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Objective The aim of the study is to compare the efficacy of topical calcipotriol (0.005%) and topical anthralin (0.5%) in treatment of Chronic Plaque Psoriasis (CPP). Methods This randomized, interventional study was conducted at Pak Emirates Military Hospital, Rawalpindi and Combined Military Hospital, Rawalpindi for 6-month period (10th January 2020 to 10th July 2020). A sample of 186 patients was randomly distributed in two groups. In group A, patients applied topical anthralin (0.5%) every night for 12 weeks. In group B, patients applied topical calcipotriol (0.005%) every night for 12 weeks. The follow up period was 12 weeks and assessment of the efficacy was done at 4, 8 and 12 weeks by utilizing PASI score. Results The age range of the individuals was from 15 to 50 years. The average duration of presenting complaint for Group A was 8.903±1.85 months while for Group B was 9.193±2.58 months. In Group A, the average PASI score before and after the treatment was 16.22±3.02 and 4.784±3.28 respectively and in Group B the average PASI score before and after the treatment was 16.03±2.09 and 2.376±2.39 respectively. The number of male patients in each group was more than female. Efficacy i.e. reduction in PASI score by 75% was seen in 21.5% patients of Group A as compared to 43% in Group B (p=0.001). Conclusion In conclusion, 0.005% calcipotriol is considerably more efficacious than 0.5% anthraline in bringing disease improvement and patient satisfaction than 0.5% anthraline. [ABSTRACT FROM AUTHOR]

Objective: to assess the impact of androgenetic alopecia (AGA)/female patterned hair loss (FPHL) on the quality of life of Pakistani patients using Skindex-29 scale. Study Design: Cross-sectional study. Place and Duration of Study: Outpatient Department of Dermatology, Combined Military Hospital, Lahore Pakistan, from Oct 2020 to Mar 2021. Methodology: Three hundred patients (150 males and 150 females) having androgenetic alopecia (AGA)/female patterned hair loss (FPHL) were selected by consecutive sampling. Skindex-19 questionnaire was used to assess the impact of alopecia on their quality of life. Results: Mean age of study participants was 41.6 ± 12.4 years (range: 18-72 years). Maximum patients (40.7%) had grade-1 severity of alopecia. Most of the patients (37.3%) had disease duration of 1-5 years. Mean global score, symptoms scale score, emotion scale score and function scale score were 31.3 ± 14.8, 22 ± 22.56, 41.67 ± 28.1 and 30 ± 26.5 respectively. Gender and disease duration were statistically significant (p=0.001 and p=0.013 respectively). Conclusion: Skindex-29 can be successfully used in our setup for quality of life studies in AGA/FPHL patients. Females were more severely affected than males as per global scores on Skindex-29. [ABSTRACT FROM AUTHOR]

Objective: To assess patient and observer reported scar quality after Basal cell carcinoma surgery of face using the Patient and Observer Scar Assessment Scale (POSAS). Study Design: Quasi experimental study. Place and Duration of Study: Dermatology Department, Tertiary Care Hospitals at Multan and Karachi and Plastic Surgery Department, Tertiary Care Hospital Multan, from Apr to Sep 2020. Methodology: Patients with basal cell carcinoma that full filled inclusion and exclusion criteria were enrolled by consecutive sampling technique at Dermatology and Plastic Surgery Department after informed consent. Surgical excision was followed by reconstruction of defect either by direct closure or by rotation or advancement flap. Surgical scar was assessed independently at 8 weeks by POSAS. Data was analyzed with SPSS-23. Results: A total of 27 patients were enrolled in study. There were 11 (37.9%) males and 16 (59.25%) females between ages of 45-70 years. Basal cell carcinoma was located on cheek in 15 (55.5%), nose in 9 (33.3%), temple 2 (7.4%) and forehead 1 (3.7%) cases. Direct closure was performed in 6 (22.2%), rotation flaps in 10 (40.7%), and advancement flaps in 11 (40.7%) cases. Mean score of observer opinion about surgical scar between different surgical techniques was not statistically significant (p=0.191). However, mean score of patient opinion of scar between different surgical techniques was statistically significant (p=0.032). Conclusion: POSAS is a valid tool for scar evaluation by patient and observer-reported scar qualities after Basal cell carcinoma surgery. [ABSTRACT FROM AUTHOR]

Angiolymphoid hyperplasia with eosinophilia (ALHE) are benign, uncommon, reactive tumors manifesting mostly in Asian adults as isolated or grouped papules or nodules in the skin of the head and neck. Histologically these have proliferation of blood vessels with large endothelial cells and accompanying eosinophilic infiltrate presenting as intrinsic component of the lesion. These lesions are usually persistent causing cosmetic nuisance. Cryotherapy, surgical excision, pulsed-dye laser, carbon dioxide laser are different treatment modalities but all have their own failure rates. Here we report a case of ALHE in a 45 years old female presenting as a group of large painful nodules on left ear (pinna) for the past 20 years and progressively increasing in size and number. After histological confirmation of diagnosis, she was treated successfully by 908 vascular diode laser. Four treatment sessions were carried out at fortnightly interval with no side effects. 908nm vascular diode laser is a good treatment option for many vascular lesions. [ABSTRACT FROM AUTHOR]

Objective: To look for migraine headaches and associated factors in patients being managed for psoriasis at a tertiary healthcare setup in Rawalpindi, Pakistan. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Dermatology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Mar 2021 to Feb 2022. Methodology: One hundred and forty patients of psoriasis being managed at our Dermatology Unit were included in the analysis. All patients were screened with the Migraine Screen Questionnaire (MS-Q), and those having scores equal to or more than four were evaluated by medical specialists, and diagnosis of migraine was established based on the International Classification of Headache Disorders diagnostic criteria for migraine. An association of relevant risk factors was established with migraine among these patients. Results: Out of 140 patients with psoriasis, 75(53.4%) were male, while 65(46.6%) were female. Eighty-five (60.7%) patients had migraine confirmed by clinical criteria, while 55(39.3%) had no migraine. Statistical analysis revealed that more body surface area involvement and longer duration of psoriasis had a statistically significant relationship with migraine among the study participants (p-value <0.05). Conclusion: The study showed that patients with psoriasis had an approximately 3-fold increased risk of migraine headaches compared to the normal population. Most of the patients had migraine without aura. Patients with longer duration of psoriasis and those with more surface area of the body affected with psoriasis were at an increased risk of migraines compared to other patients. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of oral zinc sulfate (ZnSO4) with intramuscular meglumine antimoniate (MA) in the treatment of cutaneous leishmaniasis. Study Design: Randomized controlled trial. Place and Duration of Study: Dermatology Department, Military Hospital, Rawalpindi from 1st May 2013 to 1st Jan 2014. Material and Methods: Eighty patients of cutaneous leishmaniasis from dermatology OPD fulfilling the inclusion criteria were selected after informed consent and permission from Hospital Ethical Committee. Using simple randomization patients were assigned into two treatment groups. Group A received oral zinc sulfate in a dose of 10 mg/kg/day during 45-day period in three divided doses, and group B received systemic MA (glucantime) 20 mg/kg/day intramuscularly for 20 days. The size and induration of lesions was measured by ruler and palpation respectively. Patients were followed up till the end of treatment. Three patients were excluded from the study due to discontinuation of treatment. Acceptable cure indicated efficacy at the end of treatment duration. Results: In group A 14 (35.9%) patients had moderate improvement followed by total clearance in 12 (30.8%) patients. In group B, majority of the patients i.e. 26 (68.4%) patients had total clearance followed by moderate improvement in 9 (23.7%) patients. Group B had significantly better response as compared to group A. Efficacy of the drug was significantly higher in group B as compared to group A (p = 0.001). Conclusion: Oral zinc sulfate 10mg/kg is not better than intramuscular MA in treatment of cutaneous leishmaniasis but can be considered as a treatment option if MA cannot be used. [ABSTRACT FROM AUTHOR]

Objective: To find the level of awareness and practice of preventive strategies in patients of cutaneous leishmaniasis (CL), presenting to dermatology outpatient department (OPD) of Combined Military Hospital Peshawar. Study Design: Descriptive/observational. Place and Duration of Study: Dermatology department, Combined Military Hospital, Peshawar from Oct 2015 to Jan 2016. Material and Methods: One hundred patients of cutaneous leishmaniasis from dermatology OPD were selected after informed consent and permission from Hospital Ethical committee. They were given a comprehensive questionnaire comprising questions about socio-demographic factors, knowledge and practice of preventive strategies against cutaneous leishmaniasis. Results: All the affected patients were males. Mean age was 29.34 ± 7.69 years. All were serving persons. All the patients developed the disease while serving in FATA and surrounding areas. Mean disease duration was 3.79 ± 2.6 months. Questions regarding attitudes and practices revealed that 75% patients were sleeping on the floor, 43% acquired the disease while living in residences made from rocks and mud, 34% lived near forests, 63% were using mosquito nets, 75% were using mosquito repellant, 38% had regular insecticidal spray and 87% were using barrier clothing. Conclusion: There is a need for more health education to create awareness amongst our troops and it should also be stressed that the preventive measures must be ensured at unit and brigade level to minimize the incidence of the disease. For effective anti-sandfly measures, the referred document may be consulted. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of flipped classroom on dermatology residents' learning of procedural skills, and to identify their perceptions about it., Methods: The case-control study was conducted at Dermatology department of Pak Emirates Military and Combined Military Hospital Rawalpindi from 1/3/2018 to 2/7/2018, and comprised post-graduate dermatology residents training at Pak Emirates Military and Combined Military Hospital, Rawalpindi, Pakistan. The residents were randomised into two equal groups. A pre-test consisting of multiple-choice questions was taken. Group A was emailed the related teaching material 1 week prior to the session. The in the subsequent week, both groups attended a 3-hour hands-on training session. In the first hour, Group A had small group discussion, while Group B attended interactive lecture utilising the same teaching material that was posted to Group A earlier. Both groups then participated in hands-on session with the same facilitators. The process was repeated next week for another topic. Finally, a post-test comprising multiple-choice questions and objectively structured clinical exam at 16 stations was conducted. Group A answered the flipped classroom perception instrument and three open-ended questions. Quantitative data was analysed using SPSS 21, while manual thematic analysis was done for qualitative data., Results: Of the 40 subjects, there were 40(50%) in each of the two groups. There was a significant difference between median pre-test and post-test scores in both groups (p<0.001).. With respect to objectively structured clinical exam, the median score of Group A was significantly different from Group B (p=0.001)., Conclusions: Flipped classroom was found to be an effective teaching strategy for procedural skills in dermatology residents.