Dr Muhammad Sajjad

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Here’s a structured management approach for Lichen Planus (LP):---🔹 General PrinciplesLichen Planus is a chronic inflamm...
24/09/2025

Here’s a structured management approach for Lichen Planus (LP):

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🔹 General Principles

Lichen Planus is a chronic inflammatory condition affecting skin, mucous membranes, nails, and scalp.

Cause: Immune-mediated (T-cell mediated response), sometimes associated with hepatitis C, drugs, or stress.

Aim: Relieve symptoms, heal lesions, prevent recurrence/complications.

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🔹 1. General Measures

Reassurance (often self-limiting in 1–2 years for cutaneous lesions, but mucosal/nail/scalp involvement may be chronic).

Identify and remove triggers (e.g., offending drugs, dental amalgam, hepatitis C).

Gentle skincare, avoid trauma (Koebner phenomenon).

For oral LP: stop smoking, avoid spicy/acidic food, alcohol.

Good oral hygiene.

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🔹 2. Topical Therapy (First-line for localized disease)

Topical corticosteroids (high-potency, e.g., clobetasol propionate) – mainstay.

Topical calcineurin inhibitors (tacrolimus, pimecrolimus) – especially useful for oral/ge***al LP.

Topical retinoids (tretinoin, adapalene) in resistant cases.

Antihistamines (e.g., hydroxyzine, cetirizine) for pruritus.

Emollients for skin comfort.

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🔹 3. Systemic Therapy (For widespread, severe, or resistant LP)

Oral corticosteroids (short course of prednisolone).

Systemic retinoids (acitretin, isotretinoin) for cutaneous LP.

Immunosuppressants (azathioprine, mycophenolate mofetil, methotrexate, cyclosporine) in refractory cases.

Hydroxychloroquine (sometimes useful in mucosal/nail LP).

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🔹 4. Phototherapy

Narrow-band UVB or PUVA for widespread cutaneous LP.

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🔹 5. Special Site Management

Oral LP: Topical corticosteroids (clobetasol, fluocinonide gel, triamcinolone paste), tacrolimus ointment; intralesional steroids for localized lesions.

Ge***al LP: Similar topical regimen, avoid irritants.

Scalp (Lichen Planopilaris): Potent topical steroids, intralesional triamcinolone, systemic agents to prevent scarring alopecia.

Nails: Intralesional steroids (triamcinolone), systemic therapy in severe cases.

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🔹 6. Follow-up & Complications

Monitor for oral squamous cell carcinoma (rare but important in oral LP).

Long-term follow-up for mucosal, scalp, and nail disease.

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✅ Summary:

Localized disease → topical corticosteroids + antihistamines.

Extensive/refractory → systemic steroids, retinoids, or immunosuppressants.

Oral/ge***al lesions → topical steroids or tacrolimus.

Phototherapy for generalized skin involvement.

Regular follow-up due to risk of malignant transformation (oral/ge***al).

Folliculitis = inflammation/infection of hair follicles. Management depends on severity, cause (bacterial, fungal, irrit...
24/09/2025

Folliculitis = inflammation/infection of hair follicles. Management depends on severity, cause (bacterial, fungal, irritant), and extent.

General Measures

Maintain good hygiene and keep affected area clean/dry.

Avoid shaving, tight clothing, or occlusion over lesions.

Use antibacterial soaps or mild antiseptic washes (e.g., chlorhexidine).

Topical Treatment (mild/localized)

Topical antibiotics: Mupirocin, fusidic acid, or clindamycin (for bacterial folliculitis).

Antiseptic creams/gels: Benzoyl peroxide.

Topical antifungals (if fungal/yeast suspected, e.g., pityrosporum folliculitis): Ketoconazole, clotrimazole.

Topical corticosteroids (short course, low potency) for irritant/sterile folliculitis (avoid in infection).

Systemic Treatment (moderate/severe/recurrent)

Oral antibiotics:

First line: Cephalexin, flucloxacillin, dicloxacillin.

If MRSA suspected: Doxycycline, clindamycin, or TMP-SMX (depending on local resistance).

Oral antifungals: Fluconazole or itraconazole (for fungal causes).

Special Cases

Hot tub folliculitis (Pseudomonas) → usually self-limiting, but ciprofloxacin may be used if persistent/severe.

Gram-negative folliculitis (often after long-term acne therapy) → requires oral antibiotics like ciprofloxacin.

Chronic/recurrent folliculitis → consider nasal mupirocin (for S. aureus carriage), antiseptic body washes, lifestyle modifications.

Supportive

Warm compresses for comfort.

Avoid scratching/picking to prevent secondary infection or scarring.

👉 If lesions are deep, spreading, associated with fever, or recurrent → dermatology or infectious disease referral is advised

Management of dark under fold areas Body folds such as underarms, groin, neck creases, or under the breasts. This is usu...
24/09/2025

Management of dark under fold areas

Body folds such as underarms, groin, neck creases, or under the breasts. This is usually due to friction, sweat, obesity, insulin resistance, or certain skin conditions. Here’s a structured management plan:

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🔎 Common Causes

Friction & sweat → intertrigo, post-inflammatory pigmentation

Acanthosis nigricans → linked with insulin resistance, diabetes, PCOS, obesity

Fungal infections → tinea cruris, candidiasis

Post-inflammatory hyperpigmentation → after rash, eczema, or irritation

Hormonal changes / medications → contraceptives, steroids

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🩺 General Management

1. Identify and treat cause

If overweight → gradual weight loss helps.

If diabetic/insulin resistant → strict sugar control.

If fungal infection suspected → topical antifungals (clotrimazole, terbinafine).

2. Skin care routine

Keep area clean and dry.

Use antifungal/antibacterial powders in sweaty folds.

Wear loose cotton clothes to reduce friction.

3. Topical treatments for pigmentation

Mild exfoliants: creams with lactic acid, glycolic acid, or salicylic acid (once daily at night).

Depigmenting agents:

Azelaic acid 10–20%

Kojic acid cream

Niacinamide serum (safe for sensitive folds)

Hydroquinone (only short-term, under doctor’s supervision).

4. For persistent or severe cases

Dermatologist may prescribe chemical peels (glycolic, lactic acid) or laser therapy.

If acanthosis nigricans → investigate blood sugar, insulin resistance, PCOS.

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⚠️ When to see a doctor

Rapid onset of darkening.

Associated with thickened, velvety skin (possible acanthosis nigricans).

Itching, pain, or foul smell (suggests fungal/bacterial infection).

Management of Heat Rash (Miliaria / Prickly Heat):Heat rash occurs when sweat ducts become blocked, trapping sweat under...
23/09/2025

Management of Heat Rash (Miliaria / Prickly Heat):

Heat rash occurs when sweat ducts become blocked, trapping sweat under the skin. It’s common in hot, humid weather and presents with red bumps, itching, or prickling sensation.

General Measures

1. Cool the skin:

Stay in a cool, well-ventilated, air-conditioned room.

Use fans to reduce sweating.

Take cool showers or sponge baths.

2. Reduce sweating and friction:

Avoid heavy exercise and strenuous activity in hot environments.

Wear loose, light cotton clothing; avoid synthetic or tight clothing.

3. Keep skin dry:

Gently pat (not rub) the skin dry after bathing.

Use light talcum powder or cornstarch powder to absorb sweat.

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Topical Treatments

Calamine lotion → relieves itching and soothes skin.

Zinc oxide lotion/cream → protective and soothing.

Low-potency topical corticosteroid (e.g., 1% hydrocortisone) → for severe itching and inflammation (short term only).

Topical anhydrous lanolin → can help prevent sweat duct blockage.

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Medications (if needed)

Oral antihistamines (e.g., cetirizine, loratadine) → for itching.

Antibiotics (topical or oral) → only if secondary bacterial infection develops (signs: pus, crusting, spreading redness).

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Prevention

Avoid hot, humid environments if possible.

Take frequent cool showers.

Keep rooms ventilated.

Use breathable fabrics and avoid heavy creams/oils that block pores.

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👉 Most cases resolve on their own within 2–3 days if overheating and sweating are reduced.
👉 See a doctor if rash is severe, recurrent, or shows infection signs

🌱Findings:- A well-defined cystic lesion measuring approximately 78 × 75 × 74 mm (volume ~232 ml) is noted in the right ...
23/09/2025

🌱Findings:-
A well-defined cystic lesion measuring approximately 78 × 75 × 74 mm (volume ~232 ml) is noted in the right lobe of the liver. The cyst cavity is filled with thick fluid showing internal echoes. A detached, irregular membrane is seen floating within the cyst contents, producing the characteristic “water lily sign”. No internal vascularity is demonstrated on Doppler study.

🌱Impression:- Ultrasound features are highly suggestive of a hepatic hydatid cyst with detached membrane (water lily sign).

management of Perioral Dermatitis (POD):---1. General MeasuresDiscontinue topical corticosteroids (most important trigge...
22/09/2025

management of Perioral Dermatitis (POD):

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1. General Measures

Discontinue topical corticosteroids (most important trigger). If needed, taper gradually to avoid rebound flare.

Stop use of heavy cosmetics, fluorinated toothpaste, or irritant skin products.

Use gentle cleansers (non-soap) and non-comedogenic moisturizers.

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2. Topical Treatments (first-line for mild disease)

Metronidazole 0.75–1% cream/gel, twice daily.

Clindamycin 1% lotion/gel, twice daily.

Erythromycin 2% gel, twice daily.

Azelaic acid 15–20% cream/gel.

Sulfur/sulfacetamide preparations (if available).

Topical calcineurin inhibitors (pimecrolimus, tacrolimus) may help if resistant or steroid-dependent.

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3. Systemic Treatments (for moderate–severe or resistant cases)

Oral tetracyclines (6–12 weeks):

Doxycycline 100 mg once or twice daily

Minocycline 100 mg once or twice daily

Tetracycline 500 mg twice daily

If tetracyclines contraindicated (e.g., children

Management of Pediculosis Capitis (Head Lice Infestation):---🔹 CauseCaused by Pediculus humanus capitis (head louse).Spr...
22/09/2025

Management of Pediculosis Capitis (Head Lice Infestation):

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🔹 Cause

Caused by Pediculus humanus capitis (head louse).

Spread by close contact, sharing combs, hats, bedding.

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🔹 Clinical Features

Intense itching of scalp (especially occipital and retroauricular areas).

Excoriations, secondary bacterial infection possible.

Nits (eggs) seen attached to hair shafts, usually within 1 cm of scalp.

Cervical lymphadenopathy sometimes present.

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🔹 Diagnosis

Direct visualization of live lice or nits.

Wet combing method improves detection.

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🔹 Management

1. General Measures

Avoid sharing combs, hats, towels.

Wash bedding, towels, clothes in hot water and dry on high heat.

Soak combs/hairbrushes in hot water (>60°C) for 10 min.

Check and treat family members/close contacts simultaneously.

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2. Topical Therapy (First-line)

Permethrin 1% lotion/cream rinse

Apply to washed, towel-dried hair, leave for 10 min, then rinse.

Repeat after 7 days to kill newly hatched lice.

Alternative agents:

Malathion 0.5% lotion (leave for 8–12 hrs, repeat after 7 days).

Benzyl alcohol 5% lotion (apply × 10 min, repeat after 7 days).

Dimethicone lotion (suffocates lice).

Ivermectin 0.5% lotion (single application, no need to repeat).

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3. Oral Therapy (Resistant/Refractory cases)

Ivermectin oral 200 µg/kg as a single dose, repeat after 7–10 days.

Not recommended for children

Management of Vaginal Yeast Infections (Vulvovaginal Candidiasis, VVC):---🔹 Causes & Risk FactorsOrganism: Candida albic...
22/09/2025

Management of Vaginal Yeast Infections (Vulvovaginal Candidiasis, VVC):

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🔹 Causes & Risk Factors

Organism: Candida albicans (most common), sometimes C. glabrata.

Risk factors: Antibiotic use, diabetes, pregnancy, immunosuppression, tight clothing, poor hygiene.

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🔹 Clinical Features

Intense vulval itching & burning

Thick, white, “cottage-cheese” discharge (odorless)

Vulval erythema, edema

Pain during urination or in*******se (dysuria, dyspareunia)

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🔹 Management

1. General Measures

Keep ge***al area clean and dry.

Avoid tight/synthetic underwear → prefer cotton.

Avoid perfumed soaps, douches, irritants.

Control diabetes, avoid unnecessary antibiotics.

Treat sexual partners only if symptomatic (not routinely).

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2. Antifungal Therapy

Topical (first-line for uncomplicated cases)

Clotrimazole 1% cream intravaginally once daily for 7 days

Clotrimazole 2% cream intravaginally once daily for 3 days

Miconazole 2% cream intravaginally once daily for 7 days

Nystatin vaginal tablets 100,000 units once daily × 14 days

Oral

Fluconazole 150 mg single oral dose (most common, convenient)

Itraconazole 200 mg orally BD × 1 day (alternative)

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3. Complicated / Recurrent VVC

Complicated = severe symptoms, non-albicans Candida, immunocompromised, pregnancy, or recurrent (≥4/year).

Severe VVC:

Fluconazole 150 mg PO every 72 hrs × 2–3 doses

Or topical azole for 7–14 days

Recurrent VVC:

Induction: Fluconazole 150 mg PO every 72 hrs for 3 doses

Maintenance: Fluconazole 150 mg once weekly × 6 months

Non-albicans Candida (e.g., C. glabrata):

Boric acid 600 mg vaginal capsule once daily × 14 days

Nystatin vaginal suppositories × 14 days

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4. Special Situations

Pregnancy: Topical azoles for 7 days (oral fluconazole is avoided).

HIV/immunocompromised: Longer therapy may be needed.

Management of Oral Candidiasis (Oral Thrush):🔹 TypesPseudomembranous – white, curd-like plaques (wipeable).Erythematous ...
22/09/2025

Management of Oral Candidiasis (Oral Thrush):

🔹 Types

Pseudomembranous – white, curd-like plaques (wipeable).

Erythematous (atrophic) – red, painful mucosa.

Chronic hyperplastic – white plaques, non-wipeable.

Angular cheilitis – fissures at mouth corners.

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🔹 General Measures

Maintain good oral hygiene.

Rinse mouth after inhaled corticosteroid use.

Control risk factors: diabetes, immunosuppression, antibiotics, dentures.

Soak dentures in antifungal solution overnight.

Avoid smoking, alcohol, irritants.

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🔹 Pharmacological Treatment

1. Topical Therapy (first-line for mild/moderate cases)

Nystatin oral suspension 100,000 units/mL → 5 mL swish & swallow QID for 7–14 days.

Clotrimazole troches 10 mg → dissolve in mouth 5×/day for 7–14 days.

Miconazole oral gel (where available).

👉 Continue treatment for at least 48 hours after symptoms resolve.

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2. Systemic Therapy (for severe, refractory, or immunocompromised patients)

Fluconazole 100–200 mg orally once daily for 7–14 days.

Itraconazole 200 mg OD for 7–14 days (if fluconazole not suitable).

Posaconazole or Voriconazole for resistant cases.

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3. Special Situations

HIV patients → systemic fluconazole preferred.

Recurrent cases → address underlying disease, consider longer prophylaxis.

Refractory disease → use itraconazole, posaconazole, or amphotericin B (rare).

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🔹 Supportive Care

Warm saline or antiseptic mouth rinses.

Analgesics for painful lesions.

Nutritional support if swallowing is difficult.

Herpes Simplex Virus (HSV) management🔹 Types of HSV InfectionsHSV-1 – usually oral (cold sores), but can cause ge***al i...
22/09/2025

Herpes Simplex Virus (HSV) management

🔹 Types of HSV Infections

HSV-1 – usually oral (cold sores), but can cause ge***al infection.

HSV-2 – usually ge***al herpes.

Can cause: mucocutaneous lesions, keratitis, encephalitis, neonatal herpes.

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🔹 Clinical Features

Primary infection: painful grouped vesicles on erythematous base, fever, lymphadenopathy.

Recurrent infection: milder, shorter duration, prodrome (tingling/burning).

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🔹 Management

1. General Measures

Keep lesions clean and dry.

Avoid touching/blisters → wash hands after contact.

Avoid kissing/sexual contact during active lesions.

Topical anesthetics (lidocaine gel) or oral analgesics (NSAIDs) for pain.

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2. Antiviral Therapy

(Antivirals reduce severity, duration, and recurrences; they do not cure)

For Primary Episode

Acyclovir 400 mg orally TDS (3×/day) for 7–10 days
or 200 mg 5×/day for 7–10 days

Valacyclovir 1 g orally BD (2×/day) for 7–10 days

Famciclovir 250 mg orally TDS for 7–10 days

For Recurrent Episodes

Best if started within 24 hours of symptoms

Acyclovir 400 mg orally TDS for 5 days

Valacyclovir 500 mg orally BD for 3–5 days

Famciclovir 125 mg orally BD for 5 days

For Severe / Disseminated / CNS Disease

Acyclovir IV 5–10 mg/kg every 8 hours for 10–14 days

For Suppressive (Long-term) Therapy

(If ≥6 recurrences per year or severe psychosocial distress)

Acyclovir 400 mg orally BD

Valacyclovir 500 mg orally OD (once daily) or 1 g OD

Famciclovir 250 mg orally BD

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3. Special Situations

Herpetic keratitis → urgent ophthalmology referral (topical antivirals, avoid steroids).

Neonatal herpes → IV acyclovir for 14–21 days.

Immunocompromised patients → longer courses, often IV therapy.

Hydrocortisone has more mineralocorticoid activity with mild Corticosteroids activity while Methylprednisolone has reduc...
22/09/2025

Hydrocortisone has more mineralocorticoid activity with mild Corticosteroids activity while Methylprednisolone has reduced mineralocorticoid activity and high corticosteroid activity.

Management of Dystrophic Eczema Dyshidrotic eczema (also called pompholyx) is a recurrent, chronic, and sometimes very i...
21/09/2025

Management of Dystrophic Eczema

Dyshidrotic eczema (also called pompholyx) is a recurrent, chronic, and sometimes very itchy form of eczema affecting the palms, sides of fingers, and soles, characterized by small vesicles/blisters.

Here’s the management approach:

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1. General & Lifestyle Measures

Avoid triggers: heat, sweating, prolonged water exposure, detergents, nickel/cobalt contact, and stress.

Skin care:

Use mild, fragrance-free cleansers.

Apply bland emollients (petrolatum, ceramide creams, urea, glycerin) frequently.

Protect hands/feet: cotton gloves under vinyl gloves for wet work; avoid latex and occlusive gloves for long periods.

Keep skin cool and dry: sweating often worsens flare-ups.

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2. Topical Therapy

High-potency topical corticosteroids (clobetasol, mometasone, betamethasone) during acute flares, usually short courses (1–2 weeks).

Topical calcineurin inhibitors (tacrolimus, pimecrolimus) as steroid-sparing agents, especially for long-term maintenance or steroid-sensitive areas.

Antiseptic soaks (e.g., potassium permanganate, dilute vinegar, Burow’s solution) for acute, weepy blisters.

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3. Systemic Therapy (for severe/refractory cases)

Oral corticosteroids: short course for severe flares.

Phototherapy: PUVA, narrowband UVB.

Immunosuppressives: methotrexate, azathioprine, mycophenolate mofetil, or cyclosporine in resistant cases.

Alitretinoin (oral retinoid) – licensed for severe chronic hand eczema unresponsive to topical treatment.

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4. Secondary Infection Management

Look for secondary bacterial infection (erythema, oozing, crusts) → treat with topical or oral antibiotics (flucloxacillin, cephalexin).

Antifungals if associated with tinea (rule out with KOH/microscopy when resistant).

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5. Patient Education

Condition is chronic and relapsing; treatment controls but doesn’t cure.

Stress management, good hand/foot care, and avoidance of irritants/metals are essential to reduce relapses.

Address

Sheikh Umer
Kot Addu

Opening Hours

Monday 09:00 - 17:00
Tuesday 09:00 - 17:00
Wednesday 09:00 - 17:00
Thursday 09:00 - 17:00
Friday 09:00 - 17:00
Saturday 09:00 - 17:00

Telephone

+923436358822

Website

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