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

Familial frequency of vitiligo and its association with autoimmune disorders

To determine the familial frequency of vitiligo and its association with autoimmune disorders. This cross-sectional study was conducted in the Department of Dermatology, Mayo Hospital, Lahore. Hundred patients of vitiligo of any age and either sex, diagnosed on the basis of history and clinical examination were enrolled from the outpatient department. Patients were evaluated for familial frequency of vitiligo and its association with other autoimmune diseases by means of a specially designed proforma. Total number of vitiligo patients was 100. Family history of vitiligo was seen in 22% of cases. Associated autoimmune disorders were seen in 23% of cases and were mainly diabetes mellitus, autoimmune thyroid disease, alopecia areata and eczemas. This study reveals that generalized vitiligo is associated with other autoimmune disorders, showing similar genetic basis. Therefore it is important to evaluate as well as investigate, where necessary, vitiligo patients for other autoimmune disorders

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.

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

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

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

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

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

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

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