Leprosy in Larkano region; an analysis of 102 cases from 2001-2011 at leprosy centre Larkano, Sindh, Pakistan

To evaluate the prevalence of leprosy in Larkano Region, Sindh, Pakistan. A total of 102 new leprosy cases referred and registered in Leprosy Centre Larkano from 2001-2011 were studied. Of the 102 new cases 49 [48.03%] were males and 53 [51.96%] were females. They were born in rural area of Larkano region with the peak age of disease at their fourth decade. The most common form of the disease was borderline tuberculoid [BT] form and found especially in female patients. Ulnar nerve was the most frequently affected peripheral nerve. Although Leprosy is a rare disease but in Larkano region it is still encountered. It is important for the practitioners to be aware of its diagnosis when they meet with patient of leprosy with peripheral nerve involvement

Discoid lupus erythematosus: a profile

To determine the demographic data, clinical pattern and therapeutic outcome in patients with discoid lupus erythematosus [DLE]. Case series. The Department of Dermatology, Liaquat University of Medical and Health Sciences, Jamshoro, from January 2004 to December 2008. Patients of either gender aged above 18 years diagnosed with DLE were enrolled for the study. Those with evidence of systemic lupus erythematosus were excluded. Apart from the onset, duration, symptoms, lesion's location, size and dimensions were noted. Biopsy was taken when the diagnosis was in doubt. Apart from routine investigations serum anti-nuclear factor was determined in every patient. The data were analyzed using SPSS software version 11.0 for frequencies and percentages. There were 110 patients [38 males and 72 females], with ages between 18 and 62 years. Family history was positive in 3 patients. The plaque form was the most common clinical type seen in 68 [61.8%] patients, followed by tumid [n=20, 18.2%], panniculitis [n=10, 9.1%] and ulcerative [n=8,7.3%] types. Face was the most common site affected [n=60, 54.5%]. Antinuclear antibody was present in 19 [17.3%] patients. Fatigue and joint pains were the commonest symptoms [n=52, 47%]. Pigmentation and scarring were the usual outcome. DLE is a chronic disease with multiple presentations, which usually ends with pigmentation and scarring

Cutaneous malignant tumors: a profile of ten years at LINAR, Larkana-Pakistan

Malignant tumors of skin are a group of malignancies comprising primary and metastatic tumors which involve the skin and its appendages. In this observational study, a total of 300 cases of cutaneous malignant tumors were included, who visited the Larkana Institute of Nuclear Medicine and Radiotherapy [LINAR] for management after confirmation by histopathological examination. Out of 300 cases studied, the males were 195 [65%] and females were 105 [35%], showing M: F ratio of 1.85: 1. The mean age of affected cases was 47 +/- 7.694 years and mostly affected patients were farmers [47%]. The duration of symptoms in majority of cases [27%] was 3-6 months. Most of the patients [71%] had lesions on face, while other parts of body like extremities, scalp and trunk were involved in 13%, 9% and 7%, respectively. Basal cell carcinoma [BCC] was confirmed in 183 [61%] cases, while squamous cell carcinoma [SCC] and malignant melanoma [MM] were found in 96 [32%] and 21 [7%] cases, respectively. BCC was found to be the commonest morphological type amongst the cutaneous malignant tumors. The increasing incidence rate shows an alarming situation for our population. The unawareness of public and medical professionals about the disease and late diagnosis are contributing factors in high morbidity and mortality

Oral lichen planus: a clinical study

To evaluate the clinical characteristics, predisposing/aggravating factors and malignant potential of oral lichen planus [OLP]. Case series. Department of Dermatology and Oral Pathology, Liaquat University Hospital, Hyderabad, from January 2006 to November 2007. Patients of either gender aged above 12 years, fulfilling the diagnostic criteria for OLP were enrolled for study. Patients not willing to participate or suspected to have drug-induced lichenoid reactions were excluded. History regarding the onset and duration, symptoms, addictions was elicited followed by oral, cutaneous and systemic examination. Biopsy was taken when the diagnosis was doubtful or malignancy was suspected. The data were analyzed using SPSS software version 11.0 for frequency and percentage. A total of 95 patients [40 male and 55 female], aged between 17 and 62 years were enrolled. Diabetes [n=05] and hypertension [n=04] were the accompanying comorbidities. Family history was positive in 3 patients only. Reticular form was the most common clinical type seen in 52 [54.7%], followed by erosive in 31[32.6%] and atrophic/erythematous types in 12 [12.6%] patients. The disease caused pain, burning and other symptoms in 72 [75.7%] patients. Buccal mucosa was the chief site of involvement [n=31]. Other sites involved were tongue [n=20], lips [n=28], palate [n=9] and floor of mouth [n=03]. Stress, spicy foods and poor oral hygiene aggravated disease in most [n=77] of the patients. OLP is a chronic disease with diverse clinical manifestations and multiple site involvement. Associated pigmentation of surrounding mucosa was unique finding of this study. Long-term follow up is needed to assess the malignant potential. Stress was the most important factor aggravating the disease

Pattern of skin disorders among adolescent female students at Hyderabad, Sindh

To determine the pattern and severity of skin disorders among female adolescent students at Hyderabad, Sindh, Pakistan. This observational study was conducted at Hyderabad, Sindh, Pakistan, from August, 2007 to October, 2007. Four intermediate and degree colleges of the Hyderabad city were randomly selected and visited. The students were examined with regard to the type and severity of skin disorders. The findings were recorded on a pre-structured proforma. A total of 1350 students were examined. Their ages ranged from 16-24 years. Acne was the most common disorder seen in 59.5% of subjects followed by hair loss [59%], pigmentary disorders [36.3%], dandruff [26.1], hirsutism [20.9%], ephelides [6.4%], xerosis [2.9%], pityriasis versicolor [2.9%], pruritus [2.3%] and eczema [2.1%]. There were very few cases of pyoderma, tinea corporis and scabies. Skin disorders are common among adolescent college girls. The most prevalent group of skin disorders at this age is cosmetic one. Their proper management at earlier stages with education of patients is important to prevent late disfiguring complications and psychological sequelae

Knowledge, attitude and practices regarding leprosy among general practitioners at Hyderabad

To assess the level of knowledge, social attitude towards patients, and diagnostic and management capabilities of general practitioners [KAP] regarding leprosy, practicing at Hyderabad, Pakistan. Cross-sectional study. Hyderabad, Sindh, Pakistan, during October to December 2007. A pre-tested and well-structured questionnaire consisting of 54 questions was administered to general practitioners working at various areas in Hyderabad. The questions were grouped under different headings and covered clinical features, common and uncommon presentations, complications, referral practices and stigma. The sum of correct answers marked by doctors was taken to classify the respondents. The doctors who responded correctly for upto 10 questions were assigned level 1 [poor], from 11 to 25: level 2 [average], from 26 to 40: level 3 [good], while those who marked correct answers for more than 40 questions were assigned level 4 [excellent]. Chi-square test was used to determine significance at p < 0.05. A total of 200 doctors were surveyed. Fourteen doctors [7%] had poor knowledge of disease [number of correct answers less than 10], 32 [16%] had average [number of correct answers between 11 and 25], 140 [70%] doctors good [number of correct answers between 26 and 40] while 14 [7%] had excellent [number of correct answers more than 40] knowledge of the disease. There is inconsistency and deficiencies in the knowledge, referral pattern and treatment of leprosy among general practitioners, which needs to be improved by conducting awareness activities

Generalized eruptive histiocytosis presenting with warty lesions on face

Generalized eruptive histiocytosis is a benign proliferative disorder of non-Langerhans cells. It is a very rare disease. The disease presents with soft to firm fleshy papules on face, neck and upper trunk. Biopsy is often needed to make the diagnosis because of its rarity and diverse presentation. There is tendency for the disease to regress spontaneously without treatment. Treatment, if any needed, suffices to topical modalities. We report here a case of generalized eruptive histiocytosis which presented with lesions of dual morphology. This is a very rare disease with diverse presentation being reported first ever in our country

Serum androgen levels and their relationship to pattern and severity of hair growth in hirsute women presenting at private centre in Hyderabad

To determine the frequency of raised serum androgen levels in hirsute women and their relationship to the pattern and severity of hair growth in patients presenting at private cosmetic center at Hyderabad. In this cross-sectional study, conducted in a private cosmetic and aesthetic centre, Hyderabad, from January, 2007 to December, 2007, 65 consecutive patients of hirsutism attending the centre were enrolled. Twenty normal women of similar ages [mean age 23.60 +/- 2.90 years] without signs of hirsutism and with normal menstrual cycle were also included as control group. Informed consent was obtained from all patients. Duration, pattern, and severity of hair growth [Ferriman-Gallwey score], weight, body mass index, acne and sebhorrhea were also evaluated. Serum testosterone, serum androstenedione and dehydroepiandrosterone sulphate levels were assessed in all patients and controls. Correlation between serum androgen levels and pattern and severity of hair growth was determined. Chisquare test was applied to determine p value. A total of 65 patients were enrolled in study. Their ages ranged from 16 to 45 years [mean age 24.49 +/- 6.44 years]. Thirty nine [60%] patients had normal androgen levels without evidence of significant endocrine abnormality. These were assigned idiopathic category. 26 [40%] patients had modest elevations of serum androgens. Among them, 21 had polycystic ovaries. Patients having modest to greatly elevated androgen levels [serum testosterone] had severe hirsutism with Ferriman-Gallwey scores [F-G score] >/= 8. [p

Bart's syndrome: a case report

Bart's syndrome is defined as congenital localized absence of skin [CLAS] associated with epidermolysis bullosa [EB]. It may be associated with any type of EB but is mostly reported with dominant dystrophic epidermolysis bullosa [DEB dominant]. Clinically it is characterized by raw beefy areas of denuded skin on trauma-prone areas of body e.g. hands and feet. Diagnosis is obvious clinically but requires ultrastructural microscopy for proper classification of the disease. Treatment suffices to palliative measures. We describe here a case of newborn baby who presented with rich-red areas of denuded skin on the hands and feet. Clinical appearance was sufficiently distinct to suggest the diagnosis of Bart's syndrome. We repot this case because of its rarity

Treatment of extensive alopecia areata with oral prednisolone mini-pulse regimen

Systemic steroids in mini doses have been reported effective in the treatment of alopecia areata. To evaluate the efficacy of oral prednisolone in mini pulse regimen in the treatment of severe forms of alopecia areata. This open uncontrolled study was conducted at the Department of Dermatology and Medicine, Liaquat University Hospital, Hyderabad from June, 2007 to July, 2008. All adult patients of both genders not receiving any topical or systemic treatment were enrolled in study. Non-probability convenience technique was used for sampling. After recording personal data and short history regarding the onset, duration and treatment received; thorough cutaneous and systemic examination was done. The patients were assessed clinically and with photographs at all visits. All patients received 30 mg oral prednisolone for 3 consecutive days in a week for 6 months. They were assessed for response and side effects at monthly intervals. The post treatment follow-up was done for 6 months. The findings were recorded on close ended proforma. The data were analyzed using SPSS software version 11.0. Fourteen male and 8 female patients aged between 16 and 40 years [mean 25.5 years] were enrolled for study. The duration of the disease at the time of presentation was from 6 months to 10 years [mean 3.6 years]. Fourteen patients had extensive alopecia of scalp, 6 alopecia totalis while 2 alopecia universalis. Eight [15.7%] patients showed excellent response and 5 [9.8%] good response. The response was satisfactory in 7 [13.7%] and unsatisfactory in 2 [3.9%] patients. Low dose steroids in mini-pulse regimen are an effective treatment modality for treating AA

Systemic lupus erythematosus presenting as lupus panniculitis

Systemic lupus erythematosus [SLE] is an autoimmune disease that presents in diverse ways. Panniculitis is not a common presentation of SLE. Its overall incidence is estimated to be 1-3%, occurring predominantly in women. The lesions have predilection for the fatty areas of body such as shoulders, hips, thighs and face. We present here a case of a young female who visited us with the complaint of soft tissue swellings over buttocks, shins, arms and face. The swellings appeared to be ordinary abscesses at first sight. She also had history of arthralgia and low grade fever. Laboratory examination demonstrated high litres of antinucleal antigen and anti-double-stranded DNA antibodies in serum which led us to suspect lupus panniculitis. Histopathology revealed features of lobular panniculitis with lymphohistiocytic infiltrate deep in the subcutis. We report this case because this is a rare presentation of lupus erythematosus

Embolia cutis medicamentosa

Embolia cutis medicamentosa or Nicolau syndrome is an acute necrotic condition of skin and subcutis that follows intramuscular administration of certain medicines. A young lady from rural area presented with an irregular-contoured ulceration with livedoid features on left deltoid region which she developed after receiving intramuscular injection of diclofenac sodium. The histopathological examination of the biopsied tissue demonstrated dead keratinocytes with degenerated epidermis and dermis. The condition improved on local management of wound with a residual scar