followed by pityriasis rosea 10.5%. The least common papulosquamous diseases were pityriasis rubra pilaris (1.3%) and lichen nitidus (1.3%). Most common variant of psoriasis and lichen planus was chronic plaque and classical respectively. Classical juvenile variant of pityriasis rubra pilaris was seen in our study. A single rare case of lymphomatoid papulosis was noted in our study.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Psoriasis, lichen planus and pityriasis rosea were commonest papulosquamous diseases were observed but still we need more longer duration of observational studies on papulosquamous dermatoses to understand the morphological features for the effective management of these diseases.&lt;/p&gt;

Nail changes in various dermatoses: an observational study conducted at tertiary care center, Ujjain, Madhya Pradesh, India

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Nail apparatus forms an integral part to be examined for all dermatological conditions. Nail changes are seen in various dermatosis like psoriasis, onychomycosis, lichen planus, collagen vascular disease, vesicobullous diseases and other papulosquamous diseases. Aims and objective of the study was to determine the prevalence of nail changes in various dermatological conditions.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; After applying inclusion and exclusion criteria, 269 cases with various nail changes were enrolled in the study. Detailed history and thorough nail examination was carried out along with other necessary investigations like CBC, RFT, LFT, nail clipping for fungal hyphae culture and microscopy.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 269 cases with nail disorders, male to female ratio was 1.5:1 and most common age group was 31-40 years. The most common abnormality observed was onychomycosis (34.2%) followed by nail changes in psoriasis (30.4%), LP (18.5%), eczema (4%), trachonychia (3.3%), paronychia (2.9%), lichen striatus (2.2%) and darier’s disease (0.37%). Among onychomycosis most common pattern observed was DLSO (82.6%) followed by PSO (7.6%), SWO (5.4%) and TDO (4.34%). The pattern of nail changes in psoriasis patients was pitting (30.4%), subungual hyperkeratosis (21.9%) and onycholysis (10.9%). Cases with LP had longitudinal striations (52%), thinning of nail plate and trachonychia (10% each). V shaped notching and distal splitting was seen in one of the Dariers’ disease patient.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Nail changes form an indispensible part of various dermatological conditions. The pattern of involvement is unique in each and every disease. Hence examination of all the 20 nails should never be missed.&lt;/p&gt;

A possible role of WNT5A expression in papulosquamous skin diseases

Background: Wnt genes code for a family of secreted, lipid-modified glycoproteins. Wnt5a has important functions in cell proliferation, fate determination, and differentiation. Dysregulation of Wnt5a signaling implicated in multiple disease. Aim of Work: The aim is to elucidate the possible role of Wnt5a in pathogenesis of papulosquamous skin disorders through the evaluation of its expression immunohistochemically. Patients and Methods: This study included 80 patients with various papulosquamous diseases (psoriasis, lichen planus, ptyriasis rosea, and ptyriasis rubra pilaris), in addition to 20 healthy controls served as control. Punch skin biopsies were taken from all individuals for immunohistochemical staining with Wnt5a. Results: There was a highly statistically significant upregulation in Wnt5a expression in all stained skin specimens of the studied papulosquamous diseases in both epidermis and dermal lymphocytes compared to normal control. Conclusion: The upregulated expression of Wnt5a indicated its involvement in pathogenesis of papulosquamous diseases. Wnt5a and/or its receptor can be a challenging target for therapeutic intervention. Regular follow-up for these patients is recommended as Wnt5a also may be involved in their malignant transformation.

Skin disorders among elderly patients: clinicodemographic characteristics of 808 Egyptian patients

Background Geriatric health care has increased rapidly worldwide. The frequency of skin diseases is rising among elderly patients. Objectives This study aimed to evaluate demographic features and pattern and frequency of skin disorders among elderly patients attending dermatology clinics. Patients and methods This was a cross-sectional clinical hospital-based study that included all patients aged more than or equal to 60 years old who attended the Outpatient Clinics of Dermatology, Sohag University, Upper Egypt. All the patients were subjected to a detailed medical history and complete general and dermatological examination. Results This study included 808 elderly patients, with a mean age of 70.21±7.51 years. A total of 434 (53.7%) patients were females and 374 (46.3%) were males. Among the patients, 264 (32.7%) were living in urban areas. Overall, 188 (23.3%) patients were smokers. Among patients, 268 (33.1%) had low education levels and 450 (53.2%) patients had a previous history of manual work. The most common comorbidities were diabetes mellitus, seen in 270 (33.41%) patients, and hypertension, seen in 64 (7.92%) patients. Of 808 elderly patients, 188 (23.7%) had infectious skin diseases, 162 (20%) had allergic and eczematous diseases, 98 (12.1%) had senile pruritus, 78 (9.7) had xerosis, 48 (5.9%) had papulosquamous diseases, 32 (4%) had cutaneous tumors, 30 (3.7%) had vesiculobullous diseases, 28 (3.5%) had pigmentary skin diseases, and 18 (2.3%) had vascular disorders. Conclusion Skin diseases are common among elderly patients. Infectious skin diseases, allergic and eczematous diseases, senile pruritus, and xerosis are the most common skin diseases among elderly patients.

Differentiation of inflammatory papulosquamous skin diseases based on skin biophysical and ultrasonographic properties: A decision tree model.

The biophysical and ultrasonographic properties of the skin change in papulosquamous diseases. : To identify biophysical and ultrasonographic properties for the differentiation of five main groups of papulosquamous skin diseases. Fifteen biophysical and ultrasonographic parameters were measured by multiprobe adapter system and high-frequency ultrasonography in active lesions and normal control skin in patients with chronic eczema, psoriasis, lichen planus, pityriasis rosea and parapsoriasis/mycosis fungoides. Using histological diagnosis as a gold standard, a decision tree analysis was performed based on the mean percentage changes of these parameters [(lesion-control/control) ×100] for differentiation of the diseases. The accuracy of the decision tree model for differentiation of five diseases was 67% which developed based on changes in stratum corneum hydration, epidermal thickness, skin pH, melanin index, R0 (reciprocal of firmness) and erythema. Among the flowcharts for pairs of diseases, three models for differentiation had high accuracy (> 95%): those of psoriasis from lichen planus, pityriasis rosea, and parapsoriasis/mycosis fungoides. Validation studies on a larger sample size in situations where the diagnosis is unclear are needed to confirm the accuracy and applicability of decision trees. Skin biophysical and ultrasonographic properties may help in the differentiation of papulosquamous diseases as simple and non-invasive tools.