Arika Bansal

Parthenium dermatitis treated with azathioprine weekly pulse doses

BACKGROUND Parthenium dermatitis is a serious problem in India. Corticosteroids are the mainstay of treatment but the prolonged use of corticosteroids can cause serious side effects. Azathioprine used in daily doses has been shown to be effective. AIM We have evaluated the effectiveness of azathioprine weekly pulse doses for the treatment of parthenium dermatitis. METHODS Twelve patients, ten males and two females, aged between 39 and 65 years (mean +/- SD = 53.5 +/- 8.7) having air-borne contact dermatitis to Parthenium hysterophorus for 3-19 years (mean = 6.33) were included in the study. The diagnosis in each patient was confirmed by patch-testing. The severity of the disease was determined by clinical severity score (CSS) on the basis of erythema, itching, type of lesions, and areas of body involved. RESULTS The pretreatment CSS in these patients varied from 29.7 to 55.5 (mean +/- SD: 40.40 +/- 7.95). After clinical and laboratory evaluation, the patients were treated with 300-mg azathioprine once-weekly doses for 6 months. Clinical and laboratory evaluations were repeated at weeks 1, 2, and then every 4 weeks until the end of therapy to evaluate the therapeutic response and side effects. The response was excellent (80-100% clearance of disease) in seven (58.33%) patients and good (60% clearance) in five (41.66%) patients. The post-treatment CSS decreased from the mean +/- SD of 40.4 +/- 7.95 to 10.9 +/- 8.43 (P = 0.002). There were no significant side effects of the therapy. CONCLUSIONS In this preliminary open study, azathioprine in weekly pulse doses has been found to be effective without any serious adverse effects in the treatment of parthenium dermatitis. The cost of therapy with this regimen is reduced by 60%.

Familial pigmented purpuric dermatoses

Pigmented purpuric dermatoses (PPD) are chronic, asymptomatic dermatoses characterized by petechiae, pigmentation and rarely telangiectasias. Familial occurrence of PPD is very rare. We report four individuals in a family over three generations. The inheritance is suggestive of an autosomal dominant pattern.

Twenty nail dystrophy in vitiligo

Twenty nail dystrophy (TND) is a manifestation of several dermatoses and its association with vitiligo is rare. It may be consequent upon a common autoimmune insult to the melanocytes and the nail matrix. We report a patient of acrofacial vitiligo who developed TND. Nail matrix biopsy revealed focal lichenoid reaction and chronic inflammatory infiltrate in the dermal papillae and around blood vessels. Hematological, biochemical and serological investigations showed no evidence of other autoimmune diseases.

Pachyonychia congenita with only nail involvement

Dear Editor, A 10-year-old boy presented with progressive thickening of the nails over the previous 5 years. He did not have any other cutaneous and/or systemic symptoms. He was born to healthy non-consanguineous parents following an uneventful pregnancy. Upon examination, he was found to have symmetrical involvement of the finger and toenails with marked hard thickening of the distal portion of the nail plate resulting in uplifting and tenting (Fig. 1). The palms and soles, oral cavity and scalp were normal. Potassium hydroxide examination of nails did not reveal any fungi. Systemic examination did not reveal any abnormalities. Pachyonychia congenita is a rare, autosomallydominant disorder characterized by symmetrical hard thickening of the nails with marked subungual hyperkeratosis, palmoplantar keratoderma with thick callosities, and oral leukokeratosis. 1 Various other abnormalities such as hyperkeratotic follicular papules of the extremities, keratosis pilaris, blister formation of feet and palms, hair abnormalities, and hyperhidrosis of palms and soles have also been reported. 2

Verrucous tuberculid mimicking Kyrle disease

Cutaneous tuberculosis shows wide clinical variation depending upon the virulence of the organism and host immunity. Tuberculids are difficult to diagnose since the organism often cannot be identified or isolated by microscopy, culture or polymerase chain reaction. The diagnosis rests primarily on the identification of a tuberculous focus elsewhere in the body and response to antitubercular therapy. We present the clinicopathological features of an unusual tuberculid in a 30‐year‐old man, remarkably mimicking Kyrles disease. He presented with multiple, symmetrically distributed follicular and perifollicular verrucous papules, nodules and plaques on the face, earlobes and extremities since 4 years. Histopathology revealed parakeratotic follicular plug invaginating into the dermis with multiple caseating epithelioid cell granulomas. PCR for M. tuberculosis was negative. The identification of associated axillary tubercular lymphadenitis, strongly positive Mantoux reaction, tuberculoid granulomas on histopathology and complete resolution of the lesions with antitubercular therapy helped in making the diagnosis. We propose the term “verrucous tuberculid” for this entity.

Superficial basal cell carcinoma on face treated with 5% imiquimod cream.

Imiquimod, an immune response modifier, is known to possess both anti-viral and anti-tumor effect. We report our experience of treating a large superficial spreading basal cell carcinoma with 5% imiquimod cream. A 65-year-old male had an asymptomatic, hyperpigmented, slowly progressive, indurated, 3 x 4 cm plaque on the left cheek for two months. Biopsy from the lesion showed features of basal cell carcinoma. The patient was treated with imiquimod 5% cream, topically three times a week for six months with complete resolution of the lesion and without any side-effects. There was no clinical or histological recurrence after three months of stopping the treatment.

Evaluation of photopatch test series in India

Our aim was to evaluate the usefulness of TROLAB photopatch test series (supplemented with the plant extracts). 70 patients with dermatitis on photoexposed areas or dermatitis with photosensitivity were studied. Only 2 patients had photocontact allergy – 1 each to fragrance mix 8% and p‐aminobenzoic acid 10%. Photocontact allergy to parthenium was seen in 4 and photoaggravation in 6 patients. Our results suggest that the TROLAB photopatch series are not useful for Indian patients with photodematoses.

The tricky “trichs” in dermatology!

The word “trich” is derived from the Greek word “thrix” which means pertaining to hair. Hence, terminologies or medical words starting with “trich” are related to hair more often than not. However, there are also “trichs” which are unrelated to hair. Since the terminologies are extensive and are spread across the literature related and unrelated to hair, authors have attempted to arbitrarily classify and club these into various groups for the sake of convenience.

Parthenium dermatitis severity score to assess clinical severity of disease

Background: Parthenium dermatitis is the most common type of airborne contact dermatitis in India. It is a chronic disease of a remitting and relapsing course with significant morbidity and distress, but there is no scoring system to assess its severity. Aim: To design a scoring system for the assessment of clinical severity of disease in Parthenium dermatitis and to use this scoring system in various studies to determine its sensitivity, specificity, and reproducibility. Methods and Results: In our first few studies on Parthenium dermatitis, we designed and used a basic clinical severity scoring system based on itching, morphology of the lesions, and areas involved. However, in subsequent studies, we modified it to the present scoring system as Parthenium dermatitis severity score (PDSS). Our studies showed the high sensitivity of PDSS in characterization of the disease severity at the given point of time, as well as to determine the efficacy of a prescribed treatment modality which was reliable and reproducible. Conclusion: Thus, PDSS may be used by clinicians for appropriate scoring of the clinical severity of Parthenium dermatitis and in monitoring the disease response to therapy.