DEPARTMENT OF DERMATOLOGY UNIT-II

The department was founded by the Late Professor Emeritus Syed Ghulam Shabbir in 1960, as the subject of dermatology was declared as an essential specialty of medicine for the patients. However, the present building of the department was completed in 1970. The Department was uplifted and converted into a state of the art teaching unit under the leadership of Prof. Tahir Saeed Haroon. It is the Largest Skin Unit in the country and over the years it has assumed the status of referral centre for the diagnostically and therapeutically difficult cases from all over Pakistan. There is a 60-bedded in-patient department where around 1000 patients are admitted annually.

In addition to teaching undergraduates, the department also imparts postgraduate training for FCPS, MD and MCPS. There are about 50 qualified FCPS Dermatologists in the country who have been trained in this department. Besides this, more than 50 MCPS and 10 MD in the subject received their grooming here. It is heartening to note that these qualified dermatologists have taken up their assignments as heads of various departments round the country. Moreover, nurses, family physicians & postgraduates from other disciplines of medicine and ophthalmology get their compulsory training for dermatology in this department. The department is also actively engaged in research projects and more than 100 papers have been published in the National and International Journals.

Under the able guidance of the teaching faculty of Dermatology Department, various courses, workshops and seminars are held on regular basis for the postgraduate students of dermatology & other specialties and family physicians. One such example is Leprosy Workshop which is regularly held once or twice a year for PGs and Family Physicians with the Collaboration of Aid to Leprosy Patients, Rawalpindi (An NGO which is headed by Dr. Chris Schmotzer, A German Lady).

Following is a brief account of the various educational activities carried out in the department:

Teaching Programs for Undergraduate MBBS

1. Weekly Lectures (Total 28 Lectures: 45 minutes each)—Final Year MBBS Class
2. Group Discussions in the OPD (3 hours on alternate days for One & Two weeks respectively)–4th & Final Year MBBS Class

• History Taking
• Case Presentations (Common Skin Problems)
• Demonstrations (Common Skin Problems)
• Laboratory Methods
• Minor Surgical Procedures
• Cautery
• Cryotherapy

3. College CPC (Case Presentation & Lectures on Common Skin Diseases)—Final Year MBBS Class

Teaching Programs for MD, FCPS and MCPS Students

1. Daily Morning Teaching Rounds in the Ward (30 AM 10.30 AM)
2. OPD on alternate days (Group Teaching in the Consultant OPD 11.00 AM 1.00 PM)
3. Journal Club (Weekly on Wednesday 00 AM 1.00 PM)
4. Group Discussions on Recent Advances in Dermatology (Weekly on Monday 00 AM 1.00 PM)
5. Clinical & Histopathological Slide Sessions (Twice a Month on Friday 30 AM 12.00 PM)
6. Departmental CPC: Lectures & Case Presentations (Weekly on Friday 00 AM 10.30 AM)
7. Morbidity and Mortality Conference (If & when required)
8. Medical Writing & Research Methodology Classes (Twice a Month on Friday 30 AM 12.00 PM)

Teaching Programs for Nurses, Family Physicians, Pharmacists

1. A total of Eight classes during one year for Third year nursing class
2. Two lectures to the Dispenser class
3. Pharmacist Training for 2-4 weeks
4. Weekly program of lectures for Family Physicians

CLINICAL WORK

1.INDOOR ROUNDS

Daily, on working days

2.OUTPATIENTS

No of patients seen (2015) 87,915

No. of patients admitted for management (2015) 451

3.LABORATORY

No. of Investigations Performed (2015): 10731

4.PROCEDURES (2015)

1. Punch grafting 02
2. Chemical peeling 58
3. Skin Biopsies 697
4. Punch Biopsies 186
5. Cautery 7453
6. Epilation 861
7. R.P (Platelets Rich Plasma) 20
8. Iontophoresis 166

5.EMERGENCY CLINICAL WORK

No. of patients attended 253

No. of patients admitted 34

6.A.V.H ADMISSIONS

Research Projects Completed

Scientific projects have been completed until now:

1. Kashmore: focus of cutaneous Leishmaniasis
2. A comparison of efficacy and safety of topical 0.1% adapalene and 4% benzoyl peroxide in the treatment of mild to moderate acne vulgaris
3. The efficacy & safety of oral methotrexate in chronic eczema
4. To assess the efficacy & safety of topical 1% clotrimazole in cutaneous Leishmaniasis
5. A hospital-based clinico-aetiological study of Stevens-Jhonson Syndrome
6. Etiopathogenesis of Melasma in females in relation to Estrogen and Progesterone
7. Cutaneous manifestations in Hepatitis C Virus infection
8. Role of Finasteride in androgenetic alopecia
9. Quality of life in Androgenetic Alopecia
10. Quality of life in Melasma
11. Quality of life in Acne
12. A hospital-based clinico-aetiological study on Drug Reactions
13. Frequency of Fractional CO2 Laser in the Treatment of Mild to Moderate Atrophic Ance Scars
14. Frequency of Metabolic Syndrome in Patients of Psoriasis
15. Comparison of Efficacy of 0.05% Fluticasone Propinoate Cream Versus 0.01% Tacrolimus Ointment in Vitiligo.
16. Comparative Efficacy of Intense Pulsed Light and Electrofulguration in the Treatment of Facial Freckles

Current Research Work

1. Efficacy & Safety of Intense Pulsed Light and Placebo Versus IPL and Eflornithine in the Treatment of Facial Hirsutism (A Split Face Study)
2. Comparison of Efficacy & Safety of Topical 0.1% Tacrolimus Ointment versus 0.1% Mometasone Furoate in Mild to Moderate Chronic Hand Eczema
3. Comparison of Efficacy and Safety of 0.005% Calcipotriol Ointment Versus 0.05% Betamethasone Dipropionate Ointment Versus Calcipotriol Plus Betamethasone Ointment for the Treatment of Vitiligo
4. Comparison of Efficacy and Safety of Q-Switched Nd: YAG Laser (532nm) and cryotherapy in the treatment of solar lentigines
5. Comparison of Efficacy of CO2-Fractional Laser and 40% Glycolic Acid Peel in the Treatment of Mild to Moderate Atrophic Acne Scarring
6. Efficacy of 1064 nm Q-Switched Nd:YAG Laser Treatment for Naevus of Ota
7. Comparison of Efficacy & Safety of 40% Glycolic Acid Chemical Peel and 60% Lactic Acid Peel in the Treatment of Epidermal Melasma
8. Comparison of Topical 1% Clindamycin with Blue Light Therapy in the Treatment of Mild to Moderate Inflammatory Acne Vulgaris
9. Efficacy and Safety of Spironolactone in Moderaate/ Severe Acne in Females
10. The Frequency of Positive Patch Test with Nickel in Patients suspected of Metal Contact Dermatitis
11. Frequency of Dyslipidemia in Patients of Lichen Planus
12. Determine the Safety & Efficacy of Narrow Band UVB in Chronic Hand Eczema

On Going Projects

Fifteen research projects have been started:

1. Role of different treatment modalities in onychomycosis
2. Therapeutic evaluation of Psoriasis in Pakistan
3. Role of different treatment modalities in Melasma
4. Comparison between efficacy and safety of Synalar Gel (Fluocinolone acetonide) & Minoxin 5% Spray (Minoxidil) in alopecia areata
5. Oral zinc sulphate versus salicylic acid and lactic acid combination in the treatment of warts
6. Comparison of the efficacy & safety of 4% Hydroquinone alone and in combination with 8% Glycolic acid, in the treatment of melasma
7. Comparison of the efficacy & safety of topical 5% Minoxidil solution alone and in combination with 0.05% Betamethasone dipropionate cream, in the treatment of alopecia areata
8. Patch testing with European Standard Series
9. To determine the Frequency of Dermatitis Medicamentosa with the help of Patch testing
10. Role of Cryotherapy and Intralesional Steroids alone & in combination in Keloids
11. Oral Acyclovir vs Topical Acyclovir in the treatment of Recurrent Genital Herpes
12. Comparison of Crytherapy vs Topical Podophyllotoxin in the treatment of Anogenital Warts
13. Metabolic Syndrome in Psoriasis.
14. Role of IPL in Hirsutism.
15. Role of IPL in Hyperpigmentary Disorders.

Patch Test Clinic

Patch test clinic, also first of its kind countrywide, started functioning in 1994. Patch testing is the only scientific way to confirm the diagnosis of allergic contact dermatitis. It helps in the identification of cause and hence in the management of allergy. So far, almost 1500 patients have been tested while around 10,000 patients have been treated as follow up cases.

Laser Clinic

In 1995, LASER unit was established for the treatment of vascular and pigmentary disorders of skin which were hitherto untreatable. The use of laser surgery in dermatology is the first of its kind in Pakistan where patients with diseases like freckles, lentigines, pigmented nevi and vascular blemishes are treated. The cost of single laser treatment in UK or US is Rs. 30,000 to 40,000 besides traveling and boarding expenses. Usually, four to six visits are needed at monthly interval. IPL (Intense Pulsed Light) was added in this unit in 2008 for the treatment of hirsutism in the poor patients. In 2013, three new gadgets i.e. CO2 Laser, Q-Switched Laser & Blue Light were installed to help the needy & suffering community.

Teaching Microscope

In 2014, a state of the art Multi-head Teaching Microscope was provided by the University alongwith some advanced facilities like an LED to display an enlarged image of the slide for large number of students. A latest camera was also provided to take a picture of the slide for future study and examinations.

Leprosy Cell

Leprosy Cell, Mayo Hospital, Lahore is a well established regional centre. This cell was established in 1972. This unit is working in collaboration with an NGO i.e. Rawalpindi Leprosy Hospital with a hope to control leprosy. It caters for the patients coming from all over Pakistan particularly Punjab including Lahore, Sheikhupura, Kasur, Okara, Sahiwal, Gujranwala, Gujrat, Sialkot, Narowal districts and Azad Kashmir. Leprosy is a chronic infectious Mycobacterial disease which particularly affects the skin, nerves and eyes. The disease results in mutilating deformities and disabilities leading to strong social stigma. The centre also offers domiciliary treatment, health education, social rehabilitation and advice regarding eye care to these patients.

The disease is endemic in Pakistan. Although, the overall prevalence rate is below 1 in 1000, the incidence of disease is still over 1 in 10,000. At present, 1100 patients are registered here. The total burden of the disease in Pakistan is around 40,000 to 60,000 patients. Of this load, 14% patients belong to Punjab. About 25% of patients present with deformities and disabilities. This high rate is due to the delay in the diagnosis and management of leprosy.

Dermatosurgery

In the present era of rapid technological advances, dermatosurgery has become an essential component of dermatology. Our department has a well-equipped operation theatre where sophisticated procedures like punch grafting for resistant cases of vitiligo, dermabrasion for recalcitrant hyperkeratotic skin disorders, cryotherapy for warts and other conditions and chemical peeling for resistant melasma are carried out. This centre has the potential to act as a nucleus for the dermatologic surgery in the country.

Mycology & Histopathology

The Departmental Laboratory is equipped with facilities for dermatohistopathology and mycology, in addition to basic haematology and biochemistry tests. This laboratory is perhaps the best departmental facility in the country. On an average, about 10,000 tests are performed annually.

Photochemotherapy

In the Photochemotherapy unit, ultraviolet A and B lights are used for the treatment of chronic skin disorders like vitiligo, psoriasis and mycosis fungoides (a type of skin malignancy). This facility is, also, the only one of its kind in government sector in Pakistan.

Library, Audio-visual Section, Computer Section, Auditorium

The department has a well-maintained library, audiovisual section, computer section and a well-equipped auditorium with a seating capacity of 60 persons. Through these facilities, the department is actively involved in teaching the undergraduate and post-graduate medical students, nurses and general practitioners.