A 5-year single-center study about onychomycosis with a focus on Aspergillus spp. in Albania.

BACKGROUND: Onychomycosis is a common nail infection caused by dermatophytes, nondermatophytes molds (NDM), and yeasts. The prevalence of Aspergillus spp. is increasing worldwide. This study aims to describe the epidemiological and microbiological features of onychomycosis, especially for Aspergillus spp. METHODS: This is a 5-year retrospective study of clinically suspected onychomycosis in one microbiological clinic in Albania. The mycological examination, which included direct microscopic examination of nail scrapings with 20% KOH and culture, was performed on 411 patients. After incubation, we studied the macroscopic characteristics of the colonies, size, shape, and color, and their microscopic examination. We evaluated positive cases for Aspergillus, all cases where Aspergillus was grown in the culture, the microscopy was positive, and the culture was negative for dermatophyte. RESULTS: Onychomycosis resulted positive in 267 patients (52.9% females vs. 47.1% males). A total of 62.2% resulted infected by dermatophytes, 29.6% by yeasts, and 8.2% by NDM. Onychomycosis resulted more frequent in the age group 15-64 years old (63%). Aspergillus spp. were found in 19 patients from 22 patients with NDM onychomycosis. Males (11 patients) and the age group 15-64 years old (14 patients) were more vulnerable to Aspergillus spp. A. niger, A. flavus, and A. terreus isolated from the nail cultures in our study. The culture resulted more superior to KOH examinations. CONCLUSIONS: Our study indicates that NDM, including Aspergillus spp., are still rare findings from fungal examinations. However, dermatologist's clinical suspicion and microbiologist's skills are mandatory in diagnosing and properly managing patients with Aspergillus spp.

Are military personnel at a more risk for skin cancers?

NMSC is the most common cancer in countries with a largely fair skin phenotype population and moderate sun exposure. Assessing risk factors in the military personnel. Comparing the risk factors in this occupational group to the general population. 200 active-duty military members and 1000 individuals (the control group) were randomly selected from the general population. We used transversal data collection through a questionnaire, filled in by all participants in the study based on self-report on general data, skin type, habits, lifestyle and inheritance risk for cutaneous cancer. Analyzing the connection between risk factors reported and incidence for NMSC and melanoma, the following factors resulted significant: The control group the age variable >50 yo and BMI ≥25 were significant. The study group (military personnel), among the variables statistically examined through Pearson's test resulted significant: age > 50 years old, fair skin phenotype, sunburn during childhood, familial history of cutaneous cancer, dark spots (>20) on the arm, and coffee consumption as a protective factor. Military personnel has more significant risk factors for developing cutaneous cancer compared to other population groups therefore, prevention and early detection strategies are needed.

Treatment-seeking behavior, knowledge and beliefs about acne vulgaris among adolescents: A cross-sectional study in high school students in Tirana, Albania.

Acne vulgaris is a common adolescents' disorder. Nevertheless, there is lack of knowledge about acne among adolescents. To evaluate the adolescents' knowledge and beliefs about acne, to investigate help-seeking behavior and treatment preferences. A cross-sectional study conducted in 10 public high schools in Tirana. A total of 2036 students enrolled. All participants were asked about socio-demographic data, knowledge and beliefs about acne, treatment-seeking behaviors and clinical preferences. Of participants 45.3% thought acne is a medical problem, 23.1% thought it's a cosmetic problem, and less than 10% thought acne is a normal condition for their age. Of adolescents 30% did not know that acne is not contagious, 49.7% believed acne is curable with prescribed medication, 33.4% thought acne heals by itself, and only 0.9% believed acne is non-curable. Male adolescents were more likely to have lower level of knowledge and misconceptions about acne compared to females. Only 18.5% had consulted a dermatologist. The majority (54.7%) were using anti-acne products recommended by their friends or pharmacists. Only minority of Albanian adolescents with acne consults a dermatologist. Age, gender and acne severity play a significant role in determining help-seeking behavior. Patient and parent education can significantly improve the treatment outcome.

Efficacy of acne vulgaris treatment protocols according to its clinical forms.

To compare results of different treatment regimens based on stratification of acne to prescribe the right treatment protocol according to clinical form and grade of acne. A transversal, cohort study conducted in 230 patients with acne vulgaris. Patients were divided into three groups according to acne severity and the results of each protocol determined in 0, 4, 6, 8, 12, 18 and 24 weeks. Statistical analysis was conducted using Wilcoxon and Mann-Whitney tests 230 patients (99 females and 131 males) took part in the study. In first grade acne (70 patients), the most effective drug for papulo-pustular lesions was azelaic acid, where the average value of the reduction was 1.03% per week. For comedone reduction, the most effective drug resulted retinol with 17.7% mean reduction per week. In second grade acne (66 patients), the most effective scheme was: doxycycline + topical retinoid + benzoyl peroxide. In the third grade (92 patients), the most effective drug was oral isotretinoin. Accurate stratification, based on clinical characteristics is required for better outcome. Treatment success is related to the respective individually tailored treatment schemes in patients with acne.

Therapeutic considerations and clinical characteristics of a sample of adolescent patients with acne vulgaris in Tirana, Albania: A cross-sectional study.

Acne vulgaris is a common adolescent disorder but the data related to acne vulgaris is insufficient in Albania. The aim of this study was to assess the epidemiologic features of acne vulgaris and to identify lifestyle and constitutional factors in formulating a proper management protocol. A cross-sectional study conducted on a representative sample of 2036 adolescents from 10 high schools located in Tirana. A self-administered questionnaire was administered to collect the data. The binary logistic regression was applied to assess the factors linked to the presence of acne vulgaris in adolescents. The mean age in the study population was 16.2 ± 0.9 years. The self-reported prevalence of acne was 50.3% (52.1% in females and 47.9% in males). Lifetime prevalence was 68.5%. The factors significantly associated with an increased likelihood over time were: frequent consumption of sweets, frequent endurance of stress, poor quality of sleep, positive family history of acne, oily and combination skin, menstrual disorders. Acne vulgaris is common among adolescents in our country. The identification of various modifiable factors related to acne generates opportunities to tailor and focus prevention efforts and better management and treatment planning in relevant high-risk groups.

A rare case of granulomatous Wegener with multiple pyoderma gangrenosum-like ulcers.

Wegener's granulomatosis, is a rare form of systemic vasculitis characterized by necrotic granulomas around the blood vessels. We report a case of a healthy 43-year-old man presented with multiple ulcerated lesions in head and all over the body, that has appeared spontaneously. It was characterized by a giant deep ulceration covered by thick purulent, in size from 3 to 4 cm, deep; sub febrile temperature, and minimal pain associated. Skin biopsies results pyoderma gangrenosum (PG)-like features: anti-neutrophil cytoplasmic antibody (cANCA) positive. Six months later, the patient developed dispea episodes. CT scan (CT) result with multiple focal opacities. He was diagnosed with wegener granulomatosis (WG) and was treated with corticosteroids and ciclophosphamide. Skin involvement in WG is not common and lesions in the skin vary from purpura, paniculitis to ulceration. In our case, skin elements are the first manifestations. Whether these elements are Wegener manifestation or we have coexistence of PG with WG, it remains a still uncertain question to answer. There is no histopathologic pathognomic elements for both. Skin involvement in WG with PG-like lesions have been rarely reported. In front of this type of widespread ulcerations, resistant to treatment we should be aware that one of the reasons may be a disease of autoimmune etiology such as WG.

Efficacy of biologic therapies in psoriasis vulgaris.

Psoriasis is a chronic, immune-mediated skin disease that also has systemic manifestations. Biologic preparates: Adalimumab, Etanercept, and Infliximab are licensed for psoriasis vulgaris treatment in Albania. To compare the efficacy of biologic therapies used for psoriasis based in our experience. A cohort prospective study during the years 2016-2018 at UHC "Mother Teresa" Tirana. In the study took place 78 patient diagnosed with psoriasis and treated with biologic therapies. Psoriasis Area Severity Index (PASI) 50 and PASI 75 index were the parameters of response outcomes. PASI 50 was achieved for 6.8, 7.02, and 7.2 weeks in patients with Etanercept, Adalimumab, and Infliximab respectively and PASI 75 for 12.8, 11.4, and 11.42 weeks. X2 = 0.076, p > .05, nonsignificant difference. PASI 50 was achieved in 27.2% of subject treated with Etanercept, 67.4% Adalimumab, and 55.5% with Infliximab for the weeks mentioned above. Meanwhile PASI 75 was achieved in 45.4% of subject treated with Etanercept, 61.7% Adalimumab, and 25% with Infliximab. X2 = 15.28, p < .05, significant difference. Biologics have revolutionized the treatment of psoriasis. To select the most appropriate agent for patient, should be considered multiple factors including adverse effects, tolerance, patient preference, cost, and mode of administration.

Treatment of Onychomycosis - a Clinical Study.

INTRODUCTION: Onychomycosis is a fungal infection of the nail unit. Anatomical and physiological characteristics of the nail apparatus impose the need for long-term treatment to achieve complete cure. GOAL: The main goal of this project is to study the effectiveness of several treatment protocols for onychomycosis based on Scoring Clinical Index for Onychomycosis (SCIO). MATERIAL AND METHODS: The study included 133 patients with onychomycosis, diagnosed by KOH microscopy and culture. Based on disease severity, patients were grouped into groups with SCIO values: 6-9, and 12-16. These groups were randomly subdivided to 5 subgroups according to the given treatment protocols: fluconazole 150 mg 1x weekly, itraconazole continual therapy, itraconazole pulse therapy, terbinafine 250 mg/d, and terbinafine + ciclopirox 8% lacquer, respectively. The cure rate was evaluated at the end of 48 week. RESULTS: The obtained cure rates according to the above mentioned protocols were: 92.30%, 81.81%, 83.33%, 90.90%, and 100%, respectively for groups of patients with SCIO values 6 - 9. Within patients with SCIO values 12-16, were achieved cure rates as follows: 78.57%, 78.57%, 75%, 80%, and 86.66%. CONCLUSIONS: There was no statistically significant difference in cure rate between five treatment protocols applied in this study. In patients with high SCIO values is expected a decrease in cure rate.

An epidemiological study on trigger factors and quality of life in psoriatic patients.

OBJECTIVE: to evaluate the role of stress, tobacco, drugs, infections, allergies, heredity, alcohol, hormones and skin aggressions as trigger factors and the impact on quality of life in a sample of psoriasis patients. METHODS: a transversal study performed in 90 patients affected by psoriasis between January and November 2012 at the "Nene Tereza" University Hospital, Tirane, Albania, based on two scored questionnaires. RESULTS: more than 70 % of patients reported that stressful events caused a flare- up of their psoriasis (p< 0.05). More than 60% of males and 20% of females were smokers (p< 0.05). About 20% of our patients were taking one or more of the medications listed in the questionnaire (p> 0.05). About 20% of patients reported having had recurrent infections (p<0,05). About 80% of males patients consumed alcohol (p<0,05). More than 40% reported a relative with psoriasis. Statistical comparison of the group that reported skin aggressions with the group that did not revealed a significant difference (p<0,05). Only a few of them reported to have allergies (p>0,05). About 36% of females reported that hormonal changes (puberty and menopause) exacerbated their psoriasis (p<0,05). More than 40% of patients reported that psoriasis seriously affects their quality of life. CONCLUSION: stress, tobacco, infections, heredity, alcohol, hormonal changes and skin aggressions were confirmed as trigger factors for psoriasis in the present sample. Allergies and the investigated drugs seemed not to have any influence in flare-ups. We found that psoriasis had a serious impact in the quality of life in over of 40% of the patients interviewed.

A rare case of disseminated idiopathic calcinosis cutis.

Idiopathic calcinosis cutis is an uncommon condition characterized by calcium deposits in the dermis, subcutis, and muscles that most commonly are localized in one area. We report the rare case of a 16-year-old adolescent girl who exhibited unusually widespread calcium deposits. The laboratory results showed a normal biochemistry profile. Ultrasonography revealed calcifications in the fat tissue under the skin but not in deeper tissues or muscles. The histopathologic evaluation showed deep cutaneous and subcutaneous calcium deposits. Laboratory investigation revealed normal calcium, phosphate, and parathyroid hormone levels. Calcium excretion in a 24-hour urine sample was normal, but phosphate excretion was slightly low. Scintigraphic research showed no pathology in the thyroid and parathyroid glands but revealed soft-tissue calcification. A chest roentgenogram, blood tests, and testing of stools for occult blood showed no indication of internal malignancy. On the basis of these findings,the diagnosis of idiopathic calcinosis cutis was made. We discuss the pathogenesis, clinical and histologic picture, and differential diagnosis of calcinosis cutis.

Cutaneous mastocytosis: a case of bullous urticaria pigmentosa.

Mastocytosis is characterized by an increased number of mast cells with abnormal growth and accumulation in 1 or more organs. In children, mastocytosis is commonly cutaneous and patients present with a spectrum of findings, ranging from solitary or multiple mastocytomas to urticaria pigmentosa (UP) or diffuse cutaneous mastocytosis (CM). We present a case of a 4-month-old infant with bullous UP.

Skin and sensibility: the story of bullae on the human surface.

This review presents a concise delineation of the historical roots of nomenclature and first reports of entities recognized today as immunoblistering dermatoses. The scope of the perspective of terminology is the time from Hippocrates BC to past mid-twentieth century AD, and pemphigus is the core of the matter. Researchers in this field may find these important historic facts interesting and useful as a quick reference.

A case of atypical pyoderma gangrenosum.

BACKGROUND: Pyoderma gangrenosum is a rare inflammatory disease of unknown etiology and unspecific histopathology. There are no clear-cut criteria for the diagnosis of this disease. The diagnosis is usually made based on clinical appereance, course of disease and possible, commonly coexisting disorders. In atypical cases the diagnosis is based on exclusion of other causes of similar appearing cutaneous ulcerations. MAIN OBSERVATIONS: The 67-year-old male patient, presented with a 15-year history of painful ulcers and vegetative lesions covered with sero-hemorrhagic and purulent secretions, localized on the dorsal surface of both hands leading to self-amputation of distal phalanges. We report a step-by-step The patient refers to have these complaints for more than 15 years. An extensive diagnostic procedure led to the diagnosis of pyoderma gangrenosum as a diagnosis of exclusion. CONCLUSION: This report shows an atypical variant of an ulcerative disease. Pyoderma gangrenosum, a diagnosis of exclusion, was sustained based on an extensive diagnostic procedure. In this article we describe the step-by-step approach which let to this diagnosis.