Afrequency of common etiologies of erythroderma in patients visiting a tertiary care hospital in Karachi

Objective: To determine the frequency of common etiologies of erythroderma in patients visiting a tertiary care hospital in Karachi

Methods: In this cross-sectional study, in a period from May, 2015 to November, 2015,190 patients attending the outpatient department or admitted in the dermatology ward of Civil Hospital, Karachi and fulfilling inclusion criteria[15 to 60 years of age, male/female, having erythroderma for 1week or more], were enrolled in this study after taking written informed consent. History taking and physical examination were done to assess etiology. Skin biopsy was sent for histopathology

Results: The age range was from 15 to 60 years [mean age 48.6 + 16.9 years] while mean duration of disease was 17.9 + 9.1 days. Out of 190 patients, 116 [61%] were male and 74 [39%] were female. The most common etiology was eczema 73 [38.4%] followed by psoriasis 51 [26.8%], drugs 45 [23.7%] and lymphoma 21[11.1%]

Conclusion: Eczema was the commonest etiology seen in our study. The different etiologies of erythroderma in our patients were not similar to those reported from other parts of the world

Eczema; frequency of different types in a tertiary care hospital

Objectives: To determine the frequency of different types of eczema in patients presenting in a tertiary care hospital. Study Design: Cross sectional descriptive type of study. Setting: Hamdard University Hospital Karachi. Period: January 2013 till December 2013

Patients and Methods: All new cases of any type of eczema were registered by nonprobability convenient sampling. Total 192 patients of both genders and all ages were enrolled after taking informed consent. Diagnosis was made on detailed history and clinical examination by consultant dermatologist. All specific and relevant investigations were done according to requirement. Patients were divided in two groups, exogenous eczema and endogenous eczema, for convenience. Data was analyzed by the latest version of SPSS

Results: There were 192 patients, out of which 52.08% were males and 47.91% females. Out of the total presented patients 50% had endogenous eczema, 43.37% had exogenous eczema and 25.62% had unspecified eczema. In endogenous group 11.45% had hand dermatitis followed by seborrhoeic dermatitis, atopic dermatitis and asteatotic eczema in descending frequency of presentation. Pityriasis alba, discoid eczema and pompholyx were seen less frequent. In exogenous eczema allergic contact dermatitis was seen in 14.06% patients, while irritant contact dermatitis in 11.45% patients. Infective eczema and photo-allergic eczema were seen in small number of patients

Conclusion: It was found in this study that allergic contact dermatitis was most common type of eczema followed by other types. Whatever the type is, eczema can be treated, symptoms can be relieved and recurrences can be prevented by appropriate therapy. All types of eczema affect patient's quality of life adversely. However, they can be prevented by educating patients and their relatives to take adequate safety measures like using good quality emollients prophylactically

Patterns of psoriasis in pediatric age group

Objective: To determine the patterns of psoriasis in pediatric group

Methods: In this cross-sectional study, 30 patients meeting inclusion criteria were included by nonprobability consecutive sampling technique in a period of 6 months. Patients aged 1 month to 14 years, visiting dermatology OPD or getting admitted in Department of Dermatology, CHK, were examined by a dermatologist to make a diagnosis of psoriasis and its particular pattern. Biopsies were taken wherever required. Frequency and percentages were computed for age, gender, pattern of psoriasis, severity of diseases and site of involvement

Results: The median age of patients was 8 years, majority [56.7%] falling in the range of 6-10 years with equal gender distribution. Most of the patients presented with plaque type of psoriasis [43.3%], followed by guttate [13.3%], palmoplantar [10%] and nail involvement [10%]. Psoriatic diaper rash and erythrodermic variety were seen in only 6.7% patients each. Lesions were primarily on the trunk [33.3%]. However, only 1-10% of body surface was involved in 50% of the patients, but at the same time 22.2% patients reported a greated invovlement falling in range of 30-90% body surface area

Conclusion: We conclude that plaque type is the most common pattern of psoriasis seen in children of our region and trunk is the most commonly affected site

Frequency of hepatitis B and hepatitis C in psoriatic patients

Objective: To determine the frequency of hepatitis B and hepatitis C in psoriatic patients

Study Design: Prospective cross-sectional study

Place and Duration of Study: This study was conducted at the Dermatology Department of a Tertiary Health Care Facility, Dow University of Health Sciences and Civil Hospital Karachi from January 2014 to December 2014

Materials and Methods: Irrespective of age and sex, a total of 47 patients with diagnosis of psoriasis and psoriatic arthritis were enrolled for this study

Results: Out of 47 eligible subjects, 89.4 % were male. Most of the patients [36 %] had a body involvement of 25- 50 % and the commonest type of psoriasis was plaque type. On further analysis, 8 % of the subjects were found to be positive for HBsAg on ICT method, but only 6.4 % confirmed positive on CMI techniques. Anti HCV Antibody reported positive in 10.6 % of the patients on ICT methods and the same results confirmed on CMI techniques

Conclusion: The number of psoriatic patients suffering from hepatitis B and C virus is not very much significant but should be considered. Once it is positive, then the treatment options are totally different

Frequency and clinical patterns of psoriatic arthritis in patients of psoriasis

Objective To determine the frequency of psoriatic arthritis [PsA] and its different clinical patterns in patients of Psoriasis

Methods In this cross-sectional descriptive study, conducted at Dermatology Unit, Civil Hospital, Karachi from January, 2015 to August, 2015, 200 patients of 18-60 year age and of either gender, having psoriasis with joint pain for at least 3 months were analyzed

Results Mean age of study population was 47.5+/-13.4 years. Out of 200 patients, 94 [47%] were male and 106 [53%] were female. 79 [39.5%] patients had PsA: oligoarthritis 26 [37%], symmetric 24 [34%], axial joint involvement 18 [25%], classical distal interphalangeal [DIP] 6 [8%] and arthritis mutilans 5[7 %]

Conclusion About one-third of psoriatic patients had PsA. Significant clinical presentations of PsA included oligoarthritis, symmetric, axial joint involvement, classical DIP and arthritis mutilans. Certain clinical features may be highly associated with the development of PsA in psoriatic patients

Frequency of new onset diabetes mellitus type ii in patients of psoriasis attending tertiary care hospital

OBJECTIVE: To determine the frequency of new onset diabetes mellitus type II in patients of psoriasis attending tertiary care hospital

METHODS: This cross-sectional study done in the out-patient department, Department of Dermatology, Dow University of Health Sciences and Civil Hospital Karachi. Diagnosed cases of psoriasis meeting the inclusion criteria were selected and relevant history taken. Fasting blood sugar levels were checked two times. Informed consent was taken from all the patients. Categorical variables were expressed in frequency and percentage, whereas numerical variables were expressed in mean and standard deviation. Stratification was done with regards to age, gender and duration of psoriasis 1-5 years, to find out the effect of duration upon onset of Diabetes

The data was analyzed using SPSS version 17

RESULTS: Of 114 patients 63 [55.3%] were less than 50 years of age with mean age of 48.8+/-7.3 years and 77 [67.5%] were male with male to female ratio of 2.1:1. Of 114 patients, 68 [59.6%] had duration of psoriasis less than 2 years with mean duration of 3.5+/-2.3 years. Of 114 patients, 9 [7.9%] had blood sugar >126 mg/dl with mean blood sugar 113+/-24.2 mg/dl. Frequency of new onset type II diabetes was 9 [7.9%]. Stratified analysis showed that new onset type II DM is more common in female patients of < 50 years of age

CONCLUSIONS: It is concluded from this study that patients with psoriasis are at the risk of developing type II diabetes and these patients should be screened for diabetes

Frequency of superficial fungal infections in renal transplant recipients

To determine the frequency of superficial fungal infections in renal transplant recipients. This cross-sectional study was conducted in the outpatient clinic, Department of Dermatology, Dow University of Health Sciences and Civil Hospital Karachi. Patients of 20-60 year of age undergone renal transplant 3 to 12 months back were enrolled while patients with diabetes were excluded from study. Patients were evaluated for the presence of superficial mycoses. Skin scrapings and nail clippings were collected mycologic evaluation. A total of 62 patients were enrolled. The mean age of enrolled patients was 39.9 +/- 10.3 years and 37 [59.7%] were male. The mean duration of transplant was 7.6 +/- 2.9 months. 23 [37.1%] were on steroids. Fungal infections were documented in 38 [61.3%] patients. Of 38 patients, 19 [50%] had candidiasis. Stratified analysis showed fungal infections to be similar in >/=40 or <40 years of age [63.6% v. 58.6%], female and male [64% vs. 59.5%]; duration of transplant <8 or >8 months [63.9% vs. 57.7%] and those who were on steroids [69.6%] or other drugs [62.5%]. It is concluded from this study that patient's undergone renal transplant has increased frequency of fungal infection

Frequency of pityriasis versicolor in diabetic patients attending a tertiary care hospital

To determine the frequency of pityriasis versicolor [PV] in uncontrolled diabetes patients attending a tertiary care hospital. This descriptive, cross-sectional study was conducted in the Dermatology Department, Civil Hospital, Karachi and Diabetic OPD Civil Hospital, Karachi. Diabetic patients of ages 40-70 years, of either gender who presented in OPD were selected for study. Only those patients whose random blood sugar [RBS] was more than 200 mg/dl and whose duration of diabetes was more than 5 years were included in study. Patients who were taking corticosteroids or immunosuppressive drug were excluded from study. 119 patients were enrolled in study. Patients were examined for PV and skin scrapings were taken for microscopy. PV was detected in 5 out of 119 [4.2%] patients. Males were found to be affected more than females. There was no association between PV and duration of diabetes. Pityriasis versicolor is not very common in diabetic patients.

Efficacy of Methotrexate in patients with plaque type psoriasis

Objective: To assess the efficacy of Methotrexate in patients with plaque type psoriasis

Methods: This descriptive study was conducted in the department of Dermatology, Civil Hospital Karachi from September 2009 to March 2010. Seventy three patients between 18 to 50 years of age suffering I from plaque type psoriasis with PASI score of >10 were included in the study after taking the informed consent. Oral methotrexate in a dose of 7.5 mg/week was given for 8 weeks

The data collected included demographic profile [age and gender], duration of disease, site of involvement, size of plaque, severity of plaque measured by Psoriasis Area and Severity Index [PASI] score before starting the treatment and at the end of treatment. Efficacy was labeled with a PASI score of <5 at the end of 8 weeks

Results: Out of 73 patients there were 45 [61.6%] males and 28 [38.4%] females

The mean +/-SD age was 0.0+/-12.6 years. The mean baseline PASI score showed clear and comparable improvement from a meani SD PASI score of 14.8+/-4.2 to 4.9+/-4.3.Twenty nine [40%] patients had an almost complete remission during the 8 weeks of treatment. Partial remission was achieved in 44 [60%] patients

The clearance time for psoriasis ranged from 5 - 7 weeks [mean 6+/-0.89 weeks]

Conclusion: Treatment with methotrexate for chronic plaque psoriasis brings satisfactory disease control and improved quality of life

Clinical presentations of cutaneous tuberculosis

Objective: To determine the frequency of different clinical presentations of cutaneous tuberculosis in a tertiary care hospital

Methods: This cross-sectional study was carried out in the Department of Dermatology, Civil Hospital, Karachi and Department of Dermatology, Ziauddin University, Karachi, over three years from 5[th] March 2007 to 4[th] March 2010. Patients of both sexes and all age groups suffering from histologically-confirmed cutaneous tuberculosis for last 1 month to 10 years were enrolled. A detailed history and examination were recorded on a predesigned proforma. The collected data were computed and analyzed

Results: 57 diagnosed [biopsy proven] cases of cutaneous tuberculosis comprising 35 females [61.4%] and 22 males [38.6%] were enrolled. The age range was 1 up to 80 years. Among these subjects, half the patients were aged between 11-30 years. 17 patients [29.8%] had the disease for 1-2 years constituting the highest frequency for the duration of illness. Most of the patients i.e. 33 [57.5%] had more than one lesion. The lesions were most commonly seen on limbs in 25 [43.4%] patients, followed by face and neck, trunk and genitalia. Chronic discharging sinuses and plaques were the most common presentations. Scrofuloderma was the most common tuberculosis cutis seen in 35 [62%] patients followed by lupus vulgaris, warty tuberculosis and tuberculids. Overall frequency was higher in females. However, some of the types were more frequent in females while others in males. Mean age of presentation for scrofuloderma was 25.7+/-16.9 years, warty tuberculosis 25.7+/-15.9 years, lupus vulgaris 29.4+/-16.5 years and tuberculids 30+/-11.9 years [p=0.197]

Conclusion: Scrofuloderma is the most common clinical presentation of tuberculosis cutis seen in our setting followed by lupus vulgaris, tuberculosis verrucosa cutis and tuberculids

Frequency of specific dermatoses of pregnancy in a tertiary care hospital

To assess the frequency of specific dermatoses of pregnancy in a tertiary care hospital. This cross sectional study was conducted on patients attending outpatient department of Dermatology, civil hospital, Karachi referred from the outpatient department of gynecology and obstetrics spanning, 1[st] May 2006 till 31[st] August 2006. Pregnant females of different age groups, both primigravida and multigravida fulfilling the selection criteria were enrolled. After an informed consent, selected patients were subjected to a detailed history and clinical examination. Diagnosis of the diseases was made clinically and relevant investigations were carried out where required. 100 patients, comprising 32 primigravida [32%] and 68 multigravida [68%], diagnosed as suffering from specific dermatoses of pregnancy completed the study. Minimum age of presentation was 20 years and maximum 44 years the mean age being 32 +/- 6.8 years. Prurigo of pregnancy [96%] was the most common dermatoses seen followed by pruritic folliculitis of pregnancy [2%], herpes gestationis [1%] and polymorphic eruption of pregnancy [1%]. Amongst 96 patients [96%] suffering from prurigo of pregnancy, there were 28 primigravida [29%] and 68 multigravida [71%]. Both the primigravida with pruritic folliculitis of pregnancy presented one each in the 2[nd] and 3[rd] trimester. Patients suffering from herpes gestationis and polymorphic eruption of pregnancy [PUPP] were primigravida presenting in 2[nd] trimester. Specific dermatoses of pregnancy can present in any trimester. Prurigo of pregnancy remains the most common disorder followed by pruritic folliculitis of pregnancy.

Frequency of pityriasis versicolor in patients with uncontrolled type 2 diabetes attending a tertiary care hospital

INTRODUCTION: Pityriasis versicolor is seen frequently in patients with uncontrolled diabetes mellitus

OBJECTIVE: The study was aimed to determine frequency of Pityriasis versicolor in patients with type 2 uncontrolled diabetes in a tertiary care hospital

STUDY DESIGN: Cross-sectional study

SETTING: Department of Dermatology, Civil Hospital Karachi and Department of Dermatology, Ziauddin University, Karachi

DURATION OF STUDY: Duration of study was 6 months from 1[st] May 2010 to 31[st] October 2010

SUBJECTS AND METHODS: Patients aged 40 to 70 years belonging to both sexes with uncontrolled diabetes mellitus of duration more than 5 years were included after an informed consent. Patients taking corticosteroid or immunosuppressive drugs or having any other co morbidity were excluded. Selected patients were examined with magnifying glass and wood's lamp. The diagnosis was confirmed by KOH smear, microscopy and Wood's lamp examination. The findings were recorded on a proforma. All the findings were compiled, tabulated and analyzed

RESULTS: 119 patients were included in the study comprising 68 males [57%] and 51 females [43%]. Patients aged 40 to 70 years, with the mean age of 51.3 years were studied in three age groups i.e. 40-50 years, 51-60 years and >60 years. Majority of patients [57%] belonged to the age group 40-50 years. The duration of diabetes was 5-10 years in maximum number of patients i.e. 72. Among these patients 5 [4.2%] had tinea versicolor comprising 3 males [60%] and 2 females [40%]. Three of these patients had diabetes for 5-10 years and 2 had the same for 11-15 years. 2 patients [40%] aged 40-50 years, 2 [40%] 51-60 years and remaining 1 patient aged between 61-70 years [20%]

CONCLUSION: It can be concluded from the above study that Pityriasis versicolor is not seen commonly in patients with diabetes mellitus

Frequency of oral lichen planus in patients with noninsulin dependent diabetes mellitus

The association between diabetes mellitus and lichen planus [LP], especially oral lichen planus, has been the subject of much research but the conclusion is controversial. The reported frequency of oral LP in diabetes mellitus varies from 1.6% to 85%. To determine the frequency of oral lichen planus in patients with noninsulin dependent diabetes mellitus as compared with normal subjects. Freshly registered cases of noninsulin-dependent diabetes mellitus with suspected lesions of oral lichen planus, fulfilling the selection criteria, belonging to both sexes, aged 40-70 years were enrolled. After an informed consent, enrolled patients were examined following a detailed history and were subjected to biopsy and histopathology. Any relevant investigations were performed where required. An equal number of age- and sex-matched controls were also studied for oral LP. 86 patients comprising 49 [57%] females and 37 [43%] males, aged 40 to 70 years, mean age being 51.3 years, were studied in three age groups i.e. 40-50 years, 51-60 years and >60 years. Among these patients 8 [6.9%] had histopathologically confirmed oral lichen planus [P<0.05]. Only 1 [1.2%] subject from the control group had the histopathologically confirmed disease. There were 5 females [62.5%] and 3 males [37.5%]. Buccal mucosa was involved in 7 patients [87.5%]. Oral lichen planus has a significant association with noninsulin dependent diabetes mellitus as compared to normal population

Cutaneous manifestations in Hepatitis C virus infection

To determine the nature and frequency of cutaneous manifestations in patients of Hepatitis C virus [HCV] infection. One hundred HCV positive patients presenting at Dermatology department of Civil Hospital Karachi from January 2008 to December 2008 were enrolled and evaluated for cutaneous manifestations. Relevant data regarding history, physical examination including skin and its appendages and investigations [complete blood counts, liver function tests, Serum Anti HCV antibodies, ultrasound abdomen] were recorded and analyzed. Out of 100 patients [43% males, 57% females] mean age 41 years [Range 12-70 years], pruritus was the most common dermatological feature seen in 35% patients followed by Lichen planus 12% and idiopathic thrombocytopenic purpura in 8% patients. Less common features were urticaria, alopecia areata, porphyria cutanea tarda and cryoglobulenemia. Pruritus, lichen planus and idiopathic thrombocypenic purpura are common Cutaneous manifestations in patients suffering from HCV infections. These are important and sometimes the only presenting feature of HCV infection, therefore health care providers should be vigilant while examining these patients for underlying HCV disease.

Dermatological manifestations in chronic renal failure patients on haemodialysis

Objectives: the study was carried out to evaluate the prevalence of dermatological problems in patients undergoing haemodialysis and to document the pattern of these skin alterations

Study design: prospective, descriptive

Method: the study comprised of a total number of 300 clinically diagnosed cases of chronic renal failure belonging to either sex being managed by haemodialysis. A detailed dermatological examination of these patients was carried out. The results were recorded on a preformed performa

Results: there were 169 males and 131 females with the age range of 10-80 years. Maximum duration of dialysis was 9 years and minimum 1 month. Xerosis [90.66%] was the most common finding. Pruritus was present in [64.66%]. Hyperpigmentation esp. diffuse [54%], oral lesions [69.3%] including xerostomia and gingival friability, nail changes [61.6%], including pale nails, polished nails and half and half nails and hair changes [56.6%], including dry coarse hair and loss of hair from scalp, arms and legs were also present. Other findings included haemorrhagic diathesis [easy bruisibility, bleeding gums and nasal bleeding], purpuric lesions, excoriation marks, lichenification, AV Shunt complications, cutaneous infections, hypopigmentation, delayed wound healing, hyperpigmented macules on palms and soles, calcinosis cutis, gynaecomastia, solar keratosis and kyrles disease

Conclusion: there is a high prevalence of cutaneous changes in patients undergoing haemodialysis. At least one cutaneous change was found in 96% of patients. Xerosis was the most common finding followed by pruritus, diffuse hyperpigmentation, xerostomia, easy bruisibility, pale nails and half and half nails

Langerhan cell histiocytosis with multisystem involvement in an adult

Langerhan cell histiocytosis [LCH] is a rare disorder that primarily affects children. Its occurrence in adults is very rare. We report a case of 37- year - old male patient who presented with complaints of increased thirst, excessive passage of urine, shortness of breath and skin lesions. The diagnostic workup revealed endocrine involvement with diabetes insipidus, restrictive lung disease, skin biopsy consistent with LCH, bone and periodontal involvement. The skin lesions responded well to Psoralen- Ultraviolet Radiation A therapy[PUVA]. He showed general improvement on systemic chemotherapy

Associations of lichen planus: a study of 63 cases

Lichen planus [LP] is a disease of unknown etiology, but immunopathological mechanisms are implicated in its pathogenesis. Some disorders are associated with LP more frequently than is expected by chance. The study was aimed to determine the frequency of autoimmune disorders associated with lichen planus and to compare our results with international literature. The current study was conducted in the outpatient department of dermatology, Ziauddin Medical University, KDLB Campus, Karachi. Clinically diagnosed cases of lichen planus belonging to both sexes and all age groups fulfilling the inclusion criteria were enrolled. After a detailed history and examination, patients were investigated. The diagnosis was confirmed by biopsy and histopathology. All the findings were recorded, compiled and analyzed. Sixty three patients, 39 males [62%] and 24 females [38%], aged 10 upto 60 yrs were studied. Maximum number of patients [68%] was aged 20-40 yrs. Limbs [47%] were the most common site involved. Following diseases were observed to be associated with lichen planus: HCV 4 [6.3%], diabetes mellitus 4 [6.3%], alopecia areata 3 [4.7%], systemic lupus erythematosus 2 [3%], vitiligo 2 [3%], HBV vaccination 2 [3%], morphea 1 [1.5%], lichen sclerosus et atrophicus 1 [1.5%], chronic active hepatitis 1 [1.5%], dermatomyositis 1 [1.5%] and thyroid disorders 1[1.5%]. Lichen planus, an autoimmune disorder has a frequent association with other autoimmune diseases

Atopic dermatitis: frequency of associated disorders in children

Atopic dermatitis is a chronic inflammatory disease of multifactorial origin. It is the most common type of childhood eczema seen in our community. Most of these patients have a positive family or personal history of atopy in the form of asthma, allergic rhinitis or hay fever. Multiple dermatological disorders are associated with the atopic dermatitis. The study was aimed to see the frequency of these associations in children with atopic dermatitis in our community and to compare these results with international literature. The study was carried out in the department of dermatology, "Ziauddin Medical University, KDLB Campus" from 1[st] September 2003 to 31[st] August 2004. All the freshly registered patients up to 15 years of age suffering from atopic dermatitis were enrolled in the study. The clinical diagnosis was made on the basis of diagnostic criteria for atopic dermatitis described by UK's working party. All the findings were recorded on a preformed pro forma and relevant investigations carried out. Results were compiled and tabulated. The family history of atopy was positive in 78 patients [68.4%] while the personal history of atopy in 48 [42.1%]. Irritant contact reactions were commonly observed in 52 patients [45.6%]. Dry and cold weather exacerbated the disease in 85 patients [74.5%] while 3 patients [2.6%] suffered aggravation in summer. Among endogenous eczemas discoid eczema was seen in 27 patients [30.8%], pityriasis alba in 21 [18.4%], and seborrheic dermatitis in 10 patients [8.8%]. The most common infections were bacterial, seen in 1 2 patients [1 0.5%] followed by viral and fungal infections seen in 9 [7.8%] and 4 patients [3.5%], respectively. Nail changes like pitting, ridging, thickening and discoloration were seen in 7 patients [6.1%]. Other findings observed in our patients were Dennie-Morgan fold in 4 patients [3.5%] and cataract in 5 patients [4.5%]. Atopic dermatitis is associated with multiple conditions. A high percentage of patients have a positive family or personal history of atopy. Environmental factors like weather, irritants and infections cause worsening of the disease. Atopic patients have an increased frequency of other endogenous eczemas and nail and eye changes

Alopecia areata; combination therapy with minoxidil [2%] solution and isotretinoin [0.05%] gel

Alopecia areata is a common cause of nonscarring hair loss. The cause is unknown but it is associated with an alteration in the immunological system. Treatment for alopecia areata includes topical corticosteroids, dithranol, tretinoin, minoxidil, systemic cortisone, PUVA therapy, irritants and immunosuppressive drugs. Our objective was to assess the efficacy of combination of topical 2% minoxidil lotion and isotretinoin [0.05%] gel in the treatment of alopecia areata. From 1[st] October 2003 till 30[th] September 2004, over a period of 1 year, clinically diagnosed, fresh cases of alopecia areata, fulfilling the inclusion criteria were enrolled. All the patients were advised to apply minoxidil [2%] solution in the daytime and isotretinoin [0.05%] gel in the night to avoid photosensitivity. The daily treatment was advised for a period of four months and thereafter every alternate day for another two months as a maintenance therapy. Clinical assessment was carried out by patient's self-assessment, investigator assessment and clinical evaluation on follow up visits. The total number of patients studied was 54 comprising 31 males [57.4%] and 23 females [42.6%], male to female ratio being 1 .3. Twenty-nine patients [53.7%] had three lesions, 18 [33.3%] had two lesions and seven [13%] only one lesion. Complete restoration of hair follicles was noted in 45 [83.3%, p < 0.001] by the end of therapy. All the patients with single patch responded [100%], while 15 patients [83.3%] with 2 lesions recovered completely. Twenty-three patients [79.3%] with 3 lesions had a complete restoration of hair follicles. The combination therapy of minoxidil [2%] solution and isotretinoin [0.05%] gel for alopecia areata is cost effective, stimulating hair regrowth within a shorter interval and is well-tolerated

Adverse effects of systemic isotretinoin therapy: a study of 78 patients

Isotretinoin is an effective treatment for severe forms of acne refractory to other therapies, but it is a teratogen and can cause serious side effects. The side effects, in addition to the constitutional features are related to skin, mucosae, eyes, sexual organs, central nervous system, respiratory system and gastrointestinal tract. Deranged biochemical profile may also be seen in few patients. The current study was aimed to determine the frequency of side effects of systemic isotretinoin therapy in patients treated for acne, thereby assessing its safety. During the calendar year 2004, all the acne patients attending the outpatient department of dermatology, Ziauddin Medical University, KDLB campus, Karachi, fulfilling the inclusion criteria, managed on systemic isotretinoin were enrolled. All were taking isotretinoin at a dose of 0.5mg/kg body weight daily. Baseline investigations were performed in all the patients i.e. liver function tests, lipid profile, complete blood picture and renal function tests. They were followed up for any side effects and clinical improvement. The baseline investigations were repeated monthly to see any biochemical and hematological derangements. 78 patients, 42 females [53.8%] and 36 males [46.2%], with ages ranging from 18 to 24 years, were enrolled. 72 patients [92.2%, p<0.001] developed side effects with a variable frequency of at least one feature in each of these subjects. The side effects, in addition to the constitutional features, observed were related to skin [87.2%], mucosae [10.3%], central nervous system [5.2%], eyes [3.8%], reproductive organs [2.6%], respiratory system [1.3%] and gastrointestinal tract [1.3%]. Deranged biochemical profile was also a feature in few patients [6.3%]. The majority of the patients on systemic isotretinoin have side effects, the most common being cutaneous and mucosal but are trivial. Side effects pertaining to the other systems are less frequent