This case report presents the first H‐syndrome rarity in Iraq, a 12‐year‐old female patient who was attending the Rheumatology out clinic for progressive hands joint deformities. She has a history of a multi‐systemic collection of diseases with various clinical features that include beta thalassemia minor, sensorineural deafness, and celiac disease.
Background: There are many topical therapies for the treatment of plaque psoriasis like steroid, dithranol, tar and vitamin D analogues, but none of them is ideal. Most recently, in a pilot study, podophyllin 5% ointment on every other day regimen was as effective as clobetasole 0.05% ointment twice daily. Objective: To reassess the efficacy of a higher concentration of podophyllin (10%) in the treatment of mild psoriasis in comparison with clobetasole using a different regimen. Patients and Methods: This is therapeutic, comparative, placebo-controlled study conducted at the Department of Dermatology-Baghdad Teaching Hospital, during the period of January 2011 -October 2012. Eighty-seven patients with mild plaque-type psoriasis were divided into three groups: Group A (30) patients were treated with podophyllin 10% ointment; Group B (30) patients were treated with clobetasol propionate 0.05% ointment and Group C (27) patients were treated with Vaseline as a placebo control group. All patients were treated on every other day. The efficacy was evaluated every 2 weeks for 8 weeks using PASI score and the local and systemic side effects were recorded. The relapse was recorded after cessation of therapy in those patients who achieved good response during another 8 weeks follow-up period. Results: The patients were 60 (68.9%) males and 27 (31.1%) females (male: female ratio, 2.2:1). Their ages ranged from 18 -62 (36.4 ± 10) years. Their disease duration ranged from 0.1 -40 (7.8 ± 8.5) years. Their baseline PASI score ranged from 1.6 -9.6 (4.4 ± 5.85). At the end of 8 th week of therapy, Group A patients had achieved much higher reduction in PASI score (77.4 ± 14.1) than Group B patients (60.4 ± 27.8), P value = 0.004, and both of them were with statistically and significantly higher PASI reduction than patients in Group C (28 ± 23.4), P value = <0.001. The total relapse rate during 8 weeks follow-up was much lower among Group A treated patients, 20% versus 66.6% in Group B (P-value = 0.002), while the relapse rate was 100% in the Group C patients. Regarding side effects: 3 (10%) patients developed erythema, burning, pain, blistering and hypopigmentationin Group A. No side effects were reported in Groups B nor C patients with no statistically significant difference among the three groups (P = 0.052). Conclusion: Podophyllin 10% ointment was more effective than clobetasole 0.05% ointment on every other day treatment regimen at the end of 8 weeks treatment with no side effects and a much lower relapse rate in treatment of mild plaque-type psoriasis.
Background: Port wine needs early age intervention, most effectively by pulse dye laser where about 40-45% improves only and by at least 75% after 5 to 25 sessions. Objectives: To try therapy of port wine stain in adult patients using flame of infrared light. Patients and Methods: Twenty adult patients with facial port wine stain were treated during the period from 2014-2017 years, 11 females and 9 males with ages ranged from 16-35 years with a mean of 25 years. After local anesthesia with 2% xylocaine, direct flame of infrared light that generated from heated red head of needle of diathermy was used. This light therapy was delivered with about 1-2cm away from the port wine and the time of exposure was decided by greyish blanching of the lesion, usually 1-2 minutes needed. Only one session of infrared was delivered. The response to therapy and according to the reduction rate was estimated as follow: 0-25%,>26-50%,>51-75%,>76-100%. Results: Immediately after session, there was edema, swelling. Reduction of erythema of port wine started immediately after infrared exposure and was obvious after two weeks and then slowly faded, with more improvement in the next few months. The reduction rate of port wine stain was ranged between 50-70% after only one session in 19 patients while one patient showed 25% reduction. It was noticed that, whenever the color of the port wine stain is dusky red with thickened nodular lesions, it responded quickly and better to this therapy. Conclusion: Infrared light heat therapy from diathermy needle was an effective mode of therapy in all adult patients with port wine stain. This new technique is easy to be used and non -costly procedure especially when compared with pulse dye laser.
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