Burn Hemangioma: A New Variant of Hemangioma.

BACKGROUND: Burn hemangioma, also known as scalded pyogenic granuloma, is considered a variant of pyogenic granuloma, but unlike the classic type it presents with rapid progression. Most patients are infants and young children with a history of burns caused by liquids. OBJECTIVE: The present study aims to present all patients with burn hemangiomas treated at our institutions with a full clinical and histopathological assessment. PATIENTS AND METHODS: This case series includes 34 cases that were treated during the period from 2016 to 2021. RESULTS: A total of 34 patients (16 female/18 male, mean age of 17.6 years) were included. Two age groups presented: infants and children (n = 22, age range 0.5-8 years, 10 female/12 male), and adults (n = 11, age range 25-44 years, 6 female/6 male). Lesions appeared 1-2 weeks following predominantly second-degree burns, and multiple lesions predominated in infants and children. The lesions evolved to large lesions within weeks, and these appeared to be either static or involute. The histopathology was compatible with hemangioma, rather than pyogenic granuloma. CONCLUSION: Burn hemangioma should be considered a new variant of hemangioma rather than a type of pyogenic granuloma that follows second-degree burns. They have many similarities with infantile hemangioma, both clinically and histopathologically.

COVID-19 infection is a major cause of acute telogen effluvium.

BACKGROUND: Acute telogen effluvium is a non-scaring hair loss, usually occurs 3 months after the stressful event that causes hair shedding, and lasts up to 6 months. It can be associated with post COVID-19 infection. OBJECTIVE: To study the possible effects of COVID-19 on the hair growth cycle and the relationship between COVID-19 and acute telogen effluvium. PATIENTS AND METHODS: This is an observational cross-sectional study that had been conducted during the period from September 2020 to March 2021 years. Thirty-nine patients with post COVID-19 hair loss are confirmed by polymerase chain reaction (PCR) or antibody testing. Hair pull test was carried out to confirm the diagnosis and severity of telogen effluvium. RESULTS: Thirty-nine patients were evaluated; their ages ranged from 22 to 67 years with a mean and SD of 41.3 ± 11.6 years with 36 (92.3%) females and 3 (7.69%) males. All patients with a diagnosis of ATE were enrolled in this study and had a laboratory-confirmed diagnosis of prior SARS-CoV-2 infection; 15 (38.46%) patients reported mild symptoms, 24 (61.53%) patients presented with moderate disease, and no patient required hospitalization. They all experienced excessive hair loss within 2-3 months after infection. Pull tests were strongly positive (> 10-50% with a mean of 35% of pulled hair away from scalp). CONCLUSION: COVID-19 infection is now a frequent and a common cause of acute telogen effluvium. Hence, clinicians should be aware about the relation between this infection and this pattern of hair loss. Drugs that have been used for the treatment of COVID-19 were excluded as a cause of acute telogen effluvium.

Traction Alopecia: Clinical and Cultural Patterns.

BACKGROUND: Traction alopecia is common and preventable but frequently overlooked disorder. OBJECTIVE: To evaluate patients with traction alopecia. PATIENTS AND METHODS: This study was conducted at the Dermatology Center, Medical City, Baghdad, Iraq, during the period from November 2005 to October 2019. Demographic features like age, gender, disease duration and special hair styling practices and accessories were recorded. Clinical patterns were studied. RESULTS: Thirty female patients were included in this study. Their ages ranged from 6 to 47 years with mean age ± SD was 15.63 ± 9.806. Twenty-one (70%) were below the age of 16 years. No patient had tightly curled hair. All cases were asymptomatic apart from hair loss. The fringe sign was observed in 27 (90%) of cases. The response to therapy was poor. CONCLUSION: Traction alopecia is an important type of pressure-induced hair loss evident in children and adults with or without curly hair due mainly due to cultural hair styling practices with its frequency apparently increasing in recent years. The fringe sign is common and of diagnostic importance. It is a preventable form of hair loss which can be reversed if diagnosed early; otherwise, permanent scarring alopecia results. It represents a pressure phenomenon evident worldwide in both non-Sub-Saharan lineage and Sub-Saharan lineage individuals.

Nevus depigmentosus: the analysis of 37 cases.

BACKGROUND: Nevus depigmentosus (ND) is an uncommon congenital nonprogressive hypopigmented skin disorder that can be seen anywhere on the body. We considered other depigmenting disorders and focused on distinguishing ND from vitiligo and tuberous sclerosis complex in infancy. METHODS: The diagnosis of patients with nevus depigmentosus was made differentiating it from nevus anemicus, pityriasis alba, tuberous sclerosis complex, vitiligo and other depigmenting disorders. RESULTS: Of the 37 individuals with nevus depigmentosus evaluated, 36 were children, twenty-two (59.4%) were males and 15 (40.5%) were females, with male to female ratio 1.4:1. CONCLUSIONS: Distinguishing ND from other disorders with depigmentation can be challenging, in particular in case of tuberous sclerosis complex and vitiligo in infancy.

Psoriasis and vitiligo are close relatives.

BACKGROUND: Both vitiligo and psoriasis are chronic inflammatory autoimmune diseases with genetic elements. OBJECTIVE: To estimate the frequencies of psoriasis in vitiligo patients and vice versa and to compare them with healthy controls. PATIENTS AND METHODS: A total of 1000 subjects were included, 250 of them had vitiligo, 250 had psoriasis, and 500 were healthy controls. Measurement of the frequencies of vitiligo in psoriatic patients and psoriasis in vitiligo patients was carried out. Thereafter the frequencies of both diseases were assessed in healthy controls. The frequency of vitiligo among psoriatic patients was compared with that of vitiligo in healthy controls. A similar comparison was done between the frequency of psoriasis among vitiligo patients with that in healthy controls. Other comparisons were performed between the frequency of family history of psoriasis among vitiligo patients with that in healthy controls and between the frequency of family history of vitiligo in psoriatic patients with that in healthy controls. RESULTS: The frequency of psoriasis among vitiligo patients was 15 (6%) and among healthy controls was 2 (0.4%); there is a statistically significant difference (P=0.001). The frequency of vitiligo among psoriatic patients was 5 (2%) and among healthy controls was 3 (0.6%); no statistically significant difference was found (P=0.16). The family history of psoriasis among vitiligo patients was 23 (9.2%) and among healthy controls was 20 (4%); there is a significant association (P=0.043). The family history of vitiligo among psoriatic patients was 24 (9.6%) and among healthy controls was 40 (8%); the difference is statistically significant (P=0.042). CONCLUSION: The present work has confirmed the close relationship between vitiligo and psoriasis.

Panniculitis is a common unrecognized histopathological feature of cutaneous leishmaniasis.

BACKGROUND: Cutaneous leishmaniasis (CL) is a parasitic cutaneous infection caused by Leishmania parasite. The histopathology is usually granulomatous in nature. AIMS: The aim of the present study is to elucidate the histology of CL and evaluate the presence and the frequency of panniculitis among the affected patients. SETTINGS AND DESIGN: Case series interventional study. MATERIALS AND METHODS: Thirty-five patients with CL were diagnosed clinically between December-2012 and May-2013. Diagnostic confirmation established by smears, culture, and polymerase chain reaction (PCR). The histopathological assessment was carried out to study the general pathology and to look for the presence of panniculitis. STATISTICAL ANALYSIS USED: Simple statistics utilized via SPSS version 16.0 (SPSS, Inc., Chicago, USA). RESULTS: Eighteen women and 17 men with CL were enrolled in the present work with a mean duration of their disease was 3 months. The results of the diagnostic tests were as follow: The smear was positive in 21 (60%) of cases, Leishman-Donovan (LD) bodies were seen in 7 (20%) patients, culture was positive in 24 (68%), and PCR was positive in 32 (91.4%) patients. The epidermal changes included acanthosis, pseudoepitheliomatous hyperplasia, ulceration, focal spongiosis, and interface dermatitis while the dermal changes were dependent on the spectrum of the disease, so in the ulcerative lesions there was lymphohistiocytic infiltration with foci of plasma cells and sometimes aggregate of LD bodies, whereas in the dry lesions the pathology is mainly of epithelioid granuloma. Panniculitis was seen in 16 (46%) cases as a diffuse lymphohistiocytic infiltration of both the septum and lobules of the subcutaneous layer of the skin. CONCLUSION: Panniculitis is an important feature of CL that must be differentiated from other diseases that can simulate CL such as chronic skin infections, Discoid lupus erythematosus, and cutaneous lymphoma.

Skin tumors and skin infections in kidney transplant recipients vs. patients with pemphigus vulgaris.

BACKGROUND: Pemphigus vulgaris is an autoimmune disease of the skin and mucous membrane. Renal transplantation is a common procedure in Iraq, and these patients required prolonged use of immunosuppressive drugs. OBJECTIVE: To study the frequency of skin tumors and infections in patients with pemphigus vulgaris compared with renal transplant recipients and normal controls. PATIENTS AND METHODS: One hundred kidney transplant recipients, their ages ranged from 14 to 70 (46.65 ± 4.74) years, and 50 patients with pemphigus vulgaris, their ages ranged from 22 to 70 (43.32 ± 3.46) years, were studied in Baghdad Hospital from June 2009 to August 2010. Patients were treated with immunosuppressive drugs for 0.5-25 years. Patients were examined for tumors and infections and compared with the general population as controls (100 individuals). RESULTS: In renal transplant recipients, the following infections were observed: herpetic, 25 patients (25%); bacterial, 11 (11%); and fungal, 22 (22%). These infections appeared early in the course of immunosuppression. Benign tumors increased, most importantly viral warts in 40 (40%) and actinic keratosis, 14 (14%). The malignant tumors were basal cell carcinomas in 4 (4%), squamous cell carcinomas 2 (2%), and Kaposi's sarcoma 3 (3%). These malignancies usually appeared late in the course of immunosuppression. Patients with pemphigus vulgaris showed no important skin infections or tumors. Healthy controls showed no infections apart from herpetic infections in 7 (7%) and viral warts in 9 (9%). No tumors were seen. CONCLUSIONS: Pemphigus vulgaris in prolonged immunosuppression is immunoprotective against skin infections and skin tumors while kidney transplant recipients are not protective.

The therapeutic role of isotretinoin in the management of Behçet's disease: a single-blinded, controlled therapeutic study.

OBJECTIVES: To evaluate the long-term remission efficacy and safety of isotretinoin in the treatment of Behcet's disease (BD). PATIENTS AND METHODS: This single-blind, controlled therapeutic study was conducted in the Department of Dermatology and Venereology at Baghdad Teaching Hospital from February 2011 to January 2012. Thirty patients with BD were included in this work. Each patient received isotretinoin 20 mg orally once daily for 3 months. They were assessed at week 2 and then monthly depending on the Clinical Manifestation Index (CMI) and to record any side effects. At week 12, isotretinoin was stopped and patients were given placebo therapy in a form of glucose capsules for another 3 months. RESULTS: Thirty patients were treated, 14 (46.6%) males and 16 (53.3%) females, with a male to female ratio of 1:1. Their ages ranged from 16 to 64 years (mean +/- standard deviation [SD], 38.4 +/- 10.9 years). During the first 3 months of therapy, the pathergy test, oral pathergy test, and C-reactive protein were significantly minimized. The CMI before isotretinoin therapy ranged between 2 and 8 (mean +/- SD, 4.933 +/- 1.91). After therapy, within the first 14 days, the mean CMI started to decline to a lower level, and it continued to decline significantly until week 12. It then started to increase through week 4 of placebo therapy, but remained statistically significant until the second month of placebo therapy. Isotretinoin therapy also had a statistically significant effect in reducing oral ulcers and skin manifestations. CONCLUSION: Isotretinoin is an effective therapeutic and prophylactic drug in the management of BD.

Melanocytes transplantation in patients with vitiligo using needling micrografting technique.

BACKGROUND: Some cases of vitiligo require melanocyte transplantation, but these surgical techniques have varying degrees of success. OBJECTIVES: To perform melanocytes transplantion in patients with vitiligo using a new needling micrografting technique. PATIENTS AND METHODS: This interventional case study took place at the Department of Dermatology and Venereology at Baghdad Teaching Hospital from December 2010 to September 2011. Twelve patients with vitiligo were included. A split-thickness skin graft was taken from the normal area and cut into micropieces ranging from 0.1 mm to 0.3 mm in diameter. The recipient area was anesthetized, and the micrografts were then implanted into the dermis using the needling technique. The number of implanted micrografts depended on the size of the recipient area. Follow-up was conducted every 2 weeks for the first month and then every 4 weeks for a further 16 weeks. RESULTS: The intake rate of grafting at week 2 ranged from 90% to 100%. The micrografts started producing noticeable pigmentation at week 2, and pigmentation was obvious at week 4. At week 8, the rate of pigmentation ranged from 10% to 90% (25.24%), and at week 16 it ranged from 10% to 100% (61.36%). CONCLUSION: This new approach to the treatment of vitiligo delivers rapid and satisfactory pigmentation.

Lactic Acid as a new therapeutic peeling agent in the treatment of lifa disease (frictional dermal melanosis).

BACKGROUND: Lifa disease (frictional dermal melanosis) is a common dermatological problem. Full strength lactic acid has been proved to be effective and safe peeling agent in the treatment of melasma. OBJECTIVE: To assess the effectiveness and the safety of lactic acid chemical peeling in the treatment of lifa disease. MATERIALS AND METHODS: This open label therapeutic trial was conducted in Department of Dermatology in Najaf and Baghdad Teaching Hospitals, from March 2007-October 2008. Full strength lactic acid (92%, pH 3.5) was used as a peeling agent. The treatment sessions were done every 2 weeks until the desired response was achieved (but not more than 6 sessions). The response to therapy was evaluated by objective and subjective methods. All patients were followed monthly for 3 months after the last treatment session. RESULTS: 52 patients with typical clinical features of lifa disease were included. All patients were slim with prominent bones and low body mass index, and gave history of using the lifa (washing agent) during bathing. The number of sessions ranged from 2-6 sessions. The pigmentation was improved in all patients as revealed by objective and subjective methods, and this response was statistically highly significant. No significant side effects were recorded in all treated patients. The improvement has been sustained without any obvious relapse throughout the follow-up period. CONCLUSION: Lactic acid peel is a new, non-costly mode of therapy in treating dermal melanosis in patients with lifa disease.

Panniculitis is an important feature of cutaneous leishmaniasis pathology.

Background. Cutaneous leishmaniasis is an inflammatory parasitic infection characterized by superficial and deep perivascular infiltration with or without granuloma formation. Clinical diagnosis usually requires seeing Leishmania bodies. Methods. We report two cases of cutaneous leishmaniasis with unusual histological finding of panniculitis. Case 1: a 36-year-old male presented with multiple ulcerative nodules involving the left leg for two months duration which was greatly responsive to antimony intralesional therapy. Case 2: A 45-year-old woman presented with painless nodules on her upper chest of a 10-week duration which were successfully treated with oral and topical zinc sulphate. Results. Diagnosis of both cases was confirmed by finding the Leishmania bodies with Gimesa stain in addition to the diffuse dermal inflammatory cellular infiltration of the dermis forming granulomatous dermatitis. Mixed cellular infiltration of lymphocytes, histiocytes, and plasma cells of the panniculus caused both septal and lobular panniculitis. Conclusion. Cutaneous leishmaniasis can cause panniculitis and this could be seen more commonly if deep biopsies were taken. So cutaneous leishmaniasis must be considered in evaluating pathology of panniculitis especially in endemic regions.

Treatment of scabies using 8% and 10% topical sulfur ointment in different regimens of application.

BACKGROUND: Many therapeutic modalities for scabies were available, topical sulfur ointment is a cost-effective and safe therapeutic agent. It is often applied for the whole body for three successive days. OBJECTIVE: To evaluate their therapeutic regimen of 8% and 10% topical precipitated sulfur in petrolatum ointment for single day, three successive nights or three successive days in management of scabies. PATIENTS AND METHODS: This single-blinded, comparative study was conducted in the Department of Dermatology-Baghdad Teaching Hospital from April 2008 through October 2009. A total of 97 patients with scabies were enrolled in this study. The diagnosis was established on clinical basis. The patients treated with 8% and 10% topical sulfur in petrolatum ointment were divided randomly into three groups: Group A: 33 patients treated for single day (24 hours); Group B: 32 patients treated for three successive nights (from 6 p.m. to 8 p.m. to 6 a.m. to 8 a.m. and bathing every day); and Group C: 32 patients treated for three successive days (bathing every 24 hours). The patients were seen regularly every two weeks for the duration of four weeks. RESULTS: Study included 58 (59.8%) males and 39 (40.2%) females, with a male to female ratio 1.4:1. The age range of males at presentation from 3 to 64 (26.74±15.98) years, while the females age ranged at presentation from 3 to 60 (24.05±14.53) years of age. At the end of the study, the response to treatment was: Group A, response in 14 (42.4%) patients and no response in 19 (57.6%); Group B, response in 29 (90.6%) patients and no response in 3 (9.4%); and Group C, response in 31 (96.9%) patients and no response in 1 (3.1%). There is significant statistical difference among the response of 3 groups with (P=0.00000011), but no statistically significant difference between the response of Group C and Group B, (P=0.6055). Mild burning sensation and irritating (sulfur) dermatitis were the only side effects of 8% and 10% sulfur. Pruritic rash occurred in Group C mainly, in 11 (34.4%) patients, 8 (25%) in Group B and 4 (12.1%) in Group A, with no significance (P=0.1058). Recurrence or relapse occurred in Group A mainly, with 4 (12.1%) patients, and in Group B, 1 patient, (3.1%), with no recurrence in group C, with significance (P=0.0060). CONCLUSION: Three successive days and three successive nights of 8% and 10% sulfur ointment were effective regimens with no statistical difference in favor of three successive days, while single-day application was much less effective but with fewer side effects.

Neuropathy Dermatitis following Surgical Nerve Injury.

Background. Cutting nerve during operations like saphenous vein grafting and knee joint surgery are common surgical procedures. Objective. To report cases of dermatitis at the site of neuropathy following skin incision for saphenous vein grafting and knee joint surgery. Patients and Methods. This case report work was done in the Department of Dermatology, Baghdad Teaching Hospital, during 2009-2010, seven cases were recorded, six following saphenous vein grafting and one case after knee surgery. Five males and two females, their ages ranged from 50 to 66 (58 ± 5.033223) years. Detailed history and full clinical examination were done for each patient regarding all points related to their conditions. Results. All cases presented around 2-3 months following the operation with dermatitis at the site of operational incision. The dermatitis appeared on one side of the operational scar and at area of neuropathy, and the rash did not cross to contralateral side. The dermatitis was well-defined plaque or patch erythematous slight scaly and nonitchy and subsided within few weeks with or without topical therapy. Conclusions. Neuropathy dermatitis is apparently a new variant of dermatitis that follows nerve cut during surgery.

The frequency of 21-alpha hydroxylase enzyme deficiency and related sex hormones in Iraqi healthy male subjects versus patients with acne vulgaris.

OBJECTIVE: To find out the frequency of nonclassical congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency among Iraqi healthy male individuals versus male patients with acne vulgaris. METHODS: This case-control study and single-center examination of hormone levels in a cohort of volunteers was conducted in the Department of Dermatology, Baghdad Teaching Hospital, and in the Physiological Chemistry Department of the College of Medicine, Baghdad University, Baghdad, Iraq, from September 2007 to February 2008. RESULTS: The frequency of 21-hydroxylase enzyme deficiency in healthy male subjects was 1:43 (2.3%), while in male patients with acne vulgaris, this was 6:43 (13.95%). Serum 17-hydroxyprogesterone (OHP) levels were statistically and significantly elevated in male patients with acne vulgaris compared with healthy male controls (p=0.020). The serum total cortisol level was significantly reduced in patients with acne vulgaris in comparison with that of healthy controls (p=0.022). CONCLUSION: These results support the necessity of inclusion of the 21-alpha hydroxylase enzyme activity (serum 17-OHP level) screening test in acne patients.

Topical therapy of acne vulgaris using 2% tea lotion in comparison with 5% zinc sulphate solution.

OBJECTIVE: To evaluate effectiveness of 2% tea lotion in comparison with 5% zinc sulphate solution in the treatment of acne vulgaris. METHODS: This is a single-blind randomly comparative therapeutic clinical trial carried out in the Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq from June 2006 to December 2007. Full history and clinical examination were studied for each patient regarding all relevant points of the disease, to evaluate the severity of acne. Forty-seven patients with acne vulgaris were divided randomly into 2 groups, and were instructed to use the following solutions twice daily for 2 months; group A used 2% tea lotion, group B used 5% zinc sulphate solution. Patients with papulopustular lesions were included in the study, while patients with severe acne were excluded. The clinical improvement was scored by counting the number of inflammatory lesions before, and after treatment. RESULTS: Forty patients completed the study, their ages ranged from 13-27 years with a mean+/-standard deviation of 19.5+/-3.5 years with 20 patients in each group. Two percent tea lotion was statistically significant in decreasing the number of the inflammatory lesions in acne vulgaris, while 5% zinc sulphate solution was beneficial, but did not reach statistically significant level as tea lotion. CONCLUSION: Two percent tea lotion was a good alternative remedy to be used in the treatment of acne vulgaris, and was much superior than topical 5% zinc sulphate solution.

Topical 10% zinc sulfate solution for treatment of melasma.

BACKGROUND: Multiple modalities have been used in the treatment of melasma, such as bleaching agents, chemical peels, and antioxidants. Topical zinc sulfate has peeling and antioxidant effects. OBJECTIVE: The objective was to evaluate the efficacy and safety of topical 10% zinc sulfate solution in the treatment of melasma. PATIENTS & METHODS: This study was conducted at the Department of Dermatology & Venereology, Baghdad Teaching Hospital. Twenty-eight patients with melasma were treated with 10% zinc sulfate solution. Every patient was instructed to apply the formula twice daily and to be seen every 2 weeks for 2 months. The severity of melasma was assessed before, during, and after treatment with the melasma area and severity index (MASI). All patients were instructed to apply a broad-spectrum sunscreen with SPF>30 before sun exposure during treatment and for the 3-month follow-up period. RESULTS: Fourteen patients were treated with 10% zinc sulfate solution. The mean MASI score before treatment was 9.45, which changed to 4.70 after therapy. This corresponds to a percentage improvement of 49.78% and was statistically significant (p<.0005). No side effects were reported apart from a mild stinging sensation reported in a few patients. Most patients maintained improvement 3 months after cessation of therapy. CONCLUSION: Topical 10% zinc sulfate solution is a new effective, safe, and noncostly formulation in the treatment of melasma.

The therapeutic and prophylactic role of oral zinc sulfate in management of recurrent aphthous stomatitis (ras) in comparison with dapsone.

OBJECTIVE: To evaluate the therapeutic and prophylactic effectiveness of oral zinc sulfate in recurrent aphthous stomatitis (RAS) in comparison with dapsone. METHODS: A double-blind placebo controlled study, conducted in the Department of Dermatology, Baghdad Teaching Hospitals, Baghdad, Iraq between May 2005 and October 2006, in which 45 patients with RAS were recruited and divided into 3 equal groups: group A (on zinc sulfate 150 mg twice daily), group B (on dapsone 50 mg twice daily), and group C (on glucose 250 mg as placebo). The drugs were prepared in identical capsules, and the patients were instructed to take the capsules twice daily after meals (in a double-blind manner). Assessment of each patient was carried out by the Oral Clinical Manifestation Index (OCMI) and the diameter of the ulcers at day 0, day 4, and at the second, fourth, sixth, eighth, tenth, and twelfth weeks of therapy. RESULTS: Forty-five patients were included in the study (25 males and 20 females), and their ages ranged between 16-45 years (mean+/-SD 31.24+/-8.14). In group A, the mean of OCMI and diameter of ulcers improved, with a p=0.0001 for OCMI, and 0.0001 for the diameter for ulcers at the end of the twelfth week of therapy, which was statistically significant. Group B, also showed significant improvement, however, the action was lower and slower (p=0.0001 for OCMI, and 0.001 for the diameter for ulcers). Group C revealed slight non-significant improvement (p=0.028 for OCMI, and 0.034 for the diameter of ulcers). In the sixth week of therapy, zinc sulfate was more effective than dapsone in reducing the OCMI of the ulcers (p=0.007). CONCLUSION: The present study showed that both zinc sulfate and dapsone had significant therapeutic and prophylactic effects in controlling RAS, however, zinc sulfate had much more rapid and sustained action.

Bacille Calmette-Guerin immunotherapy of viral warts.

OBJECTIVE: To assess the effectiveness of the Bacille Calmette-Guerin BCG vaccine in the treatment of viral warts. METHODS: A single blind placebo controlled study conducted at the Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq from March 2005 to June 2006. Two hundred patients with viral warts were enrolled in this study, and were fully assessed before therapy. The patients were divided into 2 equal matched groups. Group 1 was designed as the treatment group and received BCG vaccine in 1-3 doses with a one-month interval, while group 2 was injected with distilled water. The patients were evaluated every 2 weeks for evidence of regression of lesions. The follow up period lasted for 3 months after the last dose. RESULTS: A total of 154 patients completed the study: 81 patients in group I and 73 patients in group II. Thirty 39.7% patients out of 81 patients in group I showed complete recovery. These results were significantly high p<0.05 when compared with total response, 10 13.7% out of 73 patients in group II. No recurrence has been reported during the follow up period. When cases that failed to respond to placebo were treated with BCG in a similar manner to group I, there was total response in 15 42.7% out of 44 patients. No side effects were observed. CONCLUSION: The BCG vaccine was an effective and safe modality of treatment of viral warts.

Topical zinc sulphate solution for treatment of viral warts.

OBJECTIVE: To assess the efficacy and safety of topical zinc sulphate solution in the treatment of plane and common warts. METHODS: This study consisted of a pilot and double blinded clinical trails. This was carried out in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghadad, Iraq during the period from December 2002 to October 2003. Ten patients with plane warts were enrolled in pilot-clinical trial, all patients used 10% w/v zinc sulphate solution topically, 3 times daily for 4 weeks while in the double blind trial, 90 patients were included (50 patients with common warts, 40 patients with plane warts). Patients were randomly used either topical 10% or 5% zinc sulphate solution or distilled water as a control topical therapy 3 times daily for 4 weeks. Full history and close clinical examination were performed to all patients before treatment. RESULTS: In the pilot trial, the full response for plane warts was 80%, while the full response for patients with plane warts in double blinded trial was 85.7%, 42.8% and 10% for those using 10% and 5% zinc sulphate solutions and distilled water subsequently. The difference was statistically significant (p<0.008). The full response for patients with common warts were 11%, 5% and 0% for those who used 10% and 5% zinc sulphate solutions and distilled water respectively, the difference was statistically insignificant. No recurrence of warts occurred during follow up that ranged from 2-6 months after therapy. CONCLUSION: Topical 10% zinc sulphate solution was a new effective and safe modality for treatment of plane warts.