Dermatology Research and Practice The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Pattern of Pediatric Dermatoses in a Tertiary Care Hospital of Western Nepal Mon, 09 May 2016 11:26:49 +0000 Pediatric dermatoses are one of the most common presentations in a dermatology clinic and reflect the health and hygiene status of children. The incidence and severity of these skin lesions are influenced by geographical area, seasonal and cultural factors, and socioeconomic status. This study was done to show the prevalence of different pediatric dermatoses in a tertiary care hospital of Western Nepal. Chart reviews of children aged one day to 17 years, presenting to Universal Medical College Teaching Hospital, Nepal, from 1 September 2014 to 30 august 2015, were done. Descriptive analysis and two-sided chi-square test were done. Among 23992 patients visiting the dermatology outpatient department (OPD), 5398 (22.5%) were of pediatric age groups (male/female: 1.2/1); most of them belonged to young teens and teenagers (; 61.3%). Three most common dermatoses were fungal infections (18.5%), eczema (14.4%), and acne (10.1%). Fungal infections (; 65.4%) and acne (; 51.9%) were common in males, whereas eczema (; 51.7%) was more common in females. Fungal infection (), eczema (), pigmentation disorders (), and acne () were significantly more during summer, while scabies was more in winter (). Dermatophytosis, pyoderma, and warts comprised frequently occurring fungal, bacterial, and viral infections, respectively. Yogesh Poudyal, Annu Ranjit, Santosh Pathak, and Nagendra Chaudhary Copyright © 2016 Yogesh Poudyal et al. All rights reserved. A Comparison between the Effects of Glucantime, Topical Trichloroacetic Acid 50% plus Glucantime, and Fractional Carbon Dioxide Laser plus Glucantime on Cutaneous Leishmaniasis Lesions Mon, 11 Apr 2016 13:02:25 +0000 Background. Cutaneous leishmaniasis is an endemic disease in Iran. Pentavalent antimonial drugs have been the first line of therapy in cutaneous leishmaniasis for many years. However, the cure rate of these agents is still not favorable. This study was carried out to compare the efficacies of intralesional glucantime with topical trichloroacetic acid 50% (TCA 50%) + glucantime and fractional carbon dioxide laser + glucantime in the treatment of cutaneous leishmaniasis. Methods. A total of 90 patients were randomly divided into three groups of 30 to be treated with intralesional injection of glucantime, a combination of topical TCA 50% and glucantime, or a combination of fractional laser and glucantime. The overall clinical improvement and changes in sizes of lesions and scars were assessed and compared among three groups. Results. The mean duration of treatment was weeks in all patients (range: 2–12 weeks) and , , and weeks in glucantime, topical TCA plus glucantime, and fractional laser plus glucantime groups, respectively (). Complete improvement was observed in 10 (38.5%), 27 (90%), and 20 (87%) patients of glucantime, glucantime + TCA, and glucantime + laser groups, respectively (). Conclusion. Compared to glucantime alone, the combination of intralesional glucantime and TCA 50% or fractional CO2 laser had significantly higher and faster cure rate in patients with cutaneous leishmaniasis. Fariba Jaffary, Mohammad Ali Nilforoushzadeh, Amirhossein Siadat, Elaheh Haftbaradaran, Nazli Ansari, and Elham Ahmadi Copyright © 2016 Fariba Jaffary et al. All rights reserved. Jumihaidokuto (Shi-Wei-Ba-Du-Tang), a Kampo Formula, Decreases the Disease Activity of Palmoplantar Pustulosis Sun, 10 Apr 2016 09:46:06 +0000 Palmoplantar pustulosis (PPP) is a chronic skin disease characterized by sterile intraepidermal pustules associated with erythematous scaling on the palms and soles. Jumihaidokuto is a traditional herbal medicine composed of ten medical plants and has been given to patients with suppurative skin disease in Japan. This study investigated the effect of jumihaidokuto on the disease activity in PPP patients (). PPP patients were given jumihaidokuto (EKT-6; 6.0 g per day) for 4 to 8 weeks in addition to their prescribed medications. The results showed that the palmoplantar pustular psoriasis area and severity index (PPPASI) was decreased after the administration of jumihaidokuto (). Therefore, Jumihaidokuto is seemingly effective against PPP. Megumi Mizawa, Teruhiko Makino, Chieko Inami, and Tadamichi Shimizu Copyright © 2016 Megumi Mizawa et al. All rights reserved. Altered Levels of Serum Zinc and Cadmium in Patients with Chronic Vesiculobullous Hand and Feet Dermatitis Wed, 06 Apr 2016 08:18:50 +0000 Micronutrients serve many important functions in our body and altered levels of heavy and trace metals are associated with cutaneous and systemic disorders. Vesicular palmoplantar eczema is an entity whose etiopathogenesis is a mystery. In this prospective case-noncase study blood levels of Zinc and Cadmium in 37 patients of chronic vesiculobullous hand dermatitis were estimated and compared with 40 noncases with similar age and gender distributions. Low serum Zinc levels were found in patients as compared to noncases. The mean difference of serum Zinc between the case and noncase groups was 27.26; the mean value of serum Zinc between the two groups was statistically significant (). However, elevated Cadmium levels were detected in only 5 patients and in none of the noncases. The mean concentration of serum Cadmium was  μg/dL, with a range of 1.90–2.80 μg/dL for the five cases in whom Cadmium was detected. Various toxic and trace metals can interact by influencing each other’s absorption, retention, distribution, and bioavailability in the body. The clinical significance of this finding lies in the possible beneficial role of Zinc supplementation in the therapy of chronic vesiculobullous hand dermatitis. Swastika Suvirya, Alpna Thakur, S. S. Pandey, S. K. Tripathi, and Durgesh Kumar Dwivedi Copyright © 2016 Swastika Suvirya et al. All rights reserved. Promising Option for Treatment of Striae Alba: Fractionated Microneedle Radiofrequency in Combination with Fractional Carbon Dioxide Laser Wed, 16 Mar 2016 07:40:38 +0000 Background. A consistent treatment has not been proposed for treatment of Striae Alba (SA). The present study was designed to compare the fractionated microneedle radiofrequency (FMR) alone and in combination with fractional carbon dioxide laser (FMR + CO2) in the treatment of SA. Methods. Forty-eight pairs of SA from six patients were selected. Right or left SAs were randomly assigned to one of the treatment groups. The surface area of the SA before and after treatment and clinical improvement using a four-point scale were measured at the baseline, after one and three months. Results. The mean age of the patients was years. The mean difference of the surface area between pre- and posttreatment in the FMR + CO2 group was significantly higher than that in the FMR group (). Clinical improvement scales showed significantly higher improvement in the FMR + CO2 group than in the FMR group in the first and second follow-up ( and 0.004, resp.). There were no major persistence side-effects in both groups. Conclusions. The results showed that FMR + CO2 laser was more effective than FMR alone in the treatment of SA. Farahnaz Fatemi Naeini, Shadi Behfar, Bahareh Abtahi-Naeini, Shima Keyvan, and Mohsen Pourazizi Copyright © 2016 Farahnaz Fatemi Naeini et al. All rights reserved. Effects of Topical Emu Oil on Burn Wounds in the Skin of Balb/c Mice Wed, 16 Mar 2016 07:13:54 +0000 The goal of this study was to determine the effect of topical Emu oil on the healing of burn wounds and hair follicle restoration in superficial II-degree burns in the skin of Balb/c mice. Thirty-two male Balb/c mice with burns on the back of the neck were divided into two groups: The Emu oil group received topical Emu oil twice daily, whereas the control was left untreated. Skin biopsies were obtained on days 4, 7, 10, and 14 of the experiment. Then the specimens were viewed with Olympus SZX research microscope. The Emu oil treated burns were found to heal more slowly and inflammation lasted longer in this group. The number of hair follicles in the margins of the wounds increased through time in the Emu oil group compared to the control group. Also, the hair follicles in the Emu oil group were in several layers and seemed to be more active and mature. Moreover, Emu oil had a positive effect on fibrogenesis and synthesis of collagen. The findings indicate that although Emu oil delays the healing process, it has a positive effect on wound healing and it increases the number of hair follicles in the margins of the wound. Mohammad Afshar, Reza Ghaderi, Mahmoud Zardast, and Parvin Delshad Copyright © 2016 Mohammad Afshar et al. All rights reserved. Production of a Self-Aligned Scaffold, Free of Exogenous Material, from Dermal Fibroblasts Using the Self-Assembly Technique Wed, 09 Mar 2016 14:35:21 +0000 Many pathologies of skin, especially ageing and cancer, involve modifications in the matrix alignment. Such tissue reorganization could have impact on cell behaviour and/or more global biological processes. Tissue engineering provides accurate study model by mimicking the skin and it allows the construction of versatile tridimensional models using human cells. It also avoids the use of animals, which gave sometimes nontranslatable results. Among the various techniques existing, the self-assembly method allows production of a near native skin, free of exogenous material. After cultivating human dermal fibroblasts in the presence of ascorbate during two weeks, a reseeding of these cells takes place after elevation of the resulting stroma on a permeable ring and culture pursued for another two weeks. This protocol induces a clear realignment of matrix fibres and cells parallel to the horizon. The thickness of this stretched reconstructed tissue is reduced compared to the stroma produced by the standard technique. Cell count is also reduced. In conclusion, a new, easy, and inexpensive method to produce aligned tissue free of exogenous material could be used for fundamental research applications in dermatology. Stéphane Chabaud and Stéphane Bolduc Copyright © 2016 Stéphane Chabaud and Stéphane Bolduc. All rights reserved. Methylchloroisothiazolinone/Methylisothiazolinone and Methylisothiazolinone Sensitivity in Hungary Mon, 07 Mar 2016 14:36:30 +0000 Background. Due to allowing of methylisothiazolinone (MI) in cosmetics, cleaning products, and paints, an epidemic of MI-hypersensitivity emerged. Patch testing Kathon CG® (3:1 mixture of methylchloroisothiazolinone and methylisothiazolinone, MCI/MI) does not correctly detect MI contact allergy, due to the low concentration of MI in the test material. Methods. A retrospective survey was performed to estimate the prevalence of MCI/MI hypersensitivity in 14693 patients tested consecutively between 1993 and 2014. Moreover, currently 314 patients were prospectively tested with the allergens MCI/MI and with MI during one year. Results. MCI/MI hypersensitivity increased retrospectively from 0.5% to 6.0%. By current prospective testing we detected 25 patients (8%) with MCI/MI and/or MI positive reactions. Out of the 25 patients 10 were only MCI/MI positive, 9 were only MI positive, and 6 were MCI/MI and MI positive. If MI had not been tested separately, MI contact allergy would have missed in 36% of all detected cases and in 2.8% of the total 314 patients. Conclusions. The frequency of MCI/MI hypersensitivity is increasing also in Hungary. We confirm that, in order to detect MI contact allergy, it needs to be tested separately. A further increase of MI hypersensitivity might be expected in the future as products containing MI are still widely available. Györgyi Pónyai, Ilona Németh, and Erzsébet Temesvári Copyright © 2016 Györgyi Pónyai et al. All rights reserved. Clinicoepidemiological Study of Different Types of Warts Mon, 07 Mar 2016 12:54:15 +0000 Background. Warts are cutaneous and, sometimes, mucosal lesions caused by one of the several human papilloma viruses. Aim. Assessment of the clinicoepidemiological aspects of warts. Materials and Methods. One hundred consecutive patients of warts presenting to the department of our institution were assigned two broad locational groups: genital and nongenital warts, the latter subdivided into common, plane, palmoplantar, mosaic, and digitate/filiform. Results. Ninety had nongenital and 10 had genital warts in our study; common (42%), palmoplantar (20%), and plane (18%) were the common types of the nongenital warts. All the genital warts were acuminate. In the second decade, the commonest age group, encompassed all patients of mosaic, 40% of palmoplantar, and 20% of genital warts. Overall male (66%) preponderance xisted. All cases of filiform warts were males. Mosaic warts affected females more commonly. Students (32%), laborers (28%), and housewives (16%) were the usual occupations. Cosmetic concern (92%), pain (16%), and itching (15%) were the common complaints. All patients of genital warts sought treatment within 6 months. Conclusions. Common, palmoplantar, and plane warts were the common types of nongenital warts. Overall prevalence peaked during the second decade but one-third of the cases of plane warts occurred during the first. Extremities were the most common sites (66.7%); face was the next commonly (23%) involved. Shruti S. Ghadgepatil, Sanjeev Gupta, and Yugal K. Sharma Copyright © 2016 Shruti S. Ghadgepatil et al. All rights reserved. Cutaneous Side Effects of BRAF Inhibitors in Advanced Melanoma: Review of the Literature Thu, 03 Mar 2016 13:17:18 +0000 The incidence of melanoma has recently been increasing. BRAF mutations have been found in 40–60% of melanomas. The increased activity of BRAF V600E leads to the activation of downstream signaling through the mitogen-activated protein kinase (MAPK) pathway, which plays a key role as a regulator of cell growth, differentiation, and survival. The use of BRAF inhibitors in metastatic melanoma with BRAF mutation ensures clinical improvement of the disease. Vemurafenib and dabrafenib are two selective BRAF inhibitors approved by the Food and Drug Administration (FDA). Both drugs are well tolerated and successfully used in clinical practice. However, some adverse reactions have been reported in patients in the course of treatment. Cutaneous side effects are the most common adverse events among them with a broad spectrum. Both the case reports and several original clinical trials reported cutaneous reactions during the treatment with BRAF inhibitors. In this review, the common cutaneous side effects of BRAF inhibitors in the treatment of metastatic melanoma with BRAF V600E mutation were reviewed. Bilgen Gençler and Müzeyyen Gönül Copyright © 2016 Bilgen Gençler and Müzeyyen Gönül. All rights reserved. Macular Amyloidosis and Epstein-Barr Virus Sun, 14 Feb 2016 11:08:33 +0000 Background. Amyloidosis is extracellular precipitation of eosinophilic hyaline material of self-origin with special staining features and fibrillar ultrastructure. Macular amyloidosis is limited to the skin, and several factors have been proposed for its pathogenesis. Detection of Epstein-Barr virus (EBV) DNA in this lesion suggests that this virus can play a role in pathogenesis of this disease. Objective. EBV DNA detection was done on 30 skin samples with a diagnosis of macular amyloidosis and 31 healthy skin samples in the margin of removed melanocytic nevi by using PCR. Results. In patients positive for beta-globin gene in PCR, BLLF1 gene of EBV virus was positive in 23 patients (8 patients in case and 15 patients in the control group). There was no significant difference in presence of EBV DNA between macular amyloidosis (3.8%) and control (23.8%) groups (). Conclusion. The findings of this study showed that EBV is not involved in pathogenesis of macular amyloidosis. Yalda Nahidi, Naser Tayyebi Meibodi, Zahra Meshkat, and Narges Nazeri Copyright © 2016 Yalda Nahidi et al. All rights reserved. Leprosy Continues to Occur in Hilly Areas of North India Sun, 24 Jan 2016 13:09:00 +0000 Background. The aim of present study was to describe the profile of leprosy patients attending the outpatient department of dermatology in tertiary care hospital in Srinagar, Uttarakhand, North India. Methodology. This descriptive retrospective study. Patient data at the time of diagnosis were retrieved onto a predesigned proforma, which concerned the following variables at the time of registration: age, sex, and residence. Newly registered outpatients leprosy cases between 2009 and 2014 were included in the study. Results. It was found that 65 were multibacillary leprosy cases. Males constituted 62.8% of all leprosy cases. The majority (83.7%) belonged to the age group of 18–60 years. Of the total 48.8% of the new leprosy cases were from the Pauri district. The leprosy incidence rate in this population was 2.71 per 1000 patients. Conclusion. Leprosy still continues to be a communicable disease of concern. The lower incidence in women and children provokes the need to strengthen contact screening, early case detection, and referral activities in the population to sustain elimination. Deepak Dimri, Arti Gupta, and Amit Kumar Singh Copyright © 2016 Deepak Dimri et al. All rights reserved. Clinicoepidemiological Observational Study of Acquired Alopecias in Females Correlating with Anemia and Thyroid Function Wed, 20 Jan 2016 09:44:14 +0000 Alopecia can either be inherited or acquired; the latter, more common, can be diffuse, patterned, and focal, each having cicatricial and noncicatricial forms. This observational study of 135 cases in a semiurban Indian population aimed to detect the prevalence of various forms of acquired alopecia in females and correlate the same with levels of hemoglobin, serum ferritin, triiodothyronine, thyroxin, and thyroid stimulating hormone. The majority (84, 62.2%) of our cases of alopecia had telogen effluvium followed by female pattern alopecia (32, 23.7%). Stress (86, 63.7%), topical application of chemicals (72, 53.3%), systemic medications for concurrent illnesses (62, 5%), and pregnancy (14, 10.3%) were the common exacerbating factors. Neither low hemoglobin (<12 gm%, 73.4%) nor low serum ferritin (<12 μg/L, 6.7%) was found to be statistically significant. A majority (90, 90.9%) of 99 cases with anemia (hemoglobin levels of <12 gm%) had serum ferritin levels >12 μg/L. Though lack of vitamin B12 testing was a limitation of our study, its deficiency could be the probable cause of iron deficiency as the majority (58, 64.4%) of these cases, as indeed majority (89, 65.4%) of our study population, were vegetarians. Thyroid disorders (23, 17%, including 9 newly diagnosed) were not of significance statistically. Kirti Deo, Yugal K. Sharma, Meenakshi Wadhokar, and Neha Tyagi Copyright © 2016 Kirti Deo et al. All rights reserved. Skin Protection Behaviors among Young Male Latino Day Laborers: An Exploratory Study Using a Social Cognitive Approach Mon, 04 Jan 2016 09:02:05 +0000 Latino Day Laborers (LDLs) are employed in occupations where multiple work hazards exist. One such hazard is the overexposure to solar ultraviolet radiation for continuous periods of time. Regular sun exposure can put individuals at increased risk of developing skin cancers, especially without adequate protection. The purpose of this cross-sectional exploratory study was to use a social cognitive framework to assess skin protective behaviors among LDLs. A community-based nonrandom and purposive sample of LDLs was recruited in two states: Mississippi and Illinois. The study sample consisted of 137 male participants, of which the majority were of Mexican ancestry (72%). The average age was 35.40 () years. Results demonstrated that a substantial number of LDLs do not adequately practice sun protection behaviors on a regular basis. The skin cancer knowledge scores were very modest. The most frequently indicated barriers towards sun protection were “inconvenient,” “forget to use,” and “not being able to reapply sunscreen.” Overall, LDLs had moderate confidence in their abilities to adopt successful sun protection strategies. This study underscores the need for intervention programs aimed at LDLs to reduce extended time in the sun and increase use of sun protective measures when working outdoors. Javier F. Boyas, Vinayak K. Nahar, and Robert T. Brodell Copyright © 2016 Javier F. Boyas et al. All rights reserved. Cryoglobulinaemia in Egyptian Patients with Extrahepatic Cutaneous Manifestations of Chronic Hepatitis C Virus Infection Tue, 29 Dec 2015 12:35:41 +0000 Background. Hepatitis C is a global major health problem with extremely variable extrahepatic manifestations. Mixed cryoglobulinaemia (MC) shows a striking association with hepatitis C virus (HCV) infection, and it is sometimes asymptomatic. The skin is a frequently involved target organ in MC. Objective. To investigate the prevalence of cryoglobulinaemia in a sample of Egyptian patients with cutaneous manifestations of chronic HCV infection and to correlate its presence with clinical criteria and liver function tests. Methods. One hundred and eighteen patients with skin manifestations of chronic compensated hepatitis C were included. Venous blood was tested for liver function tests and serum cryoglobulins. Results. Twelve patients (10.169%) were positive for serum cryoglobulins (2 with pruritus, 4 with vasculitic lesions, 3 with livedo reticularis, one with oral lichen, one with chronic urticaria, and another with Schamberg’s disease). Vasculitic lesions and livedo reticularis of the legs showed higher prevalence in cryoglobulin-positive than in cryoglobulin-negative patients. Presence of serum cryoglobulins did not relate to patients’ demographic or laboratory findings. Conclusions. Fortunately, MC is not markedly prevalent among Egyptians with cutaneous lesions of chronic hepatitis C, and cryopositivity was commonly, but not exclusively, detected with cutaneous vasculitis and livedo reticularis. Laboratory testing for cryoglobulins in every HCV patient is advisable for earlier MC detection and management. Doaa Salah Hegab and Mohammed Abd El Rahman Sweilam Copyright © 2015 Doaa Salah Hegab and Mohammed Abd El Rahman Sweilam. All rights reserved. Evaluation of Subcision for the Correction of the Prominent Nasolabial Folds Wed, 16 Dec 2015 11:31:54 +0000 Background. A prominent nasolabial fold (NLF) is a cosmetic problem. Currently, numerous therapeutic modalities are available for pronounced NLFs with variable efficacy. Objective. To determine the efficacy and safety of subcision using a hypodermic needle for the correction of the prominent NLFs and its effect on skin elasticity. Methods. Sixteen patients with prominent NLFs underwent subcision. The investigators’ assessment of improvement and the patients’ satisfaction were both recorded 1 and 6 months after the procedure. Also, we evaluate the skin elasticity of NLFs before and after the treatment using a sensitive biometrologic device with the measurement of cutaneous resonance running time (CRRT). Results. Thirteen (81.25%) patients showed a moderate improvement at 1st month and 13 (81.25%) patients had at least a mild improvement at 6th month. There was no persistent side effect lasting more than a few days. Mean CRRT at 1 and 6 months after the treatment was significantly higher compared to the baseline. Conclusion. Subcision may be considered effective for the correction of pronounced NLFs. However, further controlled studies with larger sample size are necessary to assess the efficacy of this technique in particular with use of more objective assessment of skin biometric characteristics. This trial is registered with IRCT201108097270N1 (registered on January 27, 2012). R. M. Robati, F. Abdollahimajd, and A. M. Robati Copyright © 2015 R. M. Robati et al. All rights reserved. Decreased Circulating T Regulatory Cells in Egyptian Patients with Nonsegmental Vitiligo: Correlation with Disease Activity Tue, 15 Dec 2015 12:54:12 +0000 Background. Vitiligo is an acquired depigmentary skin disorder resulting from autoimmune destruction of melanocytes. Regulatory T cells (Tregs), specifically CD4+CD25+ and Forkhead box P3+ (FoxP3+) Tregs, acquired notable attention because of their role in a variety of autoimmune pathologies. Dysregulation of Tregs may be one of the factors that can break tolerance to melanocyte self-antigens and contribute to vitiligo pathogenesis. Methods. In order to sustain the role of Tregs in pathogenesis and disease activity of vitiligo, surface markers for CD4+CD25+ and FoxP3+ peripheral Tregs were evaluated by flow cytometry in 80 Egyptian patients with nonsegmental vitiligo in addition to 60 healthy control subjects and correlated with clinical findings. Results. Vitiligo patients had significantly decreased numbers of both peripheral CD4+CD25+ and FoxP3+ T cells compared to control subjects (11.49%  ± 8.58% of CD4+ T cells versus 21.20%  ± 3.08%, and 1.09%  ± 0.96% versus 1.44%  ± 0.24%, resp., for both). Peripheral numbers of CD4+CD25+ and FoxP3+ Tregs correlated negatively with VIDA score. Conclusion. Treg depletion with impaired immune downregulatory function might play a key role in the autoimmune conditions beyond nonsegmental vitiligo particularly in active cases. Effective Treg cell-based immunotherapies might be a future hope for patients with progressive vitiligo. Doaa Salah Hegab and Mohamed Attia Saad Attia Copyright © 2015 Doaa Salah Hegab and Mohamed Attia Saad Attia. All rights reserved. Clinical Features and Drug Characteristics of Patients with Generalized Fixed Drug Eruption in the West of Iran (2005–2014) Thu, 10 Dec 2015 13:36:42 +0000 Background. Generalized fixed drug eruption is a specific variant of fixed drug eruption with multifocal lesions. Diagnosis of this drug reaction is straightforward, but occasionally recognition of the causative drug is not possible. This study was aimed at evaluating the clinical features and culprit drugs in generalized fixed drug eruptions in the west of Iran. Method. This cross-sectional study was carried out on 30 patients with criteria of generalized fixed drug eruption over 9 years. Demographic, clinical, and drug intake information were collected. Results. Out of 30 patients (17 females and 13 males) with the mean age of years, 28 (93.3%) and 2 (6.7%) cases had plaque and bullous clinical presentation, respectively. Upper limbs were the most common (90%) site of involvement. The antibiotic group, especially cotrimoxazole (26.1%), was reported to be the most common offending drug, but the causative drug was not determined in 7 (23.3%) patients. Conclusion. Many cases of generalized fixed drug eruption firstly presented as limited lesions and led to generalized lesion due to repeated intake of the causative drug. No causative drug was found in some patients, which might be associated with concurrent intake of several drugs, multiple FDE, and peculiarity of the patch test. Hossein Kavoussi, Mansour Rezaei, Katayoun Derakhshandeh, Alireza Moradi, Ali Ebrahimi, Harif Rashidian, and Reza Kavoussi Copyright © 2015 Hossein Kavoussi et al. All rights reserved. Five-Year Retrospective Review of Acute Generalized Exanthematous Pustulosis Thu, 10 Dec 2015 13:07:35 +0000 Background. Acute generalized exanthematous pustulosis (AGEP) is an acute pustular eruption characterized by widespread nonfollicular sterile pustules. The aim of this study is to characterize the etiology, clinical features, laboratory findings, management, and outcome of patients with AGEP in Asians. Patient/Methods. A retrospective analysis was performed on patient who presented with AGEP between August 2008 and November 2012 in a tertiary center in Thailand. Results. Nineteen patients with AGEP were included. AGEP was generally distributed in seventeen patients (89.5%) and localized in two (10.5%). Fever and neutrophilia occurred in 52.6% and 68.4%, respectively. Hepatitis was found up to 26.3%. The most common etiology was drugs (94.7%), comprising of antibiotics (73.6%), proton pump inhibitors (10.5%), nonsteroidal anti-inflammatory drugs (5.3%), and herbal medicine (5.3%). Beta-lactams were the most common causal drug, particularly carbapenems and cephalosporins. This is the first report of Andrographis paniculata as an offending agent for AGEP. We found no differences between various treatment regimens (topical corticosteroid, systemic corticosteroid, and supportive treatment) regarding the time from drug cessation to pustules resolution (). Conclusions. We have highlighted the presentation of AGEP among Asians. We found high association with systemic drugs. Carbapenems were one of the leading culprit drugs. Finally, a localized variant was observed. Chitprapassorn Thienvibul, Vasanop Vachiramon, and Kumutnart Chanprapaph Copyright © 2015 Chitprapassorn Thienvibul et al. All rights reserved. Relationship between Vitamin D Status and Striae Distensae: A Case-Referent Study Mon, 09 Nov 2015 09:33:41 +0000 Vitamin D (VD) plays a role in the skin regulation. Striae Distensae (SD) are manifestations of epidermal atrophy that occurs after tissue tearing due to overstretching or rapid growth. The objective of this study was to investigate the relation between serum VD and occurrence of SD in women who had undergone mammaplasty with silicone implants. A case-referent study was conducted. The blood values of 25-hydroxyvitamin D (25OHD) were measured before the surgery. For each patient postoperatively diagnosed with SD, four other participants submitted to the same surgery, without the development of SD, were enrolled as the healthy controls. 67 women with SD after the surgery entered the study. 268 formed the control group. In the serum of healthy controls 25OHD mean was 27 ng/mL, and SD cases presented 20 ng/mL (). Scarce values of VD have been observed in 56.71% of the cases presenting SD and in 39.91% without SD (). Chance of having VD values lower than 20 ng/mL amongst cases with SD is 2.38 (). Lower serum levels of VD are linked to a higher occurrence of SD. Rafaela Koehler Zanella, Denis Souto Valente, Leo Francisco Doncatto, Daniele Dos Santos Rossi, Aline Grimaldi Lerias, and Alexandre Vontobel Padoin Copyright © 2015 Rafaela Koehler Zanella et al. All rights reserved. Epidemiological, Clinical, and Paraclinic Aspect of Cutaneous Sarcoidosis in Black Africans Sun, 08 Nov 2015 06:42:46 +0000 The specific objectives were to identify the epidemiology of cutaneous sarcoidosis and describe the clinical and laboratory aspects of the disease. Materials and Methods. We performed a descriptive cross-sectional study involving 24 referred cases of cutaneous sarcoidosis in 25 years (1990–2014) collected at Venereology Dermatology Department of the University Hospital of Treichville (Abidjan) both in consultation and in hospitalization. Results. The hospital frequency was one case per year. The average age was 42 years, ranging from 9 to 64. The sex ratio was 1. The shortest time interval between the appearance of the skin lesion and consultation of Dermatology Department at CHU Treichville was 3 months. The elementary lesions were represented primarily by a papule (18 cases), placard (3 cases), and nodule (2 cases) and mainly sat on the face and neck in 8 cases (38%). Extra cutaneous lesions were dominated by ganglion and respiratory involvement with 5 cases each followed by musculoskeletal damage in 3 cases. Chest radiography showed abnormality in 13 cases (54%). The pulmonary function test performed in 13 patients found 7 cases (54%) having restrictive ventilatory syndrome and 6 cases (46%) being normal. A tuberculin anergy was found in 11 cases (61%). Mamadou Kaloga, Ildevert Patrice Gbéry, Vagamon Bamba, Yao Isidore Kouassi, Elidjé Joseph Ecra, Almamy Diabate, Sarah Kourouma, Kouadio Celestin Ahogo, Kouassi Alexandre Kouamé, Komenan Kassi, Kanga Kouame, and Abdoulaye Sangaré Copyright © 2015 Mamadou Kaloga et al. All rights reserved. Is There Really Relationship between Androgenetic Alopecia and Metabolic Syndrome? Wed, 04 Nov 2015 12:08:52 +0000 Background. There are several studies investigating the relationship between androgenetic alopecia (AGA) and metabolic syndrome (MS) with conflicting results. Objective. We sought to investigate whether there is a relationship between AGA and MS. Methods. A case-control study including 74 male patients with AGA and 42 male controls was conducted. Age, duration of AGA, AGA onset age, anthropometric measures, body mass index, lipid parameters, fasting blood glucose, blood pressure, and presence of MS were recorded. Results. Of the 74 male AGA patients (age range 20–50 years, mean 32.14), 24 were in stage 2, 26 were in stage 3, 17 were in stage 3V, 1 was in stage 5, and 6 were in stage 7. There was no significant difference in the rate of MS between AGA and control groups . Among the evaluated parameters, only systolic blood pressure in AGA group was significantly higher than control group. Conclusion. In contrast to the most of the previous studies, our study does not support the link between AGA and MS. To exclude confounding factors such as advanced age and therefore metabolic disturbances, further studies are needed with large group of AGA patients including different age groups and varying severity. Seyran Ozbas Gok, Asli Akin Belli, and Emine Dervis Copyright © 2015 Seyran Ozbas Gok et al. All rights reserved. Dermatological Diseases Associated with Pregnancy: Pemphigoid Gestationis, Polymorphic Eruption of Pregnancy, Intrahepatic Cholestasis of Pregnancy, and Atopic Eruption of Pregnancy Mon, 02 Nov 2015 12:32:00 +0000 Dermatoses unique to pregnancy are important to recognize for the clinician as they carry considerable morbidity for pregnant mothers and in some instances constitute a risk to the fetus. These diseases include pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. This review discusses the pathogenesis, clinical importance, and management of the dermatoses of pregnancy. Christine Sävervall, Freja Lærke Sand, and Simon Francis Thomsen Copyright © 2015 Christine Sävervall et al. All rights reserved. Effect of Narrow-Band Ultraviolet B Phototherapy and Methotrexate on MicroRNA (146a) Levels in Blood of Psoriatic Patients Thu, 29 Oct 2015 06:54:48 +0000 Background. Recently, some miRNAs have been proven to show aberrant expression in psoriasis and play a role in the pathogenesis of the disease. Objective. To find out whether NB-UVB or methotrexate treatment affects whole blood levels of human miRNA (146a) in patients with psoriasis and demonstrate its correlation with disease severity. Methods. Blood samples were obtained from healthy control and from psoriatic patients before and 12 weeks after treatment with NB-UVB, methotrexate. Quantification of human miRNA (146a) by Real Time PCR (RT-PCR). Results. Blood human miRNA (146a) levels were higher in patients with psoriasis than those in healthy controls (); it had no significant positive relation with PASI scores in patients (, ). Real Time PCR showed that, after 12 weeks of treatment with NB-UVB phototherapy or treatment with methotrexate, there was significantly decreased level of miR146a (; , resp.). Conclusion. The expression of miRNA146a is increased in whole blood samples from psoriasis patients, so we can evaluate its possibility to work as a future therapeutic objective in the treatment of psoriasis. With these markers, it is able to screen therapeutics effect or changes to a further aggressive treatment for psoriasis. Asmaa M. Ele-Refaei and Fatma M. El-Esawy Copyright © 2015 Asmaa M. Ele-Refaei and Fatma M. El-Esawy. All rights reserved. Exploring the Physiological Link between Psoriasis and Mood Disorders Thu, 15 Oct 2015 13:16:57 +0000 Psoriasis is a chronic, immune-mediated skin condition with a high rate of psychiatric comorbidity, which often goes unrecognized. Beyond the negative consequences of mood disorders like depression and anxiety on patient quality of life, evidence suggests that these conditions can worsen the severity of psoriatic disease. The mechanisms behind this relationship are not entirely understood, but inflammation seems to be a key feature linking psoriasis with mood disorders, and physiologic modulators of this inflammation, including the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, demonstrate changes with psychopathology that may be contributory. Cyclical disruptions in the secretion of the sleep hormone, melatonin, are also observed in both depression and psoriasis, and with well-recognized anti-inflammatory and antioxidant activity, this aberration may represent a shared contributor to both conditions as well as common comorbidities like diabetes and cardiovascular disease. While understanding the complexities of the biological mechanisms at play will be key in optimizing the management of patients with comorbid psoriasis and depression/anxiety, one thing is certain: recognition of psychiatric comorbidity is an imperative first step in effectively treating these patients as a whole. Evidence that improvement in mood decreases psoriasis severity underscores how psychological awareness can be critical to clinicians in their practice. Cody J. Connor, Vincent Liu, and Jess G. Fiedorowicz Copyright © 2015 Cody J. Connor et al. All rights reserved. Leprosy Reaction in Thai Population: A 20-Year Retrospective Study Mon, 05 Oct 2015 06:31:09 +0000 Background. Leprosy is a chronic infectious disease that presents with varying dermatological and neurological symptoms. The leprosy reactions occur over the chronic course of the disease and lead to extensive disability and morbidity. Objective. To analyze and identify the risk factors which contribute to leprosy reactions. Methods. In a retrospective study, we reviewed the medical records of leprosy patients registered at the leprosy clinic, Ramathibodi Hospital, Thailand, between March 1995 and April 2015. One hundred and eight patients were included; descriptive analysis was used for baseline characteristics and a binary logistic regression model was applied for identifying risk factors correlated with leprosy reactions. Results. Of the 108 cases analyzed, 51 were male and 57 were female. The mean age of presentation was 45 years. The borderline tuberculoid type was the most common clinical form. Leprosy reactions were documented in 61 cases (56.5%). The average time to reaction was 8.9 months. From multivariate analysis, risk factors for leprosy reactions were being female, positive bacillary index status, and MB treatment regimen. Conclusions. Leprosy reactions are common complications in leprosy patients. Being female, positive bacillary index status, and multibacillary treatment regimen are significantly associated with the reactions. Early detection in cases with risk factors followed by appropriate treatment could prevent the morbidity of leprosy patients. Poonkiat Suchonwanit, Siripich Triamchaisri, Sanchawan Wittayakornrerk, and Ploysyne Rattanakaemakorn Copyright © 2015 Poonkiat Suchonwanit et al. All rights reserved. Study of the Etiological Causes of Toe Web Space Lesions in Cairo, Egypt Mon, 21 Sep 2015 12:29:48 +0000 Background. The etiology of foot intertrigo is varied. Several pathogens and skin conditions might play a role in toe web space lesions. Objective. To identify the possible etiological causes of toe web space lesions. Methods. 100 Egyptian patients were enrolled in this study (72 females and 28 males). Their ages ranged from 18 to 79 years. For every patient, detailed history taking, general and skin examinations, and investigations including Wood’s light examination, skin scraping for potassium hydroxide test, skin swabs for bacterial isolation, and skin biopsy all were done. Results. Among the 100 patients, positive Wood’s light fluorescence was observed in 24 and positive bacterial growth was observed in 85. With skin biopsy, 52 patients showed features characteristic for eczema, 25 showed features characteristic for fungus, 19 showed features characteristic for callosity, and 3 showed features characteristic for wart while in only 1 patient the features were characteristic for lichen planus. Conclusion. Toe web space lesions are caused by different etiological factors. The most common was interdigital eczema (52%) followed by fungal infection (25%). We suggest that patients who do not respond to antifungals should be reexamined for another primary or secondary dermatologic condition that may resemble interdigital fungal infection. Hussein Mohamed Hassab-El-Naby, Yasser Fathy Mohamed, Hamed Mohamed Abdo, Mohamed Ismail Kamel, Wael Refaat Hablas, and Osama Khalil Mohamed Copyright © 2015 Hussein Mohamed Hassab-El-Naby et al. All rights reserved. Some Epidemiological Aspects of Cutaneous Leishmaniasis in a New Focus, Central Iran Mon, 21 Sep 2015 08:42:57 +0000 Following the epidemic of cutaneous leishmaniasis in Khatam County, Yazd Province, this study was carried out to determine vector, and animal reservoir host(s) and investigate the human infection during 2005-2006. Four rural districts where the disease had higher prevalence were selected. Sticky paper traps were used to collect sand flies during April to November, biweekly. Meanwhile rodents were captured using Sherman traps from August to November. Households and primary schools were visited and examined for human infection in February 2006. The parasite was detected by RAPD-PCR method. The rate of ulcers and scars among the inhabitants was 4.8% and 9.8%, respectively. Three rodent species were captured during the study: Meriones libycus, Rhombomys opimus, and Tatera indica. Six sand fly species were also collected and identified; among them Phlebotomus papatasi had the highest frequency. Leishmania major was detected as the agent of the disease in the area. It was detected from R. opimus and native people. M. R. Yaghoobi-Ershadi, N. Marvi-Moghadam, R. Jafari, A. A. Akhavan, H. Solimani, A. R. Zahrai-Ramazani, M. H. Arandian, and A. R. Dehghan-Dehnavi Copyright © 2015 M. R. Yaghoobi-Ershadi et al. All rights reserved. Actinic Keratosis Clinical Practice Guidelines: An Appraisal of Quality Wed, 16 Sep 2015 09:25:00 +0000 Actinic keratosis (AK) is a common precancerous skin lesion and many AK management guidelines exist, but there has been limited investigation into the quality of these documents. The objective of this study was to assess the strengths and weaknesses of guidelines that address AK management. A systematic search for guidelines with recommendations for AK was performed. The Appraisal of Guidelines for Research and Evaluation (AGREE II) was used to appraise the quality of guidelines. Multiple raters independently reviewed each of the guidelines and applied the AGREE II tool and scores were calculated. Overall, 2,307 citations were identified and 7 fulfilled the study criteria. The Cancer Council of Australia/Australian Cancer Network guideline had the highest mean scores and was the only guideline to include a systematic review, include an evidence rating for recommendations, and report conflicts of interest and funding sources. High-quality, effective guidelines are evidence-based with recommendations that are concise and organized, so practical application is facilitated. Features such as concise tables, pictorial diagrams, and explicit links to evidence are helpful. However, the rigor and validity of some guidelines were weak. So, it is important for providers to be aware of the features that contribute to a high-quality, practical document. Joslyn S. Kirby, Thomas Scharnitz, Elizabeth V. Seiverling, Hadjh Ahrns, and Sara Ferguson Copyright © 2015 Joslyn S. Kirby et al. All rights reserved. Collagen and Elastic Fiber Content Correlation Analysis between Horizontal and Vertical Orientations of Skin Samples of Human Body Mon, 14 Sep 2015 11:20:49 +0000 Background. Unequal distribution of dermal collagen and elastic fibers in different orientations of skin is reported to be one of the multifocal causes of scar related complications. Present study is to understand the correlation pattern between collagen in horizontal () and in vertical () directions as well as that of elastic in horizontal () and vertical () directions. Materials and Method. A total of 320 skin samples were collected in two orientations from suprascapular, anterior chest, lateral chest, anterior abdominal wall, and inguinal regions of 32 human cadavers. Spearman correlation coefficient (r) was calculated between the variables (, , , and ). Results. Significant positive correlation between and , and between and observed in all 5 areas tested. A negative correlation between and at suprascapular, lateral chest, and inguinal regions and negative correlation between and at anterior chest and anterior abdominal wall have been identified. Conclusion. Knowledge of asymmetric content of dermal collagen and elastic fibers together with the varied strength and degree of association in the given area provides guidelines to the dermatologists and aesthetic surgeons in placing elective incisions in the direction maximally utilizing the anatomical facts for aesthetically pleasing result. Naveen Kumar, Pramod Kumar, Satheesha Nayak Badagabettu, Ranjini Kudva, Sudarshan Surendran, and Murali Adiga Copyright © 2015 Naveen Kumar et al. All rights reserved.