Doxycycline In Pityriasis Rosea: Placebo- Controlled Clinical Trial

Background: Pityriasis rosea is an acute, self-limiting skin disease, probably of infective origin. Doxycycline is a broad-spectrum antibiotic, and most probably has an immunomodulator and an anti-inflammatory effect. Objective: To assess the efficacy of doxycycline in the treatment of pityriasis rosea in patients evaluated between January 2001 and May 2002. Patients and methods: This was a placebo-controlled clinical trial. One hundred and twenty patients with pityriasis rosea were included in the study; all of them were above 12 years of age. They had been divided into 2 groups, the treatment group consisted of 60 patients and received doxycycline capsule. 100,mg orally for 14 days and the placebo group consisted of 60 patients and received glucose capsules for 14 days, all the patients were followed up clinically for 4 weeks after treatment, the responses were categorized into excellent, partial and no response. Results: forty-six patients from the treatment group completed the study. Excellent response was achieved in 30 patients (65%), partial response in 15 patients (33.5%) and no response in I patient (1.5%). Forty patients from the placebo group completed the study. Excellent response was achieved in 4 patients (10%), partial response in 20 (50%) and no response in 16 patients (40%). The results were statistically significant. Conclusions: we concluded that doxycycline was effective in the treatment of pityriasis rosea, with very few adverse effects

Topical preparations from the Iraqi plant aloe vera and their efficacy in skin infections.

The dermatological preparations consist of simple or compounded bases in which one or more active ingredients are dissolved or suspended .The plant Aloe vera is widely distributed in Iraq, in addition to it's tranditional use in the treatment of occasional constipation , it is also used to assist healing of wounds ,burns and psoriasis. In this study; the amount of aloin (the major component of the plant) in the dried juice of the Iraqi plant Aloe vera is determined and was found to be 15.4% w/w and it is the major compound responsible for the antimicrobial activity of the plant. Different ointment bases were used in this study to prepare topical preparations from the dried juice of the Iraqi plant with different concentrations and were found that 4%w/w sodium carboxy methyl cellulose gel base was the best formula using comparative diffusion study through the skin. The clinical study which is carried out in this research on 61 patients with skin infections (mainly Tinea corporis and Tinea cruris) showed that 4%w/w gel base formula of aloe gave significant improvement in comparison with those treated with nystatin and hydrocortison and proved the antipruritic and antiinflammatory action of the dried juice of the Iraqi plant Aloe vera without any adverse effect. Finally the expiration date of aloin in the selected formula is determined and was found to be ≈ 2 years

The Role Of IL-4 And IL-8 In The Itiology Of Tinea Versicolor In Group Of Iraqi Patients

Background: Tinea versicolor is a common dermatological problem ,world wide distribution , caused by a dimorphic fungus called Malassezia furfur ,it live normally on skin as a commensal . Many factors play a role in the etiology of TV among these could be the disturbed immune system which may be related to the ability of TV alter the immune system by a process called Immunomodulation leading to subsequent infection. Immuno-inflammatory activity mediated by different cytokines could have a role in the etiology of TV. Objective: To evaluate the serum level of the inflammatory cytokines ,IL-4andIL-8,in patients with TV as compared to immunocompramized patients and healthy groups. Patients and methods: This study enrolled 50 total patients, 15 of them were as patients control group who were immunocompramized with evident skin lesion ,to be compared serologically with 15 patients who had TV and normal immunity, the control group composed of20 healthy volunteers. Using ELISA test technique the following tests were done :detection of IL-4 and IL-8 in the sera of all groups. Results and discussion: The statistical differences in the rate of detectable IL-4 level between TV and healthy control p< 0.001,while the difference was a highly significant between the healthy control and immunocompramized patients with TV,P<0.00338.The difference between two diseased groups was(p< 0.219)which is non significant , when p<0. 05 was considered significant. IL-8 the results of our study showed a significant difference between the healthy control and the patients with tinea versicolor, p-value was( 0.05). In this study there was a nice findings by which the difference between the healthy control and the immunocompramized patients was highly significant as ,p<0.005.  Conclusion :The genus Malassezia is an immunological paradox. In some circumstances, it acts as an adjuvant, activates the complement cascade, and elicits both cellular and humoral immune responses in healthy individuals, among which IL8 and IL-4 were notably increased . In contrast, it also seems to have the ability not only to evade the immune system but actually to suppress the response directed agains

Chronic ulcerative Cutaneous Vasculitis of the legs Clinical and histopathological study

Background: Cutaneous small vessel vasculitis characterized by necrosis and inflammation of upper dermal blood vessels. It presents with ulcers and systemic manifestations after extensive acute onset. Many patients have a form of cutaneous vasculitis that presents with chronic painful ulcerations & purpuras involving the ankles without systemic manifestations, with some similarity in clinical presentation to livedoid vasculopathy. Patients and Methods: Thirteen patients were seen in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, for a period extending from January 2004 to March 2005. They were evaluated clinically, histopathologically and other laboratory studies. In addition, evaluation of the clinical response to prednisolone 0.5mg/kg/day and azathioprine150mg/day was done. Results: Thirteen patients were included in this study; eight females and five males, with male to female ratio of 1:1.6. Their ages ranged between 26-66 years with a mean ±SD of 42 ± 13.8 years. The duration of the disease ranged from 0.5 – 18 years with a mean ±SD of 38 ± 59.2 months.The clinical examination revealed multiple oval punched out ulcers, with an indurated base, and surrounded by a zone of erythema; affecting mainly the ankles and dorsa of feet. Histopathological evaluation showed upper dermal vessels' wall necrosis, fibrinoid deposition, obliteration of the lumen, extravasation of red blood cells, endothelial cells swelling with perivascular and vascular wall infiltration mainly by mononuclear cells.The treatment was started with prednisolone & azathioprine. The ulcers healed completely with residual hyperpigmentation - hypopigmentation, atrophy and scars within 10-15 weeks  Conclusions: Chronic ulcerative cutaneous vasculitis is often a neglected and misdiagnosed variant of vasulitis. Histologically it has vascuiltic features, and clinically looks like livedoid vasculopathy

Formulation and evaluation of ciprofloxacin as a topical gel

Ciprofloxacin is an antibacterial agent belong to floroquinolones group, it has broad spectrum activity against Gram positive and Gram negaitive bacteria. Ciprofloxacin – HCl was formulated as a gel dosage form using two different bases, a 5% methylcellulose and 5% sodium croboxy-methyl-cellulose gel base. The concentration of (1% w/w) of the drug in each base was prepared. In vitro availability of ciprofloxacin – HCl from these bases was studied, in addition the diffusion of the drug using excised mouse skin technique were also evaluated. The results indicated that the extent of ciprofloxacin – HCl release was higher from methylcellulose gel base than that from sodium caroboxy-methylcellulose gel base. While the data revealed that the diffusion of the ciprofloxacin through the excised mouse skin was higher from sodium croboxy-methyl-cellulose gel base than that from methylcellulose. According to these results, 5% methylcellulose gel base was selected for further studies. The influence of storage time and temperature on the stability of the drug, as well as physical properties and pH, for the selected formula over a period of 45 days was studied. The concentration of ciprofloxacin was found to decrease with time and temperature and no changes in the physical properties were noticed. The shelf life of the drug in the selected gel base was determined using exaggerated temperature techinque and it was equal to 2.5 years. The overall results of this study suggest that the selected formula could be used in the preparation of ciprofloxacin gel as a topical dosage form to be used in the treatment of some dermatological infections

Microbial-host co-metabolites are prodromal markers predicting phenotypic heterogeneity in behavior, obesity, and impaired glucose tolerance

The influence of the gut microbiome on metabolic and behavioral traits is widely accepted, though the microbiome-derived metabolites involved remain unclear. We carried out untargeted urine 1 H-NMR spectroscopy-based metabolic phenotyping in an isogenic C57BL/6J mouse population (n = 50) and show that microbial-host co-metabolites are prodromal (i.e., early) markers predicting future divergence in metabolic (obesity and glucose homeostasis) and behavioral (anxiety and activity) outcomes with 94%– 100% accuracy. Some of these metabolites also modulate disease phenotypes, best illustrated by trimethylamine-N-oxide (TMAO), a product of microbial-host co-metabolism predicting future obesity, impaired glucose tolerance (IGT), and behavior while reducing endoplasmic reticulum stress and lipogenesis in 3T3-L1 adipocytes. Chronic in vivo TMAO treatment limits IGT in HFD-fed mice and isolated pancreatic islets by increasing insulin secretion. We highlight the prodromal potential of microbial metabolites to predict disease outcomes and their potential in shaping mammalian phenotypic heterogeneity

Trimethylamine and Trimethylamine N-Oxide, a Flavin-Containing Monooxygenase 3 (FMO3)-Mediated Host-Microbiome Metabolic Axis Implicated in Health and Disease

Flavin-containing monooxygenase 3 (FMO3) is known primarily as an enzyme involved in the metabolism of therapeutic drugs. However, on a daily basis we are exposed to one of the most abundant substrates of the enzyme, trimethylamine, which is released from various dietary components by the action of gut bacteria. FMO3 converts the odorous trimethylamine to non-odorous trimethylamine N-oxide, which is excreted in urine. Impaired FMO3 activity gives rise to the inherited disorder primary trimethylaminuria. Affected individuals cannot produce trimethylamine N-oxide and, consequently, excrete large amounts of trimethylamine. A dysbiosis in gut bacteria can give rise to secondary trimethylaminuria. Recently, there has been much interest in FMO3 and its catalytic product trimethylamine N-oxide. This is because trimethylamine N-oxide has been implicated in various conditions affecting health, including cardiovascular disease, reverse cholesterol transport and glucose and lipid homeostasis. In this review, we consider the dietary components that can give rise to trimethylamine, the gut bacteria involved in the production of trimethylamine from dietary precursors, the metabolic reactions by which bacteria produce and utilize trimethylamine and the enzymes that catalyze the reactions. Also included is information on bacteria that produce trimethylamine in the oral cavity and vagina, two key microbiome niches that can influence health. Finally, we discuss the importance of the trimethylamine/trimethylamine N-oxide microbiome-host axis in health and disease, considering factors that affect bacterial production and host metabolism of trimethylamine, the involvement of trimethylamine N-oxide and FMO3 in disease and the implications of the host-microbiome axis for management of trimethylaminuria

Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars

The formation of a wide range of excessive scars following various skin injuries is a natural consequence of healing. Scars resulting from surgery or trauma affect approximately 100 million people per annum in the developed world and can have profound physical, aesthetic, psychological and social consequences. Thus, scar treatment is a priority for patient and physician alike. Laser treatment plays an important role in scar management with additional support from ancillary modalities. Subsequent to part 1: Burns scars, part 2 focuses on our strategies and literature review of treatment of keloid, hypertrophic, pigmented and acne scars where lasers are used in conjunction with other measures, and illustrated with case studies

Gut Flora Metabolism of Phosphatidylcholine Promotes Cardiovascular Disease

Metabolomics studies hold promise for the discovery of pathways linked to disease processes. Cardiovascular disease (CVD) represents the leading cause of death and morbidity worldwide. Here we used a metabolomics approach to generate unbiased small-molecule metabolic profiles in plasma that predict risk for CVD. Three metabolites of the dietary lipid phosphatidylcholine—choline, trimethylamine N-oxide (TMAO) and betaine—were identified and then shown to predict risk for CVD in an independent large clinical cohort. Dietary supplementation of mice with choline, TMAO or betaine promoted upregulation of multiple macrophage scavenger receptors linked to atherosclerosis, and supplementation with choline or TMAO promoted atherosclerosis. Studies using germ-free mice confirmed a critical role for dietary choline and gut flora in TMAO production, augmented macrophage cholesterol accumulation and foam cell formation. Suppression of intestinal microflora in atherosclerosis-prone mice inhibited dietary-choline-enhanced atherosclerosis. Genetic variations controlling expression of flavin monooxygenases, an enzymatic source of TMAO, segregated with atherosclerosis in hyperlipidaemic mice. Discovery of a relationship between gut-flora-dependent metabolism of dietary phosphatidylcholine and CVD pathogenesis provides opportunities for the development of new diagnostic tests and therapeutic approaches for atherosclerotic heart disease