Eftychia Platsidaki

Quality of Life and Psychosocial Implications in Patients with Hidradenitis Suppurativa

Background: Hidradenitis suppurativa (HS) is a long-term skin disorder associated with high levels of psychological distress and significant life impact. Objective: To evaluate the quality of life, depression, anxiety, loneliness, and self-esteem in patients with HS. Methods: Ninety-four patients with HS were enrolled in the study. The quality of life, depression, anxiety, loneliness, and self-esteem of the patients were assessed using the Dermatology Life Quality Index (DLQI), the Hospital Anxiety and Depression Scale (HADS), the UCLA Loneliness Scale (UCLA-Version 3), and the Rosenberg Self-Esteem Scale (RSES), respectively. Results: The DLQI mean score was 11.43 ± 6.61 in patients with HS. The patients with HS presented statistically significantly higher anxiety (6.41 ± 3.31 vs. 5.00 ± 1.59, p < 0.001), depression (5.45 ± 2.79 vs. 4.16 ± 1.54, p < 0.001), and loneliness and social isolation scores (42.86 ± 8.63 vs. 35.57 ± 6.17, p < 0.001) and lower self-esteem scores (18.91 ± 1.79 vs. 19.77 ± 2.53, p = 0.008) than the healthy controls. Conclusions: HS is a distressing, recurrent disease that impairs quality of life. We can suggest services that allow an integrated approach, which includes psychosocial support, offering the patients relief from isolation and an opportunity to share common experiences.

Combination of microneedling and 10% trichloroacetic acid peels in the management of infraorbital dark circles

Background: Dark circles (DC), seen in the periorbital area, are defined as bilateral, round, homogeneous pigmented macules whose aetiology is thought to be multifactorial. Available treatments include bleaching creams, topical retinoic acid, chemical peels, lasers, autologous fat transplantation, injectable fillers and surgery (blepharoplasty). Objective: To evaluate the efficacy and safety of a combination of microneedling and 10% trichloroacetic acid (TCA) peels in the treatment of DC. Materials and methods: Thirteen female patients with mild to severe infraorbital DC were included in the study. The patients were aged between 21 and 61 years. They were treated with Automatic Microneedle Therapy System-Handhold and topical application of 10% TCA solution to each infraorbital area for five minutes. The effect was photo-documented and a Patient and Physician Global Assessment was evaluated. Safety was assessed by evaluating early and delayed adverse events. Results: Almost all patients showed significant aesthetic improvement. Both Physician and Patient Global Assessment rated a fair, good or excellent response in 92.3%. The procedure was well tolerated. Mild discomfort, transient erythema and oedema were quite common during or immediately after the procedure. The patients were followed up regularly every month for four months, and no recurrence was recorded. Conclusion: Microneedling and 10% TCA constitute an innovative combination treatment for DC with encouraging results and minor side effects.

Chemical peels in active acne and acne scars

Chemical peeling is a widely used procedure in the management of acne and acne scars. It causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. The most frequently used peeling agents are salicylic acid, glycolic acid, pyruvic acid, lactic acid, mandelic acid, Jessner solution, trichloroacetic acid, and phenol. The appropriate peel is chosen based on the patients skin type, acne activity, and type of acne scars. Combination peels minimize side effects. In acne scars, chemical peels may be combined with other procedures to achieve better clinical results. A series of chemical peels can lead to significant improvement over a short period, leading to patient satisfaction and maintenance of clinical results.

A study of androgenic signs and disorders in Greek female patients with acne

associated with this wide range of psychocutaneous disease, we wished to review the impact of our combined dermatology/ psychology service. We aimed to determine which patients benefit most from this service; we acknowledged the challenge of measuring outcomes in psychological disease. We studied the outcome of referrals made to our psychodermatology clinic, 2009–2016. Patients were identified through the departmental database that of the clinical psychologist and by reviewing referral/discharge letters to the clinic. In total, 70 patients were referred between 2009 and present day; 25 (35.71%) male, mean age 48.73 years (range: 17–77). Engagement was assessed by the clinical psychologist; 19 patients (31.66%) did not engage. Eight patients (13.33%) were referred on to more appropriate services. Examining the 19 who did not engage, 13 (68.42%) were female, mean age 40 years (range; 18–68). Seven did not attend for an initial appointment, while eight only initially attended. One patient attended another mental health service in the interim. In three cases, the patients’ condition had improved and they did not need to be seen. Therefore, the true rate of non-engagement was 21.42%. To determine causes of lack of engagement with the service, we gained ethical approval to send letters and stamped/addressed return envelopes along a questionnaire to each ‘nonattender’. Ensuring anonymity, we contacted these 15 patients. We received six responses (40%); one was unable to take time off work, two felt they did not have a psychological issue, two patients’ feelings were too uncomfortable to discuss, and one did not believe attending would benefit their skin condition. The psychological concerns most frequently seen with the ‘engagers’ (51 cases) were distress associated with an underlying dermatological condition (i.e. shame, isolation and obsessional thoughts relating to plaque psoriasis); body-focused repetitive behaviours (e.g. nail dystrophy secondary to habitual picking on the skin of the fingers) and grief (e.g. manifesting as overwhelming vulvodynia). Each patient underwent initial psychological assessment; the average number of sessions per patient was 4.3 (range: 1–16). 48.97% patients engaged in intervention; largely within a cognitive behaviour therapy (CBT) framework e.g. development of coping strategies and habit reversal training (HRT). Eleven were referred onto other mental health services with more complex needs e.g. pre-existing psychiatric morbidity. Assessment uncovered issues including past physical and emotional abuse, past psychological trauma, grief and suicidal ideation; issues rarely uncovered in the original referral. During psychological assessment/treatment, our clinical psychologist recorded the phrases: ‘fears of falling apart’, ‘I have lost everything – I cannot leave the house’, ‘I cannot cope’, ‘I do not have a life’ and ‘I want to die’. Symptom improvements were observed, particularly in body dysmorphic disorder and compulsive skin picking. All patients were encouraged to recontact the service if required; five patients subsequently did so. We conclude that there are significant benefits to combined psychology and dermatology services – although awareness of psychological issues may arise during clinical consultation, psychological assessment allows more complete appraisal and access to an environment more conducive to compassionate understanding, providing an important support system for patients living with challenging skin conditions. For those more vulnerable patients with complex needs or underlying psychiatric comorbidities, assessment facilitated engagement with community-based mental health services and, therefore, appropriate treatment. Although only some patients engage with psychological assessment/support, psychological intervention seems to be of most benefit to patients by improving stress-coping strategies such as in habit reversal training or cognitive behavioural therapy. We feel this study revealed a more complex picture of patients’ hidden or unseen morbidity to us as clinicians. This research received no specific funding from any funding agency in any sector.

A cross-sectional study of the perceptions about triggering factors in acne patients

Acne is a common, inflammatory skin disease of the pilosebaceous unit.1 Patients often have misconceptions about factors exacerbating acne that may influence their treatment seeking behavior. We conducted a cross-sectional study to investigate the perceptions of patients with acne about triggering factors, and how they may differ among adults and adolescents. This article is protected by copyright. All rights reserved.

Disseminated verrucous porokeratosis successfully treated with 5-FU followed by oral isotretinoin- a case report

Porokeratosis represents a group of disorders of abnormal epidermal keratinization that shares the distinctive histopathologic feature of the cornoid lamella.1 The typical lesion of porokerastosis is characterized by an atrophic center surrounded by an elevated keratotic rim. The most common clinical forms are: classic porokeratosis of Mibelli (PM), disseminated superficial actinic porokeratosis (DSAP), linear porokeratosis, porokeratosis palmaris et plantaris disseminata (PPPD) and punctate porokeratosis.1 A less commonly reported clinical variant is verrucous porokeratosis resembling psoriasis usually confined to the buttocks (porokeratosis ptychotropica).2 We report a case of verrucous porokeratosis involving almost every area of the body, mostly the upper trunk.

Patients’ self-esteem before and after chemical peeling procedure

ABSTRACT Introduction: Chemical peeling is a safe method, widely used to treat a variety of skin conditions and reduce the aging effects. This study aims to evaluate self-esteem among adolescents who undergo chemical peelings. Material and methods: One hundred and twenty six patients constituted the study group. Sixty seven individuals had undergone chemical peeling for therapeutic reasons and 59 individuals for cosmetic reasons. To assess patients’ self-esteem, the Rosenberg’s Self-esteem Scale (RSES) was used before and after treatment. The control group included 71 healthy, age- and sex-matched volunteers from the general population. They were also asked to complete the RSES, after the same time interval as the patients. Results: The healthy controls (23.01 ± 3.12) presented statistically significantly higher self-esteem than both the groups of individuals who would be submitted to chemical peeling. Furthermore, patients who would undergo peeling for therapeutic reasons (21.58 ± 3.20) had statistically significantly higher self-esteem than those who would undergo the procedure for cosmetic reasons (18.97 ± 3.36). After the chemical peeling sessions, the self-esteem of patients treated for therapeutic reasons (23.48 ± 2.43) and of patients treated for cosmetic reasons (22.83 ± 3.34) improved statistically significantly, while the self-esteem of the healthy controls remained stable, as expected. Conclusion: Patients who undergo chemical peelings tend to have low levels of self-esteem. Although facial lesions in skin diseases such as acne, acne scars, rosacea, and melasma seem to have negative effect on individuals’ self-consciousness, patients who would be submitted to chemical peeling in order to treat wrinkles, loss of radiance, and skin tone clarity have even lower self-esteem. Chemical peelings were shown to favorably affect patient’s self-esteem since all patients showed an increase in self-esteem after treatment, while the control group experienced no change.

Methotrexate: an effective monotherapy for refractory generalized morphea

Introduction Morphea is an inflammatory skin disorder characterized by excessive collagen deposition. Although treatment algorithms for morphea subtypes have been suggested, no consistent recommendations are available. This study attempts to evaluate the clinical efficacy of methotrexate (MTX) as monotherapy in refractory generalized morphea. Methods It is a retrospective study, including 20 patients who had already been treated with various topical and systemic therapies with minimal clinical improvement. Patients received orally MTX at a of dosage 15 mg once weekly. Duration of the use, dosage of MTX, and adverse events were recorded. Clinical assessment of skin lesions was performed and documented. Results The mean disease duration was 27 months before the initiation of MTX treatment. After 12 months of therapy, very good response was achieved in 6 patients (30%), good response in 10 patients (50%), and fair response in 2 patients (10%), while 2 patients (10%) had failed treatment. Patients were followed up for a mean time interval of 21 months. No serious adverse event was recorded. Conclusion MTX has been already proved to be an effective and well-tolerated treatment in pediatric patients with morphea. The majority of the group of adult patients showed very good and good improvement when treated with MTX. Although this is an uncontrolled study, MTX monotherapy was considered a safe and effective treatment for the management of this specific clinical subset of morphea in adults.

Pfeifer–weber–christian disease during pregnancy successfully treated with corticosteroids

Sir, Pfeifer–Weber–Christian disease (PWCD), also known as idiopathic relapsing febrile lobular nonsuppurative panniculitis, is a rare inflammatory disorder of subcutaneous adipose tissue.[1] There is no specific test for diagnosis and extensive investigations are required to exclude systemic causes of panniculitis. No uniform effective therapy is available and various drugs have been used in the past.[2] It has been reported most frequently in people in the fourth to seventh decades of life, and 75% of cases occur in women after the second decade of life.[3] We present a case of PWCD during pregnancy successfully treated with corticosteroids. To the best of our knowledge, this is the first case of PWCD during pregnancy, described in the published literature.

Co-infection of Primary Syphilis and HIV after a Single Exposure - a Case Report

Abstract Human immunodeficiency virus type 1- infected patients with syphilis are among the most important transmitters of HIV-1 infection due to biological effects of genital ulcerations, and aggravation due to their continued risky behavior. The association between primary syphilis and acute HIV-1 co-infection is not well documented, and reports on isolated cases are raising special interest and indicate that this double primary co-infection may occur. We present a case of a 31-year-old man with no past medical history who presented with fever, papular rash on the face which lasted for a few days, and a single genital ulcer. He was diagnosed with primary syphilis and primary HIV-1 infection after a single exposure with an infected female sex worker. Male-to-female HIV transmission during vaginal intercourse is significantly more likely than female-to-male HIV transmission. However, high prevalence of sexually transmitted diseases among female sex workers contributed to high HIV transmission probability, as in our case. As far as the available world literature is concerned, this is the first case of co-infection of primary syphilis and HIV.