Oral tranexamic acid in treatment of melasma in Pakistani population: a pilot study

To evaluate the efficacy and safety of oral tranexamic acid [TA] in the treatment of melasma in our population. We performed a descriptive cross sectional study of 65 melasma patients [Fitzpatrick skin types III and IV]. Both female and male with moderate to severe melasma were given 250mg oral TA bid for 6 months along with topical sunscreen. Digital photography was performed initially, and at each visit. Follow-up extended for another six months after completion of treatment to see any recurrence or other side effects. Results were assessed clinically and photographically. 65 patients with moderate to severe melasma were enrolled in the study. The average age was 36 years. 41 patients had good, 15 had excellent and 8 patients had fair improvement. None of the patients had serious systemic side effects, only few had oligomenorrhoea, palpitation and gastric upset. Patients' satisfaction was similarly noted. Oral tranexamic acid is a safe and effective treatment in patients with melasma.

CROSS treatment of acne scars with trichloroacetic acid

To establish efficacy and safety of medium depth spot peeling with 35% TCA in atrophic and rolled acne scars, in Asian skin [Fitzpatrick skin type III to IV]. The study was carried out in the Department of Dermatology Sheikh Zayed Hospital form September 2009 to April 2010. Patients with rolled or atrophic acne scars who presented to skin or plastic surgery outdoor were enrolled in the study. After taking informed consent and counseling, the enrolled patients were put on prepeel regimen of topical application of 4% hydorquinone and tretinoin for 2 weeks. 1 to 3 spot peeling sessions, with 35% TCA, were carried out depending on severity of scars. Prepeel and postpeel photographs were taken. Nine patients with acne scars were enrolled in the study. The average age was 24 years. Total of 22 peeling sessions were done. Five patients had good, 4 had excellent and 1 patient had fair improvement. None of the patients had postinflammatory hyper- or hypopigmentation, scarring or keloid formation. 35% TCA spot peeling in rolled and atrophic acne scars is safe, effective and affordable treatment in patients with Fitzpatrick skin type III to IV

Interferon alfa and ribavirin induced hair changes

Combination therapy of lnterferon alfa and ribavirin in chronic hepatitis C has well documented cutaneous adverse effects. Most interesting of these has been reported on hair physiology. This study was conducted to determine the frequency and pattern of adverse effects involving hair in patients receiving combination of interferon alfa 2a and ribavirin for chronic hepatitis C. The study was conducted in Department of Dermatology, Division of Medicine Shaikh Zayed Hospital. Thirty Eight patients who completed treatment with interferon alfa 3 MIU subcutaneously thrice weekly] and 1200 mg ribavirin daily for 24 weeks were enrolled in this single-center study. The patient's response and examination finding particularly regarding involvement of hair was noted on a Pro forma. Thirty Two out of thirty eight [84%] patients noted adverse effects involving hair. The most frequent was diffuse hair loss and occurred in 27 patients [71 %]. Hypertrichosis of eyelashes [trichomegaly] and eyebrows [synophyrs] was observed in 18 [47%] and 16 [42%] patients respectively. Graying of hair was noted in 4 patients [11 %], while discoloration of moustache hair was seen in 2 patients [5%]. Epilation at the site of subcutaneous injection was noted in 10 patients [26%]. Alopecia areata was reported in 2 patients [5%]. It is concluded that adverse effects involving hair are frequent and varied [hair loss to excess hair growth] during combination therapy with Interferon alfa-2a and Ribavirin for chronic hepatitis C

Extra intestinal manifestations of irritable bowel syndrome

Objectives: This study was done to assess the frequency of extra intestinal features present in patients with irritable bowel syndrome

Design and place of study: It was an observational study conducted in out-patient Department of Medicine, Shaikh Zayed Hospital, Lahore affiliated with Federal Postgraduate Medical Institute, over a period of two years from January 2005 to December 2006

Subject and methods: The patients fulfilling the Rome II criteria of IBS were included in the study. A check list of extra intestinal symptoms was administered to all the patients

Results: A total of 63 patients were included in the study. There were 41 men and 22 women [male to female ratio of 1.86: I] with the age range from 18 to 61 years [mean of 33 .09 +/- 8.5 SD]. The mean duration of disease was 2.78 years. Urinary symptoms like frequency and urgency were present in almost one third of patients. These symptoms were more frequent in men [47%] than in women [33%]. The most common non-specific pain was chronic headache [62%] followed by fibromyalgia [43%] and non-specific chest pain [37%] of all cases. All of these non-specific pain symptoms were more common in women. Dysmenorrhoea [45%] was the commonest genitourinary symptom in women while impotence and premature ejaculation each were seen in 7% of men. As a group sexual and genital symptoms were more common in women than men

Conclusion: Majority of the IBS patients along with intestinal symptoms also suffers from extra intestinal complaints. Therefore, these patients should be actively screened for the presence of these extra intestinal complaints so that a timely multidisciplinary intervention may prevent further prolongation of their misery

Extensive gastrointestinal involvement in Behcet's syndrome - a case report

Behcet's syndrome is a relatively rare entity, originally characterized by a diagnostic triad of oral and genital ulceration with ocular abnormalities. Since the syndrome was described in 1937 by Behcet, a Turkish dermatologist, many papers have described multisystemic involvement in the disease. Recognized clinical features include arthritis, arterial thrombosis, encephalitis, cardiomyopathy, erythema nodosum, amyloidosis, g!omerulonephritis, and pneumonitis. We report here a case of Behcet's syndrome in 29 year old male presenting with orogenital as well as colonic ulcers

Superficial chemical peeling with glycolic acid in melasma

Melasma is an acquired hyperpigmentation of exposed parts of face and neck, for which various treatment options are available. Chemical peeling is an established treatment modality for melasma. The aim of this study was to assess the safety and efficacy of glycolic acid peel in our patients with melasma where the predominant Fitzpatrick skin type is IV and V. A prospective therapeutic trial was carried out in the Department of Dermatology, Mayo Hospital Lahore Pakistan from May 1 999 to February 2000.Twenty adult females [age range 18-38 years] with melasma [epidermal n=1 5, mixed n=3, dermal n=2] were enrolled. Trial was conducted as a series of six fortnightly hospital-based peeling sessions with increasing concentration of glycolic acid [20%-50%], and nightly application of tretinoin, 5% glycolic acid and 2% hydroquinone. Patients were followed up for a period of two months after completion of treatment. The mean pre-peel and post-peel melasma area and severity index [MASI] scores were 16.56 and 3.8 respectively, showing a significant reduction of about 75% [p < 0.05]. Among the two clinical patterns seen in our patients, malar distribution responded better as compared to the centrofacial. Mild and reversible complications noted were erythema [90%], peeling [70%], crusting [55%], post-inflammatory hyperpigmentation [20%] and moist maceration [10%]. Superficial chemical peeling with glycolic acid is safe and effective treatment modality for melasma in our population