DR ABBAS IQBAL

[ Case # 11 ]
" Neuro🧠 Fibroma🪐tosis 👀
Definition : Inherited Autosomal dominant condition in which Skin/Cns/ and eyes related problems are obvious.

C/F : 1 ) Neurofibromas
2 ) Café Au Laut Macules (Calms)
3) Crowe's sign (freckling in axilary/pelvic areas)
4) Lisch Nodules
5 ) May or not associated with neurological manifestations like Tremors/seizers/ Balance problems/loss of consciousness/vision problems

Types :
1 ) NF1 (only skin manifestation) most common but can involve (Musculoskeletal system/bone deformity/scoliosis)
2) NF2 (skin + Neurological manifestation)
Other types are rare.

How to Diagnose?

Hx: Are parents first degree relatives?
Any other person in family having this problem now or in past

1) Dermatologist will examine Neurofibromas
2) Neurophysician will Examine CnS
3) opthamologist will examin Iris for Lisch nodules

Investigations :
Eye examination via slit lamp examination
Brain imaging

Dx : NF

Rx : Symptomatic Plus Cosmetic

Credits:
Special Thanks To
Dr Rahmat Ali (Dermatologist)
Dr Fawad Ali (Neurologist)

[ Case # 10 ]

Myth about Dermatology diseases is that the patient can't die from your treatment & also can't be cured completely bcz of its reccurance..
But i think patient suffer & can be cured if treated correctly.
It was Simple scabies 1 month ago(mistreated) now with
" Infected scabies "
Some one has given him Steroid❌ injection plus AntiAllergics & Betagenic❌

(For Scabies Visit case # 6 in this page)👍

[ Case # 9 ]
"MELASMA" 🦋
Also known as Chloasma/mask of pregnancy

Def: Acquired 'Brown' hyperpigmentation of skin (Face /neck) in genetically predisposed Females (90%) Association with estrogen
(10% males)

Areas involved: Forehead , upper lip & chin areas are usually involved

How To Diagnose it ?

1) In Hx Ask about inflammatory s/s
~ If No inflammatory s/s occured before or during pigmentation & the brown pigmentation occured slowly over long period
~ If she is pregnant
~ Prolong Sun Exposure
~ Rule out other causes

2) On Examination:
Symmetric (both sides) macular (not raised/many but small) eruption of brown hyperpigmented spots

Dx: " MELASMA "

Causes:
1) Pregnancy (2/3rd trimester)
2) Sunlight exposure in susciptable individual
3) Estrogen containing oral Contraceptive pills
4) Vitamin D deficiency
5) Using Beauty cream /parlos makeup
6) Alot more ------

Rx :

A) Rule out the cause (stop cocps/use sunscreen/ Pregnancy induced usually reverses without Rx/Vit supplementation)

B) Protocol ~ Topical/Oral/ Laser
1) MelasH/Biofade/Clarimax plus Cream (raat ko mutasira jagah pe 8 weeks)
2) Hydroquine 2% containing Cream (mix with upper one)
3) Sunblock (around 30Spf) Din ko rozana.
4) Vit D supplementation
4) Azelaic Acid (Fenacia gel safe in Pregnancy)

[ # 8 Case ]
About 60 % of derma diseases respond to Steroids therapy & the remaining worsen the Disease & it can be drastic.

I wanna share one case when It was simple Tinea & she took treatment from local Quacks who given her milk Type injection (Decadron) worsening the disease.
At first it could be fully cured in just 2 weeks simply with Antifungals(400Rs).. but now she will need oral Rx of around Rs 15000 and 1 around 1 month.

[ Case # 7 ]
"Hair Loss & Tinea"
25 year old female came with
C/c
- Diffuse Hair loss
- Severe Itching

On Examination:
✓ On lil pull the hair were loosely attached to skin
✓ Hairfollicles were visible.

Dx : Black Dot Tinea

Rx : 1 ) Broad Spectrum Antifunguls (Topical / Oral/ Shampoo)
2) Symptomatic Relief (Tab Lorin Nsa)
3 ) Hairgrowth will start again like normal but we give supplements like Hair serum etc after tinea is treated.
(Note : Antifungul resistance is increasing day by day due to misuse of broad spectrum antifungals so Doctors who are interested i'll send the protocol in Inbox.😃)

[ Case # 6 ]
✓ SCABIES (50% of patients in skin opd)

On Examination:
1) Lesions will be multiple and can involve any part of the body especially look for Inter digital region & pelvic region involvement. .

2) Lesion may be primary (white burrows having scratch mark or infected (red pustular type rash)

Questions to be asked to make Dx...
1) itching will increase at night
2) other family members will also be having same problem.

Dx : Scabies

Rx : 1) Permethrin lotion (Scabrid/scabion/salicare plus/ scabfree) on 0-7-14th night each time after taking bath, dry ur skin, apply at night & take bath next morning

2) Tab/syp Lorin Nsa/ Rigix (oD for 10 days)
3) if infected then add Fudic H Cream/mupir ointment on delicate parts (BD)
+ syp Ampiclox 250mg/5ml TDs for children/ cap Ampiclox 500mg TDS for adults for 5 days.

4) In resistant scabies(more than 2 attacks+ ask about if proper protocol was followed or not for scabies Rx) or in Norwegian scabies (Pustular/crusted and severe type)

Add
5) Ivermectine(tab ivermite 6mg)
{dose adjustment according to weight}

[ Case # 5 ]
Female from Madyan

Hx of prolonged cold exposure (Rain + wet socks)

On Examination : colour changes (peripheral cyanosis), Cold on touch, numbness

Pathophysiology : Extreme vasoconstriction leads to peripheral cyanosis leading to ischemia and death of tissue.

Dx: Frost bite ( stage 4)

Rx : Reversal of vasoconstriction to vasodilation.
✓ if tissue is viable then send on conservative managment like CCB's (Nifidipine) + Pain killers
(Soaking into warm water upto 40*C for 20 to 30 mins & see if colour changes reverses or not.)

✓ If not viable then send for surgical opinion to check for viability of tissue or amputation etc.

[ Case # 4 ]
The lesion first appeared as small red papule like insect bite then grew into this yellow crusted type plaque..

Traveling Hx to shangla/chitral/mansehra

Investigations : 1) Lesion material should be sent for microscopic slit examination (parasitological)
2) Leshmania antibodies/antigen detection tests.

Dx : Cutaneous Leshmaniasis

Rx : inj Glucantime ( cardiotoxic so use with caution ☢️ )

[ Case # 3 ]
Hx of fever & malaise & then
Multiple crops of rash in different stages + mucosal involvement...

Dx : Chicken pox/ Varicella

[Case # 2]
16 years old Boy
✓These lesion for last 1 year
✓Oily skin
✓Using Golden pearl cream
✓ Using Betnovate cream for them

Dx : Nodulocystic Acne plus potent steroid induced Dermatopathy