Venereology Clinic Research Articles

Evaluation of the Association between Acne Vulgaris and Metabolic Syndrome in Adolescents at Zagazig University Hospitals

Background: Acne vulgaris is an epidemic inflammatory disease of the human sebaceous follicle and represents the most common skin disease affecting about 85% of adolescents. Until recently, very little was known about the link between metabolic syndrome (MetS) and skin diseases. Over the past several years, it has been reported that MetS is potentially associated with numerous dermatological conditions, of which acne vulgaris. Objective: To determine the relation between acne vulgaris and metabolic syndrome in adolescent males and females with different severities of acne vulgaris. Material and Methods: A cross-sectional study on acne vulgaris patients, carried out in the outpatient clinic of Dermatology, Venereology and Andrology Department, Faculty of Medicine of Zagazig University Hospitals in the period from October 2017 to August 2018. This study included 60 patients of acne vulgaris of both sexes aged 10-19 years old. Results: We found no statistically significant difference in age and sex between different patients with different disease severity. Also, no significant difference in fasting blood glucose, waist circumference, triglycerides, HDL, and blood pressure between different patients with different disease severity. There was a statistically significant difference in waist circumference and diastolic blood pressure only. There was no significant correlation between disease severity and metabolic syndrome criteria in the studied group. Conclusion: Face is the commonest site affected. No association was found between acne vulgaris and metabolic syndrome in our study. No significant difference between different patients with different disease severity and (laboratory data, blood pressure).

EVALUATION OF TOPICAL 30% POTASSIUM HYDROXIDE VERSUS 30% TRICHLOROACETIC ACID IN THE TREATMENT OF PLANE WARTS

Background: Warts are benign proliferation of skin and mucosa that result from infection with human papilloma virus (HPV) which are double stranded deoxyribonucleic acid (DNA) viruses that replicate inside the nucleus. Infection with HPV may be clinical, subclinical, or latent. Objective: To compare the efficacy and safety of potassium hydroxide 30% (KOH) versus trichloroacetic acid 30% (TCA) in treatment of plane warts. Patients and methods: Our study was carried out on 60 patients complaining of plane warts divided into A and B from November 2019 to March 2020, Group A: thirty patients treated by potassium hydroxide (KOH 30%) weekly and Group B: thirty patients treated by trichloroacetic acid (TCA 30%) weekly for maximum period of 12 weeks, with pointed end of a wooden applicator to the center of all the lesions until a white frost appeared. Patients were selected from out-patient clinic of Dermatology, Venereology and Andrology Department of Al-Azhar University Hospitals. Results: The present study showed complete cure rates of 7 patients (23.3%) in group A and 7 patients (23.3%) in group B. Partial cure rates occurred in 15 patients (50%) in group A and 16 patients (53,3%) in group B after 12 weeks of treatment. No response occurred in 8 patients (27.6%) in group A and 7 patients (23.3%) in group B. All nonresponsive patients had lesions in sites other than face except for 2 patients, one in each group had facial lesions. Conclusion: Based on our findings, both potassium hydroxide (KOH 30%) and trichloroacetic acid (TCA30%) are equally effective in treatment of plane warts without statistically significant difference at end of treatment period and follow up, but TCA (30%) was safer than KOH (30%).

Serum Fatty Acid Binding Protein 4 in Patients with Androgenetic Alopecia

Androgenetic alopecia (AGA) is the most common cause of hair loss. Adipocyte fatty acid-binding protein (FABP4), also termed adipocyte protein 2 (aP2), is an adipokine synthesized and released predominantly from adipocytes and, to a lesser extent, produced in macrophages and endothelial cells. Elevated levels of FABP4 are closely linked with the development of obesity, DM, hypertension and atherosclerosis. we aimed to assess the level of serum FABP4 in patients with AGA. This case-control study was conducted on thirty male patients and twenty female patients complaining of androgenetic alopecia, and thirty age and BMI matched healthy volunteers. Patients were recruited from outpatient clinic of Dermatology, Venereology and Andrology Department of Benha University Hospitals during the period from December 2017 to June 2018.All participants were tested for determination of fatty acid binding protein 4 serum levels. AGA patients showed significantly higher FABP4 levels when compared to controls. Serum FABP4 level was significantly higher in AGA patients than in control group so it might play a role in androgenetic alopecia pathogenesis. Moreover, it could be considered a biomarker for early diagnosis of the disease with high sensitivity, specificity and accuracy rate.

The Efficacy of Tricholoroacetic Acid 70% after Microneedling in the Treatment of Non-Segmental Vitiligo.

AbstractIntroduction: Vitiligo is a common disorder characterized by progressive depigmentation of the skin due to selective destruction of melanocytes. Although its cause is still to be exactly defined, the hypothesis of an autoimmune etiology is supported by increasing evidence.Objective: To assess the efficacy of TCA 70% after skin microneedling using dermapen in the treatment of non segmental vitiligo.Patients and Methods: This current study was conducted on 34 patients of both sexes at outpatient clinic of Dermatology, Venereology and Andrology Department at Zagazig University during the period from January 2018 to November 2018. A written informed consent was taken from each patient after explaining to them the details about the nature of study and after obtaining approval from Institutional Review Board (IRB).IRB approval number is (4587).The patients received 4 sessions of microneedling followed by TCA 70% at 2 weeks interval, followed up monthly for 3 monthsResults:Evaluation of repigmentation by the qualitative method showed that the improvement was good to excellent (repigmentation >50%) in 53% of patients, the improvement was moderate (26-50%) in 14.8% of patients, there was no effect in 8.2% of patients. Conclusion: Microneedling plus TCA 70% is considered a simple modality to treat vitiligo of all age groups with cosmetically acceptable repigmentation and a relatively safe alternative or additive method that can be used prior to (or in conjunction with) any of the well-known and widely approved treatment modalities of stable, non-segmental vitiligo.

Study on trace elements levels in vitiligo and normal subjects

Study on trace elements levels in vitiligo and normal subjects - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/j.ijced.2019.062, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Dermatol

High prevalence of group B streptococcus ST17 hypervirulent clone among non-pregnant patients from a Hungarian venereology clinic

BackgroundAlthough Streptococcus agalactiae is the leading causative agent of neonatal sepsis and meningitis, recently it is increasingly isolated from non-pregnant adults. The relation between its presence in the genitourinary tract and manifested clinical symptoms of STD patients remains an open question. In this study, a complex epidemiological investigation of GBS isolates from a venerology clinic was performed.MethodsNinety-six GBS isolates were serotyped and their genetic relatedness determined by PFGE. MLST was also performed for a subset of 20 isolates. The antibiotic susceptibility was tested with agar dilution. Surface proteins and the ST-17 hypervirulent clone was detected by PCR.ResultsThe serotype prevalence was the following: V (29.2%), III (27.1%), Ia (22.9%), IV (10.4%), II (5.2%) and Ib (4.2%). A strong association was demonstrated between surface protein genes and serotypes. All isolates were fully susceptible to penicillin, but erythromycin and clindamycin resistance was high (41.7 and 35.4%, respectively), and 8 phenotypically macrolide sensitive isolates carried the ermB gene.21.9% of all strains belonged to the hypervirulent ST17 clone, most being of serotype III and all were rib +. We found a few serotype IV isolates belonging to several STs and one serotype V/ST110 strain, containing a 44-bp deletion in the atr allele.ConclusionsThe presence of silent ermB genes is of worry, as their expression upon macrolide exposure could lead to unforeseen therapeutic failure, while clindamycin is used for intrapartum antibiotic prophylaxis, in case of penicillin allergy. The other alarming result is the high prevalence of ST17 among these strains from STD patients, who could be sources of further infections.This is the first report from Hungary providing both serotyping and genotyping data of GBS isolates. These results could be helpful for vaccine production as the major vaccine candidates are capsular antigens or surface proteins.

The Genotype of Human Papilloma Virus of Male Patient with Anogenital Warts

Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections. HPV high risk (HPVHR) were HPV16,18 related with invasive penile carcinomas, and HPV low risk (HPVLR) were HPV6,11 related to anogenital warts. Male infection is usually asymptomatic that it would be explain increasing the incidence of HPV associated cancers. Identification HPV genotype is very important for predicting the development of the diseases, to be benign or malignant cancer. The objective of this study was to identify the genotype of HPV that infect men with anogential warts. This research used 12 biopsy specimens from men patient with anogenital warts at Outpatient clinic of Department Dermatology and Venereology, Dr. Soetomo General Hospital period 2016-2017. The specimens were diagnozed by pathologist and HPV gentoyping was done to detect 40 HPV genotype including HPVHR and HPVLR. The result showed that 58% (7/12) were positive for HPVLR and 42% (5/12) were positive for HPV LR/HR. The genotype HPV that infected men patient with anogenital warts is HPVLR (HPV6,11) and HPVHR (HPV18,51,52,82) with single infection of HPVLR or mutiple infection HPVLR/LR or HPVLR/HR. The infection of HPVHR would be develops to be malignant transformation. It suggested that HPV genotype needs to be checked the for the anogenital warts cases for predicting the development of the diseases.

Does gender influence quality of life in children with atopic dermatitis?

Introduction: Atopic dermatitis (AD) is a chronic skin disease that has a significant impact on quality of life (QoL). The aim of this paper was to evaluate if gender affects some aspects of QoL in children with AD. Materials and methods: The cross-sectional study was conducted at the Clinic of Dermatology and Venereology, Clinical Center of Montenegro, between August 2017 and July 2018 and included 200 children aged 5-16 years with AD diagnosis. The severity of disease was measured by the Three Item Severity (TIS) score, while QoL was assessed with the Children's Dermatology Life Quality Index (CDLQI). Socio-demographic data on children with AD were collected by a short questionnaire. Results: The difference in overall CDLQI between boys and girls was not statistically significant. The domains that were most affected by AD were school/holidays (mean score 2.27 ± 0.65), and symptoms (mean score 2.22 ± 0.70). Swimming/ sports activities, school/holidays, teasing/bullying and sleep disturbance were more affected in girls. Overall CDLQI score and CDLQI subscale scores (except school/holidays and sleep in boys) significantly correlated with TIS. According to multivariate logistic regression analyses statistically significant differences between two genders were not found for age, AD severity, concomitant atopic disease, and family history of atopic disease. Conclusion: Although we did not find differences between the two genders in the overall health related QoL, this study confirmed the tendency for AD to have a more severe impact on girls' lives. These results may influence treatment and counselling of children affected with AD.

EFFECTIVNESS OF GLUTATHIONE (GSH) 2%, TOCOPHERYL ACETATE 1%, AND MAGNESIUM ASCORBYL PHOSPHATE 3% COMBINATION CREAM COMPARED WITH HYDROQUINONE 4% CREAM AS A SKIN LIGHTENING AGENT: A RANDOMISED STUDY

Black spots and brown spots interfere with aesthetic appearance. For this reason, there are various skin lightening products on the market, such as glutathione, vitamin C, and E. The combination of glutathione, vitamin C, and E, which is a natural antioxidant, is expected to have an equivalent effect with hydroquinone (standard therapy), but with minimal side effects. The aim of this study was to determine the score of skin brightness using Chroma Meter on the subjects before the topical glutathione (GSH) 2%, 1% tocopheryl acetate 1%, and 3% magnesium ascorbyl phosphate 3% combination therapy compared with hydroquinone 4% cream after 6 weeks of administration. A double-blind, pre- and post-treatment randomized controlled clinical trial was conducted on 34 patients at the Dermatology and Venereology clinic of Hasanuddin University Hospital in Makassar, by applying combination cream and hydroquinone on the patient's right arm twice daily. Measurement of skin brightness and erythema using Chroma Meter performed weekly. The results of the study using Wilcoxon Signed Rank and Mann-Whitney test found that the L* (brightness) score in combination cream group was significantly higher than in the hydroquinone cream group (p

Etiology of Allergic Contact Dermatitis based on Patch Test

Background : Allergic contact dermatitis is a type of contact dermatitis, whose prevalence tends to increase every year. Patch test is an important diagnostic test to confirm the disease. The result of patch test can help doctors to perform appropriate treatment. The aim of the study was to identify the most frequent allergen causing allergic contact dermatitis based on patch test results. Methods : This was a descriptive retrospective study among patients who underwent patch test at the Dermatology and Venereology Clinic in Dr.Hasan Sadikin General Hospital Bandung, Indonesia from August 1st, 2014 to August 31st, 2015. The patch test result was obtained from the patient’s medical record and recapitulation data. The patient’s medical record would be collected based on inclusion and exclusion criteria. This study also collected demographic data of the patients, including age, sex, and occupation.The collected data were presented using tables. Results : Out of 45 patient’s medical records, 19 patients were male (42.2%) and 26 patients were female (57.8%). Nickel sulphate was the most frequent allergen with 17 sensitization. Thirteen out of 17 patients who were sensitized by nickel sulphate were females. A great majority of the patients were in the age group of 15–44 years. Most of the patients were students (42.2%). Allergic contact dermatitis (64.4%) was the main clinical diagnosis among the patients. Conclusions : The most frequent allergen causes allergic contact dermatitis is nickel sulphate.

Oxidative Stress in Segmental versus Non Segmental Vitiligo

Background: vitiligo is a coetaneous autoimmune disease, cosmetically non-acceptable to patients with higher Fitzpatrick skin type because of the contrast between lesional and non-lesional skin. Oxidative stress through H2O2 that is converted by superoxide dismutase (SOD) into H2O and super oxide anion (O.-) which affects directly on preopiomelanocortin (POMC) system in the epidermis of vitiligo patients which plays the key role in melanogenesis. Aim of the work: this study aimed to measure H2O2 in segmental vs. non-segmental vitiligo. This was done through colorimetric evaluation of H2O2 in the epidermis of patients with vitiligo and it was focused on the role of the oxidative stress in the pathogenesis of vitiligo. Patients and methods: this pilot study was included 30 patients recruited from the outpatient clinic of Dermatology and Venereology at Ain Shams University Hospital and outpatient clinic of Al Haud Al Marsoud Hospital. They were all suffered from vitiligo. Fifteen of them had non-segmental and the other 15 had segmental vitiligo. Each group was subdivided into active and stationary. The active disease was defined as appearance of a new lesion and/or extension of preexisting lesionsin less than one year. Results: there was a significant increase of H2O2 level in the lesional vs. non-lesional skin in all number of patients, NSV patients, NSs patients, NSa, and SVs, but not in SVa patients. The H2O2 raised in NSV patients when compared to SV patients. There was a non-significant rise of H2O2; also in patients with SVa. There was a significant increase in the epidermal H2O2 level in the NSV patients above that of SV patients. Conclusion: this study suggested that oxidative stress was present in both SV and NSV. This might open a window for several studies concerning the patients of SV and whether the oxidative stress is primary or secondary. Also whether these patients might benefit from antioxidant medications or not.

Awareness about Sexually Transmitted Infections and Human Immunodeficiency Virus Infection among Patients with Genital Symptoms

Introduction: Sexually transmitted infections (STIs) are a major cause of public health problem. In developing countries, human immunodeficiency virus (HIV) infection is spreading rapidly, with sexually transmitted infections acting as a cofactor for the spread of HIV. Yet adequate awareness regarding these infections is lacking.Objective: To explore the knowledge and awareness about STIs and HIV infection in patients visiting Dermatology and Venereology Clinic of Institute of Medicine, Tribhuvan University Teaching Hospital (TUTH) with genital symptoms.Material and Methods: A cross sectional descriptive study was carried out in the department of dermato-venereology, TUTH for a period of one year. Total of 130 consecutive cases were enrolled. After taking consent and assuring confidentiality they were interviewed regarding awareness of STIs and HIV/AIDS.Results: Out of 130 cases, 95% and 98.5% had heard of an STI and HIV/AIDS respectively. Only 43.8% could mention discharge from genitalia as a symptom of STI whereas 38.5% could mention none. Most (91.5%) knew about the sexual mode of transmission of both STIs and HIV. None could mention about mother to child transmission of an STI, whereas 15% knew that an infected mother can transmit HIV to her baby. About 58% were aware that condoms could protect them from acquiring an STI, 63% perceived this as best method of prevention from HIV. When only 26% knew that being faithful to one partner is the best mode of prevention from an STI, 45% mentioned avoiding contact with multiple partners could prevent them from HIV transmission.Conclusions: Awareness programme on STIs as a whole could improve knowledge and awareness on HIV and STIs and hence prevent both.

The pages of history of Kazan scientific school of dermatology: the life and work of V.F. Burgsdorf

The article briefly covers the main stages of life and activities of V.F. Burgsdorf (1864-1935), his scientific achievements and priorities as the founder of one of Russian largest scientific schools, representatives of which made a huge contribution to the development of domestic dermatology. Special attention was paid to the contribution of V.F. Burgsdorf to the creation of the second in Russia phototherapy department in A.G. Ge’s Dermatology and Venereology clinic in Kazan, on the territory of which Republican Dermatology and Venereology Dispensary is currently located. The work in A.G. Ge’s (1889-1925) Dermatology and Venereology clinic became one of the most productive periods of life and activities of V.F. Burgsdorf. In November, 1900, V.F. Burgsdorf opened phototherapy department with support from professor A.G. Ge. Due to his medical and public authority V.F. Burgsdorf received large donations from Her Imperial Majesty the Empress Maria Feodorovna for further development of the department. V.F. Burgsdorf devoted most of his life to the development of treatment and prevention of skin and venereal diseases, organization of scientific research and improvement of medical education in Russia, and greatly improved the system of medical care for patients.

Verrucous Carcinoma of the Foot - Report of Two Cases

Abstract Verrucous carcinoma (VC) is a rare variant of a well-differentiated squamous cell carcinoma (SCC) with a low grade of malignancy. Epithelioma cuniculatum (EC) is a subtype of VC, usually found on the sole of the foot. Two patients, a 55-year-old female, and a 77-year-old male, with VC were treated at the Clinic of Dermatology and Venereology, Clinical Center of Serbia, from 2002 to 2011. Both patients presented with a tumor on the foot. Incisional biopsies showed a well differentiated squamous cell carcinoma. Foot x-rays showed bone involvement in one case. One patient underwent surgical amputation of the lower extremity, while the other had a partial amputation of the affected foot. In the initial stage of the disease, it is difficult to distinguish pseudoepitheliomatous hyperplasia from verrucous carcinoma. The superficial biopsy of EC lesion may mislead to a histopathological diagnosis of warts or condylomas. Multiple deep biopsies are necessary for accurate and timely diagnosis of verrucous carcinoma.

Anogenital Warts in a Major Venereology Clinic: Centro de Saúde da Lapa - Lisbon, 2008 to 2014

Human papillomavirus infection is the most common sexual transmitted infection in the world, being associated with different diseases, namely anogenital warts, recurrent respiratory papillomatosis and anal, cervical, and oropharyngeal cancers. Among sexually active people, approximately 1% has anogenital warts, 90% of cases resulting from genotypes 6 and 11. Patients diagnosed with first episode of anogenital warts from 2008 to 2014 in Lisbon's major venereology clinic were identified, and characterized according to sex, sexual orientation, age, warts location, and number of sexual partners. We observed a statistically significant decrease in first anogenital warts diagnosis among < 19 year old females (r = -0.848;p = 0.016) and a non-statistically significant decrease among < 19 ' year-old males and among 20 ' 24 year old females. In October 2008, the quadrivalent vaccine (genotypes 6, 11, 16, 18) was introduced in the Portuguese national vaccination program, targeting 13-year-old females, with a catch-up for 17 year old females. In the women'´s group, decrease in first anogenital warts diagnosis is probably related to human papillomavirus vaccination before onset of sexual activity. This study reinforces the importance of national human papillomavirus vaccination program.

Epidemic History and Iatrogenic Transmission of Blood-borne Viruses in Mid-20th Century Kinshasa.

The human immunodeficiency virus type 1 (HIV-1) pandemic was ignited in Léopoldville (now known as Kinshasa), in the former Belgian Congo. Factors that jump-started its early expansion remain unclear. Nonlethal hepatitis C virus (HCV) and human T-cell lymphotropic virus (HTLV-1) can be used to investigate past iatrogenic transmission. We undertook a cross-sectional study of elderly inhabitants of Kinshasa, with serological assays, amplification, and sequencing. Risk factors were assessed through logistic regression. Phylogenetic methods reconstructed the genetic history of HCV. A total of 217 of 839 participants (25.9%) were HCV seropositive; 26 (3.1%) were HTLV-1-seropositive. Amplification products were obtained from 118 HCV-seropositive participants; subtypes 4k (in 47 participants) and 4r (in 38) were most common. Independent risk factors for HCV subtype 4r seropositivity were intramuscular tuberculosis therapy, intravenous injections at hospital A, intravenous injections before 1960, and injections at a colonial-era venereology clinic. Intravenous injections at hospital B and antimalarials were associated with HCV subtype 4k seropositivity. Risk factors for HTLV-1 seropositivity included intravenous injections at hospitals C or D and transfusions. Evolutionary analysis of viral sequences revealed independent exponential amplification of HCV subtypes 4r and 4k from the 1950s onward. Iatrogenic transmission of HCV and HTLV-1 occurred in mid-20th century Kinshasa, at the same time and place HIV-1 emerged. Iatrogenic routes may have contributed to the early establishment of the pandemic.

Plasmid-mediated resistance to tetracyclines among Neisseria gonorrhoeae strains isolated in Poland between 2012 and 2013.

IntroductionOne of two main mechanisms of resistance in tetracycline-resistant Neisseria gonorrhoeae (TRNG) is associated with the presence of TetM protein responsible for actively blocking of the tetracycline target site in the 30S ribosomal subunit. This mechanism is encoded by conjugative plasmids. The second mechanism is chromosomal in nature and due to mutations in specific genes.AimTo determine the incidence and type of tetM determinants in TRNG strains isolated from patients presenting with gonorrhea infection to the Dermatology and Venereology Clinic in Warsaw in 2012–2013.Material and methodsTetracycline and doxycycline susceptibility was determined by E-Tests. The presence and type of the tetM gene were determined by polymerase chain reaction.ResultsTetracycline resistance was detected in 50.8% of the evaluated strains. The TRNG strains containing the tetM plasmid constituted 13.8% of all the evaluated strains. Dutch type tetM constituted 12.3% and American type tetM 1.5% of all the evaluated strains. In the remaining TRNG strains, resistance to tetracyclines was presumably chromosome-encoded. The minimal inhibitory concentration (MIC) of tetracycline ranged from 0.25 to 32.0 mg/l, MIC50 = 2.0 mg/l, MIC90 = 32.0 mg/l. The MIC of doxycycline ranged from 0.25 to 32.0 mg/l, MIC50 = 4.0 mg/l, MIC90 = 16.0 mg/l.ConclusionsUnlike most of European countries, in 2012–2013 in Poland, the Dutch type tetM was found to be much more common than the American type. Minimal inhibitory concentration values of tetracycline and doxycycline were similar, with doxycycline exhibiting a somewhat lower effectiveness in vitro than tetracycline towards chromosome-mediated tetracycline resistant strains of N. gonorrhoeae.

Prevalence of metabolic syndrome in Montenegrin patients with psoriasis.

Increasing epidemiological studies suggest the association between psoriasis and metabolic syndrome. The aim of this study was to assess the association of metabolic syndrome and its components with psoriasis in a sample of patients from Montenegro, and to predict the factors that determine the metabolic syndrome. A case-control study was conducted at the Clinic of Dermatology and Venereology, Clinical Center of Montenegro, Podgorica, Montenegro, between January and December 2012. The study group included 101 patients with psoriasis (cases) and 126 patients with the diagnosis of dermatological disease other than psoriasis (controls) consecutively admitted to the same clinic. Metabolic syndrome was more prevalent in the psoriasis patients than in the controls (48.5% vs 20.6%; OR = 2.99). In addition, the psoriasis patients were significantly more likely to be smokers (OR = 2.16) and were less physically active (OR = 0.58). The results of this study demonstrate a strong association between psoriasis and metabolic syndrome independent of psoriasis severity. Patients with psoriasis should be routinely screened for metabolic syndrome and its components. [Projekat Ministarstva nauke Republike Srbije, br. 175025: Clinical-epidemiological research of diseases of public health importance in Serbia].

Intralesional 8.33% Rifamycin infiltration; New treatment for cutaneous leishmaniasis

BackgroundCutaneous leishmaniasis (CL) is an endemic disease in Iraq, for which many therapies had been tried, aiming to induce cure with no or minimal scaring. Rifamycin is an antibacterial agent, with the ability to inhibit bacterial DNA-dependent RNA synthesis and it is effective against extra- and intracellular microorganisms. ObjectiveTo evaluate the effectiveness and safety of intralesional 8.33% Rifamycin infiltration in treatment of cutaneous leishmaniasis. Patients and methodsThis is an open controlled therapeutic trial, carried out in the outpatient clinic of Dermatology & Venereology, Al-Yarmouk Teaching Hospital during the period between the first of December 2013 to the end of June 2014. A total of 29 patients have been enrolled in this therapeutic trial, however 4 patients were defaulted and 25 patients have completed the therapeutic trial. Fourteen (56%) were males and 11 (44%) were females, with a male to female ratio 1.27. Their ages ranged from 6 to 60years, with a mean±SD of 28.6±14.9years. The total number of lesions was 56 and the duration of lesions ranged between 4 and 18weeks with a mean±SD of 9.9±4.4weeks. The size of lesions ranged from 0.5 to 6cm in diameter with a mean±SD of 2.46±1.17cm. All patients have been diagnosed through history and clinical examination and the diagnosis was confirmed by skin smear and biopsy. The lesions were divided into two groups; group A treated with intralesional 8.33% Rifamycin infiltration every 2weeks for a maximum of 5 sessions, while group B was left untreated as a control group. Follow up was every 2weeks during the treatment period, and for 6weeks after completing the therapeutic sessions. ResultsTwenty five patients with a total of 56 lesions were completed the study period. Twenty one (37%) lesions were ulcerative and 35 (63%) were non ulcerative lesions. Ten (40%) patients had single lesion whereas 15 (60%) patients had multiple lesions. In group A, 38 (92.7%) out of 41 lesions showed a cure with 2–5 sessions with a mean±SD of 4.9±0.79 sessions, while in the control group no lesion had significantly improved or cured. At the end of the study period, only 8 out of 41 treated lesions have left trivial scars. Most of the lesions showed transient hyperpigmentation at the end of the study, but fortunately, it had disappeared in all cases few weeks later. ConclusionRifamycin 8.33% solution given intralesionally in cutaneous leishmaniasis is a highly effective agent with a success rate of 92.7%. For cure, it needs 2–5 local infiltrations given every two weeks. In addition to being effective, it is a safe, and less costly therapeutic option for cutaneous leishmaniasis.

English

OBJECTIVES: 1. To find out the incidence of zoster in patients attending the dermatology and venereology clinic. 2. To determine the distribution of herpes zoster in relation to age, sex, religion, season, socio-economic status and rural urban background. 3. To study the various clinical features like site of occurrence, initial presentation and course of the disease. MATERIALS AND METHODS: A total of 100 patients of herpes zoster attending outpatient Department of Dermatology and Venereology were included in the study. Detailed history, thorough physical examination and relevant investigations were done. RESULTS: No seasonal variation was found. Out of the 100 patients of herpes zoster majority of the patients belonged to the age group 21-40 years (42%). The male to female ratio was 1.8:1. Most of the patients were from low socio-economic group. 65 patients were literate and 35 patients were illiterate. Prodromal symptoms occurred in 61% of patients. Post-herpetic neuralgia was common in elderly and immunosuppressed patients. Commonest segment involved was the thoracic segment (46%). Majority of patients had single dermatomal involvement (87%). Multidermatomal involvement was seen in 13 patients (13%), out of which majority had immunosuppression like HIV and Diabetes Mellitus. INTRODUCTION: `Herpes zoster' is a localized disease characterized by unilateral radicular pain and a vesicular eruption that is generally limited to the dermatome innervated by a single spinal or cranial sensory ganglion.1 the words are derived from Greek Herpes - Meaning to creep or to spread and 'Zoster' meaning 'Girdle' or 'Zone'. 2 Zoster is characterized by a prodromal stage characterized by fever, headache, burning pain, followed by an acute stage, with appearance of crops of vesicles on an erythematous base in a dermatomal pattern and an intractable neuropathic pain in chronic stage. Zoster is a common infection among the elderly. Chicken pox and herpes zoster (Shingles) are usually benign but are associated with morbidity and mortality especially in immuno compromised hosts. The distinction between the natural history and manifestation of these clinical syndromes caused by VZV is essential for understanding the potential value of antiviral therapy. zoster usually involves one or more dermatomes and occurs at one particular site. 3 many complications like cutaneous, visceral, ocular and neurologic can occur. Post herpetic neuralgia (PHN) is the most feared and debilitating complication of zoster. The risk for PHN is increased in patients over 60 years of age. Recurrent herpes zoster is listed as one of the AIDS defining illness. In HIV infected there are many atypical manifestations like ulceration, necrosis, ecthymatic lesions, hyperkeratotic papules and many neurological, cutaneous, ophthalmic complications. The thoracic dermatomes are the most commonly affected (56%) followed by cervical (17%), lumbar (10%), sacral (5%) and the trigeminal nerve was infected in 12%.4 the management of PHN remains a challenge, with various modalities of treatment having a modest success. Laboratory studies for herpes zoster includes, serological tests, PCR, Tzanck smear, biopsy and viral tissue culture. The drugs used for the treatment of herpes zoster are Acyclovir, Valacyclovir and Famcyclovir, Desiclovir, Penciclovir and Foscarnet.