Association of Streptococcus with Plaque Type of Psoriasis.

Background: Guttate psoriasis has a well-known association with streptococcal throat infections, but the effects of these infections in patients with chronic plaque type of psoriasis remains to be evaluated. In Bangladesh several studies were done on psoriasis but no data about association between streptococcal throat infection and plaque type psoriasis are available so far. Considering the co-morbidities of psoriasis patients, it might be justifiable to find out the events that provoke the initiation or exacerbation of psoriatic disease process. Objective: To observe the association of streptococcus with plaque type of psoriasis. Materials and Methods: This observational study was conducted in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Forty seven patients clinically and histopathologically diagnosed as having plaque psoriasis were selected as cases and patients with skin diseases other than psoriasis were selected as controls. Results: In this study majority of subjects (55%) were diagnosed as chronic plaque psoriasis. Among the subjects with guttate flare of chronic plaque psoriasis 64.2% gave a positive history of sore throat. ASO titer was raised (>200 IU/mL) in 28 (59.5%) patients of chronic plaque psoriasis and 7 (17.9%) patients of non-psoriatic respondents. The difference between two groups was significant (p<0.05). Streptococcus pyogenes was found in 12 (25.5%) in chronic plaque psoriasis patients versus in 4 (10.2%) in controls (p>0.05). Conclusion: This study shows that streptococcal throat infections are associated with plaque psoriasis and early treatment of throat infections may be beneficial for plaque type of psoriasis patients.

Efficacy of Topical 1% Oxiconazole Cream in the Treatment of Dermatophytosis.

Background: Dermatophytosis is a geographically widespread group of fungal infections. Tinea corporis and tinea cruris are the most common dermatophytoses in Bangladesh. Oxiconazole has recently been introduced in Bangladesh in the treatment of dermatophytoses. Objective: To evaluate the efficacy of topical 1% oxiconazole cream once daily in the treatment of tinea corporis and tinea cruris. Materials and Methods: A clinical trial was carried out in the department of Dermatology and Venereology, Jalalabad Ragib-Rabeya Medical College Hospital, Sylhet on 81 patients with tinea corporis and/or tinea cruris. The patients were instructed to apply 1% oxiconazole cream once daily for 2 weeks with clinical assessment made at weekly intervals during treatment period. Results: The mean age of the patients was 32.5 ± 10.5 years, with tinea corporis in 47 (58.0%) patients and tinea cruris in 34 (42.0%). The mean clinical assessment score declined from 6.6 ± 1.3 at baseline to 3.9 ± 1.2 at week 1, 0.9 ± 1.3 at week 2 and 0.7 ± 1.1 at week 4. Reduction of clinical assessment score from baseline to end of the treatment period was statistically significant (p<0.001). The improvement of clinical score was from baseline to 41.6% at week 1, 89.3% at week 2 and 91.5% at week 4. Improvement of clinical score from baseline to end of the treatment period was statistically significant (p<0.001). Global response was clear in 55 (67.9%) patients, good in 25 (30.9%) patients and fair in 1(1.2%) patient. Clinical efficacy was cure in 55 (67.9%) patients, improvement in 25 (30.9%) and failure in 1(1.2%) patient. Conclusion: Once daily topical administration of oxiconazole cream is highly effective in the treatment of superficial fungal infections of the skin.

A 29-Year-Old Male with Borderline Lepromatous Leprosy.

Leprosy (Hansen’s disease) is a chronic granulomatous infectious disease that primarily affects the peripheral nerves, skin, upper respiratory tract mucosa, eyes and certain other tissues. It is diagnosable and curable if recognized early and treated adequately. A twenty nine-year-old male from Jessore, Bangladesh reported in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh with the complaints of multiple erythematous, large, raised and circumscribed lesions with loss of sensations on different parts of the body, especially distal portions of all four limbs for last eight months. Subsequently he developed ulcers on the anesthetic fingers due to smoking and few ulcerative lesions on both feet. Skin examination revealed multiple erythematous, large nodular lesions on both sides of the cheek and forehead, multiple erythematous, indurated, large plaques with raised margin and central clearing on the trunk, waist and all four limbs, few satellite lesions around the large plaques on the trunk, few hypopigmented patches and plaques on buttock and lower limbs, multiple painless ulcers on dorsal surface of fingers of both hands, both lateral malleoluses and right sole. On examination of peripheral nerves, left great auricular nerve, both ulnar nerves and both common peroneal nerves were moderately enlarged and tender. Slit skin smear for AFB (modified Z-N stain) was done and revealed that there were large number of acid and alcohol-fast bacilli arranged in straight and curved parallel bundles with globular masses (cigar-bundle appearance), morphologically resembling Mycobacterium leprae. Skin biopsy for histopathological examination revealed extensive infiltration of macrophages in the dermis, separated from epidermis by narrow grenz zone, with destruction of skin adnexa. Few foci of poorly defined granuloma in dermis were also noted. The patient was managed with rifampicin, clofazimine, dapsone, prednisolone and omeprazole.