The therapeutic and prophylactic role of oral zinc sulfate in management of recurrent aphthous stomatitis (ras) in comparison with dapsone.

OBJECTIVE: To evaluate the therapeutic and prophylactic effectiveness of oral zinc sulfate in recurrent aphthous stomatitis (RAS) in comparison with dapsone. METHODS: A double-blind placebo controlled study, conducted in the Department of Dermatology, Baghdad Teaching Hospitals, Baghdad, Iraq between May 2005 and October 2006, in which 45 patients with RAS were recruited and divided into 3 equal groups: group A (on zinc sulfate 150 mg twice daily), group B (on dapsone 50 mg twice daily), and group C (on glucose 250 mg as placebo). The drugs were prepared in identical capsules, and the patients were instructed to take the capsules twice daily after meals (in a double-blind manner). Assessment of each patient was carried out by the Oral Clinical Manifestation Index (OCMI) and the diameter of the ulcers at day 0, day 4, and at the second, fourth, sixth, eighth, tenth, and twelfth weeks of therapy. RESULTS: Forty-five patients were included in the study (25 males and 20 females), and their ages ranged between 16-45 years (mean+/-SD 31.24+/-8.14). In group A, the mean of OCMI and diameter of ulcers improved, with a p=0.0001 for OCMI, and 0.0001 for the diameter for ulcers at the end of the twelfth week of therapy, which was statistically significant. Group B, also showed significant improvement, however, the action was lower and slower (p=0.0001 for OCMI, and 0.001 for the diameter for ulcers). Group C revealed slight non-significant improvement (p=0.028 for OCMI, and 0.034 for the diameter of ulcers). In the sixth week of therapy, zinc sulfate was more effective than dapsone in reducing the OCMI of the ulcers (p=0.007). CONCLUSION: The present study showed that both zinc sulfate and dapsone had significant therapeutic and prophylactic effects in controlling RAS, however, zinc sulfate had much more rapid and sustained action.

Bacille Calmette-Guerin immunotherapy of viral warts.

OBJECTIVE: To assess the effectiveness of the Bacille Calmette-Guerin BCG vaccine in the treatment of viral warts. METHODS: A single blind placebo controlled study conducted at the Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq from March 2005 to June 2006. Two hundred patients with viral warts were enrolled in this study, and were fully assessed before therapy. The patients were divided into 2 equal matched groups. Group 1 was designed as the treatment group and received BCG vaccine in 1-3 doses with a one-month interval, while group 2 was injected with distilled water. The patients were evaluated every 2 weeks for evidence of regression of lesions. The follow up period lasted for 3 months after the last dose. RESULTS: A total of 154 patients completed the study: 81 patients in group I and 73 patients in group II. Thirty 39.7% patients out of 81 patients in group I showed complete recovery. These results were significantly high p<0.05 when compared with total response, 10 13.7% out of 73 patients in group II. No recurrence has been reported during the follow up period. When cases that failed to respond to placebo were treated with BCG in a similar manner to group I, there was total response in 15 42.7% out of 44 patients. No side effects were observed. CONCLUSION: The BCG vaccine was an effective and safe modality of treatment of viral warts.

Topical zinc sulphate solution for treatment of viral warts.

OBJECTIVE: To assess the efficacy and safety of topical zinc sulphate solution in the treatment of plane and common warts. METHODS: This study consisted of a pilot and double blinded clinical trails. This was carried out in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghadad, Iraq during the period from December 2002 to October 2003. Ten patients with plane warts were enrolled in pilot-clinical trial, all patients used 10% w/v zinc sulphate solution topically, 3 times daily for 4 weeks while in the double blind trial, 90 patients were included (50 patients with common warts, 40 patients with plane warts). Patients were randomly used either topical 10% or 5% zinc sulphate solution or distilled water as a control topical therapy 3 times daily for 4 weeks. Full history and close clinical examination were performed to all patients before treatment. RESULTS: In the pilot trial, the full response for plane warts was 80%, while the full response for patients with plane warts in double blinded trial was 85.7%, 42.8% and 10% for those using 10% and 5% zinc sulphate solutions and distilled water subsequently. The difference was statistically significant (p<0.008). The full response for patients with common warts were 11%, 5% and 0% for those who used 10% and 5% zinc sulphate solutions and distilled water respectively, the difference was statistically insignificant. No recurrence of warts occurred during follow up that ranged from 2-6 months after therapy. CONCLUSION: Topical 10% zinc sulphate solution was a new effective and safe modality for treatment of plane warts.

Free testosterone, luteinizing hormone/follicle stimulating hormone ratio and pelvic sonography in relation to skin manifestations in patients with polycystic ovary syndrome.

OBJECTIVE: To evaluate hormonal changes and pelvic sonography in polycystic ovary syndrome (PCOS) patients, especially free testosterone and their correlations with skin manifestations of this disease. METHODS: This prospective study was carried out in the Skin Clinic, Baghdad Teaching Hospital, Iraq in the period between April 2004-March 2005. We included 126 patients with PCOS in this study. Patients were divided into 3 groups according to the body mass index (BMI). Group I: normal weight (48 patients). Group II: overweight (n=29). Group III: obese (n=49). We included 75 healthy women as a control and divided into 3 groups according to their BMI: normal weight (n=35), overweight (n=25), and obese (n=15). All patients were evaluated for features of PCOS. Hormonal assay including serum and saliva free testosterone were determined with 3.2 pg/ml as the upper normal level for both. The luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio was performed in serum of samples obtained on day 2 or 3 of the natural cycle in menstruated women, and any time in women with amenorrhea, and the ratio of LH/FSH>or=2 was regarded as the significant level. In the control group, the sonography and LH/FSH estimation were carried for all, saliva free testosterone was measured for only 30. All did not fulfill the criteria of PCOS, although some had one of the criteria. RESULTS: The age range was 15-39 (26.12+/-6.36) years with a mean BMI of 30.261+/-8.238. While the ages of 75 healthy control women ranged from 15-39 (28.82+/-6.45) years with a mean BMI of 26.99+/-4.41. Free saliva testosterone was abnormally elevated in 68, free serum testosterone elevated in 75, elevated LH/FSH ratio in 76, and positive U/S in 98 of patients. The free saliva testosterone and LH/FSH ratio were significantly increased in patients with PCOS in comparison with the control group. Frequency of skin manifestations was significantly increased in PCOS patients with abnormal saliva and serum free testosterone level in comparison with those of normal level hormones. There was a positive relationship between the increase in frequency of skin manifestations and increase in saliva and serum free testosterone levels, while their was no relation between LH/FSH ratio and frequency of skin manifestations. CONCLUSION: Free testosterone level represents the most sensitive biochemical marker supporting the diagnosis of PCOS.

Invasive squamous cell carcinoma of the eyes in patients with epidermodysplasia verruciformis.

We described 3 male patients with epidermodysplasia verruciformis seen in the Department of Dermatology and Venereology, Baghdad Teaching Hospital; their ages were 25, 30 and 34 years subsequently. They developed frequent multiple basal and squamous cell carcinoma, all of them had periorbital squamous cell carcinoma that invaded the orbit and ended with enucleation of their eyes. All available therapeutic measures failed to inhibit the progressiveness of these tumors. Great awareness and early management must be performed regarding any periorbital lesion in epidermodysplasia verruciformis patients.

Acral lentiginous melanoma versus lentigo maligna melanoma among Iraqi patients.

OBJECTIVE: To report the different clinical aspects of malignant melanoma and their varieties in Iraqi patients. METHODS: We carried out this study in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghdad, Iraq during the period from 1985-2005. Eighteen patients with malignant melanoma were enrolled in this work. The different clinical aspects and histopathological examination were determined. RESULTS: The study population consisted of 18 patients (15 females and 3 males) with a female to male ratio of 5:1. Their ages ranged from 12-75 years (mean +/- SD, 43.72 +/- 14.75 years) while the duration of the disease ranged between 0.25-5 years (1.98 +/- 1.44 years). The duration of acral lentiginous melanoma was 0.5-4 years (2.16 +/- 1.36 years) and in nodular type was 0.5-3 years (1.28 +/- 0.90 years), while in lentigo maligna melanoma was 1.5-5 years (3.37 +/- 1.49 years). Regarding the location and gender of the patients affected, 6 cases (all females) were on the acral parts of the body (4 on the feet, and 2 on the hands), 5 patients (all females) on the face, 5 cases (4 females and one male) on the lower legs, while the remaining 2 male cases, was on the interscapular region and the other one on the elbow area. CONCLUSION: We conclude that malignant melanoma in Iraqi patients is a disease of younger females, which presented mainly as acral lentiginous melanoma, nodular melanoma and lentigo maligna melanoma and superficial spreading melanoma.

Lactic acid 5 percent mouthwash is an effective mode of therapy in treatment of recurrent aphthous ulcerations.

BACKGROUND: Recurrent aphthous ulcerations (RAU) are the most common oral mucosal disease among the general population including in Iraq. There is no uniformly effective therapy for this disease. OBJECTIVE: To evaluate the therapeutic efficacy and safety of 5-percent lactic acid mouthwash in the treatment of patients with recurrent aphthous ulcerations. METHODS: This is a single-blind controlled therapeutic study. We recruited 80 subjects with early-onset oral aphthosis from patients who attended Baghdad Teaching Hospital Department of Dermatology and Venereology in the period between April 2004 and April 2005. Of those subjects, 10 defaulted; the remaining 70 patients were divided into two groups, A and B. Subjects in group A (36 patients) were instructed to use 5-percent lactic acid mouthwash, one teaspoonful three times daily before meals. Subjects in group B (34 patients) were instructed to use placebo (distilled water mouthwash) in a similar way. Assessment of each patient of both groups was done by using oral clinical manifestation index (OCMI) before, after 3 days and after 7 days of therapy. RESULTS: The mean of OCMI in group A started to decline after 3 days of therapy and attained statistically significant lower level after 7 days of therapy (p <0.05). The change in the mean OCMI of group B after 3 and 7 days of therapy was also statistically significant (p <0.05). However, the response rate (percentage of change in the mean) after 3 days of therapy in group A was 63.6 percent and in group B was 8.8 percent, and the response rate after 7 days of therapy in group A was 90.8 percent and in group B was 35.7 percent. The difference in the response rates after 3 and 7 days between groups A and B was statistically significant (p <0.05). No significant side effects were noticed apart from mild irritation in two patients using lactic acid. CONCLUSIONS: Lactic acid 5 percent mouthwash is a new effective mode of therapy for patients with RAU and had significantly reduced the signs and symptoms of the disease, especially when compared with placebo. The mechanism of action may be related to increasing spontaneous secretion of endothelial growth factor from keratinocytes.

Striae distensae-like lesions. A cause of scarring alopecia among children.

OBJECTIVE: Although alopecia areata is a common problem among children, many misdiagnoses for this condition can happen. The aim of this study was to demonstrate the striae distensae as lesions that cause scarring alopecia with a great resemblance to alopecia areata. METHODS: A total of 36 children with provisional diagnosis of alopecia areata of the scalp were assessed clinically in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghdad, Iraq, between June 1998 to June 2001. Their age ranged from 3 12 years and the mean + standard deviation (SD) was 7.30 + 2.59 years with equal sex ratio. RESULTS: All patients provided for this study had a history of patchy hair loss of few months duration. Their parents denied any history of obvious trauma and many modalities of treatment had been tried without benefit. The clinical examination revealed single or multiple (1-6) (mean + SD 2.41 + 1.22) complete linear hair loss patches resembling atrophic scar that was similar to striae distensae. The histopathological examination showed atrophy of the epidermis, full replacement of the dermis by collagen bundles, and complete loss of appendages. CONCLUSION: This is a new entity, which seems to be common among children and often confused with untreated cases of alopecia areata. This condition should be added to the differential diagnosis of patchy hair loss in children and the parents should be reassured of the cause of hair loss and no treatment therapy needed.

Treatment of viral warts by intralesional injection of zinc sulphate.

BACKGROUND: The aim of this study was to verify the efficacy of the intralesional injection of 2% zinc sulphate as compared to an injection of 7% hypertonic sodium chloride solution in the treatment of viral warts. PATIENTS AND METHODS: One hundred patients (53 females and 47 males) aged 4-45 years (mean+/-SD 19.93+/-7.92) and diagnosed with multiple verruca vulgaris (common warts) were the subject of the study. The duration of the viral warts ranged from 0.1-17 years (mean+/- SD 1.87+/-2.73). A total of 623 lesions were included in the study (mean+/- SD of lesions, 10.8+/-8.05). The treated number of lesions were 316 (mean+/- SD 4.78+/-5.09), with the untreated 307 lesions left as control. RESULTS: In 53 patients (30 females, 23 males), 173 lesions were treated with 2% zinc sulphate intralesionally, while 176 lesion were left untreated as control. The total clearance rate of the treated lesions were 98.2% within 6 weeks of follow-up (80.92% of lesions needed a single injection and showed total clearance within 2 weeks), while none of the control lesions showed any spontaneous clearance within the same period. In 47 patients (27 females, 20 males), 143 lesions were treated with 7% hypertonic sodium chloride solution intralesinally, with the remaining 131 lesions left untreated as control. Only 8.3% of treated lesions showed total clearance within 10 weeks of follow-up. CONCLUSION: Two percent zinc sulphate can be recommended as a new and effective local mode of therapy of viral warts, especially for the recalcitrant form.