Venereology Clinic Research Articles

Low Serum Vitamin E Levels Positively Correlate with the Severity of Acne Vulgaris

ABSTRACT Acne vulgaris (AV) is a common disorder of the pilosebaceous, especially prevalent in adolescents. Acne vulgaris ranks among the top ten most prevalent diseases globally. Although AV may resolve spontaneously, sequelae such as scar formation can persist, causing aesthetic and psychological disturbances. There is an antioxidant to counteract acne-causing oxidative stress, vitamin E, which is an important antioxidant in the human body. Therefore, vitamin E in the skin can reduce the formation of squalene peroxide and prevent the occurrence of AV. This is an analytical observational study using a cross-sectional design. The investigation was conducted at the Dermatology and Venereology Clinic of Prof. Dr. I.G.N.G. Ngoerah Denpasar Hospital and the laboratory of the Faculty of Medicine, Udayana University, from February 2024 until the sample size was fulfilled. The sample consisted of patients aged 12-45 years with acne vulgaris who visited the clinic and were then selected through consecutive sampling according to the inclusion and exclusion criteria. In the non-AV group, the mean serum vitamin E level was 19.3 ± 0.99 µg/ml, whereas in the AV group, it was 4.49 ± 19.1 µg/ml, indicating a significant variance. There was a positive correlation between low vitamin E levels and the severity of AV. The linearity graph shows the direction of the relationship between serum vitamin E levels and the severity of AV, which leads to the lower right, indicating that the higher the severity of AV, the lower the serum vitamin E levels. The mean levels differed significantly between the non-AV and AV groups. A favorable association was found between low vitamin E levels and the severity of AV. Keywords: Acne Vulgaris, Severity, Serum Vitamin E, Reactive Oxygen Species (ROS)

Effect of adalimumab treatment on inflammatory and hematological parameters in patients with Hidradenitis suppurativa

Objective Hidradenitis suppurativa (HS), a chronic inflammatory disease that typically manifests after puberty, is characterised by painful nodules, abscesses, draining sinus tracts, and scars in areas rich in apocrine glands such as the axillary and inguinal regions. In recent years, blood-based biomarkers such as the Neutrophil/Lymphocyte Ratio (NLR), Platelet/Lymphocyte Ratio (PLR), Monocyte/Lymphocyte Ratio (MLR), Mean Platelet Volume (MPV), Systemic Immune-Inflammation Index (SII) and Pan-Immune-Inflammation Value (PIV) have been used as significant indicators of systemic inflammation. While there are few studies evaluating these biomarkers in HS, the response of these markers to treatment has only been assessed in one study to date. Our study aims to investigate the effect of adalimumab treatment on blood-based systemic inflammation biomarkers in HS, where inflammation plays a significant role. Methods The study included 42 adult patients who received adalimumab treatment at our dermatology and venereology clinic between January 2020 and January 2023. Medical records for complete blood count results of the patients were retrospectively reviewed. All systemic inflammation-based biomarkers were calculated from the absolute values of the complete blood count. The SII was calculated with the following formula: (neutrophil count × platelet count/lymphocyte count). The PIV was calculated as follows: (neutrophil count × platelet count × monocyte count/lymphocyte count). Values before the treatment and at the 12th week of treatment were compared. Results When the changes in the inflammatory parameters of the patients were examined, it was found that NLR (2.13 ± 0.87 vs 2.26 ± 1.12), PLR (111.01 ± 39.89 vs 99.43 ± 35.34), MLR (0.27 ± 0.11 vs 0.28 ± 0.12), MPV (9.59 ± 0.71 vs 9.70 ± 0.79), SII (680.79 ± 330.18 vs 687.89 ± 442.66), and PIV (552.02 ± 330.71 vs 605.05 ± 415.96) values did not change statistically significantly after treatment (p > 0.05). While there was a significant decrease in platelet count compared to before treatment, no statistically significant difference was found in the other evaluated blood cells. Conclusion Adalimumab treatment has not had a significant effect on systemic inflammation markers in HS, an inflammatory disease. More studies are needed to evaluate the effect of adalimumab on these markers in HS.

Dermoscopic features of nails in Leprosy patients in a tertiary referral hospital in West Java, Indonesia

IntroductionLeprosy is a chronic granulomatous infectious disease, mainly affecting the skin and peripheral nerves, caused by the obligate intracellular bacteria Mycobacterium leprae. The disease has been discussed in several review articles in recent research, but as far as we know, only a few have addressed the effects of leprosy on nails, especially those who examine the dermoscopic features of nails in leprosy patients.PurposesWe aimed to document nail changes in leprosy patients and identify any particular findings through dermoscopic examination.MethodThis was an observational study conducted in the Dermatology and Venereology Clinic of Hasan Sadikin Hospital, West Java, Indonesia, from March 2023 through May 2023. All patients have established cases of leprosy, and the diagnosis is based on clinical and bacteriological examinations. Recruitment was done through total sampling. Dermoscopic examination of all fingernails and toenails was performed at 10x magnification using a handheld dermatoscope (Heine DELTA 20 T Dermatoscope) in polarized mode without the linkage fluid to document the dermoscopic features.ResultOf a total of 19 patients, 15 had nail changes due to leprosy. Out of 15 patients, 13 patients were male. Patients below 25 years old had more nail changes. Most of the patients had a duration of disease greater than two years. Both fingers and toes were involved in nine patients. In this study, the most common dermoscopic feature found was the longitudinal ridge. Other dermoscopic features found in this study were transverse lines, onycholysis, longitudinal melanonychia, leukonychia, subungual hemorrhage, subungual hyperkeratosis, anonychia, and onychorrexis.ConclusionNail changes are found in leprosy patients and have a wide variety of clinical appearances. A dermoscopy should be performed to assess nail changes in leprosy.

CLINICAL AND EPIDEMIOLOGICAL ANALYSIS ON SYPHILIS AMONG MEN WHO HAVE SEX WITH MEN

Purpose of the study: To investigate demographics, prevalence, risk factors and the different clinical forms and symptoms of syphilis in men who have sex with men (MSM). Material/Methods: 50 MSM with syphilis were registered at the Clinic of Dermatology and Venereology in the city of Pleven, Bulgaria, for the period 2008-2022. The diagnosis was confirmed by serological tests. Patients were distributed by their socio-demographic status. Risk factors and sexual behavior were studied, as well as clinical symptoms and co-morbidities of syphilis. Results: Of 50 MSM patients the most affected is the age between 20-29 years (54%). 34% of them are university graduates, 88% abused alcohol, nicotine and drugs in combination, 70% had sexual contacts with a casual partner, 26% of them had HIV co-infection. Secondary and early latent syphilis are the most common clinical forms of the disease (34%). The typical symptoms of primary and secondary syphilis were clinically manifested, 34% of them are localized in the genital. There is a significant correlation of the clinical form with the localization of the skin-mucosal lesions (p < 0.001). Antibiotic therapy is effective and leads to negative serological test results by the end of the second year of treatment. Conclusions: For 15 years (2008-2022), the number of registered MSM with syphilis in the Clinic of Dermatology and Venereology in Pleven increased after 2016 especialy in the time of the COVID-19 pandemic. Our results are close to the published data on the problem in the scientific literature for the last 10 years.

Management of Full-Thickness Lower Eyelid Defect After MOHS Procedure and Mustard Flap

Introduction : Large full-thickness eyelid defects are considered a challenging case. This study reports how to manage the reconstruction of eyelid defect in a case with a history of carcinoma cell basal of the eyelid, which is removed with MOHS procedure and mustard flap reconstruction but full-thickness of more than 50% defect of the lower eyelid remains.
 Case Illustration : A 67 years old woman was referred from the dermatology and venereology clinic with a history of eyelid cancer operation, 13 days prior. The patient's chief complaint was the left lower eyelid felt pulled down. Examination revealed a left lower eyelid full-thickness defect of more than 50% and ectropion at the lateral side. An 8 mm lagophthalmos without corneal exposure was present. The reconstruction was done with a lips mucosa graft to form posterior lamella, at the medial side anterior lamella was formed by the glabellar flap, and at the lateral side was formed by a skin graft due to lack of the anterior lamella from the mustard flap previously.
 Discussion : Eyelid reconstruction aims to provide adequate globe protection. The principle management of reconstruction in full-thickness eyelid defects horizontally of more than 50% can’t be done by an anterior flap (mustard) only because it's unstable and the eyelid can be retracted. The reconstruction must consist of the anterior and posterior lamella which have to be tight to the periosteum.
 Conclusion : One step procedure for large defects of the lower eyelid after cancer removal can be done with considering the proper plan of reconstruction technique.

PERSONAL HYGIENE AND THE INCIDENT OF SCABIES: COMPREHENSIVE CASE MANAGEMENT AT PHC SURABAYA HOSPITAL

Introduction: One of the risk factors for scabies is poor hygiene. Scabies is a skin condition caused by infestation and sensitization to the Sarcoptes scabiei var. hominis mite. While scabies can be treated, it is often diagnosed late, leading to delayed treatment and easy spread within groups. Objective: This paper aims to present a case of scabies in a patient who contracted the infection within the school environment, emphasizing the importance of hygiene and health awareness, particularly regarding skin health, to prevent disease transmission. Case Report: The patient presented to the Skin and Venereology Clinic at PHC Hospital with complaints of generalized itching persisting for 3 months, similar to symptoms experienced by classmates. The itching was accompanied by the presence of small ulcers. Treatment involved the application of Sulfur precipitatum Cream 10%, Krotamiton Cream 10%, and Permethrin Cream 5% once, to be left on for 8-10 hours (with a repeat application after 1 week), along with Cetirizine 10 mg. Conclusion: After weekly evaluations over 3 months, coupled with pharmacological therapy and adherence to hygiene practices, the patient returned symptom-free and without complications.

Pain type and neuropathic pain components in acute herpes zoster.

The aim of this study was to investigate the pain type (nociceptive or neuropathic) and neuropathic pain components in patients with acute herpes zoster (HZ). Patients with acute HZ referred to the outpatient Dermatology and Venereology clinic between January 2021 and January 2022 were retrospectively detected. The demographic data including gender and age, rash localization, pain severity, and neuropathic pain components were recorded. Pain severity and neuropathic pain components were evaluated using a Visual Analog Scale (VAS) and Douleur Neuropathique 4 (DN4), respectively. The study included a total of 58 patients, comprising 33 females and 25 males. Of these patients, 35 (60.3%) were found to have neuropathic pain. Itching, burning, pins and needles, and tingling were the most frequently reported neuropathic pain signs and symptoms. The proportion of female patients with neuropathic pain was found to be significantly higher than that of male patients (p=0.021). No significant differences were observed in the distribution of pain across different body sites or in the age of patients with neuropathic pain (p>0.05). Itching was significantly more common in younger patients (p=0.02). In conclusion, the study found that over half of the patients with acute HZ experienced neuropathic pain, and this was more frequently observed in female patients. Analysis of different components of neuropathic pain showed significant differences in age, gender, and site distribution. The findings of this study may have important implications for the manage-ment and treatment of acute HZ.

Herpes Zoster In Teenagers: Case Report

Background: Herpes Zoster (HZ) is a reactivation of the Varicella Zoster Virus (VVZ), which is characterized by an acute unilateral vesicular eruption grouped with radicular pain around the dermatome. The incidence of HZ increases with age and is rare in children. The prevalence of HZ in children can occur if they have a history of primary intrauterine infection, are immunocompromised, and are infected with varicella in the first year of life. Methods: The research design used a case study on one of the patients at the PKU Muhammadiyah Hospital Surakarta Polyclinic. The instruments include informed consent and demographic data questionnaires. Results: Ms B, 15 years old, came to the Skin and Venereology Clinic, PKU Muhammadiyah Surakarta Hospital on December 28, 2022 with complaints of itching and heat, a lesion in the form of multiple clustered vesicles, round in shape, with a size of 0.3- 0.5 cm above the skin, erythematous, unilateral, not crossing the midline, the age of the cysts in one group is the same. Still, with other groups, it is not the same; the skin between groups is normal. Treatment was given acyclovir 4x800 mg per day taken orally for five days, triamcinolone 4 mg/day, compressed NaCl 15 minutes 2x daily, calamine lotion 2x daily on intact lesions and mupirocin calcium on open wounds. Conclusion: Maintaining the body's immune system and managing stress, as well as getting the varicella vaccine/measles vaccine, can prevent the occurrence of shingles

Herpez Zoster in Teens

Herpes Zoster (HZ) is a reactivation of the Varicella Zoster Virus (VVZ), which is characterized by an acute unilateral vesicular eruption grouped with radicular pain around the dermatome. The incidence of HZ increases with age and is rare in children. The prevalence of HZ in children can occur, if they have a history of primary intrauterine infection, are immunocompromised, and who are infected with varicella in the first year of life. One daughter, Ms. B, 15 years old, came to the Skin and Venereology Clinic, PKU Muhammadiyah Surakarta Hospital on December 28, 2022 with complaints of itching and heat, a lesion in the form of multiple clustered vesicles, round in shape, with a size of 0.3-0.5 cm above the skin, erythematous, unilateral, not crossing the midline, the age of the vesicles in one group is the same, but with other groups it is not the same, the skin between groups is normal. Treatment was given acyclovir 4x800 mg per day taken orally for 5 days, triamcinolone 4 mg/day, compressed NaCl 15 minutes 2x daily, caaladine lotion 2x daily on intact lesions and mupirocin calcium on open wounds

Profile of Syphilis Risk Factors in The Productive Age Group at Dermatology and Venereology Clinic RSUD DR. Saiful Anwar, Malang Indonesia

Syphilis is a sexually transmitted infection that has the potential to cause serious complications and is closely related to the human immunodeficiency virus (HIV) infection, thus making syphilis a major public health problem. Understanding the characteristics of risk factors could be used to prevent future transmission and occurrences of syphilis. This study aimed to determine the demographic data and risk factors of syphilis in productive age at the Dermatology and Venereology Clinic, RSUD. DR. Saiful Anwar, Malang, Indonesia. This study used a descriptive approach using secondary data from the medical records of syphilis patients from January to December 2021. Sample collection was carried out using a total sampling technique. Twenty medical records that met the inclusion criteria were included, all of which belonged to the productive age group. The majority of the sample were male (70%), aged 17-25 years (45%) and 26-35 years (45%), had a high school education (55%), were private sector workers (40%), were unmarried (70%), had anogenital sexual activity (50%), never used condoms (50%), had more than one sexual partner (85%), were in the primary stage of syphilis (35%), and were HIV positive. Among male patients with syphilis-HIV coinfection, 80% of cases were homosexual. The risk factors for syphilis at a productive age include anogenital intercourse, irregular condom use, multiple sexual partners, the primary stage of syphilis, HIV infection, and homosexuality. A program focused on detecting and treating syphilis among people living with HIV/AIDS, especially those in high-risk populations such as men who have sex with men (MSM), is needed.

Characteristics of condyloma acuminata patients with HIV/AIDS at Prof. Dr. Sulianti Saroso infectious diseases hospital during 2019-2023

Introduction: Condyloma acuminata (CA) or genital warts is a sexually transmitted infection caused by the Human Papillomavirus (HPV). Individuals with CA are more susceptible to HIV compared to those without the condition. CA increases the risk of HIV occurrence and vice versa. This study examines characteristics of CA patients with HIV/AIDS visiting the Dermatology and Venereology Clinic of Prof. Dr. Sulianti Saroso Infectious Diseases Hospital during 2019-2023. Method: The research methodology employed in this study is a retrospective descriptive approach with a cross-sectional design. The sampling technique utilized was the total sampling method. Result: Among 22 recorded cases, 11 fulfilled the study criteria. Most patients were aged 19-44 years (86.7%), male (81.8%), with a history of homosexual relations (54.5%), and exhibited lesions primarily in the perianal region (54.5%). All patients received antiretroviral therapy (ART) (100%), and CD4 count results predominantly ranged from 101-200/mm3 (63.6%). Trichloroacetic acid (TCA) therapy was the most prevalent treatment modality (81.8%). Conclusion: The highest prevalence was noted within the age range of 19-44 years, with a majority of male patients. Unmarried status was most common among the patients. Homosexual history emerged as the predominant pattern of sexual intercourse. The perianal region was the most frequent location. The average CD4 count ranges from 101 to 200/mm3. The predominant treatment method utilized was the application of trichloroacetic acid (TCA).

Emergency room in a University Clinic of Dermatology and Venereology: Retrospective study of 2-year experience.

Emergency room in a University Clinic of Dermatology and Venereology: Retrospective study of 2-year experience.

Correlation between Uric Acid Levels and the Severity of Psoriasis Vulgaris Patients

Introduction: Psoriasis vulgaris (PV) is a recurrent chronic inflammatory skin disease characterized by erythematous, scaly, well-defined plaques with the greatest predilection, generally in the areas of the elbows, knees, scalp, and lower back. The psoriasis area and severity index (PASI) is one of the most widely used evaluation tools to determine the development of psoriasis vulgaris in a patient. Hyperuricemia is the dominant risk factor for PV when compared to other known risk factors, such as obesity or metabolic syndrome. This study aimed to determine whether there is a relationship between serum uric acid levels and the severity of PV based on the PASI score.
 Methods: Cross-sectional study with one-time sampling conducted from December 2021 to February 2022 in psoriasis vulgaris patients who came to the Dermatology and Venereology clinic at Dr. Moewardi General Hospital, Surakarta, Indonesia. All data were statistically analyzed using SPSS 26. Variables, including age, gender, disease duration, body mass index, and uric acid levels, were subjected to univariate analysis. Bivariate analysis was then followed by a parametric test. The p-value <0.05 was considered significant.
 Results: There were 36 patients during the study period. The average uric acid level was 6.0135, with an average PASI score of 10.6388. The relationship between uric acid levels and the severity of psoriasis vulgaris was found to be significant, with a value of p = 0.025.
 Conclusion: There is a significant relationship between uric acid levels and the severity of psoriasis vulgaris, where the higher the uric acid level, the more severe the severity of psoriasis vulgaris.

Efficacy and Safety of Diphenylcyclopropenone (DPCP) as a Depigmenting Therapy in Extensive Vitiligo

Abstract Background Patients with extensive vitiligo who have residual pigmentation affecting exposed areas especially acral sites or patients with vitiligo universalis often seek depigmentation. At present, there is no ideal depigmenting therapy available. Possible options include; monobenzyl ether of hydroquinone (MBEH) cream, phenol, cryotherapy and Q-switched lasers. Diphenylcyclopropenone (DPCP) has been reported to rarely cause vitiligo as a side effect during the treatment of alopecia areata. Aim The aim of the present work is to evaluate the efficacy and safety of DPCP as a depigmenting therapy in extensive Vitiligo. Patients and Methods This is a pilot single arm clinical trial study. Twenty patients with extensive vitiligo were recruited from the vitiligo outpatient clinic of Dermatology, Venereology and Andrology Department, Ain Shams University Hospitals. We used DPCP applied topically to residual pigmented patches (sensitization session then therapeutic sessions). Results Depigmentation occurred among 5 patients (25% of cases). Depigmentation occurred in different tested sites including the scalp, forearm and back. Itching and blister formation were the main side effects leading to intolerability to the DPCP treatment. Conclusion Cosmetic result of DPCP depigmentation was acceptable with no skin atrophy. Further studies could be done following other protocols using sensitization dose with less concentrations of DPCP to avoid patients' intolerance to the therapy.

Retrospective Study: Management of Atopic Dermatitis

Background: Atopic dermatitis (AD) is a chronic skin inflammatory disease characterized by mild to severe itching, relapses, and mostly appears in infants and children. Although there have been current advances in the management of AD, satisfactory treatment has not been achieved. Purpose: To evaluate the treatment of patients with AD in order to provide better management. Methods: A retrospective study of newly diagnosed AD patients at the Allergy and Immunology Division of the Outpatient Unit, Dermatology and Venereology Clinic, Prof. Dr. R.D. Kandou Hospital Manado from 2019-2021. Result: Antihistamines were the most widely prescribed medication, administered to 108 patients of all patients’ visits, and 94 (87%) of them were given cetirizine (the most widely prescribed type). Emollients were used adequately; they included petroleum jelly in 82 patients (90.1%) and urea 10% cream in 9 patients (9.9%). Conclusion: There were 108 AD patients in Dermatology and Venereology Clinic, Prof. Dr. R.D. Kandou Hospital Manado from 2019-2021. Treatment with antihistamine and emollient therapy gave satisfactory results.

Gene Expression of Human Beta-Defensin-3 and Cathelicidin in the Skin of Leprosy Patients, Household Contacts, and Healthy Individuals from Indonesia.

Leprosy, a chronic infectious peripheral neuropathy, is caused by Mycobacterium leprae. This bacterium produces triacylated lipopeptides that can induce the immune system via the Toll-like receptor 2/1 (TLR 2/1) complex. Activation of TLR 2/1 produces proinflammatory cytokines and antimicrobial peptides (AMPs), including human beta-defensin-3 (HBD-3) and cathelicidin. To analyze differences in gene expression of HBD-3 and cathelicidin in the skin of leprosy patients, household contacts, and healthy individuals. An analytic observational study was conducted at the Outpatient Clinic of Dermatology and Venereology of Dr Mohammad Hoesin General Hospital, Palembang, Indonesia, from January 2021 to June 2022. In each group of 18 subjects, 72 samples were collected, including skin lesion in leprosy patients, normal skin in leprosy patients, household contacts, and healthy individuals. A comparison of HBD-3 and cathelicidin gene expression between the four groups was analyzed using Pearson Chi Square, Kruskal-Wallis, and Mann-Whitney Test. The median value of HBD-3 gene expression on skin lesion in leprosy patients was 260.61 (0.19-3734.10); normal skin in leprosy patients was 1.91 (0.01-151.17); household contacts skin was 7.93 (0.27-121.10); and healthy individuals' skin was 1.00 (1.00-1.00) is highly significant difference (p < 0.0001). The median value of cathelicidin gene expression on skin lesion in leprosy patients was 38.72 (0.28-1852.17); normal skin in leprosy patients was 0.48 (0.01-15.83); household contacts skin was 9.8 (0.04-128.0); and healthy individual skin was 1.00 (1.00-1.00), also highly significant difference (p < 0.0001). Gene expression of HBD-3 and cathelicidin increased in skin lesions of leprosy patients and household contacts.

The Pattern of Pediatric Parasitic Skin Diseases in a Secondary Hospital in East Java: A Retrospective Study

Background: Epidermal parasitic skin diseases (EPSDs) are a group of neglected infectious diseases caused by parasites that infect the upper layer of the skin. A parasitic infection of the skin is caused by small insects or worms that burrow into the skin to live there or lay their eggs. EPSDs are a public health issue and can occur in children of all ages. Purpose: This study aims to describe the pattern and incidences of parasitic skin infections in children. Methods: This is a cross-sectional study utilizing medical records from the Dermatology and Venereology Clinic of Dr. Harjono Ponorogo General Public Hospital from 2016 to 2020. Result: Our study showed that, of the 1426 children brought to our clinic, parasitic infection was the second most common skin disease found in children with a prevalence of 27.1%. Parasitic infection in children was dominated by males with a proportion of 69.7%, and occurred mostly in the ≥13-year-old age group. Among all ages, scabies is the most frequent parasitic infection found, followed by cutaneous larva migrant (CLM) and pediculosis. Conclusion: The prevalence of EPSDs is increasing with age and is more common in males. This high prevalence is probably due to increased intensity of contact with other people, decreased parental care, and low socio-economic status.

Fourier transform infrared spectroscopy; can it be used as a rapid typing method of Neisseria gonorrhoeae?

BackgroundTyping of Neisseria gonorrhoeae is necessary for epidemiologic surveillance, while time consuming and resource intensive. Fourier transform infrared (FTIR) spectroscopy has shown promising results when typing several bacterial species. This study investigates whether FTIR spectroscopy can be used as a rapid method for typing clinical N. gonorrhoeae isolates, comparing FTIR spectroscopy to multi locus sequence typing (MLST), N. gonorrhoeae multi antigen sequence typing (NG-MAST) and whole genome sequencing (WGS). MethodsSixty consecutive isolates from a venereology clinic and three isolates from an outbreak were included. Isolates were analysed with FTIR spectroscopy on the IR Biotyper system (Bruker Daltonik) with the IR Biotyper software (version 2.1) with default analysis settings (spectral range 1300–800 cm−1). Four technical replicates of each isolate were analysed in three different runs. The output was a hierarchical cluster analysis (HCA) presented as a dendrogram; a tree-like overview of how closely different isolates are related. FTIR spectroscopy was compared to MLST, NG-MAST and WGS to see if the FTIR spectroscopy-dendrogram grouped the isolates in the same clusters. ResultsFifty-one out of 60 isolates, and the three outbreak isolates, produced at least one spectrum in each run and were included. No agreement between FTIR spectroscopy and MLST or NG-MAST or WGS was shown. The FTIR spectroscopy-dendrogram failed to cluster the outbreak isolates. ConclusionFTIR spectroscopy (spectral range 1300–800 cm−1) is not yet suitable for epidemiologic typing of N. gonorrhoeae. Absence of a capsule as well as phase- and antigenic variation of carbohydrate surface structures of the gonococcal cell wall may contribute to our findings. Future studies should include analysis of a wider range of the spectrum recorded (4000-500 cm−1), and should also explore further mathematical analytic approaches of the similarity between spectra.

Evaluation of safety and efficacy of fractional CO2 laser in treatment of post traumatic atrophic scars

Aim: This research evaluated the safety and efficacy of fractional CO2 LASER (FCOL) in treatment of post traumatic atrophic scarring. Research design: This was a prospective, randomized research.Place and duration of the research: Outpatient Dermatology and Venereology Clinic and Plastic Surgery Departments at Tanta University Hospitals, from December 2019 to June 2021.Methodology: This research was carried out on 20 participants with post traumatic atrophic scarring treated with FCOL. Follow up 3 months after treatment and evaluation of the improvement was done by Vancouver scar scale, 3 blinded dermatologists’ assessment, and patient satisfaction score. Results: There was improvement in all participants with variable degrees, there were no scarring showed excellent improvement, 4 scarring showed good improvement (20%), 10 scarring showed fair improvement (50%) and 6 scarring showed poor improvement (30%). Adverse reactions were in general mild and well tolerated, in the form of transient redness, mild hyperpigmentation, mild pain, that all resolved within few days. No relation between the degree of improvement and age of the participants, site of the scarring, scar duration, but in sex of the participants, it was more in males than in females. Conclusion: FCOL may be an effective approach for treating atrophic scarring, from both an aesthetic and a functional perspective.

URTICARIAL ADVERSE DRUG REACTIONS TO ACE INHIBITORS AND BETA-BLOCKERS

PURPOSE. To evaluate the incidence of urticarial adverse drug reactions (ADRs) to ACE inhibitors and beta-blockers, patient demographics, drug causality, and treatment outcome. METHODS. An epidemiological study including 154 patients with urticarial ADRs, out of a total of 3554 hospitalized patients in the Clinic of Dermatology and Venereology, for a 7-year period. ADRs were defined according to the WHO and the Naranjo algorithm was used for case drug causality assessment. RESULTS. Urticarial ADRs were found in 4,1% of the study population (≥ 18 years), the average age was 50,2 years, and female prevalence was established. Concomitant cardiovascular diseases were found in 45,2% of the patients and 30,1% declared using ACE inhibitors and/or beta-blockers. The suspected drug was withdrawn, and alternative therapy was recommended by a cardiologist. The Naranjo algorithm showed 4.5% “definitive”, 45,5% “possible”, and 50% “probable” urticarial ADRs. Systemic antihistamines were administered to all patients and single short corticosteroid courses were added in 81,8%. Clinical recovery was achieved in 59% of the patients and improvement in 41%. CONCLUSIONS. The need for drug therapy and hospitalization in severe cases of urticarial ADRs to ACE inhibitors and beta-blockers are factors contributing to the overall socio-economic burden of ADRs.