Chirag Desai

An uncommon presentation of Galli–Galli disease

A 55‐year‐old woman presented with multiple hyperpigmented lesions widely distributed on her body since early adolescence. These lesions were mostly asymptomatic with occasional itching that worsened in hot and humid conditions. On further inquiry, the patient acknowledged the presence of similar lesions in many family members of different generations, none of whom had sought medical advice. Analysis of the pedigree chart revealed that these lesions were more commonly seen among women, all of whom had a similar age of onset [Figure 1]. On examination, there was mottled hyperpigmentation on the neck, chest, abdomen and extensor as well as flexor aspects of both the upper and lower extremities [Figures 2 and 3]. Moreover, there were multiple flat‐topped hyperpigmented papular lesions. Some hyperpigmented macules were seen on the face. A provisional diagnosis of reticulate pigmentary disorders was considered, including Dowling–Degos disease and Galli–Galli disease. A biopsy of one of the papular lesions revealed elongated rete ridges with increased melanization of basal layer. There was a broad zone of suprabasal acantholytic clefting of the epidermis with discrete overlying parakeratosis without dyskeratosis. A mild superficial perivascular lymphohistiocytic infiltrate was found in the dermis [Figures 4 and 5]. No “dilapidated brick wall” appearance, typical of Hailey– Hailey disease was seen. A repeat biopsy revealed that these findings were consistently present [Figure 6]. We came to a final diagnosis of Galli–Galli disease in the patient.

Extragenital lichen sclerosus et atrophicus co-exististing with pemphigus vulgaris

Indian Dermatology Online Journal | January-February 2017 | Vol 8 | Issue 1 57 In view of the pressure‐induced lesional changes, pain on weight bearing, and clinical morphology, we favored a diagnosis of PPP but our patient had several unusual features. Most importantly, majority of the lesions were relatively large in size (2.5–3.5 cm) in contrast to the existing literature (0.2– 2 cm, average 0.8 cm)[1,3‐5] and could therefore be labeled as nodules/tumors rather than papules. Obesity resulting in increased pressure on the heels may possibly explain the development of large PPP in our patient. Although increase in diameter of PPP with increasing age and body weight has been reported in children,[5] obesity as a factor in the development of PPP has not been suggested in adults. Furthermore, the lesions were only partially reducible on release of pressure in our case (and completely reducible only on manual reduction). In contrast, typical PPP lesions characteristically disappear on taking the foot off the ground. Hence, we propose the name piezogenic pedal tumors of obesity.

Acquired smooth muscle hamartoma of foot: A rare entity

505 Indian Dermatology Online Journal | Volume 8 | Issue 6 | November‐December 2017 Vulvar pseudoverrucous papules and nodules secondary to a urethral‐vaginal fistula. Am J Dermatopathol 2011;33:410‐2. 3. Coppo P, Salomone R. Pseudoverrucous papules: An aspect of incontinence in children. J EurAcad Dermatol Venereol 2002;16:409‐10. 4. Dandale A, Dhurat R, Ghate S. Perianal pseudoverrucous papules and nodules. Indian J Sex Transm Dis 2013;34:44‐6. 5. Nelson J, Maroon M. Pseudoverrucous papules. N Engl J Med 2011;364:e50. 6. Douri T, Shawaf AZ. Pseudoverrucous papules and nodules: A case report. Dermatol Online J 2012;18:14. 7. Robson KJ, Maughan JA, Purcell SD, Petersen MJ, Haefner HK, Lowe L. Erosive papulonodular dermatosis associated with topical benzocaine: A report of two cases and evidence that granuloma gluteale, pseudoverrucous papules, and Jacquet’s erosive dermatitis are a disease spectrum. J Am Acad Dermatol 2006;55:74‐80. 8. Lyon CC, Smith AJ, Griffiths CE, Beck MH. The spectrum of skin disorders in abdominal stoma patients. Br J Dermatol 2000;143:1248‐60. How to cite this article: Kamat D, Malathi M, Prabhakaran N, Thappa DM. Pseudoverrucous papules and nodules in an infant with penoscrotal hypospadiasis. Indian Dermatol Online J 2017;8:503-5.

Masson's tumor presenting as an asymptomatic nodule on lower lip in a 30-year-old male

280 Indian Dermatology Online Journal | Volume 8 | Issue 4 | July‐August 2017 a traditional burkha‐clad woman who used to tie wet hair. Moreover, her head was mostly covered and hence protected from sunlight, which in general acts as a natural germicidal agent. All these taken together predisposed the index case to fungal infection and its persistence. It is significant to note that our patient had involvement of only scalp hair, with conspicuous sparing of other areas. It is important to learn about this condition as it may easily be mistaken for pediculosis on casual examination.

Cutaneous tuberculosis with a difference: Documenting transfollicular elimination of granulomas

A patient presented with a an asymptomatic brown to erythematous, scaly indurated solitary plaque on his elbow. The lesion was diagnosed as lupus vulgaris on the basis of clinical features and biopsy findings. The histopathology further revealed a granuloma within the follicular infundibulum, which was possibly being expelled out. The phenomenon of transepidermal elimination has been described previously in many conditions, including cutaneous tuberculosis; however, transfollicular elimination of the granuloma has not been reported. We report this unusual phenomenon as a possible mode of elimination of the granuloma.

Reactive eccrine syringofibroadenoma in hyperkeratotic eczema

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An uncommon presentation of eccrine poroma.

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