Background: Clinical diagnosis of several skin diseases is mostly supported by skin biopsies, a follow up on the clinicopathological correlation to improve the accuracy in diagnosing skin diseases.
Aims: The aim of this study is to correlate the clinical diagnosis with histopathologic findings, find factors that affect its correlation such as clinical history and differential diagnosis.
Methods: This is a retrospective study of patients seen in the Dermatology Out-Patient Clinic in a Tertiary Hospital in South-South Nigeria, who had skin biopsies done between January 2016 and November 2019.
Data collection was by convenience sampling, and recordings of clinical notes and results of skin biopsies of suitable cases seen at the out-patient clinic between January 2016 and November 2019 were collated. Details of patient’s age, gender, folder number, clinical history and diagnosis, histologic report as well as histologic diagnosis were documented. The results were seen as correlating when the provisional clinical diagnosis or any of the differential diagnosis agreed with the histopathologic diagnosis and discordant when the provisional clinical diagnosis or differential diagnosis varied with the histopathologic diagnosis.
Results: Skin biopsies done on 60 patients was recorded and reviewed. Sixteen (26.7%) were men and 44 (73.3%) women, mean age of patients was 35.5 years + 16.8. The frequency of cases were papulosquamous diseases 24 cases (40%), tumors 12 (20%), eczematous dermatoses 8 cases (13.3%) infections 2 cases (3.3%), vesiculobullous dermatoses 2 cases (3.3%) and miscellaneous diseases 12 (20.1%). Concerning papulosquamous dermatoses they were made up of 45.8% lichen planus, 41.7% psoriasis, 8.3% pityriasis rubra pilaris and 4.2% lichen nitidus. A few patients 4 (6.6%) had a provisional diagnosis with differential, while 56 (94.4%) had just the clinical diagnosis. There was clinicopathologic correlation in 43 patients (71.7%) and discordance in 17 patients (28.3%). A p value of 0.012 and kappa coefficient of 0.44 was obtained, showing significance.
Conclusion: The overall correlation between clinical and histopathologic diagnosis was good. An accurate description of the lesion with the best probable clinical diagnosis aids the pathologist.
Background: Documentations on pattern of acne and quality of life are mostly in adolescents and adult females. Female acne is said to be different from adolescent acne. It is not known if male acne is different. The aim of this study was to document the pattern of male acne vulgaris, compare with adolescent acne, determine the quality of life and the associated factors.
Methodology: This was a cross-sectional prospective study of 64 male acne patients over a one year period. Socio-demographic parameters and clinical history was documented using a data questionnaire. Clinical examination to assess lesion type, anatomical location and severity of acne was conducted. Quality of life was assessed using the Cardiff Acne Disability Index. Data was analyzed with SPSS version 22 and a p value of <0.05 was adjudged to be significant for all tests.
Results: Mean age of the group was 22.8±7.4 years. Family history of acne was present in 45.3%, self-medication for acne in 47%. Duration of acne was >5years in 39.1%. Acne was located only on the face in 76.7%, lesions were non-inflammatory in 67.2%. Acne scar was present in 78.1%. Severity of acne was moderate in 42.2%. Quality of life was impaired in 98.4%; this was moderate 40.6%. Mean CADI was 7.4±3.3. All items on the CADI were impaired in 98.4% of the patients.
Study Limitations: Inability to compare male teenage to post-adolescent acne.
Conclusion: The pattern of male acne is no different from the adolescent pattern. Quality of life is impaired in most males.
Background: A lot has been written on post adolescent acne and its effect on quality of life in women but not in men. The differences if any between post adolescent acne in men and women is not known. The aim of this study is to compare the clinical features and quality of life affectation of post adolescent acne in males and females.
Patients and Methods: This prospective cross-sectional study was conducted over one year on 77 patients who had post adolescent acne. Sociodemographic data was documented. They were clinically evaluated for lesion type and acne severity was graded. Quality of life impairment was documented using the Cardiff Acne Disability Index (CADI) instrument. Data was analyzed using the SPSS version 22. Level of significance of all statistical tests was set at P<0.05.
Results: There were 77 post adolescent acne patients made up of 27.3% males and 72.7% females. Prevalence of acne was 15.5% in males and 19.3% in females. Median age was 28 years in males and 31 years in females. Females had mixed lesions while males had non-inflammatory lesions. Quality of life was impaired in all the participants irrespective of gender. Mean Cardiff acne disability index in males was 6.6 ± 3.2 and 6.5 ± 3.8 in females. In males, only the severity of acne impaired quality of life while in females, quality of life was impaired by severity of acne, age at presentation, presence of acne scar and presence of post inflammatory hyperpigmentation.
Conclusion: Post adolescent acne in males and females differ in prevalence, family history, lesion type, type of acne, severity and quality of life affectation and the factors that negatively impact quality of life.
Aims: To highlight signs and symptoms of suspected spider bites and to evaluate local and systemic manifestations to suspect the more prevalent type of spider bites if Loxoscelism or Latrodectism, also to widen knowledge of physicians about not well known disease in Libya.
Study Design: Prospective case- series study.
Place and Duration of Study: The study was performed in dermatology department of Zliten Medical Center, which is the largest and main governmental general hospital in Zliten city. The study period was 3 years started 1st Sept. 2017 and finished on 31th Aug. 2020.
Methodology: The study has included patients from all age groups; with spider bites, nevertheless the culprit spider was seen or not. The diagnosis in cases, who did not see spiders, was mainly clinical, with or without presence of dermal necrosis. The other involvement criteria were painless bite involving proximal covered extremities or trunk.
Results: Thirty eight patients were involved (32 females, and 6 males), the majority (76%) have not seen the culprit spider. The most frequently bitten sites of the body were proximal extremities and trunk.
Local skin necrosis was the main clinical features and was seen in 71% of patients, furthermore, the majority (76 %) had developed mild systemic symptoms like fever, headache, nausea.
Conclusion: Dermonecrosis is one of main features of spider bites in Libya, and mild systemic symptoms are common, while severe systemic symptoms or complications were not registered, that the most likely disease caused by spider bites in Libya seems to be Loxoscelism. Therefore, studies to identify the culprit spiders are mandatory.
This is the second part of the article, titled "looking beyond the cutaneous manifestations of Covid 19 Part 1: The Clinical Spectrum – A Review”, which is exclusively relegated to the pathology and pathogenesis aspects. The cutaneous manifestations of Covid 19 are classified into four broad groups, from the pathology and pathogenesis point of view and the histopathology of all the cutaneous lesions are briefly reviewed. The role of vasculitis and endothelitis in the pathogenesis of skin lesions in Covid 19, are discussed. The vasculitis and thrombotic microangiopathy (TMA) are discussed at length as they occupy the centre stage of pathogenesis, in the literature, at present. The various types of vasculitis reported in literature, are classified on the basis of skin lesions seen and the rationality of the various terms used in the context of the pathogenesis are explained. It is stressed that that the central players in the pathogenesis of skin lesions in Covid 19 are, vasculitis, activation of complement pathways and coagulation cascade and the cross- talk between the two at various points in their respective pathways. For the details of the complement activation, activation of coagulative cascade and for the details of the role of innate and adaptive immunity system, the readers may refer to the author’s previous article titled “Local Immunity Concept in the Context of the Novel Corona Viral Infection- A Consideration.” *** (reference of which is provided under the additional information at the end of the article). Some contentious issues concerning the role of the vasculitis and immune complex mediated damage, of the vessel wall in the pathogenesis of cutaneous lesions of Covid 19, are discussed. A non-immune, non-vasculitis, alternative mechanism is suggested by floating a two hit hypothesis. The necessity to apply the rigours of diagnostic criteria of vasculitis is emphasized to get a standard picture of the histopathology and pathogenesis of cutaneous manifestations of Covid 19 by future research.