PATIENT CARE

 

OUTPATIENT SERVICE

Daily skin O.P.D. from 8.30 AM - 12.30 PM

 

INPATIENT SERVICES

No. Of wards

Male - 1 (Ward 1)

Female - 1 (Ward 19)

Paediatric - 1 (Ward 21-22)

SPECIAL CLINIC ACTIVITIES:

Time - 8.30 AM to 12.30 PM

Leprosy Clinic : Monday & Wednesday

Connective tissue disorder clinic :Tuesday

Steroid follow up clinic : Tuesday

Contact dermatitis clinic : Tuesday

Psoriasis clinic : Wednesday

Hair disorder clinic :Thursday

Vitiligo clinic :Thursday

STI follow up clinic : Friday & Saturday

Gonodermatoses clinic : Wednesday

Dermatoplastic clinic : Wednesday

Cryotherapy and chemical peels : Saturday

Phototherapy : All days except Sunday

SPECIAL CLINICS ACTIVITIES WITH PATIENT CARE FACILITIES

I.     LEPROSY CLINIC

Patients with hypopigmented & hypoaesthetic patches are evaluated in Hansen's clinic based on clinical parameters like thickened nerves, morphology of patches, deformities & tropic ulcers and bacteriological parameter like positive slit skin smears for bacteriological & morphological indices. Depending on the above the patients are classified according to Ridley -Jopling's classification into paucibacillary and multibacillary cases and are treated accordingly.

Treatment protocol:

      MDT-MB for one year in cases with more than five patches &/ or more than two nerves/ or positive smears. Surveillance period -5 years.

      MDT-PB for six months in cases with less than 5 patches &/or one nerve &/or smear negative cases. Surveillance period-2 years.

      ROM single dose for single patch.

      Referring of patients for continued therapy to treatment center near their residence

      Treatment of reactions in leprosy

      Referring patients to Acworth Leprosy Hospital for MCR footwear

      Co-ordination with physiotherapists & plastic surgeons for management of deformities

II. STEROID FOLLOW UP CLINIC

The most commonly encountered Vesiculobullous disorders are pemphigus vulgaris, bullous pemphigoid, linear IgA dematosis, erythema multiforme, and dermatitis herpetiformis & cicatricial pemphigoid.  Patients are valuated with regards to duration & episode of disease, causes of relapse, past & present treatment, morphology lesions, scoring of skin & mucosal lesions.

Investigation

Routine biochemical analysis

Ophthal examination

Bone densitometry

Specific investigations

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Tzanck smear

 

 

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Histopathology

 

 

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Direct Immunofluorescence

 

 

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Indirect Immunofluorescence

 

 

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ELISA for Desmoglein 1 & 3

Treatment protocol

Prednisolone (2 mg/kg) with cyclophasphasmide (2 mg/kg)

Prednisolone (2 mg/kg) with IV gamaglobulin (20 mg/kg X 3 days in a month)

Prednisolone (2 mg/kg) with Dapsone

Monthly IV pulse therapy of dexamethasone 100 mgX3 days and cyclophasphasmide 500 mg once

 

 

III.         CONTACT DERMATITIS CLINIC

 

Various eczematised dermatoses including housewife eczema are recurrent and resistant to treatment.  In such situation a patch test is important role in diagnosing suspected allergens.  Such patients are evaluated with reference to duration of disease, exacerbating factors, history of atopy or allergy in the patient & his family, site & morphology of skin lesions.

Investigation

Patch testing with universal/shoe/cosmetic/plant series

Treatment protocol

Systemic & topical steroids

Barrier cream

 

IV. HAIR CLINIC

 

In this clinic patients of alopecia areata, alopecia universals, alopecia totalis, cicatricial alopecia & patients with diffuse hair loss are evaluated with reference to duration of hair loss, precipitin factors, history of atopy, vitiligo, hypertension, diabetes & tuberculosis, morphology along with pattern of hair loss.

Investigation

PhotoTrichogram

Routine biochemical analysis

X-ray chest

Mountex test

Ultra sound of pelvis & abdomen

Serum free testosterone

Thyroid function tests

Biotinidase level

Phototrichogram

Serum ferritin level

Treatment protocol

Minipulse therapy with Betnesole forte tablet 5 mg/week

88% phenol application once in 3 weeks

Application of Anthralin

Tablet biotin in-patients with low levels of Biotinidase

Treatment of cicatricial alopecia: Plastic surgical scalp reduction

Treatment of diffuse of hair loss: Oral finasteride 1 mg/day

Topical 5% minoxidil

Topical 2% minoxidil in female pattern hair loss

 

III.         VITILLIGO CLINIC

 

As Vitiligo is a common & socially disabling disease requiring special attention to the patient with regards to social & psychological support, treatment & a prolonged follow up a separate vitiligo clinic was started in June 2001.

Protocol followed in this clinic is detailed cutaneous & examination with regards to morphology, Ophthalmologic examination to look for uveitis, irits, iridocyelitis, choroidal & retinal pigment abnormalities, ENT examination for evidence of deafness.

Investigations:

A complete blood counts

Blood sugar

X-ray chest

Renal & Liver function tests

Thyroid function test

Antigliadin antibodies

Antipariental cell AB

Serum Vit B12 level

Duodenal biopsy in cases of raised antigliadin antibodies

Treatment protocol:

Mini-pulse therapy with betnesol forte 5mg per week

Oral & topical PUVA therapy

Topical steroids

Placentrex lotion

 

IV. PSORIASIS CLINIC

 

In this clinic patients of psoriasis are valuated with regards to duration, site & progression of disease, factors for exacerbating & remissions, family & personal history, cutaneous exacerbating with calculation of baseline psoriasis area severity index.

Investigation:

A complete blood counts

Blood sugar

X-ray chest

Renal & Liver function Tests

Antigliadin antibodies

Duodenal biopsy in cases of raised antigliadin antibodies

Skin biopsy

Treatment protocol:

Oral Methotrexate

Topical &/ systemic PUVA therapy

Topical &/ systemic steroid

Topical emollients

Gluten free diet in-patients with raised antigliadin antibodies

 

V.    STI FOLLOW UP CLINIC

 

Patients with high risk factors are screened for HIV infections.  Infected patients are evaluated with regards to social, family history, physical examination.

Investigation

Complete haemogram

Routine biochemical analysis

X-ray chest

Mountex test

Ultra sound for pelvis & abdomen

CD4/CD8 count

Viral load

Mobilized sputum study for fungi, PCP, APB, routine culture

CT Scan +- MRI

Tissue biopsy

Treatment protocol

Protenex powder

Fluconazole

Acyclovir

Higher oral IV antibiotics

Anti TB drugs

 

VI. STD CLINIC

Investigation

Dark ground microscopy

Gram stain

Tzanck smear

Gonococcal culture

PCR for Chancroid, syphilis, HSV

PCR for Chlamydia and gonococci

 

VII.        GENODERMATOSES AND PEDIATRIC DERMATOLOGY CLINIC

 

Many genetic conditions are recognized due to their multiple cutaneous manifestations.  Therefore Dermatology Department decided to initiate a clinic to give special attention to these cases, as they require elaborate and highly specialised investigations to reach the final diagnosis.  Hence the special clinic of Gonodermatoses and pediatric Dermatology was started in June 2001.  The clinic has set up protocols for recording the data and has Dr. Anil Jalan, a Geneticist as an advisor.  We have received encouraging response from various departments especially the Paediatrics and neonatology. The biochemistry department has given invaluable support to undertake biochemical tests for inborn errors of metabolism.  In a short span, we have picked up elusive cases such as partial Biotinidase deficiency, homocystinuria, Hartnup's disease and many more rare cases.  We intend to collaborate with other centers for Specialised tests within and outside the country.

 

VIII.     DERMATOSURGERY CLINIC

Various condition in dermatology especially malignant and vascular tumours require surgery as modality of treatment. Surgeries are also carried out for diagnostic, therapeutic & cosmetic purposes. Minor surgical procedures are done in dermatology O.P.D. like biopsies, mole removal etc, while procedures requiring cosmetic expertise, lesions requiring deeper and complete removal like malignancies are referred to plastic surgeon. Dermatosurgery clinic is run in association with plastic surgery Dept. Patients presented with vascular tumours, carcinomas, cicatricial alopecia are evaluated by team of plastic surgeons and treated accordingly. A detailed record of patients likes name, age etc., photographic evidence and long-term follow up is maintained.

 

IX. INTEGRATED HIV CLINIC

 

Integrated HIV clinic was started with the intention of providing comprehensive care for HIV patients under one roof thus ensuring complete medical care.  This clinic is run on every Monday in O.P.D. 6.  In this clinic doctors from all faculty of medicine examine the patients and the patients are referred for specialized services accordingly.

 

X.    PHOTOTHERAPY CLINIC

Various dermatoses in skin are chronic in nature and difficult to treat like psoriasis, vitiligo, alopecia etc.  At times these dermatoses do not respond to the normal modalities of treatment.  Phototherapy which utilizes light (UVA & UVB) as a therapy is found to be a boon for the above mentioned dermatoses giving excellent results.  This clinic was started at skin OPD 16 for treating various dermatoses like generalized vitiligo, chronic plaque type psoriasis, atopic dermatitis, mycosis fungoides etc.

 

XI. CRYOTHERAPY

Liquid Nitrogen has been used to treat various benign and malignant conditions with good results.  Patients presenting with warts, keloid, seborrheic keratosis etc are subjected to liquid nitrogen therapy i.e. cryotherapy every Saturday in Skin OPD with good results.