Frequency of pityriasis versicolor in patients with uncontrolled type 2 diabetes attending a tertiary care hospital

INTRODUCTION: Pityriasis versicolor is seen frequently in patients with uncontrolled diabetes mellitus

OBJECTIVE: The study was aimed to determine frequency of Pityriasis versicolor in patients with type 2 uncontrolled diabetes in a tertiary care hospital

STUDY DESIGN: Cross-sectional study

SETTING: Department of Dermatology, Civil Hospital Karachi and Department of Dermatology, Ziauddin University, Karachi

DURATION OF STUDY: Duration of study was 6 months from 1[st] May 2010 to 31[st] October 2010

SUBJECTS AND METHODS: Patients aged 40 to 70 years belonging to both sexes with uncontrolled diabetes mellitus of duration more than 5 years were included after an informed consent. Patients taking corticosteroid or immunosuppressive drugs or having any other co morbidity were excluded. Selected patients were examined with magnifying glass and wood's lamp. The diagnosis was confirmed by KOH smear, microscopy and Wood's lamp examination. The findings were recorded on a proforma. All the findings were compiled, tabulated and analyzed

RESULTS: 119 patients were included in the study comprising 68 males [57%] and 51 females [43%]. Patients aged 40 to 70 years, with the mean age of 51.3 years were studied in three age groups i.e. 40-50 years, 51-60 years and >60 years. Majority of patients [57%] belonged to the age group 40-50 years. The duration of diabetes was 5-10 years in maximum number of patients i.e. 72. Among these patients 5 [4.2%] had tinea versicolor comprising 3 males [60%] and 2 females [40%]. Three of these patients had diabetes for 5-10 years and 2 had the same for 11-15 years. 2 patients [40%] aged 40-50 years, 2 [40%] 51-60 years and remaining 1 patient aged between 61-70 years [20%]

CONCLUSION: It can be concluded from the above study that Pityriasis versicolor is not seen commonly in patients with diabetes mellitus

Frequency of specific dermatoses of pregnancy in a tertiary care hospital

To assess the frequency of specific dermatoses of pregnancy in a tertiary care hospital. This cross sectional study was conducted on patients attending outpatient department of Dermatology, civil hospital, Karachi referred from the outpatient department of gynecology and obstetrics spanning, 1[st] May 2006 till 31[st] August 2006. Pregnant females of different age groups, both primigravida and multigravida fulfilling the selection criteria were enrolled. After an informed consent, selected patients were subjected to a detailed history and clinical examination. Diagnosis of the diseases was made clinically and relevant investigations were carried out where required. 100 patients, comprising 32 primigravida [32%] and 68 multigravida [68%], diagnosed as suffering from specific dermatoses of pregnancy completed the study. Minimum age of presentation was 20 years and maximum 44 years the mean age being 32 +/- 6.8 years. Prurigo of pregnancy [96%] was the most common dermatoses seen followed by pruritic folliculitis of pregnancy [2%], herpes gestationis [1%] and polymorphic eruption of pregnancy [1%]. Amongst 96 patients [96%] suffering from prurigo of pregnancy, there were 28 primigravida [29%] and 68 multigravida [71%]. Both the primigravida with pruritic folliculitis of pregnancy presented one each in the 2[nd] and 3[rd] trimester. Patients suffering from herpes gestationis and polymorphic eruption of pregnancy [PUPP] were primigravida presenting in 2[nd] trimester. Specific dermatoses of pregnancy can present in any trimester. Prurigo of pregnancy remains the most common disorder followed by pruritic folliculitis of pregnancy.

Frequency of oral lichen planus in patients with noninsulin dependent diabetes mellitus

The association between diabetes mellitus and lichen planus [LP], especially oral lichen planus, has been the subject of much research but the conclusion is controversial. The reported frequency of oral LP in diabetes mellitus varies from 1.6% to 85%. To determine the frequency of oral lichen planus in patients with noninsulin dependent diabetes mellitus as compared with normal subjects. Freshly registered cases of noninsulin-dependent diabetes mellitus with suspected lesions of oral lichen planus, fulfilling the selection criteria, belonging to both sexes, aged 40-70 years were enrolled. After an informed consent, enrolled patients were examined following a detailed history and were subjected to biopsy and histopathology. Any relevant investigations were performed where required. An equal number of age- and sex-matched controls were also studied for oral LP. 86 patients comprising 49 [57%] females and 37 [43%] males, aged 40 to 70 years, mean age being 51.3 years, were studied in three age groups i.e. 40-50 years, 51-60 years and >60 years. Among these patients 8 [6.9%] had histopathologically confirmed oral lichen planus [P<0.05]. Only 1 [1.2%] subject from the control group had the histopathologically confirmed disease. There were 5 females [62.5%] and 3 males [37.5%]. Buccal mucosa was involved in 7 patients [87.5%]. Oral lichen planus has a significant association with noninsulin dependent diabetes mellitus as compared to normal population

Frequency and magnitude of anxiety and depression in patients with Psoriasis vulgaris

To determine the frequency of anxiety and depression in patients with psoriasis. Cross-sectional study. Outpatient Departments of Dermatology and Psychiatry, Ziauddin University Hospital, KDLB Campus, Karachi, from October 2005 to September 2006. All patients presenting with psoriasis vulgaris above the age of 15 years, of either gender, fulfilling the selection criteria were included in the study. Clinical diagnosis was confirmed by biopsy and histopathology. Documentation of disease severity as mild, moderate and severe was done, using Psoriasis Area Severity Index [PASI], Patients were asked to fill "AKUADS" for their psychiatric assessment and scoring was done on this basis. Patients scoring equal to or above 19 were labeled as having anxiety or depression. There were 56 males [62%] and 33 females [38%], aged 20 to 65 years in the study. Out of those, 52 [58%] were married; while 37 [42%] were unmarried. The minimum duration of illness was 6 months and maximum 15 years. Thirty-four patients [38%] were suffering from mild disease, 31 [35%] from moderate and the remaining 24 [27%] from severe psoriasis. Twenty-four [27%] were on topical therapy while the other 65 [73%] were receiving systemic as well as topical therapy. Joint involvement was seen in 25 patients [28%] and nail changes in 31 [35%]. Psychiatric illness was positive in 34 patients [38%, p<0.05] i.e. 20 males [59%] and 14 females [41%]. Twenty-six patients [76%] were married [p<0.05]. Anxiety and depression was seen irrespective of the disease duration. The mean "AKUADS" scores in accordance with disease severity were mild psoriasis 20, moderate psoriasis 22 and severe psoriasis 25. Twenty-one patients [62%, p=0.05] with joint involvement and another 23 [68%, p<0.05] with nail involvement had a score above 19. Thirty-one patients [91%] were receiving systemic as well as local therapy, while 3 patients [9%] were on topical treatment [p<0.05]. There is an association of psoriasis vulgaris with anxiety and depression. The magnitude of this anxiety and depression can be influenced by variables of disease and life

Frequency and pattern of psychiatric disorders in patients with Vitiligo

Vitiligo affects one to four percent of the population, regardless of age, race or sex. People with this disorder may experience emotional stress, particularly if vitiligo develops on visible areas of the body, such as face, hands, arms, feet, or on the genitals. Some feel embarrassed, ashamed, depressed, or worried about how others will react. Severel indices have been used from time to time to measure the extent of psychiatric disabilty caused by skin disorders. Regarding vitiligo, not much work has been done in Pakistan. This study was aimed to determine the frequency and pattern of psychiatric disorders amongst patients with vitiligo. This cross sectional study was conducted in the Departments of Psychiatry and Dermatology, Ziauddin University, KDLB campus, Karachi and Institute of Surgery and Medicine, Karachi from April 2004 to March 2006. Clinically diagnosed cases of vitiligo, belonging to both sexes, aged above 15 years, fulfilling the inclusion criteria were enrolled in the study. The study was conducted in 2 stages. In the first stage, psychiatric illness was detected with the help of GHQ 12 [Urdu version], a validated tool for screening general population. In the second stage, Psychiatric Assessment Schedule, Urdu version was administrated to every patient with high scores as per GHQ 12 to differentiate between the most frequent psychiatric disorders. All the findings were recorded, compiled and tabulated. A total of 100 patients comprising 62 females and 38 males ranging between 15-60 years with a mean age of 24.6 years completed the study. Exposed parts of the body were involved in 64 patients while covered sites in 36. Of the patients studied, 54 were married and 46 unmarried. In accordance with the GHQ-12 screening, 42 patients were positive for psychiatric caseness comp rising 26 females and 16 males, 17 patients being married. Psychiatric caseness featured in patients below 30 years of age [28 patients] and those having exposed parts of the body being involved [27 patients]. On evaluation with Psychiatric Assessment Schedule [PAS], major depressive illness [15], was the most frequent psychiatric illness followed by generalized anxiety [10], mixed anxiety and depression, social phobia, agarophobia and sexual dysfunction. Psychiatric caseness has a probable association with vitiligo, the frequency being influenced by variables of disease and life. Major depression and anxiety remain the most common psychiatric disorders in these patients

Associations of lichen planus: a study of 63 cases

Lichen planus [LP] is a disease of unknown etiology, but immunopathological mechanisms are implicated in its pathogenesis. Some disorders are associated with LP more frequently than is expected by chance. The study was aimed to determine the frequency of autoimmune disorders associated with lichen planus and to compare our results with international literature. The current study was conducted in the outpatient department of dermatology, Ziauddin Medical University, KDLB Campus, Karachi. Clinically diagnosed cases of lichen planus belonging to both sexes and all age groups fulfilling the inclusion criteria were enrolled. After a detailed history and examination, patients were investigated. The diagnosis was confirmed by biopsy and histopathology. All the findings were recorded, compiled and analyzed. Sixty three patients, 39 males [62%] and 24 females [38%], aged 10 upto 60 yrs were studied. Maximum number of patients [68%] was aged 20-40 yrs. Limbs [47%] were the most common site involved. Following diseases were observed to be associated with lichen planus: HCV 4 [6.3%], diabetes mellitus 4 [6.3%], alopecia areata 3 [4.7%], systemic lupus erythematosus 2 [3%], vitiligo 2 [3%], HBV vaccination 2 [3%], morphea 1 [1.5%], lichen sclerosus et atrophicus 1 [1.5%], chronic active hepatitis 1 [1.5%], dermatomyositis 1 [1.5%] and thyroid disorders 1[1.5%]. Lichen planus, an autoimmune disorder has a frequent association with other autoimmune diseases

Atopic dermatitis: frequency of associated disorders in children

Atopic dermatitis is a chronic inflammatory disease of multifactorial origin. It is the most common type of childhood eczema seen in our community. Most of these patients have a positive family or personal history of atopy in the form of asthma, allergic rhinitis or hay fever. Multiple dermatological disorders are associated with the atopic dermatitis. The study was aimed to see the frequency of these associations in children with atopic dermatitis in our community and to compare these results with international literature. The study was carried out in the department of dermatology, "Ziauddin Medical University, KDLB Campus" from 1[st] September 2003 to 31[st] August 2004. All the freshly registered patients up to 15 years of age suffering from atopic dermatitis were enrolled in the study. The clinical diagnosis was made on the basis of diagnostic criteria for atopic dermatitis described by UK's working party. All the findings were recorded on a preformed pro forma and relevant investigations carried out. Results were compiled and tabulated. The family history of atopy was positive in 78 patients [68.4%] while the personal history of atopy in 48 [42.1%]. Irritant contact reactions were commonly observed in 52 patients [45.6%]. Dry and cold weather exacerbated the disease in 85 patients [74.5%] while 3 patients [2.6%] suffered aggravation in summer. Among endogenous eczemas discoid eczema was seen in 27 patients [30.8%], pityriasis alba in 21 [18.4%], and seborrheic dermatitis in 10 patients [8.8%]. The most common infections were bacterial, seen in 1 2 patients [1 0.5%] followed by viral and fungal infections seen in 9 [7.8%] and 4 patients [3.5%], respectively. Nail changes like pitting, ridging, thickening and discoloration were seen in 7 patients [6.1%]. Other findings observed in our patients were Dennie-Morgan fold in 4 patients [3.5%] and cataract in 5 patients [4.5%]. Atopic dermatitis is associated with multiple conditions. A high percentage of patients have a positive family or personal history of atopy. Environmental factors like weather, irritants and infections cause worsening of the disease. Atopic patients have an increased frequency of other endogenous eczemas and nail and eye changes

Alopecia areata; combination therapy with minoxidil [2%] solution and isotretinoin [0.05%] gel

Alopecia areata is a common cause of nonscarring hair loss. The cause is unknown but it is associated with an alteration in the immunological system. Treatment for alopecia areata includes topical corticosteroids, dithranol, tretinoin, minoxidil, systemic cortisone, PUVA therapy, irritants and immunosuppressive drugs. Our objective was to assess the efficacy of combination of topical 2% minoxidil lotion and isotretinoin [0.05%] gel in the treatment of alopecia areata. From 1[st] October 2003 till 30[th] September 2004, over a period of 1 year, clinically diagnosed, fresh cases of alopecia areata, fulfilling the inclusion criteria were enrolled. All the patients were advised to apply minoxidil [2%] solution in the daytime and isotretinoin [0.05%] gel in the night to avoid photosensitivity. The daily treatment was advised for a period of four months and thereafter every alternate day for another two months as a maintenance therapy. Clinical assessment was carried out by patient's self-assessment, investigator assessment and clinical evaluation on follow up visits. The total number of patients studied was 54 comprising 31 males [57.4%] and 23 females [42.6%], male to female ratio being 1 .3. Twenty-nine patients [53.7%] had three lesions, 18 [33.3%] had two lesions and seven [13%] only one lesion. Complete restoration of hair follicles was noted in 45 [83.3%, p < 0.001] by the end of therapy. All the patients with single patch responded [100%], while 15 patients [83.3%] with 2 lesions recovered completely. Twenty-three patients [79.3%] with 3 lesions had a complete restoration of hair follicles. The combination therapy of minoxidil [2%] solution and isotretinoin [0.05%] gel for alopecia areata is cost effective, stimulating hair regrowth within a shorter interval and is well-tolerated

Adverse effects of systemic isotretinoin therapy: a study of 78 patients

Isotretinoin is an effective treatment for severe forms of acne refractory to other therapies, but it is a teratogen and can cause serious side effects. The side effects, in addition to the constitutional features are related to skin, mucosae, eyes, sexual organs, central nervous system, respiratory system and gastrointestinal tract. Deranged biochemical profile may also be seen in few patients. The current study was aimed to determine the frequency of side effects of systemic isotretinoin therapy in patients treated for acne, thereby assessing its safety. During the calendar year 2004, all the acne patients attending the outpatient department of dermatology, Ziauddin Medical University, KDLB campus, Karachi, fulfilling the inclusion criteria, managed on systemic isotretinoin were enrolled. All were taking isotretinoin at a dose of 0.5mg/kg body weight daily. Baseline investigations were performed in all the patients i.e. liver function tests, lipid profile, complete blood picture and renal function tests. They were followed up for any side effects and clinical improvement. The baseline investigations were repeated monthly to see any biochemical and hematological derangements. 78 patients, 42 females [53.8%] and 36 males [46.2%], with ages ranging from 18 to 24 years, were enrolled. 72 patients [92.2%, p<0.001] developed side effects with a variable frequency of at least one feature in each of these subjects. The side effects, in addition to the constitutional features, observed were related to skin [87.2%], mucosae [10.3%], central nervous system [5.2%], eyes [3.8%], reproductive organs [2.6%], respiratory system [1.3%] and gastrointestinal tract [1.3%]. Deranged biochemical profile was also a feature in few patients [6.3%]. The majority of the patients on systemic isotretinoin have side effects, the most common being cutaneous and mucosal but are trivial. Side effects pertaining to the other systems are less frequent

Fluconazole pulse therapy: effect on inflammatory tinea capitis [kerion and agminate folliculitis]

Tinea capitis, a fungal infection of scalp hair, can be caused by any species of either Trichophyton or Microsporum genera. It requires systemic antimycotic therapy. Griseofulvin is the only FDA approved drug for the treatment of this dermatophyte infection. Fluconazole pulse therapy is cost effective in tinea capitis. The study was aimed to assess the efficacy of fluconazole pulse therapy in patients with inflammatory [kerion and agminate folliculitis] tinea capitis and to study fluconazole as an alternative therapy to griseofulvin. Patients and methods The open clinical trial was carried out in the outpatient department of "Baqai Institute Skin Diseases", Baqai Medical University, Karachi and Ziauddin Medical University, Karachi, from 1st February, 2003 till 31st January, 2004 over a period of 1 year. Clinically suspected cases of tinea capitis, suffering from inflammatory lesions [kerion and agminate folliculitis], were included in the study. Specimens were taken from the affected scalp along with hair for light microscopy and subsequent inoculation onto Sabouraud's media for fungal culture. All the mycologically confirmed patients fulfilling the inclusion criteria were given weekly oral pulses of fluconazole, 150mg for a period of 6 weeks. The patients were followed up weekly, during therapy and then fortnightly to look for clinical improvement as well as any side effects for a period of 16 weeks [10 weeks after completion of the therapy]. The clinical signs [erythema, scaling, edema, pustules, pruritus and hair loss] were assessed on four-point scale graded from 0-3 [0= absent, 1= mild, 2= moderate, 3 = severe]. Results Of the 16 patients [kerion and agminate folliculitis] completing the study, there were 9 [56.3%] males and 7 [43.7%] females, the age range being 7-14 years. The clinical findings included erythema, scaling, edema, pustules, pruritus and hair loss. Fungal culture revealed Microsporum canis in all patients. Clinical improvement was apparent by the end of 3rd week of therapy. Regrowth of hair was evident by the end of 10th week and progressed slowly by the end of follow up period i.e. 16th week. Clinical cure rate was 69% and mycological cure rate 81.2% by the end of 6th week. At the end of 10th week, the clinical and mycological cure rates were 75% and 87.5%, respectively. At final evaluation, the relevant cure rates were 93.5% and 100%, respectively. Intermittent short duration therapy with fluconazole is effective for the inflammatory types [kerion and agminate folliculitis] of tinea capitis