Background Topical corticosteroids are widely used in dermatology for their potent anti-inflammatory and immunosuppressive properties. Nevertheless, inappropriate use of or prolonged treatment with topical corticosteroids in facial skin can result in a characteristic clinical presentation called steroid-induced facial dermatitis. Objective To compare ProYellow laser therapy to traditional treatment in Iraqi patients with steroid-induced facial dermatitis, focusing on severity of erythema and pigmentationand patient satisfaction. Methods Eligible premenopausal women with steroid-induced facial dermatitis unresponsive to previous topical therapy were enrolled. Participants received either three monthly sessions of 577-nm QuadroStar® PRO Yellow laser or conventional topical treatment for three months. Facial erythema and pigmentation were assessed using standardized 0-4 scales, and patient satisfaction was compared between the groups Results Total number of patients included were 101 (laser group, n=50; conventional treatment, n=51). After treatment, there was no erythema in 48.0% vs. 0% of the laser group and conventional-treatment group, respectively, and severe erythema persisted in 0% vs. 43.1%, respectively (P<0.001). Patient satisfaction was significantly higher in the laser group (95.8% vs. 2.0%; P<0.001). No adverse events related to the treatment were noted. Conclusion Compared to usual treatment, ProYellow laser therapy reduced facial erythema and pigmentation in steroid induced facial erythema significantly. Laser patients had faster clinical improvement, shorter treatment duration, and more patient satisfaction.
Background Diabetic foot ulceration (DFU) is a severe, costly complication of diabetes mellitus carrying high morbidity and amputation risks. Identifying local predictors is vital for prevention. Objective To estimate active DFU point prevalence and identify independent clinical and behavioral predictors among diabetic patients in Diwaniyah, Iraq. Methods A hospital-based cross-sectional study screened 883 diabetic patients to estimate point prevalence. An analytical sample of 170 participants (46 cases, 124 controls) was enrolled using purposive sampling. Factors were analyzed using bivariate tests and multivariable logistic regression. Results Active DFU point prevalence was 6.57% (58/883). Bivariate analysis showed significant associations with male sex (P=0.003), age >60 years (P<0.001), neuropathy, previous DFU, deformity, fungal infection, and amputation (all P<0.001). Multivariable regression identified four independent predictors: previous DFU (AOR=19.41, 95% CI: 6.02-62.53, P<0.001), neuropathy (AOR=18.12, 95% CI: 3.53-93.07, P=0.001), HbA1c (AOR=1.63, 95% CI: 1.04-2.56, P=0.035), and self-care practices which had a strong protective effect (AOR=0.54, 95% CI: 0.41-0.72, P<0.001). Conclusion Neuropathy, prior DFU, poor self-care, and high HbA1c independently predict active DFU. Routine clinical screening with 10-g monofilaments and structured foot self-care education in simple local language are recommended to prevent amputations.
Background Narrowband ultraviolet B (NB-UVB) phototherapy is an established treatment modality for several dermatological conditions, including psoriasis, vitiligo, atopic dermatitis and other inflammatory dermatoses. Safe and effective delivery requires appropriate patient selection, dose determination, monitoring of adverse effects, and adequate documentation throughout the treatment course. Inadequate adherence to phototherapy protocols and incomplete documentation may compromise the quality and traceability of phototherapy services. Clinical audits can identify deficiencies in practice and documentation and provide an opportunity for targeted quality improvement. Therefore, a closed-loop audit was conducted in the Dermatology Department of Aziz Fatima Hospital, Faisalabad. Objective To assess and improve compliance with documentation and protocols of phototherapy in dermatology unit of Aziz Fatima Hospital, Faisalabad. Methods Thirty patients were selected who were receiving narrowband UVB phototherapy in dermatology unit of Aziz Fatima Hospital, Faisalabad on the basis of established guidelines. A structured audit checklist was used for this closed-loop audit. A standardized phototherapy proformas and consent forms were introduced after identification of deficiencies in initial audit. In addition, logbook was revised and staff was educated regarding phototherapy protocols. After eight weeks, a re-audit was performed using same standards and same number of patients. Results In the first audit cycle, major deficiencies were found in informed consent, protective measures, record of cumulative dose, documentation of dose increments, and assessment of patients after completing treatment. Following implementation of standardized documentation tools and staff education, documented compliance increased to 100 percent in all parameters. Conclusion Introduction of standardized documentation tools and staff education improved compliance with NB-UVB phototherapy standards from deficient baseline levels to 100% in all audit parameters.
Protein S deficiency is characterized by decreased activity of Protein S, a serine protease complex with role in coagulation, apoptosis and inflammation. Protein S deficiency can be congenital or acquired. Protein S deficiency can be due to multiple causes including Vitamin K antagonists, hepatic diseases, SLE, myeloproliferative disorder and DIC. It commonly presents as venous thrombotic events such as deep venous thrombosis and pulmonary embolism. We present a case of an 11-year-old boy who presented to the OPD of tertiary care hospital with a two-month history of multiple painful erosions and ulcers on both feet, predominantly involving toes. He had previously lost the distal phalanx of the third toe following a similar episode one year earlier. Extensive laboratory investigations revealed decreased levels of protein S, thereby confirming the diagnosis. This case highlights an unusual presentation ‘digital ulcers’ in a pediatric patient with underlying Protein S deficiency. This underscores the importance of considering coagulation disorders in the differential diagnosis of recurrent ulcers in young patients.
Lucio’s phenomenon (LP) is a rare reaction of lepromatous leprosy (LL) characterized by extensive skin necrosis. Standard multidrug therapy (MDT) is the mainstay of treatment, however the patient’s refusal of standard MDT may complicate management. This case report describes the management of LP using rifampicin and clarithromycin in a patient refusing standard MDT. A 66-year-old male presented with purpuric patches on the extremities and painful leg ulcers. Examination revealed leonine facies, madarosis, megalobuli, hyperpigmented purpuric macules, and multiple necrotic ulcers. Slit-skin smear showed a bacterial index of +4 and a morphological index of 7%, while histopathology confirmed LP in LL. The patient received rifampicin, clarithromycin, corticosteroids, and wound care. Marked improvement of skin lesions was observed after 3 months. Rifampicin combined with clarithromycin may be an effective alternative regimen for LP in patients who refuse standard MDT, achieving favorable clinical outcomes and improving treatment adherence.
