Topical corticosteroid can be effective in treatment for small and superficial ulcers [8] and this is shown in the treatment of two of our patients with mild nonulcerative PG who received betamethasone dipropionate

twice a day. Recurrence of PG requiring inpatient management was quite high (39%). Patients with lower limb PG are more likely to have recurrent PG requiring hospital admission. This highlights the importance of long term monitoring and follow-up in this group of patients. 4.6. Limitations Due to the small sample size of this study, the results were not statistically analysed. PG is a rare disorder and recruiting large number of patients is extremely difficult. Other PG studies had similar number of cases to our study and all their results were not statistically significant [11–15]. Another limitation of our study is that not all our cases had wound biopsies. This raises the possibility of information bias occurring—the

ulcers in patients who did not have wound biopsies may be caused by other conditions such as vasculitis and malignancy since PG is a diagnosis of exclusion. We felt that this possibility is quite low as the diagnoses of PG in all cases were made by dermatologists and vasculitic blood tests were negative. 5. Conclusion The findings of our study suggest a poor outlook for patients with PG requiring hospital admission, with long hospital stays, high death, and recurrence rates. Factors

possibly associated with poorer prognosis are age, ulcerative variant of PG, presence of associated systemic disease, high CRP levels, and clinical signs of wound infections. It is hence important to treat modifiable factors such as associated systemic diseases and wound infections. The presence of abnormally high CRP levels on admission and clinical features of infection are highly suggestive of infected PG and require a combination of intravenous broad-spectrum antibiotics and immunosuppression. Acknowledgment The authors wish to thank Professor Edward Janus for his helpful discussion and critical appraisal of their paper. Conflict of Interests The authors declare that there is no conflict of GSK-3 interests regarding the publication of this paper.
Zinc deficiency occurs in infants when its demand exceeds its supply. It presents with cutaneous signs which, in severe cases, are associated with diarrhea, alopecia, and irritability. Genetic and acquired forms of zinc deficiency have been described and often have overlapping clinical features. However, they usually differ in their time of presentation [1]. The genetic form of the disease, idiopathic acrodermatitis enteropathica (AE), is a rare autosomal recessive disease characterized by acral and periorificial dermatitis and low serum zinc levels [2]. The mutation occurs in the SLC39A4 gene, an intestinal zinc transporter.

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