Skin biopsy for histopathology is the most reliable investigation for diagnosis of skin diseases. The main purpose of skin biopsy is to confirm clinical diagnosis but dermatologists usually looking for the concordance with histopathological report. The aim of the study was to observe the consistency of clinical and histopathological diagnosis of skin diseases. An observational study was conducted on 630 patients that undertaken skin biopsy and that was performed at the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University from January 2018 to January 2019. Patients who were advised for biopsy by outpatient and inpatient department and the biopsy was done accordingly was included in the study. Finally the inclusion was confirmed when the histopathological report was available. Demographic information, clinical diagnosis, type of biopsy procedure, types of specimen taken and send for histopathological procedure and the histopathological diagnosis was noted in data collection sheet. Histopathological diagnosis and its correlation with clinical diagnosis was assessed for consistency and it was the main outcome measure of the study. The mean age of patients on whom biopsy was performed was 35.14 ±16.57 years and the age range was 5-82 years. Male patients outnumbered female and the male to female ratio was 1.15: 1. Three types of biopsy were performed among them incisional biopsy was the commonest type (93.5%). In most of the cases collected specimen was skin 94.76%, others type of specimens were mucous membrane 2.6%, nail matrix 1.9% and 0.6% specimen was hair follicle. Among the cases 71.43% was diagnosed clinically. The common clinical diagnosis in which biopsy was done was psoriasis and its types 17.77%, lichen planus and its variants 14.12%, the connective tissue diseases 6.19% and infectious diseases 5.39%. In 79.52% cases histopathological diagnosis was done and 68.22% diagnosis was consistent with the clinical diagnosis. The maximum clinico-pathological concordance was found in vesiculo-bullous disease 93.33%. Then connective tissue diseases 79.48%, vasculitides 75% and lichenoid diseases 73.56%. Skin biopsy is a conclusive tool to overcome diagnostic dilemmas in dermatological diseases. The clinico-pathological concordance is assumed lower than the expectation of dermatologists but the collective efforts of dermatologists and pathologists can improve the capacity of diagnosis of biopsy samples. Bangladesh Med J. 2020 Sept; 49(3) : 29-34
Abstract:An interventional study was carried out for a period of total two years in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Total sixty five patients of seborrheic dermatitis were selected and were treated with oral fluconazole 150mg in a single dose per week for 4 weeks. Follow up were done at the end of 4 th week and 8 th week. Among the patients, 31-45 years age group was highest 44%, highest 54% males and 21(32%) had positive family history of seborrheic dermatitis. Regarding site of lesions, maximum patients of seborrheic dermatitis 92% had involvement of scalp; next 46% had involvement in the eyebrow. The study showed that the response was very good in 31.5 of cases, good response was found in 24.5% of cases, fair in 26% of cases and poor response was observed in 18.5% of cases. The study showed that 83% of study population was seen without clinical side-effect and only 17% were seen with side-effect(anorexia and dydpepsia) and it was showed that very good improvement 35% observed on the 1 st follow up visit at the fourth week, 30% had good, 15% fair and poor improvement 20% respectively. On the 2 nd follow up visit at the end of eight week, very good improvement was 39% cases; good, fair and poor improvement was 26%, 20% and 17% respectively. The results of this study indicate that fluconazole provides benefit for the therapy of seborrheic dermatitis. However, larger studies using different dosages and durations of therapy, fluconazole may provide a rationale for systemic use of fluconazole in seborrheic dermatitis.
Bony changes in lepromatous leprosy are one of the causes of deformity and disability. Fasting calcium and creatinine ratio in urine is used as a bone resorption marker in a number of diseases such as hyperthyroidism, osteoporosis, multiple myeloma, paget’s disease and sarcodosis. In lepromatous leprosy assessment of bone resorption might be done with that marker. To assess the role of fasting urinary calcium and creatinine ratio as a marker of bone resorption in patients with lepromatous leprosy. A case control study was conducted on 28 patients diagnosed as lepromatous leprosy and 28 age-matched healthy control. The participants who fulfilled all inclusion and exclusion criteria were studied by measuring fasting urinary calcium and creatinine level as well as observing X-rays of both hands and feet of affected individuals. The mean age of cases 38.1±14.2 years and 38.9±12.9 years was in control group. Male - female ratio was 3.6: 1. It was observed that 10.7% leprosy patients showed urinary Ca/Cr ratio >0.20 (0.13±0.12) and 10.7% healthy control showed urinary Ca/Cr ratio ratio>0.20 (mean ±SD 0.11±0.7). the difference was not statistically significant (p>0.05). X-ray finding was positive in 14.3% leprosy patients and none of the control group. That difference was not significant statistically (p>0.05). there was no relation between raised urinary Ca/Cr ratio and positive findings of bone resorption on x-rays among the leprosy cases. Bangladesh Med J. 2019 Sep; 48 (3): 28-33
Facial acanthosis nigricans (FAN) is an ignored dermatological entity. Nowadays it occurs more frequently than previous days may be due to changing economic and social status of our country. Aim of this study was to assess the rate of metabolic syndrome in cases of facial acanthosis nigricans. This observational study was conducted in the outpatient department (OPD) of dermatology and Venereology of Bangabandhu Sheikh Mujib Medical University (BSMMU) in the year 2017 among thirty clinically diagnosed cases of FAN. After taking their informed written consent; BMI, random plasma glucose, fasting lipid profile and serum insulin level was estimated in venous blood and recorded accordingly. To confirm metabolic syndrome we followed NCEP ATP III guideline (2005) where 3 of 5 positive criteria confirmed the diagnosis. All data was preserved in a secured computer device and was analyzed with SPSS program with appropriate statistical tools. Mean (±SD) age of patients was 35.63 ± 14.26 years and male to female ratio was 1:1.14. The mean BMI of cases was 33.73±3. We found 11 cases with hypertension, 8 with type II diabetes mellitus and 9 with dyslipidemia. Among the 30 cases of FAN 12 zygomatic type, 8 generalized type and 5 had band like pigmentation on the forehead. Twenty-three patients had acanthosis nigricans on both sides of body. According to our preset criteria we found 26.66% cases had metabolic syndrome. The rate of metabolic syndrome is higher in facial acanthosis nigricans patients. A further large scale study is recommended for strengthening this study findings. Bangladesh Med J. 2018 May; 47 (2): 12-16
Adverse cutaneous drug reaction (ACDR) is a common issue in dermatology practice and it is crucial for every medical practitioner to remain updated of its pattern. It was a hospital based crosssectional observational study, conducted over 130 patients with adverse cutaneous drug reactionin the outpatient department of dermatology of Bangabandhu Sheikh Mujib Medical University (BSMMU). Majority of reaction was developed within one week of taking drug. Fixed drug eruption (FDE) was present in 18.5% cases followed by maculo-papular, Stevenson-Johnson-Syndrome-Toxic epidermal necrolysis (SJS- TEN), urticaria, urticaria + angioedema, lichenoid drug reaction, erythema multiforme, acneiform eruption, exfoliative dermatitis, pityriasiform, hyperpigmentation, acute generalized exanthematous pustulosis, drug induced hypersensitive syndrome, vasculitis, purpura, photosentivity, psoriasiform and other non-specific reactions. Anti convulsants (26.9%), NSAIDs (20.0%) and anti amtimicrobials (17.7%) are the most common drug group causing adverse cutaneous reaction. Many of the ACDR caused by anticonvulsants, NSAID and antimicrobials are even life threatening. Bangladesh Med J. 2018 Jan; 47 (3): 32-36
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