Indian Journal of Dermatology
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   2009| January  | Volume 54 | Issue 5  
    Online since February 11, 2009

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A skin burn associated with Ranunculus arvensis (wedding bloom)
Murat Orak, Mehmet Ustundag, Cahfer Guloglu, Mahmut Tas, Berat Baylan
January 2009, 54(5):19-20
Ranunculus arvensis L-a member of Ranunculaceae family- is grown as a wild plant in productive agriculture lands of the altitude between 1 to 1850 m mainly in the Mediterranean Region and Iran-Turan vegetation in Turkey. Skin burn cases associated with Ranunculaceae family is very limited in literature and according to the authors' knowledge this is the only report in literature from Turkey. In this report, we have presented a case of skin burn associated with Ranunculus arvensis represented to our emergency service.
  4 4,595 151
Hutchinson-Gilford syndrome (progeria)
Amar Surjushe, Minal Thakre, Resham Vasani, Dattatray Saple
January 2009, 54(5):27-28
Progeria is a rare, autosomal dominant, progeroid disorder. In the world literature less than 100 cases have been reported to date. We present this case because of its rarity.
  3 4,005 265
Epidermodysplasia verruciformis with Hansen's disease, herpes simplex labialis and multiple eccrine hidradenoma
L Padmavathy, L Lakshmana Rao, N Ethirajan, B Krishnaswamy, U Manohar
January 2009, 54(5):53-56
Epidermodysplasia verruciformis (EV) - a rare, lifelong heritable disease due to a unique susceptibility to human papilloma virus. The disseminated verrucous lesions or pityriasis versicolor like lesions persist from early childhood and can transform into a cutaneous malignancy in a fourth of patients. The association of EV with multiple eccrine hidradenoma, herpes simplex labialis and Hansen's disease is a very rare occurrence and is reported in a 25-year-old woman.
  2 3,449 156
Extensive Tinea corporis with photosensivity
Kamran Balighi, Vahide Lajevardi, Mohamad Reza Barzegar, Majid Sadri
January 2009, 54(5):57-59
Tinea corporis is a superficial fungal infection of the keratinized epithelial layer, presenting as erythematous scaling patches with central clearing. Sometimes it can resemble other skin disorders, so its misdiagnosis constitutes a problem of considerable practical importance. We describe a patient who presented with widespread Tinea corporis that morphology and distribution of the lesions mimicked lupus erythematosus and/or photodermatosis.
  1 7,465 298
Skin metastasis: A rare localization from laryngeal carcinoma and overview of similar cases
Ramin Azarhoush, Mohammad Hossein Taziki, Mohammad Jafar Golalipour, Bijan Arya
January 2009, 54(5):5-7
Cutaneous metastases from carcinoma of the larynx are very rare. Distant metastases in squamous cell carcinoma of the larynx have an incidence of 6.5-7.2% and most commonly involve the lungs, liver and bone. Metastases to the skin are exceedingly rare. We observed a 75-year-old Iranian patient with squamous cell carcinoma of the larynx who developed a subcutaneous nodule on the buttock. It was found to be a metastatic tumor from the laryngeal cancer, histopathologically. Skin metastases may represent the first clinical evidence of impending locoregional recurrence, suggest distant metastatic spread, or rarely, be the first sign of 'silent' laryngeal tumor. They are usually considered a poor prognostic sign and most often affect the supradiaphragmatic area, i.e. the head, neck, thorax or upper extremities. From stand point of topography, buttock metastasis is exceptional.
  1 3,471 133
Leishmaniasis of the face: Report of a case
Mohammad Hosein Kalantar Motamedi, Parvin Alami Harandi, Taghi Azizi
January 2009, 54(5):37-40
Leishmaniasis is a parasitic disease prevalent throughout the world. According to the geographic region in which different Leishmania species are found it can present variably. Because of the increase in both international travel and immigrant populations, the numbers of reported cases of leishmaniasis is on the increase. It is important that clinicians are able to recognize the cutaneous lesions and unusual presentations of leishmaniasis (CL). Our case was an incidental finding during treatment of a gunshot wound. The lesions were mistaken for facial pimples because they were numerous and the patient was a teenager. The patient was treated with sodium stibogluconate.
  1 3,628 164
Subungual exostosis of the thumb - first case report in youngest age
Sanjeev Gupta, Amit Mittal, Sunita Gupta, Aneet Mahendra, Anil Kumar Dhull
January 2009, 54(5):46-48
Subungual exostosis (SE) is a benign osteocartilaginous tumor of the ungual apparatus, particularly of the toes. It affects both sexes equally, more frequently in the second and third decades of life. The present case highlights this entity (SE) in a six and half year old female child affecting the terminal phalanx of the right thumb. She presented to us with gradually enlarging, painless, subungual hard nodule on the right thumb. Roentogram of the hand showed bony outgrowth arising from the terminal phalanx of right thumb. Lesion was excised and sent for histopathological examination. Histology showed evidence of SE. No recurrence at postoperated site was seen till eight months of follow-up.
  1 4,522 121
Dermatophyte infection of the male genitalia
Jayanta Kumar Das, Sujata Sengupta, Asok Gangopadhyay
January 2009, 54(5):21-23
Dermatophyte infection is a very common disease, but that of the male genitalia is said to be rare. Here we report four cases of dermatophyte infection of the male genitalia, of which one had lesion on the penis alone, one had lesions on the penis and the groins, one had lesions on penis and scrotum, and the other had involvement of scrotum, penis and groins. Two patients gave history of application of steroid-containing preparations and another had diabetes mellitus. Culture of the scraping of the lesional skin yielded Trichophyton rubrum in two cases and Epidermophyton floccosum in the other two. All cases resolved completely with topical terbinafine with or without oral antifungals.
  1 28,962 360
Basosquamous carcinoma in an Indian patient with oculocutaneous albinism
Nitin Ranjan, Satyendra K Singh, Sayeedul H Arif
January 2009, 54(5):63-65
A middle-aged man with type IA OCA presented to us with a large ulcerated plaque of three year duration over the forehead. Histopathology showed basosquamous carcinoma in the form of distinct areas of basal and squamous differentiation. Metastasis workup was negative. Complete surgical excision, strict photoprotection and regular follow-up were advised. A timely recognition of this potentially aggressive neoplasm is the key to curative treatment.
  1 3,327 142
Carotenemia in an African lady
Arfan Ul Bari
January 2009, 54(5):71-73
Carotenemia is characterized by an abnormal yellowish orange pigmentation of the skin, predominantly seen on the palms and soles. Although it may be associated with several diseases such as diabetes, hypothyroidism and anorexia nervosa, it is caused by excessive intake of carotene-rich food such as oranges and carrots in most cases. The condition is harmless, but it can lead to a mistaken diagnosis of jaundice. Herein, an interesting case of carotenemia is described in a 32-year-old female secondary to increased ingestion of oral sweet potatoes and oranges.
  1 6,549 121
Milker's nodule
PK Kaviarasan, M Yamini, PVS Prasad, P Viswanathan
January 2009, 54(5):78-79
Milker's nodule virus is a parapox virus that is endemic in cattle. The virus can be grown in tissue culture of both bovine and human cell lines. We report a 53-year-old male, milker who presented with multiple painful nodules on both hands for one month. The nodules were tender and showed central umblication and surrounding rim of erythema. Both epitrochlear and axillary lymph nodes were enlarged on both sides and were non-tender. The skin biopsy revealed marked edema in the epidermis with monouclear inflammatory cell infilitration in the upper dermis. The diagnosis was made on clinical basis. As there was no specific treatment the patient was managed only with antibiotics for secondary infection. The lesions partially resolved after two weeks. This case in reported for its occupational importance.
  1 5,003 169
Cutaneous sarcoidosis without systemic manifestations
Rajesh Mohanty, SN Singh, AB Bhattamishra
January 2009, 54(5):80-82
A 38-year-old lady, housewife by profession presented with mildly pruritic polymorphic lesions on various parts of her body. The lesions appeared as smooth, violaceous and round papules. Histopathological examination showed classical features of cutaneous sarcoidosis. She had no systemic involvement. Cutaneous sarcoidosis has many morphological presentations and often mimics other dermatologic diseases. Treatment options are reviewed.
  1 4,677 190
Juvenile xanthogranuloma in an adult
Surajit Nayak, Basanti Acharjya, Basanti Devi, Manoj Kumar Patra
January 2009, 54(5):83-85
Juvenile xanthogranuloma (JXG), a rare benign histiocytic disorder, primarily seen in the first two decades of life as a solitary cutaneous lesion. Though in majority of cases lesions are confined to the skin, systemic forms can occur in rare instances. We present here a 21-year-old male patient presenting with multiple brown-to-yellowish papules and nodules over the head, neck and trunk evolving since last 2 years. A clinico/histopathologic study was done to confirm the diagnosis of JXG. We present this case, because of the unusual presentation and morphology in regards to the age and to highlight the fact that, juvenile xanthogranulomas though not so common, may occur in older age group and should always be in mind while making a diagnosis of a disease of similar morphology.
  - 6,697 158
Hypertrophic lichen planus as a presenting feature of human immunodeficiency virus infection
Rashmi Kumari, Nidhi Singh, Devinder Mohan Thappa
January 2009, 54(5):8-10
Lichen planus (LP) is a chronic papulosquamous dermatosis in which both skin and mucous membranes may be involved. To date, there have been only five reports of human immunodeficiency virus (HIV)-positive patients with hypertrophic LP. In the present report, we describe a 37-year-old female who presented with widely distributed, hyperpigmented, pruritic scaly lesions involving the face, trunk, and upper and lower extremities for one month. She also had swelling of both lower legs with low grade fever for past one week. She was diagnosed to be a HIV-positive patient who had severe, widespread hypertrophic LP lesions along with acute eruptive lesions of LP. These LP lesions were a presenting feature of HIV infection in our case.
  - 11,356 213
Dyschromatosis universalis hereditaria
Chandra L Naik, Gurcharan Singh, TS Rajashekar, Rajendra Okade
January 2009, 54(5):74-75
Dyschromatosis universalis hereditaria is an infrequently occurring genodermatosis with a peculiar pigmentary change, consisting of varying sized hyperpigmented macules mingled with hypopigmented lesions to give an overall impression of mottling. We hereby report a case of dyschromatosis universialis hereditaria in a child with no family history of the disorder.
  - 4,241 168
Churg-strauss syndrome
BK Brar, Vivek Mehta, Dimple Chopra, Asha Kubba
January 2009, 54(5):76-77
We report a case of 29-year-old man who presented with cutaneous vasculitis and was subsequently diagnosed as a case of Churg-Strauss syndrome. The patient fulfilled five out of the six criteria of the syndrome developed by American College of Rheumatology.
  - 2,829 162
Cefoperazone induced hypersensitivity vasculitis
Subodh K Katiyar, Shivesh Prakash
January 2009, 54(5):66-67
Cefoperazone has been reported to cause vasculitic complications only once before. Here, we report yet another case of hypersensitivity vasculitis associated with cefoperazone. A 28-year-old lady with pneumococcal pneumonia developed hypersensitivity vasculitis on the fifth day of cefoperazone therapy. Hypersensitivity vasculitis resolved gradually after removal of the agent and did not recur. Although hypersensitivity vasculitis has multiple causes, coexistence of hypersensitivity vasculitis and cefoperazone treatment, and the quick resolution of the disease after removal of the drug, strongly favors a causative relationship. To our knowledge, this is the second report of a hypersensitivity vasculitis associated with cefoperazone and hence the drug should be considered as a possible cause while evaluating a case of drug induced hypersensitivity vasculitis.
  - 2,730 120
Verrucous carcinoma - report on two cases
L Padmavathy, L Lakshmana Rao, N Ethirajan, Kavitha Gunasekaran, B Krishnaswamy
January 2009, 54(5):68-70
Squamous cell carcinoma is a common malignant tumor of the keratinizing cells of the epidermis. Verrucous carcinoma or Ackerman's tumor is a subtype of low grade squamous cell carcinoma that can affect cutaneous and mucous surfaces. Two cases of Verrucous carcinoma affecting the lip and oral mucous membrane (oral florid papillomatosis) are being reported. One patient had a co-existent sub mucous fibrosis, a pre-malignant lesion and two auto-immune disorders, i.e., diabetes mellitus and vitiligo.
  - 4,267 208
Erythema gyratum repens-like atypical and persistent figurate erythema
Zehra Asiran Serdar, Ayse Tulin Mansur, Sirin Pekcan Yasar, Elvan Endogru, Pembegul Gunes
January 2009, 54(5):24-26
Figurate erythemas are a group of dermatoses mostly developing in response to an underlying condition. They are characterized by erythematous papules growing centrifugally to form annular or polycyclic figures. Here, we describe a 16-year-old girl with EGR-like lesions confined to the dorsum of hands, present since she was eight years of age.
  - 4,953 153
Fever and rash: It can be Kawasaki disease
Parveen Bhardwaj, Vijay K Sharma
January 2009, 54(5):29-31
Kawasaki disease (KD) is an illness that involves the skin, mouth, and lymph nodes, and typically affects children who are under the age of five. The cause of KD is unknown, but if the symptoms are recognized early, children with the disease can fully recover within a few days. A generalized vasculitis of unknown etiology, early recognition and treatment of KD can reduce the development of potentially life-threatening coronary artery abnormalities.
  - 8,809 242
Poikilodermatous parapsoriasis - two cases with review of literature
Sudip Das, Parag Prasun Giri
January 2009, 54(5):32-36
Poikilodermic parapsoriasis is a rare varaint of poikiloderma where the chances of going into mycoses fungoides exists.But not all cases do go to mycoses. In the early stage of poikiloderma atrophicans vasculare, without respect to its course, shows moderate thinning of stratum malpigji, effacement of rete ridges, hydropic degeneration of basal cells. In the upper dermis-there is band like infiltrate which in places invades the epidermis. The infiltrate consists of a few histiocytes-so called initial 'lichenoid pattern'. In addition there is abundance of melanophages with pigment incontinence. In late stages there is thinning of is with hydropic degeneration of basal cells. In MF inflammatory infiltrate increases rather than decreases in time. Large hyperchromatic nuclei, so called 'mycoses cells' are likely to be present in this variant and often there is moderate to marked epidermotropism. It may result in Pautrier microabscess. formation.The diagnosis of Mycoses Fungoides is supported by presence of an aberrant phenotype, for example T cell lacking one or more pan T cell antigens. Most commonly absent antigen is CD-7 followed by CD-2, CD-3 and CD-5 3 . Making a differential diagnosis between early MF and parapsoriasis is often difficult at clinical and histological level. We report two cases of poikilodermic parapsoriasis, both showing some degree of epidermotropism ,but one had panT cell marker CD 3, CD5, CD7 present and other absent.The lady with Pan T cell markers did not progress to frank mycoses fungoides while the patient with absent markers progressed rapidly and finally succumbed.
  - 5,189 173
Early onset hereditary sensory autonomic neuropathy type I and not leprosy
Sushil Pande, Vidya Kharkar, Sunanda Mahajan, Uday Khopkar
January 2009, 54(5):1-4
Hereditary sensory autonomic neuropathies (HSAN) are rare forms of chronic neuropathies in children, which lead to severe complications like foot ulcers, mutilations, fractures and deformities. We report an eight years old female who presented with nonhealing perforating ulcer over anterior sole, resorption of terminal portion of right middle finger and hyperhidrosis over back since two years of age. Deep tendon reflexes were absent in lower legs but were preserved in upper limbs. Nerve conduction studies and nerve biopsy confirmed the diagnosis of HSAN, Type I. Early diagnosis of hereditary sensory neuropathy led to significant reduction in morbidity and hence improvement in the quality of life in our patient.
  - 4,982 208
Dyschromatosis symmetrica hereditaria (reticulate acropigmentation of dohi): First report from Iran
Massoumeh Barzegari, Katrin Kiavash
January 2009, 54(5):11-13
Dyschromatosis symmetrica hereditaria (DSH) is a rare autosomal dominant genodermatosis, presenting in infancy or early childhood with areas of hyperpigmentation on dorsa of hands and feet. DSH has been reported mainly from Japan and only limited cases have been reported from other countries. This is the first report of an Iranian patient with this rare type of acropigmentation. Our patient's family history was striking with the same disorder in her grandmother, mother, uncle and her two older sisters which reveal an autosomal dominant pattern of inheritance.
  - 7,354 237
Marjolin ulcer with multifocal origin
Sudip Das, Alok Kumar Roy, Arunasis Maiti
January 2009, 54(5):14-15
Marjolin ulcer developed from a twenty years old post burn scar. The patient presented with chronic ulceration followed by multifocal development of squamous cell carcinoma with different growth pattern. One nodular lesion grew rapidly to produce a large lesion with history of a little bleeding after trauma but without any pain. Excision followed by skin grafting resulted in good cosmetic scar.
  - 3,438 105
Sebaceous carcinoma of cheek arising in a lesion of solar keratosis
Ponnuswamy Karkuzhali, Nellainayagam Gomathy, Parveen Bashir Ahamed
January 2009, 54(5):16-18
Cutaneous extraocular sebaceous carcinoma is a rare tumor that frequently occurs on face and scalp. Sebaceous carcinoma is not considered to be associated with ultra violet radiation exposure. We describe a case of sebaceous carcinoma of the right side of the cheek occurring in a lesion of solar keratosis in a 44-year-old female, who is a farmer by occupation. Actinic keratosis carries about 8-20% risk for malignant transformation into squamous cell carcinoma. Other malignant lesions that have been reported to occur in actinic keratosis include basal cell carcinoma, sebaceous carcinoma and trichilemmal carcinoma. To our knowledge, this is the third case to be reported in English language literature. Unlike the two cases reported previously, this has occurred in a younger patient and presented as an ulcerative, invasive lesion of 3cm size. The association of actinic keratosis and sebaceous carcinoma indicate that solar UVR is probably of importance in the pathogenesis of sebaceous carcinoma, as in the case of squamous cell carcinoma.
  - 4,760 127
Reticulate variant of Darrier's disease
Sudip Das, Aloke Kumar Roy, Chinmoy Kar, Parag Prasun Giri
January 2009, 54(5):49-50
Darrier disease belong to acantholytic group of disorders with loss of intraepidermal coherence. Darrier disease has an onset in puberty in the form of greasy papules, skin coloured to yellow in nature often progressing to plaques. Sites of predeliction being seborrhic areas of body. Nail abnormalities are a constant feature with a V shaped nicking.Histopathology shows orthohyperkeratoses with focal dyskeratoses, corps and ronds in stratum spinosum and grains in upper epidermis. Variable patterns have been described like bullous, haemorrhagic and linear but reticulate pattern have not been described earlier. We describe a case of reticulate variant of Darrier responding excellently to acitretin therapy.
  - 2,681 122
Parthenium dermatitis in a HIV patient
Sekar C Shanmuga, Sundaram V Shanmuga, CR Srinivas
January 2009, 54(5):41-42
Parthenium dermatitis is a distressing problem in India. Both type 1 (immediate and late phase reaction) and type 4 hypersensitivity phenomenon play a role in pathogenesis. We prick tested the patient after administering various drugs to assess the best agent to prevent late phase reaction.
  - 2,696 132
Primary sebaceous gland carcinoma of pinna
Akhilesh Kr Agarwal, Souradip Gupta, Sandipan Gupta, Gautam Guha
January 2009, 54(5):43-45
Sebaceous gland carcinoma is a rare cancer most commonly seen in the meibomian glands of the eyelid. It has predilection for periocular region and is rarely found in extra ocular sites. A case of sebaceous gland carcinoma over back of left pinna is reported.
  - 3,641 226
Verrucous hemangioma treated with electrocautory
Arun Achar, Surajit Kumar Biswas, Ashoke Kumar Maity, Biswanath Naskar
January 2009, 54(5):51-52
Verrucous hemangioma is a rare form of vascular malformation which is usually congenital. Most of the cases present as wart-like dark blue to erythematous papules, nodules and plaques with special predilection in lower extrimities. We are reporting here a 19-year-old Muslim patient with large Verrucous hemangioma in the left leg along with discending of right shoulder without any signs of neurological involvement. Patient was successfully treated with repeat serial Electrocautory.
  - 3,426 110
Two cases of confluent and reticulated papillomatosis successfully treated with Chinese drug jianpizhiyang granula
Tu-Gen Yu, Yi Cao, Xiao-Hong Yang, Dan Deng, Shan-Hui Lan
January 2009, 54(5):60-62
Confluent and reticulated papillomatosis (CRP) was first described in 1927 by Gougerot and Carteaud. It is characterized by papules that become confluent in the center and reticulated at the periphery. The etiology and pathogenesis of CRP are not precisely known and there is no standard therapy for it. In the recent cases reported, treatment of choice is minocycline. In this report, we present two cases of CRP responding well to Chinese drug, Jianpizhiyang. Some elements in Jianpizhiyang granula were thought to have anti-inflammatory. We expect that, which always has little side-effect, will be a good choice for CRP.
  - 16,180 222
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