Predictors of future haemorrhage from cerebral cavernous malformations: a retrospective cohort study.

Cerebral cavernous malformations (CCMs) are commonly diagnosed, with a low reported rate of haemorrhage on long-term follow-up. The identification of factors predictive of future haemorrhage risk would assist in guiding the management of patients with CCM. The aim of this study was to identify variables associated with haemorrhage, and calculate haemorrhage risk in CCM. We conducted a retrospective study of patients diagnosed with a CCM, managed at a specialist tertiary neuroscience centre (2007-2019). The primary outcome was symptomatic haemorrhage, and secondary outcomes were variables associated with increased risk of haemorrhage, using multivariable Cox regression analysis. Included were 545 patients, with 734 confirmed cavernomas. Median age at diagnosis was 47 (interquartile range [IQR] 35-60), with a median follow-up duration after diagnosis of 46 months (IQR 19-85). Of the patients, 15.0% had multiple lesions (N = 82/545). Symptomatic presentation was observed in 52.5% of patients (N = 286/545). The annual haemorrhage rate was 1.00% per lesion-year (25 events in 2512 lesion-years), and higher in those with symptoms at presentation (1.50% per lesion-year, 22 events vs 0.29%, 3 events, P < 0.001). The variables associated with symptomatic haemorrhage were increased size (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.01-1.07, P = 0.004), eloquent location (HR 2.63, 95% CI 1.12-6.16, P = 0.026), and symptomatic haemorrhage at presentation (HR 5.37, 95% CI 2.40-11.99, P < 0.001). This study demonstrated that CCMs have a low haemorrhage rate. Increased size, eloquent location, and haemorrhage at presentation appear to be predictive of a higher risk of haemorrhage, and could be used to stratify management protocols.

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.

Melanocytes transplantation in patients with vitiligo using needling micrografting technique.

BACKGROUND: Some cases of vitiligo require melanocyte transplantation, but these surgical techniques have varying degrees of success. OBJECTIVES: To perform melanocytes transplantion in patients with vitiligo using a new needling micrografting technique. PATIENTS AND METHODS: This interventional case study took place at the Department of Dermatology and Venereology at Baghdad Teaching Hospital from December 2010 to September 2011. Twelve patients with vitiligo were included. A split-thickness skin graft was taken from the normal area and cut into micropieces ranging from 0.1 mm to 0.3 mm in diameter. The recipient area was anesthetized, and the micrografts were then implanted into the dermis using the needling technique. The number of implanted micrografts depended on the size of the recipient area. Follow-up was conducted every 2 weeks for the first month and then every 4 weeks for a further 16 weeks. RESULTS: The intake rate of grafting at week 2 ranged from 90% to 100%. The micrografts started producing noticeable pigmentation at week 2, and pigmentation was obvious at week 4. At week 8, the rate of pigmentation ranged from 10% to 90% (25.24%), and at week 16 it ranged from 10% to 100% (61.36%). CONCLUSION: This new approach to the treatment of vitiligo delivers rapid and satisfactory pigmentation.

The therapeutic role of isotretinoin in the management of Behçet's disease: a single-blinded, controlled therapeutic study.

OBJECTIVES: To evaluate the long-term remission efficacy and safety of isotretinoin in the treatment of Behcet's disease (BD). PATIENTS AND METHODS: This single-blind, controlled therapeutic study was conducted in the Department of Dermatology and Venereology at Baghdad Teaching Hospital from February 2011 to January 2012. Thirty patients with BD were included in this work. Each patient received isotretinoin 20 mg orally once daily for 3 months. They were assessed at week 2 and then monthly depending on the Clinical Manifestation Index (CMI) and to record any side effects. At week 12, isotretinoin was stopped and patients were given placebo therapy in a form of glucose capsules for another 3 months. RESULTS: Thirty patients were treated, 14 (46.6%) males and 16 (53.3%) females, with a male to female ratio of 1:1. Their ages ranged from 16 to 64 years (mean +/- standard deviation [SD], 38.4 +/- 10.9 years). During the first 3 months of therapy, the pathergy test, oral pathergy test, and C-reactive protein were significantly minimized. The CMI before isotretinoin therapy ranged between 2 and 8 (mean +/- SD, 4.933 +/- 1.91). After therapy, within the first 14 days, the mean CMI started to decline to a lower level, and it continued to decline significantly until week 12. It then started to increase through week 4 of placebo therapy, but remained statistically significant until the second month of placebo therapy. Isotretinoin therapy also had a statistically significant effect in reducing oral ulcers and skin manifestations. CONCLUSION: Isotretinoin is an effective therapeutic and prophylactic drug in the management of BD.

Treatment of scabies using 8% and 10% topical sulfur ointment in different regimens of application.

BACKGROUND: Many therapeutic modalities for scabies were available, topical sulfur ointment is a cost-effective and safe therapeutic agent. It is often applied for the whole body for three successive days. OBJECTIVE: To evaluate their therapeutic regimen of 8% and 10% topical precipitated sulfur in petrolatum ointment for single day, three successive nights or three successive days in management of scabies. PATIENTS AND METHODS: This single-blinded, comparative study was conducted in the Department of Dermatology-Baghdad Teaching Hospital from April 2008 through October 2009. A total of 97 patients with scabies were enrolled in this study. The diagnosis was established on clinical basis. The patients treated with 8% and 10% topical sulfur in petrolatum ointment were divided randomly into three groups: Group A: 33 patients treated for single day (24 hours); Group B: 32 patients treated for three successive nights (from 6 p.m. to 8 p.m. to 6 a.m. to 8 a.m. and bathing every day); and Group C: 32 patients treated for three successive days (bathing every 24 hours). The patients were seen regularly every two weeks for the duration of four weeks. RESULTS: Study included 58 (59.8%) males and 39 (40.2%) females, with a male to female ratio 1.4:1. The age range of males at presentation from 3 to 64 (26.74±15.98) years, while the females age ranged at presentation from 3 to 60 (24.05±14.53) years of age. At the end of the study, the response to treatment was: Group A, response in 14 (42.4%) patients and no response in 19 (57.6%); Group B, response in 29 (90.6%) patients and no response in 3 (9.4%); and Group C, response in 31 (96.9%) patients and no response in 1 (3.1%). There is significant statistical difference among the response of 3 groups with (P=0.00000011), but no statistically significant difference between the response of Group C and Group B, (P=0.6055). Mild burning sensation and irritating (sulfur) dermatitis were the only side effects of 8% and 10% sulfur. Pruritic rash occurred in Group C mainly, in 11 (34.4%) patients, 8 (25%) in Group B and 4 (12.1%) in Group A, with no significance (P=0.1058). Recurrence or relapse occurred in Group A mainly, with 4 (12.1%) patients, and in Group B, 1 patient, (3.1%), with no recurrence in group C, with significance (P=0.0060). CONCLUSION: Three successive days and three successive nights of 8% and 10% sulfur ointment were effective regimens with no statistical difference in favor of three successive days, while single-day application was much less effective but with fewer side effects.

COVID-19 infection is a major cause of acute telogen effluvium.

BACKGROUND: Acute telogen effluvium is a non-scaring hair loss, usually occurs 3 months after the stressful event that causes hair shedding, and lasts up to 6 months. It can be associated with post COVID-19 infection. OBJECTIVE: To study the possible effects of COVID-19 on the hair growth cycle and the relationship between COVID-19 and acute telogen effluvium. PATIENTS AND METHODS: This is an observational cross-sectional study that had been conducted during the period from September 2020 to March 2021 years. Thirty-nine patients with post COVID-19 hair loss are confirmed by polymerase chain reaction (PCR) or antibody testing. Hair pull test was carried out to confirm the diagnosis and severity of telogen effluvium. RESULTS: Thirty-nine patients were evaluated; their ages ranged from 22 to 67 years with a mean and SD of 41.3 ± 11.6 years with 36 (92.3%) females and 3 (7.69%) males. All patients with a diagnosis of ATE were enrolled in this study and had a laboratory-confirmed diagnosis of prior SARS-CoV-2 infection; 15 (38.46%) patients reported mild symptoms, 24 (61.53%) patients presented with moderate disease, and no patient required hospitalization. They all experienced excessive hair loss within 2-3 months after infection. Pull tests were strongly positive (> 10-50% with a mean of 35% of pulled hair away from scalp). CONCLUSION: COVID-19 infection is now a frequent and a common cause of acute telogen effluvium. Hence, clinicians should be aware about the relation between this infection and this pattern of hair loss. Drugs that have been used for the treatment of COVID-19 were excluded as a cause of acute telogen effluvium.

The potential use of 29 kDa protein as a marker of pathogenicity and diagnosis of symptomatic infections with Blastocystis hominis.

The present study was performed to characterize the protein profiles of Blastocystis hominis isolates from symptomatic and asymptomatic individuals by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting using sera from symptomatic and asymptomatic patients. The presence of immunogenic bands associated with pathogenicity or of diagnostic potentials was also evaluated. The study comprised 80 individuals classified into four groups, 20 each: symptomatic blastocystosis (G1), asymptomatic blastocystosis (G2), other parasitic infections (G3), and healthy control subjects (G4). SDS-PAGE analysis of individual antigens form symptomatic and asymptomatic B. hominis isolates revealed similar and distinctive antigenic bands with significant differences in two high (123.5 and 112.3 kDa) and few low molecular weight bands (48.5, 38, 42.3, and 35.5 kDa). Immunoblotting was performed using symptomatic and asymptomatic antigen pools with sera of the four studied groups. It was found that anti-B. hominis IgG reacted with nine protein bands ranging from 100 to 18 kDa of the symptomatic antigen pool. There was a significant difference between G1 and G2 in the recognition of 64, 56, 38, and 29 kDa antigen bands. Also, anti-B. hominis IgG reacted with five protein bands ranging from 56 to 12 kDa of asymptomatic antigen pool. There was a significant difference between G1 and G2 in the recognition of 29 kDa antigen band. These findings suggest the potential use of the 29-kDa antigen as marker of pathogenicity and implicate its use in the diagnosis and differentiation between symptomatic and asymptomatic blastocystosis.

Traction Alopecia: Clinical and Cultural Patterns.

BACKGROUND: Traction alopecia is common and preventable but frequently overlooked disorder. OBJECTIVE: To evaluate patients with traction alopecia. PATIENTS AND METHODS: This study was conducted at the Dermatology Center, Medical City, Baghdad, Iraq, during the period from November 2005 to October 2019. Demographic features like age, gender, disease duration and special hair styling practices and accessories were recorded. Clinical patterns were studied. RESULTS: Thirty female patients were included in this study. Their ages ranged from 6 to 47 years with mean age ± SD was 15.63 ± 9.806. Twenty-one (70%) were below the age of 16 years. No patient had tightly curled hair. All cases were asymptomatic apart from hair loss. The fringe sign was observed in 27 (90%) of cases. The response to therapy was poor. CONCLUSION: Traction alopecia is an important type of pressure-induced hair loss evident in children and adults with or without curly hair due mainly due to cultural hair styling practices with its frequency apparently increasing in recent years. The fringe sign is common and of diagnostic importance. It is a preventable form of hair loss which can be reversed if diagnosed early; otherwise, permanent scarring alopecia results. It represents a pressure phenomenon evident worldwide in both non-Sub-Saharan lineage and Sub-Saharan lineage individuals.

Nevus depigmentosus: the analysis of 37 cases.

BACKGROUND: Nevus depigmentosus (ND) is an uncommon congenital nonprogressive hypopigmented skin disorder that can be seen anywhere on the body. We considered other depigmenting disorders and focused on distinguishing ND from vitiligo and tuberous sclerosis complex in infancy. METHODS: The diagnosis of patients with nevus depigmentosus was made differentiating it from nevus anemicus, pityriasis alba, tuberous sclerosis complex, vitiligo and other depigmenting disorders. RESULTS: Of the 37 individuals with nevus depigmentosus evaluated, 36 were children, twenty-two (59.4%) were males and 15 (40.5%) were females, with male to female ratio 1.4:1. CONCLUSIONS: Distinguishing ND from other disorders with depigmentation can be challenging, in particular in case of tuberous sclerosis complex and vitiligo in infancy.

Total dose iron dextran infusion versus oral iron for treating iron deficiency anemia in pregnant women: a randomized controlled trial.

STUDY OBJECTIVE: To test safety, efficacy, and cost-effectiveness of total dose infusion (TDI) of low molecular weight (LMW) iron dextran for treatment of iron deficiency anemia (IDA) during pregnancy in comparison to oral ferrous fumarate. DESIGN: Prospective interventional randomized controlled trial (RCT). Design classification. Canadian Task Force II3. SETTING: Antenatal clinic and causality unit of a tertiary care referral facility and University Hospital. PATIENTS: A total 66 anemic pregnant women (hemoglobin level between 7-10 g/dl). INTERVENTION: Administration of a LMW iron dextran as a TDI (group A) or Oral iron ferrous fumarate 60 mg elemental iron three times daily (group B) followed by remeasurement of hemoglobin after 4 weeks. MEASURES AND MAIN RESULTS: The main outcome measure was clinical and laboratory improvement of anemia after 4 weeks of starting the therapy. Both groups showed a significant clinical improvement of anemia 4 weeks post-therapy. However, the first improvement of symptoms was significantly faster in group A. Complete blood count (CBC) as well as all iron indices were improved in both groups after 4 weeks of therapy, but were significantly better in group A than B. Side effects in group B were mainly gastrointestinal (GIT) while one case of mild hypersensitivity to TDI and another one case of local reaction at the site of injection were reported in group A. CONCLUSIONS: It is concluded that despite being equally effective in improving both clinical and laboratory evidence of IDA, TDI allows iron restoration with a single dose faster than oral iron therapy with a reasonable safety profile. It is a good example of office one-stop therapy. Nevertheless, noninvasive selfusage at home is a clear advantage of the cheaper oral iron therapy which makes it the first choice for treating IDA in the second and third trimesters of pregnancy in tolerable cases.

Topical 10% zinc sulfate solution for treatment of melasma.

BACKGROUND: Multiple modalities have been used in the treatment of melasma, such as bleaching agents, chemical peels, and antioxidants. Topical zinc sulfate has peeling and antioxidant effects. OBJECTIVE: The objective was to evaluate the efficacy and safety of topical 10% zinc sulfate solution in the treatment of melasma. PATIENTS & METHODS: This study was conducted at the Department of Dermatology & Venereology, Baghdad Teaching Hospital. Twenty-eight patients with melasma were treated with 10% zinc sulfate solution. Every patient was instructed to apply the formula twice daily and to be seen every 2 weeks for 2 months. The severity of melasma was assessed before, during, and after treatment with the melasma area and severity index (MASI). All patients were instructed to apply a broad-spectrum sunscreen with SPF>30 before sun exposure during treatment and for the 3-month follow-up period. RESULTS: Fourteen patients were treated with 10% zinc sulfate solution. The mean MASI score before treatment was 9.45, which changed to 4.70 after therapy. This corresponds to a percentage improvement of 49.78% and was statistically significant (p<.0005). No side effects were reported apart from a mild stinging sensation reported in a few patients. Most patients maintained improvement 3 months after cessation of therapy. CONCLUSION: Topical 10% zinc sulfate solution is a new effective, safe, and noncostly formulation in the treatment of melasma.

Topical therapy of acne vulgaris using 2% tea lotion in comparison with 5% zinc sulphate solution.

OBJECTIVE: To evaluate effectiveness of 2% tea lotion in comparison with 5% zinc sulphate solution in the treatment of acne vulgaris. METHODS: This is a single-blind randomly comparative therapeutic clinical trial carried out in the Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq from June 2006 to December 2007. Full history and clinical examination were studied for each patient regarding all relevant points of the disease, to evaluate the severity of acne. Forty-seven patients with acne vulgaris were divided randomly into 2 groups, and were instructed to use the following solutions twice daily for 2 months; group A used 2% tea lotion, group B used 5% zinc sulphate solution. Patients with papulopustular lesions were included in the study, while patients with severe acne were excluded. The clinical improvement was scored by counting the number of inflammatory lesions before, and after treatment. RESULTS: Forty patients completed the study, their ages ranged from 13-27 years with a mean+/-standard deviation of 19.5+/-3.5 years with 20 patients in each group. Two percent tea lotion was statistically significant in decreasing the number of the inflammatory lesions in acne vulgaris, while 5% zinc sulphate solution was beneficial, but did not reach statistically significant level as tea lotion. CONCLUSION: Two percent tea lotion was a good alternative remedy to be used in the treatment of acne vulgaris, and was much superior than topical 5% zinc sulphate solution.

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.

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.

Oxidative stress in patients with Behcet's disease: I correlation with severity and clinical parameters.

The study was designed to investigate the possible correlation between some oxidative stress parameters in Behcet's disease and the clinical manifestations of the disease as well as the possible correlation with the disease severity. Seventy-six patients diagnosed according to the International Study Group criteria for Behcet's disease were included in the study. Sixty patients had mild-to-moderate disease and 16 patients had severe disease. Sixty matched control subjects were also included. After a full history and examination from each subject, 10 mL blood was drawn from each for analysis. Serum malondialdehyde, glutathione, ceruloplasmin, copper and zinc levels were determined. Patients with Behcet's disease showed increased levels of serum malondialdehyde and copper while glutathione and zinc levels were decreased. Comparison between these parameters in patients with mild-to-moderate disease with those with severe disease showed only that serum zinc levels were lower in severe Behcet's disease. Serum malondialdehyde levels were found to be significantly positively correlated with oral ulcer size, duration and frequency. Glutathione levels were found to be inversely correlated with the clinical manifestation index and all oral ulcer parameters. Zinc levels were found to be inversely correlated with the clinical manifestation index and pathergy test positivity grades. Copper levels were found to be positively correlated with oral ulcer number. Although the parameters of oxidative stress did not show correlation with disease severity, they were correlated with the disease manifestations. This points out the importance of oxidative stress in Behcet's disease.

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.

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.