Quality of life in patients of hirsutism

To determine the impact of hirsutism on quality of life [QoL] using Dermatology Life Quality Index [DLQI] in female patients. An observational study was carried out at the Department of Dermatology, King Edward Medical University/ Mayo Hospital, Lahore from March 1, 2012 to August 31, 2012. A total of 200 female patients suffering from hirsutism, of any severity, with age 16 years or above who themselves were able to understand and fill the DLQI questionnaire in Urdu version, were enrolled in our study. Using the DLQI questionnaire consisting of ten questions, patients were asked to score on a scale from 0-3 for each of ten items. The data were analyzed after compiling the results. The higher the DLQI score, the poorer was the QoL. Mean age of the patients was 26.12 +/- 5.83 years. Mean DLQI score of all patients was 17.9 +/- 5.78. The findings indicated several areas where hirsutism had an impact on individual's QoL, particularly in relation to symptoms and feelings, daily activities and personal relationships. Patients with moderate hirsutism and severe hirsutism had mean DLQI score of 18.2 +/- 5.57 and 17.88 +/- 5.74 respectively. Mean DLQI scores were highest for Q2 [symptoms and feelings]. Hirsutism causes a 'very large effect' on patients' quality of life. Impairment of QoL is greater in female patients irrespective of marital status and severity [either moderate or severe] of hirsutism. Longer duration of disease leads to poorer quality of life.

clinicoetiological study of Stevens-Johnson syndrome and toxic epidermal necrolysis

To present the pattern of morbidity associated complications, and causative factors in individual cases of Stevens-Johnson syndrome [SJS]/toxic epidermal necrolysis [TEN]. Patients and methods This case series descriptive study, using a convenience sampling technique, was carried out in the In-patients department of Dermatology Unit I, Mayo Hospital, King Edward Medical University, Lahore from January 2007 to September 2008. Thirty clinically diagnosed patients, suffering from SJS/TEN, fulfilling the inclusion criteria were included in the study. Patients' demographic data, symptoms, signs and any relevant investigations were recorded and scored. Using an appropriately designed pro forma, symptoms/ and signs were categorized into thirteen variables. The severity of each variable was scored froml-3 [total score range 13 to 39]. An association of these variables with patient outcome, in terms of either discharge from hospital or death, was calculated. Pain and gastrointestinal involvement were seen in all 30 [100%] patients. Mortality was found to be 13.3% and was significantly associated with infection, total morbidity score, area of epidermal involvement and respiratory system involvement. Similarly development of wound infection, area of epidermal involvement, fever and total score significantly affected the duration of hospital stay. While the causative drug/s remained unknown in 26.7% cases the most common identifiable drug was trimethoprim-sulphamethoxazole, causing disease in 13.3%. Conclusions Mortality in cases of SJS/TEN showed significant association with wound infection, area of skin involvement, total morbidity score and respiratory system involvement

Pattern of drug eruptions in a tertiary care hospital

An adverse drug reaction is unintentional which occurs at doses used for prophylaxis, diagnosis or treatment. To determine the frequency of various cutaneous drug eruptions that occur in patients in a tertiary care hospital setting. All patients with cutaneous drug eruptions seen at the Dermatology Department of Mayo Hospital, Lahore, over 6 months were enrolled and the pattern of drug eruptions like urticaria, angioedema, fixed drug eruption, maculopapular rash, erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis etc. were recorded, along with drugs that caused it. A total of 160 patients [86 males, 74 females] were included in the study. Mean age of patients was 30.7 +/- 15.4 years. Major eruptions were fixed drug eruption [21.3%] followed by urticaria without angioedema [10%], maculopapular rash [9.3%], lichenoid drug eruption [8.7%], acneiform drug eruption [7.5%], Stevens-Johnson syndrome [6.9%], vesiculobullous eruption [5.6%], erythema multiforme and eczematous eruption [5% each]. Common drugs causing eruptions were sulfonamides [16.3%], followed by NSAIDs [14.4%], herbal and homeopathic medications [12.5%], penicillins [9.3%], tetracyclines [8.7%], antituberculous drugs, cephalosporins and antiepileptics [6.3% each]. Fixed drug eruption and urticaria without angioedema were commonest eruptions while, sulfonamides and NSAIDs were the major causative drugs. Reporting of adverse drug reactions is not done in Pakistan and needs to be done in each hospital

Quality of life in patients of melasma

To determine the impact of melasma on quality of life [QoL] using Dermatology Life Quality Index [DLQI] in our patients. An observational study was carried out at the Department of Dermatology, King Edward Medical University/ Mayo Hospital, Lahore from December 12, 2009 to June 11, 2010. A total of 100 patients suffering from melasma, of any severity, with age 16 years or above, belonging to either sex, who themselves were able to understand and fill the DLQI questionnaire in English or Urdu version, were enrolled in the study. Using the DLQI questionnaire, consisting of 10 questions, patients were asked to score on a scale from 0-3 for each of 10 items. The data were analyzed after compiling the results. The higher the DLQI score, the poorer is the QoL. Mean age of the patients was 29.90 +/- 7.18 years. There were 82 [82%] female and 18 [18%] male patients. The mean DLQI score of all patients was 17.08 +/- 5.22. The findings indicate several areas in which melasma had an impact on individual's QoL, particularly in relation to symptoms and feelings and personal relationships. Women reported poorer QoL compared to men. Mean DLQI score was 16.00 +/- 4.93 in males and 17.32 +/- 5.28 in females. Patients with mild, moderate and severe disease had mean DLQI scores of 16.23 +/- 5.35, 19.32 +/- 3.99 and 22.0 +/- 2.0, respectively. Melasma causes a "very large effect" on patients' quality of life. Impairment of QoL is greater in females and patients with severe disease

effect of oral doxycycline and topical 5% benzoyl peroxide on quality of life in patients with mild to moderate acne vulgaris

The purpose of the study was to determine the impact of mild to moderate acne vulgaris on quality of life [QoL] and to assess the effect of oral doxycycline and topical 5% benzoyl peroxide treatment on QoL. One hundred patients, of either sex, suffering from mild to moderate acne vulgaris, were asked to fill the Dermatology Life Quality Index [DLQI] pro forma [Urdu and English version] independently before starting the treatment. The total score ranged from 0-30. The higher the score, the greater was the impact on QoL. All the patients were subjected to oral doxycycline 100 mg daily and were asked to apply 5% benzoyl peroxide once daily. Patients used these medicines for a period of three months, after which they were again asked to fill the DLQI pro forma. The data were analyzed after compiling the results. The results of 100 patients, who completed the study, were compiled. The mean age of patients was 20.45 +/- 3.27 years. Among 20 male patients, 8 suffered from grade 1 and 12 from grade 2 acne. Among 80 female patients, 9 suffered from grade 1 and 71 from grade 2 [p=0.012], showing a significant association between grading of acne with respect to gender of the patient. The disease was notably severe among females. Duration and progression of disease showed no significant effect on QoL. Before treatment, the mean DLQI score for females was 14.05 +/- 6.32 with minimum score of 1 and maximum score of 25. The mean score for male patients was 12.63 +/- 6.46 with minimum score of 1 and maximum of 26, showing that QoL is worse among females as compared to males. The mean pretreatment score was 12.92 +/- 6.43. The score dropped to 5.34 +/- 3.14 [p=0.000] after treatment showing that there is a significant improvement in quality of life of these patients. The study shows that mild to moderate acne vulgaris has a very large effect on the quality of life of our patients with significant psychosocial limitations. The combination treatment of oral doxycycline and topical 5% benzoyl peroxide significantly improves the quality of life in acne patients

Lupus miliaris disseminatus faciei: a case report

Lupus miliaris disseminatus faciei is an uncommon, chronic, inflammatory dermatoses characterized by multiple, monomorphic, symmetrical, reddish-brown papules on chin, forehead, cheeks and eyelids that show a characteristic granulomatous histology. Lesions may cluster around the mouth and eyes or may be widely disseminated on the face. The exact pathogenesis is unknown. Tuberculin test is usually negative. Active disease generally lasts for 1-3 years and resolves spontaneously. We report a case of this disorder along with review of literature

Role of estrogen, progesterone and prolactin in the etiopathogenesis of melasma in females

Melasma is a commonly acquired hypermelanosis of facial skin due to various etiological factors including hormonal imbalance. To find out the relationship between hormonal imbalance and melasma in females. One hundred and fifty female patients suffering from melasma, between the ages of 17-45 years, were enrolled in the study. They were examined by Wood's lamp to see the type of melasma whether epidermal, dermal or mixed [dermoepidermal]. Patients were investigated for levels of estrogen, progesterone and prolactin in two consecutive follicular and luteal phases on 9[th] and 18[th] day of cycle, respectively. Forty control cases were also investigated for the aforementioned hormonal levels in their follicular and luteal phases. Out of 150 patients, 138 completed the study while 12 patients were lost to follow up. Amongst the 138 evaluable patients, there were only 4 patients who had normal values for all the three hormones i.e. estrogen, progesterone and prolactin in all four phases. Fifteen patients [10.9%] had normal values of estrogen in both follicular [Fl and F2] and luteal phases [LI and L2] while the remaining 123 patients [89.1%] had deranged values of estrogen [mostly increased] in any of the four phases. The values of progesterone were normal in 62 [44.9%] patients while they were deranged in 76 [55.1%] patients in all four phases. The levels of prolactin were normal in 134 [97.1%] patients while deranged in 4 [2.9%]. Out of 40 controls, only 3 [7.5%] had increased values of estrogen in both follicular and luteal phases. Estrogen is found to be the causative agent of melasma

Scrofuloderma: a common type of cutaneous tuberculosis. A case report

Scrofuloderma is a common type of cutaneous tuberculosis characterized by a bluish-red nodule overlying an infected lymph gland, bone or joint that breaks down to form an undermined ulcer with a granulating tissue at the base. Progression of the disease leads to irregular adherent masses, densely fibrous at some places while fluctuant and discharging at others. It heals with a characteristic puckered scarring at the site of infection. The disease is caused by Mycobacterium tuberculosis and common anti-tuberculous drugs are recommended for treatment. Many similar cases with additional features have been reported in foreign literature. We describe a case of this disorder along with review of literature

Dermatologic manifestations in patients of renal disease on hemodialysis

Chronic renal failure [CRF] is recognized as a significant medical problem in our part of the world. It refers to an irreversible deterioration in renal function which classically develops over a period of years. The disorder has five stages and the stage 5, also called end stage renal failure [ESRF], is a severe illness and requires some form of renal replacement therapy [dialysis or renal transplant]. Cutaneous and mucosal changes are a common finding in patients of ESRF and on long-term hemodialysis and can vary from each patient population to another. The commonly seen dermatologic manifestations associated with ESRF are xerosis, pruritus, pallor, fungal, bacterial and viral infections, xerostomia, scalp hair loss, nail changes like half-and-half nails and splinter hemorrhages. The cutaneous manifestations related to hemodialysis are skin infections, arteriovenous shunt dermatitis, gynecomastia, bullous disease of dialysis etc. The present review does not highlight cutaneous changes of diseases associated with the development of ESRF but it familiarizes clinicians about the dermatologic changes in patients with chronic renal failure [CRF] undergoing hemodialysis

Local variations in the frequency and pattern of dermatoses in amputees in earthquake affected areas

To study the regional variations in the frequency and pattern of dermatoses in amputees in earthquake affected areas. District headquarter hospitals, Mansehra and Abbottabad. All patients with amputations and associated skin disease belonging to any age groups and gender were enrolled for the study. Three visits were made to the research areas. The first visit was for publicizing the time and venue of camps. In the second visit all patients presenting with any major or minor amputation acquired after the earthquake were enrolled in the study. A detailed history was taken and physical examination carried out by a qualified dermatologist. The presence or absence of amputation related dermatoses were specifically recorded and treated. At the third visit all the patients who were managed at the last visit were re-evaluated and assessed in relation to the guidelines provided to them. A total of 210 amputees [159 males and 51 females] volunteered for the study and were enrolled. Their ages ranged from 2 years to 85 years. A total of 210 cases 54 [25.7%] persons had skin lesions including ulcers [n=15], contact dermatitis [10 M, 4 F], adherent scars [6 M, 5 F], abrasions [5 M, 4 F], folliculitis [2 M], inclusion cyst [1 M], hypopigmentation [IF] and hyperpigmentation [IF]. Of the total 54 lesions, 31 lesions were seen in lower and 23 lesions were seen in the upper limb. Ulcers were the most common findings followed by allergic contact dermatitis is another significant problem. Measures should be taken to avoid unnecessary trauma and all patients with dermatitis on the residual limb should be patch tested to determine the cause

Efficacy, safety and tolerability of mometasone furoate 0.1% ointment in chronic eczema

Eczema covers a wide range of skin problems, which trouble people at different stages of their lives. Mometasone furoate has been reported to be an effective vasoconstrictive agent on human skin. To evaluate the therapeutic efficacy, safety and tolerability of mometasone furoate ointment 0.1% in chronic eczema following a four-week course of therapy and to record the main events in the cascade of eczema. This quasi-experimental, multi-center study was conducted in four cities. of Pakistan [Karachi, Lahore, Islamabad, and Peshawar] from December, 2005 to February, 2006. A total 180 patients aged > 24 months of either sex with chronic eczema without secondary infection were recruited while pregnancy, known hypersensitivity to corticosteroids, presence of skin atrophy, those on systemic steroids within 28 days were excluded. Patients were instructed to apply a thin layer of ointment once daily. Tubes of mometasone furoate ointment were dispensed to the patients on days 1, 8 and 15 of the study. Patients were asked to return the used tubes at the next weekly follow-up visit. SPSS-13.0 was used for statistical analysis. Friedman test was applied to compare the significance of clinical outcome, relief in signs/symptoms and patient`s comfort at p < 0.05. On first follow up 8 days after treatment, significant majority [77%] showed improvement and in 7 [4%] patients fully resolved. After 15 days, 75% showed improvement and resolved in 19% patients. After 21 days of treatment, improvement was seen in 32% and 55% had resolved. Efficacy in terms of relief in signs and symptoms on last follow up > 21 days after treatment revealed significant resolution of signs and symptoms [p < 0.001]. The cumulative level of comfort on various follow up visits was found significant [p < 0.001]. Mometasone furoate ointment is significantly effective in relief in sign and symptoms and provides a high level of comfort after the treatment of chronic eczema

Bone mineral density in patients with pemphigus vulgaris on long term steroid therapy

Osteoporosis is a common side-effect seen with long term steroid therapy. Patients at increased risk are over 50 years of age, postmenopausal, or have restricted mobility. To assess the bone mineral density [BMD] in patients with pemphigus vulgaris [PV] on long term steroid therapy. All patients with pemphigus vulgaris on oral/parenteral steroid therapy at the Department of Dermatology, Unit I, Mayo Hospital, Lahore were enrolled. Their BMD was measured at the heel with a quantitative ultrasound device. A control group comprising of 20 patients was also taken within the same time period that suffered from skin diseases other than pemphigus vulgaris and were not taking steroids in any form. There were 25 patients, 14 males and 11 females, with an average age of 33.8 years [range 12-60 years]. The average duration of PV was 24 months [6 months to 12 years]. The steroids used by these patients included prednisolone, betamethasone and dexamethasone. The duration of intake ranged from 2 months to 36 months. The highest dose was 120 mg and lowest was 10 mg. The mean BMD score of the patients was 0.39244 g/cm2 and 0.45773 g/cm2 for the control group. The mean T-score of the patients was -2.31, score was -2.61in female patients and -2.08 in males. The score was -1.74 in the control group. All patients requiring long-term glucocorticoid therapy are candidates for osteoporosis prevention

Evaluation and pattern of nickel dermatitis in patients with allergic contact dermatitis

Nickel is the most common allergen in allergic contact dermatitis with diverse clinical manifestations. To evaluate the clinical pattern of nickel dermatitis in our community by patch testing. 200 patients with clinical suspicion of allergic contact dermatitis of any age and either sex presenting to the department of dermatology, Mayo Hospital, Lahore were enrolled. All were patch tested using European Standard series. 23% patients had nickel sensitivity. Majority were housewives between 20-40 years of age, belonging to urban middle class. Duration of disease ranged from 2 months to 12 years. Previous history of metal allergy was seen in 41% patients. Polysensitivity was noted in 37% cases. Clinical judgment alone maybe misleading in making a correct diagnosis and patch testing with the European Standard Series is worthwhile

Vitiligo: new etiology-based treatments

Vitiligo is an acquired depigmentary disorder characterized by a chronic and progressive loss of melanocytes from the epidermis. The etiopathogenesis of vitiligo is still not fully understood, and the major theories include melanocyte destruction [autoimmune, neural and impaired redox status] and melanocyte inhibition or defective adhesion. Recently a new theory, melanocytorrhagy, was forwarded. In this review are also discussed the new etiologybased treatments, mainly topical calcipotriol, topical immunomodulators and topical catalase

Food and skin

Food is essential to keep our body healthy and in perfect harmony. The relationship between food and skin is diverse. Food can help to cure certain skin disorders but it can also trigger or aggravate various other dermatoses. This article highlights the role of different food items in dermatological disorders under various headings

Deformity and disability index in patients with leprosy

Leprosy continues to be a serious challenge in most of the developing countries, contributing significantly to the physical and social disability of the patients afflicted. The aim of this study was to estimate the disability rate in patients of leprosy. Patients and methods This study of deformities and disabilities in leprosy was conducted on 100 diagnosed cases of leprosy [70 males and 30 females], aged 9-70 years. Forty one% of the cases [32% males and 9% females], were found to have various deformities and disabilities. The deformity and disability rate was higher in males than in females and it was positively associated with increasing age and duration of the dis ease. The disability rate was much higher in patients with multibacillary leprosy [42.5%] than in paucibacillary leprosy [23.7%], the highest being in lepromatous leprosy patients [68.5%]. Hands were affected most frequently [32%] followed by feet [30%] and eyes [16%]. The most commonly found deformities and disabilities were anesthesia of hands and feet, claw hands, resorption of toes and plantar ulcers. According to WHO disability grading, 59% of the patients had no disability, 10% had grade 1 and 31% had grade 2 disability. Disability assessment is very important not only to evaluate the effectiveness of the leprosy control programs but also for the patients whose important worry is the stigmatizing deformities caused by the disease. The earlier detection of sensory loss might reduce these secondary deformities