Discoid lupus erythematosus: a profile.

OBJECTIVE: To determine the demographic data, clinical pattern and therapeutic outcome in patients with discoid lupus erythematosus (DLE). STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: The Department of Dermatology, Liaquat University of Medical and Health Sciences, Jamshoro, from January 2004 to December 2008. METHODOLOGY: Patients of either gender aged above 18 years diagnosed with DLE were enrolled for the study. Those with evidence of systemic lupus erythematosus were excluded. Apart from the onset, duration, symptoms, lesion's location, size and dimensions were noted. Biopsy was taken when the diagnosis was in doubt. Apart from routine investigations serum anti-nuclear factor was determined in every patient. The data were analyzed using SPSS software version 11.0 for frequencies and percentages. RESULTS: There were 110 patients (38 males and 72 females), with ages between 18 and 62 years. Family history was positive in 3 patients. The plaque form was the most common clinical type seen in 68 (61.8%) patients, followed by tumid (n=20, 18.2%), panniculitis (n=10, 9.1%) and ulcerative (n=8,7.3%) types. Face was the most common site affected (n=60, 54.5%). Antinuclear antibody was present in 19 (17.3%) patients. Fatigue and joint pains were the commonest symptoms (n=52, 47%). Pigmentation and scarring were the usual outcome. CONCLUSION: DLE is a chronic disease with multiple presentations, which usually ends with pigmentation and scarring.

Oral lichen planus: a clinical study.

OBJECTIVE: To evaluate the clinical characteristics, predisposing/aggravating factors and malignant potential of oral lichen planus (OLP). STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Dermatology and Oral Pathology, Liaquat University Hospital, Hyderabad, from January 2006 to November 2007. METHODOLOGY: Patients of either gender aged above 12 years, fulfilling the diagnostic criteria for OLP were enrolled for study. Patients not willing to participate or suspected to have drug-induced lichenoid reactions were excluded. History regarding the onset and duration, symptoms, addictions was elicited followed by oral, cutaneous and systemic examination. Biopsy was taken when the diagnosis was doubtful or malignancy was suspected. The data were analyzed using SPSS software version 11.0 for frequency and percentage. RESULTS: A total of 95 patients (40 male and 55 female), aged between 17 and 62 years were enrolled. Diabetes (n=05) and hypertension (n=04) were the accompanying comorbidities. Family history was positive in 3 patients only. Reticular form was the most common clinical type seen in 52 (54.7%), followed by erosive in 31 (32.6%) and atrophic/erythematous types in 12 (12.6%) patients. The disease caused pain, burning and other symptoms in 72 (75.7%) patients. Buccal mucosa was the chief site of involvement (n=31). Other sites involved were tongue (n=20), lips (n=28), palate (n=9) and floor of mouth (n=03). Stress, spicy foods and poor oral hygiene aggravated disease in most (n=77) of the patients. CONCLUSION: OLP is a chronic disease with diverse clinical manifestations and multiple site involvement. Associated pigmentation of surrounding mucosa was unique finding of this study. Long-term follow up is needed to assess the malignant potential. Stress was the most important factor aggravating the disease.

Frequency and pattern of gonorrhoea at Liaquat University Hospital, Hyderabad (a hospital based descriptive study).

OBJECTIVE: To determine the frequency and pattern of gonorrhoea at Liaquat University Hospital, Hyderabad. METHODS: This descriptive study of eight months was conducted at Liaquat University Hospital Hyderabad, Sindh, Pakistan from December 2007 to May 2008. All patients who were above 14 years of age and came with history of discharge from penis or vagina were evaluated and enrolled in the study. After recording demographic data these were screened for gonococcal infection by Gram's staining method. The frequency was determined by identifying the positive gonococcal infected patients while pattern was observed according to the presentation of patients. The data was analyzed by SPSS version 10.00. RESULT: One hundred and eighteen patients, 92 (78%) male and 26 (22%) females were identified to have infection out of 266 patients with mean age 27.4 +/- 7.77 years. Majority of the patients 92 (78%), presented in the department of dermatology. In the study group, 77 (65%) were unmarried and 41 (35%) were married, 71 (60%) belonged to Hyderabad and 47 (40%) came from periphery of Sindh province of Pakistan. Other features and presentation identified in such patients were painful micturition 98 (83%), burning micturition 94 (80%), frequent micturition 108 (92%), genital itching 85% (72%), intermenstrual bleeding 09 (8%), painful sexual intercourse 87 (74%) and skin lesions 24 (20%). All patients were treated by syndromic management. CONCLUSION: A relatively high prevalence of gonorrhoea (46% patients) was detected in the patients seen in Liaquat University Hospital.

Lipid profile in patients with psoriasis presenting at Liaquat University Hospital Hyderabad.

OBJECTIVE: To determine the lipid abnormalities in patients with psoriasis and compare it with healthy controls. METHODS: Across-sectional controlled study was conducted at the Department of Dermatology Liaquat University Hospital Hyderabad from January 2007 to November 2007. The study included 158 consecutive patients; among which 88 were males (44 patients and 44 controls) and 70 females (35 patients and 35 controls). The patients with psoriasis having less than 30% body involvement were included in the study. Patients with severe psoriasis, high BMI (.30 kg/m2), hypertension, diabetes, smoking, alcohol consumption and personal or family history of hyperlipedemia were excluded. The patients were examined clinically and findings recorded on a pre-designed proforma. Fasting lipids were measured using SELECTRA XL chemistry analyzer using Spin react kits (made in Spain) by direct method. RESULTS: All patients had psoriasis involving less than 30% of body surface. Their ages ranged from 18 years to 68 years (mean 37 +/- 7.96 years). Family history of disease was positive in 10 (6.32%) patients. 134 (84.8%) had plaque type psoriasis, 10 (6%) had in addition scalp and nail involvement, 05 (3.16%) guttate lesions, 05 (3.16%) had palmoplantar lesions while remaining 04 (2.43%) comprised of hyperkeratotic and flexural psoriasis. The duration of disease ranged between 18 months to 10 years with a mean of 4.5 +/- 1.89 years. Serum cholesterol, triglycerides and low density lipoprotein (LDL) cholesterol were significantly higher than in the normal control group (P < 0.01). There was no significant statistical difference in serum levels of very low density lipoprotein cholesterol (VLDL) and high density lipoprotein cholesterol (HDL-C) between the two groups. CONCLUSION: Psoriasis is an independent risk factor for hyperlipidaemia and its possible subsequent sequelae such as obstructive vascular disease.

Knowledge, attitude and practices regarding leprosy among general practitioners at Hyderabad.

OBJECTIVE: To assess the level of knowledge, social attitude towards patients, and diagnostic and management capabilities of general practitioners (KAP) regarding leprosy, practicing at Hyderabad, Pakistan. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Hyderabad, Sindh, Pakistan, during October to December 2007. METHODOLOGY: A pre-tested and well-structured questionnaire consisting of 54 questions was administered to general practitioners working at various areas in Hyderabad. The questions were grouped under different headings and covered clinical features, common and uncommon presentations, complications, referral practices and stigma. The sum of correct answers marked by doctors was taken to classify the respondents. The doctors who responded correctly for upto 10 questions were assigned level 1 (poor), from 11 to 25: level 2 (average), from 26 to 40: level 3 (good), while those who marked correct answers for more than 40 questions were assigned level 4 (excellent). Chi-square test was used to determine significance at p<0.05. RESULTS: A total of 200 doctors were surveyed. Fourteen doctors (7%) had poor knowledge of disease (number of correct answers less than 10), 32 (16%) had average (number of correct answers between 11 and 25), 140 (70%) doctors good (number of correct answers between 26 and 40) while 14 (7%) had excellent (number of correct answers more than 40) knowledge of the disease. CONCLUSION: There is inconsistency and deficiencies in the knowledge, referral pattern and treatment of leprosy among general practitioners, which needs to be improved by conducting awareness activities.

Generalized eruptive histiocytosis presenting with warty lesions on face.

Generalized eruptive histiocytosis is a benign proliferative disorder of non-Langerhans cells. It is a very rare disease. The disease presents with soft to firm fleshy papules on face, neck and upper trunk. Biopsy is often needed to make the diagnosis because of its rarity and diverse presentation. There is tendency for the disease to regress spontaneously without treatment. Treatment, if any needed, suffices to topical modalities. We report here a case of generalized eruptive histiocytosis which presented with lesions of dual morphology. This is a very rare disease with diverse presentation being reported first ever in our country.

Disabling pansclerotic and plaque morphoea.

Disabling pansclerotic morphoea of children is a clinical subset of morphoea that tends to involve deeper structures and progresses relentlessly. This is a case of 09 years old girl who developed morphoea in pansclerotic form on limb and in plaque form on abdomen. The combination is rare and resulted in severe shortening and functional disability of the involved limbs.

Embolia cutis medicamentosa.

Embolia cutis medicamentosa or Nicolau syndrome is an acute necrotic condition of skin and subcutis that follows intramuscular administration of certain medicines. A young lady from rural area presented with an irregular-contoured ulceration with livedoid features on left deltoid region which she developed after receiving intramuscular injection of diclofenac sodium. The histopathological examination of the biopsied tissue demonstrated dead keratinocytes with degenerated epidermis and dermis. The condition improved on local management of wound with a residual scar.