Chronic Arsenical Dermatoses from tube-well water in West Bengal during 1983-87

One thousand two hundred and fourteen cases (152 in OPD and 1062 in field study) of chronic arsenical dermatoses from drinking arsenic contaminated tube-well water were detected in 61 villages of districts of West Bengal during 1983-87. The first case was diagnosed at STM Skin OPD in July 1983 by the author. The districts involved are Murshidabad - 652 cases (53.71%), North 24-Parganas - 318 cases (26.19%), South 24-Parganas - 60 cases (4.94%), Nadia - 151 cases (12.44%), Burdwan - 30 cases (2.47%), Malda - 2 cases (0.16%) and Midnapore-1 case (0.08%). 24-Parganas (N) and 24-Parganas (S) together comprised 378 (31.14%) cases.

Melanosis (diffuse and spotted in palms, soles, trunk) and keratosis (punctate ⁺/_- diffuse in palms, soles and limbs) are the salient feaures of the disease. Cutaneous malignancy (Sq. C.C.) was detected as complication in 6 cases. Severity of dermatoses correlated well with the concentration of arsenic in the consumed water and the duration of consumption. Significant concentration of arsenic in nails, hair and skin scales not only confirmed the clinical diagnosis but also helped in confirming doubtful and subclinical cases in unaffected members of the affected family. Histology of liver showed NCPF. Depths of affected tube-wells varied from 110 to 150 ft. Mean concentration of arsenic in water consumed by affected people was 0.32 mg/1(0.06-1.25) and the duration of drinking contaminated water for the symptoms to develop varied from 6 months to 2 years or more, depending on arsenic concentration and period of arsenic contamination of tube-well water. High arsenic contents of some strainers in affected tube-wells are likely to be due to contamination from the soil. Treatment by BAL is superior to penicillamine. Prolonged use of chelating agent BAL with mechanical scrapping of water soaked keratotic sples and palms give encouraging results. Urea (20%) in cream or vaseline, followed by 6-10% salicylic acid, also helps for smoothening of skin. Follow-up treated patients at monthly interval for clinical and chemical assessment is helpful for final assessment of the treatment given.

Therapeutic Audit of Dermatological Prescriptions

Dermatological prescribing trends in outdoor patients attending Dermatology Clinic of Govt. Medical College Hospital, Nagpur were studied. In all 190 prescriptions were audited to fine number of drugs per prescription, use of generic/brand names, dosage forms, frequency, duration of treatment, dose and categorywise drug consumption. The age and sex distributions of patients and disease distribution were also studied.

Polypharmacy was found to be widely prevalent. More drugs were prescribed by brand names than generic. Dosage form, frequency and duration were mentioned in most of the prescriptions; however, doses of the drugs were not, in majority. The major drugs in the prescriptions were anthistaminics followed by antomicrobials, steroids and vitamins. Not much difference was found in sexes attending the Clinic. There were more female patients of acne vulgaris, disseminated lupus erythematosus and Hansen's disease. More males suffered from scabies and tinea infections. There were 4 patients who were prescribed drugs without diagnosis. Except in some cases, the prescribing was rational.

Cervical Spine in Psoriasis

Clinical study and X-ray of the cervical spine from patients with psoriasis and psoriatic arthritis were compared with similar films from a control population. Evidences suggest that neck is involved in psoriasis similar to those described for spondylitis. Apophyseal narrowing is 60% compared to 20% in control, apophyseal sclerosis is 40% compared to 15% in control, and apophyseal calcification of anterior ligaments is 25% compared to 10% in control.

Hardness of Human Finger Nails

This paper presents the Rockwell superficial hardness of human finger nails in vitro and its difference due to age, sex and pathological conditions. A highly significant (p < 0.01) negative correlation (r = - 0.78) is found to exist between the thickness (x) and the superficial hardness (y) of the upper surface of the finger nails, The regression equation of y on x is y = - 32.26 x + 63.82.

A Clinico-aetiological Study of Dermatoses in Paediatric Age Group

Five hundred patients of the age group 0-12 years were studied for different types of dermatoses. Pyoderma (35.6%), scabies (22.4%) and eczema (17.6%) were the most common dermatological conditions, followed by molluscum contagiosum (4.6%), papular urticaria with insect bite (4%), vitiligo (3.4%), miliaria (2.8%), nevus (1.6%). Other dermatoses (8%) were pityriasis rosea, wart, chicken pox, herps zoster, acne vulgaris, leprosy, angular stomatitis, pruritus vulvae, psoriasis, candidiasis, condylomata lata, fixed drug reaction, tinea capitis and corporis, phrynoderma, alopecia areata, phimosis, geographic tongue, trichotillomania, canitis, pediculosis, hypertrophic scar and pityriasis versicolor.

A Low-cost Effective Therapy of Pastular Dermatitis Atrophicans (PDA)

The clinical entity PDA mainly affects lower socio-economic group in tropical countries. Its cure/control poses a challenge to dermatologists. To evaluate a low-cost drug therapy, dapsone was tried among patients of chronic folliculitis of legs along with tropical prividone-iodine application. Forty-two patients who came for regular follow-up revealed satisfactory result with marked improvement in about 70% cases with minimal side-effects. The antibacterial and immunomodulatory action of dapsone may be beneficial in these cases. The possible role of androgen triggering effect remains an open question in its pathogenesis and chronicity.

Australia Antigen in Lepromatous Leprosy Patient

Forty three patients of lepromatous leprosy were studied for the presence of Australia antigen. Only 4 showed positive result. This is more or less consistent with other Indian studies.

Uncommon Presentation of Bowen's Disease

Bowen's disease is described as persistent, progressive, non-elevated, red scarry or crusted plaque which is due to an intraepidermal carcinoma and is potentially malignant. Sunlight is considered as an important aetiological factor. In the past, arsenic exposure was also said to be important. The cutaneous lesion of Bowen's disease can sometimes be hyperkeratotic or fissured. Morphology can vary depending on site of involvement.

Xanthoma Disseminatum

A young adult male patient of Xanthoma dissemintaum, presenting with typical papules, nodules and coalescing plaques mainly over flexures with some atrophic subsiding lesions, mucosal lesions involving conjunctiva, oral mucosa, pharynx and larynx, bony lesion in the form of three osteolytic lesions in skull bones and with history suggestive of mild, self-limiting diabetes insipidus, is reported for its rarity. There is associated, unrelated testicular atrophy leading to changes like absence of axillary hair and moustache and appearance of gynaecomastia.

Harlequin Fetus

A neonate with deeply fissued skin, polydactily and deformed ears is described.

Matting of Hair due to Sunsilk Shampoo

Matting of hair has been reported from time to time due to treatment of hair with detergent, shampoos, waving lotions, setting lotions and bleaches. A case of matting of hairs in a young girl due to a change in the brand of shampoo is reported.

Lethal Midline Granuloma

Midline granuloma is a term with several synonyms: Stewart's granuloma, granuloma gangraenescens nasi, lethal granuloma, polymorphous reticulosis. The condition is characterised by localized inflammation, destruction and often mutilation of tissues of the upper respiratory tract and face and, unless treated, it ends fatally within 12 to 18 months of onset. The pathological changes are those of nonspecific chronic inflammation to necrotizing vasculitis and granulomatosis. A case of lethal midline granuloma is reported.