Effects of extreme dry climate of Sudan on Pakistani peacekeepers

Objective: To determine the frequencies of nasal itching, epistaxis, dry/chapped lips and xerosis of skin among Pakistani peacekeepers exposed to the dry climate of Nyala, Sudan

Study Design: Prospective cohort study

Place and Duration of Study: Pakistan Field Hospital 6 Nyala, Sudan, from February 2014 to May 2012

Material and Methods: Total 144 United Nations Pakistani Peacekeepers of Pakistan Field Hospital 6[all ranks] were selected by non-probability convenient sampling. The data consists of frequency of four symptoms was collected after three months of exposure to dry climate

Results: The most common symptom was dryness of skin [36.1%] followed by chapping of lips [29.9%] while nasal bleeding [epistaxis] was least common [9%]. Significantly higher number of subjects of ages more than 40 years had nasal bleeding compared to the younger group [p value 0.002]

Conclusion: Exposure to extreme dry climate affects skin and nasal mucosa. Frequency of epistaxis found to be significantly more in subjects older than 40 years as compared to younger ones

prospective, split-face, randomized, open-label study comparing efficacy of trichloroacetic acid [100%] and cryotherapy in xanthelasma palpebrarum

Objective To compare the clinical efficacy of trichloroacetic acid [TCA] 100% and cryotherapy in xanthelasma palpebrarum [XP]

Methods 40 patients fulfilling the inclusion criteria were treated with cryotherapy on right eye [group A] and TCA on left eye [group B]. Patients were followed up for 6 weeks and final outcome variable of efficacy i.e. complete resolution of xanthelasma was assessed at 6 weeks. Adverse side effects of therapy were also recorded as secondary outcome variables. Data were analyzed by SPSS 19.0

Results Mean age of patients was 43.75 +/- 5.90 years and age ranged from 34 to 56 years. Out of 40 patients 9 [22.5%] were male and 40 [77.5%] were female. Complete resolution of xanthelasma was seen in only 7 [17.5%] in group A, while complete resolution of lesions was seen in 30 [75%] of patients in group B [p = 0.000]

Conclusion A single session of 100% TCA is highly effective than cryotherapy in the treatment of Xanthelasma palpebrarum

Vitamin D deficiency in alopecia areata

Objective: To compare the mean Vitamin D level in patients with alopecia areata [AA] with age and gender controlled matched healthy controls

Study Design: Case-control study

Place and Duration of Study: Dermatology OPD, JPMC, from October 2014 to March 2015

Methodology: All the patients diagnosed of alopecia areata by a trained dermatologist were selected. Controls were age and gender matched healthy volunteers. Venous blood was drawn and sent to hospital laboratory for 25 [OH] vitamin D by enzyme immunoassay method on chemical analyser. Data was recorded on SPSS version 16. Mann-Whitney test was applied to compare vitamin D levels of cases and controls. P-value <0.05 was taken as significant

Results: There are 30 cases of AA, and 30 age and gender matched controls. The mean age of our study group was 23.77 +/- 8.86 ng/dL in patients and 24.03 +/- 8.62 ng/dL in the control group. Fifteen [50%] patients presented between 3-12 months of onset of AA. Median [IQR] vitamin D level of cases was 13.5 [18.6] ng/dL and healthy controls was 22.5 [16.25] [p=0.001]

Conclusion: Serum Vitamin D levels were significantly lower in patients with alopecia areata compared to healthy controls

Skin diseases among peacekeepers at united nations and African mission in Darfur

Objective: To determine the frequency and pattern of cutaneous diseases among peacekeepers at a tertiary care hospital in United Nations and African Mission in Darfur, Sudan

Methods: This descriptive study was conducted at dermatology outpatient department of United Nations peacekeeping mission [UNAMID] level III Hospital at Darfur, Sudan from March 2014 to Feb 2015.Peacekeepers of both gender reporting to dermatology OPD were registered after informed consent. Patients' demographic profile, nature of duty, disease diagnosis and duration of illness were noted. The data was managed and analyzed using SPSS-17

Results: A total of 542 peacekeepers of the age ranging from 20-60 years were analyzed. Eczema was the most common disease [38.7%], followed by fungal infections [22.5%] and acne [10.7%]. 47.6% of patients had the disease before deployment in mission area and 52.4% developed after reaching in mission area

Conclusion: Eczema, dermatophytosis and acne were the commonest skin problems among peacekeeper. Almost half of these had dermatological problems before deployment

Unusual distribution of bullous pemphigoid lesions in a hemiplegic patient: a case report

Bullous pemphigoid [BP] is an autoimmune subepidermal blistering condition that predominantly affects older patients and characterized by local or generalized tense blister formation. Mucosal involvement with small blisters or erosions may exist in a minority of patients. BP is generally self-limiting with remission in most patients by 5 years. We report an 83-year-old hemiplegic lady with unusual distribution of bullous pemphigoid lesions

Comparison of tzanck smear with viral serology in varicella

Objective To compare Tzanck smear with viral serology in terms of concurrence of results in patients with varicella

Methods It was a descriptive case-series done at Dermatology Department, Military Hospital, Rawalpindi. We studied 50 patients of the varicella infection in 6 months. Tzanck smear was taken from each patient at presentation and stained by Giemsa stain for giant cells and evaluated by histopathologist. Viral serology was done by complement fixation method at Virology Department. The results were statistically analyzed with SPSS 16

Results Out of 50 patients of varicella 39 [78%] were males while 11 [22%] were females. Mean age was 30.52 +/- 9.763 years. Tzanck smear was positive in 33 [66%] and viral serology in 45 [90%] patients. The concurrence of results in both Tzanck smear and viral serology was seen in 31 patients [62%]

Conclusion Tzanck smear is a quick and valuable tool in the diagnosis of patients suffering from varicella

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

Diagnostic accuracy of slit skin smears in leprosy

To determine the diagnostic accuracy of slit skin smears in clinically suspected patients of leprosy using histopathology as gold standard. Validation study Study was carried out at Rawalpindi Leprosy Hospital, Dermatology Department Military Hospital [MH] and Armed Forces Institute of Pathology [AFIP], Rawalpindi from 18[th] August 2012 to 18 Feb 2013. Appropriate technical and ethical approval for the study and patient consent were obtained. All suspected patients of leprosy of any age and either gender having typical hypo-aesthetic or anesthetic, erythematous or hypo-pigmented scaly skin lesions on any part of body were included in this study. All patients who have already received treatment for leprosy, patients with pure neural leprosy, patient not giving their consent for skin biopsy and patients with lepra reactions were excluded from this study. Forty eight patients fulfilling the inclusion criteria were included in the study. Sample size had been calculated by using WHO sample size calculator taking confidence level 95%, absolute precision required 14% and anticipated population proportion 40%. Non-probability consecutive sampling technique was used to collect sample. The results of the study revealed that out of 48 clinically suspected patients of leprosy skin biopsy confirmed the diagnosis in 34 patients [70.8%] and the slit skin smear had diagnostic accuracy of 68.75% with sensitivity 55.8% and specificity and positive predictive value of 100%. Study suggested that although slit skin smears are rapid and inexpensive method of diagnosis but their diagnostic accuracy is low

Graham-Little-Piccardi-Lassueur syndrome: a rare case report and review of literature

Graham-Little-Piccardi-Lasseur syndrome [GLPLS] is a rare variant of lichen planopilaris comprising of a triad of multifocal cicatricial alopecia of scalp, non-cicatricial alopecia of axillae and pubic region and keratotic follicular papules over body. Its exact etiology is not known to date, but it primarily involves an immune mediated inflammation affecting hair follicles resulting in cicatricial alopecia. We report a case of 55 years old female diagnosed as having features of this syndrome with cicatricial alopecia of FFA and FADP.

Frequency of undiagnosed diabetes mellitus in patient with herpes zoster

Objective: To determine frequency of undiagnosed diabetes mellitus in patients with herpes zoster. [HZ]

Methods: This cross-sectional study was performed at PNS Shifa hospital, Karachi from June, 2013 to December, 2013. A total of 89 patients suffering from HZ from age 40-70 years were included in this study after taking informed consent. All patients underwent fasting blood sugar evaluation from hospital laboratory

Results: 34 [38.2%] patients were of 40-55 years of age while 55 [61.8%] were of 56-70 year age group. Mean age was 56.93 +/- 8.24 years, 48 [53.9] were male and 41 [46.1%] were females while undiagnosed diabetes mellitus in patients with HZ occurred in 36 [40.5%] while 53 [59. 5%] had no findings of the morbidity

Conclusion: Frequency of undiagnosed diabetes mellitus is higher among patients with herpes zoster. So, it is recommended that every patient who present with HZ, should be evaluated for diabetes mellitus

Bazex-Dupre-Christol syndrome - a memorable family

Bazex-Dupre-Christol syndrome [BDCS] is clinically characterized by multiple basal cell carcinomas of the face occurring mainly during the second and third decade of life, follicular atrophoderma predominantly of the dorsum of hands and feet and generalized hypotrichosis, sometimes with pili torti and trichorrhexis nodosa. Common associated features are milia, hypohidrosis and calcifying epithelial tumours. We herein report four members of one family with BDC syndrome, a mother and her three daughters. In the mother and one daughter, the clinical picture was very typical with all major features, whereas in the others only follicular atrophoderma, milia and hypotrichosis were present. BDCS is a hereditary multiple BCC syndrome whose pattern of inheritance is thought to be X-linked dominant, which implies that all daughters of the affected mothers should have this disease. In this case three out of four daughters are suffering from BDCS but one is totally asymptomatic. To our knowledge, this is the first report of a family with BDC from Pakistan

Dyslipidemia and psoriasis: a case control study

To compare the mean values of lipid profile in psoriatic patients and healthy controls. Case control study. Department of Dermatology, PNS Shifa, Karachi, from November 2012 to April 2013. Patients with psoriasis fulfilling the inclusion and exclusion criteria were selected from Dermatology Outpatient Department [OPD] of PNS Shifa, Karachi. After fasting for 14 hours, 5 ml of venous blood was drawn in sterile syringe and submitted to the Hospital Laboratory for lipid profile, by enzymatic method on Hitachi [Roshe[Registered sign]] using reagents by the same firm. The mean values lipid profile in psoriatic patients versus healthy controls were recorded and compared. A total of 256 patients [128 in each group] were enrolled. Mean lipid profile in both groups revealed cholesterol [mg/dl] value of 203.43 +/- 11.43 in cases and 173.64 +/- 13.65 in controls. Triglyceride [mg/dl] was 178.87 +/- 43.60 and in cases 144.23 +/- 34.01 in controls, HDL-C [mg/dl] was 37.81 +/- 10.78 in cases and 41.41 +/- 9.72 in controls while LDL-C [mg/dl] was 139.52 +/- 13.71 in cases and 109.44 +/- 13.80 in controls. Each parameters had p-value < 0.05 which was significant. Dyslipidemia was found in a high percentage of psoriatic patients than healthy controls. Psoriatic patients require thorough lipid and cardiovascular examinations as they should be considered as individuals with increased risk of cardiovascular diseases

Comparison of in-vitro susceptibility of sarcopties scabieivar hominis to 5% permethrin and 1 % lindane

To measure in-vitro susceptibility of Sarcopties Scabieivar Hominis to 5% permethrin and 1% lindane.Study Design: Randomized controlled trials. Study was carried out at Dermatology Department, Military Hospital, Rawalpindi from January 2012 to June 2012. A total of 60 mites from 60 patients were taken for assay. Mites from every patient were randomly allocated to two groups i.e. group A [5% permethrin] and group B [1% lindane]. Permethrin and lindane were applied in a thin film over a glass slide. Live mites were then gently transferred to the glass slide and covered with a lid. Mites were inspected for leg movements at time interval of 1hr, 2hrs, 3hrs, 4hrs and 5hrs. Death was declared once all leg movements had ceased. All mites which died within 5 hours had been declared as susceptible to drugs, while mites having active leg movements even after 5 hours of drug application were considered as non-susceptible. A total of 93.33% [n=28] of mites in group-A died within 5 hours of application of permethrin [susceptible] and 6.67% [n=2] of mites in group-A were alive after 5 hours of drug application [resistant] While 53.33% [n=16] of mites in group-B died within 5 hours of application of lindane [susceptible] and 46.67% [n=14] of mites in group-B did not die after 5 hours [non-susceptible], [p value < 0.001]. Permethrin is more effective as compared to lindane against Sarcopties Scabei in terms of in-vitro susceptibility

Efficacy of 0.1% topical tacrolimus with narrow band ultraviolet B phototherapy versus narrow band ultraviolet B phototherapy in vitiligo

To determine the efficacy of combined treatment with narrowband ultraviolet B phototherapy [NB-UVB] and topical tacrolimus in comparison with NB-UVB alone with placebo control in the treatment of vitiligo affecting face and neck. We included 60 patients with vitiligo affecting face and neck with or without involvement of the rest of body, in this randomized, double-blind, placebo-controlled trial. The patients were randomly allocated in two groups as A and B. Topical 0.1% tacrolimus ointment was given for vitiligo patches twice daily in group A, while placebo ointment was given to be applied in similar way for vitiligo patches in group B. Tri-weekly NB-UVB for depigmented areas with starting dose of 0.1J/cm2 with increment of 10% at every visit was given to the patients in both groups. Percentage of depigmented patches was calculated at the baseline, 1, 2 and 3 months. All patients completed the treatment period of 3 months. The mean response at the end of the 3rd month revealed excellent response [>75% repigmentation] in 16 [53.3%] patients in group A and 9 [30%] patients in group B. Good response [50-75% repigmentation] was seen in 11 [36.7%] in group A and 12 [40%] patients in group B. Moderate response [25-49% repigmentation] was shown by 3 [10%] patients in group A and 5 [16.7%] patients in group B. None of the patient showed poor response [<25% repigmentation] in group A, however 4 [13.3%] patients showed poor response in group B. Comparison of efficacy in both groups show excellent and efficacious response in 16 [53.5%] of patients in group A and in only 9 [30%] of patients in group B [P <0.05]. Combined treatment with NB-UVB and topical 0.1% tacrolimus ointment in comparison with NB-UVB with placebo control in the treatment of vitiligo affecting face and neck is more effective

Postherpetic pseudohernia of abdominal wall: a case report

Herpes zoster is a common disease of the dorsal root ganglia and sensory nerve fibers, clinically characterized by unilateral painful vesicular eruption of the skin in a dermatomal distribution. Segmental motor weakness is a rare complication that occurs in 0-5 percent of patients and is associated with an excellent prognosis for recovery. We herein, present a case of herpes zoster complicated by segmental motor paresis of abdominal musculature resulting in pseudohernia. This rare complication of herpes zoster, with an excellent prognosis for recovery, should be recognized by dermatologists and surgeons as it can save costly consultations and evaluations

Guidelines for the management of vitiligo

Vitiligo is an acquired disorder of depigmentation affecting 0.1%-2% of the world's population without discrimination of race, age and gender. The disease is characterized by white patches, often symmetrically distributed, which usually increase in size with time, corresponding to a considerable loss of functioning epidermal and sometimes hair follicle melanocyte. There are many treatment options available for the disease. Standardized guidelines for treating this disease in Asian skin are not readily available which leads to no set criteria for treating this cosmetically disfiguring problem. These guidelines have been prepared for dermatologists considering all the latest evidence based data available. Vitiligo is diagnosed clinically, although in some cases biopsy is required. Lesions on face and neck respond well to the treatment. However, segmental and acral types respond poorly to treatment. In the assessment of patient before starting therapy it is important to consider age, pre-existing diseases, in particular autoimmune disorders and previous medications. Topical corticosteroids and/or topical immunomodulators for localized vitiligo and phototherapy for generalized vitiligo are considered as first line therapies. As the treatment often extends over a long period of time, patients are frequently frustrated by the failure of previous treatments, so psychological stress is common and thus psychotherapy has also positive role. These comprehensive guidelines for the diagnosis and management of vitiligo in coloured skin aims to give high quality clinical advice, based on the best available evidence and expert consensus

Kindler's syndrome: a report of five cases in a family

Kindler's Syndrome [KS] is a rare genodermatosis with autosomal recessive mode of inheritance. The disease results from homozygous mutations on both alleles of the FERMT-1 gene [also known as KIND-1 gene] that encodes the protein Kindlin-1 [kindlerin]. Clinical features include a constellation of early infantile skin blistering and mild photosensitivity, which improves with age, and progressive poikiloderma with widespread cutaneous atrophy. The differential diagnosis of Kindler syndrome include other congenital poikilodermatous and photosensitive conditions including Bloom syndrome, Cockayne syndrome, dyskeratosis congenita, epidermolysis bullosa, Rothmund-Thomson syndrome and xeroderma pigmentosum. We herein, report the presence of the Kindler's syndrome in 5 out of 7 children of consanguineous parents. To authors' knowledge, this is the first report of Kindler's syndrome involving 5 members of a family

Haemodialysis vascular access practice patterns in north Pakistan

Mortality and morbidity rates in patients on haemodialysis vary among different countries widely due to variation in vascular access practices. Documented evidence of patterns and practices of various vascular access modalities in our population is scarce to allow for development of local guidelines or formulating steps to encourage adoption of international guidelines in Pakistani healthcare setup. To assess Vascular Access practices for haemodialysis patients in five dialysis facilities of Northern Pakistan. Cross sectional study. This study was carried out at five dialysis facilities in three cities of Northern Pakistan over a period of one year from March 2011 to March 2012. This cross sectional survey was completed by interviewing 536 end stage renal disease patients between 18 to 70 years of age over a period of one year. Duration of dialysis, types of access, current state and past history of vascular access were recorded and compared with International guidelines. Commonest 'current vascular access' was found to be AV fistula in 317 out of 536 patients [almost 60%] and the most common mode of 'first Vascular Access' [i.e. vascular access first used for haemodialysis] was catheter [83%]. Amongst patients who had dialysis during last eight months, 76.27% were still being dialysed via percutaneous catheters while this figure is less than 34% in Europe. Although the initial mode of dialysis in most cases is a line yet, majority of patients are dialyzed through native fistula. Need for a pre-emptive fistula is required to have superior longevity and fewer complications in haemodialysis patients