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Elbow hyperkeratosis in obese patients Emerging trends in hidradenitis suppurativa: A clinical case series

(Poster reference number 4913) (Poster reference number 4822)

Elva Dalia Rodriguez-Acosta, MD, Instituto Nacional de Ciencias Medicas y Natalia Vlassova, Johns Hopkins University School of Medicine, Baltimore, MD,
Nutricion Salvador Zubiran, Mexico City, Mexico; Linda Garcıa-Hidalgo, MD, United States; Ginette Hinds, MD, Department of Dermatology, Johns Hopkins
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Medical Institutions, Baltimore, MD, United States
City, Mexico; Rocio Orozco-Topete, MD, Instituto Nacional de Ciencias Medicas y Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory disorder of the
Nutricion Salvador Zubiran, Mexico City, Mexico hair follicles characterized by recurrent ‘‘boils,’’ sinus tracts, and hypertrophic
The hyperkeratosis of the elbows in obese patients is commonly seen by derma- scarring in the axillae, groin, and anogenital regions. The pathogenesis of HS is not
tologists but has never been well characterized. Patients present with uniform, fully understood, and there are no consistently effective treatments. Many physi-
bilateral, asymptomatic, brown darkening over the extensor surfaces of the elbows cians are unfamiliar with this disease, leading to significant delays to diagnosis.
with minimal scaling. We describe three cases of elbow hyperkeratosis in obese Herein we report the results of a comprehensive survey of 40 HS patients seen at the
patients with metabolic syndrome. An absence of family history and a history of Johns Hopkins Dermatology Clinics and review the published data. In this study the
frictional stress to the involved areas can be elicited in all cases. Patients deny any male:female distribution (1:3.4) as well as the high prevalence of obesity (70%),
symptoms of pain or pruritus, as well as exposure to contact allergens or a personal diabetes (15%), smoking (50%), and family history (63%) were in concordance with
or family history of psoriasis vulgaris. Frictional stress associated to use of elbows as previous studies. Our results also confirmed the significant impact of HS on patients’
auxiliary to rise and pressure effect play a role in the pathogenesis of this condition, quality of life. A higher than expected percentage of African American participants
which should be considered a cutaneous stigma of severe obesity. This is a common lends support to similar anecdotal reports of this ethnic predilection. Seventy-five
entity that easily can be recognized and differentiated from other conditions with percent of the participants reported 2 weeks or longer for the resolution of HS
skin darkening. A biopsy rarely is required. Keratolytic agents such as lactic acid and lesions as opposed to the previously described 6.9 days. The role of hormones in the
urea cream along with avoiding frictional stress can be effective in the management pathogenesis of HS is unclear since most patients have normal androgen profiles.
of this condition. However, the fact that 80% and 58% of our female patients reported signs of
hyperandrogenism and premenstrual HS flares respectively is in agreement with the
Commercial support: None identified. hypothesis that functional differences in peripheral androgen receptors may play a
role in the disease pathogenesis. Pregnancy has been reported to induce temporary
remission of HS but 84% of our female patients reported no improvement or
worsening of their HS during pregnancy. The mean time to diagnosis in our patients
(12.5 years) was longer than the previously reported 8 years, demonstrating the
significant delays to diagnosis of HS, and highlighting the need for education of
healthcare providers about this disease.

Commercial support: None identified.

Evaluation of bee venom and propolis in treatment of psoriasis: A pilot

(Poster reference number 4866)
Nahla Ghaly, MBBCh, MD, Tanta University, Faculty of Medicine, Department of
Dermatology and Venereology, Tanta, Egypt; Ahmed Hegazi, MBBCh, MD,
Department of Microbiology, National Research Center, Cairo, Egypt; Dalia
Shaaban, MBBCh, MD, Tanta University, Faculty of Medicine, Department of
Dermatology and Venereology, Tanta, Egypt; Doha Khader, MBBCh, MD, Tanta
University, Faculty of Medicine, Department of Dermatology and Venereology,
Tanta, Egypt; Fatma Abd Raboo, MBBCh, MD, Tanta University, Faculty of
Medicine, Department of Dermatology and Venereology, Tanta, Egypt
Background: Psoriasis is a chronic skin disease with unsettled etiology. T cells were
suggested to be of major importance in its pathogenesis. Several therapeutic
modalities have been used for treatment of psoriasis. Apitherapy entails the medical
use of honey bee products as honey, bee venom, and propolis. Based on their
antiinflammatory and immunomodulatory properties, they can be used in different
dermatologic diseases, such as eczema, herpesvirus infection, and psoriasis.
Objective: To evaluate bee venom and propolis as a new therapeutic modality for
chronic localized plaque psoriasis.
Methods: Forty-eight patients were equally randomized into four treatment groups:
group I: received intradermal bee venom twice weekly, group II: received topical
propolis ointment in Vaseline base daily, group III: received oral propolis capsules
1 g/day and group IV: received intradermal bee venom with oral and topical
propolis. Response to treatment was assessed by calculating PASI score and
measuring serum interleukin-1b (IL-1b) before and after 3 months of treatment.
Results: A significant reduction in both PASI score and serum level of IL-1b was
observed in all groups (P \.01) except group II. The mean percentage changes in
PASI score were 57%, 67%, 47%, and 75% in groups I, II, III, and IV respectively. The
Elephantiasis nostras verrucosa of a unilateral lower limb mean percentage changes in (IL-1b) were 52%, 0.67%, 18%, and 60% in groups I, II,
(Poster reference number 4691) III, and IV, respectively. Changes in PASI score and IL-1b were significantly higher
Yong Kwang Tay, MD, Changi General Hospital, Singapore; Siew Kiang Tan, MD, than in groups I and IV, when compared to groups II and III (P \.01). Changes in
Changi General Hospital, Singapore group IV were higher than group I with no significant difference. The correlation
Elephantiasis nostras verrucosa (ENV) is a rare but dramatic sequela of chronic between the improvement percentage changes of PASI score and interleukin-1b was
nonfilarial lymphedema. Mossy papules, plaques, verrucous lesions, cobblestone- only significant in group IV (P \ .05). There was a tendency for significant
like nodules, and woody fibrosis of the affected area characterize this condition. A correlation between PASI and IL-1b changes in group I (P ¼.06), whereas changes in
variety of etiologies, including infection, trauma, tumor obstruction, radiation, groups IIA and IIB revealed no significant correlation. All treatments were tolerable
chronic venous stasis, congestive heart failure, and obesity, can lead to chronic with minimal adverse effects.
lymphatic obstruction and edema. We present a case of ENV of the right lower limb Conclusions: Intradermal bee venom and oral propolis could be a potential new
in an obese 58-year-old man with poorly controlled congestive heart failure as well as therapeutic agent in treatment of chronic localized plaque psoriasis. Intradermal bee
a history of chronic right lower limb insufficiency with recurrent right medial venom has superior results than oral or topical propolis in treatment of psoriasis
malleolus ulcer. Literature review suggests that ENV is usually bilateral. We would when used alone or in combination with propolis. Interleukin-1b could be
like to highlight the unilateral finding and suggest that chronic venous insufficiency considered as an indicator in treatment of psoriasis with intradermal bee venom.
may play a more significant risk factor in the genesis of ENV as compared to Larger randomized controlled complementary studies are needed to confirm their
congestive heart failure and obesity. efficacy.

Commercial support: None identified. Commercial support: None identified.