“Acquired epidermodysplasia verruciformis” in kidney transplant patients

AbstractBackgroundEpidermodysplasia verruciformis (EV) is a well known inherited autosomal recessive skin disease associated with numerous early onset viral warts on the sun exposed parts of the body that usually progress into skin malignancies. Kidney transplant patients are also commonly associated with viral warts that might change into skin cancers.ObjectiveTo describe the clinical pictures of extensive viral warts with skin malignancies in kidney transplant patients in comparison with inherited (EV) features.Patients and methodsThis case controlled study that included 130 patients with kidney transplantation was done in kidney transplantation centers in Baghdad and Al-Karma Teaching Hospitals during December 2002 to September 2004. All recruited patients were receiving multiple immunosuppressive drugs like methyl prednisolone succinate, oral prednisolone, azathioprine and cyclosporine. History was taken from all patients including all the relevant points. These patients were divided into three groups according to the duration of kidney transplant: group A 1–10years, group B 11–20years and group C more than 20years. Biopsies were performed from the viral warts lesions and the associated tumors.Two hundred and sixty apparently healthy individuals, 206 males and 54 females had been examined as control cases for the presence of viral warts and tumors. These control cases had been taken randomly from general population in multiple regions in Baghdad.ResultsSixty-five patients out of 130 with kidney transplantation had viral warts. Their ages ranged from 20 to 71 (45.49±SD 10.82) years, 51 males and 14 females, while the duration of the warts ranged from 0.5 to 10 (3.74±SD 2.67) years. The distribution of patients with viral warts among the groups was as follows: group A 28 (43.1%), group B 30 (46.2%) and group C 7 (10.7%) cases. Viral warts were seen in 10 (3.8%) of the control group. There were statistically significant differences between patients and control cases (P value <0.001). Most of the viral warts in patients with kidney transplantation were multiple and of the verrucae vulgaris type. They were mainly located on the exposed areas of the body, mostly on the face and dorsa of hands.Skin malignancies were observed in 6 (9.2%) cases: five squamous cell carcinomas and one case of basal cell carcinoma. Squamous cell carcinoma was mainly located on the lower lips in 3 cases and 2 on the dorsa of hands, while basal cell carcinoma was observed on the nose. Two cases (7.1%) of squamous cell carcinoma were seen in group A, 2 (6.6%) in group B and 1 (14%) in group C. One case of basal cell carcinoma was noted in group B .No skin malignancy was observed in the control group.ConclusionKidney transplant patients have an increased susceptibility to infection with human papilloma virus and have served as a model for viral induced carcinogenesis. This collection of features deserves the term “acquired epidermodysplasia verruciformis”

Treatment of perniosis with oral tadalafil, pentoxifylline or prednisolone A therapeutic comparative study

Background: perniosis is a common dermatological problem. Different modalities of treatment are available with conflicting results and no single effective therapy is universally accepted. Objective: To evaluate the effectiveness of oral tadalafil and compare it with pentoxyfylline or prednisolone in treatment of perniosis Patients and methods: This was a therapeutic comparative trial conducted in the department of Dermatology, Baghdad Teaching hospital, Baghdad, Iraq between November 2011 and March 2014. Fifty eight patients with perniosis were enrolled in this study, and divided into 3 groups. Group (A) comprised 19 patients who received oral tadalafil (5 mg once daily); group (B) comprised 18 patients who received pentoxifylline tablet (400 mg three times daily) and group (C) included 21 patients who received prednisolone 15 mg twice daily. The treatment duration was 2 weeks. All patients did not receive any treatment before the study. A severity score was proposed taken in consideration the number of finger/ toes, type of lesion, coldness, cyanosis and itching Results: Forty seven patients completed the study. Their ages ranged from 13-43 with a mean ± SD of 22.38 ±6.99 years. Thirty three patients were females (70.21%) and 14 were males (29.79%). The percentage of improvement was 50.65, 44.16 and 31.51% for the groups A, B and C respectively. Conclusion: Tadalafil has a superior effect over pentoxyfylline. The latter has a better effect than prednisolone

A Comparative Study of the Effects of Age and Smoking on Nail Growth Rate in Healthy Individuals

Background: The nail organ has an important functional and aesthetic importance. Nail Growth Rate (NGR) has attracted the attention of many investigators not only due to the importance of the nail apparatus but also as a tool to reflect health. Objective: To study the effects of smoking and age on nail growth. Patients and methods:The study was conducted at the Department of Physiology and the Department of Dermatology, College of Medicine, University of Baghdad during the period from January 2011 to May 2011. Nail growth measurement was performed by etching a T – mark on the nail plate of the right and the left thumbs with a wide bore needle. The vertical distance between the point of meeting of the T and the proximal nail fold was measured using (vernier). A second measurement was performed one month later. The difference between the 2 readings was divided by the number of days between the readings to give the NGR. Results:The NGR was measured in a total of 106 subjects. The subjects were divided into 3 groups: Group1 (Smoker male subjects): 23 subjects were included in this group. Their ages ranged between 20 and 59 years with a mean of 35.87 +11.72 years. Group 2 (Non-smoker male subjects): 34 subjects were included. Their ages ranged between 13 and 52 years with a mean of 31.76 + 10.16 years.Group 3 (Non-smoker female subjects): 49 subjects were included. Their ages ranged between 8 and 58 years with a mean of 27.49 +11.66 years. NGR measurement in: Group 1:The mean growth rate in the right thumb was 95.4 + 28.8 microns/day, and for the left thumb was 96 + 34 microns/day. Group 2:The NGR was 105.6 + 34.35, and 103.4 + 34.24 microns /day, for the right thumb and the left thumb respectively. . Group 3: The NGR was 100 .5 + 33.52 microns/day for the right thumb and 101.6 + 31.77 microns /day for the left thumb. Conclusion: Age was inversely correlated with nail growth in right and left thumbs in all groups. The duration of smoking and number of cigarettes was inversely related to nail growth, but it did not reach statistical significance

Follicular vitiligo: the present clinical status

Vitiligo is a common autoimmune inflammatory disease where there is damage to the basal melanocytes of the epidermis. Hair follicles are the main reservoir of the melanocytes, and melanocytes stem cells, and these cells will supply the melanocytes for the basal layer of the epidermis when these cells are lost. But when these follicular melanocytes are damaged, this will cause follicular vitiligo either in a form gray/white hair or in form of follicular leukoderma. Although follicular vitiligo is not uncommon variant of vitiligo but rarely discussed and classified

Treatment of cutaneous leishmaniasis by topical 25% podophyllin solution (single, blinded, therapeutic, controlled study)

Background: There are many therapies that had been used to treat cutaneous leishmaniasis (CL). Objective: To evaluate the effectiveness of topical 25% podophyllin solution in treatment of CL. Patients and methods: Sixty-five patients with acute CL enrolled in this study, which was done in the Department of Dermatology, Baghdad Teaching Hospital, Baghdad, during January 2008–April 2009.The total number of lesions was 124 and duration of lesions ranged from 3 to 12(6.84 ± 2.902) weeks. The size of lesions ranged from 0.5 to 3(1.75 ± 1.81) cm. Diagnosis was confirmed by biopsy and smear. Lesions were divided into two groups with matching of type and size of lesions Group A treated with topical 25% podophyllin solution once weekly for number of sessions ranged from 3 to 6(4.51 ± 0.85) sessions. Group B was left untreated as a control group. Follow up was every 2 weeks for 8 weeks. Results: The total number of lesions was 120:79(65.84%) were ulcerated and 41(34.16%) were dry and 25(40.32%) patients had single lesion while 37(59.677%) patients had multiple lesions. Group A: 51(85%) lesions out of 60 lesions had cure with number of sessions ranging from 3 to 6(5.137 ± 0.9385) sessions. Group B: no lesion was cured. Conclusions: Topical 25% podophyllin is a new effective topical therapy for CL, with few side effects

Panniculitis is a common unrecognized histopathological feature of cutaneous leishmaniasis

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

Outbreak of thallium poisoning among Iraqi patients

AbstractBackgroundThallium is the most suitable agent for criminal poisoning of human beings as it is tasteless and odorless. It is usually associated with typical clinical features, mainly dermatological and neurological manifestations.ObjectiveTo report an outbreak of thallium poisoning in Iraq and to review the literatures.Patients and methodsThis descriptive study was conducted in the Department of Dermatology-Baghdad Teaching Hospital from February 2008 to April 2008. Twenty-two patients with thallium poisoning were seen in the Poisoning Consultation Center during this period and thallium in urine has been measured using the colorimetric method and was positive in all of them.We had the opportunity to see five cases referred for skin manifestations. Detailed history was done regarding all demographics points related to this poisoning. Full clinical examination was performed looking for skin manifestations, and other systemic involvements were also assessed.ResultsFive male patients with thallium poisoning were evaluated. Their ages ranged from 10 to 32years with a mean of 24years. All patients gave history of eating cakes laced with thallium. The dermatological findings were mainly anagen hair loss in diffuse and patchy pattern which affected the scalp and limbs. Also dusk ecchymotic red rash dermatitis-like picture was observed on the face, especially perioral region and dorsum of hands and legs. Neurological manifestations consisted of mainly peripheral neuropathy and muscular weakness was also recorded. Psychiatric findings were also observed, mainly depression and apathy.ConclusionOutbreak of thallium poisoning is now occurring in Iraq killing many people mainly for political reasons. It gives characteristic cutaneous, neurological and psychological features that can lead to the right diagnosis