Dexamethasone-Cyclophosphamide Pulse Therapy In Pemphigus : An Appraisal Of Its Outcome In A Tertiary Health Care Center In South India

Dexamethasone-cyclophosphamide pulse (DCP) therapy, designed by Pasricha and Gupta for pemphigus was first used in 1981 with the aim of reducing the toxicity of corticosteroids and also to achieve better therapeutic results. We have been using the same pulse therapy and herewith are presenting the results of pulse therapy in pemphigus patients in a referral center in south India. A total of 55 patients with pemphigus were included in the study over a period of 6 years. They consisted of 51 cases of pemphigus vulgaris and 4 cases of pemphigus foliaceous. The male to female ratio was 1.2:1. The age distribution showed a bimodal pattern with peaks at 21-30 years and 51-60 years. The body surface area involved at the time of initiation of DCP was less than 25% in 25, 25-50% in 19 and more than 50% in 11 cases. Oral cavity was involved in all cases of pemphigus vulgaris and eyes were affected in 4 patients. Twentysix cases were managed with DCP pulses only and were in remission in phase II and three of our patients in remission in phase III relapsed at 6 to 9 months. Interpulse steroids were required to induce remission in 11 patients. The remaining 18 patients did not proceed to phase II as they were either defaulting or had active disease. Only four cases progressed into phase IV and were declared cured. The various complications seen in our patients were candidiasis (n=5 ), hiccups (2), acneiform eruption (2), iatrogenic Cushing's syndrome (1), herpes zoster (1), striae distensae (1), umbilical abscess (1 ), alopecia (1), azoospermia (1), pneumonia (1) and deep vein thrombosis (1). Two patients on pulse therapy died of septicemia.

Patch Testing In Soldiers : An Evaluation

Our study concerns contact sensitization in soldiers, the frequency of which is poorly documented. During a six-year period, 128 patients of age range 17-50 years were patch tested with the Indian standard battery of 30 allergens. We obtained a reaction in 23 (18%) of our patients. Nickel sulfate, fragrance mix, wool alcohol and parthenium induced most of the positive responses. In addition, an irritant reaction was seen in 16 (12.5%) of our patients. Patients of atopic dermatitis and hand/foot dermatoses evoked a high sensitivity response. Adverse effects were seen in 15 patients.

Study Of Nail Changes In Psoriasis

Background : In psoriasis, nail involvement is quite a common phenomenon and the manifestation may range from pitting, Beau's line, leuconychia, onychorrhexis, onycholysis, subungual hyperkeratosis, thinning of nail plate to less commonly splinter hemorrhage, oil drop sign and salmon patch.
Objective : To study overall pattern of nail involvement in psoriatic patients along with making a comparison between the patterns of nail changes on finger and toe nails and to analyze the association of nail changes with arthropathy and Koebner's phenomenon.
Subjects and settings : One hundred consecutive cases of psoriasis of all age and both sexes were selected for studying the nail changes, in whom diagnosis of psoriasis was made on clinical parameters. KOH preparation was also performed in all cases where onychomycosis was considered a possibility.
Results : Thirty six percent of patients of psoriasis had nail change and fingernails (32%) were more commonly affected than toe nails (24%). Pitting was found to be the most common manifestation in fingernails (65.63%) with significant difference between fingernails and toenails (p < 0.001). The frequency of nail changes in psoriasis with joint pain was 73.33% whereas 29.41% in those without joint pain. Chi-square test with Yates correction for the association of nail changes with joint pain gave p value < 0.005 and for the association of nail changes with koebner's phenomenon p value < 0.05. The frequency of nail changes with Koebner's phenomenon was 56% whereas in those without koebner's phenomenon it was 29.33%.
Conclusion : Pitting was the most common manifestation in fingernails although in toenails subungual hyperkeratosis was the commonest finding. A very strong association was seen between nail changes and joint pain. Association was also strong between nail changes and Koebner's phenomenon in psoriasis.

Topical Tacrolimus In Atopic Dermatitis : A Placebo Controlled Study With 15 Children

Fifteen children aged 3 to 15 (mean 8.92) years with moderate to severe atopic dermatitis (AD) of 6 months to 5 years (mean 2.5 years) duration were treated with 0.1% topical tacrolimus ointment. Tacrolimus ointment was applied on 3 patches of 3 x 3 cm, twice daily for 2 weeks. An equal number of age and sex matched controls were treated with sunflower oil application on eczema lesions. There was significant reduction of severity scores (P < 0.05) after tacrolimus treatment as compared to sunflower oil application in all 15 children. Three children experienced mild and transient burning, erythema and pruritus over the lesions. Topical tacrolimus (0.1%) was found to be effective and safe in the treatment of moderate to severe AD in children.

Basal Cell Carcinoma : Evaluation Of Clinical And Histologic Variables

A retrospective review of 32 patients with basal cell carcinoma was performed with aims to characterize the demographic profile and to analyze the clinical and histological parameters influencing the treatment of basal cell carcinoma. The maximum number occurred in the sixth decade with an unusual female preponderance. Histologically, the classic type predominated while the other types included pigmented, morphoea, metatypical, adenoid, eccrine, fibroepihelioma and superficial spreading type. All patients had excision of the tumor with involvement of surgical margin in three of them. None of the three patients belonged to aggressive histological type, such as morphoea or metatypical type. Two year follow-up showed no recurrence. Size of the tumor less than 2 cm, absence of ulceration and a good inflammatory response were probably other reasons for non-recurrence.

The Spectrum Of Varicella-Zoster Virus Infection A Hospital-Based Clinic In South India

Varicella (chicken pox) and herpes zoster are two distinct clinical entities caused by the same virus, varicella-zoster virus (VZV). Our study on varicella-zoster virus infection was to ascertain the spectrum of varicella-zoster virus infection in patients attending a clinic in south India and to find out the effect of underlying HIV infection, if any, in high risk individuals. Seventeen cases of chicken pox and forty cases of herpes zoster were recruited during the study period of September 2000 to June 2002 at the Department of Dermatology and STD, JIPMER, Pondicherry. The cases of varicella included 7 children and 10 adults. In children, it was most commonly seen between the ages of 10 to14 years (57.1 %), whereas in adults, it was commonly seen in the age group of 14 to 20 years (60%). Majority of cases (82.3%) occurred above 10 years of age. Ten cases (58.8%) had a family history of or a history of contact with varicella. Forty cases of herpes zoster included 5 children and 35 adults. Most of the children were in the age group of 5 to 10 years (80%) whereas in adults, the maximum number of cases was seen between 20 to 26 years. Majority of cases (75%) occurred below 50 years of age, 22.5% were below 20 years. The dermatomes involved in the order of decreasing frequency were thoracic (24), followed by ophthalmic (6) and sacral (5). Localized dermatomal zoster was seen in 30 cases, multidermatomal zoster in 7 cases, recurrent zoster in 2 cases and disseminated zoster in one case. Fourteen cases (35%) were seropositive for HIV infection among the high-risk group. Multidermatomal, recurrent and disseminated zoster were exclusively seen in the seropositive group.

Lichen Planus Pemphigoides

We report a case of lichen planus pemphigoides. The patient had features of lichen planus and bullous pemphigoid. It was proved by histopathology and immunofluorescence test.

Basal Cell Epithelioma Eroding Into The Eye

A case of basal cell epithelioma involving and eroding into the right eye with classical clinical and histopathological featuresa has been reported.

Angiolymphoid Hyperplasia With Eosinophilia

We present three cases of the uncommon condition, angiolymphoid hyperplasia with eosinophilia. Two of them had lesions over pinna and external auditory canal while the third one had subcutaneous lesions with involvement of muscles over cheek and submandibular region.

Juvenile Xanthogranuloma With Hydrocephalus

Juvenile xanthogranuloma (JXG) is a rare, benign, self-healing tumor of unknown etiology arising from non-Langerhans' cell histiocytes. We report a case of 2 year old female child with few nodular lesions mainly over scalp, face, trunk and upper limbs. There was no other organ involvement. Histopathology showed presence of vacuolated histiocytes with Touton giant cells. There was concurrent hydrocephalus.

Nevus Lipomatosus Cutaneus Superficialis

A case of nevus lipomatosus cutaneus superficialis in a 21 year old male is reported because of rarity of this condition.

Peripheral Activity Masquerading Dermatophytosis In A Case Of Pemphigus Vulgaris

A case of pemphigus vulgaris developed a sharply marginated border, resembling that of dermatophytosis, at the periphery of healed lesions at most of the sites. The borders disappeared on increasing the dose of corticosteroid.