ABSTRACT
The term congenital adrenal hyperplasia [CAH] comprises a group of autosomal recessive disorders, each of which involves a deficiency of an enzyme involved in the synthesis of cortisol, aldosterone, or both. The clinical presentation varies according to chromosomal sex. The sex of neonate with CAH is often initially unclear because of genital ambiguity. We report a case of 25-year-old phenotypically male, presenting with generalized hyperpigmentation for 5 years and occasional syncope for 1 year. On examination there were sparse axillary and pubic hair with ambiguous genitalia. 46XX karyotype, hypoplastic uterus on CT scan and elevated ACTH and 17-hydroxyprogesterone levels lead to the diagnosis of female pseudohermaphroditism due to congenital adrenal hyperplasia and patient was started on glucocorticoids and fludrocortisone by endocrinologist and was also referred to plastic surgeon
ABSTRACT
Objective: To determine the efficacy and safety of 50% glycolic acid peels in melasma in Fitzpatrick's skin type IV and V
Methods: 50 patients of melasma were included in the study. Type of melasma was identified with the help of Wood's lamp. Patients were advised a pre-peel program of daily application of tretinoin 0.05% at bedtime for 2-weeks. MASI scoring and colored photographs of each patient were taken before each peel with 50% glycolic acid and at the end of follow-up. Treatment was carried out with an interval of 2-weeks for a total of 6 sessions. Efficacy was assessed 4 weeks after the last session. Side effects, if any, were also recorded
Results:The mean age of the patients was 28.88 +/- 6.02 years. There were 44 [88%] females and 6 [12%] male patients. 20 [40%] patients had epidermal melasma, 28 [56%] had mixed type and only 2 [4%] patients presented with dermal melasma. Mean baseline MASI score was 15.54 +/- 5.76 and the mean MASI score at the end of treatment was 9.6 +/- 4.8. The mean percentage of reduction of MASI score was 40.57 +/- 11.9%. A significant improvement from baseline to 14 weeks was observed. Only a few side effects were seen in the form of mild erythema and burning sensation
Conclusion: This study demonstrates that serial glycolic acid peels are effective and safe in the treatment of melasma in Fitzpatrick's skin type IV and V
ABSTRACT
Objective To evaluate the safety and efficacy of sulphasalazine in treatment of severe alopecia areata.
Methods It was a non-randomized open therapeutic trial. 41 subjects were included in the study. Patients were enrolled from department of dermatology Unit-II of Mayo Hospital Lahore. Subjects were stared on 500mg/day of sulphasalazine to a maximum of 3gram/day. The dose for children was 10mg/kg/day. Patients were followed fortnightly. Responsive patients were followed for another 3 months. All the relevant data was recorded and analyzed.
Results Four out of 50 patients [4%] responded to the treatment. Two of them demonstrated partial response and two had total response. There was no significant sex difference for the treatment response. Major side effect observed was hepatotoxicity seen in 3 patients resulting in discontinuation of drug.
Conclusion It is concluded that sulphasalazine is relatively safe but not effective in treatment of severe AA.
ABSTRACT
To determine the efficacy of intense pulsed light [IPL] in the treatment of melasma in Asian skin types. Fifty patients who fulfilled the inclusion criteria were selected for this study. Type of melasma was identified with the help of Wood's lamp. Before each session patients were asked to wash the area with bland soap and water. Cooling transparent gel was applied. Fluence and pulse duration of IPL was selected according to the Fitzpatrick skin type. Patients were treated with 560nm-1200nm wavelength. They were advised to use broad spectrum sunscreen with SPF >30 and to avoid heat and sunlight. Topical antibiotic was advised for few days till the crusts cleared. Treatment was carried out with an interval of three weeks for a total of four sessions. Efficacy was assessed four weeks after the last session. The mean age of the patients was 31.8 +/- 6.5 years. There were 5 [10%] males and 45 [90%] female patients. 7 [14%] patients had dermal melasma, 20 [40%] epidermal type and 23 [46%] patients had mixed disease. The mean percentage of reduction of MASI score was 29.4 +/- 10.9. In only 2 [4%] patients, IPL was found to be efficacious. Intense pulsed light is non-efficacious treatment for melasma in Asian persons.
ABSTRACT
Squamous cell carcinoma [SCC] is a rare late complication of chronic discoid lupus erythematosus [CDLE]. We report a case of SCC developing in lesions of CDLE in a 16-year-old girl suffering from SLE. A verrucous change or ulceration in lesions of CDLE should warrant a biopsy to rule out malignant transformation