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Objective To identify the various morphological types of hand eczema and to detect the common etiological sensitizers in our community by patch testing, and attempt to correlate them. Methods One hundred patients of hand eczema presenting to the department of dermatology, Mayo hospital, were enrolled in the research study after informed consent. After taking a careful history and complete examination, they were classified according to clinical presentation, and patch tested with European standard series. Patches were applied to the upper back in accordance with the principles of patch testing. Results were read at 48, 72 and 120 hours after removal of patches, and interpreted according to the International Contact Dermatitis Research Group criteria. Data was analyzed and interpreted. Results Patch testing results indicated that 46% of patients had positive allergic reactions. The commonest allergens detected were nickel (21%), chromate (13%), neomycin (12%) and cobalt (11%). Nickel sensitivity was more common in females (19%), while chromate was more common in males (11%). Attempt at clinicoetiological correlation showed few patterns, as different allergens could cause various morphological presentations. However, nickel sensitivity was noted in ring eczema (75%) and pompholyx (44%), while no allergens were detected in apron and hyperkeratotic palmar eczema. Conclusion A high allergic sensitivity (46%) was noted in our patients of hand eczema. Different allergens could cause varied morphology and no specific clinicoetiological patterns can be defined. Therefore, a patch test should essentially be done in all hand eczema patients, to detect an etiological allergen and for directing better management of our patients. [ABSTRACT FROM AUTHOR]

Background Melasma is a commonly acquired hypermelanosis of facial skin due to various etiological factors including hormonal imbalance. Objectives To find out the relationship between hormonal imbalance and melasma in females. Patients and methods One hundred and fifty female patients suffering from melasma, between the ages of 17-45 years, were enrolled in the study. They were examined by Wood's lamp to see the type of melasma whether epidermal, dermal or mixed (dermoepidermal). Patients were investigated for levels of estrogen, progesterone and prolactin in two consecutive follicular and luteal phases on 9th and 18th day of cycle, respectively. Forty control cases were also investigated for the aforementioned hormonal levels in their follicular and luteal phases. Results Out of 150 patients, 138 completed the study while 12 patients were lost to follow up. Amongst the 138 evaluable patients, there were only 4 patients who had normal values for all the three hormones i.e. estrogen, progesterone and prolactin in all four phases. Fifteen patients (10.9%) had normal values of estrogen in both follicular (F1 & F2) and luteal phases (L1 & L2) while the remaining 123 patients (89.1%) had deranged values of estrogen (mostly increased) in any of the four phases. The values of progesterone were normal in 62 (44.9%) patients while they were deranged in 76 (55.1%) patients in all four phases. The levels of prolactin were normal in 134 (97.1%) patients while deranged in 4 (2.9%). Out of 40 controls, only 3 (7.5%) had increased values of estrogen in both follicular and luteal phases. Conclusion Estrogen is found to be the causative agent of melasma [ABSTRACT FROM AUTHOR]

Over the past few decades, drugs targeting cytokines and their receptors have been researched and developed. These agents act on molecular targets at the subcellular level. The Janus Kinases family is a group of receptor-associated signaling molecules which are essential to the signal cascade originating from Type 1 and Type 2 cytokine receptors. Janus kinase inhibitors, also known as Jakinibs/JAK inhibitors, are molecules developed against this class of kinases. Initially developed for use in different inflammatory conditions, such as rheumatological problems, JAK inhibitors are emerging as new agents in dermatology. Although biologics have proved to be effective and safe in various disorders, not all patients respond to this therapy. Jakinibs are also being seen as an alternative oral therapy for such patients. This article will review the basic principles of mode of action, efficacy and safety of JAK inhibitors in autoimmune conditions such as psoriasis, alopecia areata, atopic dermatitis, lupus erythematosus, dermatomyositis and vitiligo. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy of Q-Switched Nd:YAG laser 1,064nm for the treatment of melasma. Methods A total of 100 patients were included in this study. Treatment area was cleansed and QSwitched Nd:YAG laser 1,064nm, was delivered with settings of 3mm spot size, energy fluence ranging from 500-700 joules and repeated frequency at 6 Hz. Clinical response was assessed by MASI score. Results A total of 100 patients were included in the study. Mean age of the patients was 31.18±5.51 years. There were 13 males (13%) and 87 females (87%). Mean duration of disease was 1.99±0.88 years. Type of melasma was as follows: epidermal 47 (47%), dermal 31 (31%) and mixed 22 (22%). Q-Switched Nd:YAG laser 1,064nm for the treatment of melasma was effective in 59 patients (59%). Conclusion 1064nm Nd:YAG laser was safe, effective and well-tolerated by all patients. [ABSTRACT FROM AUTHOR]

Adams-Oliver syndrome is a rare disease, which presents with cutaneous, cardiac and skeletal defects. We, herein, describe a case of 1-month-old girl with aplasia cutis, cutis marmorata telangiectatica and terminal transverse limb reduction defects with a positive HCV serology. The patient is put on regular follow-up. [ABSTRACT FROM AUTHOR]

Objectives: To determine the impact of hirsutism on quality of life (QoL) using Dermatology Life Quality Index (DLQI) in female patients. Patients and Methods: An observational study was carried out at the Department of Dermatology, King Edward Medical University/ Mayo Hospital, Lahore from March 1, 2012 to August 31, 2012. A total of 200 female patients suffering from hirsutism, of any severity, with age 16 years or above who themselves were able to understand and fill the DLQI questionnaire in Urdu version, were enrolled in our study. Using the DLQI questionnaire consisting of ten questions, patients were asked to score on a scale from 0-3 for each of ten items. The data were analyzed after compiling the results. The higher the DLQI score, the poorer was the QoL. Results: Mean age of the patients was 26.12±5.83 years. Mean DLQI score of all patients was 17.9±5.78. The findings indicated several areas where hirsutism had an impact on individual's QoL, particularly in relation to symptoms and feelings, daily activities and personal relationships. Patients with moderate hirsutism and severe hirsutism had mean DLQI score of 18.2±5.57 and 17.88±5.74 respectively. Mean DLQI scores were highest for Q2 (symptoms and feelings). Conclusion Hirsutism causes a 'very large effect' on patients' quality of life. Impairment of QoL is greater in female patients irrespective of marital status and severity (either moderate or severe) of hirsutism. Longer duration of disease leads to poorer quality of life. [ABSTRACT FROM AUTHOR]

Progressive hemifacial atrophy is a rare, unilateral, atrophic craniofacial form of morphea involving the dermis, subcutaneous tissue, fat, muscle, and even bone. We report a case of a child having progressive hemifacial atrophy, presented with rapidly progressive neurological symptoms and associated radiological manifestations. In this case of hemifacial atrophy, the sensitivity of MRI in detecting intracranial lesions is demonstrated. Recommendations for imaging these patients are proposed. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy of 1064nm Q-switched Nd:YAG laser in the treatment of Nevus of Ota. Methods This study was conducted in Department of Dermatology, Unit-II, KEMU/Mayo Hospital, Lahore. A total of 100 patients of nevus of Ota (both unilateral and bilateral) with Fitzpatrick skin type III to V were included in this study. Baseline photographs and Pigment area and Severity Index (PSI) score was recorded. All patients were treated with 1064nm Q-switched Nd:YAG laser at fluence of 500-600 V and frequency of 5Hz. A total of 10 sessions at 2 weeks interval were given. Final assessment was done at 4 weeks after last session. Improvement was measured in terms of percentage reduction in baseline PSI score. Results Mean age of the patients was 24.35±5.70 years. There were 15.0% males and 85.0% females. Majority of the patients had duration of lesion > 15 years. Most of the patients presented with skin type IV. 52.0% patients showed more than 50% clinical improvement. Improvement was higher in females (56%) and in patients with skin type III (50%) and IV (60%). Stratification with regards to age and duration of lesion showed no statistically significant difference. Conclusion Fifty two % of patients of nevus of Ota treated with 1064 nm Q-switched Nd:YAG laser showed more than 50% improvement. [ABSTRACT FROM AUTHOR]

Background Lichen planus is a chronic T-cell-mediated inflammatory disorder, where inflammation produces lipid metabolism disturbances and is therefore linked to increase in cardiovascular (CV) risk due to dyslipidemia. Increased reactive oxygen species and lipid peroxides have also been implicated in its pathogenesis. Objective To determine the frequency of dyslipidemia in patients with lichen planus. Methods In this cross sectional study 96 clinically diagnosed cases of lichen planus were included. Presence or absence of dyslipidemia was decided by the recorded parameters i.e. fasting lipid profile. Results Mean age of the patients was 37.07±11.22 year. There were 47 males (49.0%) and 49 females (51.0%). Dyslipidemia was recorded in 38 patients (39.6%). Stratification with regard to age, gender, BMI, duration of disease and history of treatment was carried out. Conclusion Lichen planus was significantly associated with an increased risk of dyslipidemia. [ABSTRACT FROM AUTHOR]

Generalized disabling pansclerotic morphea is a rare and mutilating form of morphea involving the dermis, subcutaneous tissue, fat, muscle, and even bone. It most often occurs in young children but adults can also be affected. We report a case of rapidly progressing and disabling adult onset generalized pansclerotic morphea, which responded well to methotrexate and steroid pulse therapy. [ABSTRACT FROM AUTHOR]

Background: Leprosy disease in the community is usually mistaken as a cursed disease. Leprosy disease is a chronic granulomatous infection caused by Mycobacterium leprae. Quality of life in leprosy patients with neuropathic pain in every region is varied. Objective: To determine the quality of life in leprosy patients with neuropathic pain by using the SALSA Scale and VAS. Methods: The research used analytic observational, a cross-sectional design and an interview technic. 37 subjects of 19 to 59 years age had leprosy with neuropathic pain at Donorojo Hospital. Results: SALSA score explains that 62.2% of the research subject has limitation of activity and has a correlation with leprosy disease with p 0.012. There is no correlation between VAS score and leprosy disease with p 0.034. SALSA score and VAS score in this research explain there is no correlation with p 0.458. The number of other medical conditions with limitation activity has a correlation score of 0.870 which has a very good correlation power. The number of used tools with limitation activity has a correlation score of 0.716 which has a good correlation power. Conclusion: There is activity limitation in leprosy patients with neuropathic pain at Donorojo Hospital Jepara District. The other aspect that affect activity limitation is the number of other medical conditions. Multibacillary type has more limitation than a Paucibacillary type. [ABSTRACT FROM AUTHOR]

Addison's disease is an adrenocortical insufficiency due to the dysfunction or destruction of the entire adrenal gland. The disease usually manifests when 90% or more of both adrenal cortices are dysfunctional or destroyed affecting both glucocorticoid and mineralocorticoid functions. The morbidity and mortality associated with Addison s disease is relatively high due to delay in diagnosis and initiation of therapy. Here, we report a case of a seven years old child who presented to us with diffuse hyperpigmentation of the body, body flexures, palmar creases and mucosae. He was diagnosed with Addison's disease, which is indeed a rare entity. In addition, this case report will also enhance the importance of cutaneous examination in suspecting Addison's disease. [ABSTRACT FROM AUTHOR]

Objective To compare the efficacy and safety of podophyllin resin VS cryotherapy in treatment of anogenital warts. Methods A total of 104 patients were enrolled, 52 in each group A & B. Group A was treated with cryotherapy and Group B was treated with podophyllin resin. Findings were noted in already devised proforma. Patients were evaluated at last follow up visit to assess results. Results 88% of patients in group a showed excellent results at the end of treatment whereas this figure was 8% in group B. Conclusion Cryotherapy was found to be more effective and safe than podophyllin resin in treatment of anogenital warts. [ABSTRACT FROM AUTHOR]

Eruptive vellus hair cysts are rare benign tumors of pilosebaceous unit with vellus hairs, which appear in childhood or young adults. Their etio-pathogenesis is poorly known. A review of the literature shows that eruptive vellus hair cysts (EVHC) might be inherited as autosomal dominant or acquired, and might be associated with other genodermatoses like pachyonychia congenita and anhidrotic ectodermal dysplasia. Although it is a benign tumor of pilosebaceous unit, this condition is rather difficult to treat. Here we report a case of 23 years old female with multiple, asymptomatic, slate-grey to bluish papules on face and ears for last 5 years, with a positive family history of similar lesions in other siblings. To the best of our knowledge, this is the first case of autosomal dominant facial variant of eruptive vellus hair cysts to be published from Pakistan. [ABSTRACT FROM AUTHOR]

Background Acne vulgaris is one of the commonest, chronic conditions of skin. Its estimated mean prevalence in Asian women is 30%. Androgens have a key role in the development of this disease so hormonal therapy like spironolactone is an innovative approach in the treatment of acne with successful results. Objective To determine the efficacy and safety of spironolactone in moderate to severe acne in females. Material and Methods In this longitudinal interventional study, 50 unmarried females of 18 to 45 years, suffering from moderate to severe acne according to Acne Grading Scale of American Academy of Dermatology, presenting to the outpatient of Dermatology Department Unit-II, KEMU/Mayo Hospital, Lahore, with or without raised testosterone levels were enrolled. Pretreatment, lesions were counted and Acne Severity Index (ASI) was also calculated. Oral spironolactone 100mg/day was given for 3 months. Monthly follow-up was done during treatment and for another three months after treatment. Serum testosterone and serum potassium levels were done at baseline, 3rd month and at 6th month. During follow-up visits, ASI and blood pressure were recorded. Photographs were taken at baseline and at every follow-up visit. Percentage reduction of ASI was calculated at the end of therapy. Results 50 patients completed the study with mean age of 21 years. Spironolactone was well tolerated and proved efficacious in 94% of cases (p-value ≤ 0.001). ASI score at the end of study showed 73% improvement (p-value ≤ 0.001) with decrease in the severity of acne after treatment. Patients experienced different side effects during the treatment. Maximum number of patients who had menstrual irregularities was 12, postural hypotension in 4, hyperkalaemia in 2 patients, 2 had polyuria and 8 had other side effects such as headache, weakness and vertigo. All the side effects recovered significantly at the completion of study (p-value = 0.001). Conclusion Spironolactone is effective and safe medication for females with moderate to severe acne. [ABSTRACT FROM AUTHOR]

Objective To determine the impact of psoriasis on quality of life (QoL) using Dermatology Life Quality Index (DLQI) in patients of psoriasis presenting in a tertiary care setting. Methods An observational study was carried out at Department of Dermatology, King Edward Medical University/ Mayo Hospital, Lahore from May 2013 till November 2013. A total of 200 patients compatible with inclusion criteria were enrolled after taking informed consent and were asked to fill DLQI questionnaires. Results Out of 200 patients, there were 107 males and 93 females. The mean age was 34.89±14.96 years while the mean DLQI score was 11.51±4.81. There were 58 (29%) married and 142 (71%) unmarried patients in the present study. Patients with moderate psoriasis were 184 with PASI score 40-60 and mean DLQI score 11.14±4.55 whereas 16 patients had severe psoriasis with PASI score 60-72 and mean DLQI score 15.8±5.68. The maximum mean DLQI score was highest for question 10 (treatment) followed by question 1 and 2 (symptoms and feelings). Conclusion Psoriasis is a serious condition and is associated with significantly lower quality of life regardless of age, gender, duration and severity of disease or marital status. [ABSTRACT FROM AUTHOR]

Background Atopic dermatitis is an inflammatory skin disorder with a chronic relapsing course. In troublesome cases of moderate and severe atopic dermatitis, phototherapy can be an effective treatment modality Objective To evaluate the efficacy and safety of narrowband UVB 311nm as a monotherapy in patients with moderate to severe atopic dermatitis. Patients and methods Patients suffering from moderate to severe atopic dermatitis, diagnosed according to criteria described by Hanifin and Rajka between ages of 6-70 were enrolled in the study. Severity of the disease was assessed by using SCORAD score. UVB irradiation was done thrice a week on alternate days. Efficacy was assessed every two weeks by reduction in modified SCORAD score. Results The mean cumulative dose of 25.91 J/cm² UVB at a wavelength of 311nm was given in a mean of duration 5.2 weeks treatment. Therapy reduced the atopic dermatitis scores from mean 32.2 (range 20.2-45.5) to 14.2 range (6.2-12.4). Conclusion We conclude that narrowband UVB appears to be a promising treatment for AD, but large patient series, different dosing schedules and long- term safety considerations should be carefully evaluated in the future [ABSTRACT FROM AUTHOR]