Factors associated with onychomycosis in nail psoriasis: a multicenter study in Pakistan.

BACKGROUND: Treatment of psoriatic nail disease is challenging, and dystrophic psoriatic nails can get secondarily infected with fungi. METHODS: This 2-year, matched case-control study was conducted at three tertiary care centers of Karachi, Pakistan. Data were collected from patients with nail psoriasis as cases with age- and gender-matched controls. A detailed questionnaire was filled for all study participants. Nail Psoriasis Severity Index (NAPSI) scoring tool was used to assess dystrophy. Fungal infection was inferred by nail clippings for fungal hyphae and culture. RESULTS: Among 477 participants, 159 cases and 318 controls completed the study. Their mean age was 44 years, and one-third were female. Fungal culture positivity was statistically significant in cases as compared to the control group (P < 0.001). The most frequent species identified was Candida parapsilosis in both cases and controls. Body mass index, NAPSI scoring, socioeconomic status, elevated diastolic blood pressure, smoking status psoriasis among first-degree relatives, and longstanding disease of more than 10 years were significant factors in univariable analysis. Multivariable logistic regression identified independent factors like low to middle socioeconomic status, history of psoriasis in first-degree relative, current smoker, and obesity. CONCLUSION: We found nearly one-third of the psoriatic patients with nail involvement having concomitant fungal infection. We emphasize that nail clipping for fungal smear and culture should be advised to those patients with coexisting factors found significant in our study results. This opinion can be incorporated in psoriasis management guidelines for improving treatment of psoriatic nails.

Intralesional Triamcinolone Acetonide Versus Topical Betamethasone Valearate in the Management of Localized Alopecia Areata.

OBJECTIVE: To compare the efficacy of intralesional triamcinolone and topical betamethasone in the management of localized alopecia areata. STUDY DESIGN: A randomized trial. PLACE AND DURATION OF STUDY: Dermatology OPD, PNS Shifa Hospital, Karachi, from January to June 2013. METHODOLOGY: Patients aged 18 - 50 years with localized alopecia areata were included in the study. Exclusion criteria were more than three patches and those on already steroid or immunosuppressive therapy. Patients were randomly allocated in two treatment groups: Group A received intralesional triamcinolone acetonide (10 mg/ml) and Group B received topical betamethasone valearate cream 0.1% twice daily. Final outcome was ascertained as re-growth of hair on 12th week of follow-up and labelled as efficacy. The data was entered and analyzed using SPSS version 11. Relevant descriptive statistics were calculated. Chi-square test was used to compare efficacy of hair re-growth in both groups. P-value < 0.05 was considered significant. RESULTS: A total of 226 patients were enrolled, 113 in each group. The mean age was 34.36 ± 8.7 years. One hundred and sixty-four (72.6%) were males and 62 (27.4%) were females with male to female ratio of 2.6:1. Hair re-growth was seen in 84 (74.3%) of the intralesional steroid group and in 53 (46.9%) of the topical betamethasone group (p < 0.001), which was a significant difference. CONCLUSION: Intralesional triamcinolone had a better efficacy in the treatment of localized alopecia areata as compared to topical betamethasone valearate.

Dyslipidemia and Psoriasis: A Case Control Study.

OBJECTIVE: To compare the mean values of lipid profile in psoriatic patients and healthy controls. STUDY DESIGN: Case control study. PLACE AND DURATION OF STUDY: Department of Dermatology, PNS Shifa, Karachi, from November 2012 to April 2013. METHODOLOGY: Patients with psoriasis fulfilling the inclusion and exclusion criteria were selected from Dermatology Outpatient Department (OPD) of PNS Shifa, Karachi. After fasting for 14 hours, 5 ml of venous blood was drawn in sterile syringe and submitted to the Hospital Laboratory for lipid profile, by enzymatic method on Hitachi (Roshe(®)) using reagents by the same firm. The mean values lipid profile in psoriatic patients versus healthy controls were recorded and compared. RESULTS: Atotal of 256 patients (128 in each group) were enrolled. Mean lipid profile in both groups revealed cholesterol (mg/dl) value of 203.43 ±1 1.43 in cases and 173.64 ± 13.65 in controls. Triglyceride (mg/dl) was 178.87 ± 43.60 and in cases 144.23 ± 34.01 in controls, HDL-C (mg/dl) was 37.81 ± 10.78 in cases and 41.41 ± 9.72 in controls while LDL-C (mg/dl) was 139.52 ± 13.71 in cases and 109.44 ± 13.80 in controls. Each parameters had p-value < 0.05 which was significant. CONCLUSION: Dyslipidemia was found in a high percentage of psoriatic patients than healthy controls. Psoriatic patients require thorough lipid and cardiovascular examinations as they should be considered as individuals with increased risk of cardiovascular diseases.

Kindler's syndrome: a report of five cases in a family.

Kindler's Syndrome (KS) is a rare genodermatosis with autosomal recessive mode of inheritance. The disease results from homozygous mutations on both alleles of the FERMT-1 gene (also known as KIND-1 gene) that encodes the protein Kindlin-1 (kindlerin). Clinical features include a constellation of early infantile skin blistering and mild photosensitivity, which improves with age, and progressive poikiloderma with widespread cutaneous atrophy. The differential diagnosis of Kindler syndrome include other congenital poikilodermatous and photosensitive conditions including Bloom syndrome, Cockayne syndrome, dyskeratosis congenita, epidermolysis bullosa, Rothmund-Thomson syndrome and xeroderma pigmentosum. We herein, report the presence of the Kindler's syndrome in 5 out of 7 children of consanguineous parents. To authors' knowledge, this is the first report of Kindler's syndrome involving 5 members of a family.