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   Table of Contents - Current issue
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July-December 2017
Volume 37 | Issue 2
Page Nos. 33-88

Online since Friday, August 4, 2017

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REVIEW ARTICLE  

Prevalence of pediculosis capitis among primary school students at Sharkia Governorate by using dermoscopy Highly accessed article p. 33
Manal M El-Sayed, Mohammed A Toama, Ahmed S Abdelshafy, Abdulla M Esawy, Safaa A El-Naggar
DOI:10.4103/ejdv.ejdv_47_16  
Background Pediculosis capitis is the infestation of human hair and scalp by head lice. Dermoscopy was used to improve the health of students in Sharkia Governorate by decreasing the prevalence of pediculosis capitis among them. Aim The aim of the present study was to determine the prevalence of pediculosis capitis among primary school students in Sharkia Governorate, find the risk factors associated with this infestation, and to compare the traditional methods in diagnosis of pediculosis capitis with dermoscopy. Participants and methods This study was conducted on 242 students in Sharkia Governorate. Clinical and dermoscopic examinations were carried out for all children. Results Dermoscopic examination of the studied children was as follows: 44.6% of them were free of infestation or dandruff, 17.8% were also free of infestation but showed dandruff, which may be misdiagnosed as nits, and 4.1% showed empty nits only. Thus, the total negative was 162 (66.9%). Only 0.4% of them showed empty nits with dandruff. About 7.4% of them were with empty and filled nits, 21.9% were with filled nits only, and 0.4% of them showed mobile lice. Hence, the prevalence of pediculosis capitis was 33.0% by using dermoscopic examination. Conclusion Prevalence of pediculosis capitis among primary school students in Sharkia Governorate was 33.0% by using dermoscopic examination. Pediculosis capitis was found to be affected by some sociodemographic characteristics as sex, residence, social class, father’s and mother’s education, and some behaviors as combing of hair and sharing tools; moreover, hair length was shown to increase infestation. Overall, dermoscopy was found to be better in diagnosis pediculosis capitis compared with visual examination.
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ORIGINAL ARTICLES Top

Effectiveness and safety of fexofenadine in chronic idiopathic urticaria − open-label noncomparative study in daily practice p. 43
Michel Fouad, Magdy Ragab
DOI:10.4103/ejdv.ejdv_38_16  
Objective This study aimed to evaluate effectiveness and safety of fexofenadine in the treatment of chronic idiopathic urticaria (CIU) in routine practice in Egypt. Patients and methods This study is a local, multicenter, noninterventional, prospective, open-label, noncomparative, observational product registry conducted across Egypt. Three mandatory visits were made by the investigator for each eligible patient, and patients were assessed by urticaria symptoms score. Result The results of this study showed a statistically significant reduction (P<0.001) in signs and symptoms of CIU evaluated by the urticaria-related signs and symptoms score according to patients’ completed diary cards. Pruritis was decreased in 74.9% of patients and was improved in 22.3% of patients. Hives were relieved in 81.1% of patients and were improved in 17.5% of patients, whereas other related signs and symptoms of CIU were decreased in 75.5% of patients and improved in 22.2% of patients. Mild dizziness was reported in 0.2% of total enrolled patients that recovered after 3 days without corrective treatment. Conclusion Fexofenadine demonstrated statistically significant reduction in symptoms and signs of CIU. Pruritis status was decreased in 74.95% of patients. Hives status were relieved in 81.1% of patients, after a mean treatment duration of 14.93±5.49 days at visit 2 and 27.94±4.56 days at visit 3 (end of study). In addition, treatment with fexofenadine was well tolerated.
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The role of Helicobater pylori as an aetiological factor for rosacea p. 49
Bothaina M Ghanem, Ayman A.M. El-Kholy, Nabieh A El-Ghawalby, Farha A El-Chennawy, Samia M Abdel Naby
DOI:10.4103/ejdv.ejdv_60_16  
Background Rosacea is a chronic cutaneous disorder characterized by persistent centrofacial erythema, telangiectases, papules, pustules, oedema, phymatous and ocular involvement. Despite being one of the most common skin disorders, its pathogenesis remains unclear and controversial. More recently, numerous studies have described an association with Helicobacter pylori. Objective This study was undertaken to investigate the prevalence of H. pylori in rosacea patients by performing gastroscopic biopsy, and if its eradication is a useful therapy for rosacea. Patients and methods This study was conducted on 54 patients with rosacea: 46 women and eight men, in addition to 26 healthy controls of similar age and socioeconomic status. Blood samples were taken from patients, and controls for the detection of H. pylori immunoglobulin G antibodies by enzyme-linked immunosorbent assay. Also, gastroduodenoscopy was done for 28 patients with rosacea, and two punch biopsies were taken for direct Gram stain, direct urease test and culture. Results Bacteriological tests were positive in 11 of these 28 (39.3%) patients. Seropositive prevalence was significantly higher in the rosacea group than in the control group (81.5 vs. 57.7%). On intake of H. pylori eradication therapy in the form of amoxicillin 500 mg/6 h and metronidazole 500 mg, thrice daily, for 10 days, the H. pylori positive group showed significant improvement in rosacea severity. Conclusion Our results suggest that H. pylori is a risk factor that may cause or aggravate rosacea condition. Its eradication leads to a favourable clinical outcome.
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Role of iron in telogen effluvium among premenopausal women p. 56
Abeer Abdel-Hakam Hodeib, Yomna Mazid El-Hamd Neinaa, Heba Ahmed Mourad, Riham Ali Sabry Daba
DOI:10.4103/ejdv.ejdv_64_16  
Background Telogen effluvium (TE) is the most common cause for diffuse nonscarring hair loss that is characterized by excessive loss of telogen hair. It is mainly of two types − acute TE or chronic TE. Iron deficiency has been suggested as a possible etiological factor for TE in women; however, its role is still controversial. The aim of this study was to assess the iron profile in TE among premenopausal women, to throw light on its possible role in the pathogenesis of this disease. Patients and methods A total of 40 premenopausal women with TE, and 20 age-matched healthy women were enrolled in this study. Venous blood samples were collected from all and examined for complete blood cell counts, serum iron, serum ferritin, and total iron-binding capacity. Results TE patients showed statistically significant decreased hemoglobin concentrations in comparison with controls, and acute TE women had the lowest hemoglobin concentrations. Serum iron showed a statistically highly significant decrease in TE women (both acute and chronic) in comparison with controls. No statistically significant difference could be detected between the studied groups regarding serum ferritin and total iron-binding capacity, but there was a statistically significant number of chronic TE patients with serum ferritin levels below 20 ng/ml. Conclusion Iron deficiency may have a possible role in the pathogenesis of TE among premenopausal women. Checking hemoglobin concentrations is particularly important in acute TE, whereas determining serum ferritin levels is particularly important in chronic TE.
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A retrospective study of the clinical, histopathological, and direct immunofluorescence spectrum of immunobullous disorders p. 62
Viraktamath Chanabasayya, Jayaraman Jyothi, Martis Jacintha, Dandekeri Sukumar
DOI:10.4103/ejdv.ejdv_3_17  
Context Immunobullous disorders are a heterogenous group of dermatoses with a variety of frequently changing manifestations. They have remarkable impact on the patients and their family, and have severe economic consequences. The diseases have been the subject of intensive investigation in recent years. Aim The aim of this study was to investigate the clinical spectrum of immunobullous disorders and to analyze the correlation between clinical, histopathological, and direct immunofluorescence (DIF) diagnosis in immunobullous disorders of the skin. Patients and methods This cross-sectional, descriptive, chart-based, retrospective study was conducted on 91 clinically suspected immunobullous disorder patients who attended the Outpatient Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka, India, between 1 January 2015 and 31 October 2016. Results In 91 cases of suspected immunobullous disorders (50 male and 41 female), bullous pemphigoid was the most common condition (46.15%), followed by pemphigus vulgaris (18.68%) and pemphigus foliaceus (10.98%). Of the 91 patients, histopathological diagnosis was positive in 67 (73.62%) patients and DIF was confirmatory in 55 (60.44%) patients. Conclusion We recommend that clinical, histopathological, and DIF features be taken into consideration to arrive at final diagnosis in immunobullous disorders, as these methods may not be diagnostic individually in each and every case.
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Role of high-mobility group box-1 as a marker of disease severity and diagnosis of metabolic syndrome in psoriatic patients p. 69
Mahmoud N Kamel, Eman M Hassan, Mona M Sobhy, Maryam M.I. El Sayes
DOI:10.4103/ejdv.ejdv_10_17  
Background Psoriasis is a chronic inflammatory disease with systemic immunological disturbance. Suggested pathophysiology linking psoriasis and metabolic syndrome involves overlapping inflammatory and genetic pathways. High-mobility group box-1 (HMGB1) is a nuclear transcriptional protein, which is released extracellularly to function as a proinflammatory mediator. Elevated HMGB1 was reported in autoimmune and inflammatory disorders. However, its role in inflammatory dermatological conditions such as psoriasis is under investigation. Objectives The goals of this study were to evaluate the serum level of HMGB1 in psoriasis patients and its relation to disease severity. In addition, the study aimed to compare its level between psoriatic patients with and without metabolic syndrome with assessment of its prognostic potential to diagnose metabolic syndrome in the psoriatic population. Patients and methods Fifty psoriatic patients and 20 healthy controls were included. Serum level of HMGB1 was measured using enzyme-linked immunosorbent assay and its relation to disease severity and duration using psoriasis area and severity index. Metabolic syndrome was identified among psoriatic patients, using International Diabetes Foundation. Receiver operating characteristic analysis was employed to calculate the area under the curve for HMGB1 to find the best cutoff value capable of diagnosis of metabolic syndrome in psoriasis. Results Significantly higher HMGB1 level in psoriasis patients than in controls was detected (P=0.037) and was correlated with disease severity. A higher HMGB1 level among psoriatic patients with metabolic syndrome than that among patients without metabolic syndrome was reported (P=0.007). At receiver operating characteristic analysis, HMGB1 showed 80% sensitivity and 50.43% specificity in detecting metabolic syndrome in psoriasis. Conclusion HMGB1 may be considered as a useful marker of psoriasis severity in addition to its predicting potential for metabolic syndrome in psoriatic patients.
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CASE REPORTS Top

Leprosy: a mimicker of psoriasis p. 76
Rita V Vora, Rahul Krishna S Kota, Kira A Pariath
DOI:10.4103/ejdv.ejdv_4_17  
Leprosy is a slowly progressive mutilating and stigmatizing disease. As the spectrum of disease is varied, various dermatological conditions may lead to diagnostic dilemma. Early diagnosis will help in the initiation of its treatment to avoid complications and morbidity due to the disease. The diagnosis of leprosy is made from the clinical picture, but must be complimented by biopsy and slit skin smear. Here, we report a case of leprosy that was mimicking psoriasis – a papulosqaumous disease clinically.
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Generalized papular granuloma annulare p. 79
Shailee S Gandhi, Rochit R Singhal, Niral K Sheth, Rita V Vora
DOI:10.4103/ejdv.ejdv_5_17  
Granuloma annulare is a benign skin condition that typically consists of grouped papules in an enlarging annular shape. It affects patients of all ages and is generally asymptomatic. The lesions rarely occur on the palms, soles, face, and mucous membranes. In this study, we present the case of a 47-year-old woman with lesions over her chest, bilateral forearms, and upper back, diagnosed as having generalized papular granuloma annulare.
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Delusion of parasitosis with folie à deux p. 82
Mrinal Gupta
DOI:10.4103/ejdv.ejdv_6_17  
Delusion of parasitosis (DOP) is a primary psychiatric disorder characterized by the patient’s firm belief that they have skin symptoms due to an infestation with insects. Patients prefer to consult a dermatologist because of the firm belief and refuse psychiatric advice. Folie à deux or shared psychotic disorder is a rare presentation with DOP. We present a case of DOP in a 63-year-old female patient who presented with complaints of insects crawling over her body and over her 1-year-old granddaughter, which was shared by her son also. The patient had brought a box full of the collected ‘insects’, the characteristic ‘matchbox sign’, and had also taken the photographs of the ‘insects’ on her cell phone, which we termed as the ‘snapshot sign’. The patient was treated with olanzapine, which led to partial resolution of her symptoms.
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Granulomatous cheilitis involving the lower lip p. 85
Pragya A Nair, Trusha M Patel
DOI:10.4103/ejdv.ejdv_8_17  
Granulomatous lesions of the oral and oropharyngeal submucosal tissues refer to painless, idiopathic swelling frequently affecting the buccal and labial areas. They present a diagnostic dilemma because of the wide variety of possible etiologic factors. Granulomatous cheilitis should be considered in the differential diagnosis of persistent lip swelling. It can occur in isolation as a monosymtomatic form or as a part of Melkersson–Rosenthal syndrome, which is a triad of recurrent orofacial swelling, relapsing facial paralysis, and fissuring of the tongue (lingua plicata). Spontaneous remission is rare, and recurrences are common. Corticosteroids used for treatment provide temporary improvement. A combination of intralesional triamcinolone and clofazimine or dapsone is one of the most commonly used treatment options. We present the case of a 21-year-old young man with granulomatous cheilitis who responded to intralesional steroids and dapsone.
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