Use of Skindex-29 to assess quality of life in patients with port-wine stain

Objective To determine the effect of facial port-wine stain [PWS] on quality of life [QoL] in our population with skin type III to IV, using the Skindex-29? scoring system

Methods A total number of 69 patients were enrolled in this study. Patients were examined clinically and demographic data was collected. Patients were provided with Skindex-29? questionnaire with three independent domains affecting patient emotions, symptoms and functioning. Questionnaire had to be completed by patients themselves or with the help of an interpreter. The specific scoring system was used with a scale from 1-100; higher score indicated a greater impact of skin disease

Results Facial PWS had a moderately negative impact on QoL of the patient. Subscores calculated for symptoms were 8.17+/-6.70, emotions 25.72+/-7.83, and functions 21.00+/-11.34. Composite score was 19.53+/-11.26. These scores indicate that the greatest negative effect was on emotions, followed by functions and then symptoms. There was no significant difference in scores between the sexes. A greater area of involvement was significantly associated with higher emotional [p=0.04] and symptoms score [p=0.003]. Deeper colour of PWS was associated with more symptoms [p=0.01]

Conclusion Our study indicates that facial PWS has negative impact on a patient's QoL, having more affect on emotions, followed by functions. Males and females were equally affected in all domains by PWS. Impact on emotions and symptoms is directly proportional to the size of PWS

Efficacy and safety of tap water iontophoresis for palmoplantar hyperhidrosis

To evaluate the efficacy and safety of tap water iontophoresis [TWI] for the treatment of palmoplantar hyperhidrosis in our local setting. Thirteen patients of idiopathic palmoplantar hyperhidrosis were enrolled in the study from the Department of Dermatology, Lahore Medical and Dental College/Ghurki Hospital and Skin Clinic, Gulberg, Lahore from May 2009 to August 2012. Two patients dropped out, and the study was completed by eleven patients. The patients were treated with TWI three times a week for six weeks and followed up at twelve weeks. Each session lasted for 20 minutes, with the polarity being reversed after 10 minutes. The results were assessed by the hyperhidrosis disease severity index, improvement of sweating on a scale of one to four and the starch-iodine test. Any adverse events were noted. All the patients responded well to the treatment with minimal discomfort. Tap water iontophoresis is a safe, effective, inexpensive and affordable treatment modality for palmoplantar hyperhidrosis. It improves quality of life significantly during treatment.

Efficacy and safety of ablative fractional carbon dioxide laser for acne scars

Acne may lead to long term squelae including physical scars. Lasers have been used with variable degree of success but literature pertaining to Asian population is sparse. To evaluate the efficacy and safety of carbon dioxide [CO[2]] fractional laser in the treatment of acne scars in the local population. Twenty patients with mild to moderate atrophic acne scars were registered and subjected to monthly fractional CO[2] laser resurfacing for six sessions and final evaluation was done six months after the last treatment. More than 71% patients showed variable degree of improvement. No severe long term complications were noted in any patient. Study suggests that CO[2] Fractional laser may prove a useful addition in the management of acne scars in our patients as well

Efficacy and safety of narrowband ultraviolet B therapy in moderate to severe atopic dermatitis

Atopic dermatitis is an inflammatory skin disorder with a chronic relapsing course. In troublesome cases of moderate and severe atopic dermatitis, phototherapy can be an effective treatment modality. To evaluate the efficacy and safety of narrowband UVB 311nm as a monotherapy in patients with moderate to severe atopic dermatitis. Patients suffering from moderate to severe atopic dermatitis, diagnosed according to criteria described by Hanifin and Rajka between ages of 6-70 were enrolled in the study. Severity of the disease was assessed by using SCORAD score. UVB irradiation was done thrice a week on alternate days. Efficacy was assessed every two weeks by reduction in modified SCORAD score. The mean cumulative dose of 25.91 J/cm[2] UVB at a wavelength of 31 Inm was given in a mean of duration 5.2 weeks treatment. Therapy reduced the atopic dermatitis scores from mean 32.2 [range 20.2-45.5] to 14.2 range [6.2-12.4]. We conclude that narrowband UVB appears to be a promising treatment for AD, but large patient series, different dosing schedules and long- term safety considerations should be carefully evaluated in the future

Superficial chemical peeling with glycolic acid in melasma

Melasma is an acquired hyperpigmentation of exposed parts of face and neck, for which various treatment options are available. Chemical peeling is an established treatment modality for melasma. The aim of this study was to assess the safety and efficacy of glycolic acid peel in our patients with melasma where the predominant Fitzpatrick skin type is IV and V. A prospective therapeutic trial was carried out in the Department of Dermatology, Mayo Hospital Lahore Pakistan from May 1 999 to February 2000.Twenty adult females [age range 18-38 years] with melasma [epidermal n=1 5, mixed n=3, dermal n=2] were enrolled. Trial was conducted as a series of six fortnightly hospital-based peeling sessions with increasing concentration of glycolic acid [20%-50%], and nightly application of tretinoin, 5% glycolic acid and 2% hydroquinone. Patients were followed up for a period of two months after completion of treatment. The mean pre-peel and post-peel melasma area and severity index [MASI] scores were 16.56 and 3.8 respectively, showing a significant reduction of about 75% [p < 0.05]. Among the two clinical patterns seen in our patients, malar distribution responded better as compared to the centrofacial. Mild and reversible complications noted were erythema [90%], peeling [70%], crusting [55%], post-inflammatory hyperpigmentation [20%] and moist maceration [10%]. Superficial chemical peeling with glycolic acid is safe and effective treatment modality for melasma in our population

Narrowband ultraviolet B radiation therapy for vitiligo in Asians

Vitiligo is an acquired disorder of pigmentation with 1 -2% incidence worldwide. Various treatment modalities have been described in literature with variable results. Recently, narrowband ultraviolet B [NBUVB] has been reported to be effective in vitiligo. To assess the efficacy of narrowband ultraviolet B therapy in Asian patients with localized vitiligo. The study was open and uncontrolled. All patients with localized vitiligo who were seen at the Phototherapy Unit, of the Skin Clinic, Lahore from July, 2002 to June, 2003 and fulfilled the inclusion criteria, were treated with NBUVB as part of our clinical practice. The initial dose was 0.5 J/cm2 independent of the skin type. The dose was increased by 20% at each treatment session. A total of 23 patients were recruited; 1 3 females and 10 males. Their mean age was 27 years [range 9-48 years]. 65% of patients showed > 50% improvement. Certain anatomic sites responded better than the others. The best response i.e. > 75% repigmentation was seen in lesions on face and neck. Lesions on the trunk also achieved more than 50% repigmentation. However, none had more than 10% repigmentation on hands and feet. Our results showed that NBUVB is a safe and effective option for improving cosmetic appearance in vitiligo patients. Its adverse effects were minimal and transient and were well tolerated by the patients

Netherton's syndrome: a case report

Netherton's syndrome is a rare, autosomal recessive disorder of keratinization characterized by trichorrhexis invaginata, ichthyosis linearis circumflexa and atopic diathesis. There is also failure to thrive. Recently the genetic defect has been identified as a mutation in SPINK5 gene on chromosome 5q31-q32. A case of this rare disorder with classical presentation in a 16-year-old boy is reported here. He had had congenital erythroderma, failure to thrive, ichthyosis linearis circumflexa, trichorrhexis invaginata, epilepsy, spastic gait, and rais ed IgE levels. A brief review o the literature is presented as well

Cutaneous manifestations of hyperthyroidism: a study of 50 cases from Lahore, Pakistan

To assess the pattern of cutaneous changes and associated disorders in patients with hyperthyroidism Study Design: Cross-sectional study. Place and Duration of Study: Departments of Dermatology and Thyroid Clinic, Mayo and Jinnah Hospitals, Lahore, during the period of one year from December, 1997 to December, 1998. Subjects and 50 diagnosed cases of hyperthyroidism [44 females and 6 males of age ranging 21-40 years] were examined in detail for cutaneous changes and associated disorders. Dermatological abnormalities were observed in 96% patients. Common manifestations of hyperthyroidism were altered skin texture in 48 [96%] and increased skin temperature in 46 [92%] patients. Other cutaneous findings included hyperhidrosis in 34[68%], generalized pruritus in 15 [30%], hyperpigmentation in 15 [30%] and pretibial myxedema in 2 [4%] patients. Hair and nail changes were observed in 36 p2%] and 25 [50%] patients, respectively. Other associated autoimmune diseases seen were urticaria in 20 [40%], vitiligo in 12 [24%], alopecia areata in 4 [8%] and systemic lupus erythematosus in 1 [2%] patient. Pustulosis palmoplantaris and xanthelasma were seen in one patient each. Cutaneous examination can provide important clues to the diagnosis of hyperthyroidism