Mucocutaneous manifestations of dengue viral infection during 2011 epidemic in Lahore, Pakistan

To investigate the type and correlate the appearance of mucocutaneous signs and symptoms with different stages and clinical types of Dengue viral infection. Two hundred patients of dengue virus infection admitted in the dedicated Dengue Unit at Services Hospital, Lahore from 1st September to 31st October 2011 were included in the study. Presenting features were noted. The patients were physically examined for the presence of skin and mucosal lesions and findings were recorded. Serologic tests for anti-dengue immunoglobulin M [IgM] antibodies, Total and Differential Leukocyte Count [TLC and DLC], Platelet count and Liver Function Tests [LFTs] were done in all the patients. Of the 200 patients with dengue infection, 83 [41.5%] were classified as dengue fever [DF], 116 [58%] as dengue hemorrhagic fever [DHF] and one [0.5%] as dengue shock syndrome [DSS]. Cutaneous involvement was seen in 160 [80%] of patients. Of these 160 patients, 130 [81.25%] had single while 30 [18.75%] had multiple manifestations. The most common cutaneous finding was pruritis [47.50%], followed by erythema [37.50%], flushing [23.35%], eccyhmosis [18.13%], petechiae [16.88%], and macular/scarlatiniform eruption [13.7%]. Mucosal involvement was seen in 35.63% of patient, with dry tongue/ cracked lips being the most common [39.7%], followed by mucosal bleed [36.6%], and conjunctival involvement [10.2%]. The most common initial presentation was flushing [27 patients] within 1-3 days followed by mucosal involvement [47 patients] during 4-6 days and cracked lips [30 patients] in 7-10 days. Cutaneous involvement was more common in DF [41.5%] while mucosal involvement was more remarkable in DHF [58%]. This study describes the variety of mucocutaneous features associated with dengue viral infection whichm may evolve during the course of the disease. There is a clear correlation between various skin manifestations and stages of infection. Cutaneous signs and symptoms are more commonly observed in DF and mucosal involvement in DHF

Mycophenolate mofetil: a new therapeutic option in dermatology

Mycophenolic acid [MPA] was introduced in the 1970s as a treatment for psoriasis, it has since been reformulated as mycophenolate mofetil [MMF]. With an improved side effect profile and enhanced bioavailability, MMF is a promising drug for immune-mediated skin diseases. It is currently approved for the prevention of organ rejection. Its list of dermatological indications continues to grow. As a noncompetitive inhibitor of inosine monophosphate dehydrogenase [IMPDH], MMF inhibits de novo purine synthesis. Its relative lack of hepatonephrotoxicity and perhaps low risk of carcinogenicity offer important therapeutic advantages. This new formulation showed enhanced bioavailability, tolerability and efficacy. No doubt case reports and case series of MMF therapy dominate the dermatologic literature; preliminary results are sufficiently promising to warrant larger, randomized clinical trials with this emerging therapy

Contact reactions in hospital workers

Occupational contact dermatitis is the commonest occupational skin disease worldwide. Hospital workers including doctors, nurses and paramedical staff are exposed to a wide variety of irritants and allergens in their occupational environment. To determine the pattern of contact reactions, and to identify allergens and irritants responsible for contact reactions in hospital workers, in our setup. It was a descriptive, observational study. At the department of Dermatology, Allied and Divisional Headquarters Hospitals, Punjab Medical College, Faisalabad, From 1st October 2002 to 30th April 2003. A questionnaire based screening of 732 hospital workers was done, at their workplace. Two hundred and nineteen among them, with a clinical suspicion of either contact dermatitis or contact urticaria were enrolled in the study. After establishing a clinical diagnosis, all were subjected to patch test using European Standard Series. Results show that 50% of patients had irritant contact dermatitis, 48% had allergic contact dermatitis, while contact urticaria was seen in 2% of patients. Female to male ratio was approximately 2:1. Nurses were the most frequently affected group. Nickel sulphate was the commonest allergen. Incidence of occupational irritant contact dermatitis is almost equal to allergic contact dermatitis. Occupational contact eczema is more common among female hospital workers as compared to males. Follow up of this particular group of cases might give some insight into the scenario of occupational skin diseases in our society