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Objective To correlate stress and self-esteem in undergraduate medical students with acne. Place and duration Multicenter cross-sectional study. Medical Students from Army Medical College, Rawalpindi, CMH Lahore Medical College, Rawalpindi Medical University, Sargodha Medical College and Karachi Institute of Medical Sciences were enrolled, for a duration of six months, from November 2021 to May 2022. Methods The study was conducted on 136 medical students fulfilling inclusion and exclusion criteria by non-probability, consecutive sampling technique. Self-esteem was analyzed by validated tool of Rosenberg Self-esteem scale (RSES), Acne disability was measured by Cardiff Acne Disability Index (CADI) and Stress levels were determined by Self Perceived stress scale (PSS-4). Data was analyzed by SPSS-25. Results Total of 136 medical students participated in the study. There were 80 (58.8%) females and 56 (41.2%) males. The mean age was 20.2±1.57 years. Fifty-Five students had mild, 36 moderate, 45 had severe acne. The mean Cardiff Acne Disability Index score was 5.76±2.593, range 0-12). Seventy-six students (55.07%) had a low, 50 (36.2%) had medium and 10 (7.24%) had high disability index to acne vulgaris. Mean Rosenberg self-esteem scale was 10.01±3.211 (range 0-27). Stress level secondary to acne was recorded as high in 32.1% of the medical students, moderate in 36.2% and low in 28.3%. Perceived stress scale (PSS)-4 in undergraduates had Mean PSS score of 7.3456 (±2.8854, Range 0-16). There was significant (p<0.007) association between Cardiff acne disability index and perceived stress scale among medical students. Cardiff acne disability index is significantly associated with self-esteem (p<0.001). Conclusion Rosenberg self -esteem scale and Cardiff Acne Disability Index demonstrated significant correlation between stress and acne and its impact on self -esteem levels. Health Care givers need to recognize impact of acne on self-esteem while devising management strategies and counseling sessions. [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]

Objective: To study the efficacy of topical Insulin with microneedling compared to microneedling alone in atrophic acne scars. Study Design: Prospective, split face, comparative study. Place and Duration of Study: Department of Dermatology, Combined Military Hospital, Gujranwala Pakistan, from Jan to Jul 2021. Methodology: Fifty patients with atrophic acne scars from the dermatology outpatient department were selected. The right half of the face was treated with microneedling with Dermapen, keeping the needle depth at 2 mm, along with 40 units of Insulin, while the left half was treated with microneedling alone. The sessions were repeated at monthly intervals for a total of 3 sessions. Goodman and Baron's quantitative scar scale was assessed at the beginning and then one month after the last (3 rd) session, and improvement was measured. Results: Pre-treatment Goodman and Barons quantitative score mean on the right half was 20.44±3.54 whereas on the left half was 20.62±3.23. Post-procedure Goodman and Baron's quantitative grading scale mean score on the right half was 9.78±2.88 while on the left half, 10.54±2.27. The improvement in mean global scores on the right and left halves was 10.66±2.11 and 10.08±1.88, respectively. The paired sample t-test showed a significant difference (p<0.001) in the scores of both the right and the left halves. Conclusion: Microneedling alone and combined with Insulin effectively treats atrophic acne scars. [ABSTRACT FROM AUTHOR]

Objective: To assess short and long term aesthetic and functional outcomes of nasal ala reconstruction by three staged folded forehead flap. Study Design: Prospective study. Place and Duration of Study: Plastic and Reconstructive Surgery Department of Combined Military Hospital Bahawalpur and Quetta, from Dec 2014 to Dec 2018. Methodology: Total of 29 patients were enrolled through consecutive sampling technique. Nasal ala defects were reconstructed by three staged frontal forehead flap under general anesthesia. Follow up visit at 2 weeks bleeding, wound Infection, partial skin graft loss and partial flap necrosis was documented. Follow up at 24 weeks, functional outcome of nasal reconstruction was assessed by history and clinical examination for nasal obstruction and/or crusting. Patients’ subjective satisfaction about aesthetic outcome of nasal reconstruction was documented on 5 point likert scale. Objective aesthetic assessment of reconstruction was done on 2D photograph by two independent surgeons. Results: Twenty six (89.66%) males and 3 (10.34%) females participated in study. The mean age was 35 years range 16 to 64 years. Follow up at two weeks revealed postoperative bleeding in 2 (6.8%), wound infection in 1 (3.4%) and partial flap loss in 1 (3.4%) patient. At 24 weeks follow up all patients had patent nasal ala. Subjective and objective assessment of nose shape was documented. Conclusion: Use of three staged folded forehead flapis useful method of reconstruction for full thickness defects of nasal alaewith good functional and aesthetic outcome. [ABSTRACT FROM AUTHOR]

Background: Patient suffering from psoriasis can be severely affected in their day to day activities and it may also result in reduced work efficiency and absenteeism from work leading to financial burden on the patient's family. This study was conducted using Dermatology Life Quality Index to assess the quality of life of a patient suffering from psoriasis being treated at a military hospital. Methods: This cross-sectional study was conducted in the outpatient unit of Department of Dermatology, Combined Military Hospital Abbottabad from 1st October 2013 to 31st June 2014. The demographic data and Dermatology Life Quality Index of patients of psoriasis were recorded using a standard questionnaire and their final score was calculated to assess the effect of disease on patient's life. Extent/ severity of disease were assessed according to the body surface area involved. The data was analysed using SPSS- 18. Mean and SD for numerical variables and frequencies and percentages for categorical were calculated. Results: A total of 160 patients fulfilling the inclusion criteria were included in the study. Mean age of the patients was 40.48 years (±12.58 years) with minimum age of 18 years and maximum of 74 years. 118 patients were males were (73.8%) and 42 were females (26.2%). Twenty (12.5%) patients had no effect on their life by the disease while 5 (3.1%) had extremely large effect. Most patients, i.e., 68 (42.5%) had moderate effect on their lives. 69 patients had mild psoriasis as per body surface area involved, 70 had moderate disease and 21 had severe disease. Conclusion: Psoriasis affects quality of life of patients not only physically but also psychologically and financially even when patients are under treatment. Psychological aspects also need to be addressed while treating the physical morbidity. [ABSTRACT FROM AUTHOR]

Objective: To compare the effect of endogenous and exogenous eczema on quality of life using Dermatology Life Quality Index. Study Design: Cross-sectional comparative study. Place and Duration of Study: Dermatology Department, Pak Emirates Military Hospital Rawalpindi, for a period of 6 months, from Jan to Jul 2017. Methodology: A predesigned DLQI questionnaire was distributed to 323 patients and data was collected by non-probability consecutive sampling. DLQI of endogenous and exogenous eczema was compared and data was analyzed by using SPSS version 22. Results: Out of 323 patients, 145 (44.9%) were males and 178 (51.5%) were females. The mean age was 32.35 ± 13 years. Endogenous eczema was present in 194 (60%) patients while 129 (40%) patients had exogenous eczema. The mean DLQI score of endogenous eczema was 12.25 ± 7.76 and that of exogenous eczema was 10.36 ± 6.08 with p-value of 0.021 which was less than 0.05 and therefore significant. Conclusion: Endogenous eczema had considerably more negative impact on quality of life as compared to exogenous eczema. [ABSTRACT FROM AUTHOR]

Background & Objective: Cutaneous leishmaniasis (CL) is endemic in developing countries like Pakistan. Pentavalent antimonials are still drug of choice, despite being toxic and intolerable for patients. Second line treatments have been extensively studied but the results of their efficacy are conflicting. This, to our knowledge, will be the first study in this regard. Our objective was to determine if combination of oral itraconazole with intralesional (IL) meglumine antimoniate (MA) reduces the duration of treatment for cutaneous leishmaniasis, as compared to intralesional MA alone. Methods: A randomized controlled trial (single blinded) was carried out from August 2017 till December 2017 on 69 patients who fulfilled inclusion criteria. They were assigned to Group-A or B by lottery method. Group-A patients received IL MA once a week while Group-B received oral itraconazole 200mg, once daily, for six weeks along with similar regimen of IL MA as Group-A. The patients were assessed every three weeks by the blinded assessor till clinical cure was achieved. A follow up visit, two months after clinical cure was done to look for relapse of the disease. Results: Thirty patients in Group-A and 35 patients in Group-B completed the study. At 3, 6, 9 and 12 weeks the patients were assessed for: no, partial or complete response and results of the two groups were compared for statistical significance. The p-values of 0.20, 0.57 and 0.11 at 3, 6 and 9 weeks, respectively, depict that there was no significant difference at any step of assessment between the two groups in terms of healing. The p values of each t test was>0.05 refuting the hypothesis. Conclusion: Combination of oral itraconazole with intralesional MA offered no benefit over intralesional MA alone in the management of cutaneous leishmaniasis in terms of duration of therapy. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

One and half years old baby boy admitted with history of high grade fever, dry cough and malaise for 05 days. He was given syrup Ibuprofen 100mg at home for fever resulting in swollen face, eye and rash on upper back next day. Erythematous rash progressed to involve nearly 30% of body surface area on 2nd day. Oral ulcers developed on 3rd day. Local practitioner instructed mother to keep him at rest and treat with hydration. Co-Amoxiclav syrup was added whereas Ibuprofen was continued. Diagnosis of Toxic epidermal necrolysis secondary to ibuprofen was established upon presentation to CMH Multan. [ABSTRACT FROM AUTHOR]

Objective To determine frequency of various causes associated with erythroderma. Methods This cross-sectional study was conducted in Dermatology Departments, JPMC and PNS Shifa Hospital. All the patients of erythroderma presenting fulfilling inclusion and exclusion criteria were enrolled. Complete history was taken and physical examination was done. Skin biopsy was performed and cause was established. Date were entered and analyzed in SPSS version 16. Results A total of 92 cases fulfilling the inclusion/exclusion criteria were enrolled. 66 (72%) were males whereas 26 (28%) were females. Mean age was 43.48±7.25 years. 50 (54.6%) patients were between 21-40 years and 42 (45.4%) were between 41-60 years of age. Regarding causes of erythroderma, psoriasis was the most frequent cause of erythroderma seen in 38 (41.3%) patients followed by dermatitis in 16 (17.4%), ichthyosis in 6 (6.5%) and scabies in 4 (4.3%) patients. Conclusion Psoriasis is the commonest disease associated with erythroderma followed by dermatitis and ichthyosis. Awareness of these frequent causes can help us to develop an efficient strategy for diagnosis and appropriate management of the disease. [ABSTRACT FROM AUTHOR]

Objective To compare the clinical efficacy of trichloroacetic acid (TCA) 100% and cryotherapy in xanthelasma palpebrarum (XP). Methods 40 patients fulfilling the inclusion criteria were treated with cryotherapy on right eye (group A) and TCA on left eye (group B). Patients were followed up for 6 weeks and final outcome variable of efficacy i.e. complete resolution of xanthelasma was assessed at 6 weeks. Adverse side effects of therapy were also recorded as secondary outcome variables. Data were analyzed by SPSS 19.0. Results Mean age of patients was 43.75 ± 5.90 years and age ranged from 34 to 56 years. Out of 40 patients 9 (22.5%) were male and 40 (77.5%) were female. Complete resolution of xanthelasma was seen in only 7 (17.5%) in group A, while complete resolution of lesions was seen in 30 (75%) of patients in group B (p = 0.000). Conclusion A single session of 100% TCA is highly effective than cryotherapy in the treatment of Xanthelasma palpebrarum. [ABSTRACT FROM AUTHOR]

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ABSTRACT Objective: To compare the effect of topical liquid Nitrogen and normal saline on pain during intradermal Plateletrich Plasma therapy in androgenic alopecia. Study Design: Prospective Comparative study. Place and Duration of Study: Tertiary Care Hospital, Gujranwala Pakistan, from Mar to Nov 2021. Methodology: Sixtyfour patients with the clinical diagnosis of androgenic alopecia were enrolled after informed consent. After liquid Nitrogen contact application, Group- A patients opted to receive intradermal Plateletrich Plasma on the scalp. In contrast, patients in Group-B opted to receive Plateletrich Plasma after normal Saline topical application for improved pain tolerance. Results: Out of Sixtyfour patients, there were 45(70.3%) males, 19(29.7%) females. Pain in intradermal Plateletrich Plasma injection of the scalp in Group-A had a median (IQR) score of 4 (3-5), while Group-B had a median (IQR) of 5(3-7.5). Patient satisfaction score at the end of three sessions of PRP in group-A had a median (IQR) of 1.5(1-2), and in Group-B, a median (IQR) of 2(1-2). Conclusion: Topical liquid Nitrogen application improved pain tolerance during intradermal Plateletrich Plasma therapy in androgenic alopecia compared to normal saline. Satisfaction of patients with Plateletrich Plasma therapy between the two groups had no significant difference. [ABSTRACT FROM AUTHOR]

Dermatitis herpetiformis is a rare autoimmune bullous disorder characterized by intensely pruritic polymorphic lesions over extensor surfaces of body, associated with gluten sensitive subclinical or clinical enteropathy. Dermatitis herpetiformis is often misdiagnosed and there is a paucity of guidelines for the management of dermatitis herpetiformis in literature. The present guidelines have been prepared for physician and dermatologists. It reflects highest evidence based data available at the time of formulating the guidelines. The diagnosis of dermatitis herpetiformis is made clinically, histologically, immunopathologically and supported by serology. A gluten free diet is the treatment of choice for all patients with dermatitis herpetiformis. Dapsone should be used during the acute presentation until the gluten free diet is effective. In conclusion, the present guidelines provide evidence based guidance for management of dermatitis herpetiformis. [ABSTRACT FROM AUTHOR]

Herpes zoster is a common disease of the dorsal root ganglia and sensory nerve fibers, clinically characterized by unilateral painful vesicular eruption of the skin in a dermatomal distribution. Segmental motor weakness is a rare complication that occurs in 0-5 percent of patients and is associated with an excellent prognosis for recovery. We herein, present a case of herpes zoster complicated by segmental motor paresis of abdominal musculature resulting in pseudohernia. This rare complication of herpes zoster, with an excellent prognosis for recovery, should be recognized by dermatologists and surgeons as it can save costly consultations and evaluations. [ABSTRACT FROM AUTHOR]

We report a case of Langerhan Cell Histiocytosis in a three and a half years old child. The child presented with history of low grade fever, off and on for 9 months. There was 2 months history of progressive pallor and 5 days history of epistaxis. Blood complete picture revealed pancytopenia and the patient was referred to a paediatric oncologist. Initial diagnosis of acute lymphoblastic leukaemia (ALL), Lymphoma and disseminated Tuberculosis (TB) was made on basis of initial investigations. Coetaneous involvement occurred 7 months later along with Diabetes Insipidis, bone changes and pulmonary involvement.