Intralesional Bleomycin Versus Cryotherapy For Treatment Of Cutaneous Warts: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effectiveness of intralesional bleomycin in comparison to cryotherapy in the treatment of cutaneous warts. Methods: The randomized controlled trial was conducted at the Department of Dermatology, Jinnah Postgraduate Medical Centre, Karachi, from January to July 2021, and comprised patients of either gender aged 18-60 years who had cutaneous warts for 1-48 weeks. The subjects were divided into group A treated with 0.1% intralesional bleomycin, and group B were treated with cryotherapy through non probability consecutive sampling. Follow-up examination was done at the 2, 4 and 6 weeks. Data was analysed using SPSS 23. RESULTS: Of the 154 patients, 96(62.3%) were male and 58(37.7%) were females. The overall mean age was 33.253±6.726 years. There were 77(50%) patients in each of the two groups. The therapy after 6 weeks was found to be effective 73(94.8%). group A patients and 57(74%) group B patients (p=0.001). CONCLUSIONS: Intralesional bleomycin was found to be more successful than cryotherapy in the treatment of cutaneous warts.

Treatment of Scalp Psoriasis.

Scalp involvement is seen in a majority of individuals with psoriasis, a chronic autoimmune skin disease with variable phenotypes. Occasionally, isolated scalp involvement is observed; and this causes significant psychosocial morbidity. Management of scalp psoriasis is difficult, in part due to the difficulty of applying topical agents and its refractory nature. Various treatment options are available with variable efficacy. Topical agents include topical steroids, keratolytics, tar and anthralin compounds, vitamin D analogues, and vitamin A derivatives. The combination treatment of topical betamethasone and calcipotriene is the most effective topical therapy. Systemic agents include conventional agents such as methotrexate, cyclosporine, and oral retinoids. Biologics offer a greater efficacy, with near complete or complete clearance of the scalp. In this article we review the published literature on adult and scalp psoriasis to highlight its treatment. Articles published in peer-reviewed journals were included for qualitative analysis of the literature, including reviews, clinical trials, case series, case reports published in the electronic database (MEDLINE/PubMed) through June 2021, cross references of respective articles, and trials from clinicaltrials.gov. J Drugs Dermatol. 2022;21(8):833-837. doi:10.36849/JDD.6498.

Lepra reactions in new leprosy cases at diagnosis: A study of 50 Pakistani patients.

OBJECTIVE: To determine the occurrence and characteristics of the two types of lepra reactions in new leprosy cases at initial diagnosis. METHODS: The retrospective descriptive study was conducted at the Marie Adelaide Leprosy Centre, Karachi, and comprised all new leprosy cases registered from January 1, 2016, to June 30, 2018. Data was collected from the medical record database using a predesigned proforma. RESULTS: Of the 50 cases, 2(4%) were children and 48 (96%) were adults, with overall age ranging from 12 to 85 years. There were 41(82%) males and 9(18%) females.. Of the total, 30(60%) cases presented with type 1 reaction and 20(40%) with type 2. Further, 30(60%) cases were classified as borderline lepromatous. Among them, 17(57%) had type 2 reaction. Inflamed plaques were the main feature in 27(90%) cases of type 1. Crops of painful, erythematous nodules were seen in 19(95%) cases of type 2. CONCLUSION: Lepra reactions were found to be a presenting feature in a significant number of new leprosy cases at initial diagnosis.

Mucocutaneous manifestations of Chikungunya fever, an experience of tertiary care hospital.

OBJECTIVE: To determine the frequencies of mucocutaneous manifestations of chikungunya fever, and to determine the association of positive serology with manifestations. METHODS: The observational cross-sectional study was conducted at the Department of Dermatology, Jinnah Postgraduate Medical Centre, Karachi, from May 15, 2018, to January 15, 2019, and comprised patients who presented with early and late manifestations of chikungunya fever. Different cutaneous manifestations were confirmed by a consultant dermatologist. Data was analysed using SPSS 23. RESULTS: Of the 67 patients, 46(68.7%) were females and 21(31.3%) were males. The overall mean age was 30.24±7.89 years. Hyperpigmentation was the most frequent finding 31(46%), followed by maculopapular rashes and oral ulcers in 17(25%) each, and diffuse hair fall in 14(20%). There was no significant association between clinically suspected cases and serology-positive patients. CONCLUSIONS: Chikungunya fever presented with unusual mucocutaneous findings, some of which remained present months or even years after the onset of chikungunya fever.

Comparison of efficacy of Tranexamic Acid Mesotherapy versus 0.9% normal Saline for Melasma; A split face study in a Tertiary Care Hospital of Karachi.

OBJECTIVES: To compare the efficacy of tranexamic acid mesotherapy versus 0.9% normal saline for melasma by split-face study. METHODS: It was a non-randomized clinical trial performed at the Dermatology ward of JPMC from September 2018 to June 2019 after getting approval from the Ethical Committee. A total of sixty patients were recruited in the study, who had symmetrical melasma on their faces. Both halves of the face were treated by Injection Tranexamic Acid (TA) with a dose of 4mg/ml and Normal Saline (NS) two weekly for twelve weeks. Hemi Modified Melasma Area and Severity Scoring (H-mMASI) was calculated at the start and end of the study. Analyses were done by SPSS version 23. P < 0.05 was taken as significant. RESULTS: Mean of H-mMASI score was compared on both sides at the end of study, which showed significant reduction in mean score from 3.19 ±2.57 to 1.52 ± 1.2 (P < 0.05) on A side as compared to decline in scores on NS side from 3.46 ± 2.7 to 3.45 ± 2.6 (P > 0.05). Erythema, swelling, and burning were documented as temporary side effects on both sides. CONCLUSION: Tranexamic Acid (TA) mesotherapy can be considered as the most cost-effective, safe and directly observed therapy for melasma which showed significant improvement when old prior therapies have failed.

Safety and efficacy of miltefosine in cutaneous leishmaniasis: An open label, non-comparative study from Balochistan.

BACKGROUND & OBJECTIVE: Cutaneous Leishmaniasis (CL) is endemic in Baluchistan and treated traditionally with Meglumine antimoniate. Miltefosine appears appealing therapy in cutaneous Leishmaniasis. Our objective was to evaluate safety and efficacy of Miltifossine in treatment of cutaneous Leishmaniasis. METHODS: This experimental study was conducted from 10 September 2017 to 10 May 2018 at Combined Military Hospital Quetta. Total of 42 patients were recruited by purposive sampling technique. Lesional skin smears were stained with giemsa for Leishmania amastigotes under magnification (100 x).Complete blood count, serum urea, creatinine, bilirubin, aspartate aminotransferases (AST), alanine aminotransferase (ALT) were done at the beginning of treatment and then weekly, thereafter. Cap Miltefosine 50 mg (2.5mg/kg) were given as directly observed therapy .Daily observation during treatment phase was done for clinical side effects of therapy. Clinical response was documented at two weeks then at eight weeks. Photographs were taken before and after the therapy. Data was analyzed by SPSS 16. RESULTS: Complete clinical response was observed in 39 (92.9%) patients and partial clinical response in 1(2.4%) patient. Two patients were lost to follow up at eight weeks. No significant derangements in laboratory profile were noted before and after treatment. Mean duration of treatment was 23.47+SD 4.44 days. Sixteen patients (38.1%) took Miltefosine for 28 days, 12 (28.6%) for 21 days and 9 (25%) for 25 days. CONCLUSION: Miltefosine is safe and cost effective treatment for cutaneous Leishmaniasis. It is effective in CL cases not susceptible to antimony compounds.

The Role of 5% Minoxidil versus Platelet-Rich Plasma in Treatment of Alopecia Areata.

OBJECTIVE: To compare the efficacy of topical minoxidil and platelet-rich plasma (PRP) in the treatment of alopecia areata (AA). STUDY DESIGN: Randomised control trial. Place and Duration of the Study: Department of Dermatology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from December 2021 to June 2022. METHODOLOGY: The study included all the patients who visited JPMC Karachi during the study period. Permission from the ERB was obtained. The inclusion criteria were any gender and age 10 to 45 years. Topical minoxidil 5% solution was applied twice daily to Group A (six pubs/time), while PRP injections were administered to Group B at baseline and every four weeks for three months. Serial photos and the severity of alopecia tool (SALT) were used to determine the clinical assessment. When comparing the effectiveness between the two groups, a p-value of <0.05 was considered significant. SPSS version 23 was used to analyse the data. RESULTS: Mean age was 23.11 ± 8.9 years in 376 patients. PRP and Minoxidil groups had mean SALT scores at three months that were 1.48 and 1.54, respectively. Both treatments were shown to be efficacious. There was no statistically significant difference in efficacy between the minoxidil solution and PRP (p = 0.483). CONCLUSION: There is no apparent difference between PRP and topical minoxidil 5% solution in the management of AA. To verify the results, additional studies are needed with a larger sample size and a longer duration of follow-up. KEY WORDS: Minoxidil, Platelet-rich plasma, Alopecia areata, Severity of alopecia tool score.

Acne Vulgaris and Its Association with Dietary Habits at a Tertiary Care Hospital in Karachi, Pakistan.

Background: Acne is a common skin disorder among younger age group. Dietary pattern are the key determinants among acne patients. The objective of this study is to determine the association of acne vulgaris with dietary habits among patients at tertiary care hospital in Karachi, Pakistan. Methods: it is a cross sectional study and participants were selected through simple random sampling from outpatient department of tertiary care hospital in Karachi, Pakistan. Patients presenting with acne irrespective of severity and treatment were included in the study. Bivariate analyses conducted at 95% CI and p=<0.05 considered statistically significant. Results: Females gender (62%) and family history (61%) was significantly associated with acne. Face region was most (92%) affected by acne. GI upset most common co-morbid illness with Acne (p=0.006). After adjustment of covariate, those consume oily food [Daily oily food; Twice a weekly oily food)]; sugar rich food [Daily consumed sugar; Twice a weekly consumed] and less glass of water [8-10 glass per day; 6-8 glass per day; less than 6 glass per] were significantly associated with acne. Conclusion: Study found that un-healthy diet is significantly associated with acne. Common dietary predictors for acne were frequent use of oily food, sugary food, and less amount of drink water.

Quality of Life Index in Patients with Vitiligo.

OBJECTIVE: To ascertain the quality of life (QoL) impairment among the Pakistani population with vitiligo and to determine the relationship between sociodemographic and clinical characteristics. STUDY DESIGN: Cross-sectional study. Place and Duration of the Study: Dermatology Outpatients at the Aga Khan University in collaboration with outpatients of seven tertiary care hospitals of Sindh, Punjab, KPK, Balochistan, and AJK to collect data from March 2015 to April 2019. METHODOLOGY: All clinically diagnosed patients of vitiligo, who signed consent and assent forms, were included in the study. A validated 25-item, QoL scale for vitiligo was used. Socio-economic status of the patients, clinical assessment of the disease and patients' engagement in social and domestic lives was noted. RESULTS: Five hundred and seventy-three patients were enrolled in the study, having mean age 29.8 ± 16.2 years. In 306 (53.4%) males and 267 (46.65%) females; 21.8% were below 18 years. Mean vitiligo QoL index was 38.4 ± 11.8. Patients of vitiligo with disease duration 5-10 years, those affected on exposed parts, more than five body sites, rapidly progressing disease and of female gender had a higher impairment of quality of life. These scores were found significantly higher as compared to other levels of these parameters (p<0.05). CONCLUSION: Patients with vitiligo experience low self-esteem. The disease adversely affects their quality of life. The authors recommend the use of disease-specific instruments to assess the quality of life which enables the treating physician to devise best possible management plan individually. KEY WORDS: Vitiligo, Quality of life, Pakistan, Vitiligo life quality index.

Cutaneous manifestations of Coronavirus Disease 2019.

BACKGROUND: COVID-19 has been linked to a variety of dermatological conditions. OBJECTIVE: To determine the presence of various cutaneous manifestations in patients with COVID-19, also to define their features in relation to the systemic symptoms. METHODS: This research enrolled a total of 1206 lab-confirmed COVID-19 individuals at a tertiary-care hospital in Karachi, Pakistan. Expert dermatologists assessed patients for COVID-related skin conditions. COVID-19 severity was categorized as asymptomatic/mild, moderate, or severe. RESULTS: Of the 102 (85.7%) patients with only one cutaneous sign, 26.5% developed maculopapular/morbiliform/erythematous rash; 14.7% urticaria; 9.85% vesicular/pustular exanthem; 14.7% vascular pattern; 12.7% infections, 7.8% miscellaneous and 9.8% late cutaneous findings A longer-lasting vascular pattern was related with an older age and a fatal COVID-19 outcomes (P: 0.000) compared with mild/moderate disease. Most of the retiform purpura presented exclusively with thromboembolic episodes. The moderate severity was correlated with maculopapular/morbiliform/exanthematous phenotype (P: 0.009), whereas urticaria was attributed to asymptomatic/mild disease (0.001) compared with moderate/severe infection. LIMITATIONS: Single-Center and observational study. CONCLUSION: Vascular lesions were correlated with disastrous COVID-19 outcomes, whereas retiform purpura was linked to adverse outcomes. The maculopapular/morbiliform/erythematous rash was associated with moderate severity, while the urticarial rash was linked to milder course compared with moderate/severe severity infection.

Association of androgenetic alopecia and severity of coronavirus disease 2019.

OBJECTIVE: To establish the association of androgenetic alopecia (AGA) and the severity of coronavirus disease 2019 (COVID-19). DESIGN: Observational study. METHODOLOGY: A total of 300 hospitalized patients of COVID-19 were included. Scoring of AGA was done, and severity of COVID-19 was measured as better and worse hospital outcomes. Correlation between severity of AGA and severity of COVID-19 was noted. RESULTS: Out of 300 patients, 220 (73.33%) were male and 80 (26.67%) were female. In males, mild-to-moderate Hamilton-Norwood scale (HNS<3) and severe alopecia (HNS3-7) were noted among 43(20%) and 177(80.55%) patients, respectively. In females, 43(54%) had no AGA while 37(46%) had AGA. In 37 females with AGA, mild-to-moderate (Ludwig scale <2) and severe alopecia (Ludwig scale 2-3) were seen in 9(24.32%) and 28(75.68%) patients, respectively. We report a significant increase in frequency (95%) and severity of AGA and worse outcomes in males (p-value 0.000, chi-square: 18.90) compared with females (46%) (p-value 0.273, chi-square: 7.544), with notable adverse COVID-19 disease outcomes in the younger age group of men and also in few women of younger age group suffering from AGA without any comorbidities. CONCLUSION: Our study shows a significant increase in frequency and severity of AGA and worse outcomes in men compared with women. There was a significant association between AGA severity and hospital disease outcome in men compared with women. Younger age group patients with severe AGA particularly men also faced adverse outcomes while having no known comorbidities, supporting the hypothesis that anti-androgen drugs might be valuable in patients of COVID-19.

Gestational Pemphigoid Presenting in the Second Trimester of Pregnancy: A Rare Finding.

Gestational pemphigoid (GP) is a rare autoimmune blistering disorder, occurring in 1 in 60,000 pregnancies. It occurs in the second or third trimester of pregnancy and is characterized by autoantibodies against hemidesmosomal proteins. A variety of dermatological conditions are associated with pregnancy; among these skin diseases, gestational pemphigoid is very rare. The purpose of this report is to highlight the specific findings of this rare disease to enable clinicians to take prompt intervention in treating this condition. A 23-year-old multigravida, with no known comorbidities, presented to us at 18 weeks of gestation with complaints of intensely pruritic tense blisters all over the body, sparing the scalp, palms, and soles. The diagnosis was confirmed by skin biopsy for histopathology, after which the patient was started on prednisolone, which was then gradually tapered to an appropriate maintenance dose and then discontinued as the patient did not report any new lesions after delivery. Gestational pemphigoid can recur in subsequent pregnancies with more severe lesions. However, this was the first time the patient presented with this condition in her third pregnancy. Proper management of this disease requires close monitoring and appropriate drug therapy to reduce maternal and neonatal morbidity.

Efficacy of Low Dose Naltrexone in Psoriasis.

OBJECTIVE: To determine the efficacy of low dose naltrexone in the patients of psoriasis. STUDY DESIGN: Non-randomised clinical trial. PLACE AND DURATION OF STUDY: Department of Dermatology, Jinnah Postgraduate Medical Centre, Karachi from January to July 2019. METHODOLOGY: All patients of mild, moderate, and severe psoriasis with age above 13 years without any comorbids were included in this study. Patients were started on tablet naltrexone 6mg daily after assessing PASI, BSA and DLQI scores and were called every month for follow-up. After three months of treatment, these scores were assessed again. SPSS 23 was used to analyse the data. RESULTS: Out of 71 patients, 37 (52%) were males and 34 (48%) were females with age ranging from 13 to 60 years with mean age of 37.85 ±12.211 years. The mean duration of disease was 5.27 ±3.084 years. Before treatment 1 (1.4%), 20 (28.2%), 24 (33.8%), 26 (36.6%) patients had mild, moderate, severe and very severe psoriasis according to PASI score. After treatment, 14 (19.7 %), 23 (32.4%), 23 (32.4%), 11 (15.5%) patients had mild, moderate, severe and very severe psoriasis. The mean PASI, BSA and DLQI were 18.47 ±8.157, 11.97 ±3.873 and 22.63 ±5.235 before treatment, respectively. The mean PASI, BSA and DLQI were 13.51 ±8.017, 8.07 ±3.650 and 16.31 ±7.056 after treatment, respectively. CONCLUSION: Low dose naltrexone is an effective therapy for psoriasis as in other chronic dermatological diseases. It is a cost-effective therapy with few tolerable side-effects. It requires further studies for long-term response. Key Words: Naltrexone, Psoriasis, PASI, DLQI, BSA.

Efficacy of Saline Injection Therapy for Atrophic Acne Scars.

OBJECTIVE: To determine the efficacy of saline injection in post-acne atrophic scars on face. STUDY DESIGN: Non-randomized clinical trial. PLACE AND DURATION OF STUDY: Department of Dermatology, Jinnah Postgraduate Medical Centre, Karachi, from January to July 2019. METHODOLOGY: All patients with mild, moderate and severe post-acne atrophic scars, above the age of 15 years without any co-morbid conditions were included in the study. Intra-dermal isotonic saline solution was administered under local anesthesia, into the scars weekly for 12 weeks. The results were assessed subjectively and objectively by photographs, Sharquie scoring system and Dermatology Life Quality Index (DLQI) at baseline and at the end of treatment. SPSS 23 was used for analyzing data. RESULTS: Out of 49 patients, 41 (83.7%) were females and 8 (16.3%) were males. The mean age was 24.69 ±4.35 years. According to Sharquie scoring system of grading scars at baseline, 3 (6.1%), 34 (69.4%) and 12 (24.5%) patients had mild, moderate and severe scarring respectively while at the end of treatment, 35 (71.4%), 12 (24.5%) and 2 (4.1%) patients had mild, moderate and severe scarring respectively (p=0.001). Regarding degree of satisfaction of patients, 6 (12.2%), 27 (55.1%), 12 (24.5%) and 4(8.2%) patients were mildly, moderately, greatly and completely satisfied respectively. The mean DLQI was 12.14 ±3.29 and 5.86 ±2.26 at baseline and at the end of treatment respectively (p=0.001). CONCLUSION: The response of saline injection was significant in all types of post-acne atrophic scars as assessed with Sharquie score and DLQI, but more significant in mild and moderate scars, without any significant side effects. Key Words: Acne, scars, saline solution.

A Young Boy with Persistent Nodules and Hoarseness: A Rare Presentation of Nodular Secondary Syphilis.

Syphilis is a venereal disease caused by treponema pallidum, historically known as "great mimicker" because of its variable presentations. Secondary syphilis usually presents with maculopapular or papulosquamous rash. Rare manifestations include papulonodular, annular and lichenoid lesions. Nodules are usually found in benign tertiary syphilis. We present a case of a young boy who presented with five months' history of nodular skin lesions and hoarseness of voice. Venereal disease research laboratory (VDRL) was initially negative owing to prozone phenomenon. However, histopathology was confirmatory and he responded to benzathine penicillin. We present this case because of rare clinical presentation with persistent nodular lesions, unusual age group, and negative initial VDRL test.

Vitamin D Deficiency in Alopecia Areata.

OBJECTIVE: To compare the mean Vitamin D level in patients with alopecia areata (AA) with age and gender controlled matched healthy controls. STUDY DESIGN: Case-control study. PLACE AND DURATION OF STUDY: Dermatology OPD, JPMC, from October 2014 to March 2015. METHODOLOGY: All the patients diagnosed of alopecia areata by a trained dermatologist were selected. Controls were age and gender matched healthy volunteers. Venous blood was drawn and sent to hospital laboratory for 25 (OH) vitamin D by enzyme immunoassay method on chemical analyser. Data was recorded on SPSS version 16. Mann-Whitney test was applied to compare vitamin D levels of cases and controls. P-value <0.05 was taken as significant. RESULTS: There are 30 cases of AA, and 30 age and gender matched controls. The mean age of our study group was 23.77 ±8.86 ng/dL in patients and 24.03 ±8.62 ng/dL in the control group. Fifteen (50%) patients presented between 3-12 months of onset of AA. Median (IQR) vitamin D level of cases was 13.5 (18.6) ng/dL and healthy controls was 22.5 (16.25) (p=0.001). CONCLUSION: Serum Vitamin D levels were significantly lower in patients with alopecia areata compared to healthy controls.

Intralesional Triamcinolone Acetonide Versus Topical Betamethasone Valearate in the Management of Localized Alopecia Areata.

OBJECTIVE: To compare the efficacy of intralesional triamcinolone and topical betamethasone in the management of localized alopecia areata. STUDY DESIGN: A randomized trial. PLACE AND DURATION OF STUDY: Dermatology OPD, PNS Shifa Hospital, Karachi, from January to June 2013. METHODOLOGY: Patients aged 18 - 50 years with localized alopecia areata were included in the study. Exclusion criteria were more than three patches and those on already steroid or immunosuppressive therapy. Patients were randomly allocated in two treatment groups: Group A received intralesional triamcinolone acetonide (10 mg/ml) and Group B received topical betamethasone valearate cream 0.1% twice daily. Final outcome was ascertained as re-growth of hair on 12th week of follow-up and labelled as efficacy. The data was entered and analyzed using SPSS version 11. Relevant descriptive statistics were calculated. Chi-square test was used to compare efficacy of hair re-growth in both groups. P-value < 0.05 was considered significant. RESULTS: A total of 226 patients were enrolled, 113 in each group. The mean age was 34.36 ± 8.7 years. One hundred and sixty-four (72.6%) were males and 62 (27.4%) were females with male to female ratio of 2.6:1. Hair re-growth was seen in 84 (74.3%) of the intralesional steroid group and in 53 (46.9%) of the topical betamethasone group (p < 0.001), which was a significant difference. CONCLUSION: Intralesional triamcinolone had a better efficacy in the treatment of localized alopecia areata as compared to topical betamethasone valearate.

Dyslipidemia and Psoriasis: A Case Control Study.

OBJECTIVE: To compare the mean values of lipid profile in psoriatic patients and healthy controls. STUDY DESIGN: Case control study. PLACE AND DURATION OF STUDY: Department of Dermatology, PNS Shifa, Karachi, from November 2012 to April 2013. METHODOLOGY: Patients with psoriasis fulfilling the inclusion and exclusion criteria were selected from Dermatology Outpatient Department (OPD) of PNS Shifa, Karachi. After fasting for 14 hours, 5 ml of venous blood was drawn in sterile syringe and submitted to the Hospital Laboratory for lipid profile, by enzymatic method on Hitachi (Roshe(®)) using reagents by the same firm. The mean values lipid profile in psoriatic patients versus healthy controls were recorded and compared. RESULTS: Atotal of 256 patients (128 in each group) were enrolled. Mean lipid profile in both groups revealed cholesterol (mg/dl) value of 203.43 ±1 1.43 in cases and 173.64 ± 13.65 in controls. Triglyceride (mg/dl) was 178.87 ± 43.60 and in cases 144.23 ± 34.01 in controls, HDL-C (mg/dl) was 37.81 ± 10.78 in cases and 41.41 ± 9.72 in controls while LDL-C (mg/dl) was 139.52 ± 13.71 in cases and 109.44 ± 13.80 in controls. Each parameters had p-value < 0.05 which was significant. CONCLUSION: Dyslipidemia was found in a high percentage of psoriatic patients than healthy controls. Psoriatic patients require thorough lipid and cardiovascular examinations as they should be considered as individuals with increased risk of cardiovascular diseases.

Kindler's syndrome: a report of five cases in a family.

Kindler's Syndrome (KS) is a rare genodermatosis with autosomal recessive mode of inheritance. The disease results from homozygous mutations on both alleles of the FERMT-1 gene (also known as KIND-1 gene) that encodes the protein Kindlin-1 (kindlerin). Clinical features include a constellation of early infantile skin blistering and mild photosensitivity, which improves with age, and progressive poikiloderma with widespread cutaneous atrophy. The differential diagnosis of Kindler syndrome include other congenital poikilodermatous and photosensitive conditions including Bloom syndrome, Cockayne syndrome, dyskeratosis congenita, epidermolysis bullosa, Rothmund-Thomson syndrome and xeroderma pigmentosum. We herein, report the presence of the Kindler's syndrome in 5 out of 7 children of consanguineous parents. To authors' knowledge, this is the first report of Kindler's syndrome involving 5 members of a family.