Mucocutaneous fungal infections of significance in HIV infected individuals in India

Mucocutaneous disorders remain one of the most important clinical markers of the stages of HIV infection from time of seroconversion. They function as visual markers in assessing the progression of HIV disease. In developed countries, CD4 lymphocyte count, detection of viral specific RNA, and viral culture are being used for the assessment of HIV disease. Lack of these facilities in third world countries like India, necessitates dependence on clinical markers. HIV infected person present with various cutaneous dermatoses, fungal dematoses being the most common. Many a times, cutaneous and mucosal fungal infections may give a clue to the underlying HIV infection. The increased incidence of candidal, dermatophytic and pityrosporum infections in HIV infected individuals, even in India is well established. Moreover, they are more extensive, often atypical and aggressive, sometimes life threatening. Clinicians should be aware of the various common mucocutaneous disorders in HIV disease especially fungal disorders in their specialities, because they can be used in the diagnosis and assessment of the stage of immunodeficiency at the time of presentation.

Prognostic value of immunoglobulin profile in human papilloma virus infection

Present study aimed at defining the prognostic value of immunoglobulin profile in human papilloma virus infection by assessing and correlating the levels of immunoglobulin with type, number, duration and response to therapy in 54 randomly selected cases from age group 8 to 42 years (male - 35, female - 19). Raised IgG levels were seen maximally in all spectrum of warts (59.25%) followed by IgM (40.74%) and IgA (25.92%). It was also seen that 82% of cases with elevated IgM and IgA were free from lesions with no recurrence at 6 months follow up with any form of treatment (electrodesiccation, 25% podophyllin, 50% trichloroacetic acid, 5% 5-fluorouracil). On the contrary, patients with elevated IgG level showed poor response (64%) and partial response (16%) with recurrence of 38% at the end of 6 months. Cure rate was 54% with combined elevation of IgG, IgA and IgM with recurrence rate of 24%.

Pityrosporum infection in HIV infected patients

An increased colonization of Malassezia furfur organism has been reported in patients with HIV infection. Pityriasis versicolour and pityrosporum folliculitis arise from overgrowth of M. furfur. It is also thought to have a significant role in the pathogenesis of seborrhoeic dermatitis and is one of the earliest clincial markers of HIV infection. The present study was to note the prevalence and significance of these infections in HIV infected patients. The prevalence of pityrosporum infection was 13.5% ( 25 cases amongst 185 HIV serpositive patients ) in HIV infected cases in our study. Mean age of the affected patients was 31.7 years and male to female ratio was 1.5:1. The main mode of acquisition of HIV infection was heterosexual ( 19 cases ). Tinea versicolour was seen in 10 (40%) cases, seborrhoeic dermatitis in 14 ( 56% ) and pityrosporum folliculitis in 4 ( 16% ) cases. Seborrhoeic dermatitis was found to be more explosive in onset and involving extensive areas with severe inflammation. Extensive tinea versicolour and seborrhoeic dermatitis were seen in three cases with pityrosporum infections. Nine of the pityrosporum infections were observed in HIV Group IV, which is equivalent of AIDS. To conclude, seborrhoeic dermatitis in patients with HIV/AIDS may have some unique features and may be used as a clinical marker of AIDS.

Cutaneous manifestations of neurofibromatosis type I in South India

Neurofibromatosis type 1 (NF-1) is the most common form of neurofibromatosis. Since the significance of various cutaneous manifestations of NF-1 has not been known in Indian population, hence, the present study was undertaken. A total of 40 patients with NF-1 were identified between August 1998 to June 2000 with a prevalence rate of 20.04 per 10,000 individuals attending our clinic. Male to female ratio was 2.3:1. The age of the patients ranged from 15 to 70 years with a mean age of 29.57 years. Most patients ( 18 cases ) belonged to age group of 21-30 years followed by 11-20 years age group ( 11 cases ). Twenty four cases had onset of disease between 11-20 years of age and ten cases in 21-30 years age group. Thirty one of 40 cases presented with asymptomatic nodules, three sought medical opinion for cosmetic reasons and another three for hyperpigmented patch. Analysis of cutaneous manifestations showed, 39 of 40 cases ( 97.5% ) had neurofibromas. Palmar melanotic macules were noted in 36 ( 90% ) cases whereas cafe-au-lait macules were seen in 33 ( 82.5% ) cases. Subsequent, less common findings were intertriginous freckles in 31 (77.5%) cases, plantar melanotic macules in 18 ( 45% ) cases and generalised freckles in 4 ( 10% ) cases. Statistical analysis of cases and controls revealed significant association of NF-1 with neurofibromas, palmar melanotic macules, cafe-au-lait macules, intertriginous freckles and plantar melanotic macules (p < 0.001). This study brings into focus some of the cutaneous manifestations noted in South Indian patients especially palmar and plantar melanotic macules, not highlighted in the western literature.

Comparative efficacy of 1% terbinafine hydrochloride and 1% butenafine hydrochloride cream in the treatment of tinea cruris

The aim of the study was to evaluate the comparative efficacy of 1% terbinafine hydrochloride and 1% butenafine hydrochloride cream in the treatment of Tinea cruris, was done taking with ten patients in each study group. They were found to be equipotent in one and two weeks treatment respectively.

Wells syndrome mimicking erythema elevatum diutinum

Wells' syndrome is a rare inflammatory dermatosis clinically characterised by recurrent itchy erythematous oedematous plaques with features resembling both urticaria and cellulitis and histologically characterised by tissue eosinophilia, oedema and flame figures. Erythema elevatum diutinum (EED) is a chronic localised form of cutaneous vasculitis clinically consisting of symmetrical papules and nodules most often on the back of the hands. We present a case of Wells' syndrome mimicking EED clinically.

Necrobiosis lipoidica diabeticorum

We present a case of necrobiosis lipoidica in a 55 year old female diabetic patient with multiple, disseminated lesions on both the legs, forearms, trunk, buttocks and face.

Disabling pansclerotic morphea of children

A case of disabling pansclerotic morphea in a female child of 9 years with unusual involvement of the digits is reported.

Naevus lipomatosus cutaneous superficialis

Naevus lipomatosus cutaneous superficialis (NLCS) in an eighteen year old female is reported. She had asymptomatic nodules and plaques on her lower back since birth. The diagnosis was confirmed by histopathology.

Annular elastolytic giant cell granuloma

The clinical and histopathological features of annular elastolytic giant cell granuloma in a 42-year-old female patient are described. The condition presented as annular erythematous plaques over sun-exposed skin sparing the face. Histopathology revealed dense granulomatous infiltrate consisting of numerous giant cells and lymphohistiocytes without any palisading arrangement or necrobiosis. The features differentiating it from other similar granulomatous disorders are discussed.

Subcutaneous zygomycosis - basidiobolomycosis

Subcutaneous zygomycosis, also known as basidiobolomycosis, is a rare disease caused by the fungus Basidiobolus ranarum. Since its first description in 1954, many cases have been reported. In India, so far only few cases have been described. We report this entity in a 3-year-old female child who had firm to hard swelling of the right upper extremity and chest. Histopathology showed short aseptate hyphae surrounded by eosinophilic material within the granulomatous tissue response, in the subcutaneous tissue. She responded dramatically to saturated solution of potassium iodide.

Primary tuberculosis of the glans penis

Primary tuberculosis of the glans penis is extremely rare. We report a case in a 47 years old man who presented with an ulcer over glans which mimicked malignancy. The diagnosis of tuberculosis was confirmed by biopsy and response to antituberculous chemotherapy. There was no co-existing tuebrculous infection elsewhere. The wife of the patient was under treatment for pulmonary tuberculosis. The possibility of acquiring the disease following sexual contact could not be ruled out. The importance of biopsy in the diagnosis of chronic genital ulcer is emphasised.

Bilateral naevus of Ota

Naevus of Ota is a type of dermal melanocytic naevus characterized by extensive blue patch of dermal melanocytic pigmentation of the sclera and the skin adjacent to the eye. The condition is usually unilateral. Here we report a patient with bilateral naevus of Ota in view of the rarity of this condition.

Monilethrix : report of a family

Monilethrix is a rare inherited structural defect of the hair shaft resulting in increased fragility of the hair. It is a genetically heterogenous condition. We describe a family with autosomal recessive inheritance with four members affected and a significant correlation of disease with consanguineous marriages in the family.

Mal de meleda type of keratoderma

A child born of a consanguineous marriage showing characteristic features of Mal de Meleda type of palmoplantar keratoderma is reported for its rarity and clinical interest.

Acquired Cutis Laxa

A case of acquired cutis laxa is presented for its rarity