Asian Journal of Research in Dermatological Science

The Impact of Androgenetic Alopecia and Its Treatment Protocols on the Sexual Life of Affected Males and Females: An Analytical Literature Review

Iman Mohamed Elwan Elmeaday — 2023-08-31

Out of the several cosmetic-related problems that both men and women face during their lifetime, hair loss is one of the most common ones. There are several causes behind hair loss, but the most common ones are seen to sprout from a variety of genetic and environmental reasons. Almost a wide majority of the cases of hair loss are hereditary and run in families. Androgenetic Alopecia is one of the most common types of hair loss that both men and women experience. Although it is not necessary for androgenetic alopecia to affect one gender more than the other, it is normally seen that people of either gender who have had a significant family history of experiencing more hair fall, would ultimately be more predisposed to develop it at a particular time in their life. Although it seems to be an irreversible and never-ending issue, there have been several treatments prescribed that help reverse and resolve the problem, while giving rise to new hair growth as well. However, the treatments might have side effects of their own. This review deals with the sexual side effects or problems that might arise as a consequence of taking treatment for Androgenetic Alopecia. Loss of libido, erectile dysfunction, decreased interest, and gynecomastia are some of the common side effects that are linked with the various treatment protocols that have been prescribed for Androgenetic Alopecia. This review will explore these side effects and the mechanisms that cause these problems to arise in the first place.

Pemphigus and Plummer-Vinson Syndrome: An Uncommon Association

Marwa Asermouh — 2023-04-06

Aims: The reported association of Plummer-Vinson syndrome and some autoimmune diseases, including pemphigus -association described for the first time-, raises the hypothesis of the autoimmune origin of this syndrome. On the other hand, this unexpected association represents a therapeutic challenge given the risk of the progression of pemphigus lesions after an esophageal dilatation session, hence the originality and interest of our case.

Case Report: A 60-year-old patient was admitted to our department for pemphigus foliaceus and treated with oral corticosteroids. The workup revealed an iron deficiency anemia. A dysphagia to solids evolving for 4 years led to an esophageal endoscopy which revealed the presence of esophageal ring. The diagnosis of Plummer-Vinson syndrome was retained but the dilatation could only be done after stabilizing the pemphigus to avoid a detachment of the esophageal mucosa by Koebner phenomenon.

Discussion: Plummer-Vinson syndrome is a rare condition defined by the presence of dysphagia, iron deficiency anemia and esophageal ring. Its etiopathogeny is poorly understood. It can be associated with some autoimmune pathologies suggesting an autoimmune origin. To date, no association with pemphigus has been described in the literature.

Conclusion: The autoimmune origin of Plummer Vinson syndrome is to be discussed in regard to the described associations with autoimmune diseases which would not be random.

Nicolau Syndrome, an Iatrogenic Drug Reaction Caused by Bupivacaine Injection as Spinal Anaesthesia: A Description of Two instances and Literature Review

Vishal Kumar — 2023-09-14

An uncommon side effect of administering medications parenterally is Nicolau syndrome. Pain will first manifest, followed by edema and erythema, and finally, a necrotic plaque will be seen. An uncommon side effect of parenteral medication administration is Nicolau syndrome. It is characterized by the initial manifestation of pain, followed by edema, erythema, and ultimately the formation of a necrotic plaque. In this report, we present two exceptional cases of female patients who developed Nicolau syndrome after receiving a spinal anesthetic injection of bupivacaine. Their therapeutic regimen included the use of pentoxifylline, Omnacortil, cetirizine tablets, flucidine H cream, and Calasoft AF lotion, applied in a 1:1 combination for topical application.

Treatment of Buttock Hyperhidrosis with a Microwave Device: A Case Report

Won Oak Kim — 2023-05-30

Severe buttock hyperhidrosis remains very distressing postoperative complication is characterized by excessive and uncontrollable sweating of the buttock after sympathectomy. Although various measures have been implemented to treat nasty troubling sweat, no clear results have been obtained to date. This case report describes the use of a microwave device to treat severe buttock hyperhidrosis. This system is Food and Drug Administration (FDA) approved and proven to be safe and effective for long-term treatment of axillary hyperhidrosis. It has also been shown to be equally effective in the treatment of severe buttock hyperhidrosis. Microwave device showed high patient satisfaction and appropriate treatment outcomes in the present patient.

Bupivacaine-induced Nicolau Syndrome during Spinal Anesthesia: A Rare Presentation of Two Cases

Abhishek Kumar — 2023-06-14

Purpose: We present an embolia cutis medicamentosa (Nicolau syndrome) case in a patient who received a BUPIVACANE injection with spinal anesthesia.

Summary: A pregnant woman who received a Bupivacaine injection in the OT developed a necrotic lesion at the Bupivacaine injection site on her lower back. Her chief complaints were oligohydramnios, deranged LFT, hypothyroidism, and Doppler changes. After 10 days of wound care involving topical therapy, certain medications, and frequent follow-up appointments, the patient’s wound was resolved.

Conclusion: Nicolau syndrome developed in the lower back side of a patient following a parenteral injection of BUPIVACANE. A proper injection technique is recommended to reduce the risk of this idiopathic adverse effect.

Bullous Wells Syndrome Responsive to Low-Dose Dapsone: A Case Report

Ralfi Singer — 2023-08-21

Wells’ syndrome (WS) is an uncommon inflammatory dermatosis of unknown etiology which typically presents with pruritic cellulitis-like plaques on the extremities. The condition is thought to be a hypersensitivity reaction developing against a variety of exogenous and endogenous antigenic stimuli. Although the classic plaque type variant is the most common presentation, bullous, papulonodular, papulovesicular, granuloma-like, urticarial-like and fixed drug eruption types may be encountered as well. Histopathology is characterised by tissue eosinophilia, edema and flame figures. Treatment options include topical and systemic corticosteroids, topical calcineurin inhibitors, doxycycline, cetirizine, cyclosporine, tumor necrosis factor-α inhibitors and psoralen and long-wave ultraviolet light (PUVA). Here, we present a case of bullous WS responding to low-dose dapsone treatment

Successful Elimination of a Recalcitrant Dermatopytosis Using Acyclovir and Antifungal Treatment in a Patient with High HSV IgG Antibodies

Sami Fatehi Abdalla — 2023-09-23

The prevalence of recalcitrant or widespread dermatophytosis is increasing, posing a significant challenge for dermatologists globally. The efficacy of antifungal regimens in treatment has historically been high, attributed to their broad-spectrum antifungal properties. However, there has been a noticeable increase in treatment failures in recent times. The infection caused by Herpes Simplex Virus type 1 (HSV-1) has a moderating effect on the ability of monocytes to effectively eliminate fungi that have been engulfed during phagocytosis. In the reported patient, the HSV I antibody titre was high, so the systemic antiviral (acyclovir) was added in remission dose to the existing antifungal regimen. The eradication of dermatophytes was nearly achieved within a fortnight following the administration of therapy. Therefore, it is advisable to consider obtaining HSV type I IgGs for every patient who presents with a widespread or recalcitrant superficial fungal infection, and to begin a combined antiviral and antifungal treatment approach.

Primary Focal Hyperhidrosis; Treatments of Thoracoscopic Surgery

Bayrakçi Onur — 2023-01-06

Background: Primary hyperhidrosis is an excessive amount of sweating disorder that bothers the person in the palms, soles, axillae and craniofacial regions. Primary hyperhidrosis is seen in 4.8% of the general population. Topical cream, parasympatholytic drugs, iontophoresis and botulinum toxin are used in the treatment of hyperhidrosis. Thoracic sympathetic surgery is another treatment method for patients who do n't respond to medical treatments. Outcomes of the surgical treatment of hyperhidrosis were aimed in the study.

Methodology: This study was done to include patients with a diagnosis of hyperhidrosis who admitted to hospital between Jan 2015 and Sep 2021. Digital data were analyzed by evaluating patients' age, gender, thyroid function tests, medical treatments, surgical methods, postoperative clinical features, length of hospital stay, complications and disease recurrence. According to the preference of the surgeon, it was done to operate with uniport or two ports in this method (sympathectomy or sympatholysis). However, a three-port or minithoracotomy was done due to insufficient exploration or bleeding. The statistical analysis of the study was done with the Chi-square test.

Results: The incidence of hyperhidrosis was 0.38%. It was mostly seen in the male gender and, in the ages of 18-28 ranges. Localization of sweating was most often palmar (43.3%) in primary hyperhidrosis. Stress was a factor that increased sweating. The most common surgical method was uni-port video-assisted thoracoscopic surgery (66%) and sympatholysis (85%) in this study. Compensatory sweating was 26.4% and, the recurrence rate was 5.7% in the postoperative period. Complications rates were hemothorax 5.6% and pneumothorax 1.8% in the surgery. The third port was required in 5.6% because of adhesions or bleeding or incomplete exploration, and unilateral mini-thoracotomy was required in 9.4% of patients.The average length of stay in the hospital was 3.1 days. Tube thoracostomy increased the length of stay by 1.6 days. The sweating control rate was 96.2% in the early postoperative period. There was no mortality in the patients.

Conclusions: Thoracic sympathetic surgery is successful in the treatment of primary hyperhidrosis and, there is no statistically significant difference between sympathectomy and sympatholysis.

The Impact of Libyan Pediatric Atopic Dermatitis on Their Families

Narges Ibrahim Shoaib — 2023-05-09

Background: Atopic dermatitis (AD) and psoriasis are common chronic skin diseases affecting children. These disorders negatively impact the quality of life (QoL) of patients in health related aspects such as physical, psychosocial, and mental functioning. This health impact is more accurately represented when accounting for the numerous co-morbidities associated with each disorder.

Aim of the Study: To assess the impact of atopic dermatitis on families of children under four years with the condition and to identify factors affecting family impact, in addition to correlate the impact with their quality of life.

Materials and Methods: A cross sectional survey conducted over period of 6 months. The study include 100 families of children aged 4 years and below, with the diagnosis of atopic dermatitis attending outpatients dermatology clinic at Benghazi medical center and AL-Kish polyclinic, Benghazi-Libya. Demographic and clinical data were collected directly using interview data collection form. Three Item Severity (TIS) score included in the study and based on oedema/ papulation, excoriation and erythema. The total score ranged from 0 to 9. To assess the impact of the children's AD on the parents' QoL, the Dermatitis Family Impact Questionnaire was used with score ranges from 0-30, higher score indicated bad quality of life. Data obtained were analyzed using SPSS version 26 at statistical significance 0.05.

Results: In this study 100 families of AD children, 50% males, age ranges from 4 to 47 months, 67% had family history of atopy, 47% suffered from other types of atopies. The mean severity index was 4.58. The FDQLI score was ranged from 0 to 26 (mean 16.64) reflecting moderate family impact. AD impact varies among families, to be moderate in 53%, severe in 31, small in 11% and normal in 5%. Ten areas where AD impact the families quality of life were evaluated. Extra expenditure, people reactions, burden of care, people reaction and emotional impact were the most factors showing the greatest impact caused by the presence of AD child in the family. A correlation between FDLQI and disease severity showed that quality of life was significantly more disturbed with increasing severity of the disease. There were no significant differences in families quality of life score regarding the gender and the age of the child, The quality of life showed a significant association with family’s educational level. Families with education beyond secondary (fathers and mothers) more severely affected.

Conclusion: AD appeared to have a moderate impact on the QoL of the enrolled families. QoL measured by FDLQI was significantly more disturbed with increasing severity of the disease. The quality of life showed a significant negative association with family’s educational level. To the best of our knowledge this is the first to be reported from Libya and North Africa.

Epidemiology and Treatment Aspects of Hair Loss in India – A Cross-Sectional, Multicentre, Database Study (HAILO)

G. Monil — 2023-05-10

Aims: To evaluate the demography and treatment patterns for Indian patients with hair loss.

Study Design: An electronic medical record (EMR)-based, retrospective, multicenter, cross-sectional study.

Place and Duration of Study: EMR records between June 2018 and June 2021.

Methodology: Data of patients ≥12 years of age with reported hair loss secondary to any cause was included. Informed consent waiver was obtained from ethics committees as this is a non-experimental, retrospective data analysis study. Demographic and treatment details of patients sub-grouped based on type of hair loss were noted.

Results: Data of 24595 patients diagnosed with hair loss were evaluated. Telogen effluvium (TE) was the commonest reason for hair fall (40.70%), followed by female pattern hair loss (FPHL) (22.09%), alopecia areata (AA) (12.81%), and male pattern hair loss (MPHL) (7.49%). Majority cases were females (n=10794, 74.8%), with most belonging to 12-39 years’ age group (n=11734). Commonest comorbidity noted was acne (10.4%), followed by seborrheic dermatitis (3.0%). Overall, 1658 (12.31%) continued same treatment at follow-up, 956 (7.10%) patients had an add-on of new formulation, and 975 (7.24%) cases had a change of treatment. Overall, nutritional supplements were most adopted by physicians at baseline (n=6843), while pharmacological agents were the therapy of choice at follow-up (17.41%). For MPHL, FPHL and AA groups commonest treatment option at both baseline and follow-up was pharmacological agent; for TE group, commonest treatment option at baseline was nutritional supplements, and pharmacological therapy at follow-up. The most common class of therapy prescribed as a substituted agent at follow-up was nutritional supplements for all hair-loss subgroups.

Conclusion: Hair loss was caused by various causes, with TE and FPHL noted to be more common. Young to middle-aged females were noted to be most affected by hair loss. Though pharmacological agents remain the key choice for managing hair loss, substitution or addition of nutritional supplements was noted commonly at follow-up.

Acne and Regular Menstrual Cycles: A Study of 100 Libyan Females

Tarik S. Enaairi — 2023-06-06

Background: Acne and menstrual cycles are highly prevalent among young females. The hormones and their fluctuations play an important part in the menstrual cycle and its regularity, as well as acne pathogenesis.

Aims: To look into the relationship between acne and the menstrual cycle and determine whether perimenstrual acne flares occur even with a regular menstrual cycle.

Methods: This was an observational cross-sectional study that took place between August 2021 and April 2022. It included 100 Libyan females who had visited outpatient dermatological clinics at the National Cancer Institute (Misurata, Libya) with clinically diagnosed acne and had normal menstrual cycles.

Results: A total of 100 Libyan females with clinically diagnosed acne and regular menstrual cycles were studied. The females in this study ranged in age from 17 to 26 years, with a mean of (20 ±1 years). 20% of females experienced perimenstrual acne flares, and 12% of them reported worsening symptoms in the week preceding their menstruation. Most females reported a perimestrual acne flare that was diagnosed as moderate acne. All females (20%) with a perimenstrual acne flare have an onset of acne that was accompanied by or shortly before the first menstrual cycle (menarche).

Conclusion: A perimenstrual acne flare may occur, even in women who have regular menstrual cycles. Females who develop acne during or shortly before menarche are more prone to perimenstrual acne flares.

Bacterial Dermo-Hypodermatitis (BDH) in Ziguinchor (Senegal): A 2-Year Review

Boubacar Ahy Diatta — 2023-08-22

Introduction: The incidence of bacterial dermo-hypodermatitis (BDH) varies worldwide. In Africa, a resurgence has been noted in recent years, with the identification of certain local and general risk factors in urban areas. However, the epidemiology of bacterial dermohypodermatitis in other regions of Senegal remains unknown. The aims of our study were to determine the epidemiological, clinical, and therapeutic outcome of bacterial dermo-hypodermatitis, as well as to identify the eventual associated risk factors.

Methodology: We conducted a descriptive cross-sectional study of the records of patients followed for BDH in the two Dermatology departments of the Ziguinchor region over a 4-year (01 July 2019 to 01 July 2022).

Results : We collected 148 cases of BDH. The sex ratio was 1.17. The mean age of patients was 55.83 years. Non-steroidal anti-inflammatory drugs were used in 13 cases (8.8%), with worsening of symptoms in 9.5%. Bacterial dermohypodermatitis was non-necrotizing in 133 cases (89.9%) and necrotizing in 15 (10.1%). There was a point of entry in 92 cases (62.1%). Amoxicillin-clavulanic acid has been used in 124 cases (83.8%). Surgical debridement has been performed in 12 cases (8.1%). Favorable progression noted in 141 cases (98.6%). General factors associated with BDH were arterial hypertension in 21 cases (14.2%), obesity in 20 cases (13.5%), diabetes in 14 cases (9.5%) and artificial depigmentation in 8 cases (5.4%). Skin Regional risk factors were lymphedema in 14 cases (9.5%), and no deaths were observed.

Conclusion:Bacterial dermo-hypodermatitis is common in Ziguinchor, and predominantly affects adult males, contrary to the predominance of females in the literature. Cardiovascular risk factors such as obesity and arterial hypertension were the most common.

Infectious Dermatoses in Ziguinchor (Senegal): Epidemiological, Clinical and Evolutionary Particularities

Boubacar Ahy Diatta — 2023-08-22

Introduction: Infectious dermatoses are common in tropical countries. Their prevalence varies, with fungal causes predominating. Their severity is linked to the risk of life-threatening systemic complications. We aimed to describe the epidemiological, clinical and evolutionary aspects of infectious dermatoses.

Methodology: This was a retrospective cross-sectional study conducted over a period of 08 months. It included all the records of patients treated for infectious dermatoses in the dermatology department of the Ziguinchor regional hospital. Data entry and analysis were performed using Epi Info software version 7.2.4.0. and SPSS 13.0 software. Descriptive studies have been carried out by calculating frequencies, proportions and confidence intervals for qualitative variables. And for quantitative data, by calculating averages with their standard deviation. Analytical study using cross-tabulations. To compare frequencies, we used the Chi-square test² or the Fisher test. The significance level was p < 0.05.

Results: We collected 220 cases of infectious dermatoses, representing a hospital prevalence of 30.3%. The mean age of patients was 30.35 years (107 men and 113 women). Underlying conditions were diabetes in 23cases and HIV 1 infection in 13cases. A high prevalence of mycotic dermatoses has been noted in 50.7% (n=112), dominated by dermatophytosis in 22.7%. Viral dermatoses have been noted in 28.5% (n=63), with herpes zoster predominating in 6.3%,Bacterial dermatoses have been noted in 25.4% (n=56), represented mainly by non-necrotizing dermohypodermatitis in 7.2% (n=16). Parasitic dermatoses have been noted in 11.8% (n=26) and were dominated by scabies in 17.7% (n=40). All patients received etiological and symptomatic treatment. The outcome was favorable in 69.5% (n=153), although mortality was 2.27% (n=5).

Conclusion: Infectious dermatoses are a frequent request for care in tropical Africa, particularly in Ziguinchor. They have been dominated by mycotic and viral infections in children. In adults, diabetes and HIV infection are the major contributing factors. Mortality is linked to necrotizing bacterial dermohypodermatitis. Early diagnosis and management can improve prognosis.

CD117 Positive Cells Significantly Exist in Immune-targeted Follicles of Alopecia Areata

Keroles N. Gendy — 2023-09-16

Aim: Studying the expression of CD117 (c-kit) in hair follicles of Alopecia Areata (AA).

Place and Duration of Study: Department of dermatology and venereology, Minia university hospital, Egypt and Department of Pathology and laboratory medicine, Western University, Ontario, Canada, between July 2022 and July 2023.

Methodology: This study included 16 AA patients, Skin biopsies were obtained from each participant and stained with hematoxylin and eosin (H&E) and CD117 immune stain, all hair follicles are numbered and evaluated for presence of infiltrates and expression of CD117. Correlation was done between existence of perifollicular inflammatory infiltrate and expression of CD117 in all hair follicles in cross section.

Results: Within 82 follicles examined, CD117 was significantly expressed in immune targeted follicles. The median of positive expression was 2 with interquartile range (IQR) (1-3), the expression decreased in non-infiltrated follicles the median was 1 with IQR (0-1.8) with statistically significant difference (P = 0.001).

Conclusion: CD117 is significantly expressed in hair follicles of AA and is correlated to the immune cytotoxic infiltrates and possibly to the pathogenesis of alopecia areata.