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

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

Skin disorders in patients with primary psychiatric conditions

Objective To determine the frequency of skin dermatosis in patients with primary psychiatric conditions.

Methods This cross-sectional study was conducted in the Fountain House, Lahore, which is a tertiary care center for psychiatric patients having indoor and outdoor facility. All the admitted psychiatric patients [294] were enrolled in the study. They were thoroughly examined for any skin dermatosis. Out of 294, skin disorders were seen in 172 [58.5%] patients, 89 [60.6%] males and 58 [39.4%] females. The most common primary psychiatric conditions was schizophrenia 47.5% followed by patients of substance abuse 26.5%, bipolar disorder 13.1%, depression and psychosis each in 8.2%. 2.7% patients were manic. Of the study group, 16.3% patients had infective dermatoses and the rest had noninfective dermatoses. A high incidence of generalized xerosis and pruritus was seen in both males and females. Among noninfective dermatoses, 10.1% had eczema, 6.2% acne, 5% melasma, 4.1% palmoplantar keratoderma, 3.2% neurotic excoriations, 3.2% dermatitis artifacta, 2.7% trichotillomania, 2.1% miliaria, and 1.4% had ichthyosis.

Conclusion A high incidence of fungal infections mainly tinea versicolor and onychomycosis was seen in the patients with primary psychiatric conditions.

Chronic urticaria: an approach towards etiology and diagnosis. Part I

Chronic urticaria [CU] is one of the most frustrating and challenging dermatosis for patients and physicians both. Apparently easy to diagnose, CU is still considered as a difficult to manage disease. Subtypes of CU include chronic idiopathic [spontaneous] urticaria, inducible urticaria, physical urticaria, autoimmune chronic urticaria and urticarial vasculitis. Physical urticaria may coexist with chronic idiopathic [spontaneous] urticaria. Evaluation of a patient with CU should involve consideration of various possible causes, although in most cases the cause is not identifiable. Investigation of CU should be guided by a thorough history and physical examination.

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

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

Frequency of allergic contact dermatitis in hand eczema patients with European standard and corticosteroid series

To determine the frequency of allergic contact dermatitis in patients with hand eczema by patch testing with European standard and corticosteroid series. One hundred and five patients of either sex having hand eczema, aged 12 years or above were enrolled in the study from dermatology outdoor department. After taking informed consent, patch test was performed a fortnight after complete resolution of signs and symptoms of eczema and after complete withdrawal of the drugs. Patch testing was done with European standard and corticosteroid series. Readings were taken 48, 72 and 120 hours after patches removal. Patch test reactions were graded according to international contact dermatitis research group criteria. Data was analyzed according to age, sex and percentages of positive patch test results. Allergic reaction was recorded in 48.6% of patients with European standard series and 11.4% of patients with corticosteroid series. Common allergens detected with European standard series were potassium dichromate [21%], cobalt chloride [12%] and nickel sulphate [12%]. Common allergens detected with corticosteroid series were tixocortol-21-pivalate [8.6%] and hydrocortisone-17-butyrate [4.76%]. Almost half [48.6%] of the patients showed allergic reaction with European standard series and 11.4% of the cases gave positive results with corticosteroid series. Patch test needs to be performed with corticosteroid and European standard series in patients with hand eczema not responding to therapy.

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

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 narrowband ultraviolet B therapy in moderate to severe atopic dermatitis

Atopic dermatitis is an inflammatory skin disorder with a chronic relapsing course. In troublesome cases of moderate and severe atopic dermatitis, phototherapy can be an effective treatment modality. To evaluate the efficacy and safety of narrowband UVB 311nm as a monotherapy in patients with moderate to severe atopic dermatitis. Patients suffering from moderate to severe atopic dermatitis, diagnosed according to criteria described by Hanifin and Rajka between ages of 6-70 were enrolled in the study. Severity of the disease was assessed by using SCORAD score. UVB irradiation was done thrice a week on alternate days. Efficacy was assessed every two weeks by reduction in modified SCORAD score. The mean cumulative dose of 25.91 J/cm[2] UVB at a wavelength of 31 Inm was given in a mean of duration 5.2 weeks treatment. Therapy reduced the atopic dermatitis scores from mean 32.2 [range 20.2-45.5] to 14.2 range [6.2-12.4]. We conclude that narrowband UVB appears to be a promising treatment for AD, but large patient series, different dosing schedules and long- term safety considerations should be carefully evaluated in the future

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

Narrowband ultraviolet B radiation therapy for vitiligo in Asians

Vitiligo is an acquired disorder of pigmentation with 1 -2% incidence worldwide. Various treatment modalities have been described in literature with variable results. Recently, narrowband ultraviolet B [NBUVB] has been reported to be effective in vitiligo. To assess the efficacy of narrowband ultraviolet B therapy in Asian patients with localized vitiligo. The study was open and uncontrolled. All patients with localized vitiligo who were seen at the Phototherapy Unit, of the Skin Clinic, Lahore from July, 2002 to June, 2003 and fulfilled the inclusion criteria, were treated with NBUVB as part of our clinical practice. The initial dose was 0.5 J/cm2 independent of the skin type. The dose was increased by 20% at each treatment session. A total of 23 patients were recruited; 1 3 females and 10 males. Their mean age was 27 years [range 9-48 years]. 65% of patients showed > 50% improvement. Certain anatomic sites responded better than the others. The best response i.e. > 75% repigmentation was seen in lesions on face and neck. Lesions on the trunk also achieved more than 50% repigmentation. However, none had more than 10% repigmentation on hands and feet. Our results showed that NBUVB is a safe and effective option for improving cosmetic appearance in vitiligo patients. Its adverse effects were minimal and transient and were well tolerated by the patients

Depression and skin disease

Skin shares a common embryological origin with brain and has a complex relationship with the mind. The emotional factors play a vital role in modulating the skin problems. Whether emotional factors play a primary pathogenic role or cause exacerbation of skin disease secondarily, is difficult to ascertain. This is an Editorial