Efficacy of clarithromycin in pityriasis rosea

To determine the efficacy of clarithromycin in the treatment of Pityriasis Rosea [PR]. Double blind randomized controlled trial. Dermatology OPD, Military Hospital, Rawalpindi, from July 2008 to July 2009. Patients aged above 10 years, diagnosed with PR, were randomly assigned to two groups of 30 each to receive either clarithromycin or similar-looking placebo for one week. Neither the patient nor the treating physician knew to which group the patient belonged. Patients were assessed at 1, 2, 4 and 6 weeks after presentation and compared for complete, partial or no response. Among the 60 patients, no significant difference was found between the two groups at 2 weeks after presentation [p = 0.598]. In the placebo group, complete response was seen in 20 [66.7%], partial response in 3 [10.0%] while no response was seen in 7 [23.3%]. In clarithromycin group, there was complete response in 23 [76.7%], partial response in 3 [10.0%] and no response in 4 [13.3%] patients. Clarithromycin is not effective in treatment of pityriasis rosea

Clinical audit of national institute of clinical excellence [NICE] technology appraisal guidance [TAG] 81 and 82/clinical guidelines [CG57] on atopic eczema in children

To find out how far our current practice complies with the NICE guidelines and to identify any areas in which improvement is needed Patients and methods The audit sample consists of 50 patients. The inclusion criteria include children from birth up to the age of 12 years and diagnosed with atopic eczema 100% patients [n=50] in this audit were treated with topical corticosteroids. 100% cases [n=50] were treated in accordance with NICE recommendations. The drug with lowest acquisition cost was prescribed in 31 [62%] cases. None of the 50 patients was prescribed either tacrolimus or pimecrolimus. The patients in this audit tended to be young. All patients had either mild to moderate eczema with no cases with severe eczema. All patients responded to treatment regimen comprising topical steroids with none requiring topical calcineurin inhibitors i.e. tacrolimus and pimecrolimus

Frequency of HCV infection in different dermatological disorders

Hepatitis C Virus [HCV] has estimated affected nearly 3% of the world population. Studies in Pakistan have shown a somewhat higher prevalence. The objective of this study was to determine the frequency of hepatitis C virus infection in patients with dermatological disorders, known to be associated with HCV infection. This was a descriptive study, conducted at Departments of Dermatology, Military Hospital, Rawalpindi and PNS Shifa, Karachi from September 2003 to November 2005. There were 355 patients of the dermatologic disorders mentioned above. HCV status was determined by the presence of anti-HCV antibodies in the serum, by third generation ELISA. In this study 14% of lichen planus, 8% of generalised pruritus, 7.8% of urticaria, 8.7% of prurigo, and 50% of porphyria cutanea tarda patients had underlying HCV infection. None of the patients of leukocytoclastic vasculitis, erythema multiforme or erythema nodosum had anti-HCV antibodies. No patient of mixed cryoglobulinaemia or polyarteritis nodosa was seen during the study period. Patients of lichen planus, generalised pruritus, urticaria, prurigo, and porphyria cutanea tarda have increased frequency of HCV infection compared to normal population of our country. In contrast, none of the patients of leukocytoclastic vasculitis, erythema multiforme or erythema nodosum had HCV infection.

Diagnostic accuracy of plain potassium hydroxide mount and culture in tinea pedis

To determine the diagnostic accuracy of direct microscopy in clinically diagnosed cases of tinea pedis by keeping culture as gold standard. validation study. Department of Dermatology Military Hospital and Armed Forces Institute of Pathology Rawalpindi from January 2008 to July 2008. One hundred clinically diagnosed cases of tinea pedis were subjected to direct microscopy with 10% KOH and fungal culture. Direct microscopic examination was positive in 34% and culture in 60% of the cases. The sensitivity and specificity of direct microscopy were 38.33% and 72.5%, respectively keeping culture as gold standard. Direct microscopy had a positive predictive value of 67.65% and negative predictive value of 43.94%.Direct microscopy with 10% KOH may not be sufficient alone therefore cultures should be used for a definitive diagnosis

Secondary Syphilis mimicking palmoplantar pustular Psoriasis: an unusual clinical presentation

A 38 year old Pakistani man presented with multiple, red, raised, pustular and scaly asymptomatic lesions on the palms and soles of 3 months duration. His past medical history was unremarkable. On physical examination he had multiple, symmetrically distributed erythematous plaques with well-delineated margins surmounted by pustules and scales on the palms and soles. There was paronychia around the fingernails involving nearly all the digits of the hands. Detailed examination also revealed hyperkeratotic lesions in the beard area, skin coloured papules concentrated around the nostrils and the angles of the mouth. There were mucous patches on the tongue and inner aspect of lips. Anogenital examination showed perianal condylomas with no genital erosion, ulceration or old scar mark. His vital signs were within normal limits and systemic examination did not reveal any abnormality. Biopsy finding from a scaly, erythematous plaque was consistent with syphilis i.e. perivascular infiltrate of lymphocytes and plasma cells with endarteritis obliterans. The second specimen from a pustular lesion showed localized epidermal accumulation of numerous neutrophils, lymphocytes and karyorrhectic debris. There was some overlying hyperkeratosis and parakeratosis alongwith lengthening of rete ridges with dilated, tortuous dermal capillaries. This picture was consistent with pustular psoriasis. The patient`s venereal disease research laboratory [VDRL] test and trepenoma pallidus h aemogbulination [TPHA] were positive in titers of 1:16 and 1:320 respectively. She was found to have mucous patches in the mouth and had positive serology for syphilis. Both husband and wife were treated with injection Benzyl Penicillin 10 lacs I.0 i.v 6 hourly for 2 weeks and they responded well to treatment. They were advised 3 monthly follow-up in the first year and then at 18th and 24th months. Six months after treatment the patient was symptom-free with a positive VDRL in a low titre of 1:2

Efficacy and safety of oral dexamethasone pulse treatment for vitiligo

Results of previous studies on efficacy and safety of oral corticosteroid pulse treatment for vitiligo are inconsistent. The objective of this study was to assess the efficacy and safety of oral dexamethasone pulse treatment in a cohort of Pakistani patients. This is a descriptive study. Thirty patients with vitiligo were included in the study. Of these, 21 had progressive disease and 9 had stable disease. The patients were given weekly pulses of dexamethasone on 2 consecutive days every week followed by 5 days off treatment for a maximum of 24 weeks. Clinical response and side effects were evaluated at monthly intervals. Plasma cortisol levels were also monitored. After a mean treatment period of 16 + 4 weeks, progression was arrested in 18 [85.7%] of 21 patients with active vitiligo before the study. Overall, repigmentation was noted in 14 [46.6%] patients at the end of 24 weeks. The extent of repigmentation varied from less than 25% [slight] to 51% to 75% [marked]. Twenty [66.6%] patients reported one or more side effects. Plasma cortisol values were markedly decreased 24 hours after the second dose of each pulse but returned to baseline before the next dexamethasone pulse. Oral corticosteroid pulse therapy is an effective treatment modality to arrest progressive vitiligo but is only moderately effective in inducing satisfactory repigmentation. Treatment associated side effects are frequent but reversible; however, sustained suppression of endogenous cortisol production does not occur with pulse regimen

Superficial facial chemical peeling as a treatment modality in Melasma

Melasma is a common disorder of great psychosocial concern in our population and response to various treatment modalities is often frustrating. Chemical peeling has recently been rediscovered as an effective mode of treatment in various pigmentary disorders including melasma. The study aimed to assess the comparative efficacy of chemical peeling with glycolic acid [GA] and salicylic acid [SA] in patients of melasma having predominant Fitzpatrik skin type IV and V. Fifty patients of either sex, in the age group between 18-49 years, having melasma of all types and of variable duration, were included in the study. Patients were randomly divided in two equal groups. Six fortnightly facial Peeling sessions with GA 0-60%] in group l and SA [20%-30%] in-group II were performed. Patients were followed up for one months. Avoidance of sun exposure and regular use of broad spectrum sunscreen was emphasized throughout in all patients. Evaluation was done before, after three months treatment and finally after one month follow up. Satisfactory response to chemical peeling was observed in both groups [p<0.001]. The results were almost similar with two different peeling agents. Mild and transient adverse reactions like burning, stinging, irritation, erythema and dryness were seen in most of the patients. No serious side effect was noted. It is concluded that chemical peeling is an effective and safe procedure in treatment of melasma and both chemical agents can be used effectively