Nasser Rashid Dar

Constitutional and Behavioral Risk Factors for Chilblains: A Case-Control Study From Pakistan

OBJECTIVES To study constitutional and behavioral risk factors for chilblains in patients at Abbottabad and Sialkot, Pakistan. METHODS One hundred patients and matched controls completed a single-page, close-ended questionnaire which included demographic data and questions related to possible constitutional and behavioral risk factors for chilblains. Computer program SPSS-10 was used to manage and analyze the data. Risk factors were identified statistically by determining odds ratios and 95% confidence intervals using multivariate analysis. RESULTS There were an equal number of male and female respondents in each group. Age of the patients and controls ranged from 2 to 80 years with a mean of 24.51 +/- 16.02. Twenty-six patients and 3 controls had a positive family history for chilblains (odds ratio = 9.33); 42 patients and 14 controls reported a history of constipation (odds ratio = 2.69); 32 patients and 8 controls had a history of either numbness or tingling of fingers or toes (odds ratio = 2.93); 55 patients and 45 controls led sedentary lifestyles (odds ratio = 1.27); 85 patients and 58 controls consumed a low number of cups of tea daily (odds ratio = 3.20); 65 patients and 29 controls frequently washed their hands and/or feet (odds ratio = 4.93); and 56 patients and 33 controls had occasional sun exposure during winter months (odds ratio = 2.08). CONCLUSION Significant risk factors for the development of chilblains for people at Abbottabad and Sialkot included a history of chilblains in first-degree relatives, numbness and tingling sensations of fingers or toes, frequent hand or feet washing, and lower tea consumption during winter months.

Comparison of plain potassium hydroxide mounts, fungal cultures and nail plate biopsies in the diagnosis of onychomycosis.

OBJECTIVE To compare the relative sensitivity of direct microscopy, fungal culture and nail plate biopsy in the diagnosis of onychomycosis. DESIGN Cross-sectional study. PLACE AND DURATION OF STUDY The Skin Department, Military Hospital, Rawalpindi from February 1998 to February 1999. PATIENTS AND METHODS A total of 50 patients who were suffering from different clinical variants of onychomycosis, irrespective of their age, gender, with or without simultaneous presence of systemic diseases, were subjected to laboratory investigations including direct microscopy with 20% potassium hydroxide (KOH) for fungal hyphae, fungal cultures and nail plate biopsies. These patients were later categorized into two groups based upon the results of nail plate biopsies. RESULTS Of 50 patients, 15 (30%) were positive for fungal elements in direct microscopy, 8 (16%) were positive for fungal culture and 16 (32%) revealed positive results in nail plate biopsies. Amongst nail plate biopsy positive cases, 10 (63%) were positive for direct microscopy and 6 (37.5%) were positive for fungal cultures. In biopsy negative cases, positive results for direct microscopy were seen in 5 (14.7%) patients and positive fungal culture was found in 2 (5.88%) patients. CONCLUSION The clinical impression of onychomycosis is not true in all the cases. Nail scraping for direct microscopy with 20% KOH should be the first line screening test for all patients which should then be supplemented with fungal culture and/ or nail plate biopsy.

Dermatological Clue to Diagnosis of Degos Disease in a 2-Year-Old With Obscure Chronic Abdominal Pain:

months. No cause could be found despite multiple investigations. There was poor response to medication. The child was referred to dermatology for the evaluation of a rash that had developed over the past 1 month. According to her mother, the rash appeared as erythematous papules in crops and then resolved with scars. Examination revealed multiple painful erythematous papules scattered over the limbs in different stages of evolution (Figure 1). Some were raised whereas others were umblicated in the center with a necrotic base. Healed lesions appeared as whitish, porcelain-like macular scars (Figure 2). Systemic examination was normal. Her complete blood count, renal functions, liver functions, abdominal sonography and barium meal follow-through, and coagulation profile including the international normalized ratio and serum antinuclear antibody revealed no abnormality. Skin biopsy showed a thin epidermis with hyperkeratosis overlying a necrobiotic dermal collagen with sparse inflammatory infiltrate. The blood vessels were dilated with swelling of endothelial cells and luminal thrombosis. Scattered mucin deposits were also seen. Based on historical features, characteristic skin lesions, and a supportive histology, the patient was diagnosed with Degos disease. Aspirin (3 mg/kg) and dipyridamole (5 mg/kg) were prescribed. Within 48 hours, the patient improved. Irritability reduced significantly. Active lesions started healing. Abdominal pain improved but vomiting continued although frequency was reduced significantly. At the time of reporting, the patient is still admitted in our pediatric Introduction

Ross syndrome with generalized anhidrosis and localized disabling compensatory hyperhidrosis.

Ann Saudi Med 28(1) January-February 2008 www.saudiannals.net 53 Ross syndrome is a progressive degenerative disorder of cutaneous sensory and autonomic innervation. Since Ross’ first description in 1958, approximately 40 cases have been described.1 It is clinically characterized by a triad of anhidrosis, tonic pupil and deep tendon areflexia. Anhidrosis may be acc companied by compensatory hyperhidrosis and other alterations of the autonomic nervous system.2,3 It has been suggested that sweating disorder results from progressive impairment of heat production and heat dissipation through both loss of sweating and loss of cutaneous blood flow regulation.1 The pathophysiology underlying Adie’s pupil is postcganglionic denervation of cholinergic fibers between the ciliary ganglion and the iris sphincter muscle. Initially there is dilatation of the pupil, but later, due to aberrant recinnervations of the iris or to the hypersensitive pupillary sphincter muscle, the pupil becomes constricted and tonic. In tonic pupils the near reaction is usually better than the light reaction accommodation reflex. Depression of deep tendon reflexes is due to dorsal root ganglionic degeneration or spinal interneuron loss. We report a patient with Ross syndrome who prec sented with generalized anhidrosis and socially disc abling localized compensatory hyperhidrosis along with tonic pupil and deep tendon hyporeflexia.

Facial lichen nitidus actinicus

We report an 18-year-old woman with lichen nitidus with exclusive facial distribution.We report an 18‐year‐old woman with lichen nitidus with exclusive facial distribution.