Dermatological manifestations of dengue fever

Each year dengue related infections are rising in tropical countries. There is not enough data available on dermatological manifestations of dengue fever. This study was conducted to investigate prevalence and type of dermatological manifestations of dengue fever [DF], Dngue Haemorrhagic Fever [DHF], and Dengue Shock Syndrome [DSS]. A Prospective study was contacted in Department of Medicine, Shaikh Zayed Hospital, Lahore, from 3[rd] Oct to 20[th] Nov 2010. Specific serological tests for DF were done in all 60 patients admitted with suspected diagnosis of DF, DHF or DSS. Forty-eight confirmed cases were evaluated for age, gender, mucocutaneous features and outcome of the disease. Forty-eight out of 60 patients had positive serology for dengue fever. Male to female ratio was 1.09:1. Their ages ranged 5-68 years with a mean of 31.5 +/- 15.2. DF, DHF and DSS were found in 71%, 19% and 10% respectively. Common dermatological presentations were oral mucous membrane congestion [66.67%], generalised morbiliform rash [64.58%] and eye congestion [64.58%]. Purpuric spots along with mucous membrane congestion, generalised morbiliform rash and eyes congestion was observed in 20.83%, 12.5% and 6.25% patients respectively. All except one patient improved clinically. One patient died of respiratory distress and haemorrhage on second day of admission. Dermatological features are significantly noticeable in dengue fever patients. These may help us in early diagnosis and better management of patients.

Clinical characteristics of patients with dengue fever: report of 48 patients in 2010

Dengue fever is a mosquito born viral disease. It occurs in tropical and sub-tropical areas of the world. Symptoms appear 3-14 days after the infective bite. Mortality can occur in dengue hemorrhagic fever and dengue shock syndrome unless prompt and adequate management is provided. To determine the clinical and epidemiological characteristics along with outcome of patients with dengue fever [DF] dengue hemorrhagic fever [DHF] and dengue shock syndrome [DSS]. Prospective, follow-up study. Department of Medicine, Shaikh Zayed Federal Postgraduate Medical Institute, Lahore from 3rd Oct 2010 to 20th Nov 2010. Specific serological tests for dengue fever were done in all 60 patients admitted with suspected diagnosis of DF, DHF and DSS. Forty-eight confirmed cases were evaluated for age, gender, clinical features and outcome of the disease. Forty-eight out of 60 patients had positive serology for dengue fever. Male to female ratio was 1.09:1. Their ages ranged from 5 years to 68 years with the mean of 31.5 +/- 15.2 years. DF, DHF and DSS were found in 71%, 19% and 10% cases respectively. Common presentations were fever [100%], skin rash [83.33%], myalgia [69.75%], restlessness [66.67%] and rigors and chills [66.67%]. All, except one patient improved clinically. One patient died on second day of admission. Dengue fever, a viral infection is re-emerging as a serious public health problem. Fever, rash, myalgia with rigors and chills were common presenting features

Fixed drug eruption and intradermal provocation tests

To determine the role of Intradermal Provocation [IDP] tests in Fixed Drug Eruption [FDE]. Study Design: Quasi-experimental study. Place and Duration of Study: Dermatology Unit, Shaikh Zayed Hospital, Lahore, from August 2004 to July 2006. Methodology: The tests were performed in 96 patients in two stages. At stage I, suspected drugs were given intradermally. Changes at injection site in FDE lesions or any systemic effects were observed. In patients showing no response to IDP, Oral Provocation [OP] was performed [stage II] and its effects in FDE lesions or any systemic effect were observed. The positive response of FDE lesions after IDP and OP were compared with local changes at injection site. Control intradermal tests were repeated in normal persons with drugs and in FDE patients with distilled water on normal skin. At stage I, 46 positive cases had local signs of erythematous indurated nodule with or without hemorrhagic centre, urticarial weal with hemorrhagic centre and erythematous indurated nodule with central vesicle. At stage II, 41 patients had similar local signs. The changes at injection site to those of FDE lesions were compared. Z-test for proportions showed no significant difference between groups [p-value > 0.05]. Control tests were negative. The drug producing erythematous indurated nodule with or without hemorrhagic centre, vesicle or urticarial weal with hemorrhagic centre at injection site was the most likely drug causing fixed eruption

Prevalence of Hepatitis B surface antigen carrier state in patients with Lichen planus-Report of 200 cases from Lahore, Pakistan

To determine the prevalence of hepatitis B surface antigen carrier state in patients with lichen planus. A quasi experimental cross sectional study was done at Department of Dermatology, Shaikh Zayed Federal Postgraduate Medical Institute, Lahore, Pakistan, from April 2003 to March 2005. Two hundred clinically diagnosed cases of LP and equal number of patients with other dermatoses not reportedly associated with hepatitis B virus [HBV] infection [control group] were collected from Skin Out Patient Department. They were screened for hepatitis B surface antigen [HBsAg] by Enzyme Linked Immunosorbent Assay [ELISA]. Statistical analysis was done by using SPSS package version 11. Out of 200 patients of each group, three patients with LP and seven patients from control group were positive for HBsAg. The test of significance for proportions revealed that there was no significant difference [p > 0.1] between two groups. No association between HBsAg carrier state and LP was found in our study

Cutaneous manifestations in Type-1 and type-2 diabetes mellitus [a study profile of 200 patients]

Diabetes mellitus affects every organ system in the body. Cutaneous manifestations in diabetes are varied, approaching to 100%. We conducted a study at our center to determine the prevalence of skin abnormalities in type 1 and type 2 diabetes mellitus. Two hundred patients of diabetes mellitus were observed for cutaneous manifestations. Twenty one [10.5%] patients were suffering from type 1 diabetes mellitus and 179 [89.5%] patients were suffering from type 2 diabetes mellitus. Mean duration of diabetes mellitus was 7.1+/-0.89 years and 6.8+0.84 years in type 1 and type 2 diabetes mellitus respectively. Two hundred patients [116 [58%] patients were found to have cutaneous abnormalities. Among these patients 57 [49%] were male and 59 patients [50.86%] were female. Thirteen patients [11.2%] were suffering from type 1 diabetes mellitus and 103 patients [88.7%] were suffering from type 2 diabetes mellitus. No significant effect of type of diabetes mellitus was observed on skin lesions [p=0.12]. It is concluded that skin disease is quite common in diabetes mellitus and it is equally prevalent in type 1 and type 2 diabetes mellitus

Frequency of anti - HCV antibodies in patients with lichen planus

To determine the frequency of anti-HCV antibodies, identify risk factors associated with HCV infection and to screen asymptomatic carriers in patients with lichen planus. Design: A prospective study. Place and Duration of Study: This study was carried out in the out patient department of Dermatology, Shaikh Zayed Hospital, Lahore, from October, 1999 to September, 2001. Subjects and A total of 184 clinically diagnosed cases of lichen planus [LP] were selected for the study. Blood samples of all the patients were tested for anti hapatitis C virus antibodies [anti-HCV Ab]. Polymerase chain reaction for hapatitis C virus was done in patients with positive anti-HCV Ab. Transcutaneous liver biopsy was performed in 7 patients with positive HCV-RNA. The histopathological results were evaluated using validated Metavir and Knodell scoring systems. Out of 184 LP patients, 43 [23.4%] were anti-HCV antibodies positive. Females were predominantly affected and male to female ratio was 1:5.1. Maximum positivity for anti-HCV was observed in age group 31-40 years [39.53%] followed by 41-50 years [25.58%]. Eighty-one% patients had history of dental treatment and 63% had received multiple injections for various ailments. Forty% patients had family history of jaundice while 26% had jaundice in the past. Ten out of 16 anti-HCV antibody positive patients, checked for HCV-RNA, had high levels of virus in blood. Transcutaneous liver biopsy done in 7 patients revealed underlying liver disease at various stages. Four patients treated with a-interferon and ribazole therapy for liver disease, showed marked improvement in their skin disease. A high prevalence of HCV infection was detected in patients with lichen planus. Patients with lichen planus should be screened for HCV carrier state

Waardenburg's syndrome case report and review of the literature

A case of Waardenburg syndrome [WS] is described in a 16 year old boy who presented with hetero-chromic irides, congenital deafness, white forelock and piebaldism like hypopigmented macules on dorsum of this hands, forearms and upper right chest since birth

Drugs causing fixed eruption in children. a study of 31 cases

This is the largest series of fixed drug eruption [FDE] in children ever reported from one centre. Out of thirty five clinically diagnosed cases of FDE, 31 patients were positive to oral provocation tests. Cotrimoxazole was the commonest cause of FDE. Other incriminated drugs were paracetamol, acetylsalicylic acid, phenylbutazone, ampicillin, amoxycillin, tetracycline, metamizole and mefenamic acid. Cross-sensitivity was seen between penicillin derivatives; Polysensitivity with various drugs was observed in 4 cases [12.8 percent]. Cross-sensitivity between ampicillin/amoxycillin and polysensitivity among different drugs are still unreported

Fixed drug eruption with pyrantel pamoate

A patient with fixed drug eruption [FDE] due to pyrantel pamoate is described. Perhaps it is the first report of FDE due to this drug

Tropical provocation of fixed drug eruption

To determine the usefulness of topical provocation in the diagnosis of fixed drug eruption, different drugs at various concentrations [2% and 5%] in white soft paraffin were applied on normal or affected skin of 401 patients. Reliable results were obtained with 5% ointment preparations, applied on normal skin. The results were confirmed by peroral provocation, by giving half to full therapeutic dose of the suspected drugs