Journal of Pakistan Association of Dermatologists

Importance of worldwide research of the patient with dermatomyositis/ polymyositis

Gonzalo Dominguez Alvarado — 2024-04-21

Yellow dermatology: Highlighting its diagnostic and teaching challenge

Khalifa E. Sharquie — 2024-04-21

Objective There are many skin diseases that might present as yellowish skin lesions initially or during the course of the disease. The objective of the study is to record all patients that have yellowish rash during the progress of the disease and according to daily clinical practice and their importance in dermatology and general medicine.

Methods All patients that had yellowish skin rash during the course of the disease were enrolled during the period from February 2014 to March 2021.They were well-assessed and classified. Clinical photographs with some histopathological findings were recorded.

Results The following diseases were classified to have yellow skin rash initially or during the course of the disease and their frequencies were calculated, in addition to the medical importance to patients and dermatologists: 1- Histiocytosis- xanthogranuloma group. 2- Xanthoma groups. 3-Xanthomatous morphea. 4- Keratoderma. 5- Calcinosis cutis. 6- Systemic sclerosis. 7-Pseudoxanthoma elasticum. 8- Papular mucinosis. 9- Necrobiosis lipoidica. 10-Xanthomastocytoma. 11- Yellow nail syndrome. 12- Ecchymosis. 13-Nevus sebaceous. 14-Sebaceous hyperplasia. 15-Nevus anemicus. 16-Yellow teeth. In addition, anemia and jaundice usually present as generalized yellowish skin discoloration.

Conclusion Yellow dermatology is a group of diseases that characteristically presents with yellowish skin lesions initially or during the progression of the disease. They are well classified to be informative in medical practice and teaching sessions. The cause of this color is different according to the disease status as could be fat deposition, fat engulfing cells, connective tissue degeneration, sebaceous cells hyperplasia, hemoglobin and hemosiderin deposition, vasoconstriction, or unknown reason.

Incontinentia pigmenti with remarkable cutaneous manifestations

Khalifa E Sharquie — 2024-04-21

Background Incontinentia pigmenti (IP) is a genetically determined dysplastic ectodermal disease involving the cutis, hair, teeth, micro-vascular system and central nervous system. Successive skin manifestations develop in four steps, the first one occurs during early infancy or manifest at birth. IP is a dominant mediated genetic disease of the X chromosome due to abnormalities of the IKBKG gene. The purpose of the study is to report cases of incontinentia pigmenti with variable cutaneous presentation.

Methods Twelve patients with incontinentia pigmenti were evaluated by case series descriptive study during the period from 2017-2023 years. All demographic and clinical information were recorded. Full cutaneous examination was carried out.

Results The analysis of twelve patients with incontinentia pigmenti showed that all patients were females, with positive family history in one patient and their ages ranged from 2-6 months. Eleven patients showed warty vesicular erythematous rash in a swirled and whorled pattern with some blaschkoid line features in one side of body except one patient showed generalized rash while in one patient the rash was just generalized whorled pigmentation with no blistering warty rash. More than one stage of rash evolution was noticed in 11 patients often with warty blistering plaques. The warty blistering, the rash was resolved after topical steroid cream.

Conclusion Twelve female infants with incontinentia pigmenti were assessed, mostly with unilateral warty erythematous blistering rash. The sequential stages of the disease were not revealed but in contrast more than one stage was demonstrated at the same time.

Comparison of efficacy of 50% salicylic acid versus cryotherapy in the treatment of plantar warts

Hafsa Usman — 2024-04-21

Introduction Human papilloma virus (HPV), which enters the body through skin breaks and wounds and develops as a lesion on the soles or toes, is the source of plantar warts.. There are many treatment options for plantar warts. Topical treatments are acceptable to the patients in general because of their pain free nature and less cost. Cryotherapy is a second line treatment for plantar warts. The aim of the study is to compare the efficacy of 50% salicylic acid vs. cryotherapy in the treatment of plantar warts.

Methods A total of 98 patients (49 in each group; Group A and Group B) were enrolled for this study. Group A was exposed to cryotherapy every two weekly with a minimum of 4 sessions and assessed at the end of 12th week of initiation of therapy. Group B was given 50% salicylic acid to be applied daily at home every night and removal of the dead tissues with abrasive stone in the morning for a total of 8 weeks. Final observation for efficacy was done at the end of 12^th week. Efficacy was defined here as 50% reduction in the size of wart as measured at baseline. No change in size or less than 50% reduction in size was considered as non-efficacious and partially effective respectively.

Results Complete response was seen in 26.5% of patients in group A and 18.4% patients in group B. Almost similar number of patients did not respond to either of the two treatment modalities. The efficacy was found in 34.7% in group A while in group B, the efficacy was 30.6%.

Conclusion Our study reveals no significant difference between efficacy of 50% salicylic acid and cryotherapy in treatment of plantar warts.

The impact of social media on women having dermatology procedures: A new insight in dermatology

Dhelya Widasmara — 2024-04-21

Introduction In Indonesia, the trend toward invasive and noninvasive dermatologic procedures continues to grow. This study investigates what makes Indonesian women immediately seek information about dermatology procedures and the possibility of making social media a media outlet in future implementations to provide accurate and precise information about dermatology procedures to women. This study aimed to determine the influence of social media on women undergoing dermatological treatments.

Methods Qualified participants were asked to complete an online questionnaire in October 2022, as in the Google Form.

Results A total of 91 female respondents aged 15 to 50 completed the survey. Approximately 82.5% agreed that social media can be a motivator for beautifying themselves, and 51.8% agreed that social media can encourage society to perform dermatology procedures. Acne rather than extra fat tissue bothers 34.1% of respondents. A total of 43.3% of respondents also agree that influencers on social media create beauty trends that motivate them to beautify themselves. A total of 53.6% of respondents agreed that dermatologists' social media was the most influential factor affecting their motivation to perform dermatology procedures.

Conclusion Dermatologists are currently facing a digital age of beauty. It is a further challenge for dermatologists to accurately provide information about dermatology procedures and fulfill the dynamic demands of patients by having a better awareness of market trends.

Prevalance of Metabolic Syndrome in men with androgenetic alopecia: A cross-sectional study

Muhammad Ajmal Saif — 2024-04-21

Introduction In the last twenty years, evidence has revealed a connection between androgenetic alopecia and metabolic syndrome, along with its related conditions such as cardiovascular diseases, hypertension, and insulin resistance. Metabolic syndrome is characterized by the presence of hypertension, abdominal obesity, dyslipidemia, impaired fasting glycemia, and insulin resistance, and it has been linked to an elevated risk of developing cardiovascular diseases. The aim of this study was to assess the prevalence of metabolic syndrome in men with androgenetic alopecia.

Methods This cross-sectional study was done at the Department of Dermatology, Bahawal Victoria Hospital in Bahawalpur from August 2, 2018 to February 1, 2019.The study involved 95 male participants aged between 20 and 50 with androgenetic alopecia. Exclusions were made for individuals with alopecia areata or psoriasis, those with chronic renal failure (CRF) or chronic liver disease (CLD), and those undergoing radiotherapy or chemotherapy. Informed written consent was obtained, and the researchers assessed five components of metabolic syndrome.

Results The study included participants between the ages of 20 and 50, with an average age of 34.07±6.36 years. Most participants, 61 individuals (64.21%), were between 20 to 35 years of age. The average duration of androgenetic alopecia was 6.31±2.46 months, while the mean height, weight, and BMI were 166.19±11.24 cm, 76.33±7.57 kg, and 26.19±4.57 kg/m², respectively. The study found that 16 individuals (16.84%) with androgenetic alopecia had metabolic syndrome.

Conclusion This study concluded that there is a substantial prevalence of metabolic syndrome among men with androgenetic alopecia.

Chronic involuting relapsing keratoacanthoma with grouping tendency of lesions in seven staggering cases

Khalifa E Sharquie — 2024-04-21

Background There are case reports in the medical literature showing some patients has recurrent keratoacanthoma in selected region and given different names such as chronic keratoacanthoma serpiginous, eruptive keratoacanthoma centerifugum and involuting keratoacanthoma.

Objective To report seven patients with keratoacanthoma who had recurrent relapsing and involuting keratoacanthoma in selected body regions and to suggest a covering reprehensive name for this specific medical condition.

Methods This is cross sectional descriptive study that was carried out during the period from 2013-2020 where all patients with keratoacanthoma were collected and among them the recurrent involuting keratoacanthoma were isolated. Full demographic and clinical examination was done. Skin biopsies were performed for histopathological evaluation.

Results Forty-five patients with keratoacanthoma were described with Fitzpatrick skin type III, IV among them seven (15.5%) male patients with chronic involuting relapsing keratoacanthoma (CIRKA) were detected, their ages ranged from 25-60 years with a mean of 50 years with negative family history. All had chronic picture with a round of 3-4 years duration. Patients gave story of old and new lesions appearing on the sites. The sites of lesions were on the dorsa of hands in three patients with one patient had in addition chest involvement. While the other four patients had their lesions on the legs apart of one patient had in addition lesions on the face. In all patients, the lesions on the sun exposed sites including face, hands and legs. Also, all patients and on all sites showed different stages of lesion maturation, early umblicated papules and nodules, then small and large plaques, and large tumor size some with characteristic keratoacanthoma with crateriform. All patients had grouping of their lesions in well selected sites. In addition some had atrophic areas which were the sites of involution. Histopathological evaluation demonstrated a picture of keratoacanthoma in all patients.

Conclusion All patients showed features of recurrent involuting relapsing keratoacanthoma on well-defined areas. The histopathology was that of keratoacanthoma and all cases are not part of syndrome. As literature described this entity by different names; hence we suggest the name chronic relapsing involuting keratoacanthoma (CIRKA) as representative new informative name.

Frequency and risk factors of dermatological infections in patients attending dermatology outpatient department of tertiary care hospital

Naima Luqman — 2024-04-21

Objective Dermatological infections are highly prevalent globally thus Significantly impacting individual’s quality of life and these infections has many associated risk factors. The objective of this research is to investigate the frequency of dermatological infections and the factors associated with them among individuals seeking care at a Dermatology Outpatient

Department in Bahawalpur.

Methods A Cross Sectional study was conducted at the Outpatient Department of Dermatology, Bahawal Victoria Hospital Bahawalpur, spanning a period of six months from July 1,2023 to December 31, 2023.All patients seeking treatment for skin concerns during this period were enrolled. Each patient underwent a comprehensive medical history review and thorough skin examination.

Results This study conducted on 1200 patients attending dermatology outpatient department, Bahawal Victoria Hospital, Bahawalpur. This study revealed that 720/1200(60%) patients were suffering from dermatological infections and found that 288 (40%) patients had fungal infections, 230 (32%) were suffering from scabies, 116 (16%) had bacterial infections and 36 (5%) were infected with viruses.

Conclusion Among all dermatological infections, fungal infections emerged as most common dermatological infection, followed by scabies, bacterial, viral and parasitic infection. Health education has great role in controlling preventable risk factors of infections like BMI and hygiene.

The association between vulvovaginal candidiasis and hormonal contraceptive use in the outpatient clinic of Dr Soetomo Hospital, Surabaya in 2017-2020: A retrospective study

Azalia Aprinda Bahat — 2024-04-21

Background Vulvovaginal candidiasis (VVC) is one of the most common sexually transmitted infection (STI). With the increasing use of hormonal contraceptives, it is becoming increasingly important to investigate the role of hormonal contraceptives on the occurrence of VVC. This study aims to explore the association between hormonal contraceptive use and VVC.

Methods This retrospective unmatched case-control study enrolled patients from the STI outpatient clinic of the the Dr. Soetomo Regional General Hospital Surabaya in 2017-2020.

Results A total of 308 patients presented to the clinic, 132 (42.9%) of whom had VVC, and 84 (27.3%) of whom used hormonal contraceptives. Hormonal contraceptive use may increase the odds of developing VVC by 3.4-folds (95% CI: 1.97-5.89; p<0.001), independent of STI history and immunodeficiency disorders. In addition, oral contraceptive pills may increase the odds by 2.3-folds (95% CI: 1.25-4.34; p=0.008), while other hormonal contraceptives such as injectable or implants may increase the odds by 8.7-folds (95% CI: 3.13-24.28; p<0.001). Patients using hormonal contraceptives had a probability of suffering from VVC of 58.8%, while those of patients using OCPs and other hormonal contraceptives were 49.5% and 78.6%, respectively.

Conclusion This study proves that hormonal contraceptives is a risk factor to the occurrence of VVC.

Combining topical minoxidil with procapil; an assessment of their comparative efficacy in androgenetic alopecia: A randomized control trail

Muhammad Fahim — 2024-04-21

Introduction Androgenetic alopecia (AGA) is a commonly prevalent form of non-scarring alopecia mostly involving men. It involves 50% of men, and the prevalence increases with age. Its scalp involvement ranges from mild (I) to severe (VII) based on the Norwood scoring system. Multiple modalities have been tried for its treatment, including oral and topical minoxidil and finasteride. These treatment modalities have been successful in treating androgenetic alopecia up to a certain extent but are also associated with adverse effects. Very few studies are available on the efficacy of topical procapil, and none have compared it with minoxidil on a head to-head basis. The purpose of this study was to assess the efficacy of procapil in combination with minoxidil vs. minoxidil alone in the treatment of androgenetic alopecia.

Methods Using randomized sampling technique, 140 patients were enrolled in this study. Patients were divided into two groups, with 70 patients in each group. One-half of the patients used 5% minoxidil on a twice-daily basis (Group A), while the other half used procapil 5% alternated with minoxidil for 12 months (Group B). Both subjective and objective assessment tools are used for hair regrowth evaluation in the form of an increase in the mean hair count as well as patients’ satisfaction and dermatologist assessment scores.

Results The mean age was 32.6±6.7 and 31.5±7.4 years in groups A and B, respectively. The baseline line hair count and grads of AA were also comparable in both groups. As compared to minoxidil alone, the combination therapy showed better results in terms of an increase in hair count (p value=0.0001), Patient satisfaction (p value=0.011), and Dermatologist assessment scores (p value=0.0054).

Conclusion The addition of procapil to minoxidil is more efficacious than minoxidil alone for the treatment of androgenetic alopecia.

Clinical and trichoscopic features of post-COVID-19 telogen effluvium

Muhsin Al-Dhalimi — 2024-04-21

Objective Telogen effluvium is the most common, self-limiting cause of alopecia. An association between telogen effluvium and COVID-19 has recently been reported.

Methods This cross-sectional study included 75 patients at dermatology outpatient clinic. The patients were classified according to their COVID-19 history as mild, moderate, or severe. History was taken to assess the onset of hair loss. All patients were examined by hair pull test and assessed trichoscopically for the presence of follicles with a single hair, yellow dots, decreased hair density, peri pilar sign, empty hair follicles, and upright regrowing hair.

Results The mean duration of hair loss in the current study was 8.55 weeks. Patients with higher severity of COVID-19 reported significantly earlier onset of hair loss. Pain and dystrophic anagen hair on pull test was observed in association with hair shedding in all patients with severe COVID-19 infection.

Conclusion Post-COVID-19 telogen effluvium has a significant positive correlation with the severity of COVID-19 infection with earlier onset of hair loss, increased frequency of trichodynia, and dystrophic anagen hair.

A novel therapy of combination Fractional CO2 Laser with topical insulin for treating atrophic acne scar: Single arm study

Yuli Kurniawati — 2024-04-21

Introduction Atrophic acne scars pose significant cosmetic and psychological challenges for individuals. Various treatment modalities have been explored, including fractional CO₂laser therapy and topical insulin, which have shown promising efficacy in scar remodelling and tissue regeneration. The objective of the study is to evaluate the effectiveness and safety of a novel therapy utilizing a combination of fractional CO₂ laser and topical insulin in treating atrophic acne scars.

Methods A total of 19 patients with atrophic acne scars in Palembang were enrolled in this study. The treatment regimen included a combination of fractional CO2 laser therapy and topical insulin application. Treatment sessions were performed once every two weeks for two months. Scar severity was assessed using validated scales, and patient satisfaction and adverse events were recorded.

Results The combination of fractional CO₂ laser and topical insulin therapy demonstrated promising results in treating atrophic acne scars with significant developments in all outcome variables (Goodman and Baron score, visual analog scale, and quality of life index in dermatology). Significant improvements in scar severity and patient satisfaction scores were observed at the end of the treatment period (at six weeks), with minimal reported adverse events. There is no significant result for random blood sugar with topical insulin influencing blood sugar systemic.

Conclusion A combination of fractional CO₂ laser and topical insulin therapy has been proven effective in treating acne atrophic scars. This treatment option shows promise for managing acne atrophic scars due to its effectiveness and safety.

Effects of combine treatment of tressfix and PRP on the levels of different micro ribonucleic acids among seborrheic eczema patients

Uzma Dost Muhammad Rajar — 2024-04-21

Introduction The research aid in the identification of individual micro Ribonucleic Acids (miRNA) linked to the beneficial tissue healing responses found in patients receiving the medication. Hence the study is aimed to determine the effects of PRP and tressfix serum on the levels of miRNA among seborrheic eczema patients.

Methods The research comprised both male and female individuals between the ages of 18 and 65 who had mild to moderate seborrheic eczema. Participants were either unresponsive to traditional therapy or resistive to them. Individuals with immune-related diseases, bleeding disorders, active skin infections, serious medical illnesses, allergies to PRP or tressfix serum components, and those who were pregnant or nursing were not eligible.

Results The analyses of the findings had revealed that the levels of miRNA were significantly reduced p<0.05 in all the three groups with the significant reduction were observed in combine group in comparison to PRP and tressfix serum alone groups. In group A the expression of all miRNA were reduced significantly p<0.05 in comparison to miRNA expression in group B and group C. In group C the expression of two miRNAs that were has-mir-941 and hsa-miRNA-212 were reduced significantly whereas the levels of remaining three miRNA remain non-significantly unaltered.

Conclusion The study give evidence of the efficacy of the intervention, which combines platelet-rich plasma (PRP) with tressfix serum, in treating seborrheic eczema. The drop in miRNA levels across all three groups suggests that the therapy had a significant influence on the underlying molecular pathways involved in skin healing and inflammation. The combination group, in comparison to the other treatment groups, showed the most significant drop in miRNA levels.

Trends in the use of trichoscopy among dermatologists of Pakistan

Fatima Sajid — 2024-04-21

Background Trichoscopy, also known as scalp dermatoscopy, is a non-invasive diagnostic tool used to identify hair morphological features not visible to naked eye. It is a relatively new field and despite establishing the importance of trichoscopy in clinical practice, it has repeatedly been identified as a practice gap among dermatologists.

Objective To investigate the frequency of use of trichoscope by dermatologists in Pakistan.

Methods A cross-sectional study including 265 practicing consultant dermatologists and resident dermatologists were included. Dermatologists were given an online questionnaire to be filled out. Descriptive statistics were calculated. Stratification was done. Chi square t-test was used to compare the age, sex and years of experience with the use of trichoscopy. P-value ≤0.05 was considered as significant with confidence intervals set at 95%.

Results 9.4% dermatologists reported using trichoscope to diagnose hair disorders. This use was significantly higher with older age (p=0.019), but not with gender, clinical experience, job position, place of work or government versus private set up. Only 37.2% dermatologists were trained in using a trichoscope, where most were self-trained. Limited access to a trichoscope, absence of formal training and high costs of trichoscope were identified as the main hurdles to trichoscope use in Pakistan.

Conclusion Trichoscope use is very limited in Pakistan often leading to inaccurate diagnosis and insufficient treatment of hair disorders. Access to formal training and low-cost trichoscopes are needed to bridge this important clinical gap.

A retrospective review of the spectrum of scalp hair loss at the Lagos State University Teaching Hospital Dermatology Clinic

Ehiaghe Lonia Anaba — 2024-04-21

Background: Scalp hair loss (HL) is not uncommon but the documentation of the spectrum of it in clinical settings is rare. The study aimed to document the prevalence, spectrum and any gender based differences in types of scalp hair loss.

Methodology: This was a retrospective chart review of 131 cases of HL treated at the out-patient dermatology clinic of the Lagos State University Teaching Hospital from January 2017 to December 2022. Data extracted included age, age at onset, gender, duration, family history of HL, pattern of HL (patchy or diffuse), symptoms (pain, pruritus) and type of HL.

Results.

The prevalence of HL was 3.9% and the median (IQR) age at onset of hair loss was 28 (19,37) years. The age of onset of HL occurred more between 20-29 years of age. The population was mostly female; 61.1%. Patients aged 20-39 years were predominantly affected (51.9%). Hair loss was patchy in 82.4% and symptomatic in 67.2%. Alopecia areata (AA) was the most diagnosed type of HL and the least diagnosed HL was telogen effluvium (TE). Self-medication was noted in 26.7%. Acne keloidalis nuchae and FD occurred only in males. Discoid lupus, psoriasis and CCCA occurred more in females. Traction alopecia and TE occurred only in females

Conclusion: Hair loss is an uncommon presentation in the clinic. It occurs more in females and alopecia areata is the commonest HL diagnosed. The pattern of HL is mostly patchy and non-scarring. Gender and age influence HL types.

Plantar warts, more than a nuisance: Assessment of Dermatology Life Quality Index in patients with plantar warts

Muneeza Qamar — 2024-04-21

Introduction: Plantar warts (PW) are a benign skin infection of keratinocytes caused by Human Papilloma Virus that can cause significant morbidity leading to an impairment of quality of life (QoL)

Objective: The objective of this study was to determine the mean Dermatology Life Quality Index (DLQI) in patients with plantar warts.

Materials and Methods: 98 patients were enrolled in this cross-sectional survey conducted in Jinnah Hospital, Lahore. DLQI was determined for each enrolled patient.

Results: Mean DLQI score was found to be 9.4±5.4 which falls in the category of moderate impairment of QoL.

Conclusion: PW cause significant morbidity leading to a moderate to severe impairment of DLQI in about two thirds of the cases, especially in young, male and educated subjects with chronic PW.

Hair digging folliculitis of the nape of the neck and occiput: Outbreak of cases following hair styling by close shaving of non-curly hair

Khalifa E Sharquie — 2024-04-21

Background

Folliculitis nuchae is chronic inflammatory process of hair follicles of the nape of the neck and occiput and is usually seen in persons with curly hair of African descendants. This condition might continue for months and years that often end with keloid formation if not stopped.

Objective

To do full clinical evaluation of this condition in patients with non-curly hair and non -African descendants.

Patients and methods

This is a cross sectional study with therapeutic trial that had been carried out during the period from 2019-2023 where all patients with folliculitis of the nape of the neck and occiput with or without keloidal formation were collected. All demographic and clinical features were screened and all patients with Fitzpatrick's skin types were III-IV. The disease process was passed in three phases according to the type of inflammatory process and as follow: In phase one, there were folliculitis only while in second phase, there were small hypertrophic scars with some features of folliculitis while the third phase consisted mainly of keloidal papules and nodules. Then management was applied according to the phase of the disease process and as follow: Phase one, patients were treated by topical clindamycin solution with oral desloratadine 5 mg tablet twice a day and oral sulfamethoxazole/trimethoprim (400mg/80mg) 2tablets twice a day for two weeks, then 2tablets a day.Phase two was managed similarly to the phase one with edition of topical steroid.Phase three , only oral desloratadine 5 mg tablet with topical mometasone cream twice a day and therapy continued for several months.

Results

Sixty male patients with with non-curly hair were included in this study, their ages ranged from 20-45 years with mean age of 28 years while the duration of the disease ranged from 0.5-5 years. All patients gave history of very close hair short cutting and shaving of hair of back and sides of scalp and neck. Itching and scratching were practiced by all patients while pain was mentioned in 13(21.66 %) patients. According to the phase of the disease, 48(80%), 8(13.33%) and 4(6.66%) of patients were in phase one, two and three respectively.

The response to treatment was variable and depended on the phase of the disease as phase one showed rapid and best response to treatment regimen with very satisfactory results than phase two and three.

Conclusions

There is major outbreak of digging folliculitis of neck among adult males with non-curly hair following new hair styling by close short cutting and shaving of back and sides of scalp and neck hair.

Frequency of anti-HCV antibodies in lichen planus patients attending a tertiary care hospital Quetta, Balochistan

Iftikhar Athar Rasool — 2024-04-21

Background Lichen planus (LP) is a common inflammatory disorder of the skin and mucous membranes having an unknown etiology. In addition to skin and mucous membranes, it also involves nails and hair. Classically it is characterized by pruritic, purple, polygonal, plan-topped papules and may have different clinical presentations like erosive, hypertrophic, atrophic, follicular (Lichen planopilaris), linear, actinic, pigmentosus, annular, guttate, and vesiculobullous. In recent years, many research articles showed association of Lichen planus with HCV infection. So, it is important to establish the clinical role of Lichen planus in the diagnosing of hepatitis C virus is an a pivotal and practical task.

Methods This is a cross sectional study, having consecutive sampling of Non probability type. It is conducted at department of dermatology, Sandeman (Provincial) Hospital/ Bolan Medical College Quetta between January 2018 to June 2018. All the patients of either gender, aged 30 to 60 years and clinically diagnosed with Lichen Planus were enrolled. After a complete history and clinical examination, anti HCV antibodies was checked by kit method in the institutional laboratory.

Results The mean age was 46.42 ±9.75 years. There were 89 (53.9%) females while 76 (46.1%) males. Mean duration of symptoms was 3.20±1.16 weeks. Frequency of positive anti HCV antibody was found in 53 (32.1%) patients while 112 (67.9%) patients were found to be negative.

Conclusion The results of high frequency of Anti HCV antibodies support a possible association with lichen planus.

The prevalence and risk factors of sexually transmitted infections among correctional institution inmates in Manado, Indonesia

Nurdjannah Jane Niode — 2024-04-21

Background Correctional facilities are particularly vulnerable to the spread of sexually transmitted infections (STIs). This study aimed to test for syphilis, human immunodeficiency virus (HIV), and hepatitis B virus (HBV) in inmates at the Correctional Institution Manado, Indonesia, and to evaluate its associated risk factors.

Methods 94 inmates underwent venereal disease research laboratory (VDRL), anti-HIV, and HBsAg testing. Data collection encompassed socio-demographic characteristics, risk factors including age, educational level, marital status, number of sexual partners, sexual orientation, condom usage, intravenous drug use, other drug administration methods, and blood sampling for screening purposes.

Results Sociodemographics were predominantly marked by groups between 25–49 of age (63.8%), possessing an intermediate education (63.9%), married (46.8%), sexually monogamous (54.3%), identifying as heterosexual (95.7%), never using condoms (58.5%), abstaining from intravenous drug use (95.7%), and utilizing other drug types (64.9%). Among the participants, 12.8% tested positive for VDRL, 1.1% for anti-HIV, and 6.4% for HBsAg. Only one subject exhibited reactivity to both VDRL and HBsAg tests. There was a strong connection between marital status and HBsAg (p=0.007).

Conclusion The prison environment offered insights into STI dissemination in a high-risk population, emphasizing that spread prevention needs informative and therapeutic measures.

Ocular manifestations in psoriasis of Iraqi patients

Ahmed Abdulhussein Kawen — 2024-04-21

Objective A cross-sectional study was established in Iraq Dhi Qar Governorate, which aimed to determine the prevalence of ocular manifestations in psoriasis among Iraqi patients.

Methods This study was designed according to the frequency of ocular manifestations in psoriasis in Iraq, where reliance was placed on the statistical analysis program SPSS and the Schirmer test. To semiquantitative test of tear production that measures the physical tendency of a fluid to travel along a strip of porous material by capillary action due to surface tension for the diagnosis of dry eye. The statistical analysis program SPSS was relied on to analyse demographic data and information about patients.

Results/Conclusion The statistical analysis program SPSS was relied on to analyse demographic data and information about patients. The mean age of the patients was 45.2±13.5, and results were found with a statistical correlation between ocular diseases in patients, where a high percentage of contract was found for 50 patients and 100 eyes. In addition, other abnormalities in the eye were found, including keratitis and blepharitis. Moreover, the presence of eye diseases affects the degree of disease activity and the cutaneous form of psoriasis. It can affect one or both eyes, as it generally appears with outbreaks of infections that recur over time. About half of uveitis is due to an unknown cause.

Comparison of efficacy of topical retinoid with topical steroids in the treatment of oral lichen planus in a tertiary care hospital Quetta

Murwarid Murad Baloch — 2024-04-21

Objective To compare the efficacy of topical retinoids with topical steroids in the treatment of oral lichen planus presented in tertiary care hospital Quetta.

Methods The study was designed and was conducted in Dermatology department Bolan Medical College Hospital/ Sandeman provincial hospital, Quetta. The approval of the study was taken from the institutional ethical review board. The duration of study was six months, from 15. June 2020 to 15 January 2021.

Results A total of 82 patients were selected through non-probability sampling. The patients were included after complete examination and history taking. Patients were either diagnosed clinically or lesional biopsy was taken. The patients were grouped into two groups, one was named Group R (for topical retinoids), and another was named Group S (for topical steroids). Data was analyzed using SPSS version 25. Post stratification T test was applied by taking P<0.05 as level of significance. The total number of patients were 82 with clinical diagnosis of lichen planus. The average age of patients was 41.1± 9.4 years.

Conclusion The steroid group showed significantly low post treatment scores as compared to the Retinoid group; (2.7±0.8 vs. 4.2±0.8; P=0.000). In addition, the steroid group showed significantly low post treatment symptoms score as compared to retinoid group (2.6±1.0 vs. 5.9±1.1; P= 0.000). Topical steroid therapy is more effective as compared to topical retinoids in terms of signs and symptoms in patients of lichen planus.

Assessment of clinical efficacy of Q-switched Nd:YAG laser 1064-nm in onychomycosis

Attia Tabassum — 2024-04-21

Introduction: Onychomycosis (OM) is a chronic fungal infection of the finger and toenails. Emerging treatments include lasers like CO2 laser and Nd:YAG Laser 1064-nm which combine both efficacy and safety.

Objective: To determine the clinical efficacy of Q-switched Nd:YAG Laser 1064-nm in OM.

Materials and Methods: This study undertaken in Dermatology Department, Mayo Hospital, Lahore was conducted on 118 patients with OM.

Results: More than one third (35.6%) of our subjects had excellent clinical response and only 5.1% had a poor response. Disease duration longer than 6 months was significantly associated with poorer outcome.

Conclusions: Q-Switched Nd:Yag Laser 1064-nm is an effective noninvasive treatment option for OM in our population. It should be considered in all patients with recent disease onset, especially where long term systemic agents are contraindicated or poorly tolerated.

Key Words: Onychomycosis, 1064-nm Nd:YAG wavelength laser, systemic antifungal agents

Comparison of Outcome of Microneedling with Autologous Platelet Rich Plasma Versus Topical Vitamin C for the Treatment of Acne Scars

Fazila Karim — 2024-04-21

Objective Acne vulgaris is a common chronic skin disease occurring in adolescence. It involves blockage and inflammation of pilosebaceous units. It is usually self-limiting but in 20% of affected individuals it can lead to scarring. The objective of the study is to compare and evaluate efficacy of Micro needling with PRP versus micro needling with vitamin C in treatment of atrophic acne scars.

Methods This study was conducted in a government based tertiary care hospital free of any cost. Total number of patients included was 28. Two groups were made; Group (A) was treated with microneedling with PRP and Group (B) was treated with microneedling with vitamin C using Derma pen, containing an array of microneedles arranged circularly. Each group comprised of fourteen patients.

Results Goodman’s and Baron quantitative and qualitative grading of acne scars was used to assess baseline and result. Physician’s assessment was used to grade treatment response as poor, good, and excellent.

Conclusion Physician’s assessment of improvement showed excellent response in 3 patients, good response in 8 patients and poor response in 3 patients in Group (A). Physician’s assessment showed an excellent response in 1 case, good response in 7 patients and poor response in 6 patients Group (B).

Black hair dye dermatitis is a major cause of concealed facial melanosis in patients with dark complexion

Khalifa E. Sharquie — 2024-04-21

Background: Hair dye dermatitis is a common problem that is localized to the head or even generalized, and in many countries, it runs as an outbreak problem. Many patients could present with facial melanosis but without an obvious history of dermatitis. Objective: To record patients with facial melanosis that was triggered by black hair dying and to highlight this concealed cause of facial pigmentation. Patients and methods: This is a cross-sectional descriptive study where 102 patients with black hair dye facial melanosis were seen during the period from 2014-2022. All patients with Fitzpatrick skin type 111 and 1V. Full demographic features were clarified. History and examination were carried out, and skin biopsies for histopathological assessment were done in selected cases. All other causes of facial melanosis were excluded. The therapeutic trial used Mometasone Furoate 0.1% cream twice a day for one month. Results: A total of hundred two patients with facial melanosis were analyzed; their ages ranged from 30-60 years with a mean of 50 years,70 (68.6%) males and 32(31.4%) females with a ratio of 2:1. History and examination showed that all patients were applying black hair dye from 0.5- 4 years and the duration of facial pigmentation ranged from 1-5 years. Patients mentioned some itching of the face, while others mentioned a history of an erythematous rash of the face in the early course of the disease. On examination, all patients revealed deep brown to dark hyperpigmentation of the face, neck, and hands. Woods light examination gave no contrast, while histopathological assessment showed an increase in the melanin stores both in the epidermis and dermis. Topical therapy with Mometasone Furoate, 0.1% cream, gave a very satisfactory response by lightening the skin. Conclusion: Black hair dye is an important cause of facial melanosis that is often overlooked and confused with other causes of facial melanosis, commonly diffuse lichen planus actinicus, where its therapy will be very difficult unless hair dying is prevented. Therapy with mometasone Furoate 0.1% cream showed a satisfactory result.

Correlation between Psoriasis Area Severity Index and Dermatology Life Quality Index in psoriasis

Zainab Tariq — 2024-04-21

Background: Validated dermatology-specific quality of life tools are used globally to quantify the degree to which a skin disorder affects a patient's quality of life.

Methods: A cross-sectional study of patients with psoriasis was conducted. Patients were evaluated for psoriasis severity using the Psoriasis Area and Severity Index (PASI) and its correlation with Dermatology Life Quality Index (DLQI) was assessed.

Results: 60 patients were enrolled in this study. PASI and DLQI were found to be significantly correlated (r= 0.266 p = 0.044) but the degree of correlation was much lower than that found in European studies. However, post-stratification data analysis did not show a significant relationship between PASI and DLQI except in male patients (r=0.415, p = 0.006) and in patients with disease duration between 1-6 years (r = 0.579, p=0.002).

Conclusion: The correlation between PASI and DLQI was weaker than what has previously been reported. Further validation of culturally-sensitive dermatologic quality of life instruments is needed to capture the true impact of skin disease in these patients. Currently, DLQI fails to efficiently recognize some clinically important endpoints and may not be much relevant for routine clinical practice in our society.

Keywords: Psoriasis, PASI, DLQI

Lichen sclerosus has two different faces: Western versus eastern face

Khalifa E. Sharquie — 2024-04-21

Background In Western countries, lichen sclerosus is a common disease that affects commonly middle-aged females that present most commonly as a disease of genital and anal regions in both sexes while extra-genital involvement is less frequent.

Objective To record all cases of lichen sclerosus in the Iraqi population as one of the Middle East countries and to do a full clinical evaluation and be compared with published literature as seen in Western countries

Methods This is a cross-sectional descriptive study where all patients with lichen sclerosus were recorded during the period from 2013-2022. All demographic features were estimated and full history and examination were carried out. A histopathological assessment was performed as a confirmatory test.

Results All data related to 28 patients with lichen sclerosus were registered and evaluated. The age of patients has a bimodal peak in incidence from prepubertal to a postmenopausal age group and ranged from 8-63 years with a median of 40 years with 24(85.7%) females and 4(14.2%) males with a ratio of 6:1.The clinical features of the disease were found to be genital involvement in three (10.7%) patients, one male with follicular lesions of the penis and two females with vulval involvement: one with extensive atrophy of vulva while the other with very early lesions). While 25(89.2%) cases with extragenital sites where the trunk and limbs were the main locations but lips were affected in one female patient another one the ears were involved. The primary lesions in almost half of the cases were follicular whitish sclerosed macules, some with follicular plugs. These lesions over time coalesced together into larger whitish ivory leukoderma in the form of patches and plaques. The rash was localized in 22(78.6%) cases while extensive in 5(17.9%) patients. The lesion was asymptomatic apart from slight discomfort and itching but was severe intractable itching in the female genitalia. The HE-stained sections showed complete atrophy of the epidermis with complete sclerosis of the dermis leaving sub-epidermal cleft.

Conclusion Lichen sclerosus is a disease of females that commonly presents with extragenital whitish sclerosed leukoderma in the form of follicular macules, patches and plaques while female genital involvement is a rare presentation. The likelihood of extragenital lichen sclerosus following the Blaschko lines was pronounced.

Assessment of morphological variations in superficial veins of upper limb with or without artificial discoloration of skin using Near-Infrared Illumination device in adults (Hyderabad region)

Gul Roopchand Nankani — 2024-04-21

Objective: Venous puncture is the process of obtaining intravenous access to get blood samples. Superficial veins of Upper-Limb, mainly dorsal metacarpal veins and median cubital veins are the commonest site for access. In order to get acquaintance about anatomic variation to perform safe venous puncture, the main objective of this study was to examine the variations in superficial veins of upper limb by using Near-Infrared Illumination Device.

Methodology: This was a cross-sectional study. It was conducted in the Department of Anatomy of Liaquat University of Medical & Health Sciences (LUMHS) by using non-probability convenience sampling technique. The duration was about six months. A sample size of 50 participants (100 records of both limbs) has been documented. Staff and students of LUMHS of both genders; with the age ranging from 18-60 years, were included in the study. Tourniquet/Blood Pressure monitor cuff application was applied to visualize superficial cubital veins. Another technique of Near-infrared illumination device (sure view vein illumination system ZD-JM-260-01) was applied to observe superficial veins of hand dorsum in adults with and without Hinna (Mehndi) causing artificial discoloration of skin.

Results: The Study results showed that 46(92.0%) of the total participants reported Type A right arm cubital fossa. 47(94.0%) reported Type A left cubital fossa. 15(30.0%) of the male participants had Type 6 Right hand dorsum venous arrangement. Likewise, 5(10.0%) of the female participants had Type 6 right hand dorsum venous arrangement. 14(28.0%) male participants had Type 6 Left hand dorsum venous arrangement. Similarly, 7(14.0%) males had Type 2, and 13(26.0%) males had Type 3 left hand dorsum venous arrangements. Likewise, 5(10.0%) of the female participants had Type 3 left hand dorsum venous arrangement. Moreover, 03 adult females presented with Henna (Mehndi) already applied on dorsum of hands and superficial veins were as visible as in rest of subjects without application of Henna (Mehndi).

Conclusion: This study concluded that there was no difference seen in the venous pattern of participants on the basis of gender. Furthermore, Type-A was observed most frequently in venous arrangement in cubital fossa of both left and right arms of the participants, while Type 6 was the most generally observed type in hand dorsum of both right and left arms. Moreover. artificial discoloration of skin caused by Henna (Mehndi) did not seem to effect the visibility of vein structure.

Serum zinc levels and their impact on quality of life of patients with atopic dermatitis

Thuy Nguyen Dac Luong — 2024-04-21

Background: Atopic dermatitis is a chronic, recurrent disease characterized by pruritus and eczematous lesions. Several studies have shown that atopic dermatitis severely affects the quality of life and atopic dermatitis patients have low serum zinc levels.

Objectives: This study aimed to evaluate the impact of atopic dermatitis on the quality of life and quantify the relationship between serum zinc levels and patients’ well-being.

Materials and Methods: A cross-sectional study was conducted. Atopic dermatitis was diagnosed according to the Hanifin and Rajka criteria of 1980, and the severity was assessed using the Scoring Atopic Dermatitis (SCORAD) scale. The Dermatology Life Quality Index (DLQI) was used to evaluate the quality of life in patients. The itch severity was measured using the 5-D itch scale.

Results: A total of 87 patients and 87 healthy individuals were enrolled in the study. The “itching” component had the highest DLQI score. A statistical correlation was observed between the SCORAD score and the DLQI score. In the patient group, the serum zinc levels were lower than that in the control group. Additionally, there was a negative correlation between the SCORAD scores, the DLQI scores, and the 5-D scores against serum zinc levels.

Conclusions: Atopic dermatitis is associated with low serum zinc levels; both have a major impact on patients’ quality of life.

Prevalence and risk factor of hair fall and its relation with stress in healthy female subjects: A survey based study

Fatima Ghaffar — 2024-04-21

Background Hair is the beauty and affection of a female personality. Hair fall is infuriating for young females and losing their hair is like losing their beauty. Many the females are losing their hair without knowing the reason and their risk factors.

Objective The purpose of this study was to determine the prevalence of hair loss and their risk factor and their relation with stress in the young female population of Karachi, Pakistan.

Methods To accomplish this task survey-based study was conducted. 1015 female participants were selected with the age range of 15-25 years all participants were asked different questions given in to the questionnaire to assess the level of stress and degree of hair loss by using the Depression, Anxiety, Stress Scale (DASS scale) and Ludwig scale respectively. All statistical analyses were performed by SPSS 16.

Results In this study we observed that the prevalence of hair fall was quite low, only 37 (3.7%) females have significant hair loss.

Conclusion Hair fall is low prevalent in young females. With no significant relationship between hair fall and duration of hair fall. Improper diet and lack of protein intake and tight hairstyle are common risk factors for hair fall .

Fat grafting: A historical review

Sajad Ahmad Salati — 2024-04-21

Fat grafting is a popular procedure that provides a physician with a range of aesthetic, reconstructive, and regenerative clinical applications. It involves the harvest of fat tissue from one region of the body and transfer to another. The indications and techniques of fat grafting have undergone dramatic changes over time and. This review revisits the important milestones in the historical evolution of fat grafting.

Global trends and Publication on Secretome in Dermatology Practice: A Bibliometrics Analysis from 2003 to 2023

Monica Trifitriana — 2024-04-21

Background: The secretome, also known as conditioned medium, is a collection of proteins and other molecules secreted by Mesenchymal stem cells (MSCs), has been increasingly studied for its potential applications in dermatology practice. However, there has been limited bibliometric analysis to understand the global trends in this field.

Objective: To analyze the global trends and publication activity related to secretome in dermatology practice through bibliometrics analysis.

Method: A systematic search was performed using the Web of Science Core Collection database to identify relevant publications on secretome in dermatology practice from 2003 to 2023. Statistical analyses were performed using Excel and VOSviewer software. Various bibliometric indicators were analyzed to evaluate the publication trends, research topics, and collaboration networks.

Result: A total of 304 articles with H-index 45 and 20,74 citations per paper related to secretome in dermatology practice were identified. The annual publication output showed an upward trend, with a peak in 2022. The United States (57) had the highest number of publications, followed by China (37) and Germany (37). The most common research topics were wound healing, skin regenerative & rejuvenation, inflammatory skin diseases, skin cancer and hair growth. For promising hotspots, “exosomes and regenerative medicine” showed the highest, followed by “senescence”, “photoaging”, and “wound repair”

Conclusion: Our bibliometric analysis demonstrates that secretome research in dermatology practice has been an increasingly studied field with potential applications in the development of novel therapeutics for skin disorders. Collaboration among researchers and countries is crucial for advancing secretome research in dermatology practice.

Advancing skin cancer research with machine learning and deep learning models: A systematic review

Safa Gasmi — 2024-04-21

Background The global impact of skin cancer has underscored the urgency of accurate and timely detection for effective treatment. In recent years, the medical research landscape has witnessed a rapid evolution fueled by the integration of Machine Learning (ML) and Deep Learning (DL) models, specifically aimed at enhancing skin cancer diagnosis and classification.

Methods This comprehensive exploration delves into the forefront of advancements, focusing on the strategic application of ML and DL algorithms across critical facets of skin cancer management, encompassing detection, classification, and prognosis. By synthesizing diverse studies and emerging developments, this review aims to provide an all-encompassing perspective of the current landscape in skin cancer research, underpinned by the capabilities of ML and DL models.

Results The synthesis of research outcomes within this review accentuates the remarkable progress achieved through the fusion of ML and DL methodologies. These achievements manifest as heightened accuracy and efficiency in skin cancer diagnosis and classification, offering invaluable support to healthcare professionals. The integration of these algorithmic approaches has ushered in improved patient outcomes, facilitating prompt interventions and tailored treatment strategies.

Conclusions At its core, this review strives to equip researchers, clinicians, and healthcare providers with an intricate comprehension of the existing terrain in skin cancer research, driven by the prowess of ML and DL models. By spotlighting accomplishments alongside untapped prospects for refinement, this endeavor seeks to inspire fresh breakthroughs in the domain of skin cancer detection.

Fixed drug eruption by fluconazole: A case report

Sana Rafiq — 2024-04-21

A common kind of cutaneous adverse medication reaction is fixed drug eruption (FDE). There are many groups of drugs that are notorious culprits. Fluconazole is a very commonly prescribed anti-fungal agent in dermatology outpatient departments, and up till now, less than 30 cases have been reported where Fluconazole was an established causative agent of the FDE.

We report a case of FDE caused by Fluconazole which had not ever been established in our dermatology outpatient department prior to this, with an influx of about 1000 patients every day. The lack of clinical suspicion of the association of FDE with fluconazole might be the reason for under diagnosis.

A follow-up patient of SLE presented to us with oral candidiasis for which she was prescribed oral fluconazole. A week later, she came back to the OPD with complaints of FDE-like lesions involving her truck and proximal extremities associated with burning pain. She admitted to having experienced such episodes twice before this time, but they were of much less severity and subsided on their own within a few days. The intermitted nature of the flares upon drug intake and the morphology of her skin lesions rose our clinical suspicion of FDE.

While dealing with cases of FDE, dermatologists should keep in their mind to identify causes other than the well-established and notorious culprits. This will help in making the correct association and diagnosis and will be beneficial to avoid more severe flares subsequently.

Unveiling the clinical spectrum of pseudoxanthoma elasticum: A report of two cases

Zahra Arooba — 2024-04-21

Pseudoxanthoma elasticum (PXE) is a rare inherited disorder characterized by progressive disintegration as well as calcification of elastic tissue, resulting in cutaneous, ophthalmic, cardiovascular and other systemic abnormalities. It is an autosomal recessive condition caused by alterations in the ABCC6 gene. We report two cases of pseudoxanthoma elasticum with varying degrees of cutaneous and systemic manifestations of the disease. Both patients had characteristic histopathological changes on skin biopsies and fulfilled the diagnostic criteria for definite PXE. The goal is to demonstrate diverse clinical facets of the disease and to emphasize clinical clues for prompt diagnosis in order to minimize the associated complications.

Whole genome sequencing and nested polymerase chain reaction in ocular syphilis: A case report

Muji Iswanty — 2024-04-21

Background: Syphilis is a sexually transmitted infection caused by Treponema pallidum. Ocular syphilis is a rare syphilis clinical manifestation.

Methods: This study is a case report of a patient with ocular syphilis tested by Whole Genome Sequencing (WGS) and Nested Polymerase Chain Reaction (Nested PCR).

Results: In this study, we reported a case of a 22-year-old male presented with blurry vision in his left eye. He had skin erosion on his testicles for the last year. His presenting visual acuity was 20/200 (left) and 20/200 (right). His right eye funduscopic showed an indistinct margin of papillary cranial nerve II (CN II) and hyperemia. He had reactive VDRL, TPHA, and HIV infection. Nested polymorphism chain reaction (nested PCR) showed T. pallidum A2059G mutation, but results were negative from whole genome sequencing (WGS). He received Benzathine Penicillin 2.4 million international unit injection (intramuscular) and symptomatic therapy. After three months of treatment, he had clinical improvement.

Conclusions: Ocular syphilis can occur at any stage of syphilis and may mimic various ocular diseases. Thus, it is often referred to as "the great masquerader".

Foot mycosis caused by fusarium solani mimicking tinea pedis in pediatric patient

Diah Ngesti Kumalasari — 2024-04-21

Background. Foot mycoses are mainly caused by dermatophytes, sometimes yeasts, and uncommonly and rare conditions by non-dermatophyte molds (NDMs). It is uncommon in women and children. Fusarium species are ubiquitous and may be found in the soil, air and plants. Some predisposition factors could be related with this disease including barefoot, wearing occlusive shoes, sweating of the feet. Trauma is the major risk factor for localized Fusarium infection. Case: A 11-year-old boy, complained itching and red patches on right and left feet since 1 year ago. Patient used to play barefoot, usually on the ground, in the fields and often played when it was raining. Patient also had a history of being stabbed by a twig. Patients used to wear socks for a long time at school. On Physical examination at right and left plantar pedis regions showed multiple erythematous macules with firm margins,covered with thin scales on top, plaques with yellowish crusts on top, erosions,no pus and no pustules. Potassium hydroxide 20% examination revealed fungal hyphae, and white and cotton macroscopic fungi were found from fungal culture examination. Pink or violet center, and becoming bluish-brown are present sporoconidia. Microscopically, it showed sickle or canoe shaped thin-walled macroconidia with 3–4 septa, microconidia,chlamydospore.Showed concordance with the feature of spesies namely Fusarium solani. Patients was received itraconazole 100 mg twice a day for 1 month and cetirizine 10 mg once a day, clinical cure was noted and mycological cure was obtained after 1 month of treatment. Conclusion: Foot mycosis due to non-dermatophyte species, namely Fusarium solani is a rare case. Clinical manifestation might be mimicking dermatophyte foot mycosis. A detail history and physical examination, supported by identification of etiology will lead to correct diagnosis and prompt treatment. Education to patient how to prevent reccurency by avoiding predisposition factor of the disease is the most important point of care.

Five variants of lichen planus in a middle aged HCV positive female

Javeria Rasheed — 2024-04-21

Lichen planus is an inflammatory autoimmune skin disease with characteristic features. Classic LP usually presents as polygonal, pruritic, violaceous flat-topped papules and plaques. Many variants in morphology and location also exist, including nail, linear, oral, atrophic, hypertrophic, annular, eruptive, bullous, inverse, ulcerative, lichen planopilaris, lichen planus pigmentosus. In this case we try to highlight the unusual presentation of five variants of LP in a female patient with chronic HCV.

Combining 90% trichloroacetate acid with electrosurgery to treat recurrent verruca vulgaris: A case report

Arifiana Wungu Kartika Dewi — 2024-04-21

Verruca vulgaris is a benign skin tumor that caused by Human papillomavirus (HPV) which a DNA virus that has more than 100 genotypes that being known. Verruca vulgaris commonly affects the hands, arms, legs, and feet, particularly in areas where there has been minor trauma, like the knuckles or the area around the nails. A 38-year-old man came in with chief complaints of lumps on his left thumb and right index finger since 1 month ago. Any histories of being trauma or scratched was denied. The patient had the same chief complaint approximately 2 months ago. The patient was undergoing physical and supportive examination using dermoscopy and he was diagnosed with recurrent verruca vulgaris. The patient was given the combination therapy using electrosurgery and 90% trichloroacetate (TCA) and five months later he went back for the follow up and there was no new lesion was found.

Therapeutic options in dermatoporosis: A case report

Windy Keumala Budianti — 2024-04-21

Dermatoporosis is a chronic skin insufficiency syndrome with typical manifestations of extreme skin atrophy, senile purpura, stellate pseudoscars, skin lacerations, and skin dissecting hematomas at the age of 70–90 years old. It is caused by aging process, and triggered by environmental factors and drugs which lead to the skin's protective mechanical function loss. The prevalence was 32% in French Hospitals and 30.7% in the Central Hospital of the University of Helsinki, Finland. We report a dermatoporosis case to raise awareness in clinical practice and trace study literature for choosing the most appropriate therapy. An 89-year-old man complained of red and itchy patches on his skin since the last six months. Physical examination shows dry skin, atrophy, purpura, stellate pseudoscars, and multiple arms and lower leg lacerations. The patient had been given ceramide moisturizer, but there is no significant improvement. Structural and functional skin damage in elderly is not just cosmetic problem. However, it significantly impacts life quality and increases morbidity and mortality risk if it develops into a serious condition. Therefore, clinicians have an essential role in proper management to prevent complications. Several studies have shown that hyaluronic acid and retinaldehyde improve skin function in dermatoporosis.

Deep circumscribed morphea: A case report

Bonnie Yudistha Anggawirya — 2024-04-21

Introduction: Morphea or localized scleroderma, encompasses a group of idiopathic sclerotic skin diseases. Deep circumscribed morphea is one of morphea subtype with deep induration of the skin and subcutaneous tissue extending to the underlying muscle and bone. Early diagnosis, appropriate assessment and effective treatment are crucial to improve the long-term outcome. Case: We report a case of a 3-year-old boy with a 2-year history of multiple erythematous to violaceous plaques with subcutaneous atrophy on the buccal, oral, mental, and neck area. He has difficulty of swallowing large pieces of food. The diagnosis was confirmed by skin biopsy, which revealed the typical morphology of morphea. The patient was administrated tapered systemic corticosteroid for 20 weeks and oral Methotrexate course for 24 weeks. There was clinical improvement of the lesions clinically with decreased hyperpigmentation of the lesions, regression of the induration and no difficulty of swallowing. The patient is still being followed to assess progression of the lesions and disease activity. Discussion: The diagnosis of morphea is often based on characteristic clinical findings and skin biopsy. Early diagnosis and treatment are necessary to minimize damage such as cosmetic sequelae and functional impairment that may result from unabated activity. Treatment depends on the depth of lesion involvement and the extent of the disease, focuses primarily on limiting disease activity. Conclusion: Morphea may be self-limited, but frequently has a remitting, relapsing or chronic course, resulting in significant disease burden over time.

Infantile systemic lupus erythematosus without internal organ involvement: A rare case report

Bhumesh Kumar Katakam — 2024-04-21

Systemic lupus erythematosus (SLE) is a rarity in children, especially in infancy. Current literature has very few reports of infantile SLE, and most of the reported patients had severe disease with systemic involvement and poor outcomes. We describe a case of infantile SLE in a female baby presenting with fever and rash, without any internal organ involvement.

Primary palmar hyperhidrosis treated with intradermal botulinum toxin type A injection and topical aluminum chloride

Tara Sefanya Kairupan — 2024-04-21

Background: Primary focal hyperhidrosis is a chronic, idiopathic, excessive sweating beyond the amount necessary for normal thermoregulation. It can affect one or more areas of the body, commonly the face, armpits, palms, or feet. This can cause great disruption in the quality of life of the patients and need to be treated properly. Various treatment options are available, including topical and systemic drugs, botulinum toxin type A injection, iontophoresis, microwave thermolysis, and surgery. Effective hyperhidrosis treatment varies among patients and may involve combination therapy. Case report: We report a case of primary palmar hyperhidrosis in a 33-year-old man. The patient had been using topical 15% aluminum chloride for 1 month without significant improvement. We administered intradermal botulinum toxin A injections, 100 IU for each palm, which led to marked improvements but still was not satisfying. Topical 10.8% aluminum chloride was given. Hyperhidrosis disease severity scale (HDSS) improved from 4 (severe) to 1 (mild). Discussion: Topical aluminum chloride is one of the first-line therapy for hyperhidrosis considering its safety, cost-effectiveness, and efficacy profile. Botulinum toxin A injection can be used in cases of severe hyperhidrosis or refractory to topical treatment. Nevertheless, not all patients respond to monotherapy approach, thus combination therapy can be recommended. Conclusion: In this case report, combination of intradermal botulinum toxin A injection and topical 10.8% aluminum chloride was found to be effective in controlling hyperhidrosis in a patient with partial response to monotherapy of either agent.

Artificial intelligence and teledermatology: An overview

Wajeeha Nusrat — 2024-04-21