SERUM LIPID LEVELS IN PATIENTS WITH LICHEN PLANUS: مستويات شحوم الدم عند مرضى الحزاز المسطح

Background: Lichen planus (LP) is a chronic inflammatory disease, involving the skin, mucous membranes, hair, and nails. Cardiovascular risk factors have been assessed with some chronic inflammatory skin diseases such as alopecia and psoriasis. Recently, some studies found that lichen planus (LP) was associated with dyslipidemia. So we did this study to find this association in our patients. Objective: To evaluate lipid levels in patients with L.P and compare it with controls. Materials and Methods: This case- control study included 160 participators (80 with L.P. and 80 controls) admitted to dermatology clinic at Tishreen University Hospital, Lattakia, Syria, from 2020- 2021. Results: Cholesterol, triglyceride and Low- density lipoprotein (LDL) levels in patients were significantly higher than the control group; it was only regarding high- density lipoprotein (HDL) levels that no significant difference was observed between the two groups. Triglyceride levels were significantly higher and HDL levels were lower in patients with diffused disease. There was a recognizable correlation between elevated levels of LDL and cholesterol with disease duration. Conclusion: In this study, a disrupted lipid profile was observed in LP patients, which can be associated with disease severity. This study proposes measuring lipid serum levels prior to commencing the treatment in all known cases of lichen planus, so as to preclude cardiovascular diseases if there is a problem with the lipid profile.

Quality of life in patients with scabies in Erbil, Iraq

Background and objective: Scabies, known as the seven-year itch, is a contagious skin infestation by the mite Sarcoptes scabiei that causes a pruritic skin eruption. Scabies is endemic in most of the communities of the developing world. This study aimed to assess the quality of life of scabies patients, taking into consideration the demographic profile and clinical presentation of patients in Erbil. Methods: In this cross-sectional study, 107 scabies patients attending a private dermatology clinic were recruited. Dermatology Quality of Life Index questionnaire was used for data collection. Results: More than half (51.4%) of the patients were less than 30 years of age, including 58.9% males, 70.1% of them were married, and 67.3% were living in the urban area. More than 84% of the study sample’s quality of life was very large and extremely large affected. The overall mean of the quality of life scores was 14.95±4.5 with no significant association between the overall quality of life scores to disease severity and certain sociodemographic characteristics of the patients. The mean scores of the two domains of embarrassment and shopping were significantly associated with the male gender (P = 0.003 and 0.021, respectively). However, 40.2%, 35.5%, and 29% of the patients reported that the disease affected very much on their shopping, clothing, and working activities, respectively. Conclusion: The disease had caused a significant effect on patients' lives, with no significant association between the severity of the disease and overall quality of life scores. The disease in its mild, moderate, and severe forms adversely affected patient lives. The commonest quality of life scores were those in the range of 11-20. Keywords: Quality of life; Scabies; Erbil; Iraq.

A screening checklist to minimize the adverse effects of cosmetic dermatological procedures; a short paper (Preprint)

BACKGROUND Cosmetic dermatological procedures which are aimed at enhancing the external appearance have troublesome yet preventable adverse effects. At present, there is a lack of a comprehensive screening guideline to detect patients with risk factors for such adverse effects. OBJECTIVE To introduce a comprehensive screening checklist to pick up the patients’ risk factors in advance, in order to prevent or minimize adverse effects from cosmetic dermatological procedures. METHODS The checklist was administered to 1150 patients attending an outpatient dermatology clinic for cosmetic dermatological procedures. Checklist composed of 30 ‘yes/no’ type questions and 7 other components in the pre-procedure workup. RESULTS Except for two risk factors (being pregnant and having a pacemaker inserted), all other assessed possible risk factors were present in one or more patients who attended for procedures. The most prevalent risk factor was the current use of medications in 226 (19.65%) patients. The other commonly found risk factors were: lack of full understanding of the procedure (14.52%) and phobia/fear of injections (9.30%). CONCLUSIONS The screening checklist that we used is a simple yet comprehensive tool for minimizing the possible adverse effects of cosmetic dermatological procedures. We were able to postpone, take remedial actions or alter the cosmetic dermatological procedures after going through the checklist and increase patient satisfaction and improve the safety of the doctor as well. CLINICALTRIAL Not applicable

Validation of the Persian version of Skindex-16 among older patients with skin diseases

Background Skin conditions often considerably impact the older patients’ psycho-social health and quality of life (QoL). The present study was aimed to examine the validity and reliability of the Persian version of Skindex-16 among older people with skin diseases. Methods In this validation study, 260 older patients suffering from a range of skin conditions were recruited from a dermatology clinic in Rasht, Iran. Data were collected using a checklist for demographic and clinical characteristics and the Skindex-16 questionnaire. In this study, validity (face, content, and construct) and reliability (Cronbach’s alpha) of the Skindex-16 were assessed and reported. Results The mean age of participants was 64.51 ± 5.04 years. The results of confirmatory factor analysis showed that the model had acceptable fitness into the expected three-factor structure [χ 2 /df = 249.363, P < 0.001; GFI = 0.961; TLI =0.952; RMSEA = 0.078 (90% CI = 0.06, 0.09) and SRMR = 0.06]. The reliability analysis results confirmed that the values of Cronbach’s alpha coefficient for Skindex-16 were in the acceptable range (0.923). Conclusions Our evaluation of the Skindex-16 indicates that it is reliable and a valid instrument that can be used for measuring QoL for Iranian dermatologic patients.

The Effect of Systemic Methotrexate and Cyclosporine Combination Therapy inPsoriasis Vulgaris Patients in Bandung, Indonesia

Background: Methotrexate (MTX) and cyclosporine have been used as effective systemic mono-therapy for psoriasis. Several factors are considered to switch monotherapy to combination therapy because monotherapy is no longer effective and has higher side effects. Hence,clinicians have avoided systemic therapy combinations due to its toxicity. However, some studies showed that this combination therapy could be usedeffectively for psoriasis patients. Purpose: This study aimed to analyze the efficacy and adverse effects of systemic MTX and cyclosporine combination therapy in Indonesian psoriasis vulgaris patients. Methods: The retrospective study assessed the effectiveness of 3 monthsmono-therapyand combination therapy of systemic MTX and cyclosporine in psoriasisvulgaris patients from 2016–2017 in Dermatology Clinic, Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia. Result: Psoriasis area and severity index (PASI) score 90 were achieved in the group MTX (50%) and cyclosporine group (50%), while none in the combination group.However, eight patients (50%) in group MTX and cyclosporine reached the primary endpoint of PASI 50. One patient in cyclosporine group had adverse effects on kidney profiles. Nonetheless, other patients had no biochemical changes. But, there was no significant difference in the change of PASI between each group (p=0.102). Conclusion: We propose that combination therapy of MTX and cyclosporine is relatively safe and efficacious in treating Indonesian psoriasis vulgaris patients. This combination treatment isas effective as MTX or cyclosporinemono-therapy.

Direction Change in Distal Bypass Graft due to Increased Collateral Perfusion after the Free Flap Transfer

Distal bypass combined with a free flap is a frequent surgical option for ischemic ulcers of the lower extremities. Here, we describe a patient in whom there was a change in the direction of blood flow in a distal bypass graft. A 68-year-old male patient with an ischemic ulcer on his left heel was referred to our facility by a local dermatology clinic. Surgical revascularization was performed between the popliteal artery and the dorsalis pedis artery using an ipsilateral great saphenous vein as the graft vessel. The wound site did not heal postoperatively, so it was covered using a free latissimus dorsi muscle flap. At the same time, the thoracodorsal artery was anastomosed to the bypass graft in an end-to-side manner to serve as a nutrient vessel. Initially, blood flow into the thoracodorsal artery from the bypass graft was via the popliteal artery. However, after occlusion of the proximal anastomotic site of the bypass graft, blood flow into the thoracodorsal artery from the bypass graft was via the dorsalis pedis artery, which was the distal anastomotic site. The change in direction of blood flow might have been the result of an increase in blood flow in the collateral vessels in the ischemic lower leg, which eventually overwhelmed the blood flow in the bypass graft.

Management practice, quality of life and associated factors in psoriasis patients attending a dermatological center in Ethiopia

Background Psoriasis is a chronic inflammatory disease characterized by keratinocyte hyperproliferation and aberrant differentiation with great negative impact on patients’ quality of life (QoL). This study aimed at assessing factors influencing management practice, and QoL and its associated factors among ambulatory psoriatic patients visiting All Africa Leprosy, Tuberculosis and Rehabilitation Training (ALERT) Center in Addis Ababa, Ethiopia. Materials and methods A cross sectional study was conducted in 207 patients with psoriasis attending the dermatology clinic of ALERT Center in Addis Ababa, Ethiopia. Data were collected using structured questionnaire and patients’ chart review. Dermatology Life Quality Index (DLQI) was used to measure patients’ QoL. Patients’ characteristics were summarized using descriptive statistics and predictors of QoL were identified by binary logistic regression. Results Among 207 study participants, 122 (58.9%) were females. The mean age of the study population was 37.92 (SD = 14.86) years (ranging from 16 to 68 years). The mean age at which diagnosis of psoriasis made was 32 (SD = 13.7) years ranging from 10 to 62 years. The duration of the disease in 112 (54.1%) patients were more than or equal to 5 years. Majority of study participants 145 (70.0%) had plaque psoriasis followed by sebopsoriasis, 24 (11.6%). The majority of plaque psoriasis (80%) cases were managed by topical corticosteroids with or without salicylic acid or coal tar and only 21 (14.5%) treated by methotrexate alone. The mean DLQI was 6.25 corresponding to a moderate effect. Symptoms and feelings were the most affected domains of QoL. Factors associated with poor QoL were female [AOR = 0.17 (95%CI: 0.06, 0.48)], low, above average and high family income ([AOR = 0.12 (95% CI: 0.02, 0.56)], [AOR = 0.06 (95% CI:0.01, 0.32)], and [AOR = 0.03 (95% CI: 0.01, 0.22)]), respectively, and primary education level [AOR = 0.14 (95% CI: 0.03, 0.64)] while being on systemic therapy [AOR = 4.26 (CI: 1.18, 15.35)] was predictor of better QoL. Poor QoL was predominant in females [AOR = 0.17 (95%CI: 0.06, 0.48)], low income [AOR = 0.12 (95% CI: 0.02, 0.56] patients, and patients with primary education level [AOR = 0.14 (95% CI: 0.03, 0.64)]. Patients on systemic therapy [AOR = 4.26 (CI: 1.18, 15.35)] had good QoL. Conclusion Our study identified that topical corticosteroids were the mainstay of psoriasis treatment in the dermatology clinic of ALERT Center in Addis Ababa, Ethiopia. Moderate effect QoL was achieved by study participants based on DLQL score.