Exploring practices of dermatologists in ethical dilemmas in Pakistan: a narrative analysis

Background and Objective: Specialists in dermatology come across ethical issues in their practice. The topic is subjective so dialogue and reflection is required. The main objective of this study was to explore how dermatologists deal with ethical dilemmas in their clinical practice

Methods: This was a qualitative narrative analysis. It was conducted by involving dermatologists working in tertiary care hospitals across Pakistan from January to June 2017. Open ended semi structured in-depth interviews of twelve dermatologists were recorded and transcribed manually through transcribers verbatim. Thematic interactional analysis was done by NVivo 11

Results: Ethical dilemmas were narrated. Thematic analysis showed that compromises in standard medical and ethical practices were made on academics and training. Ethics were left to individual choice. Consultation of patients suffered due to quality of patient physician relationships and breeched patient's confidentiality. In cosmetic dermatology unrestrained role of media, injudicious procedures and improper counseling created difficulties. Pharmaceuticals relation revolved around conflict of interest. In sexually transmitted diseases disclosure were difficult due to sociocultural limitations. In teledermatology practices patient's confidentiality and consent were compromised while consultation remained challenging for dermatologists being visual only

Conclusion: Dilemmas appearing in everyday life needs peer discussion, reflections and protocols that should be role modeled

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

Frequency of HCV seropositivity in lichen planus

Objective To determine the frequency of Hepatitis C [HCV] seropositivity in patients of lichen planus [LP]

Methods This observational cross-sectional study was conducted over a period of 6 months, at Dermatology Department PNS Shifa hospital Kaitachi. Eighty-two [n=82] patients with a diagnosis of LP fulfilling the inclusion and exclusion criteria were enrolled using non-probability consecutive sampling technique. Detailed history, physical examination and biochemical measurements were recorded. Outcome variable i.e. HCV seropositivity was determined in laboratory with third generation ELISA technique. All data were entered and analyzed using SPSS Version 20.0

Results The mean age of study population was 39.32+/-13.212 years. On analysis of demographics data it was observed that 25 [30.5%] were below 30 years of age and 57 [69.5%] were of age 30 years and above. 39 [47.6%] were males and 43 [52.4%] were females. On analysis of frequency of outcome variable, 15 patients [18.3%] were HCV positive out of 82 patients irrespective of gender, morphological pattern and site of disease

Conclusion HCV positivity is common in patients with lichen planus in Pakistani population. Age, gender, morphological pattern and site of involvement have no effect of HCV positivity

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

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

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

Frequency of nail changes in patients with psoriasis reporting to PNS, Shifa Naval Hospital, Karachi

To evaluate the frequency of nail involvement in psoriatic patients in local population and to evaluate major patient characteristics with nail psoriasis. One hundred consecutive patients with psoriasis in dermatology out/inpatient department participated in the study. Study duration was over one year from July 2007 to July 2008. Nail changes were present in 71 [71%] patients. Out of the 100 psoriatic patients. The most common nail abnormality observed on both fingernails and toenails was pitting followed by onycholysis. Patients with psoriatic nail changes were significantly older than psoriatic patient without nail changes. Duration of psoriasis was significantly higher in patients with psoriatic nail changes. Fungal infection was positive in 9% of patients with nail changes. Dystrophic nails are frequently found in psoriatic individuals. Frequency of nail involvement in our patient is probably similar to those in their European and American counterparts. Among various nail changes pitting and onycholysis are the most common finding. Fungal colonization of psoriatic nails is a quite frequent clinical problem and should be taken into consideration by dermatologists working with psoriatic patient

Diagnostic accuracy of plain potassium hydroxide mount and culture in tinea pedis

To determine the diagnostic accuracy of direct microscopy in clinically diagnosed cases of tinea pedis by keeping culture as gold standard. validation study. Department of Dermatology Military Hospital and Armed Forces Institute of Pathology Rawalpindi from January 2008 to July 2008. One hundred clinically diagnosed cases of tinea pedis were subjected to direct microscopy with 10% KOH and fungal culture. Direct microscopic examination was positive in 34% and culture in 60% of the cases. The sensitivity and specificity of direct microscopy were 38.33% and 72.5%, respectively keeping culture as gold standard. Direct microscopy had a positive predictive value of 67.65% and negative predictive value of 43.94%.Direct microscopy with 10% KOH may not be sufficient alone therefore cultures should be used for a definitive diagnosis