Frequency of genodermatoses among Iraqi patients

Genodermatoses are hereditary skin disorders or anomalies which can be grouped into three categories: chromosomal, single gene and multifactorial. Most genodermatoses show single gene or Mendelian inheritance [autosomal dominant, autosomal recessive or X-linked recessive genes]. To asses the frequency of genodermatoses among Iraqi patients in outpatients Dermatology and Venereology comparison with other countries. This case series descriptive epidemiological study included eighty three patients [57males and 26 females] with genodermatoses. They consulted the out patient clinic/ Department of Dermatology and Venereology Baghdad Teaching Hospital from April 2005 through April 2006. Their ages ranged from 2months-60 years [Median 10 years],With various genetic diseases. Full history, dermatological and clinical examinations were done to establish the clinical diagnosis of genodermatoses regarding all demographic points related to these disorders. The frequency of genodermatoses among outpatient attendant in Dermatology and Venereology Department was 837 20000 [0.42%]. This study had shown that the most common genodermatoses were; ichthyosis: 21 [25.3%] patients and epidermolysis bullosa which contain 16 [19.3%] patients when taken together they constituted 37 [44.6%] patients of the total, neurofibromatosis 8 [9.6%], hereditary palmoplantar keratoderma 6 [7.2%], darier's disease 5 [6%] and xeroderma pigmentosa 4 [4.8%]. Positive family history of the same disease was obtained in;8 [38.1%] patients with ichthyosis, 4 [66.6%] in hereditary palmoplantar keratoderma, 2 [12.5%] in epidermolysis bullosa and all patients with Hailey-Hailey disease had positive family history of the same condition. Consanguinity was positive in; 13 [61.9%] patients of ichthyosis, 12 [75%] epidermolysis bullosa, 2 [33.3%] hereditary palmoplantar keratoderma and [100%] patients with xeroderma pigmentosa Genodermatoses are frequently encountered among Iraqi dermatological outpatients and more common in families with positive consanguinity and were comparable to other countries

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

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

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

Treatment of perniosis with oral pentoxyfylline in comparison with oral prednisolone plus topical clobetasol ointment in Iraqi patients

To evaluate the effectiveness and safety of pentoxyfylline in treatment of perniosis in comparison with prednisolone plus topical clobetasol ointment. This is an open comparative therapeutic trial conducted in the Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq between January and March 2008. Forty patients with perniosis were enrolled in this study, and divided randomly into 2 equal groups, according to the sort of treatment. Group A comprised patients who received oral prednisolone 0.5 mg/kg in 2 divided doses, and topical clobetasol ointment for 2 weeks. Group B comprised patients who received pentoxyfylline tablet 1200 mg/day in 3 divided doses for 2 weeks. Detailed history and full clinical examination were carried out for each case, regarding all relevant points related to the disease. The age of patients ranged from 5-60 mean +/- SD 22 +/- 6.2 years, with 31 females and 9 males with a female to male ratio of 3.5:1. All patients did not receive any treatment before the study. In group A, 11 patients completed the treatment course, and only 3 27.2% patients showed good improvement and complete cure after 2 weeks. In group B, 9 patients completed the regime, and 5 55.5% patients showed good improvement, in which symptoms disappeared and lesions resolved after 2 weeks. Pentoxyfylline was shown to be an effective and safe drug for treatment of perniosis, and superior to oral plus topical glucocorticoids p < 0.05.