Dr Muhammad Abrar

07/05/2026

2 years Old Child developed these Violaceous Vesiculo-bullous lesions from last 4 days after got bitten by a Sheep.

Diagnosis: orf

Orf (or contagious ecthyma) is a contagious zoonotic virus, specifically a parapoxvirus, that causes skin lesions (nodules or pustules) in sheep and goats, often known as "sore mouth".
It spreads to humans through direct contact, typically resulting in a single, painful, blood-tinged papule on the hands or arms that self-resolves within 3–6 weeks.

What Causes Orf (Disease)Viral Agent: The disease is caused by the orf virus, a member of the Parapoxvirus genus within the Poxviridae family.

Transmission: Humans contract the virus from infected sheep or goats, particularly lambs, or contaminated materials (fomites).Occupation: It is primarily an occupational disease affecting farmers, veterinarians, butchers, and shearers.

Animal Symptoms: In animals, it causes pustules on the lips, muzzle, and nostrils, making it difficult for them to eat.Orf Disease Symptoms in HumansOrf lesions usually appear 3–8 days after exposure.Initial Stage: A small, firm, red or reddish-blue lump (papule) appears.Progression: The lesion develops into a flat-topped, blood-tinged pustule or blister (target-like lesion).

Location: Usually occurs on fingers, hands, or forearms.Systemic Symptoms: Sometimes accompanied by mild fever, malaise, and swollen lymph nodes.Healing: The lesion generally heals without scarring, typically within 6 weeks, and rarely requires surgical intervention.

Treatment and Management

Self-Limiting: Orf is self-limiting and usually resolves without specific treatment.

Care: Keep the lesion clean and covered to reduce the risk of secondary infection.

Secondary Infection: Antibiotics may be necessary if a secondary bacterial infection occurs.

Vaccine (Animals): There is a live virus vaccine (e.g., Scabigard) used in the UK for sheep and lambs to reduce clinical signs, but it is not for human use.

26/04/2026

Piezogenic papules
are common, soft, skin-coloured papules found on the feet and wrists. They result from herniation of fat through the dermis. The name 'piezogenic' refers to the origin of the papules being pressure.
Piezogenic papules are mostly asymptomatic and are noticed incidentally. Occasionally they may be painful.
No treatment is required in the absence of symptoms.
For painful lesions, conservative management may include:
Restriction of weight-bearing exercise
Weight loss
Compression stockings
Foam rubber foot pads, or foam-fitting plastic heel cups

Intralesional corticosteroid injections have been documented to provide some relief for patients with piezogenic papules with underlying Ehlers-Danlos syndrome.
Surgical excision may be helpful if symptoms persist despite above managements but this is rarely necessary.

Muhammad Abrar.

01/04/2026

PPI (Risek,Nexum,etc) curse
I have seen numerous patients taking PPI on daily basis (many renowned consultants have been giving them ppi’s again and again and patients are taking these ppi’s for months and even in some cases for years)
I have previously made a detailed video on the
S/E of PPI if we take them for a long time
https://vt.tiktok.com/ZSH238pp2/
However today i wanted to discuss that how would we discontinue this PPI as stoping abruptly is not an option as pt will come with Rebound Acid Hypersecretion (RAHS) after stopping long-term PPI therapy.
After months–years of PPI use:
• Gastrin levels ↑ (hypergastrinemia)
• Parietal cells become hyperstimulated
‘’When PPI is stopped suddenly → acid rebounds above baseline
→ Patients develop:
• Severe heartburn
• Dyspepsia
• Acid regurgitation
• Sometimes mistaken as “disease recurrence”

🌼This typically occurs within 1–2 weeks of stopping🌼

How to safely stop PPIs
✅ 1. Step-down approach
If patient on Omeprazole 40 mg OD:
1. Reduce dose:• 40 → 20 mg OD (2–4 weeks)
2. Then: • 20 mg alternate day (2–4 weeks)
3. Then: Stop

✅ 2. Switch to H2 blocker (bridge therapy)
• After tapering PPI:• Start Famotidine 20–40 mg OD/BID
👉 Helps blunt rebound acid
✅ 3. On-demand PPI (instead of daily)
• Use only when symptoms occur
• Good for mild GERD patients
✅ 4. Add supportive meds during withdrawal
• Antacids (PRN)
• Alginates (e.g., Gaviscon) → very effective for reflux
• Sucralfate (short term mucosal protection)

⭕️When NOT to stop PPI (continue long-term)
Some patients actually need lifelong PPI:
• Severe erosive esophagitis (LA grade C/D)
• Barrett’s esophagus
• Chronic NSAID users (high risk)
• Zollinger-Ellison syndrome
• Recurrent peptic ulcer / GI bleed

*Dr Muhammad Abrar karamat*

261 likes, 24 comments. “معدے والے کیپسول کو زیادہ دیر تک استعمال کرنے کے نقصانات۔ Side effects of long term use of PPI (Risek)”

30/03/2026

Numerous tiny, monomorphic, skin-colored to whitish papules
• Follicular-based (each lesion centered around a follicle)
• Diffuse over trunk
• No erythema, vesicles, crusting, or excoriated papules
• Gives a “gooseflesh / sandpaper” texture

🧾 Lesion description
• Primary lesion: Papules
• Size: 1–2 mm
• Type: Follicular keratotic papules
• Color: Skin-colored to hypopigmented
• Surface: Rough, keratinous plug
• Distribution: Generalized (predominantly trunk)
• Arrangement: Discrete, monomorphic, folliculocentric

🧠 Most Likely Diagnosis

✅ Generalized Keratosis Pilaris (KP)

⸻

❗ Why KP fits best
• Follicular, uniform papules
• “Dry skin + rough feel” pattern
• No inflammatory signs
• Common in children
• Can be itchy (especially in winters/dry skin)

⸻

⚠️ Close Differentials (ruled out clinically)

❌ Lichen spinulosus
• More grouped plaques, spiny feel → not seen clearly here

❌ Phrynoderma (Vit A deficiency)
• Usually extensor limbs + malnutrition signs

❌ Miliaria rubra
• More erythematous, acute, sweating-related

❌ Folliculitis
• Would show pustules/inflammation

⸻

💊 Treatment (Practical Pediatric Plan)

🔹 1. Emollients (Cornerstone)
• Thick moisturizers:
• Liquid paraffin / white soft paraffin
• Apply 2–3 times daily

⸻

🔹 2. Keratolytics (mild for child)
• Urea 10–20% OR
• Ammonium lactate 12%

👉 Once daily at night initially

⸻

🔹 3. For itching
• Mild steroid:
• Hydrocortisone 1% short course (5–7 days)
• OR oral antihistamine if needed

⸻

🔹 4. Gentle skin care
• Avoid harsh soaps
• Lukewarm baths
• Pat dry, immediate moisturization

⸻

🚫 Avoid
• Strong keratolytics (high salicylic acid) in child
• Overuse of steroids

⸻

💡 Clinical Pearl

KP is:
• Chronic + benign
• Improves with age
• Relapses common in winter

⸻

📌 Simple Prescription
• Moisturizer → TDS
• Urea 10% lotion → HS
• Hydrocortisone 1% → OD × 5 days (if itchy)

Dr Muhammad Abrar