Acetylation phenotype variation in pediatric patients with atopic dermatitis.

BACKGROUND: Few studies have been done on the relation between acetylator status and allergic diseases. AIM: To determine any possible association between acetylating phenotype in pediatric patients with atopic dermatitis (AD) and the disease prognosis. PATIENTS AND METHODS: Thirty-six pediatric patients and forty two healthy children as a control group were participated in the study. All participants received a single oral dose of dapsone of 1.54 mg/kg body weight, after an overnight fast. Using high performance liquid chromatography (HPLC), plasma concentrations of dapsone and its metabolite (monoacetyldapsone) were estimated to phenotype the participants as slow and rapid acetylators according to their acetylation ratio (ratio of monoacetyldapsone to dapsone). RESULTS: 72.2% of pediatric patients with AD showed slow acetylating status as compared to 69.4% of control individuals. Also, 73% of AD patients with slow acetylating phenotype had familial history of allergy. The severity of AD occurred only in slow acetylator patients. The eczematous lesions in slow acetylators presented mainly in the limbs, while in rapid acetylators, they were found mostly in face and neck. CONCLUSION: This study shows an association between the N-acetylation phenotype variation and clinical aspects of AD.

Acetylator phenotype in Iraqi patients with atopic dermatitis.

Atopic dermatitis (AD) is a common multifactorial disease which has an itchy, recurrent, flexural and symmetrical eczematous eruption. There are reports that indicate that AD is associated with a predominantly slow acetylator status. This study was designed to determine the acetylator status in children with AD and compare it to a matched group of normal children. The study included 36 AD patients diagnosed clinically and 42 healthy controls. Detailed history was taken from the parents of each patient and disease severity was assessed using the Hanifin-Rajka scoring system. After overnight fast, each control subject and patient received a single oral dose of 50 mg of dapsone; a blood sample was collected after 3 hours and plasma separated for determination of dapsone and monoacetyldapsone by HPLC. The frequency of slow acetylators in the control group was 69.4 percent, and the frequency of rapid acetylators was 30.6 percent. The frequency of slow acetylators in AD patients was 72.2 percent and the frequency of rapid acetylators was 27.80 percent. There were no statistically significant differences between the control and AD patients groups. There was an association in AD patients between the acetylator status and family history of allergy as well as the severity assessed the Hanifin-Rajka scoring system. Although slow acetylators had lesions predominantly on the limbs, the distribution of lesions on the skin of rapid acetylators favored the face and neck. Although a slow acetylator status does not predispose to AD, it is associated with a different severity and distribution of the disease.

Housewife onycholysis.

OBJECTIVE: The aim of this study was to evaluate the clinical and microbiological aspects of onycholysis in Iraqi housewives. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Colchicine and benzathine penicillin in the treatment of Behçet disease: a case comparative study.

Behçet disease is a chronic relapsing disease characterized by multiple signs and symptoms such as recurrent orogenital ulceration, eye involvement, skin manifestations, and other systemic involvement. Multiple therapeutic modalities have been used to treat Behçet disease. These agents act through different mechanisms and are associated with a variety of side effects. We performed a case-comparative study to evaluate efficacy of combined colchicine and benzathine penicillin in the treatment and prophylaxis of Behçet disease. Sixty-six patients who fulfilled the international study group criteria for diagnosis of Behçet disease were included. The patients were divided into three groups: group 1 (20 patients) received 1.2 Mu benzathine penicillin injection monthly; group 2 (21 patients) received two tablets of colchicine daily (each tablet contained 0.5 mg); and group 3 (25 patients) received both 1.2 Mu benzathine penicillin injection monthly and two tablets of colchicine daily. Each patient was followed up monthly for 5 months, 4 months on treatment and 1 additional month followup. The clinical manifestation index (CMI), the numerical sum of the clinical features, was calculated for each patient initially and then monthly. Pathergy test was performed for each patient monthly. The CMI was reduced by colchicine and benzathine penicillin treatment, and the reduction was highly significant. The reduction in the CMI remains satisfactory and good for 1 month after stopping the treatment. When each colchicine and benzathine Penicillin are used alone the index is also reduced significantly, but this reduction is much less than when both drugs are used together and there is also rapid and earlier relapse. Based on our findings, the combination of colchicine and benzathine penicillin appears to be of greater efficacy in the treatment of Behçet disease than the use of either drug alone.

Medium-depth chemical peels in the treatment of acne scars in dark-skinned individuals.

BACKGROUND: Multiple modalities are available for treating acne scars, one of which is chemical peeling. OBJECTIVE: To evaluate the efficacy of medium-depth peels in the treatment of acne scars. METHODS: A total of 15 patients (14 women and 1 man) were seen between November 1998 and March 2000. A medium-depth chemical peel was performed. The peel was performed using a combination of Jessner's solution followed by the application of 35% trichloroacetic acid (TCA). The mean age of patients who entered the study was 28 years. A total of 42 peeling sessions were performed: 13 patients had the full three-session regiment, 1 patient had two sessions, and 1 had only one session. RESULTS: Patients in our study had two forms of acne scars, the atrophic saucer or crater-like form and the pitted (ice-pick) form. Improvement occurred in all except one of our patients. Significant improvement (greater than 75% clearance of lesions) occurred in 1 patient (6.6%), moderate improvement (51-75% clearance) in 8 patients (53.3%), mild improvement (26-50% clearance) in 4 patients (26.6%), minimal improvement (1-25% clearance) in 1 patient (6.6%), and no response in 1 patient (6.6%). All patients had different combinations of the above two forms. Four patients (26.6%) had mainly pitted scars and deep atrophic scars. The clinical response in those patients was moderate, mild, minimal, and no response, respectively. The remainder of our patients had mainly atrophic scars of moderate depth. Nine patients (73.4%) suffered from transient postinflammatory hyperpigmentation. In two of them it was preceded by erythema that lasted for more than 1 month. All patients were free of noticeable pigmentation 3 months after the final peel. Patients in whom hyperpigmentation did not develop were of light brown complexion. CONCLUSION: We conclude that medium-depth chemical peel is a safe and effective method of treating acne scars even in patients with dark complexion.

Striae distensae-like lesions. A cause of scarring alopecia among children.

OBJECTIVE: Although alopecia areata is a common problem among children, many misdiagnoses for this condition can happen. The aim of this study was to demonstrate the striae distensae as lesions that cause scarring alopecia with a great resemblance to alopecia areata. METHODS: A total of 36 children with provisional diagnosis of alopecia areata of the scalp were assessed clinically in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghdad, Iraq, between June 1998 to June 2001. Their age ranged from 3 12 years and the mean + standard deviation (SD) was 7.30 + 2.59 years with equal sex ratio. RESULTS: All patients provided for this study had a history of patchy hair loss of few months duration. Their parents denied any history of obvious trauma and many modalities of treatment had been tried without benefit. The clinical examination revealed single or multiple (1-6) (mean + SD 2.41 + 1.22) complete linear hair loss patches resembling atrophic scar that was similar to striae distensae. The histopathological examination showed atrophy of the epidermis, full replacement of the dermis by collagen bundles, and complete loss of appendages. CONCLUSION: This is a new entity, which seems to be common among children and often confused with untreated cases of alopecia areata. This condition should be added to the differential diagnosis of patchy hair loss in children and the parents should be reassured of the cause of hair loss and no treatment therapy needed.