Efficacy of sclerotherapy with sodium tetradecyl sulphate in the treatment of pyogenic granuloma

Objective: To determine the efficacy of sclerotherapy in treating pyogenic granuloma

Methods: The present study was conducted at outpatient Department Dermatology, Unit I, Mayo Hospital, Lahore. 35 patients were enrolled and were injected with 0.1ml of 3% sodium tetradecyl sulfate with the help of an insulin syringe, without local anesthesia, till the point of blanching. Patient was called weekly for two weeks for follow up to see clearance of the lesion and then after 3 months to see any recurrence using a caliper

Results: The mean age of the patients was 28.48 +/- 11.64 years. 42.9% patients were males and 57.1% patients were females. Complete clearance of lesion was found in 30 [85.7%] patients whereas 2 [5.7%] patients showed no reduction

Conclusion: Sclerotherapy is an effective procedure for the treatment of pyogenic granuloma patients

Comparison of efficacy of intralesional 5-fluorouracil plus triamcinolone acetonide versus intralesional triamcinolone acetonide in the treatment of keloids

Objective: To compare efficacy of intralesional 5-fluorouracil [5-FU] plus triamcinolone acetonide [TCA] versus intralesional TCA alone in the treatment of keloids

Methods The study included 100 patients with keloids. Patients were divided into two groups. Randomization was done through lottery method. For each 1 cm area, group A was given intralesional 5-FU 50 mg/ml [0.9ml] plus TCA 40mg/ml [0.1ml] after every 4 weeks and group B was given intralesional TCA 40mg/ml [0.1ml] after every 4 weeks for total period of 12 weeks. Administration of the drugs was continued till the keloid flattened or for a maximum period of 12 weeks. Follow-up was done every 4 weeks for total period of 12 weeks after the administration of last injection. Decrease in total score using Vancouver Scar Scale was calculated

Results: After the completion of study mean reduction in Vancouver Scar Score was -71.18 +/- 8.69 in the intralesional 5-FU plus TCA group as compared to -50.80 +/- 8.59 in the intralesional TCA group [p=0.001]. 5-FU + TCA was efficacious in 98% of cases [group A] and TCA alone in 62% of cases [group B]. No serious adverse effects were noticed in either group

Conclusion: Intralesional 5-FU plus TCA is significantly better than intralesional TCA alone in the treatment of keloids

Multiple familial trichoepithelioma in mother and daughter

Trichoepithelioma is a benign adnexal tumour arising from hair matrix cells. It can be sporadic, familial or a component of other genetic diseases. We report a 40-year-old female who presented with disseminated papulonodular lesions on the face only which were confirmed histopathologically as trichoepithelioma. Her daughter also had trichoepithelioma in the nasolabial folds. They had no other systemic features and were concerned the cosmetic disfigurement imparted by the disease

Comparison of efficacy and safety of topical hydroquinone 2% and oral tranexamic acid 500 mg in patients of melasma

Objective: To compare the efficacy of topical hydroquinone 2% and oral tranexamic acid 500mg daily in patients of melisma

Methods: A total of 140 patients [70 patients in each group] were enrolled, who were randomly divided into 2 groups. Group A was treated with topical hydroquinone 2% and group B was given oral tranexamic acid 500mg daily. Follow-up was carried out at the end of 2[nd], 4[th] and 8[th] week to compare reduction in MASI score at last follow-up

Results: The mean age of patients was 29.67 +/- 6.38 years with an age range of 15 to 45 years. There were 28 [20%] male and 112 [80%] female patients. Majority i.e. 120 [85.7%] cases were married and 20 [14.3%] were unmarried. The age of onset was 15-25 years in 67 [47.9%] patients, 26-35 years in 52 [37.14%] and 36-45 years in 21[15%] patients. Both groups showed a decline in MASI score; however, the results were significantly greater in group B [oral tranexamic acid]. At final follow-up, the mean percentage reduction was higher in group B [77.97+/-8.37] as compared to group A [67.02+/-8.42], p < 0.001. Adverse effects like erythema, burning, allergic contact dermatitis and pigmentation were noticed in the first group. One [1.4%] patient developed nausea and vomiting and diarrhea with oral tranexamic acid

Conclusion: Oral tranexamic acid 500 mg had a better response when compared with topical hydroquinone 2% cream and better safety profile. It might be considered as a future treatment option

Frequency of associated factors of onychomycosis

Objective: To determine the frequency of associated factors of onychomycosis in patients presenting in a tertiary care hospital

Methods: In this cross-sectional survey conducted in Dermatology Unit-I, Outpatient Department, Mayo Hospital, Lahore, 120 patients fulfilling the inclusion criteria were analyzed. After taking informed consent and recording demographic data, complete history was taken. Examination was performed and investigations were carried out where ever needed, for determination of factors associated with onychomycosis

Results: Females were 80.8% of study cases and elderly constituted 5.8%. Positive family history for onychomycosis and smoking, each was observed in 10%. Trauma was present in 11.7% cases. 5% of patients wore occlusive shoes and 9.2% subjects were diabetic

Conclusion: Onychomycosis affected females four times more than males. The most frequent factor observed was trauma. Smoking, positive family history and diabetes mellitus were other important factors

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

Efficacy and Safety of 50% glycolic acid peels in the treatment of melasma in Fitzpatrick's skin type IV and V

Objective: To determine the efficacy and safety of 50% glycolic acid peels in melasma in Fitzpatrick's skin type IV and V

Methods: 50 patients of melasma were included in the study. Type of melasma was identified with the help of Wood's lamp. Patients were advised a pre-peel program of daily application of tretinoin 0.05% at bedtime for 2-weeks. MASI scoring and colored photographs of each patient were taken before each peel with 50% glycolic acid and at the end of follow-up. Treatment was carried out with an interval of 2-weeks for a total of 6 sessions. Efficacy was assessed 4 weeks after the last session. Side effects, if any, were also recorded

Results:The mean age of the patients was 28.88 +/- 6.02 years. There were 44 [88%] females and 6 [12%] male patients. 20 [40%] patients had epidermal melasma, 28 [56%] had mixed type and only 2 [4%] patients presented with dermal melasma. Mean baseline MASI score was 15.54 +/- 5.76 and the mean MASI score at the end of treatment was 9.6 +/- 4.8. The mean percentage of reduction of MASI score was 40.57 +/- 11.9%. A significant improvement from baseline to 14 weeks was observed. Only a few side effects were seen in the form of mild erythema and burning sensation

Conclusion: This study demonstrates that serial glycolic acid peels are effective and safe in the treatment of melasma in Fitzpatrick's skin type IV and V

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

Chronic urticaria: an approach towards etiology and diagnosis. Part I

Chronic urticaria [CU] is one of the most frustrating and challenging dermatosis for patients and physicians both. Apparently easy to diagnose, CU is still considered as a difficult to manage disease. Subtypes of CU include chronic idiopathic [spontaneous] urticaria, inducible urticaria, physical urticaria, autoimmune chronic urticaria and urticarial vasculitis. Physical urticaria may coexist with chronic idiopathic [spontaneous] urticaria. Evaluation of a patient with CU should involve consideration of various possible causes, although in most cases the cause is not identifiable. Investigation of CU should be guided by a thorough history and physical examination.

Neutral lipid storage disease-a case report

Neutral lipid storage disease is a rare autosomal recessive disorder characterized by non-bullous ichthyosiform erythroderma, liver steatosis, hepatosplenomegaly, cataracts, ataxia, bilateral sensorineural hearing loss, skeletal and cardiomyopathy, growth and mental retardation. We report a case of neutral lipid storage disease in a 14 months old child

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

Squamous cell carcinoma on discoid lesions of systemic lupus erythematosus

Squamous cell carcinoma [SCC] is a rare late complication of chronic discoid lupus erythematosus [CDLE]. We report a case of SCC developing in lesions of CDLE in a 16-year-old girl suffering from SLE. A verrucous change or ulceration in lesions of CDLE should warrant a biopsy to rule out malignant transformation