Abstract:Melasma is an acquired, symmetrical hypermelanosis of the face and is particularly seen in women with skin types IV to VI living in areas with intense UVR. So it is a great problem in our country. Treatment of melasma remains a challenge. Topical therapy with a triple combination topical agents appears to be the most clinically effective initial therapy for patients with melasma. A clinical trial was conducted to find out the efficacy of the triple combination of 4% hydroquinone, 0.05% tretinoin and 0.01% fluocinolone acetonide cream in the treatment of facial melasma. Fifty clinically diagnosed cases of melasma attending the Skin and VD outpatient department of General Hospital, Faridpur were selected randomly. Majority (54%) were between 21 to 25 years of age and most of them (86%) were female. After 20 weeks of treatment with triple combination agents, the average MASI score decreased significantly (P<.001). Reduction of the severity of melasma by 20 weeks is 82% and by 8 weeks is 71%. Regarding the distribution of melasma, 50% were found centrofacial, 45% malar and 5% mandibular. As side effects of the treatment, 36% developed erythema, 16% developed burning sensation, 6% developed pruritus and 4% developed desquamation. This study demonstrates that every night application of triple combination topical agent has significant effect on melasma.
Abstract:Vitiligo is an acquired, often progressive disorder of hypopigmentation. A lot of research has been conducted during the years yet its exact etiology still remains elusive. As a result even after so many years, there is no ideal treatment for vitiligo. Treatment options such as Narrowband Ultraviolet B (NB-UVB), Targeted Phototherapy, and Excimer laser on the medical front, in addition to epidermal cell transplantation and melanocyte culture transplants on the surgical front, have all revolutionized the management of this psychologically devastating disease.
The burden of scabies is highest in tropical countries, but recent data from Bangladesh is scanty. This cross sectional study was carried out to find the prevalence of scabies in skin & VD Out Patient Department (OPD) of Faridpur Medical College Hospital (FMCH) during the period of April 2013 to March 2014. Total 22,399 patients attended to the skin & VD OPD, were included in this study. We identified 15,455 patents with scabies. The total prevalence was 69%. Prevalence in January was highest & was 78%. Most cases were uncomplicated but 17.28% of complicated scabies patients were found. Scabies was more in poor socio-economic group than others. The present study showed a high prevalence of scabies in patients presenting to skin & VD OPD, FMCH. Prevalence was higher overall in children. Our data show that scabies is common in patients presenting to skin & VD OPD & this finding may be used as an indicator of the general population.Faridpur Med. Coll. J. Jan 2015;10(1): 17-19
Psoriasis is a chronic papulosquamous disorder with remissions and exacerbations. Varied estimates of the population prevalence of the disease in different parts of the world range from 0.1 - 3%. It is not uncommon in our country. Although there are no treatment options offering a complete cure, a number of options exist for providing symptomatic relief, inducing as well as prolonging remission. Various systemic therapies such as methotrexate, acitretin, cyclosporine, and biologic agents can be used. A review of pharmacokinetics, safety and a discussion of relapse rate establish acitretin, an aromatic retinoid as an efficacious, convenient, oral monotherapy for initial and maintenance of severe psoriasis. A prospective clinical trial was conducted to find out the efficacy and safety of acitretin as monotherapy in the treatment of moderate to severe plaque type psoriasis (PASI range 10-42). Thirty two clinically diagnosed cases of moderate to severe plaque type psoriasis attending the Skin and VD out patient department of Faridpur Medical College Hospital, Faridpur were selected randomly. Majority (46.9%) were between 61 to 80 years of age and only 3.1% patients were in the <20 years age group. The average age was 57.3 years and range was 19-90 years. Majority (68.8%) of the patients were male and 31.2% patients were female. The male female ratio was 2.2:1. After 8 weeks of treatment with acitretin PASI 50 and PASI 75 response rates were 55% and 24% respectively and after 12 weeks of treatment, PASI 50 and PASI 75 response rates were 75% and 50% respectively. As side effects of the treatment, 4(12.5%) patients developed alopecia, each of xerophthalmia and cheilitis was seen in 3(9.37%) patients, each of fatigue and pruritus was seen in 2(6.25%) patients and only 1(3.12%) patient developed myalgia. This study demonstrates that acitretin as monotherapy is effective and safe in the treatment of moderate to severe plaque type psoriasis. Faridpur Med. Coll. J. Jan 2019;14(1): 16-19
Acyclovir has well-documented efficacy and tolerability in the treatment of herpes zoster. Its limited oral bioavailability and short half-life, however, necessitates frequent dosing. Valacyclovir, the l-valyl ester of acyclovir, could be rapidly converted to acyclovir after oral administration, resulting in a three to five fold increase in acyclovir bioavailability compared with oral acyclovir in humans. The study was done in the department of Dermatology and Venereology, Faridpur Medical College Hospital (FMCH), Faridpur, Bangladesh from July 2015 to December 2016 to compare the safety and efficacy of valacyclovir with acyclovir in the treatment of herpes zoster. Relevant data was taken from 50 patients presenting with herpes zoster within 72 hours after the onset of rash and were randomized into two groups of 25 each to receive one of the following treatments: valacyclovir 1000 mg three times daily for 7 days or acyclovir 800 mg five times daily for 7 days for each group. Patients were followed up on day 7, 14, 22 and 29 to assess the rate of resolution of pain, cessation of abnormal sensations, rate of rash healing, new lesion formation and occurrence of complications or adverse effects. The intent-to-treat analysis showed that valacyclovir significantly accelerated the resolution of zoster-associated pain compared with acyclovir; on day 29, the valacyclovir group was 44% superior to the acyclovir group. The rate of cessation of abnormal sensations, rash healing and complications or adverse effects was similar with both the treatments. There were no clinically significant differences in the nature, frequency or severity of adverse events between the two treatment groups. Thus, we conclude that in the management of herpes zoster, valacyclovir accelerates the resolution of pain and offers a simpler dosing, and maintains the favorable safety profile of acyclovir. Faridpur Med. Coll. J. Jul 2018;13(2): 74-77
Abstract:Lichen planus (LP) is a common inflammatory disorder that affects the skin, mucous membranes, nails and hair. There are various modalities of treatment but none is curative. Betamethasone oral mini-pulse (OMP) therapy has been used effectively and safely in vitiligo, alopecia areata and lichen planus. We sought to evaluate the efficacy and safety of Betamethasone OMP in patients with lichen planus. This prospective study was carried out among patients with lichen planus fulfilling the inclusion criteria, attending the skin and VD outpatient department of Dhaka Medical College Hospital, Dhaka Bangladesh over a period of 6 months from January 2005 to June 2005. A total of 20 patients with lichen planus diagnosed clinically and confirmed by histopathological examination were selected randomly for this study. Among them both male and female were in equal number. The study subjects were treated with 5 mg of Betamethasone orally on 2 consecutive days per week, for 3 months. Treatment response and side effects were monitored 4 weekly. The response was good in 60% and fair in 40% and there was no excellent response. This study indicates that further prospective placebo controlled studies are needed to clarify the efficacy of oral Betamethasone in lichen planus.
Abstract:Vitiligo is an acquired multifactorial polygenic disorder with a complex pathogenesis, characterized by depigmented macules in skin. A clinical trial was conducted to evaluate the efficacy of oral mini pulse betamethasone in the treatment of vitiligo patients. The study was done in the department of Dermatology and Venereology, Faridpur Medical College Hospital (FMCH), Faridpur, Bangladesh from July 2014 to June 2015. Among thirty patients of vitiligo, most of the male patients (53.33%) and most of the female patients (40%) were between 20 to 25 years of age. Majority of patients (70%) had been suffering from vitiligo for less than 3 years and 50% patients had positive family history. Eighteen (60%) patients had acro-facial type of vitiligo and 20 (66.67%) cases were progressive in nature. In this study, response was slight in 36.67%, moderate in 33.33%, marked in 20% and excellent in 10% of cases after 12 weeks. Eight (26.66%) of total patients were seen to be with clinical side effects. Among the side effects, weight gain 4 (13.33%) was most prevalent, others include general weakness in 2 (6.66%) and acne in 2 (6.66%) patients. In conclusion, oral mini pulse betamethasone seems to be an effective treatment modality to arrest the progression of vitiligo and induction of repigmentation.
Abstract:Melasma is characterized by melanosis with sharply demarcated blotchy, brown macules usually in a symmetric distribution over the cheeks and forehead and sometimes on the upper lip and neck. It is most often seen in women during pregnancy, at menopause and while taking oral contraceptives; it occasionally occurs in women who are not pregnant or taking oral contraceptives, as well as men. So it is a great problem in our country. A clinical trial was conducted to find out the effect of the combination of 20% azelaic acid with 0.05% tretinoin cream in the treatment of melasma. Twenty clinically diagnosed cases of melasma attending the outpatient department of Dermatology and Venereology, Faridpur Medical College Hospital, Faridpur were enrolled. Majority of the study subjects (40%) were between 26 to 30 years of age and most of them (60%) were females. Regarding occupation, 60% were housewife. Out of the study subjects 75% were married and 60% were middle class. Around 60% cases had positive family history of melasma and maximum (90%) patient had no history of systemic drug and the maximum (80%) patients had no history of use of cosmetics. It was observed that highest (90%) number of patients had malar area involvement and 10% had centro-facial area involvement. The study showed moderate reduction of the severity of melasma after the treatment. Out of the study subjects, 40% and 20% developed burning sensation and erythema respectively. It could be concluded that combination of 20% azelaic acid and 0.05% tretinoin cream, has a moderate lightening effect in the treatment of melasma.
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