Introduction: Topical corticosteroids (TCS) are widely misused. Uncontrolled use of steroids can cause undesirable adverse effects especially on face. Aim: The aim of this study was to assess the skin manifestations of TCS misuse over the face in the patients attending dermatology outpatient and to analyze various factors contributing to such misuse. Material and Methods: A total of 200 patients with facial dermatoses using topical steroids over face for minimum period of 1 month, reported between June 2010 and May 2011 were enrolled in the study. Details about the usage of topical corticosteroids and their side effects were recorded. The patients were educated about the misuse. Results: Majority of the patients were females (71%). The most common reason for misuse was acne (61%) followed by use as a fairness cream (23%). The average duration of usage was 6 months to 1 year, longest being 8 years. The drug most commonly misused was Betamethaone Valerate (71%). The commonest side effect noted was acne form eruptions (52%) followed by steroid dependent face (SDF) (36%). There were no cases of allergic contact dermatitis or perioral dermatitis. The exacerbation of the lesions on stoppage of steroid cream (90%) fairness effect (10%) were the reasons for continued use. (100%) were unaware of side effects of topical steroids. Conclusions: Steroids have been misused by patients on their own or by doctors for various reasons. Hence the awareness about their correct usage is essential.

Melasma is a commonly acquired hypermelanosis of facial skin due to various etiological factors including hormonal imbalance. Although it affects any one is particularly common in women, especially pregnant women and those who taking oral or patch contraceptives or hormone replacement therapy. This research aimed to formulate stable water in oil (w/o) cream containing plant extract of Glycyrrhiza glabra as active material obtained by concentrating the alcoholic extract of the plant roots, was entrapped in the inner aqueous phase of w/o cream. Base containing no active material and a formulation containing ethanolic extract of the plant which was prepared in Samarra Drugs Industry laboratories. Samples of base and formulation were stored at different accelerated conditions (8°C, 25°C, 30°C, 40°C, 40°C +75% RH) for four weeks to predict the stability of the creams. It was concluded that the formulation was stable chemically and physically over the studied storage conditions and without induction of allergic or contact dermatitis.

Introduction: Psoriasis is a chronic immune-inflammatory-mediated disease affecting approximately 1-3% of the population worldwide. All around the world, there is growing evidence of the association between psoriasis and comorbidities, especially metabolic syndrome which increases the risk of cardiovascular disease. Co-morbidities are likely linked to underlying chronic inflammatory nature of psoriasis. Aim: The objectives of our study were to determine the prevalence of diabetes, lipid abnormalities, and cardiovascular risk factors in patients with plaque psoriasis, and also to investigate metabolic syndrome associated with plaque psoriasis. Material and Methods: One hundred and twenty patients with psoriasis vulgaris diagnosed clinically and histopathologically were recruited. A detailed history and examination was recorded for all study subjects, including the age and gender of the patients, extent of psoriasis, duration, and age at onset. Metabolic syndrome was diagnosed in the presence of three or more criteria of abdominal obesity, blood pressure >130/85 mmHg, fasting blood glucose ≥100 mg/dl, hypertriglyceridemia >150 mg/dl, and low HDL cholesterol (<40 mg/dl for males, <50mg/dl for females). Results: Prevalence of various comorbidities was: central obesity (58.3%), hypertension (46.79%), dyslipidaemia (43.3%), diabetes mellitus (26.7%), metabolic syndrome (25%), ischaemic heart disease (5%) and stroke (2.4%). Prevalence of metabolic syndrome was more in patients who had longer mean disease duration of psoriasis. Conclusions: The perception of psoriasis being merely ‘skin deep’ has to change among clinicians. Active screening for these cardiovascular comorbidities in all psoriasis patients is highly recommended.

Introduction: Aim of our study is to propose the ancient plant Desmodium adscendens, that is hitherto known for combating, when orally administered, a plethora of other ailments and diseases and considered even an anti-histaminic, for external use. An inhibition of histamine depot by inhibiting the enzymatic activity of histidine decarboxylase can be suspected, since biological principles contained in D.A. belong to the same pharmacological class of natural derivatives that elicit the same effects (nicotinic acid, cyanides and quercetine) and of synthetic alkylammines (e.g contained in bubble baths). Desmodium adscendens is a perennial plant, growing wild in Africa, especially in Camerun and Ivory Coast as well as in South and Central America and the continent of Asia. Aborigines were accustomed to employ the entire plant for rites of initiation and other shamanistic ceremonies. Notwithstanding, it has been used for thousands of years by peoples native to those areas where it grows for a variety of health issues. This plant has been studied in France, Italy, India and Canada and appreciable are the results with regard to bronchial dilation, relaxation of smooth muscles, antihistamine effects, when orally administered, albeit there is a neat evidence of an extreme paucity of references about its ability to act as a completely natural anti-histaminic herb for external use. Material and Methods: To conduct our study we have recruited 24 volunteers out from 4 cathegories of employees generally suffering from Type I Contact Dermatities. They were prayed to spread the hydroglyceric extract of Desmodium adscendens every morning at 10.00 a.m. and every afternoon at 03.00 p.m onto the skin of forearms and cheeks, where an artificial rash was evoked by the use of a mix made up with allergenic herbs. As far as the evaluation of the degree of severity of skin inflammation is concerned we have used the Reflectance Spectrophotoscopy, to measure the erythematous manifestation twice a day for one week: at 09.00 a.m. (to check the gravity of erythema induced in each single case) and at 04.30 p.m., to check the real efficacy of the D.A. hydroglyceric extract. We have to keep seriously on account that Reflectance Spectrophotoscopy can’t evaluate histamine concentration and its characteristic effects and that the 40–50% of cases of erythematous manifestations are not rigorously ascribable to the phenomenon of the histamine release. Results and Conclussions: Results are amazingly encouraging, since it has been observed that the mean value of the blanching effect of the electuary on erythema is of 48.8%.

Very interesting article, we should take care that the management of psoriasis should be shifted towards comprehensive disease management.

The association of psoriasis with cardiovascular disease, in particular, has been subject of research for many years, however, inconclusive results were always obtained as cardiovascular disease risk factors could act as confounders. Recently the topic have caught more attention as better designed studies have been performed thus confirming its association. Among these studies, it is very interesting to cite the meta-analysis performed by Miller et al [1] where they revised 75 relevant articles including more than 500,000 cases and found that psoriasis was associated with cardiovascular disease, ischemic heart disease, peripheral vascular disease, atherosclerosis, diabetes, hypertension, dyslipidemia, obesity by body mass index and by abdominal fat and metabolic syndrome but not associated with cerebrovascular disease and cardiovascular mortality.

Progressive symmetric erythrokeratoderma (PSEK) is an autosomal dominant genodermatosis with incomplete penetrance and variable expressivity. It belongs to the group of erythrokeratodermas where it can be differentiated from erythrokeratoderma variabilis in the absence of migratory erythematous lesions and in a greater incidence of palmoplantar keratoderma. Molecular basis of PSEK has not yet been established although there are reports of mutations in the loricrin gene. We report a 13-year-old boy with symmetrically distributed hyperkeratotic plaques over the dorsum of the hands and the extensor aspect of the forearms, elbows and knees. As far as we are aware, we report the first case of PSEK in the Dominican Republic.

Introduction: Linear IgA bullous dermatosis (LAD) is an immunobullous disorder, in which IgA antibodies are deposited along the basement membrane zone (BMZ) of the skin in a linear pattern. The cause of this disease is unknown, but the eruption may occur more commonly in association with certain medications. Case report: A 61 year old woman presented with blisters in the axillae and legs, with pain, itching and swelling. She was taking many medications for other conditions such diabetes and obesity. Tense blisters were seen, primarily on the legs and accompanied by some ankle swelling. Methods: Skin biopsies for hematoxylin and eosin (H&E) examination, as well as for direct immunofluorescence (DIF), and immunohistochemistry (IHC) studies were performed. Results: The H&E examination revealed a subepidermal blister, with small numbers of lymphocytes, neutrophils and eosinophils noted within the blister lumen. The dermis also displayed a mild, superficial, perivascular infiltrate of lymphocytes and histiocytes; eosinophils and neutrophils were also noted. DIF and IHC studies confirmed the diagnosis of linear IgA (LAD) at the BMZ. However, in addition to immunoglobulin A, we also observed deposits of IgA, IgM, IgG, IgD, Kappa, Lambda, Complement/C3c, C1q, fibrinogen and albumin around upper dermal blood vessels. Conclusions: LAD has been most commonly associated with medication intake; the most common DIF immune response is the presence of linear IgA at the BMZ. However, here we found additional reactivity to against dermal blood vessels. Because the patient is affected by diabetes mellitus, it is difficult to know if the observed vascular reactivity was associated with the diabetes or solely an immune reaction to the vessels. Based on our findings, we encourage searching for vascular reactivity in cases of LAD.

A 35-year-old man was referred to our hospital with a 3 months history of itchy cutaneous eruption on the trunk and asymptomatic cutaneous eruption on both groins. Physical examination revealed several, purplish-brown, scaly papules on the trunk and well-circumscribed, brown patchs in a linear distribution, on the bilateral inguinal regions. Dermoscopic examination of papules on the trunk revealed white crossing lines surrounded by brown dots; dermoscopic examination of patchs on groins revealed gray-brown dots and globules. According to histological, dermoscopical and clinical changes, the diagnoses of classical lichen planus (LP) for the lesions on the trunk; and lichen planus pigmentosus inversus (LPPI) for the lesions on the inguinal regions were made. Inhere we have described a rare case of LPPI and classical LP with dermoscopic features; and we suggest that LPPI is a variant of classical LP.

Leiomyoma is an uncommon smooth muscle tumor on the face. Its occurrence is common in the uterus. Though skin lesions have been reported, they are clinically difficult to diagnose as they have features similar to various other swelling. Here we present one such case of leiomyoma over nose that can often be misleading.

A 32 years old female presented with a single asymptomatic lesion on right thigh since 5 years. On examination, a single ill defined, irregular hyperpigmented plaque was present on medial aspect of right thigh. The plaque was firm in consistency and was non-tender. No scaling was evident. Clinically a differential diagnosis of Hansen’s disease, lupus vulgaris and deep fungal infection were made. The histopathology interestingly showed features suggestive of Kaposi’s sarcoma. The patient was HIV negative and otherwise completely asymptomatic.

Female patient 63 years old who was hospitalized due to erythroderma exfoliative (Fig. 1) after taking ciprofloxacin by urinary tract infection, 4 weeks later we began to observe the detachment of the finger and toenails from the proximal nail fold predominantly on the thumbs (Fig. 2), and the diagnosis of onychomadesis was done. Nail diseases are common but no all people and doctors know about nail changes due to drug reaction or systemic diseases. The present case shows the normal evolution of the nails after an injury due to drug reaction like erythroderma exfoliative.

Introduction: HSV is a common human pathogen that lead to lifelong latent infection. Maternal infections may be associate with transmission to the fetus. The risk factors associated with HSV 2 seropositivity in pregnant women in Iraq are not well studied. Aim: The present study conducted to verify the prevalence of HSV 2 infections in women with bad obstetric history (BOH) in Kirkuk Governorate. Material and Methods: HSV 2 seropositivity among women aged 14 to 48 years was investigated by determination of HSV 2 IgG and IgM in a prospective, case control descriptive study. Results: The overall HSV 2 seroprevalence was 29.9%, with a non significant difference between women with BOH and women with normal pregnancy. HSV 2 IgM, as an indicator of current infection was demonstrated in 2% of the studied population, and was significantly (P=0.002) higher in women with BOH compared to women with normal pregnancy. Both HSV 2 IgG and IgM were significantly varied with age groups, with trends of increasing with older ages. HSV 2 IgG was statistically significantly higher in working women (P=0.03) as compared to housewife. Conclusions: Significant association was found between HSV 2 seroprevalence and education levels, residence, smoking and animal exposure. Presence of pregnancy in women with HSV-2 latent infection was a risk factor for development of BOH.

Introduction: Cutaneous Leishmaniasis is a parasitic infection encountered in our daily dermatologic practice. Case report: We present a case of 57 year-old man of Moroccan origin, with erythematous squamous and indurated plaque on the abdomen, treated as sarcoidosis with corticosteroids with no improvement. Discussion: Cutaneous Leishmaniasis is endemic in 88 countries. Aside from its classical presentation it can manifest in multiple different ways. In our case, the diagnostic of Erysipeloide Leishmaniasis was corrected on the basis of the skin smear and the histopathological examination. Our observation is particular in its clinical presentation and location. To our knowledge it is the first Moroccan case. Conclusion: Even in endemic countries it is worth reporting unusual forms and locations of Cutaneous Leishmaniasis in order to avoid inappropriate diagnosis and management.

This paper describes Lesch-Nyhan syndrome in a 1-year-old boy. This X-linked recessive error of purine metabolism presents in infancy with a constellation of mental and developmental retardation, self-mutilating behavior, neurological features and abnormal urine uric acid: creatinine ratio. The basic defect is deficiency in phosphoribosyl transferase production but exact pathomechanism for clinical symptomatology remains un-elucidated. No specific medical treatment is available.

There are different sources of names in medical field. Similarly, the names given to pharmaceuticals companies are derived from different things. Selecting a good name is not always easy. In fact, there are now professional companies to help finding proper names for medical organizations and medications [1]. These were of help in naming pharmaceutical companies. For instance; ”Zeneca” was an invented name created by the branding consultancy Interbrand. Interbrand had been instructed to find a name which began with a letter from either the top or bottom of the alphabet and was phonetically memorable, of no more than three syllables and did not have an offensive meaning in any language.

Marjolin’s ulcer is part of a group of neoplasms arising in chronic skin lesions, whether inflammatory or traumatic. Squamous cell carcinoma is the most frequently reported in the literature, it appears most frequently in burn scars, although also described in other types of lesions. We report a case of Marjolin ulcer in a male, native, 65 years old, from the Paraguayan Chaco, with antecedents of scar post trauma in youth.

We report a patient with erythematous firm papules and nodules over palms. Histological examination, which identified epidermis showed marked hyperkeratosis and dermis with perivascular lympho-histiocytic infiltrate which also extended in between the collagen bundles with occasional multinucleated giant cells and mucin deposition. This established the diagnosis of Granuloma Annulare (GA). This is an unusual presentation because of the late onset, uncommon localization, and absence of classical lesions of GA elsewhere.

The panniculitides comprise a large and heterogeneous group of diseases, with a high prevalence in the general population, in which the inflammatory process affects the subcutaneous tissue. We briefly review the classification, clinical and histology of the primary panniculitides and present a representative case.

Male patient, 35 years old who came to dermatological consultation due to contact dermatitis on back, during his clinical examination alterations of his digits was seen. Dermatological examination reveals a rim of tissue at the distal edge of the nail of both big toenails and thickened nails (Fig.1a – c, 2a, b). Both big toenails were removed due to ingrown nails two times.

Complementary and alternative medicine is surviving across the decades and also in the medicine of 21st century. The physicians are meeting different preparations during their praxis and the challenge for them is to find the right way how to navigate the patients in the middle of thousands of preparations and methods. Complementary and alternative medicine is considered to be the therapeutic approaches and methods which are not involved in the standard conventional treatment schema. This medicine should not be alternative to the standard therapy but should be used complementary.

We read with admiration the article written by Borik L et al on eruptive syringomas (ES) of the neck [1]. We are convinced, from the clinical and histopathological findings, that syringomas is the most likely diagnosis for the patient concerned, and that the authors have provided that highest quality of care to her. We cast reservations, however, on whether the longitudinal time progression of the lesions warrant the term eruptive to be validly applied here. Specifically, the 25-year-old lady was “admitted to the dermatologist’s office with the complaint of a rash and itch on the skin on the anterior neck”. In general usage, eruptive denotes to become active or violent especially suddenly [2].

Glomus tumor is an uncommon vascular tumor involving mostly subunguum of the thumb or the index finger. It commonly presents as a pink or purplish circumscribed nodule underneath the nail plate. Pain is paroxysmal in nature and precipitated often from exposure to cold or pressure/blunt trauma. Dystrophy of the nail plate occurs rarely. The described case, a 40-year-old woman, had dystrophic thumbnail ascribed to subungual glomus tumor that resembled median canaliform nail-dystrophy of Heller.

Boy 4 years old, hospitalized due to hemorrhagic chickenpox and sepsis during his clinical examination besides hemorrhagic crust, vesicles and bullous he has also a cutaneous red lesion localized at the right proximal nail fold of the big toenail (Fig. 1), dermatoscopic view of the lesion (Fig. 2). The diagnosis of hematoma of the proximal nail fold due to oximeter was done. The proximal nail fold hematomas due to oximeter are uncommon dermatoses at this level that are caused for the pressure of the oximeter and it has been seeing in patient in Unit Intensive or Intermediate Unit Care since 2007.

Complications of cosmetic decorative tattoos were uncommon some decades ago. The practice is increasing and more cases are being reported. Red pigments are by far the commonest cause in tattoo reactions. We report two cases of lichenoid reactions limited to red tattoo pigment and review the literature on the subject.

Cutaneous myxomas also called angiomyxomas are rare benign connective tissue tumours, composed of stellate cells, set in a loose mucoid stroma. These lesions have been recognized as part of Carney complex. We report a 12 year old boy affected by multiple Superficial Angiomyxomas without any other components of Carney complex.

We have conducted a case-control study to analyze the epidemiological importance risk of family history of psoriasis. The retrospective study was done on 1236 patients diagnosed with psoriasis on clinical and histopathological grounds, between 2004-2011, in an Out-patient Clinic in North-Eastern part of Romania.

Introduction: Lupus erythematosus tumidus (LET) is an underreported variant of lupus erythematosus (LE) that is characterized by soft urticarial-like elements usually located on the sun exposed skin. LET is featured with high photosensitivity. Lesions of LET resolve without scarring and do not cause disfigurement as seen in the discoid LE variants. Lesions of LET may co-exist with other variants of LE: discoid or systemic. Main observations: The case presents a female patient with LET localized on the lateral infraorbital areas of her face and cheeks. Histopathological evaluation showed a lymphocytic infiltrate in the middle and deeper parts of the dermis. This article also presents a contemporary review of the clinical variants of LET, histopathological features and approaches to the treatment of LET. Conclusions: LET should be considered in urticarial-like lesions on the skin of the face and other skin exposed areas. Histopathological examination is needed to make a definitive diagnosis of the condition and helps in cases when the clinical presentation is subtle or non-specific.

Syringomas are benign adnexal tumors of eccrine origin. Eruptive syringomas clinically present as multiple, skin colored tiny papules that usually develop during a short period of time and are frequently misdiagnosed with other entities. Histopathological examination is essential in the diagnosis and usually reveals numerous, small ducts in the dermis lined with a double row of epithelial cells. Herein, we present an additional case of multiple eruptive syringomas on the neck in a 25 year old female.

Eponyms are used almost daily in the clinical practice of dermatology. And yet, information about the person behind the eponyms is difficult to find. Indeed, who is? What is this person’s nationality? Is this person alive or dead? How can one find the paper in which this person first described the disease? Eponyms are used to describe not only disease, but also clinical signs, surgical procedures, staining techniques, pharmacological formulations, and even pieces of equipment. In this article we present the symptoms starting with (K) and other. The symptoms and their synonyms, and those who have described this symptom or phenomenon.