Journal of Pakistan Association of Dermatologists

JPAD Composite Clinical Image Gallery

JPAD — 2026-03-31

Cutaneous manifestations in HIV/AIDS infections: Insight into prevalence patterns, CD4+correlations, and public health implications from a global perspective

Ida Ayu Govinda Lazenobia De Sanjaya Putri — 2026-03-31

Cutaneous manifestations in patients with HIV/AIDS are used as clinical markers to identify disease progression and immune status; however, there is currently no comprehensive review examining this evidence. This comprehensive review aims to synthesize the evidence and analyze the prevalence patterns of skin manifestations, their correlation with CD4+ T-cell levels, and their public health implications. A systematic literature review was conducted following the PRISMA guidelines by searching PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and GARUDA for literature from 2009 to 2024. Quantitative data on clinical manifestations were extracted from the original studies. A total of 4,700 studies were identified, of which 16 met the inclusion criteria of this review. Studies from Asia (n=9), Africa (n=5), South America, and the Middle East (n=1, respectively) were included. The findings indicate that mucocutaneous manifestations correlate with CD⁴⁺ levels, with individuals having >500 CD⁴⁺ cells/µL (seborrheic dermatitis and xerosis), 200–500 cells/µL (opportunistic infections, such as oral candidiasis [31%] and dermatophytosis [8%]), and 200 cells/µL (severe manifestations, such as Kaposi’s sarcoma and cryptococcal disease). The prevalence of oral candidiasis ranged from 11.6% to 81.1% and was significantly correlated with CD⁴⁺ T-cell levels (p<0.0001). Cutaneous clinical manifestations consistently appear in immunocompromised individuals and thus have the potential to serve as efficient clinical indicators, particularly in resource-limited settings.

Guttate psoriasis induced by Staphylococcus aureus infection

Cut Putri Hazlianda — 2026-03-31

Guttate psoriasis (GP) is an acute form of psoriasis commonly triggered by streptococcal infection, particularly in the pharyngeal or perianal regions. Its etiology involves both environmental and genetic factors that contribute to a complex immune response in the skin. Genetic predisposition, environmental factors, and immune dysfunction all contribute to the pathogenesis of psoriasis with host-microbe interaction governing the progression of this disease. Emerging evidence has indicated that infection is an environmental trigger for psoriasis and plays multiple roles in its maintenance as evidenced by the frequent association between guttate psoriasis onset and acute staphylococcal infection. Different infectious factors act on immune cells to produce inflammatory cytokines that can induce or aggravate psoriasis. We reported a 57-year-old female patient presented with erythematous plaques. The throat swab examination revealed aerobic Staphylococcus aureus growth

Metastatic acral melanoma with retroperitoneal and liver metastases: Diagnostic challenges and therapeutic dilemmas in a resource-limited clinical setting of district Swat, Pakistan

Sarab Jeet Singh — 2026-03-31

Acral melanoma is a rare subtype of cutaneous melanoma that often presents late in resource-limited settings. We report a 67-year-old woman from District Swat, Pakistan, with a 5-year history of a neglected pigmented plantar lesion who presented with jaundice and weight loss. CT imaging showed a large para-aortic retroperitoneal mass causing hydronephrosis and periampullary compression with biliary dilatation, along with liver metastases. Trucut biopsy revealed metastatic melanoma (S100+, HMB-45+, SOX10+). Molecular testing for BRAF V600 mutation was recommended but not performed due to unaffordability. Nivolumab monotherapy (anti–programmed cell death protein 1 [anti–PD-1]) was started, as dual immune checkpoint blockade was unaffordable, and a ureteric stent was placed. The patient was subsequently lost to follow-up. This case highlights diagnostic complexity and therapeutic inequities in metastatic acral melanoma in a resource-limited setting.

Pityriasis lichenoides chronica treated with combination of Narrowband Ultraviolet B (NBUVB) phototherapy and erytrhomycin

Deriel Elka Hidayat — 2026-03-31

Pityriasis lichenoides chronica (PLC) is a rare skin disorder that often resists treatment. Its etiology remains unclear but may involve triggers such as infections or medications that induce an inflammatory skin response. Recent studies have investigated treatment options for PLC, including narrowband ultraviolet B (NBUVB) phototherapy and systemic antibiotics like erythromycin. NBUVB delivers targeted anti-inflammatory effects to promote lesion clearance and minimize systemic side effects for localized conditions. Erythromycin, a macrolide antibiotic, has shown efficacy in PLC, particularly among pediatric patients, because of its anti-inflammatory mechanisms alongside antimicrobial activity. We describe a 16-year-old girl with PLC featuring erythematous papules across nearly her entire body for 2 years. Diagnosis relied on clinical history, physical examination, and histopathology. Topical corticosteroids proved ineffective. The patient then underwent combined NBUVB phototherapy and erythromycin therapy, with no side effects reported and notable lesion improvement. This dual approach offers a comprehensive strategy for PLC by targeting inflammation via NBUVB and addressing potential infectious elements with erythromycin.

Cratered soles and malodor in a teenager: A case of pitted keratolysis

Arifiana Wungu Kartika Dewi — 2026-03-31

Pitted keratolysis is a superficial bacterial infection commonly affecting individuals exposed to prolonged occlusion and hyperhidrosis. Adolescents are often underdiagnosed, particularly in shared living environments. A 16-year-old male presented with a 6-month history of pruritus and excessive moisture on both soles. He lived in a boarding school environment with prolonged footwear use. The patient denied any prior treatments or known allergies. Physical examination revealed clusters of shallow, punched-out pits on the pressure-bearing areas of the plantar surface, accompanied by maceration, malodor, and mild erythema. No signs of fungal infection were noted. Diagnosis of pitted keratolysis was established clinically. The patient was treated with topical fusidic acid applied twice daily for 14 days, along with recommendations to maintain dry feet, use absorbent socks, and alternate footwear. Two weeks later, the lesions had considerably improved, and there was a noticeable decrease in itching and odour. No recurrence was observed after four weeks.

Cutaneous metastasis- A marker of hidden malignancy with an atypical presentation of neck nodules: A diagnostic challenge

Madiha Sanai — 2026-03-31

Cutaneous metastases are rare but an indicator of internal malignancies, often presents with a wide spectrum of clinical appearances that usually cause diagnostic confusion. We report a 67-year-old male who presented with an indurated plaque over the anterior neck for six months, initially observed as hyperpigmented skin changes that progressively evolved into a firm, sclerotic plaque, studded with multiple flesh-colored nodules with a cobblestone-like texture associated with itching and restricted neck mobility. Early clinical and histopathological evaluation favoured dermatofibrosarcoma protuberans; however, subsequent tissue examination revealed an infiltrative epithelial malignancy. Immunohistochemistry (IHC) showed positivity with cytokeratin and CK7, favouring the diagnosis of cutaneous metastasis. Comprehensive systemic workup identified gastric carcinoma with skeletal dissemination. This case highlights the deceptive presentation of metastatic skin disease and emphasizes the importance of reassessment and repeat biopsy in managing the atypical and recalcitrant cutaneous lesions.

Skin manifestations associated with Glucagon-Like Peptide-1 (GLP-1) receptor agonist use for weight loss: A cross-sectional analysis

Yahya Argobi — 2026-03-31

Background Glucagon-like peptide-1 (GLP-1) receptor agonists have become widely used for weight loss, but their cutaneous side effects are still underreported.

Objective This study aims to evaluate the prevalence and characteristics of skin manifestations associated with GLP-1 RA use for weight loss.

Methods A cross-sectional study was carried out from January to April 2024 at three tertiary care centers in Saudi Arabia. A total of 254 adult participants using GLP-1 Receptor Agonists (e.g., Ozempic, Mounjaro, or Saxenda) for weight loss were enrolled. Participants with pre-existing dermatologic conditions or systemic illnesses affecting the skin were excluded. Data were analyzed using SPSS version 29.

Results Out of the 254 participants, 102 (40.2%) reported at least one skin-related side effect. The most common was dry skin (21.2%), followed by itching (8.6%) and erythema (3.9%). Mounjaro users experienced dry skin and itching, while Saxenda users had the highest rate of combined symptoms. No statistically significant differences were found between the drug types in terms of overall skin reaction rates.

Conclusion Skin manifestations are common among GLP-1 RA users, with dry skin and itching being the most common reports. Although usually mild, these effects underscore the importance of clinician awareness and potential dermatologic evaluation as part of comprehensive patient care.

Frequency of androgenic alopecia in patients presenting with polycystic ovarian syndrome at tertiary care hospital Karachi.

Fatima Hasan — 2026-03-31

Background:

Polycystic ovary syndrome (PCOS) is a multifactorial endocrine disorder characterized by hyperandrogenism, anovulation, and polycystic ovarian morphology. Dermatological manifestations of hyperandrogenism include acne, hirsutism, and androgenic alopecia, also known as female pattern hair loss (FPHL). While FPHL has significant psychosocial implications, it may also reflect underlying metabolic dysfunction. Despite the high burden of PCOS in South Asia, local epidemiological data on androgenic alopecia in PCOS remain scarce.

Objective:

To determine the frequency of androgenic alopecia in women with PCOS presenting to a tertiary care hospital in Karachi and to evaluate its association with clinical and metabolic parameters.

Methods:

This cross-sectional study was conducted at the Department of Dermatology, PNS Shifa Hospital, Karachi, from October 2021 to May 2022. A total of 135 women aged 20–60 years with a confirmed diagnosis of PCOS according to Rotterdam criteria and hair loss for more than one month were included. Patients with alopecia areata, scarring alopecia, telogen effluvium, thyroid disorders, or history of corticosteroid/hormonal therapy were excluded. Clinical diagnosis of androgenic alopecia was made by dermatological examination using Ludwig and Sinclair scales. Demographics, body mass index (BMI), clinical features, and laboratory findings were recorded. Statistical analysis was performed with SPSS version 22. Chi-square and logistic regression tests were applied with p < 0.05 considered significant.

Results:

Among 135 participants, 112 (83%) had androgenic alopecia. Significant associations were observed with age >30 years (p=0.024), hirsutism (OR 2.0, 95% CI 1.1–3.9), sleep disturbance (OR 1.9, 95% CI 1.1–3.4), and smoking (OR 1.9, 95% CI 1.0–3.9). Elevated LDL was an independent predictor, while serum androgen levels showed no significant correlation.

Conclusion:

Androgenic alopecia is highly prevalent in PCOS patients. Early dermatological screening may help identify metabolic and psychosocial risks.

Keywords: Polycystic Ovary Syndrome; Alopecia; Hyperandrogenism; Insulin Resistance; Prevalence.

Therapeutic approaches for refractory melasma: Fractional CO2 Laser and Q-Switched Nd:YAG Laser with tranexamic acid injections

Sara Ahmed Ali — 2026-03-31

Background Melasma is characterized by dyspigmentation that is difficult to treat. This is due to the complex underlying factors and high risk to recurrence.

Objective Investigating the clinical outcomes from utilizing fractional CO2 laser and Q-Switched Nd:YAG laser (QSNY) in combination with tranexamic acid (TA) in treating refractory melasma.

Methods The cross sectional study included sixty women with refractory melasma. Patients were randomly assigned into two groups (30 patients per group) to receive either the fractional CO2 laser or the QSNY laser treatment. Patients from both groups were supplemented with intradermal microinjections of TA (4 mg/ml), and laser sessions were conducted every month for a total of four successive sessions per patient. Treatment outcomes were assessed via calculating modified melasma area and severity index (mMASI) at baseline and after 30, 60, 90, and 120 days of post-treatment.

Results There was a significant reduction in mMASI score (p<.001) after each therapy session. The fractional CO2 laser with TA demonstrated higher efficacy in reducing mean mMASI score (1.98±1.0) relative to the Nd-YAG laser with TA (3.1±1.5), (p<.001). Although the clinical effectiveness of fractional CO2 laser with TA was higher, patient satisfaction among study groups were found with no significant difference (p>.05).

Conclusion Fractional CO2 laser and QSNY laser treatments in combination with intradermal TA injections are effective approaches in decreasing the overall mMASI scores in women with refractory melasma. Further studies are necessary to enhance our understanding and to guide optimal clinical practice regarding refractory melasma.

Monkeypox Preparedness in Pakistani Healthcare Workforce:Monkeypox Preparedness in Pakistani Healthcare Workforce: Assessing the Gaps

Syed Razi Haider Zaidi — 2026-03-31

Background: The 2022–2025 global Monkeypox (Mpox) outbreak highlighted critical gaps in healthcare providers’ preparedness worldwide. Prior studies in Africa, the Middle East, Europe, and Asia have reported that only one-quarter to one-half of clinicians retain adequate knowledge and confidence in the diagnosis and management of Mpox. This study evaluates Mpox awareness, attitudes, confidence, and information sources among healthcare workers in Pakistan.

Objective: To assess the level of Monkeypox knowledge, self-reported diagnostic and management confidence, perceived barriers, and the association of these factors with demographic and professional characteristics.

Methods: A cross-sectional, web-based survey was administered to 81 healthcare providers (96.3% physicians; 3.7% nurses/others). Participants reported their familiarity with Monkeypox sources of information, symptom recognition, confidence in diagnosis and case management, guideline awareness, perceived barriers, and concern about infection. Chi-square analysis examined the relationship between years of clinical experience and confidence levels.

Results: While 95.0% of respondents were at least somewhat familiar with Mpox, only 16.3% felt very confident in diagnosing cases and 15.2% in managing them. Awareness of national/international guidelines stood at 42.5%. Key barriers included lack of training (55.0%) and resources (36.2%). Concern about personal infection was high (90.0% reporting at least some concern). More experienced providers reported significantly greater confidence (p=0.010).

Conclusion: Pakistani healthcare workers demonstrate moderate Mpox awareness but suboptimal confidence and guideline familiarity. Targeted educational programs, incorporation of Mpox modules into medical and nursing curricula, and resource allocation for training are urgently needed to bolster outbreak preparedness in Pakistan.

Efficacy and safety of tofacitinib in patients with alopecia areata

Shariqa Khan — 2026-03-31

Background: Alopecia areata (AA) is an autoimmune disorder causing non-scarring hair loss with major quality-of-life impact. Tofacitinib, a Janus kinase inhibitor, has shown promise for AA, though long-term safety, durability, and data from South Asian populations remain limited.

Objective: To evaluate efficacy, safety, and relapse patterns of oral tofacitinib in AA.

Methods: In this prospective quasi-experimental study, 59 patients aged 12–60 years with ≥30% scalp involvement or alopecia totalis/universalis, refractory to first-line therapy, received tofacitinib 5 mg twice daily for 24 weeks. Primary endpoint was change in Severity of Alopecia Tool (SALT) score. Secondary endpoints included response rates (≥71% regrowth), safety, and relapse after discontinuation.

Results: Mean SALT score improved significantly from 59.98 ± 24.47 to 17.48 ± 26.58 at week 24 (p < 0.001). Perfect response occurred in 45.1% of patients, good in 21.6%, moderate in 15.7%, weak in 9.8%, and none in 7.8%. Outcomes were best in ages 20–39 years and patchy AA, with 82.6% of perfect responders showing ≥90% regrowth. Adverse events were generally mild (headache 11.9%, upper respiratory infection 10.1%, acne 6.8%). Laboratory abnormalities were rare and reversible. Relapse occurred in 45.7% within 1–2 months, 38.9% within 4–6 months, and 9.6% by 10–12 months after discontinuation.

Conclusion: Tofacitinib produced substantial regrowth with acceptable safety in AA patients. However, high relapse rates after withdrawal highlight the need for maintenance strategies. This study provides real-world evidence from an underrepresented South Asian population.

Evaluating the Effectiveness of Platelet-Rich Plasma as an Adjunct to Fractional Carbon Dioxide Laser Therapy in Improving Facial Acne Scar Appearance: A Randomized Controlled Trial

Yasaan Saaqib — 2026-03-31

Background:

Acne scars are a significant cosmetic concern, as they negatively impact self-esteem of the affected individuals. Fractional CO2 laser resurfacing is widely used to treat acne scars by stimulating collagen remodeling, but outcomes are variable with potential side effects such as post-procedural hyperpigmentation and erythema. Platelet-rich plasma (PRP) combined with fractional CO2 laser may enhance healing and reduce side effects due to anti-inflammatory properties. However, more evidence is needed to support the use of this combination therapy .

Objective:

To evaluate whether platelet-rich plasma (PRP) enhances the efficacy of fractional CO2 laser resurfacing in reducing moderate-to-severe acne scars and minimizes laser-induced complications like erythema, oedema and pain thereby enhancing patient satisfaction

Methods:

The study was conducted at DHQ Gujranwala over a period of 6 months. Participants (18-40 years) were patients moderate-to-severe acne scars admitted for FCLR with or without PRP; Both groups recieved a series of three treatments, administered at four-week intervals.Primary outcome was reduction in acne scars. Secondary outcome was FCLR complications. Assessments were conducted at baseline and four weeks post-treatment. Patient-reported pain and satisfaction were assessed by the Visual Analogue Scale (VAS) and Likert scale .

Results:

Seventy patients were enrolled and 60 completed (30 per arm), randomized to fractional CO₂ laser (FCL) with platelet-rich plasma (PRP) versus FCL alone.The primary outcome—scar severity—improved significantly in both groups. In Group A (FCL + PRP), the mean scar score reduced from 12.4 ± 3.8 at baseline to 8.2 ± 3.5 at 12 weeks. In Group B (FCL only), the mean score reduced from 11.8 ± 4.1 to 8.6 ± 4.5. Although the mean reduction was greater in the combination group (4.2 points vs 3.2 points), this difference did not reach statistical significance (p = 0.129).

Frequency of pruritus and its impact on quality of life in psoriasis: A cross-sectional study

Laila Irshad — 2026-03-31

Background Psoriasis represents a long-term inflammatory skin disorder that commonly presents with itching symptoms, significantly impacting patients' daily functioning and well-being. Epidemiological data indicates prevalence rates ranging from 0.1-1.4% among pediatric populations and 0.5-11.4% in adult cohorts.

Objective To establish the occurrence rate, severity levels and quality-of-life consequences of pruritus (itch) symptoms in patients with psoriasis.

Methods Cross-sectional analysis conducted in Dermatology Unit, Tertiary Care Hospital Gujranwala, from 01.01.2023 to 31.05.2024. A total of 132 patients with psoriasis constituted the study sample. Pruritus intensity was assessed with three validated scales: VAS, NRS and VRS. Disease severity was quantified using the Psoriasis Area and Severity Index (PASI) and Quality-of-life impact was measured via the Dermatology Life Quality Index (DLQI). Data was analyzed using SPSS version 23.

Results Among our study participants, 118 individuals (89.4%) experienced itching. Patients with pruritus demonstrated notably elevated median PASI score (7.00) when compared to those without pruritus (3.00) (p=0.001). We identified positive associations between PASI score and pruritus severity (VAS: r=0.788, NRS: r=0.743, p<0.01). Patients experiencing pruritus exhibited considerably higher DLQI values (median 10.0) versus no pruritus participants (median 5.5) (p=0.001). Pruritus was more frequently observed in patients with higher body weight affecting 37 patients (31.35% vs. 7.14%, p=0.02). Cutaneous dryness emerged as the primary exacerbating element in 65 cases (49.2%).

Conclusion Our findings demonstrate that pruritus is common in psoriatic patients and shows strong association with disease severity and diminished life quality. Comprehensive management of pruritus, incorporating body mass index considerations and environmental factor identification, remains essential for optimizing patient care outcomes.

Comparison of efficacy of topical 5% dapsone versus 1% clindamycin in mild to moderate acne vulgaris

Amina Mehmood — 2026-03-31

Background: Acne vulgaris is one of most common skin disorder, particularly among teenagers and adults. Recently, topical dapsone gel has been used as an alternative therapeutic option for mild to moderate acne vulgaris, in comparison to topical antibiotics such as clindamycin gel.

Objective: This study aimed to compare therapeutic efficacy in terms of reduction in lesions with topical 5% dapsone gel versus 1% Clindamycin gel in treatment of mild to moderate acne vulgaris.

Methods: This Quasi-Experimental study was conducted in the Dermatology Department of Sahiwal Teaching Hospital, Sahiwal from March 2024 to September 2024. Patients with mild to moderate acne vulgaris meeting the Global Acne Grading Score (GAGS) of both genders and aged between 12 - 60 years were enrolled in the study. Patients were divided through non-probability consecutive sampling technique into two equal groups: Group A (5% dapsone gel); Group B(1% Clindamycin gel) with topical once daily application. Efficacy was assessed at baseline and at 12th week according to the GAGS. Data were analyzed using SPSS v25.0.

Results: Among 340 patients female (78%) out number the male (22%) in gender distribution, with a mean age and SD of 20.82 ± 3.817 years. Patients treated with topical 5% dapsone gel achieved 76.47% “good” efficacy compared to 73.53% of patients treated with topical 1% Clindamycin gel. Efficacy in both treatments groups were statistically significant. (P-value <0.05)

Conclusion: Both 5% dapsone gel and 1% clindamycin gel are considered to be effective treatment options for mild to moderate acne vulgaris.

Assessing quality of life and contributing factors in dermatological disorder patients

Mohi Ud Din — 2026-03-31

Background Dermatological disorders substantially impair physical, psychological, and social well-being.

Objective This study assessed QoL and its determinants among dermatology patients attending a tertiary care hospital in Faisalabad.

Methods An analytical cross-sectional study was conducted among 260 adults with chronic dermatological conditions. A structured questionnaire was utilized to obtain socio-demographic and clinical data. The Dermatology Life Quality Index (DLQI) indexed the quality of life in the patients. Bivariate analyses (t-test, ANOVA) were conducted to find out associations between variables and the DLQI scores. Variables with p<.20 were entered into multiple linear regression to determine independent predictors. A significance level of p<.05 was used.

Results The mean DLQI score was 11.9±6.7, indicating moderate to very large impairment. Overall, 59.3% of patients experienced a very large to extremely large QoL impact. Acne vulgaris (30%), eczema (16.5%), and psoriasis (16.2%) were the most frequent diagnoses. Bivariate analysis showed significant associations of DLQI with age, income, employment, disease duration, disease distribution, treatment duration, treatment type, comorbidities, and concomitant medication use. Regression analysis identified three independent predictors of better QoL (lower DLQI score): longer treatment duration (B=–0.55, p=.004), more extensive disease distribution (B=–1.39, p=.017), and longer disease duration (B=–0.58, p=.002).

Conclusion Dermatological disorders markedly impair QoL, particularly younger adults and those with recent or widespread disease. Early diagnosis, sustained treatment, and psychosocial support may improve outcomes. Localized interventions addressing cultural stigma and access to care are essential.

Personal protective equipment related dermatoses among health care workers of a tertiary care hospital

Afnan Naeem — 2026-03-31

Background Personal protective equipment although is the need of the hour to prevent and stay safe from unknown infectious diseases but its use has advantages and disadvantages all depending on its type and duration of use.

Objective To assess personal protective equipment related dermatoses among health care workers attending patients at a tertiary care hospital of Pakistan.

Methods The study was carried out in the department of Pathology (Microbiology), Army Medical College/National University of Medical Sciences from June 10th 2021 to July 10th 2021. A self-administered Performa consisting of multiple-choice items was designed using Google forms. It was distributed electronically to health care workers attending patients at a tertiary care hospital. Data was collected through snowball sampling technique. Questionnaire consisted of type and duration of personal protective equipment used, site of skin lesion, sociodemographic data, department of the hospital, prior dermatological history. Data was analyzed using SPSS version 27.0.

Results The cutaneous manifestations were varied, the most common being acneiform eruption (41%) followed by ulcerating lesions (21%) and erythema with vesicular lesions (9.6%).

Conclusion Use of personal protective equipment plays a crucial role in combating infections but its continuous use brings wide array of dermatological manifestations. In order to avoid these complications, safety measures should be taken. Discovering a balance between this critical protection and methods to mitigate the harmful effects on the skin health is the key.

Comparative Study of effectiveness of low dose Oral Minoxidil vs Topical Minoxidil (5%) in Male Androgenetic Alopecia.

Arun Yadav — 2026-03-31

Background: AGA affects approximately half of men up to the age of 50 years. Traditional modalities include topical minoxidil and oral finasteride, but these have many drawbacks due to poor compliance and potential side adverse effects. LDOM has demonstrated some promise in AGA treatment.

Aim: This study aimed to compare the efficacy, safety, and patient satisfaction of 5% topical minoxidil (1 ml twice daily) versus low-dose oral minoxidil (2.5 mg daily) in men with AGA.

Methodology: A total of 100 males with AGA were randomly treated with topical and oral minoxidil in this open trial that lasted for six months at the department of dermatology of a tertiary institution. Various parameters were measured under baseline, such as medical history, physical exams, ECG, and lab work. Efficacy, safety, and satisfaction were analyzed by t-tests, ANOVA, descriptive statistics, and Kaplan-Meier analysis.

Result: The increase in hair density was 45% with oral minoxidil, which was higher compared with 38% for topical minoxidil, and levels of patient satisfaction also were higher (72% vs. 65%). Mild adverse effects were noted for both groups: 10% hypertension with oral minoxidil and 15% scalp irritation with topical minoxidil. The levels of compliance were higher with the oral regimen (90% vs. 80%).

Conclusion: Low-dose oral minoxidil was more effective and convenient than topical minoxidil, leading to faster hair regrowth, higher satisfaction, and fewer local side effects. It may be a better long-term option for managing androgenetic alopecia.

Clinico-epidemiological Study of Mucocutaneous manifestations in Substance Users : A Cross-Sectional study

Sama Asim — 2026-03-31

ABSTRACT

Introduction: Skin is considered to be mirror image of the body; we can establish diagnosis of

disease involving any organ of the body by looking into skin and mucus membranes. This

principle could be applied in suspected cases of drug abuse and drug addiction. Alcohol misuse

can have long-lasting harmful effects on one's physical and mental health. Acutely, ingestion of

alcohol may lead to transient flushing,Trauma-induced ecchymoses, it is a risk factor for many

other health problems including cirrhosis, pancreatitis, and cancers.

Objectives: To study the clinical-epidemiological profile of the skin diseases in Substance Users.

Methods: This cross-sectional observational study involved 200 substance users attending Al-

Qanat Social Rehabilitation center / Baghdad - Iraq of all age?groups, irrespective of gender

were enrolled during the period from February 2024 to February 2025. Patients were subjected

to detailed history taking and clinical evaluation of skin lesion and investigations .

Results: Two hundred were enrolled in this study; 17(8.5%) were females and 183(91.5%) were

males. The mean±SD of age was 29.38±8.4 years. Single substance addiction was noticed in

129 (64.5%) and multiple substance abuse was observed in 71(35.5%). Regarding mode of drug

intake, single and multiple modes of drug administration were seen .Cutaneous lesions ranged

from tattoo, track marks to severe ulcerations and scarring, Mucosal lesions also seen in several

patients. Major bulk of skin manifestations were chronic. The highest addiction material among

the patients were alcohol 61 (30.5%) and amphetamine 46 (23%) and the lowest were heroin,

accupane and benzodiazepine 1 (0.5%).

Conclusions: Drug abusers are prone to skin diseases due to injury caused by drugs as well as by

drug practices adopted. Alcoholic patients had wide variety of skin manifestations commonest

seen due to malnutrition. The early recognition of these signs is of importance for more

effective diagnosis and treatment and to prevent long-term complications.

Key words: substance users, cutaneous manifestations, Alcohol, amphetamine, Heroin

Profile of SCORAD, TEWL, and Skin pH values in mild-moderate adult atopic dermatitis patients in Surabaya

Sylvia Anggraeni — 2026-03-31

Background Atopic dermatitis (AD) is a chronic inflammatory skin disease with skin barrier dysfunction, often persisting into adulthood and impairing quality of life. One of the main pathophysiological characteristics of AD is skin barrier dysfunction, commonly indicated by increased transepidermal water loss (TEWL) and altered skin pH. The SCORAD (Scoring Atopic Dermatitis) index is commonly used to assess disease severity.

Objective This study aims to describe the profile of SCORAD, TEWL, and skin pH in adult patients with mild to moderate AD at Dr. Soetomo General Academic Hospital, Surabaya.

Methods A descriptive cross-sectional study was conducted from January to October 2022. A total of 32 adult patients aged 18-64 years with clinically diagnosed mild to moderate AD were recruited using consecutive sampling. SCORAD assessments were conducted alongside TEWL and skin pH measurements using Tewameter MPA5 and pH meter devices, respectively. Statistical analysis was performed to evaluate the association of SCORAD, TEWL, and pH values with age and gender.

Results The mean age of participants was 37.9±11.8 years, with a balanced sex distribution. Mean SCORAD was 22.2±6.1, TEWL was 20.8±10.2 g/m²/h, and skin pH was 5.3±0.5. Most patients (90.6%) had mild AD. No statistically significant correlations were found between age or gender and any of the three measured variables.

Conclusion SCORAD, TEWL, and skin pH profiles in adults with mild to moderate AD showed no significant association with age or gender, indicating the heterogeneity of the condition across demographic factors.

Efficacy of combination of topical 5% dapsone plus oral doxycycline versus topical adapalene plus oral doxycycline in the treatment of moderate acne vulgaris

Zakir Ullah khan — 2026-03-31

Background Acne vulgaris is one of the most prevalent dermatological conditions worldwide, particularly affecting adolescents and young adults, with significant psychological and social impact. Topical and systemic agents are commonly combined to target multiple pathogenic pathways, yet comparative data on optimal regimens remain limited in the Pakistani population

Objective To compare the efficacy of combination of topical 5% dapsone and oral Doxycycline versus topical adapalene and oral Doxycycline in the treatment of moderate acne vulgaris.

Methods This Quasi Experimental Study with two arms was conducted at the Department of Dermatology, MTI-Hayatabad Medical Complex (HMC), Peshawar, from 01 October 2023 to 01 April 2024. A total of 160 patients were enrolled, with 80 patients in each group. Group A received topical 5% dapsone and oral Doxycycline, while Group B received topical adapalene and oral Doxycycline. Efficacy was evaluated using the Global Acne Grading System (GAGS) after 12 weeks of treatment.

Results In Group A, 27.5% showed excellent efficacy, while 26.25% in Group B showed similar results. Good and fair efficacy was observed in 25% of both groups. No significant difference in overall efficacy was observed between the groups (p=0.780).

Conclusion Both treatment combinations are effective for moderate acne vulgaris, with no statistically significant difference in efficacy between the groups. Either treatment regimen can be considered for managing moderate acne.

Efficacy and safety of oral pentoxifylline and aspirin in chronic venous and arterial leg ulcers: A 12-week randomized controlled trial

Tahir Kamal — 2026-03-31

Background Chronic Venous and arterial leg ulcers are long-lasting wounds that significantly impair quality of life due to slow healing and recurrent nature. Several studies reported therapeutic role of aspirin and pentoxifylline individually, direct comparison of their efficacy remains limited.

Objective To evaluate and compare the wound-healing efficacy, safety, and tolerability of oral aspirin and pentoxifylline in the management of patients with chronic leg ulcers.

Methods The 12-week two-arm parallel randomized controlled trial included 62 patients with chronic venous, arterial, or mixed leg ulcers of ≥6 weeks’ duration, of whom 60 completed the study. Patients were randomly allocated into two groups, one group received oral aspirin 300 mg twice daily, while the other received oral pentoxifylline 400 mg twice daily. All participants received standardized wound care. Data were statistically analyzed using Mann-Whitney U test for continuous variables and chi-square tests for categorical variables. A p-value of <0.05 was considered statistically significant.

Results Both groups exhibited a significant decrease in ulcer size over time. However, participants receiving oral pentoxifylline showed a substantial reduction compared to those receiving aspirin at 1 month (p=0.001), 2 months, and 3 months (p=0.001). Baseline pain scores were comparable between groups (p=0.789), but the pentoxifylline group demonstrated greater reduction at 2 months (p=0.007). Both groups displayed minimal pain scores after three months (p=0.293). Adverse events were also infrequent and did not show significant variation between treatment groups (p>0.05).

Conclusion Pentoxifylline proved to be more effective than aspirin in accelerating ulcer healing and reducing pain in patients with chronic leg ulcers and maintaining a favorable safety profile. The observed outcomes validate its application as a treatment alternative, particularly in cases where compression therapy is unsuitable or poorly tolerated.

Molecular characterization of Malassezia species isolated from Pityriasis Versicolor patients in Thi-Qar Governorate Iraq

Marwa Amer Jalil — 2026-03-31

Abstract

Background: Malassezia are lipophilic yeasts that coexist symbiotically on the skin of humans and other warm-blooded animals. They assume two forms: unicellular yeasts and pseudofilamentous yeasts. The Pityriasis versicolor is induced by Malassezia yeast. The yeasts invade the outermost keratinized layer of human skin and induce several alterations in this layer, such as the formation of different-colored patches on the skin.

Objective: Comparison among the prevalence of Malassezia species in healthy and infected human using Molecular methods.

Methods: About 72 skin scraping samples were collected from patients diagnosed by the dermatologist at AL-Nasiriyah General Hospital, AL-Hussein Teaching Hospital, and AL-Shatra General Hospital as pityriasis versicolor patients and 30 skin swabs from healthy individuals at the period from Jul-2023 to Dec-2023.

Results: The results of the genetic sequence analysis of the PCR products of Malassezia isolates showed a large genetic diversity in the isolates of patients and healthy (control). The results showed the presence of several mutations in the DNA sequence of Malassezia isolates, and new strains were registered in the NCBI GenBank website.

Conclusion: There is a genetic relationship between the pathogenic isolates and the control isolates and there is a high genetic diversity.

Diabetic xerosis: A neglected complication deserving greater attention

Thamir Kubaisi — 2026-03-31

Sclerotherapy as a non-surgical treatment for eccrine angiomatous hamartoma in children: A case series

Srijay Saraf — 2026-03-31

Background Eccrine angiomatous hamartoma (EAH) is a rare comprising benign skin lesions eccrine glands and vascular channels, usually causing pain and localized sweating in children. Surgical excision, the standard treatment, can cause scarring and is not often feasible for lesions near joints.

Objective To assess sclerotherapy as a non-surgical treatment for eccrine angiomatous hamartoma in children.

Methods Four children (age range 2.5-13 years; three boys, one girl) with biopsy-confirmed EAH involving the lower limbs have been treated with weekly intralesional injections of 3% polidocanol. Lesion sizes ranged from 2 × 3 cm to 7 × 7 cm. Treatment was continued until clinical improvement, with sessions ranging from 8 to 12 per patient. Follow-up ranged from 2 to 3 months.

Results All four patients exhibited reduction in lesion size, ranging from approximately 50 to 80%. Pain terminated completely in three patients and improved substantially in one. One patient with localized hyperhidrosis recorded decreased sweating. During injection, patients encounter brief stinging that subsided within minutes. No ulceration or necrosis happened.

Conclusion Intralesional 3% polidocanol showed good tolerance to the treatment, with few minimal and self-limiting symptoms which did not require additional intervention option for EAH in children, with short-term improvement in size and symptoms. Longer follow-up is required to assess durability and recurrence.

The Skin–Gut Axis: Expanding The Dermatologist’s Clinical Perspective

Arfan ul Bari — 2026-03-31