AlAbleg Clinical Dermatology channel اشراف د. محمد عثمان أستشاري الجلدية

5th D

distributed in photosensitve areas

المصطلح دا اووول مره اسمعه

Exacerbations are seen most frequently in the spring or early summer after exposure to sunlight. The attacks may be provoked by a febrile illness, poor nutrition, sulfonamides, and possibly emotional stress and increased physical activity

https://www.researchgate.net/publication/293709137_Dyssebacia_-_A_fifth_D_of_pellagra

Defect in SLC6A19 which is a sodium-dependent and chloride-independent neutral amino acid transporter, expressed predominately in the kidneys and intestine

Hartnup disease is an autosomal recessive disorder caused by impaired neutral (ie, monoaminomonocarboxylic) amino acid transport in the apical brush border membrane of the small intestine and the proximal tubule of the kidney. Patients present with pellagralike skin eruptions, cerebellar ataxia, and gross aminoaciduria

Plasma concentrations of amino acids are usually normal

With urine chromatography,increased levels of neutral amino acids

Hartnup disease is caused by mutations in SLC6A19 gene (5p15. 33), encoding the sodium-dependent and chloride-independent neutral amino acid transporter B(0)AT1, expressed predominately in proximal renal tubules and intestinal epithelium.

The onset of Hartnup disease is in childhood, usually in children aged 3-9 years, but it may present as early as 10 days after birth

أسئلة أخرى
What vitamin deficiency causes Hartnup disease?
About 50% of the niacin requirement in humans is met by endogenous synthesis of this vitamin from tryptophan. Patients with Hartnup disease are likely to have tryptophan deficiency caused by increased urinary excretion. This decreases the availability of this amino acid for the synthesis of niacin

Histologically: Changes in the skin are similar to those seen in pellagra

https://pmc.ncbi.nlm.nih.gov/articles/PMC11263005/

وعليكم السلام ورحمة الله وبركاته.
شكرا د.محمد..وجميع الزملاء

Ican add
1/the importance of other micronutrients such as trace elements ie zinc, iron, copper, selenium and others..there deffiency and also *excess*.
And the conditions can be seen by dermatologist for eg patient do bariatric surgery what nutritional deffiency you can expect???..
Such surgery done frequently in saudia!
There is two types of such surgery so you have to be familiar with them because each one cause different type of nutritional deficiency..!!
2/cutaneous findings seen in obese patient as apart of nutritional deffiency..is important.
3/vit deffiency is important as you mentioned but also excess for eg excess of vit d and A sign and symptoms.


.دي بعض الملاحظات وهي خطوط عريضه المذاكره..اكرر شكري الدكتور محمد وبقية الزملاء والاخوات..
كتاب Bolognia dermatology...ممتاز في الجداول والتقسيمات دي ممكن تقروا منه

ده مثلا الزنك...

ففعلا زي ماقال د.محمد ..موضوع ..نقص الفتامينات وال trace elements..
قد ماننتبه ليهو.
للأسف معظم الفحوصات ليها في المستشفى الحكومي غالبا غير متوفر مع انه جزء مهم في التشخيص فده يزيد بخلي التشخيص سريري في اغلب الحالات... ‎<This message was edited>

Leprosy, Dr.Mohamed Salah

Meeting No. 5
Dr Nadia Hassanein
Demodicosis

https://drive.google.com/file/d/1FQVrwK68MP4NLB8D2MeiNGeser8yFo6W/view?usp=drivesdk

Mycetoma with Prof. Ahmed Alfahal video lecture

Meeting No. 3
Erectile Dysfunction

Meeting No 2
HIV challenging cases

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Itraconazole is an antifungal medication commonly used to treat various fungal infections, including onychomycosis, histoplasmosis, and aspergillosis. While it is generally effective, it can have several potential complications and side effects, particularly with long-term use or in patients with certain risk factors.

Common Side Effects:
1. Gastrointestinal Issues:
- Nausea, vomiting, diarrhea, and abdominal pain are relatively common side effects.

2. Headache and Dizziness:
- Some patients may experience headaches or dizziness, which are usually mild but can affect daily activities.

3. Rash:
- Skin rashes can occur, which may indicate a hypersensitivity reaction.

Serious Complications:
1. Hepatotoxicity:**
- Itraconazole can cause liver damage, leading to elevated liver enzymes, jaundice, or even severe hepatic failure. Liver function should be monitored regularly during treatment.

2. Cardiac Effects:
- Itraconazole has been associated with negative inotropic effects, which can worsen heart failure. It is contraindicated in patients with congestive heart failure or left ventricular dysfunction.

3. Drug Interactions:
- Itraconazole is a potent inhibitor of cytochrome P450 3A4 (CYP3A4), which can lead to significant drug interactions. It can increase the plasma levels of drugs metabolized by CYP3A4, such as certain statins, benzodiazepines, and calcium channel blockers, potentially leading to toxicity.

4. Peripheral Neuropathy:
- Long-term use of itraconazole has been associated with peripheral neuropathy, characterized by tingling, numbness, or pain in the extremities.

5. Hypokalemia:
- Itraconazole can cause low potassium levels (hypokalemia), which may require monitoring and supplementation.

6. Endocrine Effects:
- There have been reports of itraconazole affecting the adrenal glands, leading to adrenal insufficiency, particularly in patients receiving long-term therapy.

7. QT Prolongation:
- Itraconazole can prolong the QT interval on an ECG, which can increase the risk of arrhythmias like Torsades de Pointes.

Monitoring:
- Liver Function Tests (LFTs):
Regular monitoring is recommended to detect hepatotoxicity early.
- Electrolytes and ECG:
Monitoring potassium levels and ECGs may be necessary in patients at risk of QT prolongation or cardiac issues.
- Drug Levels:
In some cases, itraconazole levels may be monitored to ensure therapeutic but not toxic levels, especially when used with other medications that interact with CYP3A4.

Precautions:
- Itraconazole should be used cautiously in patients with existing liver disease, heart failure, or those on multiple medications with potential drug interactions.