Amit Kumar Dhawan

Oral lesions in leprosy revisited: a case report.

There is a scarcity of the histopathologically proven lesions of leprosy in the oral cavity, in the world literature. A 55-year-old man had come with a complaint of asymptomatic nodular lesions in the oral cavity. Cutaneous lesions and peripheral nerve examination were suggestive of lepromatous leprosy. Histopathologic examination of a nodule on the palate demonstrated diffuse macrophagic granulomas and acid-fast bacilli.

Neonatal Purpura Fulminans Due to Methicillin Resistant Staphylococcus aureus

Abstract:  Neonatal purpura fulminans is rare and may be inherited or acquired. It may ultimately lead to multiorgan failure and death. Purpura fulminans in a premature neonate resulting from Staphylococcus aureus septicemia is illustrated. Unfortunately, the baby succumbed to septicemia.

Squamous cell carcinoma complicating vitiligo in an Indian man

An elderly man, a known case of generalized vitiligo of long duration, presented to us with an ulcerated exophytic growth arising from the vitiliginous skin. The histopathological study confirmed the clinical suspicion of squamous cell carcinoma. Cutaneous neoplasia arising from the vitiliginous skin is a rare situation. Lack of melanin leaves the skin vulnerable to ultraviolet radiation damage, which may predispose to cutaneous neoplasia. Therefore, the importance of photoprotection has been stressed upon through this illustration.

Clinical and serological characteristics of nail psoriasis in Indian patients: A cross-sectional study

Background: Nail involvement in psoriasis is common with a lifetime incidence of 80-90%. It may reflect severity of cutaneous involvement and predict joint disease. Yet it remains, poorly studied and evaluated especially in Indian psoriatic patients. Aim: The present study was undertaken to evaluate clinical and serological profile of nail involvement in psoriasis and to assess quality of life impairment associated with nail involvement in Indian patients. Methods: Consecutive patients with nail psoriasis were assessed for severity of cutaneous disease (psoriasis area severity index score) and nail disease (nail psoriasis severity index score). The impairment in quality of life attributable to nail disease was scored with nail psoriasis quality of life 10 score. All patients were also assessed for joint disease and tested for inflammatory and serological markers as erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor and anti-cyclic citrullinated peptide antibodies. Results: In our cohort of 38 patients with nail psoriasis, 9 had concomitant psoriatic arthritis. The mean psoriasis area severity index was 14.4 ± 9.6 (range = 0.4–34). The most commonly recorded psoriatic nail changes were pitting (97.4%), onycholysis (94.7%) and subungual hyperkeratosis (89.5%). The mean nail psoriasis severity index score was 83.2 ± 40.1 (range = 5–156) and mean nail psoriasis quality of life 10 was 1.1 ± 0.4. Erythrocyte sedimentation rate and C-reactive protein were raised in 22/38 (57.9%) and 15/38 (39.5%) patients, respectively; rheumatoid factor was positive in 5/38 (13.2%) and anti-cyclic citrullinated peptide antibody was raised in 4/38 (10.5%) patients. Limitations: Small sample size and lack of a control group. Conclusions: In Indian patients with nail psoriasis, severity of nail involvement was found to be poorly correlated with the extent of cutaneous disease. In addition the impact of nail disease on patients quality of life was found to be minimal. This suggests the need for a quality of life questionnaire suited to the Indian population. Serological markers were raised overall in the study patients and more so in the patients with concomitant arthritis.

Significance of anti-cyclic citrullinated peptide autoantibodies in immune-mediated inflammatory skin disorders with and without arthritis

Background: Anti-cyclic citrullinated peptides (CCPs) are autoantibodies directed against citrullinated peptides. Rheumatoid factor (RF), an antibody against the Fc portion of IgG, is known to form immune complexes and contribute to the etiopathogenesis of various skin disorders. C-reactive protein (CRP), an acute-phase protein, increases following secretion of interleukin-6 from macrophages and T cells. Anti-CCP, RF, and CRP are well-established immune-markers, their diagnostic potential in immune-mediated skin disorders remains less widely studied. Aims and Objectives: To determine the correlation between anti-CCP, RF, and CRP in immune-mediated inflammatory skin diseases. Materials and Methods: About 61 clinically diagnosed cases of various immune-mediated skin diseases (psoriasis [n = 38], connective tissue diseases such as systemic lupus erythematosus and systemic sclerosis [n = 14], and immunobullous disorders including pemphigus vulgaris and pemphigus foliaceus [n = 9]) were included in the study. These patients were subclassified on the basis of presence or absence of arthritis. Arthritis was present in nine cases of psoriasis and seven connective tissue disorder patients. Detection of serum anti-CCP was done using enzyme-linked immunosorbent assay, whereas CRP and RF levels were detected using latex agglutination technique. Results: Of the 61 specimens, 14.75% had elevated serum anti-CCP levels. RF and CRP levels were elevated in 18.03% and 39.34% specimens, respectively. RF was elevated in 13.16% of inflammatory and 42.88% of connective tissue disorders, whereas anti-CCP was raised in 10.53% of inflammatory and 35.71% of connective tissue disorders. CRP positivity was highest in connective tissue disorders (50%), followed by 39.47% in inflammatory and 22.22% in immunobullous conditions. In none of the immunobullous patients, anti-CCP or RF levels were found to be elevated. Association of the presence of arthritis with elevated anti-CCP was found to be statistically significant. Conclusions: Although anti-CCP, RF, and CRP levels are valuable markers of chronic immune-mediated skin disorders, elaborate studies enrolling a larger number of patients are required to validate these diagnostic markers.

Diffuse melanonychia as a clue to vitamin B12 deficiency.

Nail changes are often considered a mirror of internal disease. Here, we present a case report of a 16-year-old girl whose primary complaint was nail hyperpigmentation, and who was later diagnosed as having megaloblastic anaemia. Melanonychia is defined as blackish discoloration of the nail plate. It has been reported rarely in vitamin B12 deficiency, in the form of longitudinal melanonychia, with a diffuse bluish discoloration and reticular pattern. This is reversible with vitamin B12 treatment.

An asymptomatic inguinal swelling: Lymphatic filariasis.

Recently, there is an increasing trend of multiple pregnancies as a result of infertility treatment by ovulation induction. Moreover, the selective feticide that is sometimes performed to safeguard a precious pregnancy and avoid multiple births results in iatrogenic fetus papyraceus. Hence, more cases of congenital absence of skin in surviving co-twins following selective feticide are being reported.[1]

Subcutaneous emphysema mimicking angioedema

Sir, Subcutaneous emphysema is an uncommon entity that may be associated with an underlying pneumothorax. Timely intervention in the form of early diagnosis and treatment is important to avoid a fatal outcome.[1,2] It may mimic angioedema, a common and often a relatively benign disorder thereby leading to inappropriate management.[3] We report a case of a 65-year-old man who was referred to the dermatology outpatient department for evaluation of progressively increasing facial swelling of two days duration associated with difficulty in breathing. There was no preceding history of drug intake. There was no history of any food allergy, drug allergy, or similar such episodes in the past. He was a chronic smoker and a known case of chronic obstructive pulmonary disease (COPD). He developed acute respiratory distress three days ago and was subsequently diagnosed as a case of angioedema by a dermatologist and was prescribed tablet prednisolone 40 mg daily and tablet hydroxyzine 25 mg thrice daily with no symptomatic improvement over the next two days. Physical examination revealed the presence of a diffuse facial swelling predominantly involving periorbital region and both cheeks extending down to the supraclavicular region and upper chest. However, there was distinct sparing of the lips, which prompted us to look for other clues and to consider other differentials. Crepitus could be elicited on palpation of the swollen areas., Chest radiograph (posteroanterior view), showed presence of opaque striations/ shadows in the scapular region suggesting subcutaneous emphysema without any evidence of pneumothorax [Figure 1]. Therefore, a final diagnosis of subcutaneous emphysema, resulting probably from the rupture of an apical lung bulla in a patient with pre-existing COPD was made. The patient was referred to medical emergency where he was treated with anxiolytics, bronchodilators, and administered ventilation with 100% oxygen leading to remarkable improvement in respiratory distress and satisfactory reduction in facial swelling over next three days.

Annular atrophic plaque over the arm

DOI: 10.4103/2229-5178.185474 melanoma. Perilesional depigmentation has been reported in metastatic melanoma.[8] This is the first Indian report of multiple brain metastases in acral lentiginous melanoma with acute hemiparesis as the presenting manifestation. It was noteworthy that he also had vitiligo. Since the chance of late metastasis cannot be ruled out even in treated cases, it is emphasized that all patients with acral lentiginous melanoma should be thoroughly investigated and followed up for a life time as brain metastases can be effectively treated when detected early.

Aquagenic syringeal acrokeratoderma.

1. Weedon D. Weedon’s Skin Pathology. 3rd ed. London: Churchill Livingstone, Elsevier, 2010. p. 799‐800. 2. Takeda H, Mitsuhashi Y, Hayashi M, Kondo S. Eccrine syringofibroadenoma: Case report and review of the literature. J Eur Acad Dermatol Venereol 2001;15:147‐9. 3. Bandyopadhyay D, Chattopadhyay S, Saha S. Reactive eccrine syringofibroadenoma on a leprous foot. Indian J Dermatol Venereol This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.