Perniosis: clinical and epidemiological study in Iraqi patients

Perniosis [chilblains] is a common skin problem. This condition results from abnormal reaction to cold which is usually seen during the cold months of year. The aim of the present study is to shed a light on different clinical and epidemiological aspects of perniosis in Iraq. A total of 40 patients with perniosis were seen between January to march 2008 in the department of dermatology and venereology of Baghdad Teaching Hospital. A detailed history was taken from each patient regarding age, sex, occupation, duration of attack, family history, smoking, drug history, medical history, relieving and aggrevating factors and previous treatment modality. Full examination was done to each patient to assess the distribution and extent and morphology of the lesions and to see if there other skin diseases. Biopsies was done for 6 patients for histopathological study. A total of 40 patients were assessed. Their ages ranged from 5-60 years with a mean age of 22 SD +/- 6.2, 31 females and 9 males [3.5:1]. Main sites of involvemnt were; toes 39%, fingers 22%, heals 10% and nose 2.5%. Main types of lesions were; erythematous cyanotic swellings 82%, vesicular lesions 23%, ulcerations 10% and erythema multiforme like lesions 15%. Family history was positive in 22.5% of patients. Perniosis occur mainly in females between 10-20 years. Most common sites of involvement are toes and fingers genetic susceptibility is an important factor in the development of the disease. Majority of patients are healthy without any medical or dermatological diseases. Majority are non smokers and did not have any history of drug intake

therapeutic and prophylactic role of oral zinc sulfate in management of recurrent aphthous stomatitis [ras] in comparison with dapsone

To evaluate the therapeutic and prophylactic effectiveness of oral zinc sulfate in recurrent aphthous stomatitis RAS in comparison with dapsone. A double-blind placebo controlled study, conducted in the Department of Dermatology, Baghdad Teaching Hospitals, Baghdad, Iraq between May 2005 and October 2006, in which 45 patients with RAS were recruited and divided into 3 equal groups: group A on zinc sulfate 150 mg twice daily, group B on dapsone 50 mg twice daily, and group C on glucose 250 mg as placebo. The drugs were prepared in identical capsules, and the patients were instructed to take the capsules twice daily after meals in a double-blind manner. Assessment of each patient was carried out by the Oral Clinical Manifestation Index OCMI and the diameter of the ulcers at day 0, day 4, and at the second, fourth, sixth, eighth, tenth, and twelfth weeks of therapy. Forty-five patients were included in the study 25 males and 20 females, and their ages ranged between 16-45 years mean +/- SD 31.24 +/- 8.14. In group A, the mean of OCMI and diameter of ulcers improved, with a p=0.0001 for OCMI, and 0.0001 for the diameter for ulcers at the end of the twelfth week of therapy, which was statistically significant. Group B, also showed significant improvement, however, the action was lower and slower p=0.0001 for OCMI, and 0.001 for the diameter for ulcers. Group C revealed slight non-significant improvement p=0.028 for OCMI, and 0.034 for the diameter of ulcers. In the sixth week of therapy, zinc sulfate was more effective than dapsone in reducing the OCMI of the ulcers p=0.007. The present study showed that both zinc sulfate and dapsone had significant therapeutic and prophylactic effects in controlling RAS, however, zinc sulfate had much more rapid and sustained action

Bacille Calmette-Guerin immunotherapy of viral warts

To assess the effectiveness of the Bacille Calmette-Guerin [BCG] vaccine in the treatment of viral warts. A single blind placebo controlled study conducted at the Department of Dermatology; Baghdad Teaching Hospital, Baghdad, Iraq from March 2005 to June 2006. Two hundred patients with viral warts were enrolled in this study, and were fully assessed before therapy. The patients were divided into 2 equal matched groups. Group 1 was designed as the treatment group and received BCG vaccine in 1-3 doses with a one-month interval, while group 2 was injected with distilled water. The patients were evaluated every 2 weeks for evidence of regression of lesions. The follow up period lasted for 3 months after the last dose. A total of 154 patients completed the study: 81 patients in group I and 73 patients in group II. Thirty [39.7%] patients out of 81 patients in group I showed complete recovery. These results were significantly high [p<0.05] when compared with total response, 10 [13.7%] out of 73 patients in group II. No recurrence has been reported during the follow up period. When cases that failed to respond to placebo were treated with BCG in a similar manner to group I, there was total response in 15 [42.7%] out of 44 patients. No side effects were observed. The BCG vaccine was an effective and safe modality of treatment of viral warts

Therapeutic evaluation of spironolactone and finasteride in the treatment of acne vulgaris

Antiandrogens have been developed to treat acne; spironolactone, an androgen receptor blocker, and fmasteride, 5 alpha reductase inhibitor, are two antiandrogens that can be used to treat acne vulgaris. To evaluate the effectiveness and safety of spironolactone, fmasteride, and combination of both drugs in the treatment of acne vulgaris. This single blinded uncontrolled clinical therapeutic trial was done in the Department of Dermatology and Venereology - Baghdad Teaching Hospital- in a period from December 2004 to October 2006. The patients were classified according to the number of inflammatory lesions as having mild, moderate and severe acne. Severe acne was excluded from the study. History and close examination were performed to all patients regarding all points related to the disease. Sixty-nine patients with acne were divided into three groups and were instructed to take the following drugs for two months; group A: spironolactone 100 mg/day, group B: fmasteride 5 mg/day, and group C: combination of both drugs. The clinical assessment was done by counting the number of inflammatory lesions every two weeks for two months, recording any local or systemic side effects, and comparison between the number of inflammatory lesions before and after treatment was done. Sixty patients had completed this work, whose mean +/- SD of their ages of the three groups totally was 18.8 +/- 2.3 years and for group A, group B, and group C as follow: 19 +/- 2.6, 19.3 +/- 1.9, and 18.1 +/- 2.4 respectively, with 20 patients in each group. Spironolactone was statistically significant in reducing the number of inflammatory lesions, fmasteride was beneficial but did not reach a statistically significant level as spironolactone, and combination of both drugs was more effective in the treatment of acne vulgaris than spironolactone alone but did not reach a statistically significant level. Spironolactone is a good alternative drug to be used in patients with acne singly or in combination therapy with fmasteride

Topical zinc sulphate solution for treatment of viral warts

To assess the efficacy and safety of topical zinc sulphate solution in the treatment of plane and common warts. This study consisted of a pilot and double blinded clinical trails. This was carried out in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghadad, Iraq during the period from December 2002 to October 2003. Ten patients with plane warts were enrolled in pilot-clinical trial, all patients used 10% w/v zinc sulphate solution topically, 3 times daily for 4 weeks while in the double blind trial, 90 patients were included [50 patients with common warts, 40 patients with plane warts]. Patients were randomly used either topical 10% or 5% zinc sulphate solution or distilled water as a control topical therapy 3 times daily for 4 weeks. Full history and close clinical examination were performed to all patients before treatment. In the pilot trial, the full response for plane warts was 80%, while the full response for patients with plane warts in double blinded trial was 85.7%, 42.8% and 10% for those using 10% and 5% zinc sulphate solutions and distilled water subsequently. The difference was statistically significant [P<0.008]. The full response for patients with common warts were 11%, 5% and 0% for those who used 10% and 5% zinc sulphate solutions and distilled water respectively, the difference was statistically insignificant. No recurrence of warts occurred during follow up that ranged from 2-6 months after therapy. Topical 10% zinc sulphate solution was a new effective and safe modality for treatment of plane warts

Acral lentiginous melanoma versus lentigo maligna melanoma among Iraqi patients

To report the different clinical aspects of malignant melanoma and their varieties in Iraqi patients. We carried out this study in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghdad, Iraq during the period from 1985-2005. Eighteen patients with malignant melanoma were enrolled in this work. The different clinical aspects and histopathological examination were determined. The study population consisted of 18 patients [15 females and 3 males] with a female to male ratio of 5:1. Their ages ranged from 12-75 years [mean +/- SD, 43.72 +/- 14.75 years] while the duration of the disease ranged between 0.25-5 years [1.98 +/- 1.44 years]. The duration of acral lentiginous melanoma was 0.5-4 years [2.16 +/- 1.36 years] and in nodular type was 0.5-3 years [1.28 +/- 0.90 years], while in lentigo maligna melanoma was 1.5-5 years [3.37 +/- 1.49 years]. Regarding the location and gender of the patients affected, 6 cases [all females] were on the acral parts of the body [4 on the feet, and 2 on the hands], 5 patients [all females] on the face, 5 cases [4 females and one male] on the lower legs, while the remaining 2 male cases, was on the interscapular region and the other one on the elbow area. We conclude that malignant melanoma in Iraqi patients is a disease of younger females, which presented mainly as acral lentiginous melanoma, nodular melanoma and lentigo maligna melanoma and superficial spreading melanoma

Invasive squamous cell carcinoma of the eyes in patients with epidermodysplasia verruciformis

We described 3 male patients with epidermodysplasia verruciformis seen in the Department of Dermatology and Venereology, Baghdad Teaching Hospital; their ages were 25, 30 and 34 years subsequently. They developed frequent multiple basal and squamous cell carcinoma, all of them had periorbital squamous cell carcinoma that invaded the orbit and ended with enucleation of their eyes. All available therapeutic measures failed to inhibit the progressiveness of these tumors. Great awareness and early management must be performed regarding any periorbital lesion in epidermodysplasia verruciformis patients

Striae distensae - like lesions. A cause of scarring alopecia among children

Although alopecia areata is a common problem among children, many misdiagnoses for this condition can happen. The aim of this study was to demonstrate the striae distensae as lesions that cause scarring alopecia with a great resemblance to alopecia areata. A total of 36 children with provisional diagnosis of alopecia areata of the scalp were assessed clinically in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghdad, Iraq, between June 1998 to June 2001. Their age ranged from 3-12 years and the mean + standard deviation [SD] was 7.30 + 2.59 years with equal sex ratio. All patients provided for this study had a history of patchy hair loss of few months duration. Their parents denied any history of obvious trauma and many modalities of treatment had been tried without benefit. The clinical examination revealed single or multiple [1-6] [mean + SD 2.41 + 1.22] complete linear hair loss patches resembling atrophic scar that was similar to striae distensae. The histopathological examination showed atrophy of the epidermis, full replacement of the dermis by collagen bundles, and complete loss of appendages. This is a new entity, which seems to be common among children and often confused with untreated cases of alopecia areata. This condition should be added to the differential diagnosis of patchy hair loss in children and the parents should be reassured of the cause of hair loss and no treatment therapy needed