BACKGROUND: Seborrheic dermatitis is a common chronic, relapsing inflammatory skin condition occurring most often on the face, scalp and chest.
OBJECTIVE: To compare the efficacy and safety of 10% guava extract shampoo versus 2% ketoconazole shampoo and clobetasol 0.05% shampoo in the treatment of scalp seborrheic dermatitis.
METHODS: Forty-five patients clinically diagnosed with scalp seborrheic dermatitis were randomized to one of the three treatment groups: 10% guava extract shampoo, 2 % ketoconazole shampoo and 0.05% clobetasol shampoo. Patients were followed-up weekly for two weeks to assess the Seborrheic Area Severity Index (SASI) scores, pruritus score, patient's global assessment of improvement and adverse events.
RESULTS: After two weeks of treatment, there was no significant difference in the three groups in terms of the mean change in SASI scores (p= 0.46, ANOVA), pruritus scores and in the patient's global assessment of improvement, and frequency of adverse events.
CONCLUSION: 10% guava extract shampoo is a safe and effective alternative treatment for scalp seborrheic dermatitis.

Human ; Male ; Aged ; Middle Aged ; Adult ; Clobetasol ; Dandruff ; Dermatitis, Seborrheic ; Ketoconazole ; Pruritus ; Psidium ; Scalp ; Skin ; Treatment Outcome

Introduction: Morpheq, also known as localized scleroderma, describes a distinctive inflammatory skin disorder that ultimately leads to sclerosis. It is differentiated from systemic scleroderma by the absence of vasculopathy and organ involvement. Initial erythema may precede the sclerotic stage by a few months causing initial diagnostic confusion. High index of suspicion and knowledge of disease evolution are essential. We report a case of morphea and its progression, the diagnostic approach and the importance of early treatment and long-term monitoring. Case Summary: A 3l-year-old Filipino female who presented with multiple erythematous plagues on the trunk and extremities and arthralgia was initially diagnosed with cutaneous drug reaction. Prompt treatment led to partial relief of symptoms. However, two months later, eruption of multiple ivory-white small patches and plaques were noted on the same affected areas prompting an impression of morphea. Serum markers revealed elevated antinuclear antibody levels and negative anti-Scl70/anti-centromere serum autoantibodies. Skin biopsy showed homogenized thick dermal collagen bundles confirming the diagnosis of morphea. Topical therapy with calcipotriol + betamethasone dipropionate ointment showed remarkable improvement with decrease in erythema and softening of the lesions while adjunct narrowband-UVB phototherapy also provided relief due to its ability to reduce collagen synthesis and cytokine production. Conclusion Morphea may be easily misdiagnosed during the early stages especially if sclerosis ensues late in the disease. Characteristic clinical appearance of erythematous plaques with violaceous borders may not always be present. Histologic examination and serum autoantibodies help exclude other disorders with the same clinical and histopathological spectrum. Treatment is individualized depending on the severity and depth of skin involvement, early treatment and monitoring should be initiated before complications arise.
Scleroderma, Localized ; Fibrosis

Introduction: IgA pemphigus is a rare, distinct variant of Pemphigus characterized by vesiculopustular eruptions mediated by IgA autoantibodies targeting keratinocyte cell surface antigens, desmocollins 1-3 and sometimes desmogleins 1 and 3. Its classical features have been described in literature but atypical cases have also been documented. This report presents such case posing a diagnostic dilemma. Case Report: A 35-year-old female presented with a 16-year history of intermittent eruptions of multiple hyperpigmented, annular and circinate, desquamating plaques and coalescing flaccid pustules on erythematous bases on the scalp, neck, trunk, and extremities. Histopathologic examination revealed subcorneal pustular dermatitis, and direct immunofluorescence was positive for granular intercellular IgG and IgA deposits in the epidermis. Antinuclear antibody test was negative and C3 level was normal. Antibody tests against desmogleins 1 and 3 were both negative. Topical potent corticosteroid therapy resulted in complete resolution of all lesions in three weeks. Conclusion Diagnostic dilemmas arise when laboratory results do not correlate with clinical findings. Findings of IgA autoantibodies in patients with pemphigus-like skin eruptions led to the diagnosis of subcorneal pustular dermatosis type of IgA pemphigus. Dapsone is the treatment of choice although topical potent corticosteroid alone may provide complete remission in some cases, avoiding the potential adverse effects of systemic therapy
Skin Diseases, Vesiculobullous