Dermoscopic evaluation of cutaneous leishmaniasis.

Cutaneous leishmaniasis (CL) is an endemic disease in Iraq that is caused by protozoan infection. Dermoscopy has been applied to help in the diagnosis of multiple skin disease, including infestations. To evaluate the dermoscopic characteristics of CL lesions and their relationship with the disease duration, site, and pattern. Dermoscopic examination using (3 Gen Dermlite DL 100) at tenfold magnification of 91 lesions in 67 patients was elicited. This study was done from December 2019 to December 2020. The main dermoscopic features were generalized erythema (100%), hyperkeratosis with central erosion or ulceration (53.8%), white scar-like patch (41.8%), yellow tears (35.2%), white starburst sign (34.1%), and milia-like cyst (2.2%). We also observed vascular structures, including linear irregular (63.1%), dotted (57.1%), glomerular (38.1%), hairpin (22.6%), and comma-shaped vessels (16.7%). Linear irregular vessels were more commonly demonstrated on the face and upper limbs; while on the lower limbs, hyperkeratosis with erosion and ulceration were the most common finding. Hyperkeratosis with erosions/ulcerations (43.8%) was the most common finding in the papular pattern, linear irregular vessels (56.7%) in the nodular pattern, glomerular vessels (64.3%) was the most common finding in noduloulcerative pattern and linear irregular vessels (71%) was the most common finding in plaque pattern. The dermoscopic features would help in the diagnosis of CL lesions by dermoscopy, especially in endemic areas. There is a good relationship between the dermoscopic features and type of CL lesions.

Evaluating the Roles of Different Types of Laser Therapy in Becker's Nevus Treatment.

Becker's nevus (BN) is a cutaneous hamartoma of benign nature that develops through adolescence and affects mostly young men. The nevus is usually located unilaterally and is characterized by hypertrichosis and hyperpigmentation. Despite recent advances in treatment modalities, no effective treatment has been established for BN hyperpigmentation. We sought to assess the efficacy and safety of fractional Erbium: YAG 2940 nm and Q-switched Nd: YAG 1064 nm lasers in the treatment of BN hyperpigmentation. Twenty-three patients with BN were included in a prospective, randomized-controlled, observer-blinded, split-lesion comparative technique trial. In each patient, two similar square test regions were randomized to either be treated with a fractional Erbium: YAG 2940 nm laser or with a Q-switched Nd: YAG 1064 nm laser. Each patient was treated with three sessions at six-week intervals. At the follow-up, clearance of hyperpigmentation was assessed by physician global assessment, visual analogue scale, grade of improvement, patient global assessment, and patient satisfaction. Regions treated with the fractional Erbium: YAG 2940 nm laser demonstrated significantly better improvement compared to ones treated with the Q-switched Nd: YAG 1064 nm (p-value = 0.001) laser. Adverse effects such as repigmentation and hypertrophic scarring were not reported during the follow-up period. The outcomes were cosmetically acceptable with overall high satisfaction among the included patients. Our data suggest a superior role for the fractional Erbium: YAG (2940 nm) laser in the treatment of BN hyperpigmentation compared to the Q-switched Nd: YAG (1064 nm) laser, along with being a safer method and having no reported side effects.

Burn Hemangioma: A New Variant of Hemangioma.

BACKGROUND: Burn hemangioma, also known as scalded pyogenic granuloma, is considered a variant of pyogenic granuloma, but unlike the classic type it presents with rapid progression. Most patients are infants and young children with a history of burns caused by liquids. OBJECTIVE: The present study aims to present all patients with burn hemangiomas treated at our institutions with a full clinical and histopathological assessment. PATIENTS AND METHODS: This case series includes 34 cases that were treated during the period from 2016 to 2021. RESULTS: A total of 34 patients (16 female/18 male, mean age of 17.6 years) were included. Two age groups presented: infants and children (n = 22, age range 0.5-8 years, 10 female/12 male), and adults (n = 11, age range 25-44 years, 6 female/6 male). Lesions appeared 1-2 weeks following predominantly second-degree burns, and multiple lesions predominated in infants and children. The lesions evolved to large lesions within weeks, and these appeared to be either static or involute. The histopathology was compatible with hemangioma, rather than pyogenic granuloma. CONCLUSION: Burn hemangioma should be considered a new variant of hemangioma rather than a type of pyogenic granuloma that follows second-degree burns. They have many similarities with infantile hemangioma, both clinically and histopathologically.

Evaluation of the of the efficacy of Fractional Erbium-Doped Yttrium Aluminum Garnet Laser-Assisted Drug Delivery of Kojic Acid in the Treatment of Melasma; A split face, comparative clinical study.

Melasma is a common, difficult to treat hyperpigmentary disorder. Recently, ablative fractional lasers were utilized to enhance topical agents delivery to treat different skin conditions. This work was designed to evaluate the efficacy of fractional Er:YAG laser in enhancing the effect of topical kojic acid in patients with facial melasma. The patients were randomly treated in a split-face mode, by simple randomization, either with kojic acid alone on one side or combined with fractional Er:YAG laser on the other side. Twenty five patients completed six laser sessions at 2 week interval. The severity of melasma was assessed before and after treatment in addition to 3 months follow up after the last treatment session. The response to the treatment was evaluated by Melasma Area and Severity Index Score, physician global assessment of photographs and patient satisfaction. The side treated with fractional Er:YAG laser and kojic acid cream was found to have a statistically significant better improvement than the side treated with kojic acid alone. The patients were reported mild tingling sensation and mild erythema on both sides. Using combination of fractional Er:YAG laser and topical kojic acid was effective in the treatment of melasma.

Split-face clinical comparative study of fractional Er:YAG (2940nm) laser versus long pulsed Nd:YAG (1064nm) laser in treatment of atrophic acne scar.

Despite various modalities used for treating acne scars, no single treatment modality was significantly satisfactory. We compare the efficacies of fractional Erbium: yttrium aluminum garnet (Er:YAG), 2940 nm, laser versus long-pulsed Neodymium: yttrium-aluminum-garnet (Nd:YAG), 1064 nm, laser for the treatment of acne scars. Twenty patients were treated in a randomized split-face manner. They underwent three sessions at a three-week interval. Assessment of the patient was done before each treatment and 3 months after the end of the treatment sessions. The treatment effect was evaluated objectively, according to Sharquie scores for grading scarring acne vulgaris and digital photographic assessment and subjectively, according to the patient's satisfaction. Results According to objective Sharquie scores, there were no significant differences in the response between the two types of laser used. Based on the visual analog score, there was a significantly higher score of improvement for the side irradiated with fractional Er:YAG (2940 nm) laser. Subjectively, the patients were significantly satisfied with the results on the fractional Er: YAG than on the long pulsed Nd:YAG side. Both lasers were effective, However, the improvement in appearance of acne scars was better with fractional Er:YAG laser with fewer side effects with Long Pulsed Nd:YAG laser.

The Use of a 1,540 nm Fractional Erbium-Glass Laser in Treatment of Alopecia Areata.

BACKGROUND AND OBJECTIVES: Varieties of laser and light sources have been tried for treatment of alopecia areata (AA) and some success has been reported. To assess the effectiveness of 1,540 nm fractional erbium-glass laser in treatment of AA. STUDY DESIGN/MATERIALS AND METHODS: The patches of AA were divided into two groups, the study group (I) underwent six sessions of laser therapy at weekly interval with topical minoxidil solution applied twice daily for 6 weeks, while group (II), the control group was received only topical minoxidil solution. The patches were evaluated objectively (hair count and percentage of regrowth) and subjectively (patient satisfaction) at the end of follow-up period (another 6 weeks). RESULTS: The percentage of hair increment between pre-treatment and follow-up period was 30% for study patches versus 6.45% for control patches. Regarding the percentage of growth, the response rate for study patches was 60% versus 16% for the control. CONCLUSIONS: Erbium-glass laser seems to be effective in regrowing hair in AA. The durability of the response is unknown. Possible mechanisms of improvement include the induction of a thermal effect on papillary dermis, which stimulates hair regrowth, or an immunological effect on the follicle. In addition, the erbium-glass laser may enhance the delivery of minoxidil solution. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

A new imaging technique for assessment of the effectiveness of long pulse Nd:YAG 532 nm laser in treatment of facial port wine stain.

BACKGROUND: PWS is a vascular malformation presented at birth and associated with a psychological problem to the patients. Many types of laser systems were used to solve this problem. AIM OF THE STUDY: To assess the efficacy of long-pulsed Nd:YAG 532-nm laser in the treatment of port wine stain both clinically and by imaging technique. PATIENTS AND METHODS: This is an interventional therapeutic clinical study for the treatment of facial port-twine stain with long-pulsed, 532-nm, Nd:YAG laser. The treatment sessions were done every 4 weeks for 12 sessions and follow-up after 3 months of the last session. The assessment of the response was done before and at the end of follow-up period, both objectively (percent of improvement, photo comparison by using PSNR) and subjectively (patient satisfaction). RESULTS: Sixteen patients completed all sessions of the treatment. The improvement score for the PWS were failure = 0%, mild = 6.25%, moderate = 12.5%, good = 31.25%, and excellent = 50%. The values of PSNR for all the patients have been recorded and were fewer than 25 which means that the response for the treated lesions was very good. CONCLUSION: The long-pulsed Nd:YAG laser 532 nm is an effective and safe method of treatment of facial PWSs without significant residue. The PSNR was a new, simple, cheap and noninvasive method for assessment of the response of PWSs to laser therapy.

Split lesion randomized comparative study between long pulsed Nd:YAG laser 532 and 1,064 nm in treatment of facial port-wine stain.

BACKGROUND: Lasers have been the treatment of choice for Port-wine stain (PWS). However, only one type of laser is not a panacea for all PWS malformations. This is may be due to the great heterogeneity of phenotypic presentation of this congenital anomaly as color, depth, and the site of the lesion. For the treatment of PWS, flash lamp-pumped pulsed dye laser, carbon dioxide, argon, krypton, copper bromide, frequency-doubled neodymium:yttrium-aluminum-garnet (Nd:YAG), and also intense pulsed light sources can be used. OBJECTIVES: To assess and compare the effectiveness of wavelength 532 and 1,064 nanometers (nm) long pulse Nd:YAG laser in the treatment of facial port-wine stain. PATIENTS AND METHODS: This was a comparative therapeutic study for the treatment of facial port-wine stain. We divided the lesion into two halves, medial and lateral, and then each half was treated by 532 or 1,064 nm Nd:YAG. The sessions were done every 4 weeks for six sessions and follow-up after 3 months, then assess the response before and after the sessions and at the end follow-up period objectively (degree of improvement, Photo comparison) and subjectively (Patient satisfaction). RESULTS: Fourteen out of nineteen patients completed all sessions of the treatment, and the other five patients were defaulted from the study due to different causes, including marriage, poor compliance for treatment, and for unknown causes. They were 13 (92.85%) females and 1 (7.15%) male. The mean age of patients was 22.07 ± 9.003 years (range 8-44 years). Three patients (21.4%) were Fitzpatrick's skin type III and four patients (78.6%) were typed IV. There was no hypertrophy in any of the lesions. All facial PWSs lie along the distribution of the trigeminal nerve. Four patients (28.6%) have V1 (ophthalmic), 12 patients (85.7%) have V2 (maxillary), and 9 (64.3%) have V3 (mandibular). The color of PWSs was pink-red in eight patients (57.1%), dark-red in four patients (28.6%), and purple-dark two patients (14.3%). The improvement score for the halves of the PWS treated with long pulsed Nd:YAG 532 nm were: failure = 0%, mild = 14.3%, moderate = 28.6%, good = 28.6%, excellent = 28.6%, while the score for long pulsed Nd:YAG 1,064 nm were: failure = 7.1%, mild = 85.7%, moderate = 7.1%, good = 0%, excellent = 0%. There are highly significant differences between the two parameters (P-value = <0.001). The visual analog scale regarding the halves of PWS treated by long pulsed Nd:YAG 532 nm before the treatment was 5.00 ± 0.96 and after treatment was 2.28 ± 1.43. There is a highly significant difference between the two scores (P-value <0.001). The visual analog scale for the halves of PWS before the use of long pulsed Nd:YAG 1,064 nm was 5.14 ± 0.77 and after treatment was 3.71 ± 0.82. There is a highly significant difference between the two scores (P-value <0.001). At the end of follow-up period, mean score ± SD for 532 nm was 2.28 ± 1.43 and for 1,064 nm was 3.71 ± 0.82. There is a highly significant difference in both wavelengths, when compared with scores for each before the treatment. In comparison, between 532 and 1,064 nm, the difference in the visual analog scale for 532 nm before and at the end of the follow-up period was 2.7143 ± 1.069, while for 1,064 nm was 1.4286 ± 0.513. There is a highly significant difference between the two wavelengths (P-value <0.001). The mean score for the satisfaction of long pulsed Nd:YAG 532 nm was 76 ± 23, while for 1,064 nm was 33 ± 8, so there is a highly significant difference between the two parameters (P-value = <0.001). None of the patients showed recurrence, scar, or hyperpigmentation after 3 months of the last treatment session. One patient developed hyperpigmentation that resolved with hydroquinone cream 4% and no scarring was seen at the end of follow-up period. CONCLUSIONS: The long pulsed Nd:YAG laser 532 nm is more effective in the treatment of superficial bright red facial PWSs than the long pulse Nd:YAG 1,064 nm. More treatment sessions may lead to better clearance of the lesions. The use of non-invasive imaging technique such as dermoscopy, skin analyzer likes spatial frequency domain imaging (SFDI) device, or confocal microscopy to assess the level of malformations and the changes before and after the treatment with each type can give a clearer view of tissue response to laser irradiation. Lasers Surg. Med. 48:852-858, 2016. © 2016 Wiley Periodicals, Inc.

A split-face comparison of facial hair removal with the long-pulsed alexandrite laser and intense pulsed light system.

BACKGROUND: Undesirable hair growth presents a significant problem for many patients. Photoepilation has become a very popular procedure in esthetic and cosmetic practice. Among the systems used are the long-pulsed alexandrite laser (755 nm) (ALX) and intense pulsed light (IPL). OBJECTIVE: To compare the safety and efficacy of long-pulsed ALX and IPL for hair removal. PATIENTS AND METHODS: This comparative study was carried out in the outpatient Department of Dermatology and Venereology, Al-Sadir Teaching Hospital, Al Najaf City during the period from June 2009 to July 2010. Thirty-five patients were included; thirty of them completed the study. They received six treatment sessions with the ALX on the left side of the face and IPL on the right side of face with 4-week intervals between sessions. Response to treatment on both sides of the face was assessed at 1, 3, and 6 treatment sessions. Hair-free intervals and patient's satisfaction were recorded in each visit. RESULTS: After six treatment sessions, IPL-treated sides showed longer median hair-free intervals compared with ALX-treated sides. Reduction in hair counts was significantly larger on the IPL compared with that on the ALX-treated sides at 1, 3, and 6 sessions. Three patients (10%) developed postinflammatory hyperpigmentation, one of them on the left side and the others on the right side. It was more severe on the right side and both the patients were of skin type IV. Slight stinging and burning sensation at time of the treatment were recorded in all patients. All reported side effects were transient and tolerated by the patients except postinflammatory hyperpigmentation which persisted and was decreasing gradually toward the end of the study. CONCLUSIONS: The results of this study suggested that IPL is more effective in reducing excessive facial hair growth, with longer hair-free intervals and greater patient satisfaction than the ALX.

Efficacy and safety of 532-nm and 1,064-nm Q-switched Nd:YAG laser treatment of frictional dermal melanosis over bony prominences (Lifa disease).

BACKGROUND: Frictional dermal melanosis over bony prominences (Lifa disease) is a common pigmentary skin disorder in Iraqi patients. Q-switched lasers are the gold standard treatment of correcting pigmentation; among them are the 532-nm and 1,064-nm lasers. OBJECTIVE: To evaluate the efficacy of these lasers in the treatment of hyperpigmentation due to Lifa disease. PATIENTS AND METHODS: A prospective, comparative, controlled, split-lesion clinical trial study was designed. Nineteen female patients with clinical diagnosis of Lifa disease were enrolled. Each patient was treated for 3 sessions at 2-week intervals. A 532-nm Q-switched Nd:YAG laser was used on the left side and 1,064-nm on the right side of each lesion. Both objective and subjective parameters were assessed 1 and 3 months after the last treatment session. Darkness score, photographic assessment and patient satisfaction, and improvement of itch were recorded, respectively. RESULTS: Seventeen patients completed the study. The color score changes of both sides demonstrated that although both lasers were effective in reducing the pigmentation, the 1,064-nm wavelength had a more significant response. Similar results were obtained for the photographic evaluations and patient satisfaction scores. These changes were sustained throughout the 3 month follow-up. CONCLUSION: Both lasers were effective in the treatment of pigmentation abnormalities caused by Lifa disease. However, the efficacy was greater with the 1,064-nm wavelength.

A comparative study of the diagnosis of Old World cutaneous leishmaniasis in Iraq by polymerase chain reaction and microbiologic and histopathologic methods.

BACKGROUND: The diagnosis of cutaneous leishmaniasis (CL) largely depends on the clinical appearance, especially in endemic areas. A diagnostic challenge arises when the lesions appear in nonendemic areas, when the clinical picture is distorted, or when an atypical variant is seen, even in endemic regions. Aim To assess the correlation of microbiologic and histopathologic diagnosis with polymerase chain reaction (PCR) findings in clinically diagnosed cases of CL. METHODS: This was an observational and descriptive study. The patients were seen at outpatient departments of dermatology in the middle Euphrates region of Iraq. Sixty-five patients with clinically suspicious CL lesions were screened. Fifty-seven clinically diagnosed cases were then subjected to slit-skin smear and skin biopsy. PCR examination was conducted in 40 cases. RESULTS: Direct slit-skin smear examination was positive in 38 patients (66.7%), and 48 specimens (84.2%) were positive by the slide-touch skin biopsy method. Histopathologic examination showed features suggestive of CL in 34 specimens (59.6%). The results of PCR examination were positive in 37 cases (92.5%). CONCLUSION: The PCR technique is highly specific (100%) and sensitive (92.5%) for the diagnosis of CL. In addition to the confirmation of the diagnosis, it may be useful in identifying a relationship between the type of microorganism and the clinical presentation of the disease.

Neonatal and infantile erythroderma: a clinical and follow-up study of 42 cases.

Erythroderma in neonates and infants is a frequently encountered problem in the daily practice of pediatric dermatology. The objective of this study was to determine the frequency of various causes of this clinical entity, as well as which clinical and laboratory findings are useful in the differentiation of these causes, and to assess the evolution of this disease in this age group. Forty-two patients with erythroderma under 1 year of age were included in this study. A follow-up period of 3-5 years was completed. The study was performed in the Department of Dermatology, Al-Sadr and Alhakeem teaching hospitals and a private section in Najaf governorate, Iraq during the period 1998-2006. The diagnosis was made at an average of 3 months after the onset of the disease. The underlying causes included seborrheic dermatitis in 21.4%, atopic dermatitis in 14.3%, different types of Ichthyoses in 31.5%, psoriasis in 4.7%, pityriasis rubra pilaris in 2.4%, Staphylococcal scalded skin syndrome in 7.14%, Netherton syndrome in 4.7%, immune deficiency syndromes in 4.8% and undetermined erythroderma in 9.5% of the patients. Of 29 cases, histopathological examination of skin biopsy showed non-specific features in 58.7% and could confirm the diagnosis in 41.3% cases. The prognosis was poor with a mortality rate of 26.2% and severe dermatoses persisted in 60% of the survivors. It is difficult to make the etiological diagnosis of neonatal erythroderma from the first examination. Associated immune deficiency should be suspected if the condition associated with skin indurations, severe alopecia, failure to thrive and/or have infectious complications. The prognosis is poor especially in those with immune deficiency or a chronic persistent course.

Keloid in Iraqi patients: a clinicohistopathologic study.

BACKGROUND: Keloid is a benign, well-demarcated area of fibrous tissue overgrowth that extends beyond the original defect. It is not an uncommon problem and is encountered frequently in daily practice. OBJECTIVE: To evaluate the different clinical and histopathologic aspects of this disease in Iraqi people. METHODS: Eighty-eight patients with keloid were clinically assessed. Histopathologic examination was performed in 16 patients. Giemsa stain was used in eight patients to assess the presence of mast cells. RESULTS: There were 47 females and 41 males. The disease started in the second and third decades of life in 62 patients (70.5%). Itching was present in 46 patients (52.2%) and was more predominant in those with early lesions. Darier sign was elicited in 22 patients (25%); all of them had itching. The duration of the disease ranged from 0.33 to 20 years, with a mean of 5.4 years. Spontaneous keloid was found in 30 patients (34%). The lesions were mainly single (63.4%). All of these patients had lesions on the face and upper trunk in addition to involvement of extremities in five of them (16.7%). BCG keloid was observed in females only, and it showed downward gravitational extension in three of seven patients (43%). The histopathologic examination of keloid in 16 patients showed many interesting findings, such as the presence of hyperplastic epidermis in six specimens (37.5%), Grenz zone in 11 patients (68.75%), telangiectasia in 12 patients (75%), and pseudopodia extension of the growth to the adjacent tissues in half of the patients. Giemsa stain of eight specimens demonstrated the presence of mast cells in four patients (50%), more in biopsies that were taken from early lesions.