Dermatomycoses in Diabetics - A Clinical Study

Two hundred diabetics including 153 non-insulin dependent diabetes mellitus and 47 insulin dependent diabetes mellitus patients, were screened for mycoses. Candidiasis was the commonest mycoses, followed by dermatophytoses and pityriasis versicolor. The fasting blood glucose level was observed to be higher in candidiasis compared to other mycoses./p>

Serum Lipid Profile in Xanthelasma Palpebrarum

Forty patients of Xanthelasma palpebrarum (XP) and forty age & sex related controls were collected from the Skin OPD of N R S Medical College Hospital and put to clinical and biochemical examinations.

XP was found to be more prevalent among female (67.5%) than in male (32.5%). Majority (55%) of the patients belonged to 31-50 years age group in both the sexes. Family history of XP was found in significantly more number of patients (27.5%) than in controls (0%). Family history of diabetes, ischaemic heart disease, hypertension was detected in 20%, 32.5% and 20% of patients respectively and no significant difference was seen from the control. Arcus senilis was detected in 25% patients.

Forty percent patients were hypercholesterolaemic among which 27.5% patients had cholesterol level>240mg/dl whereas 5% controls had the level between 200-240mg/dl. Hypertriglyceridaemia was present in 22.5% patients and 5% controls. LDL cholesterol elevation was found in more than 30% cases and only slightly elevated in 5% controls. HDL Cholesterol level was below normal in 15% patients and none among control. Overall, 52.5% patients had some form of abnormal lipid profile and only 10% control had the same problem. This difference was statistically highly significant (p<0.001).

Electrocardiography was abnormal in 22.5% patients and 5% controls and the difference was significant (p<0.02). Blood sugar level was normal in both the study & the control groups.

Adnexal Tumours of Skin

A total of 120 cases of epidermal appendage tumours of skin were analysed and classified according to the classification provided by WHO. Epidermal appendage tumours accounted for 12.87% of all skin tumours, of which 29.17% were benign and 70.83% were malignant. Most of the tumours (75.83%) were in the head and face region. The most common tumour was basal cell epithelioma (55%).

Correlation of Aspiration Cytology of Lymph node with clinical stage, Dermal and Lymph node Histopathology of Leprosy

The present study attempted to correlate, in leprosy, the clinical with dermal and lymphnode histopathologies and aspiration smear cytology from lymphnodes. The last procedure is easy, less traumatic and can be done in the outpatient department.

The study revealed overall enlargement of lymphnode in 50% cases of leprosy, being 9.09% in TT; 33.33% in BT; 60% in BB; 83.33% in BL and 88.9% in LL cases.

Histopathologies of skin and lymphnode corroborated totally in clinical TT & BT cases but this corroboration decreased as one moved down the spectrum, being 60.7% in BB; 60% in BL and 50% in LL (clinical versus dermal histopathology) and the figures were 66.7% in BB, 80%in BL and 75% in LL (clinical versus lymphnode histopathology). So it is apparent that towards tuberculoid end, histopathologies of skin and lymphnodes were reflected in clinical diagnosis. Towards lepromatous end, though skin histology sometimes lagged behind, lymphonode histology was more advanced and was often consistent with clinical diagnosis.

The aspiration cytology corroborated more consistently with the clinical diagnosis than skin histopathology and almost similar to lymphnode histopathology. Cytology reflected immune status of the patient.

Idiopathic Atrophoderma of Pasini and Pierini : Hypertrophic Scar after Punch Biopsy - An indirect Proof of Dermal Atrophy

Idiopathic atrophoderma of Pasini and Pierini (IAPP) affects typically persons in second and third decades of life. It is believed that the disorder is characterized by atrophy of dermis. Punch biopsies done in 5 consecutive patients of IAPP showed healing of the biopsy wounds with hypertrophic scar by the end of second week. The consistent finding of hypertrophic scar after punch biopsy in idiopathic atrophoderma of Pasini and Pierini indirectly proves the atrophy of the dermis.

'Circumferential' Woolly Hair Naevus

Wooly hair naevus presents as a circumscribed area of tightly coiled hair since birth, in an individual of non-negroid origin. We report a 10 year old boy of Indian origin who presented with woolly hair in the periphery of the scalp and normal straight hair in the centre - mimicking a straight hair naevus.

Linear and Whorled Naevoid Hypermelanosis

Linear and whorled naevoid hypermelanosis is a dermatosis of recent interest. A 12 year old girl presented with bizzare hyperpigmentation in whorled pattern extending from T5 to T10 dermatome following Blaschko's lines. It was strictly limited to the midline.

Clinically, the condition closely simulates incontinentia pigmenti and epidermal naevi. However, some distinct differences make it a separate entity.

Keratoderma Mutilans of Vohwinkel

A 8 year old girl developed palmoplanter keratoderma at the age of three years. At the same time she developed star shaped keratotic plaques on dorsa of hands, feet and knees. After eight months, pseudoainhum developed which deepened later on leading to autoamputation. She was deaf and dumb since birth. A typical case of keratoderma multilans of Vohwinkel is described for its rarity.

Glucagonoma Syndrome

We present the case history of a 45 year old male with a recurrent migratory dermatitis which had been refractory to all modalities of treatment. USG and CT scan of the abdomen revealed a pancreatic tumour with no evidence of metastasis. Surgical resection resulted in a rapid and complete clearing of the cutaneous lesions. Necrolytic migratory erythema is a rare polymorphous eruption which is usually associated with malignant glucagon-secreting tumours of the pancreas. It is often the earliest and most specific marker of the underlying malignancy. An awareness of this dermatosis could result in early detection of the associated tumour and resection prior to metastasis, thereby improving the patient's longterm prognosis.

Subcutaneous Sarcoidosis

Subcutaneous sarcoidosis in the trunk and proximal extremiries in a 52 year old man, is reported due to its rarity in the literature. The clinical diagnosis was confirmed by different parameters including histopathology, as well as, by exclusion method. The patient was put 40 mg prednisolone per day for two weeks when the lesions subsided dramatically.

Gunther's Disease

A three year old female child of Gunther's disease with blistering over exposed parts of body, mutilation of nose and fingers, scarring alopecia and erythrodonita, is reported. Her urine was strongly positive for uroporphyrinogen. The blistering could not be prevented by strict avoidance of sun, sunscreen with high SPF, chloroquine, high doses of activated charcoal and betacarotene, though there was significant symptomatic improvement by repeated packed erythrocyte transfusion.

Graves' Disease with Pretibial Myxoedema

A 45 year old man presented with asymptomatic skin coloured nodules, erythematous plaques on both legs alongwith features of thyrotoxicosis. Investigations confirmed the diagnosis of Graves' disease with pretibial myxoedema. The patient became euthyroid with carbimazole and the skin lesions responded partially to antithyroid treatment and local corticosteroids.

Papillon - Lefevre Syndrome in Brother and Sister

Two cases of Papillon - Lefevre syndrome in a family is reported. Both had hyperkeratosis of knees, elbows and gluteal regions other than the typical features.

Papillon - Lefevre Syndrome

Papillon Lefevre syndrome is a disorder of keratinization transmitted in an autosomal recessive fashion. Here we are reporting a case of similar disorder because of its rarity.

Notalgia Paraesthetica

Two cases of notalgia paraesthetica (NP) are presented. Both the patients were female and above 30 years of age. Clinically, the lesions closely simulated macular amyloidosis over interscapular region. However, history of associated pruritus, tingling, formication and altered sensation over the patch pointed towards the diagnosis of NP. Histopathological examination in both the cases revealed intraepidermal necrotic keratinocytes with desquamating remnants of necrotic keratinocytes in the stratum corneum. Congo red and crystal violet stains were negative for the presence of amyloid in the dermis. In both the patients, symptomatic improvement was observed after 3 weeks' application of topical capsaicin.

Angioma Serpiginosum

A rare case of angioma serpiginosum in a 35 year old female is described.