EFFICACY OF 5% POTASSIUM HYDROXIDE VERSUS 10% POTASSIUM HYDROXIDE SOLUTION FOR THE TREATMENT OF MOLLUSCUM CONTAGIOSUM AT A TERTIARY CARE HOSPITAL

Objective: To compare the efficacy of 5% potassium hydroxide (KOH) and 10% potassium hydroxide (KOH) solution for the treatment of molluscum contagiosum at a tertiary care Hospital. Study Design: Quasi-experimental study. Place and Duration of Study: Dermatology Department, Tertiary Care Hospital Karachi, from Oct 2019 to Apr 2021. Methodology: Sixty patients with molluscum contagiosum who fulfilled the inclusion and exclusion criteria were enrolled in the outpatient department of tertiary care hospital in Karachi. Patients were divided into two groups, A (5% KOH) and B (10% KOH) of 30 patients each. Potassium Hydroxide (KOH) solution was applied at home using the cotton-tipped applicator twice daily. Follow-up of patients was done at 2-weekly intervals for 12 weeks. Efficacy was measured based on the resolution of lesions or improvement from baseline. Results: Complete response occurred in 23 (76.7%) cases in 10% KOH Group while 6 (20%) in 5% KOH Group, Partial response occurred in 6 (20%) in 10% KOH group while 15 (50%) in 5% KOH group, No response occurred in 1 (3.33%) in 10% KOH group and 9 (30%) in 5% KOH group (p<0.001). Conclusion: 10% Potassium Hydroxide (KOH) is an efficient modality for the treatment of molluscum contagiosum compared to 5% Potassium Hydroxide (KOH).

Asymptomatic Scalp Carriage among Household Contacts of Children Affected by Tinea Capitis: A Prospective Study in the Metropolitan Area of Brussels, Belgium

<b><i>Introduction:</i></b> Tinea capitis (TC) is a superficial fungal infection affecting the scalp. The existence of asymptomatic carriers (ACs) could represent a potential reservoir responsible of (re)contamination and failure of treatment. No prospective studies on ACs in household contacts of TC patients in Europe have been published to date. <b><i>Objectives:</i></b> The aim of this study was to assess the prevalence of ACs in a cohort of household contacts of children who were diagnosed with TC in the metropolitan area of Bruxelles, Belgium. <b><i>Methods:</i></b> This prospective observational study was conducted from October 2015 to April 2016 at the Dermatology Department of the University Hospitals Brugmann, Saint-Pierre, Queen Fabiola Children Hospital. <b><i>Results:</i></b> Ninety-nine cases of TC from 95 different family circles were included. The main infectious agent identified was <i>Microsporum audouinii</i> in 53 cases. The mean age of TC patients was 5.8 years. Male/female ratio was 2.8. Eighty-one household contacts of TC patients were enrolled in the study. Two cases of ACs (5%) were identified. <b><i>Conclusions:</i></b> <i>M. audouinii</i> was the most common pathogen identified. The prevalence of ACs we report is on average higher compared to other European large cities. Larger prospective studies including all close contacts of affected patients are required in order to establish guidelines regarding identification and management of ACs.

Human leukocyte antigen Class II alleles associated with acral lentiginous melanoma in Mexican Mestizo patients: A case-control study

Background: Melanoma is an aggressive cutaneous cancer. Acral lentiginous melanoma is a melanoma subtype arising on palms, soles, and nail-units. The incidence, prevalence and prognosis differ among populations. The link between expression of major histocompatibility complex Class II alleles and melanoma progression is known. However, available studies report variable results regarding the association of melanoma with specific HLA Class II loci. Aims: The aim of the study was to determine HLA Class II allele frequencies in acral lentiginous melanoma patients and healthy Mexican Mestizo individuals. Methods: Eighteen patients with acral lentiginous melanoma and 99 healthy controls were recruited. HLA Class II typing was performed based on the sequence-specific oligonucleotide method. Results: Three alleles were associated with increased susceptibility to develop acral lentiginous melanoma, namely: HLA-DRB1*13:01; pC = 0.02, odds ratio = 6.1, IC95% = 1.4–25.5, HLA-DQA1*01:03; pC = 0.001, odds ratio = 9.3, IC95% = 2.7–31.3 and HLA-DQB1*02:02; pC = 0.01, odds ratio = 3.7, IC95% = 1.4–10.3. Limitations: The small sample size was a major limitation, although it included all acral lentiginous melanoma patients seen at the dermatology department of Dr. Manuel Gea González General Hospital during the study period. Conclusion: HLA-DRB1*13:01, HLA-DQB1*02:02 and HLA-DQA*01:03 alleles are associated with increased susceptibility to develop acral lentiginous melanoma in Mexican Mestizo patients.

Inpatient Teledermatology Referrals During the COVID-19 Pandemic in a UK Trust: A Comparative Review and Doctor Survey

Background The COVID-19 pandemic has broadened the scope of teledermatology services in the United Kingdom from a primarily outpatient-based triage tool to the management of inpatient referrals. In order to reduce the risk of transmission in hospital, a number of changes were implemented within our department. As part of this, our on-call referrals were transferred to a telemedicine app, which incorporates the secure transfer of user-generated patient images onto a web-based image management system providing remote access for the dermatology team. Objective This study aimed to compare how the introduction of this referral method impacted the nature and number of referrals received, the efficiency of the on-call service, and user preferences. Methods A retrospective cohort study was conducted to compare the number of referrals, time taken to review, and referral diagnoses between previous referral methods to the dermatology department (bleep, fax, email) (July and September 2019) and the new teledermatology app (July and September 2020). We also performed a survey of junior doctors, seeking their feedback and preferences pertaining to the new referral system. Results The number of referrals increased by 80%, with a 6-fold increase in lesion referrals. There is a possibility that not all referrals from 2019 were accounted for as paper documents are easily lost or discarded, highlighting another advantage of teledermatology in providing a reliable record of referrals. Dermatology referrals may have increased as the telemedicine app is more accessible to staff across sites. The telemedicine app also led to a reduction in time to review by 0.53 days, resulting in a significantly higher number of patients being given dermatology input on the day of the referral (78% vs 58%). This will have led to earlier treatment, improved patient outcomes, and shorter inpatient stays, resulting in potential cost reductions for the hospital. The survey of junior doctors showed that 81% preferred teledermatology to the previous referral methods. Conclusions The introduction of teledermatology has provided an effective and acceptable method of managing on-call dermatology referrals. Easier access to dermatology advice via teledermatology may result in higher numbers of referrals, which may warrant strict referral criteria to prevent oversubscription of the on-call service. Teledermatology ensures an accurate log of referrals, including the nature of referrals, allowing for better auditing and service improvement. Teledermatology referrals allow for advice to be provided within shorter time frames compared to previous methods. This should improve patient outcomes and reduce hospital admission stays, potentially resulting in cost savings for the hospital. Conflict of Interest None declared.

Clinical Characteristics and Management of Patients With Clinical Amyopathic Dermatomyositis: A Retrospective Study of 64 Patients at a Tertiary Dermatology Department

Background: Clinical amyopathic dermatomyositis (CADM) represents a subtype of 5–20% of patients with dermatomyositis (DM), which can be categorized into amyopathic dermatomyositis (ADM) and hypomyopathic dermatomyositis (HDM). The characteristics of patients with CADM are still limited in English literature.Objective: To investigate clinical features, cutaneous findings, diagnostic accuracy, and treatment regimen of CADM patients.Methods: Sixty-four patients diagnosed with CADM at Peking Union Medical College Hospital by dermatologists were retrospectively analyzed. Data were recorded in the electronic database at each offline clinical consultation and directly extracted from medical records. 2017 EULAR/ACR criteria for idiopathic inflammatory myositis (IIM) classification was used to identify and classify patients with CADM. Published studies were searched to extract relevant data of CADM patients.Results: This cohort included 38 ADM patients and 26 HDM patients. 2017 EULAR/ACR criteria classified 67.2% of patients with CADM into probable or definite DM. Antimalarials were given to a majority of CADM patients (72.6%, n = 45). However, 68.8% (31 out of 45) required at least one aggressive agent combined with hydroxychloroquine due to insufficient response or side effects. The median of systemic treatments in HDM was significantly higher than ADM (p = 0.007). The number of ADM patients using antimalarials as monotherapy was significantly higher than that of HDM patients (p = 0.031), while the number of HDM patients receiving steroids combined with immunosuppressants was significantly higher (p = 0.025). The median of Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) score improvement was 11.5 and 10.5 for ADM and HDM after a median follow-up of 31.5 and 32.5 months, respectively. Six patients with normal muscle strength developed muscle weakness after a median of 10.5 months (IQR 9-13), and elevated inflammatory markers at initial visit might indicate their muscle weakness development.Conclusions: 32.8% of patients may be overlooked using the three skin variables of 2017 EULAR/ACR criteria. The response rate to single hydroxychloroquine in our cohort was 68.8%. Detailed treatment modalities were different among ADM and HDM. Long-term monitoring for the development of myositis in patients with CADM, especially those with elevated inflammatory markers at initial visit, may be warranted.

Inpatient Teledermatology Referrals During the COVID-19 Pandemic in a UK Trust: A Comparative Review and Doctor Survey (Preprint)

BACKGROUND The COVID-19 pandemic has broadened the scope of teledermatology services in the United Kingdom from a primarily outpatient-based triage tool to the management of inpatient referrals. In order to reduce the risk of transmission in hospital, a number of changes were implemented within our department. As part of this, our on-call referrals were transferred to a telemedicine app, which incorporates the secure transfer of user-generated patient images onto a web-based image management system providing remote access for the dermatology team. OBJECTIVE This study aimed to compare how the introduction of this referral method impacted the nature and number of referrals received, the efficiency of the on-call service, and user preferences. METHODS A retrospective cohort study was conducted to compare the number of referrals, time taken to review, and referral diagnoses between previous referral methods to the dermatology department (bleep, fax, email) (July and September 2019) and the new teledermatology app (July and September 2020). We also performed a survey of junior doctors, seeking their feedback and preferences pertaining to the new referral system. RESULTS The number of referrals increased by 80%, with a 6-fold increase in lesion referrals. There is a possibility that not all referrals from 2019 were accounted for as paper documents are easily lost or discarded, highlighting another advantage of teledermatology in providing a reliable record of referrals. Dermatology referrals may have increased as the telemedicine app is more accessible to staff across sites. The telemedicine app also led to a reduction in time to review by 0.53 days, resulting in a significantly higher number of patients being given dermatology input on the day of the referral (78% vs 58%). This will have led to earlier treatment, improved patient outcomes, and shorter inpatient stays, resulting in potential cost reductions for the hospital. The survey of junior doctors showed that 81% preferred teledermatology to the previous referral methods. CONCLUSIONS The introduction of teledermatology has provided an effective and acceptable method of managing on-call dermatology referrals. Easier access to dermatology advice via teledermatology may result in higher numbers of referrals, which may warrant strict referral criteria to prevent oversubscription of the on-call service. Teledermatology ensures an accurate log of referrals, including the nature of referrals, allowing for better auditing and service improvement. Teledermatology referrals allow for advice to be provided within shorter time frames compared to previous methods. This should improve patient outcomes and reduce hospital admission stays, potentially resulting in cost savings for the hospital.

The Outpatient Prescribing of Topical Betamethasone in Al-Kharj

Aim: The present study aimed to describe the prescribing pattern of topical betamethasone in the outpatient setting in Alkharj. Methodology: This retrospective study that included collecting data from the electronic prescriptions in a public hospital in Alkharj in 2018. Results: During the study period from Jan to Dec 2018 only 46 patients received topical betamethasone. Most of the patients were female (63.04%). About 71.74% of the prescribed betamethasone was in ointment form and 28.26% in lotion form. Most of the prescribers were residents (97.83%). Most of the prescriptions were written by dermatology department (58.70%). Conclusion: The use of topical betamethasone was uncommon and this could be due to the availability of other topical corticosteroids and other alternatives. It is important to increase the knowledge of health care workers and the patients regarding the use of topical corticosteroids.

Fungal Infections among Teledermatology Consultations in Dermatology Department of a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction: Teledermatology provides virtual consultation to patients using telecommunication technology. Using this method dermatologists can diagnose a condition with the help of pictures of the lesions and short history. During the COVID-19 pandemic, practicing this method has become more relevant. Providing teleconsultations to patients with fungal skin infections can prevent inadvertent use of topical corticosteroids. The objective of this study was to find the prevalence of fungal infections among teledermatology consultations done in a tertiary care hospital. Methods: It was a descriptive cross-sectional study where the store and forward and real-time methods were used between February 2020 to July 2020. Ethical clearance was taken from the institutional review board (reference number: 245). Data of those patients who wanted consultations from this department were sent by medical officers deployed in military hospitals that are under the central army hospital located in Kathmandu. Convenient sampling was used. The collected data was entered and analyzed in the Statistical Package of Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: A total of 451 (33.45%) (30.93-35.97 at 95% Confidence Interval) were diagnosed with fungal infections out of 1348 patients who were enrolled for the study. About 361 (80%) of the patients suffering from fungal infections belonged to the Terai region and 90 (20%) belonged to mountainous areas. Conclusions: The prevalence of fungal infection among teledermatology consultation was lower than the findings from a similar international study.

Celiac Disease Prevalence Among Children with Dermatologic Pathology: Cross Sectional Study with Clinical Case Series

Background. Celiac disease (gluten enteropathy) is relatively rare disease. However, such patients have higher risk of skin pathology than general the population, and their therapy efficacy is limited by the use of gluten-free diet. Therefore, screening of dermatologic patients on celiac disease may be relevant. Objective. Our aim was to study the prevalence of celiac disease among children with skin pathology. Methods. The study included children hospitalized in dermatology department. Screening for celiac disease included detection in blood serum of antibodies (IgA, IgG, IgM) to tissue transglutaminase via rapid tests. In case of positive result of rapid test, we have repeated the estimation of antibodies (IgA, IgG) to tissue transglutaminase via immunochemiluminescent method with ImmunoCAP technology or via enzyme immunoassay. In case of positive serological test, we have performed HLA typing to determine haplotypes of DQ2 and DQ8, as well as esophagogastroduodenojejunoscopy (EGDJS) with biopsy of the duodenal and jejunal mucosa for further histological verification of the diagnosis. Results. We examined 1,000 children with various dermatologic pathologies. Rapid tests showed positive result in 21 patients (2.1%; 95% C11.3-3.2%). The presence of antibodies to tissue transglutaminase was confirmed via additional serological examination in all cases. HLA-haplotypes DQ2/8 were revealed in all patients with positive rapid test results. Typical form of gluten enteropathy was confirmed in 18/21 patients (86%) according to a histological study, thus, estimated prevalence of celiac disease is 1.8% (95% C11.1-2.8%). Conclusion. The prevalence of celiac disease remains underestimated among children with skin diseases. More studies are needed on the diagnostic features of rapid tests on tissue transglutaminase, as well as the benefits of screening for celiac disease to achieve patient-relevant clinical outcomes of skin pathology with wider gluten-free diet.

Mean Platelet Volume in Patients of Psoriasis in a Tertiary Care Hospital

Objective: To determine mean platelet volume in patients of psoriasis Study Design: Cross sectional study Place and duration of study: Dermatology Department, Pak Emirates Military Hospital Rawalpindi from August 2017 to January 2018. Methodology: Approval from the hospital ethical review committee was taken and a total of 100 patients were enrolled by non-probability consecutive sampling. After an informed written consent, name, gender, age, hospital record number, and phone number of each individual were noted. At the time of enrollment, all the individuals were subjected to complete blood count, bleeding time, fasting blood sugar, fasting lipid profile, renal and liver function tests. Patients with abnormal parameters were excluded from the study. A two ml venous blood sample was drawn from each patient and sent in CP bottle to the laboratory of Armed Forces Institute of Pathology for blood complete analysis by hematology analyzer machine. Data analysis was done using SPSS version 22. Results: In this study mean age was 40 ± 10.40 years. 54% patients were male and 46% patients were female. Mean platelet volume in patients presenting with psoriasis was 9.10fL with SD ± 2.12. Conclusion: Our study concludes that the mean platelet volume in patients presenting with psoriasis was 9.10fL with SD ± 2.12 which is in the normal range. Therefore, mean platelet volume is not affected by psoriasis. Key words: Mean platelet volume, psoriasis, severity, cross-sectional study