Scarring and none scarring facial Acne vulgaris and the frequency of associated skin diseases

Acne vulgaris [AV] is chronic inflammatory disease of pilosebaceous unit of young people. Patients with acne with or with out scarring might differ in regard to their immunological background from those free from acne. To evaluate the problem of facial AV especially patients with scarring and to determine the frequency of associated skin diseases and to be compared with acne free control. A cross sectional randomized controlled epidemiological study was conducted from Oct.2005-Oct 2006. Three hundred students from Basra University; 132 [44%] males and 168 [56%] females were enrolled, their ages ranged from 18-25 [20.9 +/- 1.8] years. They were divided into: Group A those free from acne [98 individuals], Growp B with non scarring facial AV [96 patients], and Group C with scarring facial AV [106 patients]. History and examination were done for their acne, scarring acne and associated skin diseases. Alien and Smith grading system for AV were used, and a new invented multiparametric scoring system for scarring acne was applied. AV was in 98[73.24%] males and 104 [61.9%] females. Scarring was 54 [50.95%] males and 52 [49.05%] females. Greasy skin was the most common type among Group B 67 [69.8%] versus 39 [39.8%] among Group A [P=0.000029] and was more common among Group C 84 [79.2%] [P=0.00000001]. Family history of AV was nearly similar in A and B Groups 55 [57.29%] and 56 [52.83%] respectively, while in Group A was 39 [39.79%]. Family history of scarring acne was in 35 [33.02%] of Group C, 16 [16.66%] of Group B, and 3 [3.1%] in Group A; [P=0.00000017]. The age of onset was similar in A and B Groups between 15-16 years. Majority of patients in Group B had non inflammatory type or mild inflammatory [papular] 65 [67.8%] patients, most of case were mild and moderate 86 [89.58%] patients, while high percent in Group C had inflammatory type 95 [89.62%], and more than half of them had severe and very severe types upon grading 56 [52.8%]. The aggravating factors were similar in A and B Groups with stress and hot weather being the leading aggravating factors. Squeezing and digging habit was in 53 [50%] in Group C versus 23 [23.95%] in Group B [P=0.00024]. In most cases of scarring acne, scarring was mild and moderate 85 [80.19%], and the most common type scars was the flat hyperpigmented [50 [47.17%] and 66 [62.26%] respectively].The most common effect of scarring acne on psyche was mild discomfort and mild dysmorphophobia 75 [70.75%]. Associated skin diseases were more common among Group A 31 [31. 63%] than among Group B 22 [22.91%] and least common among Group C 14 [13.20%] [P=0.0067] and they were mainly dermatitis and skin infections. AV might reflect the immunological status especially among patients with scarring. The frequency of skin diseases was much less among patients with scarring acne

frequency of 21-alpha hydroxylase enzyme deficiency and related sex hormones in Iraqi healthy male subjects versus patients with acne vulgaris

To find out the frequency of nonclassical congenital adrenal hyperplasia [CAH] due to 21-hydroxylase deficiency among Iraqi healthy male individuals versus male patients with acne vulgaris. This case-control study and single-center examination of hormone levels in a cohort of volunteers was conducted in the Department of Dermatology, Baghdad Teaching Hospital, and in the Physiological Chemistry Department of the College of Medicine, Baghdad University, Baghdad, Iraq, from September 2007 to February 2008. The frequency of 21-hydroxylase enzyme deficiency in healthy male subjects was 1:43 [2.3%], while in male patients with acne vulgaris, this was 6:43 [13.95%]. Serum 17-hydroxyprogesterone [OHP] levels were statistically and significantly elevated in male patients with acne vulgaris compared with healthy male controls [p=0.020]. The serum total cortisol level was significantly reduced in patients with acne vulgaris in comparison with that of healthy controls [p=0.022]. These results support the necessity of inclusion of the 21-alpha hydroxylase enzyme activity [serum 17-OHP level] screening test in acne patients

Ventral penile papillae as a new anatomical structure: a clinical-epidemiological study among Iraqi males

Ventral Penile Papillae [VPP] are benign asymptomatic structures that are found on the skin of the ventral aspect of penile shaft of many adult males; yet, no frank record or description of them is found in the English medical literatures. To hit light on the VPP. finds their frequency among circumcised Iraqi adult males, seeks about their associations with other skin conditions, and examines the histological picture. Forty seven Iraqi circumcised adult males were included in this case descriptive, comparative study which extended between July 2007-November 2007 was conducted in Department of Dermatology-Baghdad Teaching Hospital. All 47 persons were asked about sociodemographic aspects, medical and skin conditions. They were evaluated clinically regarding different clinical aspects. Statistical data were deduced. Biopsies were done for 8 papillae from 6 persons for histological assessment. Also, 50 circumcised children under the age of 10 years were examined for the presence of these papillae as a control group. Forty seven males were enrolled the present work, their ages ranged from 14-59[29.72+10.57] years. Twenty five [53.2%] persons had VPP, while 22 [46.8%] subjects showed no papillae. Fifty circumcised children of ages ranged from 3.5.40[5.97+1.42] years, all were lacking the papillae. The papillae were asymptomatic. Shapes of papillae were distributed as follows: skin tag-like papillae were 53, 93%, dome-shaped 40.44%, while wartlike in 5.61% of these papillae. Histology was normal apart from finding of dermal encapsulated structures which simulate mechanoreceptor nerve endings, so called Meissner' corpuscles. All facts start as speculative thoughts as had been proved by the present study. Ventral penile papillae are normal anatomical and physiological structures that are present in only adult males while completely absent in children. So the age of onset lies during adulthood, The location, morphology, age of onset, and the histology of these papillae are very suggestive of their sexual stimulatory function. Still further physiological and histological studies are strongly recommended

Female pattern alopecia and lipoproteins

The meaningful association of androgenetic alopecia and coronary heart disease had been well documented, but few studies had been focused on the importance of lipid parameters in patients with androgenetic alopecia. To investigate the lipid profile and its relation to female pattern alopecia. This is a case controlled study conducted at the Department of Dermatology and Venereology-Baghdad Teaching Hospital, between January 2001 and April 2002. Sixty female patients with androgenetic alopecia were enrolled in this work. From each patient a detailed history and full clinical examination were performed regarding all demographic points relative to the disease, grading of alopecia and measurement of serum lipoproteins was done. Female pattern alopecia was classified according to Sharquei's classification Sixty age and weight matched females with normal hair status were considered as a control group. Measurement of serum lipoproteins also performed for them. Sixty patients, their ages ranged between 20-60 years with mean +/- SD of 30.3 +/- 9.4 years. Twenty [33.3%] patients were having grade I, 20 [33.3%] patients grade II and another 20 [33.3%] patients grade III. The mean levels of total serum cholesterol, triglycerides, low density lipoprotein and very low density lipoprotein in all patients and those with grade II and III separately were significantly higher when compared to the control group. On the other hand, the mean levels of high density lipoprotein in all patients and those with grade I and III separately were lower in comparison to the control. The atherogenic index or risk ratio was found to be significantly high in patients with female pattern alopecia and this goes parallel with the severity of baldness

Topical therapy of xeroderma pigmentosa with 20% zinc sulfate solution

Xeroderma pigmentosa although it is autosomal recessive disease but it is not uncommon problem in a certain regions in Iraq. It is always associated with well known complications of the disease like malignancies and blindness. Zinc sulfate has been successfully used in treatment of basal cell carcinoma in a form of intralesional injection and topical solution. To evaluate the effectiveness of topical 20% zinc sulfate solution as a therapeutic and prophylactic agent in patients with xeroderma pigmentosa. This single blind therapeutic trial was done in the Department of Dermatology and Venereology-Baghdad Teaching Hospital during the period from April 2004 to April 2005. Nineteen patients with typical features of xeroderma pigmentosa enrolled in this work. Full history and clinical examination were done for each patient regarding all points related to the disease. They were treated with topical 20% topical zinc sulfate solution and follow up was carried out for 4 months to 2 years. Nineteen patients with xeroderma pigmentosa were evaluated after treated with 20% topical zinc sulfate solution. Four patients were defaulted during follow up for unknown reason. The remaining were 15 patients [11 males and 4 females]. Their ages ranged from 4-50 years with a mean +/- SD of 18 +/- 17 years. Monthly follow up showed improvement in all types of skin lesions including softening and lightening of the skin color, and clearance of solar keratosis and small malignancies. These were observed in the early course of therapy. This study showed that topical therapy with zinc sulfate solution had both therapeutic and prophylactic role in patients with xeroderma pigmentosa .We think that zinc sulfate is going to have a major role in management of this disease

Angiolymphoid hyperplasia with eosinophilia [pseudopyogenic granuloma] among Iraqi patients

Angiolymphoid hyperplasia with eosinophilia [ALHE] [pseudopyogenic granuloma] is a benign locally proliferating lesion composed of vascular channels with a surrounding infiltrate of lymphocytes and eosinophils. ALHE is a rare disease but in Iraq it apparently seems to be more common than expected, for this reason the present work was arranged to evaluate the clinical and histopathological aspects of the disease. This case descriptive study was conducted in the Department of Dermatology and Venereology- Baghdad Teaching Hospital during the period between June 1982- March 2005. Sixteen patients with this skin problem, were included in this study. All demographic points related to the disease were obtained from each case through detailed history, close clinical and histopathological means. Sixteen patients with ALHE were evaluated. Their ages of patients ranged from 20-50 years with a mean +/- SD of 35.73 +/- 8.72 years, they were 14 females and two males. The duration of the disease ranged from 1-15 [6.4 +/- 4.42] years. The clinical picture consisted of multiple dull to pinkish red angiomatous papules and nodules affecting the head only mostly around the scalp and ears. The histopathological examination revealed a proliferation and ectasia of blood vessels with eosinophilic infiltrate of the dermis. This study revealed that angiolymphoid hyperplasia with eosinophilia [ALHE] in Iraq, is a disease predominantly of adult females only affecting the head, with no lymphadenopathy and typical histopathology without lymphoid follicle formation. This is the first report describing this disease in Iraq and seems to be more common than European countries

Topical therapy of acne vulgaris using 2% tea lotion in comparison with 5% zinc sulphate solution

To evaluate effectiveness of 2% tea lotion in comparison with 5% zinc sulphate solution in the treatment of acne vulgaris. This is a single-blind randomly comparative therapeutic clinical trial carried out in the Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq from June 2006 to December 2007. Full history and clinical examination were studied for each patient regarding all relevant points of the disease, to evaluate the severity of acne. Forty-seven patients with acne vulgaris were divided randomly into 2 groups, and were instructed to use the following solutions twice daily for 2 months; group A used 2% tea lotion, group B used 5% zinc sulphate solution. Patients with papulopustular lesions were included in the study, while patients with severe acne were excluded. The clinical improvement was scored by counting the number of inflammatory lesions before, and after treatment. Forty patients completed the study, their ages ranged from 13-27 years with a mean +/- standard deviation of 19.5 +/- 3.5 years with 20 patients in each group. Two percent tea lotion was statistically significant in decreasing the number of the inflammatory lesions in acne vulgaris, while 5% zinc sulphate solution was beneficial, but did not reach statistically significant level as tea lotion. Two percent tea lotion was a good alternative remedy to be used in the treatment of acne vulgaris, and was much superior than topical 5% zinc sulphate solution

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

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

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

Treatment of acne vulgaris with 2% topical tea lotion

To use 2% tea lotion as natural plant remedy in the treatment of acne vulgaris. We conducted this study in the Department of Dermatology and Venereology in Baghdad Teaching Hospital, Iraq during the period between October 2002 and October 2004. In this single blind randomly controlled therapeutic study, we enrolled 60 patients, their ages ranged from 14-22 years. There were 35 females and 25 males. We divided the patients equally into 2 groups; we instructed group A to use freshly prepared 2% tea lotion twice daily for 2 months, while group B used a control solution. We graded the acne vulgaris as mild and moderate acne by counting the number of papules and pustules. We carried out statistical analysis by computer using t-test, f-test, and chi-square when needed. Forty-nine patients completed the study. In group A [25 patients], we noted a significantly reduced mean lesion count of papules and pustules after 2 months of therapy. The response of patients to treatment was good in 64%, moderate in 24% and no response in 12%. The satisfaction of patients with treatment was full in 64%, partial in 24%, and no satisfaction in 12%. In group B [24 patients], the lesions showed no significant reduction after 2 months and the response of patients to treatment was good in 20.8%, moderate in 45.8%, and no response in 33.4%. The satisfaction of patients with treatment in this group was full in 4.2%, partial in 12.5%, and no satisfaction in 83.3%. The mean difference in outcome after 8 weeks between the 2 study groups was statistically significant. The 2% tea lotion has proved its efficacy as a topical therapy for acne vulgaris. This is a new natural plant extract, which lacks any side effects

oxidative stress and the anti-oxidant mechanisms in patients with vitiligo in relation to the duration and severity of the disease

Vitiligo is an autoimmune disease. Previous studies showed that the progress of auto-immune diseases may be related to oxidative modification of cellular structures by free radicals, and at least partly depends on the concentration of antioxidants at critical cellular sites. The present work was arranged to evaluate the alterations in oxidative stress as measured by plasma and red blood cells Malondialdehyde [MDA] and the changes in antioxidant mechanism as measured by plasma and red blood cells Glutathione [GSH] in patients with vitiligo, in comparison to a healthy control group. These changes were studied according to the severity and duration of the disease. Fifty patients with vitiligo were included in this study. The severity of the disease was graded according to the rule of nine into three grades [mild, moderate, and severe]. Duration of the diseases was graded into 2 grades [less than 6 months and equal or more than 6 months]. Plasma and red blood cells Malondialdehyde [MDA], and plasma and red blood cells Glutathione [GSH] were assessed in all patients. The results showed that plasma and red blood cells Malondialdehyde [MDA] were high in mild cases and in the early course of the disease, while they were low in severe and chronic cases. Plasma Glutathione [GSH] was low in mild and acute cases while it reached near to normal levels in chronic and extensive cases. Free radicals are high in mild, and in the early course of the disease in patients with vitiligo, and near to normal in chronic, generalized vitiligo. Similarly, the antioxidants are low in mild, and in the early course of the disease in patients with vitiligo, and near to normal in chronic, generalized disease

Housewife onycholysis

The aim of this study was to evaluate the clinical and microbiological aspects of onycholysis in Iraqi housewives. One hundred housewives with onycholysis of the finger nails were evaluated clinically in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghdad, Iraq between October 2002 to March 2003. Swabs were taken from those patients for microbiological evaluation in the Department of Microbiology, College of Medicine, University of Baghdad, Baghdad, Iraq. All cases with skin disorder related systemic diseases like anemia, hypothyroidism and drug intake like minocycline, oral contraceptives were excluded from the study. One hundred housewives with onycholysis were enrolled in the study. Their ages ranged between 17-70 years with a mean of 41.96 +/- 12.57 years. Married females were 89 [89%], while unmarried females were 11 [11%]. The site of involvement was mainly the thumb [76%] followed by the ring finger [12%], the index [7%], little [6%] and middle [5%] fingers. The pattern of onycholysis was distal in 47 [47%], lateral in 30 [30%] and both distal and lateral in 23 [23%] of the patients. Onycholysis is a major problem among Iraqi housewives, most probably caused by repetitive mechanical, chemical and physical trauma; therefore, special preventive measures should be undertaken to minimize the incidence of the disease. Housewives should be encouraged to use preventive measures like using gloves and washing machines

Disseminated cutaneous leishmaniasis

Disseminated cutaneous leishmaniasis DCL is a condition rarely seen in the Middle East. We report a case of disseminated cutaneous leishmaniasis in a 60-years-old lady. The patient first presented 1996 with an initial lesion, which started on the butterfly area of the face and spread, probably due to immunosuppression, to involve the whole face. The lesions consisted of nodules, which did not ulcerate. The histology showed abundance of macrophages filled with amastigotes L-D bodies. The patient was started on oral zinc sulphate 10 mg/kg in 3 divided doses daily. The condition showed gradual improvement. Repeated biopsies showed upgrading of the histopathological picture. After 6-months of treatment there was complete clearance of the condition. The patient was followed up for 6-years with no recurrence. However, she presented with a new lesion on the butterfly area again in February 2003. The biopsy again showed abundance of macrophages filled with amastigotes L-D bodies. A 4-months course of zinc sulphate 10 mg/kg in 3 divided doses daily resulted in complete clearance of the lesions. Zinc sulphate might represent a new treatment for this condition that has no adequate treatment until now