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   Table of Contents - Current issue
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July-December 2019
Volume 39 | Issue 2
Page Nos. 49-104

Online since Wednesday, July 3, 2019

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ORIGINAL ARTICLES  

Herpes zoster ophthalmicus: clinicodemographic characteristics and outcomes of 64 Egyptian patients p. 49
Mohammed Abu El-Hamd, Soha Aboeldahab
DOI:10.4103/ejdv.ejdv_1_19  
Background Herpes zoster ophthalmicus (HZO) accounts for 10–20% of all patients with herpes zoster. Objectives This study aimed to evaluate demographic features, clinical presentations, and outcomes of HZO patients. Patients and methods In a prospective cross-sectional clinical study, it included 64 patients with clinically evident HZO. All patients underwent a detailed medical history and complete dermatological and ophthalmological examinations. Results This study included 64 patients with HZO; 41 (64.1%) were females and 23 (35.9%) were males. Of female patients with HZO, 30 (73.2%) were married, 20 (48.7%) were urban, 35 (85.4%) were housewives, 17 (41.4%) had medium socioeconomic levels, 41 (100%) were nonsmokers, 13 (31.70%) had diabetes mellitus, six (14.63%) had hypertension, 30 (73.2%) had eruption on the left side, 11 (26.8%) had conjunctivitis and lid edema, 13 (31.7%) had postherpetic neuralgia, 29 (70.7%) had posttreatment scars, and six (14.6%) had a reduced visual outcome. Of male patients with HZO, 20 (87%) were married, 12 (52.2%) were suburban, seven (30.4%) were worker, 14 (60.9%) had low socioeconomic levels, 15 (65.2%) were smokers, eight (34.8%) had diabetes mellitus, one (4.3%) had hypertension, 18 (78.3%) had eruption on the left side, nine (39.16%) had conjunctivitis and lid edema, seven (30.4%) had postherpetic neuralgia, 10 (43.5%) had post-HZO cutaneous scarring, and four (17.4%) had a reduced visual outcome. Limitations The sample size of this study was small. Conclusion This study concluded that HZO is a common and potentially ruinous disease that may show a significant ophthalmic morbidity if not adequately diagnosed and treated.
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Real-life experience of secukinumab injection in difficult chronic plaque-type psoriasis: a multicenter experience p. 57
GK Singh, Rajiv Sekhri, Manas Chatterjee, Sukriti Baveja, Neha Akhoon
DOI:10.4103/ejdv.ejdv_10_19  
Background Secukinumab, a fully human monoclonal antibody that selectively targets interleukin-17A, has been proven highly efficacious in the management of moderate to severe psoriasis with early response and sustained effects in many phase III clinical trials. However, data on real-life experience is lacking. Patients and methods A multicentric, retrospective study in routine clinical setting was conducted in cases of chronic plaque type of psoriasis during November 2016 to December 2017. Patients who had received 300-mg secukinumab injection subcutaneously at 0, 1, 2, 3, and 4 months and then every 4 weekly for at least 6 months were recruited for the study. Assessment of severity of psoriasis was done by psoriasis area severity index (PASI) and dermatological life quality index (DLQI). Results A total of 32 patients, comprising 24 males and 8 females, with mean age of 42.31 years (SD 11.32) and mean baseline PASI of 20.72 (SD 7.53) and DLQI of 15.31 (SD 5.25), were studied. Achievement of PASI 75/90/100 at 12 weeks was 81.25/59.37/9.3, respectively. PASI 75 at the end of 52 weeks was maintained at 65.62. DLQI reduced to 2.56 (SD 5.19) (16.72% of baseline) at the end of 12 weeks. Differences between baseline scores and each subsequent visit were statistically significant (P<0.001). Only mild adverse effects were noticed in six (18.7%) patients. Conclusion Secukinumab is a very promising new molecule in the management of chronic plaque type of psoriasis that is resistant to conventional modalities in routine clinical setting even in an Indian scenario. A retrospective analysis, with few cases, was inherent limitation of this study.
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Serum levels of interleukin-38 in sufferers with atopic eczema p. 66
Fathia M Khattab, Elsayed M Khater, Hoda A Ibraheem
DOI:10.4103/ejdv.ejdv_2_18  
Background The relation between interleukin-38 (IL-38) and atopy is not precisely regarded yet. The current study has a look at set to assess the serum level of IL-38 in atopy patients and controls in order to illustrate the disease association and correlation with severity. Objective The aim of this study was to quantify serum IL-38 titers in atopic dermatitis patients and to observe relationships with disease severity‏‏. Patients and method s Twenty-six atopic cases along with 26 healthy controls were attributed in this case–control study. Clinical severity was evaluated by SCORing Atopic Dermatitis index. Serum level of IL-38 was measured by enzyme-linked immunosorbent assay for all participants. Also, peripheral eosinophilic count and total immunoglobulin E were measured in participating patients only. Results IL-38 serum concentrations were extensively higher in atopic sufferers than controls (P<0.05). Moreover, there is a statistically significant correlation between IL-38 levels and both atopic severity and inflammatory markers as peripheral eosinophilic count and total immunoglobulin E. Conclusion IL-38 represents a mirror for atopic severity and its inflammatory state.
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Association of human leukocyte antigen-DRB1 with the response in patients with vitiligo p. 71
Mohamed Abdel Kader Toama, Fathia M Khattab, Ayman Marei
DOI:10.4103/ejdv.ejdv_3_18  
Background Vitiligo is a pigmentary disorder associated with the selective destruction of the skin melanocytes. Among the many human leukocyte antigen (HLA) alleles claimed to be incriminated in establishing vitiligo, HLA-DRB1 is included in many dermatological diseases and has been widely investigated in different studies worldwide. Aim To examine the susceptibility between HLA-DRB1 gene polymorphism and the therapeutic response of vitiligo. Patients and methods We performed a cohort study at Dermatology and Venereology Department, Zagazig Institution Hospitals from January 2018 to January 2019 on 80 patients with vitiligo who were subjected to treatment. Response to therapy was observed, and we followed up patients for 6 months. HLA-DRB1 genotyping using real-time PCR was performed once. Results The results showed that there was a significant statistical association regarding the therapeutic response in our study. Conclusion Our findings advise that DRB1 *0701 and *0413 are associated with good therapeutic response, whereas DRB1 *8 and *12 alleles are associated with worse therapeutic response among Egyptians.
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Topical calcipotriol mixed with topical steroid versus topical steroid alone in treatment of alopecia areata p. 78
Mohamed I El-Ghareeb
DOI:10.4103/ejdv.ejdv_24_18  
Background Alopecia areata (AA) is an autoimmune T-cell mediated disease characterized by a localized patchy hair loss from scalp and other hairy body parts. Topical steroid is one of the traditional therapeutic options for AA. It is considered as a recommended tool in the treatment of mild-to-moderate AA, especially when used early in the course of the disease. Calcipotriol is a vitamin D analog and acts as a potent immunomodulatory agent and can be used in the treatment of AA. Rationale Recently, vitamin D deficiency was observed in patients with autoimmune diseases including patients with AA. Calcipotriol is emerging as a novel agent in the treatment of AA in many published studies. The therapeutic effect of the mixture of topical calcipotriol and topical steroid in the treatment of AA was not mentioned in previous studies. Aim The aim of this study is to evaluate the efficacy and safety of topical calcipotriol mixed with topical steroid in the treatment of AA in comparison with topical steroid alone. Patients and methods A total of 40 patients with mild-to-moderate AA were involved in this study throughout a 12-week trial. Institutional review board (IRB) approval was obtained with informed consents from all patients. The patients were divided into two groups: 20 patients in group A and another 20 patients in group B. Group A patients had been treated with topical steroid (betamethasone valerate 0.1%) twice daily throughout the 12 weeks. Group B patients had been treated with a topical gel preparation containing calcipotriol 0.005% mixed with betamethasone dipropionate 0.05%. This gel preparation was applied to the affected area twice daily throughout the 12 weeks. Severity of Alopecia Tool (SALT) score was calculated at baseline and at 3, 6, 9, and 12 weeks. Results There was a statistically highly significant decrease in SALT scores after the 3-month treatment in group A, and there was a statistically significant decrease in SALT scores after the 3-month treatment in group B. Conclusion Topical calcipotriol mixed with topical steroid in a gel formulation is a novel therapeutic tool of AA with efficacy nearly the same as of topical steroid alone and with less adverse effects.
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Insulin resistance in androgenetic alopecia and acne vulgaris p. 83
M. Yousry Abdelmawla, Abdulla M Esawy, Elsayed Khater, Naglaa A Khalifa
DOI:10.4103/ejdv.ejdv_28_18  
Background Insulin resistance (IR) is the inability of a known quantity of exogenous or endogenous insulin to increase glucose uptake and utilization in an individual as much as it does in a normal population. Some conditions strongly associated with IR such as acanthosis nigricans, acne, and psoriasis. Some conditions potentially associated with IR such as androgenetic alopecia (AGA), hirsutism, and hyperandrogenism. Some conditions anecdotally linked to IR such as alopecia areata and vitiligo. We aimed to analyze the relationship between IR and AGA and acne vulgaris, in comparison to controls. Patients and methods The study was carried out on 54 AGA and 54 acne vulgaris patients selected from Dermatology, and Venereology Department, Zagazig University Hospitals, 54 volunteers as a control, general, and dermatological examination were done. IR was estimated by the Homeostasis Model Assessment of Insulin Resistance. Results Statistically no significant differences between cases and control regarding sociodemographic distribution, blood glucose, and insulin. Nonsignificant differences between AGA and acne groups regarding sociodemographic distribution and duration of the disease. Nonsignificant differences between AGA and acne regarding blood glucose and insulin. Conclusion There is a role of insulin in the etiopathogenesis of AGA and acne.
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Efficacy and safety of topical spironolactone 5% gel versus placebo in the treatment of acne vulgaris p. 89
Enayat M Attwa, Al Shimaa M Ibrahim, Marwa F Abd El-Halim, Hanan M Mahmoud
DOI:10.4103/ejdv.ejdv_36_18  
Background Acne is an inflammatory disorder of the pilosebaceous unit that imposes negative effects on the psychological state of patients. Indeed, even mild acne can adversely affect the patients’ quality of life. Therefore, successful management is needed. Spironolactone is one of the effective systemic treatments for acne, but its adverse effects limit its use. Objectives To assess the effectiveness and safety of 5% spironolactone gel in the treatment of acne. Patients and methods This study was a split-face study in which 22 adult patients with mild and moderate acne vulgaris were instructed to apply topical 5% spironolactone gel to their right hemifaces and topical placebo gel to their left hemifaces twice daily for 8 weeks. Results This study reported a statistically significant reduction in the total lesion count and acne severity index from the baseline. The improvement was significantly higher in the spironolactone side than the placebo side. Spironolactone mainly improves comedones and inflammatory papules. Minimal tolerable adverse effects were recorded in the form of stinging and mild erythema. Conclusion The data provided by this study support the use of topical spironolactone in the treatment of mild to moderate acne vulgaris.
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CASE REPORTS Top

Anonychia multiplex: methotrexate induced? p. 95
Bharat Bhushan Mahajan, Lovleen Kaur, Chetna Singla, Parul Chojer, Varinder Kumar
DOI:10.4103/ejdv.ejdv_2_19  
Psoriasis is a chronic systemic inflammatory disease primarily involving skin, nails, and articular system with associated disease-related comorbidities including type 2 diabetes mellitus and metabolic syndrome. In the past, studies had hypothesized that rapid nail growth of psoriatic nail plate with associated parakeratosis does not allow the fungus to lodge in the nail keratin, thereby the incidence of onychomycosis should have been low in nail psoriasis. However, current studies mention that psoriatic nails are predisposed to secondary onychomycosis, but the end result of manifesting as anonychia multiplex of these two coexistent nail diseases, further complicated by methotrexate, has not been reported in the literature till date. We hereby, report a case of anonychia multiplex of psoriatic nails with coexisting onychomycosis, probably induced by methotrexate-related immunosuppression, for its rarity.
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Chronic plaque psoriasis on diffuse systemic sclerosis: a rare association p. 98
Parul Chojer, Bharat Bhushan Mahajan
DOI:10.4103/ejdv.ejdv_26_18  
Diffuse systemic sclerosis is a multisystem autoimmune disease that is characterized by generalized vascular involvement that results in tissue necrosis and secondary fibrosis. Psoriasis is a chronic inflammatory skin disease. Both of these diseases are autoimmune in origin. Psoriasis is, however, rarely associated with systemic sclerosis, but few cases have been reported, and a common genetic and immunological background shared by these diseases has been suggested. Here we report a case of a 20-year-old female patient with diffuse systemic sclerosis who developed chronic plaque psoriasis with Psoriasis area and severity Index (PASI) of 14.0 and body surface area of 32% with diffuse skin sclerosis and respiratory involvement.
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Dermoscope as a diagnostic tool in pseudofolliculitis corporis: a dermatologist’s viewpoint p. 102
Jyoti Budhwar, Chetna Singla, Elga Muralidharan, Suresh K Malhotra
DOI:10.4103/ejdv.ejdv_6_19  
Pseudofolliculitis is an inflammatory condition of the hair follicle that mainly affects the beard area, but it can occur in any area of hair-bearing skin when hair removal methods like shaving or plucking are used. It occurs when the shaved hair curls inwards and repenetrates the skin surface inducing inflammatory changes. Sometimes, it is a simple cosmetic problem, but at other times it can present with intense itching or pain and can become quite debilitating for the patient. Here, we report a case of pseudofolliculitis corporis presenting to us with intractable itching. The patient used to rub his back against the wall and used combs and other things for itching. The diagnosis of pseudofolliculitis corporis was suspected clinically and confirmed by dermoscopy, which is a simple office procedure. Patient was advised not to rub his back against wall and was given emollients and topical adapalene gel and advised follow-up after 15 days.
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