Journal of Pakistan Association of Dermatologists

Expanding the Geographic Spectrum: First Documentation of Mal de Meleda in Three Siblings from Pakistan – A Case Series

Yasaan Saaqib — 2025-09-30

Mal de Meleda (MdM) is a rare autosomal recessive palmoplantar keratoderma caused by SLURP-1 gene mutations. It typically presents in early childhood with waxy, yellowish thickening of palms and soles that may extend to the dorsal surfaces. We report the first familial case series of MdM in Pakistan, involving three female siblings aged 11, 11, and 9 years. All showed varying degrees of transgradient hyperkeratosis, nail changes, and hyperhidrosis. Family history revealed consanguinity and a similarly affected paternal aunt. Based on clinical findings, a diagnosis of MdM was made. Management included topical keratolytics, antibiotics, and in one case, systemic therapy. This series underscores the phenotypic variability of MdM, emphasizes the diagnostic value of family history, and contributes to the expanding geographic understanding of this genodermatosis.

Combination Treatment of Itraconazole and Terbinafine for Chromoblastomycosis Caused by Fonsecaea pedrosoi

Fifa Argentina — 2025-09-30

Chromoblastomycosis is a chronic subcutaneous fungal infection mainly caused by Fonsecaea pedrosoi. This report describes a 42-year-old man with a verrucous plaque on the right ankle, initially presenting as small papules ten years ago, progressively enlarging. The patient, an oil palm worker, had a history of recurrent trauma and inadequate antifungal treatment. Diagnosis was confirmed by KOH, histopathology, and culture showing Fonsecaea pedrosoi. Combination therapy with itraconazole 100 mg twice daily and terbinafine 250 mg once daily for six months led to complete clinical and mycological cure. This case emphasizes the role of combined antifungal therapy in neglected chromoblastomycosis and the importance of early diagnosis and adherence to treatment.

Person Centered Care: Empowering Patients and Delivering Holistic Patient Care

Atiya Rahman — 2025-10-09

Patients are an important stakeholder in the healthcare programs and it is imperative to listen to and address their concerns if we want to make a robust healthcare system.^1,2 This has been recognized with the advent of patient/person centered care. The Picker’s eight-point model provides a framework to ensure this provision. Patient-centred care is a multifaceted team-based approach that helps healthcare professionals avoid making assumptions or relying on old paternalistic attitudes of physicians; in which the patient remained passive and the major decisions were made by the medical team. The advantage of this framework is that instead of making decisions for patients, it gives patients the power to express what they need and what they are capable of. With this shared decision-making the patients take more responsibility and are then largely compliant with their medication plans. It also encourages healthcare workers to think about their actions, become more self-aware, and grow both personally and professionally.

The Picker’s Eight Principles of Patient Centered Care were detailed by Harvard Medical School on behalf of Picker Institute. Employing focus group discussions to gather data of this qualitative research, initially seven points were presented with the later addition of the eighth point about access to care. This also signifies the importance of qualitative research in healthcare; apart from quantitative research to gather systematic, rigorous scientific inquiry. Patients, family members, physicians, para medical and auxiliary hospital staff participated in the focus group discussions which lead to the formulation of this eight-point model. The composition of focus groups ensured that patients and their families voices were heard and acknowledged.

Efficacy of 3% Moringa Oleifera Lam Leaf Extract Cream in Improving Xerosis Cutis In Patients with Type 2 Diabetes Mellitus

Fitriani — 2025-09-30

Background: Moringa oleifera Lam (M. oleifera Lam) leaves are plants that grow abundantly in Indonesia and are used as phytopharmaceutical. Moringa oleifera Lam leaves contain antioxidant, fatty acids, amino acids, vitamins, and minerals. These ingredients are involved in skin barrier, hydration, antioxidants, and anti-inflammatory, but the studies on the benefits of phytopharmaceutical plants on improving xerosis cutis in patients with type 2 diabetes mellitus (DM) are still limited.

Objectives: To assess the efficacy of 3% M. oleifera Lam leaf extract cream in reducing xerosis cutis in patients with type 2 DM.

Methods: Pilot study with pretest-posttest experimental design during April-August 2024. Parameters of Overall Dry Skin score (ODSS), tewameter, corneometer, sebumeter, and visual analogue score (VAS) were observed at baseline, 2 and 4 weeks. Dermatology Quality of Life Index (DLQI) was observed at pre- and post-treament.

Results: The total subjects were 66.7% females and 33.3% males, with a mean age of 64.53 ± 8.74 years. The grade 2 ODSS group of 43.4% at baseline had significant improvement at 4 weeks (p<0.001). The comparison of transepidermal water loss (TEWL) between baseline and 4 weeks showed a mean decrease of 16.94 ± 5.43 g/m²/h (p<0.001) and hydration levels increase with a mean of -23.50 ± 10.09 AU (p<0.001). The improvement that resulted in normal sebum was 6.7% (p=0.500). The VAS of subject decreased and a significant difference in DLQI. Adverse effects of extract cream were not found in this study.

Conclusion: Treatment of xerosis cutis in patients with type 2 DM using 3% M. oleifera Lam leaf extract cream gives good results, but further study is required.