Iconography in Dermatology

Dermatology as a medical speciality and as a medical discipline designated semantically as such, is about two hundred years old. This notwithstanding, skin disease has been in the focus of attention by the medical and the lay world since time immemorial. Ancient texts, be they Biblical or Vedic, attest to that.

Dermatology depends more on visual presentation of disease characteristics than do other disciplines. For this reason, dermatologic imagery has played an important role over the last two centuries during which the discipline was established. This development from woodcuts, to etchings, to chromolithographs, to photographs, is outlined.

Protease production in dermatophytes during sporulation and vegetative phase - its role in pathogenesis and mating type associated virulence

Different strains of common dermatophytes including different mating strain, collected from clinical, animal and soil sources as also some tester strains, were studied for their proteolytic enzyme activity during vegetative and sporulation phases. Sabouraud's dextrose broth and Takashio broth were used to induce vegetative and sporulation phases respectively in these dermatophytes.

All the strains of T. rubrum showed very low enzyme activity during sporulation when compared to vegetative growth phase. In other species of dermatophytes, the enzyme activity was found to be almost similar during both the growth phases. High protease production in association with one mating type of A. vanbreuseghemii was observed. The enzyme activity of clinical isolates of the non-anthropophilic species such as T. simii, M. nanum and M. gypseum were relatively low when compared to T. mentogrophytes var. interdigitale and T. tonsurans. The severity of the lesion produced by these dermatophytes supports the validity of keratin specific keratinase in dermatophytes. Our study established the fact that protease in dermatophytes has a definite role in pathogenesis. Protease production during sporulation in T. rubrum may be one of the selective of this species.

General protease production was found to be independent of mating type in most of the dermatophyte species.

Sero-prevalence of concomitant HIV and syphilitic infections among the STD clinic attendees in Calcutta

A study was undertaken from October 1997 to March 1998 with 900 subjects, 806 male and 94 female, attending the STD clinics in Calcutta. The study revealed 2.3% HIV seropositivity and 3.88% VDRL positivity among them. Evidence of combined infection (HIV and syphilis) has been observed in 10 out of 900 subjects (1.1%). Highest prevalence of HIV seropositivity (13.3%), VDRL reactivity (16.6%) or both (6.6%) was noted among young males upto 30 years of age.

An outbreak of human anthrax : A report of 15 cases of cutaneous anthrax

Anthrax, a zoonotic illness of herbivorous animals has caused epidemics in livestock and in man since antiquity. In India, the disease continues to be endemic, resulting in a few sporadic cases and outbreaks in human population. Such an outbreak was noted at our institute.

Clinical and laboratory data of 15 cases of cutaneous anthrax recorded between July 1998 to June 2000 at the Department of Dermatology and STD, JIPMER hospital, Pondicherry was reviewed. There were 8 males and 7 females in our series of 15, with a mean age of 20.3 years (range 11 months to 56 years). The children (10) outnumbered the adults (5). In most of the cases (9) there was history of death of a cattle, sheep or goat in the house or in the neighbourhood. The commonest site of cutaneous anthrax was face (7cases). Regional lymphadenitis occurred in one case and systemic features like fever in four cases. Majority of our cases responded favourably to crystalline penicillin. Smear taken from the vesicle fluid and eschar demonstrated typical large and thick Gram positive bacilli singly or in short chains. The organism could be cultured from cutaneous lesion in six cases only and blood culture was positive for Bacillus-anthracis in one case.

Cutaneous anthrax is the commonest form of human anthrax. There is increasing evidence to suggest that flies and mosquitoes play a role in the transmission of Bacillus anthracis to human beings. Since 20% of untreated cases of cutaneous anthrax develop bacteremia which leads to rapid death, it is important that the disease is recognised and treated earnestly.

Hanseniasis with Gilbert's Syndrome : A therapeutic dilemma

Therapeutic dilemma often arises in leprosy patients developing jaundice as most of the anti-hanseniasis medicines are hepatotoxic. One 26 year old lady and another 21 year old male having paucibacillary leprosy developed signs of jaundice after onset of treatment with multidrug (MDT) and then they discontinued it. MDT was reintroduced and successfully continued for 6 months with pre-and post-therapy monitoring of liver function test, haemoglobin and other relevant parameters. Total bilirubin (TB) reached maximum upto 3.6 comprising predominantly of unconjugated (3.1); other parameters were normal. The third patient, a 64 year old male with multibacillary leprosy having past history of recurrent jaundice has also been treated for last 8 months till date with MDT by monitoring. Highest peak of TB was 4.2, unconjugated being 3.4. These represented cases of Gilbert's syndrome which is a common, benign, familial unconjugated hyperbilirubinaemia without overt haemolysis are often precipitated by drugs. Partial deficiency of bilirubin glucuronosyltransferase is the main causative factor. Hence all patients of leprosy with jaundice does not need discontinuation of therapy. Some patients may have underlying Gilbert's syndrome when MDT can safely be continued with monitoring.

Multiple dermatofibroma

Sixty year old female patient presented with asymptomatic persistent cutaneous nodules and plaques since childhood. Dermatological examination revealed firm, nontender nodules and plaques (more than fifty) seen over the extremities, thighs, abdomen and back. Histology was consistent with dermatofibroma.

Conversion disorder presenting as neuritic leprosy

Conversion disorder is not normally listed amongst the conditions in differential diagnosis of leprosy neuropathy. A case of conversion reaction who was initially diagnosed as neuritic leprosy is reported. Patient responded to narcosuggestion and psychotherapy.

Psoriasiform lupus vulgaris : an unusual presentation

A 55 year old woman presented with gradually progressive erythematous scaly plaques, simulating psoriasis, on extremities and face for last 20 years. Histology confirmed the diagnosis of lupus vulgaris which is known for its notorious presentation. This case is being reported for its unusual presentation which can cause diagnostic and therapeutic problems.

Sporadic multiple zosteriform cutaneous leiomyomas

A case of cutaneous leiomyoma in a zosteriform distribution over right upper limb is described. Differential diagnoses and treatment options are discussed.

Homozygous hypercholesterolaemia with cutaneous and tendinous xanthoma in a child

A seven year old male child, born of a consanguineous marriage is reported for the rare occurrence of severe hypercholesterolaemia with cutaneous and tendinous xanthoma, mental retardation and eosionophilia in his childhood.

Mycetoma caused by Streptomyces Somaliensis involving female breast

A 25 year old female presented with discharging sinuses over breasts for 6 years duration. On the basis of FNAC report pointing out non-caseating tuberculosis, she was treated with ATD for 18 months without success. Subsequently, microscopic black grains were detected from the discharge of the sinuses and Str. somaliensis was grown in culture. The site being a covered area, was considered as an extremely rare site for occurrence of the disease.

Acne agminata-report of 3 cases

Acne agminata of lupus miliaris disseminatus faciei (LMDF) is a chronic granulomatous inflammatory disorder affecting adults of both sexes which terminates spontaneously with scarring. Histopathologically, the papules show granulomas consisting of epithelioid cells, gaint cells, with or without caseation necrosis alongwith periappendigeal lymphomononuclear cell infiltrate in the dermis. The exact aetiopathogenesis of this condition is still unknown. We report 3 cases of this uncommon dermatoses recently seen by us.

Ochronosis

Ochronosis is a rare disorder which presents with distinct clinical and biochemical features. A 57 year old male presented with fracture femur, osteoarthritis, Osler's sign, alkaptonuria and cutaneosu ochronosis. though the clinical progression of his alkaptonuria was typical, he presented interesting features including non-uniting fracture and arthritis of big and small joints.

Pansclerotic Morphea

An 8-year old girl, presented with progressive stiffness, of the right lower limb, resulting in joint immobility and apparent shortening, causing limitation of movements.