Journal of Pakistan Association of Dermatologists

Correlation Between Changes in Psoriasis Severity Score and Quality of Life Before and After Treatment in Psoriasis Vulgaris Patients

2025-04-18T08:58:49+00:00

Background: Psoriasis not only causes physical comorbidities but also leads to psychological problems in patients. The severity of the disease is believed to be related to the patient's quality of life. However, research on the relationship between PASI and DLQI often shows inconsistent results. Evaluation of changes in PASI and DLQI scores is expected to provide an overview of the relationship between changes in disease severity and improvements in the patient's quality of life after therapy.

Objective: To evaluate the relationship between changes in PASI and DLQI score in patients with psoriasis vulgaris at Department of Dermatology and Venereology, Dr. Soetomo General Hospital, Surabaya, Indonesia.

Methods: This was a retrospective study with a cross-sectional approach. This research included a total of 50 newly diagnosed psoriasis vulgaris patients who met the inclusion criteria and received treatment from January 2021 to July 2023.

Results: A significant correlation was found between PASI and DLQI scores prior to treatment (p=0.001; r=0.483). A marked improvement was observed in both PASI and DLQI scores after treatment (p=0.001; p=0.001 respectively). However, no significant correlation was observed between PASI and DLQI scores after treatment (p=0.209), nor was there a significant correlation between changes in disease severity (ΔPASI) and QoL (ΔDLQI) following therapy (p=0.120).

Conclusion: Improvements in disease severity for psoriasis vulgaris do not consistently translate into better quality of life for patients. Therefore, regular QoL evaluations and psychological support are essential for all patients, regardless of the degree of severity and the changes of PASI score.

Comparison of Fractional CO2 Laser Versus Combined Platelet Rich Plasma and Fractional CO2 Laser in Treatment of Post Acne Scars

2024-12-30T11:08:55+00:00

Background: Acne scars are a common disfiguring sequela of acne, significantly impacting patients' psychosocial well-being. A comprehensive approach tailored to individual needs is essential to treat this complex condition. Fractional carbon dioxide laser induces controlled injury to the skin promoting scar remodeling. PRP is rich in growth factors and cytokines that accelerate wound healing. Combining the two modalities may yield synergistic benefits.

Objective: To compare the results of fractional CO2 laser treatment versus a combination of platelet-rich plasma and fractional CO2 laser treatment for post-acne scars.

Methods: This randomized control trial was conducted at Department of Dermatology, Mayo Hospital, Lahore from 16^th August 2021 to 15^th February 2022. A total of 178 patients were enrolled and divided into 2 groups, group-A and group-B. Group-A was treated with fractional CO2 laser alone while group-B patients were treated using fractional CO2 laser followed by intradermal platelet rich plasma (PRP) injection. The outcome of patients was compared in terms of Goodman and Baron's acne scar grading scale at baseline and 3 months follow up. Data was analyzed statistically and was expressed as mean ± SD or frequency (%).

Results: The mean 3 months post-treatment Goodman and Baron's score of group B (2.15 ± 0.66) was significantly reduced than that of group A (2.43 ± 0.65) with p-value= 0.04.

Conclusion: Our study demonstrated that fractional CO2 laser treatment combined with PRP showed more favorable results in treatment of post-acne scars at 3 months compared to fractional CO2 alone.

Proportion of Atopic Dermatitis in the Dermatology Venereology and Aesthetics Polyclinic at Prof. Dr. Chairuddin Panusunan Lubis Universitas Sumatera Utara Hospital 2017–2022

2025-02-15T21:45:44+00:00

Background: Atopic dermatitis (AD) is a chronic, recurrent inflammatory skin disease that commonly affects both children and adults. It is characterized by intense pruritus, xerosis, and eczematous lesions, significantly impairing quality of life. Globally, the prevalence of AD has increased over the past few decades, making it a significant public health concern, especially in developing countries.

Objective: This study aimed to determine the occurrence and demographic characteristics of atopic dermatitis patients treated at the Dermatology, Venereology, and Aesthetics Polyclinic, Prof. Dr. Chairuddin Panusunan Lubis Universitas Sumatera Utara Hospital, from 2017 to 2022.

Methods: A retrospective descriptive study was conducted using secondary data obtained from medical records of patients diagnosed with AD between 2017 and 2022. Data collected included age, sex, and annual case distribution.

Results: A total of 136 patients were diagnosed with atopic dermatitis during the study period. The annual distribution showed: 10 patients in 2017, 7 in 2018, 21 in 2019, 59 in 2020, 2 in 2021, and 37 in 2022. Pediatric cases (<18 years) accounted for 112 individuals (82.3%), consisting of 64 males and 48 females. Adult cases (≥18 years) included 24 individuals, with 13 males and 11 females. Overall, male patients predominated with 77 cases (56.6%). The highest number of AD cases occurred in 2020, totaling 59 patients (43.4% of all cases). The overall proportion of AD among patients attending the Dermatology, Venereology, and Aesthetics Polyclinic during this period was 1.27%.

Conclusion: Atopic dermatitis remains a prevalent condition in pediatric populations, with a higher incidence in males. A peak in cases was observed in 2020, potentially influenced by environmental or behavioral factors during the COVID-19 pandemic. Further research is needed to identify specific contributing factors and improve prevention strategies.

Is the Addition of Oral Biotin to PRP More Beneficial for Treating Male Pattern Hair Loss Compared to PRP Alone? A Randomized Control Trial

2025-01-15T23:24:29+00:00

Background: Androgenetic Alopecia (AGA) is a common and progressive condition of patterned hair loss from the scalp and affects both genders with a genetic background. The onset and speed of progression varies among patients. Multiple treatment modalities are in use for the treatment of AA namely minoxidil, finasteride, etc.; however, they are associated with some unacceptable side effects. The efficacy of oral supplements is controversial in AGA. Little data is available on the role of Biotin supplementation in AGA so this trial aimed to fill this research gap.

Objective: To determine the effectiveness of oral Biotin in combination with PRP vs PRP alone in treating Androgenetic Alopecia.

Methods: This is Randomized controlled trial (Trial registration number#TCTR20250506001). One hundred and Eighty patients were enrolled in the study. Group A consisting of 90 patients received four sessions of PRP,1 month apart while Group B was treated with a similar protocol of PRP in combination with oral Biotin 2500mcg once daily for 6 months. Patients were called for monthly follow and final assessments done after 6 months using the Dermatology Quality of Life Index (DLQI) and Digital photography.

Results: The mean age in Groups A and B was 27.74±5.55&29.72±5.40 years respectively. The number of patients was comparable in both groups based on the Norwood Hamilton grading system. The family history was positive in 51.2 % of patients in Group A and 49.5% of patients in Group B. After 6 months of using DLQI and digital photography, compared to baseline, Patients in both groups gained significant hair regrowth but there was no intergroup difference (p value>0.05).

Conclusions: It is concluded that the combination of Biotin supplements with PRP gives no additional benefits in AGA patients.

Burn Hemangioma: Oral Propranolol is an Effective New Saving Therapy

2025-01-29T09:52:47+00:00

Background: Burn hemangioma is new described variant of hemangioma that is commonly presented in winter time, that triggered by burning heat. It has many similarities to infantile hemangioma regarding the clinical course, histopathological picture. Its therapy is surgical resection.

Objective: To report new therapy for burn hemangioma by oral propranolol in large number of patients.

Methods: This is cross-sectional descriptive study with therapeutic trial where 14 cases of burn hemangioma were reported. Full demographic and clinical evaluation was performed. All patients were treated with oral propranolol in a dose of 1 mg/kg/day in 2 divided doses. In 3 (21.42%) cases of children, there was no improvement in 2 weeks after treatment, so the dose was increased to 2 mg/kg/day.

Results: A total of 14 cases were analyzed ,8(57.14%) females and 6 (42.85 %)males, their ages ranged from 6 months to 45 years. Two age groups were assessed: infants and children in 10(71.42%) cases with a mean age 5.75 years and 4(28.57%) in adults with a mean age 42.5 years. All patients had second degree burn apart from 2(14.28%) patients had combined 2^nd and 3^rd degree burn that followed contact with boiling liquids in 11(78.57%) cases, electric shock in 2(14.28%) cases and therapeutic cautery in one (7.14%) case. The hemangioma appeared after 1-2 weeks following burn injury. The therapeutic response was observed after few days but marked after 2 weeks but therapy continued for at maximum of six weeks until full resolution. No scarring was observed followed full resolution.

Conclusion: Burn hemangioma is commonly seen among children in winter cold months following burn with boiling liquid although occasionally can follow contact with any hot object like electric shock. Oral propranolol is a new an effective safe therapy leaving very good cosmetic appearance without scarring.

Impact of Dermatological Diseases on the Quality of Life of Children and Adolescents

2025-01-15T20:34:25+00:00

Background: Dermatological disorders pose a substantial health burden in the world with the skin treatments being the 4^th largest cause of non-fatal diseases. In childhood, these ailments have a significant effect on the quality of life of the children in the most crucial stages of development. However, only a few studies have established the linkage of these two factors among the people in South Asia.

Objective: To assess how dermatological diseases affect the quality of life in children and adolescents based on a validated tool Children Dermatology Life Quality Index (CDLQI) and what factors are related to a higher degree of impairment.

Methods: The study was carried out as a cross-sectional study at Punjab Rangers Teaching Hospital Lahore, Pakistan between 1^st April – 30^th April 2024. Total 122 children and adolescents between 4-16 years of age with dermatological conditions were selected. The CDLQI questionnaire that is seen as a good measurement of the quality of life was also used in Urdu. Statistical methods involved descriptive statistics, the chi-square and the independent sample t-tests.

Results: CDLQI score average 14.2 was used where a higher point means a greater impact on life quality; therefore above 12 points are considered a very large effect. 80.4 per cent of the respondents reported moderate effects and above, which are extremely large. The most common (42.6%) disorder was eczema that had the highest mean CDLQI score (15.8 += 5.2). The group of middle childhood (6-10 years) also exhibited a high degree of impairment (mean CDLQI: 15.2 + 6.9) than other age groups (p = 0.042). There were no significant gender variations (p = 0.676). The type of disease was moderately related to the categories of CDLQI (p = 0.004).

Conclusion: Dermatological illness negatively affects the quality of life in children particularly suffering from eczema and the period of middle childhood being the most dangerous variables. These results underscore the need of regular quality-of-life evaluation and age-related comprehensive interventions in the practice of pediatric dermatology.

Comparison of Efficacy of Fractional CO2 Laser with Intralesional Steroid Versus Intralesional Steroid Alone in the Treatment of Keloids

2024-11-23T12:12:00+00:00

Background: Keloids are abnormal wound responses characterized by deposition of excessive collagen and glycoprotein. They are distressing for most of the patients symptomatically and aesthetically. Intralesional steroids are the most commonly used treatment for keloids. Fractional CO2 laser is an emerging therapeutic option for keloids which can be used alone or as combination with other therapies.

Objective: To compare the efficacy of fractional CO2 laser with intralesional steroid versus intralesional steroid alone in the treatment of keloids.

Methods: Sixty patients were randomly assigned into two groups (30 patients each). After applying topical anesthesia to patients, Group A received fractional CO2 laser sessions followed by intralesional triamcinolone acetonide (TAC) with a gap of 5 mins every 4th week for total 4 months. Group B received Intralesional TAC alone every 4th week for total 4 months. Efficacy was assessed at the end of 4th session and was labelled if there was grade 3 or grade 4 improvement in width and height of keloid, degree of hypertrophy, dyschromia and texture of keloid using modified quartile score.

Results: Total of 60 patients (30 in each group) were recruited. The mean age was 26.60 ± 5.52 years in group A and 29.76 ± 6.20 years in group B. We found that efficacy was 90% (n=27) in Group A and 66.6% (n=20) in Group B with (P-value-0.028).

Conclusion: Our study results demonstrated that fractional CO2 laser in combination with intralesional TAC has better efficacy as compared to intralesional TAC alone, with a statistically significant difference (P-value-0.028).

Skin Acidity Level in Children with Atopic Dermatitis

2025-02-03T04:49:47+00:00

Background: Atopic dermatitis (AD) is a chronic, relapsing, and pruritic inflammatory skin disease commonly found in children. It is characterized by a complex and multifactorial pathogenesis involving genetic, immunologic, and environmental factors. One of the proposed pathomechanisms includes mutations in the filaggrin gene, which plays a crucial role in maintaining epidermal barrier integrity, skin hydration, and regulating skin surface acidity or potential of hydrogen (pH). Alterations in skin pH have been associated with barrier dysfunction, increased susceptibility to infection, and worsening of inflammation in AD patients.

Objective: To analyze and compare the skin pH in children with AD, specifically between lesional and non-lesional areas.

Methods: This was a cross-sectional analytical study conducted from January to April 2024 at the Pediatric Dermatology Division, Department of Dermatology, Venereology, and Aesthetic Medicine, and the Allergy and Immunology Division, Department of Pediatrics, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Skin pH was measured in both lesional and non-lesional areas. Lesional measurements were performed on areas presenting with erythema and/or lichenification.

Results: A total of 33 patients were enrolled in the study. The mean skin pH of lesional areas was 5.92 ± 0.45, while that of non-lesional areas was 5.38 ± 0.42. Statistical analysis showed a significant difference in pH values between lesional and non-lesional skin (p = 0.001). A subgroup analysis comparing erythema and lichenified/hyperpigmented lesions revealed no significant difference in pH values (p = 0.102).

Conclusion: In children with AD, the skin pH of lesional areas is significantly higher than that of non-lesional areas.

Efficacy of 3% Moringa Oleifera Lam Leaf Extract Cream in Improving Xerosis Cutis In Patients with Type 2 Diabetes Mellitus

2025-02-03T05:20:37+00:00

Background: Moringa oleifera Lam (M. oleifera Lam) leaves are plants that grow abundantly in Indonesia and are used as phytopharmaceutical. Moringa oleifera Lam leaves contain antioxidant, fatty acids, amino acids, vitamins, and minerals. These ingredients are involved in skin barrier, hydration, antioxidants, and anti-inflammatory, but the studies on the benefits of phytopharmaceutical plants on improving xerosis cutis in patients with type 2 diabetes mellitus (DM) are still limited.

Objectives: To assess the efficacy of 3% M. oleifera Lam leaf extract cream in reducing xerosis cutis in patients with type 2 DM.

Methods: Pilot study with pretest-posttest experimental design during April-August 2024. Parameters of Overall Dry Skin score (ODSS), tewameter, corneometer, sebumeter, and visual analogue score (VAS) were observed at baseline, 2 and 4 weeks. Dermatology Quality of Life Index (DLQI) was observed at pre- and post-treament.

Results: The total subjects were 66.7% females and 33.3% males, with a mean age of 64.53 ± 8.74 years. The grade 2 ODSS group of 43.4% at baseline had significant improvement at 4 weeks (p<0.001). The comparison of transepidermal water loss (TEWL) between baseline and 4 weeks showed a mean decrease of 16.94 ± 5.43 g/m²/h (p<0.001) and hydration levels increase with a mean of -23.50 ± 10.09 AU (p<0.001). The improvement that resulted in normal sebum was 6.7% (p=0.500). The VAS of subject decreased and a significant difference in DLQI. Adverse effects of extract cream were not found in this study.

Conclusion: Treatment of xerosis cutis in patients with type 2 DM using 3% M. oleifera Lam leaf extract cream gives good results, but further study is required.

Comparing the Efficacy of Oral 200 Milligram Voriconazole Once a Day Vs Twice a Day in the Treatment of Resistant Dermatophyte Infections (Tinea Corporis and Tinea Cruris)

2025-03-05T22:46:42+00:00

Background: Treatment of dermatophyte infection in our country is becoming difficult due to the developing resistance to traditional antifungal agents. Assessing the effectiveness and feasibility of a newer antifungal drug like voriconazole is the need of the hour in resistant cases.

Objective: To compare the efficacy of oral 200 milligram voriconazole once a day vs twice a day in the treatment of resistant dermatophyte infections (tinea corporis and cruris).

Methods: This Randomized Controlled Trial (registration number NCT06680544.) was carried out in Outpatient Dermatology Department, Sheikh Zayed Hospital Rahim Yar Khan, Pakistan. Total 106 patients were divided into two groups, Group A and Group B, each consisting of 53 patients. Group A was given oral voriconazole 200mg once a day and Group B was given twice a day for a maximum of 28 days. Efficacy was assessed at day 14 and day 28, and relapse was noted at the 2-month follow-up visit. Data was recorded on a preformed Proforma for each patient and analyzed using SPSS 24. A p-value of less than 0.05 was considered statistically significant.

Results: In Group A, complete clinical cure/efficacy was noted in 28.3% and 94.7% patients at day 14 and 28, respectively. In Group B, complete clinical cure/efficacy was noted in 34.0% and 94.4% patients at day 14
p= 0.338) and 28 (p=0.817), respectively. Over all 22 patients (20.7%) showed relapse. Visual disturbance in the form of altered perception of light after first dose was the most common side effect noted.

Conclusion: Oral voriconazole at a dosage of 200 mg once daily is comparable in efficacy and safety to 200 mg twice daily regimen but is more cost effective in treatment of resistant tinea corporis and tinea cruris.

The Role of High-Frequency Ultra Sound (HFUS) in Skin Malignancy: A Literature Review

2025-01-10T02:38:55+00:00

High-frequency ultrasound (HFUS) has a significantly reduced tissue penetration depth that provides superior resolution images of tissues and structures near the skin's surface. HFUS is one of the examinations that can be performed to assess skin tumours before and after biopsy or surgery, even after therapy. The utilization of HFUS in skin malignancies covers diagnosis, staging and treatment phases. HFUS provides information about tumour features such as size, shape, depth, consistency, and vascularity, that can be done before an invasive skin biopsy or surgery. HFUS is a supporting examination and a non-invasive tool to plan the treatment of certain skin tumours. In addition, HFUS can assess prognosis in some cases that require additional management. The final diagnosis of skin tumour types is not completely feasible by using the HFUS, because it is unable to distinguish between benign and malignant tumours. Another limitation is that it cannot give tissue diagnostics. HFUS cannot discriminate between tumour and inflammatory infiltrates, which may result in overestimation of tumour dimensions. It is important to emphasise that HFUS should not be utilised as a standalone diagnostic tool, but rather in conjunction with clinical examination and histopathological findings to help reach a definite diagnosis and treatment approach

Successful Oral Corticosteroid with Doxycycline as Adjuvant Therapy in a Case of Refractory Bullous Pemphigoid

2024-09-22T05:38:02+00:00

Bullous pemphigoid (PB) is a bullous autoimmune disease that often occurs in elderly people. It can be triggered by age, drug use, trauma, ultraviolet exposure, radiation, genetic roles and stress. Treatment of PB with topical and oral corticosteroid drugs remains the main option.¹ However, recent control trial studies have shown the efficacy and safety of using doxycycline to reduce accumulated treatment dose and mortality. A 68-year-old male presented with widespread, itchy bullae that ruptured, releasing clear fluid and forming dark crusts. Physical examination revealed multiple tense bullae and erosions on the neck, trunk, and upper extremities. He was treated with oral and topical corticosteroids, wound care, topical moisturizers, and anti-inflammatory antibiotics. Clinical improvement was noted within 7 days, with continued follow-up over 2–3 months. Combined with oral and topical corticosteroids, doxycycline offers potential as a steroid-sparing agent to
attenuate inflammation and prevent recurrence of PB.

Non-Dermatophyte Onychomycosis Caused by Aspergillus in a Patient with Systemic Lupus Erythematosus: A Case Report

2024-08-30T07:28:39+00:00

Onychomycosis is a fungal infection of nails, occasionally found on fingernails. Non-dermatophytes molds (NMDs), such as Aspergillus spp., are increasingly reported, particularly in immunocompromised patients. We report a case of a 19-year-old female with systemic lupus erythematosus (SLE), treated with immunosuppressive drugs, presenting with proximal subungual onychomycosis. Fungal cultures confirmed Aspergillus flavus. The patient achieved complete clinical and mycological cure after three months of pulsed oral itraconazole therapy. This case emphasizes the need for proper mycological diagnosis in immunocompromised patients presenting with nail abnormalities.

Hypertension and Diabetes Melitus Type II Associated with Systemic Corticosteroids: Challenges of Pemphigus Vulgaris Therapy in the Elderly

2024-11-09T11:47:02+00:00

Long-term treatment and high doses of systemic corticosteroids in Pemphigus Vulgaris (PV) also carry the risk of various side effects, such as hypertension and diabetes mellitus. A male, 62 years old, has been diagnosed with PV accompanied by type 2 diabetes mellitus, and grade I hypertension. The patient was given therapy with dexamethasone 5 mg/day IV and mycophenolate mofetil 500 mg twice a day. Patients also receive treatment to control glucose and blood pressure, and debridement procedures are carried out. After administering therapy, the patient saw clinical improvement. Corticosteroid administration can also be combined with adjuvant steroid-sparing agents to increase the treatment effect, reduce the side effects of corticosteroids, and prevent recurrence if stopped gradually. The importance of considering side effects when administering corticosteroid therapy, and monitoring glucose and blood pressure can reduce morbidity and mortality in patients.

Apremilast – A Novel Treatment for Behcet’s Disease

2025-03-17T13:51:15+00:00

Behcet's disease is a chronic inflammatory disease involving multi-organ system; it results from a complex interplay of genetic, environmental, infectious, and immunological factors, though its precise etiology remains unclear. The disease is categorized as neutrophilic dermatosis and the clinical manifestations occur due to vasculitis that affects blood vessels of all types and sizes. The disease affects many other organs specifically the eye, gastrointestinal system, central nervous system, joints, kidneys and vascular system. We report the case of an 18-year-old girl having Behcet’s disease for the past 4 years with typical recurrent oral aphthosis along with pharyngeal involvement leading to dysphagia and a large ulcerative lesion over labia majora. Notably, her condition showed a remarkable response to a premilasthighlighting its potential therapeutic role in refractory mucocutaneous manifestations of Behcet’s disease. This case underscores the expanding treatment landscape and the need for further investigation into targeted immunomodulatory therapies.

Combination Treatment of Itraconazole and Terbinafine for Chromoblastomycosis Caused by Fonsecaea pedrosoi

2024-12-21T05:07:02+00:00

Chromoblastomycosis is a chronic subcutaneous fungal infection mainly caused by Fonsecaea pedrosoi. This report describes a 42-year-old man with a verrucous plaque on the right ankle, initially presenting as small papules ten years ago, progressively enlarging. The patient, an oil palm worker, had a history of recurrent trauma and inadequate antifungal treatment. Diagnosis was confirmed by KOH, histopathology, and culture showing Fonsecaea pedrosoi. Combination therapy with itraconazole 100 mg twice daily and terbinafine 250 mg once daily for six months led to complete clinical and mycological cure. This case emphasizes the role of combined antifungal therapy in neglected chromoblastomycosis and the importance of early diagnosis and adherence to treatment.

Atypical Molluscum Contagiosum Mimicking Cutaneous Warts in an HIV Patient

2025-01-02T09:55:04+00:00

Molluscum contagiosum (MC) is clinically characterized by small, dome-shaped, pearly-white to skin-colored papules and a self-limiting course. MC may present in several atypical morphologies which mimicking other dermatoses, especially on an immunocompromised patients. The lesions are usually extensive and cause disfigurement when associated with HIV. The terminology of “agminated” MC describes the dense grouping of several MC lesions. The aim of this case report is to report the agminated MC which mimicking a cutaneous wart of an HIV patient. A 36-year-old married woman with HIV complained of multiple red bumps that were initially pea-sized and gradually increased in size and number. The lesion spread over the face, armpits, hands, thighs, genital area, and feet for 9 months. History indurated, painless, and ulcerative chancre was denied. There was no history of blood transfusion, trauma, or any drug intake before the appearance of these lesions. There were no such lesions present on her husband. There was no history regarding the HIV status of the husband. Her CD4 absolute count was 61 cells/mm and serological testing for syphilis was non-reactive. Based on the findings, the patient was diagnosed with atypical MC and planned to have cryosurgery. Unfortunately the patient was loss control to follow up. Awareness among clinicians regarding the atypical presentations of MC is of paramount importance in the early diagnosis and management of this contagious disease. Rarely, atypical presentations of MC have been described in immunocompromised patients. Dermoscopy and histopathological examination is needed to determine the diagnosis of these atypical MC.

Expanding the Geographic Spectrum: First Documentation of Mal de Meleda in Three Siblings from Pakistan – A Case Series

2024-11-09T06:24:35+00:00

Mal de Meleda (MdM) is a rare autosomal recessive palmoplantar keratoderma caused by SLURP-1 gene mutations. It typically presents in early childhood with waxy, yellowish thickening of palms and soles that may extend to the dorsal surfaces. We report the first familial case series of MdM in Pakistan, involving three female siblings aged 11, 11, and 9 years. All showed varying degrees of transgradient hyperkeratosis, nail changes, and hyperhidrosis. Family history revealed consanguinity and a similarly affected paternal aunt. Based on clinical findings, a diagnosis of MdM was made. Management included topical keratolytics, antibiotics, and in one case, systemic therapy. This series underscores the phenotypic variability of MdM, emphasizes the diagnostic value of family history, and contributes to the expanding geographic understanding of this genodermatosis.

Person Centered Care: Empowering Patients and Delivering Holistic Patient Care

2025-10-09T18:58:52+00:00

Patients are an important stakeholder in the healthcare programs and it is imperative to listen to and address their concerns if we want to make a robust healthcare system.^1,2 This has been recognized with the advent of patient/person centered care. The Picker’s eight-point model provides a framework to ensure this provision. Person-centered care is a multifaceted team-based approach that helps healthcare professionals avoid making assumptions or relying on old paternalistic attitudes of physicians; in which the patient remained passive and the major decisions were made by the medical team. The advantage of this framework is that instead of making decisions for patients, it gives patients the power to express what they need and what they are capable of. With this shared decision-making the patients take more responsibility and are then largely compliant with their medication plans. It also encourages health-care workers to think about their actions, become more self-aware, and grow both personally and professionally.

The Picker’s Eight Principles of Person Centered Care were detailed by Harvard Medical School on behalf of Picker Institute. Employing focus group discussions to gather data of this qualitative research, initially seven points were presented with the later addition of the eighth point about access to care. This also signifies the importance of qualitative research in healthcare; apart from quantitative research to gather systematic, rigorous scientific inquiry. Patients, family members, physicians, para medical and auxiliary hospital staff participated in the focus group discussions which lead to the formulation of this eight-point model. The composition of focus groups ensured that patients and their families voices were heard and acknowledged.