Introduction: Lamellar ichthyosis is a genetic disorder of keratinization and the frequent skin infections in these patients may be a result of change in normal skin flora acting in addendum to breach in the physical barrier. Material and Methods: A comparative retrospective study was performed in patients with lamellar ichthyosis and age/ sex controlled matched patients attending the dermatology IPD/OPD with positive skin swab results from July 1st 2015 to June 31st 2016. The two groups were then compared in terms of bacterial culture results. Results: The mean gestational age of the study subjects at birth was 35.56 weeks (range: 30–39 weeks). The study sample consisted of 6 males and 3 females in LI group and 12 males and 6 females in the control group. Methicillin resistant Staphylococcusaureus (MRSA) was exclusively seen in LI patients, and Gram negative rods, Fusobacterium and Candida were found more in the LI patients than in the control group. The Bacteroidetes to Firmicutes ratio, lipophilic diphtheroids, Propionibacterium acnes, Fusobacterium and Micrococci were present more in the control group than in the LI patients. Conclusion: By knowing this microbiota, undue reliance on antibiotics can be reduced as these microorganisms may form normal commensals for the given micro environment. Furthermore, these organisms may be responsible for perpetuating the disease process by compounding the genetic keratinocyte barrier. What is known: Frequent skin infections are not uncommon in patients of lamellar ichthyosis. What is new:Methicillin resistant Staphylococcus aureus (MRSA) are commonly present in LI patients, and Gram negative rods, Fusobacterium and Candida are commoner in the LI patients than in the control group of patients.
Introduction. Melasma is a common skin pigmentation disorder affecting a patient’s life psychologically and socially. Topical medications or lasers can have temporary and limited therapeutic effects on melasma. Material and Methods. This study is a prospective clinical trial comparing therapeutic effects of oral Tranexamic acid (TXA) and topical Hydroquinone (HQ) cream. A total number of 69 patients were examined. During the study, 10 patients failed to appear for the follow-up and 59 of them completed the trial. The patients were also divided randomly into two groups. Group A received TXA capsule 250 mg every 12 hours and group B received 4% topical HQ cream day and night. The patients from both groups were treated for 3 months. Melasma Area and Severity Index (MASI) scores were then calculated at the baseline, 4 weeks, and 12 weeks into the treatment and 3 months after the end of intervention. Results. MASI baseline, 4 weeks,12 weeks, and 24 weeks in TXA group were 21.66, 13.69, 9.10, 9.24; respectively. Reduction of MASI between baseline and 4 weeks was statistically significant. Such a decreasing trend in MASI scores between baseline and 12 weeks was also reported as statistically significant (p=0.001). In the HQ group, MASI baseline,4 weeks, 12 weeks, and 24 weeks were 21.46, 13.57, 10.93, 11.20; respectively. Reduction of MASI scores between baseline and 4 weeks was statistically significant. Moreover, a decline in MASI scores was observed between baseline and 12 weeks that was statistically significant (p=0.001). Considering both groups MASI scores were reduced but the difference between two study groups was not statistically significant (p=0.98). Conclusion. The efficacy of TXA and HQ was the same and both could significantly reduce MASI scores.
Introduction. Multiple eruptive dermatofibromas are described in association with different immune-mediated conditions like SLE, pemphigus, myasthenia gravis, HIV infection, organ transplantation, acute myeloid leukemia, ulcerative colitis, atopic dermatitis and immunosuppressive therapy. Case Report. A forty-five year-old woman presented at our Department with over 20 dermatofibromas on her trunk and extremities developed spontaneously over the last 3 years, out of which more than 10 lesions developed over the previous year. The patient was diagnosed with systemic lupus erythematosus before the onset of lesions and was treated with different immunomodulatory agents (corticosteroids, methotrexate, antimalarials, azathioprine, belimumab, anti IL-6 antibody). Dermoscopy of different lesions revealed different dermatoscopic patterns without pattern predominance. A biopsy specimen of one lesion confirmed the diagnosis. Conclusion. There are few cases reports describing a possible link between systemic lupus erythematosus and multiple dermatofibromas. The mechanism is still unknown but is believed to be due to the altered immunity in immune-mediated diseases.
Ramsay Hunt Sydnrome is a rare and severe disease caused by the reactivation of varicella zoster virus (VZV) in the ganglia geniculate. The classic triad of this disease includes ear pain (otalgia), vesicles in the auditory canal, and facial paralysis. This case report is about a 37-year-old woman that has the classic triad of Ramsay Hunt Syndrome, as well as a rare complication of cranial polyneuritis in the form of cephalgia and vertigo which occurs only in 1.8% of cases. The patient came one week after the initial symptoms had started and was given antiviral combination therapy and steroids. Treatment of this disease is time sensitive to <72 hours and will determine the prognosis. One month later the follow up showed sequelae in the form of persistent headache and slight facial paralysis as a result of delayed treatment. This case report showed the importance of prompt diagnosis and treatment to minimize complications of Ramsay Hunt Syndrome.
Cutaneous lupus erythematosus (LE) encompasses a wide spectrum of dermatologic manifestations, including toxic epidermal necrolysis (TEN)-like presentations of acute or subacute cutaneous lupus erythematosus (TEN-like ACLE/SCLE). Although the clinical characteristics and histological features of these rare entities may closely mimic TEN, several subtle differences can help in differentiation between these conditions. We report a case of a patient with SCLE which developed drug unrelated TEN-like blisters after prolonged, intensive sun exposure and focus on a discussion of distinctive features that can be used to differentiate drug-induced TEN and TEN-like presentation of ACLE/SCLE.
Acne keloidalis nuchae (AKN) / folliculitis keloidalis nuchae (FKN) is a chronic inflammatory condition which involves hair follicles localized predominantly in occipital scalp and posterior neck area leading to hypertrophic scarring alopecia. We present a 59-year-old factory worker, Caucasian male with a whitish alopecic oval plaque about 10 cm in diameter in the occipital region. The peripheral part of plaque was mildly inflammated, with groups of tufted terminal hairs, while the central part showed cicatricial alopecia and discrete non-adherent dry scales. Skin changes firstly occurred 6 years earlier, as itchy papules and pustules that sometimes healed with scarring. The applied relevant diagnostic and therapeutical measures are discussed in this report.
Acne necrotica is a rare disease, characterized by repeated cropping of inflammatory papules and papulo-pustules, which rapidly necrotize and leave varying degrees of varioliform scars that may lead to cicatricial alopecia when terminal hair-bearing sites are involved. In early lesions, pathology shows necrotizing lymphocytic folliculitis. We report a 63-year-old male patient with chronic, relapsing, umbilicated and centrally necrotic erythematous papules and papulo-pustules involving the frontal hairline area, face, and neck. Histopathology showed epidermal spongiosis and lymphocytic exocytosis, extensive necrosis and destruction of the follicular epithelium, a dense diffuse lymphohistiocytic infiltrate and necrosis of the perifolicular dermis. The diagnosis of acne necrotica was made based on the correlation of clinical and histopathological findings. A complete clinical remission was achieved with topical erythromycin and benzoyl peroxide.
Introduction. Leprosy is a disease that predominantly affects the skin and peripheral nerves, resulting in neuropathy and associated long-term consequences, including deformities and disabilities. According to the WHO classification, there are two categories of leprosy, paucibacillary (PB) and multibacillary (MB). The standard treatment for leprosy employs the use of WHO MDT (Multi Drug Treatment) regimen, despite its multiple downsides such as clofazimine-induced pigmentation, dapsone-induced haematological adverse effects, poor compliance due to long therapy duration, drug resistance, and relapse. Multiple studies and case reports using ROM regimen have reported satisfactory results. Nevertheless, there are still insufficient data to elucidate the optimum dosage and duration of ROM regimen as an alternative treatment for leprosy. Previous experience from our institution revealed that ROM regimen given three times weekly resulted in a satisfactory outcome.
Case Reports. We report two cases of leprosy treated with ROM regimen from our institution. The first case was PB leprosy in a 64-year-old male who presented with a single scaly plaque with erythematous edge on the right popliteal fossa. Sensibility examination showed hypoesthesia with no peripheral nerve enlargement. Histopathological examination confirmed Borderline Tuberculoid leprosy. ROM regimen was started three times weekly for 6 weeks and the patient showed significant clinical improvement at the end of the treatment with no reaction or relapse until after 6 months after treatment. The second case was MB leprosy in a 24-year-old male patient with clawed hand on the 3rd-5th phalanges of the right hand and a hypoesthetic erythematous plaque on the forehead. Histopathology examination confirmed Borderline leprosy. The patients received ROM therapy 3 times a week with significant clinical improvement after 12 weeks.
Conclusion. ROM regimen given three times weekly for 6 weeks in PB leprosy and 12 weeks in MB leprosy resulted in a significant clinical improvement. Thus, ROM regimen could be a more effective, safer, faster alternative treatment for leprosy.
The balloon cell nevus is a rare and unusual benign melanocytic lesion characterized histologically by complete or predominant presence of balloon-cell transformed melanocytes. They represent approximately 1.7% of all melanocytic nevi. Three female patients, aged 30, 14 and 7 years, with lesions located on the back and head are included in the presented report. The dermoscopic examination revealed the repetitive dermoscopic features in all three patients: white and yellowish aggregated globules. In conclusion, balloon cell nevi are clinically indistinguishable from the common nevi. Dermoscopy can be useful in their recognition since balloon cell nevi exhibit some distinct dermoscopic features in a form of aggregated white and/or yellow globules.
Leprosy is a disease that is caused by Mycobacterium leprae which results in lots of disabilities in the patients. Leprosy is treated by multi-drug therapy regimen; however, this therapy might cause leprosy reactions in the patients. There are several types of lepromatous reaction: type 1 reaction, type 2 reaction and neuritis. Type 1 reaction mainly occurs in BB, BL and BT forms of leprosy and is characterized by exacerbation of preexisting lesions. The therapy of this reaction according to the WHO guideline is corticosteroid therapy. This article will explain several key points related to the corticosteroid therapy in leprosy reversal reactions, including the side effects and alternative therapies available.