National Leprosy Eradication Programme

This article traces the history of the growth and development of our National Leprosy Eradication Programme (NLEP). The aims, strategy, means of eradication, the organisational structure have been discussed. Since the beginning of this programme, the prevalence rate and disability rate have shown a sharp decline. The number of cases detected and under treatment have also increased. The achievement made has been possible due to an excellent organisation of leprosy relief work under NLEP with the active cooperation of the non-gevernmental organisations.

Now that leprosy is on the decline, the need of education and rehabilitation of patients assumes a greater importance.

Pulse Therapy with Intravenous Corticosteroids

Pulse therapy entails administration of supraphamacological dose of the drug in an intermittent fashion. Its efficacy computed with relatively minor side effects has been reported by many workers although its mechanism of action remains hypothetical. This article is an effort to review the different steroids which can be used as pulse, its efficacy in different conditions of interest to the dermatologist, the necessity for working up a patient prior to pulse therapy, the common and less common side effects encountered. The review reveals that pulse therapy is a useful treatment modality in certain condition, mostly autoimmune, and injudicious administration is associated with considerable risk.

Contact Dermatitis in Automobile Repair Workers

Automobile repair workers are at risk of developing skin morbidity including occupational dermatoses because of their exposure to mineral oils, petroleum products and its derivatives and lubricating oil. This cross-sectional study was carried out at Maharashtra State Road Transport Corporation workshops in Nagpur city to investigate prevalence of skin morbidity including contact dermatitis in automobile repair workers. The study included 288 (49.9%) automobile repair workers, 180 (31.3%) workshop office staff and 109 (18.8%) divisional office employees. Dermatitis was the commonest skin morbidity in all the study subjects and it was significantly more prevalent in automobile repair workers. Folliculitis was detected in 13.2% of auto-repair workers and was not seen in the other two groups. Increasing trend of skin morbidity was correlated with the length of service of employees. Proper protective measures along with suitable washing facilities should be provided.

Spontanneous Repigmentation of Vitiligo Patches other than Grafted Site

While surgically treating vitiligo by autologous punch grafts, spontaneous repigmentation was observed incidentally on patches other than the grafted sites, Based on this observation, the study was undertaken to see the effect of the grafts on repigmentation of other patches. Twenty patients with sixty seven patches of stable and refractory vitiligo of 2-16 yr. Duration constituted the study group. The patients were followed up for 10 months. Spontaneous repigmentation occurred in 23 sites of 8 patients. The patches started repigmenting spontaneously at the time of initiation of the perigraft pigment spread. The rate and extent of spontaneous repigmentation were more compared to the perigraft pigment spread. The study inspired us to search for the unknown stimulation of the yet-silent melanocytes becoming active after the surgical procedure.

Profile of Leishmaniasis in Central Kerala

Leishmaniasis is a group of diseases caused by several species of the genus leishmania. It is not prevalent in Kerala even though there are a few case reports. Recently, a focus of indigenous leishmaniasis is located in the north-east part of Kerala. We are also reporting probably indigenous cases along with those contracted from Middle-east countries.

Clinico-Pathological Study of Ichthyosis Vulgaris

A clinico-pathological study of 28 cases of ichthyosis vulgaris shows some new findings. In all the cases, ichthyosis vulgaris appeared within the age of 5 years. The presence of the disease since birth was also found. While most (24) patients showed a diminution of severity in summer with an aggravation during winter, 4 patients followed the opposite seasonal pattern. Only in 4 patients, fine scales in the scalp were detected. One patient showed an affection of flexures. There was also a low occurrence of palmo-planter hyperkeratosis, follicular keratosis, fissuring of hands and feet and atopy.

Semen Allergy Manifesting as Chronic Pruritas Vulva

A young woman of 24 with personal and family history of atopy developed pruritus vulva each time after sexual intercourse with her husband. History of urticaria at sites of contact with semen on her thighs gave suspicion of contact urticaria. Positive wheal and flare response to pin prick test with semen, excellent therapeutic response to topical steroid and oral Cetirizine and non-recurrence of the problem after using condom by her husband confirmed the diagnosis of semen allergy.

Tamoxifen-Induced Dermatomyositis

A 38 year old woman developed dermatomyositis after radical mastectomy and tamoxifen therapy for metastatic breast carcinoma. The possibility of the drug as the underlying cause of the connective tissue disease is discussed.

Eumycetoma Treated with Ketoconazole

A 43 year old female had progressive indolent, firm, tender, nodular swellings with multiple sinuses discharging pus containing black granules on left foot and ankle since 3 years. Smear of granule showed dark brown irregular mass with hyphae towards the periphery. Superimposed E. Coli infection was treated with cefadroxyl 500 mg B.D. Histopathologically marked acanthosis of epidermis, dense collection of mononuclears, PMNL's, plasma cells around granules of maduramycosis were seen. X-ray foor showed osteolytic lesions and culture was negative. Satisfactory and progressive improvement occurred after 7 weeks of therapy with ketoconazole 200 mg.

A Mechanobullous Disease of the New Born : Bart's Syndrome

A neonate with a unique congenital mechanobullous disorder (Bart's syndrome) is described and compared with similar patterns from the literature. The blisters were subepidermal, remitted within a few months and have not recurred on long-term follow-up. The relation of Bart's syndrome to epidermolysis bullosa is unclear.

Lupus Vulgaris Mimicking Hansen's Disease

A 40 year old female presented with erythematous infiltrating plaque on the face involving both the ears with destruction of nasal cartilage and satellite lesions on the right shoulder. Clinical diagnosis of Hansen's disease was later proved to be a case of Lupus vulgaris.

Peeling Skin Syndrome

A rare disorder of periodic Peeling Skin Syndrome, encountered in an adult male in a tropical skin clinic in Chennai, is reported along with its histopathological features.

Peeling Skin Syndrome

The clinical and histological findings of a three and a half year old female child with continuous non-seasonal peeling of skin since the age of seven months is described.

Confluent and Reticulated Papillomatosis : Treatment Response to Ketoconazole

A case of confluent and reticulated papillomatosis with classical flexual pigmented papules distributed in reticular pattern is described. Patient responded well to a one-month course of Fluconazole therapy.

Cutaneous Rhinosporidiosis

A case of cutaneous rhinosporidiosis mimicking verucca vulgaris involving an eyelid in a young male patient is described.

Cronkhite-Canada Syndrome

A case of Cronkhite-Canada syndrome in a 59 year old male is reported. The patient presented with generalized hyperpigmentation, alopecia, loss of finger and toe nails, diarrhoea, weight loss and gastro-intestinal polyposis. The case is reported for its rare presentation as the ectodermal changes preceded other clinical features.

Neurocutaneous Cysticercosis

A 53 year old male had a 3 year long history of multiple subcutaneous nodules distributed all over the body. Although no neurological manifestations were present, CT-scan demonstrated multiple cerebral lesions. Skin biopsy showed subcutaneous cysticerci.

Inoculation Leprosy Subsequent to Ear-piercing

Trauma associated with break in continuity of skin results in inoculation of M. Leprae at the site of injury with resultant development of inoculation leprosy. The present report records a case of inoculation leprosy after ear-piercing in a 45 year old female with positive smears and borderline lepromatous histopathology, due most probably to systematic steroids.

Bullous Systemic Lupus Erythematosus - A Case Report with a Brief Review of Literature

A young male patient of SLE developed bullous lesions. Histopathology and DIF were consistent with the diagnosis of bullous SLE.

Epithelioma Caniculatum

A 57 year old man had a cauliflower growth over his right sole for 2 years. Biopsy revealed pseudoepitheliomatous changes with no evidence of malignancy. Chemical cautery with trichloroacetic acid and salicylic acid was unsatisfactory.

Lofgren's Syndrome

A 36 year old female suddenly observed crops of multiple, bilateral symmetrical, well defined, tender, erythematous nodules which healed with bruise-like colour changes. Simultaneously she developed bilateral symmetrical arthritis with acute swelling of ankle joints and feet. She also had low grade fever and one almond size, non-tender, firm, freely mobile lymph node on the left side of neck. X-ray chest revealed hilar lymphadenopathy. ESR was 72 mm. Serum calcium was 8.5 g%. LE cell phenomenon and RF were negative. Mantoux test was positive. Patient was put on anti-tubercular treatment without any improvement. Patient was given Dapsone 150 mg OD, Cap. Zevit and Tab. Flexon BD and steady improvement started after 7 days and all the lesions healed by 2 months of Dapsone therapy.

Epidermolysis Bullosa Acquisita

A 35 year old man presented with features of epidemolysis bullosa acquisita. Here is the case report.

Basisquamous Carcinoma

A 50 year old woman presented with an ulceroproliferative mass in the vulva of 4 month duration. Biopsy of the lesion showed features of a basisquamous cell carcinoma. This is a rare tumour showing histopathological features of both basal cell and squamous cell carcinomas. The clinical, histopathological and histogenetic status of this tumour are discussed.

Familial Oral Pigmentation in an Autosomal Dominant Pattern

Oral pigmentation occurs in Peutz-Jeghers syndrome, Addison's disease, melanocytic nevi and fixed drug eruption. We report a case of oral pigmentation; biopsy revealed focal melanosis which was confirmed by Fontana-Masson stain. The present series in a family with oral pigmentation suggests autosomal dominant pattern of inheritance. It is imperative to exclude all other causes of oral pigmentation before diagnosing familial oral pigmentation.

Pemphigus Foliaceus in Pregnancy

A 35 year old female developed pemphigus foliaceus for the first time during her second pregnancy. Ultrasonogram done at the hospital had revealed a single live fetus of 28 weeks. But the pregnancy terminated in premature labour and still birth. Baby apparently did not have any skin lesion but was not available for examination or investigation.

Mycosis Fungoides

A 45 year old male presented with classical clinico-pathological mycosis fungoides. He had a prolonged phase of premycotic eruption closely simulating psoriasis. As expected, the patient died of systemic involvement in 2 years in spite of chemotherapy.

Pyoderma Gangrenosum

An 18 year old girl presented with multiple, painful, non-healing ulcers over the lower extremities of 2 month duration. The lesions had started as hemorhagic bullae which broke down leaving ulcers. The features were consistent with those of pyoderma gangrenosum. Patient did not have any associated disease including myeloproliferative disorder. Ulcer healed with systemic steroids.

Acrokeratosis Verruciformis and Topical Vitamin A Therapy

A case of a 32 year old female having acrokeratosis verruciformis is reported. The lesions responded partially to topical vitamin A acid (tretinoin).