Deblina Bhunia

A study of onychomycosis at a tertiary care hospital in Eastern Bihar

Background: Onychomycosis (OM) is a major public health problem which is increasing worldwide. It is associated with high morbidity and causes physical, psychological, and occupational problems in patients. Aims: This study aims to study the pattern of etiological agents, clinical features, and severity assessment of OM in this part of India. Materials and Methods: Sixty eight clinically suspected patients with positive potassium hydroxide and fungal culture were studied. Results: Males were infected more often than females (1.61:1). The most common age group affected was 21–40 years. Finger nails were affected more frequently than toe nails. Distal and lateral subungual OM was the most common (48 cases, 70.59%) clinical pattern. For most of the patients (66.18%), nail involvement was severe. Discoloration was the most common (67 cases, 98.53%) change, followed by subungual hyperkeratosis (51 cases, 75%). Principal causative agents were dermatophytes (55 cases, 80.88%) with Trichophyton rubrum being the most common one (35 cases, 51.47%). In 9 (13.23%) cases, Candida albicans, in 6 (8.82%) Aspergillus niger and in 1 (1.47%) case Acremonium sp. (AC) have been isolated as the sole causative agent. In 2 (2.94%) cases, mixed infection with dermatophyte and Aspergillus and in 1 (1.47%) case dermatophyte and Candida were noted. Conclusion: Although dermatophytes were the most common causative agent of OM, nondermatophytic molds, and yeasts were also encountered. The genus and species identification helps in the proper diagnosis and management. Morphological changes in nail may help in presumptive diagnosis of OM.

Epidermoid cyst containing molluscum bodies in a 12-year-old Indian boy: A chance phenomenon or inducer?

Indian Journal of Paediatric Dermatology | Volume 18 | Issue 2 | April-June 2017 140 or subcutaneous nodule with a surface punctum through which cheesy material can be expressed. It commonly affects adult men or women. Chest, back, head and neck region are the most common sites of involvement.[2] On the other hand, MC is a viral infection caused by a poxvirus, subgenus molluscipox virus (MCV), which comprises four genetically distinct viral subtypes. It is characterized by shiny, pearly white, hemispherical, umbilicated papule over skin and mucosa. MC is more common among children. It is common in the head and neck region, followed by flexural areas and the genitalia.[5] Extensive lesions can occur in immunocompromised patients, especially in HIV, patients receiving immunosuppressive therapy, and in atopics.[5,6] However, our patient was neither atopic nor had history of use of any topical or systemic medication. After entering through the basal epidermis, the MCV starts cellular proliferation and forms lobulated epidermal growths which further compress the papillae and, thus, fibrous septae develop between the lobules. Ultimately, cells at the center of the lesion get destroyed and appear as large hyaline bodies containing eosinophilic, cytoplasmic masses of virus material.[5] Spontaneous regression usually occurs within 1 year due to cell‐mediated immune response. Antibody to the virus is present in almost 60% of patients, which suggest the role of humoral immunity Sir, A 12‐year‐old otherwise healthy boy presented to us with an untreated asymptomatic raised lesion on his shoulder since last 2 years. Initially, the lesion was small which gradually increased to attain the present size. There was no history of atopy. No similar history was present in the family. Cutaneous examination revealed a soft to firm, nontender sessile nodule of 1.5 cm diameter on his shoulder [Figure 1a]. The lesion was free from underlying structures. There was no erythema, scaling, or erosion on the surface of the lesion. However, a punctum was seen over the nodule. Rest of the cutaneous or systemic examination was noncontributory. Routine blood examinations were within normal limits. Screening for HIV was negative. Histopathological examination (HPE) of the excised nodule, stained by hematoxylin and eosin [Figure 1b‐d], revealed multiple big to small cystic structures in the dermis. The overlying epidermis was normal with irregular proliferation of rete pegs. The cysts were lined by single‐layered granular cells of surface epithelium and contained keratin debris, hair shaft remnants, and eosinophilic globular structures suggestive of molluscum bodies. Molluscum bodies were also seen in the walls of the lining epithelium. There was a sparse inflammatory cell infiltrate consisting of eosinophils, lymphocytes, and histiocytes surrounding the cystic structures. Based on the clinical with HPE findings, a diagnosis of epidermoid cyst (EC) containing molluscum bodies was made.

Perforating lichen planus in an adolescent boy: A rare phenomenon

variant of this disease with features of both LP and transepidermal elimination in histopathology. A very few cases of perforating LP have been reported till date in the literature. A 14-year-old Indian boy presented with gradually progressive pruritic lesions over both lower legs for 6 months. On examination, we found multiple, hyperpigmented, keratotic papules and plaques over the anterior, posterior, and lateral sides of distal parts of both lower extremities [Figure 1a and b]. The mucosae, nail, hair, and systemic examinations were noncontributory. There was no history of any drug intake before the eruption. The patient also had no history of jaundice in the past. A provisional diagnosis of lichenoid dermatosis was considered. A 4-mm punch biopsy was performed including the keratotic central part of a lesion. On histopathological examination, we found hyperkeratosis, focal hypergranulosis, irregular acanthosis, basal cell degeneration, Civatte bodies, and dense band-like lymphocytic infiltrate mixed with histiocytes in the upper dermis with features of transepidermal elimination [Figure 2a and b]. The wide perforating channel was filled with dense lymphohistiocytic infiltrate [Figure 3a and b]. On the basis of these clinical and histopathological findings, the diagnosis of perforating LP was made. LP is an immune-mediated disorder classically presenting as faintly erythematous to violaceous, polygonal, flat-topped papules usually distributed symmetrically and bilaterally over the extremities. Many variations in the clinical presentations according to the morphology, configuration, or distribution have also been described. The classical epidermal changes of LP include hyperkeratosis, wedge-shaped hypergranulosis, and irregular elongation of rete ridges in sawtooth pattern. There is basal cell damage, and multiple apoptotic cells (colloid-hyaline bodies or Civatte bodies) are seen in the dermoepidermal junction. Eosinophilic colloid bodies are found in the papillary dermis. There is a band-like dense lymphocytic infiltrate mixed with histiocytes in the papillary dermis. [2] Perforating LP is a rare variant of LP which clinically presents as keratotic papules and plaques. On histopathology, there is transepidermal elimination with other features of LP. There are very few cases of perforating LP reported in the literature. Hanau and Sengel [3] reported a case in a 52-year-old woman in 1984. Histopathology of that case showed typical features of LP with an area of perforation of epidermis with a rectilinear channel containing hyaline bodies, inflammatory cells, melanophages, and fibrillar material. [4] described a case of perforating LP in a 38-year-old man with histological features of LP 3. Tsuji T, Sawada H. Eccrine angiomatous …

Benign lymphangioendothelioma: A report of a rare vascular hamartoma in a young Indian child

Sir, An 8-year-old boy presented to us with a raised asymptomatic cutaneous lesion over his left leg for the past one and half years. It started as a bluish, slightly elevated spot which gradually increased to attain its present size and shape. There was no preceding history of trauma or use of any medication. There was no overt history of external bleeding or oozing. Cutaneous examination revealed an ill-defined, oblong-shaped plaque (4 cm × 3 cm size) with a bluish hue situated over the anterior aspect of the left thigh. It was studded with a few dark-blue and reddish papules. Focal crusting over the surface was also noted [Figure 1]. The lesion was non-tender and soft in consistency, and there was no lesional thrill or bruit. No other cutaneous lesion was present elsewhere in his body. Hair, nail, and mucosae were normal. General and systemic examinations were noncontributory. Routine blood investigations were within normal limits. Assuming the case to be a vascular malformation, the lesion was completely excised a year back, and regular follow-up showed no recurrence until date. Histopathological examination (hematoxylin and eosin stain) [Figures 2-4] of the excised specimen revealed compact hyperkeratosis with irregular acanthosis. Dilated thin-walled spaces lined by intermittent flat endothelial cells resembling lymphatic channels were seen in the upper and mid-dermis. Similar, but more slit-like, structures were seen in the deeper dermis along with dilated blood vessels containing red blood cells.

Acquired Universal Melanosis (Carbon Baby Syndrome)

Generalized pigmentation in a child may be attributed to a wide range of disorders. Acquired universal melanosis (AUM), also known as carbon baby syndrome, is one such rare condition, characterized by progressive hyperpigmentation of the skin since infancy with histopathologic features of heavy melanization of the entire epidermis. Since its initial description, only a few cases of AUM have been described in the English‐language literature. We describe here a case of a young child with AUM for its rarity and a few unusual features.