Indian Journal of Dermatology
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   2013| September-October  | Volume 58 | Issue 5  
    Online since August 30, 2013

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The rate and pattern of Bcl-2 and cytokeratin 15 expression in trichoepithelioma and nodular basal cell carcinoma: A comparative study
Shahram Sabeti, Farhad Malekzad, Mehrdad Ashayer, Rohollah F Fouladi, Kambiz K Hesari, Mihan P Toutkaboni, Shima Younespour
September-October 2013, 58(5):331-336
DOI:10.4103/0019-5154.117291  PMID:24082173
Context: Histopathological evaluations can differentiate between clinically resembling trichoepithelioma (TE) and basal cell carcinoma (BCC) unless the biopsy specimens are small or superficial. Previous studies used immunohistochemical evaluation for Bcl-2 and cytokeratin 15 (CK15), in attempts to differentiate between these two entities, with heterogeneous findings. Aims: This study intended to compare the rate and patterns of Bcl-2 and CK15 expressions between specimens of TE and nodular BCC. Settings and Design: Case-series including formalin-fixed, paraffin-embedded cutaneous biopsies. Subjects and Methods: Twenty-two BCC and 12 TE specimens were stained for Bcl-2 and CK15 and examined microscopically. The rate and patterns of expressions were compared between the two groups. Statistical Analysis Used: Statistical analysis was performed using the statistical software (SPSS version 16.0; SPSS Inc., Chicago, IL, USA), Pearson Chi-square, or Fisher's exact tests, wherever appropriate. Results: The two groups were comparable for the expression rate and patterns of Bcl-2 (86.4%: 5 central, 14 diffuse in BCC vs. 83.3%: 2 central, 8 diffuse in TE; P = 0.59 and 0.54 for rate and pattern, respectively). The rate of CK15 expression was significantly higher in TE specimens (66.7%: 4 central, 3 diffuse, 1 peripheral vs. 4.5%: 1 central; P < 0.001). The positive likelihood ratio in distinguishing the two neoplasms was 14.7 (95% confidence interval: 2.1-103.7). Conclusions: CK15 but not Bcl-2 staining may help in differentiating between BCC and TE even in BCCs with follicular differentiation.
  7 3,557 78
Generalized lichenoid drug eruption associated with imatinib mesylate therapy
Sudip Kumar Ghosh
September-October 2013, 58(5):388-392
DOI:10.4103/0019-5154.117315  PMID:24082187
Imatinib mesylate (IM), an anticancer drug, has been widely used to treat chronic myeloid leukemia (CML), gastrointestinal stromal tumors (GIST), and dermato-fibrosarcoma protuberans. Cutaneous reactions to IM have been reported to occur in varying number of patients in different case series. Non-lichenoid cutaneous reactions secondary to IM have been well-documented in the literature and are the commonest non-hematologic adverse reactions associated with its use. Lichenoid drug eruption (LDE) associated with IM therapy has rarely been reported in the literature. A case of a generalized LDE associated with IM therapy has been described here for its rarity and interesting clinical presentation. As the clinical usage of IM is increasing, one might expect an increasing number of similar patients in the future. It is thus important to realize the potential of IM to produce LDE and to differentiate this entity from idiopathic lichen planus. In the present article, the reports of IM-associated LDE, described in the PubMed and Medline database (in English language literature), have also been reviewed.
  3 4,241 95
Toxic epidermal necrolysis due to concomitant use of lamotrigine and valproic acid
Sukhjot Kaur, Alka Dogra
September-October 2013, 58(5):406-406
DOI:10.4103/0019-5154.117319  PMID:24082198
Anti-epileptic drugs can be associated with a wide spectrum of cutaneous adverse reactions ranging from simple maculopapular rashes to more severe and life threatening reactions like Stevens-Johnson syndrome and toxic epidermal necrolysis. These rashes are well documented with older antiepileptic drugs like phenytoin, phenobarbitone and carbamazapine. Lamotrigine is a newer, unrelated antiepileptic drug that causes skin rashes in 3-10% of new users. Higher starting dose or rapid escalation, concurrent treatment with valproic acid, and a previous history of a rash with other antiepileptic drugs are well recognized risk factors for lamotrigine related serious rashes. We report two patients with toxic epidermal necrolysis, resulting from concomitant use of lamotrigine and valproic acid. It is emphasized that clinicians adhere to the recommended dosage guidelines and adopt a slow dose titration when initiating treatment with lamotrigine.
  2 5,219 96
Thrombosis warning in children suffering from Henoch-Schonlein Purpura
Luan Li, Jingwen Zhang, Yunying Zhang, Hong Ji
September-October 2013, 58(5):409-409
DOI:10.4103/0019-5154.117349  PMID:24082216
Henoch-Schonlein Purpura (HSP) is one of the most common types of vasculitis in children. The characteristic clinical manifestations include non-thrombocytopenic purpura, arthritis or arthralgia, abdominal pain, gastrointestinal hemorrhage and renal abnormalities. Thrombosis has been reported as, a rare complication of HSP. We present the case of a 14-year-old boy who was diagnosed with HSP and suspected superior mesenteric vein thrombosis. We reviewed the relevant literature and found eight similar reported cases. HSP is associated with thrombosis and HSP itself and some risk factors may result in thrombosis. We suggest that physicians should monitor patients with HSP who are at a higher risk of developing thrombosis more closely.
  2 4,319 37
Dapsone induced methemoglobinemia and hemolysis in a G6PD deficient girl, possibly aggravated by aggressive methylene blue therapy
Tanmoy Ghatak, Banani Poddar, Arvind Kumar Baronia
September-October 2013, 58(5):410-410
DOI:10.4103/0019-5154.117360  PMID:24082224
  2 2,499 47
Zosteriform morphea in an immunocompetent patient
Ricardo Ruiz-Villaverde, Daniel Sánchez-Cano
September-October 2013, 58(5):411-411
DOI:10.4103/0019-5154.117368  PMID:24082231
  2 2,164 40
Docetaxel-induced hand and foot syndrome in a patient with metastatic breast carcinoma
Ravichandran Gurumurthi, Ramesh BV Nimmagadda, Subhashini Mohan
September-October 2013, 58(5):380-382
DOI:10.4103/0019-5154.117309  PMID:24082184
Hand and foot syndrome (HFS) is a well-known complication of chemotherapeutic drugs given in a dose-dense manner. Our patient was a 52-year-old female with metastatic breast carcinoma on salvage chemotherapy regimen with docetaxel at a dose of 60 mg/m 2 . The patient had grade 3 HFS characterized by symmetrical, tender, and erythematous skin lesions over the palms and soles associated with dysesthesia necessitating interruption of treatment. She developed this syndrome at a much lower dose than previously described due to her altered hepatic function. An insight regarding this unique distressing side-effect and assessment of various contributing factors would help us identify and treat the patient at the earliest.
  1 3,128 69
Hallermann-Streiff syndrome
Jayakar Thomas, B Sindhu Ragavi, PK Raneesha, N Ashwak Ahmed, S Cynthia, D Manoharan, R Manoharan
September-October 2013, 58(5):383-384
DOI:10.4103/0019-5154.117311  PMID:24082185
Hallermann-Streiff syndrome (HSS) is a rare disorder characterized by dyscephalia, with facial and dental abnormalities. We report a 12-year-old female child who presented with abnormal facial features, dental abnormalities and sparse scalp hair.
  1 3,713 90
Pilomatrixoma - presented as hypopigmented tender nodule: Diagnosed by FNAC: A case report with review of literature
Sankappa P Sinhasan, Chitra R Jadhav, Ramachandra V Bhat, Anandhi Amaranathan
September-October 2013, 58(5):405-405
DOI:10.4103/0019-5154.117312  PMID:24082196
Pilomatrixoma (PMX) is a skin appendage tumor of hair matrix origin, which usually occurs on the face or upper extremities. Although the lesion can appear at any age, it is commonly seen in children and is more common in females. Despite being better defined, pilomatricomas continue to be frequently misdiagnosed and are not usually considered in differential diagnoses, either in clinical set-up or during cytological reporting. They typically present as a superficial, firm, solitary, slow-growing, painless mass in the dermis. The overlying skin may be normal or exhibit a bluish-red discoloration or ulceration. We report an 18-year-old girl presented with tender, subcutaneous nodule with overlying skin showing atrophy and hypopigmentation. Clinically, it was diagnosed as neurofibroma and sent for FNAC. We offered precise diagnosis of pilomatrixoma on cytological examination, (where chances of wrong diagnosis are very high) and it was subsequently confirmed by histopathology. We discuss the varied clinical presentations, diagnostic difficulties, and differential diagnoses of PMX.
  1 2,530 70
A case of adult-onset Still's disease presenting with urticated plaques and acute myopericarditis
Noor Hanif Said, Siew Ngoh Wong, Wei Hsia Tan
September-October 2013, 58(5):405-405
DOI:10.4103/0019-5154.117316  PMID:24082197
Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology characterized by spiking fever, evanescent skin rash, arthralgia or arthritis, involvement of various organs, and predominantly neutrophilic leucocytosis. AOSD, although uncommon, has a characteristic constellation of clinical and laboratory features and should be considered in the differential diagnosis of pyrexia of unknown origin associated with a rash and arthralgia. The diagnosis is one of clinical suspicion and it is essential that infections, malignancy, and other rheumatic diseases are excluded. We report a case which illustrates the typical features of AOSD that were treated with steroids and azathioprine.
  1 4,816 41
Nevoid hyperkeratosis of the nipple and/or areola: Treatment with topical steroid
Alireza Ghanadan, Kamran Balighi, Somayeh Khezri, Kambiz Kamyabhesari
September-October 2013, 58(5):408-408
DOI:10.4103/0019-5154.117347  PMID:24082214
Nevoid hyperkeratosis of the nipple and/or areola (NHNA) is a rare and benign disease, with poorly understood etiology and no definite therapeutic plan. Hereby, we report another case of NHNA, discuss about its clinical and histopathological features, differential diagnosis, and responsiveness to topical steroid.
  1 6,903 51
Erythema nodosum as azathioprine hypersensitivity reaction in a patient with bullous pemphigoid
Jose Antonio Vargas-Hitos, Jose Mario Sabio, Jesús Tercedor, Nuria Navarrete-Navarrete, Juan Jiménez-Alonso
September-October 2013, 58(5):406-406
DOI:10.4103/0019-5154.117332  PMID:24082202
A 65-year-old woman with bullous pemphigoid presented with fever and several red-purple nodular subcutaneous lesions on both lower legs 1 week after starting treatment with azathioprine (AZA). Biopsy of a skin nodule was compatible with erythema nodosum (EN) and hypersensitivity reaction to AZA was suspected. AZA was subsequently discontinued, observing complete remission of fever and EN within 2 weeks. This case highlights the importance of recognizing EN as a possible manifestation of hypersensitivity reaction to AZA.
  1 2,113 42
An unusual presentation of sporotrichosis
SS Vaishampayan, Priyanka Borde
September-October 2013, 58(5):409-409
DOI:10.4103/0019-5154.117350  PMID:24082217
Sporotrichosis can mimic a few diseases. Sporotrichosis presenting as a hypoaesthetic plaque or plaque suggestive of leprosy has not been mentioned in literature. Herein we present a case of a 26 years old man who presented with hypoesthetic plaque on left ankle and was clinically diagnosed to have borderline tuberculoid leprosy who later developed few nodules in linear fashion on left leg, which ruptured to form non healing ulcers. Culture from ulcer grew Sporothrix schenckii. Patient was successfully treated with oral potassium iodide.
  1 2,124 73
Epidemiological study of insect bite reactions from Central India
Sumit Kar, Atul Dongre, Ajay Krishnan, Swati Godse, Neha Singh
September-October 2013, 58(5):337-341
DOI:10.4103/0019-5154.117292  PMID:24082174
Introduction: The physical effects of the arthropod bites on human skin receive less attention, especially in the rural areas where the per capita income is less. Ours is a rural-based hospital, the vicinity having more of plants, trees, and forests; we undertook the study to find out the relation of insect bite dermatitis in a rural area. Materials and Methods: The study was carried out in the Dermatology outpatient department of our institute on 100 subjects of insect bite dermatitis who were questioned retrospectively about the sequence of events besides their environmental and living conditions. They were examined thoroughly and the relevant clinical findings were noted, also taking into account the prior treatment taken by them, if any. Results and Conclusions: It was found that insect bite dermatitis has no age or gender preponderance, and the protective factors for the same are use of full sleeve clothes and keeping the doors and windows closed at night. On the contrary, the risk factors are residence in areas of heavy insect infestation, use of perfumes and colognes, warm weather in spring and summer and the lack of protective measures. However, there was no direct association of atopy with increased risk of developing insect bite dermatitis.
  1 9,477 151
"Pseudo" nomenclature in dermatology: What's in a name?
Sangita Ghosh, Vijay Kumar Jain
September-October 2013, 58(5):369-376
DOI:10.4103/0019-5154.117305  PMID:24082182
In the bewildering array of scientific nomenclature in the medical field, it is important to use correct terminology, know their aberrations and the reason behind a specific terminology. This paper is an attempt towards compiling all the pseudo-nomenclatures coined in dermatology, in order to make it easier to retain and recollect these pseudo names, signs, morphology, diseases, and conditions. It is also imperative to know the true entities that these pseudo names masquerade as, so as to understand the explanation for assigning the term 'pseudo' to these conditions. A total of 52 pseudo-terms have been compiled here in reference to dermatology. Most of these pseudo-nomenclatures were coined due to some clinical or histopathological resemblance to the true conditions, while some were premature conclusions drawn from a flawed understanding of the basic nature of the condition. Clear understanding of each of these terms and the explanation behind them being pseudo will enable a dermatologist to avoid misdiagnosis and needless confusion.
  1 8,638 576
Continuing medical education in dermatology
Sujit Ranjan Sengupta
September-October 2013, 58(5):404-404
  - 1,951 57
Papular acantholytic dyskeratosis localized to the perineal and perianal area in a young male
Shyam B Verma
September-October 2013, 58(5):393-395
DOI:10.4103/0019-5154.117317  PMID:24082188
A case of Papular acantholytic dermatosis restricted to the perianal area is being reported in a 26 year old male without involvement of the genitalia, groin and upper thighs for the first time in English literature. The patient presented with long standing grayish white confluent papules with eroded areas in the perianal region which were asymptomatic for a long time before the area got macerated. He did not respond to many weeks of topical steroids but is now showing improvement with topical tacrolimus ointment 0.1% applied twice daily. This entity appears to be very uncommon and also underreported. It is also suggested that this entity be included in the long list of non venereal anogenital lesions as it may mimic perianal warts or molluscum contagiosum.
  - 3,629 77
Epidermotropic metastatic melanoma with perilesional depigmentation in an Indian male
Bhavana Doshi, Sunanda Mahajan, Uday S Khopkar, Vidya Kharkar, Prachi Agarwal
September-October 2013, 58(5):396-399
DOI:10.4103/0019-5154.117323  PMID:24082190
Melanoma is a rare form of cutaneous malignancy encountered in the dark skin population. Epidermotropic metastatic melanoma is a rare form of cutaneous metastatic melanoma which can mimic primary melanoma on histopathology. Hence its differentiation is of immense prognostic importance. The occurrence of rim of depigmentation around the primary cutaneous melanoma has previously been reported to portend a bad prognosis. The occurrence of vitiligo like lesions in patients with metastatic melanoma in comparison has a better prognosis. However the occurrence of depigmentation around the secondaries is rare and its importance is not well known. Hence we wish to report a case of epidermotropic metastatic melanoma with perilesional depigmentation in a 78 year old Indian male.
  - 2,592 49
Basal cell carcinoma, oculo-cutaneous albinism and actinic keratosis in a native Indian
Kingshuk Chatterjee, Farhan Rasool, Anita Chaudhuri, Gautam Chatterjee, Virendra N Sehgal, Navjeeven Singh
September-October 2013, 58(5):377-379
DOI:10.4103/0019-5154.117308  PMID:24082183
The report highlights the occurrence of basal cell carcinoma in a native Indian with oculo-cutaneous albinism, an association not frequently encountered. The clinical and histopathological features, which assisted to form the diagnosis, are outlined. A high degree of suspicion and timely recognition of the potentially aggressive neoplasm, under this unusual circumstance, is the key to its diagnosis.
  - 1,807 52
Ichthyosiform large plaque parapsoriasis: Report of a rare entity
Falguni Nag, Arghyaprasun Ghosh, Projna Biswas, Gobinda Chatterjee, Saugato Biswas
September-October 2013, 58(5):385-387
DOI:10.4103/0019-5154.117314  PMID:24082186
Large plaque parapsoriasis (LPP) is an idiopathic, chronic scaly dermatosis classified within parapsoriasis group of diseases, occurring commonly in middle aged patients of all races and geographic regions. LPP and its variants are closely related to the patch stage of mycosis fungoides. The two types of LPP mostly described are the poikilodermatous and retiform parapsoriasis. We are reporting an ichthyosiform LPP for its rarity.
  - 2,355 64
Anti SCL-70 antibody positive systemic sclerosis in a patient with lung cancer: A paraneoplastic or a purely coincidental phenomenon?
Anusree Gangopadhyay, Sumit Sen, Biswanath Naskar, Gobinda Chatterjee
September-October 2013, 58(5):400-401
DOI:10.4103/0019-5154.117326  PMID:24082191
  - 3,905 37

September-October 2013, 58(5):345-345
  - 783 28
Primary cutaneous diffuse large B-cell lymphoma of the upper limb: A fascinating entity
Manoj Madakshira Gopal, Ajay Malik
September-October 2013, 58(5):366-368
DOI:10.4103/0019-5154.117303  PMID:24082181
Primary cutaneous lymphomas are defined as lymphoid neoplasms that present themselves clinically on the skin and do not have extra-cutaneous disease, when the diagnosis is made or even after 6 months of the diagnosis. Primary cutaneous lymphomas of B-cells are less frequent than lymphomas of T-cells. Primary B-cell lymphomas have a better prognosis than secondary B-cell lymphomas. Primary B-cell cutaneous lymphomas are classified into five types according to the World Health Organization and European Organization for Research and Treatment of Cancer classification. The primary diffuse large B-cell cutaneous lymphoma - leg type corresponds to approximately 5-10% of the B-cell cutaneous lymphomas. It is predominantly seen in elderly people and has a female preponderance. Skin lesions can be single, multiple, and even grouped. A 5-year survival rate ranges from 36 to 100% of the cases. The expression of Bcl-2, presence of multiple lesions, and involvement of both the upper limbs lead to a worse prognosis. Very few cases have been described in the literature.
  - 1,673 74
Discordant HIV couple: Analysis of the possible contributing factors
BC Ravikumar, Poornima Balakrishna
September-October 2013, 58(5):405-405
DOI:10.4103/0019-5154.117304  PMID:24082193
Several intricacies still abound with respect to HIV infection. Discordance is one such intriguing aspect of HIV infection. Out of 35 discordant couples included in the study. husbands were positive in 29 couples and wives in 6. Pre/extramarital affairs was the probable reason for HIV infection in 23 out of 29 discordant males, and 2 out of 6 discordant females. Even though, decreased frequency of sexual acts between the couple was the reason for discordance in a few, but in majority of the couples who had regular sexual contact for many years, the exact cause for discordance could not be ascertained. inherent resistance to HIV in some individuals may be the reasons for the discordance.
  - 4,018 50
Hypopigmented papules over the chest
Nitin D Chaudhari, Neha C Virmani
September-October 2013, 58(5):412-412
  - 2,245 68
Ulcerative nodule on a chronic discoid lupus erythematosus lesion
Maryam Yousefi, Behrooz Barikbin, Zahra Asadi-Kani, Fahimeh Abdollahimajd, Nikoo Mozafari, Ehsan Abolhasani
September-October 2013, 58(5):412-412
  - 1,823 46
Dark age vampires or our poor patients
Seema Sharma, Pushpinder S Chauhan, Vipin Sharma, NL Sharma
September-October 2013, 58(5):412-412
  - 2,147 55
Isolated, localised extragenital bullous Lichen sclerosus et atrophicus: A rare entity
Swapna Khatu, Resham Vasani
September-October 2013, 58(5):409-409
DOI:10.4103/0019-5154.117351  PMID:24082218
Lichen sclerosus et atrophicus (LSA) is a rare, chronic, mucocutaneous disease of unknown cause. Onset can occur in subjects of any age but more prevalent in adult females around the time of menopause. In both the sexes anogenital involvement is more common. Extragenital cases are rare, and common localizations are neck and shoulders, axilla, upper arms, flexor aspects of wrists and around the umbilicus. Bullous LSA is an unusual manifestation of the disease. Isolated extragenital bullous LSA is a distinctly rare event with very few cases reported till date.
  - 3,144 56
Linear syringocystadenoma papilliferum: A case report with review of literature
Amrita Chauhan, Lipy Gupta, Ram Krishan Gautam, Minakshi Bhardwaj, Kiran Gopichandani
September-October 2013, 58(5):409-409
DOI:10.4103/0019-5154.117353  PMID:24082219
We report a rare case of syringocystadenoma papilliferum (SCAP) presenting as multiple papulonodules in a linear pattern over right lower abdomen which has been reported only once before.
  - 2,173 73
Cutaneous benign epithelioid peripheral nerve sheath tumour: A rare entity
Anuradha CK Rao, Lakshmi Rao, G Chennakeshav Rao, Vasudeva R Somayagi
September-October 2013, 58(5):409-409
DOI:10.4103/0019-5154.117354  PMID:24082220
Benign epithelioid peripheral nerve sheath tumor, a rare entity is an umbrella term describing benign, neural origin tumors with epithelioid morphology. Clinically indistinguishable from other benign cutaneous lesions, histopathology offers the only source of accurate diagnosis. Morphologic mimics include many benign and malignant soft tissue lesions. Besides a predominant epithelioid component, the lesion can also show a fair share of spindle cells. A circumscribed nodular tumour of low mitotic activity, it often exhibits areas resembling schwannoma or neurofibroma. An awareness of this entity and its varied morphological aspects helps to arrive at the correct diagnosis and hence avoid unnecessary extensive surgical procedures. This case presents features of this benign tumor which occurred in a 47 years old man.
  - 2,023 37
A case of syringocystadenoma papilliferum on lower leg: A rare location
Vinod K Khurana, Raj K Mehta, Deepak Chaudhary, Leela Pant
September-October 2013, 58(5):405-405
DOI:10.4103/0019-5154.117306  PMID:24082194
An 18 years old male presented with a slowly increasing multiple papulonodular lesions on his left leg since birth. No definite diagnosis was made on clinical ground. But verrucous epidermal naevus with secondary change and appendageal tumor was suspected on clinical examination. Histopathological examination revealed syringocystadenoma papilliferm (SCAP). SCAP is very rare on lower leg. Only one case of SCAP on lower leg has been reported in literature so far, which was superimposed on an organoid nevus. The case is reported for unusual location and unusual presentation.
  - 2,193 55
Hyperkeratotic palmoplantar lichen planus in a child
Bhushan Madke, Rameshwar Gutte, Bhavana Doshi, Uday Khopkar
September-October 2013, 58(5):405-405
DOI:10.4103/0019-5154.117310  PMID:24082195
Lichen planus (LP) is a common idiopathic inflammatory disorder that affects the flexor aspect of the wrists, the legs, and the oral and genital mucosa. Depending upon the site of involvement, LP can be divided into mucosal, nail, scalp, or palmoplantar types. Palmoplantar LP can pose a diagnostic problem to the clinician as it resembles common dermatoses like psoriasis, verruca, corn, calluses, lichenoid drug eruption, and papular syphilide of secondary syphilis. In this case report, we describe a 4-year-old male child who presented with highly pruritic erythematous to violaceous hyperkeratotic papules and plaques on his palms and soles. Typical LP papules were noted on the upper back. Histopathology of the papular lesion showed features of LP. Dermatoscopy of a papule from the back showed the characteristic Wickham striae. We report this rare involvement of palm and soles in a case of childhood LP.
  - 3,333 78
Progressive systemic sclerosis in a child
Arun K De, Kallol Das, Archan Sil, Swarnali Joardar
September-October 2013, 58(5):406-406
DOI:10.4103/0019-5154.117333  PMID:24082203
Systemic sclerosis is a clinically heterogeneous systemic disease affecting the connective tissues of skin, walls of blood vessels and internal organs like lung, heart and kidneys. Systemic sclerosis is very unusual in pediatric population. Children represent fewer than 10% of all cases. We report a case of 11 years old girl of progressive systemic sclerosis presenting with features of cutaneous sclerosis, microstomia, mask-like facies, sclerodactyly, esophageal dysmotility, Raynaud's phenomenon, arthralgia and pulmonary fibrosis.
  - 0 0
Vitamin K deficiency bleeding presenting as nodular purpura in infancy: A rare and life-threatening entity
Pratik Gahalaut, Sandhya Chauhan
September-October 2013, 58(5):407-407
DOI:10.4103/0019-5154.117334  PMID:24082204
Vitamin K deficiency bleeding (VKDB) disorder is an uncommon entity, which occurs due to inadequate activity of vitamin K-dependant coagulation factors. An 8-months-old exclusively breast-fed male infant presented with multiple, purpuric and nodular non-collapsible swellings on trunk of 4 days duration. Investigations revealed raised activated partial thromboplastin time and prothrombintime. Fibrinogen level and platelet counts were normal. Late VKDB usually presents as intra-cranial or mucosal hemorrhages. [1] Though skin and mucosal bleeding may occur in 1/3 rd of infants with VKDB, 'nodular purpura' is not the common presenting feature. Earlier recognition of VKDB and immediate investigation/treatment helps prevent the potentially fatal outcome of the disease. Very little is mentioned about this entity in dermatology literature.
  - 2,832 54
Abrikossoff's tumor: An unusual presentation
Gnanaraj Pushpa, Pradyot P Karve, K Subashini, Murali N Narasimhan, Parveen Bashir Ahmad
September-October 2013, 58(5):407-407
DOI:10.4103/0019-5154.117335  PMID:24082205
Abrikossoff's tumor or granular cell tumor is an infrequent benign neoplasm, first described by the Russian pathologist Abrikossoff in 1926. The neoplasm can affect all parts of the body with head and neck areas affected in 45-65% of patients. More than half of the head and neck lesions are localized to the oral cavity, especially the tongue. An aggressive malignant form of granular cell myoblastoma that metastasizes is rare. The treatment of choice of Abrikossoff's tumor is local surgical excision with a wide margin. Here, we present a case of Abrikossoff's tumor, occurring in the upper arm, presenting as a panniculitis-like lesion.
  - 2,516 47
A case of congenital erythropoietic porphyria without hemolysis
Arun K De, Kallol Das, Archan Sil, Swarnali Joardar
September-October 2013, 58(5):407-407
DOI:10.4103/0019-5154.117336  PMID:24082206
Porphyrias are group of disorders caused by deficiency of the enzymes in heme synthetic pathway. Congenital erythropoietic porphyria (CEP) is an extremely rare disease with mutation in the gene that codes for uroporphyrinogen III synthase leading to accumulation of porphyrin in different tissues and marked cutaneous photosensitivity. Here, we describe a case of CEP with infancy onset blistering, photosensitivity, red colored urine and teeth along with scarring but without any feature of hemolysis.
  - 2,176 50
Oral hemorrhagic blister: An enigma
BM Shashikumar, R Raghunatha Reddy, MR Harish
September-October 2013, 58(5):407-407
DOI:10.4103/0019-5154.117337  PMID:24082207
Angina bullosa hemorrhagica (ABH) is a disorder of unclear aetiology characterized by abrupt and unprovoked presentation of blood-filled blister over the oral mucosa. Histopathology reveals sub epithelial blister containing erythrocytes with superficial perivascular lymphocytic infiltrate. We report two cases of ABH of which one was idiopathic and other was associated with chronic renal failure on hemodialysis.
  - 5,086 63
Cutaneous schwannoma masquerading as trichilemmal cyst over scalp in a young male
KH Mohan, H Manjunath
September-October 2013, 58(5):407-407
DOI:10.4103/0019-5154.117338  PMID:24082208
Schwannomas are benign tumors derived from Schwann cells. They are comparatively rare on scalp and easily mistaken for tumors of hair. Trichilemmal cysts are common over scalp and present as dermal or subcutaneous growths over scalp. We present a solitary schwannoma of scalp clinically mimicking trichilemmal cyst. The tumor was surgically excised and the same was confirmed by histopathology.
  - 4,005 49
Palmar lichen planus mimicking tinea nigra
Bhushan Madke, Bhavana Doshi, Prasad Wankhede, Chitra Nayak
September-October 2013, 58(5):407-407
DOI:10.4103/0019-5154.117339  PMID:24082209
Lichen planus (LP) is a chronic inflammatory skin disease characterized by polygonal, violaceous papules commonly involving flexural areas of the wrists, legs, and oral and genital mucous membranes. This report describes a patient who presented with asymptomatic black colored patches on both palms simulating Tinea nigra, a superficial fungal infection. She was previously diagnosed as allergic contact dermatitis and was being treated with potent topical steroid i.e. clobetasol propionate 0.05% and white soft paraffin. Dermatoscopy of the lesion showed brownish pigmentation along ridges of the dermatoglyphics. A biopsy from the lesional skin showed findings of lichen planus. Our case highlights the potential diagnostic confusion that can occur with unusual variants of palmoplantar lichen planus and importance of histopathology in diagnosis of such unusual lesions.
  - 4,345 62
Transient idiopathic primary penoscrotal edema
SA Namir, A Trattner
September-October 2013, 58(5):408-408
DOI:10.4103/0019-5154.117340  PMID:24082210
We present the case of a male born prematurely at 32 weeks gestation by cesarean section following overt symptoms of maternal preeclampsia. He developed severe penoscrotal edema anew one month from birth. No remarkable exposure or trauma was identified. This unexplained swelling remained uniform till 4 months of age, while the penile edema resolved spontaneously. A small benign hydrocele remained unchanged, since onset of the edema and continued after the edema subsided. This is the first report of persistent, but transient penoscrotal edema resolving in a 3 months course, without any apparent explanation, a possible pathogenetic mechanism was suggested.
  - 2,346 33
A rare case of familial reactive perforating collagenosis
Rajesh Verma, Biju Vasudevan, Vijendran Pragasam, Prabal Deb, Ruby Venugopal, Debdeep Mitra
September-October 2013, 58(5):408-408
DOI:10.4103/0019-5154.117341  PMID:24082211
A 4 year old boy presented with history of itchy raised lesions on body of 2 years duration. Though parental consanguinity was not present, his elder brother had similar complaints. Dermatological examination revealed multiple hyperpigmented papules with a central keratotic plug distributed mainly over face and extensors of upper and lower extremities. Koebnerisation was present. Skin biopsy revealed perforating collagen bundles in the upper dermis and epidermis which was confirmed by Van Gieson staining. Patient was being treated with topical retinoids and intralesional corticosteroids with minimal relief.
  - 2,000 50
Chronic osteomyelitis of humerus presenting as scrofuloderma
Susmita Sahu, Satyadarshi Pattnaik, Indrani Mohanty, Moningi Venkata Narasimham, Pritilata Panda
September-October 2013, 58(5):408-408
DOI:10.4103/0019-5154.117344  PMID:24082212
Scrofuloderma is a common type of cutaneous tuberculosis usually manifests over an infected lymphnode, bone or joint that breaks down to form an undermined ulcer leading to discharging sinuses. We present a case of a 22 year old woman with diffuse swelling of right arm with overlying nodulo ulcerative skin lesions associated with seropurulent discharge. Routine investigations were normal and X-Ray of the right humerus showed the features of chronic osteomyelitis. Smears of the discharge for bacteria, fungi and acid fast bacilli were negative, but culture of skin biopsy showed Mycobacterium tuberculosis which was confirmed by PCR. Histopathology of skin biopsy showed epithelioid granulomatous inflammation suggestive of tuberculosis. After treating the patient with antitubercular therapy complete regression of the lesions occurred.
  - 1,902 47
Nosocomial urinary tract aspergilloma in an immunocompetent host: An unusual occurrence
Archana Singal, Chander Grover, Deepika Pandhi, Shukla Das, Bhupinder Kumar Jain
September-October 2013, 58(5):408-408
DOI:10.4103/0019-5154.117346  PMID:24082213
Fungal infections of the urinary tract are usually encountered following prolonged antibiotic use, instrumentation and indwelling urinary catheters. Candida is the most frequent causative fungus. However, infections with Aspergillus flavus have been reported previously in immune-compromised hosts. We, hereby, report a 32-year-old immunocompetent man diagnosed to have urinary tract infection caused by Aspergillus flavus following instrumentation for the removal of a ureteric stone. The infection was symptomatic, associated with abdominal pain and subsequent passage of fungal masses per urethra. Patient was treated successfully with a prolonged course of broad spectrum antifungal agent itraconazole.
  - 2,834 35
Multiple familial trichoepithelioma with malignant transformation
Rehab M Samaka, Ola A Bakry, Iman Seleit, Moshira M Abdelwahed, Rania A Hassan
September-October 2013, 58(5):409-409
DOI:10.4103/0019-5154.117348  PMID:24082215
Trichoepithelioma (TE) is a benign tumor of follicular origin that presents as small, skin-colored papules predominantly on the face. When more than one family member is affected, the disease is known as multiple familial trichoepithelioma (MFT). It is a rare autosomal dominant (AD) skin disease. Malignant transformation is very rare. We present a case of MFT in a female patient and her father with malignant transformation to basal cell carcinoma (BCC) in the father. We summarized the main histological differential parameters between TE and BCC and applied immunophenotyping for both by administration of Bcl2, CD34, CD10 and androgen receptor (AR) antibodies.
  - 2,466 60
B Devi, B Behera, ML Dash, MR Puhan, SS Pattnaik, S Patro
September-October 2013, 58(5):406-406
DOI:10.4103/0019-5154.117322  PMID:24082199
Botryomycosis is a rare chronic bacterial granulomatous disease that usually involves skin and rarely viscera. Main etiological agent is Staphylococcus aureus and less commonly Pseudomonas spp., Escherichia coli, Proteus spp., Streptococcus spp. We here report a case of 32-year-old male with polymicrobial botryomycosis on forehead and on frontal scalp. Culture from lesions revealed growth of S. aureus initially. Partial resolution was achieved with cefadroxyl and clavulanic acid, rifampicin, and linezolid. Subsequent repeat culture revealed E. coli sensitive to netilmycin. Slow and steady resolution was achieved with surgical debridement and combination therapy of injectable netilmycin and oral sufomethoxazole and trimethoprim for a prolonged period.
  - 5,171 228
Acrokeratosis verruciformis of hopf along lines of blaschko
Pragya A Nair
September-October 2013, 58(5):406-406
DOI:10.4103/0019-5154.117324  PMID:24082200
Acrokeratosis verruciformis of Hopf (AKV) is a rare genodermatosis presenting as multiple plane wart-like lesions symmetrically distributed on dorsum of hands and feet. Its pathogenesis is unknown. A case of 24 years old female is described with multiple hyperpigmented, hyperkeratotic papules on the left side of body since 5 years along the lines of Blaschko. Histopathology showed changes of AKV. Other unusual findings were the absence of family history, extensive lesions with flexural, and genital involvement.
  - 2,979 62
Multiple sub-epidermal calcified nodule mimicking eruptive xanthoma: A case report and review of the literature
Pinar Ozuguz, Ilknur Balta, Ozlem Bozkurt, Hatice Unverdi, Ahmet Dostbil
September-October 2013, 58(5):406-406
DOI:10.4103/0019-5154.117327  PMID:24082201
Sub-epidermal calcified nodule (SCN) is an uncommon form of idiopathic calcinosis. It usually occurs in children, particularly in the head and neck region, presenting as a solitary, painless, yellow-white nodule with papillomatous features. These lesions occur twice as common in males compared with females. The pathogenesis is uncertain, but the clinical and histological features of this lesion are distinctive. We report a case of 22-year-old man with multiple nodules bilaterally located on the dorsum of hands simulating eruptive xanthoma. Histopathological examination of one of the excised lesion confirmed the diagnosis showing epidermal and sub-epidermal deposition of calcium. This paper presents a review of the literature and adds a new case of SCN.
  - 2,658 38
Spongiotic intra-epidermal blister: A pitfall in the histopathologic diagnosis of bullous pemphigoid
Rajiv Joshi
September-October 2013, 58(5):410-410
DOI:10.4103/0019-5154.117355  PMID:24082221
  - 2,219 54
Paederus dermatitis: An outbreak, increasing incidence or changing seasonal pattern?
Arijit Coondoo, Jayoti Nandy
September-October 2013, 58(5):410-410
DOI:10.4103/0019-5154.117357  PMID:24082222
  - 2,658 65
Foamy discharge on the scalp of the infant: Munchausen syndrome by proxy
Satyadarshi Patnaik, Biswa R Mishra, Indrani Mohanty, Surjit Nayak
September-October 2013, 58(5):410-410
DOI:10.4103/0019-5154.117358  PMID:24082223
  - 2,478 44
Familial syringomas
Satyendra Kumar Singh, Tulika Rai
September-October 2013, 58(5):412-412
DOI:10.4103/0019-5154.117369  PMID:24082232
  - 1,703 47
A case of verrucous carcinoma on the finger
Minzhi Wu, Xinfeng Lu, Liang Zhao, Wenbo Bu, Wang Yan, Chen Hao, Fang Fang
September-October 2013, 58(5):412-412
DOI:10.4103/0019-5154.117370  PMID:24082233
  - 1,962 37
Hailey-Hailey disease on sun-exposed areas
Angoori Gnaneshwar Rao
September-October 2013, 58(5):412-412
DOI:10.4103/0019-5154.117371  PMID:24082234
  - 2,306 55
Papillon-Lefevre syndrome: Two siblings, one developing liver abscess
P Mercy, Ashish Singh, Ashok K Ghorpade, MN Das, Avanish Upadhyay
September-October 2013, 58(5):410-410
DOI:10.4103/0019-5154.117361  PMID:24082225
  - 1,695 49
LEOPARD syndrome with rare skeletal anomalies: A case report
Sonali Kohli, Yugal K Sharma, Kedar N Dash, Radhika Kopikar, Nitin C Chaudhari
September-October 2013, 58(5):411-411
DOI:10.4103/0019-5154.117362  PMID:24082226
  - 6,025 49
Favus in an elderly Kashmiri female: A rare occurrence
Iffat Hassan, Parvaiz A Rather, Peerzada Sajad
September-October 2013, 58(5):411-411
DOI:10.4103/0019-5154.117363  PMID:24082227
  - 2,621 57
A case of Juvenile xanthogranuloma in the nasal cavity of a neonate
Seo Wan Kim, Tae Young Han, June Hyunkyung Lee, Sook-Ja Son
September-October 2013, 58(5):411-411
DOI:10.4103/0019-5154.117364  PMID:24082228
  - 1,661 31
Cutaneous hyalohyphomycosis in an immunocompetent host
Vandana Mehta
September-October 2013, 58(5):411-411
DOI:10.4103/0019-5154.117365  PMID:24082229
  - 1,627 43
Isolated pedunculated collagenoma (collagen nevi) of the scalp
Bhushan Madke, Bhavana Doshi, Chitra Nayak, Rashmi Prasannan
September-October 2013, 58(5):411-411
DOI:10.4103/0019-5154.117367  PMID:24082230
  - 4,676 42
Greyish verrucous plaque with erosions on the perianal area
Mahendra M Kura, Vrushali K Rane, Virendra D Singh
September-October 2013, 58(5):402-403
  - 6,777 113

September-October 2013, 58(5):395-395
  - 687 23
Prescribing practices of topical corticosteroids in the outpatient dermatology department of a rural tertiary care teaching hospital
Suvarna S Rathod, Vijay M Motghare, Vinod S Deshmukh, Rushikesh P Deshpande, Chetanraj G Bhamare, Jyoti R Patil
September-October 2013, 58(5):342-345
DOI:10.4103/0019-5154.117293  PMID:24082175
Background: Inappropriate or excessive use of topical corticosteroids can lead to cutaneous and systemic adverse effects which occur more commonly with the use of very potent steroids. Monitoring and analysis of the prescription practices of topical steroids can help to achieve rational prescription of these drugs. Aim: The present study was carried out to study and analyze the pattern of prescribing topical corticosteroids among outpatients attending the dermatology clinic in a rural tertiary care and teaching hospital, Ambajogai, Maharashtra. Materials and Methods: A cross-sectional descriptive study was conducted for a duration of two months from August 2011 to September 2011, and 500 prescriptions were randomly collected from the dermatology pharmacy and analyzed. Results: About 66% of the prescriptions contained four to five drugs per prescription. Topical steroids were given in 28.4% of all the prescriptions. In almost all the prescriptions, strength, quantity of the steroid to be used, frequency, site, and duration of application was not mentioned. The chief complaints and diagnoses were not mentioned in about 85% of the prescriptions for topical corticosteroids. About 94.36% of the prescriptions contained very potent steroids. Conclusion: Inadequate prescribing information is a clear characteristic of the dermatological prescriptions containing topical corticosteroids. Doctors should be educated about the importance of giving patients sufficient information regarding the use of steroids. There is a need to revise hospital formulary where low-potency steroids can also be included along with potent ones so that the latter can be avoided in conditions where they are unnecessary.
  - 3,360 252
Triads in dermatology
Prachi G Agrawal, Uday S Khopkar, Sunanda A Mahajan, Sunil N Mishra
September-October 2013, 58(5):346-351
DOI:10.4103/0019-5154.117297  PMID:24082177
It is imperative for any dermatology resident to have a good knowledge of the various triads in dermatology. For an easy grasp over this topic, we have grouped the various triads on the basis of their etiologies.
  - 10,232 843
Rebamipide: A novel agent in the treatment of recurrent aphthous ulcer and Behcet's syndrome
Mohan H Kudur, Manjunath Hulmani
September-October 2013, 58(5):352-354
DOI:10.4103/0019-5154.117298  PMID:24082178
Rebamipide is an amino acid analog of 2 (1H)-quinolinone. It is being introduced and used since 1980 for the treatment of peptic ulcer. Its therapeutic use in recurrent aphthous ulcer was not known. It acts by the decrease in oxygen radicals, increase in blood flow and production of protective prostaglandins in ulcer mucosa, which accelerates the process of healing. In this article, we focus on the pharmacodynamics, pharmacokinetics, side-effects and other therapeutic uses of Rebamipide. It will be a new and effective drug in the dermatologists' drug armamentarium for the treatment of aphthous ulcers and related diseases.
  - 9,736 360
Oral ketotifen and topical antibiotic therapy in the management of pruritus in prurigo nodularis: A randomized, controlled, single-blind, parallel study
Ashimav Deb Sharma
September-October 2013, 58(5):355-359
DOI:10.4103/0019-5154.117300  PMID:24082179
Aims: To evaluate the role of oral ketotifen and topical antibiotic therapy in the management of pruritus in prurigo nodularis (PN) patients. Materials and Methods: Twenty-seven patients with PN and a history of atopy with raised IgE were included in this study in a dermatology clinic. All patients had positive growth of Staphylococcus aureus on the lesional skin swab. All patients received topical halobetasol and oral hydroxyzine for 4 weeks. In addition, all patients in the study group received oral ketotifen and topical antibiotic therapy for 4 weeks. Randomization was performed by using a table of random numbers, and the participants were randomly allocated to one of the two groups in the study. The study was a single-blind study, and the blinding was done by the investigator. Results: Of the 14 patients in the study group, 9 had complete relief from pruritus by the end of first week, which was maintained till the end of 4 weeks. In the control group, mild to moderate reduction in the intensity of pruritus in the PN lesions of all patients were noted by the end of the first week. No further improvement in the level of pruritus was noted in the participants during the trial period. The treatment was well tolerated by the patients, and the adverse reactions of drugs were minimal in both groups. Conclusions: This study showed that oral ketotifen and topical antibiotic therapy can be helpful in the management of pruritus in PN patients.
  - 2,940 124
Immunotherapy with intralesional Candida albicans antigen in resistant or recurrent warts: A study
Imran Majid, Saher Imran
September-October 2013, 58(5):360-365
DOI:10.4103/0019-5154.117301  PMID:24082180
Background: Warts are sometimes resistant or they tend to recur after every possible destructive therapy. Immunotherapy with skin-test antigens has been used as a viable therapeutic option in such recalcitrant cases. Aim: The aim of the study was to evaluate the response of resistant or recurrent warts to intralesional Candida albicans antigen immunotherapy. Materials and Methods: A total of 40 patients with resistant or recurrent warts who showed a positive test reaction to C. albicans antigen were given intralesional injections of purified C. albicans antigen solution in a single wart at 3-weekly intervals for a total of three doses. The patients were monitored for resolution of the injected wart as well as other untreated warts. The patients who responded positively were then followed up for any relapses over the next 6 months. Adverse events, if any, were also documented. Results: Of the 40 patients enrolled in the study, 34 completed the total treatment protocol of three injections and 6 months of follow-up. In these 34 patients, 19 (56%) showed a complete resolution of warts at all places on the body. In addition, two patients (6%) showed a partial or complete resolution of the treated wart, but there was no effect on the untreated warts. Thirteenpatients (38%) failed to show any response to the treatment regimen. In all patients showing resolution of all the warts, there were no relapses at any site over the next 6 months of follow-up. The most common adverse effect seen was pain during the intralesional injection. Conclusions: Intralesional Candida immunotherapy seems to be an effective treatment option in more than half of the patients who fail to show a positive response to destructive modes of treatment or in whom there are multiple recurrences. Limitations: The small sample size and lack of control group are the main limitations of the study.
  - 5,386 227
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