Indian Journal of Dermatology : 2011 - 56(5)

Epidemiology and clinical features of atopic dermatitis in India

Amrinder J Kanwar — Fri,4 Nov 2011

Amrinder J Kanwar, Dipankar De

Indian Journal of Dermatology 2011 56(5):471-475

Literature on atopic dermatitis (AD) has experienced a spurt in the recent years with interest on genetics, immunology, pathogenesis, psychological impact, development of newer more effective and safer treatment agents. Indian literature on AD is limited, probably due to lower prevalence, and milder disease. In this review, we have discussed the Indian literature on epidemiology and clinical features of AD.

The immune reconstitution inflammatory syndrome

Sanjay S Bosamiya — Fri,4 Nov 2011

Sanjay S Bosamiya

Indian Journal of Dermatology 2011 56(5):476-479

A paradoxical clinical worsening of a known condition or the appearance of a new condition after initiating antiretroviral therapy in HIV-infected patients is defined as immune reconstitution inflammatory syndrome (IRIS). Because of wide variation in clinical presentation and the still increasing spectrum of symptoms and etiologies reported, diagnosis remains problematic. Furthermore, no test is currently available to establish an IRIS diagnosis. Until a greater understanding of the syndrome is achieved in different regions of the world, clinicians need to remain vigilant when initiating ART and individualize therapy according to known treatment options for the specific infectious agent.

Hypothesis: Zinc can be effective in treatment of vitiligo

Nooshin Bagherani — Fri,4 Nov 2011

Nooshin Bagherani, Reza Yaghoobi, Mohammad Omidian

Indian Journal of Dermatology 2011 56(5):480-484

Vitiligo is a common depigmenting skin disorder (prevalence 0.1-2%), still represents a cause of stigmatization and quality of life impairment in a large population. Several theories on vitiligo etiopathogenesis have been suggested including in trauma, stress, and autoimmune and genetic predisposition, accumulation of toxic compounds, altered cellular environment, imbalance in the oxidant-antioxidant system, impaired melanocyte migration and/or proliferation, infection, and psychological factors. Zinc, as a trace element, has many vital functions in human. It is antiapoptotic factor and needed as a cofactor for antioxidant defense system. It plays an important role in the process of melanogenesis. It may be effective in prevention and treatment of vitiligo via some mechanism. Herein, we suggested some probable protective mechanism for zinc in association with vitiligo.

Consensus statement on the management of urticaria

Kiran V Godse — Fri,4 Nov 2011

Kiran V Godse, Vijay Zawar, DS Krupashankar, Mukesh Girdhar, Sanjiv Kandhari, Sandipan Dhar, Sanjay Ghosh, Murlidhar Rajagopalan, Torsten Zuberbier

Indian Journal of Dermatology 2011 56(5):485-489

This consensus statement was developed by Special Interest Group - Urticaria (IADVL). Urticaria, a heterogeneous group of diseases, often cannot be recognized by its morphology. Due to non-specific and non-affordable diagnosis, management of urticaria, especially chronic urticaria, is very challenging. This guideline includes definition, causes, classification and management of urticaria. Urticaria has a profound impact on the quality of life and causes immense distress to patients, necessitating effective treatment. One approach to manage urticaria is identification and elimination of the underlying cause(s) and/or eliciting trigger(s), while the second one is treatment aimed at providing symptomatic relief. This guideline recommends use of second-generation non-sedating H1 antihistamines as the first-line treatment. The dose can be increased up to four times to meet the expected results. In case patients still do not respond, appropriate treatment options can be selected depending on the cost.

Pharmacovigilance: Scope for a dermatologist

Bhanu Prakash — Fri,4 Nov 2011

Bhanu Prakash, Gurcharan Singh

Indian Journal of Dermatology 2011 56(5):490-493

Pharmacovigilance is defined as the science of detection, assessment, and prevention of adverse drug reactions in humans. Under-reporting of drug reactions is the major problem and has various reasons. The WHO has initiated the program of reporting all adverse drug reactions now co-ordinated by the Uppsala Monitoring Centre in Uppsala, Sweden, with oversight by an international board. This article presents in brief the relevance, functioning, importance, and the procedure of reporting adverse drug reactions. Dermatologists have the greatest opportunity in reporting various reactions that can happen as they come across majority of these drug reactions, prescribed by all sectors of the health system.

Tumor necrosis factor-alpha in patients with alopecia areata

Emina Kasumagic-Halilovic — Fri,4 Nov 2011

Emina Kasumagic-Halilovic, Asja Prohic, Semra Cavaljuga

Indian Journal of Dermatology 2011 56(5):494-496

Background : Alopecia areata (AA) is a common form of localized, nonscarring hair loss. It is characterized by the loss of hair in patches, total loss of scalp hair (alopecia totalis, AT), or total loss of body hair (alopecia universalis, AU). The cause of AA is unknown, although most evidence supports the hypothesis that AA is a T-cell-mediated autoimmune disease of the hair follicle and that cytokines play an important role. Aims : The aim of the study was to compare the serum levels of tumor necrosis factor-alpha (TNF-α) in patients with AA and the healthy subjects and also to investigate the difference between the localized form of the disease with the extensive forms like AT and AU. Materials and Methods : Sixty patients with AA and 20 healthy controls were enrolled in the study. Forty-six patients had localized AA (LAA), and 14 patients had AT, AU, or AT/AU. The serum levels of TNF-α were measured using enzyme-linked immunoassay techniques. Results: Serum levels of TNF-α were significantly higher in AA patients than in controls (10.31 ± 1.20 pg ml vs 9.59 ± 0.75 pg/ml, respectively). There was no significant difference in serum levels of TNF-α between patients with LAA and those with extensive forms of the disease. Conclusion : Our findings support the evidence that elevation of serum TNF-α is associated with AA. The exact role of serum TNF-α in AA should be additionally investigated in future studies.

HLA-A and HLA-B alleles associated in psoriasis patients from Mumbai, Western India

Shankarkumar Umapathy — Fri,4 Nov 2011

Shankarkumar Umapathy, Aruna Pawar, R Mitra, D Khuperkar, JP Devaraj, K Ghosh, U Khopkar

Indian Journal of Dermatology 2011 56(5):497-500

Background: Psoriasis, a common autoimmune disorder characterized by T cell-mediated keratinocyte hyperproliferation, is known to be associated with the presence of certain specific Human Leukocyte Antigen (HLA) alleles. Aim: To evaluate distribution of HLA-A and HLA-B alleles and hence identify the susceptible allele of psoriasis from patients in Western India. Materials and Methods: The study design included 84 psoriasis patients and 291 normal individuals as controls from same geographical region. HLA-A and HLA-B typing was done using Serology typing. Standard statistical analysis was followed to identify the odds ratio (OR), allele frequencies, and significant P value using Graphpad software. Results: The study revealed significant increase in frequencies of HLA-A2 (OR-3.976, P<0.0001), B8 (OR-5.647, P<0.0001), B17 (OR-5.452, P<0.0001), and B44 (OR-50.460, P<0.0001), when compared with controls. Furthermore, the frequencies of HLA-A28 (OR-0.074, P=0.0024), B5 (OR-0.059, P<0.0001), B12 (OR-0.051, P=0.0002), and B15 (OR-0.237, P=0.0230) were significantly decreased in psoriasis patients. Conclusion: This study shows the strong association of HLA-A2, B8, and B17 antigens with psoriasis conferring susceptibility to psoriasis patients from Western India, while the antigens HLA-A28, B5, and B12 show strong negative association with the disease.

Implications of Bax, Fas, and p53 in the pathogenesis of early-stage mycosis fungoides and alterations in expression following photochemotherapy

Fatma Aydin — Fri,4 Nov 2011

Fatma Aydin, Yildiz Levent, Senturk Nilgun, Yuksel Esra Pancar, Turanli Ahmet Yasar

Indian Journal of Dermatology 2011 56(5):501-504

Background: The underlying molecular basis of mycosis fungoides (MF) has not yet been clarified. However, defects in apoptosis may contribute to its pathogenesis. Aim: We investigated the expression of Bax, Fas, and p53 in early-stage MF patients and any alterations in expression following photochemotherapy. Materials and Methods : Bax, Fas, and p53 expressions were studied by immunohistochemistry in both keratinocytes and lymphocytes on paraffin-embedded skin specimens from 27 early-stage MF patients. Results: Bax, Fas, and p53 staining was shown in the lymphocytes in 0/27, 26/27, and 11/27 patients at the time of diagnosis, whereas these ratios were 0/27, 9/27, and 0/27, respectively, after psoralen plus ultraviolet A (PUVA) treatment. The decrease in p53 and Fas expression in the lymphocytes was found statistically significant. Bax, Fas, and p53 staining in the keratinocytes was shown in 5/27, 27/27, and 25/27 patients at the time of diagnosis, whereas these ratios were 0/27, 22/27, and 4/27, respectively, after PUVA treatment. The decrease in p53, Fas, and Bax expression in the keratinocytes was found statistically significant. Conclusion: Although Bax seems unrelated with early-stage MF, Fas and p53 expression in the lymphocytes may contribute to the understanding of the pathogenesis of this disease.

Clues to histopathological diagnosis of treated leprosy

Rajiv Joshi — Fri,4 Nov 2011

Rajiv Joshi

Indian Journal of Dermatology 2011 56(5):505-509

Background : Current recommendations for multidrug therapy (MDT) of leprosy follow a fixed duration of treatment regardless of clearance of skin lesions or presence or absence of acid-fast bacilli in the skin. A fairly high percentage of patients with leprosy who complete recommended duration of multi-drug therapy are left with residual skin lesions which are a great source of anxiety to the patient and the family. A small percentage of patients go on to develop new lesions after completion of treatment which may be either late reactions or relapse. Many such patients undergo skin biopsy to assess 'activity' of the disease. Hardly any literature exists on the histological findings in biopsies taken from patients who have completed MDT. Materials and Methods : This article describes histomorphological findings in patients with treated leprosy who underwent skin biopsies after completion of MDT because they either had persistent lesions or developed new lesions on follow-up. Results : Histology of treated leprosy may show findings that are diagnostic for leprosy (histology active) or findings that by themselves are not diagnostic for leprosy (histology inactive) but may be used as clues in confirming that the persistent skin lesions are histologically inactive and need no further treatment. These findings may be divided into 1. Epidermal findings, 2. Alterations in dermal stroma, and 3. Morphological characteristics of the dermal inflammatory infiltrate. Conclusion : Awareness of histomorphological changes that occur in skin lesions of leprosy after completion of treatment can aid the pathologist to determine whether the lesions are active or inactive histologically and assist the clinician to convince the patient that his disease is inactive and does not need further treatment.

Acute bacterial skin and skin structure infections: current perspective

Megha Shah — Fri,4 Nov 2011

Megha Shah, Hetal D Shah

Indian Journal of Dermatology 2011 56(5):510-512

A skin and skin structure infection is a bacterial infection of skin and associated tissues. It may be complicated skin and skin structure infection or uncomplicated skin and skin structure infection. Recently, the Food and Drug Administration has called them acute bacterial skin and skin structure infections (ABSSSI). ABSSSI are common and encompass a variety of disease presentations and severity. Increased antimicrobial resistance among both Gram-positive and Gram-negative bacteria with methicillin-resistant Staphylococcus aureus is the main problem in treatment. So, development of newer agents to fight against resistant microbes is the need of the hour. Ceftaroline, a newer cephalosporin, is one promising agent.

Plantar warts treated with topical adapalene

Ramji Gupta — Fri,4 Nov 2011

Ramji Gupta

Indian Journal of Dermatology 2011 56(5):513-514

Background: Treatment of plantar warts caused by human papilloma virus (HPV) strain types 1, 2 and 4 is often difficult and a challenging problem. Various therapeutic modalities available for treating this problem have not been uniformly successful. Purpose : The purpose of present study is to evaluate the efficacy of adapalene applied locally with occlusion in plantar warts. Materials and Methods: A total of 10 patient with 118 plantar warts were included in an open study. All were treated by applying adapalene gel 0.1% after paring of warts if needed followed by occlusive dressing with polythene paper in each patient. The effects of the treatment were evaluated every week till the clearance of all warts. Findings: Adapalene was used in 10 patient having 118 plantar warts. All the warts cleared in 39±15.07 days. There was no side effects like scar formation, irritation, erythema or infection with adapalene. Conclusion: Adapalene clears the plantar warts faster compared to other modalities available. Limitation: Need trial with large number of patients.

Oral itraconazole for the treatment of severe seborrhoeic dermatitis

Jayasri Das — Fri,4 Nov 2011

Jayasri Das, Monalisa Majumdar, Urmita Chakraborty, Vivek Majumdar, Gautam Mazumdar, Jayasree Nath

Indian Journal of Dermatology 2011 56(5):515-516

Background : Seborrheic dermatitis (SD) is an inflammatory skin disorder in which colonies of Malassezia furfur have been found in affected areas. Aim: The aim of this study was to evaluate the efficacy of itraconazole in the treatment of severe SD. Materials and Methods: Itraconazole was given to 30 patients of SD in a dose of 100 mg twice daily for 1 week followed by 200 mg/day for first 2 days of the following 2 months. The response was noted on day 15, 30, 60, and 90. The clinical response was graded as markedly effective, effective, or ineffective. Results: Clinical improvement (evaluated as markedly effective or effective) was observed in 83.3% cases. Conclusion : The anti-inflammatory activity of oral itraconazole suggests that it should be the first-line therapy in severe SD.

When FUE goes wrong!

Arvind Poswal — Fri,4 Nov 2011

Arvind Poswal, Sangay Bhutia, Ruby Mehta

Indian Journal of Dermatology 2011 56(5):517-519

Follicular unit extraction (FUE) is an accepted method of extracting individual follicular unit grafts for hair transplant surgery. Since follicles are harvested from the back of the scalp using tiny punches resulting in minimal scarring, it has gained rapid acceptance among the patients. However, due care needs to be exercised while performing FUE. FUE should not be confused with the older plug graft extraction methods of coring out hair-bearing skin plugs. Lack of due diligence while performing such extractions can lead to subluxation of the grafts into the subdermal layer of scalp. Overtumescence of the scalp donor area, use of blunt punches and trying to "core" out the full thickness grafts can all contribute to this. The following cases illustrate some pitfalls to be avoided while performing FUE and the adverse consequences if they occur.

A study of the prevalence of diabetes, insulin resistance, lipid abnormalities, and cardiovascular risk factors in patients with chronic plaque psoriasis

Rickson R Pereira — Fri,4 Nov 2011

Rickson R Pereira, Sangeeta T Amladi, Prema K Varthakavi

Indian Journal of Dermatology 2011 56(5):520-526

Background: The association between psoriasis, diabetes, and cardiovascular disease remains largely unelucidated in the Indian population. Aims: To study the prevalence of diabetes, insulin resistance, lipid abnormalities, and cardiovascular risk factors in patients with chronic plaque psoriasis. Materials and Methods: Seventy-seven patients of chronic plaque psoriasis and ninety two age- and sex-matched controls were enrolled in the study over a period of one year. Clinical and biometric data were noted and fasting venous blood samples were collected. Nondiabetic patients were subjected to an oral glucose tolerance test with 75 g glucose and postprandial venous blood samples collected at 120 mins. The fasting glucose, insulin, lipid levels, postprandial glucose and postprandial insulin levels were measured in samples from nondiabetic patients whereas fasting lipid levels only were measured in diabetic patients. Results: The prevalence of impaired fasting glucose, impaired glucose tolerance, and diabetes mellitus in psoriatics was 5.2%, 9.1%, and 32.5%, respectively, as compared to 6.5%, 3.3%, and 15.2%, respectively, in the controls. The difference was statistically significant. The odds ratio of having an abnormal glucose metabolism in psoriasis was 2.63. Smoking had a positive association with insulin resistance in psoriatic cases. The serum cholesterol levels were elevated in 29 (37.7%) cases with a mean of 186.27 ± 43.18 and 34 (37%) controls with a mean of 194.38 ± 57.20. The serum HDL-cholesterol levels were reduced in 50 (64.9%) cases with a mean of 53.29 ± 15.90 as compared to 71 (74.7%) in controls with a mean of 48.76 ± 12.85. The serum LDL-cholesterol levels were elevated in 38 (49.4%) cases with a mean of 102.56 ± 44.02 and 36 controls with a mean of 115.62 ± 54.37. The serum triglyceride levels were elevated in 25 (32.5%) cases with a mean of 129.99 ± 61.32 and 38 (41.3%) controls with a mean of 141.04 ± 80.10. The differences between the two groups were not statistically significant. The two groups did not differ with respect to other cardiovascular risk factors such as increased body mass index, increased waist size, increased waist-to-hip ratio, and hypertension. Conclusion: There is a positive association between insulin resistance and psoriasis. No association between psoriasis and dyslipidemia has been found in this study.

The efficacy of clobetasol propionate with varying dilutions of emollient determined by histamine wheal suppression test

M Barathi — Fri,4 Nov 2011

M Barathi, Reena Rai, CR Srinivas

Indian Journal of Dermatology 2011 56(5):527-528

Background: The ability of steroids to reduce the histamine wheal was used to assess the efficacy of topical clobetasol propionate with varying dilutions of emollients. Aim: To determine the wheal-suppressing ability of topical clobetasol with varying dilutions of emollient. Materials and Methods: It was a double-blinded randomized study. Twenty-five volunteers were included in the study. Five syringes of 5 ml were taken and the syringes were loaded with either clobetasol propionate 0.05%, emollient, or clobetasol propionate with emollient in dilutions of 1:1, 1:2, and 1:3. The syringes were coded 1 to 5. Five squares of 3 × 3 cm were marked on the flexor aspect of the forearm of the volunteers. After randomization, half fingertip unit of the cream was applied within each square uniformly. Three hours later histamine prick test was performed by the standard method. The wheal was measured after 15 min and the results were recorded. After decoding, results were statistically analyzed by analysis of variance. Result: The decrease in wheal suppression of steroid with emollient (1:1) was same as topical steroid and the wheal suppression decreased with increasing dilutions of steroid. Conclusion: We conclude that steroids and emollients can be mixed in equal proportion (1:1) and the effect is same as steroid alone and increasing dilution of steroids with emollients was not effective in suppressing the wheal.

Herpes zoster: A clinical study in 205 patients

EN Abdul Latheef — Fri,4 Nov 2011

EN Abdul Latheef, K Pavithran

Indian Journal of Dermatology 2011 56(5):529-532

Background: Even though herpes zoster is a common condition its incidence and pattern of occurrence in the era of HIV disease is significant. Aim: To analyze the incidence, pattern of occurrence and evolution of herpes zoster with special attention to provocative factors if any. Materials and Method s: This was an analytical study conducted for 2 years based on a preformed proforma containing preliminary information, a detailed clinical evaluation regarding the segment of involvement, morphology, pattern of lesions, complications, disseminations etc. and investigations to establish provocative factors if any. Results: Incidence of herpes zoster was mainly in the fourth and third decades of life. A definite history of chicken pox was present in only 63.4% cases. In the majority (70%) herpes zoster occurred spontaneously. In 30% cases, immunosuppression due to chemotherapy, malignancy, HIV infection, diabetes mellitus were observed. The commonest segment affected was thoracic (42.4%) followed by cranial (28.2%) and cervical (12.1%). Majority resolved in 7-14 days except immunosuppressed. 34.6% of the patients had complications such as secondary bacterial infection, post herpetic neuralgia, and motor weakness. Ten patients had HIV infection as a provocative factor. Conclusion: The results of incidence and clinical pattern of herpes zoster is almost parallel to the previous studies. Any factors of immunosuppression should be checked, especially HIV, particularly in disseminated and long-lasting cases.

Psoriasis and increased prevalence of hypertension and diabetes mellitus

Maryam Ghiasi — Fri,4 Nov 2011

Maryam Ghiasi, Mohammad Nouri, Ata Abbasi, Parvaneh Hatami, Mohammad Amin Abbasi, Keramat Nourijelyani

Indian Journal of Dermatology 2011 56(5):533-536

Background: Psoriasis is an autoimmune skin disease and associated with other diseases such as cardiovascular, hypertension, and diabetes mellitus. Aim: Our aim was to explore the prevalence of diabetes mellitus and hypertension in psoriatic patients. Materials and Methods: Between April 2008 and May 2010, a total of 304 psoriatic and 300 nonpsoriatic patients were enrolled in this cross sectional study. Data were obtained on age, sex, weight, heights, etc; documented medical history of diabetes mellitus and hypertension; family history of diabetes mellitus and hypertension in first relatives, history of smoking. Results: There was no significant difference in age and gender distribution between two groups. There was also no difference in body mass index between two groups. Within psoriatic group, 79.3% of patients present with plaque type of the disease and 20.7% present with other types. The results showed that within psoriatic patients, the prevalence of diabetes in women is significantly higher than in men (OR=1.93, CI95%: 1.1-3.6, P=0.004) but this difference is not present in nonpsoriatic patients. The results also showed that the prevalence of diabetes in psoriatic patients is significantly higher than nonpsoriatic patients (OR=1.76, CI95%: 1.11-2.8, P=0.015). The data showed that psoriatic patients were more likely to develop hypertension compared with nonpsoriatic patients (OR=2.2, CI95%: 1.2-4.6, P=0.003). According to results, although smoking rate within psoriatic patients is higher than the other group but the difference was not significant. Conclusion: Psoriatic patients have an increased risk of developing metabolic syndrome and hypertension in comparison to nonpsoriatic patients.

Skin lesions in lupus erythematosus: A marker of systemic involvement

Nilay Kanti Das — Fri,4 Nov 2011

Nilay Kanti Das, Rathindra Nath Dutta, Sujit Ranjan Sengupta

Indian Journal of Dermatology 2011 56(5):537-540

Background: Lupus erythematosus (LE) is an autoimmune disorder with diverse clinical manifestation ranging from mild cutaneous disorder to life-threatening systemic illness (SLE). In some patients, it remains to persist in the skin-limited form while in others it evolves into SLE. Here comes the role of identifying the markers of systemic involvement, which could determine the course and prognosis of the disease. Aim: To identify those manifestations that could be used to identify the activity of the disease SLE. Materials and Methods: An institution based, descriptive, cross-sectional study carried out over 1 year period. Sixty patients (male : female 1 : 4) with cutaneous LE were recruited for the study. The patients were classified in two groups depending on the presence or absence of ARA criteria of SLE. Detailed account of LE-specific and nonspecific lesions were noted. Statistical significance of the results was compared between the two groups using the chi-square test. Results: Among the different cutaneous manifestations, highly significant (P value <0.001) was found between SLE and nonscarring alopecia, photosensitivity, oral ulcer, malar rash (in decreasing order of odds favoring the association with SLE). Dimorphic skin lesions (P value=0.0326) also showed significant association where as discoid lesion (especially localized variant) predicted toward a skin limited form of the disease with high probability of not developing SLE (P value <0.0001). No significant association was found between SLE and papulosquamous lesions, Raynaud's phenomenon or scarring alopecia. Conclusion: Identification of lesions with high degree of association with SLE can alert the physician of the unfavorable prognosis and allow timely intervention and institution of appropriate management strategies.

Mental health in patients with pemphigus: An issue to worth consideration

Mohammad Arbabi — Fri,4 Nov 2011

Mohammad Arbabi, Zahra Ghodsi, Abolfazl Mahdanian, Naser Noormohammadi, Keivan Shalileh, Fateme Darvish, Narges Ashrafinia, Cheida Chams

Indian Journal of Dermatology 2011 56(5):541-545

Background: There exists a high prevalence of psychiatric disorders in dermatological patients. Although, investigators have evaluated psychiatric aspects of the patients suffering from skin diseases; there are rare studies concerning mental health in pemphigus patients. The objective of this study was to evaluate mental health status and quality of life of newly diagnosed pemphigus patients. Materials and Methods: Between April 2007 and June 2008, all newly diagnosed pemphigus patients attending the outpatient clinic of a dermatological hospital were given a questionnaire comprising the GHQ-28 and DLQI to fill out. Results: Of 283 patients, 212 complete forms were returned. The bimodal score of GHQ ranged from 0 to 26 (Mean = 9.4) and the Likert score of GHQ ranged from 6 to 68 (Mean = 31.9). The DLQI score ranged between 0 and 30 (Mean of 13.8). A total of 157 patients (73.7%) were yielded to be possible cases of mental disorder considering GHQ-28 bimodal scores. Significant correlation was detected between the DLQI score and bimodal and Likert scoring of GHQ-28. Conclusion: Our study has depicted high prevalence of psychiatric comorbidity in pemphigus patients. It underlines the fact that physicians, who are in-charge of care for these patients, are in an exceptional position to distinguish the psychiatric comorbidity and to take appropriate measures.

Hypopigmentary disorders in children in South India

Tukaram Sori — Fri,4 Nov 2011

Tukaram Sori, Amiya Kumar Nath, Devinder Mohan Thappa, TJ Jaisankar

Indian Journal of Dermatology 2011 56(5):546-549

Background: Hypopigmentary disorders are common group of dermatoses in pediatric age group. Aim: To study the frequency and patterns of hypopigmentary disorders in children. Materials and Methods: This study was a descriptive clinical study spanning over a period of 23 months. A total of 113 children (61 boys and 52 girls) were included in this study. Results: The frequency of hypopigmentary disorders among children was 3.28 per 1000 children attending the dermatology out patient department. The mean age of the children was 7.2 years. The mean of age of onset was 7.36 years. Most common hypopigmentary disorder in our study was pityriasis alba (24.7%), followed by vitiligo (20.4%), leprosy (11.5%), nevus depigmentosus (10.18%), and tinea versicolor (6.2%). Others were hypomelanosis of Ito (5), post-inflammatory hypopigmentation (5), pityriasis rosea (4), steroid-induced hypopigmentation (4), lichen sclerosus et atrophicus (3), pityriasis lichenoides chronica (3), lichen striatus (2), oculocutaneous albinism (2), tuberous sclerosis complex (2), pigmentary mosaicism (1), and Griscelli syndrome (1). Conclusion: Pityriasis alba, vitiligo, leprosy, nevus depigmentosus and tinea versicolor are the five most common hypopigmentary disorders in children.

A clinical and histopathological profile of patients with cutaneous tuberculosis

Neerja Puri — Fri,4 Nov 2011

Neerja Puri

Indian Journal of Dermatology 2011 56(5):550-552

Extrapulmonary tuberculosis constitutes about 10% of all cases of tuberculosis, and cutaneous tuberculosis makes up only a small proportion of these cases. Despite prevention programs, tuberculosis is still progressing endemically in developing countries. Commonest clinical variant of cutaneous tuberculosis in our study was lupus vulgaris seen in 55% patients followed by scrufuloderma seen in 25% patients followed by orificial tuberculosis, tuberculosis verrucosa cutis, papulonecrotic tuberculid, and erythema induratum seen in 5% each. The commonest site of involvement was limbs seen in 50% patients followed by neck seen in 25% patients, face in 15%, and trunk in 10% patients. Maximum percentage of patients (55%) had duration of cutaneous tuberculosis between 6-12 months followed by 35% between 13-24 months, 5% had duration of cutaneous tuberculosis less than 6 months, and the rest 5% had duration more than 24 months. The commonest histopathological feature in our study was tuberculoid granuloma with epitheloid cell and Langhans giant cells seen in 70% patients, hyperkeratosis was seen in 15% patients and AFB bacilli were seen in 5% patients.

Cardiovascular comorbiditiy in psoriasis

Gurcharan Singh — Fri,4 Nov 2011

Gurcharan Singh, Simran Pal Singh Aneja

Indian Journal of Dermatology 2011 56(5):553-556

The chronic inflammatory nature of psoriasis is also thought to predispose patients to other diseases with an inflammatory component, the most notable being cardiovascular and metabolic (cardiometabolite) disorders. This concept is supported by studies showing that psoriasis is associated with cardiovascular risk factors like diabetes, obesity, hypertension, dyslipidemia, smoking and diseases including MI. Given the increased prevalence of cardiovascular co morbidities in patients, dermatologists treating psoriasis need to approach the disease as a potentially multisystem disorder and must alert these patients to the potentially negative effects of their disease.

Progressive facial hemiatrophy - A case series

Feroze Kaliyadan — Fri,4 Nov 2011

Feroze Kaliyadan, Kaberi Biswas, AD Dharmaratnam

Indian Journal of Dermatology 2011 56(5):557-560

Six female patients diagnosed with Progressive Facial Hemiatrophy are presented here. The clinical and serological features are highlighted, and treatment options for the condition are discussed. We would like to highlight the need to differentiate the condition from localized scleroderma and the with limitation of its medical management.

Scrotal ulceration following all-trans retinoic acid therapy for acute promyelocytic leukemia

Illias Tazi — Fri,4 Nov 2011

Illias Tazi, Mohamed Rachid, Asmaa Quessar, Said Benchekroun

Indian Journal of Dermatology 2011 56(5):561-563

All-trans retinoic acid (ATRA) induces complete remission in most cases of acute promyelocytic leukemia. Toxicity of ATRA has been shown to be mild, consisting of headache, dry skin, dermatitis, and gastrointestinal disorders. We describe a case of scrotal ulceration with ATRA use in a Moroccan patient, an occurrence that has been rarely reported in the medical literature. The pathogenesis of scrotal ulceration remains unknown. Our experience indicates the importance of recognizing genital ulcers associated with ATRA in order that appropriate countermeasures can be taken.

Lethal systemic degos disease with prominent cardio-pulmonary involvement

Yaghoobi Notash Ali — Fri,4 Nov 2011

Yaghoobi Notash Ali, Mazoochy Hamed, Nikoo Azita

Indian Journal of Dermatology 2011 56(5):564-567

A 48-year-old man presented with acute abdominal pain underwent laparotomy that revealed two perforated ulcers in jejunum. He had skin lesions with porcelain white atrophic scar which were ignored for 3 years, whereas the disease revealed own malignant nature and progressed to nervous, gastrointestinal, and cardiopulmonary systems. The diagnosis of Degos disease was established on the basis of clinical and histopathological features. He expired due to cardio-pulmonary insufficiency after 5 months from the onset of systemic involvement. Autopsy showed diffuse fibrotic changes in serosal membranes and internal organs. Distribution of skin lesions that involved palmoplantar surfaces, genitalia and scalp and, furthermore, course of disease as rapid progressive cardio-polmunary involvement are remarkable point in this patient. On the other hand, this case highlights importance of clinicopathologic correlation, specially in the dermatologic field.

Cutaneous sarcoidosis - a great masquerader: A report of three interesting cases

Raghunatha R Reddy — Fri,4 Nov 2011

Raghunatha R Reddy, BM Shashi Kumar, MR Harish

Indian Journal of Dermatology 2011 56(5):568-572

It is a known fact that cutaneous sarcoidosis is a great imitator in dermatology. We report three cases of cutaneous sarcoidosis without systemic involvement and with varied dermatologic presentation with regard to age and morphology. Lesions mimicked various common dermatologic conditions, causing great confusion for the diagnosis and posing problems for management. Awareness of these varied morphologic presentations is essential for the early diagnosis and management of the master mimicker - cutaneous sarcoidosis.

Unusual clinicopathological and immunological presentation of chronic bullous dermatosis of childhood (linear IgA dermatosis)

Al-Saif Fahad — Fri,4 Nov 2011

Al-Saif Fahad, Al-Rikabi Ammar

Indian Journal of Dermatology 2011 56(5):573-575

Linear IgA bullous dermatosis is a rare sulfone-responsive subepidermal blistering disorder of unknown etiology in which smooth linear deposits of IgA are found in the basement membrane zone. Chronic bullous dermatosis of childhood is equivalent to linear IgA disease of adulthood and is characterized by an abrupt onset of large, widespread and tense bullae on a normal or erythematous base. In this case, we describe an unusual presentation of chronic bullous dermatosis in a 14-month-old Saudi girl. Histopathological examination revealed subepidermal cell poor blisters with linear deposition of IgA, IgG, IgM, and C3 along the dermoepidermal junction. The unusual clinical, histopathological and immunofluorescence findings in this patient are discussed, with an account on the differential diagnosis in such cases along with a detailed review of the relevant literature.

Disseminated superficial and warty type of porokeratosis: A rare coexistence

Kusumika Kanak — Fri,4 Nov 2011

Kusumika Kanak, AK Jaiswal, Pallavi Reddy

Indian Journal of Dermatology 2011 56(5):576-577

A 60-year-old male presented with hyperpigmented annular plaques with raised keratotic wall and central groove along with warty plaque involving the trunk and the extremities, respectively. A provisional diagnosis of porokeratosis was made which was confirmed histopathologically. Herein, we report a case of rare coexistence of disseminated superficial and warty porokeratosis.

Squamous cell carcinoma of supraglottic larynx with metastasis to all five distal phalanges of left hand

Narendra Kumar — Fri,4 Nov 2011

Narendra Kumar, Anjan Bera, Ritesh Kumar, Sushmita Ghoshal, Shabab Lalit Angurana, Radhika Srinivasan

Indian Journal of Dermatology 2011 56(5):578-580

Subcutaneous metastasis from carcinoma larynx is a rare presentation and to the phalynx is the rarest. We herein describe a case report of carcinoma supraglottic larynx, which is involving all five distal phalanges of left hand with simultaneous metastases to lung and liver. Acrometastasis is an unusual presentation, which might mimic an infectious or inflammatory pathology. The brief report highlights the importance of clinical awareness of metastatic dissemination to unusual sites in the face of increasing cancer survivorship.

Progeria in siblings: A rare case report

R Sowmiya — Fri,4 Nov 2011

R Sowmiya, D Prabhavathy, S Jayakumar

Indian Journal of Dermatology 2011 56(5):581-582

Progeria, also known as Hutchinson-Gilford syndrome, is an extremely rare, severe genetic condition wherein symptoms resembling aspects of aging are manifested at an early age. It is an autosomal dominant disorder. It is not seen in siblings of affected children although there are very few case reports of progeria affecting more than one child in a family. Here we are presenting two siblings, a 14-year-old male and a 13-year-old female with features of progeria, suggesting a possible autosomal recessive inheritance.

Glomus tumor of the nail unit

Banavasi S Girisha — Fri,4 Nov 2011

Banavasi S Girisha, Manjunath M Shenoy, Michelle Mathias, Rajashekar Mohan

Indian Journal of Dermatology 2011 56(5):583-584

Glomus tumor is a benign tumor arising from the neuromyoarterial plexus concentrated beneath the nail. This plexus is an arteriovenous anastomosis functioning without the intermediary capillary bed. Etiology is not exactly known. It is debilitating to the patient because of the chronicity of symptoms and lack of proper investigation which will help in identifying the tumor at an early stage. We report a case of glomus tumor situated in the proximal nail fold region and causing longitudinal splitting of nail.

Epithelioid sarcoma and squamous cell carcinoma arising in a burn scar

Kusum D Jashnani — Fri,4 Nov 2011

Kusum D Jashnani, Varsha M Dhume, Naresh K Bahal

Indian Journal of Dermatology 2011 56(5):585-586

Development of a malignant tumor is a well known complication of a chronic burn scar. Most of these tumors are squamous cell carcinomas and only 28 cases of burn scar sarcomas have been reported in literature. We report the first occurrence of the combination of squamous cell carcinoma and epithelioid sarcoma arising in a burn scar.

Successful treatment of multifocal cutaneous leishmaniasis with miltefosine

Bhushan Madke — Fri,4 Nov 2011

Bhushan Madke, Vidya Kharkar, Siddhi Chikhalkar, Sunanda Mahajan, Uday Khopkar

Indian Journal of Dermatology 2011 56(5):587-590

We report a 48-year-old immunocompetent male, resident of Central India, who presented with slowly progressive asymptomatic multiple red lesions on different parts of body. On enquiry, the patient gave history of travel to Middle East 6 months back. Examination showed 10 crusted erythematous indurated plaques and nodules over forearms, left leg, right index finger, left wrist and dorsa of both feet. Histopathological examination of tissue biopsy showed multiple intracellular as well as extracellular leishmania donovan bodies. Keeping in mind the higher rate of side effects to pentavalent antimony, we treated this patient with oral miltefosine 50 mg bid and the lesions showed complete resolution over 4 months of therapy.

Olmsted syndrome: Report of two cases

GK Tharini — Fri,4 Nov 2011

GK Tharini, N Hema, S Jayakumar, B Parveen

Indian Journal of Dermatology 2011 56(5):591-593

Olmsted syndrome is an uncommon genetic disorder with symmetrical, diffuse, transgredient, mutilating palmoplantar keratoderma and periorificial hyperkeratosis. Olmsted syndrome in a female patient is particularly rare, and we report two unrelated female patients of Olmsted syndrome, who presented with perioral hyperkeratosis and palmoplantar keratoderma. One of our patients also had woolly hair from birth and flexion contracture of a digit, while the other had pseudoainhum. There was no cardiac involvement. Hence, the diagnosis of Olmsted syndrome was made.

A case of dyskeratosis congenita with primary amenorrhea and adenocarcinoma of stomach

Nandini Chakrabarti — Fri,4 Nov 2011

Nandini Chakrabarti, Nilendu Sarma, Chandan Chattopadhyay, Atanu Roy Chowdhuri, Chanchal Das, Salil K Pal

Indian Journal of Dermatology 2011 56(5):594-596

Dyskeratosis congenita (DC) is a rare disease characterized by hyperpigmentation, nail dystrophy and mucous membrane abnormality. Commonly occurring in males, the patients die young usually due to bone marrow suppression. Malignancies of various descriptions have been reported in this disease, the commonest being solid tumors of head/neck (squamous cell carcinoma). We report the case of a female patient with DC, who presented to us with severe wasting and primary amenorrhea and died of carcinoma stomach in our hospital 3 weeks later.

Ebastine in chronic spontaneous urticaria in higher doses

Kiran V Godse — Fri,4 Nov 2011

Kiran V Godse

Indian Journal of Dermatology 2011 56(5):597-598

Reverse koebner phenomenon in leukocytoclastic vasculitis

S Yadav — Fri,4 Nov 2011

S Yadav, D De, AJ Kanwar

Indian Journal of Dermatology 2011 56(5):598-599

Verrucous hemangioma or angiokeratoma? A missed diagnosis

S Pavithra — Fri,4 Nov 2011

S Pavithra, H Mallya, H Kini, GS Pai

Indian Journal of Dermatology 2011 56(5):599-600

Ulcerative pyoderma gangrenosum in mixed connective tissue disorder: A rare association and role of azathioprine in the management

Partha Sardar — Fri,4 Nov 2011

Partha Sardar, Pradipta Guha, Nilay Kanti Das, Ramesh Chandra Gharami, Shounak Majumdar, Dipanjan Banerjee, Ramtanu Banerjee

Indian Journal of Dermatology 2011 56(5):600-602

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Younis Abed EL-Wahhab Skaik — Fri,4 Nov 2011

Younis Abed EL-Wahhab Skaik

Indian Journal of Dermatology 2011 56(5):603-603

Study of nail changes and nail disorders in the elderly

Sudhakar Rao — Fri,4 Nov 2011

Sudhakar Rao, Sabyasachi Banerjee, Sadhan Kumar Ghosh, Dwijendra Nath Gangopadhyay, Sukumar Jana, Kakali Mridha

Indian Journal of Dermatology 2011 56(5):603-606

Umbilical cherry

Bhushan Madke — Fri,4 Nov 2011

Bhushan Madke, Uday Khopkar

Indian Journal of Dermatology 2011 56(5):607-608