Direct immunofluorescence and histopathology in chronic discoid lupus erythematosus

Lesions of chronic discoid lupus erythematosus [DLE] are characterized by sharply demarcated, scaly, infiltrated and later atrophic red discoid plaques. They have pathognomonic histological features, helping in confirmation of the diagnosis. Since the introduction of direct immunofluorescence, the lupus band test has become an important tool for the diagnosis of cutaneous lupus erythematosus. To elaborate the specific histopathological features and direct immunofluorescence findings in the lesions of chronic discoid lupus erythematosus. Patients of any age and either sex presenting with clinically suggestive lesions of discoid lupus erythematosus, attending the outpatient dermatology department of Mayo Hospital were enrolled. The biopsy specimens of the lesional skin were bisected and subjected to histopathology and direct immunofluorescence. Out of 29 patients, the diagnostic histopathological features were found in 23 [79.9%] patients, in 5 [16%] the changes were suggestive. We could not reach to a diagnosis in one patient. Diagnostic lupus band was found in 20 [68.5%], while fluorescence at dermoepidermal junction was suggestive of lupus band in 3 [11%]. No fluorescence was observed in 6 [20.5%]. A combination of the two techniques gave better results 85%. Direct immunofluorescence is a useful technique in the diagnosis of discoid lupus erythematosus; however, it should be used in conjunction with haematoxylin and eosin-stained sections

Efficacy and safety of azathioprine in the treatment of chronic actinic dermatitis

Chronic actinic dermatitis [CAD] is a rare intractable photosensitive predominantly eczematous eruption sometimes with infiltrated plaques on the exposed areas and has a tendency to progress to erythroderma. Along with sun protection, the use of corticosteroids gives only partial response and is associated with many unwanted effects. There are promising reports of usefulness of azathioprine in the treatment of CAD. To evaluate the efficacy and safety of azathioprine in the treatment of chronic actinic dermatitis in our patients. The study was conducted in the dermatology department of Mayo Hospital, Lahore over a period of 18 months. Patients of CAD fulfilling the inclusion criteria were put on azathioprine 2-3mg/kg/day. The clinical severity was assessed at 0, 1, 3, 6, 9 and 12 months of azathioprine treatment using modified PASI score. Complete hemogram, hepatic and renal function tests, chest X-ray and urinalysis were carried before putting the patients on azathioprine. Hemograms were repeated at monthly intervals while liver enzymes were monitored at 2, 4 and 8 weeks and then at intervals of 2 months. Renal function tests were repeated at 3-monthly intervals. Eighteen patients, all men, were studied. The mean duration of disease was 6.5 years. Of the fifteen patients completing 9 months of treatment, six [40%] showed >90% reduction in PASI score, 7 [46.6%] showed >50% reduction while 1 [1.6%] showed <50% improvement. One [1.6%] patient discontinued the treatment on his own after no improvement of 4 months treatment. A definite conclusion could not be derived from this study as the number of patients was limited but the azathioprine can be used as an effective and safe treatment modality in chronic actinic dermatitis

Pattern of dermatoses and underlying psychopathological disorders in patients attending dermatology clinic in earthquake affected areas of Azad Kashmir

Psychological stress such as sexual assault, major earthquake, or plane crash has long been recognized as an etiological or precipitating factor in dermatological disorders. Treatment of these patients comprises of not only management of dermatological disorders but also on treating the underlying psychopathological diseases. These disorders can be identified by the application of the twelve item General Health Questionnaire [GHQ-12] which is a self-administered screening tool requiring only few minutes to complete and score the findings. To recognize different types of dermatoses and screen the patients for associated psychopathological disorders using General Health Questionnaire [GHQ-12] in the earthquake affected areas of Azad Kashmir. Subjects and an outpatient dermatology clinic was set up in the earthquake affected area of Muzaffarabad for four days. As it was advertised to be a dermatology specific clinic, so all patients presenting with some dermatological disorder were enrolled using non-probability convenient sampling technique. Demographic data was filled by social workers and clinical data was recorded by dermatologists on a specially designed pro forma. The patients were asked to complete 12 items General Health Questionnaire [GHQ] which was filled by patients who were literate while for others social workers assisted. Chi-Square test was used for data analysis. A total of 522 patients with different skin diseases were enrolled Dermatological infestations were seen in 207 [39%] cases followed by eczemas 90 [17.3%] and infections 80 [15.3%]. Stress mediated dermatological problems like acne 40 [7.6%] and psoriasis 27[5%] were found in these cases. Overall 192 [36.8%] patients were living in shelter based homeless situation and psychiatric morbidity was seen in 55% [173] cases having dermatological illness. Infestations, infections and eczemas were the most common skin diseases seen in earthquake victims and increased psychiatric morbidity may be responsible for rise in stress related dermatological disorders