Efficacy and safety of methotrexate versus acitretin in chronic plaque psoriasis

Objectives: To compare the treatment efficacy and safety of methotrexate with acitretin in chronic plaque psoriasis

Methodology: A total of 142 patients were enrolled, 71 patients in each group. Patients were randomly divided into two groups, A and B by lottery method. They were given methotrexate [25 mg injection deep I/M once weekly] or acitretin [0.4mg/kg orally daily]. At the end of 24 weeks, response to treatment was evaluated in terms of reduction in PASI score. Safety of treatment was accessed in terms of laboratory investigations i.e. transaminase, triglycerides, platelets and white blood cells during treatment

Results: In methotrexate group, an excellent response [PASI-75%] was noted in 38 [53.5%], good response [PASI-50%] in 13 [18.3%], fair response [less than 50% reduction in PASI] in 4 [5.6%], and no response was observed in 1[1.4%] patients. In acitretin treated group excellent response was noted in 18 [25.3%], good response in 27 [38.0%], fair response in 8 [11.2%], and no response was observed in 5 [7.04%] of patients

Conclusion: Methotrexate is better option for treatment of moderate to severe plaque psoriasis than acitretin

Juvenile hyaline fibromatosis

Juvenile hyaline fibromatosis is a rare, autosomal recessive disease. We report a 4-year-old female born of first-degree consanguineous marriage, presenting with gingival hyperplasia, nodular swellings involving the both pinna and right ankle joint. She had contractures of elbows, knees and shoulder joints, restricting the movements of these joints. Cutaneous examination revealed erythematous papules and plaques involving the nape of neck and the perianal region. Histological examination revealed deposition of PAS positive amorphous eosinophilic hyaline material with scattered intervening fibroblast like cells resembling chondroid cells. The patient was diagnosed as a case of Juvenile hyaline fibromatosis based on characteristic clinical and histopathological findings

Effectiveness of long pulsed Nd YAG laser in hair removal

To evaluate the effictiveness and safety of long pulsed Nd: YAG laser in hirsutism. Fifty adult patients [skin phototypes II-V] with dark terminal facial hair and normal hormonal profile were treated with a long-pulsed Nd:YAG laser [1064 nm, 10-mm spot size, fluence of 30 to 50 J/cm[2]]. Four consecutive laser treatments were delivered to all the patients at 4- to 6-week intervals. Photographic evaluations and hair count of skin sites were obtained at baseline, immediately, and at 1, 3, and 6 months after the final laser treatment. Maximum hair reduction was observed after the first treatment in all the patients. All the patients completed the study. The maximum hair reduction was observed after first treatment 73%, after 3 months the hair reduction was 70%, whereas the response to treatment was 65% at the end of six months after the treatment. Long pulsed Nd YAG laser is a safe and effective method for hair reduction in all skin types involving the face

Single dose fluconazole in the treatment of pityriasis versicolor

To evaluate the efficacy and safety of single dose [450mg] of fluconazole in the treatment of pityriasis versicolor. Patients suffering from pityriasis versicolor presenting to department of dermatology, Hayatabad Medical Complex, Peshawar were enrolled in the study. Diagnosis of PV was made by Wood`s lamp and confirmed by examination of scales in KOH preparation. 30 patients were included in the study. 30 patients completed the study including 24 males and 6 females. Their age ranged from 14 years to 45 years [mean 25.3 years]. Eighteen patients [60%] had complete cure and their clinical and laboratory parameters remained negative at 3 weeks and 6 weeks after completion of treatment. Twelve [40%] had no response to treatment. Treatment was well-tolerated and there were no adverse affects reported with single 450mg of fluconazole. Fluconazole 450mg as a single dose was effective in the treatment of pityriasis versicolor and well tolerated. However, long term comparative studies should be done to establish the efficacy of fluconazole as a single dose treatment in PV

Cutaneous manifestations of chronic liver disease

Hepatobiliary diseases are frequently associated with abnormalities of the skin, nails and hair. This study was undertaken to determine the cutaneous manifestations of chronic liver disease [CLD] and particular pattern associated with aetiology of disease. Patients suffering from chronic liver disease of any aetiology presenting to department of gastroenterology Hayatabad Medical Complex, Peshawar from 1st December 2004 to 30th April 2005 were enrolled in the study. All the relevant details regarding history and clinical examination were recorded on a specially designed pro forma. A total of fifty patients, 32 males and 18 females were included. Thirty [60%] patients were suffering from chronic hepatitis C virus infection, 14 patients were suffering from Chronic hepatitis B virus infection and 2 patients each were suffering from primary biliary cirrhosis and Wilson's disease. In two cases the aetiology could not be ascertained. Different manifestations included pigmentation [82%], Terry's nails [80%], xerosis and excoriations [72%], nonscarring hair loss from axilla and pubic region [64%], and spider naevi and palmar erythema [36%]. Lichen planus was seen in 4%, vitiligo and hepatocutaneous syndrome in [2%] of patients each. Cutaneous manifestations in chronic liver disease are non-specific and do not point towards specific aetiology. Physicians caring for patients with chronic liver disease should pay attention to its multisystemic nature

Quality of life in vitiligo patients

Vitiligo has a considerable impact on Quality of Life [QOL], in a society, like ours with pigmented skin. Dermatology Life Quality Index [DLQI] is a simple and practical tool, which can be used to study the effect of any disease on QOL. To assess the impact of vitiligo on QOL in our patients using DLQI and to corelate DLQI score with age, sex, marital status and sites of involvement. Patients and methods One hundre d patients [52 females and 48 males] of vitiligo were enrolled in the study. Using a ten item DLQI, translated into Urdu, patients were asked to indicate how their lives had been affected over the preceding week. The mean DLQI score was 9.56 ranging from 0 to 29.The difference between mean DLQI score for males [8.17] and females [10.85] was statistically significant. Young females [n=40] had mean DLQI score of 11.2. Unmarried females [n=16] had greater impairment of QOL [mean DLQI score = 8.28]. Patients with involvement of exposed sites of body scored [mean DLQI score= 11.03] higher than patients with disease on covered parts of body. The impact of vit iligo on QOL is greater on young and unmarried females with involvement of exposed parts of body