High Frequency Of Thyroid Dysfunction In Indian Patients With Vitiligo

This study was carried out to look for any association of vitiligo with autoimmune thyroid disease and to find out clinical characteristics of vitiligo, which may predict such an association. Thirty-five consecutive cases of vitiligo were enrolled for this study. Besides recording the clinical features of vitiligo and thyroid disease, antithyroid autoantibody assays (anti-thyroglobulin, anti-TPO) and thyroid hormone profiles were done in these cases and 30 appropriately age and sex matched controls. Radioactive iodine uptake (RAIU) thyroid scintiscan was done for all the cases and controls. Amongst the vitiligo cases, vitiligo vulgaris was the commonest type (45.70%), while mucosal vitiligo constituted 22.8% of the cases. No patient was found to have thyroid disease clinically; however, on assays, thyroid abnormality (endocrine, immunological or both) was found in 57.1% of the cases as against 10% of the controls (p<0.05). Autoantibody positivity was found in 31.4% of the cases as against 10% of the controls (p<0.05). Biochemical abnormality (predominantly hyperthyroidism) was found in 40% of the cases as against 6.7% of the controls (p<0.05). Four patients with hyperthyroidism showed diffuse increase in uptake on RAIU scan and autoantibody positivity, thus were diagnosed as Grave's disease. An early age at onset was found in patients with thyroid disease. Mucosal vitiligo was found in 35% of the cases with thyroid dysfunction as against 6.7% in those without (p<0.05) which was the most unique finding of the study. To conclude, we would like to stress that patients with vitiligo should be screened for thyroid dysfunction, especially those with mucosal vitiligo.

Cutaneous Manifestations Of Hepatitis B And C Virus Infections: A Study Of 100 Cases

Infection with hepatitis viruses, especially B and C, is a major public health problem in many countries. One hundred consecutive patients with these infections were studied for cutaneous abnormalities. Females were more commonly affected. Recurrent/chronic vascular changes (92%), urticaria (72%), leucocytoclastic vasculitis (36%), erythema nodosum (28%), Gianotti-Crosti syndrome (12%), lichen planus (8%), pyoderma gangrenosum (2 patients) and dermatomyositis like syndrome (1 patient) were the prominent cutaneous abnormalities noted in patients with hepatitis B. Likewise, the prominent skin abnormalities notes in hepatitis - C patients were vascular changes (82.2%), chronic urticaria (60.0%), xerosis of skin (56.6%), leucocytoclastic vasculitis (40%), erythema multiforme (23.3%), Sjogren's syndrome (13.2%), recurrent erythema nodosum (19.8%) and Behcet's syndrome in a single case. Extensive subcutaneous fat atrophy of the face in one case and diffuse hyperpigmentation in 5 cases were the two interesting features noted in our patients, which have not been reported earlier. The pertinent literature is briefly reviewed in the light of above findings.

Psoriasis In Eastern Nepal: Clinical Profile And Patient's Beliefs About The Disease

The purpose of the study was to know the clinical profile of psoriasis and also to assess patient's beliefs about their disease. A total of 210 patients with psoriasis was studied. The patients above 16 years of age were also subjected to Illness Perception Questionnaire (IPQ). Psoriasis vulgaris was the commonest type of psoriasis. The strongest belief of the patients in the causation of psoriasis was germs or virus (74.8%). A majority of patients believed that psoriasis had a major consequence on their lives (81.4%) and that psoriasis was a serious condition (82.9%). Women were significantly more likely to believe that their psoriasis had severe consequences on their lives. The majority of patients believed their psoriasis was more likely to be chronic (63.8%) or recurrent (70.8%). Eighty percent of patients believed that their psoriasis would improve with time and 82.9% believed that there was a lot that they themselves could do to control their condition. The most commonly reported symptoms were "skin flaking" (89.5%) followed by "itching" (81%). The overall PASI was not associated with patient's beliefs.

Morphological And Pigmentary Variations Of Tinea Versicolor In South Indian Patients

In general, tinea versicolor is thought to cause hypopigmented lesions in individuals with dark skin and hyperpigmented lesions in those with white skin. This view has come under scrutiny and hence we undertook the current study. It was a descriptive study based on a sample size of 100 patients of tinea versicolor, who attended the skin OPD of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry. These patients were recruited during the peak period. The age of patients ranged from 1 to 88 years with a mean age of 26.25 ± 5.23 years. Six cases occurred in children. Majority of cases (59%) occurred in the age group of 15-29 years, followed by 30-44 years (23%) and 45-60 years (9%). There were 81 males and 19 females with male to female ratio of 4.26:1. Trunk especially upper trunk was the predominant site involved (75 cases), followed by neck (45 cases), face (41 cases), upper limb (34 cases) and lower limb (9 cases). Majority of cases had hypopigmented macular lesions (84%), followed by hyperpigmented type (9%), combination of both (6%) and erythematous type (1%). Hyperpigmented variety of tinea versicolor was observed only in males (either alone or in combination with hypopigmented variety). To conclude, from our study, we could say that all types of pigmentary variations in tinea versicolor are present in South Indian patients with a predominance of hypopigmented ones. Moreover, both types of pigmentary anomalies can occur simultaneously in any individual case.

Superficial Granulomatous Pyoderma

Superficial granulomatous pyoderma is an uncommon, benign, superficial variant of pyoderma gangrenosum, having granulomatous histological features and no systemic association. We describe 6 Indian patients with superficial granulomatous pyoderma. In two patients, the ulcers developed due to traumatization of an existing scar. We would like to highlight that superficial granulomatous pyoderma must be considered whenever confronted by a chronic, non-tender, superficial ulcer with vegetative margins, especially if it is situated at the previous site of a surgical trauma or burn scar. Recognition and differentiation of this condition from pyoderma gangrenosum is important as many of the investigations can be avoided and the condition can be managed quite easily by early treatment with systemic corticosteroid.

Survey Of Food Handlers For Dermatological Problems

Occupational health problem in food handlers have become increasingly common in the recent years. Forty three workers, cooks and bakers were surveyed for work related problems. We noticed watering and burning of eyes in 18%, running nose in 13.95%, burning sensation of hands in 11.6%, excessive sweating in 4.65%, chronic paronychia in 11.6%, palmar hyperkeratosis in 9.3%, fissuring of distal finger tips, nail dystrophy, multiple warts in 6.9%, scaling of hands, prurigo simplex in 2.3%.

Onychomatricoma

Onychomatricoma is a rare tumor of the nail matrix. A 28 year male presented with asymptomatic gradual appearance of yellowish discoloration and thickening of lateral part of nail of the right index finger of 4 years duration. On examination, a yellow longitudinal band of discoloration involving medial one third of the nail was seen over the index finger of the right hand. The affected part of the nail was thickened and showed over curvature and longitudinal riding. Histopathology showed fibroepithelial elements, confirming the diagnosis of onychomatricoma.

Lepromatous Leprosy With Scrotal Nodules

Scrotal skin involvement in leprosy is relatively uncommon. A 27 year old male presented with multiple, skin colored papules and nodules on the face, trunk, forearm, thighs and scrotum with bilateral symmetrical nerve thickening of 4 months duration. Histology of scrotal skin lesion showed features of lepromatous leprosy and skin smear for AFB was positive.

Penile Papulonecrotic Tuberculide

A 38 year old male presented with an eight year history of recurrent papular eruptions followed by ulceration and scarring on glans penis. Based on histopathological examination, a diagnosis of papulonecrotic tuberculide was made. The lesions regressed after one month of antitubercular multidrug therapy and there was no recurrence of lesions since five months of further antitubercular treatment.

Rothmund - Thomson Syndrome

Rothmund-Thomson syndrome is a rare geno-photodermatosis of children. Poikilodermatous cutaneous changes, growth retardation, juvenile cataract and high incidence of malignancy are its classical features. A Thomson type of Rothmund-Thomson syndrome with characteristic poikiloderma congenitale, growth retardation, absence of juvenile cataract and parental non-consanguinity is described in an 8 year old Indian girl.

Penile Shaft: An Unusual Location For Skin Tags

Skin tags or acrochordons, commonly observed in the flexural surfaces and various folds of skin, are more frequently encountered in presence of obesity, diabetes and old age. Although lesions are quite characteristic clinically, at times these need to be differentiated from warts, fibromas and other benign tumors of skin and their appendages. A rare case with presence of skin tags over the shaft of penis is described.

Chronic Disseminated Histoplasmosis

A 55 year old HIV negative, controlled diabetic, male suffering from recurrent oropharyngeal ulcer for last 4 years, has recently developed papules and nodules predominantly on face and a few on upper trunk, arms and macrocheilia for about last 3 months. Some papules resembled molluscum contagiosum. His palms showed significant erythema. Multiple ulcerative nodules were visible on tongue and buccal mucosa. Histopathology revealed intracellular and extracellular yeast of Histoplasma capsulatum by PAS stain. The patient had no involvement of internal organs. He never travelled to endemic area but had exposure to a domestic 'moina' bird for last 6 years. The subject responded well to oral itraconazole 400 mg daily for 8 weeks followed by a maintenance therapy with 200 mg daily for another 8 weeks.

Bullous Congenital Ichthyosiform Erythroderma - PS 1 Type

We describe a case of bullous congenital ichthyosiform erythroderma (epidermolytic hyperkeratosis) with severe transgradient type of palmoplantar keratoderma. It occurred in a thirty year old man, who was born out of first degree consanguineous marriage. Our case had epidermolytic hyperkeratosis probably of subtype PS-1, however, transgradient palmoplantar keratoderma in this patient was a peculiar manifestation.

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Scrotal Calcinosis Presenting As Nodular Masses: A Report Of 4 Cases

Dharitri Bhat, Sanjay Parate, S K Bobhate

Scrotal calcinosis is characterized by multiple nodular masses within the scrotal skin, slowly increasing in size. The pathogenesis is obscure and is viewed by many to be idiopathic or can result from dystrophic calcification of epidermal cysts. We report 4 cases of scrotal calcinosis presenting as multiple nodules over scrotal skin.

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Trichotillomania Below Two Year Of Age

Balwinder Kaur Brar, Anuj Pall, Rajesh Rani Gupta

Trichotillomania is the compulsive habit that induces an individual to pluck hair repeatedly. Psychotherapy or psychoanalysis offers the best long-term prognosis for trichotillomania. We report two cases of trichotillomania in children less than two years of age because of its rarity.

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Xanthoma Tendinosum And Familial Hypercholesterolemia

Vikram K Mahajan, N L Sharma, Sandeep Sood

A 40 year old female presented with multiple tendon xanthomas over extensor tendons of hands and feet, xanthelasma palpebrarum, arcus corneae and early atherosclerosis of retinal vessels. Investigations revealed normal triglycerides, very high plasma cholesterol and LDL levels, consistent with familial hypercholesterolemia (Fredrickson type lla). A work-up for cardiovascular involvement was normal and biopsy from one of the nodules showed xanthoma cells.