Medical school dermatology curriculum - are our graduates adequately prepared and aligned to community needs?

Background: There is paucity of research based information regarding the dermatology learning needs and their fulfilment in primary care physicians

Objective: To determine skin diseases burden in the community AND adequacy of preparedness of Primary Care Physicians to deal with skin diseases

Methodology: This was a cross sectional study conducted from 1[st] January 2015 to 31[st] December 2016 at Dermatology Outpatient Department of Sheikh Zayed Medical College/Hospital [SZMC/H], Rahim Yar Khan, for burden of skin diseases and feedback from Primary Care Physicians of both SZMC/H and Primary Health Care setups [BHUs and RHCs] of District Rahim Yar Khan regarding adequacy of their preparedness to deal with skin disease patients. Records from a tertiary care teaching hospital was sought from OPD to assess skin disease burden and Primary Care Physicians from tertiary care hospital and BHU and RHC of district were surveyed regarding content AND teaching adequacy of undergraduates through their dermatology curriculum. Data was entered and analyzed by using SPSS version 20

Results: A total of 356 doctors participated in this study. Of these 233 [65.4%] were males. It was found that 10% of patients attending OPD in Sheikh Zayed Hospital [A tertiary care teaching hospital] suffered from skin disease. Frequencies of "Common skin diseases" in the community were; eczema 12.9%, scabies 10.8%, fungal infection 9%, bacterial infection 8% and acne 7%. Of all participants, 274 [77%] reported that <10% of their patients suffered from skin disease and only 30 [8.4%] of them were fully confident while treating skin disease patients and only 36 [10.1%] reported that most of their patients were cured. It was noted that 145 [40.7%] participants could name only 1-3 of the common skin diseases in the community, 182 [51.1%] named 4-6 while only 12[3.4%] could name 7 or more and 17[4.8%] had no knowledge of even a single common skin disease in the community. Only 92[25.8%] participants rated that their undergraduate training was adequate while 264[74.2%] rated it to be inadequate

Conclusion: This study concluded that primary care physician were not adequately prepared for managing common skin diseases during their undergraduate training. Appropriate exposure and adequate teaching in dermatology throughout undergraduate medical curriculum is essential because skin presentations manifest throughout all aspects of medicine, and most often dermatological problems are dealt with exclusively by non-dermatologists

Efficacy of terbinafine versus itraconazole in treatment of tinea capitis

Background: tinea capitis is an important skin infection in children. Terbinafine has been used as preferred drug but increasing number of resistance and side effect profile suggests search to find another drug with better efficacy and safety

Objective: to compare the efficacy and safety of terbinafine and Itraconazole in tenia capitis

Methodology: it was a randomized control trial on 120 cases of tenia capitis diagnosed on the basis of five clinical signs and symptoms [erythema, desquamation/scaling, papules, pustules and pruritis] which were rated on four point scale [0-absent, 1-mild, 2-moderate, 3-severe] summed as total signs and symptoms score [TSSS] and a positive KOH microscopy and were divided into two equal groups A and B. Group A was treated with terbinafine at a dose of 62.5 mg for children less than 20 kg, 125 mg for 20-40 kg and 250 mg for above 40 kg. Group B was treated with Itraconazole and dosage was as follows; 10-19 kg 50 mg/day, 20-40 kg 100mg/ day, more than 40 kg 200 mg/day. This study was carried out from 1[st] January to 30[th] June 2016, at department of Dermatology, Sheikh Zayed Hospital, Rahim Yar Khan. These cases were then followed at weeks 02, 04, 06 and 08 and assessed on the basis of KOH microscopy and TSSS score. Negative microscopy and zero TSSS were labeled as cured and parents were also asked about any side effect and tolerability. The data was entered and analyzed by using SPSS version 16

Results: there were 60 cases in each group. Group A has 29 males and 31 females while Group B has 34 males and 26 females. Cure was seen significantly higher in Group B where it was in 86.67% as compared to Group A with 68.33%. [p value 0.01]. There was again significant difference seen when they were compared in terms of cure time where 58.34% of cases in group B were cured by 6 weeks as compared to 40% in Group A. [P value 0.03]. There was no significant difference in terms of side effect profile [p= 0.45] while it was again significantly better in terms of tolerability with Itraconazole [p= 0.02]

Conclusion: intraconazole has better care and safety profile as compared to terbinafine in treatment of Tenia Capitis

Efficacy and safety of trichloroacetic acid 35% versus adapalene 0.1% in treatment of molluscum contagiosum in children

Objective To compare the efficacy and safety of topical trichloroacetic acid [TCA] 35% versus topical adapalene 0.1% in molluscum contagiosum [MC] in children

Methods Sixty children with MCs were divided in two equal groups. Thirty patients in group A received treatment with topical 35% TCA weekly and 30 patients in group B received treatment with topical 0.1% adapalene once daily. The patients were followed till 6 weeks for efficacy and safety

Results The efficacy of TCA and adapalene was observed in 25 [83.3%] and 20 [66.7%] patients, respectively [p> 0.136]. The safety of TCA and adapalene was seen among 21 [70%] and 29 [96.7%] patients, respectively [p < 0.05]

Conclusion The efficacy of TCA was not significantly higher than adapalene. However, adapalene is more safe than TCA

Efficacy of topical 4% liquiritin compared with topical 4% liquiritin mixed in 5% ascorbic acid in the treatment of melisma

To compare the efficacy of topical 4% liquiritin alone with combination of topical 4% liquiritin and topical 5% ascorbic acid for the treatment of melasma. This randomized control study was carried out in the Outpatient, Department of Dermatology, Nishtar Hospital, Multan. The duration of the study was six months. Eighty two patients with epidermal melasma belonging to either sex and 16-45 years of age, were divided into two equal groups. Group A was given topical 4% liquiritin and group B was given topical 4% liquiritin mixed with 5% ascorbic acid. Patients were followed up after 8 weeks of treatment to find out the efficacy of both the treatments. In group A, 25 [61%] patients showed improvement in MASI score and 16 [39%] had no improvement in MASI score. In group B, 36 [87.8%] patients showed improvement in MASI score and 5 [12.2%] were without improvement in MASI score. The observed difference of MASI score improvement between group A and group B was 26.8% [p<0.05]. Topical 4% liquiritin mixed in 5% ascorbic acid is more effective than topical 4% liquiritin alone in the treatment of melasma

Comparison of psoralen ultraviolet A phoptochemotherapy plus topical corticosteroids with PUVA plus bland emollients in the treatment of psoriasis

Psoralen Ultraviolet A [PUVA] therapy is a well-established treatment of psoriasis. The objective of the study was to compare the clinical improvement in psoriasis with PUVA photochemotherapy + topical corticosteroids and PUVA + bland emollients. Forty patients with chronic plaque type of psoriasis were divided into two equal groups each having 20 patients. PUVA therapy was given thrice weekly. In addition, patients of group-A were allowed to apply topical betamethasone 17-valerate 0.1% diluted I into 2 parts with plain vaseline twice daily. Patients of group-B were allowed to apply only plain vaseline over lesions twice daily. Clinical improvement in lesions was observed by decrease in the severity of erythema, scaling and plaque elevation. Clearance of psoriasis was achieved in 95%> of the patients treated with PUVA plus topical corticosteroids while clearance was achieved in 80%% of patients treated with PUVA plus bland emollients [P=0.0758]. Median numbers of exposures for group-A were 16 and for group-B were 17.5 [p= 0.1029]. Similarly, median cumulative dose in group-A was 64.5 J/cm2 and in group-B was 70.7 J/cm2 [p= 0.372]. There is no significant difference in clinical improvement in psoriasis treated either by PUVA plus topical steroids or PUVA plus bland emollients

Comparative efficacy of Psoralen - UVA photochemotherapy versus narrow band UVB phototherapy in the treatment of psoriasis

To compare the clinical improvement in psoriasis with psoralen ' UVA photochemotherapy versus narrow band UVB phototherapy alone. Design: An interventional quasi- experimental study. Place and Duration of Study: Dermatology Department, Nishtar Hospital, Multan, from May 2002 to June 2003. Patients and Forty patients with chronic plaque type psoriasis were included in the study. These were divided into two equal groups each having 20 patients. PUVA or UVB therapy was given thrice weekly. Clinical improvement in lesions was observed by decrease in the severity of erythema, scaling and plaque elevation. Clearance of psoriasis was achieved in significantly greater proportion of patients treated with PUVA [85%] than with UVB phototherapy [60%] [p=0.03814]. Significantly fewer number of exposures were required for clearance with PUVA [median number of treatments=17] as compared to UVB [median number of treatments=25.5] [p=0.0002]. Median cumulative dose for PUVA was 69.1 J/cm2 and for UVB was 34.15 J/cm2, respectively [p<0.0001]. When given thrice weekly, PUVA was more effective treatment for psoriasis than narrow band UVB phototherapy