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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]

Background The location of infraorbital and supraorbital foramina is critically important for avoiding iatrogenic nerve damage during surgery or cosmetic procedures on the mid-face. This study aimed to conduct the morphometric analysis of infra orbital and supraorbital foramina in dry human skulls in Pakistani population. Objective To evaluate precise anatomical position of infraorbital foramina in reference to supraorbital foramina in adult human skulls. Methods Out of 40 skulls, 35 met the criteria of selection. Measurements were taken three times and mean was calculated to increase accuracy. Mean and standard deviations, median, range and mode were calculated and analyzed using SPSS ver. 27.0. Results The mean vertical and horizontal distances of IOF on right side were 43.2±2.5 (SD) mm and 3.7±2.7 (SD) mm respectively. The mean vertical and horizontal distances of IOF on left side were 43.2±2.7 (SD) mm and 3.46±1.8 (SD) mm respectively. Conclusion The study adds information to the literature concerning morphometric value of infraorbital foramen in view of racial variations. [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 determine the frequency and spectrum of cutaneous manifestations in patients with AIDS and their relationship to CD4 counts. Methods 300 HIV seropositive patients who visited the Dermatology outpatient department and HIV clinic of Services Hospital, Lahore over a period of 1year (June 2017-May 2018) were included in this cross sectional study. Out of 300 patients, 290 were on ART. Thorough cutaneous examination was performed after informed consent. CD4 counts (cells/mm3) of the patients noted from medical record. All the mucocutaneous conditions of the patients were noted and categorized as infectious, noninfectious dermatoses and drug reactions. Clinical and immunological staging method developed by World Health Organization (WHO) was used to classify patients into different stages. Data analysis was carried out using SPSS V.22. Results Among the 300 HIV-positive individuals, a gender ratio of 3:1 was observed with 228 (76.0%) men and 72 (24%) women. Patients' average age was 33.67±10.84 years. Heterosexual route of transmission was the commonest route 96 (32%), followed by blood transfusion 84 (28%), surgical procedure 72 (24%), intravenous drug abuse 44 (14.7%) and sharing of common needle or injection 20 (6.7%). The mean duration of HIV was 1.49±0.77 years. There were more dermatoses per subject as the CD4 count dropped. Immunological deterioration lead to increase in the number of patients having dermatoses; 8% patients with CD4 count of >500 compared to 77.3% patients with CD4 count of 200-350. Dermatophytosis was the most common infection, 60 patients with a mean CD4 count of 165.6±10.2 followed by candidiasis, 40 patients with CD4 count of 220 ±179.1. Xerosis was the most common non-infectious disorder. Conclusion Mucocutaneous manifestations develop during the course of HIV infection. Dermatophytosis and candidiasis exhibit a significant reciprocal relationship with CD4 cell count, and because of this they can be utilised as an indirect evidence of severe immunosuppression to initiate highly active anti-retroviral therapy in the absence of access to resources for CD4 cell count. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy of platelet rich plasma in patients of androgenic alopecia attending the dermatology department of a tertiary care hospital in Lahore. Methods This descriptive case series was conducted at the Department of Dermatology, Services Hospital, Lahore over six months. 77 patients of both genders, aged between 18-45 years who presented with androgenic alopecia were enrolled and treated with injection of platelet rich plasma. Outcome was assessed in terms of improvement in hair quality and thickness by patient selfassessment questionnaire on a linear analogue 2 scale of 5-26 scores. Treatment was labelled effective if the score was less than 12, four weeks after the completion of all 4 sessions. A written informed consent was taken from each patient. Data was entered and analyzed using SPSS version 21. Results The mean age of patients was 29.2±9.2 years. Majority (n=51, 66.2%) of the patients were aged under 30 years. There were 52 (67.5%) male and 25 (32.5%) female patients with a male to female ratio of 2.1:1. 31 (40.3%) patients had Grade-II while 38 (49.4%) patients had Grade-III alopecia. Only 8 (10.3%) patients had Grade-IV alopecia. Platelet-rich plasma treatment was effective in 65 (84.4%) patients as per operational definition. There was no statistically significant difference in the frequency of efficacy across various age (p-value=0.972) and gender (pvalue= 0.944) groups. However, it decreased insignificantly with increasing grade of alopecia; Grade-II vs. Grade-III vs. Grade-IV (87.1% vs. 84.2% vs. 75.0%; p-value=0.701). Conclusion Platelet-rich plasma therapy was found extremely effective in patients of mild to moderate androgenic alopecia which along with cost-effectiveness, simplicity and safety of procedure advocate its preferred use in future practice. [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]

Objective To determine the frequency of various adverse cutaneous drug reactions and drugs causing these reactions in patients presenting to a tertiary care hospital. Methods This cross-sectional survey was carried out at Dermatology Department of Services Hospital, Lahore for six months. Patients who fulfilled the inclusion criteria were enrolled. Adverse drug reactions were assessed for causality, using Naranjo Algorithm. Patients were evaluated clinically for the type of drug reaction. Patients were asked for drugs/medicine used before appearance of adverse cutaneous drug reactions. Data was stratified for age, gender and duration of symptoms to address the role of effect modifiers. Post-stratification, chi-square test was applied to compare types of adverse drug reaction and medicines involved. Results Among 150 patients, 71 (47.3%) were males and 79 (52.7%) were females. Age range in this study was from 10 to 70 years with mean age of 44.3±8.7 years. According to type of adverse drug reaction, 37 (24.7%) patients had maculopapular rash, 23 (15.3%) had urticarial drug reaction, 20 (13.3%) had acneiform eruption, 19 (12.7%) had fixed drug eruption, 13 (8.7%) had Erythroderma, 11 (7.3%) had DRESS, 9 (6.0%) had Stevens-Johnson syndrome, 8 (5.3%) had erythema multiforme, 7 (4.7%) had toxic epidermal necrolysis and 3 (2.0%) had drug-induced hyperpigmentation. Phenytoin and diclofenac were the commonest offending drugs. Conclusion Knowledge of pattern and causative drugs of adverse cutaneous drug reactions is of utmost importance for any clinician as their consequences can be life threatening as well. [ABSTRACT FROM AUTHOR]

Background Acne vulgaris is a frequently encountered skin disorder among patients of all ages. It is a source of significant psychosocial trauma and reduced self-esteem especially among females. Androgens, mainly testosterone, have a significant role in its pathogenesis. They mainly increase the sebum production that plays an important role in the formation of typical lesions of acne. Objective To assess the frequency of increased levels of testosterone among female patients of acne. Methods This cross-sectional survey was carried out at Department of Dermatology Services Hospital/Services Institute of Medical Sciences, Lahore from 1st June, 2018 till 30th November, 2018. 3 ml of blood sample was drawn from each patient on 2nd day of menstrual cycle. Serum testosterone analysis was done using chemiluminescence technology. The level of serum testosterone >120 ng/dl was taken as high. Results A total of 220 female patients of acne were enrolled. Mean age of the patients was 22.7±5.4 years. Mean duration of disease was 11.8±8.7 months, while mean BMI was 24.38±3.80 kg/m2. High serum testosterone level was observed in 22 patients (10%). Statistically significant effect of age, BMI, marital status and severity of acne was noted on elevated testosterone levels. Conclusion It was observed that high serum testosterone was significantly associated with acne. Therefore, assessment of testosterone levels and androgen based treatments may help in better management of women presenting with acne. [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]

Background: Acne is a very common skin disease in our setup. Azithromycin is a new treatment while Doxycycline has been routinely used for this disorder. Objective: To assess the effectiveness of azithromycin oral pulse versus doxycycline daily in treating acne vulgaris. Methods: A randomized control trail with 304 patients of moderate acne vulgaris were enrolled. The patients were divided into two groups: Group-A (n=152) received azithromycin, 500 mg daily for 3 days in 10 days' cycle with 7 days free of drug, for 3 months, while Group B (n=152) received doxycycline 100 mg daily for 3 months. They were followed at monthly intervals. Difference between numbers of lesions before and after treatment was calculated. Outcome was analysed as healing of acne lesions in terms of percentages as: Excellent (>80%), Good (51-80%), Poor (31-50%) and No response (<30%) at the end of 3 months. Results: In group-A, 35(23.0%) patients had excellent outcome, 37(24.3%) had good, 33(21.7%) had poor and 47(31%) had no response. In group-B, 74(48.7%) patients had excellent response, 42(27.6%) had good, 34(22.4%) had poor and 2(1.3%) had no response with a p-value 0.000001, which was statistically significant. Conclusion: Doxycycline is more effective oral treatment for acne vulgaris. [ABSTRACT FROM AUTHOR]

Objective To determine the pattern of various skin disorders in Paediatric patients of Faisalabad for improving health care planning and management. Methods Patients of both genders and ages up to 14 years, presenting to the Outpatient Department of Paediatric Dermatology Children hospital / Institute of Child Health, Faisalabad over a period of one year, were included in this cross-sectional study. Their detailed history and cutaneous examination were carried out. Skin biopsies and relevant investigations were performed, where indicated, for the confirmation of diagnoses. Results A total of 24,342 children presented to the Dermatology Department. Out of those, 11,245 (46%) patients were females and 13,097 (54%) were males. Mean age noted was 6.2 ± 5.3 years. Total number of dermatoses observed was 183. Out of them, 16 dermatoses were most commonly seen and involved 89.31% of patients. Papular urticaria was the commonest disorder seen in 26.21% cases, followed by Scabies (18.29%), Folliculitis (9.1%), Impetigo (7.56%) and Atopic eczema (6.07%). Rest of the dermatoses were divided into Miscellaneous (8.23%) and Rare dermatoses (2.52%). Conclusion Dermatological disorders of paediatric patients have been overlooked for long. Better management and timely prevention of these diseases can greatly reduce burden on health care system and population at large. [ABSTRACT FROM AUTHOR]

Objective To determine the causes of adermatoglyphia in patients presenting to Services Hospital, Lahore. Methods This cross-sectional survey was carried out in the Department of Dermatology, Services Hospital, Lahore. All patients were referred by National Database and Registration Authority (NADRA) through Medical Examination Department (MED) of Services Hospital for verification of adermatoglyphia. Detailed history, physical and cutaneous examination was done. Skin of fingers and inkpad prints taken on white paper were evaluated. Causes of adermatoglyphia were assessed and data was recorded. Results A total of 152 patients of adermatoglyphia were enrolled over a period of two years. Out of them, 96 (63.2%) were males while 56 (36.8%) were females. Mean age of the patients was 41.89 ± 23.72 years. Among our study population 20 (13.2%) patients had Isolated congenital (idiopathic) adermatoglyphia, 52 (34.2%) patients suffered from Congenital adermatoglyphia associated with a syndrome, while 80 (52.6%) patients presented with acquired causes of adermatoglyphia. Conclusion It is concluded that adermatoglyphia is a challenge to biometric identification and authentication and is much more common than anticipated. With advancing technologies, other standardized alternative biometric modalities should be made available where fingerprinting is not conclusive. [ABSTRACT FROM AUTHOR]

Background Pakistan has a high prevalence of hepatitis C virus (HCV) infection. There is a well known association between HCV infection and lichen planus (LP), which is an immune mediated mucocutaneous disorder. Objective To determine the frequency of different morphological variants of lichen planus in HCV seropositive patients in a tertiary care hospital. Materials and Methods In this cross-sectional study, a total of 200 patients of LP who were seropositive for HCV infection (detected by third generation ELISA) were enrolled after written informed consent. Cutaneous examination was done in all the patients and the morphological types of LP were ascertained. Results Out of 200 patients in the study, 101 (50.5%) were males and 99 (49.5%) were females. The mean age of the patients was 38.5 ± 13.7 years. Isolated variants were found in 89% (n=178) while mixed lesions (combination of 2 or more clinical types) were found in 11% (n=22) of patients. Among isolated variants, hypertrophic LP was the predominant clinical type (25%, n=50) followed by classic (21%, n=42), oral (17.5%, n=35), pigmented (11%, n=22), annular (5.5%, n=11), follicular (4.5%, n=9), atrophic (4%, n=8) and plaque-like (0.5%, n=1). Oral involvement was most common in hypertrophic LP and was absent in pigmented, annular, follicular, atrophic and plaque-like LP. Among the mixed variants, hypertrophic and classic was the most frequent combination (3.5%, n=7), followed by hypertrophic and pigmented (3%, n=6), classic and pigmented (1.5%, n=3), atrophic and follicular (1%, n=2), annular and follicular (0.5%, n=1), annular and atrophic (0.5%, n=1), annular and hypertrophic (0.5%, n=1) and classic and plaque-like (0.5%, n=1).. Conclusion There are various morphological types of lichen planus in association with HCV infection in our patients. Recognition of these types of LP should raise the vigilance for HCV workup. This would lead to early diagnosis of this miserable chronic infection and prevent its complications. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective To determine the diagnostic value of direct immunofluorescence (DIF) findings on Tzanck smear and plucked hair in patients of pemphigus vulgaris and to compare the diagnostic value of both the tests. Methods Thirty consecutive patients of pemphigus vulgaris confirmed histopathologically were enrolled in the study. Tzanck smear from the blisters/erosions was performed. Hair were plucked in a similar manner to that of trichogram. Approximately, 4 to 5 selected anagen hair were processed. Both the Tzanck smear and hair were stained with antihuman IgG, IgM, IgA and C3 fluorescein isothiocyanate (FITC) conjugate. DIF findings were recorded and compared. Results Out of 30 patients, there were 21 (70%) males and 9 (30%) females. DIF was positive on Tzanck smear in 23 (76.7%) patients. Intercellular deposition of IgG was seen in the outer root sheath of anagen hair in 27 out of 30 (90%) patients. Conclusion DIF on Tzanck smear and plucked hair is a simple, painless and non-invasive test in diagnosing pemphigus vulgaris. DIF on hair is more reliable as compared to DIF on Tzanck smear. [ABSTRACT FROM AUTHOR]

Chromoblastomycosis is a chronic cutaneous and subcutaneous infection of tropical and subtropical climates, caused by dematiaceous (black pigmented) fungi. Infection is thought to be secondary to trauma or autoinoculation. It rarely involves other organ systems of the body especially underlying bones. Many cases with similar and additional features have been reported. We describe one case of this infection in a 20-year-old female with skeletal changes along with review of literature. [ABSTRACT FROM AUTHOR]

Objective To determine the efficacy of narrowband ultraviolet B therapy (NBUVB) with needling in patients of vitiligo. Methods A total of 100 cases were included in this study. In each patient a patch of 15 to 5 cm diameter skin area was selected as a target lesion for the study. Needling was done on the whole patch with a disposable insulin syringe, from the pigmented margins or the islands in the vitiliginous patch. After the procedure, the whole patch was subjected to NBUVB. The repigmentation was assessed according to 5-grades scale. Results Out of 100 patients of vitiligo, 45% males and 55 % females, treated with NBUVB with needling, 58% patients showed grade 4 response i.e. 75% or more repigmentation. Conclusion Narrowband UVB with needling is an effective, useful and well-tolerated therapy for treatment of vitiligo. [ABSTRACT FROM AUTHOR]

Discontinuation of the normal skin cleansing in geriatric or self-neglected patients can result in accumulation of keratinous scales, crusts on the skin and its most severe form has been named as Diogenes syndrome. The usual affected sites are upper central chest, back and the groins. These patients may have psychiatric or mood disorders or temporofrontal dementia. Alcohol abuse is a co-factor. Subjects are mainly the elderly, but a few cases in younger age group of patients have also been recorded who showed lesions on the scalp, face or arms. We report a case of Diogenes syndrome in a 20-year-old girl who was suffering from familial neurodegenerative disease. [ABSTRACT FROM AUTHOR]