Deck chair sign in lepromatous leprosy

A 40-year-old male presented with generalized asymptomatic cutaneous infiltrated plaques involving trunk, Jimbs and face. He had acraJ sensory Joss along with symmetrical nerve thickening and enlargement. Slit-skin smear revealed multiple acid-fast bacilli [AFB] on Wade-Fite staining, thus confirming the diagnosis of lepromatous leprosy

Patient had a remarkable sparing of skin creases at various sites including trunk, antecubital fossa and axillary flexures suggestive of a positive [Deck Chair Sign]. This sign has been described in literature mostly in papuloerythroderma of Ofuji and other related dermatosis. To our knowledge this is the first case report of lepromatous leprosy with deck chair sign' from Pakistan

case report of congenital insensitivity to pain and anhidrosis

Congenital insensitivity to pain with anhidrosis [CIPA] is a rare disorder characterized by episodes of fever and pain insensitivity despite the fact that all other sensory modalities remain intact or minimally impaired. Other clinical features are self-mutilated behaviour, mental retardation and anhydrosis. We present a case first time from Pakistan, 9- and 4-year-old brother and sister respectively, diagnosed as CIPA clinically with the above-mentioned clinical characteristics.

Use of liquid nitrogen and albendazole in successfully treating cutaneous larva migrans

To determine the efficacy of combination treatment of Albendazole along with liquid nitrogen in cutaneous larva migrans. Quasi-experimental study. Abbasi Shaheed Hospital and The Aga Khan Hospital, Karachi, from December 2008 to December 2010. Eighteen cases of cutaneous larva migrans were collected and divided into two groups. Group-A was administered oral Albendazole 400 mg once per day along with topical steroid and oral cetrizine 10 mg once at night for 7 days. Group-B also received oral Albendazole 400 mg once per day along with cetrizine 10 mg once at night but they also received single application of liquid nitrogen to freeze the larva. It was found that in Group-A only 2 out of 9 [22%] showed improvement whereas 78% had to be given liquid nitrogen cryotherapy 3-7 days after Albendazole to prevent migration of larva. In Group-B, the improvement was 100% and all 9 patients were successfully treated. Use of liquid nitrogen along with oral anti-helminths is very effective in treating cutaneous larva migrans than Albendazole alone

young girl with progressive symmetrical erythrokeratoderma and short height

Progressive symmetrical erythrokeratoderma is an uncommon genodermatosis and is thought to arise due to mutations in the connexin gene. However, genetic heterogeneity has been described. We report a case of progressive symmetrical erythrokeratoderma, with short height

Efficacy, safety and tolerability of mometasone furoate 0.1% cream, ointment and lotion in childhood eczema

Topical corticosteroids have been the first line treatment in children with eczema. Efforts to develop new topical glucocorticoids with reduce systemic bioactivity help to treat them. Mometasone furoate 0.1% has been found to be efficacious in children with atopic dermatitis. To evaluate the therapeutic efficacy, safety and tolerability of mometasone furoate 0.1% cream, ointment and lotion in childhood eczema. The study was conducted from Oct 2007 to Jan 2008 at the outpatient department of dermatology at Abbasi Shaheed Hospital, Karachi. A total of 50 children, aged >12 years, of either sex with all types of childhood eczema were included in the study and those with infection, complication like scars, atrophy, striae, etc, known hypersensitivity to corticosteroids and on any other medicaments were excluded. Parents of children were instructed to apply a thin layer with gentle rubbing twice daily for three weeks. Fingertip unit [FTU] was demonstrated to parents. Tubes of mometasone furoate 0.1% cream, ointment and lotion were given to parents according to the need. Emollient was applied twice daily. Children were followed up at 3, 6 and 12 weeks. SPSS - 13.0 was used for statistical analysis. Friedman test was applied to compare the significance of results at p<0.05. Out of 50 patients enrolled, at 3 weeks of follow-up only 43 reported. 29 [67% showed improvement and 14 [32%] fully resolved. At 6 weeks 32 [74.4%] had complete resolution and 7 [16.2%] had improved, but at 12 weeks only 25 patients [58%] had resolved and 6 patients [13.9%] relapsed, while 2 patients were gradually improving. Efficacy in resolution of sign/symptoms on 12 weeks was [p<0.001]. No cutaneous or systemic side effects were seen. Mometasone furoate 0.1% cream, ointment and lotion are found to be effective, safe and highly tolerable in childhood eczema and the compound was found equally safe in infants

Male androgenetic alopecia treated with finasteride

Dihydrotestosterone causes micronization of scalp hair follicles, resulting in androgenetic alopecia. Finasteride inhibits type II 5alpha-reductase, thereby, decreasing the conversion of testosterone to dihydrotestosterone. To determine the efficacy of finasteride in male androgenetic alopecia. 16 men from 18-42yrs of age with moderate vertex pattern hair loss received 1mg finasteride daily for 2 yrs. Efficacy was determined by patients self assessments, investigator assessment and assessment of clinical photographs, safety was assessed by clinical analysis of adverse experience if any. After 6 months-1yr treatment, there was a significant improvement in patient, investigator and photographic assessment. Efficacy was improved and maintained throughout the second year of the study. Finasteride was generally well tolerated. In men with male pattern hair loss finasteride 1mg for 2 yrs slowed the progression of hair fall and increased hair growth

Peripheral blood film - an important tool for diagnosing Anaemia, its types and causes

To emphasize the importance of peripheral film and pathologist's comments in diagnosing different types of anaemia and its possible causes in hospitalized patients at Abbasi Shaheed Hospital. It is a descriptive study. The study populations comprised of hospitalized patients in various wards at Abbasi Shaheed Hospital. A month of year is randomly selected for the study. The records of complete blood picture report of the patients were revised for anaemia, its morphologic type and possible cause of anaemia on the basis of blood indices and peripheral blood film. One thousand and eight blood reports of complete blood picture were reviewed. Among the total. 605 were female and 403 were male and 563 patients were found anaemic. Based on blood indices and haemoglobin, 151 showed hypochromic micro-cytic picture. Seven films showed hypochromic microcytic picture, target cells and high red cell count suggestive of thalassemia minor, or iron deficiency anaemia plus thalassemia minor. 87 cases showed dimorphic picture. Normocytic normochromic picture was seen in 134 patients. 59 slides showed target cells. Macrocytes with right shifted neutrophils were seen in 07 patients. Burr cell were seen in 7 patients. Trophozoites and schizonts of Plasmodium vivax were found in 9, while trophozoites of p.falciparam were seen in 2 peripheral slides. Fragmented cells were observed in 2 blood smears. Peripheral film is an old but very important diagnostic tool to reach to final diagnosis. So whenever blood is sent for complete blood picture. one should pay attention on the comments given on peripheral film

Acneiform Eruptions: a Hazard of beauty creams

Adolescent and post adolescent females visit Dermatologist frequently with white comedones and inflamed papules, situated mainly on cheeks and forehead. Most of these patients admit to development of these lesions after the use of a beauty cream, applied to improve their complexion. The objective of this study was to establish the incidence of skin lesions following the use of beauty creams, duration of use, frequency of application, distribution of lesions, types of lesions, and the source/advice about the use of beauty creams. This is a prospective study which lasted four months and was conducted in the Dermatology OPD of Abbasi Shaheed Hospital [Karachi Medical and Dental College]. The subjects underwent a thorough clinical history and dermatological examination regarding type and distribution of lesions. They were asked to identify the products [beauty creams and the steroid preparation] used. Those who could not identify the preparations were excluded from the study. All those patients who had any sort of lesions on the face prior to the use of the beauty cream were also excluded. Fifty patients were enrolled in the study which were divided into two groups group- A which used beauty cream alone [15 patients], and group -B which used beauty cream with an admixture of a steroid [35 patients]. Acneiform eruptions were commonly seen in both groups 30% in group A and 70% in group B. The average duration of application was 3.7 months in group A [range 1-6 months] and 2 months in groups B [range 1-4months]. Most subjects used single night time application. The predominant lesions were white comedones [100% in both groups] and inflammed papules [100% in group B and 53.3% in group A]. Macular erythema and telangiectasia were [34.2% and 28.5% in-group B] and [26.6% and 0% in-group A]. The cheeks and forehead were universally involved in all patients [100%] and chin in [17% group B and 26% in-group A]. Majorities of the subjects belong to the middle and low-income families. Acneiform eruption developed in 30% of subjects using beauty creams alone and 70% of subjects who mixed steroids in their beauty cream

Beauty creams causing acneiform eruptions

Adolescent and post adolescent females presented to Dermatology Out patients with white comedones and inflamed papules, situated mainly on cheeks and forehead. Most of these patients related the onset of these lesions after continuous use of a beauty cream to improve complexion. Twenty four patients presenting to the Outpatients Department of Dermatology at Abbassi Shaheed Hospital and Burhani Community Hospital, were collected. Subjects were questioned about their acneiform eruption. Each patient was examined and beauty products and 17 betamethasone valerate cream were shown to them for correct identification. All patients related the lesions after continuous application of the beauty cream obtained after mixing 5gm tube of betamethasone valerate cream with one tube each of two famous beauty products. The average daily application lasted for about three months. The predominant lesions were white comedones and inflamed papules [100%]; macular erythema and telangiectasia were seen in [16%.] The cheeks and forehead were universally involved in all patients and the chin was involved in four [16%]. The majority belonged to middle and low-income families. Conclusions: Since time immemorial, females have used beauty products to improve their complexion. The recent amateur addition of 17- betamethasone valerate to commercial beauty creams has led to more acneiform eruptions

Case report: dermatofibrosarcoma presenting as a scar

We report a case of dermatofibrosarcoma non-protuberans in young male, presented as atrophic plaque. Histopathology showed fairly uniform spindle cells with characteristic storiform pattern