Efficacy and safety of yellow light diode laser 577nm for treatment of melasma patients in Sulaymaniyah city

Background: Recent evidence suggests that angiogenetic factor involved in the pathogenesis of melasma. Yellow light laser which emits 577 nm may has effect on dermal vasculature and may be of benefit in the treatment of melasma

Objective: To evaluate the efficacy and safety of yellow light laser 577 nm for the treatment of melasma in Fitzpatrick skin types II-IV in both male and female patients

Methods: Thirty three patients with melasma were enrolled, from which 30 patients completed the study [5 males, 25 females], age range of [20-40] years, duration of melasma between [2-10] years. They all are either dermal or mixed according to Wood's light examination, Each patient received 2 sessions of yellow light laser 577 nm treatments to the face at 4 weeks interval. The treatment fluency ranged from 10-15 J/cm2, with the pulse duration of 100 ms for skin type II, III, and 120 ms for skin type IV. Clinical parameters included patient self assessment of changes in the pigmentations after each treatment session and 8 weeks after the last session and two investigators independently evaluated Melasma Area and Severity Index [MASI] score before each session and 8 weeks after the last session

Result: Mean MASI score decreased dramatically after treatment from 18.6 +/- 7.5 before treatment to 7.6 +/- 4.5; eight weeks after the last treatment, with a P-value < 0.001 which is statistically significant. Patient´s self assessment revealed that 14 of the patients were experienced excellent improved, 10 of the patients moderately improved, 4 of the patients mildly improved, no patients had no changes and 2 of the patients develop post inflammatory hyperpigmentation

Conclusion: The use of yellow light diode laser 577nm is an effective and safe treatment option for the demal and mixed type of melasma in both males and female patients with Fitzpatrick skin types II-IV

Diabetic dermopathy as marker for early detection of myocardial infarction

There are many cutaneous signs in diabetes mellitus [DM] which is the most common endocrine disorder among the general population. Diabetic Dermopathy [DD] or Shin Spots are the most common cutaneous signs of diabetes. Although they occur individually in people who do not have diabetes, if four or more are present the specificity is high for microvascular disease in other tissues. This study was done to evaluate frequency of diabetic dermopathy among diabetic patients and use this obvious subtle clinical sign as marker for early detection of atherosclerotic changes in diabetic patients including myocardial infarction. This study was done at diabetic center in Sulaimani intensive care unit[IUC] in teaching hospital of Suliamani during the period from November 2008 to June 2009. A total of 384 patients with Diabetes mellitus were included in this descriptive case series hospital-based study. All patients were diagnosed by specialist diabetician as a case of DM depending on classic diagnostic criteria of DM. All patients were thoroughly assessed regarding the age, sex, skin color, duration of diabetes mellitus and treatment regime. Careful skin examinations has been performed for diabetic dermopathy, diabetic wet gangrene of foot. Diagnosis of myocardial infarction was done either by electrocardiographic changes or by plasma biochemical marker. Eighty four [21.9%] case with DD were reported in our study; fifty four [64.3%] case of them were females while the remaining 30 [35.7%] cases were male. Diabetic patients with myocardial infarction were 44[11.5%] cases, 36 cases as acute MI. while the other eight cases were old cases of MI. Of these 44 cases 16[36.4%] had DD while 28[63.6%] had no DD. There was a statistically significant association between the myocardial infarction and the frequency of diabetic dermopathy and we should use this obvious subtle clinical sign as marker for early detection of atherosclerotic changes in diabetic patients including myocardial infarction. Wet gangrene of the foot is also considered a marker of bad glycemic control.

Herpes simplex labialis virus is a risk factor for vitiligo [post- herpes simplex labialis vitiligo]

Herpes simplex labialis is a common disease and is the major cause of erythema multiforme. Recently post-herpes labialis leukoderma had been noticed on the lips of Iraqi patients. The aim of the present work is to assess this new pigmentary problem. A total of 24 patients with post-herpes labialis leukoderma were included in this study. Full history and a thorough physical examination were done for all patients. Fourteen females [58.37%] and 10 males [41.67%] were studied. Their ages ranged between 7-53 years. Koebner phenomenon was positive in 17 [70.83%] patients. Family history of vitiligo in close relatives was positive in 13 [54.17%] of patients. The findings of the present work are in favor that this type of leukoderma is a variant of vitiligo that may be induced by herpes-simplex labialis.