Resistant palmoplantar lesions in patients of psoriasis: evaluation of the causes and comparison of the frequency of delayed-type hypersensitivity in patients without palm and sole lesions

To examine the reasons for resistance to treatment in cases of palmoplantar psoriasis, and also to compare the frequency of delayed-type hypersensitivity to common sensitizers with those cases of psoriasis without palmoplantar involvement. One hundred and three patients with resistant palmoplantar psoriasis were examined for a possible drug reaction, fungal infection or contact allergy. Patch testing was done for another 100 patients with psoriasis vulgaris without palm and sole involvement. X[2], Fischer's exact test, Mann-Whitney U test and logistical regression analysis were done using SPSS 15.0. Of the 103 patients with resistant palmoplantar lesions, 26 [25.24%] had a positive patch test to at least one of the tested allergens, 6 [5.8%] had psoriasiform spongiotic dermatitis on biopsy, 5 [4.8%] reported exacerbation after starting biologic therapy and 3 [2.9%] were potassium hydroxide positive in the sole lesions. In comparison, of the 100 patients with no palm or sole lesions, 11 [11%] had a positive patch test to at least one of the allergens. There was a direct relationship between the increase in the prevalence of dermatitis and the duration of psoriasis. There was no correlation between the clinical type of psoriasis and patch-test positivity. Secondary fungal infection, allergic contact dermatitis to topical agents or common allergens, or at times an unusual reaction to the antipsoriatic therapeutic agents sometimes led to treatment failure in patients with psoriasis vulgaris with palmoplantar lesions. Also, psoriasis patients with palm and sole lesions tended to have higher rates of contact hypersensitivity than patients without lesions on their palms and SOles

Associated cutaneous diseases in obese adult patients: a prospective study from a skin referral care center

The aim of the present study was to determine the spectrum of skin diseases seen among adult obese patients referred to Farwaniya Hospital. A total of 437 overweight/obese subjects [200 men and 237 women] aged 18-74 years were enrolled in the study, which was conducted from October 2008 to November 2009. Demographic details such as age, sex, occupation, personal and family history of diabetes mellitus, hypertension, and obesity were recorded. A thorough examination was performed by an experienced dermatologist [N.A.M.]. Blood investigations such as complete blood count, fasting and postprandial blood sugar levels, liver function tests, kidney function tests, lipid profile, and thyroid function tests were done for all patients in addition to hormonal assay and abdominal sonar to exclude polycystic ovary disease for indicated patients. Common skin diseases found among these patients were plantar hyperkeratosis: n = 197; acanthosis nigricans: n = 144; skin tags: n = 131; striae cutis distensae: n = 102; intertrigo: n = 97; acne vulgaris: n = 94. Diabetes mellitus was diagnosed in 87 patients, polycystic ovary syndrome/hyperandrogenism in 74 female patients, and hyperlipidemia in 209 patients. This study shows that certain dermatoses such as plantar hyperkeratosis, acanthosis nigricans, skin tags, striae cutis distensae, and intertrigo are more common among obese persons. Some, such as plantar hyperkeratosis, could serve as markers of obesity and its severity, while the presence of acanthosis nigricans and skin tags may point to underlying internal disease such as diabetes and polycystic ovary syndrome

Spectrum of cutaneous vasculitis in adult patients from the Farwaniya region of Kuwait

To determine the clinical profile, etiologic factors, disease associations, and the laboratory profile of adult patients with cutaneous leukocytoclastic vasculitis [LV] presenting to the Dermatology Department at Farwaniya Hospital, Kuwait. The medical records of 57 adult patients [>18 years] with biopsy-proven cutaneous LV from January 2004 to June 2006 at Farwaniya Hospital were reviewed. Of the 57 patients studied, 21 [36.8%] were classified as having primary cutaneous small vessel vasculitis. The most common type of skin lesions found was palpable purpura seen in 29 [50.9%] patients. No possible cause for the cutaneous vasculitis could be identified in 21 patients. Extracutaneous involvement was seen in 32 [56.1%] patients of which 29 had joint involvement. The most frequent laboratory abnormality was an elevated erythrocyte sedimentation rate [ESR]. Altered laboratory evaluation in the form of leukocytosis, raised antistreptolysin O titers and urine abnormalities were found in association with systemic vasculitis. IgA deposits were present in 33 patients. Risk factors for chronicity of cutaneous LV were female sex, advanced age, unidentified etiology, absence of fever and presence of joint involvement. The commonest type of LV in Kuwait is primary cutaneous small vessel vasculitis. The most frequent laboratory abnormality associated with LV was increased ESR

Rating errors in the assessment of clinical competence of newly graduated doctors

Clinicians and academicians attached to health care institutions who share the responsibility for training medical graduates, need to guard against common errors of measurement when assessing trainees' competencies. This study aims to identify the rating errors that may occur during the assessment of the clinical competence of interns. Trainers assigned responsibility for the internship program assessed the competencies of 45 internship trainees in the March 2002 cohort in six domains [case presentation, clinical skills, diagnosis, therapy, [h and ling of emergencies and professional behavior] using a structured format provided. Competencies related to different clinical problems were rated under 1 = Unsatisfactory, 2 = Below expected st and ard, 3 = At expected st and ard, 4 = Above expected st and ard or 5 = Excellent. 4868 assessments were made of the performances of 45 interns who completed rotations in Surgery, Medicine, Obstetrics and Gynecology, and Pediatrics. 66% of all ratings fell in Excellent category [mean = 4, mode = 5]. The rotations in Surgery and Pediatrics elicited more Excellent ratings [37.6% and 31.8% respectively] than other specialties. Of all trainers, Registrars allocated the highest proportion [46%] of Excellent ratings. When considering the number of trainers in each category Excellent ratings had been assigned to a high extent by Assistant Registrars [72%], and Registrars [70%] A high proportion of the ratings given by the trainers fell at the upper end of the Rating Scale. This could be a result of the assessments being affected by errors of leniency, compromizing their usefulness. It is desirable that the heads of the respective Clinical Departments take steps to organize appropriate training programs so that the trainers improve their knowledge in the concepts underlying the assessment of clinical competencies and skills and methods of the use of the instruments

Skin diseases seen in diabetes mellitus

Diabetes mellitus [DM] is the most common endocrine disorder, expected to affect 5.4% of the world population by the year 2025. DM is characterized by high serum glucose levels and by disturbances of carbohydrate and lipid metabolism and resultant long term systemic complications. DM has replaced syphilis of pre-antibiotic days as the great clinical imitator with a wide array of signs and symptoms affecting every organ of the body. The incidence of cutaneous disorders in diabetic patients varies between 30% and 71% according to different authors. Cutaneous manifestations of DM generally appear subsequent to the development of the disease, but may be the first presenting signs or may even precede the primary disease manifestations by many years in some diabetics. We provide a concise review of the various dermatologic disorders encountered in diabetic patients

Profile of vitiligo in farwaniya region in kuwait

Vitiligo is common worldwide. However, there are few studies available on pattern and epidemiology of vitiligo from the Gulf countries, including Kuwait. To determine the clinical patterns of Vitiligo, the associated socio-demographic factors and its associated disorders among patients attending dermatology outpatient department of Farwaniya hospital in the central region of Kuwait.Materials and methods: All patients presenting with signs and symptoms suggestive of vitiligo seen over a period of one-year [from July 2003 to June 2004] at the out-patient clinics in the Dermatology Department of Farwaniya Hospital and two affiliated dermatology clinics in Kuwait were included in the study. Socio-demographic details about age, sex, marital status, education, occupation, and nationality were recorded on a proforma. A detailed clinical history pertaining to the presenting complaint and clinical examination findings were noted on the same proforma. Relevant available investigations were carried out in all the patients depending on their signs and symptoms to determine any associated disorders with vitiligo Four hundred and forty-eight adult patients, 76 adolescents and 88 children with vitiligo were studied. Males constituted 257 [42%] patients and females 355 [5S%] of the total number of patients. Duration of disease at the time of presentation ranged from two weeks to 12 years. The lower limb was the initial site of onset of vitiligo in majority [32.19%] of the patients, followed by the upper limbs, head and neck, trunk and mucosae in decreasing order of frequency. The commonest clinical pattern observed was vitiligo vulgaris followed by focal, acrofacial, mucosal, segmental and universal types. Lesions showing leukotrichia were observed in 144 [23.53%] patients and koebnerization was observed in 141 [23%] patients. Seven child patients with halo nevi were seen. Associated abnormalities included atopic dermatitis [49 patients], alopecia areata [21 patients], psoriasis [2 patients], diabetes mellitus [9 patients] and 13 patients showed anti-thyroid antibodies. A positive family history was obtained in 8.98% of the patients. Vitiligo vulgaris is the most common clinical-type skin disorder observed in Kuwait. There were associated disorders/abnormalities in some patients such as atopic dermatitis, alopecia areata, psoriasis, and diabetes mellitus. Keeping in view the observation of anti-thyroid antibodies in some of these patients we suggest that patients having these antibodies should be followed up for the possible development of clinical thyroid dysfunction

Cutaneous manifestations of diabetes mellitus

To study the prevalence of cutaneous disorders in patients with diabetes mellitus. All diabetic patients attending the Department of Dermatology, Al-Farwaniya Hospital, Kuwait, and diabetic in-patients with skin disorders were examined over a period of 18 months from March 2004 to August 2005. A total of 106 diabetic patients displaying 1 or more dermatological manifestations were identified and thoroughly examined for any skin disorder. The diabetic profile of the patients was obtained from medical records. Of the 106 patients, 69 had only 1 cutaneous manifestation, 27 had 2, 6 had 3 and 4 had 4. Infections [68.0%] were the major cutaneous manifestations with fungal infection occurring in 41 patients followed by bacteria in 27. The second most common presenting symptom was pruritus. Hypertension [74%] was the most common systemic complication, and most of the diabetic patients who developed cutaneous manifestations were in the 40- to 60-year age group. The data show that infections were the most common cutaneous manifestation and hypertension the most common systemic complication

Rating errors in the assessment of clinical competence of newly graduated doctors

Clinicians and academicians attached to health care institutions, who share the responsibility for training medical graduates, need to guard against common errors of measurement when assessing trainees' competencies. This study aims to identify the rating errors that may occur during the assessment of the clinical competence of interns. Trainers assigned responsibility for the internship program assessed the competencies of 45 internship trainees in the March 2002 cohort in six domains [case presentation, clinical skills, diagnosis, therapy, handling of emergencies and professional behavior] using a structured format provided. Competencies related to different clinical problems were rated under 1 = Unsatisfactory, 2 = Below expected standard, 3 = At expected standard, 4 = Above expected standard or 5 = Excellent. 4868 assessments were made of the performances of 45 interns who completed rotations in Surgery, Medicine, Obstetrics and Gynecology, and Pediatrics. 66% of all ratings fell in Excellent category [mean = 4, mode = 5]. The rotations in Surgery and Pediatrics elicited more Excellent ratings [37.6% and 31 .8% respectively] than other specialties. Of all trainers, Registrars allocated the highest proportion [46%] of Excellent ratings. When considering the number of trainers in each category, Excellent ratings had been assigned to a high extent by Assistant Registrars [72%], and Registrars [70%]. A high proportion of the ratings given by the trainers fell at the upper end of the Rating Scale. This could be a result of the assessments being affected by errors of leniency, compromizing their usefulness. It is desirable that the Heads of the respective Clinical Departments take steps to organize appropriate training programs so that the trainers improve their knowledge in the concepts underlying the assessment of clinical competencies and skills and methods of the use of the instruments

Skin eruption with myalgia and proximal muscle weakness

This article, Skin eruption with myalgia and proximal muscle weakness is designated as CME/CPD. It provides the reader with the opportunity to obtain credits under the MPC Program of KIMS. Readers who study it, answer the questions related to it on page 49, and send a copy of the Answer Sheet [page 50] to the CME Center of KIMS become eligible for 0.5 CME/CPD credit in Category 1. To claim credit, the reader has to be registered in the MPC Program, the answer sheet should be received by the CME Center before 31[st] May 2005, and all questions should have been attempted. Readers would then receive a certificate from the CME Center indicating the credit data