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Objective Onychomycosis (OM) is a chronic fungal infection of the finger and toenails. Emerging treatments include lasers like CO2 laser and Nd:YAG Laser 1064-nm which combine both efficacy and safety. The objective of the study is to determine the clinical efficacy of Q-switched Nd:YAG Laser 1064-nm in OM. Methods This study undertaken in Dermatology Department, Mayo Hospital, Lahore was conducted on 118 adult patients with clinical OM and positive KOH smear for fungal hyphae. Results There was mild female predominance (54% females versus 46% males) in our subjects. More than one third (35.6%) of our subjects had excellent clinical response and only 5.1% had a poor response. Disease duration longer than 6 months was significantly associated with poorer outcome. No side effects were observed except mild discomfort during the treatment session. Conclusion Q-Switched Nd: YAG Laser 1064-nm is an effective noninvasive treatment option for OM in our population. It should be considered in all patients with recent disease onset, especially where long term systemic agents are contraindicated or poorly tolerated. [ABSTRACT FROM AUTHOR]

Objective To assess the effectiveness of Chemical reconstruction of skin scars (CROSS) with 50% TCA peel and Microneedling in acne scars in the treatment of acne scars. Methods This trial was carried out from 15th March to 14th September 2022, at Outpatient Department of Dermatology, Services Hospital, Lahore. Patients of both genders and 18 to 50 years of age, who had grade 2 to 4 acne scars were enrolled. Their acne scars were graded by Goodman's Qualitative Acne Scarring Grading System. Paper lottery method was used to randomly divide them into 2 groups. Group A patients received 50% TCA peel whereas in Group B, patients were treated with microneedling with dermapen. Follow-up was done one month after the last treatment session and the response was recorded. Excellent response was labelled if patient's acne scars reduced by two grades, good response if one grade was reduced and a poor response was no improvement. Efficacy was considered as good or excellent response. Results A total of 84 patients were enrolled. The mean of the ages of patients in group A was 33.21±7.22 years and in group B was 32.12±6.59 years. Majority of the patients 60 (71.43%) were between 18 to 35 years of age. Out of 84 patients, 73 (86.90%) were females and 11 (13.10%) were males with female to male ratio of 6.6:1. Efficacy of Group A (50% TCA peel) was noted in 31 (73.81%) patients while in Group B (microneedling with dermapen) was seen in 39 (92.86%) patients (p-value = 0.019). Conclusion We concluded that microneedling with dermapen was more efficacious in the treatment of post acne facial scars than chemical reconstruction of scars (CROSS) with 50% TCA peel. [ABSTRACT FROM AUTHOR]

Objective To determine the frequency of nail changes in patients of psoriasis to Dermatology Department of Services Hospital, Lahore. Methods It was a cross-sectional survey conducted in the Department of Dermatology, SIMS/Services Hospital, from September 2022 to March 2023. 80 patients of psoriasis were enrolled. Detailed history and examination for psoriasis was done. All patients underwent evaluation for nail changes (as per operational definition). The presence/absence of nail changes was recorded on a pre-designed proforma (annexure). Results In this study, mean age of patients was 27.24±4.57 years, 59 (73.8%) were male whereas 21 (26.3%) were females, 55 (68.8%), moderate in 17 (21.3%) and severe in 8 (10%) of the cases. Descriptive statistics of nail changes of patients in psoriasis shows 72 (90%) had pitting, 64 (80%) had Onycholysis, 24 (30%) had Splinter Haemorrhage, Oil Drop Discoloration in 71 (88.8%) and Subungual hyperkeratosis in 64 (80%) of the cases. Conclusion We found pitting as the leading nail change in psoriatic disease followed by Oil Drop Discoloration and Onycholysis. Psoriasis can significantly impair a patient's quality of life. Nail changes can significantly affect cosmetic concerns of the patients and need to be addressed adequately and timely. [ABSTRACT FROM AUTHOR]

Objective To assess the effectiveness and safety profile of glycolic acid peel combined with microneedling versus 35% glycolic acid peel in the management of acne scars. Methods This study was conducted from 27th September 2021 to 28th March 2022 at Outpatient Department of Dermatology, Services Hospital, Lahore. Patients of either gender, having acne scars of grade 2 to grade 4 were included. After written informed consent, they were divided randomly into two treatment groups. Patients in Group A were treated with 35% glycolic acid peel combined with microneedling while Group B was received 35% glycolic acid peel only. All patients underwent six treatment sessions at two weekly intervals. They were called for follow-up one month after the last treatment session and treatment response was noted. 'Treatment response' or efficacy was defined as Excellent response (reduction in two grades of scars), Good response (reduction in one grade) or Poor response (no reduction in grade of scars). Safety of treatments was assessed by side effects reported by patients and observed on examination. Results Out of 60 patients, 51 (85%) were women and 09 (15%) were men with a ratio of 5.7:1. They were divided equally into two treatment groups. Group A patients had a mean age of 32.43±6.91 years while it was 33.27±7.24 years in group B patients. Majority of the patients (58.33%) were between 31 to 45 years of age. Efficacy of Group A (glycolic acid peel 35%, combined with microneedling) was seen in 29 (96.67%) patients whereas it was observed in 22 (73.33%) patients (p-value=0.011) in Group B. Two patients in combination group reported postinflammatory hyperpigmentation, rest of the patients reported improvement in tone and texture of skin. Conclusion This study concluded that use of glycolic acid peel 35% combined with microneedling is more effective treatment option in acne scars versus the peel alone. Patients in both the groups reported improvement in the quality of skin with a relatively good safety profile. [ABSTRACT FROM AUTHOR]

Objective To assess the impact of vitiligo on psychosocial health of patients by applying Dermatology Life Quality Index (DLQI) score and to estimate the frequency of patients having significant effect of vitiligo on their life. Methods This descriptive survey was conducted at the Department of Dermatology, Services Hospital, Lahore over six months. Physical examination of the patients was done and patients were asked to fill DLQI questionnaires in Urdu. Final scores were analysed and impact on psychological and social well-being of patients was noted. The higher the score, the more the quality of life impaired. Outcome variables i.e. mean DLQI score and frequency of significant effect on quality of life was recorded on proforma. Data was entered and analyzed using SPSS version 21. Results The mean age of patients was 33.45±10.21 years. Out of 200, there were 91 (45.5%) males and 109 (54.5%) females. The mean duration of symptoms was 2.88±1.34 years. The mean DLQI score was 16.78±8.31. Out of 200, quality of life of 177 (88.5%) patients was significantly affected by vitiligo. Conclusion Vitiligo profoundly effects daily life of majority of patients. The disease has a tremendous impact on everyday life and self-esteem of most of the patients. [ABSTRACT FROM AUTHOR]

Background Skin diseases in underprivileged populations are under-estimated. Prisons may harbour several dermatoses due to congestion and neglected hygienic conditions of their inhabitants. This may further aggravate their misery and psychological health. No study addressing skin disorders in this population has been conducted in our part of the world. Objective To analyse the pattern of various skin disorders among prison inmates. Methods Clinical data of male prisoners of Central Jail Lahore seen from 2016 to 2021 were retrospectively analysed in this cross-sectional study. Frequencies and patterns of their skin diseases were studied and grouped according to their ages. Results A total of 194 inmates were seen. The most commonly observed skin disease was scabies, followed by tinea pedis and acne. The mean age of the patients was 41.78±10.9 years. Most (57.2%) of the patients were less than 40 years of age. The frequencies of skin disorders observed were as follows: Infections and infestations (53.1%), eczematous disorders (23.2%), autoimmune disorders (5.7%), disorders of pigmentation and solar damage (3.6%) and miscellaneous diseases (14.4%). Among infections, scabies was most frequently seen (42.8%), followed by fungal (38.8%), viral (12.6%) and bacterial infections (5.8%). Conclusion Infestations and infections are the commonest dermatological conditions observed among inmates, probably due to overcrowding and poor hygienic conditions prevalent in jails. [ABSTRACT FROM AUTHOR]

Introduction: Psoriasis is a chronic and proliferative inflammatory condition of the skin which is quite common in both sexes. Environmental and genetic factors both are involved in its occurrence. Various topical and systemic treatment modalities are used for psoriasis including methotrexate but phototherapy is also one of the effective treatment modality. Objective: Objective was to compare the safety and efficacy of narrowband ultraviolet B (NB-UVB) and methotrexate (MTX) in chronic plaque psoriasis. Methodology: In this interventional comparative study (Quasi experimental), sixty patients with more than 10% body surface area involved were enrolled according to inclusion criteria and randomly divided into two groups containing even number of patients. In group A patients were given narrowband UVB, three times a week while those in group B were given 15 mg of oral MTX weekly for twelve weeks. The response to the treatment was observed at 4th, 8th and 12th week of therapy and two weeks after stopping therapy. The therapy was considered efficacious in patients when there was ? 50% reduction in the PASI score (Psoriasis Area Severity Index) from baseline. The group in which there was greater mean % reduction in PASI score was considered more efficacious. Results: In group A, NB-UVB was effective in 100% of patients with excellent results in 80% of patients and good results in 20% of patients. Efficacy was seen in 100% of patients in group B with excellent response in 76.66% of patients and good response in 23.34% patients. Side effects were seen in 29.93% of patients in group 'A' and 23.34% in group 'B'. Erythema and tanning were observed in group A while nausea in group B. Conclusion: Narrowband UVB is as good as methotrexate in both safety as well as efficacy in the treatment of chronic plaque psoriasis. Maximum improvement was seen with narrowband UVB during the first month of treatment while with methotrexate, it was seen in the 2nd and 3rd month of therapy. NB-UVB units should be introduced in all government hospitals with dermatology units so that maximum number of patients can be benefited. [ABSTRACT FROM AUTHOR]

Objective To compare the outcome with topical tranexamic acid versus hydroquinone for management of patients presenting with melasma. Methods The present study was conducted in the outpatient department of dermatology unit 1. 354 patients fulfilling selection criteria were enrolled and divided in two groups. In group A, patients were prescribed topical cream of 5% TA and in group B, patients were prescribed topical cream of 2% hydroquinone. MASI score was assessed at presentation and at 4 weeks of follow up. Results In this study the mean age of cases in Tranexamic acid group was 35.42±10.68 years and in Hydroquinone group was 36.25 ±10.42 years. In Tranexamic acid there were 13(7.3%) male and 164(92.7%) female cases and in Hydroquinone group there were 26(14.7%) male and 151(85.3%) female cases. Mean duration of pigmentation in Tranexamic acid group was 6.45±3.10 months and in Hydroquinone group was 6.50±3.02 months. The mean MASI score at baseline in Tranexamic acid group was 36.14 ± 6.85 and in Hydroquinone group was 36.61 ± 6.81. The mean MASI score at last follow up in Tranexamic acid group was 23.68±7.96 and in Hydroquinone group was 19.32±8.33. The mean MASI score was statistically less in Hydroquinone group as compared to Tranexamic acid group, p-value < 0.01. In Tranexamic acid group 39(22%) cases had side effects and in Hydroquinone group 83(46.9%) cases had side effects. Conclusion This study concludes that MASI score was significantly reduced in hydroquinone group but cases in topical tranexamic acid group developed less side effects. So, further studies are required to establish the use of topical tranexamic acid. [ABSTRACT FROM AUTHOR]

Objective To determine the frequency of polycystic ovarian syndrome among patients presenting with acne. Methods 200 female patients having grade I-IV acne vulgaris, fulfilling inclusion and exclusion criteria were enrolled in the study after taking informed consent. They were screened for the presence of polycystic ovarian syndrome (PCOS) by using Rotterdam criteria 2003. Results Out of 200 females with acne vulgaris, 92 (46%) had polycystic ovarian syndrome. Age of the patients ranged from 14-40 years. In grade I to IV acne 6%, 16%, 12% and 12% patients had PCOS, respectively. Conclusion Polycystic ovarian syndrome is not uncommon in patients with acne vulgaris. However it is not related to the severity of acne. [ABSTRACT FROM AUTHOR]

Objective To determine the association between toenail onychomycosis and venous insufficiency. Methods 100 patients and 100 controls fulfilling inclusion and exclusion criteria were enrolled in the study after taking informed consent. Venous insufficiency was detected by performing color Doppler ultrasound of lower limb veins. Results Out of 100 cases, 3% patients had venous insufficiency. Two persons among controls were found to have venous incompetence. Conclusion A positive association was found between venous insufficiency and toenail onychomycosis, however, this was not significant statistically. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of sclerotherapy in treating pyogenic granuloma. Methods: The present study was conducted at outpatient Department Dermatology, Unit I, Mayo Hospital, Lahore. 35 patients were enrolled and were injected with 0.1ml of 3% sodium tetradecyl sulfate with the help of an insulin syringe, without local anesthesia, till the point of blanching. Patient was called weekly for two weeks for follow up to see clearance of the lesion and then after 3 months to see any recurrence using a caliper. Results: The mean age of the patients was 28.48±11.64 years. 42.9% patients were males and 57.1% patients were females. Complete clearance of lesion was found in 30 (85.7%) patients whereas 2 (5.7%) patients showed no reduction. Conclusion: Sclerotherapy is an effective procedure for the treatment of pyogenic granuloma patients. [ABSTRACT FROM AUTHOR]

Objective To compare the efficacy and safety of ultraviolet A versus ultraviolet B in atopic dermatitis. Methods In this randomized trial, conducted in the Dermatology Department Unit-II, King Edward Medical University Mayo Hospital, Lahore, 60 patients with AD fulfilling the inclusion criteria were entered in the study. In group A, 30 patients were given UVA treatment. In group B, 30 patients were treated with UVB. The treatment was given thrice a week till clearance or for maximum of 12 weeks. Emollients were applied in both groups. Patients were assessed at 2nd, 4th, 6th, 8th, 10th and 12th weeks. After completion of treatment they were followed monthly for 3 months. Results 100% patients in group B (UVB) and 93% patients in group A (UVA) showed >50% reduction in SCORAD. Side effects were observed in 47% patients in group A (pigmentation being statistically significant) and 25% patients in group B in which serious side effects of erythema and burns were seen, though statistically insignificant. Conclusion Both UVA and UVB are equal in terms of efficacy. Pigmentation is more common with UVA while erythema and burns were only seen with UVB. [ABSTRACT FROM AUTHOR]

Objective:To determine the frequency of autoimmune disorders associated with alopecia areata in patients presenting in a tertiary care hospital. Methods: This study was conducted at the Dermatology Department, Unit II, KEMU/Mayo Hospital, Lahore.120 patients fulfilling the inclusion criteria were entered in the study during May 2013 to January 2014. After taking informed consent and recording demographic data, complete history was taken. Examination was performed and investigations were carried out where needed, for determination of factors associated with alopecia areata. Results: Out of 120 patients studied, 30.8% of patients had positive family history of alopecia areata. Atopic dermatitis was found in 29.2% of patients. Vitiligo and hypothyroidism were seen in 4.2% each. Diabetes mellitus was seen in 1.7% of the cases and 0.8% were hyperthyroid. Conclusion: Postive family history and atopic dermatitis were seen in one third of our patients with alopecia areata. Vitiligo and hypothyroidism were other important associations observed. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy and safety of methotrexate in lichen planus. Methods This quasi-experimental study was carried out in the Skin outdoor, Mayo Hospital, Lahore from March 2011 to September 2011. Fifty five patients of either sex from puberty onwards were included in the study. Efficacy was determined by ≥50% clearance of number of mucocutaneous lesions after 12 weeks of oral methotrexate 15mg/week. Safety of methotrexate was analyzed by taking history of nausea, fatigue and measuring hemoglobin (Hb), white blood cell count (WBC), platelet count, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) levels at base line, 2nd, 4th, 8th and 12th week. Results Methotrexate was efficacious in 63.6% patients. Out of these, 21.8% patients were with cutaneous involvement while 41.8% patients had both skin and mucous membrane involvement. There was a significant reduction in number of cutaneous lesions, with little or no effect on mucosal lesions of patients. Methotrexate did not prove efficacious even in a single patient with isolated mucosal involvement. The drug was safe and well tolerated in 91% cases. Conclusion Methotrexate proved efficacious and safe in our study for most of the patients. [ABSTRACT FROM AUTHOR]

Chronic urticaria (CU) is one of the most frustrating and challenging dermatosis for patients and physicians both. Apparently easy to diagnose, CU is still considered as a difficult to manage disease. Subtypes of CU include chronic idiopathic (spontaneous) urticaria, inducible urticaria, physical urticaria, autoimmune chronic urticaria and urticarial vasculitis. Physical urticaria may coexist with chronic idiopathic (spontaneous) urticaria. Evaluation of a patient with CU should involve consideration of various possible causes, although in most cases the cause is not identifiable. Investigation of CU should be guided by a thorough history and physical examination. [ABSTRACT FROM AUTHOR]

Objective To determine the common allergens in patients with chronic eczema by applying European Standard series. Methods This study was conducted at the Dermatology Department Unit II KEMU/Mayo Hospital, Lahore. Seventy five patients aged 12 years and above of either sex having chronic eczema were enrolled. Patients using oral corticosteroids and immunosuppressive drugs during the last 15 days, as well as, pregnant females were excluded from the study. Each patient was patch tested with allergens of European Standard series. Positive reactions were observed and recorded after 48, 72 and 120 hours, according to International Contact Dermatitis Research Group Criteria. Results There were a total of 75 patients, 37 females and 38 males. Their age ranged from 13 to 45 years. Mean duration of the disease was 2.25 years. Positive reactions were noted in 52% of patients. Most common allergens were potassium dichromate (24%), nickel sulfate (17.3%), cobalt (17.3%) and tixocortol (10.4%). Conclusion More than 50% of cases with chronic eczema reacted positively to various allergens so patch test must be applied to such patients to determine its cause. Metals were the mains allergens detected. [ABSTRACT FROM AUTHOR]

Neutral lipid storage disease is a rare autosomal recessive disorder characterized by non-bullous ichthyosiform erythroderma, liver steatosis, hepatosplenomegaly, cataracts, ataxia, bilateral sensorineural hearing loss, skeletal and cardiomyopathy, growth and mental retardation. We report a case of neutral lipid storage disease in a 14 months old child. [ABSTRACT FROM AUTHOR]

Objective To determine the frequency of allergic contact dermatitis in patients with hand eczema by patch testing with European standard and corticosteroid series. Patients and methods One hundred and five patients of either sex having hand eczema, aged 12 years or above were enrolled in the study from dermatology outdoor department. After taking informed consent, patch test was performed a fortnight after complete resolution of signs and symptoms of eczema and after complete withdrawal of the drugs. Patch testing was done with European standard and corticosteroid series. Readings were taken 48, 72 and 120 hours after patches removal. Patch test reactions were graded according to international contact dermatitis research group criteria. Data was analyzed according to age, sex and percentages of positive patch test results. Results Allergic reaction was recorded in 48.6% of patients with European standard series and 11.4% of patients with corticosteroid series. Common allergens detected with European standard series were potassium dichromate (21%), cobalt chloride (12%) and nickel sulphate (12%). Common allergens detected with corticosteroid series were tixocortol-21-pivalate (8.6%) and hydrocortisone-17-butyrate (4.76%). Conclusion Almost half (48.6%) of the patients showed allergic reaction with European standard series and 11.4% of the cases gave positive results with corticosteroid series. Patch test needs to be performed with corticosteroid and European standard series in patients with hand eczema not responding to therapy. [ABSTRACT FROM AUTHOR]

Objective To determine the efficacy and safety of simvastatin in chronic plaque psoriasis. Patients and methods Sixty patients of either sex, aged between 18 and 70 years were included in the study. Efficacy was determined by percentage reduction in psoriasis area and severity index (PASI) score from baseline. Safety of simvastatin was evaluated by measuring serum alanine aminotransferase (ALT), creatinine phosphokinase (CPK) and bilirubin at baseline, 4th, 8th and 12th week. The data were analyzed for variables like age, sex and percentage reduction in PASI score. Results There was >50% reduction in PASI score in 20% patients. Out of these, 8 patients had moderate plaque psoriasis and 4 patients had severe psoriasis. In remaining 80% cases simvastatin did not prove to be efficacious. The drug was safe and well-tolerated. Conclusion Simvastatin can be affective in patients with moderate disease as compared to cases with severe plaque psoriasis. The drug was safe and well-tolerated. [ABSTRACT FROM AUTHOR]

Background Lesions of chronic discoid lupus erythematosus (DLE) are characterized by sharply demarcated, scaly, infiltrated and later atrophic red discoid plaques. They have pathognomonic histological features, helping in confirmation of the diagnosis. Since the introduction of direct immunofluorescence, the lupus band test has become an important tool for the diagnosis of cutaneous lupus erythematosus. Objective To elaborate the specific histopathological features and direct immunofluorescence findings in the lesions of chronic discoid lupus erythematosus. Patients and methods Patients of any age and either sex presenting with clinically suggestive lesions of discoid lupus erythematosus, attending the outpatient dermatology department of Mayo Hospital were enrolled. The biopsy specimens of the lesional skin were bisected and subjected to histopathology and direct immunofluorescence. Results Out of 29 patients, the diagnostic histopathological features were found in 23 (79.9%) patients, in 5 (16%) the changes were suggestive. We could not reach to a diagnosis in one patient. Diagnostic lupus band was found in 20 (68.5%), while fluorescence at dermoepidermal junction was suggestive of lupus band in 3 (11%). No fluorescence was observed in 6 (20.5%). A combination of the two techniques gave better results 85%. Conclusion Direct immunofluorescence is a useful technique in the diagnosis of discoid lupus erythematosus; however, it should be used in conjunction with haematoxylin and eosin-stained sections. [ABSTRACT FROM AUTHOR]

Objective To determine the frequency of skin dermatosis in patients with primary psychiatric conditions. Methods This cross-sectional study was conducted in the Fountain House, Lahore, which is a tertiary care center for psychiatric patients having indoor and outdoor facility. All the admitted psychiatric patients (294) were enrolled in the study. They were thoroughly examined for any skin dermatosis. Out of 294, skin disorders were seen in 172 (58.5%) patients, 89 (60.6%) males and 58 (39.4%) females. The most common primary psychiatric conditions was schizophrenia 47.5% followed by patients of substance abuse 26.5%, bipolar disorder 13.1%, depression and psychosis each in 8.2%. 2.7% patients were manic. Of the study group, 16.3% patients had infective dermatoses and the rest had noninfective dermatoses. A high incidence of generalized xerosis and pruritus was seen in both males and females. Among noninfective dermatoses, 10.1% had eczema, 6.2% acne, 5% melasma, 4.1% palmoplantar keratoderma, 3.2% neurotic excoriations, 3.2% dermatitis artifacta, 2.7% trichotillomania, 2.1% miliaria, and 1.4% had ichthyosis. Conclusion A high incidence of fungal infections mainly tinea versicolor and onychomycosis was seen in the patients with primary psychiatric conditions. [ABSTRACT FROM AUTHOR]

The article describes a case of Hailey-Hailey disease in a 26-year-old female. The patient presented with a three-year history of recurrent scaly, exudative, erythematous, lesions on the sides of her neck, axillae, inframammary regions and groin. Treatment options for the disease include long-term antibiotics and/or antifungals.

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]