Dermatology Research and Practice The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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. A Comparative Study Examining the Management of Bowen’s Disease in the United Kingdom and Australia Wed, 09 Sep 2015 06:44:37 +0000 Background and Aim. The optimum management of Bowen’s Disease (BD) is undefined. A review of current practice is required to allow the development of best practice guidelines. Methods. All BD cases, diagnosed in one UK centre and one Australian centre over a year (1 July 2012–30 June 2013), were analysed retrospectively. Patients with BD were identified from histopathology reports and their medical records were analysed to collect demographic data, site of lesion, and treatment used. Results. The treatment of 155 lesions from the UK centre and 151 lesions from the Australian centre was analysed. At both centres BD was most frequently observed on the face: UK had 70 (45%) lesions and Australia had 83 (55%) lesions (). The greatest number of lesions was managed by the plastic surgery department in the UK centre, 72 (46%), and the dermatology department in the Australian centre, 121 (80%). The most common therapy was surgical excision at both centres. Conclusions. In both UK and Australia, BD arises on sun-exposed sites and was most commonly treated with surgical excision despite a lack of robust evidence-based guidelines. G. L. Morley, J. H. Matthews, I. Verpetinske, and G. A. Thom Copyright © 2015 G. L. Morley et al. All rights reserved. Sun Protection Behaviors Associated with Self-Efficacy, Susceptibility, and Awareness among Uninsured Primary Care Patients Utilizing a Free Clinic Sun, 06 Sep 2015 11:34:14 +0000 Background. Skin cancer is the most commonly diagnosed form of cancer in the United States (US). However, knowledge, behaviors, and attitudes regarding sun protection vary among the general population. The purpose of this study is to examine sun protection behaviors of low-income primary care patients and assess the association between these health behaviors and the self-efficacy, susceptibility, and skin cancer awareness. Methods. Uninsured primary care patients utilizing a free clinic () completed a self-administered survey in May and June 2015. Results. Using sunscreen was the least common tactic among the participants of this study. Skin cancer awareness and self-efficacy are important to improve sun protection behaviors. Spanish speakers may have lower levels of skin care awareness compared to US born and non-US born English speakers. Male and female participants use different sun protection methods. Conclusion. It is important to increase skin cancer awareness with self-efficacy interventions as well as education on low-cost sun protection methods. Spanish speaking patients would be a target population for promoting awareness. Male and female patients would need separate gender-specific sun protection education. Future studies should implement educational programs and assess the effectiveness of the programs to further promote skin cancer prevention among underserved populations. Akiko Kamimura, Maziar M. Nourian, Jeanie Ashby, Ha Ngoc Trinh, Jennifer Tabler, Nushean Assasnik, and Bethany K. H. Lewis Copyright © 2015 Akiko Kamimura et al. All rights reserved. Comment on “Metabolic Changes and Serum Ghrelin Level in Patients with Psoriasis” Wed, 22 Apr 2015 09:02:04 +0000 Mehmet Agilli, Fevzi Nuri Aydin, Tuncer Cayci, and Yasemin Gulcan Kurt Copyright © 2015 Mehmet Agilli et al. All rights reserved. A Left-Sided Prevalence of Lentigo Maligna: A UK Based Observational Study and Review of the Evidence Wed, 01 Apr 2015 08:56:15 +0000 Skin cancer has been shown to present asymmetrically, prevalent on the left side of the body, more so in subtypes of cutaneous melanoma such as lentigo maligna. Biases have been linked to cumulative UV light exposure and automobile driving patterns. Though left-right ratios have previously correlated with the side men or women tend to position themselves or countries drive on, more recent trends indicate a consistent left-sided bias. To clarify reasons for changing trends, a review of the evidence base and LM’s laterality in a UK cohort (99 cases 2000–2011) was conducted for the first time. The strong correlation of left-sided excess, found in both genders (ratios 1.381–1.5,    0.841), is congruent with more recent findings. Though evidence indicates that driving position is no longer a risk factor for LM, due most likely to improved car window UV protection, it remains the most commonly attributed cause. Understanding phenomena such as UV lights “scatter effect” or that cumulative exposure may not be a significant risk factor helps rationalize older conclusions that would otherwise appear contradictory. The reasons for left-sided excess remain unclear but may be due to factors requiring further research such as the body’s anatomical/embryological asymmetry. Mark Gorman, Andrew Hart, and Bipin Mathew Copyright © 2015 Mark Gorman et al. All rights reserved. A 3-Month, Randomized, Double-Blind, Placebo-Controlled Study Evaluating the Ability of an Extra-Strength Marine Protein Supplement to Promote Hair Growth and Decrease Shedding in Women with Self-Perceived Thinning Hair Wed, 25 Mar 2015 13:46:42 +0000 An oral marine protein supplement (MPS) is designed to promote hair growth in women with temporary thinning hair (Viviscal Extra Strength; Lifes2good, Inc., Chicago, IL). This double-blind, placebo-controlled study assessed the ability of MPS to promote terminal hair growth in adult women with self-perceived thinning hair associated with poor diet, stress, hormonal influences, or abnormal menstrual cycles. Adult women with thinning hair were randomized to receive MPS () or placebo () twice daily for 90 days. Digital images were obtained from a 4 cm2 area scalp target area. Each subject’s hair was washed and shed hairs were collected and counted. After 90 days, these measures were repeated and subjects completed Quality of Life and Self-Assessment Questionnaires. MPS-treated subjects achieved a significant increase in the number of terminal hairs within the target area () which was significantly greater than placebo (). MPS use also resulted in significantly less hair shedding () and higher total Self-Assessment () and Quality of Life Questionnaires scores (). There were no reported adverse events. MPS promotes hair growth and decreases hair loss in women suffering from temporary thinning hair. This trial is registered with Identifier: NCT02297360. Glynis Ablon Copyright © 2015 Glynis Ablon. All rights reserved. Management of Pruritus in Chronic Liver Disease Tue, 10 Mar 2015 08:59:15 +0000 Background. There continues to be uncertainty on the ideal treatment of pruritus in chronic liver disease. The aim of this study was to gather the latest information on the evidence-based management of pruritus in chronic liver disease. Methodology. A literature search for pruritus in chronic liver disease was conducted using Pubmed and Embase database systems using the MeSH terms “pruritus,” “chronic liver disease,” “cholestatic liver disease,” and “treatment.” Results. The current understanding of the pathophysiology of pruritus is described in addition to detailing research into contemporary treatment options of the condition. These medical treatments range from bile salts, rifampicin, and opioid receptor antagonists to antihistamines. Conclusion. The burden of pruritus in liver disease patients persists and, although it is a common symptom, it can be difficult to manage. In recent years there has been greater study into the etiology and treatment of the condition. Nonetheless, pruritus remains poorly understood and many patients continue to suffer, reiterating the need for further research to improve our understanding of the etiology and treatment for the condition. Angeline Bhalerao and Gurdeep S. Mannu Copyright © 2015 Angeline Bhalerao and Gurdeep S. Mannu. All rights reserved. Epidermal Permeability Barrier in the Treatment of Keratosis Pilaris Tue, 24 Feb 2015 12:04:59 +0000 Objectives. To evaluate and compare the efficacy, safety, hydrating properties, and tolerability of 10% lactic acid (LA) and 5% salicylic acid (SA) in the therapy of keratosis pilaris (KP). Material and Method. Patients with KP were randomized for treatment with either 10% LA or 5% SA creams being applied twice daily for 3 months. The patients were clinically assessed at baseline and after 4, 8, and 12 weeks of treatment and 4 weeks after treatment. The functional properties of the stratum corneum (SC) were determined before treatment, 12 weeks, and follow-up phase by high-frequency conductance and transepidermal water loss (TEWL). Results. At the end of the trial, the mean reduction of the lesions from baseline was statistically significant for 10% LA (66%) and 5% SA (52%). During the treatment, higher conductance values were found on both group and this improvement was maintained until the follow up period. No significant differences in transepidermal water loss were observed after treatment. The adverse effects were limited to mild irritation localized on the skin without systemic side effect. Conclusion. The study demonstrated that 10% LA and 5% SA are beneficial to treat KP with the significantly clearance and marked improvement as by instrumental evaluation. Tanawatt Kootiratrakarn, Kowit Kampirapap, and Chakkrapong Chunhasewee Copyright © 2015 Tanawatt Kootiratrakarn et al. All rights reserved. Erratum to “Quantitative Fraction Evaluation of Dermal Collagen and Elastic Fibres in the Skin Samples Obtained in Two Orientations from the Trunk Region” Mon, 05 Jan 2015 09:10:47 +0000 Naveen Kumar, Pramod Kumar, Satheesha Nayak Badagabettu, Keerthana Prasad, Ranjini Kudva, and Coimbatore Vasudevarao Raghuveer Copyright © 2015 Naveen Kumar et al. All rights reserved. Sporotrichosis: An Overview and Therapeutic Options Mon, 29 Dec 2014 00:10:23 +0000 Sporotrichosis is a chronic granulomatous mycotic infection caused by Sporothrix schenckii, a common saprophyte of soil, decaying wood, hay, and sphagnum moss, that is endemic in tropical/subtropical areas. The recent phylogenetic studies have delineated the geographic distribution of multiple distinct Sporothrix species causing sporotrichosis. It characteristically involves the skin and subcutaneous tissue following traumatic inoculation of the pathogen. After a variable incubation period, progressively enlarging papulo-nodule at the inoculation site develops that may ulcerate (fixed cutaneous sporotrichosis) or multiple nodules appear proximally along lymphatics (lymphocutaneous sporotrichosis). Osteoarticular sporotrichosis or primary pulmonary sporotrichosis are rare and occur from direct inoculation or inhalation of conidia, respectively. Disseminated cutaneous sporotrichosis or involvement of multiple visceral organs, particularly the central nervous system, occurs most commonly in persons with immunosuppression. Saturated solution of potassium iodide remains a first line treatment choice for uncomplicated cutaneous sporotrichosis in resource poor countries but itraconazole is currently used/recommended for the treatment of all forms of sporotrichosis. Terbinafine has been observed to be effective in the treatment of cutaneous sporotrichosis. Amphotericin B is used initially for the treatment of severe, systemic disease, during pregnancy and in immunosuppressed patients until recovery, then followed by itraconazole for the rest of the therapy. Vikram K. Mahajan Copyright © 2014 Vikram K. Mahajan. All rights reserved. Metabolic Changes and Serum Ghrelin Level in Patients with Psoriasis Thu, 18 Dec 2014 00:10:32 +0000 Background. Serum ghrelin levels may be related to metabolic and clinical changes in patients with psoriasis. Objective. This study was performed to determine the possible effects of serum ghrelin in patients with psoriasis. Methods. The study population consisted of 25 patients with plaque psoriasis. The patients were questioned with regard to age, gender, age of onset, duration of disease, height, weight, and body mass index (BMI). In addition, fasting blood sugar, triglyceride, cholesterol levels, insulin, and ghrelin levels were measured. Results. The mean serum ghrelin level was 45.41 ± 22.41 in the psoriasis group and 29.92 ± 14.65 in the healthy control group. Serum ghrelin level was significantly higher in the psoriasis group compared with the controls (). The mean ghrelin level in patients with a lower PASI score was significantly higher than in those with a higher PASI score (). Conclusion. The present study was performed to determine the effects of ghrelin in psoriasis patients. We found a negative correlation between severity of psoriasis and ghrelin level. Larger and especially experimental studies focusing on correlation of immune system-ghrelin levels and severity of psoriasis may be valuable to clarify the etiopathogenesis of the disease. Haydar Ucak, Betul Demir, Demet Cicek, Ilker Erden, Suleyman Aydin, Selma Bakar Dertlioglu, and Mustafa Arica Copyright © 2014 Haydar Ucak et al. All rights reserved. Expression of Maspin and Ezrin Proteins in Periocular Basal Cell Carcinoma Mon, 15 Dec 2014 09:28:05 +0000 Background. The aim of this study was to investigate maspin and ezrin expression in different subtypes of periocular basal cell carcinoma (BCC). Methods. Tissue samples from 43 patients with periocular BCC. Our cases were comprised of 10 morpheaform, 25 nodular, and 8 adenoid type BCCs. Immunohistochemical staining for maspin and ezrin was performed by Envision detection system. Results. There was no difference between different subtypes of BCC in maspin expression regarding positivity, intensity, and pattern of expression. Ezrin was expressed in all subtypes of BCC but the intensity was significantly higher in morpheaform BCC compared to nodular and adenoid types ( and , resp.); ninety percent of morpheaform samples showed strong ezrin intensity, while this strong intensity was only present in 25% and 12% of adenoid and nodular subtypes, respectively. There was no correlation between age, sex, or tumor margin involvement and expression of neither maspin nor ezrin. There was no correlation between maspin and ezrin expression except in nodular type, in which an inverse correlation was found . Conclusion. Ezrin is expressed intensely in morpheaform BCC of periocular region. Further studies are needed to show the significance of this finding in prognosis of morpheaform BCC. Mansooreh Bagheri, Masoomeh Eghtedari, Mandana Bagheri, Bita Geramizadeh, and Mohammadreza Talebnejad Copyright © 2014 Mansooreh Bagheri et al. All rights reserved. The Prevalence and Pattern of Superficial Fungal Infections among School Children in Ile-Ife, South-Western Nigeria Wed, 10 Dec 2014 00:10:28 +0000 Fungal infections of the skin and nails are common global problems with attendant morbidity among affected individuals. Children are mostly affected due to predisposing factors such as overcrowding and low socioeconomic factors. The aim of this study was to determine the prevalence and the clinical patterns of superficial fungal infections among primary school children in Ile-Ife. A multistage sampling was conducted to select eight hundred pupils from ten primary schools in Ile-Ife. Data on epidemiological characteristics and clinical history was collected using a semistructured questionnaire and skin scrapings were done. The prevalence of superficial fungal infections among the 800 respondents was 35.0%. Male pupils constituted 51.0% of respondents while the females were 49.0%. The mean age for all the respondents was 9.42 ± 2.00. Tinea capitis was the commonest infection with a prevalence of 26.9% and tinea unguium, tinea corporis, and tinea faciei had a prevalence of 0.8%, 0.6%, and 0.5%, respectively. Tinea manuum had the least prevalence of 0.1%. Pityriasis versicolor had a prevalence of 4.4%. Microsporum audouinii was the leading organism isolated. The study shows that the prevalence of superficial fungal infection (SFI) among primary school children in Ile-Ife is high with tinea capitis as the commonest SFI. Olaide Olutoyin Oke, Olaniyi Onayemi, Olayinka Abimbola Olasode, Akinlolu Gabriel Omisore, and Olumayowa Abimbola Oninla Copyright © 2014 Olaide Olutoyin Oke et al. All rights reserved. High Frequency of Symptomatic Zinc Deficiency in Infants in Northern Ethiopia Sun, 07 Dec 2014 13:29:51 +0000 Background. Zinc deficiency occurs in infants when its demand exceeds its supply. It presents with cutaneous signs which, in severe cases, are associated with diarrhea, alopecia, and irritability. Genetic and acquired forms of zinc deficiency have been reported and often overlap clinical features. Malnutrition, prematurity, malabsorption syndromes, and burns may cause an increased demand for zinc. Methods. Cases of acquired transient infantile zinc deficiency (TIZD) observed during a period of 3 years at Ayder Referral Hospital of Mekelle, Northern Ethiopia, are reported here. Since no sophisticated tests were available at our center, the diagnosis was based on the clinical signs and prompt response to oral zinc supplementation. Results. We observed 18 cases of TIZD at our center. All patients were full-term and breastfeeding infants with no relevant associated diseases. Conclusions. In this region, a high incidence of this condition is observed. We could not rule out whether heterozygosity for the genetic mutation was present or that the disease was caused by a nutritional deficiency in the mothers or more probably because both the factors coexisted together. However, further studies are necessary to better understand the causes of the increased incidence of this disease in Northern Ethiopia. Federica Dassoni, Zerihun Abebe, Federica Ricceri, Aldo Morrone, Cristiana Albertin, and Bernard Naafs Copyright © 2014 Federica Dassoni et al. All rights reserved. Mycobacterium ulcerans Disease with Unusual Sites Not to Be Ignored Thu, 16 Oct 2014 09:16:08 +0000 Objective. The usual preferential site of BU is in the limbs. In our experience, we noticed atypical and often misleading sites which pose serious issues for the diagnosis and often for the treatment. Methods. This is a retrospective study conducted over a period of ten years of BU treatment at the Department of Dermatology of the University Teaching Hospital of Treichville (Abidjan, Côte d’Ivoire). We included in this study all BU cases with atypical site diagnosed clinically and confirmed either by the histology, by smear, or by PCR. Results. Epidemiologically, the age of patients ranged from 3 to 72 years with a median age of 14.2 years. Children aged less than 15 years were affected in almost 80% of case. The clinical table was dominated by ulcerated forms in 82.1% of cases. The unusual topography mostly observed was that of the torso (thorax, back, and abdomen) in 76.8% of cases. Conclusion. BU is an endemic disease in Côte d’Ivoire where it constitutes a serious public health issue. Several years following its first cases, BU still is little known. This dermatosis may present atypical misleading clinical aspects which must be ignored. Sangaré Abdoulaye, Kourouma Sarah Hamdan, Kouassi Yao Isidore, Ecra Elidjé Joseph, Kaloga Mamadou, and Gbery Ildevert Patrice Copyright © 2014 Sangaré Abdoulaye et al. All rights reserved. Superpulsed CO2 Laser with Intraoperative Pathologic Assessment for Treatment of Periorbital Basal Cell Carcinoma Involving Eyelash Line Mon, 13 Oct 2014 06:44:14 +0000 Background. Periorbital basal cell carcinoma (BCC) is considered a high risk case because it is associated with high rate of recurrence and complication. Superpulsed CO2 laser with intraoperative pathologic assessment could be an alternative and appropriate treatment for periocular lesions where Mohs micrographic surgery is not available. Objective. To evaluate the efficacy of superpulsed CO2 laser therapy with intraoperative pathologic assessment on periocular BCC involving eyelash line. Method. This follow-up study was performed on 20 patients with a total of 21 BCC lesions that were pathologically documented. Firstly, debulkation of tumoral mass was done by curettage. Then, irradiation and intraoperative pathologic evaluation were done by concurrent CO2 laser. The patients were followed up for a period of 36 months. Results. Out of 21 lesions, the nodular type accounted for 15 (71.4%) lesions, and 12 (57.1%) lesions were seen in the lower lid as the most common clinical type and site involvement. Twenty BCC lesions (95.2%) were treated after one session. Damage to eyelash was seen in 2 (10%) patients, but ectropion and other complications were not seen in any patient. Conclusion. Treatment with superpulsed CO2 laser and intraoperative pathologic evaluation for periorbital BCC lesions much close to conjunctiva could be an effective method with minimal complications without major danger of recurrence. This modality can be used with care in the inner canthus and high risk pathologic lesions. Ali Ebrahimi, Mansour Rezaei, Reza Kavoussi, Mojtaba Eidizadeh, Seyed Hamid Madani, and Hossein Kavoussi Copyright © 2014 Ali Ebrahimi et al. All rights reserved. Pyoderma Gangrenosum: A Review of Clinical Features and Outcomes of 23 Cases Requiring Inpatient Management Wed, 08 Oct 2014 14:08:31 +0000 Pyoderma gangrenosum (PG) is a rare dermatological disorder characterised by the rapid progression of a painful, necrolytic ulcer. This study retrospectively identified patients who were admitted and treated for PG during a 10-year period (2003–2013). Twenty-three patients were included in this study, 16 women and seven men. The mean age at initial admission was 62.8 years (range 30 to 89 years). Lesions were localised to lower limb in 13 patients, peristomal region in four, breast in three, and upper limb in one, and two patients had PG at multiple sites. The variants of PG noted were ulcerative (18), bullous (2), vegetative (2), and pustular (1). Associated systemic diseases were observed in 11 patients (47.8%). Systemic therapies were initiated in 21 patients while two patients received topical treatments. The mean length of hospital stay was 47 days (range 5 to 243 days) and five patients died during their admissions. Seven patients required readmissions for exacerbations of their PG. Our study showed that patients admitted for treatment of PG had high morbidity and mortality. This study also highlights the importance of early and aggressive treatment of patients admitted with PG as well as treating associated systemic diseases and wound infections. Mingwei Joel Ye and Joshua Mingsheng Ye Copyright © 2014 Mingwei Joel Ye and Joshua Mingsheng Ye. All rights reserved. The Preliminary Study of Effects of Tolfenamic Acid on Cell Proliferation, Cell Apoptosis, and Intracellular Collagen Deposition in Keloid Fibroblasts In Vitro Mon, 22 Sep 2014 08:03:40 +0000 Keloid scarring is a fibroproliferative disorder due to the accumulation of collagen type I. Tolfenamic acid (TA), a nonsteroidal anti-inflammatory drug, has been found to potentially affect the synthesis of collagen in rats. In this preliminary study, we aimed to test the effects of TA on cell proliferation, cell apoptosis, and the deposition of intracellular collagen in keloid fibroblasts. Normal fibroblasts (NFs) and keloid fibroblasts (KFs) were obtained from human dermis tissue. Within the dose range 10−3–10−6 M and exposure times 24 h, 48 h, and 72 h, we found that 0.55 × 10−3 M TA at 48 h exposure exhibited significantly decreased cell proliferation in both NFs and KFs. Under these experimental conditions, we demonstrated that (1) TA treatment induced a remarkable apoptotic rate in KFs compared to NFs; (2) TA treatment reduced collagen production in KFs versus NFs; (3) TA treatment decreased collagen type I expression in KFs comparing to that of NFs. In summary, our data suggest that TA decreases cell proliferation, induces cell apoptosis, and inhibits collagen accumulation in KFs. Dan Yi, Ji Bihl, Mackenzie S. Newman, Yanfang Chen, and Richard Simman Copyright © 2014 Dan Yi et al. All rights reserved. A Critical Review of Personal Statements Submitted by Dermatology Residency Applicants Sun, 14 Sep 2014 05:22:52 +0000 Background. A strong personal statement is deemed favorable in the overall application review process. However, research on the role of personal statements in the application process is lacking. Objective. To determine if personal statements from matched applicants differ from unmatched applicants. Methods. All dermatology residency applications () submitted to UC Davis Dermatology in the year of 2012 were evaluated. Two investigators identified the characteristics and recurring themes of content present in the personal statements. Then, both investigators individually evaluated the content of these personal statements in order to determine if any of the defined themes was present. Chi-square, Fisher’s exact, and reliability tests were used. Results. The following themes were emphasized more often by the matched applicants than the unmatched applicants as their reasons for going into dermatology are to study the cutaneous manifestations of systemic disease (33.8% versus 22.8%), to contribute to the literature gap (8.3% versus 1.1%), and to study the pathophysiology of skin diseases (8.3% versus 2.2%; for all). Conclusion. The prevalence of certain themes in personal statements of dermatology applicants differs according to match status; nevertheless, whether certain themes impact match outcome needs to be further elucidated. Jeannette Olazagasti, Farzam Gorouhi, and Nasim Fazel Copyright © 2014 Jeannette Olazagasti et al. All rights reserved. Malignant and Noninvasive Skin Tumours in Renal Transplant Recipients Sun, 14 Sep 2014 00:00:00 +0000 Background. Transplant recipients require immunosuppression to prevent graft rejection. This conveys an increased risk of malignancy, particularly skin tumours. There is a need for up-to-date data for the South of England. Method. Pathology records were reviewed for 709 kidney transplant recipients on immunosuppression at our hospital from 1995 to 2008. Skin tumours were recorded/analysed. Results. Mean age at transplant was 46 years. Mean length of follow-up was 7.2 years and total follow-up was 4926 person-years. 53 (7.5%) patients (39/458 (8.5%) males and 14/251 (5.6%) females) developed ≥1 skin malignancy. Cumulative incidences of 4.0%, 7.5%, and 12.2% were observed for those with <5, <10, and ≥10 years follow-up, respectively. The rate was 45 tumours per 1000 person-years at risk. Additionally, 21 patients (3.0%) only had noninvasive tumours. 221 malignant skin tumours were found: 50.2% were SCCs, 47.1% BCCs, and 2.7% malignant melanomas. Mean years to first tumour were 5.8. Mean number of tumours per patient was 4, with mean interval of 12 months. Conclusions. Despite changes in transplantation practice during the time since the last data were published in this region, these findings are similar to previous studies. This adds to the evidence allowing clinicians to inform patients in this region of their risk. Christopher D. Roche, Joelle S. Dobson, Sion K. Williams, Mara Quante, Joyce Popoola, and Jade W. M. Chow Copyright © 2014 Christopher D. Roche et al. All rights reserved. Quantitative Fraction Evaluation of Dermal Collagen and Elastic Fibres in the Skin Samples Obtained in Two Orientations from the Trunk Region Tue, 09 Sep 2014 09:13:23 +0000 Background. Histomorphic evaluation of dermal collagen and elastic fibres was analysed by image analysis technique. The quantification of dermal elements was performed in skin tissues, collected in horizontal and vertical directions from trunk region and discussed under the perspective of consequences of scar related complications. Materials and Method. Total number of 200 skin samples collected from 5 areas of trunk region were processed histologically and subjected to tissue-quant image analysis. Statistical analysis involving mean with SEM and paired test by SPSS were employed to the percentage values obtained from image analysis. Result. Among the chosen 5 areas of trunk region, abdomen showed the statistically significant difference for both collagen and elastic content between horizontal and vertical orientations (), whereas upper back, presternal, and lateral chest areas showed significant difference () only for collagen and groin only for elastic content. Conclusion. The differences in the distribution of dermal collagen and elastic fibres in 2 directions of the samples from the same areas might be attributed to final outcome of wound healing process by influencing the appearance and behaviour of scar related complications in the region of trunk. Naveen Kumar, Pramod Kumar, Satheesha Nayak Badagabettu, Keerthana Prasad, Ranjini Kudva, and Coimbatore Vasudevarao Raghuveer Copyright © 2014 Naveen Kumar et al. All rights reserved. Patch Testing in Suspected Allergic Contact Dermatitis to Cosmetics Tue, 09 Sep 2014 05:34:09 +0000 Background. Increasing use of cosmetics has contributed to a rise in the incidence of allergic contact dermatitis (ACD) to cosmetics. It is estimated that 1–5.4% of the population is sensitized to a cosmetic ingredient. Patch testing helps to confirm the presence of an allergy and to identify the actual allergens which are chemical mixtures of various ingredients. Objectives. The aims of this study are to perform patch testing in suspected ACD to cosmetics and to identify the most common allergen and cosmetic product causing dermatitis. Methods. Fifty patients with suspected ACD to cosmetics were patch-tested with 38 antigens of the Indian Cosmetic Series and 12 antigens of the Indian Standard Series. Results. The majority (58%) of patients belonged to the 21–40 years age group. The presence of ACD to cosmetics was confirmed in 38 (76%) patients. Face creams (20%), hair dyes (14%), and soaps (12%) were the most commonly implicated. The most common allergens identified were gallate mix (40%), cetrimide (28%), and thiomersal (20%). Out of a total of 2531 patches applied, positive reactions were obtained in 3.75%. Conclusion. Incidence of ACD to cosmetics was greater in females. Face creams and hair dyes were the most common cosmetic products implicated. The principal allergens were gallate mix, cetrimide, and thiomersal. Pramod Kumar and Rekha Paulose Copyright © 2014 Pramod Kumar and Rekha Paulose. All rights reserved. Effect of Oral PUVAsol on the Quality of Life in Indian Patients Having Chronic Plaque Psoriasis Thu, 04 Sep 2014 00:00:00 +0000 Background. Psoriasis is associated with a high impact on health-related QoL (quality of life). PUVAsol has been successfully used for treating psoriasis instead of standard PUVA therapy in developing countries. However, data for PUVAsol therapy and its effect on QoL in psoriatic patients is meagre. Objective. To investigate the effect of PUVAsol on the quality of life in patients having chronic plaque psoriasis. Materials and Methods. An observational prospective study done in patients having chronic plaque psoriasis. PASI and DLQI were calculated before initiating treatment with oral PUVAsol. These were compared with the respective scores after 12 weeks of regular treatment with PUVAsol. Statistical analysis was done using SPSS version 20.0. Results. Both PASI and DLQI showed statistically significant reduction after 12 weeks of regular treatment. 90% of patients responded favourably to PUVAsol therapy in the study and all the domains of DLQI showed significant reduction except domain of “work and school.” Conclusion. Our results show that regular PUVAsol treatment improves the physical appearance of disease as evident by decrease in PASI scores. It also improves the QoL of the patients. This study will add upon the growing evidence of efficacy of PUVAsol. Pratik Gahalaut, Nitin Mishra, Puneet S. Soodan, and Madhur K. Rastogi Copyright © 2014 Pratik Gahalaut et al. All rights reserved. Methylisothiazolinone: An Emergent Allergen in Common Pediatric Skin Care Products Wed, 27 Aug 2014 08:22:33 +0000 Recalcitrant dermatitis, such as that of the hands, face, or genitals, may be due to allergic contact dermatitis (ACD) from ingredients in seemingly innocuous personal care products. Rising rates of allergy have been noted due to the preservative methylisothiazolinone (MI). This preservative is commonly found in skin and hair care products, especially wipes. This study evaluated the use of MI in products specifically marketed for babies and children and examined the associated marketing terms of such products. Ingredients of skin care products specifically marketed for babies and children were surveyed at two major retailers. Of 152 products surveyed, 30 products contained MI. Categories of products surveyed included facial or body wipes, antibacterial hand wipes, hair products, soaps, bubble baths, moisturizers, and sunscreens. Facial or body wipes and hair products were the categories with the greatest number of MI-containing products. MI-containing products were manufactured by a number of popular brands. Of note, products marketed as “gentle,” “sensitive,” “organic,” or “hypoallergenic” often contained MI, thus emphasizing the importance of consumer scrutiny of product choices. These findings reinforce the importance of educating parents and providing consumer decision-making advice regarding common skin care products, in order to help prevent ACD in children. Megan J. Schlichte and Rajani Katta Copyright © 2014 Megan J. Schlichte and Rajani Katta. All rights reserved. Comparison of Zn, Cu, and Fe Content in Hair and Serum in Alopecia Areata Patients with Normal Group Wed, 27 Aug 2014 00:00:00 +0000 Background. Alopecia areata (AA) is an autoimmune condition, in which hair is lost from some areas of the body. Though its etiopathogenesis is not fully understood, there are claims that imbalance of trace elements may trigger the onset of AA, by distorting immune functions. In this study, we tried to investigate the relationship between AA and iron, zinc, and copper levels of serum and hair. Materials and Methods. Sixteen female patients with AA (14–40 years old) and 27 healthy female controls were enrolled in this study. Serum and hair level of iron, zinc, and copper were measured by flame emission spectroscopy. The resulting data was analyzed with SPSS15. Results. We did not detect a significant difference in the serum and hair level of iron, zinc, and copper between patients and controls. There was a significant correlation between serum and hair level of iron (,  ), zinc (,  ), and copper (, ) in patients and controls. Discussion and Conclusion. According to this study, there was no statistically significant difference between trace elements among AA patients and controls. So the trace elements level in hair and serum may not be relevant to the immunologic dysfunction that exists in AA patients. Ladan Dastgheib, Zohreh Mostafavi-pour, Ahmad Adnan Abdorazagh, Zahra Khoshdel, Maryam Sadat Sadati, Iman Ahrari, Sajjad Ahrari, and Mahsa Ghavipisheh Copyright © 2014 Ladan Dastgheib et al. All rights reserved. Narrow-Band Ultraviolet B versus Oral Minocycline in Treatment of Unstable Vitiligo: A Prospective Comparative Trial Thu, 21 Aug 2014 06:22:18 +0000 Background. We have compared NB-UVB and oral minocycline in stabilizing vitiligo for the first time. Subjects and Methods. 42 patients were divided equally into two groups: the NB-UVB and minocycline groups. Phototherapy was administered twice a week on nonconsecutive days. In the minocycline group, patients were advised to take minocycline 100 mg once daily. The treatment period was 3 months. Vitiligo disease activity (VIDA) score was noted every 4 weeks for 12 months. Digital photographs were taken at baseline and monthly intervals. Results. Before the therapy, disease activity was present in 100% of the patients, which was reduced to 23.8% and 66.1% by the end of therapy in the NB-UVB and minocycline groups retrospectively (). 16 of the 21 (76/1%) patients with unstable disease in the NB-UVB group achieved stability, whereas this was the case for only 7 of the 21 (33.3%) in the minocycline group (). The diameter changes were statistically significant at the end of treatment in the NB-UVB group compared to the minocycline group (). Side effects in both groups were mild. Conclusion. NB-UVB was statistically more advantageous than oral minocycline in unstable vitiligo in terms of efficacy and the resulting stability. Amir Hossein Siadat, Naser Zeinali, Fariba Iraji, Bahareh Abtahi-Naeini, Mohammad Ali Nilforoushzadeh, Kioumars Jamshidi, and Parastoo Khosravani Copyright © 2014 Amir Hossein Siadat et al. All rights reserved.