Efficacy of combination of intralesional corticosteroid injection and cryotherapy versus intralesional corticosteroid injection alone in patients of keloid

Objective: to compare the efficacy of combination of intralesional corticosteroid injection and cryotherapy with intralesional corticosteroid injection alone in patients of keloid

Methods: a clinical trial was carried out in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University [BSMMU], Dhaka, Bangladesh for duration of January 2013 to August 2013. About 30 patients [group A] were treated with intralesional triamcinolone acetonide with cryotherapy and 30 patients [group B] were treated with intralesional triamcinolone acetonide

Results: improvement rate was highest for the lesions on the chest, which was 18 [34.6%] and lowest for back 3 [5.8%]. Out of all patients from group A, the mean size of the lesions were 8.17cm, 5.90 cm, 4.32 cm, and 3.57 cm at 1st visit, 2nd visit, 3rd visit and 4th visit, respectively. In-group B, the mean size of the lesions was 7.50 cm, 4.92 cm, 3.00 cm, and 4.75 cm at 1st visit, 2nd visit, 3rd visit and 4th visit, respectively. Among the patients of group A and B, 27 [90%] and 25 [83.3%] cases improved, respectively

Conclusion: each of the treatment was individually effective in the treatment of keloid but study with a larger group of patients for longer period may result in superior outcome in clinical practice through improved compliance

Efficacy of benzoyl peroxide and clindamycin combination therapy with benzoyl peroxide alone in the treatment of acne vulgaris

Objective: to assess the efficacy of benzoyl peroxide and clindamycin combination therapy with benzoyl peroxide alone in the treatment of acne vulgaris

Methods: a clinical trial was carried out in the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University [BSMMU], Dhaka. The study duration was from July 2013 to December 2013. Total sixty patients of clinically diagnosed mild to moderate acne was enrolled and thirty of group A patients were treated by benzoyl peroxide alone and thirty of group B patients were treated by benzoyl peroxide and clindamycin combination therapy

Results: at baseline mean number of comedones in group A and group B was 12.77 +/- 4.01 and 11.80 +/- 3.93, respectively [p=0.350] and at final follow-up 4.17 +/- 4.02 and 3.47 +/- 4.00 [p>0.05]. At baseline mean number of papules in group A and group B was 17.30 +/- 10.29 and 18.57 +/- 13.88, respectively [p=0.690] and at final follow-up 7.63 +/- 8.08 and 7.73 +/- 9.98 [p>0.05]. At baseline mean number of pustules in group A and group B was 0.50 +/- 1.33 and 0.53 +/- 1.28, respectively [p=0.922] and at final follow-up 0.07 +/- 0.37 and 0.00 [p>0.05]. At baseline mean of total acne score was 30.57 +/- 13.62 and 30.90 +/- 17.17 in group A and B and at final follow-up it was 11.87 +/- 12.04 and 11.20 +/- 13.85, respectively in group A and B [p>0.05]. Percent reduction of acne severity from baseline to final follow-up was 69.20 +/- 23.41 in-group A and 74.77 +/- 23.30 in-group B [p=0.360]. At final follow-up 56.7% of group A and 63.3% of group B achieved excellent response and 13.3% of group A and 16.7% of group B achieved good response

Conclusion: it can be concluded that the drug, benzoyl peroxide when used individually, was found to be effective in the treatment of acne, but the combination of the two clindamycin and benzoyl peroxide was found to be superior in efficacy

Efficacy of topical tacrolimus 0.1% and clobetasol propionate 0.05% in the treatment of alopecia areata

Objective: To assess the efficacy of tacrolimus and clobetasol propionate in the treatment of alopecia areata

Methods A clinical trial was carried out in the department of Dermatology and Venereology, Dhaka Medical College Hospital, Dhaka, Bangladesh from May 2013 to April 2014. Total sixty patients were enrolled and divided into group A and group B. Thirty of group A patients were treated with topical tacrolimus and thirty of group B patients were treated with topical clobetasol propionate

Results: In group A, the duration of illness ranged from 2 months to 36 months and in group B, from 1 month to 24 months. Among the patients of group A and B, 25 [83.3%] and 27 [90%] patients improved, respectively. After 16th week of treatment, slight response in 6 [20%] and 4 [13.3%] and moderate response in 18 [59.4%] and 22 [63.2%] and marked response in 1 [3.3%] and 1 [3.3%] was seen in group A and group B, respectively. No significant difference was observed [p value = 0.648]

Conclusion: Both the drugs, clobetasol propionate and tacrolimus when used individually, were found to be equally effective in the treatment of alopecia areata and tacrolimus ointment 0.1% can be used as an alternate therapeutic modality

Comparative adverse effects of low-dose oral prednisolone and oral mini pulse dexamethasone in patients of vitiligo

To compare the adverse effects of low-dose oral prednisolone and oral mini pulse dexamethasone in patients of vitiligo. A clinical trial was carried out from January 2013 to December 2013. Total sixty patients of vitiligo were enrolled and 30 of group A patients were treated with low dose oral prednisolone [0.3 mg/kg body weight] daily and 30 of group B patients were treated with oral dexamethasone pulse therapy [10 mg per week] for 16 weeks. During 12 week follow-up, increased body weight, headache, dyspepsia and fatigue were more frequent in group A as compared to group B. Similarly, in group A other side effects noted were acne [33.3%], mooning of face [26.6%], striae [26.6%], hypertrichosis 13.2%, purpura [6.7%] and among the female patients, menstrual abnormality [71.4%] whereas in group B, no patient developed these problems from baseline to follow-up period [p<0.05] Low dose oral prednisolone was found to be associated with more adverse effects than oral dexamethasone pulse therapy in treating vitiligo

Comparative efficacy of topical mometasone furoate 0.1% cream vs topical tacrolimus 0.03% ointment in the treatment of atopic dermatitis

To compare the efficacy of mometasone furoate and tacrolimus in the treatment of atopic dermatitis. Sixty patients of atopic dermatitis were treated with mometasone furoate 0.1% [n=30] and tacrolimus 0.03% [n=30]. Both treatments were applied twice daily for 12 weeks. Patients were followed up monthly. The disease severity assessed by SCORAD index. A 4-point scale was used to measure the level of response to treatment. Before treatment the respective mean SCORAD was 30.57 +/- 13.62 and 30.90 +/- 17.17 in group A and B and at the end of treatment decreased to 11.87 +/- 12.04 and 11.20 +/- 13.85, respectively [p>0.05]. Percent reduction of severity from baseline to final follow-up was 69.20 +/- 23.41 in group A and 74.77 +/- 23.30 in group B [p=0.360]. At final follow-up 56.7% of group A and 63.3% of group B achieved excellent response, 13.3% of group A and 16.7% of group B achieved good response. We conclude that both treatments, mometasone furoate and tacrolimus, are effective in the treatment of atopic dermatitis

Comparative efficacy and safety of the combination of betamethasone dipropionate and calcipotriene with topical betamethasone dipropionate and calcipotriene alone in the treatment of localized vitiligo

Objective: To compare the efficacy and safety of topical calcipotriol ointment [0.005%] and betamethasone dipropionate [0.05%] cream, given alone and in combination, in treatment of localized vitiligo

Methods: It was a clinical trial conducted from January 2012 to August 2012. Patients of localized vitiligo attending outpatient department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka were the study population. In group A, 20 patients applied betamethasone dipropionate cream 0.05% in the morning and topical calcipotriene ointment [0.005%] in the evening, in group B, 20 patients applied betamethasone dipropionate cream 0.05% twice daily; In group C, 20 patients used calcipotriene ointment 0.005%

Results: in The vitiligo score in group A, B and C reduced from 26, 25 and 23, respectively to 3, 8 and 6 [p<0.05]. The side effects experienced by patients at 5[th] follow-up were: in group A, erythema [15%], dryness [15%], scaling [5%] and pruritus [5%]; in group B, erythema [15%], scaling [5%], dryness [5%] and pruritus [5%]; and in group C, erythema [10%] [p=0.005]

Conclusion: Both the drugs, calcipotriol and betamethasone dipropionate when used individually as monotherapy, were found to be equally effective in the treatment of vitiligo, but the combination of the two was found to be superior in efficacy. Regarding safety level, calcipotriene and betamethasone dipropionate when used individually, were found to be safer in the treatment of vitiligo, than the combination of the two

Clinico-mycological correlation in onychomycosis in a tertiary level hospital

To correlate the clinical patterns of onychomycosis with the type of mycological agents in onychomycosis. In this cross-sectional study, 120 patients with onychomycosis, attending outpatient department, were selected by purposive type of sampling technique. They were subjected to thorough clinical examination. Nail material was collected for mycological diagnosis by microscopy and culture on dermatophyte test medium. Microscopy was positive in 47 [39.2%] cases, whereas culture yielded Trichophyton rubrum in 53 [44.2%] and T. mentagrophytes in 2 [1.7%] patients. Common clinical nail changes in mycologically proven cases were thickening of nail plate [68.9%], subungual hyperkeratosis [63.9%], onycholysis [55.7%], roughening of nail plate [29.5%], yellowish discoloration [29.5%] and brownish-yellow discoloration [21.3%]. Only, subungual hyperkeratosis was found significantly more in mycologically positive cases [63.9%] than in mycologically negative cases [37.3%], p<0.05. The validity of microscopic examination for prediction of onychomycosis revealed sensitivity [74.5%], specificity [90.8%], accuracy [83.3%], positive predictive values [87.2%] and negative predictive values [80.8%]. There is an insignificant correlation between clinical pattern and mycological diagnosis. No single clinical feature is suggestive of onychomycosis, hence, direct microscopy must always be coupled with fungal culture for accurate diagnosis.

Pattern of contact dermatitis in a tertiary level hospital in Bangladesh

To evaluate the pattern of contact dermatitis [CD] among patients in a tertiary care hospital in Dhaka, Bangladesh. In this cross-sectional study, 120 patients of contact dermatitis, diagnosed clinically were evaluated by detail history and clinical examination. The clinical patterns were correlated with the likely sources of allergens. Mean age was 32.8 +/- 14.0 years and majority of the patients were housewives 36 [30.0%] and students 33 [27.5%]. 60.0% of the patients came from low-middle class. Itching 117 [97.5%] and disfigurement 89 [74.2%] were chief complaints of the patients. 63 [52.5%] patients showed erythematous rash, 42 [35%] vesicular eruption, 34 [28.3%] pustular eruption and 16 [13.3%] post-inflammatory hyperpigmentation. Both hands 69 [57.5%], right hand 41 [34.2%], both feet 50 [41.7], neck and ear 42 [35%] and face 30 [25.0%] were the commonly involved sites. Allergic contact dermatitis [52.5%] was more common than photocontact CD [26.7%] and irritant CD [20.8%]. Regarding the source of contact dermatitis, detergents 88 [73.3%], cooking materials 67 [55.8%], shoes or sandals 61 [50.8%], cosmetics 42 [35%], gold/jewellery 38 [31.7%], insects 29 [24.2%] were the main etiological factors of contact dermatitis. The study highlighted that contact dermatitis depends on patients' occupational exposure of different substances.

Safety of parenteral dexamethasone vs. oral prednisolone in the treatment of pemphigus vulgaris

To observe the safety of parenteral dexamethasone compared with oral prednisolone in the treatment of pemphigus vulgaris. A clinical trial was carried out in the department of Dermatology and Venereology, Bangabandu Sheikh Mujib Medical University, Dhaka, Bangladesh. Total number of patients was thirty. Among them fifteen patients were treated with injection dexamethasone [group A] and other fifteen were treated with oral prednisolone [group B]. Statistically significant improvement was observed in both groups in all clinical parameters after 6 weeks. But dexamethasone group showed statistically more significant improvement than prednisolone group in all clinical parameters except Nikolsky's sign. Most common adverse effects in both groups were weight gain, increased appetite, puffy face and hyperglycemia. In dexamethasone group other side effect was sleep disturbance. In prednisolone group other side effects were gastritis, sleep disturbance, nausea and vomiting, herpes zoster infection, reactivation of tuberculosis and mood change. Parenteral dexamethasone appears to be safer than oral prednisolone in the management of pemphigus vulgaris with an acceptable efficacy profile

Safety of oral itraconazole in the treatment of seborrheic dermatitis

Seborrheic dermatitis [SD] is a chronic, papulosquamous dermatosis and Malassezia yeasts are considered as causative factors. The dual antifungal and anti-inflammatory effects of oral itraconazole account for its prolonged therapeutic action in SD. To assess the safety of oral itraconazole in the treatment of seborrheic dermatitis. During a period of total 2 years from January, 2008 to December, 2009, 37 patients of SD were treated with oral itraconazole [200 mg/day for 7 days] in first month and consecutive use of 200 mg/day for the first 2 days of the following 11 months. Patients were followed up monthly for clinical side effects and biochemical derangements. 16 [43.2%] patients suffered from different side effects of drug i.e. nausea in 16 [76.2%] patients, followed by abdominal pain in 3 [14.3%] and diarrhea in 2 [9.5%]. These were self-limiting and did not warrant discontinuation of therapy. Biochemical abnormalities were not seen in any patient. The study suggests that oral itraconazole is a safe treatment option of seborrheic dermatitis

Pulse dose of oral itraconazole is effective in the treatment of onychomycosis

Onychomycosis is a recalcitrant disease of the nails caused by dermatophytes, yeasts, and molds. To see the efficacy of pulse dose of oral itraconazole in the treatment of onychomycosis. It was an open clinical trial which was carried out for a period of 2 years from March 2009 to February 2011, in the outpatient department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University [BSMMU] Dhaka. Bangladesh. Thirty patients with onychomycosis were recruited purposively. 30 patients of onychomycosis were treated with oral itraconazole 400 mg/day, seven days a month for three months. Mean age of the respondents was 36.57 +/- 14.01 years and male to female ratio was 1:1. Among the patients, 36.7% cases had involvement of toenails and 63.3% cases had involvement of fingernails. In 6.7% cases onychomycosis was mild, 80.0% cases moderate and in 13.3% cases severe. Three months after treatment with itraconazole, improvement was found in 66.7% cases and marked improvement in 33.3%. Before treatment, culture was found positive in 30% cases and three months after treatment, culture became negative in 66.7% cases. Monthly one week cycle of oral itraconazole 400 mg daily for 3 months is effective therapeutic option for onychomycosis

Tinea pedis: a clinical dilemma in Bangladeshi population

Tinea pedis is an important public health problem because of the increase in immunosuppressive states. Large scale studies in Asia are scarce, and the baseline incidence of tinea pedis is not firmly established. To find out the clinical types of tiena pedis amont the Bangladeshi population. 200 clinically suspected cases of tinea pedis were included in this study. In all cases, samples were collected for KOH microscopy and culture. Clinical pattern and associated relevant factors were noted according to a predetermined protocol. Papulosquamous tinea pedis was the most common clinical pattern in 80 [40%] followed by interteriginous type in 70 [35%] patients. Hyperkeratotic pattern was found less commonly in 45 [22.5%] patients followed by bullous pattern in 5 [2.5%] patients. The incidence of papulosquamous type of tinea pedis is relatively higher among the Bangladeshi population than other countries