Tuberculosis is a serious infection that affects many people worldwide, with a recent increasing prevalence especially in high-risk patients, such as HIV infection, intravenous drug abuse, diabetes mellitus, immunosuppressive therapy, malignancies, end-stage renal disease, and and/or with multiple comorbidities. Although the incidence of Cutaneous Tuberculosis (CTB) is rare, it should be considered in patients presenting with atypical skin lesions suggestive of an underlying infectious etiology. Most often TB is an airborne transmissible disease with skin manifestations presenting as a result of hematogenous spread or direct extension from a latent or active foci of infection. However, primary inoculation may occur as a direct introduction of the mycobacterium into the skin or mucosa of a susceptible individual by trauma or injury. Although rare, it is important for clinicians to recognize the many clinical variants of CTB to prevent missed or delayed diagnoses. It is imperative that physicians have a high index of suspicion in order to quickly and effectively diagnose and treat these substantially morbid skin conditions. We report here a case with atypical presentation that we saw in our Out Patient Department (OPD). The aim of this communication is to bring to attention this often overlooked, but definitely curable clinical entity. This case report demonstrates the importance of a proper history and physical examination as well as diligent laboratory and diagnostic testing in determining the etiology of a suspicious and treatment-resistant skin lesion. Prompt consideration leads to a swift diagnosis and proper treatment resulting in high patient satisfaction.
Introduction As the Human Immunodeficiency virus/ Acquired Immunodeficiency Syndrome (HIV/AIDS) continue to advance worldwide, sexually transmitted infections (STIs) rates remain high in much of the world. Each year about 330 million new cases of STIs occur, of which more than 90% are in developing countries. Prevalence of HIV in people effected with STIs is 10 times more as compared to general population i.e. 10%. Objectives To determine the frequency of HIV in patients who are presenting for the treatment of STIs in dermatology department of tertiary care hospital. Methods A descriptive cross-sectional study was conducted in the Department of Dermatology, KEMU/Mayo Hospital, Lahore in collaboration with Punjab AIDS Control Program (PACP). Study was carried out over a period of six months from 20-12-2016 to 19-06-2017. A total of 285 patients were included in the study. Whole blood sample was taken and tested for HIV using kit provided by PACP. Patients were also evaluated and investigated for the type of their STI and medications given for treatment of their STIs. HIV was confirmed by ELISA and they were referred to HIV clinic Mayo hospital, Lahore for further management. Results Mean age of the patients was 30 years. There were 153 males (53.7%), 121 females (42.5%) while 11 patients (3.8%) were hijras. Married patients were 55% and 45% patients were unmarried. Sexual orientation vise there were 8.8% homosexuals, 87.7% heterosexuals and 3.5% bisexuals. Out of 285 patients, 34% used condoms. History of blood transfusion was found in 4%. History of IV drug abuse was given by 5%. Types of STIs were as follows: warts 36%, secondary syphilis 20%), scabies 20%, tinea cruris 9%, vaginal discharge 11%), gonorrhoea 2%), and genital herpes 3%). Majority of the patients (88%) had 1-4 sexual partners. HIV positive patients found among these patients with STIs were 24 (8%). Conclusion In conclusion, the frequency of HIV among patients with STIs was 8%. To prevent HIV/STIs, campaigns promoting condom use are needed to boost the frequency of condom use.
Objective To assess the awareness, perceptions and practices towards acne vulgaris among acne patients. Methods The cross-sectional study was conducted on 100 patients of acne vulgaris visiting Dermatology outpatient department of Bahawal Victoria Hospital, Bahawalpur. Results In this study conducted on 100 patients, 72% were females and 28% were males. Out of 100 patients, only 10% were married. 30% belonged to rural areas and 70% had urban background. 53% of the participants having acne were students. Eighty-six (86%) had good knowledge and 14 (14%) had poor knowledge. Forty- eight percent participants were in favor of using traditional medicine on acne and 86% consulted doctor. Majority of patients 52% did not answer self-care questionnaire. Conclusion The present study showed that patients suffering from acne had poor practice and unfavorable attitude inspite of good knowledge.
Objective To determine the frequency of the skin diseases in patients attending dermatology OPD in a tertiary care Hospital in Faisalabad. Materials and Methods It is a descriptive study carried out from 1st September.2019 to 29th February 2020 for the period of six months. It was carried out on patients attending dermatology OPD at Aziz Fatima Hospital Faisalabad which is a tertiary care hospital affiliated with Aziz Fatima Hospital Faisalabad. Total of two thousand eight hundred seventy nine patients were enrolled after informal consent. Study was based on the newly diagnosed cases presenting in dermatology OPD, irrespective of age and sex. The diseases were diagnosed clinically and relevant investigations were carried out at laboratory of hospital. History and Physical examination was recorded on a predesigned standared proforma and analysed through computer Microsoft SPSS. Biochemical tests were carried out where needed. Skin biopsy and histopathology was carried out in selected cases where diagnosis was proved or otherwise. All the data was recorded and analyzed by SPSS software to assess the burden of these diseases in our setup and finally comparison was made with different studies. Results A total of 2879 patients were enrolled in the study from 1st September 2019 to 29th February 2020 for a period of six months. It include 1928 female patients (66.97%) and 951 male patients (33.03%), female to male ratio was 2:1 approximately. A general classification into infective and non infective groups was categorized. All the diseases were broadly divided in to infective and non infective groups. Infective group comprised of 1288(44.73%) and non infective group consists of 1592 patients.ie55.27%. Acne was most common (n=489 ie.16.98%) non infective disease. Scabies was (n=873 ie.30.32%) among the infective group. Conclusion Our study found the higher incidence of non-infective disease i.e. n= 1591(55.27%) and acne was most common disorder (n=489 i.e. 16.98%) and among infective disorder (n=1288 i.e. 44.73%) scabies was most common n=873 i.e30.32%.
Introduction The incidence of human immunodeficiency virus (HIV) infection, is increasing in Pakistan. Seborrheic dermatitis (SD) can be seen in patients having HIV infection, so it can be a marker of disease diagnosis and progression. Objective To see the occurrence of HIV infection in patients with SD. Methods A prospective study was conducted in Dermatology Department, DHQ teaching hospital, University Medical Complex and Research Center, Sargodha, from September, 2019-February, 2020. Two hundred and eighty-five cases of SD diagnosed clinically were taken and serological examination for HIV by rapid diagnostic test was done on all cases. Data analysis were done by Statistical Package for the Social Sciences (SPSS) Version 20 and expressed as frequency and percentage. Results In 285 cases of SD majority (53.6%) were males. Ages of patients ranged from 8 months to 60 years. Out of the 31 patients positive for HIV, 25 were males and rest were females. Majority of HIV positive cases (70.96%) had severe SD. Conclusion SD is a dermatological manifestation of HIV infection. As in developing countries like Pakistan with limited health facilities it is difficult to have CD4+ counts done, skin examination should be an important tool for assessing immune status and management of HIV positive patients.
Background The SARS‐CoV‐2 virus and the disease it causes, termed coronavirus disease 2019 (COVID‐19), has rapidly swept across the world since its first known human manifestation on December 8, 2019. Confirmed cases are present in over 160 countries. This article summarized the impact of COVID-19 on Dermatology private practice. The purpose of this study was to assess the magnitude of the impact of COVID-19 on the private practice of dermatologists across the country through a survey. Methods A questionnaire, containing fifteen questions was created through Google forms and sent to the dermatologists practicing in different cities of Pakistan through WhatsApp or email and data was collected. Results 122 dermatologists from all over Pakistan participated in the survey out of which 78.6% Dermatologist’s private practice was completely affected by COVID-19 outbreak. Conclusion Dermatology private practice greatly affected by COVID-19 outbreak.
Artificial neural networks were developed a few decades ago and had applications in various fields while its role in dermatology remained limited. Hinton in 2006 proposed the concept of deep learning and its training methods that involved multiple processing layers to learn representation of data with various levels of abstraction. 1 After more than ten years of development, deep learning with conventional neural network (CNN) as the core has been widely applied in image processing in other fields such as radiology to differentiate between benign and malignant tumors. 1 AI has also been used in identification of ophthalmological diseases and recognition of breast carcinomas by ‘deep mind’ established in 2010. Currently imaging techniques such as dermoscopy, reflectant confocal microscopy and very high frequency ultrasound are being frequently used to help aid the dermatologists to reach a diagnosis. 1 These images are being used to develop deep learning. The application of AI requires massive skin image resources. The imaging data can be used to form a “multi dimensional skin image resource library” as a platform for user oriented image services based on the internet technology. AI requires extremely large datasets of images/slides for an accurate enough algorithm to be “learned”. This huge volume of data does exist globally albeit in analog form with millions of slides held in storage around the world, and images of skin lesions stored electronically but the utilization of such resource is complicated by many technical hurdles. 2
Objective To determine various dermoscopic patterns in active and regressive Lichen Planus. Methods It was an observational study carried out at department of dermatology unit-II, Mayo Hospital Lahore. A total of 70 dermoscopic images from 35 patients (20 females, 15 males) were studied. Their clinical pictures were taken with iPhone 6 and patients diagnosed both clinically and histologically of lichen planus were enrolled in the study. Dermoscopic pictures were taken at the same time with fireflypro DE 350 model, a polarized dermoscopic device, using both optical and digital magnification. Clinical and dermoscopic data of both active and regressive Lichen Planus was compiled separately. Predominant patterns were described keeping in mind the internationally accepted terminology & criteria. Results 40 out of 70 images belonged to patients with clinically active LP, while 30 images showed features of regressive LP. Predominant features in active LP included wikhams stria (WS), vascular structures and various forms of pigmentation. WS and vascular structures are absent in majority of treated or regressive cases. Conclusion Dermoscopy is a reliable non-invasive tool in differentiating active from regressive LP.
Angioedema is a deep swelling of subcutaneous tissue or mucosa because of increased vascular permeability. It is commonly seen as manifestation of an allergic reaction. It may occur with or without urticaria, or may be recurrent secondary to triggers like trauma, drugs, autoimmune diseases, physical or emotional stress. Severe angioedema can compromise airway patency. Avoidance of known triggering stimuli is the primary strategy in any treatment
This is a case of a 22-year old female who presented to outpatient department with the complaint of swelling over her right ear since 2 years associated with itching. Lesion started over the right ear lobule gradually progressed upwards involving the antihelix. On enquiring about history of trauma prior to the onset of lesions, patient gave history of ear piercing 3 years back. There is no history of any ear discharge, hearing difficulty, neither was there any complaints of oozing, scaling, pus discharge, pain, or bleeding from the lesion. Patient cannot recollect any history of insect bite, fever, or chronic cough. There is no history suggestive of keloidal tendencies in the past or in the family. On examination, there is a solitary erythematous nodule over right ear lobule extending upwards to cover lower part of helix, measuring 3x 3 cm, firm in consistency, with no tenderness or bleeding on palpation (Figure 1 and 2). Skin over the lesion is fixed and was not pinchable and two piercings are present over the ear lobule as “prima facie” of the trauma probably leading to the growth. There was no involvement of external auditory canal, or enlargement of cervical lymph nodes, and the respiratory system as well as ear, nose and throat is found to be normal. A clinical differential of keloid, lobomycosis, deep fungal infection and cutaneous tuberculosis was kept. Complete blood count, liver function test, chest X-ray does not show any abnormality. Mantoux test is found to be negative. Biopsy for histopathology stained with hematoxylin and eosin reveals keratinized epithelium overlying dermal nodules composed of proliferating capillaries, lined by plump endothelial cells, surrounded by dense infiltrate of lymphocytes, few histiocytes, eosinophils, plasma cells forming lymphoid aggregates (Figure 3-5).
Introduction Oral manifestations can occur in 80% of patients infected with HIV. It causes significant morbidity and also provide diagnostic clues to the underlying immunocompromised status. Objective The present study was conducted to determine the prevalence of oral manifestations in HIV infected patients and to correlate those manifestations to the degree of cellular immune deficiency. Material & Methods This was a cross sectional study conducted in Out patient department of SKIN & STD between September 2016 and March 2018. A total of 192 HIV patients between 18- 70 years of age were included in the study. Oral lesions were diagnosed clinically, according to the presumptive diagnostic criteria established by the European Community Clearinghouse on oral problems related to HIV infection in August 1990 and September 1992. Data were coded and analyzed. Results The prevalence of oral manifestations in our study was 49.0%. More commonly seen in the age group of 40-45 years (34%) and males were more commonly affected (56%). Pseudomembranous candidiasis (28.6%) was the most common oral manifestation in our study followed by Aphthous ulcer (16.14%), linear gingival erythema (13.2%) and Oral hairy leukoplakia (10.4%). It was observed that more number of patients having oral manifestations had a CD4+ count of less than 200 cells/ mm3. Conclusion Oral manifestations are highly predictive markers of severe immune deterioration and disease progression. Oral examinations are an essential component for early recognition of disease progression and comprehensive evaluation of HIV infected patients.
Objective We aimed to assess the efficacy and safety of NB-UVB phototherapy in relieving uremic pruritus. Patients and Methods Over a period of 12 months, we recruited 17 patients with uremic pruritus having skin phototype III and more, aged from 21 to 67 years, 19(52.9%) females and 8(47.1%) male. They received NB-UVB, 2 sessions per week for 10 weeks. The response was assessed using 5-D itch scale. Results There was a 60.7±29.2% reduction of 5D-itch score compared to baseline (19.53±3 versus 7.59±5.8, p<0.001). The mean cumulative dose of NB-UVB for one patient was 24.99 joule/ cm2 (1.25±0.6 J/cm2 per session). At the end of the trial, according to 5-D itch score criteria, 82.4% of patients were considered as a responder (good in 47.1%, very good in 35.3%) and after the treatment at follow up for 8 weeks, 35.7% developed pruritus again. Transient erythema was observed in 2 patients (10.5%) on phototherapy. Conclusion In our population, with Fitzpatrick skin phototypes 3-5, NB-UVB phototherapy seems to be safe and effective choice for uremic pruritus, albeit tentative in some patients. High doses were required to achieve a satisfactory response.
Background Treatment of acne scars involves a concoction of various treatment modalities. Minimally invasive procedures like microneedling along with platelet rich plasma are new combination modalities used for scar remodeling with lesser downtime and side effects. Methods The present study was conducted on 40 patients having Goodman and Baron’s acne scar grade II-IV. The efficacy of PRP in combination with microneedling was compared to microneedling alone in the treatment of post acne scars. Right half of the patient’s face was taken as study side where microneedling was done followed by PRP injections. The left half of the same patient’s face was taken as control side where microneedling was done followed by normal saline injections. Results The combination therapy of microneedling along with PRP improved the scar grading significantly, with the decrease of the mean of Goodman and Baron’s grade from 3.20±0.40 at baseline, to 2.13±0.56 at final treatment whereas on the left half of patient’s face mean acne scar grade reduced from 3.20± 0.40 to 2.36±0.56 at final treatment. Conclusion Combination approach using dermaroller and PRP is a better option than using dermaroller alone in atrophic acne scars for clinical improvement although the association is not statistically significant.
Background Finasteride is approved treatment for androgenic alopecia and benign prostatic hypertrophy. It may have an effect on sperm, however the data is lacking. Few published papers described the association between 1mg/day of finasteride treatment for androgenic alopecia and sperm. Objective Reviewing all articles describing the association between treatment of finasteride (1mg/day) for androgenic alopecia and sperm concentration. Methods Comprehensive literature review using PubMed as a search engine from 1980 till present. Main outcome measures: Sperm concentrations during treatment and after treatment are the main outcome measures of this analysis. Results Seven papers were found on PubMed using the mentioned keywords on the management of androgenic alopecia giving a total of 113 subjects in all papers. No baseline sperm concentration was measured except for one paper. All papers but one (n=22) showed increase in sperm concentration after cessation of finasteride. However, the largest study (n=91) had baseline, during and post treatment measurements of sperm and showed no change in sperm concentration level. Conclusion The analysis of reviewed papers showed that long-term treatment with finasteride is safe on sperm concentration. However, there are some signs of short-term effect during treatment.
A patient of urticaria due to milk and milk product is being reported. She was having urticaria since 8 months. The urticaria improves with antihistamine only. She was off the urticaria when she was put on total fast for 48 hour. Provocation test after 10th day with milk, she developed urticaria 8 hours after taking milk.
Background Hirsutism is very disturbing condition for most of the women and affects their lives. Hirsute is a medical sign defined as the thick, dark male pattern growth of hair in women. The aim of this study is to explore the factors associated with hirsutism in women of Lahore, Pakistan. Methods This is a case/control study consisted of 300 subjects from whom 150 were cases and 150 controls. Researcher collected data through questionnaires from different beauty parlors, women development centers and Sanatzar institution. Descriptive and inferential analyses were used in order to explain the risk factors associated with hirsutim. To measure the association of hirsute with its risk factors Chi-square, phi and Kendall’s Tau b were used. Odd ratios and 95% confidence intervals computed with the help of logistic regression model. Results Odd ratios and 95% confidence interval for Decrease Breast Size (OR=8.162, C.I=2.797-23.819), Family History of Hirsute (OR=6.980, C.I=3.184-15.299), Acne (OR=2.164, C.I=1.084-4.320) and Polycystic Ovary Syndrome (OR=9.060, C.I=3.492-23.507) were significant. Conclusion There were several risk factors associated with hirsutism, out of these factors decrease breast size, family history, acne and age were most common. Family history and Polycystic Ovary Syndrome (PCOS) were highly associated with hirsute.
Vitiligo is the most common depigmentation disease with complex pathogenesis that is not well understood and therapeutic outcomes are often unsatisfactory. Leukotrichia in vitiligo is often associated with poor prognosis for vitiligo treatment. Until now narrowband ultraviolet B (NB-UVB) is considered the most effective and safe treatment for vitiligo. Evaluation of therapy by looking at the amount of melanocytes that can be seen with S100 protein immunohistochemistry will become more objective and accurate. Melanocyte count in four non segmental vitiligo patient with leukotrichia were evaluated. The patient was given only NB-UVB therapy twice a week for eight times. Skin biopsy was done before and after therapies using immunohistochemistry staining. The number of S100 protein in vitiligo patients with leukotrichia after NB-UVB therapy increased. Leukotrichia is a poor indicator for treatment response in vitiligo, but this case report showed that leucotrichia did not contribute to the lack of response upon medical treatment.
Background Chronic and recurrent dermatophytic infections cause significant distress to the patients. The causal relationship of clothing in these patients remains underscored. The present study highlights the effect of clothing in causing multiple recurrences among Chronic Dermatophytosis patients. Methods Patients of chronic recurrent dermatophytosis were enrolled from dermatology OPD and divided into Group I & II, each having patients with less than three & more than three recurrences during the last 6 months respectively. Each group was further divided into three subgroups i.e. Group A, B & C comprising of patients affected with tinea cruris, tinea corporis and both i.e. tinea cruris et corporis respectively. All groups were evaluated in reference to various clothing habits i.e. Type and material of cloth, Frequency of washing clothes, Separate washing of infected clothes, washing, drying and ironing of clothes along with the use of “V” shape inner garments. Results Comparative evaluation of tinea corporis patients in Group I & II in relation to clothes washed in hot or cold water revealed 73% in Group I & 25% patients in Group II were washing their clothes in hot water while the rest were washing them in cold water. The data was statistically significant. Conclusion Clothing habits can be a confounding factor in multiple recurrences of Dermatophytosis and washing clothes in hot water can prevent multiple recurrences of tinea corporis.
Objective To identify various isolates causing complicated skin and skin structure infections with their antibiotic susceptibility patterns. Methods A total of 436 samples of pus/ discharge from skin lesions were collected and cultured. Bacterial colonies were identified by using gram stain and biochemical test. Kirby-Bauer disc diffusion technique was followed for testing antibiotics susceptibility patterns. Results The most commonly affected age group observed in the present study was 15-44 years (44.03%). The predominant Gram-positive bacteria was Staphylococcus aureus and gram negative was Escherichia coli. 20 (19.60%) of S. aureus and 22 (40.74%) of Coagulase negative Staphylococci (CONS) were methicillin resistant. Vancomycin was found as most efficient drug followed by Fusidic acid, linezolid, Amikacin chloramphenicol and gentamicin in case of gram positive isolates. Tigecycline was found as most efficient drug as all isolates were found susceptible to it. Incase of gram negative isolates, maximum resistance was shown to cephalosporin, ampicillin, erythromycin and co-trimoxazole while least resistance was recorded against Ticarcillin, Tazobactam-pipiracillin, amikacin and gentamicin. Conclusion Vancomycin, tigecycline, amikacin, gentamicin and fusidic acid showed more efficacy in the present study.
Background Acquired immune-deficiency syndrome (AIDS) is a fatal illness caused by a retrovirus known as Human Immunodeficiency Virus (HIV) which breaks down the immune system of the body, leaving the victim vulnerable to a host of life-threatening opportunistic infections, neurological disorders, or unusual malignancies. Dermatological disorders are health problems among HIV positive patients which present with a variety of manifestations. Skin diseases cause significant morbidity and may be initial signs of immunosuppression. They affect between 80 and 95% of HIV-infected patients, occurring at any time in the course of infection. Objective 1- To study the pattern of mucocutaneous manifestation of HIV infected patients attending Dermatology Outpatient Department (OPD) of Karnataka Institute Of Medical Sciences (KIMS) Hubballi. 2- To assess the relation of mucocutaneous manifestations of HIV infected patients with CD4 count. Methods All HIV positive patients with mucocutaneous manifestation attending Dermatology OPD, KIMS, Hubballi from December 2017 to May 2019 were enrolled. Results In this study, the most common dermatosis was pruritic papular eruption (21%) with a mean CD 4 count of 499.81±319.31 cells/mm 3 . Among viral infections, the most common infection was herpes genitalis (32.4%) with a mean CD 4 count of 291.25±194.22 cells/mm 3 . The most common fungal infection was dermatophytosis (59.1%) with a mean CD 4 count of 489.69±260.13 cells/mm 3 . The most common bacterial infection was pyoderma (73.7%) and the mean CD 4 count was 485.21±308.30 cells/mm 3 . The most common parasitic infestation was scabies with a mean CD 4 count of 375.60±117.59 cells/mm 3 . Among malignancies, only two cases of basal cell carcinoma was seen in this study and the mean CD 4 count was 89.50±57.28 cells/mm 3 . Conclusion The skin manifestations in HIV can serve as an important marker for underlying immunodeficiency state. The CD 4 count of a patient can be used to know the level of immunosuppression as different dermatosis are seen at various stages of HIV infection.
