Bijaylaxmi Sahoo

Childhood lichen planus: a study of 87 cases

Aims We undertook this study to analyze the clinical profile of childhood lichen planus (LP) prevailing in north India, and to highlight differences from and similarities with adult LP.

Oral hyposensitization in patients with contact dermatitis from Parthenium hysterophorus.

Parthenium hysterophorus is the commonest cause of airborne contact dermatitis in northern India. Treatment is mostly palliative and consists of repeated courses of antihistamines and topical and/or systemic corticosteroids. We have evaluated the effect of oral hyposensitization as an alternative therapeutic modality. In 70% of those patients who completed the study, there was a gradual improvement in their clinical status, as evident from a fall in their clinical severity score for eczema. 30% of patients had an exacerbation during the course of the study and hence hyposensitization in them was stopped. Patients tolerated therapy well and no significant side‐effects were seen, except for abdominal pain, ‘heartburn’ and cheilitis.

Rising incidence of genital herpes over two decades in a sexually transmitted disease clinic in north India.

Genital herpes, which was considered to be a minor sexually transmitted disease (STD) in the past in developing countries, is rapidly increasing; in contrast, bacterial STDs are declining. This changing trend of various STDs prompted us to analyze our data retrospectively to see whether a similar change is occurring in this part of India as well. The records of sexually transmitted diseases (STDs) clinic attendees from January 1977 to December 2000 were analyzed. The demographic profile of patients with genital herpes was also considered for analysis. STDs were diagnosed clinically and by appropriate laboratory tests wherever applicable. VDRL test was done in all patients, and HIV antibody detection was performed from 1987 onwards. The incidences of chancroid, donovanosis, and gonorrhea were 12.2%, 6.3%, and 16.9%, respectively, from January 1977 to December 1985. The figures for the same decreased to 2.5%, 0.9%, and 2.3%, respectively, from January 1993 to December 2000. The decreasing incidence of the above bacterial STDs is statistically significant (p<0.001). However, there was an approximately two‐fold increase in the incidence of genital herpes in recent years (20.5%) in comparison to the figures from the late 70s (11.4%). Molluscum contagiosum also showed an upward trend (1% in 1977–85 vs. 9.8% in 1993–2000). Condylomata accuminata remained almost unchanged (21.4% in 1977–85 vs. 20% in 1993–2000). To conclude, a significant increase in the number of viral STDs and a decline in the bacterial diseases were observed in recent years in comparison to the figures from the late 70s. This may be due to awareness of HIV, success of control programs, syndromic management of STDs, and adoption of safer sexual practices, which prevent bacterial STDs more efficiently than viral ones.

KID Syndrome : Response to Acitretin

KID syndrome is rare. We report a 17‐year‐old girl who presented with universally ichthyotic red hue on the face, trunk, and extremities along with deafness and keratitis since childhood. She was diagnosed with KID syndrome. Treatment with acitretin cleared the hyperkeratotic ichthyotic lesions with little effect on the cornea or hearing. Acitretin seems to be a promising new treatment in KID syndrome.

Tuberous sclerosis with macrodactyly.

Abstract: Tuberous sclerosis with macrodactyly is a very uncommon presentation. We report a 15‐year‐old girl with a thick, loose hyperpigmented area on the dorsum of the left hand with macrodactyly. A skin biopsy specimen from the dorsum of the left hand revealed dense collagenization in the dermis. Radiographs showed marked irregular thickening of the cortex of the metacarpals and phalanges of the left index and middle fingers.

Zosteriform Pilar Leiomyoma

Pilar leiomyomas are usually multiple and are commonly found on the extensor aspects of the arm, trunk, and face. They are rarely distributed in a linear fashion or seem to follow a dermatome. We report a case of painful, unilateral, zosteriform cutaneous leiomyoma in a 25‐year‐old housewife. Histopathology revealed interlacing smooth muscle bundles arising from arrector pili muscles. Nifedipine (10 mg) twice daily was remarkably effective in diminishing the pain in our patient.

Treating ingrown toenails by nail splinting with a flexible tube: An Indian experience

Ingrown toenail is a common problem, and currently available treatments are either quite invasive or associated with unacceptably high recurrence rate. Recently a new non‐invasive therapy, “Nail splinting”, has been introduced. In this procedure, the nail is splinted with a longitudinally incised plastic tube. We conducted the present study to evaluate the efficacy and safety of this procedure in fifty patients (68 nail edges in 61 nails) with ingrown toenails at all stages. The pain disappeared almost immediately, and inflammation subsided in about one week in all nail edges. Thirty‐nine patients came for regular follow‐up for six months after removal of the tube. Eight (20.5%) of these patients showed recurrence of the problem. No serious side effects were noted.

Eczema herpeticum in parthenium dermatitis

Keywords: eczema herpeticum; Kaposis varicelliform eruption; parthenium dermatitis; allergic contact dermatitis; plants; airborne

The Coexistence of Photosensitive Psoriasis with Chronic Actinic Dermatitis

A 57-year-old-male who had been a known case of psoriasis vulgaris for 30 years had a history of summer exacerbation of the disease. Subsequently in the course of the disease process, he developed lesions of chronic actinic dermatitis (CAD) on the face and dorsum of both hands. The association of CAD with photosensitive psoriasis is very rare. Only one case report is known till now. It may suggest that there is a relationship between the two diseases.

Cutaneous Leishmaniasis in Hilly Areas of Himachal Pradesh (India)

To the Editor: Old world cutaneous leishmaniasis is usually seen in plains and desert areas in India. It was not known to occur in the hilly areas in Himachal Pradesh (India), which are an endemic zone for sporotrichosis. We report two cases from this area. Case 1: A 52-year-old female from a hilly area (Kinnaur) at an altitude of above 2350 meters above mean sea level of Himachal Pradesh had an accidental thorn prick on the bridge of the nose with slight bleeding six months previously. After a few days, she developed an erythematous papular lesion at the same site, which remained asymptomatic for 2–3 months. This lesion gradually increased in size and then ulcerated. On examination, she had a single ulcer on the bridge of the nose covered with golden crusts with bright erythema and swelling at the periphery (Fig.1A). The swelling surrounding the ulcer extended toward both the eyelids and part of the cheek on the left side. Multiple satellite papular lesions were also present. Systemic examination did not reveal any abnormality. The patient was diagnosed with sporotrichosis or cutaneous leishmaniasis (rural variety). Her hemogram, liver function, renal function, chest X-ray, and ECG were normal. Skin biopsy showed hyperkeratosis, exocytosis, keratotic plugging, and few neutrophilic abscesses of the epidermis with dense mixed inflammation in the dermis composed of lymphocytes, histiocytes, and few plasma cells. There were plenty of amastigotes, both intraand extra-cellularly, in the macrophages (LD bodies) in the dermis (Fig. 1B). The diagnosis was confirmed to be cutaneous leishmaniasis. Unfortunately we could not culture this organism because of contamination. The antibodies to leishmania antigen, as examined by ELISA, were negative. The patient was treated with IV Stibogluconate 40mg/kg/body weight diluted in 200 ml of 5% Dextrose solution daily for 3 weeks. ECG and electrolytes were monitored at regular intervals. The lesions healed completely after 3 weeks. Case 2: A 35-year-old female patient presented with a single ulcer with golden crusting on the bridge of the nose for two months. She gave a history of travel to Kinnaur (Himachal Pradesh) two months prior to the onset of the lesion. On examination, there was a single ulcer covered with crusting and erythema at the periphery. A skin biopsy from the lesion revealed LD bodies. The patient was lost to follow-up. The Journal of Dermatology Vol. 29: 248–249, 2002