Physiological skin changes during pregnancy

Objective: To find out the frequency and pattern of physiological skin changes in pregnant women

Methods: This descriptive study evaluated 200 consecutive pregnant females presenting to Dermatology Outpatient Department of Nawaz Social Security Hospital, Lahore over a period of one year

Results: Total of twenty-three cutaneous manifestations were studied including striae gravidarum, hyperpigmentation, hair, nail and vascular changes. Majority of pregnant females complained of striae gravidarum [stretch marks] affecting 71.5 percent of study population closely followed by pigmentation i.e. linea nigra [64.5 percent] and melasma [63.5 percent]. The most common vascular change noticed was palmar erythema [43.5 percent] and nail changes included leukonychia [15 percent], while diffuse hair loss [11.5 percent] was the most frequently found hair change

Conclusion: The appreciation of common physiological skin changes during pregnancy will assist in better patient care during antenatal period

Prevalence of body dysmorphic disorder in medical versus nonmedical students: a questionnaire based pilot study

Objective: To prepare a dermatologic version of body dysmorphic disorder [BDD] questionnaire and to ascertain and compare the prevalence of BDD among the medical students versus general university students in Pakistani community

Subjects and Methods: This was a prospective questionnaire-based pilot study conducted at dermatology department of Nawaz Sharif Social Security Teaching Hospital affiliated with The University of Lahore. After informed consent, 400 students, half from medical college and half from non medical institutions, were interviewed with a self reporting questionnaire and evaluated for BDD by employing the clinical parameters as per DSM-5

Results: The age range of participant students was 18-26 years in both the groups and 97.5% were unmarried. In group A, 72 students were males and 128 were females while in group B, 77 were males and 123 were females. The top areas of concern in both the groups were density of scalp hair, acne and its sequelae, skin type and dark complexion of skin with female preponderance in both the groups. Although 35% students were preoccupied to some extent but the prevalence of subjective distress to the threshold of BDD was found in 5% medical students compared to 10% nonmedical students, with female dominance in both the groups

Conclusion: Our study reflects that BDD is relatively more frequent among general university students compared to medical students with overall predominance of female gender

Facial abuse of topical steroids and fairness creams: a clinical study of 200 patients

To estimate the magnitude of problem with reference to social demography, motivation and to record adverse effects of topical steroids [TCs] and fairness creams abuse on face. This study was conducted at Dermatology Department of Nawaz Sharif Social Security Teaching Hospital affiliated with University of Lahore. Patients with steroidal rosacea reporting to the investigator were asked about their current use of topical steroids and fairness creams and observations recorded. Out of 200 patients studied 152 [76%] were females and 48 [24%] males, the majority belonging to low income group from urban area. Sixty six [33%] patients used potent TCs, 100 [50%] patients used TCs in combination with various fairness creams and 34 [17%] patients used fairness creams exclusively. The main indications for these creams, in order of preference were acne, improving dark complexion and melasma. Patients were ignorant of the ingredients and the adverse effects of TCs versus fairness creams among abusers were comparable. Unwarranted cosmetic use of TCs with or without fairness creams is quite common in facial dermatoses resulting in steroidal dermatitis resembling rosacea.

Psoriasis in Pakistani population: associations, comorbidities, and hematological profile

To observe the clinical features, laboratory profile, associations and comorbidities of psoriasis in a segment of Pakistani population. This cross-sectional descriptive study was carried out at PAF base hospital, Sargodha from January 2010 to December 2010. One hundred consecutive patients with a diagnosis of psoriasis were included in the study. The diagnosis was confirmed by one of the consultant dermatologists. Pretested, especially designed questionnaire was filled by all the participating patients. Information regarding age, sex, duration of disease, clinical type and severity of disease, nail and joint involvement, koebnerization, associated diseases, and hematological profile including hemoglobin level, blood ESR, uric acid level and its association with joint involvement were recorded. Out of the 100 consecutive patients included in the study, 71 were males and 29 were females. Mean age of onset was 39.8 years. 88 patients had chronic plaque psoriasis, 8 had guttate and 4 had erythrodermic psoriasis. 46 patients had some sort of joint involvement and 29 patients had some sort of nail involvement. Only 14 patients gave history of koebnerization. Only 10 patients had associated skin disease while 15 patients had some associated medical disease. Mean hemoglobin levels were 13.25 gm/dl. Mean ESR was 22.6 mm/h. Rise in serum uric acid level was significantly associated with psoriatic arthritis. Pakistani patients with psoriasis are more likely to have a lower hemoglobin and a raised ESR. Rise in serum uric acid level is associated with joint involvement

Down Syndrome with Gingival Enlargement.

Down syndrome is the commonest autosomal chromosomal anomaly with an incidence of 1 in 600 to 1000 live births in all races and economic groups. In this condition extra genetic material causes mental and physical retardation. The physical features and medical problems associated with Down syndrome can vary widely. Generally, these patients now live longer due to increase medical attention. Dental practitioners are challenged by the high incidence of early onset aggressive dentine problems. The complex anatomy, physiology, immunology, and microbiology underscore the need to describe a case report of a 15-year old male patient with the classical features of Down syndrome with gingival enlargement and its dental treatment.

Comparison of clinical and sonographical findings of Achilles tendon involvement in newly diagnosed and established cases of psoriasis

To compare the clinical and sonographical findings of Achilles tendon involvement in newly diagnosed [disease duration <6 months] and established psoriatic patients [disease duration >5years]. This cross-sectional, comparative study was carried out in Departments of Dermatology and Radiology, Military Hospital, Rawalpindi, over a period of six months. 70 patients of psoriasis were divided into two groups comprising 35 patients in each. Group I patients were newly diagnosed cases while group II included the established psoriatic patients. All patients with clinical and histological evidence of psoriasis were included. Patients with history of osteoarthritis, rheumatoid arthritis or foot trauma were excluded. Detailed history and complete clinical examination was carried out as per pro forma. The condition was considered symptomatic when there was tendon swelling, pain, tenderness or functional impairment. Ultrasound of Achilles tendon was done, keeping patient in prone position by using Pro Sound SSD 5500 Toshiba ultrasonographic machine with high frequency probe [7.5MHz] to assess findings of Achilles tendon in psoriatic patients. Fibrillar tendon structures, tendon thickness, peritenon, and bursae were evaluated. On clinical assessment 1 [2.8%] patient in group I and 5 [14.3%] patients in group II had Achilles tendon involvement. On ultrasonographic assessment, 3 [8.5%] patients in group I and 15 [42.8%] patients in group II showed involvement of Achilles tendon [p <0.05]. Achilles tendon involvement occurs in significant number of patients with long standing psoriasis as compared to newly diagnosed cases. It also revealed that enthesitis progresses with the duration of disease

Herpes zoster: seasonal variations and morphological patterns in Pakistan

To determine the relevance of seasonal variations and pattern of herpes zoster among the labor community in Lahore. This observational, cross sectional study was conducted at Nawaz Sharif Social Security Teaching Hospital from June, 2009 to May, 2010. Entitled patients that included the industrial labour and their dependents who were clinically diagnosed to be suffering from Herpes zoster during the above mentioned period were included in the study. All the findings were recorded on a pre-designed pro forma. Fifty two enrolled patients constituted 0.46 per cent of overall OPD patients, with male to female ratio of 2:1 and the mean age at presentation was 47 years. Average duration of symptoms at presentation in Herpes zoster ophthalmicus [HZO] was 4.5 days while in remaining cases it was 5.6 days. The surge of the cases was noted with onset of summer and most common dermatomes involved were thoracic followed by ophthalmic division of trigeminal nerve. There is a relationship between Herpes zoster and seasonal variations which seems to be different from temperate climate of western countries

Value of patch testing with indigenous battery of allergens in shoe dermatitis

To explore the potential allergens used in our domestic shoe industry and to determine the efficiency of indigenously prepared battery of allergens in shoe dermatitis. A comprehensive list of 49 chemicals used in local processing and manufacturing of footwear was acquired from local sources. Potential irritants were excluded and a finished battery of 20 allergens relevant to our industrial environment was prepared by using standard techniques. Fifty patients and same number of control subjects were enrolled in the study for patch testing using Finn chambers and polyethylene IQ chambers. Results were read using standard protocol at 1 hour, 48 hours, 4[th] day, and 7[th] day. A pre tested, structured questionnaire was filled for each patient. Data were analyzed using SPSS version 12.0 for statistical analysis. Chi square test was applied for comparative analysis between patients and controls. Out of 50 patients 33 [66%] were found to be allergic to 14 different chemicals present in indigenous test battery as opposed to 4 [8%] in control group [p<.0001, chi square test]. Fifteen [30%] patients were reactive to additives used in processing and manufacturing of rubber. Eight [16%] patients were sensitive to agents used in tanning the leather. Four [8%] patients exhibited sensitivity to both leather and rubber and 6 [12%] patients were allergic to the chemicals present in resins, glues, plastics, dyes and metals. No reaction was observed at the site of application of blank chamber and vehicle. The indigenous battery is reliable, cost effective and flexible to adapt to changes in exposure and to introduction of new allergens in market. It would be prudent to recommend exploring the other industries like perfume, garments, and rubber, etc. on similar lines

Onset of chilblains in relation with weather conditions

Chilblains or perniosis is a moderately severe form of cold injury, localized to peripheral parts of the body, which occurs after exposure to non-freezing temperatures and damp conditions. Although inter-individual variations exist with respect to susceptibility to develop chilblains, no study has been carried out in this region to determine the role of different weather conditions either alone or in combination, in predisposing the susceptible individuals to chilblains. The objective of this study was to determine the relationship between weather conditions and onset of chilblains at a moderately cold weather station. This study was conducted at the Department of Dermatology, Combined Military Hospital, Abbottabad, from Dec 2004 to Mar 2005. All patients fulfilling the clinical criteria for diagnosis of chilblains were included in the study. These patients were interviewed and examined thoroughly. A specially designed proforma was filled for each patient separately. Meteorological department was contacted for record of weather conditions. Onset of chilblains in each patient was related with weather conditions of that particular month. Computer programme SPSS 10 was used for statistical analysis. Out of 111 patients, 67 [60.4%] were males and 44 [39.6%] were females. Eighty nine [80.2%], 90 [81.1%] and 90 [81.1%] patients had onset in relation with lower temperature [<10 °C], relatively low atmospheric pressure [<1500 kpa] and higher relative humidity [>60%] respectively. There was statistically significant relationship of weather conditions with onset of chilblains when different groups, i.e., elderly and young, males and females, locals and non locals, outdoor workers and those remaining inside most of the time and those having disease of longer or shorter duration were compared. The cold weather conditions that can be endured by humans depend on combination of the duration and the extent of the exposure, in addition to physiological adaptive changes. However, susceptibility to chilblains increases when ambient temperature is less than 10°C and relative humidity is more than 60%. Elderly, females, outdoor workers and those having chronic or recurrent episodes of chilblains are less tolerant to cold weather and develop the disease under lesser ambient cold

Sjogren-larsson syndrome

We present a case report of two brothers suffering from Sjogren-Larsson syndrome, who were born to consanguineous parents. Sjogren-Larsson syndrome is one of the congenital icthyoses with an autosomal recessive inheritance. It is characterized by the combination of congenital ichthyosis with spastic diplegia, moderate mental retardation and retinopathy. Defects in essential fatty acid metabolism have been attributed to as the cause

Small vessel vasculitis-a clinicopathological correlation

Small vessel vasculitis in a dermatologic patient may present with clinically indeterminate lesions such as palpable purpura, plaques, nodules or ulcers. In this study, it was aimed to determine the cause of such lesions by correlating clinical with histopathological features to formulate a final diagnosis. This was a study of the descriptive type. Patients of both genders aged between 30-60 years presenting with palpable purpura, plaques, nodules and ulcers of less than 6 months' duration which did not fit into any other disease entity were selected for skin biopsy. The findings on histopathology were correlated with the clinical features for the final diagnosis. A total of 18 patients were evaluated histologically. Six [33.3%] patients were diagnosed as various types of small vessel vasculitis. Five [27.7%] patients were found to be insect bite reactions. Three [16.7%] patients were diagnosed as urticarial vasculitis. There were 2[11.1%] cases of pyoderma gangrenosum and 1[5.55%] each of erythema elevatum diutinum and lupus profundus. In clinically indeterminate cutaneous vasculitic lesions which do not resolve spontaneously, correlation of clinical with histopathological features aids in reaching the diagnosis and prognosis for better patient outcome

Aplasia cutis congenita in two brothers - a rare occurence

Aplasia cutis congenita [ACC] is characterized by the absence of a portion of skin in a localized or widespread area at birth. It is a rare disorder with a complicated pattern of inheritance. No unifying theory can account for all lesions of ACC. Apart from the isolated finding of aplasia cutis; several reports have associated it with a large number of developmental anomalies. Therefore, a complete physical examination should be performed to search for associated physical anomalies or recognizable malformation syndromes. We document two brothers aged, 6 years and I year, who presented with aplasia cutis congenita at almost the same location on scalp

Femoral Lengthening by Ilizarov Technique: Results and Complications

Femoral lengthening using Ilizarov technique was performed in ten patients comprising of 6 females and 4 males in an age group of 10-19 years with an average shortening of 6.8 cms. The etiology of shortening was post-infective in 8 patients and post-traumatic in two patients. The desired length was achieved in six patients and in four patients the final limb length discrepancy ranged between 1 to 3 cms. The total duration of external fixation ranged from 24 weeks to 90 weeks with an average healing index of 6.23 weeks/cm. There were 10 problems and 2 true complications. Temporary decrease in knee range of motion was a common difficulty encountered during lengthening. Results were rated as excellent in five, good in two, fair in two and poor in one patient. Key words Ilizarov Technique, Femoral lengthening Introduction The