Quality of life assessment in patients of psoriasis

Objective To determine the impact of psoriasis on quality of life [QoL] using Dermatology Life Quality Index [DLQI] in patients of psoriasis presenting in a tertiary care setting

Methods An observational study was carried out at Department of Dermatology, King Edward Medical University/ Mayo Hospital, Lahore from May 2013 till November 2013. A total of 200 patients compatible with inclusion criteria were enrolled after taking informed consent and were asked to fill DLQI questionnaires

Results Out of 200 patients, there were 107 males and 93 females. The mean age was 34.89+/-14.96 years while the mean DLQI score was 11.51+/-4.81. There were 58 [29 percent] married and 142 [71 percent] unmarried patients in the present study. Patients with moderate psoriasis were 184 with PASI score 40-60 and mean DLQI score 11.14+/-4.55 whereas 16 patients had severe psoriasis with PASI score 60-72 and mean DLQI score 15.8+/-5.68. The maximum mean DLQI score was highest for question 10 [treatment] followed by question 1 and 2 [symptoms and feelings]

Conclusion Psoriasis is a serious condition and is associated with significantly lower quality of life regardless of age, gender, duration and severity of disease or marital status

Atypical presentations of cutaneous leishmaniasis: a case series

Cutaneous leishmaniasis [CL] is endemic in many areas of Pakistan. The typical clinical presentations of cutaneous leishmaniasis are papulonodular, plaque and ulcer but certain atypical types have also been reported worldwide. Here, we describe eleven patients with uncommon lesions that were difficult to recognize clinically as CL and the diagnosis of CL was made on histopathology. Out of 11 patients, there were 9 males and 2 females. The commonly affected sites were face [55%], upper limbs [36%] and lower limbs [9%]. The morphological patterns noted were lupoid [5], sporotrichoid [2], eczematous [2], furuncle-like [1] and tinea faciei-like [1]

Chromoblastomycosis with skeletal involvement: a case report

Chromoblastomycosis is a chronic cutaneous and subcutaneous infection of tropical and subtropical climates, caused by dematiaceous [black pigmented] fungi. Infection is thought to be secondary to trauma or autoinoculation. It rarely involves other organ systems of the body especially underlying bones. Many cases with similar and additional features have been reported. We describe one case of this infection in a 20-year-old female with skeletal changes along with review of literature

Skin and sports

This review focuses on conditions associated with sports, which directly or indirectly affect athletes' health and their performances during competitions. These include wide spectrum of dermatoses ranging from infections, frictional and trauma induced dermatoses, UV light and performance enhancing drugs related problems

Quality of life in patients of hirsutism

To determine the impact of hirsutism on quality of life [QoL] using Dermatology Life Quality Index [DLQI] in female patients. An observational study was carried out at the Department of Dermatology, King Edward Medical University/ Mayo Hospital, Lahore from March 1, 2012 to August 31, 2012. A total of 200 female patients suffering from hirsutism, of any severity, with age 16 years or above who themselves were able to understand and fill the DLQI questionnaire in Urdu version, were enrolled in our study. Using the DLQI questionnaire consisting of ten questions, patients were asked to score on a scale from 0-3 for each of ten items. The data were analyzed after compiling the results. The higher the DLQI score, the poorer was the QoL. Mean age of the patients was 26.12 +/- 5.83 years. Mean DLQI score of all patients was 17.9 +/- 5.78. The findings indicated several areas where hirsutism had an impact on individual's QoL, particularly in relation to symptoms and feelings, daily activities and personal relationships. Patients with moderate hirsutism and severe hirsutism had mean DLQI score of 18.2 +/- 5.57 and 17.88 +/- 5.74 respectively. Mean DLQI scores were highest for Q2 [symptoms and feelings]. Hirsutism causes a 'very large effect' on patients' quality of life. Impairment of QoL is greater in female patients irrespective of marital status and severity [either moderate or severe] of hirsutism. Longer duration of disease leads to poorer quality of life.

Lamellar Ichthyosis with rickets

Lamellar ichthyosis [LI] is a rare genetic disorder with autosomal recessive inheritance. It is equally seen in both sexes and usually manifests at birth. The child presents as a collodion baby. The erythema is minimal or absent; but when present, it is maximum on the face. The scaling is generalized, accentuated on lower extremities and flexural areas. Rickets is a condition in which there is softening of bones leading to fractures and deformities. It is caused by vitamin D deficiency and lack of adequate calcium in diet. Children, 6 to 24 months of age, are at a higher risk due to rapidly growing bones. The association between various types of ichthyoses and rickets is well documented. We report a case of lamellar ichthyosis with rickets in a 14-year-old girl from our part of the world

Quality of life in patients of melasma

To determine the impact of melasma on quality of life [QoL] using Dermatology Life Quality Index [DLQI] in our patients. An observational study was carried out at the Department of Dermatology, King Edward Medical University/ Mayo Hospital, Lahore from December 12, 2009 to June 11, 2010. A total of 100 patients suffering from melasma, of any severity, with age 16 years or above, belonging to either sex, who themselves were able to understand and fill the DLQI questionnaire in English or Urdu version, were enrolled in the study. Using the DLQI questionnaire, consisting of 10 questions, patients were asked to score on a scale from 0-3 for each of 10 items. The data were analyzed after compiling the results. The higher the DLQI score, the poorer is the QoL. Mean age of the patients was 29.90 +/- 7.18 years. There were 82 [82%] female and 18 [18%] male patients. The mean DLQI score of all patients was 17.08 +/- 5.22. The findings indicate several areas in which melasma had an impact on individual's QoL, particularly in relation to symptoms and feelings and personal relationships. Women reported poorer QoL compared to men. Mean DLQI score was 16.00 +/- 4.93 in males and 17.32 +/- 5.28 in females. Patients with mild, moderate and severe disease had mean DLQI scores of 16.23 +/- 5.35, 19.32 +/- 3.99 and 22.0 +/- 2.0, respectively. Melasma causes a "very large effect" on patients' quality of life. Impairment of QoL is greater in females and patients with severe disease

effect of oral doxycycline and topical 5% benzoyl peroxide on quality of life in patients with mild to moderate acne vulgaris

The purpose of the study was to determine the impact of mild to moderate acne vulgaris on quality of life [QoL] and to assess the effect of oral doxycycline and topical 5% benzoyl peroxide treatment on QoL. One hundred patients, of either sex, suffering from mild to moderate acne vulgaris, were asked to fill the Dermatology Life Quality Index [DLQI] pro forma [Urdu and English version] independently before starting the treatment. The total score ranged from 0-30. The higher the score, the greater was the impact on QoL. All the patients were subjected to oral doxycycline 100 mg daily and were asked to apply 5% benzoyl peroxide once daily. Patients used these medicines for a period of three months, after which they were again asked to fill the DLQI pro forma. The data were analyzed after compiling the results. The results of 100 patients, who completed the study, were compiled. The mean age of patients was 20.45 +/- 3.27 years. Among 20 male patients, 8 suffered from grade 1 and 12 from grade 2 acne. Among 80 female patients, 9 suffered from grade 1 and 71 from grade 2 [p=0.012], showing a significant association between grading of acne with respect to gender of the patient. The disease was notably severe among females. Duration and progression of disease showed no significant effect on QoL. Before treatment, the mean DLQI score for females was 14.05 +/- 6.32 with minimum score of 1 and maximum score of 25. The mean score for male patients was 12.63 +/- 6.46 with minimum score of 1 and maximum of 26, showing that QoL is worse among females as compared to males. The mean pretreatment score was 12.92 +/- 6.43. The score dropped to 5.34 +/- 3.14 [p=0.000] after treatment showing that there is a significant improvement in quality of life of these patients. The study shows that mild to moderate acne vulgaris has a very large effect on the quality of life of our patients with significant psychosocial limitations. The combination treatment of oral doxycycline and topical 5% benzoyl peroxide significantly improves the quality of life in acne patients

Lupus miliaris disseminatus faciei: a case report

Lupus miliaris disseminatus faciei is an uncommon, chronic, inflammatory dermatoses characterized by multiple, monomorphic, symmetrical, reddish-brown papules on chin, forehead, cheeks and eyelids that show a characteristic granulomatous histology. Lesions may cluster around the mouth and eyes or may be widely disseminated on the face. The exact pathogenesis is unknown. Tuberculin test is usually negative. Active disease generally lasts for 1-3 years and resolves spontaneously. We report a case of this disorder along with review of literature

clinicoetiological study of Stevens-Johnson syndrome and toxic epidermal necrolysis

To present the pattern of morbidity associated complications, and causative factors in individual cases of Stevens-Johnson syndrome [SJS]/toxic epidermal necrolysis [TEN]. Patients and methods This case series descriptive study, using a convenience sampling technique, was carried out in the In-patients department of Dermatology Unit I, Mayo Hospital, King Edward Medical University, Lahore from January 2007 to September 2008. Thirty clinically diagnosed patients, suffering from SJS/TEN, fulfilling the inclusion criteria were included in the study. Patients' demographic data, symptoms, signs and any relevant investigations were recorded and scored. Using an appropriately designed pro forma, symptoms/ and signs were categorized into thirteen variables. The severity of each variable was scored froml-3 [total score range 13 to 39]. An association of these variables with patient outcome, in terms of either discharge from hospital or death, was calculated. Pain and gastrointestinal involvement were seen in all 30 [100%] patients. Mortality was found to be 13.3% and was significantly associated with infection, total morbidity score, area of epidermal involvement and respiratory system involvement. Similarly development of wound infection, area of epidermal involvement, fever and total score significantly affected the duration of hospital stay. While the causative drug/s remained unknown in 26.7% cases the most common identifiable drug was trimethoprim-sulphamethoxazole, causing disease in 13.3%. Conclusions Mortality in cases of SJS/TEN showed significant association with wound infection, area of skin involvement, total morbidity score and respiratory system involvement

Pattern of drug eruptions in a tertiary care hospital

An adverse drug reaction is unintentional which occurs at doses used for prophylaxis, diagnosis or treatment. To determine the frequency of various cutaneous drug eruptions that occur in patients in a tertiary care hospital setting. All patients with cutaneous drug eruptions seen at the Dermatology Department of Mayo Hospital, Lahore, over 6 months were enrolled and the pattern of drug eruptions like urticaria, angioedema, fixed drug eruption, maculopapular rash, erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis etc. were recorded, along with drugs that caused it. A total of 160 patients [86 males, 74 females] were included in the study. Mean age of patients was 30.7 +/- 15.4 years. Major eruptions were fixed drug eruption [21.3%] followed by urticaria without angioedema [10%], maculopapular rash [9.3%], lichenoid drug eruption [8.7%], acneiform drug eruption [7.5%], Stevens-Johnson syndrome [6.9%], vesiculobullous eruption [5.6%], erythema multiforme and eczematous eruption [5% each]. Common drugs causing eruptions were sulfonamides [16.3%], followed by NSAIDs [14.4%], herbal and homeopathic medications [12.5%], penicillins [9.3%], tetracyclines [8.7%], antituberculous drugs, cephalosporins and antiepileptics [6.3% each]. Fixed drug eruption and urticaria without angioedema were commonest eruptions while, sulfonamides and NSAIDs were the major causative drugs. Reporting of adverse drug reactions is not done in Pakistan and needs to be done in each hospital

Role of estrogen, progesterone and prolactin in the etiopathogenesis of melasma in females

Melasma is a commonly acquired hypermelanosis of facial skin due to various etiological factors including hormonal imbalance. To find out the relationship between hormonal imbalance and melasma in females. One hundred and fifty female patients suffering from melasma, between the ages of 17-45 years, were enrolled in the study. They were examined by Wood's lamp to see the type of melasma whether epidermal, dermal or mixed [dermoepidermal]. Patients were investigated for levels of estrogen, progesterone and prolactin in two consecutive follicular and luteal phases on 9[th] and 18[th] day of cycle, respectively. Forty control cases were also investigated for the aforementioned hormonal levels in their follicular and luteal phases. Out of 150 patients, 138 completed the study while 12 patients were lost to follow up. Amongst the 138 evaluable patients, there were only 4 patients who had normal values for all the three hormones i.e. estrogen, progesterone and prolactin in all four phases. Fifteen patients [10.9%] had normal values of estrogen in both follicular [Fl and F2] and luteal phases [LI and L2] while the remaining 123 patients [89.1%] had deranged values of estrogen [mostly increased] in any of the four phases. The values of progesterone were normal in 62 [44.9%] patients while they were deranged in 76 [55.1%] patients in all four phases. The levels of prolactin were normal in 134 [97.1%] patients while deranged in 4 [2.9%]. Out of 40 controls, only 3 [7.5%] had increased values of estrogen in both follicular and luteal phases. Estrogen is found to be the causative agent of melasma

Scrofuloderma: a common type of cutaneous tuberculosis. A case report

Scrofuloderma is a common type of cutaneous tuberculosis characterized by a bluish-red nodule overlying an infected lymph gland, bone or joint that breaks down to form an undermined ulcer with a granulating tissue at the base. Progression of the disease leads to irregular adherent masses, densely fibrous at some places while fluctuant and discharging at others. It heals with a characteristic puckered scarring at the site of infection. The disease is caused by Mycobacterium tuberculosis and common anti-tuberculous drugs are recommended for treatment. Many similar cases with additional features have been reported in foreign literature. We describe a case of this disorder along with review of literature

Dermatologic manifestations in patients of renal disease on hemodialysis

Chronic renal failure [CRF] is recognized as a significant medical problem in our part of the world. It refers to an irreversible deterioration in renal function which classically develops over a period of years. The disorder has five stages and the stage 5, also called end stage renal failure [ESRF], is a severe illness and requires some form of renal replacement therapy [dialysis or renal transplant]. Cutaneous and mucosal changes are a common finding in patients of ESRF and on long-term hemodialysis and can vary from each patient population to another. The commonly seen dermatologic manifestations associated with ESRF are xerosis, pruritus, pallor, fungal, bacterial and viral infections, xerostomia, scalp hair loss, nail changes like half-and-half nails and splinter hemorrhages. The cutaneous manifestations related to hemodialysis are skin infections, arteriovenous shunt dermatitis, gynecomastia, bullous disease of dialysis etc. The present review does not highlight cutaneous changes of diseases associated with the development of ESRF but it familiarizes clinicians about the dermatologic changes in patients with chronic renal failure [CRF] undergoing hemodialysis

Successful treatment of proximal white subungual onychomycosis with oral terbinafine therapy

Proximal white subungual onychomycosis [PWSO] is a rare form of onychomycosis of both fingernails and toenails. It occurs when the fungus invades the stratum corneum of the proximal nailfold followed by infection of the deeper parts of the nail plate. The surface of the overlying nail is usually normal. A case of PWSO is described with complete cure by the use of oral terbinafine 250 mg/day for 3 months continuously

Food and skin

Food is essential to keep our body healthy and in perfect harmony. The relationship between food and skin is diverse. Food can help to cure certain skin disorders but it can also trigger or aggravate various other dermatoses. This article highlights the role of different food items in dermatological disorders under various headings

Chromoblastomycosis: an unusual cutaneous dematiaceous fungal infection

Chromoblastomycosis is a chronic fungal infection with a slow evolution, caused by dematiaceous fungi inducing skin lesions being difficult to treat and have frequent recurrences. The clinicopathological features and diagnosis of one such case is reported here to share our experience with others. A nine years old male with a three years history of a slowly spreading painless skin lesion involving the whole of right cheek and nose. The patient gave a typical history of trauma in that region followed by a dark red skin eruption, which gradually grew to form erythematous papule. Physical examination revealed large hyperkeratotic, raised, thick crusted, verrucous plaques with areas of scaring and ulceration on the right cheek and nose extending down in a tumorous fashion. A small scaly lesion was observed next to the right eyebrow. However, the borders of the lesion were well defined and the surrounding skin was normal. No lymphadenopathy was seen

Itraconazole pulse therapy in the treatment of disto-lateral subungual onychomycosis

To assess the efficacy of itraconazole pulse therapy in disto-lateral subungual onychomycosis. Design: Quasi interventional study. Place and Duration of Study: The study was conducted at the Department of Dermatology, KEMC/Mayo Hospital, Lahore, during the period from 1996-1998. Subjects and Sixty-seven patients, ages ranging from 19 to 55 years, with disto-lateral subungual onychomycosis were enrolled in the study period. Therapy was started with short pulse doses of itraconazole 200 mg twice daily for one week followed by a medicine-free interval of three weeks. Pulses were administered for two consecutive months in fingernail and three months for toenail onychomycosis. Patients were followed upto six months for fingernail onychomycosis and nine months for toenail onychomycosis. Out of 67 cases, there were 62 evaluable patients. Trichophyton rubrum was the most common pathogen, isolated in 42 [67.8%] followed by Candida in 11 [17.8%], T. violaceum in 5 [8%], T. interdigitale in 3 [4.8%] and Epidermophyton floccosum in one [1.6%]. Fingernails were affected in 46 cases whereas 16 had toenail infection. Clinical cure in finger and toenail onychomycosis was seen in 41 [89%] and 13 [81.2%] patients, respectively while mycological cure in 43 [93.5%] and 14 [87.5%] patients, respectively with itraconazole pulse therapy. Itraconazole was found to be effective, well-tolerated and safe therapy for disto-lateral subungual onychomycosis