Effect of environment on pediatric dermatoses

The environment has profound effect on the prevalence of dermatoses. The exposure to environment varies among different age groups particularly so among the pediatric age group. In the present study we assessed the prevalence of dermatoses among the pediatric population and an analysis was done with age as surrogate for environmental exposure.

Two hundred pediatric patients up to the age of 12 years were selected randomly from the dermatology OPD of a teaching hospital and the dermatosis was elicited. The subjects were classified into 3 categories: up to 1 year, 1 to 5 years and 6 to 12 years. Analysis of any difference in the prevalence of dermatoses among these three groups showed that, pyoderma was the most common dermatosis in the whole pediatric population and it increased significantly with increasing age (p<0.001). Pediculosis though absent during the first year of life, showed a similar trend (p<0.01) and was more frequent among females (p<0.01). However, seborrheic dermatitis, miliaria and candidiasis were more frequent in the lower age group (p<0.001). The results suggest a significant effect of environment on the prevalence of different dermatoses using age as a surrogate for environmental exposure.

Topical therapies in plaque psoriasis: a randomized comparative study

The present study was undertaken to assess the response of three topical regimes in patients of mild to moderate plaque psoriasis. A total of 90 patients were randomly divided into three treatment groups of 0.05% clobetasol propionate, coal tar 6% with salicylic acid 3% and methotrexate 0.25% in a hydroxy gel. The regimes were tried for 12 weeks and followed up for one year. The lesions were assessed for response in terms of psoriasis area severity index (PASI).

The results were analysed among 73 patients (49 males and 24 females) of age 12-65 years (mean 34.25 +10.65), which were similar with respect to age, sex ratio, duration of the disease and surface area involved (p>.05) among different treatment groups. Maximum fall in the PASI was seen with clobetasol propionate 79% (6.24 to 1.31), followed by coal tar 77.23% (5.9 to 1.34) and minimum with methotrexate 45.87% (5.08 to 2.75). To the contrary maximum relapse was seen with clobetasol propionate 20/25 (77%) followed by 11/26 (44%) with coal tar and minimum with methotrexate 4/22 (4%).

All the treatment regimes were effective in inducing remission in psoriasis but response with clobetasol and coal tar was better than with methotrexate. Relapse during follow up period was more common with clobetasol propionate.

HIV seropositivity among sexually high-risk groups - a 15 year study in Kolkata

A total of 6,519 commercial sex workers (CSW) and 2,242 sexually promiscuous persons (SPP) and 19,045 STD clinic attendees were screened between July 1987 and July 2002. All the blood samples were tested by ELISA for HIV. The ELISA reactive subjects were further tested for confirmation by Western Blot. Of STD clinic attendees 149 (0.78 %), of CSW 247 (3.78 %) and of SPP 637 (28.4%) were confirmed HIV sero-positive. Sampling age group was 15-45 years. Maximum screened were between 22-40 years. Our study revealed higher prevalence of HIV among the SPP followed by CSW and among the patients attending STD clinics in Kolkata. Infection appears to be remarkable in the age group 22-40 years.

Immunoprecipitation as a diagnostic tool in subepidermal blistering disorders

This study was done to validate the role of immunoprecipitation (IP) in the diagnosis of subepidermal blistering disorders. IP assay was done in 21 cases and 9 controls using a standard protocol. Thirty three percent of bullous pemphigoid, 33% of linear IgA dermatoses and 40% of CBDC precipitated the disease specific antigens. IP in controls (9) detected specific BP antigens in 3 and specific EBA antigens in 2. This study highlights the high specificity but low sensitivity of IP test in subepidermal blistering disorders.

Masson's tumor - a lesion of uncertain histogenesis

Masson's tumor is a rare vascular lesion. It is of interest to pathologists due to its doubtful histogenesis (reactive or neoplastic) and also because of its close resemblance to angiosarcoma histologically. Clinical profile of five cases of Masson's tumor is presented in this series. Issues regarding its origin and distinguishing features from angiosarcoma are also discussed.

Tophaceous gout : a rare case with nasal perforation

Gout is a disease caused by persistent hyperuricemia leading to deposition of urates in the bones and tissues. In the absence of treatment, the typical initial attack of arthritis evolves towards chronic tophaceous gout. Tophaceous gout along with subcutaneous lesions is rarely seen today. We report a 51 year old male with history of recurrent joint pain in the past, presenting with multiple soft to firm nodules on the hands and abscess-like lesions on right hand and both feet with hyperuricemia. Patient also had nasal perforation, advanced bony involvement and bilateral renal involvement. This patient was an extremely neglected and advanced case of chronic tophaceous gout. Although gouty involvement of nasal cartilage has been reported earlier, nasal perforation is a new manifestation seen.

Keloid - an under-reported complication of herpes zoster: report of 4 cases

Keloid has rarely been reported as complication of post-herpes zoster scar. We report this previously under-reported complication in four patients with a brief review of the relevant literature. It is highlighted that prompt treatment of secondary infection is essential to minimize the keloidal formation.

Sudden onset of unilateral facial flushing and sweating in a patient with long standing acne

A 28 year old woman having a long history of acne from her teens and having had numerous treatments for it, presented with an eighteen month history of right sided hemifacial flushing and excessive sweating with anhidrosis on the left side. The asymmetry in skin appearance was particularly noted after exertion. There was no other neurological abnormality. MRIs of her head, cervical spine and dorsal spine failed to reveal any structural cause for this. We tried botulinum injection without any success. She showed signs of improvement with selective serotonin reuptake inhibitors.

Herpes zoster ophthalmicus with ophthalmoplegia

Herpes zoster ophthalmicus (HZO) is a disease of elderly affecting individuals in the sixth or seventh decades of life. It rarely results in extraocular muscle palsy. We herewith report two cases of HZO associated with cranial nerve palsies who tested positive for HIV. Case I had third, fourth and sixth nerve palsies whereas case 2 had third nerve palsy with pupillary movement affected in association with ophthalmic herpes zoster. A course of systemic acyclovir and steroids led to complete recovery in the first case and partial recovery in the second case..

Preseptal cellulitis due to cutaneous anthrax

Anthrax is a zoonosis caused by Bacillus anthracis. Humans mostly contract this disease in endemic regions by direct contact with infected animals or carcasses. Eyelid involvement is rarely seen. We describe two cases with black eschar formation in the lower lid with extensive edema giving a strong suspicion of anthrax. Gram's stained smear taken from the eschar site in both the cases revealed gram-positive bacilli in short chains with typical boxcar appearance suggestive of Bacillus anthracis. The patients were treated with intravenous penicillin G, 2 million units six hourly for two weeks. The lesions finally healed with minimal scarring and ectropion in the second case.

Hypohidrotic ectodermal dysplasia with bronchial asthma - a rare association

Hypohidrotic ectodermal dysplasia is an uncommon disorder of tissues derived from ectoderm, characterized by the triad of hypotrichosis, hypohidrosis and hypodontia. Its association with chronic bronchial disease has been described in the literature. Here we report a case of hypohidrotic ectodermal dysplasia associated with bronchial asthma, in a 14 year old female.

Lipoid proteinosis with vesicular eruptions and hypertrichosis: rare associations

Lipoid proteinosis is a rare autosomal recessive metabolic disorder characterized by deposition of hyaline material in the dermis. A young Muslim female with history of consanguinity among parents presented with classical signs of the disease, like multiple pearly white beaded papules along eyelid margins, hyperpigmented scars and hoarseness of voice. Vocal cords showed diffuse thickening and ophthalmological examination revealed trichiasis and distichiasis though no drusen was seen. Interestingly the patient had history of recurrent bullous eruptions, a rare presentation and also there was hypertrichosis over limbs instead of the usually reported alopecia.

Tubercular gumma mimicking cutaneous metastasis of breast cancer

We report a case of a seventy year old female who had undergone modified radical mastectomy, chemotherapy and radiotherapy for stage IIB breast adenocarcinoma and subsequently developed subcutaneous nodular lesion, diagnosed clinically as cutaneous metastasis. Histologically, the lesion turned out to be tubercular gumma and responded adequately to antitubercular therapy.

Goltz syndrome (focal dermal hypoplasia)

Goltz syndrome is a rare genodermatosis characterized by mesodermal and ectodermal dysplasia. A girl with short stature, physical retardation, typical facies, lobster claw deformity, linear fat herniations along focal linear atrophic bands is being described.

Epidermolytic hyperkeratosis and rickets - a rare association

Epidermolytic hyperkeratosis, a rare congenital disorder of cornification is reported in a young boy who also showed clinical and radiological signs of rickets. The possibility of an association of this disorder with rickets is rare.