Dermatology Commons^™

Ispad Clinical Practice Consensus Guidelines 2022: Assessment And Management Of Hypoglycemia In Children And Adolescents With Diabetes, Mary B. Abraham, Beate Karges, Klemen Dovc, Diana Naranjo, Ana Maria Arbelaez, Joyce Mbogo, Ganesh Javelikar, Timothy W. Jones, Farid H. Mahmud

Paediatrics and Child Health, East Africa

No abstract provided.

Monkeypox Outbreak In The Age Of Covid-19: A New Global Health Emergency, Rahim Hirani, Dawood Rashid, Joshua Lewis, Rasheed Hosein-Woodley, Ali Issani

Department of Emergency Medicine

No abstract provided.

Reporting Of Mycetoma Cases From Skin And Soft Tissue Biopsies Over A Period Of Ten Years: A Single Center Report And Literature Review From Pakistan, Mohammad Zeeshan, Saira Fatima, Joveria Farooqi, Kauser Jabeen, Arsalan Ahmed, Afreen Haq, Muhammad Omer Arif, Afia Zafar

Department of Pathology and Laboratory Medicine

Background: Mycetoma is an important neglected tropical disease associated with debilitation, disfigurement and death if not diagnosed and treated adequately. In Pakistan, mycetoma cases have frequently been diagnosed in histopathology and microbiology laboratories. However, there is scarcity of published data from this country. Therefore, the objectives of this study were to evaluate the frequency and type of mycetoma reported in skin and soft tissue biopsies from a single center over 10 years and review of published literature from Pakistan.
Method: This descriptive observational retrospective study was conducted at the Aga Khan University Hospital laboratory, Karachi, Pakistan. Laboratory data from 2009-2018 …

Human Papillomavirus Associated Prevention: Knowledge, Attitudes, And Perceived Risks Among Men Who Have Sex With Men And Transgender Women In Pakistan: A Qualitative Study, Muslima Ejaz, Anna Mia Ekström, Alyan Ahmed, Aymen Haroon, Dania Ali, Tazeen Saeed Ali, Mariano Salazar

Community Health Sciences

Objectives: Men who have sex with men (MSM) and transgender individuals are at higher risk of genital warts and anal cancer due to sexually transmitted human papillomavirus infection. This study explores MSM and transgender women's perceptions of Human papillomavirus (HPV) infection and HPV prevention strategies (screening and vaccination) in Pakistan.
Design: A qualitative study using focus group discussions (FGD) with self-identified MSM, male sex workers and transgender women were conducted between March 2019 to August 2019 in Karachi, Pakistan.
Methods: Participants were recruited from community-based organization (CBO) working for MSM and transgender women. A total of 38 men and 10 …

Contact Dermatitis Due To Personal Protective Equipment Use And Hygiene Practices During The Covid-19 Pandemic: A Systematic Review Of Case Reports, Zouina Sarfraz, Azza Sarfraz, Muzna Sarfraz, Miguel Felix, Jonathan A. Bernstein, Luz Fonacier, Ivan Cherrez-Ojeda

Department of Paediatrics and Child Health

Background: Prolonged use of personal protective equipment (PPE) may lead to contact dermatitis during the coronavirus disease 19 (COVID-19) pandemic. This paper aims to identify the causative factors of contact dermatitis from PPE and hygiene practices.
Methods: The search was conducted adhering to PRISMA 2020 guidelines. A Delphi process was employed to ensure that the aims of this study were met. PubMed and Web of Science databases were systematically searched through September 12, 2021, using search terms: Contact dermatitis, case report, covid-19. The findings were tabulated as author/year, gender, age, presentation, cause, dermatological diagnosis, testing modality, provided treatment, symptom resolution …

Acute Generalized Exanthematous Pustulosis Induced By Cetuximab, Sadia Masood, Mohammad Rizwan, Saira Fatima, Palwasha Jalil

Department of Medicine

A wide variety of diseases and drugs can cause cutaneous pustular eruptions. Acute generalized exanthematous pustulosis (AGEP) is a unique drug-induced dermatosis clinically presented as erythematous papular and pustular eruption, usually caused by certain systemic drugs. We are presenting a very rare association of AGEP with a biological agent, cetuximab. A male aged 66 years, who was recently diagnosed with a case of squamous cell carcinoma of glottis, presented in the dermatology clinic with a recent onset of fever and widespread pustular eruption over the face, trunk, and limbs. The eruption was noted after the injection of cetuximab given for …

A Retrospective Observational Study: Is Absolute Lymphocyte Count A Prognostic Marker In Covid-19?, Mansoor Zafar, Muhammad Shahbaz, Mangala Karkhanis, Mohamed Abdelbagi, Opeyemi A. Makanjuola, Bipin Pun, Ratan S. Randhawa, Frederic Cuison, Dana Safarova, Najam-Us-Saher Rizvi

Section of Internal Medicine

Aim: Our study aimed to find a correlation between low absolute lymphocyte count and COVID-19-related mortality.
Methods: This study followed a retrospective observational cohort design to analyze the data of patients who presented with symptoms and signs of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), at the Conquest Hospital and Eastbourne District General Hospital in East Sussex, United Kingdom, between February 10, 2020 and May 1, 2020, retrospectively. Survival and mortality for the first 30 days and comorbidities were analyzed for all patients who were tested for COVID-19 irrespective of swab results and had blood lymphocyte levels taken at the …

Hypertrophic Gastric Folds With Hypomagnesemia, Linking The Dots, Mansoor Zafar, Tila Muhammad, Najam-Us-Saher Rizvi, Muhammad Toqeer

Section of Internal Medicine

A Caucasian man in early 80s was seen in Gastroenterology Clinic, following, referral from the Endocrinology Clinic for concerns for CT Abdomen requested for tiredness and weight loss of three kilograms. The patient also had microcytic picture with low MCV and Ferritin and hypomagnesemia. The CT suggested gross circumferential thickening of the wall of stomach with advice for invasive investigations to further characterise the CT findings. The Endoscopy suggested grossly enlarged rugae in the stomach, and enlarged gastric polyps. Patient was assured no new sinister abnormality. Treatment challenges to consider were to stop acid suppression by prescribing Proton Pump Inhibitors …

Morphological Spectrum Of Vesiculobullous Skin Lesions: An Institutional Perspective, Javaria Ali, Sabeeh Islam, Syed Munqaad Ali, Syed Rafay Yaqeen, Anum Aslam, Qurat Ul Ain Khan, Umair Arshad Malik, Muhammad Irfan, Hanna Naqvi, Atif A. Hashmi

Section of Internal Medicine

Introduction: A vesiculobullous lesion of the skin encompasses a group of dermatological disorders with protean clinicopathological features. They usually occur as a part of the spectrum of various infectious, inflammatory, drug-induced, genetic, and autoimmune disorders. Therefore, accurate diagnosis of these lesions is essential for appropriate management and to reduce the associated morbidity and mortality. The conventional skin punch biopsy is the mainstay in the diagnosis of dermatological diseases, especially when combined with confirmatory tests, such as direct immunofluorescence (DIF). Our study evaluated the clinicopathological spectrum of vesiculobullous lesions.
Methods: We studied 150 cases of vesiculobullous lesions at the Department of …

Impact Of Acne On Quality Of Life In Young Pakistani Adults And Its Relationship With Severity: A Multicenter Study, Shaheen Naveed, Sadia Masood, Atiya Rahman, Safia Awan, Saadia Tabassum

Department of Medicine

Objectives: The current study aimed to determine the effect of acne vulgaris on quality of life of young adults and to assess the correlation between acne severity and impairment of quality of life (QOLI).
Methods: In this multi-center cross-sectional study, 163 young adults with acne vulgaris were assessed for severity and quality of life impairment between December 2016 and May 2017 at three tertiary care hospitals. Cardiff Acne Disability Index (CADI) was used to assess the quality of life while the severity of acne measured by Global Acne Grading System (GAGS). Data were collected on standardized forms, with CADI, GAGS …

Prevalence Of Clinical Spectrum Of Cutaneous Adverse Drug Reactions In Patients Presenting At A Tertiary Care Hospital In Pakistan, Ayesha Hina 2nd, Sadia Masood, Sajjad Jamil, Saadia Tabassum, Palwasha Jalil, Unzela Ghulam

Section of Internal Medicine

Introduction: Cutaneous adverse drug reactions (CADRs) are the most common adverse drug reactions reported in the literature. CADRs have resulted in disabling infirmities during hospitalization and complications following outdoor drug therapy. The pattern of CADRs and the responsible drugs usually changes with the introduction of newer drugs and evolving clinical practices. Moreover, several international studies showed variable prevalence, emphasizing the need for local data in light of different socioeconomic and demographic practices. Therefore, the purpose of this study is to evaluate the prevalence of adverse cutaneous drug reactions and identify the clinical spectrum and any potential risk factors.
Methodology: The …

Bilateral Systematised Epidermolytic Epidermal Nevus: A Case Report, Sabeika R. Kerawala, Najam-Us-Saher Rizvi, Saadia Tabassum

Section of Internal Medicine

Verrucous epidermal nevi (VEN) are benign congenital hamartomas consisting of keratinocytes. Histological examination mostly exhibits hyperkeratosis, acanthosis, papillomatosis and, rarely, the features of epidermolytic hyperkeratosis (EHK). We report a case of a 6-year-old boy who presented at Aga Khan University Hospital, Karachi, Pakistan with bilaterally symmetrical linear epidermal nevi following Blaschko's lines and showing epidermolytic hyperkeratosis on histology. The patient was treated with topical keratolytics and emolients which led to considerable improvement. To the best of the authors' knowledge, this is the first report of VEN from Pakistan.

Erythema Annulare Centrifugum: A Rare Skin Manifestation Of Hashimoto Thyroiditis, Palwasha Jalil, Sadia Masood, Saira Fatima

Section of Internal Medicine

Erythema annulare centrifugum (EAC) is an unusual skin condition appearing as recurrent erythematous annular eruptions associated with autoimmune disorders, infections, and various neoplastic conditions. We present a very rarely reported association of EAC with Hashimoto thyroiditis (HT) in a young male. A 26-year-old male recently diagnosed as case of HT presented in the dermatology clinic with nine-month history of non-itchy persistent annular lesions on the body. The morphology and biopsy of lesions confirmed the diagnosis of EAC. HT is a part of the spectrum of autoimmune thyroid diseases with its own specific cutaneous manifestations. Our case also depicts the impact …

Covid-19 Pandemic & Skin Care Guidelines For Health Care Professionals, Sadia Masood, Saadia Tabassum, Shaheen Naveed, Palwasha Jalil

Section of Internal Medicine

The Novel corona virus is bringing multiple challenges for health care professionals. Skin is the biggest organ and the first line of defense against different infections and external factors. Being the front line warriors, health care professionals are susceptible to various skin conditions due to prolonged use of personal protective equipment. These adverse skin conditions are redness, irritation, itching, contact dermatitis, and aggravation of underlying skin conditions like seborrheic dermatitis and acne vulgaris. In the current global situation, the potential incidence of such adverse dermatological effects does not in any manner cause the HCPs to deviate from the strict specific …

Bullous Striae Distensae With Prolonged Steroid Use: An Unusual Clinical Presentation, Sadia Masood, Palwasha Jalil, Shaheen Naveed, Samra Kanwal

Section of Internal Medicine

No abstract provided.

Neonatal Purpura Fulminans, A Rare Genetic Disorder Due To Protein C Deficiency: A Case Report., Ghazala Irfan Kazi, Emaduddin Siddiqui, Saadia Tabassum, Badar Afzal, Irum Qamar Khan

Department of Emergency Medicine

Neonatal Purpura Fulminans is a rare and fatal disorder associated with perivascular haemorrhage and disseminated intravascular coagulation. Early clinical recognition, timely investigation and treatment is utmost important. A 6 days old baby boy was brought to emergency with blackish ulcers all over the body. Initially these were over the feet and scalp but later appeared on the abdomen. On examination, child was vitally stable, mildly icteric and had multiple erythematous large bullous blackish lesions on scalp, lower abdomen, perineum, back and soles. Neonatal reflexes and systemic examination was normal. Laboratory investigations showed normal CBC, PT/APTT and Protein S level while …

Systemic Sclerosis: Clinical Manifestations, Anesthetic And Orthopedic Considerations In A Patient, Obada Hasan, Muneeba Jessar, Muhammad Ashar, Shahryar Noordin, Tashfeen Ahmad

Section of Orthopaedic Surgery

Introduction: Systemic sclerosis is a rare and progressive multisystem autoimmune disorder that is characterized pathologically by vascular abnormalities, connective tissue sclerosis and atrophy of skin and various internal organs (e.g., alimentary tract, lungs, heart, kidney, CNS), and autoantibodies. With an unknown etiology, Scleroderma is a complex polygenetic disease. A recent Genome Wide Association Study (GWAS) confirmed a strong association with the Major Histocompatibility Complex (MHC) and autoimmunity. We provide a case scenario along with a review of the systems involved and challenges physicians can face in dealing with this rare disease.
Case Presentation: Our patient, a known case of systemic …

Slc11a1 Polymorphisms And Host Susceptibility To Cutaneous Leishmaniasis In Pakistan., Mariam Sophie,, Abdul L Hameed Institute Of Biomedical And Genetic Engineering (Ibge), 24-Mauve Area, G- 9/1, Islamabad, Pakistan., Akhtar Muneer, Azam J. Samdani, Saima Saleem, Abid Azhar

Department of Medicine

Background:The vector-borne cutaneous leishmaniasis (CL) is endemic in several regions of Pakistan mainly affecting poor populations. Host genetic factors, particularly SLC11A1 (solute carrier transmembrane protein) within macrophages, play a crucial role in disease pathology and susceptibility. Association of SLC11A1 with cutaneous leishmaniasis, a neglected tropical disease, is not well established. Inconsistencies have been observed within different populations worldwide with respect to genetic susceptibility. This study was designed to investigate genetic variation(s) in SLC11A1 and to assess possible association with cutaneous leishmaniasis in Pakistan.

Results: Eight polymorphisms (rs2276631, rs3731864, rs2290708, rs2695342, rs201565523, rs17215556, rs17235409, rs17235416) were genotyped across SLC11A1 in …

Re-Recurrent Dermatofibrosarcomaprotuberans Of The Chest Wall., Niaz Hussain, Mujtaba Zaki Naveed, Ghulam H

Section of Pulmonary & Critical Care

Dermatofibrosarcomaprotuberans is a rare, soft tissue tumour with high rate of recurrence. It is locally aggressive, with a low rate of metastasis. We describe the case of a 42 year old man who presented with a re-recurrent, large tumour situated on the anterior chest wall in the sternal region. We did a wide local excision and covered the resulting defect by using bilateral, pectoralis major myocutaneous flaps. Histopathology and immunohistochemical staining findings were consistent with the diagnosis of Dermatofibrosarcoma Protuberance. Post operatively the patient was treated with chemotherapy and radiotherapy.

Mediastinal Synovial Sarcoma., Niaz Hussain Soomro, Sanaullah Junejo, Aneeqa Ahsan Zafar, Shirin Siddiqi, Ghulam H

Department of Medicine

The mediastinum is an uncommon site of synovial sarcoma which is a rare soft tissue malignancy. An 18 year old boy was admitted for right sided chest pain since one year. Based on the CT scan chest findings, tru-cut biopsy of the mass was performed and histopathology initially reported as neurofibroma. The tumor was excised via posterolateral thoracotomy and excisional biopsy established the diagnosis of primary synovial sarcoma arising from the mediastinum. Patient was started on adjuvant chemotherapy at the oncologist tumor board’s recommendation and he received 6 cycles of adriamycin and ifosfamide. At last follow up he is free …

Frequency And Clinical Variants Of Specific Dermatoses In Third Trimester Of Pregnancy: A Study From A Tertiary Care Centre, Sadra Masood, Dilawar Abbas Rizvi, Saadia Tabassum, Shaheen Akhtar, Rehan Uddin Alvi

Section of Internal Medicine

OBJECTIVE: To determine the frequency of patients with dermatoses in the third trimester of pregnancy and to identify various clinical types of dermatoses in the third trimester.

METHODS: The study was carried out at the Department of Dermatology and the Department of Gynaecology & Obstetrics, PNS Shifa Hospital, Karachi, from January 2 to July 1, 2008. Two hundred pregnant women in their third trimester were included in the study. The diagnosis was based on history, clinical examination and relevant investigations. Patients with physiological dermatoses and dermatoses which flare up during pregnancy were excluded. A comprehensive pro-forma was used to evaluate …

Detection Of Filaggrin Gene Mutation (2282del4) In Pakistani Ichthyosis Vulgaris Families., Naghma Naz, Azam J. Samdani

Department of Medicine

The aim of this study was to detect an 811 bp filaggrin (FLG) gene fragment known to carry a mutation 2282del4 which causes ichthyosis vulgaris. Seven clinically examined ichthyosis vulgaris families were included in this study. An 811 bp FLG gene fragment was targeted in the genomic DNA of all the members of the seven families by PCR amplification using known primers RPT1P7 and RPT2P1. Successful amplification of an 811 bp FLG gene fragment in all the families suggested the possible role of the 2282del4 mutation in causing ichthyosis vulgaris in Pakistani population.

Homozygous Frame Shift Mutation In Ecm1 Gene In Two Siblings With Lipoid Proteinosis., Azam J. Samdani, Abid Azhar, Syed M. Shahid, Syeda N. . Nawab, Rozeena Shaikh, Shah A. Qader, Qaisar Mansoor, Bahram K. Khoso, Muhammad Ismail

Department of Medicine

Background: The extracellular matrix protein 1 (ECM1) is a glycoprotein, expressed in skin and other tissues. Loss-of-function mutation in ECM1 causes a rare autosomal recessive disorder called lipoid proteinosis. Lipoid proteinosis is presented by varying degrees of skin scars, beaded papules along the eyelid margins, variable signs of hoarseness of voice and respiratory disorders. More than 250 cases of this disorder have been described in the literature, but occurrence of lipoid proteinosis in siblings is very rare. This study was designed to investigate the possible mutation causing lipoid proteinosis in a Pakistani family and to elaborate the scope of possible …

Molecular Studies Of Ichthyosis Vulgaris In Pakistani Families., Azam J. Samdani, Naghma Naz, Nuzhat Ahmed

Department of Medicine

Objective: To target and amplify a 1.5 kb FLG gene fragment known to carry R501X mutation responsible for causing ichthyosis vulgaris.

Study Design: A case series.

Place and Duration of Study: Centre for Molecular Genetics, University of Karachi and Dermatology Department, Jinnah Postgraduate Medical Centre (JPMC), Karachi, from October 2007 to December 2008.

Methodology: Clinically examined seven ichthyosis vulgaris families were included in this study. The 1.5 kb FLG gene fragment was located in the genomic DNA of both the affected (patients) and unaffected (normal, controls) members of the families by PCR amplification using known primers FilF3 and RPTIP6.

Results: …

Angiokeratoma Of Tongue:A Series Of 14 Cases, Nausheen Yaqoob, Aamir Ahsan, Zubair Ahmed, Akhter Husain, Rashid Ahmed, Naila Kayani, Shahid Pervez, Sheema Hassan

Department of Pathology and Laboratory Medicine

Angiokeratomas (AC) are vascular lesions which are defined histologically as one or more dilated blood vessels lying directly subepidermal and showing an epidermal proliferative reaction with ectatic capillaries in the papillary dermis. Only three other cases of isolated mucosal angiokeratoma have been reported in the indexed literature. We reviewed all cases of angiokeratoma located on the tongue, diagnosed in our department during a study period of 10 years (1995-2005). Histologically all 14 cases showed dilated and congested blood vessels in the upper papillary dermis. They lack deep dermal involvement. Hyperkeratosis and acanthosis were also seen in most of the cases. …

Dermatophyte Growth And Degradation Of Human Stratum Corneum In Vitro (Pathogenesis Of Dermatophytosis)., Azam J. Samdani

Department of Medicine

Background: This study was carried out to determine growth of dermatophytes using human stratum corneum in vitro and the degrading effect of Keratinases (Proteinases) on stratum corneum for a complete understanding of the host parasite relationship.

Method: Trichophyton rubrum isolates derived from patients with tinea cruris infections were obtained from the Department of Medical Microbiology, University Hospital of Wales, U.K. Human stratum corneum sterilized with ethylene oxide was used as a nitrogen source in agar culture medium plates.

Result: Fungal growth took place in plates which contained human stratum corneum particles while there was no growth in the plates without …

Menke's Kinky Hair Syndrome--A Rare Medical Condition., Yaseer Al-Bita, Azam J. Samdani, Tania Azam

Department of Medicine

The case of a 16-month-old boy is described who had typical clinical and radiological features and was proven biochemically to be a case of Menke's disease. Clinical manifestations began in the first few months with hypothermia, hypotonia, seizures and death occurring at the age of 18 months.

Cutaneous Manifestations Of Hyper-Ige Syndrome In Twins: A Case Report From Saudi Arabia., Azam J. Samdani, A. Tania

Department of Medicine

The hyper-IgE syndrome with recurrent infections is a rare immunodeficiency disorder characterized by very high levels of IgE in serum. It is inherited in most of the cases in a dominant fashion meaning that it can run in families with a high frequency. About 250 cases have been published in literature so far.

Pregnancy Dermatoses: A Three-Year Study, Azam J. Samdani

Department of Medicine

Objective: To determine the percentage occurrence, clinical features and the age distribution of pregnancy-related dermatoses in pregnant females who were referred from Maternity Hospital Makkah to dermatology department for management at King Abdul Aziz Hospital, Makkah, Saudi-Arabia.

Methods: Patients who attended the dermatology clinic at King Abdul Aziz Hospital, Makkah were examined clinically and appropriate laboratory evaluation was done to facilitate diagnosis. These cases were managed till the termination of pregnancy and 10 weeks follow up in the puerperium. This study lasted for a period of 03 calendar years.

Results: A total of 47 females were seen, with polymorphic …

The Effect Of Proteinases (Keratinases) In The Pathogenesis Of Dermatophyte Infection Using Scanning Electron Microscope, Azam J. Samdani, Yaseer Al-Bitar

Department of Medicine

Objective: To study the inter-relationship between the stratum corneum of host and the fungal microorganisms using scanning electron microscopy for a complete understanding of the host parasite relationship.

Setting: The patients attended the outpatients of Department of Dermatology, King Abdul Aziz Hospital Makkah. The isolation & identification was carried out at the Department of Mycology University Hospital of Wales, Cardiff, U.K.

Material and Methods: Skin surface biopsies were obtained from two patients suffering from tinea cruris infection. One patient was infected with Trichophyton rubrum and the other with Epidermophyton floccosum strains.

Results: The scanning electron microphotographs obtained from two patients …