Background
Treatment of psoriatic nail disease is challenging, and dystrophic psoriatic nails can get secondarily infected with fungi.
Methods
This 2‐year, matched case–control study was conducted at three tertiary care centers of Karachi, Pakistan. Data were collected from patients with nail psoriasis as cases with age‐ and gender‐matched controls. A detailed questionnaire was filled for all study participants. Nail Psoriasis Severity Index (NAPSI) scoring tool was used to assess dystrophy. Fungal infection was inferred by nail clippings for fungal hyphae and culture.
Results
Among 477 participants, 159 cases and 318 controls completed the study. Their mean age was 44 years, and one‐third were female. Fungal culture positivity was statistically significant in cases as compared to the control group (P < 0.001). The most frequent species identified was Candida parapsilosis in both cases and controls. Body mass index, NAPSI scoring, socioeconomic status, elevated diastolic blood pressure, smoking status psoriasis among first‐degree relatives, and longstanding disease of more than 10 years were significant factors in univariable analysis. Multivariable logistic regression identified independent factors like low to middle socioeconomic status, history of psoriasis in first‐degree relative, current smoker, and obesity.
Conclusion
We found nearly one‐third of the psoriatic patients with nail involvement having concomitant fungal infection. We emphasize that nail clipping for fungal smear and culture should be advised to those patients with coexisting factors found significant in our study results. This opinion can be incorporated in psoriasis management guidelines for improving treatment of psoriatic nails.
Objective: To find out causative pathogens and their frequency in study group in common cutaneousbacterial infection and determine antibacterial susceptibility pattern. Design: Samples were collected either by swabsfrom skin lesions or where required aspiration of tissue fluid followed by examination in the laboratory for identificationof organisms through culture on appropriate media and antimicrobial susceptibility testing. Setting: Department ofDermatology Military Hospital Rawalpindi. Subjects: Hundred patients irrespective of age and sex who had notreceived antibiotic in last 72 hours, with a clinical diagnosis of any common cutaneous bacterial infection were selectedirrespective of any coexisting cutaneous or systemic disease. Results: The data was compiled and statistical analysiswas done by using SPSS version 10. Isolated colonies of Staphylococcus aureus were found in 52% of the cases whileStreptococcus pyogenes was found as a pure growth in 18% of the cases. Mixed cultures of both these organisms werefound in 30% of the cases. Staphylococcus aureus resistance to Penicillin (97.5%), Erythromycin (37.8%),Cotrimoxazole (31.7%), Cephradine (30.4%) and Tetracycline (34.1%). Resistance against Cloxacillin (3.6%) andGentamicin (2.4%) was much less. Among 82 isolated Staphylococcus aureus three isolated (3.6%) were found to beMRSA (Methicillin Resistant Staphylococcus Aureus). Streptococcus pyogenes although found completely sensitiveto penicillins, showed resistance to Tetracycline (39.5%), Cotrimoxazole (31.2%) Erythromycin (27%) and Gentamicin(10.5%) Vancomycin sensitivity was shown by 100% of isolates. Conclusion: The comparison of this study withprevious studies indicates that problem of bacterial resistance amongst common cutaneous pathogens is increasing.The situation calls for creating awareness regarding dangers of indiscriminate use of antibiotics.
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