Comparing the Efficacy for Pulse Versus Continuous Dose Terbinafine Therapy in Patients With Onychomycosis.

Recently, treatment outcomes in patients with toenail onychomycosis have improved considerably due to more effective oral antifungal medications such as terbinafine and itraconazole. These medications can either be used continuously for several weeks at a lower dose or intermittently (pulsed) at a higher dose. Previous literature comparing pulse and continuous therapy has generated mixed results.  Our study aims to compare the efficacy, in terms of clinical cure rate, of continuous vs pulse dose terbinafine regimens for toenail onychomycosis. Sixty patients with onychomycosis of Fitzpatrick skin types IV to VI, between 15 and 65 years of age, were divided into a continuous treatment group receiving 250 mg terbinafine once daily for 12 weeks and a pulse treatment group receiving 250 mg twice daily terbinafine for 1 week repeated every 4 weeks for 12 weeks. Each patient was followed up at weeks 4, 8, and 12.  Efficacy of the continuous treatment group was significantly greater at 76.67% compared with 26.67% in the pulse treatment group. Thus, we conclude that the clinical cure rate of a continuous dose regimen of terbinafine is a superior treatment option for toenail onychomycosis. However, we also suggest further studies including combinations of multiple agents and hybrid regimen models for the optimal onychomycosis treatment.   J Drugs Dermatol. 2023;22(10):     doi:10.36849/JDD.7323R1.

Intradermal application of tranexamic acid (TA) as treatment of melasma in the out-patients department of a public sector hospital: A pilot study.

The effect of intradermal TA on melasma was evaluated as a possible treatment modality on all of the 11 patients (fitting the inclusion criteria) presenting in the out-patient department of the Benazir Bhutto Hospital, Rawalpindi during Sep 2019 to Mar 2020. Their pre- and post-interventional results were evaluated after being injected with 4 mg/ml of TA on the lesions once weekly for 6 weeks, using Wilcoxon signed rank test in SPSS v 24. The average duration of melasma in our patients was 25.3±7.6 in months. The mean modified MASI score rating was 12.2 (2.3) and 5.1 (1.4) before and after intervention with intradermal TA respectively. The largest difference obtained in the mMASI scores of the patients was 10.8. TA has a distinctive effect as a treatment modality for melasma, as it is easily employable with very few side effects.

COVID-19 in a Dermatologist's Clinic: A Case From Pakistan.

SARS-CoV-2 is a novel virus that is the causative agent of COVID-19. It can affect a variety of human organ systems, including the skin. Five clinical patterns of this infection have been described. These patterns not only help in diagnosing the disease but are also helpful in predicting the severity of infection. The percentage of dermatological manifestations of COVID-19 is highly variable in different regions of the world, with some western countries reporting the percentage as high as 20%. However, the data from Asia, especially Pakistan, in this regard is sparse. We report a case of COVID-19 infection (PCR proven) with maculopapular eruption. To our knowledge, this is the first case report of its kind being reported from Pakistan. We would encourage our fellow physicians to report more such cases so that the dermatological pattern of COVID-19 in Pakistan can be appropriately categorized in the literature.

Comparison Of Efficacy Of Permethrin 5% Cream With Crotamiton 10% Cream In Patients With Scabies.

BACKGROUND: Scabies is a common dermatological presentation in Pakistan. Permethrin and Crotamiton both are used widely for treating scabies. As there is no local study available regarding comparison of efficacy of Permethrin and Crotamiton in patients of scabies, current study was undertaken. The objective of the study was to compare the efficacy of 5% Permethrin with 10% Crotamiton in patients of scabies. METHODS: A Randomized control trial was conducted at Dermatology Department, Military Hospital, Rawalpindi. One hundred and sixty patients with scabies (diagnosis made by scraping the burrows to extract mite, larva or eggs and to see under light microscope) were randomly assigned either to Permethrin or Crotamiton group. Patients were followed over for 4 weeks to determine the effectiveness of either treatment. RESULTS: A total of 160 patients were included in the study with a mean age of 45.49±17.047 years and ranging from 13-65 years. One hundred and one patients (63.1%) were male and remaining 59 patients (26.9%) were female. Treatment was effective in 81.3% patients being treated with 5% Permethrin and 53.8% in 10% Crotamiton group. Comparison of treatment showed superiority of 5% Permethrin over 10% Crotamiton (p=0.001). There was no effect of age and gender on this outcome difference. CONCLUSIONS: Our study concludes that 5% Permethrin cream is significantly superior to 10% Crotamiton cream in treating patients of scabies (81.3% vs. 53.8%, p=0.001).

Comparison Of Efficacy Of Two Different Doses Of Famciclovir In The Prevention And Treatment Of Postherpetic Neuralgia.

BACKGROUND: Herpes Zoster is a common dermatological ailment. Various treatment modalities are in use for prevention of Post Herpetic Neuralgia (PHN) which is the most common complication of herpes zoster. Our study aimed to compare the efficacy of famciclovir 250 mg versus 500 mg in this regard. METHODS: The study was conducted at a tertiary care hospital recruiting subjects by using simple random sampling, group A patients received famciclovir 250 mg thrice daily for 1 week while group B patients were administered 500 mg. Follow ups were arranged at 2, 4 & 12 weeks. Efficacy was assessed by pain evaluation as per numeric rating scale and counting number of skin lesions. PHN was taken as persistent pain at 4 weeks follow up. All the statistical analysis was done using SPSS. RESULTS: A total of 30 patients were included in the study with each group (A & B) containing 15 patients each. Both dosing groups were statistically consistent with each other in reducing pain at 2, 4 and 12 weeks follow up. Skin lesions were not observed after 2 weeks in either group. The median of difference of pain scores at 2 weeks was similar as at 4 weeks. CONCLUSION: Famciclovir 250 mg thrice daily for one week is equally effective as 500 mg in treating active herpes zoster and prevention of PHN. However, long term follow-up is required for assessing the true incidence of PHN.

Assessment of metered dose inhaler technique in patients with chronic lung disease at government hospitals of Rawalpindi.

BACKGROUND: Metered dose inhalers (MDIs) are an affective modality of treatment for fast relief from asthma flare-ups and other symptoms, and are often used by asthmatic athletes. It has got lots of benefits and some drawbacks depending on usage technique. With proper technique and training drawbacks can be minimised. The objective of this study was to assess the metered dose inhaler technique in patients with chronic lung disease at government hospitals of Rawalpindi. METHODS: A cross-sectional study was conducted in three government hospitals of Rawalpindi. The inhalation technique was assessed in six steps. RESULTS: Clear evidence showed that only 24% patient could perform all the steps correctly. Percentages of people that followed individual steps properly were: preparation (87.5%), exhalation (53.85%), lip closure (68.27%), inhalation (56.73%), breath-holding (27.88%) and puff interval (36.54%). CONCLUSION: This study showed that a number of patients in government hospitals of Rawalpindi were unable to use metered-dose-inhaler properly and therefore indicates the need to make people aware of this technique either by counselling or arranging seminars.

Effect of gender on echocardiographic outcomes of patients presenting with mitral stenosis at a tertiary care hospital.

BACKGROUND: To assess the gender-based differences in the echocardiographic outcomes of patients with mitral stenosis presenting at a tertiary care hospital and the clinical implications of such differences. METHODS: A total of 90 echocardiographs of both men and women (aged < or = 15 years) having mitral valve area (MVA) less than 4 cm2 were assessed. In addition to MVA, pressure halftime and left atrial diameter (LAD) of the patients was also recorded. Other co-existing valvular lesions were also assessed in addition to mitral stenosis. Statistical analysis was done using SPSS-17. RESULTS: A higher prevalence of mitral stenosis (MS) was found in women than men (76.66% vs 24.44%). Men were having more severe mitral stenosis as compared to women (MVA = 1.19 cm2 vs 1.32 cm2). This also resulted in significantly higher left atrial dilatation in males as compared to women (45.09 vs 41.75, p = 0.0422). Most of the patients had other coexisting valvular lesions and isolated MS was rare. However, men had a predominance of aortic stenosis along with mitral stenosis (27% vs 4%, p = 0.0059) whereas women had a higher prevalence of mitral regurgitation along with mitral stenosis than the men (65% vs 36%, p = 0.0258). CONCLUSION: There were certain significant differences in echocardiographic outcomes of patients based upon their gender. A gender-specific management approach towards the patients with mitral stenosis is essential to have better outcome.