C Balachandran

Chronic idiopathic urticaria: Comparison of clinical features with positive autologous serum skin test

BACKGROUND Chronic idiopathic urticaria (CIU), in its extremely severe form, can pose a therapeutic challenge to the treating physician. It has been noted that in one third of such patients, autoantibodies against the IgE receptor are seen and such patients have more severe and unremitting urticaria. AIM To compare clinical features of autoimmune urticaria with those of other CIU patients. METHODS We conducted a prospective study in an attempt to correlate the clinical features with autoantibodies, indirectly detected via the autologous serum skin test (ASST), which is the simplest and the best in vivo clinical test for detection of basophil histamine-releasing activity. DISCUSSION Out of 100 patients with chronic idiopathic urticaria, 34 showed a positive reaction to the autologous serum skin test and it was found that the frequency and severity of attacks was higher in these patients. CONCLUSION ASST may be used as a simple and cost-effective test for the classification of chronic urticaria, which has proven to be a therapeutic challenge to the treating physician.

Lichen amyloidosus: A study of clinical, histopathologic and immunofluorescence findings in 30 cases

BACKGROUND Lichen amyloidosus (LA) is a primary localized cutaneous amyloidosis characterized clinically by discrete hyperkeratotic hyperpigmented papules and histologically by deposition of amyloid material in previously normal skin without any evidence of visceral involvement. AIMS AND OBJECTIVES The aim of this work was to study the etiology, clinical features, histopathology and direct immunofluorescence findings in LA. METHODS A prospective study of 30 patients with clinical, histological and immunofluorescence findings suggestive of LA was undertaken. After a detailed history and clinical examination, two punch biopsies for histopathology and immunofluorescence were taken. RESULTS Of the 30 patients, 19 (63.3%) were males and 11 (36.7%) were females with duration of LA ranging from 6-20 months. Pruritus was the presenting symptom in 27 (90%) patients. Shin was involved in 26 (86.7%) followed by arms in three (10%) and back in one (3.3%). Seventeen patients (56%) had used scrubs for more than 2 years. Histopathology, direct immunofluorescence and Congo red staining detected amyloid in all cases. CONCLUSIONS LA commonly presents over the shins as pruritic discrete hyperpigmented papules. Familial predisposition and friction may have a pathogenic role. Histopathological examination is very useful in the detection of amyloid which may be supplemented with direct immunofluorescence and Congo red staining.

Coexistence of frontal fibrosing alopecia with lichen planus pigmentosus

A 47-year-old, postmenopausal woman presented with asymptomatic, excessive hair loss on the frontal region of the scalp of one year’s duration. Over the same period, she had noticed progressive, diffuse pigmentation of the face. She reported no history of hair manipulation or cosmetic practices involving the hair prior to the beginning of hair loss and no regular use of facial cosmetics. She had been using antihypertensive medication (amlodipine and atenolol) for the previous four years and had been applying hair dye for five years with no untoward side effects. She had no history of gynecological or endocrine problems. Clinical examination revealed a 2-cm band of recession along the frontotemporal hairline; the underlying skin was smooth, shiny, and atrophic (Figs. 1 and 2). Follicular orifices were absent from the patches. Follicular keratotic papules were seen around the alopecia patches, but there was no perifollicular erythema. Interestingly, hairs in the eyebrows were preserved. There was diffuse hyperpigmentation of the forehead, ear lobule, preauricular region, and sides of the neck. Examination of mucosae and nails did not reveal any abnormality. The subject’s

Zosteriform cutaneous metastases: a case report and brief review of literature.

A 56-year-old woman presented with painful erythematous, papulo-nodular lesions on the left side of the trunk in a dermatomal distribution of two-weeks duration. She had earlier undergone surgery for breast carcinoma and was receiving palliative chemo-radiotherapy, when seen by us. A diagnosis of zosteriform cutaneous metastases was made and biopsy was done from the representative lesion which showed chords and sheets of malignant cells. Majority of these cases in the past have been misdiagnosed as herpes zoster and were treated with antiviral drugs. Metastatic diseases should be considered in the differential diagnosis of zosteriform rash in elderly.

Giant granular cell tumor of the vulva

A 55-year-old lady presented with a large skin colored growth on her vulva since the age of 15 years, which gradually increased to the present state, with the development of a new lesion on her left thigh. There were no systemic symptoms. Biopsy followed by immunohistochemistry showed features consistent with a granular cell tumor.

Nasal NK/T cell lymphoma presenting as a lethal midline granuloma.

Nasal NK/T cell lymphomas are aggressive, locally destructive, midfacial, necrotizing lesions. The nonspecific clinical symptoms constitute a major stumbling block in the early diagnosis and management of these lymphomas. We report here a case of probable nasal NK/T cell lymphoma in an apparently healthy male that progressed rapidly in a short span of time and was managed subsequently with chemotherapy and external beam irradiation with which the lesion regressed.

Multiple grade II deformities in a child: tragic effect of leprosy.

Stigma is almost synonymous with visible deformity and this is what makes leprosy a dreaded disease for the common man. Deformities in children are more distressing, due to the limitation of their physical, academic and social life. An 11-year-old female child was presented with trophic ulceration of right foot and triple nerve paralysis (i.e. total claw hand with wrist drop) of the left hand of 2 years duration. In addition, she had multiple hypopigmented hypoaesthetic patches on the extremities and buttocks. She was diagnosed as a case of borderline tuberculoid leprosy and was started on WHO MB MDT therapy. Leprosy in children is an indicator for disease prevalence in general population and occurrence of deformities points towards the delay in making the diagnosis and the stigma associated with the disease.

Clinical evaluation of patients patch tested with plant series: A prospective study

Background: Plants are ubiquitous in nature and are essential for human life, though some do have detrimental effects. In India, there are various indigenous and foreign plants that are well known to cause dermatitis, Parthenium hysterophorus being the foremost. Aims of the Study: To study the clinical features of patients presenting with plant dermatitis and evaluate plant allergen series patch test results. Materials and Methods: 50 patients with suspected plant dermatitis were evaluated regarding evolution of dermatitis, precipitating factors and contact with various plants. 31 patients (62%) complained of photo sensitivity and 24 (48%) had involvement of sun-exposed areas. Our provisional diagnoses included allergic contact dermatitis in 16, air borne contact dermatitis in 9, phytophotodermatitis in 7, photodermatitis in 6, airborne contact dermatitis to other causes in 4, phytodermatitis in 3. Patients were patch tested with Indian standard series of allergens as well as plant allergen series consisting of common allergenic plants of local flora in and around Manipal and also with plants strongly suspected by the patient. 35 tested positive with maximum positives (26 patients, i.e., 52%) to Parthenium hysterophorus (Compositae). Results: The result of patch testing was correlated with the history and clinical examination and relevance established. Conclusions: Majority of the patients with clinically suspected plant dermatitis belonged to 3rd or 4th decade and Parthenium was the leading plant allergen Sensitization to Leguminosae plants and Hopea ponga, seen in 9 cases, have not been reported earlier in literature.

Lupus band test.

Systemic lupus erythematosus is a heterogenous chronic autoimmune disease affecting one or more organ systems and is characterized by the production of various autoantibodies, complement consumption and the presence of circulating immune complexes. In the diseased tissue of SLE and DLE, liquefactive degeneration of the basal cells with edematous changes and thickened subepidermal basement membrane are characteristic features.

Clinical profile of forefoot eczema: a study of 42 cases.

BACKGROUND Forefoot eczema (FE) is characterized by dry fissured dermatitis of the plantar surface of the feet. AIM To study the clinical profile of FE and the possible etiological factors. METHODS Forty-two patients with FE were included in the study. A detailed history was recorded and examination done. Fungal scrapings and patch test with Indian Standard Series (ISS) were performed in all patients. RESULTS The most common site affected was the plantar surface of the great toe in 16 (38.09%) patients. Hand involvement, with fissuring and soreness of the fingertips and palm, was seen in four patients (9.5%). Seven patients (16.6%) had a personal history of atopy whereas family history of atopy was present in six (14.2%). Seven patients (16.6%) reported aggravation of itching with plastic, rubber or leather footwear, and 13 (30.9%), with detergents and prolonged contact with water. Negative fungal scrapings in all patients ruled out a dermatophyte infection. Patch testing with ISS was performed in 19 patients and was positive in five. CONCLUSIONS FE is a distinctive dermatosis of the second and third decade, predominantly in females, with a multifactorial etiology, possible factors being chronic irritation, atopy, footwear and seasonal influence.