Study Comparing Topical Ivermectin Versus Topical Permethrin in the Treatment of Scabies.

Introduction Scabies is a highly contagious skin disease caused by an ectoparasite mite called Sarcoptes scabiei. Ivermectin and permethrin have been commonly used for the treatment of scabies. However, topical ivermectin has been compared to other treatment modalities to a lesser extent. Objective This study aimed to compare the efficacy of topical ivermectin versus topical permethrin in the treatment of uncomplicated scabies. Methods 354 patients with scabies attending the dermatology outpatient department of Pak Emirates Military Hospital Rawalpindi were enrolled. Patients were divided into two groups randomly. The first group and their family contacts received 1% ivermectin lotion whereas the other received 5% permethrin lotion. Patients were evaluated at the end of the second and the fourth week. Results At the end of the second week, initial follow-up showed that 97 out of 159 patients (61.0%) in the ivermectin 1% group, and 107 out of 159 patients (67.3%) in the permethrin 5% group had achieved clinical cure (P=0.24). On the final follow-up at the end of Week 4, the cure rate amounted to 85.5% (136 of 159 patients) in the ivermectin group and 89.9% (143 of 159 patients) in the permethrin group. Differences among both groups remained statistically insignificant (P=0.23). Conclusions The use of ivermectin 1% versus permethrin 5% as topical therapy showed almost identical results for the treatment of uncomplicated scabies. Side effects were minimal and there were no significant differences observed in patients with regard to compliance among both the groups.

Comparison of Efficacy of Platelet-Rich Plasma (PRP) With PRP Microneedling in Androgenetic Alopecia.

Background Limited data are available on the efficacy of platelet-rich plasma (PRP) and microneedling versus PRP alone. In this study, we aimed to compare the efficacy of PRP and microneedling with PRP alone in androgenetic alopecia (AGA). Methodology This prospective, randomized, interventional study was conducted in Pak-Emirates Military Hospital, Rawalpindi, from September 2020 to December 2020. In total, 60 individuals suffering from AGA of up to Hamilton-Norwood grade 4 were randomly assigned to two groups, namely, PRP+microneedling versus PRP alone. A total of three sessions, each one month apart, were offered. Pre and post-intervention photographs, hair count (/cm2), hair-pull test, and physician's and patient's perception of hair loss were recorded. The data were statistically analyzed. Results A greater proportion of patients in the microneedling group achieved a negative hair-pull test and improved perception of hair loss compared to the PRP-alone group (82.1% vs. 51.9% and 88.0% vs. 73.9%, respectively). The percentage increase in mean hair count in the microneedling group (24.53 ± 9.49%) was significantly higher than the increase in the PRP-alone group (17.88 ± 10.15%) (p = 0.011). For grades 2 and 3 hair loss, microneedling+PRP caused a much greater increase in hair count than PRP alone. This difference was less pronounced for Norwood grade 4. No notable side effects were noted in any patient. Conclusions Combined PRP and microneedling is more efficacious than PRP alone in patients with AGA up to Hamilton-Norwood grade 4.

Split-Face Comparative Analysis Of Micro-Needling With Tranexamic Acid Vs Vitamin C Serum In Melasma.

BACKGROUND: Melasma is a very common skin problem that is much more prevalent in women. In our society, it results in many psycho-social implications and eventually leads to an impaired quality of life. Many treatment modalities have been developed for it. However, in recent years resistant forms of melasma have emerged that are unresponsive to the usual first line treatment options. Thus, this study is being conducted to explore new treatment modalities for this disease by using micro-needling with vitamin C and tranexamic acid. METHODS: Thirty patients participated in this non-randomized clinical trial including 11 males and 19 females. All patients received Tranexamic acid via micro-needling on right side of the face and Vitamin C on the left side. A total of three biweekly sessions were performed. Patients' response was evaluated at week 2, 4 and 6 on the basis of Physician Global Assessment, Patient Global Assessment, modified Melasma Area Severity Index and clinical assessment. Paired sample t-tests were used to calculate the difference in the means of two groups at 2, 4 and 6 weeks and p-value of <0.05 was considered significant. RESULTS: After first session, there was more improvement observed with tranexamic acid. At the end of 6 weeks, modified Melasma Area Severity Index, Physician Global Assessment and Patient Global Assessment showed significant improvement with both tranexamic acid and vitamin C. However, the difference between them was not statistically significant (p>0.05). CONCLUSIONS: Both Tranexamic acid and Vitamin C are potent therapies for melasma as an adjuvant to micro-needling.

Dermatological Manifestations of COVID-19 in Patients Reporting to a Tertiary Care Hospital in Rawalpindi, Pakistan.

Introduction The clinicopathological description of dermatological manifestations of COVID-19 leaves much to be desired. There is a need to determine their association with disease severity, outcome, and other clinical variables. Objectives The objectives of this study are to record and histopathologically examine the cutaneous manifestations of COVID-19 and correlate these to age, disease severity, and mortality. Methods All confirmed COVID-19 patients admitted to a single tertiary healthcare hospital in Rawalpindi, Pakistan, were included. Their diseases were classified as mild, moderate, severe, and critical. The recent onset skin eruptions in these patients were recorded via photographs along with relevant clinical data. The photographs were independently reviewed by a group of three dermatologists without knowledge of the clinical information. The skin manifestations were divided into disease-specific and nonspecific categories using an already defined algorithm. Histopathological examination of skin manifestations was conducted. Results A total of 23% (n=47) had "new" skin manifestations. Specific skin findings were seen in 21.6% (n=44), which consisted of ecchymosis/purpura in 50% (n=22), maculopapular exanthem in 18% (n=8), livedo reticularis in 16.2% (n=7), ischemia/gangrene in 16.2% (n=7), perniosis in 15.9 % (n=7), vesiculo-bullous rash in 9% (n=4) and urticaria in 4% (n=1). Non-specific findings were seen in 6% (n=13) and included bedsores, dermatitis passivata, dryness, herpes labialis, oral ulcerations, and nasogastric tube-induced ulcerations. There was a significant association (p=0.03) between disease severity and specific skin lesions. Ischemia/gangrene was significantly associated with COVID-19 disease severity and mortality. Vesiculobullous lesions were associated with higher mortality, though not with disease severity. Livedo reticularis had a higher-than-expected count in critical disease, albeit statistically insignificant. The association of maculopapular exanthem and ecchymosis/purpura with severe/critical disease was statistically insignificant. Urticaria was significantly associated with low disease severity. Mean age with specific manifestations was 56.86 ± 15.81 and with nonspecific/without any manifestations was 42.58 ± 16.96, a highly significant difference, with p-value < 0.001. Old age (>60 years) was significantly associated with ecchymosis (p=0.038), maculopapular exanthem (p=0.021), and vesiculo-bullous rash (p=0.029). Histopathology varied according to the type of skin lesion. Conclusions Dermatological manifestations coexist in many patients and tend to appear more in severe cases of COVID-19 among the older age group and only minimally in mild/moderate cases. Their presence could help set prognostic criteria of COVID-19 disease in the future.

Frequency Of Metabolic Syndrome In Patients With Psoriasis.

BACKGROUND: Psoriasis is a non-communicable, long-lasting disorder of the skin comprising various immunological inflammatory changes. Increasing evidence suggests that psoriasis is closely related to multiple organ systems, potentially arising due to underlying co-morbid conditions such as diabetes, hypertension, dyslipidaemia and obesity. Aim of this study was to know the frequency of metabolic syndrome in psoriasis patients. METHODS: This cross-sectional study was conducted from May to November 2020 in a Tertiary-care hospital. Eighty patients diagnosed with psoriasis were selected using non-probability consecutive sampling. Informed written consent was obtained from each patient and a questionnaire was filled. Blood pressure, waist circumference, body surface area covered by psoriasis, Psoriasis Area Severity Index were recorded on initial visit. Fasting blood sugar, serum triglyceride and HDL cholesterol levels were advised. Patients were diagnosed to have metabolic syndrome if ≥3 out of 5 criteria for the modified version of National Cholesterol Education Program Adult Panel III were met. RESULTS: There were 62 male and 18 female patients. A total of 39 patients (48.8%) met the criteria for metabolic syndrome. Amongst these, 26/62 (41.9%) males vs 13/18 (72.2%) females fulfilled the criteria. The mean BMI of males was 26.0 while those of females was 28.3, comparison of which demonstrated a noteworthy difference (p=0.04). A statistically significant (p=0.038) positive correlation (r) of 0.233 was observed between body surface area and BMI. CONCLUSIONS: Metabolic syndrome is seen frequently in patients of Psoriasis. Female patients have a significant frequency of metabolic syndrome and tend to have a higher BMI than males.

Role Of Intralesional Vitamin-D In Viral Wartse.

BACKGROUND: The study was to look for effectiveness of vitamin D-3 in cutaneous warts in comparison with cryotherapy at dermatology department of Pak Emirates Military Hospital Rawalpindi. It was a randomized control trial conducted at the Department of dermatology Pak Emirates Military Hospital Rawalpindi. Ten months, June 2019 to May 2020. METHODS: A total of 50 patients of cutaneous warts diagnosed by consultant dermatologist were included in the study. Patients were randomized into groups by lottery method. Group A received the Intralesional vitamin D 3 while Group B received cryotherapy. Comparison was made in both the groups regarding the response as complete or partial or no resolution of the wart. RESULTS: Out of 50 patients with cutaneous warts on any location of the body, 23 (46%) received intralesional vitamin D3 while 27 (54%) received cryotherapy as allocated treatment. Twenty-four (48%) patients were female while 26 (52%) were male. Planter warts 41 (82%) were the commonest type according to the site of warts followed by palmar 6 (12%). Application of chi-square test revealed that Vitamin D3 was statistically significantly related to complete resolution of warts as compared to cryotherapy (p-value<0.05). CONCLUSION: Cutaneous warts were most commonly seen on the feet of the affected patients. They had a good response to both of the therapies but intralesional vitamin D3 emerged as more effective option of the two in terms of management of these cutaneous warts.

Efficacy of rifampicin in eradication of carrier state of Staphylococcus aureus in anterior nares with recurrent furunculosis.

OBJECTIVE: To compare the frequency of detection of Staphylococcus aureus carrier state in anterior nares of the patients suffering from recurrent furunculosis with the normal population and to determine the efficacy of rifampicin in eradication of the carrier state. DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Skin Department of Combined Military Hospital, Peshawar and Multan, from March 2004 to December 2005. PATIENTS AND METHODS: The study consisted of 80 individuals. They were placed in two groups. Group I comprised of 40 patients suffering from recurrent furuncles and group II included 40 healthy adults, kept as controls. Nasal swab was taken from the individuals belonging to both the groups, when they first reported to skin OPD. The patients who were suffering from furuncles were treated with co-amoxiclav 375 or 625 mg three times a day. The patients in whom S. aureus carrier state was detected were again divided into two groups. Group 1 was prescribed rifampicin 450-600 mg daily (depending on the body weight) for 10 days, while the group 2 was not offered any treatment. After this course, a second nasal swab was taken and submitted for cultures. RESULTS: Among the 40 patients belonging to group I, S. aureus carrier state was detected in 23 (57.5%), while in group II the carrier state was found in 8 (20%) individuals (p<0.001). Among the 13 patients who received rifampicin, 10 got cured of carrier state, while in 3 patients nasal swab was still positive after a course of rifampicin. In 10 patients, who were not offered any treatment, the nasal swabs remained positive (p<0.001). These patients were followed-up in skin OPD for another 3 months, and did not develop any recurrence of the infection. CONCLUSION: Nasal swab for detection of S. aureus carrier state should be done in all patients of recurrent furunculosis. If the nasal swab culture is positive, then as the infection gets cured, the patients should receive a course of rifampicin for 10 days. This may eradicate the carrier state in majority of cases and prevent the recurrence of the infection.

The efficacy of local infiltration of triamcinolone acetonide with lignocaine compared with lignocaine alone in the treatment of postherpetic neuralgia.

OBJECTIVE: To assess the efficacy of local infiltration of corticosteroid with lignocaine compared to lignocaine alone in the treatment of postherpetic neuralgia. DESIGN: A randomized clinical trial. PLACE AND DURATION OF STUDY: The Skin Department, Military Hospital, Rawalpindi from September 2002 to March 2003. PATIENTS AND METHODS: Sixty patients were selected for the study. They were randomly assigned to two groups. Group-I received injection triamcinolone acetonide with lignocaine and group-II was given injection lignocaine alone. Three injections were given to each patient at fortnightly interval and pain relief was assessed by visual analogue scale at 6 and 12 weeks following the first injection. RESULTS: Follow-up at 6 weeks showed complete pain relief in 63.3% (n=19) patients of group-I in comparison to 16.6% (n=5) of group-II. Chi-square value was 13.3 (p<0.001). At 12 weeks follow-up group-I showed further improvement with complete pain relief in 83.3% (n=25) whereas group-II showed diminishing response with cure rates falling to 6.6% (n=2). Chi-square value was 35.6 (p<0.001). CONCLUSION: Locally infiltrated injection triamcinolone acetonide with lignocaine was significantly more effective than injection lignocaine alone in the treatment of postherpetic neuralgia both at 6 and 12 weeks follow-up.

Fine needle aspiration cytology versus histopathology in the diagnosis of cutaneous leishmaniasis in Pakistan.

OBJECTIVE: To compare FNAC with histopathology as an alternate method of diagnosing cutaneous leishmaniasis. DESIGN: Comparative study. PLACE AND DURATION OF STUDY: The duration of the study was from August 2003 to April 2004 at CMH, Peshawar. MATERIALS AND METHODS: A total of 40 patients were included in this study. They were referred from various areas of North-West Frontier Province. FNAC and skin biopsy was performed on every patient. Haematoxylin and eosin (H&E) stain was used for both procedures. RESULTS: The study group included 39 males and one female, their age ranging from 8-60 years with a mean age of 31.97 years. Detection of LT bodies was considered as a single criterion of the positive result. Histopathological examination was able to diagnose 14 out of 40 patients (positive yield of 35%), while FNAC picked up 11 out of 40 patients (positive yield of 27.5%). CONCLUSION: FNAC is easier, less painful and more cost-effective than the conventional skin biopsy. The high sensitivity and specificity eliminate the need for other time-consuming and invasive procedures. However, if LT bodies are not detected then any further comment cannot be made regarding the diagnosis and it is necessary to perform skin biopsy.

Unilateral tuberous sclerosis complex.

Tuberous sclerosis is a rare genetic disease of autosomal dominant inheritance, associated with hamartomata formation in several organs and various skin findings. A case of young male is presented here with multiple fibromas on right side of his face, peri-ungual fibromas in right index and middle fingers and right second toe, a small shagreen plaque over right lower back and multiple, ill-defined hypopigmented patches over his right side of the trunk and right buttocks. Fundoscopic examination revealed retinal phacomas on right side. CT-scan brain showed right-sided paraventricular calcification.

Furuncular myiasis by tumbu fly.

OBJECTIVE: To study cases of furuncular myiasis by tumbu fly (Cordylobia anthropophaga) among Pakistani troops in Sierra Leone, Africa. DESIGN: Observational study. PLACE AND DURATION OF STUDY: Pakistani troops in Sierra Leone, Africa. The duration of the study was 1 year, from July 2001 to August 2002. SUBJECTS AND METHODS: Two hundred and forty-eight cases of furuncular myiasis were observed among Pakistani soldiers. All the patients were male. The lesions were treated by removal of the larva followed by twice daily application of an antibacterial ointment. The extraction was done by injecting 2% xylocaine over the base of the nodule. Care was exercised in not damaging the larva while extracting. RESULTS: The ages were from 22 to 43 years. Mean age was 29.42 years. The patients presented with a solitary lesion (178 out of total 248 cases, 71.8%) or multiple lesions (70 out of 248 cases, 28.2%). The lesions were almost always on the non-exposed parts of the body (239 cases out of total 248 cases, 96.37%). One case presented with a lesion on the face and 8 cases had lesions over dorsum of hands or feet. CONCLUSION: This disease is common in tropical Africa. The knowledge of the disease, its management and prevention is necessary for all the individuals who are planning to visit tropical Africa.