Comparison of efficacy and safety of topical betamethasone valerate 0.1 percent with narrowband-UVB in atopic dermatitis

Objective: To compare the efficacy and safety of topical betamethasone valerate 0.1 percent with narrowband ultraviolet B [NB-UVB] therapy in atopic dermatitis

Method: Sixty patients with AD fulfilling the inclusion criteria were entered in the study. Patients were divided into 2 groups. Group A were given betamethasone valerate 0.1 percent twice a day for 4 weeks. Group B were given NB-UVB thrice a week for 8 weeks. Starting dose was 75 percent of minimal erythema dose [MED] for the skin type III and IV. Dose was increased by 20 percent on each visit as tolerated by the patients. During treatment patients were assessed at 2[nd]and 4[th]week for betamethasone valerate and 2[nd], 4[th], 6[th] and 8[th]week for NB-UVB

Results: 84 percent patients in group A [betamethasone] showed >50 percent reduction in Scoring of Atopic Dermatitis [SCORAD] whereas 94 percent patients in group B [NB-UVB] showed >50 percent reduction in SCORAD [p=0.554]. Side effects were seen in 34 percent patients in group A and 20 percent in group B

Conclusion: Both betamethasone valerate 0.1 percent and NB-UVB are almost equal in terms of efficacy but NB-UVB is more safe than betamethasone valerate 0.1 percent

Female pseudohermaphroditism: Congenital adrenal hyperplasia presenting with diffuse hyperpigmentation

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

Efficacy of sclerotherapy with sodium tetradecyl sulphate in the treatment of pyogenic granuloma

Objective: To determine the efficacy of sclerotherapy in treating pyogenic granuloma

Methods: The present study was conducted at outpatient Department Dermatology, Unit I, Mayo Hospital, Lahore. 35 patients were enrolled and were injected with 0.1ml of 3% sodium tetradecyl sulfate with the help of an insulin syringe, without local anesthesia, till the point of blanching. Patient was called weekly for two weeks for follow up to see clearance of the lesion and then after 3 months to see any recurrence using a caliper

Results: The mean age of the patients was 28.48 +/- 11.64 years. 42.9% patients were males and 57.1% patients were females. Complete clearance of lesion was found in 30 [85.7%] patients whereas 2 [5.7%] patients showed no reduction

Conclusion: Sclerotherapy is an effective procedure for the treatment of pyogenic granuloma patients

Comparison of efficacy of intralesional 5-fluorouracil plus triamcinolone acetonide versus intralesional triamcinolone acetonide in the treatment of keloids

Objective: To compare efficacy of intralesional 5-fluorouracil [5-FU] plus triamcinolone acetonide [TCA] versus intralesional TCA alone in the treatment of keloids

Methods The study included 100 patients with keloids. Patients were divided into two groups. Randomization was done through lottery method. For each 1 cm area, group A was given intralesional 5-FU 50 mg/ml [0.9ml] plus TCA 40mg/ml [0.1ml] after every 4 weeks and group B was given intralesional TCA 40mg/ml [0.1ml] after every 4 weeks for total period of 12 weeks. Administration of the drugs was continued till the keloid flattened or for a maximum period of 12 weeks. Follow-up was done every 4 weeks for total period of 12 weeks after the administration of last injection. Decrease in total score using Vancouver Scar Scale was calculated

Results: After the completion of study mean reduction in Vancouver Scar Score was -71.18 +/- 8.69 in the intralesional 5-FU plus TCA group as compared to -50.80 +/- 8.59 in the intralesional TCA group [p=0.001]. 5-FU + TCA was efficacious in 98% of cases [group A] and TCA alone in 62% of cases [group B]. No serious adverse effects were noticed in either group

Conclusion: Intralesional 5-FU plus TCA is significantly better than intralesional TCA alone in the treatment of keloids

Efficacy and safety of methotrexate in lichen Planus

Objective: To evaluate the efficacy and safety of methotrexate in lichen planus

Methods: This quasi-experimental study was carried out in the Skin outdoor, Mayo Hospital, Lahore from March 2011 to September 2011. Fifty five patients of either sex from puberty onwards were included in the study. Efficacy was determined by >/=50% clearance of number of mucocutaneous lesions after 12 weeks of oral methotrexate 15mg/week. Safety of methotrexate was analyzed by taking history of nausea, fatigue and measuring hemoglobin [Hb], white blood cell count [WBC], platelet count, serum alanine aminotransferase [ALT], aspartate aminotransferase [AST] levels at base line, 2nd, 4th,8th and 12th week

Results: Methotrexate was efficacious in 63.6% patients. Out of these, 21.8% patients were with cutaneous involvement while 41.8% patients had both skin and mucous membrane involvement. There was a significant reduction in number of cutaneous lesions, with little or no effect on mucosal lesions of patients. Methotrexate did not prove efficacious even in a single patient with isolated mucosal involvement. The drug was safe and well tolerated in 91% cases

Conclusion: Methotrexate proved efficacious and safe in our study for most of the patients

Frequency of autoimmune disorders in patients of alopecia areata

Objective: To determine the frequency of autoimmune disorders associated alopecia areata in patients presenting in a tertiary care hospital

Methods: This study was conducted at the Dermatology Department, Unit II, KEMU/Mayo Hospital, Lahore. 120 patients fulfilling the inclusion criteria were entered in the study during May 2013 to January 2014. After takin informed consent and recording demographic data, complete history was taken. Examination was performed and investigations were carried out where needed, for determination of factors associated with alopecia areata

Results: Out of 120 patients studied, 30.8% of patients had positive family history of alopecia areata. Atopic dermatitis was found in 29.2% of patients. Vitiligo and hypothyroidism were seen in 4.2% each. Diabetes mellitus was seen in 1.7% of the cases and 0.8% were hyperthyroid

Conclusion: Positive family history and atopic dermatitis were seen in one third of our patients with alopecia areata. Vitiligo and hypothyroidism were other important associations observed

Comparison of topical 0.03% tacrolimus with 0.05% clobetasol in treatment of vitiligo

Objective: To compare the efficacy and safety of topical tacrolimus ointment with topical clobetasol ointment in vitiligo patients

Methods: This quasi-experimental study was carried out in outpatient, Department of Dermatology Unit-II, KMEU/ Mayo Hospital, Lahore. Sixty patients above 12 years were selected by non-probability purposieve sampling method and were divided into two equal groups. Patients having lesions of less than 2 years of duration were included. After obtaining an informed consent, patients in group I were treated with twice daily application of 0.1% tacrolimus ointment and group II with clobetasol ointement for a period of six months. If no response was obtained, treatment was stopped after three months

Results Repigmentation was seen in 15 [50%] patients in tacrolimus group and 27 [90.0%] in clobetasol group. Contact dermatitis was noted in one patient in ecah group and acneiform eruption was recorded in one patients in the clobetasol group

Conclusion: Topically, clobetasol remains to be an effective therapy in vitiligo. Topical tacrolimus was not effective in our patients. Intermittent use of clobetasol is as safe as continuous use of tacrolimus

Neutral lipid storage disease-a case report

Neutral lipid storage disease is a rare autosomal recessive disorder characterized by non-bullous ichthyosiform erythroderma, liver steatosis, hepatosplenomegaly, cataracts, ataxia, bilateral sensorineural hearing loss, skeletal and cardiomyopathy, growth and mental retardation. We report a case of neutral lipid storage disease in a 14 months old child

Common allergens in patients of chronic eczema by patch testing with European standard series

To determine the common allergens in patients with chronic eczema by applying European Standard series. This study was conducted at the Dermatology Department Unit II KEMU/Mayo Hospital, Lahore. Seventy five patients aged 12 years and above of either sex having chronic eczema were enrolled. Patients using oral corticosteroids and immunosuppressive drugs during the last 15 days, as well as, pregnant females were excluded from the study. Each patient was patch tested with allergens of European Standard series. Positive reactions were observed and recorded after 48, 72 and 120 hours, according to International Contact Dermatitis Research Group Criteria. There were a total of 75 patients, 37 females and 38 males. Their age ranged from 13 to 45 years. Mean duration of the disease was 2.25 years. Positive reactions were noted in 52% of patients. Most common allergens were potassium dichromate [24%], nickel sulfate [17.3%], cobalt [17.3%] and tixocortol [10.4%]. More than 50% of cases with chronic eczema reacted positively to various allergens so patch test must be applied to such patients to determine its cause. Metals were the mains allergens detected

Efficacy of intense pulsed light in melasma

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.

Efficacy and safety of simvastatin in chronic plaque psoriasis

To determine the efficacy and safety of simvastatin in chronic plaque psoriasis. Sixty patients of either sex, aged between 18 and 70 years were included in the study. Efficacy was determined by percentage reduction in psoriasis area and severity index [PASI] score from baseline. Safety of simvastatin was evaluated by measuring serum alanine aminotransferase [ALT], creatinine phosphokinase [CPK] and bilirubin at baseline, 4[th], 8[th] and 12[th] week. The data were analyzed for variables like age, sex and percentage reduction in PASI score. There was >50% reduction in PASI score in 20% patients. Out of these, 8 patients had moderate plaque psoriasis and 4 patients had severe psoriasis. In remaining 80% cases simvastatin did not prove to be efficacious. The drug was safe and well-tolerated. Simvastatin can be affective in patients with moderate disease as compared to cases with severe plaque psoriasis. The drug was safe and well-tolerated.

Frequency of pulmonary tuberculosis in patients with skin diseases requiring high dose long-term systemic steroid therapy

To determine the frequency of pulmonary tuberculosis in patients with skin diseases requiring high dose long-term systemic steroid therapy. This cross-sectional study was conducted in the Department of Dermatology Unit-II, Mayo Hospital, Lahore. Newly diagnosed patients of skin disease were screened for tuberculosis and then followed up after 6 weeks, 3 months and 6 months to evaluate pulmonary tuberculosis while patients were on high dose systemic steroids. At each visit, history, examination and screening tests for tuberculosis were performed which included sputum smear for acid-fast bacilli [AFB], chest radiograph and sputum culture for AFB. Out of fifty patients, who were on high dose long-term systemic steroid therapy, four patients [8%] developed pulmonary tuberculosis after a period of three months [P= 0.0001]. Patients on high dose long-term systemic steroid therapy can develop pulmonary tuberculosis

Frequency of cutaneous diseases in geriatric population of type IV and V skin

To determine the frequency of common cutaneous diseases in geriatric population of type IV and V skin. This Cross-sectional Survey was conducted at Skin outdoor department in May Hospital, Lahore. Two hundred and seventy patients of either sex aged sixty years and above were included in the study. Frequency of common dermatoses was noted. The data were analyzed according to age, sex and skin type. Two hundred and seventy patients were included in the study. The mean age of the patients in the study was 66.85 [ +/- 8.1: range 60-105] years. Eczemas were found in [40%] of geriatric population, scabies [25.2%], fungal infection [14.8%], pruritus [9.6%], viral [8.1%] and bacterial [2.2%] infections. Regarding miscellaneous diseases, significantly greater number of patients aged 80 years or more were diagnosed to have malignant skin disorders. Eczemas were the most common dermatoses. Scabies was more prevalent in females as compared to males. The chances of skin cancer like BCC increases as the age advances

Squamous cell carcinoma on discoid lesions of systemic lupus erythematosus

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

Comparison of treatment with tacrolimus 0.03% and superoxide dismutase and catalase in vitiligo

To compare the efficacy and safety of topical tacrolimus 0.03% with superoxide dismutase and catalase in vitiligo. This hospital based quasi-experimental study was carried out in out patients department of Dermatology Unit-II, Mayo Hospital Lahore in year 2006-2007. Patients were selected by non-probability purposive sampling method after obtaining an informed consent. Both sexes [above S years] were included with head and neck vitiligo. They were randomly divided into 2 groups; group 1: superoxide dismutase and catalase; group 2: tacrolimus by using random number table. There were 34[56.7%] females and 26[43.3%] males. Age of the patients ranged from 5 to 60 years with the mean age of 20.52 +/- 14.34 years. Overall 31[62%] patients showed repigmentation of varied grades. Repigmentation was shown by 14[46.6%] patients in superoxide dismutase and catalase group and 17[56.6%] patients in tacrolimus group. Topical superoxide dismutase and catalase and tacrolimus are effective treatment modalities in patients with vitiligo. There is no significant difference regarding efficacy and safety between both forms of treatment

Comparison of efficacy and safety of oral ivermectin with topical permethrin in treatment of scabies

Scabies is an ectoparasitic, highly contagious skin disease caused by a mite called Sarcoptes scabiei. Topical permethrin and oral ivermectin are currently being used and considered to be safe and effective than the previously used agents. To compare the efficacy and safety of oral ivermectin with topical permethrin in treating scabies. It was an interventional [quasi-experimental] study, conducted in out-patient clinic of Dermatology Department, Unit II, Mayo Hospital, Lahore. Hundred patients belonging to either sex and from 2 to 60 years of age were divided into two groups. Oral ivermectin was given to group A in a single dose of 200 microg/kg body weight. Group B was given single application of topical permethrin 5% cream at night on whole body for 12 hours. When there was no cure in two weeks, a 2[nd] treatment was given with either drug in their respective group. Investigations were carried out at presentation and at 2[nd] week while patients were followed up at 2[nd] and 4[th] weeks. Permethrin showed marginal better efficacy [88.1%] in completely clearing scabietic lesions at fourth week of therapy as compared to ivermectin [79.5%], the difference was insignificant [p=0.15]. Seven patients in ivermectin group had side effects as headache, increase in itching and secondary bacterial infections as compared to permethrin group in which one patient had erythema [P<0.05]. Ivermectin is as effective as permethrin in the treatment of scabies when used in two doses over a period of 4 weeks

Lichen planus/lupus erythematosus overlap with hypothyroidism: a case report

Lupus erythematosus [LE] and lichen planus [LP] are usually seen as individual entities. Their overlap comprises patients who have clinical, histological and/or immunopathological characteristics of both diseases simultaneously. This rare syndrome has been associated with certain other disorders e.g. vitiligo, pemphigus foliaceus, Hashimoto's thyroiditis and Reynold's syndrome. We report a case of LE/LP overlap associated with hypothyroidism

Topical calcipotriol versus oral psoralen-UVA [PUVA] and topical calcipotriol in thetreatment of vitiligo in type IV skin

The treatment of vitiligo is a challenging task. Several therapeutic modalities have been tried till date. Topical calcipotriol alone and in conjunction with PUVA have shown good results in various international studies in the treatment of type I and II vitiliginous skin. Our aim was to evaluate and compare the efficacy of topical calcipotriol alone and in combination with PUVA in the treatment of vitiligo in type IV skin. Sixty patients of vitiligo [26 males and 34 females], aged 12-60 years and involving < 30% of the body surface area were enrolled and randomly divided into two equal groups. Group I patients were treated with twice daily application of topical calcipotriol for six months. In group II patients, in addition to topical calcipotriol, photochemotherapy [PUVA] was advised thrice a week for the same duration. Response was graded according to the degree of repigmentation. In group I, only one sixth [16.7%] of the cases responded and all of them had less than 50% repigmentation whereas in group II, all the patients responded. Seventy percent of the cases in this group showed excellent response [> 75% of repigmentation]. We conclude that topical calcipotriol alone has no role in the treatment of vitiligo in type IV skin but when combined with PUVA leads to an excellent response in greater than two third of the patients

Cornelia de lange syndrome with generalized pustular psoriasis: a rare coexistence

Cornelia De Lange Syndrome is a rare disorder of unknown etiology, characterized by peculiar facial appearance. Patients are small at birth and remain so as compared to children of the same age. Their ability to learn is delayed. All patients present delayed or limited speech development. A case of this rare disorder is reported here, which has a classical presentation, but unusual association with generalized pustular psoriasis not reported earlier

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