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Objective: To compare the efficacy of topical 0.05% Isotretinoin gel versus 0.1% Adapalene gel in treating mild to moderate acne vulgaris. Study Design: Quasi-Experimental study. Place and Duration of Study: Department of Dermatology, Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, From Feb to Jul 2018. Methodology: A total of ninety-two patients aged 12 to 25 years with mild to moderate facial acne vulgaris were enrolled and divided into two treatment Groups, Group-A (0.05% Isotretinoin Gel) and Group-B (0.1% Adapalene Gel). Efficacy was measured at 12 weeks post-treatment. Results: Treatment was found efficacious in 84.8% (n=39/46) of patients in Group-A and 50.0% (n=23/46) of patients in Group-B (p= 0.001). There were similar results when treatment efficacy in both Groups was disease severity. In all cases, efficacy was better in Group-A (p<0.05). Conclusions: The efficacy of topical 0.05% Isotretinoin gel was better than topical 0.1% Adapalene gel for treating mild to moderate acne vulgaris. [ABSTRACT FROM AUTHOR]

Objective: To compare the reduction in mean pain score with local Methylcobalamin injection versus local Bupivacaine injection in patients with acute herpetic neuralgia. Study Design: Quasi experimental study. Place and Duration of Study: Dermatology Outpatient Department, Pak Emirates Military Hospital, Rawalpindi, from Jun to Dec 2019. Methodology: Total 100 patients, having pain score more than 3, fulfilling the selection criteria were divided into two groups. Group A was treated with daily subcutaneous injection Bupivacaine, whereas Group B was treated with daily subcutaneous injection Methycobalamin at the site of neuralgia. Patients were followed up for 4 weeks. The pain score was noted. All the data was entered and analyzed on SPSS version 21. Results: In this study mean age of patients in group A was 43.82 ± 15.76 years and in group B was 44.76 ± 16.92 years. The mean visual analogue pain score at 4th week in the group A patients was 1.14 ± 0.32 and in group B was 1.90 ± 0.97. Statistically significant difference was found in group A (local Bupivacaine) with visual analogue score (VAS) at 4th week (pvalue= 0.002). Conclusion: The local Bupivacaine injection showed significant reduction in mean pain score than local Methylcobalamin injection in patients with acute herpetic neuralgia. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of oral fluconazole and oral itraconazole in the treatment of Pityriasis versicolor. Study Design: Comparative prospective study. Methodology: Total 72 patients of both genders with Pityriasis versicolor were included. Patients were randomly allocated into two treatment groups with 36 patients in each group: group A and group B by lottery method. Patients in group A received Cap Fluconazole 150 mg bi-weekly for two consecutive weeks while those in group B received two doses of 400 mg of itraconazole once weekly for two weeks. Patients were asked to follow-up after 4 weeks skin scrapings for microscopy using 10% KOH mount was done at follow-up. Efficacy was assessed in terms of negative fungal hyphae on microscopy. Results: In this study, age ranged from 18 to 40 years with mean age of 33.52 ± 4.12 years in group A, whereas 35.055 ± 4.18 years in group B. Mean duration of disease was 4.66 ± 1.51 months in group A and 5.27 ± 1.70 months in group B. Efficacy was seen in 77.8% of group A patients as compared to 50% in group B patients (p=0.014). Conclusion: Oral Fluconazole two doses of 150 mg/week (total 300mg/week) for two consecutive weeks was found more effective than oral itraconazole. [ABSTRACT FROM AUTHOR]

Abstract Introduction Dermatosis neglecta is an often misdiagnosed and under-diagnosed condition. In dermatosis neglecta, a progressive accumulation of sebum, sweat, keratin and other dirt and debris, occurs due to inadequate local hygiene resulting in a localized hyperpigmented patch or a verrucous plaque. Vigorous rubbing with alcohol-soaked gauze or soap and water results in a complete resolution of the lesion. This is the first case of dermatosis neglecta reported in a patient with multiple traumatic injuries. Case presentation We report a case of a 35-year-old male Caucasian of Pakistani origin, with multiple fractures, neurological deficit and immobility sustained in a fall, leading to the development of dermatosis neglecta of the left hand. Conclusion Early and prompt clinical recognition of this condition eliminates the need for aggressive diagnostic and therapeutic procedures.

Objective: To compare oral Montelukast with oral Doxycycline in the treatment of moderate Acne Vulgaris in terms of mean change in acne severity index. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Dermatology, Pak Emirates Military Hospital Rawalpindi, from Mar 2016 to Aug 2016. Methodology: A total of 84 patients were included in the study. They were randomly assigned to group A and B by consecutive non probability sampling technique. Group A was given 100mg Doxycycline with topical 10% benzoyl peroxide and group B was given 5mg Montelukast with topical 10% benzoyl peroxide. Acne severity index (ASI) was calculated at base line and after one month. Mean change in acne severity index was observed for both the groups. Results: Independent sample t-test was used to compare the means. Mean post treatment change in acne severity index of group A was 5.45 ± 1.29 and group B was 1.80 ± .59 respectively (p-value <0.001). On post stratification analysis for age and gender results were consistent. Conclusion: Efficacy of Doxycycline is significantly better in terms of mean change in Acne Severity Index, as compared to Montelukast. [ABSTRACT FROM AUTHOR]

Objective: To compare the frequency of success of intralesional vitamin D3 versus cryotherapy for management of patients with plantar warts. Study Design: Quasi experimental study. Place and Duration of Study: Department of Dermatology, Pak Emirates Military Hospital, Rawalpindi, from Aug 2016 to Feb 2017. Methodology: Total 60 patients, fulfilling the selection criteria, were included in the study. The patients were randomly divided in two groups by using lottery method. In group 1, Vitamin D3 was injected into the base of the warts after local anaesthetic agent, prilocaine. In group 2, cryotherapy was done by using a high-intensity regimen of one session every two weeks till 6 weeks. All patients were followed-up in Out-Patient Department (OPD) for 13 weeks. After 13 weeks, condition of warts was assessed. In case of complete resolution of warts, the success was labeled. Results: In this study success rate of intralesional D3 was 63.3% and for cryotherapy success rate was 43.3% (p-value=0.121). Stratification of age and gender did not show any statistically significant difference between success rates of both treatment modalities. However patients with history of shorter duration ranging in between 11-15 days showed significant higher success rate for intralesional vitamin-D3 as compared to cryotherapy. Conclusion: Frequency of success of intralesional vitamin-D3 was more than that of cryotherapy for treating planter warts. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To establish the incidence and identify the risk factors correlated to surgical site infections (SSIs) in geriatric patient having a surgery of fractured neck of femur in a district general hospital (DGH). METHODOLOGY: An initial audit was done for all fractured neck of femur patients who underwent for surgery in a three-month period. Electronic records were checked, and case notes were reviewed. After the initial audit, recommendations were made and the incidence of SSIs was re-audited 16 months later in 2 sessions (2nd and 3rd Audit). RESULTS: The initial audit in 89 patients showed an infection rate of 8.9% of which half were deep infections. The mean age was 79 years. Four superficial and 4 deep infections were identified. Patients with superficial infection had, Fixation with DHS, THR, Hemiarthroplasty and IM nailing. Patients with Deep infection had fixation with Dynamic hip screw (DHS), Cannulated hip screw (CHS), Hemiarthroplasty and IM nailing respectively, A Re-audit of 184 patients in 2 sessions (2nd and 3rd Audit) showed the infection rate reduced to 0.54%. One patient with infection had hemiarthroplasty, with mean age of patients was 80 years. CONCLUSION: Multiple techniques can be used to reduce Surgical site infection in fracture neck of femur patients and infection can be reduced to acceptable level such as Senior surgeon operating or Direct supervision, Pre-operative on table skin wash with chlorhexidine soap solution, Use of alcoholic betadine and Chlorhexidine, Two Opsite technique to isolate groin area, Non-braided suture for closure and layered washout, Re application of Chlorhexidine to skin prior to closure. [ABSTRACT FROM AUTHOR]

Byline: Arfan. Ul Bari, Naeem. Raza Background: Lupoid cutaneous leishmaniasis (CL) is known as the chronic form of CL. However, keeping its clinical presentation in view, there is a need [...]

Byline: Amer. Ejaz, Naeem. Raza, Nadia. Iftikhar, Arshi. Iftikhar, Mohammad. Farooq Background: Early onset psoriasis and late onset psoriasis are known to have different clinical patterns in Caucasian population. However, [...]

Objective: To see the frequency and histological pattern of malignant skin lesions on histopathological examination. Study Design: Prospective descriptive study. Place and Duration of Study: Histopathology Department, Army Medical College Rawalpindi, from 1st Nov 2016 to 31st Oct 2018. Material and Methods: Malignant skin lesions diagnosed on the skin biopsies received in histopathology department of Army Medical College, were analyzed to see the frequency and histological pattern of malignant skin lesions. All malignant skin lesions diagnosed on histopathological examination of skin biopsies received were included in the study. Skin biopsies having inadequate material, benign skin lesions or showing equivocal diagnosis of malignancy were excluded from the study. Data was entered and analyzed by using SPSS version 17. Results: A total of 15500 biopsies were dealt with during the study period. Out of these 15500 biopsies, 1450 were malignant lesions. Out of 1450 malignant lesions, 100 were malignant skin lesions accounting 6.89% of all skin malignancies. On histological analysis, out of 100 malignant skin lesions, 45 (45%) were basal cell carcinoma, 25 (20%) were squamous cell carcinoma, 05were malignant melanoma and 03 were Bowen's disease. Other malignant epithelial lesions included 03 malignant adnexal tumours. Among the non epithelial malignant lesions, 10 were cutaneous lymphomas, 03 were Kaposi sarcoma, 03 were angiosarcomas, 03 metastatic malignancies. Conclusion: The frequency of skin malignancies is relatively less in our population as compared to the western world. In our population, most of the skin malignancies are non melanoma skin cancers, basal cell carcinoma being the leading skin malignancy, followed by squamous cell carcinoma. The knowledge of skin malignancies in our population can be of some help in planning the effective management for the disease and to predict the prognostic outlook of the patients. [ABSTRACT FROM AUTHOR]

Objective: Comparison of efficacy of combination comprising 2% ketoconazole solution wash plus topical 1% clotrimazole versus topical 1% clotrimazole alone in management of patients with Pityriasis versicolor. Study Design: Randomized controlled trial. Place and Duration of Study: Dermatology department, Pak Emirates Military Hospital Rawalpindi, from Oct 2016 to Apr 2017. Material and Methods: Sixty patients of Pityriasis versicolor, both male and female were included in study. Diagnosis of Pityriasis versicolor was made clinically and confirmed microscopically by examining skin scrapings for fungal hyphae. Patients with concomitant systemic illnesses or those who had received anti-fungal in last three months were excluded from study. Random number tables were used to allocate patients to the two treatment groups. Group A received 2% ketoconazole shampoo twice per week for four weeks plus topical 1% clotrimazole twice daily application for 2 weeks. Group B received only topical therapy with 1% clotrimazole cream applied twice daily for 2 weeks. Assessment of treatment efficacy was done by clinical examination of patient and microscopy of skin scrapping for fungal hyphaedone at baseline and at end of study (4 weeks of treatment). A negative clinical examination and negative skin scrapping for fungal hyphae was considered effective therapeutic response. Results: In group A, the mean age of patients was 29.76 ± 8.89 years and in group B was 27.67 ± 10.46 years. Efficacy in group A was observed in 22 (73.33%) patients while in group B in 14 (46.67%) patients. Conclusion: Combination of 2% ketoconazole solution wash plus topical 1% clotrimazole was found more effective in treatment of patients with Pityriasis versicolor as compared totopical 1% clotrimazole alone. [ABSTRACT FROM AUTHOR]

Objective: To compare the diagnostic yields of KOH mount and PAS staining of nail clippings for demonstration of hyphae. Study Design: Cross sectional study. Place and Duration of Study: Study was conducted at dermatology department, POFs' Hospital Wah Cantt. The duration of the study was one year, from Aug 2016 to Aug 2017. Material and Methods: The sample size of 60 patients was calculated using WHO calculator. Non probability consecutive sampling was used for recruitment of participants. Patients of any age and of either sex with clinical suspicion of onychomycosis were included in the study. Nail clippings of affected nails of each subject were examined for hyphae after KOH mount and PAS staining. SPSS software was used for data analysis. Chi-square test and ROC curve analysis were used for diagnostic accuracy measurement. Results: Out of sixty patients, hyphae were seen in 49 (81.66%) after PAS staining and in 19 (31.66%) after KOH mount. PAS staining is found to be more sensitive (80.3%) for diagnosis of onychomycosis as compared to KOH (29.4%) (p=0.02). ROC curve analysis showed PAS had good diagnostic accuracy (ROC curve area=0.80) while KOH had poor diagnostic accuracy (ROC curve area=0.60). Conclusion: PAS staining of nail clippings for hyphae is a very sensitive method for diagnosis of onychomycosis as compared to KOH mount. The current gold standard needs to be reviewed. [ABSTRACT FROM AUTHOR]

Background: Scabies is a common dermatological presentation in Pakistan. Permethrin and Crotamiton both are used widely for treating scabies. As there is no local study available regarding comparison of efficacy of Permethrin and Crotamiton in patients of scabies, current study was undertaken. The objective of the study was to compare the efficacy of 5% Permethrin with 10% Crotamiton in patients of scabies. Methods: A Randomized control trial was conducted at Dermatology Department, Military Hospital, Rawalpindi. One hundred and sixty patients with scabies (diagnosis made by scraping the burrows to extract mite, larva or eggs and to see under light microscope) were randomly assigned either to Permethrin or Crotamiton group. Patients were followed over for 4 weeks to determine the effectiveness of either treatment. Results: A total of 160 patients were included in the study with a mean age of 45.49±17.047 years and ranging from 13–65 years. One hundred and one patients (63.1%) were male and remaining 59 patients (26.9%) were female. Treatment was effective in 81.3% patients being treated with 5% Permethrin and 53.8% in 10% Crotamiton group. Comparison of treatment showed superiority of 5% Permethrin over 10% Crotamiton (p=0.001). There was no effect of age and gender on this outcome difference. Conclusion: Our study concludes that 5% Permethrin cream is significantly superior to 10% Crotamiton cream in treating patients of scabies (81.3% vs. 53.8%, p=0.001). [ABSTRACT FROM AUTHOR]